Psychosocial Integrity
Therapeutic communication
Use open-ended questions, reflection, restatement, exploring, silence, and offering self. Avoid false reassurance ("you'll be fine"), giving advice, closed yes/no questioning, "why" questions, changing the subject, and agreeing with a delusion. Validate the feeling rather than the false content: "That sounds frightening" rather than "Yes, the agency is watching you." With delusions or hallucinations, acknowledge the feeling, present reality gently, and focus on safety - never argue or challenge.
Defense mechanisms
Denial, projection, rationalization, displacement, regression, sublimation, reaction formation, suppression. Items ask you to name the mechanism from a one-line behavior. Regression (bedwetting in a hospitalized child) and displacement (yelling at a spouse after a bad day) are favorites.
Grief and loss
Kübler-Ross: denial, anger, bargaining, depression, acceptance - not linear and not mandatory. Grief is individual; do not impose stages on a patient. Perinatal loss, sudden death, and anticipatory grief each carry distinct dynamics.
Crisis, abuse, and safety
A crisis is a temporary state in which usual coping fails; intervene immediately and concretely. For suspected abuse, the priority is safety and separation from the abuser, and know your mandatory reporting duty. Suicide risk: ask directly - asking does not plant the idea. Assess plan, means, intent, and history; sudden calm in a previously agitated patient may signal a decision to act.
Boundaries and milieu
Early in care, consistency, safety, and structured routine matter more than insight. The relationship is professional, not a friendship: avoid self-disclosure, gifts, and special treatment.
Worked example
A patient says, "The nurses are poisoning my food." Best response: "You're afraid the food isn't safe. I'll stay with you while you eat." That acknowledges the feeling, states reality, and keeps the patient safe - no argument, no collusion.