Ch. 3

Chapter Three: Psychosocial Theories and Therapy

Key Terms

  • Alternative Medicine: Therapies used in place of traditional or conventional medical practices.

  • Behavior Modification: A method of attempting to strengthen a desired behavior or response by reinforcement, either positive or negative.

  • Self-help Group: Members share a common experience, but the group is not a formal or structured therapy group.

  • Subconscious: Thoughts or feelings in the preconscious or unconscious level of awareness.

  • Superego: In psychoanalytic theory, this is the part of a person's nature that reflects moral and ethical concepts, values, and parental and social expectations; this is in direct opposition to the id. It has fears and anxiety associated with phobias.

Therapeutic Community or Milieu

  • Refers to a beneficial environment where client-to-client interaction is seen as beneficial, emphasizing the role of these interactions in treatment.

Therapeutic Nurse-Patient Relationship

  • Professional Relationship: A planned relationship between the client and the nurse that focuses on client needs, feelings, problems, and ideas.

  • Phases: Involves three phases:

    • Orientation Phase: Nurse engages the patient, clarifies problems and needs, explains routines and expectations.

    • Working Phase: Involves identification and exploitation where the patient expresses feelings and begins interdependent work with the nurse.

    • Termination Phase: Patient gives up dependent behavior and services are no longer needed.

  • Transference: Occurs when a client displaces onto the therapist attitudes and feelings originally experienced in past relationships; common among clients transferring feelings towards significant others onto the nurse.

Learning Objectives

  • Explain the basic beliefs and approaches of various psychosocial theories: psychoanalytic, developmental, interpersonal, humanistic, behavioral, existential, and crisis intervention.

  • Describe various psychosocial treatment modalities such as:

    • Individual psychotherapy

    • Group psychotherapy

    • Family therapy

    • Behavior modification

    • Systematic desensitization

    • Token economy

    • Self-help groups

    • Support groups

    • Education groups

    • Cognitive therapy

    • Therapy and psychiatric rehabilitation.

  • Identify the psychosocial theory on which each treatment strategy is based and how theoretical perspectives influence nursing practice, including concepts related to behaviors, care delivery, cognition, communication, development, family, teaching, and learning.

Introduction

  • Theories suggest strategies clinicians can utilize to work with clients. Many prevalent theories are not rooted in empirical evidence but have evolved from individual experiences, better described as conceptual models or frameworks.

Types of Psychosocial Theories

  1. Psychoanalytic Theories

    • Sigmund Freud (1856-1939) is recognized as the father of psychoanalysis.

    • His theory of childhood development centers around the belief that sexual energy, termed "libido," drives human behavior.

    • Stages of Psychosexual Development:

      • Oral Stage: Birth to 18 months, where the primary focus is on the mouth.

      • Anal Stage: 18-36 months, focusing on bowel control.

      • Phallic Stage: 3-5 years, involving the exploration of genitalia and the development of Oedipal and Electra complexes.

      • Latency Stage: 5-11 years (or up to 13 years), where sexual energy is channeled into other activities.

      • Genital Stage: 11-13 years, marking the onset of mature sexual relationships.

    • Psychopathology: Results from difficulties in transitioning through stages, such as remaining fixated at a stage or regressing.

    • Defense Mechanisms identified by Freud include:

      • Compensation: Overachievement in one area to offset perceived deficiencies in another.

      • Conversion: Expression of emotional conflicts through physical symptoms.

      • Intellectualization: Separating emotional responses from facts of a painful situation.

      • Interjection: Adopting the characteristics of others to cope.

      • Repression: Burying distressing memories to avoid anxiety.

      • Suppression: Consciously deciding to forget a thought or feeling.

    • Psychoanalysis focuses on uncovering the sources of unconscious conflicts causing anxiety and aims to help clients gain insights to resolve issues through free association, dream analysis, and behavior interpretation.

  2. Developmental Theories

    • Eric Erikson (1902-1994) elaborated on Freud's theories, establishing eight psychosocial stages of development where successful completion of tasks leads to virtues.

    • Stages Include:

      • Trust vs. Mistrust (Infancy)

      • 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 Adulthood)

      • Ego Integrity vs. Despair (Maturity)

    • Each stage is critical for developing strengths and virtues essential for facing life's challenges.

  3. Cognitive Development Theories by Jean Piaget (1896-1980)

    • Proposition of cognitive growth occurring in stages, transforming reasoning abilities.

    • Stages of Cognitive Development:

      • Sensorimotor Stage (birth to 2 years): Learning through sensory experiences and interactions.

      • Preoperational Stage (2-7 years): Development of language and symbolic thinking but lacking in logical thought.

      • Concrete Operations Stage (7-11 years): Logical reasoning applied to concrete objects; understanding of conservation.

      • Formal Operations Stage (12 years and beyond): Ability to think abstractly and engage in deductive reasoning.

  4. Interpersonal Theory (Harry Stack Sullivan, 1892-1949)

    • Emphasizes interpersonal relationships and their impact on personality development and emotional health.

    • Sullivan proposed four life stages focusing on social interactions and the importance of relationships in developing anxiety and emotional issues.

  5. Humanistic Theories

    • Signify a shift from viewing individuals as neurotic to recognizing the person’s ability to change and promote self-esteem.

    • Humanists address past experiences but focus on the present and future potentials.

Behavioral Therapy

  • Behavioral Theory: Investigates the role of reinforcement in shaping behaviors.

  • Based on the principles of operant conditioning pioneered by B.F. Skinner (1974):

    • All behavior is learned.

    • Consequences influence behavior; rewarded behaviors are likely to recur.

    • Positive and negative reinforcements serve to increase behavior likelihood.

Cognitive Behavioral Therapy (CBT)

  • Focuses on changing faulty thinking patterns leading to emotional distress and psychological issues.

  • Teaches individuals to be their own therapists, coping with life's challenges effectively.

Crisis Intervention

  • Defined as a time of significant emotional upheaval that a person cannot manage using their standard coping mechanisms.

  • Kaplan (1964) identified four stages of crisis:

    1. Exposure to a stressor, leading to anxiety

    2. Failure of customary coping skills leading to increased anxiety

    3. Attempts at new coping strategies

    4. Possible disequilibrium when coping is ineffective

  • Types of crises include:

    • Maturational crises: Developmental transitions

    • Situational crises: Events like natural disasters or significant personal changes

Group Therapy

  • Types of Groups:

    • Psychotherapy Groups: Target behavior change through group dynamics.

    • Support Groups: Provide emotional and practical support among members with similar experiences.

    • Education Groups: Focus on imparting knowledge and skill-building.

  • Group Development Stages Include:

    • Beginning Stage: Establishing ground rules and member introductions.

    • Working Stage: Members interact, resolve issues, and support one another through various dynamics.

    • Termination Stage: Reflection on achievements and the group’s completed work.

Therapeutic Relationships by Hildegard Peplau

  • Peplau identified phases in nurse-patient interactions which include orientation, identification, exploitation, and resolution, focusing on therapeutic tasks to facilitate recovery.

  • Roles of nurses include being a teacher, leader, resource person, surrogate, and counselor, which cater to the specific needs of patients for effective therapy.

Conclusion

  • These theories and therapeutic modalities provide frameworks for professionals in the mental health field to comprehend client needs and foster well-being. They stress the importance of both interpersonal dynamics in therapy and the significance of structured approaches to emotional and psychological healing.