THERAPEUTIC MODALITIES,

PSYCHOSOCIAL SKILLS AND

NURSING STRATEGIES
PREPARED BY:
MARY RUTH V. ENRIQUEZ, RN MAN

THERAPEUTIC MODALITIES
Treatment receive by mentally ill
client in variety of settings.
Biophysical/Somatic Intervention
Supportive Psychotherapy
Counseling
Assertive Training

Stress Management
Behavior Modification
Cognitive Restructuring
Milieu therapy

BIOPHYSICAL /SOMATIC
INTERVENTION

Somatic Intervention: is a tool used

by psychologist to influence nervous
system regulation and therapy.
Somatoforms Disorders:
characterized by multiple, recurrent
physical symptoms in a variety of
bodily system that have no organic or
medical basis.

ECT (ELECTRO CONVULSIVE THERAPY)

ECT (Electro Convulsive Therapy)=

shock therapy
Is used primarily for treating
Depression but has been used to
treat MANIA, CATATONIA, and
SCHIZOPRENIA that is
unresponsive to medications.

ECT

It requires consent form

May be administered 2 to 3 times per week,
for total of 6 to 12 treatments.
The procedure involves inducing
unconsciousness (short acting anesthesia is
used), then passing an electric current
through the brain, the clients V/S,
oxygenation and cardiac functioning are
carefully monitored before and after ECT.
An electric current ( 70 to 150 volts) is
applied through the brain for 0.5 to 2
seconds, producing a seizure that last for 30
to 60 seconds.

ECT

Following ECT, the client is monitored

according to routine post operative
protocols.
Traditionally the electrodes have been
applied BILATERALLY.
Alternative electrode placements are
routinely used, including: UNILATERAL
AND BIFRONTAL

ELECTROCONVULSIVE THERAPY

SUPPORTIVE PSYCHOTHERAPY
It involves interaction with the patient
(not silent listening) and emphasizes a
focus on the present (not on the past).
Questioning is less challenging and critical, and
the approach conveys empathy and
understanding.
Conduct:
Nurse-client relationship
Group therapy
Family therapy

NURSE CLIENT THERAPY/INDIVIDUAL

PSYCHOTHERAPY

Is a method of bringing about change in a

person by exploring his/her feelings,
attitude, thinking, & behavior.
It involves a one-one relationship between
therapist and the client.
Reason why people seek psychotherapy:
to understand themselves and their behavior,
To make personal changes
To improve interpersonal relationships
To get relief from emotional pain or unhappiness.

ONE-ON ONE THERAPY

GROUP THERAPY

Client participate in sessions with a group

of people.
The members share a common purpose and are
expected to contribute to the group to benefit
others and receive benefit from others in return
Being a member of a group allows the client to
learn new ways of looking at a problem or ways
of coping with or solving problems and also
helps him/her to learn important interpersonal
skills.

GROUP THERAPY

Ex. By interacting with other

members, client often received
feedback on how other perceives
and react to them and their
behavior.
This is extremely important
information for many clients with
mental disorders, who have
difficulty with interpersonal skills.

THE THERAPEUTIC RESULTS OF GROUP

THERAPY:
1.
2.
3.
4.
5.

6.

7.

Gaining new information, or learning

Gaining inspiration or hope
Interacting with others
Feeling acceptance and belonging
Becoming aware that one is not alone and
that others share the same problems
gaining insight into ones problems and
behaviors and how they affect others.
Gaining of oneself for the benefit of
others (ALTRUISM)

FAMILY THERAPY
A form of a group therapy which the client
and his/her family members participate.
THE GOALS include:
1. Understanding how family dynamics
contribute to the clients psychotherapy
2. Mobilizing the familys interest
strengths and functional resources
3. Restructuring maladaptive family
behavior styles.
4. Strengthening family problem-solving
behavior.

FAMILY THERAPY
Can be used both to assess and
treat various psychiatric disorders.
Although one family member
usually is identified initially as the
one who has problems and needs
help, it often becomes evident
through the therapeutic process
that other family members also
have emotional problems and
difficulties.

COUNSELING

COUNSELING PSYCHOLOGY: as a psychological

specialty facilitates personal and
interpersonal functioning across the life span
with a focus on emotional, health-related,
developmental and organizational concerns.
ex,. Group therapy
Family therapy
Group members can ventilate feelings, try
out problem-solving approaches, and resolves
conflict in a rational, systematic manner.

ASSERTIVE TRAINING

Is a form of behavior therapy designed to help people

stand up for themselves- to empower themselves, in
more contemporary terms.
Helps the person take more control over life situations.
Techniques help the person negotiate interpersonal
situations and foster self-assurance.
They involve using I statement s to identify feelings
and to communicate concerns or needs to others.
Ex. I feel angry when you turn your back while Im
talking.
dont say yes when you want to say no.
Speak up for yourself

STRESS MANAGEMENT

Is techniques intended to equip a person

with psychological stress,
Stress : as a persons physiological
response to an internal and external
stimulus that triggers the fight-or- flight
response.
3 TECHNIQUES OF STRESS MANAGEMENT:
1. POSITIVE REFRAMING
2. DECASTROPHIZING
3.ASSERTIVE TRAINING

POSITIVE REFRAMING

Means turning negative messages to

positive messages.
The therapist teaches the person to
create positive messages for use during
panic episodes.
Ex. Instead of thinking, my heart is
pounding. I think Im going to
die!(NEGATIVE)
I can stand this. This is just anxiety. It
will go away. (POSITIVE)

DECASTROPHYZING

The technique consists of confronting the

worst-case scenario of a feared event or
object, using mental imagery to examine
whether the effects of the event or object
have been overestimated (magnified or
exaggerated) and where the patients
coping kills have been underestimated.
Is also called the what if technique" because
the worst-case scenario is confronting by asking
what if the feared event or object happened,
what would occur then?

DECASTROPHYZING
Ex.
I would make an absolute fool of
myself if I say the wrong thing.
what if you say the wrong thing,
what would happen then?
he might think Im weird.

ASSERTIVENESS TRAINING

It helps the person take more

control over life situations and
help the person negotiate
interpersonal situations.

BEHAVIOR MODIFICATION

Is a method of
attempting to
strengthen a desire
behavior or response by
reinforcement, either
positive or negative.

TECHNIQUES OF BEHAVIOR
MODIFICATION:
1. POSITIVE and NEGATIVE
REINFORCEMENT
Positive reinforcement = is provided
by giving a person attention and
positive feedback.
Negative reinforcement = is done by
removing a stimulus after a behavior
occurred to prevent it from
occurring again.

POSITVE AND NEGATIVE

REINFORCEMENT

Ex.

Reinforcement

punishable

Do

Do Not

Ex. Classical conditioning of

Ivan Pavlov (stimulus)
Operant conditioning of B.F.
Skinner (reward and
punishment)

OPERANT CONDITIONING (REWARD & PUNISHMENT)

TECHNIQUES OF BEHAVIOR
MODIFICATION:

2. Systematic Desensitization: it is
used to help clients overcome
irrational fears and anxiety
associated with a phobia.
The client is asked to make list
of situations involving the phobic
object, from the least to the
most anxiety- provoking.
The client learns and practices
relaxation techniques to

COGNITIVE RESTRUCTURING

Is a technique useful in
changing patterns of
thinking by helping client to
recognize negative thoughts
and feelings and to replace
them with positive pattern
of thinking.

TECHNIQUES OF COGNITIVE RESTRUCTURING:

1.

2.

THOUGHT-STOPPING: is a technique
to alter the process of negative or self
critical thought patterns. Ex.
Splashing the face with cold
water.
POSITIVE SELF TALK: client
reframes negative thoughts to
positive ones

MILIEU THERAPY

Refers to the physical and social

environment in which an individual is
receiving treatment.
Uses a safe environment to meet the
individual clients treatment needs.
Safety is the most important priority in
managing milieu.
All treatment team members are viewed
as significant and valuable to the clients
successful treatment outcomes.

ELEMENTS OF THE TREATMENT ENVIRONMENT

For the treatment environment to managed be

effectively, we consider several interrelated
elements essential.
These elements, which provide the foundation
necessary for the nurse to manage the
environment effectively, include:
Safety
Structure
Norms
Limit setting
Balance

SAFETY

Is the primary to all other aspects of

the environment.
Safety includes both physical and
psychological protection.
Physical protection: refers to safety
from physical harm through the
management of risks in the environment,
such as the prevention of physical
aggression and the requirement of staff
supervision for patients when using
potentially unsafe grooming items ( e.g.
Sharps, glass items, and plastic bags).

SAFETY

Psychological safety: involves

the nurses active intervention to
prohibit verbal abuse, ridicule, or
harassment of patients.

STRUCTURE

Refers to the physical environment, rules, and

daily schedules of treatment activities.
Is an essential component of psychiatric
treatment because , without it, there is no
justification for the patient being in a
treatment environment, particularly if custodial
care is outmoded.
Nurses lead activities such as patient education
and social skills training groups.
Teaching about medications, side effects, and
after care support for both patients and
families is an important function of the
psychiatric nurse in minimizing patient
noncompliance

NORMS

Are specific expectations of behavior

that permeate the treatment
environment; they are intended to
promote safety and trust in the
environment through the sanctioning
of socially acceptable behaviors and
consistency about what to expect.
For ex. A norm of nonviolence provides
physical and emotional security in the
environment.

LIMIT SETTING

Is an important element of the treatment

environment and is related to norms.
Limits should be set on acting-out behavior
such as self destructive acts, physical
aggressiveness, and sexual behavior.
It is also sometimes necessary to set limits on
behaviors such as excessive requests,
attempts to overly personalize the
therapeutic relationship, and refusal to
participate in treatment activities.
Closely related to limit setting are rules.

BALANCE

Involves the process of gradually

allowing independent behaviors and
in a dependent situation.
It might be necessary to make
specific judgments about a patients
readiness to assume certain
responsibilities for his/her own care
versus providing assistance when
the patient might not be able to act
on his/her own behalf.

FOCUS OF MILIEU THERAPY

To use the physical and social

environment to affect a positive
change directed toward
accomplishing the clients goals.
To empower the clients through
involvement in setting his/her
own goals and development
purposeful relations with the staff
to assist in meeting these goals.

One on one relationships with

the staff are used to examine client
behaviors, feelings and interactions
with the context of the therapeutic
group activities.
To use community meetings,
activity groups, social skills
group and physical exercise
programs to accomplish
treatment goals

PLAY THERAPY

PLAY THERAPY (ADHD)

Treatment modality in which the

therapist engages in play with the
child.
Therapeutic play, PLAY
techniques are used to understand
the childs thoughts and feelings and
to promote communication. This
should not be confused with play
therapy.
PLAY THERAPY: a psychoanalytic

THERAPEUTIC PLAY
Dramatic Play: is acting out an anxietyproducing situation such as allowing the child to
be a doctor or use a stethoscope or other
equipment to take care of a patient (a doll).
Play Techniques: to release energy could
include: pounding pegs, running, or working with
modelling clay.
Creative Play: techniques can help the children to
express themselves, ex. By drawing pictures of
themselves, their family, and peers.
These techniques are especially useful when
children are unable or unwilling to express
themselves verbally.

PSYCHOSOCIAL INTERVENTION

Are nursing activities that enhance the

clients social and psychological functioning
and improve social skills, interpersonal
relationships, and communication.
Nurses often use psychosocial intervention
to help meet clients needs and achieve
outcomes in all practices settings, not just
mental health.
Ex. Medical-surgical nurse might need to use
interventions that incorporate behavioral
principles such as limits with manipulative
behavior or giving positive feedback

Ex. A client with diabetic tells

the nurse, I promise to have
just one bite of cake. Please!
Its my grandsons birthday
cake (manipulative
behavior)

THATS ALL FOR NOW FOLKS!