Lesson 2 Outline
Lesson 2 Outline
Lesson 2 Outline
LEARNING OUTCOMES
After working on this module, you should:
1. Identify the factors that protects or puts a person’s mental health at-risk through
the individual, interpersonal, and Cultural factors;
2. Distinguish the basic beliefs and approaches of the following psychosocial theories:
psychoanalytic, developmental, interpersonal, humanistic, behavioral, existential; and
3. Determine the various ego defense mechanisms applied in specific circumstances.
- Younger clients may lack experiences of successful independent living and self-sufficiency, impacting
personal identity.
- Age and Expression of Illness:
- Young children with attention-deficit/hyperactivity disorder may struggle to describe
feelings.
- Nurses need to understand a child's language level to manage the disorder effectively.
- Erik Erikson's Psychosocial Development:
- Developmental tasks at each life stage.
- Successful completion of each stage crucial for well-being and mental health.
- Failure to complete tasks in one stage hinders future task completion.
- Example: Infancy stage (birth to 18 months) - "trust versus mistrust," essential for
developing trust in relationships.
- Impact of Age on Psychosocial Development:
- Erikson's stages highlight the importance of age in forming essential life skills.
- Successful completion contributes to positive mental health.
- Failure in early stages may affect later relationships and well-being.
A. Individual Factors
2. Genetics and Biologic Factors
- Heredity and biologic factors are beyond voluntary control.
- Genetic links identified in disorders like Alzheimer's.
- While specific genetic links are not identified for some mental disorders, research indicates a
familial tendency.
- Genetic makeup plays a significant role in a person's response to illness and potentially treatment.
- Nursing Assessment Importance:
- Family history and background are crucial components of nursing assessment.
- Understanding genetic influences helps inform the approach to care and treatment.
A. Individual Factors
3. Physical Health and Health Practices
- Better physical health enhances coping with stress or illness.
- Poor nutritional status, lack of sleep, or chronic physical illness may hinder coping abilities.
- Unlike genetic factors, lifestyle choices can influence these factors.
- Nurses should assess physical health even when clients seek help for mental health issues.
- Personal Health Practices:
- Exercise as a self-help intervention can mitigate negative effects of depression and anxiety.
- Group exercise fosters increased social support, improved well-being, and happiness.
- Continued participation in exercise indicates positive health indicators, while cessation may
suggest declining mental health.
A. Individual Factors
4. Response to Drugs
- Biologic differences affect client response to psychotropic drugs.
- Ethnic groups vary in drug metabolism and efficacy.
- Some groups metabolize drugs more slowly, requiring lower doses to achieve the desired effect.
- Nurses must monitor side effects and serum drug levels, especially in clients from diverse ethnic
backgrounds.
A. Individual Factors
5. Self-Efficacy
- Self-efficacy Defined:
- Belief that personal abilities and efforts influence life events.
- Those with high self-efficacy take action, set goals, are self-motivated, and cope effectively
with stress.
- Low self-efficacy is linked to low aspirations, self-doubt, anxiety, and depression.
- Factors Influencing Self-efficacy:
- Experience of success or mastery in overcoming obstacles.
- Social modeling (observing successful people inspires belief in one's potential).
- Social persuasion (encouraging self-belief).
- Stress reduction, building physical strength, and positive interpretation of physical
sensations. (e.g., viewing fatigue as a sign that one has accomplished something rather than as a lack
of stamina)
- Impact of Self-efficacy on Clients:
- Higher self-efficacy leads to confidence and positive expectations.
- Clients returning to the community with increased self-efficacy show improved
interpersonal relationships, coping skills, functional living, and community integration.
- Therapeutic Interventions for Self-efficacy:
- Focused on assessing physical health.
- Facilitating experiences of success.
- Providing social models for inspiration.
- Engaging in social persuasion.
- Emphasizing stress reduction, physical strength building, and positive interpretation of
physical sensations.
A. Individual Factors
6. Hardiness
- Hardiness Defined:
- Ability to resist illness during stressful situations.
- Three components:
1. Commitment: Active involvement in life activities.
2. Control: Ability to make appropriate decisions in life activities.
3. Challenge: Ability to perceive change as beneficial rather than just stressful.
- Moderating Effect on Stress:
- Hardiness moderates or buffers the impact of stress.
- High hardiness linked to lower occurrence of illness in individuals experiencing high stress.
- Personal Hardiness Characteristics:
- Described as a pattern of attitudes and actions.
- Helps turn stressful circumstances into opportunities for growth.
- Individuals with high hardiness perceive stressors accurately and problem-solve effectively.
Resilience Factor:
- Important resilience factor for families dealing with mental illness.
- Assists individuals in coping with psychological stress and adversity.
Potential Limitations of Hardiness:
- Some view the concept as vague and indistinct.
- Not universally beneficial; may be more relevant for those who value individualism.
- May not be as useful for people and cultures that prioritize relationships over individual
achievement.
A. Individual Factors
7. Resilience and Resourcefulness
- Resilience Defined:
- Healthy responses to stressful circumstances or risky situations.
- Explains varying reactions to stress; why some experience severe anxiety while others do
not.
- Associations with Mental Health:
- High resilience linked to promoting and protecting mental health, often described as
flourishing.
- Family Resilience:
- Successful coping of family members under stress.
- Factors in resilient families include positive outlook, spirituality, family accord, flexibility,
communication, and support networks.
- Resilient families engage in shared activities, recreational pursuits, and rituals.
- Resourcefulness Defined:
- Involves using problem-solving abilities and believing in one's ability to cope with adverse
or novel situations.
- Developed through successful coping with life experiences.
- Examples of Resourcefulness:
- Performing health-seeking behaviors.
- Learning self-care practices.
- Monitoring thoughts and feelings about stressful situations.
- Taking proactive action to deal with stressful circumstances.
A. Individual Factors
8. Spirituality
- Spirituality Defined:
- Involves the essence of a person's being and beliefs about the meaning of life and purpose
for living.
- Encompasses belief in God or a higher power, religious practices, cultural beliefs, and a
relationship with the environment.
- Role in Coping:
- While some with mental disorders may have disturbing religious delusions, for many,
religion and spirituality provide comfort and help during stress or trauma.
- Spirituality serves as a primary coping device for adults with mental illness, offering
meaning and coherence in their lives and establishing a social network.
- Impact of Religious Activities:
- Church attendance, praying, and associated social support are linked with better health and
a sense of well-being.
- These activities help people cope with poor health, and hope and faith are critical factors in
psychiatric and physical rehabilitation.
- Support for Families:
- Religion and spirituality provide support and solace to caregivers of relatives with mental
illness
B. Interpersonal Factors
1. Sense of Belonging
- Definition of Sense of Belonging:
- Feeling connected or involved in a social system or environment.
- Described by Abraham Maslow as a basic human psychosocial need.
- Impact on Functioning:
- Closely related to social and psychological functioning.
- Promotes health, while a lack impairs health.
- Associated with decreased anxiety.
- Nursing Focus:
- Interventions to increase a client’s sense of belonging.
B. Interpersonal Factors
2. Social Networks and Social Support
- Social Networks and Health:
- Groups of people one knows, providing emotional support.
- Studies show a social network helps reduce stress, diminish illness, and positively influence coping.
- Client's Perception:
- Support system bolstering confidence and self-esteem.
- Providing stress-related interpersonal help, like assisting in problem-solving.
B. Interpersonal Factors
3. Family Support
- Family as Social Support:
- Key factor in the recovery of clients with psychiatric illnesses.
- Despite potential challenges, family is often crucial for recovery.
- Irreplaceability of Family:
- Health care professionals cannot entirely replace the role of family members.
- Nurse's Role:
- Encourage family support during hospitalization.
- Identify family strengths, such as love and caring, as a valuable resource for the client.
C. Cultural Factors
1. Beliefs about Causes of Illness
- Culture's Influence on Health Beliefs:
- Culture has the most significant impact on a person's health beliefs and practices.
- Influences the concept of disease and illness.
C. Cultural Factors
2. Communication
- Challenges in Verbal Communication:
- Difficulty arises when the client and nurse speak different languages.
C. Cultural Factors
3. Physical Distance or Space
- Cultural Perspectives on Physical Distance:
- Diverse cultures hold varying views on comfortable communication distances.
- Preferences range from 2 to 3 ft, closer proximity, or distances greater than 2 or 3 ft.
C. Cultural Factors
4. Social Organization
- Definition of Social Organization:
- Encompasses family structure, religious values, ethnicity, and culture.
- Influences an individual's role and, consequently, health and illness behavior.
- Decision-Making Preferences:
- Individuals may seek advice from friends or family or make decisions independently.
- Strong emphasis on family role in health care decisions for many individuals.
- Delays in decision-making until consultation with appropriate family members are common.
C. Cultural Factors
5. Time Orientation
- Definition of Time Orientation:
- Refers to whether one views time as precise or approximate.
- Avoiding Mislabeling:
- Nurses should avoid labeling clients as noncompliant without considering cultural differences.
- Sensitivity to the client's time orientation is crucial, especially with follow-up appointments.
C. Cultural Factors
6. Environmental Control
- Definition of Environmental Control:
- Refers to a client's ability to control the surroundings or direct factors in the environment.
C. Cultural Factors
7. Biologic Variations
- Biologic Variations:
- Exist among individuals from different cultural backgrounds.
C. Cultural Factors
8. Socioeconomic Status and Social Class
Socioeconomic Status (SES)
- Refers to income, education, and occupation.
- Influence on Health:
- Strongly influences health, affecting factors like insurance, access to healthcare, and treatment
affordability.
- Nurse's Role:
- Must assess if social class influences how clients relate to healthcare providers and the system.
C. Cultural Factors
9. Cultural Patterns and Differences
- Understanding Cultural Patterns:
- Provides a starting point for the nurse to relate to individuals with different ethnic backgrounds.
- Enables the nurse to know what to ask and how to assess preferences and health practices.
- Individual Variations:
- Variations among people from any culture are wide; not everyone fits the general pattern.
- Individual assessment of each person and family is necessary for culturally competent care.
Nurse's Role
- Avoiding Assumptions:
- Never assume a patient's preferences based on stereotypes or the dominant culture.
- Always ask the client and/or family about their cultural beliefs and practices, demonstrating respect
and avoiding errors.
A. Psychosocial Theories
1. Psychoanalytic
Sigmund Freud: The Father of Psychoanalysis
- Resulting Behaviors:
- "Hysterical" or neurotic behaviors seen as manifestations of unresolved conflicts.
Personality Components
- Id:
- Reflects basic and innate desires.
- Includes pleasure-seeking behavior, aggression, and sexual impulses.
- Seeks instant gratification.
- Causes impulsive and unthinking behavior.
- Disregards rules and social conventions.
- Superego:
- Reflects moral and ethical concepts.
- Represents values and parental/social expectations.
- Opposes the id.
- Ego:
- Balancing force between id and superego.
- Represents mature and adaptive behavior.
- Enables successful functioning in the world.
- Freud's Concept:
- Anxiety results from the ego balancing id's impulsive instincts and superego's stringent rules.
Freudian Slip:
- A term used to describe slips of the tongue, such as saying something unintentionally.
- Freud viewed these slips not as accidents but as indications of subconscious feelings or thoughts
surfacing in casual day-to-day conversation.
Free Association:
- A method to access subconscious thoughts and feelings by prompting quick responses to words.
- Freud believed this technique could reveal repressed thoughts or feelings.
Transference:
- Definition: Client displaces onto the therapist attitudes and feelings originally experienced in other
relationships.
- Nature: Automatic and unconscious in the therapeutic relationship.
- Example: Adolescent female client reacts to a nurse of similar age as her parents, displaying intense
feelings of rebellion or making sarcastic remarks based on her experiences with her parents, not the
nurse.
Countertransference:
- Definition: Therapist displaces onto the client attitudes or feelings from his or her past.
- Nature: Involves the therapist's emotional reactions to the client.
- Example: A female nurse with teenage children and extreme frustration may adopt a parental or
chastising tone with an adolescent client, projecting her own attitudes and feelings toward her
children onto the client.
Self-Examination: Therapists can examine their own feelings and responses to identify
countertransference.
Communication: Talking with colleagues and seeking supervision to discuss and process
countertransference reactions.
Professional Growth: Continuous learning and personal development to minimize the impact of
countertransference on therapeutic relationships.
Therapeutic Goal:
- Help the client gain insight into and resolve conflicts and anxieties.
Techniques:
- Utilize free association as a method for clients to express thoughts and feelings without censorship.
- Apply dream analysis to uncover hidden meanings and conflicts.
- Interpret behavior to reveal unconscious motivations.
Practice Characteristics:
- Psychoanalysis is still practiced but on a limited basis.
- Analysis is lengthy, involving weekly or more frequent sessions for several years.
Financial Considerations:
- Considered costly and not covered by conventional health insurance programs.
- Earned the reputation of "therapy for the wealthy" due to financial barriers.
A. Psychosocial Theories
2. Developmental
Erik Erikson and Psychosocial Stages of Development
(1902–1994)
German-born psychoanalyst.
Extended Freud's work on personality development.
Focused on social and psychological development across the lifespan.
2. Preoperational (2 to 6 years):
- Development of language expression.
- Understanding symbolic gestures.
- Commencement of object classification.
Cognitive Maturity: Piaget suggests individuals reach cognitive maturity by middle to late
adolescence.
- Practical Applications:
- In Child Interaction:
- Understanding a child's cognitive development aids in interpreting their expressions.
- Educational Context:
- Structuring teaching methods based on cognitive development enhances learning for children.
A. Psychosocial Theories
3. Interpersonal
Harry Stack Sullivan: Interpersonal Relationships and Milieu Therapy
(1892–1949):
American psychiatrist.
Extended personality development theory to emphasize the significance of interpersonal
relationships.
Key Beliefs:
Personality involves interactions with others, not just individual characteristics.
Inadequate or unsatisfying relationships lead to anxiety, the basis for emotional problems.
Major Contribution:
Emphasized the importance of interpersonal relationships in mental health.
Five Life Stages
1. Infancy:
Focus: Early interpersonal relationships.
2. Childhood:
Focus: Development of relationships during childhood.
3. Juvenile:
Focus: Interpersonal dynamics in juvenile years.
4. Preadolescence:
Focus: Relationships during preadolescence.
5. Adolescence:
Focus: Interpersonal interactions in adolescence.
Characteristics: Perceiving oneself and the world within the environmental context.
Ability: Analyzing experiences in various settings.
Maturity: Predominance of the syntaxic mode is associated with maturity.
Overall Perspective:
Mental disorders are related to the persistence of one of the early cognitive modes.
Maturity is defined by the predominance of the syntaxic mode.
3. Interpersonal
Hildegard Peplau: Therapeutic Nurse–Patient Relationships
(1909–1999)
- Developed the concept of the therapeutic nurse–patient relationship based on Sullivan’s
interpersonal theories.
- Emphasized the role of the nurse as a participant observer.
- Identified four phases of the therapeutic nurse–patient relationship: orientation, identification,
exploitation, and resolution.
1. Orientation Phase
- Nurse-directed phase involving clarification of patient's problems and needs.
- Explanation of hospital routines and expectations.
- Patient's full participation is encouraged.
2. Identification Phase
- Begins when the patient perceives helpful individuals and expresses feelings.
- Interdependent work with the nurse occurs.
- Roles of both patient and nurse are clarified.
3. Exploitation Phase
- Patient makes full use of available services.
- Goals such as returning home and work emerge.
- Patient fluctuates between dependence and independence.
4. Resolution Phase
- Patient no longer needs professional services and gives up dependent behavior.
- Assumes power to meet own needs and set new goals.
A. Psychosocial Theories
4. Humanistic
Abraham Maslow: Hierarchy of Needs
(1921–1970)
- American psychologist
- Focused on individual needs and motivations
- Emphasized holistic approach and health
- Hierarchy of Needs:
- Maslow (1954) formulated hierarchy as a pyramid
- Illustrates basic drives or needs motivating human behavior
- Arranged in levels:
- Physiological Needs: Food, water, sleep, shelter, sexual expression, freedom from pain
- Safety and Security Needs: Protection, security, freedom from harm or deprivation
- Love and Belonging Needs: Enduring intimacy, friendship, acceptance
- Esteem Needs: Self-respect, esteem from others
- Self-Actualization: Pursuit of beauty, truth, justice
- Behavioral Dominance:
- Basic needs dominate behavior until fulfilled
- Successive levels become dominant upon fulfillment
- Example: Unmet needs for food and shelter overshadow other concerns, leading to risk-taking
behaviors
- Self-Actualization:
- Achievement of all needs in hierarchy
- Realization of fullest potential in life
- Attainment is rare
Behavioral Theories
- Foundation of Behaviorism:
- Reaction to introspection models
- Focuses on observable behaviors rather than internal mental processes
Principles:
- *Reward and Punishment:* Behavior can be changed through rewards and punishments
- *Examples:*
- Regular paycheck as positive reinforcement for work
- Speeding ticket as negative reinforcement for speeding behavior
- Removal of negative reinforcer may lead to resumption of behavior
This outline encapsulates Carl Rogers' client-centered therapy approach and introduces key concepts
in behavioral theories, emphasizing observable behaviors and mechanisms of behavior change.
A. Psychosocial Theories
5. Behavioral
Ivan Pavlov: Classical Conditioning
(1849–1936)
- Pavlov's theory of classical conditioning asserts behavior change through conditioning with external
stimuli.
- Experimental Basis:
- Conducted laboratory experiments with dogs.
- Observed dogs' natural salivation response to food stimuli.
- Pavlov's Experiment:
- Introduced new stimulus: ringing a bell.
- Paired bell with presentation of food.
- Dogs salivated in response to food.
- Repeated Conditioning:
- Repeated bell ringing with food presentation numerous times.
- Dogs learned to associate bell with food and salivated upon hearing the bell alone.
- Outcome:
- Dogs "conditioned" to salivate at the sound of the bell.
- Behavior modified through classical conditioning.
A. Psychosocial Theories
6. Existential
Jean-Paul Sartre
(1905-1980)
1. Existentialism and Humanism:
- Sartre's essay "Existentialism is a Humanism" (1945) emphasizes that without a divine designer
(God), there is no intrinsic essence of human life.
- Consequently, humans must invent their own purpose and define their own "essence."
2. Existential Phenomenology:
- Sartre's early works build upon classic phenomenology but diverge from Husserl's approach.
- He focuses on understanding human existence rather than the external world.
- Key themes include freedom, consciousness, and the tension between facts and freedom in an
indifferent world.
3. Being and Nothingness:
- Sartre's philosophical masterpiece, "Being and Nothingness," outlines his ontology.
- He defines two types of reality:
- Being of the object of consciousness ("in-itself"): Independent and non-relational existence.
- Being of consciousness itself ("for-itself"): Defined in relation to something else.
- Negative power of consciousness: Allows us to experience "nothingness."
- Self-identity as a task: The unity of the self is not given but created through projects.
- Authenticity vs. bad faith: Choosing in a way that reveals both factual and transcendent existence.
Viktor Frankl
(1905-1997)
1. Logotherapy:
- Developed by Viktor Frankl, logotherapy is a form of existential psychotherapy.
- The term "logos" refers to meaning or purpose, emphasizing its central focus.
- Frankl believed that humans are motivated by a "will to meaning", which drives them to seek and
create meaning in life.
- Logotherapy has been recognized as a scientifically based school of psychotherapy by professional
associations¹.
2. Fundamental Properties:
- Healthy Core: Every person possesses an inner core of health and resilience.
- Enlightenment: Logotherapy aims to enlighten individuals about their internal resources and
provide tools for self-discovery.
- Purpose and Fulfillment: While life offers meaning, it does not guarantee happiness or fulfillment.
3. Finding Meaning:
- Logotherapy asserts that finding meaning in life is a primary motivational force.
- Even in the face of suffering, individuals can discover meaning through their attitudes, choices, and
actions.
- Three ways to find meaning:
- Creative value: Creating or accomplishing tasks.
- Experiential value: Appreciating and receiving from the world.
- Attitudinal value: Choosing one's response to life's challenges.
4. Holocaust Experience:
- Frankl's personal experience in Nazi concentration camps deeply influenced his theory.
- He observed that those who found meaning and purpose were more resilient in adversity.
Methods employed by the ego to protect the self and cope with basic drives or emotionally painful
thoughts, feelings, or events.
- Most operate at the unconscious level of awareness.
- Often require external help to recognize reality.
1. Compensation:
- Overachievement in one area to offset deficiencies in another.
- Example: Nurse with low self-esteem works double shifts to gain supervisor's approval.
Management: Encourage self-awareness and self-acceptance. Help the individual identify their
strengths and weaknesses realistically. Offer opportunities for skill development and provide positive
feedback on achievements in various areas to build self-esteem. Therapy focused on enhancing self-
esteem can also be beneficial.
2. Conversion:
- Expression of emotional conflict through development of physical symptoms.
- Example: Teenager forbidden to watch X-rated movies develops blindness unconcernedly.
Management: Provide psychological support and therapy to help the individual understand and
express their emotions in a healthy way. Teach coping skills to manage emotional conflicts effectively.
Address underlying issues contributing to the conversion symptoms through therapy, such as
cognitive-behavioral therapy or psychodynamic therapy.
3. Denial:
- Failure to acknowledge unbearable condition or reality.
- Examples: Diabetic person indulging in chocolate; spending money freely when broke.
Management: Create a supportive environment where the individual feels safe to acknowledge and
discuss their concerns. Provide education about the importance of facing reality and seeking
appropriate help. Encourage open communication and offer reassurance. Therapy aimed at increasing
insight and coping skills can be beneficial.
4. Displacement:
- Ventilation of intense feelings towards less threatening targets.
- Examples: Person mad at boss yells at spouse; bullied child mistreats younger sibling.
Management: Help the individual identify and understand their feelings and triggers for displacement.
Teach healthy ways to express emotions and manage anger or frustration, such as assertiveness
training or relaxation techniques. Address underlying issues contributing to the displacement through
therapy, such as anger management or interpersonal therapy.
5. Dissociation:
- Temporary alteration in consciousness or identity to deal with emotional conflict.
- Examples: Amnesia following auto accident; adult forgetting childhood sexual abuse.
Management: Provide a safe and supportive environment for the individual to explore and process
their experiences. Offer therapy focused on grounding techniques, mindfulness, and coping strategies
for managing dissociative episodes. Address underlying trauma or stressors contributing to
dissociation through trauma-focused therapy or dialectical behavior therapy.
6. Fixation:
- Immobilization of personality due to unsuccessful task completion in developmental stage.
- Examples: Never learning to delay gratification; lack of clear identity as adult.
Management: Encourage exploration and development in areas where the individual feels stuck.
Provide opportunities for personal growth and achievement. Offer therapy focused on addressing
unresolved developmental tasks and promoting adaptive coping strategies. Support the individual in
developing a sense of identity and autonomy.
7. Identification:
- Modeling actions and opinions of influential others while searching for identity or goal.
- Example: Nursing student choosing critical care specialty admired by instructor.
Management: Encourage self-reflection and exploration of personal values and beliefs. Help the
individual differentiate between their own identity and the influence of others. Offer therapy focused
on building self-awareness, assertiveness, and self-esteem. Support the individual in developing
autonomy and making independent choices.
8. Intellectualization:
- Separating emotions of painful event from facts involved.
- Example: Showing no emotional expression when discussing serious car accident.
Management: Encourage emotional expression and exploration of underlying feelings. Help the
individual connect their thoughts with their emotions and experiences. Offer therapy focused on
increasing emotional awareness and processing difficult emotions. Support the individual in
developing healthy coping strategies for managing emotional challenges.
9. Introjection:
- Accepting another's attitudes, beliefs, and values as one's own.
- Example: Person disliking guns becoming avid hunter like best friend.
Management: Facilitate exploration of personal values and beliefs independent of others. Encourage
critical thinking and reflection on the origin of adopted attitudes and beliefs. Offer therapy focused on
building self-confidence and assertiveness. Support the individual in developing a sense of self and
making authentic choices.
10. Projection:
- Unconscious blaming of unacceptable thoughts on external objects.
- Examples: Man projecting thoughts about same-gender relationship onto gay man; person loudly
identifying others as bigots.
Management: Provide education about projection and help the individual recognize when they are
projecting onto others. Encourage self-reflection and exploration of underlying feelings and
motivations. Offer therapy focused on increasing self-awareness and addressing underlying
insecurities or conflicts. Support the individual in developing healthy coping strategies for managing
emotions.
11. Rationalization:
- Excusing own behavior to avoid guilt or responsibility.
- Examples: Student blaming failure on mean teacher; man justifying beating wife for not listening.
Management: Encourage accountability and responsibility for one's actions. Provide education about
rationalization and its potential consequences. Help the individual explore alternative perspectives
and challenge rationalizations. Offer therapy focused on increasing self-awareness and addressing
underlying fears or insecurities. Support the individual in developing healthy coping strategies for
managing guilt and anxiety.
13. Regression:
- Returning to previous developmental stage to feel safe or have needs met.
- Examples: 5-year-old asking for bottle like baby brother; man pouting like 4-year-old for attention.
Management: Provide support and reassurance during times of stress or transition. Help the
individual identify triggers for regression and develop alternative coping strategies. Offer therapy
focused on building resilience and adaptive coping skills. Support the individual in processing
underlying feelings and addressing unresolved issues contributing to regression.
14. Repression:
- Excluding emotionally painful thoughts or feelings from conscious awareness.
- Examples: Woman forgetting mugging incident; woman having no memory before age 7 due to
abusive childhood.
Management: Create a safe and supportive therapeutic environment where the individual feels
comfortable exploring difficult thoughts and emotions. Help the individual develop insight into their
repressed thoughts and feelings. Offer therapy focused on increasing emotional awareness and
processing unresolved trauma or conflicts. Support the individual in developing healthy coping
strategies for managing distress.
15. Resistance:
- Overt or covert antagonism toward remembering or processing anxiety-producing information.
- Examples: Nurse avoiding time with dying patient; person attending treatment but refusing to
participate.
Management: Establish trust and rapport with the individual to facilitate open communication.
Validate the individual's concerns and fears about facing anxiety-provoking information. Offer therapy
focused on exploring the underlying reasons for resistance and addressing any underlying conflicts or
anxieties. Support the individual in developing coping strategies for managing anxiety and increasing
willingness to engage in therapy.
16. Sublimation:
- Substituting socially acceptable activity for unacceptable impulse.
- Examples: Former smoker sucking on hard candy; person going for walk when tempted to eat junk
food.
Management: Encourage the individual to channel their impulses into socially acceptable activities.
Provide opportunities for creative expression and skill development in areas of interest. Offer therapy
focused on identifying and cultivating healthy outlets for emotional expression and gratification.
Support the individual in finding meaningful ways to channel their energy and impulses.
17. Substitution:
- Replacing desired gratification with more readily available option.
- Example: Woman opening day care center instead of having own children.
Management: Help the individual explore and address the underlying desires or needs driving the
substitution. Provide support and guidance in pursuing alternative avenues for gratification or
fulfillment. Offer therapy focused on increasing self-awareness and developing coping strategies for
managing unmet needs or desires. Support the individual in making positive changes to improve their
well-being.
18. Suppression:
- Conscious exclusion of unacceptable thoughts or feelings from conscious awareness.
- Examples: Student avoiding thoughts of parent's illness to study; woman telling friend she can't
think about son's death.
Management: Provide education about the potential consequences of suppressing thoughts and
feelings. Encourage the individual to explore and express their emotions in a safe and supportive
environment. Offer therapy focused on increasing emotional awareness and processing unresolved
issues. Support the individual in developing healthy coping strategies for managing distress and
regulating emotions.
19. Undoing:
- Exhibiting acceptable behavior to negate unacceptable behavior.
- Examples: Cheating spouse bringing bouquet to spouse; ruthless businessperson donating to
charity.
Management: Encourage accountability and responsibility for one's actions. Help the individual
explore and address the underlying motivations for undoing behaviors. Offer therapy focused on
increasing self-awareness and developing healthier ways of coping with guilt or anxiety. Support the
individual in building self-esteem and making positive changes in their behavior patterns.