Chapters 7, 8, 9, 34, 35 Outline PDF

**Chapter 7: The Nursing Process and Standards of Care** Psychiatric Nursing Care - A.D.P.I.E. (Assessment, Diagnosis, Planning, Implementation, Evaluation) - Assessment - Subjective information - What the patient states - HPI- history of prese...

**Chapter 7: The Nursing Process and Standards of Care** Psychiatric Nursing Care - A.D.P.I.E. (Assessment, Diagnosis, Planning, Implementation, Evaluation) - Assessment - Subjective information - What the patient states - HPI- history of present illness - What the patient tells you regarding their reason for seeking treatment - includes all of the following: - statements regarding their reason for treatment - voluntary or involuntary - thought content and perception - suicide risk assessment - subjective information regarding suicidal ideations - homicidal risk assessment - subjective information regarding homicidal ideations - hallucinations, delusions, illusions - obsessions, ruminations - insight - understanding their own condition - judgment - problem solving ability - psychiatric history - age of onset of symptoms - age when sought treatment - age received diagnosis and what diagnosis - medication history - psychiatric hospitalization - suicide attempt or self harm history - homicidal ideation history - legal history - trauma history - substance use history - caffeine - nicotine - controlled substances - illicit substances - social history - developmental information - relationship history - as a child and adult - do they have children? - Education - Occupation - current living situation - support - medical history - surgical history - current medications - allergies - review of systems - subjective information related to disease or illness in any of the body systems outside of the reason for seeking treatment - Objective information - What you observe or assess - does not include any subjective information - vital signs - physical assessment - diagnostic tests - labs - scans - results of screening tools - Mental Status Exam (MSE) - Structured assessment used by healthcare professionals, particularly in mental health settings, to evaluate a patient\'s cognitive, emotional, and psychological functioning. - Provides a snapshot of the patient\'s current mental state and is crucial for diagnosis, treatment planning, and monitoring progress. - Diagnosis - analyze assessment data to determine diagnosis, problems and areas of care and treatment focus, including level of risk - diagnostic statement components - problem / potential problem (unmet need) - probable cause ("due to") - supporting data (signs and symptoms/ "as evidenced by") - Example: - disturbed mood regulation r/t emotional dysregulation a.e.b. Prolonged periods of mood irritability - outcomes identification - outcome criteria - identify expected outcomes that reflect the maximal level of patient health that can realistically be achieved through planning nursing interventions - principles - reflect a measurable desired change - provide direction for continuity of care - written in positive terms - Outcomes identification criteria - Specific - goals should be clearly defined and focused on a particular outcome. For example, instead of saying "improve mobility", state "patient will ambulate 50 feet using a Walker". - Measurable - established criteria for measuring progress. For instance, include quantifiable metrics (e.g., "will report pain level of three or less on a scale of 0-10"). - Achievable - Goals must be realistic and attainable based on the patient\'s condition, resources, and support systems. Consider the patients baseline abilities and limitations. - Relevant - goals should align with the patient\'s overall care plan and address their specific health issues or conditions. - Time-bound - assign a time frame for achieving the goals to provide urgency and allow for evaluation. For instance, "within 3 days". - Patient-driven - involve the patient in goal setting to ensure that their priorities, motivations, and preferences guide the objective set. - Flexible - bulls should allow for modifications based on ongoing assessments and changes in the patient\'s condition or situation. - Planning - Prescribe strategies to assist patient in attaining expected outcomes. - Principles to consider when planning care: - Safe - Compatible and appropriate - Realistic and individualized - Evidence based - Nursing Interventions - Evidence based - Intervention should be supported by current research and best practices within the nursing profession. - Individualized - Intervention should be tailored to meet the specific needs, preferences, and circumstances for each patient. Consider cultural, ethical, and personal factors. - Safe - Interventions must prioritize patient safety and minimize risks. Assess for any contraindications or potential side effects. - Feasible - The availability of resources, time, and support must be considered. Interventions should be practical and manageable within the healthcare setting. - Holistic - Interventions should address the physical, emotional, psychological, and social aspects of the patient\'s well-being. - Collaborative - When necessary, involve other healthcare professionals to implement comprehensive care plans that may include interdisciplinary approaches. - Patient-Centered - Engage the patient in the care planning process and ensure that their values and preferences are considered. - Measurable - Interventions should have defined outcomes that can be evaluated for effectiveness, allowing for adjustments as needed. - Outcome identification and implementation - Goal - Example: - Utilize 3 coping mechanisms to help with mood regulation by the end of hospital stay - Interventions to meet goal - Examples: - Provide written and verbal education to patient and dysregulated mood by end of first day of admission - Discuss possible competing mechanisms to help with dysregulated mood by end of day 2 - Have patient identify 3 coping mechanisms they would like to use for dysregulated mood by end of day three - Have patient demonstrate identified coping mechanisms throughout hospital stay when experiencing dysregulated mood - Evaluation - Criteria for evaluation: - specificity: - evaluate whether the patient outcomes are specific and clearly defined as outlined in the nursing goals. - Each objective should provide clarity on what is expected. - Measurability: - Outcomes should be measurable to determine the degree of success. Use quantitative methods and qualitative observations for assessment. - Quantitative - lab values, vital signs - Qualitative - patient self-reports - Achievability: - assess whether the goals set were realistic given the patient\'s conditions, lifestyle, and available resources. Consider the time frame in which goals were set to determine if they were feasible. - Relevance: - Evaluate the relevance of the goals and outcomes in relation to the patient\'s current health condition and overall treatment plan. - Ensure that they align with the patient\'s priorities. - Timeliness: - Consider the time frame for achieving goals. Were the timeliness appropriate, and were the evaluations conducted at the designated intervals? - Documentation: - Document the evaluation findings thoroughly, including any modifications needed to the care plan based on outcomes. - Proper documentation ensures continuity of care. - Patient engagement: - Involve the patient in the evaluation process by soliciting their feedback on the perceived effectiveness of the interventions and their own progress toward goals. - Comparison against standards: - Compare the patients outcomes against established clinical standards or norms. This helps to determine the effectiveness of interventions in relation to best practices. - Analysis of factors influencing outcomes: - Analyze any external factors that may have affected the outcomes, such as support systems, psychosocial factors, or adherence to the treatment plan. **Chapter 8: Therapeutic Relationships** - Nurse-Patient relationship - Patient-Centered Care - Dignity and respect - information sharing - patient and family participation - collaboration and policy and program development - clear and appropriate boundaries - Therapeutic Use of Self - The Therapeutic Use of Self - refers to the conscious use of one\'s personality, experiences, and insights as a therapeutic tool in the helping process. - Emphasizing the importance of the nurse\'s self-awareness and interpersonal skills to facilitate client growth and healing. - Can enhance the effectiveness of treatment by creating a more meaningful and impactful therapeutic relationship. - Ultimately facilitating positive client outcomes - Concepts of Therapeutic Use of Self - Self-awareness: - Therapists must be aware of their own beliefs, values, feelings, and experiences. - This awareness allows them to recognize how their personal characteristics can influence the therapeutic relationship. - Authenticity: - Being genuine in interactions helps build trust with clients. - Authenticity promotes a safe environment where clients feel comfortable sharing their thoughts and feelings. - Empathy: - The ability to understand and share the feelings of another is critical in creating a connection with clients. - Empathetic responses foster a supportive atmosphere. - Boundary setting: - Maintaining professional boundaries while still being approachable is crucial. - This balance ensures that the therapeutic relationship remains focused on the client\'s needs. - Reflection and supervision: - Engaging in reflective practice and seeking supervision can help therapists process their experiences and improve their effectiveness in using their selves in therapy. - Cultural competence: - understanding and respecting diverse backgrounds and perspectives enhances the therapeutic relationship and helps tailor interventions to meet clients\' unique needs. - Therapeutic relationships - Refers to the professional bond between a therapist and a client, which plays a critical role in the effectiveness of therapy. - Characterized by trust, respect, empathy, and collaboration. - Key components of therapeutic relationships - trust and safety - a foundation of trust allows clients to feel safe in expressing their thoughts and feelings. - Vital for effective exploration of issues. - Empathy and understanding - nurse/ therapist demonstrate empathy by striving to understand the client\'s perspective and experiences. - Helps clients feel validated and understood. - Genuine connection - authentic communication fosters a genuine connection. - Therapists are encouraged to be themselves while maintaining professionalism, enhancing the rapport between therapists and client. - Non-judgmental attitude - creates an environment where clients can openly discuss their concerns without fear of criticism or shame. - Collaboration - collaborative process where both therapist and client work together towards the client\'s goals. - Active participation from the client is encouraged. - Boundaries - essential for a healthy therapeutic relationship. - Ensures the focus remains on the client\'s needs and well-being. - Active listening - involves being fully present, reflecting back what clients say, and responding thoughtfully. - Enhances communication and fosters deeper insights. - Support and encouragement - empowers clients to explore their feelings, set goals, and make positive changes. - Transference - occurs when a client projects feelings, attitudes, and expectations about significant figures in their life onto the nurse/ therapist. - This may involve emotions related to past relationships, such as those with parents, partners, or authority figures. - Examples: - a client may begin to see the nurse as a parental figure and express dependency or resentment that reflects past experiences. - If a client had a critical teacher, they might react to the nurse with anxiety or defensiveness even in the absence of critical comments from the therapist. - Impact on therapy: - provides valuable insights into the clients emotional and relational patterns. - It can help the nurse address unresolved issues from the client\'s past, facilitating deeper exploration and healing. - Countertransference - Refers to the therapist\'s emotional reactions to the client, which can be influenced by the therapist\'s own history, feelings, and unresolved issues. This may include feelings of attraction, frustration, protective instincts, or even personal biases. - Examples: - a therapist might feel overly protective of a client whose background mirrors their own traumatic experiences. - If a therapist is reminded of someone they dislike, they may exhibit bias or withdraw emotionally from the client, potentially affecting the therapy process. - Impact on therapy: - nurses must remain aware of their own feelings and seek supervision or consultation when countertransference issues arise to ensure they do not impede the client\'s progress. - Nurses self-awareness - it is helpful to realize that our values and beliefs: - Reflect our own culture or subculture. - Derived from a range of choices. - Chose values stem from religious, cultural, and societal forces. - Values guide us in making decisions and taking actions that we hope will make our lives meaningful, rewarding, and fulfilled. - Being self-aware helps in accepting the uniqueness and differences in others. - Hildegard Peplau - Developed a theoretical framework for the nurse-patient relationship that emphasizes the interpersonal aspects of nursing care. - Interpersonal relations: - Emphasized the importance of communication and interpersonal relationships in nursing. - The nurse's ability to connect with patients on an emotional level is essential for healing. - Nurse's role: - The nurse acts not only as a caregiver but also as a resource, educator, and advocate. - Nurses are expected to facilitate patient insights, coping strategies, and independence. - Patient-centered care: - Promotes a collaborative, patient centered approach, recognizing the patient\'s role in their own care and recovery. - Phases of the nurse-patient relationship - Preorientation Phase: - Researching the patients history. - Recognizing one\'s own thoughts and feelings about meeting this patient. - Anticipating and setting ground rules before the first meeting. - Orientation Phase: - In this initial phase, both the nurse and the patient meet and begin to establish a rapport. - The patient discusses their needs and concerns. - The nurse assesses the patient\'s needs, gathers information, and helps the patient understand the purpose of the relationship. - Working Phase: - This phase involves active collaboration between the nurse and the patient. - Goals for therapy are identified, and interventions are implemented. - The nurse supports the patient in exploring thoughts and feelings, fostering personal growth, and encouraging self-awareness. - May be resistance to change by patient and/ or family. - Termination Phase: - The relationship culminates in this phase, where the focus is on evaluating progress and discussing the attainment of goals. - The nurse assists the patient in preparing for the end of the relationship, reinforcing skills learned and planning for future challenges. **Chapter 9: Therapeutic Communication** - Therapeutic Communication - Refers to the purposeful and professional interaction between a healthcare provider, particularly or nurse or therapist, and a patient. - This type of communication aims to promote a therapeutic relationship and facilitate: - Understanding - Healing - Support for the patient - Techniques in Therapeutic Communication - Active listening - fully concentrate on the speaker, showing interest and engagement. This involves not only hearing the words but also understanding the message behind them. - Example: nodding and maintaining eye contact while the patient talks - Empathy - demonstrating understanding and compassion for a patients feelings and experiences. This helps validate the patient\'s emotions and fosters trust. - Example: "It sounds like you\'re feeling really overwhelmed; That must be difficult." - Open-ended questions - asking questions that encourage elaboration and discussion rather than simple yes or no responses. - Example: "Can you tell me more about what you\'ve been experiencing?" - Clarification - Seeking to understand the patient\'s message by asking questions or paraphrasing their statement to ensure accuracy. - Example: "When you say you\'re feeling blue, could you explain what that means for you?" - Reflection - mirroring back what the patient has said to help them explore their thoughts and feelings further. - Example: "You seem to feel that no one understands your situation. Can you tell me more about that?" - Silence - allowing pauses in conversation to give patients time to think, feel, or reflect. Silence can be a powerful tool in letting patients gather their thoughts. - Example: after asking a significant question, waiting patiently for the patient to respond. - Focusing - directing the conversation towards specific issues or concerns, which helps manage the flow of dialogue and keeps discussions relevant. - Example: "Let\'s talk more about how your medication is affecting your energy levels." - Validation - acknowledging and affirming the patient\'s feelings or experiences to demonstrate understanding and acceptance. - Example: "It's perfectly normal to feel anxious in this situation, and many others feel the same way." - Humor - when appropriate, using light humor can help reduce tension and create a more relaxed environment, fostering connection and rapport. - Example: sharing a lighthearted comment about a common healthcare experience. - Exploring - the purpose of exploring is to delve further into the subject, idea, experience, or relationship. - This technique is especially helpful with clients who tend to remain on a superficial level of communication. - Example: "So tell me more about what led you to make that decision about moving out." - Barrier identification and addressing - recognizing and addressing barriers to communication, such as language differences or cultural beliefs, enhancing understanding and connection. - Example: "I noticed that some of the medical terms may be confusing period let\'s go through them together." - Empowerment - encouraging patients to take an active role in their care and decision making, which fosters a sense of control and confidence. - Example: "What are your thoughts about this treatment option? Your voice is important in making this decision." - Making an observation - an objective, non judgmental statement about a patient\'s behavior, appearance, or emotional state. - This technique helps convey interest and awareness, facilitating a deeper exploration of the patient\'s feelings and experiences. - Example: "I see that you are avoiding eye contact and have a frown on your face. Is there something bothering you?" - Presenting reality/ reorientation - involves providing patients with factual information or clarification to help them understand their situation more accurately. - Useful for patients who may be experiencing hallucinations, delusions, or distorted perceptions. - Example: "I know you think you are seeing the image of a man in the corner, but I do not see anyone there." - Summarization - condensing the main points of the conversation to reinforce understanding and ensure that the key issues have been covered. - Example: "So, if I understand correctly, you\'ve been feeling anxious about your upcoming surgery and concerned about recovery." - Factors that can affect communication - Cultural Background - Influence: different cultures have distinct communication styles, beliefs, and practices. Variations in language, gestures, and social norms can impact understanding. - Consideration: cultural sensitivity is crucial; Healthcare providers should be aware of cultural diversity and adapt their communication accordingly. - Language proficiency - Influence: a patients language proficiency can affect their ability to understand medical terminology and expressed their concerns. - Consideration: use simple language; Provide translation services or materials in the patients preferred language when necessary. - Emotional state - Influence: emotions such as anxiety, fear, sadness, or anger can hinder effective communication, making it difficult for individuals to express themselves clearly or to listen attentively. - Consideration: recognize and address the patient\'s emotional state; Create a supportive environment that encourages open dialogue. - Personal beliefs and values - Influence: individual beliefs about health, Wellness, and treatment can shape how patients communicate about their conditions and respond to health care advice. - Consideration: respect and acknowledge patients beliefs and values while providing care; Engage in discussions to find common ground. - Age and developmental stage - Influence: communication styles can differ based on age and developmental stages, with children, adults, and elderly individuals often requiring different approaches. - Consideration: adjust communication techniques to be age appropriate; Simplify explanations for children and ensure clarity for older adults. - Gender - Influence: Gender can influence communication styles, preferences, and comfort levels and discussing personal issues or health concerns. - Consideration: be aware of potential differences in communication based on gender and create a respectful environment for all patients. - Education level - Influence: a patient\'s level of education can affect their understanding of medical information and their ability to engage in discussions about their health. - Consideration: tailor communication to match the patient\'s comprehension level, avoiding medical jargon and complex explanations. - Personality traits - Influence: traits such as introversion, extroversion, openness, and assertiveness can affect how individuals engage in conversations and express their feelings. - Consideration: adapt communication approaches to accommodate different personality types; For example, allow more time for introverted individuals to share their thoughts. - Experience and previous interactions - Influence: past experiences with healthcare providers can shape a patient\'s expectation and willingness to communicate openly. - Consideration build rapport by encouraging feedback and discussing previous experiences, demonstrating understanding and willingness to listen. - Health status - Influence: patients with acute or chronic health conditions may have difficulty concentrating or processing information, affecting communication. - Consideration: assessed the patient\'s health status and tailor conversations to address their immediate needs and capabilities. **Chapter 34: Therapeutic Groups** - Group - Group - Interconnected and independent set of individuals who come together for a shared purpose. - Therapeutic group - group of people who meet for personal development and psychological growth. - Group therapy - Shared purpose - Mental Health Disorder - DBT- skills group for borderline personality disorder, post-traumatic stress disorder - AA- group for alcohol use disorder - Trauma groups - Grief groups - Advantages and Disadvantages of Group Therapy - Advantages. - Multiple members can be in treatment at the same time, thereby reaching more patients and reducing personnel costs. - Members of a therapeutic group benefit from knowledge, insights, and life experiences of. Both the leader and the participants. - A therapeutic group can be a safe setting to learn new ways of relating to other people and to practice new communication skills. - Groups can promote feelings of cohesiveness. - Disadvantages. - Individual members may feel cheated of participation time, particularly in large groups. - Concerns over privacy. - Disruptive group members reduce a group\'s effectiveness. - Group norms may discourage personal opinions. - Not all patients benefit from group treatments. - Yalom's Curative Factors - Curative Factors in Group Work. - Instillation of Hope. - The leader shares optimism about the successes of the group treatment, and members share their improvements. - Universality. - Members realize that they are not alone with their problems, feelings, or thoughts. - Imparting of information. - Participants receive formal teachings by the leader or advice from peers. - Altruism. - Members gain or profit from giving support to others, leading to improved self-esteem. - Corrective recapitulation of the primary family group. - Members repeat patterns of behavior in the group that they learned in their families; From the safety of the group. With the feedback from the leader and peers, they learn about their own behavior. - Development of socializing techniques. - Members learn new social skills based on others feedback and modeling. - Imitative behavior. - Members may copy the behavior of the leader or peers and thus can adopt healthier habits. - Interpersonal Learning. - The group itself is a laboratory for trying out new interpersonal skills. Members gain insight from others feedback and from trying out new behaviors in the group. - Group cohesiveness. - This factor arises in a mature group when members feel connected to one another, the leader, and the group as a whole. - Catharsis. - A genuine expression of feelings that can be interpreted by both the patient and the group. Overexpression of feelings can be detrimental to group processes. - Existential factors. - Members examine aspects of life- such as loss, meaning, and mortality- that affect everyone in constructing meaning. - Group work terms. - Group content: - All that is verbalized in the group. - Example: the group\'s topics. - Group process: - The dynamics of interaction among the members. - Example: interaction, facial expressions, body language, and progression of group work. - Group Norms: - Expectations for behavior in the group that develop over time and provide structure. - Example: rules about starting on time, not interrupting. - Group Themes: - Members' expressed ideas or feelings that recur and share a common thread. - The leader may clarify a theme to help members recognize it more fully. - Feedback: - Providing group members with feedback about how they affect one another. - Conflict: - Open disagreement among members. - Positive conflict resolution within a group is key to successful outcomes. - Group phases and leader. - Group leader. - Specific roles and challenges to address. - Support of positive interaction, growth, and change. - Group phases. - Represent distinct periods or stages in the process of group development. - Similar to therapeutic relationship. - Planning phase. - The name of the group. - Objectives of the group. - Types of individuals (e.g., diagnosis, age, gender) for inclusion. - Group schedule (frequency, time of meetings) - Physical setting. - Seating configuration. - Description of leader and member responsibilities. - Means or methods of evaluating outcomes. - Orientation phase. - Group forms. - Leader lays ground rules- respect, confidentiality, and trust. - Participants start to interact- may be more reserved. - Working phase. - Leader. - Facilitates communication, flow of processes, and conduct. - Group. - May revert to earlier phases with conflict. - Storming. - Disagreements, attempts at dominance, and personality conflicts addressed. - Leaders ability and authority questioned. - Norming. - Personality clashes and disagreements are resolved. - Cooperation emerges. - Performing. - Establishing norms and roles. - Focus on achieving goals. - Termination phase. - Leader. - Summarizes accomplishments to each participant and to group as a whole. - Shares insights and identifies future goals. - Encourages positive and negative feedback from group. - Participants. - May experience grief as a group comes to a close. - May direct feelings to other participants or the leader. - Rules of the group. - Functional roles of group members. - Task roles. - Elaborator. - Gives examples and follows up the meaning of ideas. - Energizer. - Encourages the group to make decisions or act. - Information giver. - Provides facts or shares experience as an authority figure. - Opinion giver. - Shares opinions, especially to influence group values. - Orienter. - Notes the progress of the group towards goals. - Maintenance roles. - Compromiser. - During conflict, yields to preserve group harmony. - Encourager. - Praises and seeks input from others. - Follower. - Agrees with the flow of the group. - Gatekeeper. - Monitors the participation of all members to keep communication open and equal. - Standard setter. - Verbalizes standards for the group. - Individual roles. - Aggressor. - Criticizes and attacks others' ideas and feelings. - Blocker. - Disagrees with and halts group issues; Oppositional. - Help seeker. - Excessively seeks sympathy from the group. - Recognition Seeker. - Seeks attention by boasting and discussing achievements. - Self-confessor. - Verbalizes feelings or observations beyond the scope of the group topic. - Communication techniques. - Group leader communication techniques. - Active listening. - Eye contact; Head nod, "go on\..."... - Ask questions. - "Could you tell us the last time you did that?" - Giving information. - "Antidepressants may take as long as four weeks or more to show full therapeutic effects." - Clarification. - "What do you mean when you say 'I can\'t go back to work'?" - Confrontation. - "Jane, you\'re saying 'Nothing is wrong', But you are crying." - Empathizing. - "I can see how that experience was very painful." - Reflection. - "I notice you\'re clenching your fists. What are you feeling right now?" "It sounds like that really upset you." - Summarizing. - "We\'ve talked about different types of cognitive distortions, and everyone identified at least one irrational thought that has influenced their behavior in a negative way. In the next session, we\'ll explore. Some strategies for correcting negative thinking." - Support. - "It took a lot of courage to explore those painful feelings. You\'re really working hard on resolving this problem." - Leadership styles. - Autocratic leaders. - Exert control over the group and do not directly encourage much interaction among members. - Does not ask for feedback from group. - Democratic leaders. - Support extensive group interaction in the process of problem solving. - Lead the group, but encourage interaction and support the narrative of the group. - Laissez-faire leaders. - Allow the group members to behave in any way they choose and do not attempt to control the direction of the group. - Minimal directive from leader and allow group to be in control. **Chapter 35: Family Interventions** - Family structure. - Nuclear family. - Children living with two parents who are married to each other and are each the biological or adoptive parents to all the children in the family. - Single parent family. - Children living with a single adult of either gender. - Unmarried biological or adoptive family. - Children living with two unmarried parents who are the biological/adoptive parents to all the family\'s children. - Blended family/ stepfamily. - Children living with one biological/ adoptive parent and that parent's spouse. - Cohabitating family. - Children living with one biological/ adoptive parent and that parent's unmarried cohabitating partner. - Extended Family. - Children living with at least one biological/ adoptive parent and at least one related non parent adult, such as grandparent or adult sibling. - Grandparent Family. - Children living with one or more grandparents. - Childless family. - Consists of partners living together and working together. - They may have extensive involvement with pets and children of siblings and friends. - "Other" family. - Children living with related or unrelated adults who are not biological or adoptive parents. - This includes children living with grandparents and foster families. - Family functions: - Management. - Typically, parent(s) - Make decisions. - Power. - Resource allocation. - Rule-making. - Finances. - Can be overwhelming, especially in single parent families or in dysfunctional families. - Boundaries. - Defined as limit setting. - Three types: clear, diffuse, and/ or rigid. - Clear. - Adaptive and healthy. - All family members understand expectations. - Firm, but flexible. - Provide structure that responds to and adapts to change. - Diffuse. - Unclear and lacks independence. - Families have difficulty with defining themselves. - Co-dependency on each other. - No one is in a place of authority. - Differentiation. - Discourage self-identity. - Discourage members from providing their opinion. - Parent/ child relationship blurry. - Groupthink mentality. - Rigid. - Adherence to expectations. - No room for discussion or change. - Disengaged family members. - Difficulty with insight into feelings due to rigid structure. - Dysfunctional communication. - Manipulating. - Action designed to influence or control another person. - Usually underhanded or unfair manner. - Distracting. - Add additional information that is not relevant. - Used to diffuse conflict. - Generalizing. - Global statements. - Used to not apply blame to anyone, but address the topic in an unspecified way. - Blaming. - Place accountability on others instead of self. - Placating. - Appease or pacify to avoid conflict. - Family therapy concepts. - Identified patient. - Regarded as the "problem". - Focus on the family\'s concern. - May be used to divert attention from ignored/ hidden problem. - Behavior violates boundaries. - Triangulation. - Third person brought into the problem. - Can be seen as manipulation. - Two against one mentality. - Causes splitting. - Risk and benefit of family therapy. - Risk. - Not beneficial if there is risk for harm, physically or emotionally. - Benefits. - Reduce dysfunctional behaviors. - Resolve/ reduce intra family relationship conflicts. - Mobilize family resources. - Problem solving. - Increase awareness and sensitivity. - Coping mechanisms. - Improve integration of family system and society. - Promote appropriate psychosocial development of members. - Family dynamics terms: - *Boundaries*: Clear boundaries are those that maintain distinctions between individuals within the family and between the family and the outside world. Clear boundaries allow for a balanced flow of energy between members. The roles of children and parents are clearly defined. Diffuse or enmeshed boundaries are those in which there is a blending together of the roles, thoughts, and feelings of the individuals so that clear distinctions among family members fail to emerge. Rigid or disengaged boundaries are those in which the rules and roles are adhered to no matter what. - *Differentiation*: The ability to develop a strong identity and sense of self while at the same time maintaining an emotional connectedness with one\'s family of origin. - *Double bind*: Double binds occur between two or more people as a repeated experience. They involve 2 or more conflicting messages, A situation in which a positive command (often verbal) is followed by a negative command (often nonverbal). Double binds leave recipients confused, trapped, and immobilized because there is no appropriate way to act. A classic example is to command to "be spontaneous". - *Family life cycle*: The family\'s developmental process over time, which occurs in stages. Traditional stages include single young adult, Newly married couple, a family with young children, a family with adolescence, launching children, and a family in later life. Needless to say, there are many different types of family life cycles, including single parent families or families without children. - *Hierarchy*: the function of power and its structures in families, differentiating parental and sibling roles, and generational boundaries. - *Multigenerational issues/Intergenerational issues*: emotional patterns of interaction between family members that are passed down from previous generations. Examples of these patterns include the reenactment of fairly predictable and almost ritual like patterns, repetitions of themes or toxic issues, and repetition of reciprocal dyads, such as one person being the overfunctioner and another the underfunctioner. - *Scapegoating*: a form of displacement in which a family member, usually the least powerful or more different, is blamed for another family member\'s distress. The purpose is to keep the focus off the painful issues and the problems of the blamers. In a family, the blamers are often the parents, and the scapegoat is a child. This child may continue to be scapegoated into adulthood. - *Sociocultural context*: the framework for viewing the family in terms of their gender, race, ethnicity, religion, economic class, and sexual orientation. - *Triangulation*: triangulation is used to balance anxiety, distance, and conflict in a two person relationship by inserting a third person into the relationship.