APPLICATION OF COGNITIVE THERAPY AND FAMILY TO CLIENTS psychoeducation LOW

SELF-ESTEEM IN THE HOSPITAL Dr. YUDISTIRA

H. Marzoeki MAHDI BOGOR YEAR 2013

Suerni¹ point, Budi Anna Keliat 2 and Novy Helena CD 3

¹Departemen Psychiatric Nursing, Mental Hospital Dr. Amino Gondohutomo Semarang, 50191.
E-mail: titiksuerni@yahoo.com

The specificity of the Scientific ²Departemen Psychiatric Nursing, Faculty of Nursing, University of Indonesia, FIK UI
Depok Campus, 16424.
E-mail: budianna_kelia@yahoo.com

The specificity of the Scientific ³Departemen soul Nursing, Faculty of Nursing, University of Indonesia, FIK UI Depok
Campus, 16424.
E-mail: novy.pangemanan@lycos.com

ABSTRACT

Clients with chronic low self-esteem in Space Yudhisthira Hospital Dr. H. Marzoeki Mahdi Bogor as much as 58.33% of the 60
clients who were treated. The purpose of this Final Scientific Work to illustrate the application of cognitive therapy and family
psychoeducation in low self esteem clients. The method used is case study. At 15 clients given generalist nursing actions and
cognitive therapy and the 20 clients are given a generalist nursing actions, cognitive therapy and family psychoeducation. The result
of the application on the client group with generalist nursing actions and cognitive therapy showed a decrease in the signs and
symptoms of an average of 54.94%; increase the ability of the average 89.57%; the average length of 37 days. The result of the
application on the client group with generalist nursing actions, cognitive therapy and family psychoeducation showed a decrease in
the signs and symptoms an average of 71.2%; increase the client's ability average of 100%; increase the ability of the average
family 98%; The average length of 26 days. Based on the reduction of signs and symptoms, upgrading the clients and families as
well as long-day care that cognitive therapy and family psychoeducation recommended to clients with low self esteem. Keywords:

Cognitive therapy, family psycho-education, low self-esteem

References: 71 (1989-2013)

ABSTRACT

There are 58.33% from 60 clients with low self esteem that cronic treatment in ward Yudistira Dr. H. Marzoeki Mahdi Bogor
Hospital. The goal of this study is to describe the implementation of cognitive therapy and family psychoeducation with low self
esteem. The method that used is case study. The nursing generalize and cognitive therapy is given to 15 clients. And cognitive
therapy, nursing generalize and family psychoeducation to 20 clients. The result to the group of clients that received nursing
generalize, cognitive therapy show symptoms Decreased average of 54.94% and Increased leverage of Abilities

89.57%; average of time of treatment is 37 days. The result to the group of clients with nursing generalize, cognitive therapy and
family psychoeducation show Decreased of symptoms averages of 71.2% and abalities Increased leverage of 100%, with family
Abilities average 98%, average of time of treatment is 26 days. By virtue of symptoms and Increased Decreased of clients and
families of abilities, cognitive therapy and psychoeducation to recommended to clients with low self esteem. Key words: cognitive
therapy, family psychoeducation, low self esteem References:

71 (1989-2013)

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Self-Esteem Bogor inIn 2013 161
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Budi Anna Bogor
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2013Helena CD
Suerni point, Budi Anna Keliat and Novy Helena CD
PRELIMINARY
Mental health is a prosperous condition
when someone capable
realize the potential which are owned,
have good coping to stressors, productive
and able to contribute
to the community (WHO, 2007 in
Varcarolis & Halter, 2010). If someone can respond
positively to a stressor that mental health will be
achieved which is characterized by a good situation
either emotional, psychological, and social behavior,
is able to realize about themselves and respond
negatively when there will be a condition of mental
disorders. Severe mental disorder that is often
encountered in the community is schizophrenia
(Ibrahim,
2011). Schizophrenia is a group of clinical
syndrome characterized by cognitive changes,
emotions, perceptions and other aspects of
behavior (Kaplan & Saddock,
2007). Negative symptoms of
schizophrenia include difficult start
talks, blunted or flat affect, reduced motivation,
lessening
attention, passivity, apathy and social withdrawal
and discomfort (Videbeck, 2008). Based on the
negative symptoms of schizophrenia clients nurse
nursing diagnosis of low self esteem.
Low self-esteem also is feeling worthless,
meaningless and low self-esteem due to
evaluation
negative against themselves alone and
abilities, and often accompanied by a lack of
self-care, to dress neatly, decreased appetite, not
daring to look interlocutors
more
down, talk slow and weak voice tone (Keliat, 2010).
Data client in RS Dr.
H. Marzoeki Mahdi Bogor showed that 60 clients
schizophrenia have low self esteem problems,
hallucinations and violent behavior (Lelono, Keliat
Besral,
2011).
Efforts are being made to deal with low self-esteem
client is with
give action nursing
generalist performed by nurses at all levels of
education (Keliat & Akemat,
2010). however for
optimizing nursing actions
specialist nursing action is the soul given by
specialist nurses nursing people (Stuart, 2009).
Specialist nursing action is needed on the client
with low self esteem is cognitive therapy,
interpersonal therapy, behavior therapy, and family
therapy (Kaplan & Saddock, 2010). Nursing action
on the clients of low self esteem can be an
individual, family therapy and treatment in
communities both generalists or specialists.
Cognitive therapy is psychotherapy individuals
whose implementation by train clients to transform
how clients interpret and perceive things when
clients experience disappointment, so that clients
feel better and be able to act more productive
(Townsend, 2005). Through individual cognitive
therapy taught / trained to
control distortion
thoughts / ideas / ideas with really expensive
factor in
rise and menetapnya
mood disorder. Research on cognitive therapy
already done by
Rahayuningsih, Hamid, Mulyono (2007);
Kristyaningsih, Keliat and Helena (2009) and the
application of cognitive therapy has been done by
Jumaini, Hamid and Wardani (2011); Syarniah,
Hamid and Susanti
(2011); Sartika, Hamid and Wardani
(2011), with the result that the effect of cognitive
therapy to change cognitive self-esteem and
independence.
Specialist nursing actions for families with clients
who have low self-esteem is to do a family
psychoeducation. Research related
with psychoeducation family
performed by Wardhaningsih, Keliat and Helena
(2007); Sari, Keliat, Helena, Susanti (2009);
Nurbani, Keliat, Conan, Susanti (2009); Wiyati,
Hamid, Gayatri (2009) with the result that the
influence

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Family psychoeducation Therapy significantly in approximation theory and the theory of stress adaptation Stuart
reducing the burden on families and enhance the interpersonal Hildegard Peplau shows the
ability of families in caring for clients. Families need change in signs and symptoms symptoms and
to be empowered to help resolve problems with a improve the ability of clients and families in caring.
family member equipped with the knowledge how
to care through
METHOD
nursing actions on the family. Process This scientific work using case study design.
Sampling technique
are all clients with major nursing
nursing starts from diagnosis of low self esteem. In this scientific work
assessment, determination diagnosis the respondent amounted to 35 clients of low self
making plan intervention, esteem in Space Yudhisthira Hospital Dr. H.
execution and implementation (Stuart, Marzoeki Mahdi Bogor. Evaluation of the results by
2009). Nursing according Peplau is therapeutic is comparing the signs and symptoms as well as the
an art to heal, help ability of the client and family pre- post given the
individuals who are ill or nursing actions.
need service health
through an interpersonal process because it involves
interaction between two or more individuals with RESULTS AND DISCUSSION
the same purpose
(Alligood & Tomey, 2010). This theory very Characteristics of 35 clients of low self esteem are
precisely applied on clients who have self-esteem the majority of clients in adulthood are 32 clients
low because (91.5%). Age is a socio-cultural aspects of mental
describes the process of the relationship between the disorders with the risk of the occurrence of the
nurse and the client starts from Step highest frequency of mental disorders in adulthood,
orientation, exploitation and
identification, namely (Stuart, 2009). All clients of male sex
resolution. Improved nurse and client relationships (100%) due to the practice room is a space man.
can conducted through Gender low self esteem clients are managed as a
cooperation as a team to whole is
increase self-awareness, level
maturity, and knowledge for
treatment processes through adaptation stress approach Male. Male more
Stuart and approach allowing negative symptoms than women, and
interpersonal Peplau. women appear to have a better social functioning
than men (Grebb, 1999; Davison & Neale, 2001, in
In the space of 60 clients Yudistira treated there Fausiah and Widury,
were 35 clients (58.33%) with low self esteem.
Nursing actions on the client low self-esteem do in 2005).
space Yudhisthira approach Professional Nursing The majority of clients have a background in
Practice Model (PNPM). Nursing actions secondary education (junior high school) that 29
undertaken include the provision generalist therapy clients (82.86%). Client Education is one of the
at 35 clients (100%), generalist therapy and social and cultural factors that can be associated
cognitive therapy to clients 15 clients (42.48%), and with the occurrence of chronic low self-esteem
the combination of generalist therapy, cognitive (Townsend, 2009). The ability of a person to
therapy and family psychoeducation in 20 clients receive information in order to solve the problems
(57, 14%). The results of the implementation of facing highly correlated with the level of education.
nursing actions on the application of cognitive
therapy and family psychoeducation on the client

Job status clients who were treated with low

low self-esteem with self-esteem problems largely

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do not have a job that is (62.86%). Work is a
source of stress in a person who if not
insurmountable concerned may fall ill (Hawari,
2001). The conditions did not have a job in this
increasingly make the case managed clients
criticize yourself, feel useless or worthless.
Client status unmarried many as 18 people
(51.43%). Marital status, low self-esteem clients
are treated mostly unmarried as many as 18 clients
(51.43%) and with the status of widower 7 client
(20%). Most of the client
subjectively schizophrenia states that feel
lose hope,
lonely and have a pleasant social relations (Cohen,
et al, 1990 in Fortinash & Worret, 2004).
Loneliness and live in solitude is a stressor in itself
for someone who is not married.
Old ill clients majority less than 10 years at 27
clients (77.14%), length of which is now the largest
one month is 16 clients (45.7%),
frequency into the house
sick Most over three times as many as 13
clients (37.14%), and the status of client care by 27
clients with a status return (77.14%),
Economic status of low self esteem clients were
treated in the room as much Yudistira
85.7% against a background of low economic
status. Treatment of mental disorders is expensive
because it is long-term (Videbeck, 2008). Low
income will greatly affect the delivery of care to
clients with mental disorders.
Predisposing factors are risk factors of stress
which include factor
biological, psychological, and social culture. In the
predisposing factors most prevalent psychological
factors are introvert and a history of failure as
much as 35 clients (100%) and low socio-economic
factors as much as 30 clients (85.7%) and
employment issues 22 clients (62.9%).
Predisposing factors that most are from
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overall psychological aspects that have a history of
failure / loss and has a personality introvert.
Failure to carry out the task of development
could result
individuals are not confident, do not trust others, doubt,
fear of being wrong, very pessimistic,
capable formulate and
express wishes and depressed. Factor Precipitation
may be biological, psychological, social and
cultural causes the client being treated. In
biological precipitation factors that most are drug
withdrawal of 30 clients (85.7%). On the
psychological factors that most clients have
unfulfilled desires as many as 25 people (71.4%),
namely the desire to get married,
desire
have jobs and incomes, as well as the desire to get
the attention of others.
at factor
Most precipitation is on the biological aspect, namely
the withdrawal. Non-compliant behavior in taking
medicine because the client and the family does not
feel the benefits of taking medication and feel
uncomfortable, especially
in physical with
consume medicines antipsychotic
(Wardani, Hamid, Wiarsih, 2009).
Lack of information to clients and families
adequate of amenities
health care benefits and impact on relapse of drug
effects which worsen the condition of the client.
Signs and symptoms of clients low self-esteem
after a given act of nursing generalist and cognitive
therapy, the cognitive response of 100% of clients
who think useless dropped to 20%, the affective
response of 100% of clients felt sad and ashamed
dropped to 20%, in the behavioral response of
100% of clients who criticize themselves down to
20%. Signs and symptoms of low self esteem
clients after being given a generalist nursing
actions,
Cognitive therapy and family
psychoeducation therapy on cognitive responses of
100% of clients who think useless
drops to 0%, the affective response of 100% of
clients felt sad and ashamed drops to 0%, in
response to the behavior of 100% of clients who
criticize themselves down to 0%.
The client's ability low self-esteem after a given act
of nursing generalist and cognitive therapy of 100%
of clients who are not able to identify automatic
thoughts Negative rose to 80% which is capable of
100% of clients who are not able to use rational
responses to the automatic thoughts Negative rose
to 80% of clients capable, of 100% of clients who
are not able to identify the benefits of using
response rational ride
be 86.67% of clients who are able, of 100% of
clients that Not capable
use support system rising to 80% of clients who can
afford. the ability of the client
after being given
generalist nursing actions, therapy
Cognitive therapy and family psychoeducation of
100% of clients who are not able to identify the
negative automatic thoughts rose to 100% client
capable, of 100% of clients
that Not capable
using a rational response to the negative automatic
thoughts rose to 100% client capable, of 100% of
clients who are not able to identify the benefits of
using
response rational ride
to 100% client capable, of 100% of clients
that Not capable
use support system rose to 90% of clients who can
afford.
The ability of the family after a given action
generalists and therapeutic psikoedikasi families of
the 85% of families do not recognize the problem
rose to 100% who knows, from 85% of families
who are not able to decide to resolve the problem
rose to 100% capable, of 100% of the families can
not afford taking care rose to 100% capable, of
100% of the families who are unable to modify
positive environment rises
to 90% are able, from 55% of families who are
unable to take advantage of
health services rose to 100% capable, of 100% of
the families can not afford the stress management
rose to 100% capable, of 75% of families who can
not afford the burden of management rose to 90%
are able to. Cognitive therapy focuses on
processing the mind immediately, ie how
individuals
perceive or
interpret experience and
determine how he feels and behaves
(Viedebeck, 2008).
Cognitive therapy can help the client to change her
statement that affects his feelings toward more
positive thoughts. The role of nurses in the
provision of cognitive therapy is to make the
client's mind veiled be
more
open and this is very important to overcome the
cognitive automatic (Gladding,
2009). cognitive or
domain knowledge is very important for the
formation of action that refers to the rational mind,
learn the facts, make decisions and develop ideas,
while psychomotor
or the ability to practice
refers to the movement muskuler which is the result
of coordination of knowledge and demonstrate
mastery of a task or skill (Craven,
2006).
Improving the ability of the client as well as a
decrease in the signs and symptoms of low self
esteem clients according to expert opinion which
stated that cognitive therapy
focused to recognize negative
automatic thoughts, changing negative automatic
thoughts, changing beliefs (presumption) that is not
logical, reasoning wrong, develop a rational
mindset and overcome deformities mind (cognitive
distortions) by way of replacing them with better
thoughts realistic (Stuart, 2009); Townsend (2009);
Copel (2007); Beck et al (1987) in Townsend,
2009).

Application of Cognitive Therapy And Family psychoeducation On Client Self-Esteem Low On Space Yudistira 165
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reduction signs and symptoms and family also feel the influence of the situation. low
an increase in the ability of clients and families in self-esteem of the client,
the group receiving the combination of generalist so that the client can be productive
nursing actions, therapy again.
family psychoeducation and cognitive therapy is
more effective for clients low self esteem. It shows CONCLUSION
that family psychoeducation therapy needs to be
done simultaneously with individual therapy because the ability of the client after being given
it shows a more optimal result. generalist nursing actions and cognitive therapy
80% client capable
identifying negative automatic thoughts, 80% were
The ability of the family after being given a able to use a rational response to the negative
generalist nursing actions and automatic thoughts,
psychoeducation family show 86.67% of clients were able to identify the benefits
increase of as much as 100% of the families were of the use of rational responses and 80% of clients
able to recognize the problem, unable to decide, are able to use
capable of caring client, support system. The ability of the client after being
able to capitalize service given a generalist nursing actions, cognitive
health, capable of stress management, capable of therapy and family psychoeducation 100% client is
load management, and as much as 90% of families able to identify negative automatic thoughts, 100%
are able to modifications to a positive atmosphere. able to use a rational response to the negative
family psychoeducation automatic thoughts, 100% client capable
very be required in
client care mental disorder because it reduces identified benefit
recurrence client the use of rational responses and 90% of clients
psychiatric disorders, improve the function of the client are able to use support system. The results of the
and family making it easier for the client back to implementation of nursing actions have an impact
family environment and on nursing services,
Public with give so that author
appreciation of the social and occupational functioning recommend for nurses provide cognitive therapy
clients with mental disorders (Levine, 2002 in Stuart, individually for each
2009). client have
different abilities; involving family
Family psychoeducation is used to provide in every action
information to families experiencing distress, providing nursing to optimize
education reduction signs and symptoms and
to them for increase the client's ability and the ability of the
improve skills in order to understand and have family. For
coping due to interference head field nursing
soul that cause problems in family facilitates to improve the quality of service
relationships (Goldenberg & Goldenberg, nursing with
2004). indoor facilities include a consultation to maintain
Community empowerment through a cadre of the privacy of clients and their families as given
mental health community resource potential and nursing actions and planned program development
are expected to participate in the treatment of specialist nurses soul and make proposals
mental disorders in the community clients (Keliat
determination standard care
2010). Family psychoeducation is a form of The nursing application of cognitive therapy and family
comprehensive treatment and is done so that the psychoeducation in low self esteem clients. For
family can still function properly because it
indirectly all members Hospital director for
set policies so that every client

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treated at least 3 times visiting family in order to violence, Thesis. Jakarta. FIK UI. Unpublished
provide nursing services comprehension; set
Fortinash, KM, & Worret, PAH (2005).

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