Theoretical Foundations for Psychiatric Nursing - Research Paper Example

 I. Introduction II. The Reality Therapy paradigm Human nature/Development of personality 2. Basic assumptions 3. Distinguishing Features 4. Fundamental ideas III. The Therapeutic process 1. The Theory reality Theory and Analyzing the Case Study of Mr. R 2. Therapeutic goals 3. Functions and the Role of the Theorist 4. Nature of the Relationship between Client and Therapist IV. Application: Techniques and Procedures 1. Applicable techniques and Methods to Mr. R 2. Critique of Reality Therapy a) Where Reality Therapy is most Applicable b) Limitations 3. A Synthesized Counseling Design Abstract The theoretical premise of reality therapy is examined in its depth. Reality therapy is a distinguished approach for it has completely different conception of mental illness, its causes and treatments. Most importantly, reality therapy does not see the client as mentally ill unless s/he is not suffering from brain damage. The article examines the applicability reality therapy in the case analysis of Mr. R who is DSM- IV symptoms and also chronically affected by morbid obesity from childhood. The critique of the reality therapy looks at the non-individualist factors which considerably affects the client’s mental health. I. Introduction As a short term approach, reality theory is based on choice theory. It is centered on the notion that client could assume reality in the present whatever his/her mental condition is of. According to reality theory, clients are enabled to invent appropriate means to meet their needs. Reality theory relates counseling and problem solving by efficiently networking between the here-and-now of the client and his/her aspirations toward future. The crux of reality therapy is to make the client able to control the controllable aspects of his behavior pertinent to relationships. II. The Reality Therapy paradigm 1. Human nature/Development of personality Reality therapy at first questions the concept of child’s mind as blank slate. Basic needs of human beings are genetically encoded, which are- survival, love and belonging, power or achievement, freedom or independence, and fun. Importantly, love is not only to be received but also to be given. Corey (2008) asserts that love is too difficult to be achieved ‘because we must have a cooperative person to help us meet it. Control system is the mode of functioning of human brain as it functions as a regulator of our genetically encoded needs and corresponding emotions. Quality word is the system through which we store data on well being from experiences personal or social. Everyone seeks to live forever in his/her quality world in which people are the vital factor. 2. Basic assumptions No client is completely deprived of normality. For the therapeutic success, it is always better to deal with the normal part of the client’s personality. Mostly, the lack of relationship or a satisfying relationship is the basic conditions on which the problems of the clients are based. Corey (2008) suggests that client problems are ‘caused by their inability to connect, to get close to others, or to have a satisfying or successful relationship with at least one significant person in their lives’. It is not that the client is unaware of the way he actually behaves and its consequences in his life. Rather, the clients consciously choose their behaviors as they want to fight the ills of their own problematic relationships. Strikingly, Glasser fiercely argued against labeling the clients with diagnosis. 3. Distinguishing Features The most distinguishing factor of reality therapy is that it does not see a person with relationship difficulties as mentally ill. Besides, the reality therapy characteristically emphasizes the enabling aspects of ones personality in order to get out of the problematic state of affairs. 4. Fundamental ideas Clients could take charge of their behavior choices vis-à-vis relationships provided that they are assisted with appropriate therapeutic delivery system. As human beings are in charge of their own live, hey tend to choose their behaviors rather rightly or wrongly. III. The Therapeutic process 1. The Theory reality Theory and Analyzing the Case Study of Mr. R The major focus of reality therapy is relationship problems of the client. The therapist is not the one finds problems with the behavior choices of the client. On the contrary, the therapist persuades the client to revise the clients’ behavior choices by eliminating the depressing elements in it as they too are chosen intentionally or unintentionally. For the purpose, the client’s choices are emphasized and responsibilities towards it highlighted. The supreme concern of the reality therapist is not the past of the client but the present in which he is embedded. Therefore, the symptoms of the client are not projected, on the other hand, points out ways for eliminating the living conditions of client which make the symptoms necessary or unavoidable. Above all, behavioral difficulties of the client are not seen as constitutive of mental illness. Holmes (2008) is of the view that obesity ‘not only affects physiological health, but also greatly affects psychological health’. In the case of Mr. R, he has been affected by morbid obesity from his childhood. He has developed inertia in his relationships. He is completely unaware of the causes of the divorce with his first wife. It shows that he is rather cold in his relationship although he has high aspirations and hopes about relationships. However, it is apparent in Mr. R’s case study that he is a successful person in almost all the spheres of his life. Therefore, it can be safely told that his problems have some other hidden connections like ethnicity or class status. 2. Therapeutic goals Primarily, the therapist attempts to counsel the client and solve his problems. It aims the client to know the purposes and meanings of his own life. Moreover, the therapist acts as a guiding person for enabling the client to make successful relationships and help him to adopt effective behavioral models which progressively modify his present personality. Also, reality therapy tries to make appropriate choices in terms of personal behavior in order to develop healthy relationship based on the understanding of the absolute necessity of satisfying relationships. Reality therapist could examine the validity of the behavior choices of the client with relation to his wants. For Mr. R, reality therapy is aimed at overcoming his conscious association with obesity and success in relationships. He fears that his obesity is the primary reason for him being not successful in his relationships. He has to gain the correct understanding that he can be loved regardless of his weight. 3. Functions and the Role of the Theorist It is therapist who assists the client to build up social networks in order to enhance relationships and thereby experience real happiness in life. Importantly, therapist make the client realize that he could overcome his problems simply by advancing the very way he behaves. The paramount role of a reality therapist is of a guide or teacher of matters related to relationships. It is extremely important that ‘[f]or therapy to have chance of success, a therapist must be the kind of person that clients would consider putting in their quality world’ (Corey, 2008). Reality therapist does not reexamine the behavioral choices for the client but necessitates the client to reexamine his behavior model in order to achieve his life goals. 4. Nature of the Relationship between Client and Therapist The therapist must develop a close and healthy relationship with the client by becoming part of the quality world of the client. Based on this sort of a relationship with the therapist, client would be in a position to establish better relationships in his life. IV. Application: Techniques and Procedures 1. Applicable techniques and Methods to Mr. R At first, a proper counseling environment must be created for the client to fell easy and freedom from his usual problems. The client must be prepared to see the changes taking place in his life. An appropriate therapeutic alliance between the therapist and the client is the key in putting reality therapy into practice. Procedures for making the client realize the possibility of change are the necessary condition for the successful practice of reality therapy. In the very beginning of the therapy session itself, the client should realize his goals through the right interventions by the therapist. Knowing what is controllable from the side of the client is the critical procedure in the reality therapy. Schoo (2008) argues that body typology could be an important reality therapy method for understanding specific personality types and mental illnesses. Shoo asserts that ‘observing physical and non-physical features clients exhibit can complement the assessment and subsequent treatment’. In order to make Mr. R understand about his relationship difficulties, it is necessary to introduce him to the psychological implications of being morbid obese. 2. Critique of Reality Therapy Reality therapy is too individualistic as it makes the client fully responsible for his behavior choices. It forgets that much of ones behavior choices are simply responses to the events taking place around. Here, it is so apparent that the role of social and political institutions in shaping the behavioral choices of individuals is not taken care of. Larger socio-economic processes such as prevailing financial system or culture are completely ignored. In brief, reality theory does not see human beings as social entities living in concrete structures and contexts. Here, individuals are seen as isolated and autonomous actors who have sheer ability to change their personality independent of the larger social settings. a) Where Reality Therapy is most Applicable The approach is most applicable to resolve the behavioral difficulties of a he client in relations to his social and personal relationships. It has high relevance in making the client aware of their creative potentials and the way out available to them. Furthermore, reality therapy could be applied to multiply determine the influence of the clients past life in his present life. b) Limitations Reality therapy cannot take account of the socio-economic conditions of the client. It also fails to examine crucial factors such as race and gender and their role in the making of the personality of the client. Reality theory cannot provide any concrete solutions to the client rather than inducing him to find the solutions for himself, which would not always be possible for the client. 3. A Synthesized Counseling Design Reality therapy concept such as the non determinacy of past factors and clients ability to find solutions are useful for dealing with the case Mr. R’s relationship difficulties. However, he has so much existential issues too especially stemming out of his age. Reality therapy needs to incorporate existential therapy in order to examine the cases in which age and ethnicity also play vital roles. References Corey, J. (2008). Theory and Practice of Counseling and Psychotherapy. 8th ed. Thomson Brooks. Cole. pp. 315-336 Holmes, T. (2008, Fall2008). Using Reality Therapy to Influence Health Behaviors: Childhood Obesity. International Journal of Reality Therapy, 28(1), 78-80. Retrieved March 22, 2009, from Academic Search Premier database. http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=35009654&site=ehost-live Schoo, A. (2008, Fall2008). Counseling: Working with Different Personalities and Behaviors to Improve and Maintain Mental and Physical Well-being. International Journal of Reality Therapy, 28(1), 34-40. Retrieved March 20, 2009, from Academic Search Premier database. Read More