Chapter 3 Psychosocial Theories & Therapy Flashcards
Why were theoretical methods of behavior developed?
To explain emotional & mental health
Six Psychosocial Theorists
1) Psychoanalytic (Freud)
2) Developmental (Erikson, Piaget)
3) Interpersonal (Sullivan, Peplau)
4) Humanistic (Maslow, Rogers)
5) Behavioral (Pavlov, Skinner)
6) Existential (Beck, Ellis, Frankl,
Perls, Glasser)
Sigmund Freud
Father of Psychoanalysis: All human behavior is influenced by unconscious memories, thoughts, & urges (repressed sexual urges)
- Repressed: Driven form one’s own consciousness
Believed a person could be “cured” by making unconscious thoughts conscious & thereby gaining insight
Personality Components: Id, ego, & superego
Behavior is motivated by subconscious thoughts & feelings
- Conscious, unconscious, preconscious
Freudian Slip
A term used to describe slips of the tongue
Ex) Accidentally calling your teacher, “Mom”
Freud believes these slips are not accidental or coincidental but, are subconscious thoughts & feelings that emerge in conversation
Id
The part of one’s nature that reflects basic or innate desires such as pleasure-seeking behavior, aggression, & sexual impulses
Seeks instant gratification, causes impulsive (unthinking) behavior, & has no regard for rules or societal convention
Ego
Balancing or mediating force between the id & the superego
Represents mature & adaptive behavior that allows a person to function successfully in the world
- Freud believed that anxiety resulted from the ego’s attempts to balance the impulsive instincts of the id & the rigid rules of the superego
Superego
Part of the person’s nature that reflects moral & ethical concepts, values, & parental and societal expectations
- Direct opposition of the id
Freud’s Three Levels of Awareness
1) Conscious
2) Preconscious
3) Unconscious
Conscious
Refers to perceptions, thoughts, & emotions that exist in a person’s awareness
Ex) Being aware of happy feelings or thinking of a loved one
Preconscious
Thoughts & emotions that are not currently in the person’s awareness, but they can recall them w/ some effort
Ex) Remembering what they did, thought, & felt as a child
Unconscious
Realm of thoughts & feelings that motivate a person even though they are totally unaware of them
Includes most ego defense mechanisms
Dream Analysis
A primary technique used in psychoanalysis that involves discussing a patient’s dreams to discover their true meaning and significance
- Freud believed that a person’s dream reveals their subconscious & have significant meaning
Free Association
The therapist tries to uncover the client’s true thoughts and feelings by saying a word and asking the client to respond quickly with the first thing that comes to mind
Ego Defense Mechanisms
Methods of attempting to protect the self & cope w/basic drives or emotionally painful thoughts, feelings, or events
Alturism
Dealing w/anxiety by reaching out to others
Adaptive Use: A mother who lost a son to a drunk
driver starts Mothers Against Drunk
Driving (MADD)
Sublimation
Dealing w/ unacceptable feelings or impulses by unconsciously substituting acceptable & constructive forms of expression
Adaptive Use: A person who just had an argument
w/ his girlfriend goes for a five-mile run
Suppression
Voluntarily blocking unpleasant thoughts & feelings from consciousness
Adaptive Use: A worker who just saw the Twin Towers get hit by airplanes on 911 goes back to their desk and focuses on some important work they need
to get done that morning
Maladaptive Use: When asked to recount a traumatic event, a patient w/ PTSD is unable to recall key fragments of the event, loses train of thought or describes it in very vague terms
Splitting
Demonstrating an inability to reconcile negative & positive attributes of self or others into a cohesive image
Maladaptive Use: When a woman’s boyfriend who
was very nice to her at first starts to treat her badly, she still thinks he’s a great guy
Projection
Attributing one’s unacceptable ideas, thoughts, & emotions
Maladaptive Use: A husband angrily says to his wife, “You’re so stubborn!” when he is the one who is stubborn
Reaction Formation
Unacceptable feelings or behaviors are controlled or kept out of awareness by overcompensating or demonstrating the opposite behavior of what is felt
Adaptive Use: An employee who despises his boss
goes to his boss’s annual Halloween Party and acts like he really likes his boss
Maladaptive Use: Man who has thought about same-gender sexual relationship but never had one beats a man who is gay
Undoing
Performing an act to make up for prior unacceptable thoughts or behavior (most commonly seen in children)
Adaptive Use: An adolescent cleans his room after mouthing off at his parents at dinner
Maladaptive Use: An abusive husband says to his wife,
“I’m so sorry. I love you. I promise - I’ll never do it again” after giving her a black eye when angry & arguing loudly
Rationalization
Creating reasonable & acceptable explanations for unacceptable feelings or behavior
Adaptive Use: A teenage girl says to herself, “someone
must have just told a good joke” when a group of her peers start laughing as she walks by
Maladaptive Use: A woman who feels guilty after eating a whole box of Girl Scout cookies says, “I had to eat the cookies because nobody else would”
Dissociation
A disruption in consciousness, memory, identity, or perception of the environment that results in compartmentalizing uncomfortable or unpleasant thoughts, feelings, or experiences
Adaptive Use: A student who is studying in the library
for a test because his roommates are having a party blocks out unexpected construction noise
Maladaptive Use: A person who just experienced a
significant stressor wanders off from home and forgets their identity
Repression
Unconsciously putting unacceptable ideas, thoughts, & emotions out of conscious awareness
Adaptive Use: A person who was molested as a child
has no recollection of it
Maladaptive Use: A guy who has been wanting to break up w/ his girlfriend for a while forgets he told her they would go out Saturday night
Displacement
Shifting feelings related to an object, person, or situation to another less threatening object, person or situation
Adaptive Use: A student who is angry about his grade
on a paper goes to a batting cage & swings hard at every ball
Maladaptive Use: A woman who just got in an argument w/ her boyfriend yells at her mother over the phone
Denial
Pretending the truth is not reality to manage unpleasant, anxiety-causing thoughts or feelings
Adaptive Use: A patient whose breast cancer caused an open wound on her chest says, “it’s just a few cells”
Maladaptive Use: A person who just got their third DUI emphatically says, “I don’t have a drinking problem!”
Psychosexual Stages of Development
1) Oral (Birth-8 months): Major site of tension and gratification is the mouth, lips, and tongue
- Includes biting and sucking activities.
- Id is present at birth. Ego develops gradually from rudimentary structure present at birth.
2) Anal (18-36 months): Anus and surrounding area are major source of interest
-Potty training (voluntary sphincter control is acquired)
3) Phallic/oedipal (3-5 years): Genital is the focus of interest, stimulation, and excitement
- Discovering one’s genitals, aligning with the parent of the opposite sex
4) Latency (5-11 or 13 years): Resolution of oedipal complex
- Sexual drive channeled into socially appropriate activities such as school work and sports
- Formation of the superego
- Final stage of psychosexual development
5) Genital (11-13 years): Begins with puberty and the biologic capacity for orgasm
- Involves the capacity for true intimacy.
Transference
Unconscious process of displaying feelings for significant people in the past onto a healthcare provider in the present
Countertransference
Emotional reaction by a healthcare provider to a patient based on feelings the provider had for significant people in the past
Psychoanalysis
Focus on discovering causes of client’s unconscious, repressed thoughts, feelings, conflicts related to anxiety
Skills Utilized: Free association, dream analysis, interpretation of behavior used to gain insight into and resolve these conflicts, anxieties
Lengthy, expensive, practiced on limited basis today
Erikson’s Psychosocial Stages of Development
Trust vs Mistrust (Infant): Viewing the world as safe & reliable
- Virtue: HOPE
Autonomy vs Shame & Doubt (Toddler 18 months-3 years of age): Achieving a sense of control & free will
- Virtue: WILL
Initiative vs Guilt (Preschool): Beginning development of conscience
- Virtue: PURPOSE
Industry vs Inferiority (School Age): Emerging confidence in own abilities
- Taking pleasure in accomplishments
- Virtue: COMPETENCE
Identity vs. Role Confusion (adolescence): Formulating a sense of self and belonging
- Virtue: Fidelity
Intimacy vs. Isolation (young adult): Forming adult, loving relationships, and meaningful attachments to others
- Virtue: LOVE
Generativity vs. stagnation (middle adult): Being creative and productive; establishing the next generation
- Virtue: CARE
Ego integrity vs. despair (maturity): Accepting responsibility for oneself and life
- Virtue: Wisdom
Piaget’s Cognitive Stages of Development
Sensorimotor (Birth–2 years old): Sense self as separate from the environment, object permanence
Preoperational (2 years old–7 years old): Express self w/language , understand symbolic gestures, classify objects
Concrete Operations (7-11 years old): Apply logic to thinking
- Understand spatiality & reversibility
- Increase sociability
- Apply rules
- Still think concretely
Formal Operations (11-15 y.o. +): Think & reason in abstract terms
- Expand & refine logical thinking &
reasoning
- Achieve cognitive maturity
Maslow’s Hierarchy of Needs (Listed in Order of Needs that Must Be Met 1st)
1) Physiological Needs: Oxygen, food, water, sleep,
shelter, sex, freedom from pain
2) Safety & Security: Protection, security, & freedom from harm or threatened deprivation
3) Love & Belonging: Enduring intimacy, friendship, & acceptance
4) Self-Actualization (Highest Level): Need for beauty, truth, & justice
Interpersonal Theories
Sullivan: Significance of interpersonal relationships
- Therapeutic milieu: Patients participating in groups
Peplau: Therapeutic Nurse–Client Relationships
- 4 Phases: Orientation, identification, exploitation, resolution
- Nurses’ roles
- Mild Phase of Anxiety
- Moderate Phase of Anxiety
- Severe Phase of Anxiety
- Panic Anxiety: Distorted perceptions, fight-flight-freeze
The (4) Phases of Therapeutic Nurse-Client Relationship
1) Orientation Phase: Directed by the nurse & involves engaging the patient in treatment, providing explanations and information, and answering questions.
2) Identification Phase: Begins when the patient works interdependently w/ the nurse, expresses feelings, and begins to feel stronger
3) Exploitation Phase: The patient makes full use of the services offered
4) Resolution Phase: The patient no longer needs professional services & gives up dependent behavior
- The relationship ends
Humanities
Focuses on a person’s positive qualities, their capacity to change (human potential), and the promotion of self-esteem
Humanistic Theories
Begin to focus on the positive aspects of the patient (what tools can be given to help improve mental health)
Abraham Maslow: Hierarchy of Needs
- Basic physiological, 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
Roles of the Nurses in Therapeutic Relationships
Stranger: Offering the patient the same acceptance and courtesy that the nurse would to any stranger
Resource person: Providing specific answers to questions w/in a larger context
Teacher: Helping the patient learn either formally or informally
Leader: Offering direction to the patient or group
Surrogate: Serving as a substitute for another, such as a parent or sibling
Counselor: Promoting experiences leading to health for the patient, such as expression of feelings
Client-Centered Therapy
Focuses on the role of the client, rather than the therapist, as the key to the healing process
Rogers believed that each person experiences the world differently and knows their own experience best
Behavioral Theories
Focuses on observable behaviors & behavior changes
Does NOT focus on how the mind works
Ivan Pavlov: Classical conditioning
B.F. Skinner: Operant Conditioning
Mild Anxiety Level (Peplau)
A positive state of heightened awareness & sharpened senses, allowing the person to learn new behaviors and solve problems
-The person can take in all available stimuli (perceptual field)
Signs & Symptoms:
- Sharpened senses
- Increased motivation
- Alert
- Enlarged perceptual field
- Can solve problems
- Learning is effective
- Restless
- Gastrointestinal “butterflies”
- Sleepless
- Irritable
- Hypersensitive to noise
Moderate Anxiety Level (Peplau)
Involves a decreased perceptual field (focus on immediate task only)
- The person can learn new behavior or solve problems only with assistance
- Another person can redirect the person to the task
Signs & Symptoms:
- Selectively attentive
- Perceptual field limited to the immediate task
- Can be redirected
- Cannot connect thoughts or events independently
- Muscle tension
- Diaphoresis
- Pounding pulse
- Headache
- Dry mouth
- Higher voice pitch
- Increased rate of speech
- GI upset
- Frequent urination
- Increased automatisms (nervous mannerisms)
Severe Anxiety Level (Peplau)
Involves feelings of dread or terror
- The person cannot be redirected to a task; they focus only on scattered details and have physiologic symptoms of tachycardia, diaphoresis, and chest pain.
- A person with severe anxiety may go to an emergency department, believing they are having a heart attack
Signs & Symptoms:
- Perceptual field reduced to one detail or scattered details
- Cannot complete tasks
- Cannot solve problems or learn effectively
- Behavior geared toward anxiety relief and is usually ineffective
- Feels awe, dread, or horror
- Doesn’t respond to redirection
- Severe headache
- N/V, diarrhea
- Trembling
- Rigid stance
- Vertigo
- Pale
- Tachycardia
- Chest pain
- Crying
- Ritualistic (purposeless, repetitive) behavior
Panic Level of Anxiety
Can involve loss of rational thought, delusions, hallucinations, and complete physical immobility and muteness
The person may bolt and run aimlessly, often exposing themself to injury
Signs & Symptoms:
- Perceptual field reduced to focus on self
- Cannot process environmental stimuli
- Distorted perceptions
- Loss of rational thought
- Personality disorganization
- Doesn’t recognize danger
- Possibly suicidal
- Delusions or hallucination possible
- Can’t communicate verbally
- Either cannot sit (may bolt and run) or is totally mute and immobile
Crisis
A turning point in an individual’s life that produces an overwhelming emotional response
Individuals experience a crisis when they confront some life circumstance or stressor that they cannot effectively manage through the use of their customary coping skills
Stages of Crisis
1) The person is exposed to a stressor, experiences anxiety, and tries to cope in a customary manner
2) Anxiety increases when customary coping skills are ineffective
3) The person makes all possible efforts to deal with the stressor, including attempts at new methods of coping
4) When coping attempts fail, the person experiences disequilibrium and significant distress
Maturational Crisis
Sometimes called Developmental Crisis
Predictable events in the normal course of life, such as leaving home for the first time, getting married, having a baby, and beginning a career
Situational Crisis
Unanticipated or sudden events that threaten the individual’s integrity, such as the death of a loved one, loss of a job, and physical or emotional illness in the individual or family member.
Adventitious Crisis
AKA Social Crisis
Include natural disasters like floods, earthquakes, or hurricanes; war; terrorist attacks; riots; and violent crimes such as rape or murder
(T/F) True or False: All crises are negative in nature.
FALSE
Events like marriage, childbirth, & retirement are often desirable to the individual but may still present overwhelming challenges
3 Factors that Determine If an Individual Experiences Crisis
1) Perception of the event
2) Availability of emotional support
3) Availability of adequate coping mechanisms
Crisis Resolution
Usually self-limiting: Lasts usually 4-6 weeks
Can be resolved in (3) ways:
1) Return to precrisis level of functioning
2) Begins to function at a higher level
3) Stabilizes at level lower than precrisis level of functioning
Positive outcomes are more likely to occur when:
- The problem (precipitating event & response) is clearly & thoroughly defined
- Early intervention
Crisis Intervention
Includes a variety of techniques based on the assessment of the individual
Directive Intervention
Designed to assess the person’s health status & promote problem-solving, such as:
- Offering the person new information, knowledge, or meaning
- Raising the person’s self-awareness by providing feedback about behavior
- Directing the person’s behavior by offering suggestions or courses of action
Supportive Intervention
Aim at dealing with the person’s needs for empathetic understanding, such as:
- Encouraging the person to identify and discuss feelings
- Serving as a sounding board for the person
- Affirming the person’s self-worth.
Treatment Modalities Using Behavioral Theories
Behavior modification
Positive reinforcement
Negative reinforcement
Token economy
Systematic desensitization
Aversion therapy
Meditation
Biofeedback
Behavior Modification
A method of attempting to strengthen a desired behavior or response by reinforcement, either positive or negative
Positive Reinforcement
A reward immediately following a behavior to increase the likelihood that the behavior will be repeated
Negative Reinforcement
Involves removing a stimulus immediately after a behavior occurs so that the behavior is more likely to occur again
Systematic Desensitization
Behavioral technique used to help overcome irrational fears & anxiety associated w/ a phobia
1) Client is asked to make a list of situations involving the phobic object, from the least to the most anxiety-provoking
- Learns and practices relaxation techniques to decrease and manage anxiety
2) Exposed to the least anxiety-provoking situation and use the relaxation techniques to manage the resulting anxiety
- Gradually exposed to more and more anxiety-provoking situations until they can manage the most anxiety-provoking situation
What type of therapy is often used as the last mode of treatment, instead of 1st?
Inpatient treatment
Current treatment reflects the belief that it is more beneficial and certainly more cost-effective for clients to remain in the community and receive outpatient treatment whenever possible
The client can often continue to work and can stay connected to family, friends, and other support systems while participating in therapy
Under what cases, is hospital admission indicated?
1) When the person is severely depressed and suicidal
2) Severely psychotic
3) Experiencing alcohol or drug withdrawal
4) Exhibiting behaviors that require close supervision in a safe, supportive environment.
Individual Psychotherapy
A method of bringing about change in a person by exploring their feelings, attitudes, thinking, and behavior
Involves a one-to-one relationship between the therapist and the client
People generally seek this kind of therapy based on:
- Their desire to understand themselves and their behavior
- To make personal changes
- To improve interpersonal relationships
- To get relief from emotional pain or unhappiness
What is the key to success in individual psychotherapy?
The therapist-client relationship
Both the client and the therapist must be compatible for therapy to be effective.
- Therapists vary in their formal credentials, experience, and model of practice
Selecting a therapist is extremely important in terms of successful outcomes for the client
- The client must select a therapist whose theoretical beliefs and style of therapy are congruent with the client’s needs and expectations of therapy
The client may also have to try different therapists to find a good match
What influences a therapist’s style of therapy?
A therapist’s theoretical beliefs
Group
A # of persons who gather in a face-to-face setting to accomplish tasks that require cooperation, collaboration, or working together
Each person in a group is in a position to influence and to be influenced by other group members
Group Content
Refers to what is said in the context of the group, including educational material, feelings and emotions, or discussions of the project to be completed
Group Process
Refers to the behavior of the group & its individual members, including seating arrangements, tone of voice, who speaks to whom, who is quiet, and so forth.
Group Leadership
Formal leader usually for therapy groups & education groups
Informal leader may emerge in support groups & self-help groups.
Effective leaders focus on group process & group content
Initial Stage of Group Development
Commences as soon as the group begins to meet
Members introduce themselves, a leader can be selected (if not done previously), the group purpose is discussed, and rules and expectations for group participation are reviewed
Group members begin to “check out” one another and the leader as they determine their levels of comfort in the group setting
Working Stage of Group Development
Begins as members begin to focus their attention on the purpose or task the group is trying to accomplish
This may happen relatively quickly in a work group with a specific assigned project but may take two or three sessions in a therapy group because members must develop some level of trust before sharing personal feelings or difficult situations
During this phase, several group characteristics may be seen
- Group cohesiveness: The degree to which members work together cooperatively to accomplish the purpose
Cohesiveness is a desirable group characteristic and is associated with positive group outcomes
- It is evidenced when members value one another’s contributions to the group; members think of themselves as “we” and share responsibility for the work of the group.
When a group is cohesive, members feel free to express all opinions, positive and negative, with little fear of rejection or retribution.
- If a group is “overly cohesive,” in that uniformity and agreement become the group’s implicit goals, there may be a negative effect on the group outcome.
In a therapy group, members do not give one another needed feedback if the group is overly cohesive. In a work group, critical thinking and creative problem-solving are unlikely, which may make the work of the group less meaningful.
Termination Stage of Group Development
Occurs before the group disbands
The work of the group is reviewed, with the focus on group accomplishments or growth of group members or both, depending on the purpose of the group
Monopolizer
A group member who makes excessive verbal contributions -> prevent equal participation of other members
Decide if, how, and when to intervene
Ex) Politely interrupt by acknowledging contribution then redirect the discussion
May choose to limit discussion time per member
“Yes, but…”
Avoid problem-solving
Encourage person to develop own solutions
Disliked Member
Show respect for the disliked member
Acknowledge contribution
Stay neutral
Avoid displaying negative verbal / nonverbal behaviors
Silent Member
Respect the person’s silent manner
Understand the meaning of the member’s silence before encouraging interaction
Group Conflict
Determine if the conflict is a natural part of group process or whether the group needs to address issues
With leader-to-member conflict, be sensitive to the power differential
- If necessary, handle conflict through conflict resolution
Therapeutic Results of Group Therapy
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)
Psychotherapy Groups
Goal: For members to learn their behavior & make positive changes via interacting & communicating w/others
May be organized around a specific medical diagnosis (ex: depression) or a particular issue (ex: improving interpersonal relationships)
Often formal in structure
1 or 2 leaders that are therapists
- One task of the group leader or the entire group is to establish the rules for the group
- Rules deal w/ confidentiality, punctuality, attendance, and social contact between members outside group time.
Open Groups
Ongoing and run indefinitely, allowing members to join or leave the group as they need to
Closed Groups
Structured to keep the same members in the group for a specified number of sessions
If the group is closed, the members decide how to handle members who wish to leave the group and the possible addition of new group members
Family Therapy
A form of group therapy in which the client and their family members participate
Goals of Family Therapy
Include:
- Understanding how family dynamics contribute to the client’s psychopathology
- Mobilizing the family’s inherent strengths and functional resources
- Restructuring maladaptive family behavioral styles
- Strengthening family problem-solving behaviors
Areas of Functioning w/in Families
Communication
Management
Boundaries
Socialization
Emotions & Support
Healthy Communication w/in Families
Clear, understandable messages between family members
Each member is encouraged to express thoughts and feelings
Dysfunctional Communication w/in Families
Blaming: Members blame others to shift the focus away from their own inadequacies
Manipulating: Members use dishonesty to support their own agendas
Placating: One member takes responsibility for problems to keep peace at all costs
Distracting: A member inserts irrelevant information during attempts at problem-solving
Management w/in A Healthy Family
Adults of a family agree on important issues, such as rule making, finances, and plans for the future
Management w/in Dysfunctional Families
Management may be chaotic, with a child making management decisions at times
Boundaries w/in Healthy Families
Boundaries are distinguishable between family roles
Clear boundaries define roles of each member and are understood by all
Each member functions appropriately
Boundaries w/in Dysfunctional Families
Enmeshed boundaries: Thoughts, roles, and feelings blend so much that individual roles are unclear
Rigid boundaries: These families tend to have members that isolate themselves
Socialization w/in Healthy Families
All members interact, plan, and adopt healthy ways of coping
Children learn to function as family members, as well as members of society
Members are able to change as the family grows and matures
Socialization w/in Dysfunctional Families
Children do not learn healthy socialization skills w/in the family and have difficulty adapting to socialization roles of society
Emotions & Support w/in Healthy Families
Emotional needs of family members are met most of the time, and members have concerns about each other
Conflict and anger do not dominate
Emotions & Support w/in Dysfunctional Families
Negative emotions predominate most of the time
Members are isolated and afraid and do not show concern for each other
Education Group
Provide info to members about a specific issue
Ex) stress management, med management, or assertive training
Support Groups
Organized to help members who share a common problem how to cope w/it
Self-Help Groups
Members share a common experience but, not in a formal/structured therapy group
Complementary Medicine
Includes therapies used w/ conventional medicine practices
Alternative Medicine
Therapies used in place of conventional treatment
Integrative Medicine
Combines conventional & CAM (complementary & alternative med) therapy that have scientific evidence supporting their safety & efficacy
Alternative Medical System Interventions
Include homeopathic & naturopathic medicine
- Herbal & nutritional therapy
- Restorative physical exercises (yoga & tai chi)
- Meditation
- Acupuncture
- Remedial massage
Biologically-Based Therapies
Uses herbs, foods, & medicines
Manipulative & Body-Based Therapies
Therapeutic massage, chiropractic manipulation
Energy Therapies
Therapeutic touch, qi-gong, pulsed fields, magnetic fields
Psychiatric Rehabilitation
Involves providing services to people w/ severe & persistent mental illness to help them live w/in the community
Focuses on client’s strengths
Often called “support services” or programs
Activities involve:
- Med management
- Transportation
- Shopping
- Hygiene
- Finances
- Social support
