Academic journal article Perspectives in Psychiatric Care

Psychotherapeutic Strategies

Academic journal article Perspectives in Psychiatric Care

Psychotherapeutic Strategies

Article excerpt

The only similarity in the presentations of this panel so far is the goal. Certainly, there has been no similarity in the approaches, and I think you will see that my approach is quite different from what has already been said.

The aim of nursing care of psychiatric patients is to assist the patient to struggle toward full development of his potential for productive living in the community. This aim requires nursing strategies which will aid the patient to resolve obstacles that stand in the way of full development. These obstacles are primarily of two kinds: (1) disturbances in thought, feeling, and action, which might be called the pathological use of one's potential; and (2) lacks and gaps in the development of intellectual and interpersonal competencies which are absolutely essential for healthy social interaction in the community.

It is not easy to design nursing tactics that will bring about realization of this aim of nursing care, for most, if not all, psychiatric patients. Theoretical knowledge concerning the observable pathology and hidden assets of persons diagnosed as mentally ill is still quite limited in quality and quantity. The social sciences and the applied psychiatric disciplines are still in very early stages of theory development. Nevertheless, it is possible to suggest some feasible dimensions of such nursing care which merit clinical trial as well as further careful study.

For a tactic used in nursing care to be considered psychotherapeutic, the strategy or approach must have demonstrable impact on the item of behavior which is representative of an aspect of the pathology or of an asset of the patient. Furthermore, the tactic for which there is anticipated a beneficial effect on the patient or a coercive pull in the direction of mental health must be sustained over time; there are no "magical" tactics which, if used once or twice, will produce substantial, constructive, and lasting effects observable in the behavior of a patient. Nursing strategies which are considered to be psychotherapeutic must be used persistently, many times, in situations in which a specific pathological item is presented by a patient and observed by the nurse. Therefore the alertness of the nurse in immediately noticing, assigning meaning to, and then responding specifically to the item of behavior presented by a patient is crucial to psychotherapeutic outcome.

One facet of mental illness is the tendency toward replication of inept behavior and, frequently, of the earlier social interactions from which it derived. For example, it is not uncommon for a firstborn child to attempt to retain his initial status as an only child by reporting to his parents the "bad" behavior of his siblings. If the parents accept the messages and court further "informer" behavior in this child, his relationships with his siblings will deteriorate. Since his focus is upon getting more rewards than the siblings get from the mother, the child will not particularly notice the reasons the other siblings manage to enjoy each other and to exclude him from their play.

On entrance to school, this child will attempt to use the same talebearing tactic to enhance his powers with the teacher. Again, if the teacher listens and courts further messages from this child, one major consequence will be isolation from his peers. Six-to-nine-year-olds particularly do not like teacher's pets, informers, tattletales. They tend to exclude them from the informal peer groups in which the major focus is learning interpersonal competencies essential for group living. The child who does not get into the peer group feels less human -- an isolate set apart from others substantially like himself. To assuage this very lonely feeling he may increase his obsequiousness with authority figures, thereby becoming a more perfect, though exceedingly lonely, "apple polisher." Later on, through high school, sometimes in schools of nursing, and in the employment situation this behavior is used, exploited, and held in contempt by others. …

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