Learning Objectives

After studying this topic, you should be able

to:
Describe what is meant by theory and why
theories are important to clinical practices.
Analyze the psychodynamic theory.
Diffrentiate behavioural, cognitive, cognitive-
behavioural, humanistic, sociocultural,
biophysiological and interpersonal theories.
Describe several theories and its importance to
understanding clients in development and
context.
Articulate how theory is applied to practice.
Conceptual frameworks and theories

Conceptual frameworks and theories are

nothing more than worldviews-ideas about how
world works.
Theory is nothing more than one person’s or
group’s beliefs about how something happens
or works.
Theories of human behaviour
 1. Psychoanalytic theory
(Sigmund Freud)

Topographical
Model

Preconsciousness Consciousness Unconsciousness

 Consciousness
The conscious represents the small area, the content of
which can only be communicated by language or
behavior..
The conscious system is that region of the mind in which
perceptions coming from the outside world or from within
the body or mind are brought into awareness.
Internal perceptions can include introspective
observations of thought processes or affective states of
various kinds.
It was assumed that the function of consciousness used
a form of neutralized psychic energy called attention
cathexis.
 Preconsciousness

The preconscious system consists of those mental

events, processes, and contents that are, for the most
part, capable of reaching or being brought into conscious
awareness by the act of focusing attention.
The quality of preconscious organizations may range
from reality-oriented thought sequences or problem-
solving analysis with highly elaborated secondary
process schemata all the way to more primitive
fantasies, daydreams, or dream-like images, which
reflect a more primary process organization.
 uncounsciousness
The unconscious is as referring to those mental
contents and processes that are incapable of achieving
consciousness because of the operation of a
counterforce of censorship or repression.
The unconscious mental contents in this dynamic sense
consist of drive representations or wishes that are in
some measure unacceptable, threatening, or abhorrent
to the intellectual or ethical standpoint of the individual.
This results in intrapsychic conflict between the
repressed forces and the repressing forces of the mind.
When repressive countercathexis weakens, this may
result in formation of neurotic symptoms.
Person’s behaviour based on
Psychoanalytic theory

The interplay three subsystem on

A person’s behaviour

Id Ego Superego
 Characteristic of the Id
Id consists of everything psychological a
person inherits at birth, including instinct.
Id as the person’s instinctual drives ofr
pleasure principles (Destructive or
constructive drives)
The id is completely selfish and concerned
with immediate gratification of desires and
needs, regardless of reality and the
external world.
 Characteristics of the ego
The ego mediates between the id and the
external world.
The function of the ego is to meet the
needs of the id, but in a way that ensure
the person’s well-being.
Characteristics of the superego
The superego is related to norms and
values.
The outgrowth of learning the taboos and
moral values of society – essentially, one’s
conscience.
 Stages of Psychosexual Development
Oral Stage ( Birth – 18 month)
Earliest stage of development in which the
infant's needs, perceptions, and modes of
expression are primarily centered in mouth, lips,
tongue, and other organs related to the oral
zone.
Excessive oral gratifications or deprivation can
result in libidinal fixations contributing to
pathological traits. Such traits can include
excessive optimism, narcissism, pessimism (as
in depressive states), or demandingness. Envy
and jealousy often associated with oral traits.
 Cont….
Anal Stage
Maturation of neuromuscular control over sphincters,
particularly anal sphincters, permitting more voluntary
control over retention or expulsion of feces.
Maladaptive character traits, often apparently
inconsistent, derive from anal erotism and defenses
against it. Orderliness, obstinacy, stubbornness,
willfulness, frugality, and parsimony are features of anal
character.
When defenses against anal traits are less effective,
anal character reveals traits of heightened ambivalence,
lack of tidiness, messiness, defiance, rage. Anal
characteristics and defenses are typically seen in
obsessive-compulsive neuroses.
Urethral Stage
This stage not explicitly treated by Sigmund Freud but
serves as transitional stage between anal and phallic
stages. It shares some characteristics of anal phase and
some from subsequent phallic phase.
Predominant urethral trait is competitiveness and
ambition, probably related to compensation for shame
due to loss of urethral control. This may be start for
development of penis envy, related to feminine sense of
shame and inadequacy in being unable to match male
urethral performance. Also related to issues of control
and shaming.
Phallic Stage
Phallic stage begins sometime during 3rd yr and
continues until approximately end of 5th yr.
Focus on castration in males and penis envy in
females. Patterns of identification developed
from resolution of oedipal complex provide
another important focus of developmental
distortions.
They also subsume and integrate residues of
previous psychosexual stages so that fixations
or conflicts deriving from preceding stages can
contaminate and modify oedipal resolution.
Latency Stage
From approximately 5–6 yrs of age until
approximately 11–13 yrs of age).
Danger in latency period can arise either from
lack of development of inner controls or excess
of them.
Lack of control can lead to inability to sufficiently
sublimate energies in interest of learning and
development of skills; excess of inner control,
however, can lead to premature closure of
personality development and precocious
elaboration of obsessive character traits.
Genital Stage
Genital or adolescent phase extends from onset of puberty from
11–13 yrs of age until young adulthood.
This stage is divided into preadolescent, early adolescent, middle
adolescent, late adolescent, and even postadolescent periods.
Pathological deviations due to inability to achieve successful
resolution of this stage can arise from whole spectrum of
psychosexual residues because developmental task of adolescence
is in a sense a partial reopening and reworking and reintegrating of
all of these aspects of development.
Previous unsuccessful resolutions and fixations in various phases or
aspects of psychosexual development produce pathological defects
in the emerging adult personality.
 Comparison psychosexual and
psychosocial developments
Psychosexual Psychosocial developments
developments
Oral Trust versus Mistrust (Birth to
Approximately 18 Months)

Anal Autonomy versus Shame and

Doubt (Approximately 18 Months
to Approximately 3 Years)

Phallic Initiative versus Guilt

(Approximately 3 Years to
Approximately 5 Years

Latency Industry versus Inferiority

(Approximately 5 Years to
Approximately 13 Years)
 Comparison psychosexual and
psychosocial developments
Psychosexual developments Psychosocial developments
Adolescence Identity versus Role Confusion
(Approximately 13 Years to
Approximately 21 Years)
Intimacy versus Isolation
(Approximately 21 Years to
Approximately 40 Years)

Generativity versus Stagnation

(Approximately 40 Years to
Approximately 60 Years)

Integrity versus Despair

(Approximately 60 Years to Death)
 2. Behaviour theory
The behaviour theory maintain that all human
behaviour is learned.
It focuses on the question of how environmental
conditions result in the acquisition, modification,
maintenance, and elimination of adaptive and
maladaptive behaviours.
Behaviour theory is used in many treatment
setings.
Behavioural modification : Classical
conditioning, operant conditioning,
reinforcement, punishment, shaping/ modeling.
 Cognitive theory

Rational-emotive theory (Albert Ellis ) and

Cognitive theory ( Aaron Beck) emphasize the
central of cognition ( thought) in how people feel
and act.
This theory stated that activating events do not
cause emotional or behavioural consequences
directly. Rather belief about these activating
events are important causes of how people feel
and act.
 Cont….
RET approach:
A is the antecedent behaviour
B is the belief
C is the consequence ( of the belief)
D is the disputation of those maladaptive
belief.
 Cognitive behavioural theory

Donald Meichenbaum enhanced behaviour

theory by introducing the role of cognition or
mediating processes between stimulus and
response.
Cognitive behavioural modification (CBM)
incorporate concept of RET and Beck’s
cognitive therapy, problem solving training,
behavioural therapy, skills training, self
instructional training.
 The humanistic perspective

The humanistic approach recognizes the

importance of learning an other psychological
processes.
Psychological processes include creativity, hope,
love, self fulfillment, personal growth, values,
meaning.
Humanists believe that psychopathology result
from the blocking or distortion of personal
growth, excessive stress and unfavorable social
condition.
 The interpersonal Perspective

Harry Stack Sullivan believed that poor

relationships with others caused a person
anxiety, which served as the basis for all
emotional problems.
Interpersonal theorists emphasize the
interpersonal socialization of human beings
throughout their developmental stages.
Failure to proceed through these stages can
cause maladaptive behaviour.
 The biophysiological perspective

This perspective states that psychopathology

result from some physiologic condition, primarily
deviation within the central nervous system.
The therapeutic action based on the
biophysiological perspective are medication,
Electro convulsive therapy, sleep devripation,
photo (light) therapy.
 The stress-diathesis model

Diathesis : Vulnerability of
Psychiatric disorders
Environmental stressors :
1. Genetic inheritance
1. Noxious physical stressor
2. Early learning experiences
2. Relationship problems
3. Biological processes
3. Trauma, abuse, neglect
( Brain abnoramlities,
neurotransmiter problems)

Psychiatric disorders
 Biopsychological components of Stuart stress Adaptation

Predisposing factors
Biological Psychological Sociocultural

Precipitating stressor
Nature Origin Timing Number

Appraisal of stressor
Cognitive Affective Physiological Behavioural Social

Coping resources
Personal abilities Social support Material assets Positive belief

Coping Mechanisms
Destructive Constructive
 Further readings
Mohr, WK (2006) Psychiatric –Mental
Health Nursing, Philadelphia, Lippincott
Williams & Wilkins, pp 37-53.
Shives, R (2005), Basic Concept of
Psychiatric Mental Health Nursing, pp 8-22
Stuart, GW & Laraia, MT (1998),
Principles and Practice of Psychiatric
Nursing, Philadelphia, Mosby pp 66-71
Thank you, see u then….