Download Psychoanalytic Theories

Chapter 3
Psychosocial Theories and
Therapy
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Psychosocial Theories
• Psychoanalytic (Freud)
• Developmental (Erikson, Piaget)
• Interpersonal (Sullivan, Peplau)
• Humanistic (Maslow, Rogers)
• Behavioral (Pavlov, Skinner)
• Existential (Beck, Ellis, Frankl, Perls, Glasser)
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Psychoanalytic Theories: Sigmund Freud
• All human behavior is caused, explainable
• Repressed sexual impulses, desires as motivation for
behavior
• Personality components
– Id
– Ego
– Superego
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Psychoanalytic Theories: Sigmund Freud
(cont.)
• Behavior motivation due to subconscious thoughts,
feelings
– Conscious, preconscious, unconscious
– Subconscious
• Ego defense mechanisms (see Table 3.1)
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Psychoanalytic Theories: Sigmund Freud
(cont.)
• Psychosexual stages of development
– Oral
– Anal
– Phallic/oedipal
– Latency
– Genital (see Table 3.2)
• Transference, countertransference
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Current Psychoanalytic Practice
• Psychoanalysis
– Focus on discovering causes of patient’s unconscious,
repressed thoughts, feelings, conflicts related to
anxiety
– Free association, dream analysis, behavior
interpretation used to gain insight into and resolve
these conflicts, anxieties
• Lengthy, expensive, practiced on limited basis today
• Freud’s defense mechanisms still current
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Question
• Is the following statement true or false?
• Freud identified three stages of psychosexual
development.
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Answer
• False
• Rationale: Freud identified five stages of psychosexual
development: oral, anal, phallic/oedipal, latency, and
genital.
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Developmental Theories
• Erik Erikson
– Eight stages of psychosocial development (see Table
3.3)
– Achievement of life’s virtues
• Jean Piaget
– Cognitive, intellectual development
– Four stages: sensorimotor, preoperational, concrete
operations, formal operations
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Interpersonal Theories: Sullivan
• Five life stages: infancy, childhood, juvenile,
preadolescence, adolescence (see Table 3.4)
• Three developmental cognitive modes
– Prototaxic (infancy, childhood)
– Parataxic (early childhood)
– Syntaxic (school-aged children; more predominant in
preadolescence)
• Significance of interpersonal relationships
• Therapeutic milieu or community
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Interpersonal Theories: Peplau
• Therapeutic nurse–patient relationship
• Four phases: orientation, identification, exploitation,
resolution (see Table 3.5)
• Nurse’s roles to meet patient’s needs: stranger, resource
person, teacher, leader, surrogate, counselor
• Four levels of anxiety: mild, moderate, severe, panic (see
Table 3.6)
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Humanistic Theories
• Abraham Maslow
– Hierarchy of needs
– Basic physiologic, safety and security, love and
belonging, esteem, self-actualization
• Carl Rogers
– Client-centered therapy (focus on client’s role)
– Unconditional positive regard, genuineness,
empathetic understanding
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Behavioral Theories
• Behaviorism: focus on behaviors and behavior changes,
not how mind works
• Ivan Pavlov: classical conditioning
• B. F. Skinner: operant conditioning
– All behavior learned
– Behavior with consequences (reward or punishment)
– Recurrence of rewarded behavior
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Behavioral Theories (cont.)
• B. F. Skinner: operant conditioning (cont.)
– Positive reinforcement: increased frequency of
behavior
– Removal of negative reinforcers: increased frequency
of behavior
– Continuous reinforcement: fastest way to increase
behavior; random intermittent reinforcement
increasing behavior more slowly but with a longerlasting effect
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Behavioral Theories (cont.)
• Treatment modalities: behavior modification, token
economy, systematic desensitization
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Question
• Is the following statement true or false?
• Abraham Maslow was the first theorist to focus on the
client’s role.
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Answer
• False
• Rationale: Carl Rogers was the first to focus on the
client’s role in his client-centered therapy.
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Existential Theories
• Overall belief: deviations occur when person is out of
touch with self or environment
– Goal: to return person to authentic sense of self
• Cognitive therapy
– Focus on immediate thought processing
– Use by most existential therapists
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Existential Theories (cont.)
• Rational emotive therapy (Albert Ellis)
– 11 “irrational beliefs” leading to unhappiness
– “Automatic thoughts”; use of ABC technique
• Logotherapy (Viktor Frankl): life with meaning; therapy
as search for that meaning
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Existential Theories (cont.)
• Gestalt therapy (Frederick “Fritz” Perls)
– Emphasis on self-awareness
– Identification of thoughts, feelings in the here and
now
• Reality therapy (William Glasser)
– Focus on person’s behavior and how that behavior
keeps a person from achieving life goals
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Crisis Intervention
• Four stages of crisis
– Exposure to stressor
– Increased anxiety when usual coping ineffective
– Increased efforts to cope
– Disequilibrium, significant distress
• Categories of crises
– Maturational
– Situational
– Adventitious
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Crisis Intervention (cont.)
• Duration: usually 4 to 6 weeks
• Outcome: resolution to functioning at precrisis level,
higher level, or lower level
• Crisis intervention techniques
– Directive interventions: assess health status,
promote problem solving
– Supportive interventions: deal with person’s needs
for empathetic understanding
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Question
• Which of the following includes the concept of automatic
thoughts?
– A. Cognitive therapy
–
B. Rational emotive therapy
–
C. Logotherapy
–
D. Gestalt therapy
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Answer
•
•
B. Rational emotive therapy
Rationale: Rational emotive therapy focuses on 11
irrational beliefs and automatic thoughts.
– Cognitive therapy focuses on immediate through
processing. Logotherapy involves therapy as a search
for life with meaning. Gestalt therapy emphasizes
self-awareness.
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Treatment Modalities
• Community mental health treatment (primary mode of
treatment)
– Clients continue to work and are able to stay
connected with family, friends, and other support
systems.
– Personality or behavior patterns gradually develop;
unable to be changed in a relatively short inpatient
course of treatment
– Peer counseling, advocacy, and mentoring are
showing positive results.
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Treatment Modalities (cont.)
• Hospital (inpatient) treatment (often last mode of
treatment)
– Indications: severe depression/suicidal; severe
psychosis; alcohol or drug withdrawal; behaviors
requiring close supervision in a safe, supportive
environment
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Individual Psychotherapy
• Bringing about change in a person by exploring his or her
feelings, attitudes, thinking, behavior
• One-to-one relationship between the therapist and the
patient
– Progression through stages
– Relationship as key to success
• Therapist’s theoretical beliefs strongly influence style of
therapy
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Groups and Group Therapy
• Therapist or leader and group of clients sharing common
purpose
• Members contribute to group with expectations of
benefiting from it.
• Stages of group development:
– Pregroup stage
– Beginning or initial stage
– Working stage
– Termination
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Groups and Group Therapy (cont.)
• Group leadership
– Formal leader usually for therapy groups and
education groups; informal leader usually for support
groups and self-help groups
– Focus on group process, group content to be
effective
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Groups and Group Therapy (cont.)
• Group roles
– Growth producing: information seeker, opinion
seeker, information giver, energizer, coordinator,
harmonizer, encourager, elaborator
– Growth inhibiting: monopolizer, aggressor,
dominator, critic, recognition seeker, passive follower
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Groups and Group Therapy (cont.)
• Therapeutic results (Yalom, 1995):
– New information or learning, inspiration or hope
– Interaction with others
– Feelings of acceptance, belonging
– Awareness of not being alone; others share same
problems
– Insight into problems, behaviors, and effects on
others
– Altruism
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Types of Therapy Groups
• Psychotherapy groups
• Family therapy
• Family education
• Education groups
• Support groups
• Self-help groups
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Question
• Is the following statement true or false?
• Self-help groups tend to have an informal or no definitive
leader.
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Answer
• True
• Rationale: Support groups and self-help groups tend to
have an informal leader or no leader at all.
– Therapy and education groups typically have a
formal leader.
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Complementary and Alternative Therapies
• Alternative medical systems (homeopathy, traditional
Chinese medicine)
• Mind–body interventions (meditation, art, music therapy)
• Biologically based therapies (herbs, foods, vitamins)
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Complementary and Alternative Therapies
(cont.)
• Manipulative and body-based therapies (therapeutic
massage, chiropractic manipulation)
• Energy therapies (therapeutic touch, qi gong, pulsed
fields, magnetic fields)
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Psychiatric Rehabilitation
• Services to patients with persistent, severe mental illness
in the community
• Also known as community support services or programs
• Focus on patient’s strengths
• Activities involving medication management,
transportation, shopping, food preparation, hygiene,
finances, social support, vocational referral
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Psychosocial Interventions
• Nursing activities that enhance patient’s social and
psychological functioning and promote social skills,
interpersonal relationships, communication
• Skills used in mental health, other practice areas
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Self-Awareness Issues
• No one theory or treatment approach is effective for all
patients.
• Using a variety of psychosocial approaches increases
nurse’s effectiveness.
• Patient’s feelings, perceptions most influential in
determining his or her response
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