chapter 3 psychosocial theories and therapy

Chapter 3 Psychosocial Theories and

Therapy

Chapter 3 Psychosocial Theories and

Therapy

Psychoanalytic Theories (cont’d)Psychoanalytic Theories (cont’d)• All human behavior is caused and can be

explained

• Personality components conceptualized as id, ego, and superego

• Behavior motivated by subconscious thoughts and feelings; treatment involving analysis of dreams and free association

• Ego defense mechanisms

• Psychosexual stages of development

• Transference and countertransference

Psychoanalytic Theories (cont’d)Psychoanalytic Theories (cont’d)

Psychoanalysis focuses on discovering the causes of the client’s unconscious and repressed thoughts, feelings, and conflicts believed to cause anxiety and helping the client 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 mechanisms remain current.

Psychoanalytic TheoriesPsychoanalytic TheoriesPioneered by Sigmund Freud (1856–1939) in Vienna

Developmental TheoriesDevelopmental Theories

Erik Erikson (1902–1994)

Human personality in principle develops according to steps predetermined in the growing person's readiness to be driven toward, to be aware of and to interact with a widening social radius

Described eight stages of psychosocial developmentDescribed eight stages of psychosocial development• Trust vs. Mistrust

• Autonomy vs. Shame & Doubt

• Initiative vs. Guilt

• Industry vs. Inferiority

• Identity vs. Role Confusion

• Intimacy vs. Isolation

• Generativity vs. Stagnation

• Integrity vs. Despair.

Jean Piaget (1896–1980) Jean Piaget (1896–1980)

Described cognitive and intellectual development in children in four stages:

• Sensorimotor

• Preoperational

• Concrete operations

• Formal operations

Interpersonal TheoriesInterpersonal TheoriesHarry Stack Sullivan (1892–1949)

Harry Stack Sullivan (1892–1949) Harry Stack Sullivan (1892–1949)

•Established five life stages of personality development that included the significance of interpersonal relationships

•Described three developmental cognitive modes: prototaxic, parataxic, syntaxic

•Believed that unsatisfying relationships were the basis for all emotional problems

•Described the concept of therapeutic milieu or community

Interpersonal Theories (cont’d)Interpersonal Theories (cont’d)

Hildegard Peplau (1909–1999)

Hildegard Peplau (1909–1999)Hildegard Peplau (1909–1999)

•Leading nursing theorist and clinician: developed the nurse–patient relationship with phases and tasks

•Identified roles of the nurse: stranger, resource person, teacher, leader, surrogate, counselor

•Described four levels of anxiety (mild, moderate, severe, panic) still widely used today

Humanistic TheoriesHumanistic Theories

Abraham Maslow (1921–1970)

•Hierarchy of needs

Carl Rogers (1902–1987)Carl Rogers (1902–1987)

Experience is, for me, the highest authority. The touchstone of validity is my own experience. No other person's ideas, and none of my own ideas, are as authoritative as my experience. It is to experience that I must return again and again, to discover a closer approximation to truth as it is in the process of becoming in me.

Client-centered therapy

Behavioral TheoriesBehavioral Theories

• Behaviorism focuses on behaviors and behavior changes rather than on explaining how the mind works

• All behavior is learned

• Behavior has consequences (reward or punishment)

• Rewarded behavior tends to recur

B. F. Skinner (1904–1990)

• Positive reinforcement increases the frequency of behavior

• Removal of negative

reinforcers increases the frequency of behavior

Behavioral Theories (cont’d)Behavioral Theories (cont’d)

• 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 TheoriesExistential Theories

Cognitive therapy

focuses on immediate thought

processing and is used by

most existential therapists

Albert Ellis 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

Viktor FranklViktor Frankl• Logotherapy: life must have

meaning and therapy is the search for that meaning

• "Ultimately, man should not ask what the meaning of his life is, but rather must recognize that it is he who is asked. In a word, each man is questioned by life; and he can only answer to life by answering for his own life; to life he can only respond by being responsible."

Existential theoristsExistential theorists

Believe that deviations occur when the

person is out of touch with self or environment;

thus, the goal of therapy is to return the

person to an authentic sense of self

Existential Theories (cont’d)Existential Theories (cont’d)

Frederick “Fritz” Perls

Gestalt therapy

emphasizes self-awareness

and identifying thoughts

and feelings in the here

and now

William GlasserWilliam Glasser

• Reality therapy

focuses on the person’s

behavior and how that

behavior keeps the person

from achieving life goals

Crisis InterventionCrisis Intervention• Four stages of crisis:

– Exposure to stressor

– Increased anxiety when customary coping is ineffective

– Increased efforts to cope

– Disequilibrium and significant distress

Types of crisesTypes of crises

– Maturational

– Situational

– Adventitious

Crisis Intervention (cont’d)Crisis Intervention (cont’d)

Crisis state lasts 4–6 weeks.

Outcome is either return to previous functioning level, improved coping, or decreased coping.

Crisis intervention techniques are authoritative and facilitative. A balance of both types is most effective.

Treatment Modalities Treatment Modalities

Community (outpatient) mental health treatment

• The client can often continue to work and can stay connected with family, friends, and other support systems while participating in therapy

• Personality or behavior patterns gradually develop over the course of a lifetime and cannot be changed in a relatively short inpatient course of treatment

Treatment Modalities (cont’d)Treatment Modalities (cont’d)

Hospital (inpatient) treatment

•Severely depressed and suicidal

•Severely psychotic

•Experiencing alcohol or drug withdrawal

•Exhibiting behaviors that require close supervision in a safe, supportive environment


Individual psychotherapy

•A method of bringing about change in a person by exploring his or her feelings, attitudes, thinking, and behavior

•It involves a one-to-one relationship between the therapist and the client

•The therapist’s theoretical beliefs strongly influence his or her style of therapy


• Psychotherapy groups

• Family therapy

• Family education

• Education groups

• Support groups

• Self-help groups

Group therapy involves a therapist or leader and a group of clients sharing a common purpose; members contribute to the group and expect to benefit from it.

Types of groups include:

Group Therapy (cont’d)Group Therapy (cont’d)

•Stages of group development

– Pregroup stage

– Initial stage

– Working stage

– Termination stage


•Group leadership

– Therapy groups and education groups: formal leader

– Support groups and self-help groups: no formal leader

Effective group leaders focus on group process as well as group content

• Opinion-seeker

• Information-seeker

• Information-giver

• Energizer

Growth producing roleGrowth producing role

• Coordinator• Encourager• Harmonizer• Elaborator

Growth-inhibiting rolesGrowth-inhibiting roles

• Monopolizer

• Aggressor,

• Dominator

• Critic

• Recognition-seeker

• Passive follower


The therapeutic results of group therapy (Yalom, 1995) include the following:

• 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)

Psychiatric Rehabilitation Psychiatric Rehabilitation

Involves providing services to clients with persistent and severe mental illness in the community

May involve medication management, transportation, shopping, food preparation, hygiene, finances, social support, vocational referral

Psychosocial InterventionsPsychosocial Interventions

Psychosocial interventions are nursing activities that enhance the client’s social and psychological functioning and promote social skills, interpersonal relationships, and communication.

These interventions are used in mental health and other practice areas.

Self-Awareness IssuesSelf-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 feelings and perceptions are most influential in determining his or her response.

chapter 3 psychosocial theories and therapy

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