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
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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. Data also should be gathered regarding the role of significant
others that may provide compensatory attachment relationships, thereby
providing a secure foundation for future relationships. There are other data
that would help establish a linkage between attachment and violence. Are
there biochemical changes or other relationship supports that counterbalanced
self-esteem and autonomy issues when the attachment figure was
inadequate? Are there specific child care issues that occurred at key points
that seem to buffer the amount of aggression associated with attachment
needs? Such future work is needed to elaborate on the preliminary findings
of this study. In doing so, social scientists could provide a much needed
theoretical explanation of the etiology of male violence toward a female
intimate.
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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.
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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