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Difficulty: MediumCoping Mechanisms

An adult client is admitted to the inpatient behavioral health unit following a severe depressive episode triggered by an unexpected job termination. The client is observed pacing the common area, smiling tightly, and states to the nurse, 'I really do not understand why my family brought me here. I am just on a short sabbatical. My employer is restructuring and will definitely call me back with a promotion soon.' Which response by the nurse is the most therapeutic?

  1. Job changes can be incredibly stressful. I am here if you would like to talk about how you are feeling.Answer
  2. B
    You need to accept that your employment was terminated so we can begin working on your treatment plan.
  3. C
    Why do you believe the company will promote you after they formally let you go?
  4. D
    Everything happens for a reason, and you will likely find a much better position very soon.

Answer

The most therapeutic response is to acknowledge the stress of job changes and offer presence, stating, 'Job changes can be incredibly stressful. I am here if you would like to talk about how you are feeling.'
The correct response demonstrates an understanding of the client's use of denial. By stating that job changes are stressful and offering to listen, the nurse uses the therapeutic techniques of 'making an observation' and 'offering self.' This approach validates the underlying emotional pain without aggressively challenging the defense mechanism, allowing the client to feel safe.

Step-by-Step Solution

1
Identify the defense mechanism the client is currently exhibiting.
The client's refusal to acknowledge the reality of the job termination indicates they are using denial.
Denial acts as a temporary psychological buffer against overwhelming anxiety or emotional pain.
2
Determine the therapeutic goal when a client is in acute denial.
The nurse should not aggressively confront the denial, nor should they play along with it. The goal is to build trust and gently acknowledge underlying feelings.
Stripping away a defense mechanism before the client has healthier coping strategies in place can cause severe anxiety and psychological distress.
3
Evaluate the nursing responses to find the therapeutic communication technique.
Acknowledging the stress of the situation and offering to listen uses the therapeutic techniques of 'broad openings' and 'offering self' while avoiding confrontation.
This approach keeps the communication lines open and allows the client to process their reality at their own pace.

Key Concept

Therapeutic Communication in the presence of Maladaptive Coping (Denial)
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Topics

Coping Mechanisms

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