PSY Chapter 2: Theories & Therapies

Psychoanalytic therapy

• developed by Sigmund Freud

• rarely used (3-5x per week)

• intrapsychic conflict thought to be cause for all mental illness

• purpose was to uncover unconscious conflicts

• free association

• dream analysis

• defence mechanism recognition

Free association

analysts actively encourage patients to freely share whatever thoughts or words come to mind to access the unconsciouse

Dream analysis

patients are encouraged to share the content of dreams, which the therapiest analyzes for symbolic meanings

Defense mechanism recognition

analyst assists the patient in recognizing and subsequently changing the overuse of maladaptive defense mechanisms, such as denial, projection, and rationalization

Transference

unconscious feelings that the patient has toward a healthcare worker that were originally felt in childhood for a significant other; can be positive or negative

Countertransference

the unconscious feelings that the healthcare worker has toward the patient

Psychodynamic therapy

• similar to psychoanalytic therapy

• the therapist has increased involvement and interacts with the patient more freely

• 20 or more sessions

• focused on “here and now” rather than origins of conflict

• best candidates are the “worried well” patients

Interpersonal therapy

• an effective short-term therapy

• improve interpersonal functioning and satisfaction with social relationships

• therapist identifies the nature of the problem to be resolved and then selects strategies consistent with the problem area

• three types of problems treated

Grief and loss

part of interpersonal therapy; complicated bereavement after death, divorce, or other loss

Interpersonal disputes

part of interpersonal therapy; conflicts with a significant other

Role transition

part of interpersonal therapy; problematic change in life status or social or vocational role

Hildegard Peplau

• developed the first systematic theoretical framework for psychiatric nursing

• established the foundation for the professional practice of psychiatric nursing

• enriched psychiatric nuring theory and work for the advancement of nursing practice throughout her career

• mother of psychiatric nursing

Behavior therapy

assumes that changes in maladaptive behavior can occur without insight into the underlying cause; five types

Modeling

the therapist provides a role model for specific identified behaviors, and the patient learns through imitation

Operant conditioning

the basis for behavior modification; uses positive reinforcement to increase desired behaviors

Exposure therapy

used for people who experience anxiety due to fears, phobias, or traumatic memories; patients are encouraged to face their fears and emotionally process them in a safe environment

Systematic desensitization

incorporates the incremental exposure of graded exposure along with relaxation techniques such as slow, deep breathing

Flooding

most extreme method; relies upon confronting the most feared object, situation, or event and then managing and processing it

Aversion therapy

pairs a target behavior with a negative stimulus to extinguish undesirable behavior

Biofeedback

used for controlling the body’s physiological response to stress and anxiety

Cognitive behavioral therapy (CBT)

based on cognitive psychology and behavioral therapy; focuses on changing thinking and behaviors to improve emotional regulation

CBT is used to treat

• depression

• anxiety

• phobias

• pain

Cognitive distortions

automatic thoughts; irrational and lead to false assumptions and misinterpretations

Trauma-focused CBT

developed to address sexual abuse trauma in children and expanded to address the needs of individuals who are impacted by severe trauma and abuse

• lasts 12-16 sessions

• helps children and adolescents identify feelings and how to manage them

• identify negative thoughts and replace with more positive thoughts

Dialectical behavioral therapy (DBT)

developed for individuals with intractable behavioral disorders involving emotional dysregulation

• long-term therapy (1-1.5 years)

• effective for depression, suicidal thoughts, hopelessness, anger, substance use, and dissociation

DBT strategies

• mindfulness

• distress tolerance

• interpersonal effectiveness

• emotional regulation

Maslow’s hierarchy of needs

conceptualized as a pyramid with the strongest, most fundamental needs placed on the lower levels, the higher levels are more distinctly human needs

Physiological needs

the most basic needs

• food

• oxygen

• water

• sleep

• sex

• constant body temperature

Safety needs

second level of the pyramid

• security

• protection

• freedom from fear, anxiety, and chaos

• need for law, order, and limits

Belonging and love needs

third level of the pyramid; people have a need for intimate relationships, love, affection, and belonging and will seek to overcome feelings of loneliness and alienation

Esteem needs

fourth level of the pyramid; people need to have a high self-regard and have it reflected to them from others; if met, they feel confident, valued, and valuable

Self-acualization

fifth and final level of the pyramid; human beings are preset to strive to be everything they are capable of becoming

Biological model

• medical model

• assumes that abnormal behavior is the result of a physical problem

• focuses on neurological, chemical, biological and genetic issues

• locates the illness or disease in the body and uses drugs, diet, or surgery to target it

Pharmacotherapy

uses medication to treat psychiatric illness; psychotropic medication effective for treating psychosis, mania, depression, and anxiety

Brain stimulation therapies

involve focused electrical stimulation of the brain; treat psychiatric disorders and neurological disorders

• electroconvulsive therapy (ECT)

• transcranial magnetic stimulation - repetitive (rTMS)

• vagus nerve stimulation (VNS)

• deep brain stimulation (DBS)

Cognitive development

• developed by Jean Piaget

• concluded that cognitive development was dynamic progression from primitive awareness and simple reflexes to complex thought and responses

Sensorimotor stage

• birth to 2 years

• basic reflexes and culminate with purposeful movement, spatial abilities, and hand-eye coordination

• physical interaction with the environment provides the child with a basic understanding of the world

• object permanence achieved by 9 months

Preoperational stage

• 2 to 7 years

• children are not yet able to think abstractly or generalize qualities in the absence of specific object

• think in a concrete fashion

• tendency to expect others to view the world as they do

• unable to conserve mass, volume or number

Concrete operational stage

• 7 to 11 years

• logical thought appears and abstract problem solving is possible

• able to see a situation from another’s point of view and can take into account a variety of solutions to a problems

• conservation is possible

• classify based on discrete characteristics, order objects in a pattern, and understand the concept of reversibility

Formal operational stage

• 11 years to adulthood

• conceptual reasoning commences at approximately the same time as puberty

• the child’s basic abilities to think abstractly and problem solve mirror those of an adult

Psychosocial development

• developed by Erik Erikson

• believed Freudian theory was restrictive and negative in its approach

• emphasized the role of culture and society on personality development

Infancy stage

• 0-1.5 years

• forming attachment to mother, which lays foundations for later trust in others

• trust vs. mistrust

Early childhood

• 1.5-3 years

• gaining some basic control of self and environment

• autonomy vs. shame and doubt

Preschool

• 3-6 years

• becoming purposeful and directive

• initiative vs. guilt

School age

• 6-12 years

• developing social, physical, and school skills

• industry vs. inferiority

Adolescence

• 12-20 years

• making transition from childhood to adulthood

• devleoping sense of identity

• identity vs. role confusion

Early adulthood

• 20-35 years

• establishing intimate bonds of love and friendship

• intimacy vs. isolation

Middle adulthood

• 35-65 years

• fulfilling life goals that involve family, career, and society

• developing concerns that embrace future generations

• generatively vs. self-absorption

Later years

• 65 years to death

• looking back over one’s life and accepting its meaning

• integrity vs. despair