Summary

The psychoanalytic theory from Sigmund Freud provides a foundation to understand psychiatric problems. This theory is the basis for the nurse to view the client through the lens of personality development and unconscious influences on behavior, and to incorporate this into the care of the client.

The id, ego, and superego keep the person in balance between satisfying every primal want and bowing to societal pressures. The use of defense mechanisms is necessary for all humans to emotionally adjust to their environment. At the same time, defense mechanisms utilized over the long-term can become patterns of ineffective coping, causing problems with social adjustment and emotional growth.

Freud also created stages of sexual development that he believed affected a person’s emotional growth and/or adaptation. And the two concepts of transference and countertransference reveal that all clients have a past and are attempting to frame their reality in ways that are safe and familiar. These ideas enhance therapeutic communication and active listening to assist the client as needed.

Interpersonal theories identify interpersonal relationships as drivers for human development. Erikson believed the personality develops throughout the life span and presented an age-based order to reflect this. Nursing observation of client behavior can provide cues to the client’s developmental stage, which allows nurses to address psychological needs and develop a therapeutic relationship. Peplau applied interpersonal theory to nursing. She defined the nurse-client relationship, which includes the phases of pre-orientation, orientation, working, and mutual termination. Peplau also presented nurses with focused approaches for the described four levels of anxiety: mild, moderate, severe, and panic.

Behavioral therapeutic interventions for emotional problems can include one or more of the following: milieu therapy, group therapy, family therapy, and forms of cognitive behavioral therapy. Goals of these therapies include awareness of emotions and modification of associated negative behaviors. Learned techniques assist the person to be more effective at coping with stressors in identified situations. Nurses are teachers, advocates, and support persons. Comprehensive knowledge of the different types of behavioral and cognitive behavioral therapy helps the nurse select appropriate and effective interventions and treatment approaches.

Humanistic theory views persons as holistic beings utilizing free will to reach self-actualization, as defined by the person. Maslow’s hierarchy of needs model guides nursing assessment and Rogers’s concepts of the person’s sense of self assists the nurse with individualized care planning. Both theorists cite self-actualization as the ultimate goal of human achievement. In a therapeutic approach based on humanistic theory, clients are empowered and supported toward their own recovery.

Biological theories have helped with the stigma of mental health by identifying organic bases for many disorders. Biological therapies include medications, diet, surgery, or other therapies such as brain stimulation. Nurses function as educators and advocates through direct care, medication administration, surgical and procedural care, monitoring, and teaching for clients and families. In addition, nurses should remain aware of the latest in developments of biological therapies so that recipients of care receive current information and optimal support.

Developmental theories investigate human development through the life span. Theorists Jean Piaget, Margaret Mahler, and Lawrence Kohlberg all contributed developmental theories to explain how children develop throughout stages to reach a more complex way of thinking. Moral development also takes on more complex forms as individuals age and develop the ability to distinguish right from wrong. Nurses can apply these theories to practice to understand exactly where their clients stand in their ability to understand concepts and make decisions. These theories also come into play when ethical dilemmas arise.

To provide quality holistic care, the nurse must recognize multiple determinants—the physical, emotional, cultural, family, spiritual, psychological, and environmental influences to which the client is exposed. To achieve this, the nurse must find out as much as possible about a client’s personal values, beliefs, and health practices. Healthy People 2030 describes identified obstacles affecting a client’s ability to achieve health-care goals. Nurses who become knowledgeable in these obstacles can develop client-specific interventions to overcome negative effects of social determinants. Nurses should remember the client is the best source of information.

Mindfulness has a long history and has been proven as an effective intervention in both physiological and psychological disorders. Techniques such as guided imagery, mindfulness-based stress reduction, yoga, and physical exercise are techniques the nurse can incorporate into the client’s plan of care. Nurses must practice self-awareness to build trusting therapeutic relationships and provide judgment-free quality care.