Contribution of transference to the psychiatric nursing process

ABSTRACT Objective: to describe the contribution of the concept of transference to the application of the nursing process in the care of patients with psychical suffering. Method: Theoretical study, structured from the following question: Is it possible to develop the nursing process in the care of patients with psychical suffering by using transference? Result: The patient is considered as a subject of the unconscious and has a demand he/she is unaware of. Discussion: The transference guides the nursing process and favors the elaboration of what has no meaning in the symptom. Final considerations: As an implication for practice, the nursing process will articulate the transference function through the nursing diagnosis, which will promote the capture of subsidies for the planning and implementation of care, in which the purpose will be the symbolization of the symptom. To highlight speech as a means to therapeutic relation will offer the patients the condition to dictate the pace of articulation between their signifiers, which will dynamically temporalize the process.

Phenomenology and Therapy

This chapter examines Martin Heidegger's claim, articulated in the Zollikon Seminars, about the distinction between motivation and causality and relates it to the question of the other, Husserlian phenomenology, and therapy. If causality is acting and constraining, motivation is by contrast determining and free. The motive can thus act by itself, as does the cause, and it can be a motivation only insofar as it is understood; as such, it is never independent of the understanding that one has of it. The same goes for the doctor: he must not be understood as the efficient cause of the healing lest he remove the human and “communitarian” dimension from the therapeutic relation. He must instead be understood and behave as the occasion for the cure. The chapter also considers how Medard Boss situated the therapeutic relation with respect to what in Heidegger is “the name for the whole unfolding essence of Dasein.”

Between Imagination and Rigour: A Response to Farhad Dalal’s Article ‘The Analytic and the Relational: Inquiring into Practice’

The relational perspective of analysis is a way of looking at, practising, and understanding the whole of analysis—including psycho-analysis, group-analysis, and socio-analysis—rather than a specific school of psychoanalysis. Farhad Dalal’s excellent article describes the evolution of his thinking and practice, from a classical analytic stance to a relational conception of it. There are two ways of conceiving and practising psychoanalysis, which he calls ‘the analytic’ and ‘the relational’, derived from two contrasting conceptions of the world and of life. This generates a split between theory and practice in analysis. Some practitioners adhere to the classical view, but are actually relational in their practice; others have adopted relational theory, but maintain the detached scientific attitude of the classical Freudian analyst. Freud’s abandonment of the traumatic theory of neuroses had unconscious sources that determined the injunction for analysts not to be relational. Group analysis, on the other hand, has been relational from the beginning. S.H. Foulkes had a contradiction between his adherence to Freudian theory and the revolutionary aspects of his thinking and practice—what Dalal calls ‘radical Foulkes’. The hierarchical, detached, and emotionally closed off form of relating prescribed by classical analysis is anti-therapeutic. By contrast, the kind of therapeutic relation that Dalal strives to develop has connotations with engagement, reciprocity and mutuality, and may generate corrective emotional experiences. But human events are never fully explained or predictable, so that the corrective emotional experience is an occurrence, not a technique. The analyst works in a radical uncertainty and can only be guided by his intuition, which has then to be checked by rational critical analysis. This generates a dialectic tension between imagination and rigour, which must be kept and nursed, not solved. This corresponds to an analogical hermeneutic stance, which rejects both the dogmatic univocality of Modernism and the relativistic equivocality of Postmodernism. The analyst must respond with his whole being, and this being must be developed through a process of personality development, not training but formation (Bildung in German). This implies a particular epistemology, ontology, axiology, and ethics, a whole Weltanschauung and Lebensanschauung that includes the Golden Braid of thinking, feeling, and acting, on a basis of relating.

Schema Therapy for Personality Disorders: a Qualitative Study of Patients’ and Therapists’ Perspectives

Background: Several studies have evaluated the (cost) effectiveness of schema therapy for personality disorders, but little research has been done on the perspectives of patients and therapists. Aim: The present study aims to explore patients’ and therapists’ perspectives on schema therapy. Method: Qualitative data were collected through in-depth semi-structured interviews with 15 patients and a focus group of 8 therapists. A thematic analysis was performed. Results: Most patients and therapists agreed that helpful aspects in schema therapy were the highly committed therapeutic relationship, the transparent and clear theoretical model, and the specific schema therapy techniques. About unhelpful aspects, several patients and some therapists shared the opinion that 50 sessions was not enough. Furthermore, patients lacked clear advance information about the possibility that they might temporarily experience stronger emotions during therapy and the possibility of having telephone contact outside session hours. They missed practical goals in the later stage of therapy. With regard to imagery, patients experienced time pressure and they missed a proper link between the past and the present. For therapists, it was hard to manage the therapeutic relation, to get used to a new kind of therapy and to keep the treatment focused on personality problems. Conclusions: Patients and therapists found some aspects of the schema therapy protocol helpful. Their views about which aspects are unhelpful and their recommendations need to be taken into consideration when adjusting the protocol and implementing schema therapy.

PERSEPSI KLIEN TENTANG PERAWAT

AbstrakKesesuaian antara pengetahuan perawat tentang perawat yang kompeten dengan persepsi klien akan perawat adalah sangat penting. Kesesuaian ini menimbulkan rasa saling memahami yang merupakan kunci hubungan terapeutik perawat klien. Metode penelitian fenomenologi dipilih untuk mengidentifikasi persepsi klien akan perawat, karena metode ini dapat mengeksplor pemikiran klien dengan mendalam. Data didapat dari 8 orang partisipan di rumah sakit di Jakarta selama 2 bulan, dengan cara interview dan observasi. Hasil dideskripsikan dalam tiga katagori, yaitu: 1. Berespon positif terhadap kebutuhan klien dengan sub katagori: tanggap akan kebutuhan klien, dan menghargai klien; 2. Terampil dan berpengetahuan; serta 3. Berkomunikasi dan mendidik. Ketiga katagori ini menjadi satu kesatuan yang saling berhubungan dalam bentuk lingkaran, dan tidak dapat dipecah menjadi katagori yang berdiri sendiri. Ketiga katagori ini saling mengisi agar perawat dapat bertindak sigap, terampil, sesuai dengan kebutuhan dan karakter klien sehingga dapat meningkatkan kemampuan klien untuk menjadi sehat. AbstractThe appropriateness between the knowledge of a nurse on nurse’s competency and perception of client about nurse is very important. Such appropriateness will produce a sense of understanding which is the key of therapeutic relation between a nurse and the client. This research chooses the phenomenology research in order to identify the perception of client on nurse in order to explore the client judgment in detail. The data and information are obtained from 8 participants from various hospitals in Jakarta within 2 months through interview and direct observation. The results are described in three categories: 1. Positive responsive to the client’s need with one sub category: response to the client’s need and respect to the clients; 2. Skillful and knowledgeable, and 3. Communicative and educative. These three categories will be integrated and interacting with each other in a circle form and cannot be disintegrated into one single category. The three category will assist each other to enable a nurse to act responsive and skillful based on the need and character on client. This is hoped to enhance the client ability to be more healthy.