Transcript Concepts of personality development

Psychiatric nursing
Concepts of personality development
Objectives
 Define personality
 Discuss the major component of the following
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personality developmental theories:
Psychoanalytic theory (Freud)
Interpersonal theory (Sullivan)
Theory of psychosocial development (Erikson)
Object relations development (Mahler)
Nursing model of interpersonal development (Peplau)
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Definition and introduction to the
personality development
 Personality: patterns of perceiving, relating to, and
thinking about the environment and oneself that are
exhibited in a wide range of social & personal contexts.
(a dynamic and organized set of characteristics possessed
by a person that uniquely influences his or her cognitions,
emotions, interpersonal orientation, motivation, and
behaviors in various situations.)
 Each developmental level (stage) has its own
appropriate behaviors.
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Introduction cont.
 People continue to develop and change throughout
their life, however, infancy and early childhood (up to
5 years old) are the major life periods for the
origination of developmental changes where
individual’s basic character is formed.
 Developmental stages overlap & they are identified
by age 4.
 Environment affects developmental stages (i.e.
individuals reared in dysfunctional family often have
retarded ego development).
 Behaviors from unsuccessfully completed stage can
be modified & corrected in a later stage.
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Introduction cont.
 When personality traits are inflexible &
maladaptive & cause either significant
functional impairment or subjective distress,
they constitute personality disorders.
 Q: Why psychiatric/mental health nurses
must have knowledge of personality
development?
 A: To understand maladaptive behavioral
responses commonly seen in psychiatric
clients.
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Symbolic interactionism, introduced by
Herbert Blumer (1969),
 describes an approach to the study of human
conduct. It is based on:
1- Life experiences have different meanings for
different people.
- Because all behavior has meaning, the
psychiatric–mental health nurse must develop
skill in observing, interpreting, and
responding to the client’s lived experiences in
the hope of arriving at a common ground of
negotiated meanings and authentic
communication;
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be wary of interventions that ignore,
discount, or discredit the meaning an
experience has for the client in favor of
the nurse’s own definition of the
situation.
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Symbolic interactionism,
2- Meanings arise in one’s social world.
Meanings arise in the process of interaction
with others.
- Psychiatric–mental health nurses must take
into account each client’s social and cultural
environment, and holistically assess client
accounts for the interaction patterns in that
person’s social world
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3- Meaning is a basis for behavior.
- People handle situations in terms of what
they consider important about the situation.
To understand clients’ actions, the
psychiatric–mental health nurse must
identify the meanings those actions have
for them.
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the major principles of humanism
 The humanistic perspective has eight central
propositions (Lamont, 1967).
 Humanism is a philosophy of service to
benefit humanity through reason, science,
and democracy.
 The central concept of humanism is that the
chief end of human life is to work for wellbeing within the limitations of life in today’s
world
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the influence of the knowledge
explosion in psychobiology
 The last decades have seen major
breakthroughs in knowledge about the brain,
the mind, the spirit, and behavior. This
knowledge explosion has been named
psychobiology
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 Research has generated new understanding
of how genetics, immunology, biorhythms,
brain structure, and brain biochemistry
influence mental disorders.
 New imaging techniques allow
neuroscientists to better understand thoughts
by analyzing physiological activity.
 New medications can correct biochemical
imbalances in the brain, and psychobiologic
interventions have become commonplace.
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how the premises of human interactionism and psychobiology
relate to psychiatric–mental health nursing.
 Interactionism considers human beings as
having purpose and control over their lives,
even if they have altered brain structure and
chemistry and stressful environments.
 Interactionism is a philosophy of caring with a
strong humanistic cast, acknowledging the
interaction of psychology, psychobiology, and
sociocultural contexts
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 Humanism incorporates devotion to the
interests of human beings wherever
they live and whatever their status or
culture, reaffirming the spirit of
compassion and caring toward others.
 It is a constructive philosophy that
wholeheartedly affirms the joys, beauty,
and values of human living.
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 The humanistic interactionism considers
physical and mental factors as interrelated; a
change in one may result in a change in
another.
 Healing and caring must be approached in a
holistic manner.
 Psychiatric–mental health nurses have an
expanded role, becoming involved in social
goals that advance health holistically.
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 The model for intervention and change is one
of negotiation and advocacy.
 Clients and their families are not passive
recipients of care given by psychiatric
professionals, but rather are empowered in
the process of developing new perspectives
and encouraged to weigh alternatives and
make self-directed choices
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The medical–psychobiologic model
 Psychobiology has implications for psychiatric–
mental health nursing practice as well.
 It includes a focus on the human aspects of care as
well as biologic and medical aspects, bringing a
contemporary holistic perspective to psychiatric–
mental health care;
 integrating the rapidly accumulating knowledge in
psychobiology;
 redefining the traditional art of psychiatric–mental
health nursing care and caring in the new millennium;
and nursing practice and research that integrates
“high tech” and “high touch,” nature and nurture, and
the biologic sciences and the behavioral sciences
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1. Psychoanalytic Theory (Freud)
 Freud: Austria, neurologists, father of
psychoanalysis
 1856-1939
 Affecting behavioral change through having
patients talk about their difficulties
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 Freud believed that all psychologic and
emotional events are understandable, that
childhood experiences caused adult
neuroses, and that therapy provided insight
into the meaning of events
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Psychoanalytic Theory
 Structure of the personality
1. Id: “pleasure principle.”
 Present at birth, provides infant with
instinctual drives that seek satisfaction &
achievement of immediate gratification.
 Id-driven behaviors are spontaneous & may
be irrational.
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Structure of the personality
2. Ego: the rational self or “reality principle.” It
is the mediator that maintains harmony
among the external world, the id and the
superego.
 Begins to develop between 4 & 6 months.
 Ego experiences reality of the external
world, adapts to it, & responds to it.
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Structure of the personality
3. Superego: the “perfection principle.” It derives
from the rewards for “good” behaviors (egoideal) and punishment for “bad” behaviors
(conscience).
 Develops between 3 & 6 years.
 Important in socialization of the individual
because it assists ego in control of id impulses.
 Example: a conflict between a father and his
son….
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Psychoanalytic Theory
 Categories of mental contents
1. Conscious: includes all memories that remain
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within an individuals’ awareness (events that
are easily remembered such as telephone
numbers, dates of special holidays).
Controlled by the ego, the rational & logical
structure of the personality.
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Psychoanalytic Theory
2. Preconscious: includes all memories that
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have been forgotten or not in present
awareness but can be recalled with
attention.
Examples: addresses once known but little
used; feelings associated with significant life
events that occurred in the past.
Controlled partially by superego, which
helps to suppress unacceptable thoughts &
behaviors.
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Psychoanalytic Theory
3. Unconscious (the largest): memories that
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one is unable to bring to conscious
awareness.
Consists of unpleasant or nonessential
memories which can be retrieved only
through therapy, hypnosis, & with
awareness-alteration substances.
Emerges in dreams.
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Psychoanalytic Theory
 According to Freud, psychic energy is the force
required for mental functioning. This psychic
energy originates in the id; is used to fulfill the
basic physiological needs & is called the libido.
 Cathexis & anticathexis are forces within id, ego,
& superego used to invest psychic energy in
external sources to satisfy needs.
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Psychoanalytic Theory
 Cathexis: process by which id invests energy
into object to achieve gratification (i.e.,
alcohol to relieve stress).
 Anticathexis: use of psychic energy by ego &
superego to control id impulses (i.e., control
use of alcohol with rational thinking like “I will
not drink; I already have ulcer”).
 Imbalance between cathexis & anticathexis
results in internal conflicts, leading to tension
& anxiety within the individual.
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Defense mechanisms
 DM: mechanisms used consciously or
unconsciously as protective devices for the ego
in an effort to relieve mild-to-moderate anxiety
in mediating between excessive demands of id,
& excessive restrictions of superego.
 DM become maladaptive if used in extreme
degree that they distort reality.
 Examples of DM include: compensation and
denial.
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Dr. Masa'deh
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Psychoanalytic Theory
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Freud described formation of the personality
through five stages of psychosexual development.
Freud’s Stages of personality development
Oral stage--birth to 18 months
Anal stage--18 months to 3 years
Phallic stage--3 to 6 years (Oedipus and Electra
complex)
Latency stage--6 to 12 years
Genital stage--13 to 20 years
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Freud’s Psychosexual Stages
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STAGE
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FOCUS
Oral
(0-18 months)
Pleasure centers on the mouth-sucking,
chewing, biting
Anal
(18-36 months)
Pleasure focuses on bowel and bladder
elimination; coping with demands for
control
Phallic
(3-6 years)
Latency
(6 to puberty)
Pleasure zone is the genitals; coping with
incestuous sexual feelings
Dormant sexual feeling
Genital
(puberty on)
Maturation of sexual interest
Psychoanalytic Theory
 Relevance to nursing practice
 Knowledge of the structure of the
personality can assist nurse to:
1. Recognizing behaviors associated with the
id, the ego, & the superego will assist in the
assessment of developmental level.
2. Understanding the use of ego defense
mechanisms is important in making
determinations about maladaptive behaviors
& in planning care for the clients.
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 In the past 40 years, psychoanalytic theory
has seen a steady decline in the reliance on
psychoanalytic theory and psychoanalysis.
Psychoanalysis requires a person to be
relatively well-functioning, introspective, and
financially secure, thus creating a barrier to
many mental health clients.
 Basic level nurses are not trained in
psychoanalysis and are not usually involved
in a psychotherapeutic treatment role.
 The nurse’s role has increased somewhat
with long-term treatment of hospitalized
clients in specific settings.
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Cognitive–behavioral theory
 focuses on the present rather than the past.
The theory has roots in psychology and
neurophysiology.
 Behavior therapy is also known as cognitive–
behavior therapy.
 Symptoms associated with neuroses and
psychoses are identified as clusters of
learned behaviors that persist because they
are rewarding to the individual.
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Classical Conditioning
 One of the most important contributions to
this framework was made by Pavlov who
discovered a phenomenon he called the
conditioned response in a famous experiment
with a dog and a bell (1902).
 The experiment found that the conditioned or
learned response is the basic unit of all
learning on which more complex behavioral
patterns are constructed.
 Such construction occurs through a process
of reinforcement, in which behaviors are
rewarded and persist.
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 Response is a reaction to stimuli
 If the new and different stimuli is presented
with, just before, the original stimulating
event, the same response reaction can be
obtained
 Eventually the new stimuli can replace the
original one so the response can occur in
reaction to the new stimuli alone
 This based in “reinforcement”
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Skinner: Operant Conditioning
 which says people learn their behavior from
their history or past experiences, particularly
those experiences that were repeatedly
reinforced.
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principles of operant conditioning
 1. All behavior is learned.
 2. Consequences result from behavior—
broadly speaking, reward and punishment.
 3. Behavior that is rewarded with reinforcers
tends to recur.
 4. Positive reinforcers that follow a behavior
increase the likelihood that the behavior will
recur.
 5. Negative reinforcers that are removed after
a behavior increase the likelihood that the
behavior will recur.
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B. F. Skinner (1971)
 developed psychiatric treatment
approaches that represent one form of
conditioning and reflect the assumptions
mentioned earlier.
 Operant conditioning emphasizes
discovering why the behavioral
response was elicited and what actively
reinforces it.
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Key assumptions of the theory
include
The conditioned or learned response is the
basic unit of all learning.
 The self is the sum of past conditionings.
 Behavior is the way in which a person acts.
It can be observed, described, and
recorded.
 There is no autonomous person. People
are what they do and what they are
reinforced for doing by conditions in their
environment.
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The self is a structure of stimulus–
response hierarchies of habit. It is possible
to know and predict conditions under which
behavior will occur.
 The symptoms of a mental disorder are the
substance of that person’s troubles. There
is no hidden motive, no underlying cause,
and no internal pathogenic process. There
is only the symptom or the behavior, and
the aim of cognitive–behavior therapy is to
change the behavior.
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 The therapist determines what behavior
should be changed and what plan should be
followed.
 Change comes about by identifying events in
the client’s life that have been critical stimuli
for the behavior and then arranging
interventions for extinguishing those
behaviors.
 A changed way of acting precedes a changed
way of thinking.
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Relevance to the practice
 In institutional environments, nurses
prescribe schedules for daily living that
include behavior modification through a
“token economy” where clients are rewarded
by token reinforcements, such as food,
candy, and verbal approval.
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 In community-based settings, nurses also
plan schedules that attempt to replace
maladaptive behavior with behavior that
allows people to function effectively within
their natural environment.
 Interventions focus on the individual and
empower clients to learn new skills.
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 The movement has attempted to replace
maladaptive behavior with behavior that
encourages increased functioning.
 Psychiatric–mental health nurses also have a
role in teaching the effective use of
behaviorist principles to nonprofessional staff
to assist clients when professional staff is not
needed or available
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Social–interpersonal theories
 Two separate but philosophically congruent
schools of thought contribute to social–
interpersonal theories: interpersonal theory
and general systems theory
 Adolf Meyer (1948–1952) and Harry Stack
Sullivan (1953) made significant contributions
to social–interpersonal theory
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2. Interpersonal Theory (Sullivan)
 It is believed that individual behavior and
personality development are the direct result of
interpersonal relationships (Sullivan, 1953).
 Sullivan used concepts such as anxiety,
satisfaction of needs, interpersonal security
(relief from anxiety), and self-system (security
measures to protect against anxiety).
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social–interpersonal theory
 The self-system or self-dynamism. The self-system
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provides tools that enable people to deal with the
tasks of avoiding anxiety and establishing security.
The self is a construct built from the child’s
experience.
It is made up of reflected appraisals the person
learns in contact with significant others.
The self develops in the process of seeking physical
satisfaction of bodily needs and security.
To feel secure, the self essentially requires feelings
of approval and prestige as protection against
anxiety.
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 The interpersonal school of psychiatry in general
takes a developmental–interpersonal view of the self.
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Interpersonal Theory
 Components of self-system…
1) “Good me” in response to +ve feedback.
2) “Bad me” in response to –ve feedback.
3) “Not me” but someone else in response to
situations that produce intense anxiety in the
child.
 Sullivan described six stages of
personality development.
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Interpersonal Theory
 Relevance to nursing practice
1. Nurses develop therapeutic relationships
with clients to help them generalize this
ability to interact successfully with others.
2. By knowing the behaviors associated with all
levels of anxiety, nurses can help clients
achieve interpersonal security and a sense
of well-being.
3. Nurses use the concept of Sullivan’s theory
to help clients achieve a higher degree of
independent and interpersonal functioning.
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 In social–interpersonal theory, nursing roles
include case management, social psychiatry,
community psychiatry, psychoeducation, and
milieu therapy.
 Therapeutic interventions include programs
for social change, political involvement,
community organization, social planning,
family support groups, and education about
medications, symptom management, genetic
risk, and family environment.
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 All are associated with efforts to provide
psychiatric services more efficiently to large
groups of people, particularly those
previously neglected, and attempt to
counteract the debilitating effects of long-term
institutionalization.
 All are associated with a movement to
address the client’s social context in providing
psychiatric care
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Social interpersonal theory
includes
Holistic approaches: Interrelationship of
multiple dimensions increase the number
of assessment factors.
 Broad definition of clients: Clients are
defined as part of a system–family, couple,
or community.
 Primary prevention: Interventions include
psychoeducation, social change, and
research.
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Therapy Goals: Gain perspective on
lifestyle and environment issues, coping
skills, and resources versus controlling
symptoms.
 Autonomous practice: Nurses are
members of teams that value and move
toward diffusion of roles.
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Abraham Maslow: Hierarchy of
Needs
 The most basic needs—the physiological
needs of food, water, sleep, shelter, sexual
expression, and freedom from pain—must be
met first.
 The second level involves safety and security
needs, which include protection, security, and
freedom from harm or threatened deprivation.
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 The third level is love and belonging needs,
which include enduring intimacy, friendship,
and acceptance.
 The fourth level involves esteem needs,
which include the need for self-respect and
esteem from others.
 The highest level is self-actualization, the
need for beauty, truth, and justice
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 Maslow’s theory explains individual
differences in terms of a person’s motivation,
which is not necessarily stable throughout
life.
 Traumatic life circumstances or compromised
health can cause a person to regress to a
lower level of motivation
 This theory helps nurses understand how
clients’ motivations and behaviors change
during life crises
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Dr. Masa'deh
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Carl Rigers: client centered therapy
 First one use client
 Focus on client as the healer
 Successful therapeutic relationship:
- Reflection: Is literally a mirroring of the client’s
statement
- unconditional positive regard: respect clients
and their feelings, value, and goals.
- Empathy
- Authenticity: ability to be open, genuine, and
honest in response to the client
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3. Psychosocial Development Theory
(Erikson)
 Erikson studied the influence of social processes
on the development of the personality.
 Erikson described eight stages of the life cycle
during which the individuals struggle with
developmental “crises.”
 Specific tasks associated with each stage must
be completed for resolution of crisis and for the
occurrence of emotional growth.
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Psychosocial Development Theory (Stages)
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Trust vs. mistrust: birth to 18 months
Autonomy vs. shame & doubt: 18 months to 3 years
Initiative vs. guilt: 3 to 6 years
Industry vs. inferiority: 6 to 12 years
Identity vs. role confusion: 12 to 20 years
Intimacy vs. isolation: 20 to 30 years
Generativity vs. stagnation or self-absorption: 30 to 65
years
Ego integrity vs. despair: 65 years to death
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Psychosocial Development Theory
(PDT)
 Relevance to nursing practice
1. Nurses can plan care to assist clients in
fulfilling the tasks that should be performed in
each developmental stage and moving on to
a higher developmental level.
2. Nurses use the tasks of each stage to assess
the clients’ conditions.
3. PDT incorporates sociocultural concepts into
the development of personality.
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General system theory
 Every system are maintained by mutual
interaction of its parts
 A system is more than the sum of its parts
when things are organized into a system
 This theory provides a conceptual framework
For integrating the biologic and social sciences
With the physical science.
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 In psychiatry, its offer resolution of the mind-
body dichotomy, an integration of biologic
and social approaches to the nature of
human being and an approach to
psychopathology, diagnosis and therapy
 Its used in understanding how families
function
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General Systems Theory:
 Menninger (1963) views normal personality
functioning and psychopathology in terms of
general systems theory.
 His work addresses four major issues:
1- adjustment or individual–environment
interaction;
2- the organization of living systems;
3- psychological regulation and control, known
as ego theory in psychoanalysis;
4- and motivation, which is often called instinct
or drive in the psychoanalytic framework.
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A key concept of the theory is
homeostasis (equilibrium).
 He asserts that the greater the threat or
stress on a system, the greater the number of
system components involved in coping with
or adapting to it. Thus, pathology can exist at
various levels:
 the cell and organ level (behavioral changes
that follow cellular alterations due to drug
use, a blood clot, or a tumor);
 the group level (family violence);
 the community level (overpopulation,
pollution, homelessness, and poverty).
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 A system’s well-being depends on the
amount of stress on it and the effectiveness
of its coping mechanisms.
 Mental illness is an impairment of selfregulation in which comfort, growth, and
production are surrendered for the sake of
survival at the best level possible but at the
sacrifice of emergency coping devices.
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THANK YOU
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