Psychoanalytic Theories

 Pioneered by Sigmund Freud (1856–

1939) in Vienna
Theories
MARIA ESTRELLA T.
CAOILI, RN, MAN
 Psychoanalytic Theories (cont’d)
 All human behavior is caused and
can be explained
 Personality components
conceptualized as id, ego, and
superego
 Behavior motivated by
subconscious thoughts and feelings;
 Treatment involving analysis of
dreams and free association
 Ego defense mechanisms
 Psychosexual stages of
development
 Transference and
countertransference
Psychoanalytic Theories (cont’d)
Psychoanalysis focuses on discovering the
causes of the client’s unconscious and
repressed thoughts, feelings, and conflicts
believed to cause anxiety and helping the
client to gain insight into and resolve these
conflicts and anxieties.
Psychoanalysis is lengthy, expensive, and
practiced on a limited basis today;
however, Freud’s defense mechanisms
remain current.
Freuds psychosexual theory
 Libido – inner drive
 Parts of body –focus of gratification
 Unsuccesful resolution – fixation
 - Deviations in behavior result from
unsuccessful task.
 Behavior is motivated by anxiety,
cornerstone of psychopathology.
Structures of personality
 Id – pleasure principle-instinct

 Ego – controls action and perception –

reality principle

 Superego – moral behavior - conscience

 0-18 mos ;oral – mouth – trust and
discriminating
 18 mos. – 3 years ; anal – bowels –
holding on or letting go
 Negativism and toilet training age
 3 -6 years phallic ; genitals –exploration
and discovery ( inc. sexual tension)
 Gender identification and genital awareness
 Oedipus and Electra complex //

 Castration anxiety and penis envy

 6-12 years –latency (quiet stage)
sexual energy diverted to play.
Institution of superego…control of
instinctual impulses
 12 – young adult – genital ;
reawakening of sexual drives –
relationships
 Sexual maturation
 Sexual identity ,ability to love and work
DEFENSE MECHANISMS
 unconscious intrapsychic adoptive
efforts to resolve emotional conflict
and cope with anxiety
 automatic
 pathology is determined by the
frequency of use
 DEFENSE MECHANISMS
 DENIAL – failure to acknowledge an intolerable
thought , feeling, experience or reality

 DISPLACEMENT – redirection of emotions or

feelings to a subject that is more acceptable or
less threatening

 PROJECTION – attributing to others one’s

feelings, impulses , thought or wishes

 UNDOING – an attempt to erase an act ,

thought , feeling or desire

 COMPENSATION – an attempt to overcome real

 SYMBOLIZATION – a less threatening object or idea
is used to epresent another

 SUBSTITUTION – replacing desired , impractical ,

unattainable object with one that is acceptable

 INTROJECTION – a form of identification in which

there is a taking into oneself the characteristic of
another(love object)

 REPRESSION – unacceptable thoughts is kept from

awareness(unconscious)

 SUPPRESSION- consciously putting a disturbing

thought or incident out of awareness
 REACTION FORMATION - expressing attitude
directly opposite to unconscious wish or fear

 REGRESSION – returning to an earlier

developmental phase in the face of stress

 DISSOCIATION – detachment of painful

emotional conflicts from consciousness

 CONVERSION – emotional problems are

converted into symptoms

 FANTASY – conscious distortion of unconscious

feelings or wishes
 IDENTIFICATION – conscious
patterning of one’s self from another
person
 INTELLECTUALIZATION - over use of
intellectual concepts by an individual
to avoid expression of feelings
 RATIONALIZATION – justifying ones
actions which are based on other
motives
 SUBLIMATION - rechanneling of
unacceptable instinctual drives with
one hat is acceptable
George Eman Vaillant's (1977) categorization,
defenses form a continuum related to their
psychoanalytical developmental level.

 Vaillant's levels are:

 Level I - psychotic defenses
(i.e. psychotic denial, delusional
projection)
 permit one to effectively rearrange
external experiences to eliminate the
need to cope with reality.
 Level II - immature defenses (i.e.
fantasy, projection, passive aggression,
acting out)
 These mechanisms lessen distress and
anxiety provoked by threatening people
or by uncomfortable reality. -excessively
use such defenses are seen as socially
undesirable in that they are immature,
difficult to deal with and seriously out of
touch with reality.
 Level III - neurotic defenses (i.e.
intellectualization, reaction formation,
dissociation, displacement, repression)
 common in adults. Such defenses have
short-term advantages in coping, but can
often cause long-term problems in
relationships, work and in enjoying life
when used as one's primary style of coping
with the world.
 Level IV - mature defenses (i.e. humour,
sublimation, suppression, altruism, anticipation)
 These are commonly found among
emotionally healthy adults and are considered
mature,
 These defenses help us integrate conflicting
emotions and thoughts, while still remaining
effective. Those who use these mechanisms
are usually considered virtuous.
Developmental Theories
Erik Erikson (1902–1994)
Described eight stages of
psychosocial development
 Psychosocial – Erickson
developmental milestones //delay
 0-18mos; TRUST vs. MISTRUST
 1 ½ -3y AUTONOMY vs Shame, doubt
 3-6 INITIATIVE vs Guilt
 6-12 INDUSTRY vs. Inferiority
 12-18 IDENTITY vs Role confusion
 18-25 INTIMACY vs. isolation
 25-60 GENERATIVITY vs. self absorption
 60 and above EGO INTEGRITY vs. despair
ERIKSON CONT.
 EGO as rational part of the personality
 Growth at social setting of the family and
its cultural heritage
 Stages – span the full life cycle
 Healthy personality
 Social determinants of personality
 CONFLICTS- roles of society vs. individual
 Individual – strengths and weaknesses
 FAILURES- rectified at later stage
Jean Piaget (1896–1980)

Described cognitive and intellectual

development in children in four
stages:
 Sensorimotor,
 Preoperational,
 Concrete Operations,
 Formal Operations
Piaget’s Cognitive Development

1. Sensorimotor ( 0-2y)
2. Preoperational ( 2-7y)
3. Concrete operation ( 7-11y)
4. Formal Operation ( 11-
adulthood)
 Piaget’s
 Human adapt to their environment
psychologically.
 Schema – refer to the cognitive structure
or framework of thought.
 Schemata – categories that form in mind
to organize and understand the world.
 Assimilation– incorporate new ideas, objects,
and experiences into a framework of one’s
thoughts.
 Accommodation – refers to the ability to
change the schema in order to introduce new
0-2 SENSORIMOTOR
 Reflexes
 Imitative Repetitive Behavior
 Sense Of Object Permanence And
Self Separate From Envt.
 Trial And Error Results In Problem
Solving
2-7Y PRE-OPERATIONAL
 Self-centered,egocentric
 Cannot Conceptualize Other’s View
 Animistic Thinking
 Imaginary Playmate – Symbolic
Mental Representation – Creativity
 2-4 Pre-conceptual (Pre-logical)
 4-7 Intuitive (Understanding Of Roles)
7-12Y CONCRETE
OPERATIONAL
 Logical Concrete Thought
 Inductive Reasoning (Specific To
General)
 Can Relate ,Problem Solving Ability
 Reasoning And Self-regulation
12-ABOVE FORMAL
OPERATIONAL THOUGHT
 Abstract thinking
 Separation of fantasy and fact
 Reality oriented
 Deductive reasoning
 Apply scientific method
Interpersonal Theories
 Harry Stack Sullivan (1892–1949)
 Harry Stack Sullivan (1892–1949)
 Established Five Life Stages of personality
development that included the
significance of INTERPERSONAL
RELATIONSHIPS - Infancy; Childjood,
Juvenile, Preadolescence, Adolescence
 Described Three Developmental Cognitive
modes: Prototaxic, Parataxic, Syntaxic
 Believed that Unsatisfying Relationships
were the basis for all emotional problems
 Described the concept of Therapeutic
Milieu Or Community
 behavior is motivated by avoidance
to anxiety and attainment of
satisfaction.
Interpersonal Theories (cont’d

Hildegard Peplau (1909–1999)

Hildegard Peplau (1909–1999)
 Leading nursing theorist and
clinician: developed the nurse–
patient relationship with phases and
tasks
 Identified roles of the nurse: stranger,
resource person, teacher, leader,
surrogate, counselor
 Described four levels of anxiety (mild,
moderate, severe, panic) still widely
used today
 She proposed:
 Nurses must promote the np
relationship – trust & foster
helathyrelationship
 Therapeutic use of self –promotes
healing
 Therapeutic relationship – patient’s
neds
Humanistic Theories
Abraham Maslow (1921–1970)
 , emphazising a hierarchy of needs and
motivations;
 Needs and motivations
Carl Rogers (1902–1987)
Client-centered therapy
Concepts of unconditional positive regard, genuineness,
and empathetic understanding
person-centered or client-centered therapy of, which is
centered on the clients' capacity for self-direction and
understanding of his/her own development (Clay, 2002).
Use of empathy in the therapeutic process
 HUMANISTIC THEORY
 -based on the views of human potential for
goodness
 - focus: one’s ability to learn about oneself,
acceptance of oneself and exploration of
personal capabilities
 - "positivist" and "empiricist" approaches.
 - emphasis on the actual experience of persons
 -it stresses a phenomenological view of human
experience, seeking to understand human
beings and their behavior by conducting
qualitative research.
Behavioral Theories
Ivan Pavlov (1849–1936)
B. F. Skinner (1904–1990)
 Behaviorism focuses on behaviors and
behavior changes rather than on
explaining how the mind works (actions)
 All behavior is learned( inc. mental illness)
 Behavior has consequences (reward or
punishment)
 Rewarded behavior tends to recur
Behavioral Theories (cont’d)
 Positive reinforcement increases the
frequency of behavior
 Removal of negative reinforcers increases the
frequency of behavior
 Continuous reinforcement is the fastest way
to increase behavior; random intermittent
reinforcement increases behavior more
slowly but with longer-lasting effect
 Treatment modalities based on behaviorism
include behavior modification, token
economy, and systematic
desensitization
Existential Theories( Frankl, Perls, Mary
 Cognitive therapy focuses on immediate
thought processing and is used by most
existential therapists
 Centers on present experiences.
 Alienation from self – deviant behavior
 People – free choices of behavior.
 Nurse – works to restore “full life” from state of
“self alienation”
Albert Ellis
 Rational emotive therapy: people
make themselves unhappy through
“irrational beliefs and automatic
thinking”—the basis for the technique
of changing or stopping thoughts
Viktor Frankl
 Logotherapy: life must have
meaning and therapy is the search
for that meaning
Existential Theories (cont’d)
Frederick “Fritz” Perls
 Gestalt therapy emphasizes self-awareness
and identifying thoughts and feelings in the
here and now

William Glasser
 Reality therapy focuses on the person’s
behavior and how that behavior keeps the
person from achieving life goals

Existential theorists believe that deviations

occur when the person is out of touch with self
or environment; thus, the goal of therapy is to
return the person to an authentic sense of
self.
 Havighurst

Developmental Tasks
 Baby to early childhood
 Right from wrong and Conscience

 Late childhood
 Physical skills,wholesome attitude,social roles

 Conscience morality and values

 Fundamental skills in academics

 Personal independence

 Adolescence
 Sexual social roles

 Relationships

 Independence and ideology

 Early adulthood
 Career

 Selecting a mate

 Finding Civic or social responsibility

 Middle age
 Achieving Civic or social responsibility

 Adjusting to changes

 Satisfactory career performance

 Adjusting to aging parents

 Adjusting to parental roles

 Old age
 Adjusting to changes

 Establishing satisfactory living arrangements

and affiliations
Kohlberg – MORAL
DEVELOPMENT/ THINKING/
JUDGEMENT
 Pre-conventional (0-6)
 Punishment And Obedience

 Obedience To Rules To Avoid Punishment

 Conventional ( 6-12 )
 Mutual Interpersonal Expectations ,
relationships And Conformity
 Social System And Conscience Maintenance

 Being Good Is Important Self Respect Or

Conscience
 POST –CONVENTIONAL (12 – 18 Y)
 Prior Right Or Social Contract

 Universal Ethical Principle

 Abide For Common Good

 Rational Person-validity Of Principles-and

Become Committed To Them
 Inner Control Of Behavior Understanding The
Equality Of Human Rights And Dignity Of
Human Beings As Individuals
SULLIVANS
INTERPERSONAL
THEORY
INFANCY
 Need For Security-infant Learns To
Rely On Others To Gratify Needs
And Satisfy Wishes,
 Develops A Sense Of Basic Trust,
 Security And Self Worth When This
Occurs
TODDLERHOOD / EARLY
CHILDHOOD
 Child Learns To Communicate
Needs Through Use Of Words And
 Acceptance Of Delayed
Gratification And
 Interference Of Wish Fulfillment
PRE-SCHOOL
 Development Of Body Image And
Self-perception
 Organizes And Uses Experiences In
Terms Of Approval And Disapproval
Received
 Begins Using Selective Inattention
And Disassociates Those Experiences
That Cause Physical Or Emotional
Discomfort And Pain
SCHOOL AGE
 The Period Of Learning To Form
Satisfying Relationships With Peers-
 uses Competition, compromise
And Cooperation
 The Pre-adolescent Learns To Relate
To Peers Of The Same Sex
ADOLESCENCE
 Learns Independence
 Establish Satisfactory Relationships
With Members Of The Opposite Sex
YOUNG ADULTHOOD
 Becomes Economically,
Intellectually And Emotionally Self
Suficient
LATER ADULTHOOD
 Learns To Be Interdependent And
Assumes Responsibility For Others
SENESCENCE
 Develops An Acceptance Of
Responsibility For What Life Is And
Was And Of Its Place In The Flow Of
History
 FORMATION OF PERSONALITY

 Certain Goals Must Be Accomplished,

If This Goals Are Not Accomplished At A
Certain Stage,….Personality Will Be
Weakened….Factors In Each Stage
Persists As A Permanent Part Of
Personality….
 Each Stage Has Major Traumas And
Frustrations That Must Be Overcome
…….Successful Resolution Of Conflicts
Associated With Each Stage Is Essential
To Development…..Unresolved Conflicts
Remain In The Unconscious And May, At
Times, Result In Maladaptive Behavior
Crisis Intervention
 Four stages of crisis:
 Exposure to stressor
 Increased anxiety when customary coping is
ineffective
 Increased efforts to cope
 Disequilibrium and significant distress
 Types of crises:
 Maturational
 Situational
 Adventitious
Crisis Intervention (cont’d)

Crisis state lasts 4–6 weeks.

Outcome is either return to previous
functioning level, improved coping,
or decreased coping.
Crisis intervention techniques are
authoritative and facilitative. A
balance of both types is most
effective.
Treatment Modalities
Community (outpatient) mental health
treatment
 The client can often continue to work and
can stay connected with family, friends,
and other support systems while
participating in therapy
 Personality or behavior patterns gradually
develop over the course of a lifetime and
cannot be changed in a relatively short
inpatient course of treatment
Treatment Modalities (cont’d)

Hospital (inpatient) treatment

 Severely depressed and suicidal

 Severely psychotic

 Experiencing alcohol or drug withdrawal

 Exhibiting behaviors that require close

supervision in a safe, supportive
environment
Treatment Modalities (cont’d)

Individual psychotherapy
 A method of bringing about change in
a person by exploring his or her
feelings, attitudes, thinking, and
behavior
 It involves a one-to-one relationship
between the therapist and the client
 The therapist’s theoretical beliefs
strongly influence his or her style of
therapy
Group Therapy (cont’d)
 Stages of group development
Pregroup stage

Initial stage

Working stage

Termination stage
Group Therapy (cont’d)
 Group leadership
Therapy groups and education
groups: formal leader
Support groups and self-help groups:
no formal leader
Effective group leaders focus on group
process as well as group content
Group Therapy (cont’d)
 Group roles
Growth-producing roles: information-
seeker, opinion-seeker, information-
giver, energizer, coordinator,
harmonizer, encourager, and
elaborator
Growth-inhibiting roles: monopolizer,
aggressor, dominator, critic,
recognition-seeker, and passive
follower
Group Therapy (cont’d)
The therapeutic results of group therapy
(Yalom, 1995) include the following:
 Gaining new information or learning
 Gaining inspiration or hope
 Interacting with others
 Feeling acceptance and belonging
 Becoming aware that one is not alone and
that others share the same problems
 Gaining insight into one’s problems and
behaviors and how they affect others
 Giving of oneself for the benefit of others
(altruism)
Psychiatric Rehabilitation
Involves providing services to
clients with persistent and
severe mental illness in the
community
May involve medication
management, transportation,
shopping, food preparation,
hygiene, finances, social
support, vocational referral
Psychosocial Interventions
Psychosocial interventions are
nursing activities that enhance
the client’s social and
psychological functioning and
promote social skills,
interpersonal relationships, and
communication.
These interventions are used in
mental health and other practice
areas.
Self-Awareness Issues
 No one theory or treatment approach
is effective for all clients.
 Using a variety of psychosocial
approaches increases nurse
effectiveness.
 The client’s feelings and perceptions
are most influential in determining his
or her response.
 COGNITIVE BEHAVIORAL
THERAPY( Albert Ellis)
 Cognition, emotion and behaviors
are integrated and holistic
 Therapeutic approach -Rational
Emotive Therapy

 AIMS: to change or reframe an
individual’s cognitions that result in
a new view of self and environment.
--- restructure how a person
perceives events in his or her life to
facilitate behavioral and emotional
change.
 Key Concept: is ahighly structured
psychotherapeutic method used to
alter distorted beliefs and problem
behaviors by identifying and
replacing negative and inaccurate
thoughts and changing the rewards
for behaviors.
 Effective: depressions, OCD,
dchizophrenia, Axis I
 CBT operates on the following assumptions:
 People are disturbed not by an event,
but by the perception of that event
 Whenever and however a belief
develops, the individual believes it.
 Work and practice can modify beliefs that
create difficulties in living.
 Shakespear: “ For there is nothing
either good or bad but thinking makes it
so.”
 Models of Perception:
 EVENT  Perception  Mood State
 Feelings  Thoughts  beliefs
Event
 COGNITIVE PROCESS
 COGNITIVE TRIAD –thoughts
about oneself, the world, and the
future.