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Other psych0 social therapy


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Other psych0 social therapy

  1. 1. MR. JAYESH
  2. 2. • Therapeutic community• Millieu therapy• Occupational therapy• Play therapy• Recreational therapy• Attitude therapy• Music therapy• Dance therapy JAYESH PATIDAR 4/24/2013 2
  4. 4.  The concept of therapeutic community was first developed by Maxwell Jones in 1953 . He wrote a book entitled “Social Psychiatric” which was first published in England. Later on when it was published in the United States, its title was changed to “Therapeutic Community.” JAYESH PATIDAR 4/24/2013 4
  5. 5.  Stuart & Sundeen defined therapeutic community as “a therapy in which patient‟s social environment would be used to provide a therapeutic experience for the patient by involving him as an active participant in his own care & the daily problems of his community.” JAYESH PATIDAR 4/24/2013 5
  6. 6.  To use patient‟s social environment to provide a therapeutic experience for him. To enable the patient to be an active participant in his own care & become involved in daily activities of his community. To help patients to solve problems, plan activities & to develop the necessary rules & regulations for the community. To increase their independence & gain control over many of their own personal activities. To enable the patients become aware of how their behavior affects others. JAYESH PATIDAR 4/24/2013 6
  7. 7.  Free communication Shared responsibilities Active participation Involvement in decision making Understanding of roles, responsibilities, limitations & authorities. JAYESH PATIDAR 4/24/2013 7
  8. 8.  Responsibility for treatment belong to the staff & client. Roles of staff & clients are equalized- may discuss either staff behavior or clients behavior. Democratic environment is fostered. Open communication is encouraged Focus is on client assets. Peer pressure is utilized to reinforce rules & regulations. JAYESH PATIDAR 4/24/2013 8
  9. 9.  Interpersonal interactions are utilized to improve communication skills. Inappropriate behavior are dealt with as they occur. Team approach is used. Clients are involved in all phases of treatment Community government is set up – Use meetings to teach standards, values & behavior, explore behavior, make decision, use problem solving. Two main goals for clients – Learn to set limits, Learn psychosocial skills JAYESH PATIDAR 4/24/2013 9
  10. 10. 1. Daily community Meetings2. Patient Government or Ward Council3. Staff Meeting or Review4. Living & Learning Opportunities JAYESH PATIDAR 4/24/2013 10
  11. 11.  These meetings are composed of 60-90 patients. All levels of unit staff are involved, including administrative personnel. Acute patients are involved in the meetings. Meetings should be held regularly for 60 minutes. Discussion should focus mainly on day-to-day life in the unit. During discussion patients‟ feelings & behaviors are examined by other members. Frank discussion are encouraged, these may take place with much outpouring of emotions & anger. JAYESH PATIDAR 4/24/2013 11
  12. 12.  The purpose of patient government is to deal with practical unit details such as house-keeping functions, activity planning & privileges. A group of 5-6 patient will have specific responsibilities, such as house keeping, physical exercise, personal hygiene, meal distribution, a group to observe suicidal patients, etc. staff members should be available always. All decisions should be feedback to the community through the community meetings. JAYESH PATIDAR 4/24/2013 12
  13. 13.  A staff meeting should be held following each community meeting (patient are excluded & only staff are present). In this meeting the staff would examine their own responses, expectations, & prejudices.4. Living & Learning Opportunities: Learning opportunities are to be provided within the social milieu, which should provide realistic learning experiences for the patients. JAYESH PATIDAR 4/24/2013 13
  14. 14.  Schizophrenia Substance abuse disorder Antisocial disorder Children‟s care taking environment JAYESH PATIDAR 4/24/2013 14
  15. 15.  Free communication both within & between staff & patient group. Communication are directed towards the modification of patient‟s attitude, behavior & role performance. Atmosphere in the community will be democratic as opposed to hierarchical, rehabilitative rather than custodial, permissive instead of limited & controlled. Nurses will be more communal with the patient instead of displaying all the time therapeutic role. JAYESH PATIDAR 4/24/2013 15
  16. 16.  Environment will be essentially permissive & flexible. Patient‟s activities are individualized & the role of patients are unspecified & their participation is completely voluntary. A compulsory daily community meeting that all staff members have to attend & all patients are encouraged to attend. The primary role of staff is to help the patients gain new insights & test new behavioral patterns. Problems of the patients are discussed & the solutions are sought in the small group therapy session following each community meeting. JAYESH PATIDAR 4/24/2013 16
  17. 17.  Patient government or ward council is to deal with practical unit details such as privileges & house keeping rosters. Staff member is available to the patient government, & all decisions are fed back to the community through the community meetings. Staff meeting or review is essential to on-the- ward training. It gives opportunity for the staff members to examine their own responses, expectations & prejudices. Feedback is one of the fundamental concepts in therapeutic community practice. JAYESH PATIDAR 4/24/2013 17
  18. 18.  Patient develops harmonious relationship with other members of the community. Gains self-confidence. Develop leadership skills. Learns to understand & solve problems of self & others. Become socio-centric. JAYESH PATIDAR 4/24/2013 18
  19. 19.  Learns to live & think collectively with the members of the community. Lastly therapeutic community provides opportunities to participate in the formulation of hospital rules & regulations that affect patient‟s personal liberties like bedtime, meal time, weekend permission, control of radio or TV, social activities, late night privileges etc. JAYESH PATIDAR 4/24/2013 19
  20. 20.  Role blurring between staff & patient. Group responsibility can easily become nobody‟s responsibility. Individual needs & concerns may not be met. Patient may find the transition to community difficulty. JAYESH PATIDAR 4/24/2013 20
  21. 21.  Providing & maintaining a safe & conflict free environment through role modeling & group leadership. Sharing of responsibilities with patients. Encouraging patient to participate in decision- making functions. Assisting patients to assume leadership roles. Giving feedback. Carrying out supervisory functions. JAYESH PATIDAR 4/24/2013 21
  23. 23.  „Milieu‟ is a French word meaning “Middle Place”. In English language, milieu means “environment” or “setting”, as used in psychiatric mental health nursing, it refers to the people & all other social & physical factors in the environment with which the client interacts. JAYESH PATIDAR 4/24/2013 23
  24. 24.  A therapeutic milieu is a 24 – hour environment designed to provide a secure retreat for individuals whose capacities for coping with reality have deteriorated. The therapeutic milieu gives them opportunities to acquire adaptive coping skills. By offering secure, comfortable physical facilities for sleeping, dining, bathing & engaging in recreational, occupational, social, psychiatric & medical therapies, the therapeutic milieu does many advantages. JAYESH PATIDAR 4/24/2013 24
  25. 25.  A therapeutic milieu is a “safe space,” a non-punitive atmosphere in which caring is a basic factor. In this environment, confrontation may be a positive therapeutic tool that can be tolerated by the client. Nurses & treatment team members should be aware of their own roles in this environment, maintaining stability & safety, but minimizing authoritarian behavior Clients are expected to assume responsibility for themselves within the structure of the milieu as much as possible. Feedback from other clients & the sharing of tasks or duties within the treatment program facilitate the client‟s growth. JAYESH PATIDAR 4/24/2013 25
  26. 26.  Shelters clients physically from what they perceive as painful, terrifying stressors. Protects clients physically from discharges of their own & other‟s maladaptive behaviors. Supports the physiological existence of clients. Provides pleasant, attractive, sensory stimulation of clients. Educates clients & their families about adaptive, effective coping. JAYESH PATIDAR 4/24/2013 26
  27. 27. 1. Maintaining Safe Environment2. The Trust Relationship3. Building Self-esteem4. Limit-setting JAYESH PATIDAR 4/24/2013 27
  28. 28. The nursing staff should follow the facility‟s policies with regard to prevention of routine safety hazards & supplement these policies as necessary.For Example; Dispose of all needles safety & out of reach of client. Restrict or monitor the use of matches & lighters. Do not allow smoking. JAYESH PATIDAR 4/24/2013 28
  29. 29.  Remove mouthwash, aftershave lotions & so forth, if substance abuse is suspected. Keep sharp objects out of reach of client Identify potential weapons & dangerous equipment. Do not leave medicines unattended or unlocked. Keep keys (to unit door, medicines) on your person at all times. Search packages brought in by visitors, explain the reason for such rules briefly, & do not make any exceptions. JAYESH PATIDAR 4/24/2013 29
  30. 30. one of the keys to a therapeuticenvironment is the establishment of trust.Both the client & the nurse must trust thattreatment is desirable & productive. Trust isthe foundation of a therapeutic relationship,& limit-setting & consistency are itsbuilding blocks. JAYESH PATIDAR 4/24/2013 30
  31. 31. Strategies to help build or enhance self-esteem must be individualized & built on honesty & on the client‟s strengths.Some general suggestions are: Set & maintain limits. Accept the client as a person. Be non-judgmental at all times. Structure the client‟s time & activities. JAYESH PATIDAR 4/24/2013 31
  32. 32.  Have realistic expectations of the client & make them clear to the client. Initially provide the client with tasks, responsibilities & activities that can be easily accomplished. Never flatter the client. Allow the client to make his own decisions whenever possible. JAYESH PATIDAR 4/24/2013 32
  33. 33.  Setting & maintaining limits are integral to a trust relationship & to a therapeutic milieu. Before stating a limit explain the reason for limit- setting. Some basic guidelines for effective using limits are: State the expectations or the limit as clearly, directly & simply as possible. JAYESH PATIDAR 4/24/2013 33
  34. 34.  The consequence that will follow the client‟s exceeding the limit also must be clearly stated at the outset. The consequences should immediately follow the client‟s exceeding the limit & must be consistent, both over time (each time the limit is exceeded) & among staff (each staff member must enforce the limit). Consequences are essential to setting & maintaining limits, they are not an opportunity to be punitive to a client. JAYESH PATIDAR 4/24/2013 34
  35. 35.  In conclusion, the nurse works with other health professionals in an interdisciplinary team; The interdisciplinary team works within a milieu that is constructed as a therapeutic environment, with the aim of developing a holistic view of the client & providing effective treatment. JAYESH PATIDAR 4/24/2013 35
  36. 36.  Use nursing process to provide comprehensive care. Provide direct client care Manages the day-to-day care of individual clients. Assists the client for re-entry into the community. Give indirect client care Maintains on going communication with other mental health team members. Enforces rules, policies & regulations of therapeutic milieu. A schedule, assigns, manages, & evaluates clinical work JAYESH PATIDAR 4/24/2013 36
  37. 37.  Administer medication & give medication teaching Provide psychosocial care Uses informal group interventions such as community meetings & structured or unstructured group therapy sessions to assist client with problems in their current life situations. Conducts brief, “on-the-spot” counseling with clients & families. Set limits to deal with behaviors destructive to the self, others, or the environment. Helps the clients use their time productively for leisure & work. Involves withdrawn clients in the milieu. JAYESH PATIDAR 4/24/2013 37
  38. 38.  Encourages clients who have low self-esteem to value themselves. Serves as a role model by demonstrating inter personal effectiveness in relating to clients & other mental health team members. Conducts one-to-one therapy sessions daily with selective clients. Conducts group therapy on a daily basis to help clients to gain self-awareness about how they behave in groups Provide mental health teaching Psychotropic medications, methods of coping, inter personal effectiveness (eg; assertiveness training, communication, problem-solving skills, parenting skills & so forth) stress management, relaxation & physical exercise etc. JAYESH PATIDAR 4/24/2013 38
  39. 39.  Encourage clients to help & support each other individually & as a group. Assist clients to understand each other‟s feelings & problems. Conduct community meetings. Participate freely in milieu activities (i.e, exercise, art, craft classes, social function) JAYESH PATIDAR 4/24/2013 39
  41. 41.  Occupational therapy is the application of goal-oriented, purposeful activity in the assessment & treatment of individuals with psychological, physical or developmental disabilities. JAYESH PATIDAR 4/24/2013 41
  42. 42.  “Any activity, which engages a person‟s resources of time & energy & is composed of skills & values” (Reed & Sanderson, 1980). “Any goal-directed activity meaningful to the individual & providing feedback to him about his worth & value as an individual & about his inter- relatedness to others”. JAYESH PATIDAR 4/24/2013 42
  43. 43.  The aim of the occupational therapist‟s intervention is the alleviation of dysfunction & the development of maximum functional independence in all aspects of living. Specific aims of occupational therapy are:I. Promotion of recoveryII. Mobilization of total assets of the patientIII. Prevention of hospitalization.IV. Creation of good habits of work & leisure.V. Rehabilitation with return of self-confidence. JAYESH PATIDAR 4/24/2013 43
  44. 44. The main goal is to enable the patient to achieve a healthy balance of occupations through the development of skills that will allow him to function at a level satisfactory to himself & others. JAYESH PATIDAR 4/24/2013 44
  45. 45.  Occupational therapy is provided to children, adolescents, adults & elderly patients. These programs are offered in psychiatric hospitals, nursing homes, rehabilitation centers, special schools, community group homes, community mental health centers, day care centers, halfway homes & addiction centers. JAYESH PATIDAR 4/24/2013 45
  46. 46.  Helps to develop social skills & provide an outlet for self-expression. Strengthens ego defenses. Develops a more realistic view of the self in relation to other. JAYESH PATIDAR 4/24/2013 46
  47. 47.  The client should be involved as much as possible in selecting the activity. Select an activity that interests or has the potential to interest him. The activity should utilize the client‟s strengths & abilities. The activity should be of short duration to foster a feeling of accomplishment. If possible, the selected activity should provide some new experience for the client. JAYESH PATIDAR 4/24/2013 47
  48. 48. It consists of six stages:1. Initial evaluation of what patient can do & cannot do in a variety of situations over a period of time.2. Development of immediate & long-term goals by the patient & therapist together. Goals should be concrete & measurable so that it is easy to see when they have been attained.3. Development of therapy plan with planned intervention. JAYESH PATIDAR 4/24/2013 48
  49. 49. 4. Implementation of the plan & monitoring the progress. The plan is followed until the first evaluation. If found satisfactory it is continued & altered, it not.5. Review meetings with patient & all the staff involved in treatment.6. Setting further goals when immediate goals have been achieved; modifying the treatment program as relevant. JAYESH PATIDAR 4/24/2013 49
  50. 50. 1. Diversional activity: These activities are used to divert one‟s thoughts from life stresses or to fill time. For example, organized games.2. Therapeutic activities: These activities are used to attain a specific care plan or goal. For example, basket making, carpentry etc. JAYESH PATIDAR 4/24/2013 50
  51. 51.  Anxiety disorder: Simple concrete tasks with no more than 3 or 4 steps that can be learnt quickly. For example, kitchen tasks, washing, sweeping, mopping, mowing lawn & wedding gardens. Depressive disorder: Simple concrete tasks which are achievable; it is important for the patient to experience success. Provide positive reinforcement after each achievement. For example, craft, mowing lawn, wedding gardens. JAYESH PATIDAR 4/24/2013 51
  52. 52.  Manic disorder: Non-competitive activities that allow to use of energy & expression of feelings. Activities should be limited & changed frequently. Patient needs to work in an area away from distraction. For example, raking, grass, sweeping, etc. Schizophrenia (paranoid): Non- competitive, solitary meaningful tasks that require some degree of concentration so that less time is available for focus on delusions. For example, puzzles, scrabble. JAYESH PATIDAR 4/24/2013 52
  53. 53.  Schizophrenia (catatonic): Simple concrete tasks in which patient is actively involved. Patient needs continuous supervision & at first works best on a one-to-one basis. For example, metal work, molding clay, etc. Antisocial personality: Activities that enhance self-esteem & are expressive & creative, but not too complicated. Patient needs supervision to makes sure each tasks is completed. For example, leather works, painting, etc. JAYESH PATIDAR 4/24/2013 53
  54. 54.  Dementia: Group activities to increase feeling of belonging & self-worth. Provide those activities which promote familiar individual hobbies. Activities need to be structured requiring little time for completion & not much concentration. Explain & demonstrate each task, then have patient repeat the demonstration. For example, cover making, packing goods. Substance abuse: Group activities in which patient uses his talent. For example, involving patient in planning social activities, encouraging interaction with others etc. JAYESH PATIDAR 4/24/2013 54
  55. 55.  Childhood & Adolescent disorders: Children: Playing, story telling, painting, poetry, music etc Adolescent: Creative activities such as leather works, drawing, painting Mental retardation: Repetitive work assignments are ideal; positive reinforcement after each achievement. For example, cover making, candle making packaging goods etc. JAYESH PATIDAR 4/24/2013 55
  56. 56. PLAYTHERAPY JAYESH PATIDAR 4/24/2013 56
  57. 57.  Play is a natural mode of growth & development in children. Through play a child learns to express his emotions & it serves as a tool in the development of the child. JAYESH PATIDAR 4/24/2013 57
  58. 58.  It releases tension & pent-up emotions. It allows compensation for loss & failures. It improves emotional growth through his relationship with other children. It provides an opportunity to the child to act out his fantasies & conflict, to get rid of aggression & to learn positive qualities from other children. JAYESH PATIDAR 4/24/2013 58
  59. 59.  Play therapy gives the therapist a chance to explore family relationships of the child & discover what difficulties are contributing to the child‟s problem. Play therapy allows studying hidden aspects of the child‟s problems. It is possible to obtain a good ideas of the intelligence level of the child. Through play inter-sibling relationships can be adequately studied. JAYESH PATIDAR 4/24/2013 59
  60. 60.  Individual vs group play therapy: In individual therapy the child is allowed to play by himself & the therapist‟s attention is focused on this one child alone. In group play therapy other children are involved. Free play vs controlled play therapy: In free play the child is given freedom in deciding with what toys he wants to play. In controlled play therapy, the child is introduced into a scene where the situation or setting is already established. JAYESH PATIDAR 4/24/2013 60
  61. 61.  Structured vs unstructured play therapy: Structured play therapy involves organizing the situation in such a way so as to obtain more information. In unstructured play therapy no situation is set & no plans are followed. Directive vs non-directive play therapy: In directive play therapy, the therapist totally sets the direction, whereas in non-directive play therapy, the child receives no direction. Play therapy is generally conducted in a playroom. The playroom should be suitably stocked with adequate play material, depending upon the problems of the child. JAYESH PATIDAR 4/24/2013 61
  63. 63.  Recreation is a form of activity therapy used in most psychiatric setting. It is planned therapeutic activity that enables people with limitations to engage in recreational experiences. JAYESH PATIDAR 4/24/2013 63
  64. 64.  To encourage social interaction. To decrease withdrawal tendencies To provide outlet for feelings. To promote socially acceptable behavior To develop skills, talents & abilities To increase physical confidence & a feeling of self worth. JAYESH PATIDAR 4/24/2013 64
  65. 65.  Provide a non-threatening & non- demanding environment. Provide activities that are relaxing & without rigid guidelines & time- frames. Provide activities that are enjoyable & self-satisfying. JAYESH PATIDAR 4/24/2013 65
  66. 66.  Motor forms: These can be further divided into fundamental & accessory; among the fundamental forms are such games as hockey & football, while the accessory forms are exemplified by play activity & dancing. Sensory forms: These can be either visual for example, looking at motion pictures, play, etc., or auditory such as listening to a concert. Intellectual forms: These include reading, debating & so on. JAYESH PATIDAR 4/24/2013 66
  67. 67.  Anxiety disorder: Aerobic activities like walking, jogging, etc. Depressive disorder: Non-competitive sports, which provide outlet for anger, like jogging, walking , running, etc. Manic disorder: One-to-one basis individual games like shuttle badminton, ball badminton, etc. Schizophrenia (paranoid): Activities requiring concentration like chess, puzzles. JAYESH PATIDAR 4/24/2013 67
  68. 68.  Schizophrenia (catatonic): Social activities to give patient contact with reality like dancing, athletics. Dementia: Concrete, repetitious craft & projects that breed familiarization & comfort. Childhood & adolescent disorders: It is better to work with the child on a one-to-one basis & give him a feeling of importance. Employ activities such as playing, story telling & painting. Adolescents fare better in groups; provide gross motor activities like sports & games to use up excess energy. Mental Retardation: Activities should be according to the patient‟s level of functioning such as walking, dancing, swimming, ball playing. Etc. 68 JAYESH PATIDAR 4/24/2013
  70. 70. Attitude therapy is a form of milieutherapy in which all staff membersassume a consistent, prescribedattitude designed to be therapeutictowards patients. JAYESH PATIDAR 4/24/2013 70
  71. 71. i. When the patient is in the hospital for a long time:• The patient is interviewed to assess his emotional state & activity level.• Family members are interviewed to acquaint them with the attitude therapy which will be used for the patient.ii. After this, a staff meeting is held in which all the team members are present. JAYESH PATIDAR 4/24/2013 71
  72. 72. iii. A clinical diagnosis is made by the psychiatrist.iv. A plan of attitude to be adopted for a particular patient is discussed with purpose.v. One Principal Line of Approach at a time by all the team members. The attitude therapy is basically meaning to change the attitude of the patient in specific situations. A general attitude which the nurse needs to adopt for psychiatric patients is kept in mind. JAYESH PATIDAR 4/24/2013 72
  73. 73.  The patient starts feeling that an organized approach is being used for his/her treatment. Guesswork & haphazard plans by individual members of the team are reduced. The patient‟s problems or conflict are solved in less time. JAYESH PATIDAR 4/24/2013 73
  74. 74.  This approach also provides an opportunity for the members to explore, test & change the therapeutic attitude which will bring best results in patient. It brings members of the team together to plan, work & evaluate each other‟s efforts & to discover new ways of helping the patient. JAYESH PATIDAR 4/24/2013 74
  75. 75. MUSICTHERAPY JAYESH PATIDAR 4/24/2013 75
  76. 76.  Music therapy is the functional application of music towards the attainment of specific therapeutic goals. JAYESH PATIDAR 4/24/2013 76
  77. 77.  Facilitates emotional expressions Improves cognitive skills like learning, listening & attention span. Social interaction is stimulated. JAYESH PATIDAR 4/24/2013 77
  78. 78. DANCETHERAPY JAYESH PATIDAR 4/24/2013 78
  79. 79.  It is a psychotherapeutic use of movement, which furthers the emotional & physical integration of the individual. JAYESH PATIDAR 4/24/2013 79
  80. 80.  Helps to develop body awareness. Facilitates expression of feelings. Improves interaction & communication Fosters integration of physical, emotional & social experiences that results in a sense of increased self-confidence & contentment. Exercise through body movement maintains good circulation & muscle tone. JAYESH PATIDAR 4/24/2013 80
  81. 81. JAYESH PATIDAR 4/24/2013 81