The role of mental health nurses and psychiatric nurses is much more comprehensive in today’s healthcare world than it was even just a few years ago. A mental health nursing student is trained not just to assist psychiatrists and doctors in their rounds or caseloads, but to work closely with individual patients, families, and communities. They will be making assessments, diagnosing, and helping to manage mental health conditions using a range of therapeutic approaches or modalities.
While mental health nursing is still very much a collaborative role, nurses today have a much greater degree of independence and responsibility than previously. As such, they have access to a choice of modalities, from pharmacotherapy to talking therapies in the form of different kinds of counseling. Other approaches could include occupational therapy, where the patient engages in a physical task, often art or craft-based, that takes their mind off their condition and may also help them to work through their problems.
This article explores the modalities available to mental health nurses in more detail.
The goal of mental health nursing is to improve a patient’s sense of agency and wellbeing, aiming to give them greater independence, self-direction, understanding, and contentment. A patient may have mental health-related problems in a specific area, such as interpersonal relationships, or they may have a more serious condition that leaves them unable to function in society for long periods. Mental health nursing students must develop a broad palette of skills to meet the wide and varied challenges they will encounter in their professional lives.
To this end, it is important for them to learn about different forms, categories, or modalities of therapy that can be used when appropriate in different situations and circumstances. Therapeutic modalities (sometimes called counseling modalities) are techniques or approaches to mental health therapy. Some are designed for certain conditions, while others have a broader use. A mental health professional such as a counselor or psychiatrist may use one or more of these modalities when treating a patient.
Providing therapy as a mental health nurse
Counseling and psychotherapy can be considered as distinct therapy modalities. But a counselor or therapist will use different modalities within both areas as a part of their practice. Some may specialize in a particular discipline, but most will be familiar with a range of different modalities and will apply these as appropriate to the needs of their clients.
Of course, mental health nurses are not therapists or counselors. Nevertheless, they will often build therapeutic relationships with their patients and can deliver evidence-based therapeutic practices suited to their patients’ needs. Many mental health nurses will be expected to provide some form of therapy for patients, including counseling-based therapies, as part of their day-to-day work.
Students with an MSN or DNP degree and a 3.0 grade point average can become fully qualified Psychiatric Mental Health Nursing Practitioners (PMHNPs) by taking online PMHNP certificate programs at Wilkes University. As well as learning the skills required to make full mental health assessments and administer treatment to individuals, families, and groups, they will earn a post-master’s nurse practitioner certificate. This will enable them to enter the workplace and embark upon their vocation with confidence.
All mental health nursing students should be trained in pharmacotherapy, which is the administering and dispensing of drugs and medications. This is likely the therapeutic modality that PMHNPs will most often be called upon to work with. Medication is frequently used to alleviate the symptoms of mental illness, either enabling the patient to function normally or making their condition easier to manage.
In many cases, drugs and medication are the best way of controlling a mental health condition and can also be a prerequisite to addressing underlying causes. While some mental illnesses have a psychological basis and can be successfully treated using talking therapies, others have a biological or chemical basis and are best treated using pharmacotherapy. Sometimes, the causes of mental illness are complex and may be both physical and psychological. In such circumstances, the use of medication is one of several therapeutic modalities that may be applied.
In practicing pharmacotherapy, mental health nurses need to be aware of the possible side effects of medication, both short-term and long-term. Drugs such as antidepressants, antipsychotics, and mood stabilizers are powerful chemical agents and may generate unwanted effects even while they remain the most effective way of addressing the patient’s problems. Balancing the positive with the negative, closely monitoring patient responses, and keeping the patient informed about their treatment are all part of a mental health nurse’s therapeutic practice and will contribute towards a positive outcome.
When patients have an adverse reaction to medication, they may prefer to discontinue treatment, even against medical advice. By educating patients on what to expect from pharmacotherapy, managing expectations, and being honest about both the positive and negative effects of medicine, mental health nurses can help patients make an informed decision about their treatment.
Not everyone responds to the same medication in the same way. Nurses must closely monitor patients to observe how they are reacting, and to predict as much as possible how a given drug may interact with their physiology. They must decide whether to administer the drug and what precautions to take if it is used. Mental health nursing students therefore need to build an in-depth knowledge of different medications and how they can affect patients in order to improve their chances of being successful in a professional career.
Counseling modalities: Overview
As well as medication-based therapies, there are a wide range of therapeutic modalities that can be used as part of counseling practice. Some common examples include Cognitive Behavioral Therapy (CBT), art therapy, exposure therapy, and Eye Movement Desensitization and Reprocessing (EMDR).
EMDR is often used to treat Post-Traumatic Stress Disorder (PTSD). It involves the patient moving their eyes in a specific way while recalling the traumatic event. This should help to reduce the stress they associate with the event, eventually enabling them to move on with their lives.
A mental health nurse working with patients who struggle with depression, anxiety, or low self-esteem, or who have Obsessive-Compulsive Disorder (OCD) might use CBT to change negative thought patterns into processes that are more positive and helpful. This could be applied in one-to-one sessions or as part of group therapy.
Cognitive therapies focus on changing conscious thought patterns, while a psychodynamic approach works with unconscious impulses and beliefs that may be causing the patient difficulties. A behavioral approach is concerned with changing behavior, which may or may not require working on the underlying causes. Like regular counselors and therapists, a mental health nurse might combine different modalities to best serve their patient or patient group.
Humanistic or person-centered therapies reject the implicit determinism of traditional forms of psychoanalysis in favor of a holistic approach that helps patients to realize their full potential. In humanistic therapies, the counselor or therapist encourages the patient to find the tools they need to heal themselves. This is a positive technique which originates from the premise that humans are inherently good, strong, and capable of high achievements if they are not held back by external forces such as childhood conditioning.
A mental health nurse might use a humanistic therapy technique such as gestalt therapy, transactional analysis, or transpersonal therapy to help a patient address the conditions that are holding them back. The aim is to achieve personal growth, acceptance, and self-actualization, using creativity and individual expression. In using this type of therapy, the nurse doesn’t provide a solution but helps the patient to find their own answers, gently guiding them through the process of self-discovery.
Emotional ailments like depression, anxiety, and stress can respond well to a humanistic approach. Behavioral disorders and substance abuse issues can also be successfully treated this way. Gestalt therapy uses techniques of mindfulness to help patients become more aware of themselves, their thoughts, and their actions. By recognizing the emotional patterns that they habitually repeat, and by focusing on their immediate present experience, they can affect lasting change in how they feel, think, and behave. This therapy helps them to become self-aware and wholly present in the moment, giving them greater control over their lives, as well as greater self-acceptance.
More than most other healthcare professionals, mental health nurses are expected to provide evidence-based care that supports patients in all aspects of their lives. This may mean working with a whole community rather than isolated individuals or initiating family therapy sessions. The causes and enabling factors of poor mental health are often complex and intersectional. Mental health nurses will look at non-medical contributory factors such as housing, employment, income, and personal circumstances as well as more traditional indicators of illness.
For this reason, mental health nursing students must develop skills in critical thinking, research, and clinical expertise to support evidence-based practices. These may include assertive community treatment, integrated treatment for co-occurring disorders, and illness management and recovery. Nurses may incorporate evidence-based therapeutic modalities like CBT or Dialectical Behavior Therapy (DBT).
DBT is similar to CBT but focuses on managing extreme emotions more than thought patterns. DBT uses four main techniques: mindfulness, emotional regulation, distress tolerance, and interpersonal effectiveness. Originally designed to treat borderline personality disorders, DBT has also proved effective as a treatment for PTSD, bipolar disorder, eating disorders, depression, and substance abuse.
Complementary and alternative therapies are increasingly being used in mental health nursing alongside more traditional therapeutic modalities. While nursing students may not learn about these therapies as part of their core curriculum, familiarity with how they are employed may be a useful extra skill when embarking on a professional career. As the term suggests, complementary therapies aren’t intended to replace other recognized forms of treatment like psychotherapy or medication. However, they can be useful in some cases when prescribed alongside evidence-based practice.
Over the past few decades, yoga has moved from the fringes to the mainstream and is now a popular form of physical exercise that can be scaled to the needs and ability of the individual. Yoga is also a spiritual and mental practice that is intended to calm and focus the mind. As such, it can potentially help patients with depression, PTSD, ADHD, and even more serious conditions like schizophrenia. It may also be combined with other techniques like breathwork or muscle relaxation (massage) for greater benefits.
Animal therapy is another complementary approach that uses animals including dogs and horses to improve mental wellbeing. People living with anxiety and depression may find their mood improved by the presence of these animals in a controlled setting. Many animals are highly sensitive to human emotions and will respond accordingly.
Equine-Assisted Psychotherapy (EAP) involves patients learning to ride and care for horses under professional healthcare guidance. Building a connection with an animal in this way can improve self-awareness and give patients a greater sense of self-worth and individual agency.
Expanding the nursing toolkit
The range of therapeutic modalities available to mental health nurses is impressive and continues to grow. Mental health nursing students will learn how to apply many of these techniques during their studies, as they can be considered core competencies for modern nurses. Other modalities, particularly in the field of complementary therapies, may require additional courses and qualifications.
By becoming competent in different modalities, mental health nursing students improve their employment prospects and expand the choice of tools available to them in professional life. Many therapies complement each other, and often learning a new technique will throw fresh light upon a practice the nurse already employs. Each patient they meet will have different needs, so having a selection of treatment methods available means that nurses can tailor their approach more accurately and effectively.