Maladaptive

Therapeutic Models & Its Relevance To Nursing DEFENSE MECHANISMS
Practice
REPRESSION
PSYCHOANALYTICAL MODEL (or Psychodynamic Theory)
By Sigmund Freud;  Unconscious and involuntary forgetting of
painful ideas, events and conflicts.
 Emphasizes unconscious processes or psychodynamic
factors as the basis for motivation and behavior; A nursing student who failed the recent board exam,
can’t remember any of the questions asked
He believed that repressed (driven from conscious
DENIAL
awareness) sexual impulses and desires motivate much
human behavior.  Unconscious refusal to admit an unacceptable
idea or behavior.
 Personality is developed by early childhood;
 Sometimes mistaken for rationalization.
Personality Components/Processes
“I’m not drunk… I can still drive…”
Id: Instincts
Alcoholics
Ego: Reality
Battered wives
Superego: Morality
Anorexia nervosa DENIAL
Drug dependents
Conscious Level (EGO)
Executive mediating between id impulses and superego
inhibitions; testing reality; rational. Operates mainly at RATIONALIZATION
conscious level but also at preconscious level.  Attempts to make or prove that one’s feelings
Preconscious Level (SUPEREGO) or behaviors are justifiable.
Ideals and morals; striving for perfection; incorporated A student states, “I failed the recent board exam
from parents; becoming a person’s conscience. because there was a leakage and it doesn’t had any
Operates mostly at preconscious level. credibility
Unconscious Level (ID) IDENTIFICATION
Basic impulses (sex and aggression); seeking immediate  A conscious or unconscious attempt to model
gratification; irritational and impulsive. Operates at oneself after a respected person.
unconscious level. “I want to be just like you… a very good reviewer ……
nurse….”
LEVELS OF CONSCIOUSNESS INTROJECTION
Conscious Level – Thoughts Perception  Unconsciously incorporating wishes, values,

attitudes of others as if they were your own.
Subconscious Level – Memories Stored Knowledge
While her mother is gone, a young girl disciplines her
Unconscious Level – Fears, Violent Motives, brother just like her mother would.
Unacceptable Sexual Desires, Irritational wishes,
Immoral urges, Shameful experiences, Selfish needs COMPENSATION
Defense Mechanisms  Covering up for a weakness by overemphasizing

or making up a desirable trait.
 Psychological strategies that are unconsciously
used to protect a person from anxiety arising An academically weak high school student was sworn
from unacceptable thoughts or feelings. as the new president of the supreme SC.
 Involves a distortion of reality in wome way so
that we are better able to cope with a situation.
REACTION FORMATION
 A conscious behavior that is the exact opposite PSYCHOSOCIAL MODEL
of an unconscious feeling.
 or Developmental Model;
An older brother who dislikes his younger brother sends
him gifts for every holiday.  Spans the total life cycle from birth to death;
SUBLIMATION  Each stage of development is an emotional crisis

involving positive and negative experiences;
 Channeling instinctual drives into acceptable
activities.
A former NPA hitman, talks about the importance of INTERPERSONAL THEORY
life, democracy, justice, and following laws of the land.”  Interpersonal theory systems for the work of
DISPLACEMENT Harry Stack Suvillan, who believed that “we
come to treat ourselves as we have been
 Discharging pent-up feelings to a less treated by our parents”
threatening object.  Early relationships can encounter with others ,
interpersonal transactions, shape our view of
After the board exam, Andy went directly to his room
ourselves and create behavioral tendencies that
and smashed his reading table.
persist over the life span.
UNDOING STAGES OF PSYCHOSOCIAL DEVELOPMENT
 Doing something to counteract or make up for a

transgression or wrongdoing.
After hitting his wife, Venicio offered jewelries and
money to her.
PROJECTION
 Blaming someone else for one’s difficulties or
placing one’s unethical desires on someone
else.
 Involves in the development of DELUSIONS;
A nursing graduate
blamed a dean of a
nursing school in Recto
for not passing the
nursing exam.
REGRESSION
 Return to earlier
and more
comfortable
developmental
level.
An examinee went
directly to her room and
sleeps in fetal position
and thumb sucks after
knowing she failed the
board exam……..…… for
physicians.
Interpersonal Theory
- Stems from the work of Harry Stack Sulivan, Hildegard Peplau Interpersonal Relations
who believed that “we come to treat ourselves
PEPLAU’S STAGES AND TASKS OR RELATIONSHIPS
as we have been treated by parents”
- Early relationships and encounters with others, (STAGE) ORIENTATION
interpersonal transactions, shapes our view of
ourselves and create behavioral tendencies that TASKS:
persist over the life span. - Patient’s problems and needs are clarified
Harry Stack Sullivan’s Interpersonal Psychodynamic - Patient asks questions
Theory - Hospital routines and expectations are explained
- Patient harnesses energy toward meeting problems
Hildegard Peplau’s Interpersonal Relations Theory - Patient’s full participation is elicited
IDENTIFICATION
 Emphasized the nurse-client relationship as the
- Patient responds to persons he or she perceives as
foundation of nursing practice. It emphasized the give-
helpful
and-take of nurse-client relationships that was seen by
- Patient feels stronger
many as revolutionary.
- Patient expresses feelings
 Peplau went on to form an interpersonal model - Interdependent work with the nurse occurs.
emphasizing the need for a partnership between nurse - Roles of both patient and nurse are clarified
and client as opposed to the client passively receiving
treatment and the nurse passively acting out doctor’s
orders.
Exploitation
STAGES OF DEVELOPMENT
- Patient makes full use of available services
- Goals such as going home and returning to work
emerge.
NURSES PATIENT - Patient’s behavior fluctuate between dependence
Values Values and interdependence
NURSE -
Culture race Culture race RESOLUTION
PATIENT
Beliefs Beliefs - Patient give up dependent behavior
RELATIO
Past experiences - Services are no longer needed by patient
NSHIP Past experiences
Expectations - Patient’s assumes power to meet own needs, set
expectations
new goals and so forth.
Preconceived
ideas
Jean Piaget's Theory of Cognitive Development
Suggests that children move through four different
stages of mental development.
Focuses not only on understanding how children
acquire knowledge, but also on understanding the
nature of intelligence.
PIAGET’S STAGES OF OGNITIVE DEVELOPMENT
Sensorimotor Stage
- Birth to 2 years
Preoperational Stage
- 2 to 7 years
Concrete Operational Stage
- 7 to 11 years
Formal Operational Stage
- 12 and up

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Maladaptive

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Therapeutic Models & Its Relevance To Nursing DEFENSE MECHANISMS

Unconscious Level (ID) IDENTIFICATION

LEVELS OF CONSCIOUSNESS INTROJECTION

Conscious Level – Thoughts Perception  Unconsciously incorporating wishes, values,

Defense Mechanisms  Covering up for a weakness by overemphasizing

SUBLIMATION  Each stage of development is an emotional crisis

 Doing something to counteract or make up for a

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