Repression and suppression Repression and suppression are defense mechanisms that are commonly confused with each other. In repression, a person cannot voluntarily recall a traumatic event such as a rape or terrorist attack (Halter, 2018). Only through therapy and sometimes hypnosis can the memories start to painfully resurface; when they do, the event will be as acutely distressful Displacement Displacement occurs in our everyday lives. For example, when a person has a bad day at work and goes home and takes it out on their spouse or children, displacement has occurred as the person has shifted their feelings away from the intended object Rationalizing Rationalizing is the attempt to explain away situations while not taking responsibility for one’s own actions. A senator who is arrested for taking gifts or money from lobbyists may try to Identification An adolescent who tries to emulate a respected authority figure is using identification. Identifying with others and trying to be like them is adaptive and useful when the role model is a positive influence (e.g., father, mother, minister), but it can be very maladaptive when the role model is a negative influence (e.g., gang leader, rock star with drug problems). The psychiatric nurse who understands the various defense mechanisms patients in emotional distress use will be able to develop a treatment plan that addresses the use of defense mechanisms and presents alternatives that are more conducive to mental health and
as if it had just happened. In suppression, a person chooses to ignore or forget painful events; however, when queried, they can instantly recall them (Halter, 2018). This can be very productive for the nurse in an emergency, when they are able to temporarily push aside personal feelings and reactions to deal with the crisis at hand (https://www.ncbi.nlm.nih.gov/books/NBK559106/). (job, boss, etc.) and onto an innocent and unsuspecting other. Displacement can be the defense mechanism behind anger outbursts such as road rage (https://www.ncbi.nlm.nih.gov/ books/NBK559106/).
rationalize this behavior by saying, everyone does it, or that’s the way you get business done (https://www.ncbi.nlm.nih.gov/ books/NBK559106/).
improved quality of life (https://www.ncbi.nlm.nih.gov/books/ NBK559106/). Self-Assessment Quiz Question #3 Which best describes the meaning of defense mechanisms? a. Behaviors used to deal with stressors. b. False sensory perceptions. c. Beliefs that lack substantiation. d. Overall emotional state.
THERAPEUTIC APPROACHES IN MENTAL HEALTH
Milieu therapy The word milieu means surroundings or environment; milieu therapy is also referred to as therapeutic community. Milieu therapy is a structuring of the environment in order to affect behavioral changes and improve the psychological health and functioning of the individual. The goal of milieu therapy is to manipulate the environment so that all aspects of a patient’s hospital environment are considered therapeutic (Townsend, 2019). Within this setting, the patient is expected to learn adaptive coping, interaction, and relationship skills that can be generalized to other aspects of the patient’s life. Although milieu therapy was originally developed for patients in the inpatient setting, these principles have been adapted for a variety of outpatient settings (https://easpublisher.com/media/articles/ EASJNM_22_129-135.pdf) Care of patients in the therapeutic milieu is directed by an interdisciplinary treatment team, but overall management is the responsibility of the nurse. The initial assessment is made by the nurse or psychiatrist and the comprehensive treatment is developed by the treatment team. Basic assumptions of milieu therapy include the opportunity for therapeutic intervention, the powerful use of peer pressure within the environment, and inappropriate behavior can be addressed as it occurs (Boyd, 2018). There are certain conditions that promote a therapeutic community. 1. The patient is protected from injury from self or others. 2. The patient’s physical needs are met. 3. Programming is structured, and routines are encouraged. 4. Staff members remain relatively consistent. 5. Emphasis is placed on social interaction among patients and staff. 6. Decision-making authority is clearly defined. 7. The patient is respected as an individual and is encouraged to express emotion 8. The patient is afforded opportunities for freedom of choice. 9. The environment provides opportunities for testing new behaviors. (Townsend, 2019; https://currentnursing.com/pn/milieu_therapy.html)
It is understood that basic physiologic needs are fulfilled, and safety is paramount. Within this environment, a democratic self-government exists through community group participation. This promotes member interaction and communication. The therapeutic milieu provides structure and consistent limit setting at a time when individuals need it the most. These elements provide an assessment of the patient’s progress toward treatment goals. The nurse assumes responsibility for the overall management of the therapeutic milieu including assessment, safety and limit setting, medication administration, and education. Effects of the environment can easily be understood by thinking about common events in one’s own life. Going to a party may evoke a sense of festivity, joy, and excitement; going to a funeral can cause somber feelings of sadness; when walking into a quiet library, a person may feel the need to whisper and walk softly; and a starkly painted, tiled hospital room may lead us to feel fearful, anonymous, or disengaged. Even schools reflect environmental or milieu manipulation and effects (consider a Montessori-style school compared with a stricter military school). Inpatient psychiatric settings and residential settings are the most common places in which milieu therapy occurs. A patient who is disorganized, paranoid, or agitated responds better to an environment that is calm, well structured, and predictable, with staff persons who are pleasant in nature but consistent, directive, and firm. Self-Assessment Quiz Question #4 The nurse is explaining milieu therapy to a group of students. What is the primary role of the nurse in milieu therapy? a. Conducts individual, group and family therapy b. Directs drama that portrays real life situations c. Assumes responsibility for management of milieu d. Focuses on rehabilitation and vocational training
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