NCM 117 - Psychosocial theories

● Conceptual models
- Is a framework of related concepts. Conceptual models used by mental health
providers address the bases for behavior to direct interventions. Most mental
health providers use an eclectic approach in which they employ one or more
approaches from several methods
● Types of psychosocial theories:
○ Psychoanalytic (sigmund freud 1856-1939)
➔ founder of the psychoanalytic model
➔ Austrian physician who began his career as a neurologist
➔ developed an elaborate theory of human behavior based primarily on his
work with persons suffering from disabling anxiety
➔ treatment approach derived from his theories
➔ Three levels of awareness:
1. Conscious
- refers to the perceptions, thoughts, and emotions that exist
in the person's awareness
- example: being aware of happy feelings or thinking about a
loved one
- part of the mind that is aware of the present and functions
only when the person is awake
- represents the smallest part of the mind and directs an
individual's rational, thoughtful behavior
2. Preconscious
- thoughts and emotions are not currently in the person's
awareness, but he or she can recall them with some effort
- example: an adult remembering what he or she did,
thought, or felt as a child
- part of the mind in which thoughts, feelings, and
sensations are stored.
- outside of the awareness, but can be brought to the
conscious mind with the proper stimulus, such as a direct
question
 3. Unconscious
- realm of thoughts and feelings that motivate a person even
though he or she is totally unaware of them
- represents the largest part of the mind and is the
storehouse for all the thoughts, feelings, and sensations
experienced during the individual's lifetime.
- the person is rarely aware of the unconscious mind, except
when it demonstrates its presence through dreams, slips of
the tongue, unexplained behavior, jokes, and lapses of
memory (Taylor, 1994)
➔ Freudian slips
- term commonly used to describe slips of the tongue
- not accidents but rather are indications of subconscious feelings
or thoughts that accidentally emerge in casual day-to-day
conversation
➔ Structure of the personality
- Freud believed that the personality consists of three aspects, the
id, the ego, and the superego
1. ID
- part of and derived from the unconscious
- unlearned, primitive, and selfish
- does not have a sense of right and wrong
- insists on immediate satisfaction of its impulses and
desires, which are geared toward avoiding pain and
experiencing pleasure.
- a newborn's personality consists solely of id, a
belief that is not difficult to accept when one
observes the behavior of infants.
- even mature adults experience unceasing pressure
from the id to satisfy its demands
- The other parts of the personality are responsible
for keeping the id under control.
2. EGO
 - develops as a result of the infant's interaction with
its environment
- it establishes an acceptable compromise between
the crude, pleasure-seeking strivings of the id and
the inhibitions of the superego through reality
testing
- practical part of the personality
- becomes the rational, reasonable, conscious part of
the personality as an individual matures
- represents the self to others and individualizes the
person from other human beings.
- 2 aspects of EGO:
A. Conscience - punishes individuals through
guilt and anxiety when their behavior
deviates from the strict standards of the
superego.
B. Ego ideal - rewards individuals with feelings
of well-being when their behavior achieves
those standards believed desirable by the
superego.
3. SUPEREGO
- develops last
- acts as the moral judge of the individual based on
what the person has learned from significant others
- operates mostly at the unconscious level and
controls the id
- morality , it is the right or wrong.
➔ Transference and countertransference
1. Transference
- occurs when the patient displaces onto the therapist
attitudes and feelings that the patient originally experience
in other relationships (Freud, 1923/1962)
- patterns are automatic and unconscious in the therapeutic
relationship
 2. Countertransference
- occurs when the therapist displaces onto the patient
attitudes or feelings from his or her past.
➔ Psychosexual theory of personality development
- Theory of personality development by Freud.
- Personality is a dynamic, evolving process that develops from
birth through young adulthood.
- Freud's stages of psychosexual development:
1. Oral Birth to 18 months
2. Anal 18 months to 3 years
3. Phallic 3 to 6 years
4. Genital 13 years to adulthood
○ Developmental theories
➔ Freud's theories provided the foundation for the work of subsequent
theories:
➔ Erik Erikson extended Freud's theory of personality development to
include the entire life span and emphasized the importance of culture as a
major determinant of personality development.
➔ Eight Ages of Man:
Trust vs Mistrust Infancy 0 to 1 year

Autonomy versus shame and doubt Early childhood 1 to 3 years

Initiative versus guilt Preschool 3 to 6 years

Industry versus inferiority School age 6 to 12 years

Identity versus role confusion Adolescence 12 to 18 years

Intimacy versus isolation Young adulthood 18 to 25 years

Generativity versus stagnation Adulthood 25 to 45 years

Ego integrity versus despair Older adulthood 45 years to death

➔ Cognitive models (Jean piaget, 1930)

- Examine the perceptual and intellectual growth of the individual.
- an early cognitive theorist of the 1930s
 - focused on the process involved in a child's ability to know and
understand
- Stages of cognitive development:
➢ Sensorimotor (birth to 18 months)
➢ Preoperational (2 to 7 years)
➢ Concrete operations (6 to 12 years)
➢ Formal operations (12 years to adulthood)
○ Interpersonal model
➔ First developed by an American-born psychiatrist, Harry Stack Sullivan
(1892-1949)
➔ Sullivan believed the most critical factor in the development of the
individual's personality, thus his or her behavior, is the person's
relationship with significant others.
➔ Need for satisfaction
- Derived from person's biologic needs for air, food, sex, shelter,
and so on.
➔ Need for security
- Derives from the person's emotional needs for feeling states
- Example: interpersonal intimacy, status, and self-esteem
➔ Dynamism
- age-specific which helps to explain the characteristics of each
stage of personality development.
➢ Infancy birth to 18 months
➢ Childhood 18 months to 6 years
➢ Juvenile 6 to 9 years
➢ Preadolescence 9 to 12 years
➢ Early adolescence 12 to 14 years
➢ Late adolescence 14 to 21 years
○ Humanistic
○ Behavioral model
➔ Concerned with the here and now.
➔ Ivan Pavlov - first behavioral researcher
➔ Classical conditioning by Ivan Pavlov
- well known to all students of psychology
- Focuses on involuntary behaviors, such as blinking and salivation.
 - Example: A person who exhibits the involuntary symptoms of
anxiety (pounding heart, rapid respirations) when he or she sees a
picture of a tall building. He/She has learned to associate tall
buildings or heights with danger.
➔ Operant Conditioning by B.F. Skinner
- Concerned with the relationship between voluntary behavior and
the environment
- Demonstrated that behaviors are influenced by their
consequences
- Those behaviors that have a positive consequence increase in
strength and are likely to be repeated
- Behaviors that result in negative consequences are weakened and
are less likely to be repeated.
➔ Increasing a desired behavior is achieved through:
1. POSITIVE REINFORCEMENT
- Rewards the desired behavior
- Example: a person who receives a pay raise because he
or she produced more widgets is likely to continue trying to
produce even more widgets, assuming that he or she
values an increase in pay.
2. NEGATIVE REINFORCEMENT
- Increases the frequency of a behavior by reinforcing the
behavior's power to control a negative stimulus
- Example: children quickly learn which behaviors are likely
to prevent their parents from yelling at them.
➔ Decreasing behavior is a more difficult task. It is achieved through
1. PUNISHMENT
- An aversive stimulus that occurs after the behavior and
serves to decrease its future occurrence
- Example: a child whose parents make him take a "time
out" by standing in the corner every time he uses a swear
word is likely to decrease his use of swear words after
several time outs.
2. RESPONSE COST
 - A person experiences a loss or penalty as a consequence
of engaging in a certain behavior.
- Example: a teenager who is "grounded" 1 day for every 5
minutes she is coming home from a date is likely to a
3. EXTINCTION
- The process of eliminating a behavior by ignoring or not
rewarding it.
- Example: repeatedly ignoring a child's temper tantrums
○ Neurobiologic model
➔ Psychiatric-mental health nurses and other clinicians are increasingly
challenged to understand neurons, neuronal transmitter brain receptors,
ion channel variants, and intracellular neuronal molecules and their effect
on neural circuits, and behavior of individuals.
➔ For most patients, pharmacologic treatment controls the main symptoms
of the mental illness or disorder and is used in conjunction with supportive
therapies such as individual psychotherapy, group therapy, family therapy,
and self-help groups.
○ Existential theories
➔ Believe that behavioral deviations result when a person is out of touch
with himself or herself or the environment.
➔ Lack of self-awareness with harsh self-criticism prevents the person from
participating in satisfying relationships
➔ Existential theorists believe that the person is avoiding personal
responsibility and giving in to the wishes or demands of others.
➔ Goal: helping the person discover an authentic sense of self.
➔ Emphasis on personal responsibility for one's self, feelings, behaviors,
and choices.

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These contents here are from the powerpoint provided by maam sasan.

NCM 117 - Psychosocial theories

● Psychoanalytic theories
 - All human behavior is caused and can be explained
- Personality conceptualized as id, ego, and superego
- Behavior motivated by subconscious thoughts and feelings
- Ego defense mechanism
- Psychosexual stages of development
- Transference and countertransference
- Psychoanalysis focuses on discovering the causes of the client's unconscious
and repressed thoughts, feelings and conflicts believed to cause anxiety and
helping the clients 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 mechanism remain current
● Developmental theories
➔ Erik Erikson (1902 - 1994) - 8 stages of psychosocial development
➔ Jean Piaget (1896 - 1980) - cognitive and intellectual development (Four stages:
sensorimotor, preoperational, concrete operations, formal operations.)
● Interpersonal theories
➔ By Harry stack sullivan (1892 - 1949)
- 5 life stages of personality and development including the significance of
interpersonal relationship
- 3 cognitive modes: prototaxic, parataxic, syntaxic
- Unsatisfying relationships were the basis for all emotional problems
- Therapeutic milieu or community
➔ By Hildegard Peplau (1909 - 1999)
- The nurse-patient relationship with phases and tasks
- Identified roles of the nurs: stranger, resource person, teacher, leader,
surrogate, counselor.
- 4 levels of anxiety: mild, moderate, severe, panic
● Humanistic theories
➔ Abraham maslow (1921 - 1970)
- Hierarchy of needs; basic physiological needs, safety and security needs,
love and belongingness, esteem, self actualization.
➔ Carl rogers (1902 - 1987)
- Client centered therapy
 - Concepts of unconditional positive regard, genuineness, and empathic
understanding.
● Behavioral theories
➔ Ivan pavlov (1849 - 1936)
➔ B.F. Skinner (1904 - 1990)
- Behaviorism focuses on behaviors and behavior changes, rather than
explaining how the mind works.
- All behavior is learned
- Behavior has consequences (reward or punishment)
- Rewarded behavior tends to recur
➔ Positive reinforcement increases the frequency of behavior
➔ Removal of negative reinforcers increases the frequency 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
➔ Cognitive therapy - focuses on immediate thought processing and is used by
existential therapists - 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
➔ Logotherapy: life must have meaning and therapy is the search for that meaning
➔ Gestalt therapy - emphasizes self-awareness and identifying thoughts and
feelings in the here and now - Frederick “fritz” perls
➔ Reality therapy - focuses on ther person’s behavior and how that behavior keeps
the person from achieving life goals - william Glasser
➔ Existential theorists believe that deviation occurs when the person is out of touch
with self or environment; thus, authentic sense y is to return the person to an
authentic sense of self
● Crisis intervention
➔ Crisis stage lasts 4-6 weeks
 ➔ Outcome is either to return to previous functioning levels improved coping, or
decreased coping
➔ Crisis intervention techniques are authoritative and facilitative; a balance of both
types is most effective
➔ 4 stages of crisis
- Exposure to stressors
- Increased anxiety when customary coping is ineffective
- Increased efforts to cope
- Disequilibrium and significant distress
➔ Types of crises
1. Maturational
2. Situational
3. adventitous
● 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 feeling and perceptions are most influential in determining his or her
response