Psychiatric Nursing
Theoretical Foundations
Learning Objectives:
On completion of this unit the learner will be able to:
1- Discuss basic assumptions of some theoretical approaches
2- Suggest special strategies to modify or change behavior
3- Identify some concepts (milieu therapy& therapeutic relationship)
4- Understanding the level of needs in Maslow Hierarchy.
5- Identify the principle of OPRANT conditioning therapy
 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 assumptions to be tested.
1- Psychoanalytic Theories
The Pioneer Sigmund Freud (1856–1939) from Vienna
 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
Personality Stages and Functional Awareness
 Conscious – perceptions, thoughts and emotion that exist in the
person’s awareness
 Pre-conscious/Subconscious- Thoughts and emotions not
currently in awareness but can be recalled with effort
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 Unconscious- thoughts, drives and emotions totally a person is
Unaware
According to this theory, much of our behavior is motivated by our
SUBCONSCIOUS thoughts or
feelings
Five Stages of psychosexual development
1. Oral
2. Anal
3. Phallic or Oedipal
4. Latency
5. Genital
Psychosexual/Psychoanalytical
Freud's Sit of gratification
Focus
Age
Site of gratification :Mouth
18-0
Oral
months
3 - ½ 1 Anal
years
Site of gratification :Anus
Site of gratification :Genitals
Phase
5 -3
years
12 -6
years
& 12
above
Phallic
Focus
Age
Phase
Major task :Weaning
18-0
Oral
months
Site of gratification( :School Activities)
Site of gratification :Genitals
Latency
Genital
Developmental tasks
2
Major task :Toilet training
3-½1
years
Anal
Major task :Oedipal & Electra complex
5 -3
years
12 -6
years
& 12
above
Phallic
Major task : School activities
Major task :Sexual intimacy
Latency
Genital
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 Dissatisfaction: resurface
later by overeating, smoking, nail-biting
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
Possible problems




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Compulsive need to be clean and orderly.
Frugality and stinginess
Greed
Insistence on doing things at one's own rate at the expense of
others
 Rigid training
 Excessive messiness and disorderly habits.
 Nursing Implication: Help children achieve bowel and bladder
control without undue emphasis on its importance.
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
Possible problems





Oedipus complex
Electra complex
Nursing implications:
Accept child's sexual interest
Help the parents answer child's questions about birth or sexual
differences.
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
e Acquires friends
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
Psychoanalysis
 Freud developed psychoanalysis, a therapeutic process of
accessing the unconscious and resolving the conflicts that
originated in childhood with a mature adult mind.
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 As a system of psychotherapy, psychoanalysis attempted to
reconstruct the personality by examining free associations
(spontaneous, uncensored verbalizations of whatever comes to
mind) and the interpretation of dreams. Therapeutic
relationships had their beginnings within the psychoanalytic
framework.
Unconscious Ego defense mechanism
 These are PSYCHOLOGIC adaptive mechanisms
 Mental mechanisms that develop as the personality attempts to
DEFEND itself, establishes compromises among conflicting
impulses and allays inner tensions
 The unconscious mind working to protect the person from
anxiety
 Releases tension
Ego Defense Mechanisms
 Compensation: Covering up weaknesses by emphasizing a
more desirable trait
 Denial: Attempt to ignore unacceptable realities by refusing to
acknowledge them
 Displacement: Discharging emotional reactions from one
object to a LESS threatening object/person
 Identification: Imitation of someone feared or respected
 Intellectualization: Use of rational explanations that remove
from the event any personal significance and feelings
 Introjections: Acceptance of other’s norms as oneself
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 Regression: Resorting to an earlier, more comfortable level of
functioning that is less demanding
 Repression: Unconscious mechanism of keeping threatening
desires or thoughts from becoming CONSCIOUS
 Sublimation: Re-channeling of aggressive energies into socially
acceptable activities
 Substitution: Replacement of a highly valued object by a LESS
valuable or acceptable and available object.
 Undoing: Actions or words designed to cancel some
disapproved thoughts, impulses , or acts in which the person
relieves GUILT by making reparation
 PROJECTION: Blaming someone else for one’s difficulties or
placing one’s unethical desires on someone else.
Involves in the development of DELUSIONS;
A nursing graduate blamed a dean of a nursing school in Recto
for not passing the nursing exam.
CONVERSION: The unconscious expression of intrapsychic
conflict symbolically through physical symptoms.
A nursing student suddenly went blind after her recent
nursing board exam.
Psychosexual/Psychoanalytical:
Transference and Counter-transference
 TRANSFERENCE is the clients feeling toward nurse arising
from unconscious experiences with early significant others
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 COUNTER TRANSFERENCE is the nurse’s feelings toward
the patient arising also form previous experiences
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
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