person to identify and discuss feelings, serving as a
sounding board for the person, and affirming the per-
son’s self-worth. Techniques and strategies that in-
clude a balance of these different types of intervention
are the most effective.CULTURAL CONSIDERATIONS
The major psychosocial theorists were white and
born in Europe or the United States, as were many
of the people whom they treated. What they consid-
ered normal or typical may not apply equally well
to people with different racial, ethnic, or cultural
backgrounds. For example, Erikson’s developmen-
tal stages focus on autonomy and independence for
toddlers, but this focus may not be appropriate for
people from other cultures in which early individual
independence is not a developmental milestone. There-
fore it is important that the nurse avoids reaching
faulty conclusions when working with clients and
families from other cultures. Chapter 7 discusses
cultural factors in depth.
TREATMENT MODALITIES
Benefits of Community
Mental Health Treatment
Recent changes in health care and reimbursement
have affected mental health treatment, as they have
all areas of medicine, nursing, and related health
disciplines (see Chap. 4). Inpatient treatment is
often the last, rather than the first, mode of treat-
ment for mental illness. Current treatment reflects
the belief that it is more beneficial and certainly more
cost-effective for clients to remain in the community
and receive outpatient treatment whenever possible.
The client can often continue to work and can stay
connected with family, friends, and other support
systems while participating in therapy. Outpatient
therapy also takes into account that a person’s per-
sonality or behavior patterns such as coping skills,
styles of communication, and level of self-esteem,
gradually develop over the course of a lifetime and
cannot be changed in a relatively short inpatient
course of treatment. Hospital admission is indicated
when the person is severely depressed and suicidal,
severely psychotic, experiencing alcohol or drug with-
drawal, or exhibiting behaviors that require close
supervision in a safe supportive environment.
This section briefly describes the treatment
modalities currently used in both inpatient and out-
patient settings.
Individual Psychotherapy
Individual psychotherapy is a method of bringing
about change in a person by exploring his or her feel-
ings, attitudes, thinking, and behavior. It involves a
one-to-one relationship between the therapist and
the client. People generally seek this kind of therapy
based on their desire to understand themselves and
their behavior, to make personal changes, to improve
interpersonal relationships, or to get relief from emo-
tional pain or unhappiness. The relationship between
the client and the therapist proceeds through stages
similar to those of the nurse–client relationship: intro-
duction, working, and termination. Cost-containment
measures mandated by health maintenance organi-
zations and other insurers may necessitate moving
into the working phase rapidly so the client can get
the maximum benefit possible from therapy.
The therapist–client relationship is key to the
success of this type of therapy. The client and the
therapist must be compatible for therapy to be effec-
tive. Therapists vary in their formal credentials, ex-
perience, and model of practice. Selecting a therapist
is extremely important in terms of successful out-
comes for the client. The client must select a thera-
pist whose theoretical beliefs and style of therapy are
congruent with the client’s needs and expectations of
therapy. The client also may have to try different
therapists to find a good match.
A therapist’s theoretical beliefs strongly influ-
ence his or her style of therapy (discussed earlier in
this chapter). For example, a therapist grounded in
interpersonal theory emphasizes relationships,
whereas an existential therapist focuses on the
client’s self-responsibility.
The nurse or other health care provider who is
familiar with the client may be in a position to rec-
ommend a therapist or a choice of therapists. He or
she also may help the client understand what differ-
ent therapists have to offer.
The client should select a therapist carefully and
should ask about the therapist’s treatment approach
and area of specialization. State laws regulate the
practice and licensing of therapists; thus, from state
to state the qualifications to practice psychotherapy,
the requirements for licensure, or even the need for
a license can vary. A few therapists have little or no
formal education, credentials, or experience but still
practice entirely within the legal limits of their state.
A client can verify a therapist’s legal credentials with
the state licensing board; state government listings
are in the local phone book. The Better Business Bu-
reau can inform consumers if a particular therapist
has been reported to them for investigation. Calling62 Unit 1 CURRENTTHEORIES ANDPRACTICE