Psychiatric Mental Health Nursing by Videbeck

involved clients’ interactions with one another; i.e.,
practicing interpersonal relationship skills, giving
one another feedback about behavior, and working co-
operatively as a group to solve day-to-day problems.
Milieu therapy was one of the primary modes of
treatment in the acute hospital setting. In today’s
health care environment, however, inpatient hospital
stays are often too short for clients to develop mean-
ingful relationships with one another. Therefore the
concept of milieu therapy receives little attention.
Management of the milieu or environment is still a
primary role for the nurse in terms of providing safety
and protection for all clients and promoting social
interaction.

HILDEGARD PEPLAU: THERAPEUTIC

NURSE–PATIENT RELATIONSHIP

Hildegard Peplau (1909–1999; Fig. 3-3) was a nurs-
ing theorist and clinician who built on Sullivan’s in-
terpersonal theories and also saw the role of the nurse
as a participant observer. Peplau developed the con-

3 PSYCHOSOCIALTHEORIES ANDTHERAPY 55

Table 3-4

SULLIVAN’SLIFESTAGES

Stage Ages Focus

Infancy

Childhood

Juvenile

Preadolescence

Adolescence

Primary need for bodily contact and tenderness

Prototaxic mode dominates (no relation between experiences)

Primary zones are oral and anal.

If needs are met, infant has sense of well-being; unmet needs lead

to dread and anxiety.

Parents viewed as source of praise and acceptance

Shift to parataxic mode (experiences are connected in sequence to

each other)

Primary zone is anal.

Gratification leads to positive self-esteem.

Moderate anxiety leads to uncertainty and insecurity; severe

anxiety results in self-defeating patterns of behavior.

Shift to the sytaxic mode begins (thinking about self and others

based on analysis of experiences in a variety of situations).

Opportunities for approval and acceptance of others

Learn to negotiate own needs

Severe anxiety may result in a need to control or restrictive,

prejudicial attitudes.

Move to genuine intimacy with friend of the same sex

Move away from family as source of satisfaction in relationships

Major shift to syntaxic mode

Capacity for attachment, love, and collaboration emerges or fails

to develop.

Lust is added to interpersonal equation.

Need for special sharing relationship shifts to the opposite sex.

New opportunities for social experimentation lead to the consoli-

dation of self-esteem or self-ridicule.

If the self-system is intact, areas of concern expand to include

values, ideals, career decisions, and social concerns.

Birth to onset

of language

Language to 5 years

5–8 years

8–12 years

Puberty to adulthood

Adapted from Gabbard, G. O. (2000). Theories of personality and psychopathology: Psychoanalysis.
In B. J. Sadock & V. A. Sadock (Eds.). Comprehensive textbook of psychiatry,Vol. 2 (7th ed., pp. 563–607).
Philadelphia, Lippincott Williams & Wilkins.

Figure 3-3.Hildegard Peplau, who developed the phases

of the nurse–client therapeutic relationship, which has

made great contributions to the foundation of nursing

practice today.