Psychosocial Theories and Therapy

Sigmund Freud, the Father of Psychoanalysis

Founded the personality components; Id, Ego, and Superego

o
Id: The part of ones nature that reflects basic or innate desires such a
pleasure seeking behavior, aggression, and sexual impulses. The id seeks instant
gratification, causes impulsive thinking behavior, and has no rules or regard for
social convection.
o
Superego: The part of ones nature that reflects moral and ethical
concepts, values, parental and social expectations; therefore, it is the directional
opposite to the id.
o
Ego: The balancing or mediating force between the id and the superego.
The ego represents mature and adaptive behavior that allows a person to
function successfully.

Psychosexual development

Oral (birth to 18 months)

Anal (18 to 36 months)

Phallic/Oedipal (3 to 5 years)

Latency (5 to 11 or 13 years)

Genital (11 or 13 years)

Transference and Countertranference

o
Transference occurs when the client onto the therapist/nurse attitudes and
feelings that the client previously felt in other relationships.
o
Countertranference occurs when the therapist/nurse displaces onto the
client attitudes or feelings from his or her past.

Developmental Theorists; Erikson and Piaget

Erikson focused on personality development across the life span while

focusing on social and psychological development in life stages.
o

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)

Ego integrity vs. despair (maturity)


Erikson believed that psychosocial growth occurs in sequential stages, and
each stage is dependent on the completion of the previous stage/life task.

Piaget explored how intelligence and cognitive functioning develop in

children.
o
Sensorimotor (birth to 2 years): The child develops a sense of self as
separate from the environment and the concept of object permanence. Begins to
form mental images.
o
Preoperational (2-6 years): Child begins to express himself with language,
understands the meaning of symbolic gestures, and begins to classify objects.
o
Concrete operations (6-12 years): Child begins to apply logical thinking,
understands reversibility, is increasingly social and able to apply rules; however,
thinking is still concrete.
o
Formal operations (12 to 15 years and beyond): Child learns to think and
reason in abstract terms, further develops logical thinking and reasoning, and
achieves cognitive maturity.

Harry Stacks Sullivan: Interpersonal Relationships and Milieu therapy

The importance and significance of interpersonal relationships in ones life

was Sullivans greatest contribution to the field of mental health.

Sullivan developed the first therapeutic community or milieu with young

men with schizophrenia in 1929. He found that within the milieu, the interactions
among clients were beneficial, and then the treatment should emphasize on the
roles of the client-client interaction.
o
Milieu therapy is used in the acute care setting; one of the nurses primary
roles is to provide safety and protection while promoting social interaction.

Hildegard Peplau: Therapeutic nurse-patient relationship (The bomb-diggity of

nursing)

Developed the concept of the therapeutic nurse-patient relationship,

which includes 4 phases: orientation, identification, exploitation, and resolution.
o
The orientation phase is directed by the nurse and involves engaging the
client in treatment, providing explanations and information, and answering
questions. During this time the nurse would orient the patient to the rules and
expectations (if in an acute setting).
o
The identification phase begins when the client works interdependently
with the nurse, expresses feelings, and begins to feel stronger. This phase can
begin either within a few hours to a few days; the patient can identify the nurse
and environment on his own. They come together. Kinky.
o
In the exploitation phase, the client makes full use of the services offered.
He moves toward independence.

o
In the resolution phase, the client no longer needs professional services
and gives up dependent behavior.
o
Keep in mind that after the resolution phase, the client can regress and
move back into the above mentioned phases.

Paplau defined anxiety as the initial response to a psychic threat,

describing 4 levels of anxiety: acute, moderate, severe, and panic.
o
Acute anxiety is a positive state of heightened awareness and sharpened
senses, allowing the person to learn new behaviors and solve problems. The
person can take in all available stimuli (perceptual field).
o
Moderate anxiety involved a decreased perceptual field (focus on
immediate task only); the person can learn new behavior or solve problems only
with assistance. Another person can redirect the person to the task. Remember,
this is the ideal anxiety state for teaching a client regarding health concerns
such as diabetes, as Cathy says so.
o
Severe anxiety involves feelings of dread or terror. The person CANNOT be
redirected to a task; he focuses only on scattered details and has physiologic
symptoms such as tachycardia, diaphoresis, and chest pain. The client may go to
the ER thinking he is having a heart attack. In lecture, Cathy stated that this
person can still be talked down. The first priority is to move the person away
from all stimuli, and then attempt to talk with them to calm down.
o
Panic anxiety can involve loss of rational thought, delusions,
hallucinations, and complete physical immobility and muteness. The person my
bolt and run aimlessly, often exposing himself and others to injury.

Humanistic Theories; Maslows Hierarchy of needs.

Everyone should know this one. It is outlined on page 56 in your book.

He used a pyramid to arrange and illustrate the basic drives or needs to

motivate people.
o
The most basic needs, physiologic needs, need to be met first. This
includes food, water, shelter, sleep, sexual expression, and freedom of pain.
These MUST be met first.
o
The second level involves safety and security needs, which involve
protection, security, freedom from harm or threatened deprivation.
o
The third level is love and belonging needs, which include enduring
intimacy, friendship, and acceptance.
o
The fourth level involves esteem needs, which includes the need for selfrespect and esteem from others.
o
The highest level is self-actualization, the need for beauty, truth, and
justice. Few people actually become self-actualized.
o
Remember, traumatic life experiences or compromised health can cause a
person to regress to a lower level of motivation.

Pavlov: Classic conditioning (Behavior theory)

Pavlov believed that behavior can be changed through conditioning with

external or environmental conditions or stimuli.