Types of tx modalities

Milieu Therapy

1. the planned use of people, resources, and activities in the environment to assist in improving interpersonal skills, social functioning and performing ADL's

2. the focus is on the here and now (assisting the pt in dealing with the realities of today rather than focusing on the past)

3. it uses limit setting

4. it involves the client making decisions about own care.

5. uses activities that supprot group sharing, cooperation and compromise.

6. nursing interventions support client privacy and autonomy & provide clear expectations.

Types of tx modalities

Behavior modification

1. this process is used to change ineffective behavior patterns; it focuses on the consequences of actions rather than peer pressure.

2. positive reinforcement is used to strenghten desired behavior (client is praised or given a token that can be exchanged for treat or activity)

3. negative reinforcement is used to decrease or eliminate inappropriate behavior (given a time out or taking token away)

4. role modeling and teaching new behaviors are important interventions

Types of tx modalities

Family therapy

1. this form of group therapy identifies the entire family as the client

2. it is based on the concept of the family as a system of interrelated parts forming a whole.

3. the focus is on the patterns of interactions within the family, not an individual member

4. the therapist assists the family in identifying the roles assigned to each member based on family rules.

5. life scripts (living out parents dreams) and self fulfilling prophecies (unconciuosly following what one thinks should happen, therefore setting it up to happen) are identified.

6. congruent and incongruent communication patterns & behaviors are identified.

7. the goal is to develop appropriate role relationships.

Types of tx modalities

Crisis intervention

1. this form of therapy is directed at the resolution of an immediate crisis, which the individual is unable to handle alone.

2. a crisis may develop when previous learned coping mechanisms are ineffective in dealing with the current problem

3. the individual is usually in a state of disequilibrium

4. if a client is in a panic state as a result of the disorganization, be very directive

5. forcus on the problem, not the cause

6. identify supprot systems

7. identify fast coping patterns used in other stressful situations.

8. the goal is to return individual to precrisis level of functioning

9. crisis intervention is usually limited to 6 wks

Types of tx modalities

Cognitive therapy

1. it is directed at replacing a client's irrational beliefs and distorted attitudes.

2. it is focused, problem solving therapy

3. the therapist and client work together to identify and solve problems and overcome difficulties

4. short term therapy of 2-3 months duration

5. it involves cognitive restructuring

ECT

electroconvulsive therapy

ect involves the use of electrically induced siezures for psychiatric purposes. It is used with severely depressed clients who fail to respond to antidepressant meds and therapy.

(may be used with extremely suicidal clients because meds usually take 2 wks to take effect)

• prepare client by teaching what the tx involves
• avoid using the word "shock" when discussing with client & family
• an anticholinergic (atropine sulfate) is usually given 30 min prior to dry oral secretions
• a fast acting muscle relaxant (succinylcholine[anectine]) is given to client before ect to help prevent bone or muscle damage.
• have an emergency cart, suction equipment and O2 available in room

• maintain a patent airway; client is in an unconscious state immediately following
• check vitals Q15 min until client is alert
• reorient client after ect (confusion is likely)

• headache
• muscle soreness
• nausea

Helpful techniques

Acknowledgement

Helpful techniques

Clarifying

Helpful techniques

Confrontation

Helpful techniques

Focusing

Helpful techniques

Information giving

• establish trust
• demonstrate a nonjudgemental attitude
• offer self; be empathetic not sympathetic
• use active listening
• accept and support client's feelings
• clarify and validate client's statements
• use matter-of-fact approach

• keep the interaction open, genuine and client-centered

• phrases that are useful in theraputic interaction

• keep the client as the focus

• be aware of your own anxiety level and feelings

• "Tell me about..."
• "Go on..."
• "I'd like to discuss what you are thinking"
• "What are your thoughts?"
• "Are you saying that...?"
• "What are you feeling?"
• "Its seems as if..."

Forbidden phrases for theraputic communication

What you should NEVER say

• Avoid words like good, bad, right, wrong and nice
• "You should..."
• "You'll have to..."
• "You can't..."
• "If it were me, I'd..."
• "Why don't you..."
• "I think you..."
• "It's the policy on this unit"
• "Don't worry"
• "Everyone..."
• "Why...?"
• "Just a second..."
• "I know..."

Denial

(defense machanisms)

Displacement

(defense mechanisms)

Identification

(defense mechanisms)

Intellectualization

(defense mechanisms)

using reason to avoid emotional conflicts

(ex.) a wife of a substance abuser describes the dynamics of enabling behavior yet she still calls him in sick at work

Introjection

(defense mechanisms)

incorporation of values or qualities of an admired person or group into one's own ego structure

(ex.) a young man deals with a business client the same way his father does)

Isolation

(defense mechanisms)

Passive-agression

(defense mechanisms)

Projection

(defense mechanisms)

Rationalization

(defense mechanisms)

offering an acceptable, logical explanation to make unacceptable feelings & behavior acceptable

(ex lol at this one! a student who did not do well on an exam says it was poorly taught )

Reaction formation

(defense mechanisms)

Regression

(defense mechanisms)

Repression

(defense mechanisms)

Sublimation

(defense mechanisms)

substitution of an unacceptable feeling by a more socially acceptable one

(ex.) a student who feels too small to play football becomes a champion marathon swimmer

Suppression

(defense machanisms)

Undoing

(defense mechanisms)

communication or behavior done to negate a previously unacceptable act

(ex.) a young man who used to hunt wild animals now chairs a committee for the protection of animals