Introduction to

Clinical Psychology
Science, Practice and Ethics
Chapter 3
Psychological Models in Clinical
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The Role of Theoretical Models
 How models help
 Suggest patterns of human experience
 Can be tested
 Discarded when no longer useful
 Dangers of models
 Can distort observations
 One-dimensional models are limited

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Copyright ©Allyn & Bacon 2005
Sigmund Freud (1856-1939) developed
psychoanalysis as
(1) a theory of psychological development,
personality, and neurosis;
(2) a method for studying symbolic cognitive
processes and the unconscious; and
(3) a technique of psychotherapy.
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There are 3 intertwined strands:
 a structural theory of personality and the
topography of the mind
 a theory of development positing a series of standard
psychosexual stages, each marked by
 a sensual focus on a particular part of the body
 the need to confront a certain challenging conflict
 the central concept of the unconscious, referring to
the hidden workings of dynamic mental processes
that cause most emotionally-significant behavior

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 ID pleasure principle/primary process
 EGO reality principle/secondary process
 conscience
 ego ideal
 ID/EGO conflicts can cause neurotic anxiety
 conflicts between the EGO and external
reality can cause realistic anxiety
 conflicts between the EGO and SUPEREGO
can cause moral anxiety
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The “it” (or, the id) . . .
 The minds of newborn children have practically no
structure initially, so infants tend to go directly into
action to satisfy the demands of the instincts; the
guiding principle is the pleasure principle.
 Infants’ thinking patterns are dominated by
hallucinatory images, the type we are familiar with
when we are daydreaming or dreaming. This form of
cognition is known as primary process, a form of
wishful thinking that coincides with the infant’s
difficulty in separating fantasy from reality.
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The “me” (or, the ego) . . .
 Children learn to follow the reality principle in
dealing effectively with life’s demands. This coincides
with the development of the ego. The id is the
original pleasure-seeking mind, driven by instincts,
and the ego is the newer, realistic one, driven by the
need to compromise with the demands, pressures,
and frustrations imposed by the outside world.
Threats, internal or external, create anxiety, a signal
to the ego to deal effectively and practically with the
 A more mature thinking style develops, secondary
process thinking, that realistic, pragmatic, goal-
oriented, rational cognitive activity that we associate
with waking life in adulthood.
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The “over-me” (or, the superego) . . .
 The superego is an ideal ego that, as the
conscience, exercises moral censorship on
 It contains the commands and prohibitions
that we learn from parents, teachers, and
others in authority during our childhood years.
 It both arises from, and allows resolution of,
the Oedipus complex that all humans have to
negotiate at about the age of five
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 The Oedipus Complex
 The Case of Little Hans
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 these were described by Anna Freud
 examples include:
 defense mechanisms operate unconsciously
to protect the ego from threats from the id and
from external reality
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The oral stage (0 – 18 months)
 Newborn infants are already equipped with a
sucking reflex that allows them to feed from
the mother’s breast or from the bottle, but the
breast or the bottle are not always available.
 The resulting frustration is the first significant
psychological challenge faced by the infant.
Handled poorly, this frustration can lead to
 Unconsciously, the oral stage brings the
hidden threat of the loss of the parent who
brings food.
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The anal stage (18 months to 4 years)
 The conflicting tendencies are between being tidy,
clean, dutiful, and cooperative versus being messy,
rebellious, and uncooperative.
 Ideally, parents will approach toilet-training
sensitively, presenting neither too great nor too small
a challenge at each point.
 If fixation occurs, the child may develop personality
traits that are symbolically related to toileting
 Uncooperative, mean, stingy, and emotionally
constricted versus generous, giving, careless,
wasteful, and emotionally expressive.
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The phallic stage (4 - 6 years)
 Themes of rivalry with the same-sex parent
for the attention of the other; the Oedipus
Complex is resolved partly by repression
and partly by identification, though the
process differs for boys and girls.
 “The girl accepts castration as an
accomplished fact, whereas the boy fears the
possibility of its occurrence” (Freud,
1924/1989, p. 665).
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The latency stage (7 to puberty)
 Either a time when whatever may be going on
psychosexually is hidden or latent,
 or a stage in which the child’s ego functioning
develops as he or she learns to deal with the
practicalities of school, peer relationships,
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The genital stage (puberty to young
 After puberty comes the genital stage in the
teenage years, in which young adults learn to
focus their sexual interests upon another
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 these were described by Anna Freud
 examples include:
 defense mechanisms operate unconsciously
to protect the ego from threats from the id and
from external reality
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Psychoanalysis: Influences on Clinical
 First systematized school of psychotherapy
 Several psychodynamic therapies developed
in reaction to Freudian psychoanalysis
 Unconscious processes
 Psychological testing
 Projective tests
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Interpersonal and Neo-Freudian
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ALFRED ADLER (1870-1937)
 Adler accepted Freud’s psychodynamic theory and
agreed that
 symptoms are purposeful
 dreams are meaningful
 early childhood experiences are highly significant
 but he rejected
 the stages of psychosexual development
 the Oedipus complex
 and stressed instead each individual’s search for a
positive role within the family, the prototype for all
other social interactions
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ADLER (continued)
 in the process we form conclusions that
contain errors and partial truths together with
accurate judgments
 we create a cognitive map or life-style, an
implicit set of convictions that serve as guides
for dealing with other people
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ADLER (continued)
These implicit convictions include
 the self-concept (the sense of who one is)
 the self-ideal (the sense of who one should
 the world-concept (the sense of what the
natural and social world demands)
 the ethical convictions (the sense of what is
right and wrong)
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ADLER (continued)
 discrepancies between self-concept and self-
ideal may result in inferiority feelings that
could expand into the pathological inferiority
 this is a social view of neuroses
 feelings of inferiority to others is debilitating,
but constructive engagement in interpersonal
relationships is the key to a creative and
fulfilling life
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 the terms include ego psychology, object relations,
and the cultural school of psychoanalysis
 neo-Freudians was the label both for the innovators
in general and for the specific sub-group who gave
prominence to interpersonal relationships in
personality, psychopathology, and psychotherapy
 Erich Fromm, Karen Horney, and Harry Stack
Sullivan represent the Adler-like neo-Freudians who
rejected the libido theory and stressed the
importance of interpersonal issues
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Erich Fromm (1900-1980)
 Freud believed that in return for the advantages of
living in a civilized society we have to restrict our
personal freedom, making it necessary to repress our
instinctive urges
 Fromm was more optimistic, viewing aggression as
caused by the frustrations of living in human society,
not by an automatic, innate drive
 he explained the sense of inferiority experienced by
many women in terms of how they were treated in
contemporary society
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Karen Horney (1885-1952)
 recognizing that what is “normal” in one
culture may be seen as abnormal in another,
Horney emphasized cultural rather than
biological factors in human development,
especially concerning gender differences
 children begin life with basic anxiety, but it
can be overcome with appropriate nurturing
from parents or others
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Karen Horney (continued)
 children who have been deprived of this vital
parental love develop low self-esteem and
patterns of impairment in social relationships
 we try to deal with anxiety by our orientation
toward people; we can move towards,
against, or away from others
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Harry Stack Sullivan (1892-1949)
 Sullivan was born in the United States and
became known as the founder of the
Washington school of psychiatry, in addition
to having been a prominent figure in the
cultural school
 viewed personality as the enduring pattern of
social interactions
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Sullivan (continued)
 the self consists of the reflected appraisals of
parent figures and other significant adults
 if parents are excessively critical, children
grow up to criticize themselves and thereby
live with anxiety. If parents are loving,
children grow up capable of “love, fellowship
and good social adjustment in general”
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 interpersonal theory stems from the work of
Harry Stack Sullivan, who believed that “we
come to treat ourselves as we have been
treated by our parents”
 early relationships and encounters with
others, interpersonal transactions, shape our
view of ourselves and create behavioral
tendencies that persist over the life span
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(continued) . . .
 mental disorders are seen as rooted in the
patterns of early interpersonal relationships
 specific life events and current interpersonal
issues are strongly linked to clients’ present
mood states
 altering the interpersonal environment can
help clients alleviate their symptoms and
reduce excessive, negative emotions
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Interpersonal Models: Influences on
Clinical Psychology
 the interpersonal model has helped bring
clinical psychologists into contact with social
 Harry Stack Sullivan, Gerald Klerman, and
other psychiatrists established an image of
psychiatry different from the traditional
medical model of symptoms and diseases
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Influences continued…
 interpersonal psychotherapists have shown that one
may adopt a psychodynamic orientation without
accepting traditional psychoanalysis
 many psychodynamic therapies emphasize early
childhood relationships over unconscious drives and
 interpersonal psychotherapy is a contemporary
empirically supported psychotherapy

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 a loosely grouped set of approaches to
 Emphasize potential for positive development
and personal growth
 Related to existentialists
 Existential philosophy emphasizes freedom to
 With freedom comes responsibility

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Client-Centered Therapy
 Carl Rogers (1902- 1987)
 Developed thinking about psychotherapy in
the 1940s and 1950s
 Landmark paper in 1957
 Essential conditions for therapeutic change
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Assumptions of client-centered
 Actualizing tendency
 Orgasmic Valuing Process
 Trusting our innate sense of what feels right people will
move toward actualizing tendency
 Conditions of Worth
 Therapeutic Principles
 Nondirective
 Therapist-offered conditions
 Empathy
 Unconditional Positive Regard
 Genuineness

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Humanism: Influences on Clinical
 Springboard to a variety of forms of psychotherapy
 Existential analysis
 Client-centered therapy
 Gestalt therapy
 Therapist-Offered Conditions central to strong
therapist-client alliance across therapies
 Fostered research on process of psychotherapy
Behavioral Models
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Behavioral Models: Key Assumptions
 Rejection of medical model
 Abnormal – normal continuum
 Basis in experimental psychology
 Direct modification of overt behavior
 Focus on maintaining factors
 Commitment to experimental evaluation of

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Behavior Therapy: History
 South Africa
 Joseph Wolpe (Psychotherapy by Reciprocal Inhibition,
 England
 Hans Eyesenck
 Monte Shapiro
 United States
 John B. Watson
 B.F. Skinner
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Learning Theory
 Classical conditioning
 Unconditioned Stimulus (UCS)
 Unconditioned Response (UCS)
 Conditioned Stimulus (CS)
 Conditioned Response (CR)
 Operant Conditioning
 Reinforcement
 Schedules of reinforcement
 Extinction
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Behavioral Models: Influences on
Clinical Psychology
 Challenged psychodynamic myths
 e.g., symptom substitution
 Single case experimental design
 Extensive research on behavioral therapies
 Empirically supported treatments
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Cognitive Model
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Cognitive Models: Development
 Aaron Beck
 Cognitive therapy
 Albert Ellis
 Rational-Emotive Behavior Therapy
 Albert Bandura
 Social Learning Theory
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Cognitive Models: Key
 Behavior and emotions are influenced by
thoughts and beliefs about events more so
than the events themselves
 Expectancies
 Outcome expecations
 Self-efficacy
 Observational learning
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Cognitive Models: Links to
Behavior Therapy
 Commitment to empirical research
 Ties to experimental psychology (cognitive
 Social learning theory an expansion of classic
learning theory
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Cognitive Models: Influences on
Clinical Psychology
 Empirically supported
 Panic disorder
 Social anxiety
 Depression
 Bulimia
 Increased in popularity
 Popular among clinicians
 Popular among clinical scientists