Documente Academic
Documente Profesional
Documente Cultură
WaughJic
Fifth Edition
I .'; ----7
-
Mental
This book is dedicated to ny ehildre~
Evfick- Anne,Malik, and Jan@.
$teti&& ,,, ranfrontaeion
b&&m modBcarion
@Q
o p e r a mnditioning
&cematie d a x a t i ~ n negative condit~onlng
dmemitization positiw conditioning
implosive therapy %@wive
modebg passive
rol~-p1ayin& assertive
I/
coping
selected Rapid pulse Mei?RanMm I
focus of attention
tense muscles
posture
\ \ Increased
biood preswve
respiration
I
Anxiety-pmdueing situations are not the same for all people A situs-
tion that is unimportant to m e person may cause andety in another
(EguE 543. A situation that is seen as a chanage to one person may Severe anxiety: loss of control.
cause panic in another person The followfng are emmplee of anxi*- no coping mechanisms
producing situations.
FlOURE 5-2 A seemingly insignfmant sttuation can lead m severe
Joyce was broqht up in a family that considered time very anxiew Tfthe person views the situation as a severe Mlreat,
importmt She was mntinually admanshed ts, h w and
was punished for being late. She internalized thi?. value !~f
being on time and coatinued to function under its shess. b e a e f e w her thinIeing was disorgmhed, and she feIp
l o p coped with && I stress by being M y aware of tim%
- helplas. I-laving excw en-& nor lolowing what to do,
organizing h a activkb by the clock,and allovving added she moved from place to place, becornin$ bs aware ofher
W e for possible delays. e n k o m t She kltEke smeambg or crying. SSh looked
One morning Joyce overslept She handled this added , at her keys mvefztl times bm did not we them.As h a a m -
~treSsor hunying. At the last minute, she discovered her ieygrew, thee w;rsa greater dispuptieninprocestngstim-
car kevs were miss&. She felt omwhelmed and no fozxger tdi firom hei senses. When samepne eIse fotad the k m
ab~e rely on her usual coping me-sms. Her muscles p 3 hai~dedt h m tc, 4% the severam&e%g ended. Ex this
cham5
.mm
One evening, Jack was cWViq car doslg a da"Bmw
mountain road. eight-mold son was sitting
him.m e was:hmvy in tbe opposite direction and most
of &led to dim their h&gh&. JaOk WaS driv-
@1dy,but the dnvm bebind him semed to be in a
h m . mey f~uowedclosely behind and honked
horn. Jack began calJbg tbe other He Pm
posefuny turned on his bright lights whenever a
appIm&ed when bit: Yaung S O n BZXRaPkd that his dad
seemed awfully tense, the father responded by shuin&
~~~~t gau $lare my a w a d If it was not for gou, I w d d
hmad, so yon jm k e q*~
not be on t
mn
waysin which people tend to hmdk a stres$ful6kua- Desensitiiation
tion and lessen anxiety include dependenmt domhtioni withdrawid, hother method used by therapisrs to r&me a r ~ d * is && des--
and a m a & n ~oycevgas dependent mr Me. More w d l g , one thflon Desensitization is a way of conditioning a to be non.
depends on omer people In a time of is MpfuL but It. re@Ponsive to a stimulus. This technique is usuaIly done by counselors,
b e e o m a pmblem when the dependence P s i s @and is mane. I
nurse w-, and psy~hologists,but other health w e tyopkers
Dependent perrple are inseaup.and C ~ X K J ace*~ that thyhaw should be kmjliax with the method Cliem arefirst trained muscle
bilitia, mey are mhly ~et&tive ~~%idsm, @w& Or *tion They are then asked t6 identi& (13 the &etpprodueing
-
mily be v i m d iqection For this reason dependant pea~le sfmad- *itaatio21;(2) a place iusually home) in which theg feel safea d seem;
1~f o l l the
~ d-ds of othd, men if those denan& canflict with and 13) another place or situation that is rekxing, such lying on the
their mwishes. , b e d C k n t ~ then asked to imagine the &ey-pmdudng
ji~p, John Jack were in a crisis, A crisis OClXJ3 when fie fion while tbe therapist desixibes it in some detail men &ts feel
p r o w that produced the M e t @ and @ * d m p the16wts@ of w e % a pmmmged signal,such as mov$lg
ing m e h e ape not effecave,Helping a person a a The description of the stressful evene is stopped and the am-
helpin$ the solve problems, Par PIVblm sol*g to n g safe haven When clients fed seme they
aPist be@ d e ~ ~ 1 i i fbg
OCCw,m e t y be latvered to a l e d at which learning are taken, thmugh imagination, to tbe re- situ&on m e n dents
p r a .~& ~ p t i n gto help Joyce, John or Jack p r o a m in their WYr&e& the entire process r e p e a e
state ofsevere a m wuld ha% been Wtl-3. Su~posebundergoes desensitization. The therapst might
ask Karen to * e e.
hemeIf in a specific s i t u a t i ~as he H~
%ht begin saying You are now sitting m the ~ s r o o myow . desk
RELIEVING ANXIETY is chred. Your p m d is out You are ready to take the exam. he pro-
fessor walks in the room. He has papers under his a m He
Systematic Relaxation O m to clear their desks. The test papeas are passed out you reeive
~ystemaflc
-tian is one method fodopsd by hehwioral psZT- Papa and look it over. There are some questiom ym do not
a01*ts to relieve d e t y . It is based on the faa that M e V and remember ever d i s e u a . You are trplng to think offhe ansrnrerbut ft
-tiOn ea&at ge~axationexercises stem from the *that
awareness of a tense mvde wables one to that musch is Fh?n might & h~ froger at this point The therapht immd-
not easy to do and consums &art must be used afiou$h the atel~ with, "OX,YOII ant now out ofthe- classroom you are
of -ety begin to ltnuer immdiatdy, total relaxation take @ h-e with YO^ MY. you are sitting at the p*. your is
seved w e . gw and YoW father is smokiog his favorlte pipe. m e dog lies near-.
-
@Thereis a ~ i n t h e f h p l a c e a n d t h e ~ f i . a m % f egood
& from avmeneh. Time .is mated on srrper6.M W w while the
Ynur father d i e s as he lrstens ro gou play:* real probLem gQ%. W:c&wdIf J Q wen: ~ && her pB1m
When Karen app- more mlaxed, the thempist &t continue vm, she prokwy would .wm&, UI axmot find ,mykepac or.UIfI wdd
~"N~wyouarelying~thebeach.ThewfiiCesandiswarm~t L find my keys, I w@ddnot h a pmblem? mnld no W b t gay
your skin You ean hew the quiet q~kshhgof the waves a m the Pr-have ta make an Ann-@&test' &en ifshecould not *lain why.,
*The sun is warm. YOU ean feel youpmdes rek&g as the J e h muld be qe.et@ to rampkin ofphysical d i m &en ifI&
sa$s umlm ea& p a + &ds k@, EU%J gets M.&and J o b 5 abd&I &em&m is
The therapist d e n takes baok to tbe dibssmorn wh84 sh@ f e l i e ~ dthe undefllying problems-the o m th.a am the d e t y
appears relaxed MTau have nsw handed in the test pap&. YOUhimst0 the first placeiaresrilldm.These am upbrl$ng probIw thatneed
wait* the grade. Ypn have no idea hawyou did, but you are wcirzkd
about the questiom you did not r e m e . ! The f6h.~~shformati011about Karen rmght hdprbe. team &
The entire proms is repeated aver d over, mtflhtaren n@ .W&? pmlem and assess the sbatim
lower elrperiendes amiety&tt,?hbk&% about t b me6sful-t
-
l a g m-hours and time a ~ a liam
y the WY He pnxess sbessffil&mti~m.
st&s mt he also is in the M 1 e of a d & d t & X k & d
suit He & a ~ ~ & x e abl t q of~thmaricattack. Zie wiuhave an oppo&~~-
A complete blaod m t and an uppet gas-
@e d e e d for the next morning. The mm p d t f m -
ap x o m & W s see a clinfcaI s p d s t in ps)rchi-
n ~ i n gtb &CUBS the S~IXSWS in his Me The initial 2b-~ p ~ b 1 ~ m - ~ o dI v i-
n $ Zb. LeamLFle, ~mbIan.go~ving
e g ri~aalsthat he is expepieneingsymptome of m 0 h - +-%Iqllesencpurageu Chris
ate to -8 anxiety. ws ha agreed to an extended d m - W seepofBible opticm~ and
tion &er the inttial fntemie~Chris elates that he b de-es
ap&en&g fkquent headaches and is fmdbg it @cult to
2c Qlristo keep a 2c. J g d wring provih an
c o n e a t e on his corn Wed
d * ~ o ~ o f ~omnritpf"orCMst€l
~ ~
methods of so* m& pooeess I@ situations.
NURSING MOM-8 1
28. ~eardhmetho& ofrelie* $tress.rn- m4w
SEWS f.%, -dse, y@or
feIaxa,tianante.&q@e@.
, I ~va~uation I
I Chris is wmd&g three timesa week @,ndpfactiices ~ h -
I ation teehnquea wheA he hcomm t w e . He fs BPI*
amepmble5ns&ving tdmiqrres in iAs daily Bfk
I
I
1 1 outcome Identification
I I Qz& will &ate pafehtldl oEtcameg of divorct?aEtd OCOU-
paziuaal mpoetiea and prlo~izeresults uuithin one I
N u Y S I ~Interventions
~
RoIe-pIs\yinmctiomwith
f i d y a d work modatea
nee and mim.
-
ati ion ales
Dlrms Chrlfi'S exgeECatioliti Dwssing ~ e m o d
, o&upatjId -a-
ofmagiage and c m h p ~ t i i ~ ~and
tiam asgIsrS in vd-
&Itrplaying prcwide~oppoP-
Wty to identifywith otheri+
.fee- &ndt b o ~ g b .
I7iscuw possible behavior
&ages as needed.
I $ Chapter 5
-monfng; reinfarein$ a desirable G W m is called Own needs, but unlike m a n , it & ~ . m c ~ ~ il d e~s i~nthe
g ,other
conmoning.~ehavibr, whether sodally acceptableor not
is continued for a reason. The individual the bbehavior sees S d y , ,women were wnaoned to be p&ve J' -)&
reason as g o d , no matter howdbtwdng it may s e e m to 0tha8. were aught to s y p r a their needs. The pawiye person is
change an undesirable behavior, the reward for the behavior oftentaken ah- of ~ & e peopleem be counted onto do w&t
is - ~ d . ~o a-engthen an acceptable behavior, the behavior is
rewarded. It souads simple,but inactual practice it is not easy. Not all
beh&~Tsare wntinued by the same reinfarc-t and not aILpeople
respond to the same reward
Tf a behavior is to be ehnged, must- be speci6edlyidenti-
fied The beh~xiormustbe stated inconmte t m . A baseline is then
estabIished by obsming the bhvior to be changed and rec~rdingthe
n w e r of times it ouws. This provides a basis for d e t w the
effectivenessof modifiealtion attempts.
~ nofthee most d@I&t aspects of behavior modificationiS to dis-
mvtr the rewanl the individual is mxiving ,&m the behavior. DDuring
the baseline observations, events before and after their behavior
This fnay give a clue to tfie reward the individtd is mitrjng
from the WOI. In the htillowhg examfle, it is evident that the
an &&rewives i&J from a behavior is not alway~0bhllS.
On sL*(ieTBIoccasioas, M y hit Annie Mthile playing in the
4 Chanter 5
p 1 e t e ~ T~k rt e i s a k e a d n m
RN, and an aide Jane hirs been a s w e d &$it
cIienb, the RP6 has five clients, a d Phe aide
bas s e w 4 Jane f& she cannot give adequate
~ t 0 ~ a a d t h i t' t ~ tisuidw
&ee ;;he has taka &z? =*at
dI week Slxe decides to tak ta the head nurse
a b u t the &wtPDn The head amst ~esponds,
*I m somy Them i9 nothing I can do. The
Eelieuing Anxiety
~~
)REV1EW
--
mow AND C O M ~ P R E H ~
& MuMpk &ice* 6el@ the one Bpst
x ~ ~ p & , ~ fn~~t ~-3* . g ~
Q lZPa*ans.res~tBtBfrsmp&$&,J
0 B . .~~ , h $ d l ; s . i S . mF
;
A
..
,
p C,,%&@\@
~
>eUS,.&;&k
p D.,>Z~* :$$?= or g .- w
2. ; . fJ$tw@&:w d = e I &.&&,&p
& @g ne~,&@
~~b~~
0 B. fdkge~~ mtj$f@~
Q Q ~ ~
Q a mrn~-;
: , " ,
"a. A,&&$p.*~ @
-,$-
SUGGESTED ACTIVITIES
Consider the ds-r undw whi&yo~become d o u s .
Do yo8 usually respand byh"oz&g dependent witMraw
@gcessive, or &mt?
T q ~d the feeling9 evoked in you when you are a r o d
someone uiho is e x p & m moderate or severe anxietyty
Pmctb fhe relaxation ezergsw d w d e d in this chapter for
twmly to thkgr minutesa day.
a m e a crtmdous &-to Mm b&r&your next ~sni&+@a.
D- be.enam,tr~a d m p w &eUnp;g. q m &q d i f ?
h-w . , mw& ,duringan w t s o n y
183E Chapter 5
r n L Y YOUR LEARiuma
A. MuEtiple choice. Sdeetthe one bedt ansnier.
1.A n m e has worked a shift fm Eor weekends so that
fbe peer could have time ofTfor reamtiowl &ties. The
per says to therurr^je,"Im d ~ o u m w&for~nextw&-
end, too." Choose an meptive response fw the nurse to give
ta fbg co-worker,
d A,Y~~dthaty~uhavep~forthe~eelren&hutI
lave plan9 also. Sfnce Pae already WQW three week-
ends for you, please mk komeone elsew
P B. ? had made p h fax the h e n d but realize 2 s ImpDx-
tant tg help yon Sur& Ill work nwt we%kendfor paa
0 C,~o~bahiMtysaskingmetoryarkforyo~ Youneedg,
agk m e b o d y else.{
Lt D. m y do you k q askUl;e: me fa work for you? Dodt
youthWTba&lkkT"
2. The anme gathers data fivm a new client adWted with
Genera&ed lX8arder. Which statement the client
wouId hcfkate the client uses pasame beha16m i n-tape-
sonal lalapimhips7
3 d Y've b e e n m m my &ter do my h o n m r k fm me:
4
She d o a t have a job and might as ;well help me."
D B, "I dwnp put my Mdrenasand spouse's nee.& first but
itdytiresmemta,adit'shardmkeegupwithwhat
fhey wantu
D C. JI think I talfe good care dmf*sselE I'm proud of my
professiand work and hawe a d g dationskip
with my BenndsP
P D.'"L'~&gotto~valcecareafmy6e1Pbearusewb~&~ia
$0- @ '&lve them an inch md
to tfait. I d ~ y say,
b y ' U ale a mile."
5. fear
j" -,
p&&apy mble 61). Althoq$ t kheN is not apsychothWpW not $he event itself and to know that he MUSCle PelMtlOR
the LWN inrwam with &ens who arp beirrg treated by +&empu or me hss tns a111lty Problem solving
to Cope WIM events Asslsoeg readings
and therefore, should mde&and the prindpb ofthe p@otherapY x and actlwtles
..
,.,
'PSVC~O*~~~~~~
~-
*& v:-m*2.hieve
@-@ miad g ImYimg Libido refas to the sexual dIf'vp. P i e d pz-opr~sedb\tthe lib$&,
be$ins ta deoelap at birth imd & & @ ~ ! ~ ~ ~ t a g the mih
,&t@%
g&@pa&&
bmp&
.
,*
ts, @ '-&US
hb W OD
%&it%i.:aR!
mw& ,d a
,
life of the individual rable 6-31.The
&DU@
~ hstage
t of
is from birth to e i p ; h months. This is & o m m &the
libido devilop-t
st
a s
t3 @ m t& m
,,, ,
because the idint recziva all of his or her pleas- h u g h the
I*hknri$*f&~ @ $ ~ t a W , , - & g b%mB&- , 2! @&tFy
& mouth The second stage is the anal we,whi& oecm Between the
%
-,
,a ,*,
*a&,W @+@@ma
&m& *- 3*.-,
not tare w
-$' :,
@r-;f,i.i@
g p e n t iiWHSs,
~'erma88&
rn @the 8ab%o*%
fl-j
W m of one and Three. It is in this period that toilet V
very ~bportant The third stage is^ the p h a c %a$e.
be@ to develop a wxwd idenBty and becomes aware ofhis or her
q become
&e child
4 9 w m w & e &wm&yd &;anytw"
body, espealIygenitalia
d &w.
* *
Mris ail
.mi e a t p e , t saima a a~bf, m & w q y.@ n a g the W d stage, the child develops stsong feelings towad
Incwe,g-Mee&ne
,*
+.*
@~w-:@,'@g
,& dae@
& , a m *f@&
&e,-~
@gl:w.adbred,
sw
~&s@, a
Tfre
x?:@
$l
PSrenf ofthe opposite sex The boy 6Us in love'with
and becomes jealouiofhis f&m. The $irl grows doser €0her father
a d kames jealoou8ofher mother. This behavior, n e c p s s fa
dweIopment is mned me Oedipus conplw
e @ a complex in females. The Oedipus: comple m d &m the
x_ inmales
~ mother
~ nor-
and
@
-- CLIENWCEMERED THERAPY
I.
anrc stage %ma1 ~r&ntltybwlns to develop. he Plea- : Elient-centered or nondirective therapyww developed by Carl Rogers,
,5 zone 1s the genT&l area. The rdVld a wntemperary psychologist Accordfag to Rogen, the actuakhg ten-
rirr~lalnnsm w n s feeLlhss forthe parent W , dencg i# the person's motive for action. He b&eves that under the
- - - - ~ ~~,
i7vy"-,-.'---
.-;
the opposite sexand w&ts:that
.. p e w all t@r J propet cDndifiow, people have a natural tendency to progress to self-
:?
,
Tbe zttinule of b e therap?& is af primary concern to hgk+. Some terms m m m n in belraviorlsm are eztinctiolr, displace-
me- r e i $ m m and conflid E3tinrrion occurs when a conditioned
Rogers b b v m rhat the therapbt mmt have thee basic qnatitim to response is stopped. To Frend, displacanent mmeant taking our hostili-
bring about behavioral change €T&path~, pmitive regard, d genuine- ty on someane orher than the one for whom it is intended ?t, beha*-
ness. The meet i m p m t Ofthwe 13 m g . knpathg is the quali- i o m , dispkmmmt is the act of engaging in %&stitUte behavim
ty df fur$ undersyandhg Zbe person b o q I& or her ex@eriences, Reir&ormrwt is &e saiefaction one gets from a @ d a r respon9e. It
and tqing to &eethe world as the client $mit Empathy is under- is why the behabehavior continues. Con$& as wed by the behaviorist,
stmding the person's fediap, even h s e b e h awareness The sw- re& to a situation in which two conditioned respomes oppose each
ond, quatily, positive regar& mwns that the thempist must accept the o*het Por example, Jane's boyfriend has requested that she we= a par-
pmon as he or she iS,The therapist w%er judge%interprets, a probes. ti& dress on a spedal date. U n f o r t ~ ~ ~ tJane + , hih(i gllined weight
The cIient is mtstedto ma-ka the change mssaty iar m e I f ~rhW- and the dress no longer firs.Jane has been cqditbned to please her
self. -eness is thethird q d i @ For chage to o m thetheraipist boytitend so she goes an a dlet She also has been conditioned .to sat-
must w m a @ t eSincerity .to the pwon. isfy frustration & eating.If Jane becomes Eutratexl while diettag?she
is faced with c&ct bemuse she must give up one conditioned
respame to satispYanother.
Maladaptive w o n s e s mult fmm e a r h wents, but the behav-
Behawinpism is a type of therapy that examine RarZnal and a b w ~ ioral there 'st& net interested in exploring the cIienfs prast It is the
current be ravior and its eurreut stimulus that interest fhe thefapi&
mal hehadior a8 a result of mdiri[~nedreflexes It i$ppNarily used fw Behavior conrinues only as 104% as it js reh%orcedced The stimulus or
p q i e in anxiety states or vvitb &eah disodpps. It ts Geldom rised rein%ommust be determhed and stopped, an avmive comequmce
with a thaught-d.isodered perso% Joseph %1pe hits d m muebwork added, or a difkent b e h a w reinfor~dfor change PO o c m
III beha4orism. Dm@ the first sea$iOn,the them@&takes a derailed his,tory,The
Behaviolism is based an the bewthat a11 aaion { r a p m l is brstory includes such hhemsw the client's age, marital status, edueat~n,
mused by a p d o u s m t ( s h ~ lb.p o n s a are learned durjng and occupation as well as & a her relations@s with athers, U d
-. m m . %%en a stindm o'ccnps, a pasgn wponds in a m y
life behavion, activities, and hkes and dis- also are & ~ s e dat this
Wt @wes plea8um or pnts hurf. Tor exdmplle, each time a W tim% The focus is on the hehavior the dent wishes to chan$;e The
$a= near a glass w e , the mother sap M with it @ at Of purdshment k a p f s t may ask the client to keep a The &'tory and d i q help
This is the thetsndm. The cbild stops to save or hm1P from the therapist determine the maladaptive behavior, the extent of the
h e This is the rspnnw When the child Iearns that stoppin$ is the behaPior, and the stimulus for and consequences o f d e behavior.
safest bebvior, this behavier continues 6h e the sthuh mcm'9. The behiorisst is primarily a teacher of new behavia=. Arti~ix
BvenfuaDythe response becomea automatic The child is &en safd to are oriented totvcird a goal fh;lt is stated in specific, m u r a b l e tams.
be c~ditbnedAll rwonsm M e both pnsitiw and negative aspects. Helping a permn to impme his or her personality is not a measura-
The childls respoase saves him qr her &omp i i s h e n &but itdenis I ble god because it is too vague Success of the therapy cannot be deter-
the plmwe of twi%ng the was& If arespome has more positim tban mined bya vague goal, Gods musf be specificAn example of a sp&c
ne&tive aspects, it is said to be nrlaptive. goal is Teach the client musele relamion exercim .she can use ro
childten m y respond to &mulus with temper tan-. .-.
Efhe relieve a m i q r before examhatiom:
The technique used by the behaviorist depends on the sitllrrtion
'i
tan€mmrestrlt &them getting what thep wsnt Gin this we, han-
and the consent of the client. Tkchaiqaes include
the vilse3,tl~ey;o\Fi2tmiauausing this behavior H ~ Fa tan,-
ws& in terms of en=, so &isconsidered a maladaptive rmpme.
is
" Modeling to demonstrate appropriate behavior.
Once a beha8ior h;?s been learned, it may result £ruma s t b d u s Q Desensitization.
similar to a associated wi& the orlghd one. Tbis iS calledgetlemliaa- ': Maselerelaxation
&sf For axample, a a m n dev8Iops a fear &plane tdps beawe of an
a
w.
acdaeht. EarentuaIly, this faar may p m l i a e to other The I T S 13 Assertiveness training.
mag feel anxiery when he goes to rhe airport to mea a friend.72ssmf Role pb@ngq
and s m d of a pl&e msy b q distress.Eoen t%llbddings ma$"c aw Behawirk modification.
him €0&el uneasy
I'M-,Chapter 6
crs respond in a certain wvay. Some ~!~ents arc impc~rtant,hut none are
- Negative rbo&t:: 1am a &taI B.ot at math
*- Positiw thonght: I'm h aw a W d t time r4gat how-
important, Some events ?re unrlcsirill~lt.rjr ~ncc~nvellierlt. hut none eve?, I I fmpr- mymsth scorn now fhat I bat% a tutor.
are b t r o u s . 3 All-o~mthhg thmk.ing' things are black or white, good or b9d,
To Ellis, whep a person sees an went as awful or tenible, he or
she is aa@IizinJ; or c a t a s f m p w . Catastrophizing results in a
lass of caanol over behavior. 'W~thoutconboL there is no problem
solving. The consequen- may be s&-defeating or maladaptit-e.The
-
ohm is no midTEle ground.
Nqdve thought: I am not perf- I an a rmal W m
Posirhte thought I have imperfections, sa dodoes eoerJrone I
philosophy of rational emowe therapy is expressed in the phrase %' am making an effort to feel good about myself
the world gives you almon, make lanowdcNIt is not what happens &lapfed $om Buras, J3.fi98D). Feelingped. Mew %irkSignet.
to a petson but what theperson does about the event that counts.
Since problems are a result of masturbatory rhinking, the thera-
pbt wbally attacks the &leafs thinkjng ~r belief system Though GESTALT THERAPY
other techniques are used, this wnfsontation or attack is the 6ne m e , Gest;llt therapy w a developd by Pritz MIS. It t 5 my cornplat
basic RET technique. The therapist might say something such as tern based on the theory that the mind conceives Brperiences as a
Where is the law that says you must always get an A?" "%ow me The whole When an cqmime is inmmpl&e, a pmblem may rmIt The
proof that you are an awfd stdent' Throuph this technique, the dm- goal of the Gestalt thm@$t.is to help the pemn complete rha experi-
apist tea- the person to thmk realistfcally.Realistic thinking leads to ence and incrwe au\mreness. A wmpleted eqedenee is &d a
problem solving or to the ability to cope uith situations that cannot be
chanffed.Many RET thefipists ehffluragetheir clients to live bythe fol- Zb the Gestalt themprst homfflsktiiebalanOe between the person
a d ltis or hez imimmentis inrponmt tahealth. Theh d y person
God grant me the serenity to accept the things I cannot is in b h e e w i d tbe enairarmern and rnathted by an awareness of
change, the muage to c h q e the W g s I can, and thewis- needs, ~ ~ u r c eas d, re&-&
i ans. This avwenes8 makes choiw avail-
dom to h o w the difference able and allm the pason to take fflnml of his or her Me.Problem
-- ~ -
~
I I
3
-
-~-
s;, Chapter 6
1
result from a disturbance in homeostasis+Symptoms anse as a result in &wt of the h e E The stadeat pretends -rt.leaunt is
of the body's attempt to maintain the stam quo. e a t e l inthe chair. She is then asked to converse wfth the
Fqmknce and awareness are thetwo most important.aspem of mt The student alternawiakm t M part of her asmi and
Wtalt ~ P J " Only . the preswt r t m because only tIuc present can hers* dxqing chairs whea appmpriate. $be is enegm-
be experienced. C d f s that were inmxnplete in the past mwt be aged to say w&Ww c m s to her while pkBrng each
brought to the present in order to be completed. Each person has the part, She is ah0 encouraged to be aware of her fadings
ability to complete his or her etlperience and relieve the prqblem. The while playing each This d i a l m e is a fmtasy, but it
thempbt acts as a guide in helping-the p m became m m aware ~ helps to inwease awaenms. Through the pleexce, she is
GestaIt therapy is used to treat people in anxiety states and tho* able to b a m e amre of her fedhgs toward hergreat annt
with somaticand affective disorders. It can alsa he used to enhanceliv- Ammess is usually sudden as if a 14ght has been fumed
ing Eor the mentally heal* person. Three common techniques in onw& m e a s comas wnW. The student Ls thenable
Gestalt therapy are exaggeration, f a n t q and ppesentiEin$. to rid hm@ofhff gt&"feelin@.
Ezgp&n i5 a technique used to help the persat become Por Gestalt thempgrto be effective9 tbe perma m m ~think t dw
aware of his or her body hguageI verbal language, or frEa6ine;s. For fn$- presentizinp,hPasiz&g, ar ~ ~ t ihe or o h e~is jusr
, to ape-
exampl~the student jvst baught herself anew dress. She spent a great rienee &dingis. Peehgs amthe matar Tancern.Forthe person to
deal of money onit, but now she does not like it The problem is that riencefdhgss,it is neeessuy to be selfdware.A great d d oftime m y
she dues not know why. The qtudent is mld to Iaok at the dress and he qent b y a e thaapist inhdping tb.~hecfteat increase his ox hw selP-
tdlthedress she does aotlike it Shemaybe agked ta rep& the wards awapqness The therapist map dracy amtionto the &en& pasture o?
several times, meh time saying tbem iwder and more f o d u l $ Soon tone of voice, 13rether%pWsawnfee&@+ doubts, fadatasld &en*
will o e m if the student is listening to her feelings instead also be expressed.
of just her wards. D r m are a dfmmttmtion of an ?.xompl& e q m r i m ~U~&,
Ettggeratian is &o used when a person is unaware of his or he2 Freud, the G e s W t daes wt attempt to d e m a n d or malye
body lang~~+$eIffhe dient wwm his h a d while talking,the therapist dreams The &erapi& helps the &eat expalent% the &am and
might ask him fo waggerate the movement by waving his atm in an increase awmeness. &periencees are taken at fa&vaIue. The Gestalt
ever-widening arc. Since fhe movement is cxagpated, awaxenes of therapist feels &at meanings emerge by tbemsdves with time. TIE
the m o m e n t increases. When a person is aware of behaviorr be or &.era@t uses &ed and p w o m &qua. AU te&miqnes are
she can control it geared to hdp the person in-e his is her self-a-m, qai-
When ;Fan&ng, the &eat is asked to b d g the futufe to &e enee *s, am3 complere previouS2gii~~mglete experiences.
here and now. The student wan@to buy a nay car and has tQ choose
hemeen two possib&ies. Oae is a baghfly eolored sporty caf and the
othef is a much less q x p e n s i a e wmpact She conTindy uaciIlates REALITY THERAPY
betareen the two md just m o t make up her mind. Ta help her, the WlEiam Glaasef8 waby thesapyfs one of the newresf psychotherapies.
tbarapist agks the student to fantasize that she has each ofthe w,obe Itsp q s e is to M p people gee themselves aamatel. 6ce re&$, and
at a time She is ask& to pretend that she is 8-g in them, dslYing I fhEU their q ~ ~eeds.
n Glasser beliweg that each pawn fias a mpm-
them and meeting herfrienh, Then she trm on each situation she is
asked to concentrate on how each fek, II sibility for his mher owm k W r . A pason's prmmt behaoior mmot
be blamed oar what wcumd in t k p m RediQtherapy has been used
Presentkingis a means o f b r h g i i a past went into tbe pment Wensiveipin the rehabilitatfon o f j u v a e delinquents and with W-
as &own in the follomg example. who h&ie&led in ~ a o iIt. has &o succmfdy berrn used tu
A student come8 to the M p b t bemuse she f& @lty. @duncethe lives ofpegpie during m&d eonnicts, &es, and in treat-
She bad been invited to yisit her great aunt but went 8ut ment for chemical d q e n h Reality therap has been sukwWp
with her Bends. The avnt djnd suddenly and the student: applied by parents, teachers, and nder Ia~tpeopLe
cannot forgive W The therapist encowages a dialogue The xed+@ dmm@t must be a warm, conceined person who js
bemen the aunt and the student A n empty chair is plat& real and genuim %%en sppmpriate,thmapIstsdismss their anm ape
13enm,achnitpezmd faults, an$ are w iQ n& W m
&&%ewS M- m e mmm!yb&&ypeopk .a& as &o$e &
& eep ~ w i e s , w-
+&~ld
"Wllen wit
dinnep Be
ready?"
*
4
in a few minutps. You fust sit dowa thee and put your feet up. Gee
honey,you look SO tired," she would be responding in her " u d n g
parentn Her 'child e g mmight have s&d " k f sgo out and eat to-hp
- that
nr 4* -- vou fc:am mey Ha "adulf would have simply said
'Dinnet d ire reah in a half hour."
Jn any tl:a.nsaction one m o t predict the ego state in whi&
another p e r s o n d respand. Iftheresponse is in the same ego state a6
„ go state sgm state
Of
-
1
1- IWE bf tpe ppwm tips p r ~ b l k ~ a be h m e t to
can
of the ebmtioua migm Wile@, it w be d d t w%&The id, w, and
husband wife
sup&zB;o balance eaCh oibw to check behavior. P~yehoanalyskis a
E l-
aery lang p m w , some- taKing-y yeare.
CIientcenteed thff~apyis based on the belief that peoplenat-
Parent
m a y gww t u w d seEa~twht%on under the rigla canditiuns. It is
"when wUl Tranbfemd the p p s e afthe h a @ to praide these conditfons. The @ax-
dinner be to parent pist provides an accqTtng, nonnjagmmtal environment aimed at
ready?" for reducftlg the client% m$iety and clefemsea that block ?his driwe.
response
Client9 are m u r a g e d to ~ r e z their
s f-ge and i n m their
self-awamaesa When people are amre of howthey feel an6 what
"IF you W O U I ~hem . ... makes them feel fiat way, they can wowork on improxdng behaxioe
me, you might Empathy, positive regard and g a u h m w are dhmctedstirs that
have dinner the client-oriented therapist mwt show the client
on the." kh;wjorism is a school of therap that believes actioIbg m
ChiId
caused by past even- Behadom mnthue only if they are aceampa-
nied by a ward m e n a learned response becomes a m &
people am M d to be canditioned to tlre response- ThaapWme ptlr
FII;URE &2 Crossed transaction. The husband asks a question in m y teachem of new behaviom m u s e a d y of te&nique
his adult ego state, but tne wlfe responds in her ctltEal parent. t~eliminate rewards for und&ble Behavior or in- m i l s
The critical parent directs her statement to the child; thus, the Ew d&able behavior.
transaction is crossed. CrQsseatransactions are often destructive. Ra?iorlal emotive therapy is related to b&vimism Its fmder,
&rt Ellis, w u wvinced tbat a person's behwkr is due to his or
Others, though, feel that the vanous schools ofp~ychologyhave her her tbhkmg. Prabierns are not caused by evenfa .that happen
samethig to offer, but none has the entire an?.= Thwe therapbts but are a result of wha B e p a o n b e b s about the eyents.
Therapy is aimed at h @ p g the pwon's belief s g a k and t e d -
are known as eclectics. They pick and c h o w techniwes from any
~~epersonthatheorshehas'theab~toc~pe~anye~enf
school that seem to fit the siD1ation They might d y z e relationships
with one client and use fantasy with ano€her. They may confront one CogniGive-behawid therapy is a+ted ftom the work of
AaronBeck It is a cum&zt and successful form of therapy in ouLpa-
client and use the word assouation with another. Mmy times these
b t Bettings. a i m ate wnf5onted with hatio~lgLnegative beli&
therapists have two or threefavorire therapies that they usemost oftw
but they use none exclusive&. end a W e 8 and learn how their belie% influence thefr thongbts,
iWin@,d a c t b m .
Gestalt theram is hued onrhe theory Bat the mind conceives
SUMMARY -
---
--: ---- e?rperiences a whole. When an experience is hwmplete, a pmb-
Iem may mirlt Tl?e gml of the Gestalt tke~tpististo help tke client
Psychotherapy is a method of trea?ingmental illness in which ver- m p l e t e the expaknce though awareness. ExpMendng and
bal ana expressive techniques are used W help the person resolve awweness am the two =st irtlpmant aspem of k a p y . ma
inner c&cts and m o d e behavior. Mmy techniques are used, wmes9,the person canchange his or her a o ~ behavim n The t h e
including psychodysis, client-centered therapy, behavio&m, apkt ~pendsmuch tjme help* people hacome more anrafe.
rational emotive therapy, Gat& thepapy, and transactid mdpis. ReaEQ Therapy ahas to wsiat people €0 see themseha accu-
Psyhoanaly~isis based on the work of Siptmd Freud The rately, ro fam reaIi@, and to bXlll peFsanal nee&. Individuals are
thempist obtains hformation about past and present eacpefa~es mpomible far t b k own behior; present behavior cannot be
that have been repressed in the client's subcomkious mind By b k e d on past events. The r e w aerapbt is concerned wiih
3. A Gestalt therapist assists s client in acting out a manary af
b&+r, r&@ ;@Q fw*. :@tpare @ % a g e d @@uate _> a tra-atic childhood experience vvfth m abusive family
&& bkvi~r o m f13@&g?q inahtdap!@eb-@cr: The
wrq&t helps @ &&e,pI@m for fhat &~&t$r @@a* member. Which technique'is tbe rhmpist using?
tl A. fantasizing
p*; h&epp. &;lt rwm$$ig &, M e :@mend&ealrh, tl B. presentizing
pmP&d
-&+-&&.*
wusipn,
i s g . 9th~~py~@@hud
o,X,,ym9te-QXK
~ ~
agd ;@,id@ maitg *:
Ifhelps pe~-
D G resistance
Ll D. awareness
& &tapBt wegg&Biqgea from mme than one B. Erwd d&ed the O&pm avnplea aswhich of the foUmving?
sch00I &pq&oiO@ O A. an abnormal hahador in developing gii-IB
a&& ~ d e@&trpn&$ &Q%@8to o 3. a f e e k g of inferior+tyassociatedwith familg.relation-
a a t & ~e w&
@f&e &.en@ may .red&@ The
a
me ,- cwnmonlly nsed d . & e g& Qf Q C. a strong; f w of doseness a child has for the p w n t
the rherapies mimes migilt rn.WUDlW. of the appasitesa
-..,
.., .
8- =J * L.x,;~I . Q D. a smng feeling of doseness a child has for the p p n t
of the same sex
5.The term Ebidu refers to which afthe following?
SUGGESTED ACTIVlTlES
-
Q A. canseience
m Wth a small groupr make and play word b i o . M e several
o B. setf-conoept
Q C. available sexual enexgy
bingo car& with d W m 0fpyehuthmpji terms, A d e r
0 D. m d t i o reapme
~
caIks Qttt the thnns. Ea& player alea to &d the ddW%onon
h& or hm d T h firstplayer to mer the definitions m e t - ?-rt
6. Which phrase c m C t l y defhe8
&*, O A moving wwmcious thmgha to the consworn level
hhkv a 4 fk fm the yadoug p6ychOthmapie8. Lrstthe p w Q B. anributing b c f M e S of a sigmEcant other to the
choth.ewpy, its intended goal,andthe techntgaes used to
P C. substituting one behavior for m d e r
aamnpbh this gad 0 D. verb- fPelin$s af@ and anxiety
9 Whkh situation accurately identifies incongruencs? Clients:
REVIEW Q k see themselves as different &amwhat theg m
earperienefng.
KNOW rn C O ~ m m 0 B,play m a n i p W Y e gslnes to aadsfy internd drives.
k Maltiple choice, Select the one b& answer. 12C. respond t6 a message in a cbild-Wnemarmer.
CI D. change their behavior inresponse to a repeated
1. C o n d i W r@m f~ a term aswciated with whi& ofthe
m n h g psycho€herapiie9? stimuIus.
o k b&Wwm 3. Which therapist W d use dwensitimtion and r~laxation
o B. Getitdt *ob@ te~hniques?
0 C,~ Z c e n ~ D A behavioriet
D. reality t h e r m Q B. client-entered therapist
a. According to Preud whit& ofthe f o U o W controls and P c. psy&oan*t
guides the actions afa p w a d 0 D, reality therapist
P tl ego Q C, libido
Q B.id 0 D. superego
niques? mend gsychothwpy sessIcms trs help me with my problemsj
D A, dient-ceatered therapist a. .. but I'm n a going. I've s m examplea of paychoan&ysfsin
e e s md th&s nat fos me? Whtch response by the nurse
P B. Gestalt therapist .Im t .
0 C. transactional analyst I . would be most apEnapPiate?
C;I k Tsychoanalysis would be y a y efferpive for pour prob-
U D.behado&
lems You should follaw your doctor's r e m d -
10. Accarding to Freud's Stag'& of libido developx~ntwhich tion"
stage develops fist? !2 a 'T9ychoanalysis is j ~ m one
t type ofpayeho&erap~
U k anal "Iclyour therapist can dedlde WMch approach i s bem for
a B. phallic yau?
0 C superego U C. %a have the right to d&de w h a e r or not to follow
O D. osal your doctor'sr e c c n n m d a t i ~ ~ . "
R D. '"It does% 5 m d &e yanr doam is o~eringhelpful rec-
mmendatim. Terhap9 you s h d d w e docto&
APPLY YOUR LEARNING
4. Thg nurse assists a client daring an acts and cr& group. The
B.Multiple cboie Seled the one best answer. client sagis, Tm jlSst no gomi at fhis stuff I don" t o w why I
1.The nurse is assigned to care for a nwly admitted adult cEw keep coming to rh- $roupkV The clients plan of m e also
on the ps'ychiatric unit The n&s physical features and indudes c o ~ ~ h e h a v i o rth
aal w swsions Wee il week
mane@rns are similar to those ofthe client's motha, who Fhi& wsnment by the n m e would be qprckre of the
was physically abusive during the client's childhood. Which planofwe7
factor below is most likely t~ affect the nurse-client relation- O A /? notieed yoa srayed for the entire arb anti crafts group
ship? and were encoxmgbg to
O A. transferenw D B. "What typm of activities d d appeal to you more tban
O B. disphcement a m and cr&T
CJ C, game playing O C. Tou &odd uy hanler to &b the a& projects you
a D. ca6amis start You give up too
2. A client diagnosed with an anxiev disorder is involved* U D. "GOeasiex on pornelf: Aas and 6is just a 6imple
Gestalt psychotherapy. 73% client attends sessions twi- wm- aeiiw
week with the psychotherapist In w W of the following 5. A &entin a psy.chiatric unit who i s also a suctressful inmt-
ways would the practical nurse most appropmte1y suppm ment dm%, sap te the nurse Y'm nmr going ro bemmt: a
the pyehatherapy? partner at my wmpans I jm can't predict ibanda].trends
Q A. Have the client describe the dis&on from each a=- Eke other &ys@.I The hoqital uses problem-ariated
sion with the psychotherapist progress notes, Beside which ofthc fdnowing problem state-
D B. Use exaggeration, fantrtsiz'i and presentiang tech- ments would the n m e doeament the &e&s d m n m n t ?
niques in the nurse-client interactions. Ci A, defmkve coping
01 C. Ask the client to deswibe dreams and hdp the client a B. impaired adjmtment
interpret the dreams' meanings.
u D. Assist the client to attend the psydmthempy sessions
U c. altered role petfonnance
R D. self-esteemdistwban-ce
regularly and to be on time.
3. Name three essenW awbutes of the dient-ed therapist,
I
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