Psychological approaches Flashcards
What is the definition of a mental disorder in the DSM-5?
Clinically-significant disturbances in cognition, emotional regulation, or behaviour that indicate a dysfunction in mental functioning and are usually associated with significant distress or disability in work, relationships, or other areas of functioning.
The holistic approach led to which consideration regarding the nature of psychological distress?
Psychological distress is multifactorial
- impacts several areas of someone’s life (DSM-5)
What is Sigmund Freud’s (late 19th) theory of development and organisation of personality?
> Deterministic view of human nature, as led by:
- irrational forces
- biological drives
- unconscious motivations
- > explore the unconscious
> Humans are dominated by two basic instincts
- eros (life): sexual drive, creative life force
- thanatos (death): death, destructiveness
- > we are constantly balancing these energies
How is the theory of development and organisation of personality that guides psychoanalysis used to treat psychological distress?
> Personality is shaped through sexual stages
Constant conflict between biological drives and social expectations
> Successful navigation of internal conflicts
+ Mastery at each developmental stage
= Fully mature healthy personality
> Unsuccessful navigation or fixing at stage
-> unhelpful behaviours develop
What are the psychosexual stages of the psychoanalytic model?
> Oral (birth - 1 year)
- erogenous zone: mouth
> Anal (1 - 3 years)
- erogenous zone: bowel and bladder elimination
> Phallic (3 - 6 years)
- erogenous zone: genitalia
> Latency (6 - puberty)
- dormant sexual feelings
> Genital (puberty - death)
- sexual interests mature
What are the consequences of psychological fixation at one of the psychosexual stages of the psychoanalytical model?
> Oral
- orally agressive: chewing gum and ends of pencils, …
- orally passive: smoking, kissing, oral sexual practices
- oral stage: fixation might result in a passive, gullible, immature, manipulative personality
> Anal
- anal retentive: obsessively organised, or excessively neat
- anal expulsive: reckless, careless, defiant disorganised, coprophiliac (sexual pleasure from excrement)
> Phallic
- Oedipus complex
- Electra complex
> Latency
- sexual unfulfillment if fixation occurs in the stage
> Genital
- frigidity, impotence, unsatisfactory relationships
What are the 3 elements that constitute personality, in the psychoanalytical model?
What is the relevance of dynamic equilibrium/balance?
> Id
- driven by internal basic drives and needs
- instinctual: anger, thirst, sex
- pleasure principle
- no consideration for others (and the shared reality)
- impulsive and unaware of the implications of their actions
> Ego
- start interacting with the external world
- reality principle
- goal: achieve the id’s wishes in the most realistic way
- in a healthy person, the ego is the strongest of the 3
- satisfies the need of the id
- doesn’t upset the superego
- understands the reality of every situation
> Superego
- develops by the age of 5
- moral part of us
- dictate right and wrong
-> These forces should be in a state of dynamic equilibrium
Lack of balance will cause conflict
- if Id is out of control -> impulsive
Conflict causes psychological difficulty
- if superego is too strong -> overcritical/rigid and may develop depression
Where do the id, ego and superego stand in the conscious and unconscious mind, in the psychoanalytical model?
> Ego - conscious mind / level
- small part of us
> Id and superego - unconscious mind / level
- most of what drives us dwells in the subconscious
- most of what we are and know is buried and inaccessible
- majority of our inner experiences, emotions, beliefs, feelings and impulses -> not available on a conscious level
> Preconscious level
- not regularly accessible but can be retrieved
What is the object-relations theory?
> Derived from psychoanalytic theory > Emphasis on: - interpersonal relationships - family - mother and child
> Roots in psychoanalytical principles, however:
- less emphasis on biological drives
- emphasised the significance of the mother
What is Melanie Klein’s object-relations theory?
> “Mother” of Object-relations theory
Interested in the early causes of psychosis
- first six-months are crucial to the development of the ego
> Paranoid-schizoid position
- baby is only able to relate to the mother and external world in part objects
- baby projects loving and hating feelings onto separate parts of the mother
- maternal object is divided into Bad (hated) breast: mother considered frustrating, persecutory
vs. Good (loved) breast: gratifying, loving - Splitting (clivage): good stays separate from bad
- projection allows to eject the bad, and introject the good enough experience -> basis for integration
The mother’s continued survival of the child’s attacks allows the infant to eventually progress to the depressive position
> Depressive position (what we should aspire to)
- infant can relate to objects as whole objects
- good and bad (love and hate) exist together
- Ambivalence: good and bad can coexist
- infant is aware of his destructive impulses -> fear of losing the good object -> perceives guilt -> inhibiting destructive impulses + attempts of reparation
What is Donald Winnicott’s (late 19th - 20th) object-relation theory?
What is the mother’s ‘flight insanity’?
What is the ‘good-enough mother’?
What are the steps towards the child’s and the caregiver’s individuality, and through what does that happen?
> Emphasis on the infant’s vulnerability
Caregiver needs to provide a good holding environment
> the ‘good-enough mother’
- develops heightened state of sensitivity during pregnancy
- when this passes, the mother has a ‘flight insanity’: awareness of the world outside her state of primary maternal preoccupation
- continues to provide a safe and consistent holding environment
- meets her baby’s needs on physical and emotional level
> Through play and use of transitional object
- initially the carer supports the illusion of symbiosis
- gradually and carefully allow disillusionment (including of infant’s feeling of omnipotence) by failing to adapt to the baby’s needs
- allow the child to realise their own and the caregiver’s individuality
- > with the good-enough mother, the baby develops the continuous sense of individual existence = “self”
In Donald Winnicott’s object-relation theory, when do psychological difficulties develop?
What is he criticised for?
> Psychological difficulties develop when:
- environment is not holding
- mother fails to meet the needs of the baby - failing to provide a reasonably-attuned care
- fails to protect the baby from experiencing overwhelming distress
> Winnicott sometimes criticised for putting mothers on the ‘naughty step’
- suggesting that when the environment is not holding, when the mother isn’t “good enough” -> child develops a false sense of self -> can give rise to emotional distress
What is John Bowlby’s (20th century) attachment theory?
What is the “internal working model” and how is it developed?
> Relationship with the caregiver is crucial in development of a healthy individual
Work most likely shaped by his early life:
- raised by a nanny that left when he was 4
- he speaks of grieving her as a mother figure
Working experiences prior to his psychiatry training:
- encounter with two boys
- one extremely anxious, his “shadow” (would follow him everywhere
- the other quite affectionless and prone to stealing
-> Bowlby realised common thread: lack of a reliable mother figure
> Subsequent work focused on children separated from their primary caregiver
-> “In order to grow up healthy, the child should experience a warm, intimate and continuous relationship with its mother
> Attachment
- we have an innate primary drive to “seek proximity to, and contact with, a specific figure and to do so in certain situations, notably when frightened, tired or ill”
- quality and nature of this bond is crucial for social, cognitive and emotional development
- child’s attachment experiences with primary caregiver -> development of an internal working model: cognitive framework/prototype for future relationships
What is Bowlby’s internal working model?
What are the attachment style predictions for each initial experience?
According to this model, where do the causes of psychological distress come from?
How a child is cared for in their early life will become a prototype for:
- future expectations
- how they will relate to others
- how others relate to them
Primary Caregiver’s Behavior towards child
-> child’s “working model” of itself
- Positive and loved initial experience
- > Secure attachment style: understanding of myself in relations to others:
- individuals are available
- might be caring
- I am a loveable and likeable person - Unloved and rejected initial experience
- > Avoidant attachment style
- sense that others are rejecting, not emotionally available - Inconsistent initial experience
- > Ambivalent attachement style
- insecure with ambivalence and resistance
=> Causes of psychological distress lie in the early life experience with the primary caregiver
What does the behavioural model proposes?
What are classical and operant conditioning?
> Psychology = science of behavior
Principles of learning theory to explain human behaviour
- humans learn through conditioning -> equal at birth
- environmental factors determine our behaviour
> Dysfunctional behaviours (phobia/depression) are learned
> Classical conditioning (Pavlov)
- a naturally-occurring stimulus is placed with a neutral stimulus allowing the neutral stimulus to, in time, evoke a natural reflex
Operant conditioning (Skinner)
- learner makes a connection with the consequences associated with his/her behaviour through positive and negative reinforcement and punishment
e.g. Little Albert conditioned to become fearful of neutral stimuli (learned fear of white rats through very loud noise upon presentation)
> Abnormal behaviour develops from faulty learning
- > as it is learned, it can be unlearned
e. g. depression: - environmental stressors cause a person to receive a lower rate of positive reinforcement -> lower-response contingent to positive behaviour elicits depressive behaviours
