The Psychotherapy of Hildegard Peplau in the Treatment of People with Serious Mental Illness
Thelander, Burton L., Perspectives in Psychiatric Care
TOPIC. The use of Peplau's interpersonal nursing theory with people suffering from serious mental disorder.
PURPOSE. To describe Peplau's theory and its application using a case study.
SOURCE. Author's own clinical work.
CONCLUSION. Peplau's theory can be used to help patients resolve symptoms by guiding them through the steps of observation, description, analysis, formulation, validation, testing, integration, utilization.
Key words: Nurse-patient relationship, Peplau's interpersonal nursing theory, psychotherapy, schizophrenia, serious mental illness
In the age of managed care, we hear little about long-term psychotherapy with people experiencing serious mental illness (SMI). This is unfortunate, because despite the biopsychopharmacological movement, the number of those diagnosed with SMI has not decreased. While it is an accepted fact today that people who are depressed recover best with a combination of psychotherapy and medication, the same has not been documented for those suffering from schizophrenia. Many believe these people cannot be helped by psychotherapy. While many of us know anecdotally of patients who have recovered, we seldom read of these in the psychiatric nursing literature.
A person with serious mental illness suffers from symptoms over an extended period of time that constantly or intermittently remit and relapse. These symptoms seriously interfere with function and quality of life in such areas as work, social interaction, recreation, intimate relationships, and meeting community standards.
Dr. Hildegard Peplau introduced an interpersonal relations paradigm for the study and practice of nursing in the late 1940s and early 1950s (Peplau, 1995). The paradigm evolved from her work with H. Sullivan, E. Fromm, F. Fromm-Reichmann, other eminent clinicians, and her experience working with seriously mentally ill patients in public and private psychiatric hospitals (O'Toole & Welt, 1989). Her Interpersonal Relations Theory has had particular relevance and usefulness in understanding and intervening to reduce symptoms, re-establish relatedness, restore a sense of self-identity, improve function, and promote health.
Practicing psychotherapy at a public psychiatric hospital, I have found interpersonal theory and interventions useful for patients with a wide variety of diagnostic labels, including schizophrenia, depression, mood disorders, borderline personality disorders, and mild mental retardation. These interventions are useful both in one-to-one therapeutic relationships and milieu interventions. The theory and interventions provide an effective adjunct for psychopharmacology and psychiatric rehabilitation, particularly with people who have complex behavioral problems refractory to psychopharmacological intervention. My anecdotal clinical experience is not consistent with Beeber's (1995) contention that the Peplau model does not fit psychiatric nursing practice in inpatient settings. Employed as a certified specialist/nurse psychotherapist with an assigned caseload of patients with complex behavior problems and as Assistant Director of Nursing responsible for milieu intervention, I sought to answer Beeber's questions:
* How do phenomena/patterns within a person's life experience create problems for the person?
* What are the contextual variables that affect the person?
* What strategies in the one-to-one relationship are effective in intervening with people experiencing these problems?
I discovered that patients are able to identify patterns and contextual variables through my use of the interpersonal paradigm and psychotherapeutic interventions suggested by Peplau (1989a, b; 1995, 1996b). This paper will briefly discuss concepts and definitions of Peplau's paradigm that help explain the reasons for the seriously mentally ill person's problems, and it concludes with a case presentation.
I will not make an effort to contrast the assumptions and expectations of this practice paradigm with the medical model, which relies primarily upon biology and neuroscience to explain etiology and pharmacological interventions to treat it. …