Transcript Week Three 7 11 12 Overview of Psychological Theories and OT

Overview of
Theories of Mental
Health and OT
Practice
Cara & McRae, 2013, Chap. 5
OT 460A
OT Practice
Introduction
Need to view clients from biological,
psychological, and socio-cultural factors
 Must consider multiple theories of mental
illness
 Most prominent theories are humanistic, . I
biological, psychodynamic, behavioral, and
cognitive
 These theories drive OT practice
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introduction
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Need to have a comprehensive
Biopsychosocial focus:
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Most therapists have an eclectic approach
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Attend to biological, intrapsychic, interpersonal
factors creating and/or maintaining mental
dysfunction
Choose the best of each and synthesizes these
into an overall approach
Success with use of an eclectic approach is
variable
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Humanistic
Perspectives
 More
of a philosophy
 Emphasizes value, worth, and potential
of the individual
 Focus on client-therapist relationship
 Therapy is client-centered
 Moral treatment- consistent with OT
 Focuses on broad dimensions of an
individual’s life
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Theorists in
Humanism
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Maslow (Hierarchy of needs)
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Carl Rogers (father of client-centered tx)
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Unconditional positive regard; empathy;
genuineness
Victor Frankl- Existentialist
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Physiological, safety, belonginess, love, esteem,
cognitive, aesthetic, self actualization
Basic drive to find meaning in life
Lack of meaning creates psychiatric disturbances
Informed current day Occupational Science Theory
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Humanistic
application to OT
 Focus
on “whole person”- Mind, body,
spirit
 Meaning is pivotal to well being
 Empowering client to take an active role
in healing
 Non-judgmental; rapport with client
 Belief that behaviorism and
psychodynamic theories were to
reductionistic
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Biological
Perspectives
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Disease caused by:
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Infections, neuroanatomical defects; biochemical
imbalances and genetic predisposition
First connection to mental illness was syphillis
Psychopharmacology: Problems with
neurotransmitters and hormonal imbalances:
 Too much or too little NT
 Too few receptors on post synaptic membrane
 Presence or absence of other chemicals that interfere with
neural transmission
 Interrelationship between different NT and other factors
(such as stress)
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OT application of
biological perspectives
 Symptom
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Associated physical symptoms; side effects
of meds
Medication management
 Biological
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recognition and management
explanations vs. behavioral
Sensory modulation
New skills, routines, and learnning
influence brain plasticity and neuronal
pathways
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Psychodynamic
Perspectives
 Emotional
and personality development of
individual
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Emphasis on early childhood experience
Unconscious forces and internal processes
Abnormal behaviors result when dynamic
forces come in conflict (intrapsychic conflict)
Proponents: Freud; Charcot & Breuer;
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Neo-Freudian:Jung; Horney
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Psychodynamic
concepts
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Structure of the mind
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Levels of consciousness
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Repression; denial; projection; displacement;
reaction formation; intellectualization; regression;
identification; sublimation
Psychosexual developmental stages:
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Conscious; surface awareness; preconscious;
unconscious
Defense mechanisms
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Id, ego, superego
Oral; anal; phallic; latency; genital
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Applications in
Psychodynamic OT
 Fidler
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Relationships to objects in environment are
integral to development of ego
OT uses activities requiring clients to
interact with both human and non human
objects
Helps to have client reveal feelings and needs
 “The potential of activities in their own right to
represent, reflect, and infers social, cultural and
personal meanings”
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Applications in
Psychodynamic OT
 Mosey
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Therapist can learn about a client’s selfesteem and the presence of underlying
conflicts through expressive activities
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Eg. Collages, tile, drawings, clay
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Behavioral
Perspectives
Proponents: Descartes; Sherrington; Skinner,
Pavlov, etc
 Interaction of the person and environment
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All behavior is learned through:
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Stimulus/ response
Classical / respondent conditioning
Operant / instrumental conditioning
Modeling
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Concepts in
behaviorism
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Reinforcement
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Punishment
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Positive= rewards; praise, etc that increases
likelihood of behavior
Negative= also increases likelihood of behavior
(removal of aversive stimulus)
Done on continuous or intermittent schedule
Positive= delivery of aversive stimulus in response
to a behavior (spanking)
Negative=removal of a positive stimulus in
response to a behavior (losing TV)
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Behavioral
concepts
 Shaping-approximating
the behavior
 Chaining-linking steps/ parts of behavior
 Modeling- providing example
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Social learning- requires:
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Attending; form and retain mental image of
target behavior; reproduce model behavior from
stored image; motivation to learn
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OT application of
Behavioral concepts
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Widely used in society
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Grades; performance evals; schools
Application to adolescents and children
 Applicable to people with cognitive
impairment
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Cognitive-Behavior therapy
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Schizophrenia; MR; Autism; Dementia
Applicable to people with eating disorders; pain
management
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Cognitive
Perspectives
 Take
issue with simplicity in behaviorism
 Key concepts:
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Expectations (you are what you believe)
Appraisals
Attributions
Beliefs
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Ellis’ Rational
Emotive Therapy
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Change irrational beliefs:
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Must be loved and approved by all
In order to be worthy must be perfect in all aspects
of life
Catastrophic when things don’t go my way
Unhappiness is externally caused
Past history is critical determinant of present
behavior
There is always a perfect solution to a problem and
it is a catastrophe if a perfect solution is not found
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Applications in OT
 Life
skills training
 Multiple opportunities to test actions/
ideas
 Toglia
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Insight and generalization
Mental flexibility- multiple solutions
Understanding context
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