The document discusses the key concepts of interpersonal theory developed by Harry Stack Sullivan. It states that personality develops through social interactions and is influenced by biological and social factors. Anxiety is a primary motivator in personality formation and human behavior. Interpersonal experiences determine personality organization, and security mechanisms are used to reduce anxiety. Personality develops through stages of relationships from infancy to adulthood. Failure to progress through stages can lead to maladaptive behaviors.

2.  Significant contributions in the interpersonal
theory were made by Harry Stack Sullivan.

3. BASIC ASSUMPTIONS OF
INTERPERSONAL THEORY
 Human being is a social being. His behavior
grows out of his attempts to establish
meaningful social relationship with others.
 Personality development is determined in the
context of social interactions with others and
is influenced by both biological and social
factors.

4.  Anxiety is a primary motivator of human
personality formation and exhibition of human
behavior. Anxiety is important in building self
esteem and enabling a person to learn from
their life experiences.
 Interpersonal experiences determine the
personality organization achieved by human
beings.
 Security mechanisms are used to overcome or
avoid or reduce the anxiety.

5. BASIC PRINCIPLES OF INTERPERSONAL THEORY
 Developmental proceeds through various stages, in each
stage there is involvement of different patterns of
relationship,
- e.g. in infancy- need for contact was fulfilled by the
parents.
 In childhood- active participation in activities and interaction
with adults will be observed.
 In early childhood- - detachment from parents and
attachment with peer group increases.
 In preadolescent and adolescent - intimate relationship with
heterosexual groups resulting into marriage and family
formation.
 If any failure to make progress satisfactorily through various
stages may result into maladaptive behavior.

6.  Anxiety has direct relationship in the
personality formation, e.g. for fulfillment of
basic needs an infant will depend on
caretaker, lack of any of these needs will
lead to develop mistrust or anxious or
insecure and may prone for maladjustment.

7. CONTI…
 Early life experiences will influence
individual’s development throughout his life.
 This lasting effect is produced by
personifications, feelings, attitudes and
ideas, forms as the result of experiences
with anxiety and needs satisfaction with the
mothering one.

8.  CONTI…
 Socialization causes a lot of pressure on
children, E.g. appreciation and praise by
others, experiences of approval and
tenderness is associated with good feelings
about the self ‘good me.’

9. CONTI…
 Experiences associated with criticism, high
anxiety situations results into ‘bad me’ and
are associated with feelings of shame, guilt
and low self-esteem

10. CONTI…
 ‘Not I’ develops in reaction to overwhelming
anxiety arising from situations that provoke
feelings of ‘horror or dread’.
 Over a period an individual develops a ‘self
system’ and ‘self-esteem’ by using coping
mechanisms to reduce anxiety of
socialization pressures.

11. CONTI…
 Social exchange: social relationship is established
to meet the mutual needs. Each person needs
mutual help, recognition from others for self-
identification.
 Social roles: every individual has to perform
specific role set by the society, e.g. teacher,
mother, priest, etc.
 Interpersonal accommodation: Two or more
persons interact with each other and establish
certain goals to build a satisfying relationship.
 It enables the nurse to understand clients’
background, relationship with significant people,
etc.

12. MODES IN COGNITIVE PROCESSES
1. PROTOTAXIC MODE
 It is characterized by sensations, feelings and fleeting
images occurring during infancy which are primitive and
 illogical.
2. PARATAXIC MODE
 It is also illogical in nature. Simultaneous events are
considered as casually related.
 For example, a child who has experienced the amount of
loss of several significant members in the family will
conclude that all people entering in the hospital will die. It
may be commonly observed in early childhood, if it
continues into adulthood it may predispose into racial,
sexual and ethnic stereotype and prejudices.

13. 3. SYNTAXIC MODE
 It is developed form, characterized by
logical thinking emerges in the juvenile
stage.
 i.e. the process by which people come to
agreement about the meaning and
significance of specific symbols.
 Human development proceeds through
stages of development from infancy to old
age.

14.  Peplau has explained the interpersonal
nursing roles:
 Stranger
 Resource person
 Teacher
 Leader
 Surrogate parent
 Counselor

15.  Cornerstone in psychiatric nursing. Concepts
like anxiety, trust, security, self-esteem and
nurse-client relationship, etc. were included in
nursing curriculums, which were derived from
Sullivan’s work.
 The use of interpersonal process recordings in
the clinical aspect of mental health nursing
practice.
 It is deterministic in nature and more hopeful
outlook for clients and practitioners in using this
theory.

17.  It is derived from ‘learning theories’ focused
on client’s actions, not on thoughts and
feelings.
 Behavioral approach is used frequently to
control the undesirable behavior.
 Prominent therapists of behavioral
theory/model/therapy include Joseph
Wolpe, BF Skinner, Ivan Pavlov and
JohnWatson.

18.  Behavior is a response to stimuli from the
environment.
 Either adaptive or maladaptive behavior is
learnt.
 Change in behavior leads to a change in the
cognitive and affective spheres.
 Therapist will emphasize on quantitative aspect
of observable behavior.
 Deviations from the norm are habitual
responses that can be modified through
application of learning theory.

19.  Positive response is reinforced. The response is
strengthened by repetition of the learning
sequence. Reinforcement is essential to get the
response. Positive reinforcement is a reward for
selected behavior.
 Human beings are passive organisms that can
be shaped or conditioned to do anything. If
correct responses are rewarded or reinforced.
 Maladaptive behavior can be unlearnt and
replaced with adaptive behavior, if the person
receives appropriate stimuli to eliminate the
maladaptive learning.

20. I. SYSTEMIC DESENSITIZATION
 Based on ‘Reciprocal Inhibition Behavioral
Principle’ of counter conditioning.
 In this the clients will attain a state of
complete relaxation and are then exposed to
the stimulus that elicits the anxiety response.

21. CONTI…
1. Relaxation training

23. 1. Relaxation training will be given, e.g. mediation,
hypnosis, mental imagery, biofeedback,
Jacobson progressive relaxation.
2. Ask the client to construct a hierarchy of anxiety
provoking situation in descending order of
anxiety provocation.
3. Desensitization of the stimuli: patient is asked to
give a signal whenever anxiety is produced with
each signal; he is asked to relax, after a few
trials, client is able to control his anxiety
gradually.

24.  Prolonged contact with the anxiety will make
the client to face the frustration and anxiety
situation without much difficulty.

25.  Pairing of pleasant stimuli with an
unpleasant response so that even in the
absence of unpleasant response, the
pleasant stimuli becomes unpleasant
because of association.

26. 1. Positive reinforcement
 To reinforce or improve the performance of
the desirable behavior repeatedly a token.
 Reward material or symbolic appreciation
will be given whenever the client performs an
acceptable behavior,
 e.g. Modeling, Shaping.

29. Indications- chronic hospitalized
 patients, children up to adolescent age.
 It is a positive reinforcement programme to
encourage socially acceptable or desirable
behavior among client;
 A small token will be given as an exchange
for privileges.

30. 1. Modeling
2. Shaping
3. Chaining

31. 1. Modeling:
 Acquiring new desirable behavior through
imitation or by demonstration; the client will be
given an opportunity to observe ‘Model
behavior’ either from therapist or psychiatric
team members or through other patients.
 The team members will exhibit a specific
desirable behavior which will be observed by
the client and the he will be given an
opportunity to perform target behavior in
desirable manner, if he does so, reward or an
appreciation will be given to encourage the
client to perform those act repeatedly whenever
is required.

32. 2. Shaping:
 Indication: Neurosis, Phobias, Physically
handicapped, Autism, Obsession.
 Skills can be achieved through shaping
technique; the therapist tries to shape the
desired behavioral skill step by step.
 He positively reinforces the existing behavior
and the responses which are closest for the
desired behavior and ignores the other
responses.
 Therapist will praise the client for his desired
behavioral performance and if he fails no
response will be given.

33. 3. Chaining:
 Training will be given to learn complex tasks in
break up manner, step by step:
Forward chaining:
 The therapist will identify the difficulty of the
client in performing complex tasks. He will give
training to the client to learn first step, after
client achieves it, the second step and the third
until client achieves the task.
• Backward chaining:
 In backward direction, step by step the client
will be assisted to learn desirable tasks from
last step to next step likewise, e.g. for mentally
disabled this training is adapted.

36.  If the client performs undesirable acts or
exhibits undesirable behavior. He will not be
encouraged to perform the similar act and will
be given negative reinforcement by some sort
of punishment, e.g. if the child exhibits odd
behavior, he is not allowed to play until he
changes the behavior and adapts healthy,
desirable behavior, punishment can be avoided
if the caretaker is satisfied with the behavior.

38.  To teach adaptive behavior among the client
token programs were activated. If those
clients exhibit undesirable behavior, a fixed
number of tokens or pints deducted from
what the individual has got already.

40.  Whenever undesirable behavior exhibits, it
has to be avoided by administering some
sort of punishment with proper explanation; it
will be used to decrease the undesirable
behavior /maladaptive behavior.

42.  Whenever the problematic behavior exists
rewards or attention can be removed, e.g.
not to have eye to eye contact or physical
contact or moving away, not showing interest
to talk or mingle with them.

43.  If the client exhibits undesired or problematic
behavior, it will be corrected by wide range of
punishment, e.g. if the child passes stools
within the dress after toilet training, to avoid
the repetition of the undesirable behavior,
mother will ask the child to wash his clothes
by himself.

45. • In 1949, Salter and in 1958, Wolpe have
described assertiveness training.
• Aims:
• Alleviates interpersonally based anxiety.
• Improves interpersonal relationship, self-
esteem, self-control
• Improves the ability to stand up for one’s own
rights
• Clients are assisted to identify the usual
mode of behavior
• Brings change in emotion and other behavior
pattern.

46. Indications:
• Chronic depression
• Socially anxious person or socially awkward
in nature
• Shy tendency

47.  Technique:
• The therapist will give assertive behavior training
by role playing, coaching, modeling and role
reversal technique and the by practicing it in
real life situations.
• This training will help the client not to infringe on
the rights of others and helps to ascertain the
ability to stand for their rights, ignores passive
behavior, inculcates the client for usual mode of
behavior.
• Through assertiveness training, the client will
learn social skills and improves interpersonal
relationships, social behavior and social
contacts. For example, eye- to eye contact
while speaking, appropriate behavior, étiquette
behavior, interaction pattern, etc.

48. • Nurses have to keep in mind, the principles of
learning while administering behavioral
therapy for the clients.
• Uses behavioral approaches like positive
reinforcement, relaxation techniques.
• Involves the client and significant people in
provision of care
• Positive responses will be reinforced.