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The strenghts and limitation of utilising a psychodynamic approach within mental health nursing.

The strenghts and limitation of utilising a psychodynamic approach within mental health nursing.

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The aim of this essay is to provide an overview of the key concepts within psychodynamic therapy and their strenghts and limitations within mental health nursing. Through comparing this approach with other therapies available within the field of nursing the effectiveness and the implications for nursing practice of psychodynamic therapy are discussed.
The aim of this essay is to provide an overview of the key concepts within psychodynamic therapy and their strenghts and limitations within mental health nursing. Through comparing this approach with other therapies available within the field of nursing the effectiveness and the implications for nursing practice of psychodynamic therapy are discussed.

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Published by: Undergraduate Awards on Sep 01, 2012
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10/27/2013

 
The aim of this assignment is to discuss one therapeutic approachwiththe focus of this paper being onanindividualised psychodynamic approach,although certain circumstances may require family, couple or social therapies which are applicable under this approach.This paper discusses this approach in relation to its strengths andlimitations and its use within mental health nursing. The author has chosen this approachas it is felt that it is the most beneficialand versatile, withthe advantage of sourcing outthe initialand predisposingproblems. Cognitive Behavioural therapy, humanistic,solution centered and numerous other therapies offer alternant explanations for thedevelopment and maintenance of mental distress and propose psychological techniques or  psychotherapies that aim to ease or remove mental distress. By exploring their contrasting views in relation to a psychodynamic approach the author aims to further highlight its strengths and limitations.To understand the application of the psychodynamic approach within mental healthnursing there is need to understand the core concepts of the approach itself. With regardto this approach nursing practice today works from a psychodynamic view although itoriginated from Freud’s work in psychoanalysis. Freud was the founder of  psychoanalysis and the core concepts within this approach derive from his work. A graspof these concepts is needed if the nurseis to understand and resolve the inner turmoilcloudingtheir patient’smindand the thought patterns anddefense mechanismsthat evoke anxiety and damaging behaviour. Freud divided personality into threeinterdependent domains the id, ego and superego. The Id is biologically determined, itrepresents all the instinctual drives and operates on the ‘pleasure principle’ that is,1
 
seeking pleasure and avoiding pain. It is impulsive and irrational. The Ego is theintermediary between the id and the superego. It operates on the ‘reality principle’ that is,controlling the id’s demands by consciously and rationally dealing with the restrictionsthat reality imposes. The superego is the moral aspect of the personality made up of theego-ideal (a sense of what is right and proper) and the conscious (a sense of what iswrong and unacceptable) (Malim and Birch, 1998). The stronger the superego is, thegreater the guilt. Unhealthy conflicts between these domains may account for somedegree of mentaldistress.It is also important to explore the conscious, preconscious and unconscious mind. Theconsciousmindrepresents all the thoughts and feelings that one is aware of at any giventime, whereas the preconscious contains the thoughts that may not be conscious all of thetime but are still accessible. The unconscious mindishowever the focus of  psychodynamic therapy as here lies the traumatic experiences and irrational thoughtsresponsible for the patient’s sufferingthat have been lost and suppressed due to defencemechanisms.Figure 1. visually demonstrates the relationship between all of theseconcepts.Freud’s interpretation under a psychoanalytic approach and a belief held byPost Freudiantheorists within thepsychodynamic approach was that certain experiences duringchildhood are too uncomfortable to remember and are therefore repressed into theunconscious. Freud proposed that these were mainly of a sexual nature although he waslater criticised for his over emphasis on this. However, in studying people with delusionsRead and Argyle found that 50% of patients had a history of childhood sexual abuse or 2
 
 physical abuse and an additional 29% experienced both. So although an over emphasis onthis proposition maylimit this approach it is clearly relevant to consider within nursing practice. It is believed that these thoughts would eventually give rise to a state of anxietyor depression that may manifest in physical symptoms (Walker et al, 2004). It is believedthat repressed thoughts are revealed through word association, dream analysis, slips of the tongue and the interpretation of visual images. The aim of psychodynamic therapy isto find an escape from illness rather then jus modify behaviour, as seen in CBT, or focussolelyon the problem as it presents rather then exploring the past, as seen in solutionfocused therapy. This is a major advantage as it provides long term benefits althoughwith this comes the disadvantage of being very time consuming on the part of the nurseand the patient. It explores past experiences and facilitates the release of these repressedthoughts through processes such as transference and catharsis.Consideringthe focus of therapyison helping the patient to retrieve and resolve difficult or traumatic memoriesthrough the processes mentioned, there has been a rise in concerns about the introductionof false memories (Walker et al, 2004). Thereforethe nurse needs to be able to tolerateuncertainty on behalf of the patient without jumping to premature conclusions about their situation.Malim and Birch (1998) also falter this theory’s poor empirical support,concerned thatpersistent questioning on the part of the nurse may lead to memoryreconstruction. It is hard to dispute these accusations due to the non existence of quantitative data or statistical analysis to prove otherwise. Although these are limitationswithin this approach they do not take away from the positive intervention that can take place and of the beneficial outcome of the therapeutic relationship which forms when3

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