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Peplau Interpersonal Relations Theory and Bowlby Human Attachment Theory essay example

Peplau Interpersonal Relations Theory and Bowlby Human Attachment Theory essay example

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Peplau Interpersonal Relations Theory and Bowlby Human Attachment Theory essay example

Peplau Interpersonal Relations Theory and Bowlby Human Attachment Theory essay example

Please answer the following 2 questions:
1. In what ways might Peplau’s theory of interpersonal relations need to be revised to be the most useful to nurses in the health care environment in which contact time between nurse and client is limited?

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2. One of the patterns of attachment is referred to as ”earned secure” This pattern, characterized by coherence and balance, is achieved by adults who experienced unloving or harsh parenting. What individual characteristics or life experiences might contribute to achievement of this pattern? Peplau Interpersonal Relations Theory and Bowlby Human Attachment Theory essay example.

Use Question and Answer format. Questions above can be used as the header for each section.

Please use to the textbook, use citations and include reference page (in APA format)

Text: Middle Range Theories: Application to Nursing Research
Sandra J. Peterson PhD RN, Timothy S. Bredow PhD RN NP-C
LWW, Fourth, 2017 (ISBN-10: 0060000449)

Other sources: Articles within the last 5 years, from from peer-reviewed nursing journals may be used. Please attempt to add at least two other sources.

Refer to the Rubric for further assignment details. Peplau Interpersonal Relations Theory and Bowlby Human Attachment Theory essay example.

Peplau and Bowlby Theories

Question 1. In what ways might Peplau’s theory of interpersonal relations need to be revised to be the most useful to nurses in the health care environment in which contact time between nurse and client is limited?

Peplau’s Theory holds that the core function of nurses is to aid others who are in difficulty and need their help. In fact, it explains that nurses are therapeutic agents. In this case, it emphasizes the importance of the contact between nurses and their clients since this allows the nurses to have closer interactions with patients. Peplau Interpersonal Relations Theory and Bowlby Human Attachment Theory essay example. For that matter, it views maintaining good interpersonal relationships as a core responsibility of nurses. Longer interaction times allows the relationship between the nurse and client to become mature at a faster rate so that they arrive at an acceptable goal speedily. The implication is that should the contact time between the patient and the client be limited, then the relationship will mature at a much slower pace and an acceptable solution will only be developed at a later time (Barker, 1998). To address the concern of limited contact time between the nurse and client that results in slower rate of relationship maturity, there is a need to revise Peplau’s Theory so that it allows for adoption of information technology solutions, particularly self-guiding applications that direct the clients through routine processes such as acting as a resource that offers specific required information on a situation or emerging problem. Self-guiding applications entail simple operations without the need for complex user guides. This would allow the theory to be abreast with the social transformations that have characterized the 21st century to include information technology advances and Internet developments (Peplau, 1997). Social transformations refer to social changes that have been experienced to include the internet and social media. These information technology solutions (such as smartphone applications and online resource centers) can substitute for the nurses in routine activities and only require nurses to intervene in areas where automated application cannot substitute for them. It is important to note that the revision does not eliminate the need for nurses Peplau Interpersonal Relations Theory and Bowlby Human Attachment Theory essay example. Rather, it assigns them a supervisory role where they only intervene when in-depth clarification is necessary (Peplau, 1997). For instance, when the nurse acts as a contact point and is required to assess the patient’s suitability for the technology or when building the interpersonal aspect of the relationship. In this respect, Peplau’s Theory should be revised to adopt information technology solutions and self-guiding applications to address the issues brought about by limited contact time between the nurses and clients.

Question 2. One of the patterns of attachment is referred to as “earned secure” This pattern, characterized by coherence and balance, is achieved by adults who experienced unloving or harsh parenting. What individual characteristics or life experiences might contribute to achievement of this pattern?

The term ‘earned secure’ refers to a specific pattern of attachment that describes persons who had initially been evaluated to be insecure but later in time would change their assessment to secure. The change between secure and insecure describes the level of trust assigned to relationships. For instance, a trusting relationship is considered secure. Peplau Interpersonal Relations Theory and Bowlby Human Attachment Theory essay example. The change from insecure during childhood to securing in adulthood is typically seen in adults whose childhood was particularly difficult and caused an expected assessment of insecure and yet their state of mind turns out to be secure in adulthood. In essence, it can be interpreted that the adult being assessed has an interchangeable attachment status since he or she does not have a specific way of regulating attachment distress and can regulate it over time. There are specific individual characteristics and life experiences that might contribute to the achievement of ‘earned secure’ pattern of attachment (Peterson & Bredow, 2017). The most common contributor is relationships that allow children to change from insecure when younger to secure as they turn into adults. In this case, the child understands the difficulties associated with insecurity and tries to address these difficulties by striving for security in adulthood. For that matter, if the child had uncooperative and insensitive parents and complained about the detriments of such a relationship, then he or she would try to be cooperative and sensitive as an adult so that a secure relationship is created. It can be understood that security and insecurity are resultant of relationships so that ‘earned secure’ ensues when the individual gains greater control over the relationship and can pursue desired outcomes. Additionally, it would explain an acknowledgment of attachment needs. For instance, being avoidant and failing to acknowledge attachment needs results in insecurity with ‘earned secure’ resulting when an attachment is acknowledged. Peplau Interpersonal Relations Theory and Bowlby Human Attachment Theory essay example. This is typically seen when clingy children deal with unpredictable and preoccupied parents who are caught up in their attachment experiences. The children envision the security that they desire and apply it as they grow older resulting in ‘earned secure’ (Peterson & Bredow, 2017). As a result, experiencing insecure childhoods with disorganized, insensitive, uncooperative, dismissive and preoccupied parents can result in secure adulthoods when the child seeks to reverse the bad childhood-relationship experiences.

References

Barker, P. (1998). The future of the Theory of Interpersonal Relations? A personal reflection on Peplau’s legacy. Journal of Psychiatric and Mental Health Nursing, 5, 173-180.

Peplau, H. E. (1997). Peplau’s Theory of Interpersonal Relations. Nursing Science Quarterly, 10(4), 162-167.

Peterson, S. J. & Bredow, T. S. (2017). Middle Range Theories: Application to nursing research (4th ed.). Philadelphia, PA: Lippincott Williams & Wilkins. Peplau Interpersonal Relations Theory and Bowlby Human Attachment Theory essay example.

 

Discussions Grading Rubric:
Criteria
<69
Unacceptable
70-80
Developing
80-90
Competent
90-100
Exemplary
1. Original
response
Original
response is at
least 100 words
in length
Original response is at
least 150 words in length
Original response is at
least 200 words in length
Original response does not
exceed 350 words in
length
2. Critical
thinking
Does not
demonstrate
critical thinking,
only repeats
concepts stated.
Posting demonstrates
some critical thinking but
does not connect the
subject matter of the
discussion with the
assigned reading –
including examples
outside of what is
mentioned in the text.
Posting demonstrates
some critical thinking
where student connects
the subject matter of the
discussion with the
assigned reading and
demonstrates some
understanding of
concepts presented in
the post question
including examples
outside of what is
mentioned in the text.
Posting demonstrates
critical thinking where
student connects the
subject matter of the
discussion with the
assigned reading and
clearly demonstrates
understanding of concepts
presented in the post
question including
examples outside of what
is mentioned in the text.
3.
Engagement
Not engaged
through the
week, posted
late on the
weekend, which
did not actively
engage others in
discussions.
Engaged in the discussion
forums with at least two
(2) postings to other
learners per post forum
in a manner that
demonstrates
substantive
evaluation. Did not
include a minimum of
100 word response that
addresses the learner’s
post, shares an
experience or provides
an example relevant to
the assigned subject
matter in the post, OR
ask a follow-up question
to move the post
forward.
Actively engaged in the
discussion forums with at
least two (2) postings to
other learners per post
forum in a manner that
demonstrates
substantive
evaluation. Did not
include a minimum of
100 word response that
addresses the learner’s
post, shares an
experience or provides
an example relevant to
the assigned subject
matter in the post, AND
asks a follow-up question
to move the post
forward.
Actively engaged in the
discussion forums with at
least two (2) postings to
other learners per post
forum in a manner that
demonstrates substantive
evaluation. This includes
a minimum of 100 word
response that addresses
the learner’s post, shares
an experience or provides
an example relevant to the
assigned subject matter in
the post, AND asks a
follow-up question to
move the post forward.
4. APA Does not
attempt
assignment,
multiple errors,
no citations
Posting is polished some
errors in mechanics,
spelling, usage and
sentence structure as
well as APA format of
citations and reference
list
Posting is polished
minor errors in
mechanics, spelling,
usage and sentence
structure as well as APA
format of citations and
reference list
Posting is polished
generally free of errors in
mechanics, spelling, usage
and sentence structure as
well as APA format of
citations and reference list
5. Citations
and
references
No citation or
references
used.
Citations and appropriate
references no relevant to
support the postings. No
other credible used to
support the post. A clear
connection of the
citation to support the
post must be evident.
Citations and appropriate
references are included
from the assigned
reading to support the
main post OR Other
credible sources in
ADDITON TO THE TEXT
may be used to support
the post. A clear
connection of the
citation to support the
post NOT evident.
Citations and appropriate
references are included
from the assigned reading
to support the main post.
Other credible sources in
ADDITON TO THE TEXT
may be used to support
the post. A clear
connection of the citation
to support the post must
be evident.

 

The legacy
In formal terms, psychiatric nursing has been the
beneficiary of Peplau’s interpretation of the theory of
interpersonal relations for more than 45 years (e.g. Peplau
1952, 1962, 1963, 1964, 1969, 1987, 1990, 1992, 1996).
For those nurses who were her colleagues, or her early students, the legacy of her understanding of the significance of
that theory, and of the proper focus of nursing, is even
longer. As someone whose encounter with Peplau’s work
was serendipitous, and occurred relatively late in my
career, my appetite for her theoretical, professional and
practical writing derives, in part, from an appreciation of
what I might have missed. That said, I hope that this
paper will be read neither as an apologia for Peplau’s position on psychiatric–mental health nursing (PMHN) nor a
hagiography. Whichever perspective one takes, Peplau’s
exploration and clarification of the theory, and her examination of its relevance to various practice contexts, has significance. Peplau Interpersonal Relations Theory and Bowlby Human Attachment Theory essay example. However, the greatest compliment anyone
might pay to this pioneer, in the professional and academic development of PMHN, would be to submit her work to
continuing critical appreciation and appraisal.
A significant dimension of Peplau’s work involves its
focus on human issues. It is that aspect of Peplau’s oeuvre
that I shall emphasize, in this estimate of her value for
future generations of PMH nurses (cf. Peplau 1995).
Peplau’s humanity has been acknowledged by her colleagues, who recognize the ‘mother of psychiatric nursing’
(Lego 1996) as a:
wise, caring and gentle person (who) is one of the finest
and best scholars the profession has known . . . for over
60 years her scholarship has been evocative, informative, and provocative (Sills 1989, p. viii).
This suggests the complex dimensions of true leadership,
and connotes the benefits accrued by the field during her
tenure as one of its leaders. Today, PMHN is under threat
in most of the countries in the developed world, either in
terms of its presumed function or its substantive focus
(cf. Barker 1995, Dawson 1997). During the writing of this
Journal of Psychiatric and Mental Health Nursing, 1998, 5, 213–220
© 1998 Blackwell Science Ltd 213
The future of the Theory of Interpersonal Relations? A personal
reflection on Peplau’s legacy
P. BARKER P h D RN FRCN
Professor of Psychiatric Nursing Practice, Department of Neuroscience and Psychiatry, University of Newcastle,
Royal Victoria Infirmary, Newcastle Upon Tyne
BARKER P. (1998) Journal of Psychiatric and Mental Health Nursing 5, 173–180
The future of the Theory of Interpersonal Relations? A personal reflection on
Peplau’s legacy
The work of Hildegard Peplau represents the most significant influence, worldwide, on the
development of psychiatric nursing practice. Her use of the Theory of Interpersonal
Relations created the basis for defining the potential significance of the psychiatric nurse’s
role as a therapeutic agent. Forty years later she has indicated the means by which nurses
might sharpen their focus on the person often overshadowed by the ‘patient’ label. Peplau’s
writings have, over this 40-year period, helped clarify the broad range of roles required of
the nurse in general and in particular, within psychotherapeutic nursing.
Keywords: interpersonal relations, Peplau’s theory, psychiatric–mental health nursing
Accepted for publication: 15 January 1998 Peplau Interpersonal Relations Theory and Bowlby Human Attachment Theory essay example
Correspondence:
Phil Barker
Department of Neuroscience and
Psychiatry
University of Newcastle
Royal Victoria Infirmary
Newcastle Upon Tyne NE1 4LP
UK
paper, I received requests, simultaneously, from colleagues
in Spain and England to help them argue the case against
the removal of nurses from specific mental health care settings (especially for people with ‘chronic mental illness’)
and their replacement with ‘generic care workers’. Nurses
around the globe, almost daily on the Internet, echo such
defensive actions. As the ‘mother of psychiatric nursing’
grows toward her 90th year, one wonders who might, conceivably, take her place in providing the evocative and
provocative advocacy that psychiatric and mental health
nursing appears to need now more than ever. Peplau Interpersonal Relations Theory and Bowlby Human Attachment Theory essay example.
Paper models and living theories
Peplau is, unarguably, the most widely acclaimed psychiatric nursing theorist. However, McKenna (1993) discovered that, at least at the level of implementation in practice,
she had only limited popularity. It is not altogether clear
what this might mean for nursing theory or practice. Given
the academic significance of Peplau’s exposition of the
theory of interpersonal relations in nursing, no obvious
acceptable explanation exists for the disinterest or apparent hostility towards her work (Gournay 1995). These
conditions may be a function of cultural differences. The
North American nursing tradition, within which Peplau’s
work is embedded, characteristically differs from that of
other countries. There exists a well-established graduate
tradition within PMHN, including a 40-year history of
Master’s level education. These twin traditions also have
enjoyed a theoretical and practical understanding of psychotherapeutic nursing which, arguably, is to be found in no other part of the world. In 1994 the American
Psychiatric Nurses Association hosted a conference based
upon a critical appraisal of psychiatric nursing spanning
almost five decades (1947–94). No other nation could
match the sheer quantity of literature published since the
end of World War Two, far less the quality of its academic
standing. In that sense most, if not all, other nations are
‘underdeveloped’ by comparison with the USA. Nurses in
other countries who have tried to ‘implement’ Peplau’s
theory may, in a professional sense, simply not be ready for
the challenges associated with Interpersonal Theory.
In more specific terms, it is clear that many of the
nurses who have tried to accommodate the Theory of
Interpersonal Relations in their work will have only
limited opportunity to experience, at first hand, the experiential teaching dimension (Peplau 1957) of education in
practice, for practice. In the UK, for example, many generations of nurses have been taught in classrooms by nurse
teachers, both of which are remote from the everyday clinical practice context to which Peplau referred (cf. Reynolds
1982). By contrast, many North American nursing students will have been exposed to ‘clinically focused learning’ by their teachers – up to and including the Professor of
Nursing – in the clinical milieu.
If there are any grounds for accepting this professional–cultural hypothesis, it may be that the nature of
their educational preparation generates, unwittingly, a
contextual threat when nurses are required to ‘experience
directly’ and ‘reflect upon the experience’ of relating to
their patients, far less (how they experience) themselves.
Such anxieties may encourage nurses to elect to employ
‘models’ of nursing (as opposed to a theory) that provide
them with the security they desire: structures that will
contain their interactions with patients. Such ‘containment’ may also serve as a buffer against too close an
engagement with people in severe mental distress. A
handful of authors have, within recent history, expressed
overtly critical views of Peplau and her theorizing, wishing
to consign them both to the dustbin of history, or to write
them off as mere footnotes to nursing history. Such criticisms may have a critical subtext. They may merely be
extreme examples of the ‘continuing critical appreciation
and appraisal’ of Peplau’s contribution Peplau Interpersonal Relations Theory and Bowlby Human Attachment Theory essay example. They may, alternatively, be illustrations of the experiences of nurses who
have not been acculturated in the experiential tradition
that underpins Peplau’s theorizing. Such criticisms may
even be interpreted as indicative of a lack of understanding
of Peplau’s work, or a failure to appreciate its significance.
In Lego’s view, some critics – such as Gournay (1995) –
may even be harbouring competing ambitions for the
future of PMHN (cf. Lego 1997). What is not in dispute,
and is remarkable, is that the first theory to be applied rigorously within nursing, and its advocate, should still be at
the heart of an academic controversy almost 50 years after
its first publication.
Despite having been in retirement for more than two
decades Peplau continues to contribute to debates about
nursing, mental illness and health, and the role of the
nurse in describing and responding to such phenomena.
However, her recent re-emphasis of the personal dimension of interpersonal theory presents some nurses with a
conundrum. As Rolfe (1996) has observed, Peplau is
proposing that everyone should be treated as individuals,
emphasizing how people differ from one another. However, this may mean that (Rolfe 1996, p. 332):
She is saying, in effect: my model, which applies to
everyone, is that there are no models which apply to
everyone. Thus, if the proper focus of nursing is the
unique and individual therapeutic relationship, then
neither models nor theories (nor indeed, research-based
practice) have a primary role to play in the planning and
implementation of nursing care.
Rolfe’s view presents an intriguing challenge: does the
P. Barker
214 © 1998 Blackwell Science Ltd, Journal of Psychiatric and Mental Health Nursing 5, 213–220
mere existence of any model or theory of interpersonal
relations prejudice naturalistic inquiry into the ‘uniqueness’ of the individual patient? Alternatively, how shall we
‘map’ the unique territory of the individual person qua
patient, without the guiding parameters of some model or
theory? (cf. Grinder & Bandler 1976). Given that the
answers to such questions are not immediately apparent,
they may represent areas of further research into the roles
and functions of models and theories for professional practice.
The identity of psychiatric nursing: paradigms
old and new
Although not specifically concerned with consciousness per
se Peplau’s use of the Theory of Interpersonal Relations
encouraged nurses to look beyond the delimiting parameters of the patient label and to begin to consider what it
might mean to be the person. Indeed, her recent interest in
‘persons’ (Peplau 1995) suggested the almost infinite possibilities afforded by the exploration of interpersonal dialogue. As Oatley (1990, p. 83) observed:
Freud’s striking proposal is that in a dialogue, that can
be retold in a story form, about abuses of power, about
imperfections and evasions, we can take a few steps
towards truths that may be transformative. It was this
idea that Freud glimpsed; even if not quite clearly
enough to transform himself .
Peplau had earlier remarked that: ‘language influences
thought, thought then influences action; thought & action
together evoke feelings in relation to a situation or context
(Peplau 1969, p. 267). The interest in the role of language
extends to contemporary cognitive scientists. Fodor (1983,
p. 56) has acknowledged that:
Our privileged access to thoughts is, to a considerable
extent, a matter of the contents of our beliefs and
intentions being available for verbal report [emphasis
added].
Common sense logic decrees that we could hardly overstate the importance of such ‘verbal reports’, as contributions towards our understanding of what it means to be a
person, in any given situation – including that of health or
illness. Yet, increasingly the examination and exploration
of the state of being – on an existential level – has been
marginalized. The emerging consensus is that we might
understand what it means to be human, by unravelling the
mysteries of the brain through which our beliefs and intentions are expressed.
This raises the question, what is the proper focus of
nursing? (Barker & Reynolds 1996). More specifically, we
might ask is nursing concerned with the ‘mind’ or its
brain? Almost 20 years ago the US government pledged its
support for a portfolio of neuroscientific research earning
the 1980s the title ‘Decade of the Brain’. Although the
impetus for that paradigm shift has grown exponentially, it
remains unclear to what extent laboratory-based research
will explain, far less resolve, human problems that may
derive from a complex of person–environment interactions
in the organized chaos of the everyday world (Barker
1996a). The influence of the ascendancy of neuroscience is
now being felt within PMHN. It has been advocated that
psychiatric nurses should accommodate various biomedical models of understanding human problems (e.g.
Torrance & Jordan 1995) and should employ biological or
psychopharmacological models as a means of understanding their patients (cf. Gournay 1995). Whether or not such
approaches will help us understand those patients as
persons (cf. Rolfe 1996) remains unclear. These views
appear closely aligned to the contemporary drive towards
‘clinical effectiveness’ and ‘evidence-based practice’ (e.g.
NHSE 1993), both of which appear to favour the perceived ‘gold standard’ of randomized control trials (RCTs)
and the virtue of quantifying human experience.
At the risk of stereotyping, these latter-day representations of the ‘old (Cartesian–Newtonian) paradigm’ (cf.
Capra 1976) appear to represent an overtly ‘masculine’
psychiatric world view: focused on the negative attributes
of people; their conflicts and past traumas, or their contemporary consequences. That paradigm adopts an essentially rational, analytic, linear, objectifying, fragmenting,
dismantling, disempowering and distancing approach to
human distress; assuming the presence of a subject-object
duality that neither fits with everyday experience nor with
the propositions of contemporary physics, far less psychology and sociology. Ultimately, its conjoint aims may be the
control of such psychiatric phenomena, through the
refinement of its techniques. Peplau Interpersonal Relations Theory and Bowlby Human Attachment Theory essay example. The ‘old paradigm’ may represent the patriarchal imbalance in post-modern society,
one that fails to acknowledge – far less approve of – its
‘feminine’ side. Dawson (1997, p. 70) has argued that:
the language of nursing, of meaning, of care, of subjectivity and of spirituality has been suborned by the onedimensional language of the technocratic society, which
purchases a spurious exactness at the cost of meaning.
In healthcare that ‘old paradigm’ technocracy finds
expression in materialism and managerialism, both of
which implicitly challenge the principles upon which many
nurses believe that nursing is founded, and is (Dawson
1997 p. 70):
revealed in the tortured vocabulary that attempts to
reconstitute the whole from the pieces left strewn on the
battlefield of rational investigation: ‘biopsychosociocultural’, ‘psychosocial’ mantras that are repeated ad
nauseam in psychiatric nursing texts. The words themFuture of Interpersonal Relations
© 1998 Blackwell Science Ltd, Journal of Psychiatric and Mental Health Nursing 5, 213–220 215
selves indicate the essentially divided and atomistic
nature of the constructed reality that their enforced
unity parodies; the mode of reasoning being employed is
still, in essence, analytic rather than holistic, and the
praxis is instrumental and objectifying.
In its ambition to ‘treat’ people, albeit compassionately,
approaches derived from the ‘old paradigms’ largely
eschew attempts at understanding. Despite its continued
celebration of the value and relevance of post-positivist
methodology (cf. Guba 1991), Western culture has been
flooded with proposals for a ‘new paradigm’ of science;
one that suggests the inherent wisdom of balancing ‘masculine’ and ‘feminine’ world views. Borrowing the Oriental
metaphor of Yin and Yang, this new paradigm recognizes
that science and the arts are complementary and, more
importantly, emphasize the need to view human experience
in terms of contexts and wholes, rather than isolated parts
(cf. Barker 1998). Within the context of mental distress
and health the new paradigm emphasizes the value: in
research, of co-operative inquiry (Heron 1996); in practice,
of working alliances (Anderson 1991); in mental health, of
valuing personal experience (Chamberlin 1984, Fisher
1992); and, generally, of tolerating paradox and uncertainty (Ikehara 1995). Given these assumptions, the ‘new
paradigm’ honours people’s feelings and intuition, recognizing that in deciding upon and enacting life change a
person must first reclaim her (sic) inner wisdom and
power.
Qualitative research methods are integral to this paradigm shift and nursing has, perhaps, embraced such
approaches to human inquiry, more so than other health
care disciplines. Several studies have suggested that the
‘value’ attributed to psychiatric nursing, by people receiving nursing, is predicated on the form and function of
the interpersonal relationship (Barker 1995, Barker et al.
1997, Beech & Norman 1995, Hellzen et al. 1995, Wray
1994). These studies echo the dictum of the ANA (1980)
that nursing is focused on human responses to health care
problems rather than on the problems themselves. Of particular note, in this context, was the English national
survey of over 500 former ‘patients’ which not only
reported greater value attached to nurses over any other
discipline, but a preference for the ‘soft focus’ of relationships over formal methods of counselling or therapy
(Rogers, Pilgrim & Lacey 1993).
Even some psychiatrists have challenged the potential
confusion between what might be happening in the brain
as opposed to what might be happening within the person
(cf. Thomas 1997). Given the importance of psychopharmacology in contemporary psychiatry, Healy (1990) proposed the need to re-establish a phenomenological
approach to drug treatment: how do drugs affect the mind
or the individual consciousness? These examples suggest
that reflective psychiatrists also recognize the interpersonal
importance of the psychiatric experience: persons may
have as much of a relationship with their brains as they do
with other aspects of their experiential world.
Relationships, partnerships and alliances
These contemporary developments carry discrete implications for the role of the PMH nurse. As awareness of the
interdependent, or reflexive, nature of the interpersonal
relationship grows, it has been recognized that ‘consumers’
of mental health services need (or perhaps rather deserve) a
voice to determine their own affairs. This has led, indirectly, to greater emphasis being put upon the potential
for, or desirability of, a more collaborative style of relationship; one guided more by co-operative inquiry than the
objective style of inquisition often favoure

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