Chapter 2 - Theories

Question 1

Hildegard Peplau

Answer 1

mother of psychiatric nursing

Question 2

Freud’s Psychoanalytic Theory - Freud’s Levels of Awareness

Answer 2

Conscious
Preconscious
Unconscious

Question 3

Freud’s Psychoanalytic Theory: Conscious

Answer 3

Contains all the material a person is aware of at any one time

Question 4

Freud’s Psychoanalytic Theory: Preconscious

Answer 4

Contains material that can be retrieved rather easily through conscious effort

Question 5

Freud’s Psychoanalytic Theory: Unconscious

Answer 5

Includes all repressed memories, passions, and unacceptable urges lying deep below the surface

Question 6

Freud’s Psychoanalytic Theory: Id

Answer 6

Pleasure principle
Reflex action
Primary process

**The id is totally unconscious and impulsive. It cannot tolerate frustration and seeks to discharge tension and return to a more comfortable level of energy. The id lacks the ability to problem solve and is illogical. Operates according to pleasure principle. Think: hungry, screaming baby.
Pleasure seeking

Question 7

Freud’s Psychoanalytic Theory: Ego

Answer 7

Problem solver
Reality tester

***Within the first few years of life as the child begins to interact with others, the ego develops. The ego resides in the conscious, preconscious, and unconscious levels of awareness. The problem solver and reality tester, the ego attempts to navigate the outside world. It is able to differentiate subjective experiences, memory images, and objective reality. THINK, PLAN, Do.
Problem solver
Part of the personality that works through how to do something

Question 8

Freud’s Psychoanalytic Theory: Superego

Answer 8

Moral component

**develops between the ages of 3 and 5, represents the moral component of personality. The superego resides in the conscious, preconscious, and unconscious levels of awareness. The superego consists of the conscience (all the “should nots” internalized from parents and society) and the ego ideal (all the “shoulds” internalized from parents and society). It seeks perfection and when it falls short, it may induce feelings of guilt.
Bad vs. Good

Question 9

Transference

Answer 9

refers to unconscious feelings that the patient has toward a health care worker that were originally felt in childhood for a significant other.

Question 10

Countertransference

Answer 10

refers to unconscious feelings that the health care worker has toward the patient.

Question 11

According to Freud, which aspect of the personality motivates an individual to seek perfection?

A. Id
B. Ego
C. Superego
D. Not sure

Answer 11

ANS: C

The superego represents the ideal rather than the real; it seeks perfection, as opposed to seeking pleasure or engaging reason.

Question 12

Psychodynamic Therapy

Answer 12

Therapist more involved and interacts more freely with the patient

There is more give/take, interaction between therapist and patient
Focuses more on the now
The patient seeks treatment and motivated to improve quality of life

Question 13

Interpersonal Theory

Answer 13

Needs are met through interaction of others

Harry Stack Sullivan. Originally followed Freud, but then focused on interpersonal processes that could be observed in a social framework.

Sullivan defined personality as behavior observed within interpersonal relationships.

Question 14

Security operations

Answer 14

measures the individual employs to reduce anxiety and enhance security

Question 15

Self-system

Answer 15

all of the security operations an individual uses to defend against anxiety and ensure self-esteem

Question 16

Interpersonal therapy is most effective in treating

Answer 16

Grief and loss
Interpersonal disputes
Role transition

Question 17

As you begin working with her, you notice Ms. V has an uncanny resemblance to your younger sister. As a child, this sister lied and criticized you constantly, then screamed and cried to others if you challenged her. You realize that you are responding negatively to this patient. What’s going on here?

A. Mutuality
B. Transference
C. Self-actualization
D. Countertransference

Answer 17

ANS: D

Countertransference—unconscious feelings the health care worker has toward the patient.

Now that you have identified the personal struggles you have in working with this patient, what should you do?
The nurse should realize the importance of maintaining self-awareness and seeking supervisory guidance as the therapeutic relationship progresses.

Question 18

Modeling

Answer 18

therapist provides a role model for a behavior, patient learns through imitation and role-play

Question 19

Operant conditioning

Answer 19

uses positive reinforcement for behavior modification

Question 20

Systematic desensitization:

Answer 20

uses customized behavioral tasks based on the patient’s own fears. Patient also uses learned relaxation techniques.

Question 21

Aversion therapy

Answer 21

Used after other therapies have failed, also known as punishment therapy. This therapy must be closely supervised and evaluated

Question 22

Biofeedback

Answer 22

helps to control body’s physiological response to stress and anxiety.

Question 23

Four Types of Behavioral Therapy

Answer 23

Modeling
Operant conditioning
Systematic desensitization
Aversion Therapy

**Honorary mention: Biofeedback

Question 24

Cognitive Theory and Therapies

Answer 24

Dynamic interplay between individuals and the environment
Thoughts come before feelings and actions
Thoughts about the world and our place in it are based on our own unique perspectives, which may or may not be based on reality.

**Thinking comes before action – there is always a thought prior to action

Question 25

Cognitive-Behavioral Therapy (Beck)

Answer 25

Based on both cognitive psychology and behavioral theory

Very commonly used, well-researched
Test distorted beliefs and change way of thinking; reduce symptoms
Patients taught to challenge own negative thinking and substitute it with positive rational thoughts.
How people feel and behave is determined by the way they think about the world and their place in it.

Question 26

Dialectical behavioral therapy (DBT)

Answer 26

Focusing on mindfulness and grounding and being self reflective
Focusing on the individual being present

Technique seen in cases such as:
Emotional behavioral disturbances
Multiple personality disorders

Question 27

Maslow’s Hierarchy of Needs

Answer 27

Physiological needs
Safety
Belonging and love needs
Esteem needs
Self-actualization

Question 28

The Biological Model

Answer 28

The Biological Model Focus on:
Neurological
Chemical
Biological
Genetic

How the body and brain interact to create:
Emotions
Memories
Perceptual experiences

**Also locates the illness or disease in the body, targets the site of the illness, seeks to stop or alter it.

Question 29

Theory of psychosocial development (Erikson): Trust vs Mistrust

Answer 29

0 - 1.5

**Trust (or mistrust) that basic needs, such as nourishment and affection, will be met

Question 30

Theory of psychosocial development (Erikson): Autonomy vs. Shame-Doubt

Answer 30

1.5 - 3

**Develop a sense of independence in many tasks

Question 31

Theory of psychosocial development (Erikson): Initiative vs Guilt

Answer 31

3 - 6

**Take initiative on some activities—may develop guilt when unsuccessful or boundaries overstepped

Question 32

Theory of psychosocial development (Erikson): Industry v. Inferiority

Answer 32

6 - 12

**Develop self-confidence in abilities when competent or sense of inferiority when not

Question 33

Theory of psychosocial development (Erikson): Identity vs. Role Confusion

Answer 33

12 - 20

**Experiment with and develop identity and roles

Question 34

Theory of psychosocial development (Erikson): Intimacy vs Isolation

Answer 34

20 - 35

**Establish intimacy and relationships with others

Question 35

Theory of psychosocial development (Erikson): Generativity vs. Self absorption

Answer 35

35 - 65

**Contribute to society and be part of a family

Question 36

Theory of psychosocial development (Erikson): Integrity vs. despair

Answer 36

65+

**Assess and make sense of life and meaning of contributions

Question 37

Erikson’s Theory

Answer 37

Your personality continues to develop as you age and it is not determined based on an early traumatic event

Question 38

Stages of Moral Development (Kohlberg)

Answer 38

Preconventional
Conventional
Postconventional

Question 39

Stages of Moral Development (Kohlberg): Preconventional

Answer 39

Stage 1: Obedience & punishment
Stage 2: Individualism & exchange

Question 40

Stages of Moral Development (Kohlberg): Conventional

Answer 40

Stage 3: Good interpersonal relationships
Stage 4: Maintaining social order

Question 41

Stages of Moral Development (Kohlberg): Postconventional

Answer 41

Stage 5: Social contract & individual rights
Stage 6: Universal ethical principles

Question 42

Describe the Stages of Moral Development (Kohlberg)

Answer 42

Kohlberg’s theory provides a framework for understanding the progression from black-and-white thinking about right and wrong to a complex, variable, and context-dependent decision-making process regarding the rightness or wrongness of action.

Question 43

Carol Gilligan - Ethics of Care Theory Stages

Answer 43

Preconventional: I LOVE ME to I LOVE YOU

Conventional: I LOVE YOU MORE THAN ME

Postconventional: I LOVE MYSELF AND YOU

Question 44

Carol Gilligan - Ethics of Care Theory

Answer 44

Carol Gilligan proposed that women come to prioritize an “ethics of care” as their sense of morality evolves along with their sense of self while men prioritize an “ethics of justice.“

Gilligan’s ethics of care theory asserts that progression through Kohlberg’s level is less cognitive and more about personal development and sense of self.

Question 45

Which theorist most influenced the professional practice of psychiatric nursing?

A. Harry Stack Sullivan
B. Hildegard Peplau
C. Erik Erikson
D. Ivan Pavlov

Answer 45

ANS: B

Peplau not only established the foundation for the professional practice of psychiatric nursing, she also continued to enrich psychiatric nursing theory and work for the advancement of nursing practice throughout her career. Invite students to identify major contributions of the other theorists listed.

Question 46

Theory of object relations (Mahler)

Answer 46

Past relationships influence sense of self and present relationships

“Object” = a significant person

Disruption of early separation