PSYCHOSOCIAL THEORIES

AND THERAPY
NCM 117 PRELIM
WEEK 3-4
A.Psychosocial Theories
b. Cultural Considerations
c. Treatment Modalities
LEARNING OBJECTIVES
1. Explain the basic beliefs and approaches of the following psychosocial theories: psychoanalytic,
developmental, interpersonal, humanistic, behavioral, existential, and crisis intervention.

2. Describe the following psychosocial treatment modalities: individual psychotherapy, group

psychotherapy, family therapy, behavior modification, systematic desensitization, token economy,
self-help groups, support groups, education groups, cognitive therapy, milieu therapy, and

psychiatric rehabilitation.

3. Identify the psychosocial theory on which each treatment strategy is based.

4. Identify how several of the theoretical perspectives have influenced current nursing practice.
What is the psychosocial theory?

• Psychosocial theory explains changes in self-understanding,

social relationships, and one's relationship to society from
infancy through later life.
6 PSYCHOSOCIAL THEORIES

•Psychoanalytic • Developmental
• Interpersonal • Humanistic •
Behavioral • Existential
PSYCHOANALYTIC THEORIES
Sigmund Freud: The Father of Psychoanalysis
• Sigmund Freud (1856–1939) developed
psychoanalytic theory in the late 19th and
early 20th centuries in Vienna,Austria where
he spent most of his life.
• Psychoanalytic theory supports the notion
that all human behavior is caused and can
be explained (deterministic theory).
• Freud believed that repressed (driven from
conscious awareness) sexual impulses and
desires motivate much human behavior
Personality Components: Id, Ego, and
Superego
Behavior Motivated by Subconscious
Thoughts and Feelings.
• Freud believed that the human
personality functions at three
levels of awareness:
• Conscious, Preconscious, and
Unconscious (Freud, 1923,
1962)
A. Conscious mind refers to the perceptions,
thoughts, and emotions that exist in the
person’s awareness, such as being aware of
happy feelings or thinking about a loved one.
B. Preconscious thoughts and emotions are
not currently in the person’s
awareness, but he or she can recall them with
some effort—for example, an
adult remembering what he or she did,
thought, or felt as a child. According to Freud’s
C. Unconscious is the realm of thoughts and theories, the person
feelings that motivates a person even though represses (subdues) the
he or she is totally unaware of them.
memory of traumatic
This realm includes most defense events that are too
mechanisms and some instinctual drives or
motivations.
painful to remember into
the unconscious.
• Freud believed that much of what we
do and say is motivated by our
subconscious thoughts or feelings
(those in the preconscious or
unconscious level of awareness).
• A Freudian slip is a term we
commonly use to describe slips of
the tongue these slips are not
accidents or coincidences, but rather
are indications of subconscious
feelings or thoughts that accidentally
emerge in casual day-to-day
conversation.
Freud’s Dream Analysis.
• Freud believed that a person’s dreams reflect his or
her subconscious and have significant meaning,
though sometimes the
meaning is hidden or symbolic.
• Dream analysis, a primary technique used in
psychoanalysis, involves discussing a client’s
dreams to discover their true meaning and
significance. For example, a client might report
having recurrent
frightening dreams about snakes chasing her. Freud’s
interpretation might be that the woman fears
intimacy with men; he would view the snake as a
phallic (phallus)symbol, representing the penis.
What/who do you remember by these
descriptors?
•NURTURING
•STRONG
•GIVER
•INTELLIGENT
•ROLE MODEL
•BRAVE
•LEADER
Free association
• A method used to gain access to subconscious thoughts and feelings
is free association, in which the therapist tries to uncover the client’s
true thoughts and feelings by saying a word and asking the client to
respond quickly with the first thing that comes to mind.
• Freud believed that such quick responses would be likely to uncover
subconscious or repressed thoughts or feelings
Ego Defense Mechanisms.
• Methods of attempting to protect the self and cope
with basic drives or emotionally painful thoughts,
feelings, or events.
• Most defense mechanisms operate at the
unconscious level of awareness, so people are not
aware of what they are doing and often need help to
see the reality.
 • EGO DEFENSE MECHANISMS
DEFENSE MECHANISMS/DESCRIPTION
Compensation: Overachievement in one area to offset real
or perceived deficiencies in another area
Conversion: Expression of an emotional conflict through
the development of a physical symptom, usually
sensorimotor in nature
Denial:Failure to acknowledge an unbearable condition; failure to
admit the reality of a situation or how one enables the problem to
continue.
Displacement:a Ventilation of intense feelings toward
persons less threatening than the one who aroused those
feelings
Dissociation:Dealing with emotional conflict by a
temporary alteration in consciousness or identity
Fixation:Immobilization of a portion of the personality
resulting from unsuccessful completion of tasks in a
developmental stage
EXAMPLE
• Napoleon complex: diminutive man becoming emperor
• paralysis, tremor, tactile insensitivity, weakness, numbness,
seizures, loss of consciousness, and vision and hearing
problems
• Diabetic person eating chocolate candy
• Person who is mad at the boss yells at his or her spouse
• Child who is harassed by a bully at school mistreats a
younger sibling
• Amnesia that prevents recall of yesterday’s auto
accident
• Adult remembers nothing of childhood sexual abuse
• Never learning to delay gratification
• Lack of a clear sense of identity as an adult
• E.g.Fixated on oral stage: may be over-dependent on others and
may seek oral stimulation through smoking, drinking, or eating.
EGO DEFENSE MECHANISMS
DEFENSE MECHANISMS/DESCRIPTION
Identification:Modeling actions and opinions of
influential others while searching for identity, or aspiring this is the specialty of an instructor she admires
to reach a personal, social, or occupational goal
Intellectualization :Separation of the emotions of a
painful event or situation from the facts involved;
acknowledging the facts but not the emotions
Introjection:Accepting another person’s attitudes,
beliefs, and values as one’s own
Projection:Unconscious blaming of unacceptable
inclinations or thoughts on an external object
Rationalization : Excusing own behavior to avoid guilt,
responsibility, conflict, anxiety, or loss of self-respect
Reaction formation:Acting the opposite of what one
thinks or feels
EXAMPLES
Nursing student becoming a critical care nurse because
Person shows no emotional expression when discussing
serious car accident
Person who dislikes guns becomes an avid hunter, just
like a best friend
• Man who has thought about same-gender sexual
relationship but never had one beats a man who is gay
• Person with many prejudices loudly identifies others as
bigots
Student blames failure on teacher being mean • Man
says he beats his wife because she does not listen to him
Woman who never wanted to have children becomes a
supermom • Person who despises the boss tells
everyone what a great boss she is
DEFENSE MECHANISMS/DESCRIPTIONS EXAMPLE
Regression:Moving back to a previous developmental • A 5-year-old asks for a bottle when new baby brother is
stage to feel safe or have needs met being fed
Repression:Excluding emotionally painful or anxiety- Woman has no memory of the mugging she suffered
provoking thoughts and feelings from conscious yesterday • Woman has no memory before age 7, when
awareness she was removed from abusive parents
Resistance:Overt or covert antagonism toward Person attends court-ordered treatment for alcoholism
remembering or processing anxiety-producing but refuses to participate
information
Sublimation:Substituting a socially acceptable activity for Person who has quit smoking sucks on hard candy when
an impulse that is unacceptable the urge to smoke arises • Person goes for a 15-minute
walk when tempted to eat junk food
Substitution:Replacing the desired gratification with one Woman who would like to have her own children opens a
that is more readily available day care center
Suppression:Conscious exclusion of unacceptable • Student decides not to think about a parent’s illness to
thoughts and feelings from conscious awareness study for a test • Woman tells a friend she cannot think
about her son’s death right now
Undoing:Exhibiting acceptable behavior to make up for or • Person who cheats on a spouse brings the spouse a
negate unacceptable behavior bouquet of roses • Man who is ruthless in business
donates large amounts of money to charity
FREUD’S Five Stages of Psychosexual
Development
• Freud based his theory of childhood development on the belief that
sexual energy, termed libido, was the driving force of human
behavior.
• He proposed that children progress through five stages of
psychosexual development: oral (birth to 18 months), anal (18–36
months), phallic/oedipal (3–5 years), latency (5–11 years or 13
years), and genital (11–13 years).
• Psychopathology results when a person has difficulty making the
transition from one stage to the next or when a person remains
stalled at a particular stage or regresses to an earlier stage.
FREUD’S DEVELOPMENTAL STAGES
PHASE AGE FOCUS
ORAL Birth to 18 months Major site of tension and gratification is the mouth,
(0- 1.5 yrs. Old) lips, and tongue; includes biting and sucking activities.
Id is present at birth. Ego develops gradually from
rudimentary structure present at birth.
ANAL 18–36 months (1.5- Anus and surrounding area are major source of
3 yrs old) interest. Voluntary sphincter control (toilet training) is
acquired.
PHALLIC/OEDIPAL 3–5 years Genital is the focus of interest, stimulation, and excitement.
Penis is organ of interest for both sexes. Masturbation is
common. Penis envy (wish to possess penis) is seen in girls;
oedipal complex (wish to marry opposite-sex parent and be
rid of same-sex parent) is seen in boys and girls.
LATENCY 5–11 or 13 years Resolution of oedipal complex. Sexual drive
channeled into socially appropriate activities such as
school work and sports. Formation of the superego.
GENITAL 11–13 years Final stage of psychosexual development
Begins with puberty and the biologic capacity for
orgasm; involves the capacity for true intimacy.
Developmental Theories
• Erik Erikson and Psychosocial Stages of Development
• Jean Piaget and Cognitive Stages of Development
Erik Erikson and Psychosocial Stages of
Development • Erik Erikson (1902–1994) was a German-
born psychoanalyst, who extended
Freud’s work on personality
development across the life span while
focusing on social and psychological
development in the life stages
• He described eight psychosocial stages of
development. In each stage, the person
must complete a life task that is essential
to his or her well-being and mental
health. These tasks allow the person to
achieve life’s virtues: hope, purpose,
fidelity, love, caring, and wisdom
(Erikson, 1963).
Erikson’s Stages of Psychosocial Development
STAGE VIRTUE TASK

Trust vs. mistrust (infant)
Autonomy vs. shame and doubt
(toddler)
Initiative vs. guilt (preschool)
Industry vs. inferiority (school age)
Identity vs. role confusion
(adolescence)
Intimacy vs. isolation (young adult)
Generativity vs. stagnation (middle
adult)
Hope Viewing the world as safe and reliable;
relationships as nurturing, stable, and
dependable
Will Achieving a sense of control and free will
Purpose Beginning development of a conscience;
learning to manage conflict and anxiety
Competence Emerging confidence in own abilities; taking
pleasure in accomplishments
Fidelity Formulating a sense of self and
belonging
Love Forming adult, loving relationships, and
meaningful attachments to others
Care Being creative and productive;
establishing the next generation

Ego integrity vs. despair (maturity) Wisdom Accepting responsibility for oneself and
life
Jean Piaget and Cognitive Stages of
Development
• Jean Piaget (1896–1980) explored how
intelligence and cognitive functioning
develop in children.
• He believed that human intelligence
progresses through a series of stages based
on age, with the child at each successive
stage demonstrating a higher level of
functioning than at previous stages.
• In his schema, Piaget strongly believed that
biologic changes and maturation were
responsible for cognitive development.