Kubler-Ross Stages of Dying / Grief

Precipitating Factors of Grief

• Death in family
• Separation
• Divorce
• Physical Illness
• Work failure disappointments

1. Denial

• Initial response to protect the self from anxiety.
• “No not me”, “Its not true”, “Its not impossible”
• May continue to make impractical/unrealistic plans
• May comment that a mistake has been made about the diagnosis of terminal illness
• May appear normal and can continued ADL as if nothing is wrong
• May not conform with the advised treatment regimen
• Adaptive response – crying, verbal denial
• Maladptive response – absence or reaction such as crying.

2. Anger

• Individual feel that they are victims of incompetence or a vengeful God (they did something wrong so they are being punished), fate (karma), circumstances (wrong place and wrong time).
• “Why me”, “What did I do to deserve this?”
• They seek for reasons, answers and explanations
• May express anger overtly – being irritable, impatient, critical verbally abusive.
• May express anger covertly by neglecting self, not eating, nor going to check ups, committing suicide, drinking alcohol.
• Adaptive response – verbal expression
• Maladaptive – persistent guilt or low self esteem, aggression, self destructive ideation or behavior.

3. Bargaining

• The person try to inhibit good behavior, make up for perceived wrong doings or other engage in behaviors that would please GOD so he will be given more time-an extension of life or granted recovery.
• “Yes, me but”
• “If I live until Christmas or until my child’s graduation ( So many if’s), I will do this…”
• Adaptive response – bargains for treatment control, express wish to be alive for specific events in the near future.
• Maladaptive response – bargains for unrealistic activities or events in the distant future.

4. Depression

• Occurs when the reality of loss or impending loss cannot be ignored anymore and the person grieves for himself and those he will leave behind, for the things that he can no longer accomplish or experience.
• “Yes, I’m dying”
• Withdrawn, has no energy and interest to interact.
• Cries
• Makes few demands
• Adaptive response – crying, withdrawing from interaction
• Maladaptive response – self destructive actions, despair.

5. Acceptance

• Occurs when the person has come to peace with himself and others
• “Yes, I am ready”
• Stage of affective void – not happy nor sad
• Only persons who are highly significant to him stimulates a reaction. Others are merely tolerated.
• Makes realistic preparation
• Adaptive response – may wish to be alone, limit conversation, complete personal and family business.

Nursing Interventions:

• Assess; specific loss, meaning of loss, coping skills, support persons.
• Accept the client; do not respond personally to the client.
• Support adaptive responses; allow to express feelings
• Support defense mechanism – reassure client that denial and wanting to be alone is normal.
• Help find constructive outlets of anger. Do not take clients hostility personally. Do no retaliate.
• Monitor for self destructive behaviors
• Help express feelings: Ask how they feel
• Meet needs
• Allow as much decision making as possible to maintain dignity by giving choices and alternatives.

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Korsakoff’s Syndrome (Korsakoff’s Psychosis)

Definition

Korsakoff’s syndrome is a condition that mainly affects chronic alcoholics. It is also called Korsakov’s syndrome, Korsakoff’s psychosis or amnesic-confabulatory syndrome. It is a brain or neurological disorder caused by thiamine or Vitamin B1 deficiency. The syndrome is named after Sergie Korsakoff, a neuropsychiatrist who popularized the theory.

Causes

1. Chronic Alcoholism. This syndrome is due to the direct effects of alcohol or to the severe nutritional deficiencies that are associated with chronic alcoholism. A lack of Vitamin B1 is common in people with alcoholism thus, Vitamin B deficiency is noted. In chronic alcoholism the condition usually occurs following delirium tremens.
2. Malabsorption. It is also common in persons whose bodies do not absorb food properly (malabsorption).
3. Other severe brain disturbances. The syndrome also occurs in other severe brain disturbances such as paralysis, dementia, brain damage, infections and poisonings.
4. Dietary deficiencies
5. Prolonged vomiting
6. Eating disorders
7. Effects of chemotherapy
8. Hyperemesis gravidarum
9. Severe malnutrition. Alcoholism may be an indicator of poor nutrition, which in addition to inflammation of the stomach lining causes thiamine deficiency.

Disease Process

A deficiency of thiamine or Vitamin B causes damage to the medial thalamus and to the mammillary bodies of the hypothalamus. As a result, generalized cerebral atrophy may occur. In cases where Wernicke’s encephalopathy, a neurological disorder that causes brain damage in lower parts of the brain called the thalamus and hypothalamus, accompanies Korsakoff’s syndrome the disorder is called Wernicke-Korsakoff syndrome.
In most cases, Korsakoff syndrome, or Korsakoff psychosis, tends to develop as Wernicke’s symptoms go away. It results from damage to areas of the brain involved with memory, thus, Korsakoff’s syndrome involves:

• Neuronal loss or damage to neurons
• Gliosis, which is a result of injury to the supporting cells of the central nervous system.
• Hemorrhage or bleeding of the mammilary bodies.

Signs and Symptoms

1. Anterograde amnesia or the inability to form new memories
2. Retrograde amnesia or the loss of memory (can be severe)
3. Confabulation or the reciting of imaginary experiences.
4. Lack of insight
5. Apathy or the absence of interest in or concern about emotional, social, or physical life
6. Hallucinations or seeing and hearing things are not really present
7. Delirium
8. Anxiety
9. Fear
10. Depression
11. Confusion
12. Delusions and insomnia
13. Painful extremities

Treatment

1. Thiamine by injection into a vein or a muscle or by mouth. Usually, thiamine does not improve loss of memory and intellect that occur with Korsakoff’s psychosis. However it may improve symptoms such as delirium or confusion.
2. Stopping alcohol use to prevent additional loss of brain function and damage to the nerves.
3. Eating a well balanced and nourishing diet with increase intake of foods containing Vitamin B1.

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Kohlberg’s Theory of Moral Development

 

Born: October 25, 1927
Birthplace: Bronxville, New York, United States
Died: January 19, 1987
Location of death: Cape Cod, Massachusetts, United States
Nationality: American
Occupation: Psychologist, College Teacher
Moral development is the process thought which children develop proper attitudes and behaviours toward other people in society, based on social and cultural norms, rules, and laws.

 

Moral Development by Lawrence Kohlberg

Level of Moral development	Stage of Reasoning	Approximate Age
Preconventional “do’s and don’ts”	Stage 1: (Punishment and Obedience Orientation). Right is obedience to power and avoidance of punishment. (“I must follow the rules otherwise I will be punished”). Stage 2: Instrumental Relativist Orientation. Right is taking responsibility and leaving others to be responsible for themselves. (”I must follow the rules for the reward and favor it gives”).	<11
Conventional	Stage 3: Good-Boy-Nice Girl Orientation. Right is being considerate: “uphold the values of other adolescents and adults” rules of society”. (”I must follow the rules so I will be accepted”) Stage 4: Society-Maintaining Orientation. Right is being good, with the values and norms of family and society at large. (”I must follow rules so there is order in the society”).	adolescence and adulthood
Postconventional	Stage 5: Social Contract Reorientation. Right is finding inner “universal rights” balance between self-rights and societal rules – a social contract. (”I must follow rules as there are reasonable laws for it”). Stage 6: Universal Ethical Principle orientation. Right is based on a higher order of applying principles to all human-kind; being non-judgmental and respecting all human life. (”I must follow rules because my conscience tells me”).	after 20

Three Levels of Moral Development

PRECONVENTIONAL LEVEL.

The child at the first and most basic level, the preconventional level, is concerned with avoiding punishment and getting needs met. This level has two stages and applies to children up to 10 years of age.

• Punishment-Obedience stage. Children obey rules because they are told to do so by an authority figure (parent or teacher), and they fear punishment if they do not follow rules. Children at this stage are not able to see someone else’s side.
• Individual, Instrumentation, and Exchange stage. Here, the behavior is governed by moral reciprocity. The  child will follow rules if there is a known benefit to him or her. Children at this stage also mete out justice in an eye-for-an-eye manner or according to Golden Rule logic. In other words, if one child hits another, the injured child will hit back. This is considered equitable justice. Children in this stage are very concerned with what is fair.Children will also make deals with each other and even adults. They will agree to behave in a certain way for a payoff. “I’ll do this, if you will do that.” Sometimes, the payoff is in the knowledge that behaving correctly is in the child’s own best interest. They receive approval from authority figures or admiration from peers, avoids blame, or behaves in accordance with their concept of self. They are just beginning to understand that others have their own needs and drives.

CONVENTIONAL LEVEL.

This level broadens the scope of human wants and needs. Children in this level are concerned about being accepted by others and living up to their expectations. This stage begins around age 10 but lasts well into adulthood, and is the stage most adults remain at throughout their lives.

• Interpersonal Conformity is often called the “good boy/good girl” stage. Here, children do the right thing because it is good for the family, peer group, team, school, or church. They understand the concepts of trust, loyalty, and gratitude. They abide by the Golden Rule as it applies to people around them every day. Morality is acting in accordance to what the social group says is right and moral.
• Law and Order or Social System and Conscience stage. Children and adults at this stage abide by the rules of the society in which they live. These laws and rules become the backbone for all right and wrong actions. Children and adults feel compelled to do their duty and show respect for authority. This is still moral behavior based on authority, but reflects a shift from the social group to society at large.

POST-CONVENTIONAL LEVEL.

Some teenagers and adults move beyond conventional morality and enter morality based on reason, examining the relative values and opinions of the groups with which they interact. Few adults reach this stage.

• Social Contract and Individual Rights stage. Individuals in this stage understand that codes of conduct are relative to their social group. This varies from culture to culture and subgroup to subgroup. With that in mind, the individual enters into a contract with fellow human beings to treat them fairly and kindly and to respect authority when it is equally moral and deserved. They also agree to obey laws and social rules of conduct that promote respect for individuals and value the few universal moral values that they recognize. Moral behavior and moral decisions are based on the greatest good for the greatest number.
• Principled Conscience or the Universal/Ethical Principles stage. Here, individuals examine the validity of society’s laws and govern themselves by what they consider to be universal moral principles, usually involving equal rights and respect. They obey laws and social rules that fall in line with these universal principles, but not others they deem as aberrant. Adults here are motivated by individual conscience that transcends cultural, religious, or social convention rules. Kohlberg recognized this last stage but found so few people who lived by this concept of moral behavior that he could not study it in detail.

References:
Dizon,. General Psychology. Manila: Rex Bookstore, 2003
Uriarte, Gabriel G. General Psychology. Manila, 2007 http://www.answers.com/Moral%20%20Development

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Johari Window

Description

As a nurse, dealing with physically and/or mentally ill patients requires a great deal of patience and understanding. However, before a person can understand and empathize with others, he or she must first know himself or herself. The process of knowing ones own principle, beliefs, feelings, personality, strengths, weaknesses, preconceptions, attitudes and responses in different situations is called self awareness. Discerning ones own capabilities and limitations allow a nurse to consider, observe and pay attention to the bizarre or subtle reactions of clients.
Self-awareness gives the nurse a skill in establishing relationships with clients of different values, beliefs, attitudes and principles. This is achieved by the nurse’s utilization of aspects in his or her personality, values, feelings and coping skills commonly known as the therapeutic use of self.

Johari window is a psychological tool used to develop self-awareness and promote better relationshipsamong people. It was created by two American Psychologists Joseph Luft and Harry Ingham in 1955. The word “JOHARI” comes from the first names of its developers Joseph and Harry (Joharry).  It is also known as “disclosure or feedback model of self awareness.”
Utilizing this tool creates a portrait of someone; this is done by giving the person a psychosocial exercise. A list of 56 adjectives is given to the subject and he or she is instructed to choose five or six words that best describe him or her. The same list is given to the subject’s peers, friends and colleagues. These people will also choose 5 or 6 adjectives that best describe the subject. After the test, the answers are mapped, compared and categorized in four areas. The four areas are as follows:

Quadrant 1: Open Arena or Public self

• These pertain to the qualities known to others and the subject himself.
• If quadrant 1 is the longest, it means that the subject is open to others and has gained self-awareness.
• If this area is the shortest, the subject shares little about him or her.

Area or Quadrant 2: Blind spot or Blind Area

• These refer to the subject’s attributes that are unknown to him but are known by his or her peers.

Area or Quadrant 3: Hidden or Private self

• The things that the subject knows about himself.

Area or Quadrant 4: Unknown

• An empty quadrant which symbolizes the qualities undiscovered by the neither the subject nor others.

The success of the test depends on the honesty of the opinions given. A person is represented with little insight if quadrants 1 and 3 have the smallest adjective listed. The main goal the subject is to work towards moving the qualities from quadrants 2, 3, and 4 to the first area.

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Jean Piaget’s Theory of Cognitive Development

Born: Aug 9, 1896
Birthplace: Neuchâtel, Switzerland
Died: September 17, 1980
Location of death: Geneva, Switzerland
Cause of death: unspecified
Gender: Male
Race or Ethnicity: White
Occupation: Psychologist
Nationality: Switzerland
Executive summary: Elaborated the stages of childhood
Cognitive development refers to how a person perceives, thinks, and gains understanding of his or her world through the interaction of genetic and learned factors. Among the areas of cognitive development are information processing, intelligence, reasoning, language development, and memory.

Cognitive Stages of Development

Sensorimotor (0-2 years)	Development proceeds from reflex activity to representation and sensorimotor solutions to problems
Pre-operational (2-7 years)	Problems solved through representation; language development; (2-4 years); thoughts and language both egocentric; cannot solve conservation problems.
Concrete Operation (7-11 years)	Reversibility attained; can solve conservation problems; Logical operation developed and applied to concrete problems; cannot solve complex verbal problems.
Formal Operation (11 years-adulthood)	Logically solves all types of problems; thinks scientifically; solves complex problems; cognitive structures mature.

• Sensorimotor stage (infancy): In this period, which has six sub-stages, intelligence is demonstrated through motor activity without the use of symbols. Knowledge of the world is limited, but developing, because it is based on physical interactions and experiences. Children acquire object permanence at about seven months of age (memory). Physical development (mobility) allows the child to begin developing new intellectual abilities. Some symbolic (language) abilities are developed at the end of this stage.

• Pre-operational stage (toddlerhood and early childhood): In this period, which has two sub stages, intelligence is demonstrated through the use of symbols, language use matures, and memory and imagination are developed, but thinking is done in a non-logical, non-reversible manner. Egocentric thinking predominates.

• Concrete operational stage (elementary and early adolescence): In this stage, characterized by seven types of conservation (number, length, liquid, mass, weight, area, and volume), intelligence is demonstrated through logical and systematic manipulation of symbols related to concrete objects. Operational thinking develops (mental actions that are reversible). Egocentric thought diminishes.

• Formal operational stage (adolescence and adulthood): In this stage, intelligence is demonstrated through the logical use of symbols related to abstract concepts. Early in the period there is a return to egocentric thought. Only 35 percent of high school graduates in industrialized countries obtain formal operations; many people do not think formally during adulthood.

References:
Dizon,. General Psychology. Manila: Rex Bookstore, 2003
Uriarte, Gabriel G. General Psychology. Manila, 2007
http://www.answers.com/Cognitive%20Development

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Human Growth and Development

Definition

The term growth and development both refers to dynamic process. Often used interchangeably, these terms have different meanings. Growth and development are interdependent, interrelated process. Growth generally takes place during the first 20 years of life.; development continues after that.

Growth:

1. Is physical change and increase in size.
2. It can be measured quantitatively.
3. Indicators of growth includes height, weight, bone size, and dentition.
4. Growth rates vary during different stages of growth and development.
5. The growth rate is rapid during the prenatal, neonatal, infancy and adolescent stages and slows during childhood.
6. Physical growth is minimal during adulthood.

Development:

1. Is an increase in the complexity of function and skill progression.
2. It is the capacity and skill of a person to adapt to the environment.
3. Development is the behavioral aspect of growth

 Freud’s Psychosexual Development Theory

STAGE	AGE	CHARACTERISTICS
1. Oral	Birth to 1½ y/o	Center of pleasure: mouth (major source of gratification & exploration) Primary need: Security Major conflict: weaning
2. Anal	1½ to 3 y/o	Source of pleasure: anus & bladder (sensual satisfaction & self-control) Major conflict: toilet training
3. Phallic	4 to 6 y/o	Center of pleasure: child’s genital (masturbation) Major conflict: Oedipus & Electra Complex
4. Latency	6 y/o to puberty	Energy directed to physical & intellectual activities Sexual impulses repressed Relationship between peers of same sex
5. Genital	Puberty onwards	Energy directed towards full sexual maturity & function & development of skills to cope with the environment

Erikson’s Stages of Psychosocial Development Theory

STAGE	AGE	CENTRAL TASK	(+) RESOLUTION	(-) RESOLUTION
1. Infancy	Birth-18 mos	Trust vs Mistrust	Learn to trust others	Mistrust, withdrawal, estrangement
2. Early childhood	1½ to 3 y/o	Autonomy vs Shame & doubt	Self control w/o loss of self esteem Ability of cooperate & express oneself	Compulsive, self-restraint or compliance. Willfulness & defiance.
3. Late childhood	3 to 5 y/o	Initiative vs guilt	Learns to become assertive Ability to evaluate one’s own behavior	Lack of self-confidence. Pessimism, fear of wrongdoing. Over-control & over-restriction.
4. School Age	6 to 12 y/o	Industry vs Inferiority	Learns to create, develop & manipulate. Develop sense of competence & perseverance.	Loss of hope, sense of being mediocre. Withdrawal from school & peers.
5. Adolescence	12–20 y/o	Identity vs role confusion	Coherent sense of self. Plans to actualize one’s abilities	Feelings of confusion, indecisiveness, & possible anti-social behavior.
6. Young Adulthood	18-25 y/o	Intimacy vs isolation	Intimate relationship with another person. Commitment to work and relationships.	Impersonal relationships. Avoidance of relationship, career or lifestyle commitments.
7. Adulthood	25-65 y/o	Generativity vs stagnation	Creativity, productivity, concern for others.	Self-indulgence, self-concern, lack of interests & commitments.
8. Maturity	65 y/o to death	Integrity vs despair	Acceptance of worth & uniqueness of one’s own life. Acceptance of death.	Sense of loss, contempt for others.

Havighurst’s Developmental Stage and Tasks

DEVELOPMENTAL STAGE	DEVELOPMENTAL TASK
1. Infancy & early childhood	eat solid foods walk talk control elimination of wastes relate emotionally to others distinguish right from wrong through development of a conscience learn sex differences and sexual modesty achieve personal independence form simple concepts of social & physical reality
2. Middle childhood	learn physical skills, required for games build healthy attitudes towards oneself learn to socialize with peers learn appropriate masculine or feminine role gain basic reading, writing & mathematical skills develop concepts necessary for everyday living formulate a conscience based on a value system achieve personal independence develop attitudes toward social groups & institutions
3. Adolescence	establish more mature relationships with same-age individuals of both sexes achieve a masculine or feminine social role accept own body establish emotional independence from parents achieve assurance of economic independence prepare for an occupation prepare for marriage & establishment of a family acquire skills necessary to fulfill civic responsibilities develop a set of values that guides behavior
4. Early Adulthood	select a partner learn to live with a partner start a family manage a home establish self in a career/occupation assume civic responsibilities become part of a social group
5. Middle Adulthood	fulfill civic & social responsibilities maintain an economic standard of living assist adolescent children to become responsible, happy adults relate one’s partner adjust to physiological changes adjust to aging parents
6. Later Maturity	– adjust to physiological changes & alterations in health status – adjust to retirement & altered income – adjust to death of spouse – develop affiliation with one’s age group – meet civic & social responsibilities – establish satisfactory living arrangements

Levinson’s Seasons of Adulthood

AGE	SEASON	CHARACTERISTICS
18-20 yrs	Early adult transition	Seeks independence by separating from family
21-27 yrs	Entrance into the adult world	Experiments with different careers & lifestyles
28-32 yrs	Transition	Makes lifestyle adjustments
33-39 yrs	Settling down	Experiences greater stability
45-65 yrs	Pay-off years	Is self-directed & engages in self-evaluation

Sullivan’s Interpersonal Model of Personality Development

STAGE	AGE	DESCRIPTION
1. Infancy	Birth to 1½ yrs	Infant learns to rely on caregivers to meet needs & desires
2. Childhood	1½ to 6 yrs	Child begins learning to delay immediate gratification of needs & desires
3. Juvenile	6 to 9 yrs	Child forms fulfilling peer relationships
4. Preadolescence	9 to 12 yrs	Child relates successfully to same-sex peers
5. Early Adolescence	12 to 14 yrs	Adolescent learns to be independent & forms relationships with members of opposite sex
6. Late Adolescence	14 to 21 yrs	Person establishes an intimate, long-lasting relationship with someone of the opposite sex

Piaget’s Phases of Cognitive Development

PHASE	AGE	DESCRIPTION
a. Sensorimotor	Birth to 2 yrs	Sensory organs & muscles become more functional
Stage 1: Use of reflexes	Birth to 1 month	Movements are primarily reflexive
Stage 2: Primary circular reaction	1-4 months	Perceptions center around one’s body. Objects are perceived as extensions of the self.
Stage 3: Secondary circular reaction	4-8 months	Becomes aware of external environment. Initiates acts to change the movement.
Stage 4: Coordination of secondary schemata	8-12 months	Differentiates goals and goal-directed activities.
Stage 5: Tertiary circular reaction	12-18 months	Experiments with methods to reach goals. Develops rituals that become significant.
Stage 6: Invention of new means	18-24 months	Uses mental imagery to understand the environment. Uses fantasy.
b. Pre-operational	2-7 years	Emerging ability to think
Pre-conceptual stage	2-4 year	Thinking tends to be egocentric. Exhibits use of symbolism.
Intuitive stage	4-7 years	Unable to break down a whole into separate parts. Able to classify objects according to one trait.
c. Concrete Operations	7-11 years	Learns to reason about events in the here-and-now.
d. Formal Operations	11+ years	Able to see relationships and to reason in the abstract.

Kohlberg’s Stages of Moral Development

LEVEL AND STAGE	DESCRIPTION
LEVEL I: Pre-conventional	Authority figures are obeyed.
(Birth to 9 years)	Misbehavior is viewed in terms of damage done.
Stage 1: Punishment & obedience orientation	A deed is perceived as “wrong” if one is punished; the activity is “right” if one is not punished.
Stage 2: Instrumental-relativist orientation	“Right” is defined as that which is acceptable to & approved by the self. When actions satisfy one’s needs, they are “right.”
LEVEL II: Conventional	Cordial interpersonal relationships are maintained.
(9-13 years)	Approval of others is sought through one’s actions.
Stage 3: Interpersonal concordance	Authority is respected.
Stage 4: Law and order orientation	Individual feels “duty bound” to maintain social order. Behavior is “right” when it conforms to the rules.
LEVEL III: Post-conventional	Individual understands the morality of having democratically established laws.
(13+ years)
Stage 5: Social contract orientation	It is “wrong” to violate others’ rights.
Stage 6: Universal ethics orientation	The person understands the principles of human rights & personal conscience. Person believes that trust is basis for relationships.

Gilligan’s Theory of Moral Development

LEVEL	CHARACTERISTICS
I. Orientation of Individual Survival Transition	Concentrates on what is best for self. Selfish. Dependent on others.
Transition 1: From Selfishness to Responsibility	Recognizes connections to others. Makes responsible choices in terms of self and others.
II. Goodness as Self-sacrifice	Puts needs of others ahead of own. Feels responsible for others. Is dependent. May use guilt to manipulate others when attempting to “help.”
Transition 2: From Goodness to Truth	Decisions based on intentions & consequences, not on others’ responses. Considers needs of self and others. Wants to help others while being responsible to self. Increased social participation.
III. Morality of Nonviolence	Sees self and others as morally equal Assumes responsibilities for own decisions. Basic tenet to hurt no one including self. Conflict between selfishness and selflessness. Self-judgment is not dependent on others’ perceptions but rather on consequences & intentions of actions.

Fowler’s Stages of Faith

STAGE	AGE	CHARACTERISTICS
Pre-stage: Undifferentiated faith	Infant	Trust, hope and love compete with environmental inconsistencies or threats if abandonment.
Stage 1: Intuitive-projective faith	Toddler-preschooler	Imitates parental behaviors and attitudes about religion and spirituality. Has no real understanding of spiritual concepts.
Stage 2: Mythical-literal faith	School-aged child	Accepts existence of a deity. Religious & moral beliefs are symbolized by stories. Appreciates others’ viewpoints. Accepts concept of reciprocal fairness.
Stage 3: Synthetic-conventional faith	Adolescent	Questions values & religious beliefs in an attempt to form own identity.
Stage 4: Individuative-reflective faith	Late adolescent & young adult	Assumes responsibility for own attitudes & beliefs.
Stage 5: Conjunctive faith	Adult	Integrates other perspectives about faith into own definition of truth.
Stage 6: Universalizing faith	Adult	Makes concepts of love & justice tangible.

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Group Therapy

Definition

Group therapy is a form of psychotherapy which as small, carefully selected group of individuals meets regularly with a therapist. The client participates in sessions with a group of people. These individuals share a common purpose and are expected to contribute to the group to benefit from others in return.
In group therapy approximately 6-10 individuals meet face-to-face with a trained group therapist. During the group meeting time, members decide what they want to talk about. Members are encouraged to give feedback to others. Feedback includes expressing your own feelings about what someone says or does. Group rules are established that all members must observe. These set of rules vary according to the type of group.

Purpose of a Group Therapy

1. It helps an individual gain new information or learning
2. It helps an individual gain inspiration or hope.
3. The group also allows a person to develop new ways of relating to people.
4. During group therapy, people begin to see that they are not alone and that there is hope and help. It is comforting to hear that other people have a similar difficulty, or have already worked through a problem that deeply disturbs another group member.
5. In a group, a person feels accepted.
6. Group therapy sessions allow an individual to interact freely with other members that shares the same past or present difficulties and problems. The individual then, becomes aware that he is not alone and that others share the same problem.
7. A person gains insight into one’s problem and behaviors and how they affect to others.
8. Altruistic behavior is practiced. Altruism is the giving of oneself for the benefit of others.

As the group members begin to feel more comfortable, they will be able to speak freely. The psychological safety of the group will allow the expression of those feelings which are often difficult to express outside of group. The client will begin to ask for the support he or she needs.

Types of Group Therapy

1. Psychotherapy Groups
2. Family therapy
3. Education groups
4. Support groups
5. Self-help groups

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Gestalt Therapy

Definition

Gestalt therapy is a form of psychotherapy, based on the experiential ideal of “here and now,” and relationships with others and the world. It is an existential or experiential form of psychotherapy that emphasizes personal responsibility. Gestalt therapy is used often to increase a client’s self-awareness by putting the past to rest and focus on the present.

History

Gestalt therapy was originally developed by Frederick “Fritz” Perls, Laura Perls, and Paul Goodman in the 1940s. Perls believed that self-awareness leads to self-acceptance and responsibility for one’s thoughts and feelings. Gestalt therapy rose from its beginnings in the middle of the 20th century to rapid and widespread popularity during the decade of the 1960s and early 1970s. During the 70s and 80s Gestalt therapy training centers spread globally, but they were, for the most part, not aligned with formal academic settings.

Focus of the therapy

The therapy focuses upon the individual’s experience in the present moment, the therapist-client relationship, the environmental and social contexts of a person’s life, and the self-regulating adjustments people make as a result of their overall situation.

Goals that are encouraged to achieved by the patient during Gestalt Therapy

1. Identifying the person’s action or becoming aware of what they are doing.
2. Becoming aware of how they are doing a certain behavior.
3. Learning how to change the behaviors that keeps him or her from achieving life goals.
4. Accepting and valuing him or herself as a person.
5. Emphasizes of what is being done, thought and felt at the present time rather than what might have been, should have been, was or might be. It FOCUSES on what is happening instead of on the subject being discussed.

Gestalt Techniques

1. Increasing the awareness of body language and of negative internal messages.
2. Making a client speak continually in the present tense and in the first person to emphasize self-awareness.
3. Creation of episodes by the therapist and diversions that clearly demonstrate a point rather that explaining in words.
4. Asking the client to concentrate on a part of his or her personality or one emotion. The therapist would then ask the client to address it as if it were sitting by itself in the client’s chair.
5. To increase self-awareness the therapist often use this therapy by having then write and read letters, keep journals and perform other activities designed to put the past tp rest and focus on the present.

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General Nursing Interventions for the Mental Health Client

General Nursing Interventions for the Mental Health Client 

Forming a one-to-one relationship with the client

• It will help the client to enhance communication, problem solving, and social skills.
• Coping skills and trust in relationships may be learned or enhanced.
• The nurse who establishes this relationship needs to be clear about its purpose and provide positive interaction with the client.
• Establishment of a specific meeting time, expectations for interaction, and the duration of therapy are important boundaries to establish.

Constructive Feedback

• Given to the client so that the client’s self-esteem will not be compromised.
• When the confrontation technique is used, the nurse needs to discuss the discrepancies between the client’s verbalized intensions and non-verbal behavior carefully, without appearing to be attacking the client.

Trust

• Essential to establish a therapeutic relationship.
• Consistency is the key.
• If the nurse cannot meet with client at an appointed time, the client must be informed at the earliest possible time.
• A new meeting time is scheduled.
• Direct communication is essential for the building of a therapeutic relationship.
• Other factors that facilitate trust within the nurse/client relationship include:

1. Recognizing the client’s feelings.
2. Honesty
3. Respect for the client
4. Non-judgmental attitude

Emphasize Positive Results

• Do not argue with the client.
• Recognize that the client is experiencing pain but do not dwell on that pain.

Assessment

• Critical of their behavior at the time of admission or initial treatment. Reassessment is indicated at appropriate intervals.
• The client must also learn how to self-monitor his or her symptoms.
• This communicates to the client that he or she is respected and can control his or her symptoms.

Safety

• The primary concern.
• The client may require protection interventions; these must be provided in a safe manner with respect for the client.
• The milieu may need to be evaluated for safety

Environment

• Provide privacy and time with decreased stimuli.
• It should be a calm environment in which the client feels safe from psychological and physical threats.

Physical needs

• Intricately related to psychological function.
• Ensure that the client’s nutritional, fluid, sleep, hygiene, activities of daily leaving, and exercise needs are met.

Treatment planning

• The client should encourage to participate in every planning.

Medications

• Approach the confused or combative client in a calm, firm manner when administering client.
• Restrains or the assistance of another care provider may be necessary for injections.
• Ensure that the client takes medications and is not hoarding pills.
• Client will need to learn about his or her medications and hot to maintain this treatment without direct staff supervision.

Education

• Very important throughout treatment.

Discharge planning

• Begins with the client is admitted, whether it is in the hospital, home care, or any other treatment program.
• The family must be involved in the process to become successful.

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