Relationships
Stage 4
• Stage 1: Womb – 12 months
– Motor Functions and security
• Stage 2: 6 months – 2 years old
– Mobility and emotion
• Stage 3: 18 months – 4 years old
– Will and action
• Stage 4: 4 – 7 years old
– Social Identity
• Stage 5: 7 – 12 years old
– Social contract
• Stage 6: Adolescence
– Reconstitution
• Stage 7: Early Adulthood and Beyond
– Self-knowledge
Stage 4: 4 – 7 years
 Behaviours are consciously adapted to gain or express
love
 Ego development forms the foundation for relationship
with others
 Family provide the first model for relationship
formation
 Internalised family relationships are used for
interaction with peers
 Self-esteem is greatly influenced by these relationships
Stage 4: Relationships
 Conceptual thinking and logic, as a product of the
generation of cognitive maps, allows a perception
of the world as a complex set of relationships


Why does fire burn?
Why is he wearing a hat and you aren’t?
 Self-acceptance allows for the acceptance of
others

More likely with a secure group
Stage 4: Social Identity
 Social identity (“Persona” – mask) created to interact
with others

The part of ourselves that the ego allows to rise above the
surface, subsequent to consequence (response) control
 Self-concept initially based on how we are treated
 Whether we are admired or criticised, identification of self
through relationships
 Maturation includes perception of service to others
 Self-acceptance expands beyond self-centred needs and
embraces external awareness
Stage 4: Comparative models
 Erikson: initiative vs guilt
  resolution brings direction and purpose
 Jung: Persona corresponds with archetypal
structures – the helper, the pleaser, the entertainer,
the lost child, the hero, “good girl/bad girl”, rebel,
angel, etc.
Stage 4: Comparative models
 Freud: Phallic Stage

Primary erogenous zone is the genitals

Oedipus complex: Natural love of parent transfers
libidal energy from anal region to genitals. Aggression
arises towards father, sexual competition who removed
females’ penis (castration anxiety). Life sexual role
develops from identification with father in attempt to
possess mother
Electra complex: Realisation of no penis (penis envy –
blaming mother for penis removal), attempted
possession of father, always remain slightly fixated at
this stage

 Phallic character: reckless, narcissistic, afraid of close
love, possible root cause of homosexuality
Stage 4: Trauma
 Trauma may result in judgemental attitude toward
sexual orientation
 May be caused by parental dysfunction, racial
strife, cultural prejudice, war

Broken will, inability to communicate – lack of a voice
 Feelings of rejection and loss (relationship –
advanced external connectivity)
 Feelings of love, the right to love and be loved
Bowlby’s Attachment Theory
• John Bowlby (1969): Attachment Theory
• Early emotional communication between
children and their significant attachment figures
• Directly impacts mental health in later life
Internal working models
• Internal working models formed through the
shared level of predictability (trust) of infant’s
display of signals and parental response
▫ i.e. Treatment should predictably influence the child’s
development
▫ Psychodynamic theory including evolutionary and
cybernetic theories
▫ Potentially including behavioural genetics
Attachment Paradigm
• Behaviour patterns in early life will be directly
comparable to behaviour patterns in later life
▫ Relationships
▫ Mental Health
▫ Social/Cognitive challenges
• Assumptions:
▫ Blank-slate (behaviourist) philosophy
▫ Attachment as evolutionary advantage (survival mechanism)
▫ Assumes all children seek close proximity with their attachment
figures
▫ Assumes parent’s role is to orient towards, to comfort, and overall
for the survival of the child
Ainsworth’s Strange Situation
• Ainsworth (1973) : Strange Situation Paradigm
• Assesses security of infant-adult attachment by
exposing infants to increasing amounts of stress
to observe their organisation of attachment
behaviours
▫
▫
▫
▫
Secure
Insecure-avoidant
Anxious-ambivalent
Disorganised (Main & Solomon, 1990)
• Predictive of behaviour and mental health in
later life
Adult Attachment Interview (AAI)
• Berkeley AAI: Semi-structured interview about
childhood attachment relationships and the
meaning that the individual currently gives to
past experiences in these relationships
▫
▫
▫
▫
Secure
Dismissing
Preoccupied
Disorganised
Secure group
• Uses one or a few attachment figures as a secure base
from which to explore novel environments
• Confident of those persons’ availability, responsiveness
and competence to serve as a secure base
• Learned rules of social interaction from the caregiver
• Learned reciprocity and predictability
• Child sees caregiver as responsive and accessible which
allows for competent social interaction with other people
Secure group
• Predicts superior problem-solving abilities
• Increased persistence and enthusiasm in
cognitively challenging situations
• Engage in more positive peer interactions
• Desire to reengage in interaction and use
proponent signals to attract comfort and assistance
Secure group
• More coherent, elaborate and emotionally open
at age 6
• Represent themselves more positively in
interviews
• More willing to accept less-than-perfect aspects
of self
Insecure-avoidant
• Working model of the caregiver as rejecting or
inconsistent
• Child later relies on hostile, aggressive, hesitant
or impulsive interaction styles
• Less likely to engage in exploratory behaviour in
their attempts to maintain attachments to
rejecting or inconsistent parents
 may not express needs for closeness
Insecure-avoidant
• Leads to social isolation including family
disengagement
• Less socially desirable parenting –
overstimulation, rejection or coldness
• Increased likelihood of depression (separation
anxiety disorders)
Anxious-ambivalent
• Employment of hyperactivation strategies,
hypervigilent for threat and rejection cues due to
unpredictable responses of caregivers
• Similar outcomes as insecure-avoidant
• Likely to play down relationships or the
importance of love
• Less likely to develop stable relationships etc
Disorganised subtype
• Contradictory behaviour patterns
• Chaotic, conflicted behaviour
• Apparent incapability of applying any consistent
attachment strategy
• Parents may be frightening and do little to ease
distress in child
Disorganised subtype
• May be a result of severe failures in early
attachment, abuse and neglect
• May not receive any fulfilment of comfort even
when best attempts are made to meet their
needs (learned helplessness)
• Associated with high levels of antisocial and
externalised behaviour problems
• Impairment in stress and coping-related
functions, leading to maladaptive mental health
Disorganised subtype
• Associated with psychopathology
▫ Personality disorders as extensions of attachment
disruptions
▫  splitting: child internalises negative views in
order to maintain a false security attachment to a
rejecting or abusive parent
▫  leads to negative self-image in later life
• Contradictory evidence
• Does not offer framework for
objective analysis of internal
working models
• Vast evidence supporting
• Continuity of behaviour
predictability of adult
patterns into adulthood can
behaviour
change easily (50% of secure
infants changed to insecure
• Neural corollaries built in
styles after experiencing a
childhood correspond with negative life event)
attachment behaviours
• Blank-slate philosophy does
not account for genetic
• Cognitive evidence of
evidence (twin studies etc)…
internal working models
yet.
• Lack of cross-cultural studies
and varied sampling
Love
• Harlow (1958)
• Experimental Monkey mothers – groups with
surrogates made from cloth or wire, and
presented with fearful or stimulating objects
▫ Basic need in infant monkeys for close contact
with something soft and comforting
▫ Babies seek out their mothers when afraid
▫ Attachment persists after periods of seperation
Harlow (1958)
• Fulfilling of biological needs (hunger and thirst)
was of almost no importance in the money’s
choice of mother.
▫ Contact Comfort
• Infants with wire mother did not digest the milk
as well and got diarrhea
• Criticism:
▫ Attachment is slower in humans
▫ Unethical animal experiments
Sexuality
In Mental Illness
Sex
 Genotypic (XX female, XY male), and
 Phenotypic categories (physical and behavioural level)
 Kelly (1991) reported that 1 in 20,000 males have two X
chromosomes and no Y
 and 1 in 20,000 females have XY chromosomes
Sex
 mosaic genetics can exist whereby a person has some XX and
some XY genes




male genotype) with androgen sensitivity syndrome (female
phenotype), XX individuals with congenital adrenal hyperplasia,
manifesting male genetalia
Intersex, phenotypic irregularities (including those born with
genetalia deemed ambiguous, such as having hypertrophied
clitorises, micropenises and interabdominal testes), as distinct from
male and female biological categories
between 1 and 2 per 1,000 livebirths receive genital reassignment
surgery, and 1 in every 1500-2000 people are born with ambiguous
genitalia such that sex differentiation specialists are needed
true hermaphrodites: develop ovotestes, containing both ovarian
and testicular tissue
Gender
 Gender: the sex role to which a person is assigned in a
wider social context
 Gender Identity Disorder: involving individual persistent discomfort with
assigned sex or a sense of inappropriateness in the gender role of that sex
 American law mandates the presence of two sexes which must be labelled at
birth, and that label may not be changed
 so medical categorisation of intersex may be psychologically traumatic
 Transsexuality: outside of the biological category of intersex
 1 in 30,000 adult males and 1 in 100,000 adult females seek sex reassignment
surgery
 1 in 11,900 males and 1 in 30,400 females in Holland as being transsexual
 Cross-sex hormones, mastectomy, neophallus surgery and other interventions
offer valuable treatment
 little evidence shows that psychological treatment of gender identity disorder
and transsexualism is effective (a comparable disorder but in adults)
Orientation
 Orientation: a person’s entire set of fantasies, romantic emotion




and sexual inclinations
“the sex of the erotic/love/affectional partners a person prefers”
(Diamant & McAnulty, 1995)
externalised sexual behaviour is separate, although related, to sex
and gender identity
degree of measurability on a classification scale between
Heterosexual and Homosexual
Behavioural manifestations of desires for specific behaviours and
fetishes are often forced into non-mainstream, underground
culture, as seen in the vast arrays of specific pornographies available
on the internet and elsewhere
Arousal
 Integration of psychological and physiological influences,
after which psychology guides the response in behaviour
 Emotions, thoughts, attitudes and beliefs are all integrated
in orientation, and arousal likewise incorporates these
processes, often with an aim of resolution, be it orgasm or
spiritual unification
 Some evidence shows that women are more likely to engage
in sexual behaviours without arousal (Geer & Broussard,
1990), showing emphasis of social factors in determination
of behaviour.
Arousal
 Activation of the gonads through stimulation of the
anterior pituitary gland by the hypothalamic region of
the forebrain, which then releases the gonadotropic
hormone, follicle-stimulating hormone and
luteinising hormone
 Estrogen is the predominate gonadal hormone of the
female, which, with luteinising hormones and
progesterone, stimulate ovulation
 Testosterone is more linked with sexual arousal and
behaviour, seen more dominantly in the male gamete
production by the luteinising hormone
• Anxious-ambivalent and avoidant children are more likely to have
low self esteem and poor relationship skills
• Insecure parent-child relationship have been significantly
associated with coercive sexual behaviours
• Anxious-ambivalent relations show a likelihood of high
responsivity to any adult attention, thus being more susceptible to
child abuse, which may later influence relationship and sexual
development
•Physiological arousal patterns act as reinforcers
•A person can pair sexual stimulation or arousal with any possible
neutral or unconditioned stimulus
•Initial sexual experiences may have a disproportionate impact on
long-term sexual arousal, especially on association with subsequent
sexual experience, such as masturbation
•positive and negative reinforcement of masturbation,
• whereby a child may masturbate for pleasure, or as a coping
strategy to elude negative situations
• power and control,
• humiliation and expression of aggression
Money (1988) also claimed a parallel of sexuality with language
development
Roche & Barnes (1998) offer a conditioning theory whereby
behavioural conditioning may occur through a linguistic process
of semantic overlapping
pyrolangia, sexual gratification from lighting fires, may be seen
as an outcome from connections between sexual arousal and
words like “hot”, “burning” and “explosive”
Sexual disorders
 mental illnesses involving apparent violations of social norms of
sexuality
 orientation to include objects, concepts, or in some cases, elements
 Paraphilias: eight major categories and seven subtypes
 include attraction to unusual objects or activities, sometimes
involving sexually deviant behaviours involving harm
 Voyeurism, for example, which involves the intense and recurrent
desire for sexual gratification through watching others undress or
have sex
 Sadist needs to inflict physical suffering or humiliation in order to
achieve sexual gratification
 only diagnosed if present without another axis-I disorder
 observation, participation or fantasy must be necessary for the
individual to achieve sexual arousal and gratification
 a diagnosis under the DSM-IV must be inclusive of subjective
distress or impairments in normal functioning
Pedophilia
 Orientations are directed towards children under 13 years of age
 Children deemed too young to understand the requirements for
informed consent
 What is sex, possibilities of psychological and social dilemmas
 Any pedophile who does act on their fantasies then becomes a
child molester and, if legally convicted of this crime, a sex
offender
 Studies of pedophiles show less than 15% of them to be
classifiable as having a psychopathology under the Minnesota
Multiphasic Personality Inventory (Erickson, Luxenberg, Walbek
& Seely, 1987).
 Only a very small number of pedophiles are actually child
molesters, and many child molesters are not, in fact, pedophiles
(Diamont & McAnulty, 1995).
 Inaccurate beliefs, such as a pedophile thinking that a child can
consent to and enjoy sex, may be a vital point for therapeutic
modulation
Childhood Sexual Abuse


13.5% of women, 2.5% of men
About half of children exposed to CSA will develop
symptoms such as depression, low self-esteem,
conduct disorder or anxiety disorders like PTSD.
 Almost
half do not appear to experience
adverse short-term effects
Childhood Sexual Abuse



Can lead to dissociative identity disorder, eating
disorders, borderline personality disorder, sexual
dysfunction and substance abuse
Negative reactions increase when a perpetrator
threatens a child, the child blames his/herself, or the
family is unsupportive.
More pronounced when CSA involves sexual
intercourse
Childhood Sexual Abuse

Psychological Factors
 Betrayal:
Molester is usually not a stranger, which tears
the allegiance of the child between the abuser and the
fear, revulsion and knowledge that it is wrong
 Power of authority figures
 Self-blame
Childhood Sexual Abuse

Problems with Research
 Sampling
Bias:
 Over-estimation
of role of abuse in treatment,
 Under-estimation in research with college students
 Repressed
memories cannot always be accepted as real
when recovered during therapy
 Many courts now refuse to allow testimony based on
recovered memories
Childhood Sexual Abuse
Genetic and Environmental Risks:

Internal family incest often includes alcohol
addiction and other psychopathology, thus it is
difficult to isolate the effects of abuse
Prevention
Teach children to recognise inappropriate adult
behaviour.



May result in altered manifested behaviour of child
May empower the child to tell parents/teachers if
they have been abused
Dealing with the Problem
 Great
skill required in questioning children to avoid
biasing
 Parents often overwhelmed with shame, guilt, fear or
anger
 Much less likely for internal family incest to be reported
 When states within the USA first passed legislation
requiring healthcare professionals and teachers to
report suspected child abuse, confirmed cases rose
from 50 to 500%