UNIT II

CONCEPTUAL FRAMEWORK IN PSYCHIATRIC CARE

Overview

 Theory
o Nothing more than a set of conventions constructed by theorists

 Psychotherapy
o The use of a group of psychological techniques to change behaviors, feelings, thoughts
or habits

SCHOOLS OF PSYCHOTHERAPY
I. Supportive therapy
 It allows the client to express feelings, explore alternatives, and makes
decisions in a safe, caring environment

II. Reeducative therapy

 Focuses on the exploration of new ways of perceiving and behaving
(individual or group)

III. Reconstructive psychotherapy

 Focuses on emotional and cognitive restructuring of self

I. PSYCHODYNAMIC FRAMEWORK
A. Concepts
1. Sigmund Freud’s Psychoanalytic Theory (Psychosexual/Intrapsychic Theory)
a. Human personality functions at three levels of awareness.
b. Anxiety results from the ego’s attempts to balance the id and superego.
c. Sexual energy (libido) is the driving force of human behavior.
d. Transference and counter transference

LEVELS OF AWARENESS

CONSCIOUS PRECONSCIOUS/SUBCONSCIOUS UNCONSCIOUS

 Concerned with perceptions,
thoughts, and emotions that
exist in the person’s
awareness
 Can be recalled voluntarily
 Stores temporarily important
ideas, events, experiences,
emotions which are partially
forgotten
 Can be recalled at will / with
some effort
 Serves as a censoring part of the
mind
 Reservoir of all past
experiences which are
usually painful and
unresolved
 Cannot be recalled at will
 Motivates a person even
though he is totally
unaware of them

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 PERSONALITY COMPONENTS / STRUCTURES OF PERSONALITY

Id Ego Superego
Period of  Present at birth and  Starts to develop at 4-6  Starts to develop at 3-6
development throughout life months based on years old, develops out
experience, of the ego on the basis
identification, learning of assimilation,
and interaction with the identification with
environment parental and social-
moral codes
Governing   
principle
Role   
Characteristic  Impulsive, unthinking  Thought rationality and  Blindly rigid, and
mode of thought behavior, no regard for ability to solve problems moralistic
rule/social convention,
no sense of right or
wrong, wishful, illogical,
emotional, unlearned,
unable to differentiate
between memory,
images and objective
perception
Focus  Seeks instant  Represents mature and  Parental expectation
gratification adaptive behavior that
allows a person to
function successfully in
the world

PSYCHOSEXUAL DEVELOPMENT STAGES

STAGE AGE CHARACTERISTICS

Oral 0-1 1/2  Center of energy:  Excess: stubborn, no form of
years old  Ways to relieve tension include sucking control
(passive) and biting (aggressive) activities
 Focus: self-love  Deprived: gum chewing,
talkative, overeating, nail biting,
smoking, alcoholic, gossiping
Anal 1 1/2 -3  Center of energy:  Too strict: too much self / social
years old  Acquisition of voluntary sphincter control control, miser, thrifty,
 Ways to relieve tension: release of tension meticulous, strict, orderly,
through the release of excretory products compulsive, cleaner collector,
 Focus: gain recognition from others due to perfectionist, rigid
mastery of toilet training
 Too lax: no self / social control,
disorderly, untidy, antisocial,
stubborn
Phallic 3-6 years  Center of energy:  Residual phallic – sexual
old  Release of tension: sexual interest, deviance
questions gender formation and sex role,
explores body, genital exhibitionism
 Family triangle period
 Oedipal complex / Elektra complex
 Penis is organ of interest for both sexes
 Penis envy (girls) / castration fear (boys)
 Focus: love of parents
 Gender formation / identity

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Latency 6-12  Center of energy:  Formation of superego
years  Release of tension: learning new tasks and
knowing new people
 Relationship is homosexual
 Focus: socially acceptable behaviors
 Sense of industry and mastery developed
 Concerned with group success to become
dominant in competition
Genital 12-18  Center of energy:
years  Release of tension: capacity to love
 Relationship is heterosexual
 Focus: freeing self from parents
 With ambivalent feeling: wanting to be a
child but also wants to be an adult
 Needs trust and open communication
 Frustrations and conflicts are present

TRANSFERENCE VS. COUNTERTRANSFERENCE

Transference Counter transference

2. Erik Erikson’s Psychosocial Development Theory

a. Epigenetic principle: each individual has a genetic endowment but once
the person interacts with others, his behavior changes
b. Psychosocial growth occurs in sequential phases and each stage is
dependent on the completion of the previous stage and life task
c. Success or failure to develop and earlier task would mean success or
failure to go to the next task
d. Late development is possible but difficult

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 EIGHT STAGES OF PSYCHOSOCIAL DEVELOPMENT

Stage Age Virtue Task of other people Task

Trust vs. Infant Hope  Needs of the infant  View the world as safe
Mistrust are met consistently and reliable;
relationships as
 Significant Other: nurturing, stable and
dependable

 (+) = loving,
affectionate, friendly,
self-confident
 (-) = suspicious, over
jealous, envious,
paranoid
Autonomy Toddler Will  Let the toddler  Achieving a sense of
vs. Shame explore / control self control and free will
and doubt and environment
with supervision  (+) = independent, with
self-control
 SO:  (-) = overly compliant
Initiative vs. Preschool Purpose  Let the preschooler  Beginning development
Guilt explore of a conscience,
environment with learning to manage
supervision conflict and anxiety

 SO:  (+) = responsible, role

identification
 (-) = too much use of
denial and restriction
Industry vs. School age Competenc  Support the child’s  Emerging confidence in
Inferiority e efforts at learning ; own abilities; taking
do not compare pleasure in
with others accomplishments

 SO:  (+) = sense of mastery –

enjoys school activities
and competition

 (-) = school dropout;

loner
Identity vs. Adolescenc Fidelity  Support  Formulating a sense of
Role e adolescent’s self and belonging
confusion vocational decision
 (+) = plans for future
 SO:
 (-) = identity crisis,
antisocial
Intimacy vs. Young adult Love  Support adult’s  Forming adult, loving
isolation decision regarding relationships and
love relationship meaningful
attachments to others
 (+) = can form adult,
loving relationship

 (-) = single blessedness;

relationship and jobs in
temporary basis

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 Generativity Middle Care  Support from family  Being creative and
vs. adult productive; establishing
stagnation next generation
M
 (+) =productive,
creative, establish the
next generation
 (-) = selfish, self-
centered
Ego Maturity Wisdom  Accepting responsibility
integrity vs. for one’s self and life
Despair M
 (+) = sense of
completeness or
worthiness, accepts
death, accepts
responsibility for one’s
self and life
 (-) = helpless, fear of
death

B. Psychodynamic View of Mental Illness

1. Applies to non-psychotic conditions
2. Abnormal behavior is traced back to unresolved problems
3. A person behaves in less mature ways because defenses are fixed at an earlier
development stage

C. Psychodynamic Treatment
 Seeks to alter behavior and thought by examining and resolving earlier conflicts
through
a. Free association
b. Dream analysis
c. Transference analysis
d. Catharsis
e. Hypnotherapy

II. BEHAVIORAL THEORIES

A. Concepts
1. Ivan Pavlov: Classical Conditioning
o Behavior can be changed through conditioning with external /
environmental conditions or stimuli

2. BF Skinner: Operant Conditioning

o People learn their behavior from their history of past experiences
especially those experiences that were repeatedly reinforced
o Behavior is that only which could be observed, studied,
learned/unlearned. If these can be changed, then can change also in
thoughts and feelings

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 CONDITIONING

Respondent (Classical) Operant

 Happens when a response and stimulus
become connected
 Conditioned response develops through the
repeated pairing of stimuli and response.
 People respond to reach a goal
 They “operate” on their environment to achieve
something rewarding or to avoid something
aversive
 The response precedes the stimulus

REINFORCEMENT

Positive
 When this is used, the response happens by
adding something to increase the probability of
the response
 But the nature of the positive reinforcement
can differ for different people
Negative
 Involves termination or removal of a
consequence
 Something is removed after a desired response
to increase the probability of behavior
 Negative reinforces are usually unpleasant or
aversive so that the person is motivated to
exhibit a desired target behavior to escape from
the unpleasant condition

B. Behavioral View of Mental illness

1. Applies to anxiety disorder, phobias and behavioral problems
2. Maladaptive behaviors are learned through classical and operant problems
3. Maladaptive behaviors are maintained through reinforcement
4. Maladaptive behaviors can be modified by changing the environment
5. The environment can be changed by altering the original stimuli and using
positive or negative reinforcements

C. Treatment from a Behavioral Framework

Behavior modification
o Method of attempting to strengthen a desired behavior / response by
reinforcement, either positive or negative

Behavioral techniques:

1. Systematic desensitization
2. Flooding
3. Biofeedback
4. Relaxation techniques
5. Aversive therapy
6. Token economy
7. Behavioral contract

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