Therapeuti impasse

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Therapeuti impasse

  1. 1. www.drjayeshpatidar.blogspot.com
  2. 2. www.drjayeshpatidar.blogspot.com
  3. 3. 1.Resistance2.Transference3.Countertransference4.Gift giving5.Boundry violationwww.drjayeshpatidar.blogspot.com
  4. 4.  Resistance is thepatient’s attempt toremain unaware ofanxiety producingaspects withinhimself. It’s a natural learnedreluctance toavoidance ofverbalizing or evenexperiencingtroubled aspects ofself.www.drjayeshpatidar.blogspot.com
  5. 5. PRIMARYOften caused bypatient’sunwillingness tochange when theneed for change isrecognizedIt may be also areaction by thepatient to the nursewho has moved toorapidly & too deeplyinto patient’s feeling.SECONDARYSecondary gain- favorableenvironmental,interpersonal & situationalchanges occur. Materialadvantage as a result ofillness.It include financialcompensation, avoidingunpleasant situations,increased sympathy orattention, escape fromresponsibility, lessening ofsocial pressure.www.drjayeshpatidar.blogspot.com
  6. 6.  1. SUPRESSION & REPRTESSION OF PERTINENTINFORMATION. 2. INTENSIFICATION OF SYMTOMS. 3. SELF DEVALUATION & A HOPELESS OUTLOOKON THE FUTURE. 4. FORCED FLIGHT INTO HEALTH. 5. INTELECTUAL INHIBITION- FORGETFULNEESS,LATE FOR SESSIONS 6. ACTIONS OUT OR IRRATIONALE BEHAVIOR.www.drjayeshpatidar.blogspot.com
  7. 7.  7. Superficial talk. 8. Use of defense of intellectualizationwhere there is no insight. 9. Patient has developed insight but refusesto assume responsibility. 10. Transference.www.drjayeshpatidar.blogspot.com
  8. 8.  Active listening Clarification – Give for focused idea of whatis happening. Reflexion – Helps the patient to becomeaware of what has been going in his mind. Explore behavior to find possible reason. Maintain open communication withsupervisorwww.drjayeshpatidar.blogspot.com
  9. 9.  It is an unconscious response of the patientin which he experiences feeling & attitudestowards the nurse that were originallyassociated with significant figures in his earlylife. Such response utilize the defense mechanismof displacement. Transference reactions are harmful to thetherapeutic process only if they remainignored & unexamined.www.drjayeshpatidar.blogspot.com
  10. 10. • HOSTILE TRANSFERENCE• (External hostility)• (Internal hostility)1.• DEPENDENT REACTIONTRANSFERENCE2.www.drjayeshpatidar.blogspot.com
  11. 11.  No need to terminate relationship unless poses aserious barrier to therapy or safety. Nurse should work with patient in sorting outpast from the present Assist patient in identifying the transference &reassign a new & more appropriate meaning tothe current nurse patient relationship. The goal is to guide the patient to independenceby teaching them assume responsibility for theirown behaviors, feeling & thoughts & to assignthe correct meaning to the relationship based onthe present circumstances instead of past.www.drjayeshpatidar.blogspot.com
  12. 12.  It’s a therapeutic impassecreated by the nurse. It refers to nurse’s specificemotional responsegenerated by the qualities ofthe patient. In this case the nurseidentifies the patient withindividuals from her past &personal needs will interferewith therapeuticeffectiveness. The nurse’s unresolvedconflicts about authority, sex,assertiveness & independenceten to create problems ratherthan solve them.www.drjayeshpatidar.blogspot.com
  13. 13. www.drjayeshpatidar.blogspot.com
  14. 14.  Inability to empathize with patient in certainproblem areas. Depressed feelings during or after thesessions. Carelessness about implementing thecontract by being late, running overtime etc. Drowsiness during sessions. Feeling of anger or impatience because ofpatient’s unwillingness to change. Encouragement of patients dependentbehavior, praise affection.www.drjayeshpatidar.blogspot.com
  15. 15.  Pushing the patient before he is ready orarguing. Trying to help the patient in matters notrelated to the identified nursing goals. Dreaming or preoccupation with the patient. Sexual or aggressive fantasies about thepatient. Recurrent anxiety, unease or guilt feelingsabout the patient. A tendency to focus repeatedly on only oneaspect or looking at the informationpresented by the patient.www.drjayeshpatidar.blogspot.com
  16. 16.  Powerful tool in exploration & potentinstrument for uncovering inner states. They aredangerous only if they are brushed aside,ignored or not taken seriously. It can lead to further information, can bring tolight new materials & help in developing insight. Nurse’s understanding of countertransference &her own feelings help to maintain a workingrelationship with the patient.www.drjayeshpatidar.blogspot.com
  17. 17.  Need not terminate relationship. Support the nurse. Assist her identifying countertransference. Discuss with superiors. Self examination. Pursue to find out source of problem. Exercise control countertransference. Peer consultation & professional meetings.www.drjayeshpatidar.blogspot.com
  18. 18.  Receiving a gift from patient make the nurseto inhibit independent decision making &create a feeling of anxiety or guilt. Gift is something of value is voluntarilyoffered to another person, usually to conveya gratitude.www.drjayeshpatidar.blogspot.com
  19. 19.  The timing of a particular situation, theintent of giving & the contextual meaning ofgiving of the gift.www.drjayeshpatidar.blogspot.com
  20. 20.  It occurs when nurse goes outside theboundaries of therapeutic relationship &establishes a social, economic or personalrelationship with the patient.www.drjayeshpatidar.blogspot.com
  21. 21.  Receives feedback that her behavior is intrusivewith patient or their families. Has difficulty in setting limit with patient. Relates the patient to a friend or familymember. Has sexual feeling towards a patient. Feels that she is the only one who understandsthe patient. Receives feedback that she is too involved witha patient or family. Feels that other staffs are too critical or jealousof her relationship with the patient.www.drjayeshpatidar.blogspot.com
  22. 22. www.drjayeshpatidar.blogspot.com
  23. 23. Difficulty in self analysis & selfacceptance.AnxietyBoredomAngerIndifferenceDepressionwww.drjayeshpatidar.blogspot.com
  24. 24.  Help from peers and supervisor in selfanalysis & facing reality. Analyze herself & recognize her asset &limitation.www.drjayeshpatidar.blogspot.com
  25. 25. Perception of each other as uniqueindividual may not take place.Problems related to establishing anagreement or pact between the &patient.www.drjayeshpatidar.blogspot.com
  26. 26.  Nurse must be willing to relate honestly toher feeling & share it with supervisor. Nurse must feel free to reveal self withoutfear of criticism. Difficulty may be faced in assisting a nursewith countertransference since most of thisbehavior is unconsciously determined. A alert supervisor can detect this & guide thenurse appropriately.www.drjayeshpatidar.blogspot.com
  27. 27.  Testing of nurse by the patient. Unrealistic assumption about progress ofpatient. The nurse’s fear of closeness. Life stressors of nurse. Resistance behavior. Transference Countertransferencewww.drjayeshpatidar.blogspot.com
  28. 28.  Anger Punitive behavior Depression or assuming non caring attitude Flight to health Flight to illness. Nurse’s inability or unwillingness to makespecific plans & implement them.www.drjayeshpatidar.blogspot.com
  29. 29.  Nurse should be aware of patients feeling &be able to deal with them appropriately. Assist the patient by openly eliciting histhoughts & feelings about termination. Supervisor can assist the nurse in preparingpatient for discharge.www.drjayeshpatidar.blogspot.com
  30. 30.  Listening Broad openings Restating Clarification Reflection Humor Informing Suggesting Sharing perception Focusingwww.drjayeshpatidar.blogspot.com
  31. 31.  Define therapeutic impasses. Discuss varioustypes therapeutic impasses & ways toovercome them.www.drjayeshpatidar.blogspot.com
  32. 32. www.drjayeshpatidar.blogspot.com

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