Mental Health Crisis, issues among College students

1. state level conference
on
‘MENTAL HEALTH crisis’
a GROWING CONCERN FOR COLLEGE
STUDENTS
AT
ABHIRAMI COLLEGE OF
NURSING,
COIMBATORE
30TH NOVEMBER 2017

2. THERAPEUTIC IMPASSE
A HEALTHY RELATIONSHIP DOESN’T DRAG YOU DOWN,
IT INSPIRES YOU TO BE BETTER
Prof. Sara Samuel
Principal
RVS College of Nursing
Sulur, Coimbatore 641402.

3. Help !!
help!!
Help !!
help!!

4. Types of relationships-
Social,
Intimate and
therapeutic

5. SOCIAL RELATIONSHIPS
friendship, socialization & companionship

6. Intimate relationship
Emotional bonding, may be sexual too

7. Therapeutic relationship
Problem solving, goal oriented
• The therapeutic
relationship refers to the
relationship between a
healthcare professional
and a client
• It is the means by which
a therapist and a client
hope to engage with
each other, and effect
beneficial change in the
client.

11. Therapeutic Impasse
Impasses can occur as a
result of disagreement
between the therapist
and client,
unacknowledged issues
within therapy, or
stagnation in therapy.
When an impasse first
occurs, therapy stops
making progress.

12. History of therapeutic Impasse
IDA BAUER-
DORA 1905

13. TYPES OF THERAPEUTIC IMPASSE
RESISTANCE
TRANSFERANCE
COUNTER
TRANSFERANCE
GIFT GIVING
BOUNDARY
VIOLATIONS
I
M
P
A
S
S
E

14. RESISTANCE
Resistance is the
patient’s attempt to
remain unaware of
anxiety producing
aspects within
himself..

15. TYPES OF RESISTANCE
•Patient’s unwillingness to
change
PRIMARY
RESISTANCE
•Desiring increased
sympathy
•Avoiding unpleasant
situations, Financial
compensations
SECONDARY
RESISTANCE

16. MANIFESTATION OF RESISTANCE
SUPRESSION & REPRESSION OF PERTINENT INFORMATION
INTENSIFICATION OF SYMPTOMS
SELF DEVALUATION & HOPELESS OUTLOOKTO LIFE
INTELLECTUAL INHIBITION-FORGETFULNESS LATE FOR SESSIONS
IRRATIONAL BEHAVIOUR, SUPERFICIAL TALKS
HAS GAINED INSIGHT BUT REFUSES TO BE RESPONSIBLE
TRANSFERANCE

17. Management
Active
listening
Clarification
Reflexion
Explore
behavior
Open lines
of
Communicat
ion

18. TRANSFERANCE
• Transference is
characterized by an
unconscious response
whereby the client
identifies the therapist/
nurse with some
significant others.
• Transferring of some
aspects of a relationship
not the person.

19. Management of Transference
Therapy can
continue if it is
safe.
No need to
terminate
Help the client
recognize the
transference
&
Clarify new
meaning
To the client
therapist
relationship
Helping clients to
take ownership
for their
behavior.
Live in the
present not in the
past.

20. COUNTER TRANSFERANCE
• This time it is from the
Nurse/therapist- Client
• Client’s qualities triggers an
emotional response from
the Nurse/ therapist
• The Nurse/ therapist
identifies the client as
someone from her past.
This affects the
effectiveness of the
therapy.
• Unresolved issues like
authority, sex,
assertiveness and
independence can cause
the impasse.

21. Manifestations

22. Management
SUPPORT THE NURSE/ THERAPIST, IDENTIFY COUNTERTRANSFERANCE
SELF EXAMINATION WITH HELP FROM SENIORS, IDENTIFY THE SOURCE OF THE
PROBLEM
PEER CONSULTATION AND PROFESSIONAL HELP, MAY RESUME THERAPY

23. GIFT GIVING
• Receiving a gift from
a client will inhibit
effective,
independent
decision making.
• May create a feeling
of anxiety or guilt
• The context and the
intention behind the
gift giving is also
important.

24. BOUNDARY VIOLATIONS
• A boundary violation is harmful or potentially
harmful, to the patient and the therapy. It
constitutes exploitation of the patient.
• It occurs when the therapist goes beyond the
professional relationship and establishes social,
economic or intimate relationship with the client.

25. SIGNALS
• Intrusive Behavior
• Difficulty in setting
limits
• Has sexual feeling
towards the client
• Feels a sense of
jealousy when others
relate with the client
• Feels only she can
understand the client.

26. Boundary violations- Prevention
Know and identify
your limits
Engage in Self care
Stress Management
Attend to personal
relationships and
intimacy
• Know your
Competence
• Be aware of sexual
feelings
• Avoid work holism
• Burnout
• Seek supervision