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• Psychosocial theories include:
  • Psychoanalytic
  • Developmental
  • Interpersonal
  • Humanistic
  • Behavioral
  • Existential

Psychoanalytic Theories

• Sigmund Freud (1856-1939) developed psychoanalytic theory in the late 19th and early 20th centuries in Vienna.
• Psychoanalytic theory says human behavior is caused and explained by repressed sexual impulses and desires.
• Problems resulted from childhood trauma or failure to complete tasks of psychosexual development
• Hysterical or neurotic behaviors resulted from unresolved conflicts

Personality Components

• The Id reflects basic desires like pleasure-seeking, aggression, and sexual impulses, seeking instant gratification without regard for rules.
• The Superego reflects moral and ethical concepts, values, and expectations, directly opposing the Id.
• The Ego balances the Id and Superego, representing mature and adaptive behavior for successful functioning.
• Anxiety resulted from the Ego's attempt to balance the Id's impulses with the Superego's rules

Three Levels of Awareness

• Conscious awareness includes current perceptions, thoughts, and emotions.
• Preconscious thoughts and emotions are not currently in awareness but can be recalled with effort.
• The unconscious motivates a person even without their awareness, including defense mechanisms and instinctual drives.

Freud's Theories

• Traumatic events that are too painful to remember are repressed into the unconscious.
• Subconscious thoughts or feelings motivate much of what humans do
• Freudian slips indicate subconscious feelings or thoughts emerging in conversation.
• Dreams reflect subconscious and can hold significant hidden or symbolic meaning

Techniques Used in Psychoanalysis

• Dream analysis involves discussing dreams to find their true meaning and significance.
• Free association uncovers true thoughts by saying a word and asking for the first response that comes to mind.

Defense Mechanisms

• Methods of protecting the self from anxiety, based on basic drives or emotionally painful thoughts or events.
• Most operate at the unconscious level of awareness.

Ego Defense Mechanisms

• Compensation: Overachievement in one area to offset deficiencies in another.
  • Ex. A nurse with low self-esteem working double shifts so her supervisor will like her.
• Conversion: Expression of conflict through a sensorimotor physical symptom.
  • Ex. A teenager forbidden to watch x-rated movies develops blindness, without concern about the loss of sight.
• Denial: Failure to acknowledge an unbearable condition.
  • Ex. A diabetic person eating chocolate candy.
• Displacement: Venting intense feelings toward less threatening persons.
  • Ex. A person mad at their boss yells at their spouse.
• Dissociation: Dealing with conflict by altering consciousness or identity.
  • Ex. Amnesia occurs, preventing recall of yesterday's auto accident.
• Fixation: Immobilization of personality from not completing tasks in a developmental stage.
  • Ex. Lack of a clear sense of identity as an adult.
• Identification: Modeling actions of others to reach a goal.
  • Ex. Nursing student becoming a critical care nurse because this is the specialty of an instructor they admire.
• Intellectualization: Separating emotions from facts.
  • Ex. A person shows no emotion when discussing a serious car accident.
• Introjection: Accepting another person's beliefs as one's own.
  • Ex. A person who dislikes guns becomes an avid hunter, following a best friend.
• Projection: Unconsciously blaming unacceptable thoughts on others.
  • Ex. A person with prejudices identifies others as bigots.
• Rationalization: Excusing behavior to avoid guilt or anxiety.
  • Ex. A student blames failure on a mean teacher.
• Reaction formation: Acting opposite of one's true feelings.
  • Ex. A Person despises a boss, but tells everyone what a great boss she is.
• Regression: Moving back to a previous developmental stage for safety.
  • Ex. A 5-year-old asks for a bottle when a new baby brother is being fed.
• Repression: Excluding painful thoughts from awareness.
  • Ex. A woman has no memory before age 7, after removal from abusive parents.
• Resistance: Antagonism to remembering or processing anxiety-producing info.
  • Ex. A nurse is too busy with tasks to spend time talking to a dying patient.
• Sublimation: Substituting a socially acceptable activity for unacceptable impulses.
  • Ex. A person who quit smoking sucks on hard candy when triggered.
• Substitution: Replacing desired gratification with what is readily available.
  • Ex. A woman who would like to have her own children opens a day care center.
• Suppression: Consciously excluding unacceptable thoughts and feelings from awareness.
  • Ex. A student decides not to think about a parent's illness in order to study for a test.
• Undoing: Exhibiting behavior to negate unacceptable acts/feelings.
  • Ex. A man brings flowers to appease his spouse.

Freud's Developmental Stages

• Oral Stage (birth to 18 months): focus on the mouth, lips, and tongue.
  • The Id is present at birth
• Anal Stage (18–36 months): the anus and surrounding area are major sources of interest; it's when voluntary sphincter control (toilet training) is acquired.
• Phallic/Oedipal Stage (3-5 years): the Genital is the focus of interest with masturbation being common; penis envy is seen in girls and Oedipal complex in boys and girls
• Latency Stage (5-11 or 13): Sexual drive is channeled to socially appropriate activities while forming a Superego
• Genital Stage (11-13): Begins with puberty and biologic capacity for orgasm, and involves the capacity for true intimacy.

Concepts Introduced by Freud

• Transference is when the client displaces attitudes and feelings onto the therapist from other relationships.
• Countertransference is when the therapist displaces attitudes or feelings onto the client from their past.
• Psychoanalysis discovers the causes of unconscious thoughts, feelings, and conflicts to resolve them.

Developmental Theories: Erik Erikson and Psychosocial Stages

• Erik Erikson (1902-1994): Developed personality based on social and psychological development throughout life stages
• Describes eight psychosocial stages of development.
• In each stage, a person must complete a task essential to their well-being and mental health,

Erikson's Stages of Psychosocial Development

• Stage 1 Trust vs. Mistrust: viewing the world as safe and reliable; relationships are nurturing, stable, and dependable
  • Virtue is hope
• Stage 2 Autonomy vs. Shame and Doubt: achieving a sense of control and free will
  • Virtue is will
• Stage 3 Initiative vs. Guilt: beginning development of a conscience, and learning to manage conflict and anxiety.
  • Virtue is Purpose
• Stage 4 Industry vs. Inferiority: emerging confidence in own abilities and taking pleasure in accomplishments.
  • Virtue is Competence
• Stage 5 Identity vs. Role Confusion: formulating a sense of self and belonging
  • Virtue is Fidelity
• Stage 6 Intimacy vs. Isolation: formulating adult, love relationships, and meaningful attachments to others.
  • Virtue is Love
• Stage 7 Generativity vs. Stagnation: being creative and producing something, establish the next generation.
  • Virtue is Care
• Stage 8 Ego Integrity vs. Despair: accepting responsibility for one's self and life.
  • Virtue is Wisdom

Piaget Stages of Cognitive Development

• Sensorimotor (birth to 2 years): a sense of self, an environment, and the concept of object permanence develop–that tangible objects do not cease to exist just because they are out of sight.
• Preoperational (2 to 6 years): express self with language, symbolic gestures, and beginning to classify objects
• Concrete operations (6 to 12 years): apply logic to thinking, spatiality/reversibility, social interactions
• Formal operations (12 to 15 years): abstract terms, logical thinking, and reasoning, and cognitive maturity.

Harry Stack Sullivan: Interpersonal relationship and Milieu Therapy

• Infancy (birth to onset of language): Primary need exists for bodily contact and tenderness.
  • prototaxic mode dominates
  • If needs are met, the infant has a sense of well-being; unmet needs lead to dread and anxiety.
• Childhood (language to 5 years): Parents are viewed as a source of praise and acceptance.
  • paralaxic mode: Experiences are connected in sequence to each other.
  • Gratification leads to positive self-esteem.
• Juvenile (5 to 8 years): opportunities for approval and acceptance of others through analysis of experiences in a variety of situations
  • Learn to negotiate own needs.
  • Severe anxiety may result from control, restrictive, prejudicial attitudes
• Preadolescence (8 to 12): Move to genuine intimacy with a same-sex friend + away From family -syntaxic mode: Capacity for attachment, love, and collaboration emerges or completely develops.
• Adolescence (puberty to adulthood): Lust is added to interpersonal equation; experiments lead to consolidating self-esteem
  • Needshifts to the opposite sex.
  • self-esteem intact? areas of concern expand to include values, ideals, career decisions, and social concerns.
• Therapeutic Community or Milieu is a structured setting with specialized staff to treat clients with mental disorders.