A conceptual model is a framework of related concepts. Conceptual models used by mental health practitioners address the bases for behavior in order to direct intervention. Although some mental health practitioners adhere strictly to one conceptual model, most practitioners in the United States use an eclectic approach in which they employ one or more approaches from several models.
1. Psychoanalytical Model (Freud, Erickson)
Sigmund Freud (1856-1939), an Austrian psychiatrist and the founder of psychoanalysis, developed a complex theoretical formulation of the nature of the human personality. Freud believed that the personality is formed in early childhood and that knowledge of how an individual's drives, instincts, psychic energy or libido, and psychosexual attitude are formed during the first 6 years of life is crucial to an understanding of the personality.
View of Behavioral Deviations
Psychoanalytical Therapeutic Process
Psychoanalysis uses free association and dream analysis to reconstruct the personality. Free association is the verbalization of thoughts as they occur without any conscious screening or censorship. Of course, there is always unconscious censorship 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, since dreams symbolically communicate areas of intrapsychic conflict.
The therapist helps the patient recognize intrapsychic conflicts by using interpretation. Interpretation involves explaining to the patient the meaning of dream symbolism and the significance of the issues that are discussed or avoided. Strong positive transference causes the patient to want to please the therapist and to accept the therapist's interpretations of the patient's behavior. Strong negative transference may impede the progress of therapy as the patient actively resists the therapist's interventions.
Roles of Patient and Psychoanalyst
The patient was to be an active participant, freely revealing all thoughts exactly as they occurred and describing all dreams. The patient often lies down during therapy to induce relaxation, which facilitates free association. The psychoanalyst is a shadow person. The patient is expected to reveal all private thoughts and feelings, and the analyst reveals nothing personal. The analyst usually is out of the patient's sight to ensure that nonverbal responses do not influence the patient. Verbal responses are brief and noncommittal for the most part to prevent interference with the associative flow. By the end of therapy, the patient should be able to view the analyst realistically, having work through conflicts and dependency needs.
2. Interpersonal Model (Sullivan, Peplau)
The interpersonal model was first developed by an American-born psychiatrist, Harry Stack Sullivan (1892-1949). He considered the healthy person as a social being with the ability to live effectively in relationship with others. mental illness was viewed as any degree of lack of awareness of the processes in interpersonal relationship. In addition, attention is given to the interpersonal nursing theory of hildegard Peplau. Her theory focuses primarily on the nurse-client relationship in which problem-solving skills are developed.
View of Behavioral Deviations
Sullivan's theory states that the person bases behavior on two drives: the drive for satisfaction and the drive for security. Satisfaction refers to the basic human drives, including hunger, sleep, lust, and loneliness. Security relates to culturally defined needs such as conformity to the social norms and value system of the individual's ethnic group. Sullivan states that when the nature of a person's self-system interferes with the ability to attend to the need for either satisfaction or security, the person will become mentally ill.
When Peplau defined nursing as an interpersonal process, she also discussed the importance of basic human needs. Needs must be met if a healthy state is to be achieved and maintained. For Peplau, the two interacting components of health are physiological demands and interpersonal conditions.
Interpersonal Therapeutic Process
The therapist helps the patient identify interpersonal problems and then encourages attempts at more successful styles of relating. For example, patient often have a fear of intimacy. The therapist allows the patient to become close while clearly showing that there is no threat of sexual involvement. It is believed that closeness within the therapeutic relationship builds trust, facilitates empathy, enhances sekf-esteem, and fosters growth toward healthy behavior. Peplau described this process as "psychological mothering" which includes the following steps:
1. The patient is accepted unconditionally as a participant in a relationship that satisfies
needs.
2. There is recognition of and response to the patient's readiness for growth, as initiated
by the patient.
3. Power in the relationship shifts to the patient, as the patient is able to delay
gratification and to invest energy in goal achievement.
Therapy is completed when the patient can establish satisfying human relationship, thereby meeting basic needs.
Roles of Patient and Interpersonal Therapist
The patient-therapist dyad is viewed as a partnership in interpersonal therapy. Sullivan describes the therapist as a "participant observer" whose role is to engage the patient, establish trust, and empathize. The therapist interacts as a real person who also has beliefs, values, thoughts, and feelings. The patient's role is to share concerns with the therapist and to participate as fully as possible in the relationship. The therapist helps the patient meet the goals of therapy: need satisfaction and personal growth.
3. Social Model (Caplan, Szasz)
The social model moves beyond the individual to consider the social environment as it effects the person and the person's life experience. Some theorists such as Thomas Szasz and Gerald Caplan believe that the culture itself is useful in defining mental illness, prescribing the nature of therapy, and determining the patient's future.
View of Behavioral Deviations
According to the social theorists, social conditions are largely responsible for deviant behavior. Deviancy is culturally defined. Szasz believes that people are responsible for their behavior. The person has control over whether to conform to social expectations. Szasz objects to describing deviant behavior as "illness." He believes that illness can occur in the body and that diseases of the body can influence behavior (e.g. brain tumors) but that no physiological disruption can be demonstrated to cause most deviancy. He distinguishes between the biological condition that is central to illness and the social role that is the focus of deviancy.
Caplan believes that social situations can predispose a person to mental illness. such situations include poverty, family instability, and inadequate education. Deprivation throughout the life cycle results in limited ability to cope with stress. The person has few available environmental supports. The result is a predisposition to maladaptive coping responses.
Social Therapeutic Process
Szasz advocates freedom of choice for psychiatric patients. people should be allowed to select their own therapeutic modality and therapist. This also implies a well-informed consumer who can base this decision on knowledge of available modes of therapy. Szasz does not believe in involuntary hospitalization of mentally ill. Caplan, in the other hand, supports community psychiatry. He sees the mental health professional as using consultation to combat societal problems. He believes that future psychiatric patients would benefit indirectly from positive social change.
Roles of Patient and Social Therapist
Szasz believes that a therapist can help the patient only if the patient requests help. The patient, then, initiates therapy and defines the problem to be solved. The patient also has the right to approve or reject the recomended therapeutic intervention. Therapy is successfully completed when the patient is satisfied with the changes made in lifestyle. The therapist collaborates with the patient to promote change. This includes making recommendations to the patient about possible means of effecting behavioral change, but it does not include any element of coercion, particularly the threat of hospitalization if the patient does not agree with the therapist's recommendations. The therapist's role also may involve protecting the patient from social demands for being treated unwillingly. The patient has a consumer role and selects the appropriate level of help from a wide array of available services.
4. Existential Model (Ellis, Rogers)
The existential model focuses on the person's experience in the here and now, with much less attention to the person's past than in other theoretical models.
View of Behavioral Deviations
Existentialist theorists believes that behavioral deviations result when the individual is out of touch with the self or the environment. This alienation is caused by self-imposed restrictions. The individual is not free to choose from among all alternative behaviors. Deviant behavior frequently is a way of avoiding more socially acceptable or more responsible behavior. The person who is self-alienated feels helpless, sad, and lonely. Self-criticism and lack of self-awareness prevent participation in authentic, rewarding relationships with others. Theoretically, the person has many choices in terms of behavior. However, existentialists believe that people tend to avoid being real and instead give in to the demands of others.
Existential Therapeutic Process
There are several existential therapies, all of which assume that the patient must be able to choose freely from what life has to offer. Although the approaches are somewhat different, the goal is to return the patient to an authentic awareness of being. 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. Through the encounter the patient is helped to accept and understand personal history, to live fully in the present, and to look forward to the future.
Roles of Patient and Existential Therapist
Existential theorists emphasize that the therapist and the patient are equal in their common humanity. The therapist acts as a guide to the patient, who has gone astray in the search for authenticity. The therapist is direct in pointing out areas where the patient should consider changing. However, caring and warmth are also emphasized. The therapist and the patient are to be open and honest. The therapeutic experience is a model for the patient; new behavior can be tested before risks are taken in daily life.
The patient is expected to assume and accept responsibility for behavior. Dependence on the therapist generally is not encouraged. The patient is treated as an adult. Frequently, illness is deemphasize. The patient is viewed as a person alienated from the self and others, but for whom there is hope if the therapist is trusted and directions are followed. The patient is always active in therapy, working to meet the challenge presented by the therapist.
5. Supportive Therapy Model (Wermon, Rockland)
Supportive therapy is a relatively new mode of psychotherapy that is widely used in hospital and community based psychiatric treatment settings. It differs from ather models in that it is not dependent on any overriding concept or theory.
View of Behavioral Deviations
Supportive therapists are psychodynamically based and they describe behavioral deviations as neurotic, borderline, or psychitic. They subscribe to the concepts of id, ego, and superego, an emphasize the important role of psychological defenses in adaptive functioning. Compared with other models of psychiatric treatment, however, their focus is more behavior oriented. They emphasize current biopsychosocial coping responses and the person's ability to use available resources.
Supportive Therapeutic Process
The methods and goals of supportive therapy are equally applicable to highf-unctioning patients in crisis and low-functioning patients suffering from psychosis or persistent mental illness. Its emphasis is on improving behavior and subjective feelings of distress, rather than on achieving insight or self-understanding.
Principles of supportive therapy include the following:
- Giving immediate help to the patient that may include a variety of treatment modalities.
- Family and social support system involvement.
- Focus on the present and not the past.
- Anxiety reduction through supportive measures and medication if necessary.
- Clarification of the patient's current problem using a variety of approaches including advice,
supportive confrontation, limit setting, education, and environmental change.
- Assisting the patient to avoid future crises and seek help early when under stress.
Roles of Patient and Supportive Therapist
In supportive therapy the therapist plays an active and directive role in helping the patient improve social functioning and coping skills. The therapist is involved and is willing to contribute to a true therapeutic alliance with the patient. Expressing empathy, concern, and nonjudgmental acceptance of the patient are important therapist qualities. The therapist supports the patient's healthy adaptive efforts, conveys a willingness to understand, respects the patient as a unique human being, and takes a genuine interest in the patient's life activities and well-being. Finally the therapist regards the patient as a partner in treatment and encourages the patient's autonomy to make treatment and life decisions. In turn, the patient is expected to demonstrate a willingness to talk about life events, to accept the therapist's supportive role, to participate in the therapeutic program, and to adhere to the therapeutic structure.
6. Medical Model (Meyer, Kraeplin)
The medical model refers to psychiatric care that is based on the traditional physician-patient relationship. It focuses on the diagnosis of mental illness, and subsequent treatment is based on this diagnosis. Somatic treatments, including pharmacotherapy and electroconvulsive therapy are important components of the treatment process. The interpersonal aspect of the medical model varies widely from intensive insight-oriented intervention to brief sessions involving medical management of medications.
View of Behavioral Deviations
The medical model proposes that deviant behavior is a symptom of a central bervous system disorder. Currently the exact nature of the physiological disruption is not well understood. It is thought that the psychotic disorders such as bipolar disorder, major depression, and schizophrenia involve an abnormality in the transmission of neural impulses. It is also thought that this difficulty occurs at the sypnatic level and involves neurochemicals such as dopamine, serotonin, and norepinephrine.
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 system, physical examination, and mental status examination. Additional data may be collected from significant others, and past medical records are reviewed if available. A preliminary diagnosis is then formulated, pending further diagnostic studies and observation of the patient's behavior. This process may take place on an ambulatory or an inpatient basis, depending on the patient's condition.
Roles of Patient and Medical Therapist
The roles of physician and the patient have been well defined by tradition and apply in the psychiatric setting. The physician, as the healer, identifies the patient's illness and institutes a treatment plan. The patient may have some say about the plan, but the physician prescribes the therapy. 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 actively resist treatment. This is not congruent with the medical model. The patient is expected to comply with the treatment program and to try to get well. If observable improvement does not occur, caregivers and significant others often suspect that the patient is not trying hard enough. This can be frustrating to a patient who is trying to get well and is disappointed with the lack of progress. The patient also may have difficulty letting people extend care and at same time be self-sufficient.
Thomson.
Guimon, Jose. 2004. Relational Mental Health: Beyond Evidence-Based Interventions. New
York: Kluwer Academic/Plenum.
Keltner, Schwerkem Bostrom. 1995. Psychiatric Nursing. 2 ed. St. Louis, Missouri:Mosby-Year
Book.
O'Brien, Kennedy, Ballard. 2007. Psychiatric Mental Health Nursing: An Introduction to
Theory and Practice. Canada: Jones & Bartlett Publisher.
Shives, L.R. 2007. Basic Concepts of Psychiatric-Mental Health Nursing. 7 ed. Philadelphia:
Lippincott Williams & Wilkins.
Stuart, G.W. & Sundeen S.J. 1995. Principles and Practice of Psychiatric Nursing. 5 ed. St.
Louis, Missouri: Mosby-Year Book.
Varcarolis, E.M. 1994. Foundation of Psychiatric-Mental Health Nursing. 2 ed. Pennsylvania:
Saunders.
Sigmund Freud (1856-1939), an Austrian psychiatrist and the founder of psychoanalysis, developed a complex theoretical formulation of the nature of the human personality. Freud believed that the personality is formed in early childhood and that knowledge of how an individual's drives, instincts, psychic energy or libido, and psychosexual attitude are formed during the first 6 years of life is crucial to an understanding of the personality.
View of Behavioral Deviations
Psychoanalysts trace distrupted behavior in the adult to earlier developmental stages. Each stage of development has a task that must be accomplished. If too much emphasis is placed on any stage or if unusual difficulty arises in dealing with the associated conflicts, psychological energy (libido) becomes fixated in an attempt to deal with anxiety.
Psychoanalysts believe that neurotic symptoms arise when so much energy goes into controlling anxiety that it interferes with the individual's ability to function. They believe that everyone is neurotic to some extent. Everyone carries the burden of childhood conflicts and is influenced in adulthood by childhood experiences. According to psychoanalytic theory, symptoms are symbols of the original conflict.
Psychoanalysts believe that neurotic symptoms arise when so much energy goes into controlling anxiety that it interferes with the individual's ability to function. They believe that everyone is neurotic to some extent. Everyone carries the burden of childhood conflicts and is influenced in adulthood by childhood experiences. According to psychoanalytic theory, symptoms are symbols of the original conflict.
Psychoanalytical Therapeutic Process
Psychoanalysis uses free association and dream analysis to reconstruct the personality. Free association is the verbalization of thoughts as they occur without any conscious screening or censorship. Of course, there is always unconscious censorship 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, since dreams symbolically communicate areas of intrapsychic conflict.
The therapist helps the patient recognize intrapsychic conflicts by using interpretation. Interpretation involves explaining to the patient the meaning of dream symbolism and the significance of the issues that are discussed or avoided. Strong positive transference causes the patient to want to please the therapist and to accept the therapist's interpretations of the patient's behavior. Strong negative transference may impede the progress of therapy as the patient actively resists the therapist's interventions.
Roles of Patient and Psychoanalyst
The patient was to be an active participant, freely revealing all thoughts exactly as they occurred and describing all dreams. The patient often lies down during therapy to induce relaxation, which facilitates free association. The psychoanalyst is a shadow person. The patient is expected to reveal all private thoughts and feelings, and the analyst reveals nothing personal. The analyst usually is out of the patient's sight to ensure that nonverbal responses do not influence the patient. Verbal responses are brief and noncommittal for the most part to prevent interference with the associative flow. By the end of therapy, the patient should be able to view the analyst realistically, having work through conflicts and dependency needs.
2. Interpersonal Model (Sullivan, Peplau)
The interpersonal model was first developed by an American-born psychiatrist, Harry Stack Sullivan (1892-1949). He considered the healthy person as a social being with the ability to live effectively in relationship with others. mental illness was viewed as any degree of lack of awareness of the processes in interpersonal relationship. In addition, attention is given to the interpersonal nursing theory of hildegard Peplau. Her theory focuses primarily on the nurse-client relationship in which problem-solving skills are developed.
View of Behavioral Deviations
Sullivan's theory states that the person bases behavior on two drives: the drive for satisfaction and the drive for security. Satisfaction refers to the basic human drives, including hunger, sleep, lust, and loneliness. Security relates to culturally defined needs such as conformity to the social norms and value system of the individual's ethnic group. Sullivan states that when the nature of a person's self-system interferes with the ability to attend to the need for either satisfaction or security, the person will become mentally ill.
When Peplau defined nursing as an interpersonal process, she also discussed the importance of basic human needs. Needs must be met if a healthy state is to be achieved and maintained. For Peplau, the two interacting components of health are physiological demands and interpersonal conditions.
Interpersonal Therapeutic Process
The therapist helps the patient identify interpersonal problems and then encourages attempts at more successful styles of relating. For example, patient often have a fear of intimacy. The therapist allows the patient to become close while clearly showing that there is no threat of sexual involvement. It is believed that closeness within the therapeutic relationship builds trust, facilitates empathy, enhances sekf-esteem, and fosters growth toward healthy behavior. Peplau described this process as "psychological mothering" which includes the following steps:
1. The patient is accepted unconditionally as a participant in a relationship that satisfies
needs.
2. There is recognition of and response to the patient's readiness for growth, as initiated
by the patient.
3. Power in the relationship shifts to the patient, as the patient is able to delay
gratification and to invest energy in goal achievement.
Therapy is completed when the patient can establish satisfying human relationship, thereby meeting basic needs.
Roles of Patient and Interpersonal Therapist
The patient-therapist dyad is viewed as a partnership in interpersonal therapy. Sullivan describes the therapist as a "participant observer" whose role is to engage the patient, establish trust, and empathize. The therapist interacts as a real person who also has beliefs, values, thoughts, and feelings. The patient's role is to share concerns with the therapist and to participate as fully as possible in the relationship. The therapist helps the patient meet the goals of therapy: need satisfaction and personal growth.
3. Social Model (Caplan, Szasz)
The social model moves beyond the individual to consider the social environment as it effects the person and the person's life experience. Some theorists such as Thomas Szasz and Gerald Caplan believe that the culture itself is useful in defining mental illness, prescribing the nature of therapy, and determining the patient's future.
View of Behavioral Deviations
According to the social theorists, social conditions are largely responsible for deviant behavior. Deviancy is culturally defined. Szasz believes that people are responsible for their behavior. The person has control over whether to conform to social expectations. Szasz objects to describing deviant behavior as "illness." He believes that illness can occur in the body and that diseases of the body can influence behavior (e.g. brain tumors) but that no physiological disruption can be demonstrated to cause most deviancy. He distinguishes between the biological condition that is central to illness and the social role that is the focus of deviancy.
Caplan believes that social situations can predispose a person to mental illness. such situations include poverty, family instability, and inadequate education. Deprivation throughout the life cycle results in limited ability to cope with stress. The person has few available environmental supports. The result is a predisposition to maladaptive coping responses.
Social Therapeutic Process
Szasz advocates freedom of choice for psychiatric patients. people should be allowed to select their own therapeutic modality and therapist. This also implies a well-informed consumer who can base this decision on knowledge of available modes of therapy. Szasz does not believe in involuntary hospitalization of mentally ill. Caplan, in the other hand, supports community psychiatry. He sees the mental health professional as using consultation to combat societal problems. He believes that future psychiatric patients would benefit indirectly from positive social change.
Roles of Patient and Social Therapist
Szasz believes that a therapist can help the patient only if the patient requests help. The patient, then, initiates therapy and defines the problem to be solved. The patient also has the right to approve or reject the recomended therapeutic intervention. Therapy is successfully completed when the patient is satisfied with the changes made in lifestyle. The therapist collaborates with the patient to promote change. This includes making recommendations to the patient about possible means of effecting behavioral change, but it does not include any element of coercion, particularly the threat of hospitalization if the patient does not agree with the therapist's recommendations. The therapist's role also may involve protecting the patient from social demands for being treated unwillingly. The patient has a consumer role and selects the appropriate level of help from a wide array of available services.
4. Existential Model (Ellis, Rogers)
The existential model focuses on the person's experience in the here and now, with much less attention to the person's past than in other theoretical models.
View of Behavioral Deviations
Existentialist theorists believes that behavioral deviations result when the individual is out of touch with the self or the environment. This alienation is caused by self-imposed restrictions. The individual is not free to choose from among all alternative behaviors. Deviant behavior frequently is a way of avoiding more socially acceptable or more responsible behavior. The person who is self-alienated feels helpless, sad, and lonely. Self-criticism and lack of self-awareness prevent participation in authentic, rewarding relationships with others. Theoretically, the person has many choices in terms of behavior. However, existentialists believe that people tend to avoid being real and instead give in to the demands of others.
Existential Therapeutic Process
There are several existential therapies, all of which assume that the patient must be able to choose freely from what life has to offer. Although the approaches are somewhat different, the goal is to return the patient to an authentic awareness of being. 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. Through the encounter the patient is helped to accept and understand personal history, to live fully in the present, and to look forward to the future.
Roles of Patient and Existential Therapist
Existential theorists emphasize that the therapist and the patient are equal in their common humanity. The therapist acts as a guide to the patient, who has gone astray in the search for authenticity. The therapist is direct in pointing out areas where the patient should consider changing. However, caring and warmth are also emphasized. The therapist and the patient are to be open and honest. The therapeutic experience is a model for the patient; new behavior can be tested before risks are taken in daily life.
The patient is expected to assume and accept responsibility for behavior. Dependence on the therapist generally is not encouraged. The patient is treated as an adult. Frequently, illness is deemphasize. The patient is viewed as a person alienated from the self and others, but for whom there is hope if the therapist is trusted and directions are followed. The patient is always active in therapy, working to meet the challenge presented by the therapist.
5. Supportive Therapy Model (Wermon, Rockland)
Supportive therapy is a relatively new mode of psychotherapy that is widely used in hospital and community based psychiatric treatment settings. It differs from ather models in that it is not dependent on any overriding concept or theory.
View of Behavioral Deviations
Supportive therapists are psychodynamically based and they describe behavioral deviations as neurotic, borderline, or psychitic. They subscribe to the concepts of id, ego, and superego, an emphasize the important role of psychological defenses in adaptive functioning. Compared with other models of psychiatric treatment, however, their focus is more behavior oriented. They emphasize current biopsychosocial coping responses and the person's ability to use available resources.
Supportive Therapeutic Process
The methods and goals of supportive therapy are equally applicable to highf-unctioning patients in crisis and low-functioning patients suffering from psychosis or persistent mental illness. Its emphasis is on improving behavior and subjective feelings of distress, rather than on achieving insight or self-understanding.
Principles of supportive therapy include the following:
- Giving immediate help to the patient that may include a variety of treatment modalities.
- Family and social support system involvement.
- Focus on the present and not the past.
- Anxiety reduction through supportive measures and medication if necessary.
- Clarification of the patient's current problem using a variety of approaches including advice,
supportive confrontation, limit setting, education, and environmental change.
- Assisting the patient to avoid future crises and seek help early when under stress.
Roles of Patient and Supportive Therapist
In supportive therapy the therapist plays an active and directive role in helping the patient improve social functioning and coping skills. The therapist is involved and is willing to contribute to a true therapeutic alliance with the patient. Expressing empathy, concern, and nonjudgmental acceptance of the patient are important therapist qualities. The therapist supports the patient's healthy adaptive efforts, conveys a willingness to understand, respects the patient as a unique human being, and takes a genuine interest in the patient's life activities and well-being. Finally the therapist regards the patient as a partner in treatment and encourages the patient's autonomy to make treatment and life decisions. In turn, the patient is expected to demonstrate a willingness to talk about life events, to accept the therapist's supportive role, to participate in the therapeutic program, and to adhere to the therapeutic structure.
6. Medical Model (Meyer, Kraeplin)
The medical model refers to psychiatric care that is based on the traditional physician-patient relationship. It focuses on the diagnosis of mental illness, and subsequent treatment is based on this diagnosis. Somatic treatments, including pharmacotherapy and electroconvulsive therapy are important components of the treatment process. The interpersonal aspect of the medical model varies widely from intensive insight-oriented intervention to brief sessions involving medical management of medications.
View of Behavioral Deviations
The medical model proposes that deviant behavior is a symptom of a central bervous system disorder. Currently the exact nature of the physiological disruption is not well understood. It is thought that the psychotic disorders such as bipolar disorder, major depression, and schizophrenia involve an abnormality in the transmission of neural impulses. It is also thought that this difficulty occurs at the sypnatic level and involves neurochemicals such as dopamine, serotonin, and norepinephrine.
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 system, physical examination, and mental status examination. Additional data may be collected from significant others, and past medical records are reviewed if available. A preliminary diagnosis is then formulated, pending further diagnostic studies and observation of the patient's behavior. This process may take place on an ambulatory or an inpatient basis, depending on the patient's condition.
Roles of Patient and Medical Therapist
The roles of physician and the patient have been well defined by tradition and apply in the psychiatric setting. The physician, as the healer, identifies the patient's illness and institutes a treatment plan. The patient may have some say about the plan, but the physician prescribes the therapy. 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 actively resist treatment. This is not congruent with the medical model. The patient is expected to comply with the treatment program and to try to get well. If observable improvement does not occur, caregivers and significant others often suspect that the patient is not trying hard enough. This can be frustrating to a patient who is trying to get well and is disappointed with the lack of progress. The patient also may have difficulty letting people extend care and at same time be self-sufficient.
References
Evans, Elder, Nizette. 2004. Psychiatric and Mental Health Nursing. New Zealand: Mosby.
Frisch, N.C. & Lawrence E.F. 2006. Psychiatric Mental Health Nursing. 3 ed. New York:Evans, Elder, Nizette. 2004. Psychiatric and Mental Health Nursing. New Zealand: Mosby.
Thomson.
Guimon, Jose. 2004. Relational Mental Health: Beyond Evidence-Based Interventions. New
York: Kluwer Academic/Plenum.
Keltner, Schwerkem Bostrom. 1995. Psychiatric Nursing. 2 ed. St. Louis, Missouri:Mosby-Year
Book.
O'Brien, Kennedy, Ballard. 2007. Psychiatric Mental Health Nursing: An Introduction to
Theory and Practice. Canada: Jones & Bartlett Publisher.
Shives, L.R. 2007. Basic Concepts of Psychiatric-Mental Health Nursing. 7 ed. Philadelphia:
Lippincott Williams & Wilkins.
Stuart, G.W. & Sundeen S.J. 1995. Principles and Practice of Psychiatric Nursing. 5 ed. St.
Louis, Missouri: Mosby-Year Book.
Varcarolis, E.M. 1994. Foundation of Psychiatric-Mental Health Nursing. 2 ed. Pennsylvania:
Saunders.
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