Mental disorder is a disease with multi-causal, a disease with many causes that vary widely. Causes of mental disorders has been identified include the movement in the area of organo-biological, psycho-educational areas, and socio-cultural areas. In the concept of stress-adaptation cause maladaptive behavior as the stage began the predisposing factors, precipitation factor in the form of a stressor originator,
capability assessment of stressors, coping resources of the individual, and how the coping mechanisms chosen by an individual. From here and then determine whether an individual's behavior is adaptive or maladaptive.
Many experts in mental health have a different perception of what is a mental disorder and how behavioral disorders occur. The divergent views embodied in the form of conceptual model of mental health. View psychoanalysis models in contrast with the view of social models, behavioral models, existential models, medical models, in contrast also with models of stress - adaptation. Each model has a unique approach in the treatment of mental disorders.
Various approaches of handling clients with a mental disorder defined as therapeutic modalities. An approach to the handling of clients with varying disorders that aim to change the behavior of clients with mental disorders with maladaptive behavior, to be the adaptive behavior.
Type Modality Therapy
There are several types of therapeutic modalities, among others:
- Individual therapy.
- Environmental therapy (milleu therapy).
- Biological therapy or somatic therapy.
- Cognitive therapy.
- Family therapy.
- Group therapy.
- Behavioral therapy.
- Play therapy.
Individual therapy
Individual therapy is the treatment of mental disorders client with an individual approach to the relationship between a therapist with a client. A structured relationship that exists between the nurse and the client to change the client's behavior. Relationship is woven is intentional relationship with the goal of therapy, conducted in stages, systematic (structured) so that through these relationships change the client's behavior in accordance with the objectives set at the beginning of the relationship.
Relationships structured in individual therapy aims for clients able to resolve the conflict they experienced. In addition the client is also expected to alleviate suffering (distress) emotionally, and to develop appropriate way to meet their basic needs.
Stages of relationships in individual therapy include:
- orientation
- work
- termination
Nurses perform nursing interventions after the client trusts the nurse as a therapist. This is done in the working phase, in which the client doing self-exploration. Clients reveal what happened. For that nurses do not just pay attention to the context of the client's stories, but must consider also how the client's feelings, while telling problem. In this phase the client is helped to develop an understanding of who he was, what happened to him, and are encouraged to take risks to change the behavior of maladaptive behaviors become adaptive behavior.
After both parties (client and nurse) agreed that the problem started the establishment of the therapeutic relationship has eased and more controllable so nurses can terminate the client. Another consideration is to terminate if the client has to feel better, there is increased functionality themselves, social and employment, and more importantly is the therapeutic goal has been reached.
Environmental therapy
Environmental therapy is a form of therapy that is managing the environment in order to change the behavior of the clients of maladaptive behaviors become adaptive behavior. Nurses use all of the hospital environment in a therapeutic sense. The form is to give the client the opportunity to grow and change behavior by focusing on the therapeutic value of the activity and interaction.
In environments therapy nurses must provide opportunity, support, understanding that the client can evolve into a responsible person. Clients were also presented at the rules that must be obeyed, environmental expectations, peer pressure, and learn how to interact with others. Nurses also encourage communication and decision-making, increase self-esteem, learn new skills and behaviors.
That the hospital environment is the environment in which the client while going back home, the goal of therapy is to enable the client environment can live outside of institutions created through the learn competencies required to switch from the hospital environment to their home environment.
Biological therapy
The application of biological therapy or somatic therapy is based on the medical model of mental disorder which, viewed as a disease. This is different from another concept model which considers that a purely mental disorder is a disorder of the soul alone, not considering any pathophysiological abnormalities. Pressure medical models is specific assessment and grouping of symptoms in a specific syndrome. Abnormal behavior is believed due to the presence of certain biochemical changes.
There are several types of somatic treatment of mental disorders include: medication (medications and psycho-pharma), nutritional interventions, electro convulsive therapy (ECT), photo therapy, and surgical brain. Some therapies which until now still applied in mental health services include psychoactive medications and ECT.
Cognitive therapy
Cognitive therapy is a strategy to modify the beliefs and attitudes that affect feelings and behavior of the client. The process that is applied is helpful to consider the stressor and then continued by identifying patterns of thinking and beliefs that are not accurate about the stressor. Behavioral disorders caused by the client is experiencing patterns of belief and thought inaccurate. For that one's behavior is modified by changing the thought patterns and beliefs. Helping clients to a reevaluation of ideas, values which are believed, expectations, and then followed by the drafting of cognitive changes.
There are three goals of cognitive therapy include:
- Develop rational thinking pattern. Changing irrational thought patterns that often lead to behavioral disorders become rational thinking patterns based on actual facts and information.
- Familiarize always using reality testing in response to each stimulus so as to avoid distortion of mind.
- Shaping behavior by internal message. Behavior is modified by first changing thought patterns. Intervention in the form of cognitive therapy include taught to substitute the client's mind, learn problem solving and modifying negative self-talk.
Family Therapy
Family therapy is treatment given to all members of the family as a unit handling (treatment unit). The purpose of family therapy is that the family is able to carry out its functions. The main target of family therapy is on family dysfunction; can not carry out the functions demanded by its members.
In family therapy all the family perceived problems identified and the contribution of each member of the family for the problem is drilled. Thus the first of each family member introspective; what problems occurring in the family, what is the contribution of each to the onset of the problem, to then find solutions to maintain the family unit and improve or restore family functioning as it should.
Group therapy
Group therapy is a form of therapy to clients established in the group, an approach to behavior change through the media group. In group therapy nurse interacting with a group of clients on a regular basis. The goal is to increase self-awareness of clients, improve interpersonal relationships, and change maladaptive behaviors. Stages include: the early stage, working stage, ending termination stage.
Group therapy initiated start-up phase or often also referred to as the orientation phase. In this phase the client is oriented to what is required in the interaction, activities to be implemented, and what the activity is carried out. The role of the therapist in this phase is as a role model in the way proposed group structure, relieve anxiety are common in the initial formation of the group, and facilitates interaction among group members. The initial phase followed by a phase of work.
In the working phase the therapist helps the client to explore the issue by focusing on the state here and now. Support is provided so that each member of the group carry out activities agreed in the initial phase to achieve the goal of therapy. Phase of work is the core of a group therapy where the client along with group activities to achieve behavior change with mutual support between each other member of the group. Once the target is reached in accordance goals set then ends with the termination phase.
Termination phase carried out if the group has facilitated and involved in interpersonal relationships between members. The nurse's role is to encourage the group members to give each other feedback, support and tolerate any differences. The end of the group therapy is to encourage members of the bold and able to solve problems that might occur in the future.
Behaviour Therapy
Basic assumption of behavior therapy is the fact that the behavior arises as a result of the learning process. Basic techniques used in this type of therapy are:
- role models
- operant conditioning
- systematic desensitization
- self-control
- aversion therapy
Behavioral therapy that is suitable for the client phobia is systematic desensitization technique is a technique to overcome anxiety about something stimulus or condition by gradually introducing / describing the stimulus or situation that causes the anxiety gradually in a state of the client is relaxed. The longer the exposure stimulus intensity increased as the tolerance of the client against the stimulus. The end result is the client will successfully overcome the fear or anxiety will be the stimulus.
To overcome the impulse behavior maladaptive behaviors can be trained clients with self-control techniques. Form of training is practice changing negative words into positive words. If this is successful then the client already has the ability to control the behavior of others so as to produce a decrease in the level of distress of the client.
Play therapy
Play therapy applied because there is a basic assumption that children will be able to communicate well through the game than with verbal expression. By playing the nurse can assess the level of development, the child's emotional status, diagnostic hypotheses, and to intervene to resolve the problem of the child.
The principle of play therapy includes a warm relationship with the child, the child's feelings reflect radiated through the game, believing that the child can solve the problem, and then interpret the behavior of the child. Play therapy is indicated for depressed children, children who experience anxiety, or as victims of abuse. Even play therapy is recommended for adult clients who experience post-traumatic stress, dissociative identity disorder, and clients who experienced persecution.
Conclusion
Up to now there is no type of therapeutic modality that can resolve all the problems of mental disorders. Combination therapy modalities is mandatory. For that nurses have a very important role to combine various therapeutic modalities so that changes in behavior will be the maximum achievable. To achieve this step certainly demanded increasing the ability of nurses in implementing various approaches / strategies of this modality therapy. Continuous Learning therefore becomes a must do every psychiatric nurse.
Reading list
Guze, B., Richeimer, S., and Siegel, D.J. (1990). The Handbook of Psychiatry. California: Year Book Medical Publishers
Kaplan, H.I., Sadock, B.J., and Grebb, J.A. (1996). Synopsis of Psychiatry. New York: Williams and Wilkins
Stuart, G.W. and Laraia, M.T. (2001). Principles and Practice of Psychiatric Nursing. (Ed 7th). St. Louis: Mosby, Inc.