psychosocial theories.ppt

7/27/2019 PSYCHOSOCIAL THEORIES.ppt

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PSYCHOSOCIAL THEORIES

Review


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SIGMUND FREUD: THE FATHER OF PSYCHOANALYSIS

Freud believed that repressed (driven from conscious awareness)sexual impulses and desires motivated much human behavior.

He developed his initial ideas and explanations of human behaviorfrom his experiences with a few clients, all of them women who

displayed unusual behaviors such as disturbances of sight andspeech, inability to eat, and paralysis of limbs.

These symptoms had no physiologic basis, so Freud consideredthem to be the hysterical or neurotic behavior of women. Afterseveral years of working with these women, Freud concluded thatmany of their problems resulted from childhood trauma or failure tocomplete tasks of psychosexual development.

These women repressed their unmet needs and sexual feelings aswell as traumatic events. The hysterical or neurotic behaviorsresulted from these unresolved conflicts.


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Personal i ty Components: Id, Ego, and Superego .

Freud conceptualized personality structure as havingthree

components: (id, ego, and superego).

The id is thepart ofones nature that reflects basic or innate desiressuch as pleasure-seeking behavior, aggression, and sexualimpulses. The id seeks instant gratification; causes impulsive,unthinking behavior; and has no regard for rules or social

convention.

The superego is the part of a persons nature that reflects moraland ethical concepts, values, and parental and socialexpectations;therefore, it is in direct opposition to theid.

The third component, the ego, is the balancing ormediating forcebetween the id and the superego. Theego represents mature andadaptive behavior that allowsa person to function successfully in theworld.Freud believed that anxiety resulted from the egosattemptsto balance the impulsive instincts of the idwith the stringent rules ofthe superego. The accompanying drawing demonstrates the

relationship ofthese personality structures.


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Behavior Mot ivated b y Subc onsc ious Thoughts and Feelings.

Freud believed that the human personality functions at three levels ofawareness: conscious, preconscious, and unconscious (Gabbard,2000).

Conscious refers to the perceptions, thoughts, and emotions thatexist in the persons awareness such as being aware of happyfeelings or thinking about aloved one.

Preconscious thoughts and emotions are not currently in thepersons awareness, but he or she can recall them with someeffortfor example, an adult remembering what he or she did,thought, orfelt as a child.

The unconsc ious is the realm of thoughts and feelings thatmotivate a person, even though heor she is totally unaware of them.

This realm includes most defense mechanisms (see discussionbelow) and some instinctual drives or motivations. According toFreuds theories, the person represses into the unconscious thememory of traumatic events that are too painful to remember.


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Freud believed that much of what we do and say ismotivated by our subconscious thoughts or feelings(those in the preconscious or unconscious level ofawareness).

A Freudian slip is a term we commonly use todescribe slips of the tonguefor example, saying, Youlook portly today to an overweight friend instead of,You look pretty today. Freud believed these slipswere not accidents or coincidences; rather, they were

indications of subconscious feelings or thoughts thataccidentally emerged in casual day-today conversation.

Behavior Mot ivated b y Subc onsc ious Thoughts and Feelings.


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Freuds Dream Analysis.

Freud believed that a persons dreams reflected his or hersubconscious and had significant meaning, although sometimes themeaning was hidden or symbolic (Gabbard, 2000).

Dream analysis, a primary method used in psychoanalysis,involves discussing a clients dreams to discover their true meaningand significance.

For example, a client might report having recurrent, frighteningdreams about snakes chasing her. Freuds interpretation might bethat the woman fears intimacy with men; he would view the snake asa phallic symbol, representing the penis.

Another method used to gain access to subconscious thoughts andfeelings is free association in which the therapist tries to uncover

the clientstrue thoughts and feelings by saying a word and askingthe client to respond quickly with the first thing that comes to mind.Freud believed that such quick responses would be likely to uncoversubconscious or repressed thoughts or feelings.


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Ego Defense Mechanism s.

Freud believed the self or ego used ego

defense mechanisms, which are

methods of attempting to protect the self

and cope with basic drives or emotionallypainful thoughts, feelings, or events.


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Five Stages of Psychosexual Developm ent.

Freuds based his theory of childhooddevelopment on the belief that sexual energy,termed libido, was the driving force of humanbehavior.

He proposed that children progress throughfive stages of psychosexual development:

1. Oral (birth to 18 months),

2. Anal (18 to 36 months),

3. Phallic /oedipal (3 to 5 years),4. Latency (5 to 11 or 13 years), and

5. Genital (11 to 13 years).


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Five Stages of Psy chosexual Development.

FocusAgePhase

Major site of tension and gratification is the mouth, lips, and tongue; includes biting and sucking

activities.

Id present at birth

Ego develops gradually from rudimentary structure present at birth.

0-18 monthOral

Anus and surrounding area are major source of interest.

Acquisition of voluntary sphincter control (toilet training)

18-36 mothsAnal

Genital focus of interest, stimulation, and excitement

Penis is organ of interest for both sexes.

Masturbation is common.

Penis envy (wish to possess penis) seen in girls; oedipal complex (wish to marry opposite-sex parent and

be rid of same-sex parent) seen in boys and girls

3-5 yearsPhallic/

Oedipal

Resolution of oedipal complex

Sexual drive channeled into socially appropriate activities such as school work and sports

Formation of the superego

5-11/or 13 yearLatency

Final stage of psychosexual development

Begins with puberty and the biologic capacity for orgasm; involves the capacity for true intimacy

11-13Genital


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Transference and Countertransference.

Freud developed the concept of transference andcountertransference.

Transference occurs when the client displaces onto thetherapist attitudes and feelings that the client originallyexperienced in other relationships (Gabbard, 2000).

Transference patterns are automatic and unconscious inthe therapeutic relationship.

For example, an adolescent female client working with anurse who is about the same age as the teens parentsmight react to the nurse like she reacts to her parents.She might experience intense feelings of rebellion ormake sarcastic remarks; these reactions are actuallybased on her experiences with her parents, not thenurse.


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Transference and Countertransference.

Countertransference occurs when the therapistdisplaces onto the client attitudes or feelings from his orher past.

For example, a female nurse who has teenage children

and who is experiencing extreme frustration with anadolescent client may respond by adopting a parental orchastising tone. The nurse is countertransfering her ownattitudes and feelings toward her children onto the client.Nurses can deal with countertransference by examining

their own feelings and responses, using self-awareness,and talking with colleagues.


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CURRENT PSYCHOANALYTIC PRACTICE

Psychoanalysis focuses on discoveringthe causes of the clients unconscious andrepressed thoughts, feelings, and conflicts

believed to cause anxiety and helping theclient to gain insight into and resolve theseconflicts and anxieties.

The analytic therapist uses the techniquesof free association, dream analysis, andinterpretation of behavior.


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Developmental Theories

1. ERIK ERIKSON AND PSYCHOSOCIAL [STAGES OF

DEVELOPMENT]

2. JEAN PIAGET AND COGNITIVE STAGES OF DEVELOPMENT


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1. ERIK ERIKSON AND PSYCHOSOCIAL [STAGES OF DEVELOPMENT]

Erik Erikson (19021994) was a German-born psychoanalyst who

extended Freuds work on personality development across the life

span while focusing on social development as well as

psychological development in the life stages.

In 1950, Erikson published Childhood and Society, in which he

described eight psychosocial stages of development. In each stage,

the person must complete a life task that is essential to his or her

well-being and mental health. These tasks allow the person to

achieve lifes virtues: hope, purpose, fidelity, love, caring, and

wisdom. The stages, life tasks, and virtues.


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Erikson stage of psychosocial development

TaskVirtuePhase

Viewing the world as safe and reliable; relationships as nurturing, stable, and

dependable

HopeTrust vs. mistrust (infant)

Achieving a sense of control and free willWillAutonomy vs. shame and

doubt (toddler)

Beginning development of a conscience; learning to manage conflict and anxietyPurposeInitiative vs. guilt(preschool)

Emerging confidence in own abilities; taking pleasure in accomplishmentsCompetenceIndustry vs. inferiority

(school age)

Formulating a sense of self and belongingFidelityIdentity vs. role confusion

(adolescence)

Forming adult, loving relationships and meaningful attachments to othersLoveIntimacy vs. isolation(young adult)

Being creative and productive; establishing the next generationCareGenerativity vs. stagnation

(middle adult)

Accepting responsibility for ones self and lifeWisdomEgo integrity vs. despair

(maturity)


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2. JEAN PIAGET AND COGNITIVE STAGES OF DEVELOPMENT

Jean Piaget (18961980) explored how intelligence and cognitive

functioning developed in children.

He believed that human intelligence progresses through a series of

stages based on age with the child at each successive stage

demonstrating a higher level of functioning than at previous stages.

In his schema, Piaget strongly believed that biologic changes and

maturation were responsible for cognitive development.


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Piagets four stages of cognitive development

Piagets four stages of cognitive development are as follows:

1. Sensorimotorbirth to 2 years: The child develops a sense ofself as separate from the environment and the concept of objectpermanence; that is, tangible objects dont cease to exist justbecause they are out of sight. He or she begins to form mentalimages.

2. Preoperational2 to 6 years: The child develops the ability to

express self with language, understands the meaning of symbolicgestures, and begins to classify objects.

3. Concrete operations6 to 12 years: The child begins to applylogic to thinking, understands spatiality and reversibility, and isincreasingly social and able to apply rules; however, thinking is stillconcrete.

4. Formal operations12 to 15 years and beyond: The childlearns to think and reason in abstract terms, further develops logicalthinking and reasoning, and achieves cognitive maturity.


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HARRY STACK SULLIVAN:

INTERPERSONAL/ RELATIONSHIPS AND MILIEU THERAPY

Harry Stack Sullivan (18921949; Fig. 3-2) was an American

psychiatrist who extended the theory of personality development toinclude the significance of interpersonal relationships.

Sullivan believed that ones personality involved more thanindividual characteristics, particularly how one interacted withothers. He thought that inadequate or nonsatisfying relationshipsproduced anxiety, which he saw as the basis for all emotional

problems (Sullivan, 1953). The importance and significance of interpersonal relationships in

ones life was probably Sullivans greatest contribution to the field ofmental health.

Five Life Stages. Sullivan established five life stages ofdevelopment (infancy, childhood, juvenile, preadolescence, and

adolescence), each focusing on various interpersonal relationships(Table 3-4).

Sullivan also described three developmental cognitive modes ofexperience and believed that mental disorders were related to thepersistence of one of the early modes.


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SULLIVAN Life stages

FocusAgePhase

Primary need for bodily contact and tenderness

Prototaxic mode dominates (no relation between experiences)

Primary zones are oral and anal.If needs are met, infant has sense of well-being; unmet needs lead to dread and anxiety.

Birth to onset

of language

Infancy

Parents viewed as source of praise and acceptance

Shift to parataxic mode (experiences are connected in sequence to each other)

Primary zone is anal.

Gratification leads to positive self-esteem.

Moderate anxiety leads to uncertainty and insecurity; severe anxiety results in self-

defeating patterns of behavior.

Language to 5

years

Childhood

Shift to the sytaxic mode begins (thinking about self and others based on analysis of

experiences in a variety of situations).

Opportunities for approval and acceptance of others

Learn to negotiate own needs

Severe anxiety may result in a need to control or restrictive, prejudicial attitudes.

58 yearsJuvenile

Move to genuine intimacy with friend of the same sex

Move away from family as source of satisfaction in relationships

Major shift to syntaxic modeCapacity for attachment, love, and collaboration emerges or fails to develop.

812 yearsPreadolescence

Need for special sharing relationship shifts to the opposite sex.

New opportunities for social experimentation lead to the consolidation

of self-esteem or self-ridicule.

If the self-system is intact, areas of concern expand to include values, ideals, career

decisions, and social concerns.

Puberty to

adulthood

Adolescence


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prototaxic mode, parataxic mode , syntaxic mode

The prototaxic mode, characteristic of infancy and childhood,involves brief unconnected experiences that have no relationship toone another. Adults with schizophrenia exhibit persistent prototaxicexperiences.

The parataxic mode begins in early childhood as the child begins toconnect experiences in sequence. The child may not make logical

sense of the experiences and may see them as coincidence orchance events. The child seeks to relieve anxiety by repeatingfamiliar experiences, although he or she may not understand whathe or she is doing. Sullivan explained paranoid ideas and slips ofthe tongue as a person operating in the parataxic mode. In the

syntaxic mode, which begins to appear in schoolage children and

becomes more predominant in preadolescence, the person beginsto perceive himself or herself and the world within the context of theenvironment and can analyze experiences in a variety of settings.Maturity may be defined as predominance of the syntaxic mode(Sullivan, 1953).


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Therapeutic Community o r Mil ieu.

Sullivan envisioned the goal of treatment as theestablishment of satisfying interpersonal relationships.The therapist provides a corrective interpersonalrelationship for the client.

Sullivan coined the term participant observer for thetherapists role, meaning that the therapist bothparticipates in and observes the progress of therelationship.

The concept of milieu therapy, originally developed by

Sullivan, involved clients interactions with one another;i.e., practicing interpersonal relationship skills, giving oneanother feedback about behavior, and workingcooperatively as a group to solve day-to-day problems.


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Humanistic Theories

Humanism represents a significant shift away fromthe psychoanalytic view of the individual as aneurotic, impulse-driven person with repressedpsychic problems and away from the focus on and

examination of the clients past experiences. Humanism focuses on a persons positive qualities,

his or her capacity to change (human potential), andthe promotion of self-esteem. Humanists doconsider the persons past experiences, but they

direct more attention toward the present and future.1. ABRAHAM MASLOW: HIERARCHY OF NEEDS

2. CARL ROGERS: CLIENT-CENTERED THERAPY


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1. ABRAHAM MASLOW: HIERARCHY OF NEEDS

Abraham Maslow (19211970) was anAmerican psychologist who studied the needs ormotivations of the individual. He differed fromprevious theorists in that he focused on the totalperson, not just one facet of the person, andemphasized health instead of simply illness andproblems.

Maslow (1954) formulated the hierarchy ofneeds in which he used a pyramid to arrangeand illustrate the basic drives or needs thatmotivate people.


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hierarchy of needs

1. The most basic needsthe physiologic needs of food,water, sleep, shelter, sexual expression, and freedomfrom painmust be met first.

2. The second level involves safety and security needs,

which include protection, security, and freedom fromharm or threatened deprivation.

3. The third level is love and belonging needs, whichinclude enduring intimacy, friendship, and acceptance.

4. The fourth level involves esteem needs, which includethe need for self-respect and esteem from others.

5. The highest level is self-actualization, the need forbeauty, truth, and justice.


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ABRAHAM MASLOW

Maslow hypothesized that the basic needsat the bottom of the pyramid woulddominate the persons behavior until those

needs were met, at which time the nextlevel of needs would become dominant.

For example, if needs for food and shelterare not met, they become the overridingconcern in life: the hungry person risksdanger and social ostracism to find food.


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ABRAHAM MASLOW

Maslows theory explains individual differences in termsof a persons motivation, which is not necessarily stablethroughout life. Traumatic life circumstances orcompromised health can cause a person to regress to a

lower level of motivation. For example, if a 35-year-old woman who is functioningat the love and belonging level discovers she hascancer, she may regress to the safety level to undergotreatment for the cancer and preserve her own health.

This theory helps nurses understand how clientsmotivations and behaviors change during life crises.


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CENTERED THERAPY-CLIENT. CARL ROGERS:2

Carl Rogers (19021987) was a humanistic American psychologistwho focused on the therapeutic relationship and developed a newmethod of client-centered therapy.

Rogers was one of the first to use the term client rather thanpatient.

Client-centered therapy focused on the role of the client, ratherthan the therapist, as the key to the healing process. Rogersbelieved that each person experiences the world differently andknows his or her own experience best (Rogers, 1961).

According to Rogers, clients do the work ofhealing, and within asupportive and nurturing clienttherapist relationship, clients cancure themselves.

Clients are in the best position to know their own experiences andmake sense of them, to regain their self-esteem, and to progresstoward selfactualization. The therapist takes a person-centeredapproach, a supportive role, rather than a directive or expert role.Rogers viewed the client as the expert on his or her life.


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CENTERED THERAPY-CLIENTCARL ROGERS:

The therapist must promote the clients selfesteem asmuch as possible through three central concepts:

1. Uncond it ional pos it ive regarda nonjudgmentalcaring for the client that is not dependent on the clients

behavior2. Genuinenessrealness or congruence between what

the therapist feels and what he or she says to the client

3. Empathet ic understand ingin which the therapistsenses the feelings and personal meaning from theclient and communicates this understanding to the client


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Behavioral Theories

1. IVAN PAVLOV: CLASSICAL CONDITIONING

2. B. F. SKINNER: OPERANT CONDITIONING


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Behavioral Theories

Behaviorism is a school of psychology that focuses on observable

behaviors and what one can do externally to bring about behaviorchanges.

It does not attempt to explain how the mind works. Behavioristsbelieve that behavior can be changed through a system of rewardsand punishments.

For adults, receiving a regular paycheck is a constant positive

reinforcer that motivates people to continue to go to work every dayand to try to do a good job. It helps motivate positive behavior in theworkplace. If someone stops receiving a paycheck, he or she ismost likely to stop working.

If a motorist consistently speeds (negative behavior) and does notget caught, he or she is likely to continue to speed. If the driver

receives a speeding ticket (a negative reinforcer), he or she is likelyto slow down. However, if the motorist does not get caught forspeeding for the next 4 weeks (negative reinforcer is removed), heor she is likely to resume speeding.


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1. IVAN PAVLOV: CLASSICAL CONDITIONING

Laboratory experiments with dogs provided the basis for thedevelopment of Ivan Pavlovs theory of classical conditioning:behavior can be changed through conditioning with external orenvironmental conditions or stimuli.

His experiment with dogs involved his observation that dogsnaturally began to salivate (response) when they saw or smelled

food (stimulus). Pavlov (18491936) set out to change this salivating response or

behavior through conditioning. He would ring a bell (new stimulus)then produce the food, and the dogs would salivate (the desiredresponse). Pavlov repeated this ringing of the bell along with thepresentation of food many times. Eventually he could ring the bell

and the dogs would salivate without seeing or smelling food. Thedogs had been conditioned or had learned a new responsetosalivate when they heard the bell. Their behavior had been modifiedthrough classical conditioning or a conditioned response.


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2. B. F. SKINNER: OPERANT CONDITIONING

One of the most influential behaviorists was B. F. Skinner (19041990), an American psychologist.

He developed the theory of operant conditioning, which sayspeople learn their behavior from their history or past experiences,particularly those experiences that were repeatedly reinforced.

Although some criticize his theories for not considering the role that

thoughts, feelings, or needs play in motivating behavior, his workhas provided several important principles still used today.

Skinner did not deny the existence of feelings and needs inmotivation; however, he viewed behavior as only that which couldbe observed, studied, and learned or unlearned. He maintained thatif the behavior could be changed then so too could the

accompanying thoughts or feelings. Changing the behavior waswhat was important.


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)1974Principles of operant conditioning described by Skinner (

1. All behavior is learned.2. Consequences result from behavior broadly speaking, reward and

punishment.

3. Behavior that is rewarded with reinforcers tends to recur.

4. Positive reinforcers that follow a behavior increase the likelihood that

the behavior will recur.5. Negative reinforcers that are removed after a behavior increase thelikelihood that the behavior will recur.

6. Continuous reinforcement (a reward every time the behavior occurs)is the fastest way to increase that behavior, but the behavior will notlast long after the reward ceases.

7. Random, intermittent reinforcement (an occasional reward for thedesired behavior) is slower to produce an increase in behavior, butthe behavior continues after the reward ceases.


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Behavior modification

Behavior modification is a method of attempting to

strengthen a desired behavior or response by

reinforcement, either positive or negative.

For example, if the desired behavior is assertiveness,

whenever the client uses assertiveness skills in acommunication group, the group leader provides

Positive reinforcement by giving the client attention

and positive feedback.

Negative reinforcement involves removing a stimulusimmediately after a behavior occurs so that the behavior

is more likely to occur again.


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Behavior modification

For example, if a client becomes anxious when waiting to talk in agroup, he or she may volunteer to speak first to avoid the anxiety.

In a group home setting, operant principles may come into play in atoken economy, a way to involve residents in performing activities ofdaily living.

A chart of desired behaviors, such as getting up on time, taking ashower, and getting dressed, is kept for each resident. Each day,the chart is marked when the desired behavior occurs. At the end ofthe day or the week, the resident gets a reward or token for eachtime each of the desired behaviors occurred. The resident canredeem the tokens for items such as snacks, TV time, or a relaxedcurfew. Conditioned responses, such as fears or phobias, can be

treated with behavioral techniques.


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Systematicdesensitization

Systematicdesensitization can be used to help clientsovercome irrational fears and anxiety associated with aphobia. The client is asked to make a list of situationsinvolving the phobic object, from the least to the most

anxiety-provoking. The client learns and practices relaxation techniques todecrease and manage anxiety. The client then isexposed to the least anxiety provoking situation anduses the relaxation techniques to manage the resulting

anxiety. The client is gradually exposed to more andmore anxiety-provoking situations until he or she canmanage the most anxiety provoking situation.


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Existential Theories

Existential theorists believe that behavioral deviations result when a

person is out of touch with himself or herself or the environment. The person who is self-alienated is lonely and sad and feels

helpless. Lack of self-awareness, coupled with harsh self-criticism,prevents the person from participating in satisfying relationships.The person is not free to choose from all possible alternativesbecause of self-imposed restrictions.

Existential theorists believe that the person is avoiding personalresponsibility and giving in to the wishes or demands of others. Allexistential therapies have the goal of helping the person discover anauthentic sense of self.

They emphasize personal responsibility for ones self, feelings,behaviors, and choices.

These therapies encourage the person to live fully in the presentand to look forward to the future. Carl Rogers is sometimes groupedwith existential therapists.


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1. COGNITIVE THERAPY

Many existential therapists use cognitive therapy,which focuses on immediate thought processinghow aperson perceives or interprets his or her experienceanddetermines how he or she feels and behaves.

For example, if a person interprets a situation asdangerous, he or she experiences anxiety and tries toescape. Basic emotions of sadness, elation, anxiety, andanger are reactions to perceptions of loss, gain, danger,and wrongdoing by others (Beck & Rush, 1995). Aaron

Beck is credited with pioneering cognitive theory inpersons with depression.


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2. RATIONAL EMOTIVE THERAPY

Albert Ellis, founder of rational emotive therapy, identified 11irrationalbeliefs that people use to make themselves unhappy.

An example of an irrational belief is, If I love someone, he or shemust love me back just as much.

Ellis claimed that continuing to believe this patently untrue statementwill make the person utterly unhappy, but he or she will blame it on

the person who does not return his or her love. Ellis also believes that people have automaticthoughts that cause

them unhappiness in certain situations.

He used the ABC technique to help people identify these automaticthoughts: A is the activating stimulus or event, C is the excessiveinappropriate response, and B is the blank in the persons mind that

he or she must fill in by identifying the automatic thought.


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3. VIKTOR FRANKL AND LOGOTHERAPY

Viktor Frankl based his beliefs on his observations ofpeople in Nazi concentration camps during World War II.

His curiosity about why some survived and others did notled him to conclude that survivors were able to findmeaning in their lives even under miserable conditions.

Hence the search for meaning (logos) is the centraltheme in logotherapy.

Counselors and therapists who work with clients inspirituality and grief counseling often use the conceptsthat Frankl developed.


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4. GESTALT THERAPY

Gestalt therapy, founded by Frederick Fritz Perls,emphasizes identifying the persons feelings andthoughts in the here and now.

Perls believed that self-awareness leads to self-

acceptance and responsibility for ones own thoughtsand feelings.

Therapists often use gestalt therapy to increase clientsself awareness by writing and reading letters, journaling,and other activities designed to put the past to rest and

focus on the present.


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5. REALITY THERAPY

William Glasser devised an approach called realitytherapy that focuses on the persons behavior and howthat behavior keeps him or her from achieving life goals.

He developed this approach while working with personswith delinquent behavior, unsuccessful school

performance, and emotional problems. He believed that persons who were unsuccessful often

blame their problems on other people, the system, orsociety.

He believed they needed to find their own identity

through responsible behavior. Reality therapy challenges clients to examine the ways

in which their own behavior thwarts their attempts toachieve life goals.


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