THEORIES OF PERSONALITY Techniques: 1.

Free association- talks about

Major Theorist: 2. Dream analysis- symbols from id
1. Sigmund Freud 3. Interpretation of behavior
2. Erik Erikson Other 4. Transference- pt to nurse
3. Abraham Maslow concepts: 5. Countertransference- nurse to pt
4. Lawrence Kohlberg
5. Carl Rogers  PSYCHOANALYTIC VIEW OF THE BEHAVIORAL
DEVIATION
SIGMUND FREUD (1856-1939) o Disrupted behaviors result from difficulty
 “Psychosexul” moving to next stage (pt gets fixated)
 An Austrian Psychiatrist o Neurotic sx arise when so much energy
 “Founder of Psychoanalysis” goes into controlling aniety that interferes
w/ the pt’s function
“Typology of the Mind” o Sx are symbols of the original conflicts
CONSCIOUS Thinking, feeling & actions a person o Everyone carries burden of childhood
is aware of & is able to control conflicts & is influenced in adulthood by
PRECONSCIUS Thoughts, feelings and desires childhood experiences
(Subconscious) below the surface that a person is  PRINCIPLES DERIVED FROM PSYCHOANALYTIC
to recall to consciousness MODEL
UNCONSCIOUS Thoughts, feelings, desires &  Behavior deviations are rooted in childhood
memories that are repressed dev. fixations
 Problems arising during dev. stages cause
fixations
“Structure of Personality”
 Physical sx are symbols/metaphors for
ID “Pleasure principle”
psychological distress
includes primitive urges (sexual
 Later stress causes regression
desires, aggression & dreams)
 Insight own behaviors can add to personal
EGO “Reality principle”
maturity & understanding of others
Conscious & mediates bet. id &
superego
SUPEREGO “Moral principle” ERIK ERIKSON (1902-1904)
Where ego finds the rules to  “Psychosocial Development”
control id  An American psychoanalyst
Traditional values & ideals of  Initially a follower of Freud who later on
society broadened Freud’s theory of human development
 Erikson= ego rational; Freud= ego irrational
LIBIDO  Erikson= larger social setting; Freud= mother-
 Driving force of human behavior. child-father
PSYCHOPATHOLOGY  Erikson= life full cycle; Freud= 5 y.o.
 Results from difficulty of making transition from  Erikson= healthy personality; Freud= neurotic pt
one stage to another
PSYCHOANALYSIS HARRY STACK SULLIVAN (1892-1942)
 Focuses on discovering the causes of the pt’s  “Interpersonal theory of Psychiatry”
unconscious & repressed thoughts, feelings &  American born theorist
conflicts w/c are believed to cause anxiety & on  Used the Freudian framework early in his career
helping pt to gain insight & resolve these conflicts
& anxieties INTERPERSONAL THEORY: VIEW OF BEHAVIORAL
DEVIATION
 When the nature of a person’s self-system
interferes w/ the ability to attend to the need for
either satisfaction or security, the person will
become mentally ill
 PRINCIPLES TO CONSIDER IN A THERAPEUTIC NURSE-
“Components of the Self-System”
PATINET RELATIONSHIP
GOOD ME Child received nurture &
 Relationship= therapeutic rather than social
tenderness
 Focus of relationship remains on pt’s issues
BAD ME Child failed to received nurture &
 Relationship= purposeful & goal directed
tenderness
 Relationship= objective in quality
NOT ME Child experienced excessive
 Relationship= time-limited interactions
anxiety due to disapproving
emotions transmitted by the
GOALS OF THERAPEUTIC RELATIONSHIP
mothering one
The pt will have:
1. Self-realization, self-acceptance, & increased
genuine self-respect
JEAN PIAGET 2. Clear sense of personal identity & empowered
 “Cognitive Development” level personal integration
3. Ability to form an intimate, independent,
“Modes of Communication/Experiencing” interpersonal relationship w/ a capacity to give &
1. PROTOTAXIC Infant still unable to differentiate receive love
MODE self from the outside world 4. Improved functioning & increased ability to stisfy
2. PARATAXIC Refers to experiences needs & achieve realistic personal goals
MODE characterized by symbols used in
private (autistic) way & “Essential Characteristics of Nurse in TNPR”
encompasses fantasy, marginal 1. EMPATHY Placing self in the pt’s
thinking & lack of cause-&-effect perception w/o loosing identity
3. SYNTAXIC Refers to experiences whereby 2. WARMTH Non-possessive caring
MODE persons communicate w/ each 3. GENUINESS Congruent verbal & non-verbal
other using language or symbols messages
that are mutually understood
4. RESPECT Unconditioned positive regard
to pt
DEFENSE MECHANISM
5. CONCRETENESS Use of specific realistic terms
 Method of attempting to protect the self & cope 6. IMMEDIACY Interactions focus on
w/ basic desires & emotionally painful events, interpersonal relationships at
feelings & thoughts the moment
 Used when we feel threatened & to alleviate 7. CONFRONTATION Pt’s awareness of problems
unpleasant feelings to make the individual feel
8. SELF-DISCLOSURE Nurse gives personal info only
better
when relevant to pt’s concerns
 Natural & majority are form our UNCONSCIOUS
“Trusting Behaviors a Nurse Should Manifest”
HILDEGARD PEPLAU
1. Friendliness 2. Treat pt as human being
 “Therapeutic Nurse-Client Relationship”
3. Caring 4. Suggesting w/o telling
5. Interest 6. Approachability
THEAREPEUTC NURSE-CLIENT RELATIONSHIP
7. Understanding 8. Providing schedules of
 Mutual learning experience & corrective
activities
emotional experience for the pt in w/c the nurse
9. Consistency 10. Listening
uses herself & specified clinical techniques in
11. Keeping promise 12. Honesty
working w/ the pt to bring about behavioral
change
 Based on the underlying humanity of the nurse &
pt, w/ mutual respect & acceptance of
ethnocultural differences
 Pre-Orientation Phase
TASKS a) Explore personal beliefs, feeling,
fears & fantasies
b) Analyze own strengths &
limitations
c) Review appropriate theory
d) Plan for first meeting w/ pt
e) Gather initial data about pt
STRATEGIES a) Clarify misconceptions & fears
b) Join self-awareness activity
c) Read factual info about the nature
of psych-mental conditions &
basic concepts
d) Review successful interventions &
role play them in hypothetical
situations
e) Review about pt’s medical
diagnosis
f) Review techniques
g) Give special considerations to
relevant practices
h) Strategize initial meeting w/ pt
Orientation Phase
TASKS 1. Establish trust, acceptance & an
acceptable mode of
communication
2. Determine pt’s desires & needs
3. Gather data about pt
4. Identify & define pt’s problem
5. Formulate a contract together
6. Set goals together
7. Establish therapeutic environment
STRATEGIES 1. Building trust
2. Beginning assessment
3. Management of emotions
4. Providing support
5. Starting termination
CONTRACT
 Agreement w/in the nurse-client relationship
involving setting goals & the plan of action for
carrying out the goals to achieve behavior change
ELEMENTS OF A NURSE-PT CONTRACT
 Names of individuals
 Roles of nurse & pt
 Responsibilities of nurse & pt
 Expectations of nurse & pt
 Purpose of the relationship
 Meeting location & time
 Conditions of termination
 Confidentiality
Working Phase
TASKS 1. Maintain relationship
2. Gather further data & explore
relevant stressors
3. Promote pt’s dev. of insight &
positive self-concept
4. Promote pt’s independence
5. Develop realistic plan of care &
implement interventions
6. Promote problem solving skills &
use of communication
7. Facilitate practice of alternative
adaptive behaviors/ constructive
coping mechanisms
8. Work through resistance &
transference behaviors
9. Identify support systems
10. Evaluate problems & goals &
redefine as necessary
STRATEGIES 1. In depth data collection
2. Reality testing & cognitive
restructuring
3. Writing & journaling by pt
4. Supportive confrontation
5. Promoting change
Termination Phase
TASKS 1. Establish reality of separation
2. Bring a therapeutic end to
relationship
3. Mutually explore feelings of
rejections, loss & sadness
4. Encourage pt to channel feelings
into constructive activity
5. Evaluate progress of therapy &
attainment of goals
6. Establish mechanisms for meeting
future therapy needs
STRATEGIES 1. Facilitate acceptable parting
behaviors
2. Closure
3. Evaluation
4. Dealing w/ pt resistance
5. Discharge planning
6. Rehearsing skills & solutions w/ pt
7. Tapping resources & support
system
8. Emphasis on pt’s independence
CRITERIA FOR TERMINATIONS Methods to increase self-awareness
 Pt experience relief from present problems
 Pt’s functioning has improved
 Increased self-esteem & a stronger sense of
identity
 Pt uses more adaptive coping response
 Pt has achieved planned treatment outcome
 An impasse has been reached in the nurse-pt
relationship that can’t be worked through

NURSE’S SELF-AWARENESS
 Process of developing & understanding of one’s
values, beliefs, thoughts, feelings, attitudes,
motivations, prejudices, strengths & limitations &
how these qualifies affect others “Defense Mechanism”
1. COMPENSATION Makes up for a perceived lack
NATURE OF SELF AWARENESS in one area of emphasizing
 Self-awareness capabilities in another
o Is a pre requisite to the genuine 2. COMPROMISE Reciprocal give-and-take
acceptance of responsibility for oneself. To necessary in many relationships
be a whole person, one must develop an to salvage some part of the
awareness of oneself, one’s environment situation or goal
(including nurse’s pt) & his/her connection 3. RATIONALIZATION Makes acceptable excuses for
to the environment. behavior through logical
a) Awareness of oneself reasoning
b) Awareness of the environment 4. CONVERSION Emotional conflict is
c) Awareness of interactions w/ the unconsciously changed into a
environment physical sx
5. DENIAL Emotional conflict is blocked
 Significance of self-awareness from the conscious mind &
o Awareness of self & others helps nurses person refuses to recognize its
effectively promote self-awareness in their existence
pt 6. DISPLACEMENT Emotions shifted to object or
o Awareness is the foundation of change situation
7. REACTION Unconsciously reverse
 Goal of self-awareness INFORMATION unacceptable & behave in the
o An individual w/ great openness to the exact opposite manner
world, much of whose potential is being 8. REGRESSION Return to an earlier stage when
developed & realized, w/ an increase stress creates problems
capacity for experiences of all kinds, w/ 9. REPRESSION Involuntary exclusion from
fewer defenses, & the capacity for consciousness of these ideas
spontaneous & honest interaction w/ 10. SUPPRESSION Voluntary exclusion form
others consciousness of these ideas
11. IDENTIFICATION Internalizes characteristics of
an idealized person
12. UNDOING Exhibiting acceptable behavior
to make up for negative
behavior
LAWRENCE KOHLBERG
 “Moral Development”

CARL ROGERS
 “Self-concept”
FREUD’S PSYCHOSECUAL STAGES OF DEVELOPMENT
1. ORAL STAGE (0-1)
2. ANAL STAGE (1-3)
3. PHALLISC/ OEDIPAL STAGE (3-6)
4. LATENCY STAGE (6-12)
5. GENITAL STAGE (13 yrs up)