Behavioral psychology, also known as behaviorism, is a theory of learning based upon the idea

that all behaviors are acquired through conditioning. Advocated by famous psychologists such
as John B. Watson and B.F. Skinner, behavioral theories dominated psychology during the early
half of the twentieth century. Today, behavioral techniques are still widely used in therapeutic
settings to help clients learn new skills and behaviors.

Behaviorism, also known as behavioral psychology, is a theory of learning based upon the idea
that all behaviors are acquired through conditioning. Conditioning occurs through interaction
with the environment. Behaviorists believe that our responses to environmental stimuli shapes
our behaviors.

According to behaviorism, behavior can be studied in a systematic and observable manner with
no consideration of internal mental states. This school of thought suggests that only observable
behaviors should be studied, since internal states such as cognitions, emotions and moods are
too subjective.

There are two major types of conditioning:

1. Classical conditioning is a technique used in behavioral training in which a naturally

occurring stimulus is paired with a response. Next, a previously neutral stimulus is paired
with the naturally occurring stimulus. Eventually, the previously neutral stimulus comes
to evoke the response without the presence of the naturally occurring stimulus. The two
elements are then known as the conditioned stimulus and the conditioned response.

2. Operant conditioning Operant conditioning (sometimes referred to as instrumental

conditioning) is a method of learning that occurs through rewards and punishments for
behavior. Through operant conditioning, an association is made between a behavior and
a consequence for that behavior.

3. 2. Learning Can Occur Through Associations

4. Have you ever heard someone compare something to "Pavlov's dogs" and wondered
exactly what the reference means? The phrase refers to an accidental discovery by
physiologist Ivan Pavlov, who found that dogs could be conditioned to salivate to the
 sound of a bell. This process, known as classical conditioning, became a fundamental
part of behavioral psychology.
5. 3. Phenomena in Classical Conditioning
6. There are a number of different phenomena that impact classical conditioning. These
factors can impact how quickly a behavior is acquired and the strength of that
association. For example, a process known as extinction occurs when an association
disappears; this causes the behavior to gradually weaken or vanish.
7. 4. Learning Can Occur Through Rewards and Punishments
8. In addition to conditioning natural responses through association, behaviorist B.F.
Skinner described a process in which learning could occur through reinforcement and
punishment. This process, known as operant conditioning, functions by forming an
association between a behavior and the consequences of the behavior.
9. 5. Reinforcement Schedules Are Important
10. At first glance, the operant conditioning process seems fairly straight forward. Simply
observe a behavior and then offer a reward or punishment. However, B.F. Skinner
discovered that the timing of these rewards and punishments has an important
influence on how quickly a new behavior is acquired and the strength of the response.

OPERANT CONDITIONING (SKINER)

The theory of B.F. Skinner is based upon the idea that learning is a function of change in overt
behavior. Changes in behavior are the result of an individual's response to events (stimuli) that
occur in the environment. A response produces a consequence such as defining a word, hitting
a ball, or solving a math problem. When a particular Stimulus-Response (S-R) pattern is
reinforced (rewarded), the individual is conditioned to respond. The distinctive characteristic of
operant conditioning relative to previous forms of behaviorism (e.g., connectionism, drive
reduction) is that the organism can emit responses instead of only eliciting response due to an
external stimulus.

Reinforcement is the key element in Skinner's S-R theory. A reinforcer is anything that
strengthens the desired response. It could be verbal praise, a good grade or a feeling of
increased accomplishment or satisfaction. The theory also covers negative reinforcers -- any
stimulus that results in the increased frequency of a response when it is withdrawn (different
from adversive stimuli -- punishment -- which result in reduced responses). A great deal of
attention was given to schedules of reinforcement (e.g. interval versus ratio) and their effects
on establishing and maintaining behavior.

One of the distinctive aspects of Skinner's theory is that it attempted to provide behavioral
explanations for a broad range of cognitive phenomena. For example, Skinner explained drive
(motivation) in terms of deprivation and reinforcement schedules. Skinner (1957) tried to
account for verbal learning and language within the operant conditioning paradigm, although
this effort was strongly rejected by linguists and psycholinguists. Skinner (1971) deals with the
issue of free will and social control.

Application

Operant conditioning has been widely applied in clinical settings (i.e., behavior modification) as
well as teaching (i.e., classroom management) and instructional development (e.g.,
programmed instruction). Parenthetically, it should be noted that Skinner rejected the idea of
theories of learning (see Skinner, 1950).

Example

By way of example, consider the implications of reinforcement theory as applied to the

development of programmed instruction (Markle, 1969; Skinner, 1968)

1. Practice should take the form of question (stimulus) - answer (response) frames which
expose the student to the subject in gradual steps

2. Require that the learner make a response for every frame and receive immediate feedback

3. Try to arrange the difficulty of the questions so the response is always correct and hence a
positive reinforcement

4. Ensure that good performance in the lesson is paired with secondary reinforcers such as
verbal praise, prizes and good grades.

Principles

1. Behavior that is positively reinforced will reoccur; intermittent reinforcement is

particularly effective
 2. Information should be presented in small amounts so that responses can be reinforced
("shaping")
3. Reinforcements will generalize across similar stimuli ("stimulus generalization")
producing secondary conditioning

What Is Operant Conditioning?

Operant conditioning (sometimes referred to as instrumental conditioning) is a method of

learning that occurs through rewards and punishments for behavior. Through operant
conditioning, an association is made between a behavior and a consequence for that behavior.
Operant conditioning was coined by behaviorist B.F. Skinner, which is why you may occasionally
hear it referred to as Skinnerian conditioning. As a behaviorist, Skinner believed that internal
thoughts and motivations could not be used to explain behavior. Instead, he suggested, we
should look only at the external, observable causes of human behavior.

Skinner used the term operant to refer to any "active behavior that operates upon the
environment to generate consequences" (1953). In other words, Skinner's theory explained
how we acquire the range of learned behaviors we exhibit each and every day.

Examples of Operant Conditioning

We can find examples of operant conditioning at work all around us. Consider the case of
children completing homework to earn a reward from a parent or teacher, or employees
finishing projects to receive praise or promotions.

In these examples, the promise or possibility of rewards causes an increase in behavior, but
operant conditioning can also be used to decrease a behavior. The removal of an undesirable
outcome or the use of punishment can be used to decrease or prevent undesirable behaviors.
For example, a child may be told they will lose recess privileges if they talk out of turn in class.
This potential for punishment may lead to a decrease in disruptive behaviors.

Components of Operant Conditioning

Some key concepts in operant conditioning:

Reinforcement is any event that strengthens or increases the behavior it follows. There are two
kinds of reinforcers:
1. Positive reinforcers are favorable events or outcomes that are presented after the
behavior. In situations that reflect positive reinforcement, a response or behavior is
strengthened by the addition of something, such as praise or a direct reward.

2. Negative reinforcers involve the removal of an unfavorable events or outcomes after the
display of a behavior. In these situations, a response is strengthened by the removal of
something considered unpleasant.

In both of these cases of reinforcement, the behavior increases.

Punishment, on the other hand, is the presentation of an adverse event or outcome that causes
a decrease in the behavior it follows. There are two kinds of punishment:
1. Positive punishment, sometimes referred to as punishment by application, involves the
presentation of an unfavorable event or outcome in order to weaken the response it
follows.

2. Negative punishment, also known as punishment by removal, occurs when an favorable

event or outcome is removed after a behavior occurs.

In both of these cases of punishment, the behavior decreases.

The behavioural model

The behavioural model understands mental dysfunction in terms theory emerging from
experimental psychology.

Symptoms, as understood by the behavioural model, are a patients behaviour. This behaviour
has come about by a process of learning, or conditioning. Most learning is useful as it helps us
to adapt to our environment, for example by learning new skills. However some learning is
maladaptive and behaviour therapy aims to reverse this learning (counter conditioning).
This model best applies to phobias.

The disease or biological model

This model holds that any dysfunction that effects mental functioning can be regarded as
disease in a similar way to dysfunction that affects other parts of the body.

In the disease model, a disorder affecting mental functioning is assumed to be a consequence

of physical and chemical changes which take place primarily in the brain. Just like any other
disease a mental disease can be recognised by specific and consistent signs, symptoms and test
results. These distinguish it from other diseases.

Psychiatrists who adhere to the disease model are often referred to as biological psychiatrists
(as in hes very biological).
With a biological approach comes a preference for physical treatment methods, primarily
drugs, but also ECT.

This model best applies to schizophrenia

The psychodynamic model

The central tenet of the psychodynamic model is that a patients feelings have lead to
problematic thinking and behaviour. These feelings may be unknown to the patient and have
formed during critical times in their life, due to interpersonal relationships.

These unknown (or unconscious) feelings are uncovered during therapy. Therapy can take
place over a large number of sessions and over a time period of a year and beyond.

During therapy a relationship builds up between therapist and patient. The emotions that the
patient attaches to the therapist are collectively known as transference, and those the
therapist attaches to the patient collectively as counter transference. By understanding these
feelings a patient may gain an understanding that they can take with them to future
relationships.
This model is applied broadly, but has limited applicability to the most severe mental disorders.

The behavioural model

The behavioural model understands mental dysfunction in terms theory emerging from
experimental psychology.

Symptoms, as understood by the behavioural model, are a patients behaviour. This behaviour
has come about by a process of learning, or conditioning. Most learning is useful as it helps us
to adapt to our environment, for example by learning new skills. However some learning is
maladaptive and behaviour therapy aims to reverse this learning (counter conditioning).

This model best applies to phobias.

The cognitive model

The cognitive model understands mental disorder as being a result of errors or biases in
thinking. Our view of the world is determined by our thinking, and dysfunctional thinking can
lead to mental disorder. Therefore to correct mental disorder, what is necessary is a change in
thinking.

This model will be familiar to anyone who has trained or undergone cognitive behavioural
therapy (CBT). CBT aims to identify and correct errors in thinking. In this way, unlike
psychodynamic therapy, it takes little interest in a patients past.
This model is widely used, but classically applies to depression and anxiety.

The social model.

The social model regards social forces as the most important determinants of mental disorder.
The social model takes a broader view of psychiatric disorder than any other model. It regards
a patients environment and their behaviour as being intrinsically linked.

In some ways it is like the psychodynamic model, which also sees patients as moulded by
external events. However whereas the psychodynamic model sees mental disorder as highly
personalized and its determinants not immediately recognizable, the social model sees mental
disorder as based on general theories of groups and caused by observable environmental
factors.

Example

For someone who develops persistent depression following the death of a close relative :
This can be perceived in several ways by psychiatrists. One sees the depression as a
pathological event that is directly due to the biochemical changes occurring in the brain of
someone who is predisposed to pathological depression through an accident of illness. Another
sees the depression as a reactivation of unresolved childhood conflicts over an early loss.
Another regards the depression as part of the normal mourning process that has got out of
control because the persons thoughts become fixed in a negative set which sees everything in
the most pessimistic light. Yet others conclude that the mourning response has been
exaggerated primarily by society or see it as an abnormal form of learning which is no longer
appropriate for the situation but is receiving encouragement from some quarter (positive
reinforcement)

Human behavior is learned, thus all behavior can be unlearned and newbehaviors learned in its
place. Behaviorism is concerned primarily with theobservable and measurable aspects of
human behavior. Therefore when behaviorsbecome unacceptable, they can be unlearned.
Behaviorism views development as acontinuous process in which children play a relatively
passive role. It is alsoa general approach that is used in a variety of settings including both
clinicaland educational.

Behaviorists assume that the only things that are real (or at leastworth studying) are the things
we can see and observe. We cannot see the mind ,the id, or the unconscious, but we can see
how people act, react and behave. From behavior we may be able to make inferences about
the minds and the brain,but they are not the primary focus of the investigation. What
people do,not what they think or feel, is the object of the study. Likewise the behaviorist does
not look to the mind or the brain to understandthe causes of abnormal behavior. He assumes
that the behavior representscertain learned habits, and he attempts to determine how they are
learned.

The material that is studied is always behavior. Because behavioristsare not interested in the
mind, or its more rarified equivalents such as psycheand soul, inferences about the conditions
that maintain and reinforce humanbehavior can be made from the study of animal behavior.
Animal research hasprovided a very important foundation for the behavioral approach.
Thebehavioral researcher is interested in understanding the mechanisms underlyingthe
behavior of both normal individuals and those with problems that might bereferred as
"mental illness". When the behavioral model is applied tomental illness, it tends to be used
for a wide variety of presenting problems. It is perhaps most effective in treating behavioral
disorders and disorders ofimpulse control, such as excessivedrinking, obesity, or sexual
problems. Behavioral approaches may bequite useful in treatment of anxiety and have
occasionally been helpful in themanagement of more severe mental disorders such
as schizophrenia, negative reinforcement, punishment,, self management, shaping,time
out, andsystematic desensitization

The biological model

This perspective is adopted from a medical approach and typically regards a

malfunctioning brain as the cause of abnormal behavior. Many factors are considered to be
potential causes of biological dysfunction, ranging from head injury to poor nutrition.
Genetics, evolution, and viral infection are areas that have received a great deal of attention.
Treatments by biological practitioners utilize psychotropic medications, electroconvulsive
therapy (ECT), and neurosurgery.

The psychodynamic model

Sigmund Freud

The psychodynamic theory regards human behavior to be determined by underlying

psychological influences that usually are unconscious. These influences (also called forces) are
dynamic in that the relationship between them gives rise to behavior. Abnormal symptoms are
created when conflicts arise in this relationship. This theory postulates that all behavior is
determined by childhood events and past experience. Sigmund Freud (1856 1939) and Josef
Brener (1842 1925) conducted experiments with hypnosis which put Freud on the path of
formulating this theory. He contended that a person could become fixated or stuck at a stage
where trauma occurred (usuallychildhood). Treatment then consists of psychoanalysis, which
involves bringing into conscious awareness the traumatic childhood conflicts that have been
repressed, and thus making them amenable to resolution.

The behavioral model

The behavioral model originated in laboratories experimenting with learning, where the
understanding of conditioning arose. In operant conditioning, for example, human beings and
animals learn to behave a certain way based on the rewards that they receive for certain
responses. In classical conditioning, discovered by Ivan Pavlov (1849 1946) while
experimenting with dogs, events occurring closely together in time whether positive or
negative will be generalized and create the same response for either event at a later time. If
one event produced happiness, the other event (even if it was negative) can be remembered as
positive. The behavioral model of psychopathology suggests that abnormal responses,
particularly phobias, were formed through a conditioning process, and also can be treated
through new learninga process known as behavior therapy.

The cognitive model

Albert Ellis

Albert Ellis (1962) and Aaron Beck (1967) developed the cognitive model in the early 1960s.
They proposed that cognitive processes are at the center of behavior, thought, and emotions.
To understand abnormal behavior required the clinician to ask their client questions about
their attitudes and assumptions.[5]

Abnormal functioning according to cognitive theorists is explained by realizing that everyone

creates their view of the world that comprises their reality. If the view created by an individual
is flawed then unhealthy thoughts create dysfunctional behavior. Poorly adapted personal
world views are the result of assumptions that are inaccurate. This leads to attitudes that are
negative. Illogical thinking processes also are a source of destructive thinking patterns. One of
these manifests as over-generalization which draws a broad negative conclusion following a
minor event.

Treatment in this approach involves therapy sessions which work to change a client's self-
defeating beliefs and behaviors by demonstrating their irrationality and rigidity. It is believed
that through rational analysis, people can understand their errors in light of the core irrational
beliefs and then construct a more rational way of conceptualizing themselves, their world, and
the events in their lives.

The humanisticexistential model

Humanists and existential theorists ate grouped together in the humanistic-existential model
because of their focus on the broader dimensions of human existence. However, there are
differences between them. Humanistic psychologists maintain that human beings are naturally
born with positive tendencies such as cooperation. The goal of people is to fulfill their potential
for goodness and growth called self-actualization. Carl Rogers (1902 1987) is often considered
the pioneer of the humanistic framework. He developed a warm approach to his work
called client-centered therapy which focuses on supporting the person's achievement of their
potential and their life goals.

Existentialists believe that from birth, each person has total freedom to face existence and find
meaning or avoid taking responsibility. The existential view derived from nineteenth-century
European existential philosophers.

The sociocultural model

The sociocultural approach holds that abnormal behavior is caused by the role
that society and culture play in an individuals life. It considers societal norms, roles in the social
environment, cultural background,family, and views of others. Sociocultural theorists focus on
societal labels and rules, social networks, family structure, communication, cultural influences,
and religious beliefs.[6]

The biopsychosocial model

Beyond understanding how the genetic, chemical, electrical, and molecular dimensions
in brain function, many practitioners have taken on a more eclectic approach to treating their
clients. In this approach abnormal behavior is studied from the viewpoint of the psychological,
biological, and societal influences on behavior.
Biological Model: is the concept that behavior is caused by biological factors. Thus when
behavior is abnormal it is caused by biochemical imbalance. Medical means are used to correct
this problem such as medication or surgery. This can also be referred to as the Medical Model.

Psychoanalytic Model: approaches abnormal behavior from the psychodynamic theoretical

base that there are issues with anxiety and conflicts which are too immense for the defense
mechanisms. Abnormal behavior is the symptom of internal issues. Treatment is focused on
the curing of the sources of anxiety and conflicts.

Cognitive Model: approaches abnormal behavior as non- effective thinking and problem
solving. The treatment approach is to help the person understand his/her problems and learn
effective ways of problem solving.
Behavioral Model: Consider abnormal behavior the result of learned social
maladjustment. This results in learned inappropriate role expectations and
behaviors. Treatment is focused on learning new behavior and unlearning behaviors that are
maladaptive.

Sociocultural Model: cultural and social variables influence and define behavior and what is
considered abnormal. Also, one must look at what forces in the society and culture cause or
creates deviance.

Legal Model: Society sets up laws, regulations and standards of conduct. Violation of these is
not acceptable therefore 'deviance or abnormal'.

Statistical Model: Abnormal behavior is considered deviation from the statistical norm.
The Medical Model

by Saul McLeod published 2008

The medical model of abnormal psychology treats mental disorders in the same way as a

broken arm, i.e. there is thought to be a physical cause.

Supporters of the medical model consequently consider symptoms to be outward signs of the

inner physical disorder and believe that if symptoms are grouped together and classified into a

syndrome the true cause can eventually be discovered and appropriate physical treatment

administered.

Assumptions

Behaviors such as hallucinations are 'symptoms' of mental illness as are suicidal ideas or

extreme fears such as phobias about snakes and so on. Different illnesses can be identified

as 'syndromes', clusters of symptoms that go together and are caused by the illness.
 These symptoms lead the psychiatrist to make a 'diagnosis' for example 'this patient is

suffering from a severe psychosis, he is suffering from the medical condition we call

schizophrenia'.

The model assumes biological causes, pathology of the brain, germs or genes.

What is happening here? The doctor makes a judgement of the patient's behavior, usually in a

clinical interview after a relative or general practitioner has asked for an assessment. The

doctor will judge that the 'patient' is exhibiting abnormal behavior by asking questions and

observing the patient. Judgement will also be influenced heavily by what the relatives and

others near to the patient say and the context is mental illness more likely to be diagnosed in

a mental hospital.

Treatment On the basis of the diagnosis, the doctor will prescribe treatment such as drugs,

psychosurgery or electro-convulsive therapy.

Drug Treatment

The film One flew over the cuckoos nestdemonstrates the way in which drugs are handed out

like smarties merely to keep the patients subdued.

Note also in the film that the same type of drug is given to every patient with no regard for the

individuals case history or symptoms; the aim is merely to drug them up to the eye balls to

shut them up!

Note that drugs do not deal with the cause of the problem, they only reduce the symptoms.

Patients often welcome drug therapy, as it is quicker, easier and less threatening than talk

therapy.

Some drugs cause dependency.

Drug treatment is usually superior to no treatment.

Between 50 65% of patients benefit from drug treatments.

Psychosurgery

As a last result when drugs and ECT have apparently failed psychosurgery is an option. This

basically involves either cutting out brain nerve fibres or burning parts of the nerves that are

thought to be involved in the disorder (when the patient is conscious).

The most common form of psychosurgery is a prefrontal lobotomy.

Unfortunately these operations have a nasty tendency to leave the patient vegetablized or

numb with a flat personality, shuffling movements etc. due to their inaccuracy. Moniz

discovered the lobotomy in 1935 after successfully snatching out bits of chimps brains.

It didnt take long for him to get the message that his revolutionary treatment was not so

perfect; in 1944 a rather dissatisfied patient called his name in the street and shot him in the

spine, paralysing him for life! As a consolation he received the Nobel prize for his contribution

to science in 1949.

Surgery is used only as a last resort, where the patient has failed to respond to other forms of

treatment and their disorder is very severe. This is because all surgery is risky and the effects of

neurosurgery can be unpredictable. Also, there may be no benefit to the patient and the effects

are irreversible.

There are four major types of lobotomy:

BBC Radio 4: The Lobotomists. This programme tells the story of three key figures in the strange

history of lobotomy - and for the first time explores the popularity of lobotomy in the UK in

detail.
ECT

Electro Convulsive Therapy (ECT) began in the 1930s after it was noticed that when cows are

executed by electric shocks they appear to convulse as if they are having an epileptic shock.

The idea was extrapolated to humans as a treatment for schizophrenia on the theoretical basis

that nobody can have schizophrenia and epilepsy together, so if epilepsy is induced by electric

shock the schizophrenic symptoms will be forced into submission! Bizzare train of thought, but

it did seem to work to a certain extent on some patients and to this day is used as a last resort

for treating severe depression.

There are many critics of this extreme form of treatment, especially of its uncontrolled and

unwarranted use in many large, under staffed mental institutions where it may be used simply

to make patients docile and manageable or as a punishment (Breggin 1979).

ECT side effects include impaired language and memory as well as loss of self esteem due to

not being able to remember important personal facts or perform routine tasks.

The procedure for administering ECT involves giving a muscle relaxant (to minimise the violent

physical reactions) followed by an anaesthetic and topped with a 80-110 volt electric shock

through electrodes placed on the temples which produces an artificial Grand Mal epileptic fit

(loss of consciousness and strong bodily convulsions followed by a period of coma like sleep).

There is a debate on the ethics of using ECT, primarily because it often takes place without the

consent of the individual and we dont know how it works!

There are three theories as to how ECT may work:

1. The shock literally shocks the person out of their illness as it is regarded as a punishment for

the inappropriate behavior.

2. Biochemical changes take place in the brain following the shocks which stimulate particular

neurotransmitters.

3. The associated memory loss following shock allows the person to start afresh. They literally

forget they were depressed or suffering from schizophrenia.

Evaluation of The Medical Model
Strengths:

It is objective, being based on mature biological science.

It has given insight into the causes of some conditions, such as GPI and Alzheimer's disease, an

organic condition causing confusion in the elderly.

Treatment is quick and, relative to alternatives, cheap and easy to administer. It has proved to

be effective in controlling serious mental illness like schizophrenia allowing patients who would

otherwise have to remain in hospital to live at home.

The sickness label has reduced the fear of those with mental disorders. Historically, they were

thought to be possessed by evil spirits or the devil especially women who were burned as

witches!

Weaknesses:

The treatments have serious side-effects, for example ECT can cause memory loss, and they

are not always effective. Drugs may not 'cure' the condition, but simply act as a chemical

straitjacket.

The failure to find convincing physical causes for most mental illnesses must throw the validity

of the medical model into question, for example affective disorders and neuroses. For this

reason, many mental disorders are called 'functional'. The test case is schizophrenia but even

here genetic or neurochemical explanations are inconclusive. The medical model is therefore

focused on physical causes and largely ignores environmental or psychological causes.

 There are also ethical problems in labelling someone mentally ill Szasz says that, apart from

identified diseases of the brain, most so-called mental disorders are really problems of living.

Labelling can lead to discrimination and loss of rights.

The medical model has been the one that has been most influential in determining the way

that mentally disturbed people are treated, but most psychologists would say that at best, it

only provides a partial explanation, and may even be totally inappropriate.

Medical Model of Abnormal Behavior

The medical model of abnormal behavior developed in the latter half of the nineteenth century
and views abnormal behavior as a disease. As you are aware, diseases have causes such as
germs, viruses, or destructive organisms that frequently produce disease symptoms. For
instance, a virus is the cause of a cold and a cough is a symptom resulting from that cause.
Physicans were well aware that treating a symptom could eliminate a symptom, like a cough,
but that this would do little to destroy the disease. Furthermore, treating the symptom often
produced undesirable side effects.

Freud and others adopted this model in an effort to explain abnormal behaviors. The behaviors
themselves, like seeing hallicucinations or phobic responses, were considered symptoms. More
difficult was identifying the underlying cause. Freud postulated that these "mental illnesses"
were often the result of hidden psychic conflicts. Kraft-Ebing's discovery in 1897 that a
spirochete caused many of the behaviors associated with the final stage of syphilis produced an
optimism that the medical model would be a useful conceptual tool for understanding
abnormal behavior.

The application of the medical model to abnormal behavior had a number of positive and
negative aspects. A few of these are summarized below with a special emphasis given to
Freud's theory and therapeutic procedures.

I. Positive Aspects

Making "mental illness" just like "any other illness" meant that people with abnormal
behaviors were treated with kindness as if they were a sick person. Educated people
came to believe that persons exhibiting abnormal behaviors were sick and not
possessed by demons.
 Since cures and treatments were found for other illnesses, there was a belief that
mental illness was also curable and treatable.

Freud provided very good descriptions of neurotic behavior; his explanations are very
questionable.

Freud emphasized the importance of the social environmental causes in causing

abnormal behavior. Unfortunately, he stressed the social environment of children and
neglected the importance of the adult social environment.

II. Negative Aspects

Many Freudian concepts such as libido, ego strength, or an underlying conflict, are
difficult to scientifically test. The problem is that many of these concepts are difficult or
impossible to measure. We cannot measure libido, we do not know objectively how
much ego strength a person has, nor can we observe the presence or absence of an
underlying conflict.

Freudian theory did make a clear-cut prediction that was open to scientific investigation
and to experimental testing; but this hypothesis of symptom substitution was not
validated. The Freudians would say that since abnormal behavior is only a symptom of
an underlying cause, if only the abnormal behavior is removed without considering an
underlying cause (which is what behavior modification does since it only deals with
behavior), then the underlying cause will manifest itself in a new symptom. This is the
concept called "symptom substitution". Evidence (Cahoon, 1968; Lazarus, 1963; Yates,
1958) has shown that symptom substitution usually does not occur; in fact, when
behavior modifiers improve abnormal behavior, the persons overall life tends to
improve, rather than new symptoms appearing.
 Labeling a person as "mentally ill" is a stigma. Research indicates that people who have
been diagnosed with mental illnesses are often not given an fair chance.

Labeling people as "ill" implies a passivity and that they must be cured by others and
have no active involvement in changing their own behavior.

Psychoanalysis is a costly and usually time consuming treatment, requiring a highly

trained specialist. Even if psychoanalysis were always successful, it would still have little
impact when one considers the number of persons that would benefit from therapy.

LEARNED BEHAVIOUR

Behavioural models suggest that all behaviour, abnormal

included, is a product of learning mainly learning by association

(see chapter 4).

For example, according to the classical conditioning model of

learning (e.g. Pavlov, 1928), if a man experiences chest pains

which result in anxiety while shopping in a department store, he

may develop a fear of department stores and begin to avoid them

because he associates them with anxiety. There is nothing inherently frightening about
department stores, but this man fears

them because of the association that he has formed with his earlier anxiety about having a
possible heart attack. Here is another

example which instead uses the operant model of learning (e.g.

Skinner, 1953): if a young normal weight woman begins to lose

weight and her friends and family praise her for doing so, she may
continue to lose weight, even if it means starving herself. Her

restricted eating behaviour will continue because she now associates a reduction in her diet
with the praise and acceptance of

others.

There is a third type of learning that does not rely on personal

experiences to establish associations. In observational learning,

behaviour is learned simply by watching someone else do something and observing what
happens to them (Bandura, 1969). For

example, a young boy may learn to be aggressive after watching

his peers act aggressively.

Each of these learning models was built on a solid foundation

of empirical research, and there is a great deal of evidence that

each of the three learning processes plays an important role in

abnormal behaviour.

INTERPERSONAL RELATION

Peplau published her Theory of Interpersonal Relations in 1952, and in 1968, interpersonal
techniques became the crux ofpsychiatric nursing. The Theory of Interpersonal Relations is a
middle-range descriptive classification theory. It was influenced by Henry Stack Sullivan,
Percival Symonds, Abraham Maslow, and Neal Elger Miller.

The four components of the theory are: person, which is a developing organism that tries to
reduce anxiety caused by needs; environment, which consists of existing forces outside of the
person, and put in the context of culture; health, which is a word symbol that implies forward
movement of personality and other other human processes toward creative, constructive,
productive, personal, and community living.

The nursing model identifies four sequential phases in the interpersonal relationship:
orientation, identification, exploitation, and resolution.

The orientation phase defines the problem. It starts when the nurse meets the patient, and the
two are strangers. After defining the problem, the orientation phase identifies the type of
service needed by the patient. The patient seeks assistance, tells the nurse what he or she
needs, asks questions, and shares preconceptions and expectations based on past experiences.
Essentially, the orientation phase is the nurse's assessment of the patient's health and
situation.

The identification phase includes the selection of the appropriate assistance by a professional.
In this phase, the patient begins to feel as if he or she belongs, and feels capable of dealing with
the problem which decreases the feeling of helplessness and hopelessness. The identification
phase is the development of a nursing care plan based on the patient's situation and goals.

The exploitation phase uses professional assistance for problem-solving alternatives. The
advantages of the professional services used are based on the needs and interests of the
patients. In the exploitation phase, the patient feels like an integral part of the helping
environment, and may make minor requests or use attention-getting techniques. When
communicating with the patient, the nurse should use interview techniques to explore,
understand, and adequately deal with the underlying problem. The nurse must also be aware of
the various phases of communication since the patient's independence is likely to fluctuate. The
nurse should help the patient exploit all avenues of help as progress is made toward the final
phase. This phase is the implementation of the nursing plan, taking actions toward meeting the
goals set in the identification phase.

The final phase is the resolution phase. It is the termination of the professional relationship
since the patient's needs have been met through the collaboration of patient and nurse. They
must sever their relationship and dissolve any ties between them. This can be difficult for both
if psychological dependence still exists. The patient drifts away from the nurse and breaks the
bond between them. A healthier emotional balance is achieved and both become mature
individuals. This is the evaluation of the nursing process. The nurse and patient evaluate the
situation based on the goals set and whether or not they were met.

The goal of psychodynamic nursing is to help understand one's own behavior, help others
identify felt difficulties, and apply principles of human relations to the problems that come up
at all experience levels. Peplau explains that nursing is therapeutic because it is a healing art,
assisting a patient who is sick or in need of health care. It is also an interpersonal process
because of the interaction between two or more individuals who have a common goal. The
nurse and patient work together so both become mature and knowledgeable in the care
process.

The nurse has a variety of roles in Hildegard Peplau's nursing theory. The six main roles are:
stranger, teacher, resource person, counselor, surrogate, and leader.

As a stranger, the nurse receives the patient in the same way the patient meets a stranger in
other life situations. The nurse should create an environment that builds trust. As a teacher, the
nurse imparts knowledge in reference to the needs or interests of the patient. In this way, the
nurse is also a resource person, providing specific information needed by the patient that helps
the patient understand a problem or situation. The nurse's role as a counselor helps the patient
understand and integrate the meaning of current life situations, as well as provide guidance
and encouragement in order to make changes. As a surrogate, the nurse helps the patient
clarify the domains of dependence, interdependence, and independence, and acts as an
advocate for the patient. As a leader, the nurse helps the patient take on maximum
responsibility for meeting his or her treatment goals. Additional roles of a nurse include
technical expert, consultant, tutor, socializing and safety agent, environment manager,
mediator, administrator, record observer, and researcher.

Some limitations of Peplau's theory include the lack of emphasis on health promotion and
maintenance; that intra-family dynamics, personal space considerations, and community social
service resources are less considered; it can't be used on a patient who is unable to express a
need; and some areas are not specific enough to generate a hypothesis.

ERICKSON MODELING AND ROLE MODELING THEORY

The Modeling and Role Modeling Theory was developed by Helen C. Erickson, Evelyn M. Tomlin,
and Mary Anne P. Swain. It was first published in 1983 in their book Modeling and Role
Modeling: a Theory and Paradigm for Nursing. The theory enables nurses to care for and
nurture each patient with an awareness of and respect for the individual patient's uniqueness.
This exemplifies theory-based clinical practice that focuses on the patient's needs.

The theory draws concepts from a variety of sources. Included in the sources are Maslow's
Theory of Hierarchy of Needs, Erikson's Theory of Psychosocial Stages, Piaget's Theory of
Cognitive Development, and Seyle and Lazarus's General Adaptation Syndrome.

The Modeling and Role Modeling Theory explains some commonalities and differences among
people.
The commonalities among people include:
Holism, which is the belief that people are more than the sum of their parts. Instead,
mind, body, emotion, and spirit function as one unit, affecting and controlling the parts
in dynamic interaction with one another. This means conscious and unconscious
processes are equally important.
Basic needs, which drive behavior. Basic needs are only met when the patient perceives
they are met. According to Maslow, whose hierarchical ordering of basic and growth
needs is the basis for basic needs in the Modeling and Role Modeling Theory, when a
need is met, it no longer exists, and growth can occur. When needs are left unmet, a
situation may be perceived as a threat, leading to distress and illness. Lack of growth-
need satisfaction usually provides challenging anxiety and stimulates growth. Need to
know and fear of knowing are associated with meeting safety and security needs.
Affiliated Individuation is a concept unique to the Modeling and Role Modeling Theory,
based on the belief that all people have an instinctual drive to be accepted and
dependent on support systems throughout life, while also maintaining a sense of
independence and freedom. This differs from the concept of interdependence.
Attachment and Loss addresses the idea that people have an innate drive to attach to
objects that meet their needs repeatedly. They also grieve the loss of any of these
objects. The loss can be real, as well as perceived or threatened. Unresolved loss leads
to a lack of resources to cope with daily stressors, which results in morbid grief and
chronic need deficits.
Psychosocial Stages, based on Erikson's theory, say that task resolution depends on the
degree of need satisfaction. Resolution of stage-critical tasks lead to growth-promoting
or growth-impeding residual attributes that affect one's ability to be fully functional and
able to respond in a healthy way to daily stressors. As each age-specific task is
negotiated, the person gains enduring character-building strengths and virtues.
Cognitive Stages are based on Piaget's theory, and are the thinking abilities that develop
in a sequential order. It is useful to understand the stages to determine what
developmental stage the patient may have had difficulty with.

The differences among people include:

Inherent Endowment, which is genetic as well as prenatal and perinatal influences that
affect health status.
Model of the World is the patient's perspective of his or her own environment based on
past experiences, knowledge, state in life, etc.
Adaptation is the way a patient responds to stressors that are health- and growth-
directed.
Adaptation Potential is the individual patient's ability to cope with a stressor. This can
be predicted with an assessment model that delineates three categories of coping:
 arousal, equilibrium, and impoverishment.
Stress is a general response to stressful stimuli in a pattern of changes involving the
endocrine, GI, and lymphatic systems.
Self-Care is the process of managing responses to stressors. It includes what the patient
knows about him or herself, his or her resources, and his or her behaviors.
Self-Care Knowledge is the information about the self that a person has concerning what
promotes or interferes with his or her own health, growth, and development. This
includes mind-body data.
Self-Care Resources are internal and external sources of help for coping with stressors.
They develop over time as basic needs are met and developmental tasks are achieved.
Self-Care Action is the development and utilization of self-care knowledge and resources
to promote optimum health. This includes all conscious and unconscious behaviors
directed toward health, growth, development, and adaptation.

In the theory, modeling is the process by which the nurse seeks to know and understand the
patient's personal model of his or her own world, as well as learns to appreciate its value and
significance. Modeling recognizes that each patient has a unique perspective of his or her own
world. These perspectives are called models. The nurse uses the process to develop an image
and understanding of the patient's world from that patient's unique perspective.

Role modeling is the process by which the nurse facilitates and nurtures the individual in
attaining, maintaining, and promoting health. It accepts the patient as he or she is
unconditionally, and allows the planning of unique interventions. According to this concept, the
patient is the expert in his or her own care, and knows best how he or she needs to be helped.

This model gives the nurse three main roles. They are facilitation, nurturance, and
unconditional acceptance. As a facilitator, the nurse helps the patient take steps toward health,
including providing necessary resources and information. As a nurturer, the nurse provides care
and comfort to the patient. In unconditional acceptance, the nurse accepts each patient just as
he or she is without any conditions.

The basic theoretical linkages used in nursing practice for this model are: developmental task
resolution (residual) and need satisfaction are related; basic need status, object attachment
and loss, growth and development are all interrelated; and adaptive potential and need status
are related.

According to the theory, the five goals of nursing intervention are to build trust, promote the
patient's positive orientation, promote the patient's control, affirm and promote the patient's
strengths, and set mutual, health-directed goals.

Modeling refers to the development of an understanding of the patient's world, while role
modeling is the nursing intervention, or nurturance, that requires unconditional acceptance.
This model considers nursing as a self-care model based on the patient's perception of the
world, as well as his or her adaptation to stressors.

When it comes to research, the following are some theoretical propositions presented by the
model:
The individual's ability to contend with new stressors is directly related to the ability to
mobilize resources needed.
The individual's ability to mobilize resources is directly related to their need deficits and
assets.
Distressors are unmet basic needs; stressors are unmet growth.
Objects that repeatedly facilitate the individual patient in need take on significance for
that individual patient. When this occurs, attachment to the significant object occurs.
Secure attachment produces feelings of worthiness.
Feelings of worthiness result in a sense of futurity.
Real, threatened, or perceived loss of the attachment object results in morbid grief.
Basic need deficits co-exist with the grief process.
An adequate alternative object must be perceived as available in order for the patient to
resolve his or her grief process.
Prolonged grief due to an unavailable or inadequate object results in morbid grief.
Unmet basic and growth needs interfere with growth processes for the patient.
Repeated satisfaction of basic needs is a prerequisite to working through developmental
tasks and resolution of related developmental crises.
Morbid grief is always related to need deficits.