W4 - Psychosocial approaches to care in the community Flashcards
What is the DSM-5 definition of mental disorder?
‘A clinically significant disturbance in cognition, emotional regulation, or behaviour
that indicates dysfunction in mental functioning and
are usually associated with significant distress or disability in work, relationships, or other areas of functioning. ‘
What is the definition of the psychoanalytic model?
Psychoanalytic theory is the theory of personality organization and the dynamics of personality development relating to the practice of psychoanalysis, a clinical method for treating psychopathology.
Also, the theory of development and organisation of personality that guides psychoanalysis.
Explain the evolution of the psychoanalytic model.
First laid out by Freud in the late 19th century.
It adopts a deterministic view of human nature and argues that human beings are actually driven by
irrational forces,
biological and instinctual drives,
and unconscious motivations.
The model focuses and really emphasises the need to explore the unconscious.
The validity of this view is now disputed and rejected by some, for the lack of empirical evidence.
Explain Freud theory.
Human beings are dominated by two basic instincts:
Eros (the sexual drive or creative life force)
Eros represents life, creativity and growth.
Thanatos (death force or destructiveness force)
Thanatos represents destruction and death.
Such forces are in a constant battle for balance.
Explain the psychoanalytic stance on aetiology of mental illness. (What causes mental illness)
We must consider Freud’s approach to the development of personalities, which he argued that it is shaped through sexual stages.
During each stage, a child is presented with a conflict between biological drives and social expectations.
The mastery of every developmental phase will depend on how the child navigates through until he becomes fully mature and healthy. (his personality).
When an individual fails to navigate or becomes fixated at a stage, unhelpful behaviour can develop and give rise to psychological distress.
What are the psychosexual stages in the psychoanalytic model?
Oral stage / from birth to 1 y / mouth is the erogenous zone
Consequences of psychological fixation:
Orally aggressive or passive. May result in manipulative personality. (chewing gum, smoking, sexual practices)
Anal stage / from 1 to 3 y / bowel and bladder elimination
Consequences of psychological fixation:
Anal retentive or expulsive (OCD or ADHD)
Phallic stage / from 3 to 6 y / genitalia
Consequences of psychological fixation:
Oedipus complex in boys
Electra complex in girls
Latency / from 6 to puberty / dormant sexual feelings
Consequences of psychological fixation:
Sexual unfulfillment if fixation occurs in this stage
Genital / Puberty to death / sexual interest matures
Consequences of psychological fixation:
Frigidity, impotence, unsatisfactory relationships.
What is the Oedipus complex?
The Oedipus complex is an idea in psychoanalytic theory. The complex is an ostensibly universal phase in the life of a young boy in which, to try to immediately satisfy basic desires, he unconsciously wishes to have sex with his mother and disdains his father for having sex and being satisfied before him
What is the Electra complex?
The Electra complex is a term used to describe the female version of the Oedipus complex. It involves a girl, aged between 3 and 6, becoming subconsciously sexually attached to her father and increasingly hostile toward her mother.
Explain Freud’s psychosocial theory of development of personality.
This theory sets the ground for how personality develops and what could be the causes for psychological distress.
The personality consists of three elements:
Id, ego and superego.
Explain the Id (the pleasure principle)
It is the personality element driven by internal basic drives and needs.
Instinct: hunger, thirst, sex.
It acts in accordance to the pleasure principle as it completely avoids pain.
It is always seeking pleasure and has no consideration for others.
The id is impulsive and unaware of the implications of its actions.
Example:
When the baby is hungry it will seek pleasure (food) and will cry as an instinct, no matter how much his mother tries to calm him down, he wants to be fed.
Phase develpment:
As the infant interacts more with the external world, the next stage of personality starts to develop, meaning, the Ego.
Explain Ego (the reality principle)
The ego develops with the interaction with the external world.
It understands that other people have needs and desires, so it works to achieve or grant the id (childish) wishes without causing consequences.
It compromises.
In a healthy person Ego is the strongest. Trying to not upset the Superego and sees reality and understands it.
Explain Superego (the moral principle)
By the age of five the superego develops.
It appears due to the moral and ethical restraints that are placed on us by our family and society.
It can be called: the conscience, as it dictates right from wrong.
What is the dynamic of the three personality forces?
They must be in equilibrium.
Lack of balance will cause conflict and psychological difficulties.
If Id is too strong the person can be impulsive and out of control.
Of superego is too strong the person can be overcritical and rigid, may develop depression.
When the ego is not in control through direct methods, it can operate at an unconscious level by distorting reality through ego defences.
Explain the three parts of consciousness according to Freud. (the iceberg theory)
Ego work in the conscious level of our mind.
Superego and id work within the unconscious level.
The conscious level is just a small part of our personality and the majority of our inner feelings (beliefs, impulses) are not available at this level.
Most of what drives us is buried in the unconscious and is mostly inaccessible.
However, there is also a part between the conscience and unconscious that has information that is not readily available but that we can retrieve.
It is call the preconscious level.
Explain the object-relations theory.
The object-relations theory is a branch of psychoanalytic theory, however, it places less importance on biological drives.
It emphasises interpersonal relationships, primarily in family and mother and child.
Object means ‘other’ and relations means ‘interpersonal relations’.
While Freud is more paternalistic (Oedipus complex), the ORT emphasises the mother.
Name two contributors to the object-relations theory.
Melanie Klein (1882-1960)
Donald Winnicott (1886-1971)
Explain Melanie Klein’s contribution to ORT?
Post-freudian
She is the mother of the ORT.
Particularly interested in early causes of psychosis.
Her theory:
first six months are crucial for the healthy development of the infant’s ego.
infants suffer from anxiety, because of its innate aggressive and destructive instincts.
Explain Klein’s two positions for infant’s development?
- Paranoid-schizoid position (0 to 3 months)
The infants projects out his loving hating feelings onto separate parts of the mother. (life and death instincts)
Baby is only able to relate to the mother and external in part objects.
Maternal object is divided into bad (hated) or good (loved).
There is a clear separation between goo and bad, they cannot coexist together.
- Depressive position (3 to 6 months)
Infant can now relate to objects as whole objects.
There is ambivalence and good and bad, love and hate can coexist.
Explain Donald Winnicott’s contribution to ORT?
Winnicott emphasises
the vulnerability of the infant,
the importance of a good holding environment provided by the care giver,
he also introduced the good-enough mother concept.
Explain the good-enough mother concept.
The good-enough mother concept
develops a heightened state of sensitivity during pregnancy
when it passes, the mother has a ‘flight insanity’ (awareness of what exists outside of maternity)
No matter what, the good enough mother continues to provide a safe and consistent holding environment
hence, meeting the baby’s needs on a physical and emotional level, also protecting the baby from her bad parts.
Explain the symbiosis process by Winnicott.
Winnicott emphasises the state of complete symbiosis between mother and child (infant and caregiver) in the early stages of the baby’s life.
Initially, the carer supports this ‘illusion of symbiosis’, and then gradually and carefully allows ‘disillusionment’ by failing to adapt to the baby’s needs.
This process allows the child to be aware of the separateness between his individuality and the mother’s.
All processes happen through play and the use of transitional objects.
When do psychological difficulties develop in the good-enough mother concept?
Psychological difficulties develop when the environment is not holding,
when the mother fails to meet the baby’s needs (at least reasonable care),
when the carer fails to protect the baby from experiencing overwhelming distress (emotional or physical).
Name the main figure behind the attachment theory.
John Bowlby (1907-1990)
His work was shaped by his early life experiences. From grieving a nanny at 4 to going to boarding school alone.
Explain John Bowlby’s attachment theory.
He studied children who had been separated from their primary caregivers through hospital admission and children who had been institutionalised.
The result of these observations made him argue that
in order to grow up mentally healthy a child must experience a warm, intimate and continuous relationship with his mother.
This relationship (carer/mother) is crucial in the development of healthy individuals.
He coined the term ‘attachment’ to describe the bond between child and carer.
