# Situation: A nurse on the psychiatric ward of a general hospital is assigned to a 34-year-old woman admitted for major depressive disorder. The nurse will hold one-to-one sessions with her three times a week during her expected 4-week stay. In the second week, whenever the nurse asks about her marriage, she changes the subject to the hospital food. She has also arrived 15 minutes late to the last two sessions. What should the nurse do?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=629998  
> language: ko  
> subject: Nursing Practice V — Care of Clients with Maladaptive Patterns of Behavior; Care of Clients with Life-Threatening Conditions, Acute Multi-Organ Problems, High Acuity and Emergency Situations

## 문제

Situation: A nurse on the psychiatric ward of a general hospital is assigned to a 34-year-old woman admitted for major depressive disorder. The nurse will hold one-to-one sessions with her three times a week during her expected 4-week stay.

In the second week, whenever the nurse asks about her marriage, she changes the subject to the hospital food. She has also arrived 15 minutes late to the last two sessions. What should the nurse do?

## 보기

1. Shorten the sessions until she shows she is ready to talk
2. Tell her the marriage must be discussed to meet the contract goals
3. Gently note the pattern and explore what makes the topic hard **✔ 정답**
4. Go back to the orientation phase and rewrite the contract

**정답: 3**

## 해설

Changing the subject and arriving late when painful material comes up are signs of resistance, which is expected in the working phase. The nurse explores it gently and does not force the topic, so the client can face the anxiety at a tolerable pace.

## 심화 해설

Recognizing resistance in the working phase
In the second week, whenever the nurse asks about her marriage, the client changes the subject to the hospital food, and she has arrived 15 minutes late to the last two sessions. These behaviors appear when painful material comes close, which is the classic picture of resistance. Resistance is an expected event in the working phase, when the client begins to face difficult issues. The nurse gently notes the pattern and explores what makes the topic hard, without forcing it or ignoring it.

Why gentle exploration works
Resistance protects the client from anxiety that feels overwhelming. Pointing out the pattern in a calm, nonjudgmental way, for example, "I notice that when we talk about your marriage, we move to another topic. What is it like to talk about it?", helps her become aware of the avoidance and invites her to examine it. This allows her to approach the painful topic at a pace she can tolerate. The relationship stays consistent, and trust built in the orientation phase is used to support the work.

| Option | Effect |
| --- | --- |
| Shorten the sessions until she is ready | Rewards avoidance and makes the relationship less consistent |
| Tell her the marriage must be discussed | Raises anxiety and increases resistance |
| Gently note the pattern and explore it | Builds insight at a tolerable pace |
| Go back to orientation and rewrite the contract | Misreads a normal working-phase event as failure |

Why the other responses are wrong
Shortening the sessions reduces contact precisely when support is needed and teaches her that avoidance works. Insisting that the marriage must be discussed to meet contract goals turns the session into a power struggle and usually increases resistance. Returning to the orientation phase and rewriting the contract treats a normal part of the working phase as a sign that the relationship has failed; the contract remains valid, and the nurse may simply remind her of its terms, such as the session time.

Watch out! Lateness, missed sessions, changing the subject, and superficial talk are all forms of resistance. Also consider transference, in which the client reacts to the nurse as she would to someone from her past.

Exam takeaway
Key point! Resistance is expected in the working phase; the nurse explores it gently, neither forcing the topic nor ignoring the pattern. Consistency in session time and length supports the work.

## 임상 시나리오

Resistance in the Working PhaseChanging the subject and arriving late
Changing the subject when painful topics come up and arriving late to sessions are signs of resistance, which is expected in the working phase.

Gently note the pattern and explore what makes the topic hard, so she can face the anxiety at a pace she can tolerate.

Keep sessions consistent. Shortening them rewards avoidance, and forcing the topic increases resistance.

CautionResistance does not mean the contract has failed; there is no need to return to the orientation phase.

## 핵심 개념

- **Resistance** — A client's avoidance of anxiety-provoking material, such as changing the subject or arriving late.
- **Working phase** — The phase in which the client explores problems, gains insight, and practices new behaviors.
- **Transference** — A client's unconscious reaction to the nurse based on feelings toward someone from the past.
- **Therapeutic contract** — An agreement on the time, place, length, and goals of the nurse-client sessions.

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