Biopsychosocial Theories

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An Introduction to Theories in Social Work
By Bruce Hartsell
Social work is built on the biopsychosocial perspective. That term contains a hint as to
how many theories are needed to be able to engage in social work practice that is
informed by theory. One needs biological, psychological, and social or sociological
theories. Since the realm of psychology includes thoughts, feelings, and behaviors,
practitioners need to be able to use at least one theory that addresses each of those.
I conceptualize the theory structure like this (illustrating theories that might be useful in
each “domain”).
Bio
Psycho
Social
Evolutionary theory
Ecosystems theory
Thoughts
Cognitive theory
Ecological theory
General systems theory
Feelings
Behaviors
Psychodynamic theory
Behavioral theory
Although individual practitioners may chose different theories, being able to use at least
one theory to address each domain is necessary to be minimally competent as a social
worker. Following are brief introductions to some theories that might be useful.
Biological Theories
Evolutionary Theory
The key concept of evolutionary theory is that speciation occurs over time as individuals
compete for reproductive success. Through the processes of normal variation and
mutation, some individuals are more reproductively successful than others, and because
they are more reproductively successful, their “beneficial” genes occur with increasing
frequency within a population. Over time, enough mutations occur that a new species is
formed. Definitions of species are complicated, but a general idea is that a species is a
group of individuals that can and does breed with each other and that produces similar,
reproductively competent, offspring.
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Evolutionary theory, although based in biology, may have some explanatory power
relative to human behavior. For example, individuals are likely to do more to assure the
survival of individuals who carry their genes than they are of individuals who don’t.
Further, from the evolutionary perspective, behavior patterns that persist from generation
to generation within a species are said to do so because they have survived the same
selection pressure that physical characteristics have survived. The field of evolutionary
psychology explores ideas such as these.
Evolutionary theory is primarily an explanatory theory. It has little if any predictive
value regarding the behaviors of individuals. I am not aware of any psychosocial
interventions that follow logically from evolutionary theory.
Ecosystems Theory (or perspective)
Ecosystems theory combines ideas from ecological theory (which is built on evolutionary
theory) and from general systems theory. The biological components of ecological
theory are relevant within the biopsychosocial perspective, and they may also serve as
metaphors for social interactions. For example, competition for resources may refer to
competition for a job necessary to obtain food (a biological resource), or it may refer to
competition for social status (a social resource).
The key concept of ecological theory is that species compete for resources within an
environment. But the competition also occurs at the individual level. In fact, some
individuals argue that competition occurs at the gene level, i.e. that genes compete with
each other and that individuals are merely carriers of genes.
In ecology, the ecosystem is the focus of study. An ecosystem is a group of organisms
that interact with each other and with an environment, known as a habitat. The species
occupies a niche, or a role, within a physical and temporal space. Each habitat has a
carrying capacity, which is the maximum number of individuals of a species that can live
within the habitat. As the number of individuals increases, competition among
individuals increases.
As environmental factors change, individuals and species adapt. Adaptation may occur at
an individual level, e.g. such as when some individuals shift their feeding times, or it may
occur at a genetic level, e.g. such as when eyes evolve their ability to see in low light
levels.
One way to reduce competition between species is called specialization, such as the
capacity of a species of bats to feed on a particular flower species. But specialization
involves the risk that the species has fewer other options if the food for which it
specializes is no longer available.
Different species in an ecosystem interact in different ways. In predation, one species
eats another. Symbiosis involves frequent interactions where one or both species benefit.
The three types of symbiosis are mutualism, in which both species benefit,
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commensalism, in which one species benefits and the other is neither helped nor harmed,
and parasitism, in which one species benefits at the expense of the other.
Some writers argue that ecological theory is a specific application of general systems
theory. A system is a set of interrelated elements that form an identifiable whole. The
whole is greater than the sum of the parts, and most parts are subparts of other larger
parts, which are, in turn, sub parts of yet larger parts. For example, all of my organ
systems are parts of “me,” I am part of my family, my family is a part of my
neighborhood, my neighborhood is part of my community, etc. Larger parts are called
“suprasystems,” but most suprasystems are “subsystems” of yet larger suprasystems.
(The universe might be the only system that has no suprasystem.)
Subsystems and suprasystems are distinguished by their boundaries, which have varying
degrees of permeability. Functioning systems regulate the permeability of their
boundaries to let in resources and to let out waste. Systems tend toward dynamic
equilibrium or a steady state. Some systems are more adaptive than others to
environmental changes and can return to dynamic equilibrium relatively easily after
disruption, but other systems have difficulty returning to equilibrium or may become so
disrupted that the system is destroyed. Equilibrium is sought through four mechanisms:
input, conversion (processes that change input into useful forms), output, and feedback.
These mechanisms may be material or informational.
Two key ideas from general systems are equifinality and multifinality. Equifinality
means that many different causes or processes may lead to the same outcome. For
example, many different conditions can produce a fever. Multifinality means that one
event or process may lead to many different outcomes. For example, telling one joke in
class may produce a wide range of reactions among students, or, as a biological example,
exposure to one species of microbe may have no apparent effect on some individuals,
weaken others, and kill yet others.
Another key idea from systems theory is that a change in any part of the system will
precipitate changes in all other parts of the system. This idea is key in strategic therapy,
which intentionally disrupts patterns of interaction within a system based on the belief
that if the system experiences disruption, unproductive or maladaptive patterns are likely
to become more productive or adaptive.
Ecosystems theory is primarily an explanatory theory. It has little predictive value
regarding the behavior of individuals. Structural therapy and strategic therapy are both
influenced by systems theory.
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Psychological Theories
Behaviorism
Behaviorism is based in the idea that many patterns of behavior are learned through a
process of reinforcement and punishment. By definition, a reinforcer increases the
frequency of a behavior, and a punisher decreases the frequency of the behavior. Positive
reinforcement involves the application of a desired consequence. Negative reinforcement
involves the withdrawal of a negative condition. For example, letting child out of “time
out” while he is crying increases the likelihood that the child will cry the next time he is
in time out and that we will cry until he is let out.
In the ABC model of behaviorism, an antecedent (A) occurs to stimulate a behavior (B)
and then a consequence (C) follows. The consequence –which may be a reinforcer, a
punisher, or neutral—influences the likelihood that the behavior will occur again.
From the social work person-in-environment perspective, (although not unique to social
work or to that perspective) is the idea that changing antecedents can change behaviors.
For example, if Johnny gets into fights at school when the boy next to him whispers
derogatory comments about Johnny’s mother, moving either Johnny or the boy to the
other side of the room would likely result in fewer fights for Johnny.
Social learning theory is a behavioral theory that focuses on the capacity for individuals
to learn not only from their own experiences of antecedents and consequences but also
from the antecedents and consequences that they observe others experiencing.
Behavioral theory is a relatively robust theory in that it withstands many challenges to its
principals and assumptions and it is internally consistent. It also has predictive value and
fits with a set of interventions, many of which have been shown to be effective in a wide
range of research studies. Some of those interventions include contingency management,
shaping, and social skills training.
Cognitive Theory
Cognitive theory is based on the idea that behavior is influenced primarily by core beliefs
within each individual. Maladaptive or unproductive behaviors are a consequence of
flawed core beliefs. Those core beliefs may be unconscious, but they may be made
conscious. Behavior patterns provide clues about core beliefs. Once core beliefs are
made conscious, they may be examined and revised or replaced.
Cognitive theory is a relatively robust theory, it has predictive value, and it fits with a set
of interventions that are supported by a wide range of research studies.
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Cognitive Behavioral Theory
Several variations of cognitive behavioral theory exist. I will base this discussion on
Albert Ellis’s model of Rational Emotive Behavior Therapy (REBT).
Ellis posits that maladaptive cognitions produce disturbed behaviors and emotions and
that thoughts, feelings, and behaviors mutually influence each other, either toward better
outcomes or toward worse outcomes, as defined by the individual. He does not promote
the use of the approach “on” individuals, but “with” individuals who seek to change their
own thoughts, feelings, and behaviors.
Ellis’s model is based on the acronym ABCD, in which “A” stands for “Activating
Event,” “B” stands for “Belief,” “C” stands for “Consequence.” I’ll get to “D” in a
moment. The activating event is something that occurs, usually an external event, but
possibly also an internal event, that leads to undesired thoughts, feelings, or behaviors –
the “consequence.” But Ellis points out that beliefs mediate activating events and
consequences. For example, if I tell my wife about a joke I told in class and how some
people were offended by the joke, and she grins at me and says “Maybe you learned
something,” if I believe that she is being helpful and supportive, I will respond differently
than if I believe she is insulting me, and I will respond with thoughts, feelings, and
behaviors that fit my belief—the meaning I attribute to her behavior. Therefore it is not
her comment that causes my response, but it is my belief about her comment that causes
my response.
Using this example further, assume I interpret her comment to be insulting and I
additionally have the belief that my wife should never insult me, always show
understanding and kindness, and do whatever it takes to make me feel better. The fact
that she has not fulfilled these expectations is likely to contribute to hurt or angry
thoughts, feelings, and behaviors – which can easily become the activating event for a
belief-consequence series of responses – on her part.
The key to REBT is to identify the beliefs that contribute to undesired outcomes and to
teach clients to Dispute (“D”) those beliefs, i.e. to change the unproductive or
maladaptive beliefs (Ellis calls them irrational beliefs), to more productive, adaptive, or
rational beliefs (thus the name rational emotive behavior therapy).
Irrational beliefs usually take the form of “should,” “ought,” “must,” or “have to.”
Individuals convert preferences to “rules,” and when the rules are violated, they upset
themselves with their beliefs (cognitions).
I posit that every irrational belief contains an unrealistic expectation, an awfulization, and
a justification. It works something like this: I think “Something ought to be different
from the way it is” (an unrealistic expectation since it “is” whatever it “is, at least at the
moment), that it does not meet my expectations is simply awful, and because it doesn’t
meet my expectation and is awful, I’m justified in showing my displeasure, upset, etc.”
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The “disputed” belief might look something like this: I think “Although I prefer that
everyone follow my rules, I realize that m rules are merely strong preferences and that no
one has a duty to adhere to my strong preferences. Further, although I really don’t like it
when things don’t go my way, it’s not awful – at least not awful enough to justify
upsetting myself a lot, and so I’d better figure out a more productive way to deal with my
upset than to do things that make the situation worse.”
Cognitive-behavioral theory is a relatively robust theory, it has predictive value, and it
fits with a set of interventions that are supported by a wide range of research studies.
Attachment Theory
Attachment theory was developed by John Bowlby and Mary Ainsworth, among others.
The primary idea of attachment theory is that children learn patterns of attachment from
their primary caregivers and that these patterns of attachment in turn contribute to the
patterns of emotion that children experience and to their patterns of social interaction.
The three types of attachment are secure, avoidant, anxious, and disorganized. Children
form secure attachment when caregivers respond appropriately to their needs. They form
avoidant attachments when caregivers ignore their needs. They form anxious
attachments when caregivers respond appropriately sometimes and ignore needs at other
times. They form disorganized attachments when caregivers are abusive, frightening, or
intrusive.
Attachment theory is not an intervention theory, but it has been influential in several
approaches to intervention, including psychodynamic therapy, and Parent-Child
Interaction Therapy, and it is supported by a body of research.
Psychodynamic Theory
Psychodynamic theory is built on the idea that each individual has a set of emotions that
are common to members of the species and that emotions and related behaviors develop
through childhood experiences. Behavior is influenced by defense mechanisms, most of
which are unconscious, and which serve to manage uncomfortable emotions and conflicts
among emotions. The theory proposes that many behaviors are attempts to meet
unconscious needs, including the need to resolve conflicts among emotions.
According to psychodynamic theory, therapeutic change comes when unconscious
conflicts and emotions become conscious, from understanding of how unproductive and
maladaptive patterns of emotions and behavior developed, and from resolving the inner
conflicts.
Although psychodynamic theory rests on a variety of untestable ideas, it has some
explanatory power, and some research shows that psychodynamic therapy can be
effective for some conditions.
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Social Theories
When ecological theory, general systems theory, and ecosystems theory are used to
examine social interactions, they are social theories. They also illustrate that biological,
psychological, and social factors interact all the time. Human beings (biological
organisms) socially interact with each other according to their biological and
psychological processes. Psychological processes are influenced by biological and social
processes. Etc.
Some additional social theories include feminist theory, Marxist theory, conflict theory,
and critical race theory. A core idea of feminist theory is that gender inequality results
from social systems and structure. A primary idea of Marxist theory is that a society’s
economic system determines its other systems and that conflict over economic resources
is responsible for many of society’s ills. A key idea of conflict theory is that social ills
result from conflict over resources. An important idea from critical race theory is that
experiences of a group can be adequately described only by the members of the group
and that attempts by others to define the group and its experiences are further examples
of the injustices inherent in the social structures that allow the distinctions among the
groups.
To some extent each of these related theories is built on the idea that social structures
allow some groups to have power over other groups, and they view those power
differentials as both unnecessary and wrong. These theories tend to be built on
ideologies about how societies ought to be constructed, and they tend to share ideas about
the social construction of ideas that contribute to the subjugation of individuals and
groups. Their approach to intervention is generally to raise awareness of the sociallyconstructed nature of societal structures and to then confront those constructs. Of all of
the theories listed, these are most explicitly aligned with the value of social justice.
Step Theories
Step theories are not general theories of human behavior, so they don’t neatly fit the
schema outlined at the beginning of this summary. They are theories of the
developmental processes through which abilities are developed or behaviors are
displayed.
Piaget
Piaget identified four stages of cognitive development. In the first stage, sensorimotor,
which lasts from about birth through two years of age, “thoughts” are based in physical
and social interactions. During this stage, infants learn that self and other are separate
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and that objects continue to exist after they disappear from view (think of playing
peekaboo). In the preoperational stage, which lasts from age two until about age seven,
children begin to use language and other symbols. They have little sense of time and
little ability to distinguish fantasy from reality. During the stage of concrete operations,
which lasts from about age seven through early adolescence, individuals are able to use
certain rules of logic, for example, that if c is bigger than b, and b is bigger than a, then c
is bigger than a. Also during the stage of concrete operations, individuals are able to think
about things from the point of view of other individuals. In the stage of formal
operations, which begins in adolescence, individuals are able not only to think about
“real” situations abstractly but also to think about ideas that exist only as abstractions.
Freud
Freud hypothesized that a variety of human behaviors are related to instinctual drives
(commonly thought of as psychosexual drives, but this may be a result of mistranslation)
that develop through a series of stages. The first stage, the oral stage, which lasts for
about the first year of life, involves pleasure through the mouth and is likely related to the
rooting and nursing instincts that are necessary for survival. The next stage is the anal
stage, which lasts from about one year of age through three years of age. The anal stage
involves learning bowel and bladder control. The phallic stage lasts from about three
years of age through six years of age and focuses on awareness of gender differences and
famously (or infamously) on the development of the Oedipus and Electra complexes, in
which children supposedly want to partner with the parent of the opposite gender.
During the latency stage, which lasts from about age six through puberty, individuals
experience relatively few psychosexual conflicts, awareness of differences between boys
and girls is relatively muted, and so psychic energy can be expended on tasks related to
school, hobbies, etc. The final stage, the genital stage, begins at puberty. The focus
returns to sexual awareness and pursuit of the kinds of relationships necessary for
procreation and rearing children
Erikson
Students often learn Erickson’s stages as a series of issues or conflicts, as outlined here.
Trust vs. Mistrust – birth to two years
Autonomy vs. Shame and Doubt – two years to three years
Initiative vs. Guilt – three years through five years
Industry vs. Inferiority – six years through 11 years
Identity vs. Role Confusion – 12 years through 18 years
Intimacy vs. Isolation – 19 years through 40 years
Generativity vs. Stagnation – 40 years through 65 years
Integrity vs. Despair – 65 years through end of life
The following discussion mentions the “desired” outcomes of each stage. In the first
stage, individuals learn that the world is predictable and that needs can be reliably met.
In the second stage, individuals learn basic mastery over their own bodies and that they
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are separate from others. In the third stage, they learn control over their environments.
In the fourth stage, individuals learn to be productive members of a group (usually at
school in Western societies). In the fifth stage, individuals develop a personal identity
that is, at least to some extent, a conscious choice and that may not be the “identity” that
the parents would have chosen. In the sixth stage, individuals develop the ability to
interact effectively in close personal relationships. In the seventh stage, individuals learn
to contribute to society – often via work and rearing children. In the last stage,
individuals reflect on what they have accomplished and feel good about their
contributions, or early in the stage, they negatively evaluate their social contributions and
make adjustments so they can feel good about their contributions.
Kohlberg
Building on the work of Piaget, Kohlberg asserted that individuals develop their moral
thinking, a sense of justice, through a series of six stages. The stages can be group in
pairs into each of three levels – pre-conventional, conventional, and post-conventional.
The stages and the basis for determining “what is right” are listed below.
Stage 1 – Obedience and punishment orientation (avoiding punishment)
Stage 2 – Self-interest orientation (meeting one’s personal desires)
Stage 3 – Social conformity (fitting into a peer group)
Stage 4 – Social order orientation (a law-and-order mentality)
Stage 5 – Social contract (the level of the US constitution – balancing majority will
against rights of individuals)
Stage 6 – Universal principles (based in principles that transcend individuals and
cultures)
Fowler
Fowler’s work examines the development of faith over the life span. His ideas are
summarized below.
Stage 0 – Birth to three years – Primal or undifferentiated faith. Either the environment
is safe or it is not.
Stage 1 – Ages three to seven – Intuitive-projective faith. Connected primarily to the
unconscious.
Stage 2 – Ages seven to adolescence – Mythic-literal faith. Faith is built on ideas of
fairness, and deities are anthropomorphic.
Stage 3 – Adolescence – Synthetic-conventional faith. Faith is built on conformity to a
norm.
Stage 4 – Mid-twenties to late thirties – Individuative-reflective faith. Individuals work
out and take responsibility for their beliefs.
Stage 5 – Midlife – Conjunctive faith. Acknowledges and accepts paradox and
contradictions.
Stage 6 – Senior years – Universalizing faith. Accepts a variety of views as not being
different.
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Maslow
Maslow’s hierarchy of needs is not a stage theory in that he does not focus on
development but on needs. According to Maslow, lower order needs must be met before
higher order needs can be addresses. The most basic needs are physiological needs, such
as for food and water. The next needs relate to safety. The third level relates to lovingbelonging. These three levels are generally considered lower-order needs. The higherorder needs include the need for esteem and the need for self-actualization. Lower order
needs arise when something is missing and are sometimes called “D-needs” or
deprivation needs. The higher-order needs don’t result from a lack of something but
from a need for growth and are sometimes called “B-needs” or being needs.
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