Peplau Theory on Interpersonal Relations & Bowlby Theory on Human Attachment Essay Assignment Paper

Peplau Theory on Interpersonal Relations & Bowlby Theory on Human Attachment Essay Assignment Paper

Peplau Theory on Interpersonal Relations & Bowlby Theory on Human Attachment Essay Assignment Paper

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 Theory on Interpersonal Relations & Bowlby Theory on Human Attachment Essay Assignment Paper

Application of Attachment Theory to Male Violence Toward Female Intimates

Peplau’s Theory of Interpersonal Relations

The future of the Theory of Interpersonal Relations – A personal reflection on Peplau’s legacy

The real and the researchable- A brief review of the contribution of John Bowlby

Joumal of Family Violence, VoL 12, No. 2, 1997
Application of Attachment Theory to Male
Violence Toward Female Intimates
John E. Kesner,!’” Teresa Julian,^ Patrick C. McKenry^
Ninety one men were interviewed regarding their intimate relationships and
childhood experiences. A secondary analysis of an extant data set was
conducted to explore the applicability of Bowlby’s attachment theory in
explaining the etiology of male intimate violence. Various attachment-related
variables were hypothesized to be related to male intimate violence. Results of
a hierarchical regression analysis indicated that the attachment cluster of
variables served as unique predictors of male intimate violence. The male’s
perceived relationship support and recollection of maternal relationship were
the two significant predictors of male intimate violence within the attachment
cluster. Race and education were also found to be significant predictors of
male violence toward a female intimate.
KEY WORDS: attachment theory; male violence; domestic violence; hierarchical regression
analysis.
INTRODUCTION
Violence perpetrated by male intimates may be the most common origin
of injuries to women (Hadiey, 1992; Stark and Flitcraft, 1985), A survey
by the National Institute of Justice reports that an average of a half million
violent acts are committed against women by intimates each year (U.S. De-
‘Department of Early Childhood Education, College of Education, Georgia State University,
Atlanta, Georgia 30303.
^Department of Nursing, Otterbein College, Westerville, Ohio 43081.
^Department of Family Relations and Human Development and Department of Black Studies,
College of Human Ecology, The Ohio State University, Columbus, Ohio 43210.
‘*Tt> whom correspondence should be addressed.
211
0885-7482/97/O60(W)211$12J0/O C 1997 Plenum Publishing Corporation
212 Kesner et at.
partment of Justice, 1994), Furthermore, 75% of all homicides of women
are perpetrated by male intimate partners (Campbell, 1992).
Despite much media attention, systematic research conceming male
hostility and aggression toward women is limited (Margolin et al., 1988;
Steinmetz, 1987). Most studies of domestic violence have been atheoretical,
focusing on conceptually unrelated individual factors such as alcohol, stage
in the life cycle, and social class—often in isolation from one another (Howell
and Pugliesi, 1988, Gelles and Comell, 1990).
It was thus the purpose of this study to apply concepts from attachment
to determine their utility in explaining to male violence toward female
intimates.
ATTACHMENT THEORY
Attachment theory (Bowlby, 1969) is an ethological theory of interpersonal
relationships that emphasizes the evolutionary significance of intimate
relationships, especially those in early childhood. Bowlby believed
that individuals possess an inbom need for close attachments to significant
others in order to survive (Bowlby, 1969). The “attachment behavioral system”
is made up of behaviors that elicit care and nurturing from primary
caregiver. Satisfaction of attachment needs by the primary caregiver enables
the individual to form a secure attachment with the caregiver. When
stressed, the attachment behavioral system achieves a state of heightened
activation motivating the individual to seek out the attachment figure for
support, nurturance and protection. Based on the history of early attachment
relationships an “internal working model” is formed which serves as
the foundation for future relationships (Bowlby, 1969). The internal working
model guides and motivates the individual’s relationship behaviors by
predicting the availability of the attachment figure to provide care and nurturance.
Thus, individuals with an insecure model(i.e., one that is based on
a history of the attachment figure not meeting attachment needs) will expect
future attachment figures to similarly not meet these needs. Individuals
who have a history of secure relationships will develop an intemal working
model of relationships that anticipates the attachment figures will meet attachment
needs.
Attachment theory has been used extensively to explain parent-child
relationships (Ainsworth et ai, 1978; Bretherton, 1987; Main et al., 1985;
Lyons-Ruth et al., 1990). There is abundant evidence supporting the role
of attachment security in infiuencing social competence in children. However,
attachment theorists and researchers believe early childhood relationAttachment
Theoty 213
ships play a major role in interpersonal relationships throughout the
lifespan (Bowlby, 1988),
Adult Attachment
Adult attachment researchers contend that romantic love is an attachment
process (Hazan and Shaver, 1987). During adult relationships,
Ainsworth (1989) argues that attachment issues are still salient and while
not replacing the initial attachment figure, the intimate other tends to become
the primary attachment figure for the individual. According to attachment
theory, individuals in adult intimate relationships are still looking
for the same sense of security and support from their partners that was
important in their secure attachment relationships during early childhood.
Hazan and Shaver (1987) have identified adult “attachment styles” that
characterize how an individual thinks about intimate relationships. These
styles represent characteristic ways of thinking about intimate relationships
based on past experiences. Additionally, they guide the interpretation of
incoming relationship information in accordance with the expectations built
into the model (Bretherton, 1987). These attachment styles have been validated
against retrospective accounts of early childhood attachment experiences
(Shaver and Brennan, 1992).
Stress and the Attachment Behavioral System
From an attachment perspective, the effects of stress can be twofold.
In childhood, stressful situations tend to activate the attachment behaviors
(attachment behavioral system) (Bowlby, 1973), causing the individual to
seek out the attachment figure for support and comfort. Excessive stress
in childhood, without amelioration by a sensitive caregiver, can negatively
infiuence the security of the developing attachment relationship, adversely
affecting one way of dealing with stress. Past research clearly indicates that
stress is highly related to relationship violence (e.g., MacEwen and Barling,
1988; Neidig et al, 1986). However, stress levels may trigger attachment
issues which lead to violence. In adult relationships, stress can be alleviated
by various coping mechanisms (e.g., including obtaining support from a secure
attachment relationship). However, if coping resources are limited due
to adverse childhood experiences, and if the source of stress is the attachment
relationship, an intense confiict can result. Thus, individuals and families
who find themselves in situations where they are unable to successfully
cope with the demands of stress find that their frustrations are likely to
214 Kesner et al.
increase, and this frustration may result in violent behavior (Dollard et al,
1939).
Individuals operating with an insecure attachment model may perceive
ambiguous behaviors by the intimate other as rejecting and unsupportive.
Thus, life stress may be compounded when one is predisposed to expect
rejection fi-om the intimate partner, and yet the intimate partner may be
the only source of support an individual has to alleviate stress.
Aggression and the Attachment Behavioral System
Aggression has been linked to the attachment behavioral system during
early childhood. Bowlby (1988) states that angry behavior is a way that
children may communicate to their primary attachment figure that their
attachment behavioral system has been activated and that attachment needs
are not being met. This generally occurs in response to a separation where
the child perceives that the attachment figure is unavailable. Bowlby termed
this “functional anger.” That is, it communicates to the attachment figure
displeasure at being separated, and if responded to appropriately by the
attachment figure, will facilitate a secure relationship.
A consistent history of insecure attachment experiences may distort
this functional anger into violence by the male. Males who batter their
wives may be utilizing physical violence during times that they perceive an
attachment need not being met by their partners. Thus violence by the
male may be a dysfunctional coping mechanism for dealing with perceived
unresponsiveness or rejection by the intimate partner.
HYPOTHESES
Separation from the attachment figure in adult relationships becomes
a matter of perceived availability of relationship support from the partner
rather than physical proximity. That is, psychological availability of the attachment
figure replaces the need for physical closeness that is important
in childhood. Thus, the male’s perception of the amount of relationship support
provided to him by his partner may impact the degree of male perpetuated
violence toward his female partner.
An individual with an insecure attachment history may not have the
usual coping mechanisms that a secure individual would have (i.e., the attachment
figure). Therefore, stress may not be able to be alleviated and,
thus an individual with an insecure attachment model may be experiencing
a high level of negative life events stress.
Attachment Theory 215
Attachment theory contends that the sense of self develops concurrently
with the intemal model of attachment relationships. Consequently,
individuals who receive insensitive and inappropriate caregiving during
early childhood may develop the sense that they are unworthy of love and
nurturing (Bretherton 1987, 1992). Additionally, Collins and Read (1990)
have found lower levels of self-esteem in adults with insecure attachment
styles. Thus, the male’s level of self-esteem may be an indicator of attachment
security and another important variable in understanding interpersonal violence.
During early childhood, the attachment behavioral system is activated
in an environment of insensitive caregiving. Chronic insensitivity by the
caregiver can result in persistent activation of the attachment behavioral
system. Bowlby posited that the attachment behavioral system, because of
its inherent survival value, dominates other behavioral systems (Bowlby,
1969), Thus, activation of the attachment behavioral system suppresses
other behavioral systems, and chronic activation may inhibit the development
of autonomy and individuation (Bretherton, 1987, 1992). If the intimate
other is the primary attachment figure, the male’s perception of how
autonomous he is in the intimate relationship may be an indicator of the
security of the relationship and may be predictive of male violence toward
the intimate.
Attachment theory contends that the success of initial attachment relationship
exerts a unique influence on subsequent relationships. Given the
fact that the majority of the caregiving in westem society is performed by
the mother this relationship is believed to have special significance. Therefore,
recollections of the mother may be an indicator of attachment history
and security.
The purpose of this study was to examine the relationship between
the attachment related factors oi perceived relationship support, negative life
events stress, self esteem, sense of autonomy, and perceived quality of early
childhood relationship and male violence toward a female intimate. The
variables in this study were selected from an extant data set, and were not
originally chosen to measure attachment. However, they were theoretically
related to attachment concepts to make them useful in this preliminary
examination of the relationship between attachment and male violence.
Specifically, it was hypothesized that attachment related variables
would be correlated with and serve as unique predictors of male intimate
violence; that is, they would account for unique variance in a model predicting
male violence against a female intimate beyond that which would
be accounted for by significant demographic variables.
216 Kesner et al.
METHODS
Subjects
A total of 94 men were interviewed; 41 were defined as physically violent
toward their spouse, and fifty were defined as nonviolent. Three subjects
were eliminated from the final data analysis because of incomplete
interviews.
Some of the violent males were recmited from a population of men
participating in a group program for male batterers at a community mental
health center in a large midwestern city. Most of the men participating in
this mental health program were court referrals; others were therapeutic
referrals. Study inclusion criteria included (a) first-time participation in the
program, and (b) involvement in an intimate relationship with a female.
Agency personnel assisted in the recmitment of subjects.
Other participants in the violent group and all of the nonviolent subjects
were solicited through newspaper advertisements for participants in
a study of men’s health and family roles. Those men whose Confiict/Tkctics
Scale scores indicated any physical violence toward their female intimate
in the past year were assigned to the violent group. Additional inclusion
criteria for the comparison group of nonviolent men were: (a) involvement
in an intimate relationship for at least the past year (i.e., married, cohabitating
or just recently divorced); and (b) annual incomes of less than thirty
thousand dollars per year and educational levels of less than fourteen years,
comparable to the men participating in the group program for male batterers
at the mental health center.
After all participants were screened, an appointment was scheduled
for a one hour, face-to-face interview. Subjects were interviewed by trained
interviewers. The participants were informed of their voluntary status, that
they could withdraw at anytime, and that their responses were confidential.
Consent forms were reviewed and signed, and subjects were reimbursed
$25 for their participation in the study. Data collection for both groups of
males took place at a university medical research center. A combination
of interview and self-report measures were used.
Sample Characteristics
As shown in Tkble I, the mean ages of the nonviolent and violent
groups were comparable (violent = 31.8, and nonviolent = 33). Approximately
percent of the violent males were Caucasian, and 38% were African-
American, whereas Caucasians represented 88% and African-American
Attachment Theory 217
represented 12% of the nonviolent group. Both groups were similar in
terms of marital status. However, a higher percentage of the violent group
reported being separated from their spouses, whereas members of the nonviolent
group were more likely to report being married. Violent subjects
reported incomes of less than $5000 more frequently than nonviolent males.
The majority of the incomes of both nonviolent and violent men fell within
the $10,000 to $25,000 range. Although both groups had roughly similar
educational levels, the participants that were categorized in the violent
group had almost 1 year less education (x = 12,71 years) than the nonviolent
group (x = 13.38 years). Most participants reported good to excellent
health; only four violent males and four nonviolent males perceived
their health as less than good.
Instrumentation
The interview consisted of various demographic background questions
as well as standardized instmmentation. Demographic data included respondent’s
age, race, marital/cohabitation status, socioeconomic status, history
of parental abuse, and health status. Poverty status was defined by an
Thhie I, Selected Sociodemographic Characteristics of Study Participants
Violent Males
(« = 41)
Nonviolent Males
(« = 50)
Age
X = 31.8 {SD = 7.63)
Race
White = 62% (n = 26)
Black = 38% {n = 16)
Marital status
Married = 31.0% (n = 13)
Separated = 21.4% (n = 19)
Divorced = 11.9% (n = 5)
Single = 35.7% (/» = 15)
tncome
Less than $5,000 = 21.4% (n = 9)
$5,000 to $10,000 = 11.9% (n = 5)
$10,000 to $24,999 = 50.0% (« = 1)
$25,000 to $30,000 = 14.3% {n = 6)
Education
X = 12.71 {SD = 2.2)
Health status
Excellent = 40.5%
Good = 40.0%
Fair = 9.5%
Poor = 0.0%
X = 33.0 {SD = 7.7)
White = 88% (n = 44)
Black = 12% {n = 6)
Married = 46% (« = 23)
Separated = 6% (n = 3)
Divorced = 10% (n = 10)
Single = 28% {n = 14)
Less than $5,000 = 6% (n = 3)
$5,000 to $10,000 = 20% (n = 10)
$10,000 to $24,999 = 50% {n = 25)
$25,000 to $30,000 = 24% {n =12)
X = 13.4 {SD = 1.7)
Excellent = 56.0% (n = 28)
Good = 36.0% {n = 18)
Fair = 8.0% (n = 4)
Poor = 0.0% {n = 0)
218 Kesner et at.
annual family income of $10,000 or less; the Federal poverty line for a
family of three was approximately $9900 in 1989 (U.S. Bureau of the Census,
1991). Males whose incomes were greater than $10,000 were categorized
as not being within the poverty range. Educational level was defined
by the number of completed years of education. The race of the subject
was defined either as Caucasian or African-American; no other racial
groups were represented.
Perceived Relationship Support
Male perceived relationship support was measured by the support
subscale of the Autonomy/Relatedness Inventory (ARI) (Schaefer and Edgerton,
1982). This subscale was computed by summing four items on the
ARI that assessed the degree to which the intimate partner provides emotional
support to the respondent. Items asked how much the partner “Is
there when I need her,” or “Does what she can to make things easier for
me,” Five possible responses ranged from “not at all like her” to “very
much like her.” These items are thought to assess issues salient to attachment
theory. Whether an individual feels that he can turn to the attachment
figure when stressed is critical for secure attachment formation. Reliability
for relationship support was found to be .91. Vahdity was moderate to
strong as evidenced by correlations with the Spanier Dyadic Adjustment
Scale (Schaefer and Edgerton, 1982). The Cronbach alpha reliability for
the entire scale in this study was .72.
Self-Esteem
Self-esteem was measured by the Rosenberg (1979) Self-Esteem Scale.
This measure is a 10-item scale with a 5-point response range from
(l)”strongly disagree” to (5) “strongly agree.” Items tap issues of esteem
such as personal qualities, abilities, and general evaluation of the self. This
measure has been found to have high intemal consistency. In this study, the
Cronbach alpha coefficient was .91. The development of the sense of self
is linked to the development of attachment models, thus, the level of selfesteem
may indicate the security of the attachment model of an individual.
Sense of Autonomy
Sense of autonomy within the interpersonal relationship was measured
by four items of the autonomy subscale of the Autonomy/Relatedness InAttachment
Theory 219
ventory (Schaefer and Edgerton, 1982). Short statements about the autonomy
of the interpersonal relationship are asked covering topics such as personal
freedom, disagreements, and decision making. Attachment theory
contends that an individual strives to achieve a balance between autonomy
and satisfying attachment needs. Failure to alleviate attachment needs will
adversely affect the individuals abilify to achieve autonomy. Five possible
responses ranged from “not at all like her” to “very much like her.” The
Cronbach alpha reliability for this scale was ,69.
Perceived Quality of Early Chiidhood Relationship
Perceived quality of early childhood relationship was measured by asking
the respondent his recollection of his mother when growing up and
how often his mother expressed love and caring. This study variable was
measured on a Likert-type scale ranging from “Never” to “Rarely.” An
individual’s recollection of the maternal relationship is a good indicator of
attachment history. This perception is a critical component of many attachment
history measures (George, Kaplan, and Main, 1987; Pottharst and
Kessler, 1991), thus demonstrating face validity.
Perceived Life Stressors
Perceived life stressors were measured with the Life Experiences Survey
(Sarason et al, 1978); this instrument assesses perceived life stressors
within the past year. This 57-item self-report measure allows for respondents
to indicate events that they have experienced during the past year
and rate whether they perceived these events as positive or negative stressors.
Items covered topics related to work, home life (including intimate
relationships), finances, and personal health. Summing the ratings provided
a negative change score, a positive change score, and a total change score.
This measure was only administered once, so test-retest reliability is not
possible to determine. However, Sarason et al report test-retest correlations
for negative change were ,19 and ,53 (p < .001), positive change .56 and .88 (p < ,001), and total change score .63 and ,64 (p < .001). Aggression/Male Perpetrated Physical Violence Toward the Female Intimate Aggression/male perpetrated physical violence toward the female intimate was measured by the Conflict-Tkctics Scale (CTS) (Straus, 1979). The (CTS) is a 19-item self-report measure in which the individual reports on 220 Kesner et at. the tactics used in conflicts with the intimate partner during the past year, and then if these tactics have ever been used. The CTS has 19 descriptions of conflict tactics that range from less to most severe with the individual answering how many times in the past year each tactic has been used. These 19 items are broken down into three subscales: (a) reasoning; (b) verbal aggression; and (c) violence. The respondent answers in relation to himself and his intimate partner, using a 7-point scale ranging from 0 times to more than 20 times. For these analyses, only the violence subscale was used which includes only actual acts of physical violence against an intimate, Cronbach’s alpha was ,82 for the entire scale and .83 for the violence subscale. The nature of this measure yields a substantial number of subjects indicating no violence. This can create a highly skewed sample. Thus, a log procedure (Moore and McCabe, 1989) was utilized to normalize the distribution. RESULTS Univariate Analyses Initial univariate analysis indicated that demographic variables, male’s educational level and race, were significantly correlated (negative) with male physical violence against an intimate partner. Because of the dichotomous nature of the sample (either African American or Caucasian) a single dichotomous variable for race was created; subjects were coded either as 1 if they were Caucasian, or 0 if they were African American, T-tests were performed out on these and other demographic variables (i.e., male’s education, male’s race, male’s income, male’s marital status, and male’s physical health) to determine differences between the violent and nonviolent groups. Race was the only one of these demographic variables that showed significant differences between violent and non-violent males (t = 3,46, p < .01), Additionally, self-esteem, perceived relationship support, perceived relationship autonomy, and the male’s recollection of his mother, were significantly related (negative) with male physical violence. Male negative life events stress was positively related to male violence as indicated in Tkble II, Multiple Regression Analysis A hierarchical regression analysis was used to address study hypotheses because the intent of the study was to demonstrate a unique effect of attachment factors on male violence beyond that variance explained by demoAttachment Theory 221 •c p II O II ° II p ON ON .1), ON I II 3 II ° II o II S II 33 II p II p II ^ II O « ON » ON • ON on I N II jS l’ I 11 -I ..” o o -a II ,-i II ON ON ; II :: II m II c5 I li1 11 .,” o p II ^ II S II e * o i” li V V V 222 Kesner et al. graphic variables. Hierarchical regression determines if the addition of a set of variables significantly increases the i?^ accounted for beyond a previous set of variables (Cohen and Cohen, 1983). The independent variables were analyzed by structuring them in two clusters, demographic and attachment. The first cluster, included traditional demographic variables (i.e., race and educational level). Education and race were included because of their significance in relation to violence in the univariate analyses. The model that included only demographic variables accounted for 13% (F = 6.45, p < .01) of the variance in predicting male violence. Both male’s education and race were significant predictors of male violence (see Ikble III). The second cluster included the first cluster as well as the attachment related variables. The analysis indicated that the addition of attachment variables (i.e., perceived quality of early childhood mother-son relationship, self esteem, relationship support, sense of autonomy, and perceived life stressors) significantly increased the R^ of the model by 27% (F = 7.50, p < ,01). The model that included demographic and attachment related variables accounted for 40% of the variance in predicting male violence (F = 7,88, p < .001). The best predictor in this model was male perceived relationship support (F = 8.09, p < .01) (see Tkble IV). Other predictors in order of significance were race (F = 6.21, p < .05); recollection of mother (F = 5.15, p < .05); and education(F = 2.96, p < .05). Results of a stepwise regression using all independent variables yielded four significant variables, and also indicated that male perceived relationship support was the best predictor in the model. In order of entry into the regression equation, the variables were as follows: male perceived relationship support (F = 24.06,;? < .001); male life events stress (F = 7.39, p < .01); male’s recollection of mother (F = 5,34, p < .05); and male’s race (F = 6.40, p < .01). Because stress may interact with childhood and adult variables, resulting in variations in attachment with level of stress, interaction terms were Ibhle tu. Multiple Variable Male’s education Male’s race F^ = .13 F = 6.45 p < .01. Regression Analysis of Male Violence Tbward Female Selected Demographic ^riables Standardized Regression Coefficient -.10 -.63 Standard Error .05 .22 F 4.49 8.42 tntimates and P < .05 .01 Attachment Theory 223 Ihble IV Multiple Regression Analysis of Male Physical Violence Tbward a Female tntimate and Selected Independent Variables Variable Male’s education Male’s race Male’s recollection of mother Male’s preceived relationship support ^= .40 F = 7.88 p < .001. Standardized Regression Coefficient -.07 -.49 -.16 -.07 Standard Error .04 .20 .07 .02 F 2.96 6.21 5.15 8.09 P < .05 .05 .05 .01 created with two child attachment related variables and three adult attachment related variables. None of the interaction terms proved to be significantly related to male violence against a female intimate. DISCUSSION Results of these analyses indicate the potential value of an attachment theoretical perspective in predicting male physical violence against a female intimate. The model developed through the data analysis supports a major tenet of Bowlby’s (1969) attachment theory (i.e., early parent-child relationships may infiuence intimate relationship behavior throughout an individual’s life span). Results of this study indicated that the cluster of attachment-related variables was significantly related to male violence in interpersonal relationships. Specifically, violence in males was related to: (a) a perceived deficiency in love and caring from their mother while growing up; (b) lower self-esteem; (c) perception of less relationship support; (d) perceptions of low relationship autonomy and (e) number of recent life stressors. The strongest predictor of male violence in the regression model was male’s perceived relationship support from his female intimate. Although not specifically designed to measure attachment, the adult’s abilify to feel support from the intimate other may be a direct reflection of attachment securify. The fact that the male’s recollection of his relationship with his mother was also a significant predictor of male aggression further supports the salience of attachment issues in understanding male violence. Although this variable was not specifically designed to assess childhood attachment 224 Kesner et al. history, it assesses the male’s current understanding of his relationship with his mother. The perception of childhood attachment relationships is a critical component of adult attachment status (George et al, 1987). According to attachment theory, individuals who received insensitive and inappropriate caregiving from their primary attachment figure in childhood are more likely to have expectations for similar treatment in adult attachment relationships. That is, insecure attachments in childhood create models about intimate relationships that may persist into adulthood. The aggression that served a functional purpose in childhood by communicating attachment needs may become distorted into violence by the male who perceives the same insensitivify in his attachment relationship in adulthood even though it may not exist (Mayseless, 1991). Life events stress also appeared to have a significant effect on male violence. Although not significant in the multiple regression analysis, life event stress was the second variable to enter a stepwise regression analysis. In terms of attachment per se, the lack of interaction effect between attachment and life events stress on the dependent variable suggests that life stress did not confound the attachment system resulting in greater violence. The findings of this study did not indicate that the female intimates were ineffective primary attachment figures. It may be that men with insecure attachment histories may have unrealistic expectations which their partners can never fulfill. In these analyses male’s perception of relationship support is a key predictor of male intimate violence. Such findings would imply that female intimates may be in a vulnerable position with men who have insecure attachments. Consciously or unconsciously, the adult male may be predisposed to believe that the new primary attachment figure will not be available to assist him in times of stress and thus react with extreme aggressive behaviors. In addition, the findings of this study indicated that race and education were important variables in understanding male violence toward female intimates. Past findings relative to the relationship between African-American men, decreased educational opportunities, and the propensify for violence have been inconsistent (Allen and Straus, 1980; Stark and McEvoy, 1970). Void (1986) notes that violence among African-Americans is better explained by structural factors such as resource inequalify. It is important to note that in the stepwise regression analysis, race was the last variable to enter the model. Although a significant predictor, it only added 4% to the variance accounted for in this model. However, in this sample, Caucasians and African-Americans had similar earning power and educational attainment. Also, there were no racial differences in perceived life stressors. In addition, African-Americans in this study were significantly more likely to view their relationship with their female partner negatively. According to Attachment Theory 225 Staples (1988), there is tension in the Black male and Black female relationship because of the lack of opportunities available for Black males to succeed in the traditional good provider role. Also, the greater independence of Black women makes it even more difficult for men to engage in traditional role behaviors, what Franklin (1984) terms “incompatible role enactments,” Ball and Robbins (1986) found, in fact, that being married was a stressor for Black men and was actually related to lower levels of well-being. CONCLUSIONS In terms of applying attachment theory to understanding male intimate violence, again caution should be exercised in drawing conclusions from this data. First, this research is based on the selection of study participants who corresponded to specific demographic characteristics (i.e., characteristics similar to the men who were mandated by the courts to participate in a communify agency’s batterers program). Second a noncausal model was used, it is not possible to state the direction of the relationship between male violence and the variables of interest. For example, violent episodes may have influenced perceptions of the intimate relationship. However, it was not the purpose of this study to establish causalify, but merely to determine the relationship of specific theoretically related variables to male violence toward female intimates. Also, this was a secondary analysis of an extant data set. The variables used were not originally designed to measure attachment and although they are conceptually similar to attachment issues there generalizabilify is limited. However, these data do provide some tentative support for an attachment perspective . In so doing, this study helps to fill a void in the literature which has traditionally been bereft of theory. Despite these limitations, these findings suggest some tentative implications for prevention and treatment programs. The findings in this study suggests the infiuence of early relationships in forming a foundation for future relationships. Thus, programs and policies that attempt to reduce the incidence of adult male violence toward female intimates might profit from primary interventions that begins in childhood by providing educational opportunities to parents that enable them to provide the secure and nurturing caregiving that is critical to the child’s optimal development. Individuals who provide a secure base for their children may help to prevent dysfunctional anger. Also, the study’s findings suggest the utilify of individual and family therapy. Violence-prone individuals still may be dealing with attachment 226 Kesner et al. issues that remain from their own childhoods. Individual and family therapy may be the means of providing couples with appropriate interpersonal expectations, insight into their own behavior, individual behavioral responsibilify, and new behaviors associated with appropriate attachment-related behaviors and nonviolence. The findings of this study also suggest the importance of the two demographic variables included in the analysis. That is, the significance of education and race underscores the importance of macro level indicators that would increase the resource base and self esteem of lower socioeconomic status African-American males. Along with macro system changes, it is critical that culturally relevant methods of both studying and interviewing African- American and lower SES families be developed and implemented. In future efforts to determine the viabilify of an attachment perspective in predicting domestic violence, researchers should utilize established attachment instruments to more fully determine the applicabilify of this theory to family violence. In addition, future research might provide insights into the role of attachment in domestic violence by identifying the coping mechanisms of nonviolent males who report poor attachment relationship histories. 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A., and Waters, E. (1977). Attachment as an organizational construct. Child DeveL 49: 1184-1199. Staples, R. (1988). The Black Am. Family. In Mindel, C. H., Habenstein, R. W, and Wright, R. (eds.). Ethnic Families in America, Elsevier, Amsterdam, The Netherlands. Star, B. (1980). Patterns of Family Violence. Social Casework 61: 261-263. Stark, E., and Flitcraft, A. (1985). Souse abuse. In Surgeon General Violence and Public Health Sourcebook, Center for Disease Control, U.S. Public Health Service, Atlanta. Stark, R., and McEvoy, I. (1970). Middle-class violence. PsychoL Today 4: 52-54. Steinmetz, S. K. (1987). Family violence: Past present and future. In Sussman, M. B., and Steinmetz, S. K. (eds.). Handbook of Marriage and the Family, Plenum Press, New York, pp. 725-765. Straus, M. A. (1980). Social stress and marital violence in a national sample of American families. Symposium on Forensic Psychology and Psychiatry, New York Academy of Sciences. 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M., Stevenson-Hinde, J., and Marris, P (eds.), Attachment Across the Life Cycle, Routledge, London, pp. 42-62. Wodarski, J. (1987). An examination of spouse abuse: Practice issues for the profession. Clin. Social Work J, 172-187. Peplau Theory on Interpersonal Relations & Bowlby Theory on Human Attachment Essay Assignment Paper 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. 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 PhD 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 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. 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. 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. 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 them- Future 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 favoured by the ‘old paradigm’. Contemporaneously, the value (and virtue) of psychotherapy in general has been attacked (Masson 1988), and many mental health service consumers appear openly antagonistic to any form of ‘systematic’ therapy (Rogers, Pilgrim & Lacey 1993). Although representing differing perspectives, these critiques invite us to consider the potential of concepts such as ‘working in partnership’ (cf. DoH 1994). Given that partnerships are predicated on equality, conspicuously absent from most, if not all, care and treatment settings, it might be more appropriate to consider a future established on alliances (cf. Bordin 1976). Such a concept might form the basis for exploring the interpersonal relationship between nurse and patient (sic). This concept might also represent a new dimension for the supervisory and mentoring relationship which, despite widespread popularity, is still misunderstood (Barker 1990). More than 30 years ago Peplau began to identify some of the issues involved (O’Toole & Welt 1989, p. 165): (what would it [clinical supervision] be like?), e.g. a systematic study of instances of clinical data in one case or several cases; relevant literature; and a beginning formulation of an explanation of the data. The kind of supervisory relationship which Peplau was discussing appeared to be predicated on a power relationship: where the supervisor and supervisees were defined, at least in part, by their respective qualifications, experience, etc. Currently, I am a member of a peer supervision group where, despite my professional status as ‘the Professor’ I am re-defined – by my colleagues – as being on the same level as the most ‘junior’ staff nurse member. The agenda for all meetings of the group are mutually negotiated and, despite the differentials in length of experience and social status, my contribution is (in principle) of no greater value P. Barker 216 © 1998 Blackwell Science Ltd, Journal of Psychiatric and Mental Health Nursing 5, 213–220 than that of any other member. Such developments in the structure of clinical supervision suggest the potentially limitless range of ways in which nurses might come to know their professional practice (cf. Reynolds 1982). Such developments might even reflect one way in which the basic tenets of Interpersonal Theory might be used in contemporary practice to cover the processes governing the relationship with self and others, of both patients & nurses. The focus on the person: a future for human inquiry? In her keynote address to the second ‘State of the Art in Psychiatric Nursing’ conference, held in Columbus, Ohio in 1974, Peplau returned to one of her prevailing interests – people in schizophrenia. Perhaps, of equal significance to her consideration of how nurses might address the human responses associated with schizophrenia (cf. ANA 1980), was her assertion that nurses needed to emphasize the ‘personhood’ of patients. Two decades earlier, at the first ‘State of the Art’ conference, she urged her colleagues to recognize that (Peplau 1995): It is not enough to preach commitment to nursing or to patients. The commitment of a professional requires thinking deeply about unanswered questions, doing something to clarify them, and reporting results of actions to colleagues in the profession at large. Peplau’s concern to explore the ‘personal’ and ‘human’ context of the expression of mental distress echoed the early writing of Harry Stack Sullivan, with whom Peplau worked early in her career at Chestnut Lodge (Barker 1993). Sullivan had observed that even the ‘most peculiar behaviour’ of the acutely schizophrenic patient was intelligible, since it comprised interpersonal processes ‘with which each one of us is or historically has been familiar’ (Sullivan 1947). In Sullivan’s view people were ‘all much more simply human than otherwise’, leading him to conclude that it was possible to understand psychotic phenomena, since we are all more alike than different. Sullivan represented a radical stance in post-war psychiatry that most of his contemporaries found too uncomfortable. His emphasis of the interpersonal and human nature of psychiatric care and treatment was revived 20 years later when Laing paid homage to Sullivan’s respect for the ‘patient’, repeating the apocryphal story that Sullivan told all young psychiatrists who came to work with him (Laing 1967): I want you to remember that in the present state of our society the patient is right and you are wrong. It was not surprising that Sullivan’s views found an echo in the psychiatric counterculture of the 1960s. Given her history, neither is it surprising that Peplau should appear to be advocating a more inductive approach to gaining real understanding of the human experience of what is designated mental illness – through an acknowledgement of the personal nature of such experience. What is, perhaps, surprising is that in the late 1990s some psychiatric nurses advocate that we should return to the method of approaching patients (sic) against which Sullivan cautioned more than 50 years ago: treating people designated patients as if they were all likely to present the same phenomena (cf. Gournay 1995). There is room for all manner of inquiry in PMHN. However, attempting to understand the experience of human distress associated with mental illness (sic) may well be the ‘proper focus of nursing’ (Barker & Reynolds 1996; Barker, Reynolds & Stevenson 1997). The furtherance of an ‘existential epistemology of mental health’ may be one of the threads of human inquiry that will link tomorrow’s psychiatric nurses with Peplau’s original theory and may, in practice terms, be the royal road to care. Psychiatric nursing practice research: grounded inquiry As Peplau observed, nursing has for at least a generation espoused the virtues of person-centredness or holism or both (Peplau 1995). In keeping with such an attitude it may be appropriate for nurses to approach the person (sic) in much the same way that a student approaches any ‘subject’; with the expectation of learning something of interest or value. In my own clinical work and research I have attempted to extend the basic Peplau method (if there is such a thing) to integrate the twin philosophies of ‘personhood’ and ‘holism’ (Barker 1996b). Almost a decade ago I counselled a young woman who had been described as having a depressive illness, in association with an ‘interpersonal relationship problem’, involving ‘especially men’. Her problems were attributed to her experience of rape in her early teens. When I first met her she was reluctant to discuss anything at all, and mumbled inaudibly in response to my question: ‘What have you brought along that you would like to talk about?’ (cf. Robinson 1983). Wholly intuitively I found myself saying: OK, maybe there is nothing that you would like to talk about. Maybe there is something that you need to talk about but don’t want to talk about. Talk about that then, but don’t tell me what it is. When she appeared perplexed by this suggestion, again intuitively, I said: ‘well . . . just call it “X” or the “blue banana”!’ (at which point she laughed, incredulously). After a pause, I returned to the tried-and tested interviewing technique that I had derived from Peplau’s writings: OK, tell me . . . when did you first notice that X (or are Future of Interpersonal Relations © 1998 Blackwell Science Ltd, Journal of Psychiatric and Mental Health Nursing 5, 213–220 217 you going to call it the blue banana) was a problem for you? The rest was, as they say, history. I saw the young woman only twice: the second time when she came back to report that ‘things are much better’ and that she had ‘got my life back on track’. From that single clinical experience, I developed a method for teaching nurses how to interview people without knowing what (exactly) was the patient’s problem. This allows the exploration of at least eight dimensions of any anonymized problems: from its ‘origins in time’ to its holistic context (Barker 1997). A delimited study (Barker 1996b) suggested that nurses can explore the person’s problem without becoming overly concerned with the detail of the story, and in the process appear, by the patient’s account, to develop considerable rapport. More importantly, the approach affords the person qua patient a degree of security that might prove helpful in the early stages of the development of therapeutic relationship. Although nurses could apply this method in any clinical situation, it may have special applications in contexts where the patient is reluctant to discuss the focal phenomenon, for fear of negative evaluation by the nurse or others: experience of sexual abuse or hallucinations. Other areas of practice that offer fertile conditions for the further examination of Peplau’s theory in its original form, or as part of some wider research brief include: • the assessment of the patient’s interpersonal world (Barker et al. 1997); • mutual assessment of the nurse–patient relationship; • the outcomes of focused relationships – e.g. on the experience of discrete phenomena such as hearing voices; • the experience of long-term drug therapy; and • invisible forces and subconscious crises. I was honoured to be asked to give the first keynote address to the inaugural conference of the nursing section of the Association of Psychoanalytic Psychotherapists in the NHS (APP) at the Tavistock Clinic in London in 1996. In my paper I discussed the respective contributions made by Peplau – and her British counterpart, Annie T. Altschul – to the development of interests and expertise in the therapeutic use of the nurse-patient relationship (Barker 1997, Winship 1997). I was struck by the number of participants – many of them sophisticated nurse psychotherapists – who knew little of Peplau’s work, or the huge literature associated with her Theory of Interpersonal Relations. I was similarly intrigued by the relative absence of references to the nursing literature in some of the clinical papers that followed. This experience echoed Peplau’s observation, made in her Preface to the report on the first state of the art conference (Huey 1975; Peplau 1995, p. ix): Psychiatric nures need to judge what has been done in the light of such questions as: How adequate is the published theory? Is it all borrowed from other basic or applied sciences or have psychiatric nurses suggested new concepts or practices or expanded existing ones? In the light of changing nurse practice acts and other social and health care trends, what are the weak, unexplored, untouched areas that should capture the interest of psychiatric nurses in theory scholarly and research efforts in the years ahead? In that same Report Lego (Lego 1995 p. 82), describing developments in the ‘one-to-one nurse–patient relationship’, observed that, despite Peplau’s primacy in the nursing theory literature, at that time (1974 – Peplau 1995, p. 2): most psychiatric nursing textbooks, while emphasising the nurse-patient relationship, base nursing actions on non-nursing theory, particularly psychoanalytic or sociocultural theory. Twenty years later, Peplau echoed that observation, when she commented on ‘seven recently published books on PMHN’: I expected to find a psychiatric nursing approach to the care of persons diagnosed as schizophrenic that would be complementary to but different from the prevailing biomedical model of psychiatric treatment. The DSMIII-R . . . was presented in whole or in part in virtually all chapters. In several texts, schizophrenia was described with pessimistic words such as ‘irreversible’, ‘chronic’ and life-long, rather than as a persistent enigma for which the health professionals have not yet found reliable explanatory theories and effective remedial measures. . . . Most of the bibliographic references cited were non-nursing psychiatric ones; only two authors used quite a few nursing publications; one author did not use any nursing references (emphasis added). I was struck by the fact that, 20 years into her retirement, Peplau retained a sense of purpose, concerning the clarification of nursing theory and practice. She also exhibited a concern for the human condition, which appeared to be missing from my generation, who were still young children when Peplau first published her seminal text (Peplau 1952). One might argue that, in her advocacy for ‘persons’ in schizophrenia (or indeed any other category of human distress), Peplau is still holding the baton of human inquiry (and compassion) that may have been held by Sullivan, and was held briefly by Laing and others. Clara Thompson, a long-time colleague of Sullivan’s, suggested that his principal contribution to psychiatry was a very simple idea (Hausdorff 1985): . . . ever present awareness of the need to convey respect for the patient and to maintain the patient’s own selfesteem. P. Barker 218 © 1998 Blackwell Science Ltd, Journal of Psychiatric and Mental Health Nursing 5, 213–220 Sills’ appreciation of Peplau (Sills 1989) clearly indicates that she perceived her in a similar light. If psychiatric nurses could continue to explore, collaboratively – with the people in their care – the experience of human distress, then they might honestly be said to be ‘working in partnership’ (DoH 1994) or involved in the development of ‘mental health nursing’, predicated on human growth and development, derived from the logic of their own experience (Barker 1996b). Notes 1 Where I am making ‘personal’ observations it seems appropriate to employ the first person. 2 I use this conjoint title to convey the mutual interdependence that I believe Peplau intended. 3 My speculations about the future are, like most such thoughts, woven through my past and present experiences. References American Nurses Association (1980) Nursing: A Social Policy Statement. Author, Kansas, MO, USA. Anderson T. (1991) The Reflecting Team. Norton and Co., NY, USA. Barker P. (1990) Psychiatric nursing. In Clinical supervision and mentorship in nursing (eds Butterworth T. & Faugier J.). 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(1997) Establishing the role of the nurse psychotherapiost in the United Kingdom. Perspectives in Psychiatric Care 33, 25–30. Wray S.J. (1994) Schizophrenia sufferers and their carers: a survey of understandings of the condition and its treatment and of satisfaction with services. Journal of Psychiatric and Mental Health Nursing 1, 115–123. P. Barker 220 © 1998 Blackwell Science Ltd, Journal of Psychiatric and Mental Health Nursing 5, 213–220 Peplau Theory on Interpersonal Relations & Bowlby Theory on Human Attachment Essay Assignment Paper 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. Peplau Theory on Interpersonal Relations & Bowlby Theory on Human Attachment Essay Assignment Paper