Just as nurses need ti identify the theoretical bases of their practice, it is helpful to understand the theoretical bases of practice of others in health care. In psychiatric nursing, the interdisciplinary team is of particular importance and may include psychiatrists, psychologists, social workers, and counselors as well as nurses. Each of these individuals, including nurses, may use psychological theories as the basis for their practice.
Most mental health professionals practice within the framework of a conceptual model of psychiatric treatment. A model is a way of organizing a complex body of knowledge, such as concepts related to human behavior.
· PSYCHOANALITICAL MODEL
Psychoanalitical theory was developed by Sigmund Freud in the late nineteenth and early twentieth centuries. It focused on the nature of deviant behavior and proposed a new perspective on human development.
1.View of Behavioral Deviations
Psychoanalysts trace disrupted behavior in the adult to earlier developmental stages. Each stages of development has a task that must be accomplished.
2.Psychoanalitical therapeutic Process
Psychoanalysis uses free assoviation and dream analysis to reconstruct the personality. Free association is the verbalization of thoughts as they occur without any conscious screening or cencorship. Of course, there is always unconscious cencorship of thoughts and impulses that threaten the ego. The psychoanalyst searches for patterns in the areas that are unconsciously avoided. Conflictual areas that the patient does not discuss or recognize are identified as resistances.
3.Roles of Patient and Psychoanalyst
The roles of the patient and the psychoanalyst were defined by Freud. The patient was to be an active participant, freely revealing all thoughts exactly as they occurred and describing all dreams.
· INTERPERSONAL MODEL
The theorists most representative of the interpersonal models is Harry Stack Sullivan. Harry Stack Sullivan was a leader in emphasizing the importance of interpersonal relationships.
1.View of Behavioral Deviations
Interpersonal theorists believe that behavior evolves around interpersonal relationships. Sullivan, like Freud, traces a progression of psychological development. Sullivan’s theory states that the person bases behavior on two drives: the drive for satisfaction and the drive for security.
2.Interpersonal therapeutic process
Therapy is completed when the patient can establish satisfying human relationships, thereby meeting basic needs. Termination is a significant part of the relationship that must be experienced and shared by both the therapist and the patient. The patient learns that leaving a significant other involves pain but can also be an opportunity for growth.
3.Roles of patient and interpersonal therapist
Interpersonal nursing roles identified by Peplau :
1. Stranger
2. Resource person
3. Teacher
4. Leader
5. Surrogate
6. Counselor
· SOCIAL MODEL
The two preceding models focused on the individual and intrapsychic processes and interpersonal experimentences. The social model moves beyond the individual to consider the social environment as it affects the person and the person’s life experience.
1. View of Behavioral Deviations
According to the theorists, social conditions are largely responsible for deviant behavior. Deviancy is culturally defined. Behavior considered normal in one cultural setting may be eccentric in another and psychotic in a third.
2. Social Therapeutic Process
Szasz advocates freedom of choice for psychiatric patients. People should be allowed to select their own therapeutic modality and therapists.
Caplan, on the other hand, supports community psychiatry. He sees the mental health professionals as using consultation to combat societal problems.
3. Roles of Patient and Social Therapist
Szasz believes that a therapists can help the patient only if the patient requestes help. The patient, then, initiates therapy and defines the problem to be solved. Therapy is successfully completed when the patient is satisfied with the changes made in lifestyle.
· EXISTENTIAL MODEL
The existential model focuses on the person’s experimence in the here and now. With much less attention to the person’s past than in other theoretical models.
1. View of behavioral deviations
The person who is self-alienated feels helpless, sad, and lonely. Self-critism and lack of self-awareness prevent participation in authentic, rewarding, relationships with others.
2. Existential therapeutic process
The existential therapeutic process focuses on the encounter. The encounter is not merely the meeting of two or more people: it also involves their appreciation of the total existence of each other.
3. Roles of patient and existential therapist
Existential theorists emphasize that the therapists and the patient are equal in their common humanity. The therapists acts as a guide to the patient, who has gone astray in the search for authenticity.
· SUPPORTIVE THERAPY MODEL
Supportve therapy model is a relatively new mode of psychotherapy that is widely used in hospital and community based psychiatric tretment settings.
1. View of Behavioral Deviations
Supportive therapists are psychodynamically based, and they describe behavioral deviations as neurotic, borderline, or psychotic.
2. Supportive Therapeutic Process
Principles of supportive therapy include the following :
1. Giving immadiate help to the patient that may include a variety of treatment modalities
2.Family and social support system involvement
3.Focus on the present and not past
3.Roles of Patient and Supportive Therapists
In supportive therapy the therapists plays an active and directive role in helping the patient improve social functioning and coping skills.
· MEDICAL MODEL
The medical model refers to psychiatric care that is based on the traditional physician-patient relationship. It focuses on the diagnosis of a mental illness and consequent tretment is based on this diagnosis.
1. View of Behavioral Deviations
The medical model proposes that deviant behavior is a symptom of a central nervous system disorder. As Andreasen write, “Mental illness is trully a nervous breakdown—a breakdown that occurs when the nerves of the brain have an injury so severe that their own internal healing capacities cannot repair it.”
2. Medical therapeutic Process
The medical process of therapy is well defined and familiar to most patients. The physician’s examination of the patient includes the history of the present illness, past history, social history, medical history, review of body systems, physical examination, and mental status.
3. Roles of Patient and Medical Therapist
The role of the patient involves admitting being ill, which can be a problem in psychiatry. Patients sometimes are not aware of their disturbed behavior and may actvely resist treatment.
Daftar Pustaka
1. Wiscarz Stuart, Sandra I. Sundeen. 1995. Principles and Practice of Psychiatric Nursing. 5th edition. Missouri : Mosby-year book
2. Noreen Cavan Frisch, Lawrence E.Frisch. 2006. Psychiatric mental Health Nursing. 3rd edition. New York : Thomson
