Psychosocial Theories

These theories explain human behavior, development, and mental illness by looking at how psychological processes interact with the social environment. You will not recite them at the bedside, but they are the scaffolding under the interventions you do use, from milieu therapy to client-centered communication, so know what each one assumes and what it tells you to do with a patient.

Types of Psychosocial Theories

• Psychoanalytic. All human behavior is caused and can be explained (a deterministic view).
• Developmental. At each stage the person must complete a life task essential to well-being and mental health.
• Interpersonal. Personality is more than individual traits; it is how a person interacts with others.
• Humanistic. A shift away from the psychoanalytic image of the neurotic, impulse-driven person and away from dwelling on past experiences.
• Behavioral. Focuses on observable behavior and what you can change externally to alter it.
• Existential. Behavioral deviations result when the person is out of touch with himself or his environment.

Psychoanalytic Theories

Psychoanalytic theory holds that all behavior is caused and explainable.

Sigmund Freud: The Father of Psychoanalysis

Freud (1856-1939) developed psychoanalytic theory in late-19th and early-20th-century Vienna. He believed repressed sexual impulses and desires motivate much of human behavior. He divided personality into three components: the id (basic, innate desires such as pleasure-seeking, aggression, and sexual impulses), the superego (moral and ethical concepts, values, and parental and social expectations, in direct opposition to the id), and the ego (the mediating force between them). He also placed the personality at three levels of awareness: conscious (perceptions, thoughts, and emotions in current awareness), preconscious (recallable with some effort), and unconscious (thoughts and feelings that motivate a person who is unaware of them).

Developmental Theories

At each stage the person must complete a life task essential to well-being and mental health.

Erik Erikson: Psychosocial Stages

Erikson, a German-born psychoanalyst, extended Freud's work across the lifespan, focusing on social and psychological development. Psychosocial growth occurs in sequential phases, each dependent on completing the previous stage and its life task.

Jean Piaget: Cognitive Stages

Piaget studied how intelligence and cognition develop in children. Human intelligence progresses through age-based stages, with each successive stage showing higher functioning than the one before.

Interpersonal Theories

Personality is more than individual traits; it is how a person interacts with others.

Harry Stack Sullivan: Interpersonal Relationships and Milieu Therapy

Sullivan, an American psychiatrist, extended personality development to include the significance of interpersonal relationships. He set five life stages: infancy, childhood, juvenile, preadolescence, and adolescence, each focused on particular interpersonal relationships.

Humanistic Theories

Humanism moved away from the psychoanalytic view of the neurotic, impulse-driven individual and away from examining the client's past.

Abraham Maslow: Hierarchy of Needs

Maslow, an American psychologist, studied human needs and motivation. In 1954 he arranged the basic drives into a pyramid. The most basic, the physiologic needs (food, water, sleep, shelter, sexual expression, and freedom from pain), must be met first. Next come safety and security needs (protection, security, freedom from harm or deprivation), then love and belonging (intimacy, friendship, acceptance), then esteem (self-respect and esteem from others), and at the top self-actualization (the need for beauty, truth, and justice).

Carl Rogers: Client-Centered Therapy

Rogers, a humanistic American psychologist, focused on the therapeutic relationship and developed client-centered therapy, which makes the client, not the therapist, the key to healing. The therapist promotes the client's self-esteem through three concepts: unconditional positive regard (nonjudgmental caring not dependent on the client's behavior), genuineness (congruence between what the therapist feels and what he says), and empathetic understanding (sensing the client's feelings and personal meaning and communicating that back).

Behavioral Theories

Behaviorism focuses on observable behavior and on external changes that shift it.

Ivan Pavlov: Classical Conditioning

Pavlov's laboratory experiments with dogs grounded classical conditioning: behavior can be changed through conditioning with external or environmental stimuli.

B.F. Skinner: Operant Conditioning

Skinner, an American psychologist and one of the most influential behaviorists, developed operant conditioning: people learn behavior from past experiences, particularly those that were repeatedly reinforced.

Existential Theories

Behavioral deviations result when the person is out of touch with himself or the environment. Existential therapists often use cognitive therapy.

Cognitive Therapy

Cognitive therapy focuses on immediate thought processing: how a person perceives or interprets an experience determines how he feels and behaves. Aaron Beck pioneered cognitive therapy for depression.

Rational Emotive Therapy

Albert Ellis, its founder, identified 11 irrational beliefs that people use against their own happiness. The therapy confronts those irrational beliefs that keep the individual from accepting responsibility for self and behavior.

Logotherapy

Viktor Frankl based his work on observing people in Nazi concentration camps during World War II. Logotherapy helps individuals assume personal responsibility, with the search for meaning (logos) as the central theme.

Gestalt Therapy

Frederick "Fritz" Perls founded Gestalt therapy, which emphasizes feelings and thoughts in the here and now and works toward self-acceptance.

Reality Therapy

William Glasser's reality therapy focuses on the person's behavior and how it keeps him from achieving life goals. The patient is challenged to examine the ways his behavior thwarts his own aims, and to find identity through responsible behavior.