Psychiatric Mental Health Nursing by Videbeck

Behavioral techniques can be used for a variety
of different problems. In the treatment of anorexia
nervosa, the goal is weight gain. A behavioral con-
tract between the client and therapist or physician
is initiated when treatment begins. Initially the
client has little unsupervised time and is restricted
to the hospital unit. The contract may specify that
if the client gains a certain amount of weight such
as 0.2 kg/day, in return he or she will get increased
unsupervised time or time off the unit as long as the
weight gain progresses (Agras, 1995).

Existential Theories

Existential theorists believe that behavioral devia-
tions result when a person is out of touch with himself
or herself or the environment. The person who is self-
alienated is lonely and sad and feels helpless. Lack of
self-awareness, coupled with harsh self-criticism, pre-
vents the person from participating in satisfying rela-
tionships. The person is not free to choose from all
possible alternatives because of self-imposed restric-
tions. Existential theorists believe that the person is
avoiding personal responsibility and giving in to the
wishes or demands of others.
All existential therapies have the goal of help-
ing the person discover an authentic sense of self.
They emphasize personal responsibility for one’s self,
feelings, behaviors, and choices. These therapies en-
courage the person to live fully in the present and to
look forward to the future. Carl Rogers is sometimes
grouped with existential therapists. Table 3-7 sum-
marizes existential therapies.

COGNITIVE THERAPY

Many existential therapists use cognitive therapy,
which focuses on immediate thought processing—
how a person perceives or interprets his or her expe-

rience and determines how he or she feels and be-

haves. For example, if a person interprets a situation

as dangerous, he or she experiences anxiety and tries

to escape. Basic emotions of sadness, elation, anxiety,

and anger are reactions to perceptions of loss, gain,

danger, and wrongdoing by others (Beck & Rush,

1995). Aaron Beck is credited with pioneering cogni-

tive theory in persons with depression.

RATIONAL EMOTIVE THERAPY

Albert Ellis, founder of rational emotive therapy, iden-

tified 11 “irrational beliefs” that people use to make

themselves unhappy. An example of an irrational be-

lief is, “If I love someone, he or she must love me back

just as much.” Ellis claimed that continuing to believe

this patently untrue statement will make the person

utterly unhappy, but he or she will blame it on the

person who does not return his or her love. Ellis also

believes that people have “automatic thoughts” that

cause them unhappiness in certain situations. He

used the ABC technique to help people identify these

automatic thoughts: Ais the activating stimulus or

event, Cis the excessive inappropriate response, and

Bis the blank in the person’s mind that he or she must

fill in by identifying the automatic thought.

VIKTOR FRANKL AND LOGOTHERAPY

Viktor Frankl based his beliefs on his observations of

people in Nazi concentration camps during World

War II. His curiosity about why some survived and

others did not led him to conclude that survivors

were able to find meaning in their lives even under

miserable conditions. Hence the search for meaning

(logos) is the central theme in logotherapy. Coun-

selors and therapists who work with clients in spiri-

tuality and grief counseling often use the concepts

that Frankl developed.

60 Unit 1 CURRENTTHEORIES ANDPRACTICE

Table 3-7

EXISTENTIALTHERAPIES

Therapy Therapist Therapeutic Process

Rational emotive

therapy

Logotherapy

Gestalt therapy

Reality therapy

Albert Ellis

Viktor E. Frankl

Frederick S. Perls

William Glasser

A cognitive therapy using confrontation of “irrational beliefs” that

prevent the individual from accepting responsibility for self and

behavior

A therapy designed to help individuals assume personal responsibil-

ity. The search for meaning (logos) in life is a central theme.

A therapy focusing on the identification of feelings in the here and

now, which leads to self-acceptance

Therapeutic focus is need for identity through responsible behavior.

Individuals are challenged to examine ways in which their behav-

ior thwarts their attempts to achieve life goals.