THERAPIES USED IN PSYCHIATRIC MENTAL HEALTH NURSING

MUSIC THERAPY
PURPOSE: Music therapists primarily help clients improve their observable level of functioning and selfreported quality of life in various domains (e.g., cognitive functioning, motor skills, emotional and affective development, behavior and social skills) by using music experiences(e.g., singing, song writing, listening to and discussing music, moving to music) to achieve measurable treatment goals and objectives. INDICATION: Music therapy is most frequently used to help the mentally or physically disabled. For example is a patient suffering from speech difficulties or autism, may be enabled to express themselves more effectively by making musical sounds and music can help people with physical disabilities to develop better motor control. PROCEDURE: Use of music as an addition to relaxation therapy or in psychotherapy to elicit expressions of suppressed emotions by prompting patients to dance, shout, laugh or cry in response.

REALITY THERAPY
PURPOSE: The Reality Therapy approach to counselling and problem-solving focuses on the here-and-now of the client and how to create a better future, instead of concentrating at length on the past. It emphasizes making decisions, and taking action and control of one's own life. Typically, clients seek to discover what they really want and whether what they are currently doing (how they are choosing to behave)is actually bringing them nearer to, or further away from, that goal.

INDICATION: Reality therapy is more than a counselling technique. Reality therapy is a problem solving method that works well with people who are experiencing problems they want help solving, as well as those who are having problems and appear to not want any assistance.

Reality therapy also provides an excellent model for helping individuals solve their own problems objectively and serves as the ideal questioning series during coaching sessions.

PROCEDURE: Reality therapy provides a model of building relationships by instructing helpers to create a need-satisfying counselling environment. The five basic needs of all humans are survival; love and belonging; power; freedom and fun. So, in a helping relationship, the helper must create an environment where it is possible for the person being helped to feel safe; to feel connected to the helper in some way; to be listened to and respected; to have some choices; and to have some fun or learning with the helper. After creating this needsatisfying environment and working hard to maintain it throughout the relationship, the helper can move on to the actual problem. After hearing the persons story, the helper needs to determine what the ideal solution would look like from the other persons point of view. So, for example, if the person were complaining about a fight he had with his girlfriend, ask the question, What do you want to happen? How do you want this to work out? It is critical to get a specific picture of what the ideal solution will look like from the perspective of the person experiencing the problem. The helper is leading him or her away from the problem and into a problem-solution mode. In this way, the focus is off the past and the problem, which cannot be changed. The focus instead is on the behavior the person can create to move himself in the direction of the solution he wants. The next step is to take an inventory of all the things the person is doing to get the situation to work out the way they want. The helper asks the person to list the steps they're taking to reach their goal. Typically, the person will only list positive things, but the helper must ask them to consider everything that is both helping and hindering.

TALK THERAPY
PURPOSE:
Talk therapy, also known as psychotherapy, is based on the core idea that talking about the things that are bothering you can help clarify them and put them in perspective. Some talk therapists follow a specific school of thought, such as cognitive theory or behaviorism. Others use a more eclectic approach, drawing techniques and principles from several different theories. There is an age-old debate in the mental health community regarding the usefulness of talk therapy as opposed to medication therapy. According to the medical model, mental disorders are the result of physiological causes and should be treated by medication, surgery or other medical processes.

Proponents of talk therapy believe that mental disorders are largely based on reactions to ones environment. Therefore, they can be treated through discussion, resolution of conflict, behavioral changes and changes in thinking. Today, most members of the mental health community feel that the truth lies somewhere in the middle. Some conditions may be caused by physiological changes, while others are the result of conflict and unhealthy reactions. Most issues are based on a combination of factors. Therefore, many therapists choose to use both medical and talk therapy solutions depending on the situation. Goals of Therapy The ultimate goal of any type of therapy is to help the client deal more successfully with a disorder or a situation. The specific treatment goals depend on the individual client, the therapists theories and the situation at hand. The goal may be concrete, such as quitting smoking, or more abstract, such as anger management. When talk therapy is used for phobia treatment, there are generally two goals. One is to help the client overcome the fear. The second goal is to help the client learn to manage any remaining fear, so that he or she is able to live a normal, functional life. Some forms of talk therapy have a third goal. In psychoanalysis and related therapies, the goal is to discover and resolve the underlying conflict that caused the phobia or other disorder. In interpersonal therapies, the goal is to resolve problems in interpersonal relationships that have resulted from or contributed to the phobia or other disorder.

PROCEDURE: Talk therapy begins with an initial appointment, often referred to as an intake interview. During this appointment, the client will describe what brings him or her to therapy. This is known as the presenting problem. The therapist will then ask questions to help clarify the nature of the problem, its duration and its severity. He will also try to determine the clients goals for therapy. By the end of the first session, the therapist will have the beginnings of a treatment plan, although many therapists will wait until the second session to provide a more formalized plan to the client. Some therapists choose to maintain the treatment plan as a reference document for themselves, but do not present it to the client unless requested. Despite the treatment plan, the client should always remain in control of the progression of his therapy. The issue may require more or fewer sessions than originally planned. Family members or friends may be invited to join in certain sessions. Auxiliary resources, such as support groups, may be recommended.

INDIVIDUAL THERAPY
PURPOSE: To relieve painful symptoms and to feel increased satisfaction in life.

INDICATION: (1)The patient has suffered traumatic separations ;(2)separate help is asked for; (3) the therapist considers individuation necessary and (4)unusual life experience. MECHANIC/ PROCEDURE: Below are a few of the specific theories/techniques I may employ during our work together: Behavioral therapy Behavioral therapies use learning principles(examples given below)to eliminate or reduce unwanted reactions to external situations, ones one thoughts and feelings, and bodily sensations or functions. Exposure therapy Instead of trying to avoid or escape upsetting experiences which can bring shortterm relief, but in the longer run usually prolong or worsen ones vulnerability clients voluntarily expose themselves to the experiences while in a relaxed state. Behavioral activation This is a method commonly used in treating depression. It involves developing a list of activities the client is likely to enjoy, or needs to engage in as part of a normal and satisfying life. Cognitive therapy Cognitive therapies rely onother, largely verbal, learning principles namely, those that involve cognition (perception, thinking, reasoning, attention and judgment).

RELAXATION THERAPY
PURPOSE: To overcome anxiety, phobias, or panic attacks it is of paramount importance to learn how to relax. It is impossible to feel relaxed and tense at the same time. People who live with high levels of anxiety often do not know how to relax or to release the tension stored in their muscles that is contributing to the experience of anxiety. The aim of relaxation therapy is to quiet the mind; to allow thoughts to flow in a smooth, level rhythm, and induce the relaxation response. This mental quiet allows for rest and rejuvenation that does not always occur, even during sleep.

INDICATION:

Relaxation therapy for anxiety disorders; Helpful for depression, but does not work as well as psychological treatments.

MECHANIC/ PROCEDURE: Progressive muscle relaxation is a technique where you tense and relax one at a time, all the major muscle groups of the body. The idea is to tense each muscle group hard for about 10 seconds, and then to let go of it suddenly. You then give yourself 15-20 seconds to relax and become aware of the contrast between the feelings of relaxation to how it felt when tensed. You then move onto the next muscle group until you have worked your way through your whole body. Often it is helpful to have some quiet, gentle music in the background.

REMOTIVATION THERAPY
PURPOSE: Used to orient to reality for community living. The focus is present oriented. Remotivation therapy is useful for the long-term chronically ill psychiatric in a nursing home or extended care facility.

INDICATION: A simple group therapy which aims to bridge the fantasy- world of the Psychotics to the real world.

MECHANIC/ PROCEDURE: 1. Climate Acceptance (5min)

b. Leader must ask the patient to introduce themselves. c. After the intro, the leader may comment on the weather, the patients appearance or may give a pleasant compliment. d. The objective: create a pleasant and relaxed atmosphere.

2. Bridge to Reality (15min.) a. Ask bounce questions. Questions showed are short and easy to answer.

b. Then ask for anybody who knows a poem about the topic of discussion. c. Questions are from general- specific. d. Try to read your poetry to the group and later ask the patients to read it. Show your visual aid. 3. Sharing the world we live (15 min.) a. Stimulating question leading to the topic b. Leader should try to explore the topic under discussion. 4. Appreciation of the works of the world (15 min) a. The step is blended with step 3
b. Be sure to relate the patient so he will be able to think of himself in

relation into certain job 5. Climate of Appreciation (15min) a. Leader should try to ask a summary about the topic which has discussed b. Express your appreciation to the patient for coming to the sessions & tell them about the next session &what topic to be discussed. A climate or warm friendliness and acceptance are essential. Reading, poetry, and current events from bridges to reality. Props are used to promote discussion of topics. An appreciation of the clients work in the past is emphasized.

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