Running head: PERSON CENTERED APPROACH TO PSYCHIATRIC NURING PRACTICE 1

The Relevance of Person Centered Approach to Psychiatric Nursing Practice Dermot Connolly Stenberg College 0312 PSYN 201-3 Introduction to Counseling April 2013

PERSON CENTERED APPROACH TO PSYCHIATRIC NURING PRACTICE The Relevance of Person Centered Approach to Psychiatric Nursing Practice

The fundamental philosophy behind the person centered approach to therapy is the belief that all humans are trustworthy. (Palmer 2008). When it was first introduced, this humanistic approach to therapy was in stark contrast to the other approaches being employed at the time. (McLeod 2008). This discussion will focus its attention on the person centered approach to therapy by first looking at its history and development. Its traditional uses and applications in todays nursing sector will also be explored. Focus will also be given to its use in the long term and palliate care environment before addressing its implications to the field of psychiatric nursing. It is the purpose of this discussion therefore is to examine more closely the application and uses of person centered therapy in the long term and palliative care settings, while also exploring its relevance in the field of psychiatric nursing. The person centered approach to therapy was founded by Carl Rogers in 1959 at a time when a more humanistic approach to therapy was being developed in the United States. (McLeod 2008). Rodgers views on therapy were in stark contrast to the psychodynamic and behavioral approaches in that he believed that everyone possessed in ability to become what they were capable of becoming without being bound to their past experiences. (Burnard 2005). Rodgers developed his theory through his work with people suffering from emotional difficulties and first published his work in 1942 in his book counselling and psychotherapy and again in 1951 when he published Client Centered Therapy (Palmer 2008). Central to person centered therapy is the notion of self concept, a term developed by Rodgers where he defines the values, ideas and perceptions held by each individual. This self concept is important as it influences a persons perception of themselves and the world in which

PERSON CENTERED APPROACH TO PSYCHIATRIC NURING PRACTICE they live. (McLeod 2008). Unlike other forms of therapy, client centered therapy focuses on the clients ability to identify their own problems and improve on them. There is a notable absence of techniques in this approach, but key to its success is the development of a working relationship between the counselor and the client. (McLeod 2008). In order for this relationship to be established, the client must first believe that they have the ability to identify and resolve their problems, which cannot take place if the therapist does not show complete acceptance and understanding towards the client. (McLeod 2008). Rodgers proposed therefore that there are

three principles that must be displayed by the therapist in order for person centered therapy to be successful. These principles are genuineness, unconditional positive regard and empathy. (Palmer 2008). Applications and uses of person centered therapy vary greatly and there are no restrictions on those who can benefit from its use. Some would argue however that the application of this approach is not feasible when working with serious mental illnesses such as schizophrenia and manic depression. (Palmer 2008). Despite the wide range of issues being addressed using this approach, some clients respond better to treatment than others. In particular, the core principles of genuineness, unconditional positive regard and empathy work particularly well in the long term and palliative care settings. Person centered therapy works well in these settings as it helps the individual maintain a level of independence through the development of personal care and support services tailored to meet their needs. (Mahoney 2011). Therefore as the client becomes more independent, their level of confidence and self esteem is reestablished. The application of the person centered approach can also apply to the clients home where home modification programs have being shown to help

PERSON CENTERED APPROACH TO PSYCHIATRIC NURING PRACTICE the client identify and eliminate barriers to completing their activities for daily living (ADLs). (Stark, Landsbaum, Palmer, Somerville & Morris 2010). The application of the person centered approach is also evident in the palliative care setting where its application has being shown to help meet the emotional and psychological needs of the palliative client and their families. (Green 2006). In the case study presented by Green for example, a lack of effective communication between an elderly married couple

prevented the palliative client from being able to express her fears of dying towards her husband. Using the principles of genuineness, unconditional positive regard and empathy, Green was able to reopen the lines of communication where the patients increasing needs were effectively communicated and met. (Green 2006). Why then is person centered therapy so prevalent in the long term and palliative care settings? Palmer suggests that often times the client of person centered therapy will feel cut off from themselves and become overwhelmed or frightened resulting in the development of an altered self concept. (Palmer 2008). Such feelings become more prevalent as we age, or when we undergo a life changing event such as a terminal illness, that impacts our ability to carry out our ADLs. As the core principles of genuineness, unconditional positive regard and empathy are important aspects in the development of a therapeutic relationship in psychiatric nursing, the use of person centered therapy is therefore very relevant to the psychiatric nursing sector. This link is also evident through the increasing need for effective communication combined with physical and emotional support in the long term and palliative care settings. In fact evidence suggests that as the clients needs increase, so too to the needs of their families. (Green 2006).

PERSON CENTERED APPROACH TO PSYCHIATRIC NURING PRACTICE In addition, the application and implementation of this approach has being experienced firsthand by this writer through his clinical exposure to those in long term care facilities and palliative care wards. While the clients diagnoses may differ, many of the emotions expressed are common. Key to the role of a palliative care volunteer and nursing student of the older adult is the need for empathy and active listening. Such qualities creates an atmosphere where the

client and their families can effectively communicate their fears and other emotions as they come to terms with their altered self concept. For person centered therapy to be successful, its implementation must be initiated and supported across multiple levels of nursing. Nursing staff must be prepared to develop and share best practices of implementation which includes many of the core principles of psychiatric nursing. In addition, empowering others to embrace the concept will help support the development of an interdisciplinary team to ensure all the nursing needs of the client are adequately met. (Crandall, White, Schuldheis & Talerico 2007).

PERSON CENTERED APPROACH TO PSYCHIATRIC NURING PRACTICE References Burnard, P. (2005). Counselling skills for health professionals. (4th Ed). United Kingdom: Nelson Thornes. Crandall, L., G., White, D., L., Schuldheis, S. & Talerico, K., A. (2007). Initiating person-

centered care practices in long term care facilities. Journal of Gerontological Nursing.4756. Retrieved from: http://web.ebscohost.com/ehost/pdfviewer/pdfviewer? vid=11&sid=c1c9d348-abe7-4a1a-a62f-67017a00fb9c%40sessionmgr111&hid=118 Green, A. (2006). A person centered approach to palliative care nursing. Journal of hospice and palliative nursing. 294-301.Retrieved from: http://web.ebscohost.com/ehost/pdfviewer/pdfviewer?vid=14&sid=a1e94523-8468-49d88d3d-27f32a47ca80%40sessionmgr12&hid=14 Mahoney, K., J. (2011). Person centered planning and participant decision making. National Association of Social Workers. 233-235. Retrieved from: http://web.ebscohost.com/ehost/pdfviewer/pdfviewer?vid=7&sid=c1c9d348-abe7-4a1aa62f-67017a00fb9c%40sessionmgr111&hid=118 McLeod, S., A. (2008). Person Centered Therapy. Retrieved from: http://www.simplypsychology.org/client-centred-therapy.html Palmer, S. (2008). Introduction to Counselling and Psychotherapy The Essential Guide. Sage Publishing London.

PERSON CENTERED APPROACH TO PSYCHIATRIC NURING PRACTICE Shebib. B. (2011). Choices. Interviewing and counselling skills for Canadians 4th ed. Pearson Canada. Stark, S., Landsbaum, A., Palmer, J., Somerville, E., K. & Morris, J., C. (2010). Client centered home modifications improve daily activity performance of older adult. Journal of Occupational Therapy. Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2857667/