Mental Health HESI Hints: Therapeutic Communication and Therapy Modalities – Flashcards
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Coping/Defense Mechanisms
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automatic psychological processes that protect the individual against anxiety and from awareness of internal and external dangers and stressors
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Helpful Communication Techniques: Acknowledgment
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Recognize client's opinions without imposing own values or judgement
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Helpful Communication Techniques: Clarifying
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Making sure you have understood the meaning of what was said
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Helpful Communication Techniques: Confrontation
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Use judiciously- call attention to inconsistent behavior
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Helpful Communication Techniques: Focusing
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Assist client to explore specific topic
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Helpful Communication Techniques: Information giving
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Feedback about observed behavior
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Helpful Communication Techniques: Open-ended questions
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Questions that require more than a yes/no response
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Helpful Communication Techniques: Reflecting/Restating
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Paraphrasing or repeating what the client said (don't use this too often or they will feel you are not listening)
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Helpful Communication Techniques: Silence
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Therapeutic or to control interactions Use carefully with paranoid client
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Helpful Communication Techniques: Suggesting
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Offering alternatives: "Have you ever considered..."
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What is the purpose of therapeutic communication?
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-Allows client autonomy -Remember: Advice free, opinion free, reassurance free. JUST THE FACTS!
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What action should the nurse take in a psychiatric situation when the client describes a physical problem?
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Assess it! The nurse cannot ignore physiologic needs.
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Forbidden phrases/non-therapeutic phrases
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-"You should" -"You'll have to" -"You can't" -"If it were me, I'd" -"Why don't you" -"I think you should" -"It's the policy" -"Don't worry" -"Everyone..." -"Why?" -"Just a second" -"I know...."
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Basic communication principles to apply
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-establish trust -nonjudgmental attitude -Offer self -Active listening -Support client feelings -Clarify/validate statements -use matter-of-fact approach
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Coping/Defense Mechanism: Denial
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failure to acknowledge an event, thought, feeling too painful for conscious awareness
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Coping/Defense Mechanism: Displacement
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Transference of feelings to another person or object
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Coping/Defense Mechanism: Identification
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Attempt to be like someone or emulate the personality, traits, or behaviors of another person
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Coping/Defense Mechanism: Intellectualization
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Using reason to avoid emotional conflicts
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Coping/Defense Mechanism: Introjection
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Incorporation of values or qualities of an admired person or group into one's own ego structure
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Coping/Defense Mechanism: Isolation
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Separation of an unacceptable feeling, idea, or impulse from ones' thought process
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Coping/Defense Mechanism: Passive-aggression
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Indirectly expressing aggression toward others; a facade of overt compliance masks covert resentment
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Coping/Defense Mechanism: Projection
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Attributing one's own thoughts or impulses to another person
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Coping/Defense Mechanism: Rationalization
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Offering an acceptable, logical explanation to make unacceptable feelings and behavior acceptable
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Coping/Defense Mechanism: Reaction formation
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Development of conscious attitudes and behaviors that are the opposite of what is really felt
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Coping/Defense Mechanism: Regression
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Reverting to an earlier level of development when anxious or highly stressed
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Coping/Defense Mechanism: Repression
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The involuntary exclusion of a painful thought or memory from awareness
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Coping/Defense Mechanism: Sublimation
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Substitution of an unacceptable feeling with a more socially acceptable one
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Coping/Defense Mechanism: Suppression
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The intentional exclusion of feelings and ideas
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Coping/Defense Mechanism: Undoing
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Communication or behavior done to negate a previously unacceptable act
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Treatment Modalities: Milieu Therapy
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Safe environment established through people/resources/activities that promote active participation and social interaction by the client. Staff uses consistent, limit setting techniques
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Treatment Modalities: Behavior modification
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Attempts to change behavior focusing on consequences of actions rather than peer pressure. Utilizes negative and positive reinforcement and role modeling.
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Treatment Modalities: Family therapy
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The entire family is the client. Focus is patterns of interaction. Goal is to decrease family conflict and develop appropriate role relationships.
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Treatment Modalities: Crisis Intervention
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Attempts to resolve an immediate crisis. Client is in state of disequilibrium. Focus on the problem, not the cause. Goal is to return to precrisis level functioning.
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Treatment Modalities: Cognitive therapy
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Replaces client's irrational beliefs. Focused, problem-solving therapy. Short term.
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Treatment Modalities: Electroconvulsive therapy (ECT)
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For severely depressed or extremely suicidal patients not responsive to meds and therapy. Preparing client: NPO 6-8 hours prior, anticholinergic given 30 minutes prior, muscle relaxant given, ensure crash cart, O2, suction equipment is available. Post: Maintain airway since pt is unconscious immediately after, VS q15minutes until alert, reorient,
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Treatment Modalities: Group intervention
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-Closed or open groups, small or large groups -3 phases
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Initial/Orientation Phase of Group Therapy
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-high anxiety -superficial interactions -testing the therapist
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Middle/Working Phase of Group Therapy
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-Problem identification -beginning of problem solving -beginning of group sense of "we"
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Termination Phase of Group Therapy
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-Evaluation of the experience -Expression of feelings ranging from anger to joy
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Common complaints after ECT
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-Headache -Muscle Soreness -Nausea (risk for aspiration-maintain airway!) -Retrograde amnesia
