# Situation: The nurse works on an acute psychiatric unit that uses milieu therapy, attitude therapy, and planned activity groups. Each client has an individual plan of care with measurable outcomes. A 35-year-old man with persecutory delusions watches the staff closely and refuses to sit near staff in group activities. Under attitude therapy, which attitude should all staff use with him?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630013  
> 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: The nurse works on an acute psychiatric unit that uses milieu therapy, attitude therapy, and planned activity groups. Each client has an individual plan of care with measurable outcomes.

A 35-year-old man with persecutory delusions watches the staff closely and refuses to sit near staff in group activities. Under attitude therapy, which attitude should all staff use with him?

## 보기

1. Active friendliness: seek him out and offer help before he asks
2. Passive friendliness: be available but let him set the pace **✔ 정답**
3. Kind firmness: expect him to carry out requests without delay
4. Matter-of-fact: respond casually and give no special attention

**정답: 2**

## 해설

Attitude therapy prescribes one consistent staff attitude based on the client's behavior: active friendliness for withdrawn clients, passive friendliness for suspicious clients, kind firmness for depressed clients, matter-of-fact for manipulative clients, and no demand for assaultive clients. A suspicious client needs staff who are available but do not force closeness.

## 심화 해설

One consistent attitude matched to the behavior
Attitude therapy prescribes a single staff attitude that every team member uses with a client, chosen according to the client's main behavior. Consistency is the active ingredient: when all staff respond in the same way, the client receives a clear and predictable message. This 35-year-old man has persecutory delusions, watches staff closely, and refuses to sit near them. A suspicious client is given passive friendliness: staff remain available and friendly but let him set the pace of contact.

Why passive friendliness fits a suspicious client
A person who believes others intend to harm him experiences approach as threat. Seeking him out, offering help before he asks, or sitting close increases his distrust and anxiety and may provoke defensive aggression. Passive friendliness communicates interest and acceptance without pressure: staff greet him, stay nearby at a comfortable distance, keep promises, and wait for him to approach. Over time this predictability allows trust to develop.

| Client behavior | Prescribed attitude |
| --- | --- |
| Withdrawn, apathetic | Active friendliness |
| Suspicious, distrustful | Passive friendliness |
| Depressed | Kind firmness |
| Manipulative | Matter-of-fact |
| Assaultive or acting out | No demand |

Why the other attitudes do not fit
Active friendliness, in which staff seek the client out and offer help freely, is prescribed for withdrawn, apathetic clients who need encouragement to engage. Kind firmness is prescribed for depressed clients, who benefit from clear, confident expectations that reduce indecision. A matter-of-fact attitude, casual and without special attention, is prescribed for manipulative clients so that manipulation is not rewarded. None of these suits a client whose main problem is distrust.

Watch out! With a suspicious client, also avoid whispering or laughing near him, keep explanations simple and honest, and do not argue with the delusion. Offer sealed or self-served food if he fears poisoning.

Exam takeaway
Key point! Attitude therapy pairs behaviors with attitudes: withdrawn with active friendliness, suspicious with passive friendliness, depressed with kind firmness, manipulative with matter-of-fact. The whole team uses the same attitude consistently.

## 임상 시나리오

Attitude TherapyPassive friendliness for a suspicious client
A client with persecutory delusions who watches staff and avoids sitting near them is suspicious. The prescribed attitude is passive friendliness.

Staff stay available and friendly at a comfortable distance, keep promises, and let him set the pace of contact. All staff use the same attitude.

Active friendliness suits withdrawn clients, kind firmness suits depressed clients, and matter-of-fact suits manipulative clients.

CautionPressing attention on a suspicious client increases distrust and may provoke defensive aggression.

## 핵심 개념

- **Attitude therapy** — A milieu approach in which all staff use one prescribed attitude toward a client based on the client's behavior.
- **Passive friendliness** — An attitude of availability and warmth without pressure, prescribed for suspicious clients.
- **Persecutory delusion** — A fixed false belief that one is being harmed, followed, or plotted against.
- **Milieu therapy** — Use of the whole ward environment, its people, routines, and activities, as a means of treatment.

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