San Beda College – College of Nursing
Psychology – science which studies the function of
the mind, sensation perception, memory, thoughts
and behavior of a man in relation to environment
Psychologist →is the one studying Psychology;
listen only to what the ptx. says
IQ Test → academic and clinical
Personality test (help psychiatrist in diagnosing ptx)
Psychiatric Nursing – specialty in nursing profession
that focuses on the PROMOTION, PREVENTION,
EARLY IDENTIFICATION and INTERVENTION &
FOLLOW-UP CARE of patients who have psychotic
episodes to minimize long term effects of mental
disturbance
Science – body of
knowledge; use
scientific method
Both
Art – utilize self
as a tool in
changing client
Core of Psychiatric Nursing
 Interpersonal relationship
 FOCUS → Patient
Mental Health
- A state of emotional, psychological and social
wellness as evidenced by satisfying interpersonal
relationships, effective behavior and coping,
positive self-concept and emotional stability.
COMPONENTS OF MENTAL HEALTH:
 Autonomy and Independence - can work
interdependently without losing autonomy;
freedom, self-regulation
- follows guiding values & rules to live by
- engage in independent action & thinking
- consider opinions and wishes of others
- work independently or cooperatively with
others
 Maximizing One’s Potential - oriented towards
growth and self-actualization; don’t be a
mediocre; don’t be contented in status quo
- keep aiming
- keep going
- use talents
- continually strive to grow
- self octualization
 Self-esteem-has realistic awareness of her
abilities and limitations; good self concept or
acceptance
- accept strength and limitations
- awareness of abilities and limitations
 Tolerating Life’s Uncertainties - can face the
challenges of day-to-day living with hope &
positive look; resiliency – if you fail, then stand
again and try
- positive outlook in life - optimism
Prepared by: JISG 06/29/10
PSYCHIATRIC NURSING
- face challenges life has to offer
- have the courage to rise after falling
 Mastering the Environment – can deal with and
influence the environment
- learn to adopt or cope& relate
- can deal with the environment
- can influence the environment
- being competent and creative
 Reality Orientation - can distinguish the real
world from a dream, fact from fantasy
- behave appropriately
- act accordingly
 Stress Management
- tolerate life’s stress
- experience failure without devastation
- cope and tolerate anxiety
- resolve conflicts, stress & anxiety
- believes that crises are temporary
MENTALLY HEALTHY INDIVIDUAL:
 Have positive self-concept and relate well to
people and their environment
 Form close relationship with others
 Make decision pertaining to reality rather than
fantasy
 Be optimistic and appreciate & enjoy life
 Be independent or autonomous in thought and
action
 Be creative, using varying approaches as the
perform task or solve problem
 Consistent as they appreciate and respect the
rights of others
 Display willingness to listen and learn from
others
Factors Affecting Mental health:
1. INDIVIDUAL FACTORS – vitality, finding
meaning to life, biological make-up (genetic
illness), emotional resiliency, spirituality,
sense of harmony in one’s life.
2. INTERPERSONAL FACTORS – intimacy,
helping others, effective communication,
maintaining a balance of separateness &
connection
3. SOCIO-CULTURAL FACTORS – access to
adequate resources, sense of community,
intolerance of violence.
e.g Post-traumatic Stress Disorder (PTSD)
→ Pag laki nakakakita ng violence
Mental Illness – illness with psychological and
behavioral manifestation characterized by
symptoms or impairment in functioning
– State of imbalance characterized
by a disturbance in a person’s thoughts, feelings
and behavior
1
4BCN A.Y. 10 - 11
 San Beda College – College of Nursing PSYCHIATRIC NURSING

Mental Hygiene – science that deals with measures 3. The Hermit

to promote mental health, prevent mental illness
and suffering & facilitate rehabilitation
SELF-AWARENESS (Basis of the Relationship)
- process of developing, understanding of one’s own
beliefs, values, thoughts, feelings, attitudes,
motivation, prejudice, strengths & limitations and
how these qualities affect each other.
 process by which the individual gains
recognition his/her own feelings, beliefs,
attitudes
 ability to recognize the nature of one’s own
behavior, attitude and emotion
 key to self-understanding
 help understand and accept the difference of
others
Therapeutic use of self
Nurse use themselves as → THERAPEUTIC TOOL
- to establish the therapeutic relationship with
clients and to help clients grow, change and heal
 LARGE UNKNOWN AREA
 lack of self-knowledge & understanding
 person you can’t figure out
 behavior is unpredictable & security oriented
 employees tend to feel insecure and confuse
about expectations
4. The Receptive Person
 LARGE PUBLIC AREA
 someone who is open about him/herself
 receptive to feedbacks from others
 clear self-image and enough confidence in who
he/she is visible to others
 employees tend to feel respected and
encouraged to grow
Self-awareness is enhanced by
→increasing self-knowledge – “listen to self”
→ listening and learning from others
→self disclosure – letting others know about
your hidden area

Tool that is helpful in learning more about oneself is METHODS USED TO INCREASE SELF-AWARENESS:
the → JOHARI WINDOW
Role-play
JOHARI WINDOW → put self in client’s situation
Known to self Not known to self Introspection
Known OPEN BLIND → spend time reflecting
to others
Discussion
Not HIDDEN UNKNOWN → talk with friends
known to
others Enlarging one’s experience
→ involve in new situations & experience
STEPS: ---------------------------------------------------------------------
1st Step – appraise one’s own qualities by creating a
list of those qualities PSYCHODYNAMICS OF PERSONALITY

2nd Step – INTERVIEWING OTHERS and asking them
to identify qualities (positive and negative)
3rd Step – compare list and assign qualities
1. The Pumper
 LARGE HIDDEN AREA
 someone who keeps information to him/herself
 always ask information and give little in return
→ “THE GAME PLAYER”
 employees tend to feel defensive and resentful
to individual in this type
Sigmund Freud (1856-1939)
→ Father of Psychoanalysis
- mental disorders were due to unresolved
issues that originate in childhood.
- “Your behavior today is directly or
indirectly affected by your childhood days or
experiences.”
STRUCTURE – Personality Structure
“Freud’s conception of human psyche”
ICE BERG METAPHOR

2. The Blabbermouth
 LARGE BLIND AREA
 someone who talks a lot but doesn’t listen too
well
 preoccupied with him/herself and doesn’t know
when to keep quiet
 employees tend to get annoyed with this
person and eventually will either actively or
passively, learn to shut him/her.
2
Prepared by: JISG 06/29/10 4BCN A.Y. 10 - 11
 San Beda College – College of Nursing PSYCHIATRIC NURSING

relationship with others: operates REALITY

 Conscious – perceptions, thought, emotions PRINCIPLE
that exist in person’s awareness  the self or the “I” (4-6 months of age)
 secondary process of thinking
 Preconscious – thoughts and emotions that are  attempts to negotiate solution with outside
not currently in the person’s awareness, but world
he/she can recall them with some effort – SLIPS  controls guidelines and action
OF THE TONGUE  Conscious ; Competencies
 Decision Maker; Problem-Solving; Critical and
 Unconscious – realm of thoughts and feelings Creative thinking
that motivate a person even though he/she is
totally unaware of them GO
xecutive Secretary

STRUCTURE OF PERSONALITY (Id, Ego, Superego)

REALITY PRINCIPLE
 ID - a completely reservoir of energy derived
from drives and instincts; operates on the Impaired reality
PLEASURE PRINCIPLE; Instinctual drive Schizophrenia

D eat
mpulsive drink
want to urinate
want PLEASURE defecate
 SUPER EGO – concerned with MORAL
PLEASURABLE PRINCIPLE BEHAVIOR; allies itself with EGO against ID,
Pain Avoidance imposing demands in the form of CONSCIENCE
It’s all “I” or GUILT
 Super ego domination → OA (OC; Anorexia)
 Moral component of personality
Dominant ID - Evil  consist of conscience (“should not”)
Mania  Operates both in the conscious and unconscious
Antisocial but operates mostly on the unconscious level
 Develops around 3-4 yrs. and fairly develop at
Narcissistic
age 10
 formed and influence from the internalization
I of what parents teach their children regarding
right or wrong through reward or punishment.
→ know RIGHT & WRONG

S
UPER EGO
E hould not
mall voice of God
 baby is ID-dominated (all their wants should be
attended: nursing, change diapers)
CONSCIENCE PRINCIPLE
 source of all drives, instinct, reflexes, needs,
genetic inheritance, and capability to respond
Dominant Super ego
to wishes that motivate us
 present at birth Obsessive-compulsive
 unlearned selfish source of libidal energy Anorexia Nervosa
 compulsive with no sense of right or wrong
 demands immediate satisfaction and S
gratification

 EGO – controls action and perception; controls I

contact with reality through defense
mechanism E
 inhibits primary instinctual drives; it has the
capacity for developing mutually satisfying
3
Prepared by: JISG 06/29/10 4BCN A.Y. 10 - 11
 San Beda College – College of Nursing PSYCHIATRIC NURSING

PSYCHOSEXUAL STAGES OF DEVELOPMENT:  EGO is develop in the 6th month

 Freud advanced a theory of personality
development that centered → on the effects of Child cries
the sexual pleasure drive on individual psyche
 A single body part is particularly sensitive to Feed the infant Ignore the infant
sexual, erotic stimulation ↓ ↓
EROGENOUS ZONES – mouth, anus, genitals Successful Unsuccessful
↓
LIBIDO – centers on behavior affecting the primary Narcissistic
erogenous zones of his age. Stage Source of Primary Task Desired
→ sexual energy responsible for survival (Age) Satisfaction Conflict Outcome
2.ANAL ANAL Toilet Beginning of Control
(1 – 3 yr) REGION Training development over
 He cannot focus on the primary erogenous (expulsion of sense of impulses
zone of the next stage without resolving the and control over
developmental conflict of immediate one retention of instinctual
feces) drives; ability
Frustration → occurs when needs are not met to delay
Overindulgence → reluctant to progress beyond immediate
gratification to
the stage gain a future
goal
“BOTH, lock some amount of the child’s libido
permanently into stage where they occur”
 ANAL (1-3 years)
FIXATION – Stuck in a certain  Ateen – 3 years old (18 months – 3yrs)
developmental stage  Toilet training
REGRESSION – returning to an earlier
developmental stage → “SUPER EGO develop”
Stage Source of Primary Task Desired
 represents a classic conflict between the:
(Age) Satisfaction Conflict Outcome
1.ORAL MOUTH Weaning Mastery of Developm- →ID (deprives pleasure of expulsion of body
(0 – 1 yr) (sucking, gratification ent of wastes) and
biting, of oral trust in →EGO & SUPEREGO (represent practical and
chewing) needs; environme societal pressures to control bodily functions)
beginning of -nt with
EGO the
 If parents are LINIENT
developme- realization
nt that needs →Anal Expulsive personality: messy,
can be met disorganized, reckless/irresponsible, careless,
defiant/disobedient, wasteful and destructive
 ORAL (0 – 18 months old) personality
 Survival
 I want to eat, sleep, urinate, defecate  If parents are too STRICT / Begin toilet training
 “ID formation” too early
 Cry & Suck  mouth →Anal Retentive personality: neat, precise,
 Mouth → pleasure area orderly, careful, stringent, withholding,
 sense of security and ability to trust others meticulous, passive aggressive, rigid and
→ gratification of basic needs obsessive.
 UNMET needs: pessimism, envy, sarcasm,
suspicion  Proper toilet training permanently affects the
- smokers, gum chewers, alcoholics, binge- individual propensities to possession and
eaters, paranoia attitudes towards AUTHORITY
 OVERLY INDULGED Oral characters:
optimistic, gullible and full of admiration for  FIXATION : Obsessive-Compulsive; Borderline
others around him Personality Disorder

Defense Mechanism:
o FIXATION  when a person is stuck in a
certain developmental stage
o REGRESSION  return to an earlier
developmental stage
4
Prepared by: JISG 06/29/10 4BCN A.Y. 10 - 11
 San Beda College – College of Nursing PSYCHIATRIC NURSING

Toilet training  Penis Envy  envy of little girl towards daddy

Good mother Bad mother

↓ ↓ Dr. Karen Horney  opposition to penis envy
Successful Unsuccessful
 Level of Awareness
o Conscious  highest level of awareness
Too rigid training Dirty
o Preconscious  Tip of the tongue
SE ↓ Disorganized
Clean Disobedient o Unconscious  deepest level of
Organized ↓ awareness
Obedient ANTISOCIAL
↓ (Anal Expulsive)  Birth Trauma  First traumatic experience of
OBSESSIVE-COMPULSIVE Small child
(Anal Retentive) SE
 REPRESSION  unconscious forgetting of an
anxiety provoking concept
BIG  SUPRESSION  conscious forgetting of an
SE anxiety provoking concept

 FIXATION: reckless, resolute/stubborn, self-

assures, narcissistic – excessively vain and
Stage Source of Primary Task Desired proud
(Age) Satisfaction Conflict Outcome →leads to HOMOSEXUALITY
3.PHALLIC GENITALS Oedipus Sexual Identification
(3 – 6 yr) (masturbati and identity of parent
-on) Electra with with same  Boy want to possess his mother → “gaya-gaya”
Complex parent of sex to father → identify appropriate sexual role in
the same life
sex
 Girl want to possess his father → “gaya-gaya”
to mother → identify appropriate sexual role
in life
 PHALLIC (3 – 6 yrs) Stage Source of Primary Task Desired
 setting for the greatest, most crucial sexual (Age) Satisfaction Conflict Outcome
conflict 4.LATENCY ASEXUAL Growth of Ability to
 Penis/Vagina (6– 12 yr) PURSUITS EGO, create
(school functions friendship
 Parents → significant person
works, (social,
 Called as “Pre-schooler” sports) intellectual,
 identification of the parent of same sex mechanical)
development of → SEXUAL IDENTITY
Ability to
take care
about and
relate to
others
outside
home

 LATENCY (6-12 yrs)

 SCHOOLatency
 Sexual energy is dormant
 Oedipus Complex  little boy loves  period of unparalled repression of sexual
mommy desires and erogenous impulses
 Electra Complex  little girl loves  Reading, wRiting, aRithmetic
daddy  SUBLIMATION: placing sexual energies toward
 Identification  boy associates a more productive endeavors
with daddy, girl assoc. with mommy
 Castration  fear of the little boy
to daddy
5
Prepared by: JISG 06/29/10 4BCN A.Y. 10 - 11
 San Beda College – College of Nursing PSYCHIATRIC NURSING

Stage Source of Primary Task Desired  CRISIS: a turning point; crucial period of
(Age) Satisfaction Conflict Outcome increased vulnerability and heightened
5.GENITAL GENITALS Development of Ability to be
potential.
(12yrs – (sexual satisfying sexual creative and
beyond) intercourse) and emotional find pleasure  Individual develops →“healthy personality”
relationship in love and by mastering life’s outer and inner
with members work danger
of opposite sex
 EPIGENETIC PRINCIPLE: personality
Emancipation
continues to develop throughout the entire
from parents →
planning of
life span.
life’s goals and Each part of the personality has a
development of particular time in life span when it
strong sense of must develop, if it is going to
identity develop
at all
 GENITAL (12yrs – beyond)
 Heterosexual relationship
8 MAJOR STAGES of SOCIAL-EMOTIONAL
 Planning life’s goals
DEVELOPMENT:
 FIXATION: If having problems in this stage, the
cause is a fixation stemming from Oral, Anal, 1. Infant: TRUST vs. MISTRUST
Phallic
 → needs of infant must be met by caregivers
who are responsive and sensitive
 attachment to mother which lays foundations
 ERIK ERIKSON
for later trust in others
 CONFLICT: general difficulties relating to others.
Psychosocial Theory of Development
suspicion, fear of the future
Affecting
Age
+ -
Major Factor
RESOLUTION: development of trust, sense of
0-18 mos. Trust Mistrust Feeding the world as a safe & dependable place
(Infant)
NON-RESOLUTION: Mistrust, fear of the future
18 mos. – 3 Autonomy Shame/ Toilet Training and suspicious mind
y.o. AU nal (anal) doubt
(Toddler) TO ilet training 2. Toddler: AUTONOMY vs. SHAME & DOUBT
NO favorite  → as child begins to crawl, walk and explores
word his surroundings, the conflict is whether to
MY assert their will or not
3 – 6 y.o. Initiative Guilt Independence  Gaining some basic control of self and
(Pre-school)
environment
6 – 12 y.o. Industry Inferiority In da-school
(Schoolage)
 CONFLICT: independence-fear conflict, severe
12 – 20 y.o. Identity Role Peer feelings of self-doubt
(Adolescence) confusion
RESOLUTION: Children acquire sense of
20 – 25 y.o. Intimacy Isolation Love
(Young independence and competence when parents
adulthood) are patient and encouraging
25 – 45 y.o. Generativity Stagnation Parenting
(Middle NON-RESOLUTION: Children develop excessive
adulthood) shame and doubt when parents are
45 y.o. and Ego Integrity Despair Reflection overprotective and always curtail their child’s
above freedom of movement
(Old age)
 Each stage has unique developmental task or 3. Preschool: INITIATIVE vs. GUILT
dilemma that must be resolved  → development of mental and motor activities
 The individual is presented with CRISIS that  becoming purposeful and directive
must be resolve  CONFLICT: aggression-fear conflict; sense of
inadequacy and guilt

6
Prepared by: JISG 06/29/10 4BCN A.Y. 10 - 11
 San Beda College – College of Nursing
RESOLUTION: develop initiative if parents allow
them freedom to run, slide, play with other
children, go bike-riding
NON-RESOLUTION: children develop sense
of ineptness or inadequacy and
→feel that they are mere intruders or
“istorbo” and “pasaway”; they become
passive recipients of whatever the
environment brings.
4. Schoolage: INDUSTRY vs. INFERIORITY
 → child’s concern is “HOW THINGS WORK” and
“HOW THEY ARE MADE”
 Developing social, physical and school skills,
competence
 CONFLICT: sense of inferiority; difficulty
learning and working
RESOLUTION: children gain sense of industry or
accomplishment if their efforts are recognized,
rewarded and reinforced
NON-RESOLUTION: sense of inadequacy and
inferiority especially if parents and/or
teachers, rebuff, ridicule, constantly scold or
ignore the child’s effort to improve.
5. Adolescence: IDENTITY vs. ROLE CONFUSION
 → entering adolescence, children experience
“Psychological revolution”
Search for answers to:
“Who am I?”
“What do I value?”
“Where am I headed in life?”
 Trying on many new roles; Parent/teen conflict
usually occurs
 Making transition from childhood to adulthood;
developing a sense of identity
 CONFLICT: confusion of who one is, identity
submerged in relationships or group
memberships
RESOLUTION: establishment of an integrated
and coherent image of oneself as a unique
person resulting to a sense of centered identity
NON-RESOLUTION: role confusion or negative
identity like a “hoodlum” or delinquent;
6. Young Adulthood: INTIMACY vs. ISOLATION
 establishing intimate bonds of love and
friendship
 CONFLICT: emotional isolation
 Intimacy: the capacity to reach out and make
contact with other people
Prepared by: JISG 06/29/10
PSYCHIATRIC NURSING
→ ability to share with and care for another
person without fear of loosing oneself in the
process (e.g. deep friendship, lasting
relationships)
 Rejection: results to withdrawal, isolation and
formation of shallow relationships
7. Middle Adulthood: GENERATIVITY vs.
STAGNATION
 → fulfilling life’s goals that involve family,
career and society, developing concerns that
embrace future generations
 CONFLICT: self-absorption. Inability to grow as
a person
 Generativity: entails selflessness; reaching out
beyond one’s own concerns to embrace the
welfare of society and future generations
through creative or productive work and caring
for children
 Stagnation: people are preoccupied with their
material possessions or physical well-being
(e.g. self-centered, embittered individual)
8. Old age: EGO INTEGRITY vs. DESPAIR
 towards twilight years, people tend to take
stock of their lives or do a self-accounting
 May result to sense of satisfaction with their
accomplishments or despair (“so much to do, so
little time”)
 Looking back into one’s life and accepting its
meaning
 CONFLICT: dissatisfaction with life, denial of or
despair over prospect of death
MASLOW’S HEIRARCHY OF NEEDS:
1. Physiologic Needs
o Air, food, water, shelter, rest, sleep,
activity and temperature maintenance
that are crucial for survival
2. Safety and Security Needs
o Safe in physical and psychological
aspects
3. Love and Belonging Needs
o Giving and receiving affection, attaining
a place in a group, maintaining the
feeling of belonging
4. Self – esteem Needs
o Self esteem – feelings of independence,
competence and self respect
7
4BCN A.Y. 10 - 11
 San Beda College – College of Nursing PSYCHIATRIC NURSING

oEsteem from others – recognition,

respect, appreciation
5. Self Actualization
o One’s maximum potential and realize
one’s abilities and qualities

8
Prepared by: JISG 06/29/10 4BCN A.Y. 10 - 11
 San Beda College – College of Nursing
 JEAN PIAGET
Theory of Cognitive Development
 A person understands whatever information fits
into his established view of world.
 When it doesn’t fit → person must reexamine
and adjust thinking to accommodate new
information
 ASSIMILATION: people transform incoming
information so that it fits within their existing
schemes or thought patterns
 ACCOMODATION: people adapt their schemes
to include incoming information
THEORY OF COGNITIVE DEVELOPMENT
1. SENSORIMOTOR STAGE (0 to 18 mo.)
Infancy
→development proceeds from reflex activity to
representation and sensorimotor solutions to
problems
 motor and reflex actions
 Thought derives from sensation and movement
 child learns that he is separate from his
environment and that aspects of environment –
his parents or favorite toy -exist even though
they may be outside the reach of his senses
 Develops “OBJECT PERMANENCE”
 Physical development (mobility) allows child to
begin developing new intellectual activities
 Language → incomplete
2. PRE-OPERATIONAL STAGE (2 – 7yrs)
Toddler and Early childhood
→development proceeds from sensorimotor
representation to prelogical thought and solutions
to problems
 can use these representational skills only to
view the world from their own perspective.
 Understand the meaning of symbolic gestures
 Intelligence → through use of symbols
 memory and imagination are developed
 Thinking is done in nonlogical, nonreversible
manner
 “ABSTRACT THINKING”
 Egocentric thinking predominates
Palaging s’ya ang bida; sa kanya ang atensyon
3. CONCRETE OPERATIONAL STAGE (7 – 12 yrs)
Elementary and Early Adolescence
→ development proceeds from prelogical thought
to logical solutions to concrete problems
 “LOGICAL THINKING”
 understand concrete problems
 cannot yet contemplate or solve abstract
problems
Prepared by: JISG 06/29/10
PSYCHIATRIC NURSING
 characterized by 7 types of conservation:
number, length, liquid, mass, weight, area,
volume
 intelligence → logical and systematic
manipulation of symbols related to concrete
objects
 8 -11 yrs – development of Math ability
4. FORMAL OPERATIONAL STAGE (12 and above)
Adolescence and Adulthood
→development proceeds from logical solutions to
concrete problems to logical solutions to all classes
of problems
 can also reason theoretically
 intelligence → logical use of symbols related to
to abstract concepts
 Abstract ideas/reasoning
---------------------------------------------------------------------
 HARRY STACK SULLIVAN
Interpersonal Theory
1. INFANCY (0 – 18 months)
 anxiety develops as a result of → unmet needs
by the mother (bodily needs)
 needs met,→ the child has sense of well-being
2. CHILDHOOD (18 mo. – 6 yrs)
 anxiety as a result of → lack of
praise/acceptance from parents
 gratification → leads to positive self-esteem
moderate anxiety → uncertainty and
insecurity
severe anxiety → self-defeating patterns of
behavior
3. JUVENILE (6 – 9 yrs)
 severe anxiety may result in a need to control
or restrictive, prejudicial attitudes
 learns to → negotiate own needs
4. PRE-ADOLESCENCE (9 – 12 yrs)
 capacity to attachment, love and collaboration
emerges or fails to develop
 move to genuine intimacy with friend of the
same sex
5. ADOLESCENCE (12 – adulthood)
 if self-system is intact, areas of concern expand
to include values, career decisions and social
concerns
 LUST is added to interpersonal equation
 need for special sharing relationship shifts to
opposite sex
 new opportunities for social experimentation
lead to consolidation or self-ridicule
9
4BCN A.Y. 10 - 11
 San Beda College – College of Nursing PSYCHIATRIC NURSING

BEHAVIORAL MODELS
1. Ivan Pavlov
 Classical Conditioning Model
 All behavior are learned
 Food  dog  Salivation
 Bell  Food  Dog 
Salivation
 Bell  Salivation
2. B.F. Skinner
 Operant Conditioning
 All behaviors are unlearned
 Reward (+ reinforcement) and
Punishment (- Reinforcement)

 HILDEGARD PEPLAU

NursePatient Relationship

 PRE-INTERACTION
o Major task of nurse- to develop self-
awareness
 ORIENTATION
o Major task of the nurse: to develop a
mutual acceptable contract
 WORKING
o Major task: identification and
resolution of patient’s problem
 TERMINATION
o Major task: to assist the patient to
review what he has learned and
transfer his learning to his relationship
with others

10
Prepared by: JISG 06/29/10 4BCN A.Y. 10 - 11