Theoretical Foundations

• Theoretical frameworks
– allow the systematic organization
of knowledge
– guide data collection
– provide explanations for assessed
behaviors
– guide care plan development
– provides rationales for
interventions and
– determine evaluation criteria
– Guide research by providing
Theoretical Foundations
Psychosexual- Psychoanalytical Sigmund FREUD
Theory

Psychosocial Theory Erik ERIKSON

Cognitive Theory Jean PIAGET

Interpersonal Theory Harry Stack Sullivan

Moral Theory KOHLBERG

Spiritual Theory FOWLER

Theoretical Foundations
Behavioral Theories Pavlov and Skinner

Humanistic Theories Maslow and Carl Rogers

Psychobiology theory Neuroanatomy and physiology

Theories of Personality
development
• Freud’s Psychoanalytic theory
• Erikson’s Psychosocial theory
• Sullivan’s interpersonal theory
• Piaget’s Cognitive theory
• Fowler’s Spiritual theory
• Kohlberg’s Moral theory
Psychosexual/Psychoanalyti
cal
• This theory supports the notion
that EVERY human behavior is
caused and can be explained

• Freud believes that “repressed”

sexual urges, desires, impulses
or drives motivated much human
behavior
Psychosexual/Psychoanalyti
cal
Components of Personality
2. ID- part of a person that
reflects BASIC or innate
DESIRES, INSTINCT and
SURVIVAL impulses
3. EGO- represents the REALITY
aspect
4. SUPER-EGO- part that reflects
MORALITY and ethical concepts,
Psychosexual/Psychoanalyti
cal
Personality Stages and Functional
Awareness
2. Conscious – perceptions,
thoughts and emotion that
exist in the person’s awareness
3. Pre-conscious/Subconscious-
Thoughts and emotions not
currently in awareness but can
be recalled with effort
4. Unconscious- thoughts, drives
Psychosexual/Psychoanalyti
cal

According to this theory,

much of our behavior is
motivated by our
SUBCONSCIOUS thoughts
or
feelings
Psychosexual/Psychoanalyti
cal
Five Stages of psychosexual
development
2. Oral
3. Anal
4. Phallic or Oedipal
5. Latency
6. Genital
Psychosexual/Psychoanalytic
al
Phase Age Focus

Oral 0-18 Site of gratification: Mouth

months
Anal 1½-3 Site of gratification: Anus
years
Phallic 3- 5 years Site of gratification: Genitals

Latenc 6- 12 years Site of gratification: (School

y Activities)
Genital 12 & above Site of gratification: Genitals
Psychosexual/Psychoanalytic
al
Phase Age Focus

Oral 0-18 Major task: Weaning

months
Anal 1½-3 Major task: Toilet training
years
Phallic 3- 5 years Major task: Oedipal & Electra
complex
Latenc 6- 12 years Major task : School activities
y
Genital 12 & above Major task: Sexual intimacy
Psychosexual model (Freud)
1. Oral
a. 0-18 months
b. Pleasure and gratification
through mouth
c. Behaviors: dependency, eating,
crying, biting
d. Distinguishes between self and
mother
e. Develops body image, aggressive
drives
Psychosexual model (Freud)
2. Anal
a. 18 months - 3 years
b. Pleasure through elimination or
retention of feces
c. Behaviors: control of holding on
or letting go
d. Develops concept of power,
punishment, ambivalence,
concern with cleanliness or being
dirty
Psychosexual model (Freud)
3. Phallic/Oedipal
a. 3 - 6 years
b. Pleasure through genitals
c. Behaviors: touching of genitals,
erotic attachment to parent of
opposite sex
d. Develops fear of punishment by
parent of same sex, guilt, sexual
identity
Psychosexual model (Freud)
4. Latency
a. 6 - 12 years
b. Energy used to gain new skills in
social relationships and
knowledge
c. Behaviors: sense of industry and
mastery
d. Learns control over aggressive,
destructive impulses
Psychosexual model (Freud)
5. Genital
a. 12 - 20 years
b. Sexual pleasure through genitals
c. Behaviors: becomes independent
of parents, responsible for self
d. Develops sexual identity, ability
to love and work
Psychosexual/Psychoanalytic
al
Transference and Counter-
transference
 TRANSFERENCE is the clients
feeling toward nurse arising
from unconscious experiences
with early significant others
 COUNTER TRANSFERENCE is the
nurse’s feelings toward the
patient arising also form
previous experiences
Psychosexual/Psychoanalytic
al
The Freudian View of Mental
Illness
 All behavior has meaning
 Mental illness and
manifestations are caused by
unconscious INTERNAL conflict
arising from unresolved issues in
early childhood
 Ego defenses are utilized to
relieve inner tension
 Psychosocial Theory
 Theory that focuses on
developmental task, focuses on
EGO as this develops from social
interaction
 The developmental tasks are
sequential and depend on prior
successful mastery
 An individual who fails to
“master” the task at appropriate
age may return to work on
 Psychosocial Theory
Use of the theory in Nursing
 Assessment can be done
focusing on the psychosocial
development at specific age
 Appropriate interventions can be
selected based on task
 Nurses can promote healthy
behaviors and encourages hope
that re-learning is possible
Erikson’s Psychosocial theory
 Trust versus mistrust
 Autonomy versus shame and doubt
 Initiative versus guilt
 Industry versus inferiority
 Identity versus role confusion
 Intimacy versus isolation
 Generativity versus stagnation
 Ego integrity versus despair
Psychosocial Model (Erikson)
1. Trust vs mistrust
a. 0 - 18 months
b. Learn to trust others and self vs
withdrawal, estrangement
2. Autonomy vs shame and
doubt
a. 18 months - 3 years
b. Learn self-control and the degree to
which one has control over the
environment vs compulsive
Psychosocial Model (Erikson)
3. Initiative vs guilt
a. 3 - 5 years
b. Learn to influence environment,
evaluate own behavior vs fear of
doing wrong, lack of self-
confidence, over restricting actions
4. Industry vs inferiority
a. 6 - 12 years
b. Creative; develop sense of
competency vs sense of inadequacy
Psychosocial Model (Erikson)
5. Identity vs role confusion
a. 12 - 20 years
b. Develop sense of self; preparation,
planning for adult roles vs doubts
relating to sexual identity,
occupational career
6. Intimacy vs isolation
a. 18 - 25 years
b. Develop intimate relationship with
another; commitment to career vs
Psychosocial Model (Erikson)
7. Generativity vs stagnation
a. 21 - 45 years
b. Productive; use of energies to guide
next generation vs lack of interests,
concern with own needs
8. Integrity vs despair
a. 45 years to end of life
b. Relationships extended, belief that
own life has been worthwhile vs
lack of meaning of one’s life, fear of
 Interpersonal theory
 This concept focuses on interaction between
an individual and his environment
 Personality is shaped through “interaction”
with significant others
 We internalize approval or disapproval
form our parents
 Interpersonal theory
Personality has three SELF-SYSTEM
1. “Good Me” develops in response to
behaviors receiving approval by parents/SO
2. “Bad Me” develops in response to
behaviors receiving disapproval by
parents/SO
3. “Not Me” develops in response to behaviors
generating extreme anxiety in parents/SO
and this is denied as part of oneself
 Interpersonal theory
Mental Health is Viewed as:
2. Related to conflict or problematic
interpersonal relationships
3. Past relationships, inappropriate
communication and current relationship
crisis are etiologic factors of mental illness
 Interpersonal theory
Treatment of Mental illness:
 Focuses on anxiety and its causes
 Therapeutic relationship with client that is
active and participative
 Feelings and emotions are verbalized by
the clients to modify problematic
relationships
 Interpersonal theory
Usefulness in Nursing
 Nurse and client can participate in and
contribute to the relationship that is
therapeutic
 This relationship can be used as a
corrective interpersonal experience
 Anxiety management
 Interpersonal Model (Sullivan)
1. Infancy
a. 0 - 18 months
b. Others will satisfy needs
2. Childhood
a. 18 months - 6 years
b. Learn to delay need gratification
3. Juvenile
a. 6 - 9 years
b. Learn to relate to peers
 Interpersonal Model (Sullivan)
4. Preadolescence
a. 9—12 years
b. Learn to relate to friends of same sex
5. Early adolescence
a. 12—14 years
b. Learn independence and how to relate to
opposite sex
6. Late adolescence
a. 14—21 years
b. Develop intimate relationship with person of
opposite sex
 Cognitive Theory
 This theory focuses on the inborn
development of thinking ability from
infancy to adulthood
 A person is born with a tendency to
organize and to adapt to their environment
 Mental illness is not directly discussed
 Cognitive Theory
Usefulness of Cognitive theory in Nursing
2. This provides an understanding how an
individual think and communicate. Nurse
can provide intervention accordingly
3. Nursing interventions should be
congruent to the age-specific cognitive
level
4. Teaching strategies are modified
according to cognitive process
 Piaget
 Sensori-motor (birth to 2 )
 Pre-operational (2-7)
 Preoperational preconceptual (2-4)
 Preoperational intuitive (4-7)
 Concrete operational (7-12)
 Formal operational (12 to adulthood)
 Cognitive Theory (Piaget)
A. 0 - 2 years: sensorimotor
-reflexes, repetition of acts
B. 2 - 4 years: preoperational/preconceptual
-no cause and effect reasoning;
egocentrism; use of symbols; magical
thinking
C. 4 - 7 years: intuitive/preoperational
-beginning of causation
 Cognitive Theory (Piaget)
D. 7 - 11 years: concrete operations
- uses memory to learn
- aware of reversibility
E. 11 - 15 years: formal operations
-reality, abstract thought
-can deal with the past, present and future
 Behavioral Theory
 This concept describes a person’s function
in terms of identified BEHAVIORS
 People learn to be who they are
 Behavior can be observed, described and
recorded
 Behavior is subject to reward or
punishment
 Behavior can be modified by changing
environment
 Behavioral Theory
 The Classical Conditioning by Pavlov
 Learning can occur when a stimulus is paired
with an unconditioned response
 Conditioned responses happens when stimulus
is present
 Acquisition – gain of learned response
 Extinction – loss of learned response
 Behavioral Theory
 The Operant Conditioning by Skinner
 Rewards and punishments are utilized
 Positive reinforcement- rewards
 Negative reinforcement-
 Positive punishment
 Negative punishment- withdrawing reward
 Behavioral Theory
Mental Illness is viewed as:
 Mal-adaptive BEHAVIORS are learned

through classical and operant conditioning

 Mal-adaptive behaviors can be changed by

altering environment
 Behavioral Theory
Application to Nursing
2. The nurse assess both adaptive and ,al-
adaptive behaviors
3. The nurse and client collaborate in
identifying behaviors that need to change
4. Behavioral modification techniques are
utilized by the nurse in the treatment of
mental illness
 Humanistic theory
 Human nature is positive and growth
centered and existence involves search for
meaning and truth
 Maslow’s theory of Needs are organized in a
hierarchy
 Humanistic theory
Mental illness in this framework
2. The failure to develop one’s FULL
potential leads to poor coping
3. Lack of self awareness and unmet needs
interfere with feelings of security
4. Fundamental human anxiety is fear of
death which leads to existential anxiety
 Humanistic theory
Application of the theory to Nursing
2. NCR is based on positive regard, respect
and empathy
3. Nurses assess the spiritual aspects of the
client including religion, love and
relationships
4. Through reflective listening and emphatic
responses, the nurse helps the client gain
self-understanding
 KOHLBERG’S STAGES
OF
MORAL DEVELOPMENT
PRECONVENTIONAL LEVEL
 Stage 1 Age 2-3
 Description:
 Punishment or obedience (heteronomous

morality)
 A child does the right things because a

parent tells him or her to avoid

punishment
PRECONVENTIONAL LEVEL
 Stage 2 Age : 4-7
 Description:
 Individualism

 Child carries out actions to satisfy own

needs rather than society’s. The child

does something for another if that person
does something for him in return
 CONVENTIONAL LEVEL level 2
 Stage 3 Age : 7-10
 Description:
 Orientation to interpersonal relations of

mutuality
 A child follows rules because of a need to

be a good person in own eyes and in the

eyes of others
 CONVENTIONAL LEVEL level 2
 Stage 4 Age : 10-12
 Description:
 Maintenance of social order, fixed rules

and authority
 Child follows rules of authority figures as

well as parents to keep the system

working
POSTCONVENTIONAL LEVEL level 3

 Stage 5 Age :older than 12

 Description:
 social contract, utilitarian law making

perspective
 child follows standards of society for the

good of all people

 POSTCONVENTIONAL LEVEL level 3

 Stage 6 Age :older than 12

 Descriptions:
 universal ethical principle orientation

 child follows internalized standards of

conduct