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Overview of Theories of Mental Health and OT Practice Cara & McRae, 2013, Chap. 5 OT 460A OT Practice Introduction Need to view clients from biological, psychological, and socio-cultural factors Must consider multiple theories of mental illness Most prominent theories are humanistic, . I biological, psychodynamic, behavioral, and cognitive These theories drive OT practice 9/11/12 2 OT 460 A introduction Need to have a comprehensive Biopsychosocial focus: Most therapists have an eclectic approach 9/11/12 Attend to biological, intrapsychic, interpersonal factors creating and/or maintaining mental dysfunction Choose the best of each and synthesizes these into an overall approach Success with use of an eclectic approach is variable 3 OT 460 A Humanistic Perspectives More of a philosophy Emphasizes value, worth, and potential of the individual Focus on client-therapist relationship Therapy is client-centered Moral treatment- consistent with OT Focuses on broad dimensions of an individual’s life 9/11/12 4 OT 460 A Theorists in Humanism Maslow (Hierarchy of needs) Carl Rogers (father of client-centered tx) Unconditional positive regard; empathy; genuineness Victor Frankl- Existentialist 9/11/12 Physiological, safety, belonginess, love, esteem, cognitive, aesthetic, self actualization Basic drive to find meaning in life Lack of meaning creates psychiatric disturbances Informed current day Occupational Science Theory 5 OT 460 A Humanistic application to OT Focus on “whole person”- Mind, body, spirit Meaning is pivotal to well being Empowering client to take an active role in healing Non-judgmental; rapport with client Belief that behaviorism and psychodynamic theories were to reductionistic 9/11/12 6 OT 460 A Biological Perspectives Disease caused by: Infections, neuroanatomical defects; biochemical imbalances and genetic predisposition First connection to mental illness was syphillis Psychopharmacology: Problems with neurotransmitters and hormonal imbalances: Too much or too little NT Too few receptors on post synaptic membrane Presence or absence of other chemicals that interfere with neural transmission Interrelationship between different NT and other factors (such as stress) 9/11/12 7 OT 460 A OT application of biological perspectives Symptom Associated physical symptoms; side effects of meds Medication management Biological 9/11/12 recognition and management explanations vs. behavioral Sensory modulation New skills, routines, and learnning influence brain plasticity and neuronal pathways 8 OT 460 A Psychodynamic Perspectives Emotional and personality development of individual Emphasis on early childhood experience Unconscious forces and internal processes Abnormal behaviors result when dynamic forces come in conflict (intrapsychic conflict) Proponents: Freud; Charcot & Breuer; 9/11/12 9 Neo-Freudian:Jung; Horney OT 460 A Psychodynamic concepts Structure of the mind Levels of consciousness Repression; denial; projection; displacement; reaction formation; intellectualization; regression; identification; sublimation Psychosexual developmental stages: 9/11/12 Conscious; surface awareness; preconscious; unconscious Defense mechanisms Id, ego, superego Oral; anal; phallic; latency; genital 10 OT 460 A Applications in Psychodynamic OT Fidler Relationships to objects in environment are integral to development of ego OT uses activities requiring clients to interact with both human and non human objects Helps to have client reveal feelings and needs “The potential of activities in their own right to represent, reflect, and infers social, cultural and personal meanings” 9/11/12 11 OT 460 A Applications in Psychodynamic OT Mosey Therapist can learn about a client’s selfesteem and the presence of underlying conflicts through expressive activities 9/11/12 12 Eg. Collages, tile, drawings, clay OT 460 A Behavioral Perspectives Proponents: Descartes; Sherrington; Skinner, Pavlov, etc Interaction of the person and environment All behavior is learned through: 9/11/12 Stimulus/ response Classical / respondent conditioning Operant / instrumental conditioning Modeling 13 OT 460 A Concepts in behaviorism Reinforcement Punishment 9/11/12 Positive= rewards; praise, etc that increases likelihood of behavior Negative= also increases likelihood of behavior (removal of aversive stimulus) Done on continuous or intermittent schedule Positive= delivery of aversive stimulus in response to a behavior (spanking) Negative=removal of a positive stimulus in response to a behavior (losing TV) 14 OT 460 A Behavioral concepts Shaping-approximating the behavior Chaining-linking steps/ parts of behavior Modeling- providing example Social learning- requires: 9/11/12 15 Attending; form and retain mental image of target behavior; reproduce model behavior from stored image; motivation to learn OT 460 A OT application of Behavioral concepts Widely used in society Grades; performance evals; schools Application to adolescents and children Applicable to people with cognitive impairment Cognitive-Behavior therapy 9/11/12 Schizophrenia; MR; Autism; Dementia Applicable to people with eating disorders; pain management 16 OT 460 A Cognitive Perspectives Take issue with simplicity in behaviorism Key concepts: 9/11/12 Expectations (you are what you believe) Appraisals Attributions Beliefs 17 OT 460 A Ellis’ Rational Emotive Therapy Change irrational beliefs: 9/11/12 Must be loved and approved by all In order to be worthy must be perfect in all aspects of life Catastrophic when things don’t go my way Unhappiness is externally caused Past history is critical determinant of present behavior There is always a perfect solution to a problem and it is a catastrophe if a perfect solution is not found 18 OT 460 A Applications in OT Life skills training Multiple opportunities to test actions/ ideas Toglia 9/11/12 Insight and generalization Mental flexibility- multiple solutions Understanding context 19 OT 460 A