THEORIES, MODELS
AND APPROACHES
Amy Burgess MS. OTR/L
Theories Description and overview
Basis for our OT models and Frames of Reference(FOR).
Integral part of clinical reasoning and EBP.
Many different theories to explain human behavior as we are complex
Describe, organize, explain and predict aspects of human behavior, mental health or mental disorders.
Often do not directly describe treatment. This is what OT models and FOR do.
No theory explains everything or is the absolute truth
Validity is always questioned, researched, and revised as needed.
Theories that guide psychosocial aspects of practice
Developmental Theories
Behavioral and Social Behavior Theories
Cognitive Behavioral Theories
Humanistic Theories
Biological/ Neuroscience Theories
Object Relations, Psychoanalytic & Psychodynamic Theories
View of people’s behavior and development
–Growth occurs in hierarchical and sequential process
Developmental
Theories
–Mature through a series of stages
–Developmental tasks/skills are mastered at each stage
–Mastered skills are foundation for next stage
Erickson, Piaget,
etc.
View of mental health disorders or problems
–Problems occur when stage skills are not mastered
–Can be interrupted by disease, emotion/social issues or deprivation.
–Developmental lag may occur
Developmental Continued
Central Concepts or Ideas:
–Erickson’s Psychosocial stages (interaction of self with society)
–
Trust vs. Mistrust
–
Autonomy vs. Shame and Doubt
–
Initiative vs. Guilt
–
Industry vs. Inferiority
–
Identity vs. Role Confusion
–
Intimacy vs. Isolation
–
Generativity vs. Stagnation
–
Ego Integrity vs. Despair
APPROACH TO TREATMENT
Expose person to situations that provide opportunity for
growth in the deficit stage of development. (see p. 29)
Developmental
Continues
OT
Compare expected developmental skills/stage to actual behavior as
part of assessment
Guides direction for treatment
Can be time consuming treatment approach
BEHAVIORAL
LEARNING
THEORIES
Pavlov and Skinner
View of Behavior & Development
Behaviors include abilities, interactions, actions
Everything is learned thru reinforcement
Behaviors that have pleasurable results tend to be repeated
Behavioral
Those with negative or unpleasant consequences tend to not be repeated
Through life experience a person develops a repertoire of behaviors that “work” for
them
Learning
Theories
Pavlov and Skinner
View of Mental Health Disorders & Problems
Wrong behaviors are learned or reinforced by environment
Adaptive or healthy behavior was not reinforced/rewarded
Approach to Treatment
Analyze behavior that is to be
changed
Use reinforcement to change
behavior
Key concepts
Antecedent- What happens before a non-desired behavior is seen
Terminal Behavior - “normal” or adaptive behavior that is wanted
Reinforcement- provision of that which is pleasurable or valued by the client
Reinforcement Schedule
–Continuous- every time the terminal behavior is performed
–Intermittant – use once behavior is established, can be powerful
Planned ignoring- to provide no reinforcement of a behavior
Shaping – reinforcing successive approximations of desired behavior
Chaining- teaching multistep behavior 1 step at a time (forward or backward)
Used as part of treatment in many settings.
OT
Frequently used in work with children
Historically used in psychiatric settings
SOCIAL LEARNING
THEORY
Bandura
View of people and learning
Behavior is not just learned thru reinforcement and shaping, etc. but also vicariously or thru observation
People learn by watching others and what is reinforced or works for those models.
If another person’s behavior appears to be reinforced/rewarded it will tend to be imitated. It may then be reinforced
after being imitated.
We learn from our models
People’s cognitive abilities play a big role in learning.
–What is thought about what is observed?
–Observations are committed to memory for use later.
VIEW OF MENTAL ILLNESS
Behaviors that were maladaptive were observed and then
learned. Also reinforced.
More social
learning theory
Healthy adaptive behaviors were not modeled or reinforced.
KEY CONCEPTS AND OT
Role modeling works
OT’s rely heavily on this theory when treating in groups.
Why?
COGNITIVEBEHAVIORAL
THEORIES (CBT)
Ie. Ellis, Beck
All behavior is based on what we think and believe
View of people
Cognition determines how we act (behavior)
The actual events around us are neutral till we add thought /meaning
and their
behavior
What we think and believe also impacts our emotions.
Many thoughts are automatic and may habitual or a set pattern based
on life experience
Some automatic thoughts and beliefs are maladaptive or not
View of mental
helpful
health issues
maladaptive behaviors
and mental
illness
These types of thoughts can lead to unsuccessful or
Unhelpful and automatic thought patterns can become a
pattern that is not recognized by the person despite the
negative impact on their life.
These thoughts are often seen as “the truth”
Unhelpful/malaptive thoughts > negative feelings>
maladaptive/less helpful behaviors
TREATMENT
Identifying the automatic unhelpful or negative thoughts
Learning to modify or challenge those automatic thoughts (distorted thinking)
Idnetifying associates behaviors and evaluating their effectiveness including the
consequences
Homework is typical- cognitive rehearsal, activity schedules and self monitoring techniques
More Cognitive
Behavioral
OT
This theory is widely used in OT as it is well researched and
supported as effective.
Anger management (Taylor) and Dialectical Behavioral Therapy (DBT)
by Marsha Linehan as two specific treatment approaches OT’s use.
OBJECTS
RELATIONS
THEORIES
Aka – Psychodynamic or
psychoanalytic theories
There are many different types of these theories the
majority of which arise from Sigmund Freud.
Description
OT did use these theories extensively years ago but not
currently.
These theories provide some foundational concepts still
accepted as “true” today
FOCUS IS ON EMOTIONAL FUNCTIONING
AND PERSONALITY DEVELOPMENT
THE WAY WE RELATE TO OBJECTS
(HUMAN AND NONHUMAN) ARE
LIFE-LONG PATTERNS THAT ARE
ESTABLISHED PRIMARILY THROUGH
CHILDHOOD EXPERIENCES
DRIVES ARE INNATE AND SERVE TO
SATISFY NEEDS (SELF PRESERVATION,
EXPLORATION, PLEASURE, HUNGER, ETC)
CHILDREN USE OBJECTS TO SATISFY
NEEDS/DRIVES SUCH AS THIRST OR
HUNGER. THIS IS THE BEGINNING OF
THE LIFE-LONG PATTERNS OF RELATING
TO OBJECTS.
Assertions
about people
More about the view of people
All behavior is a product of forces beyond immediate awareness and control of the individual (
Unconscious psychological forces/processes)
These processes are summarized as the Id, the Superego and the Ego
Interactions between these produces behaviors thoughts and emotions.
The Id, Superego and Ego are developed at least partially thru interaction with the environment.
ID
functions to satisfy drives, needs and urges.
Superego
Develops by learning to control drives and urges (Id)
Often includes social rules, norms, and the should and should nots of upbringing
Ego
Includes cognition, reality testing and defense mechanisms.
Resolves conflict s between the Id, and Superego
More about Ed, Superego and Ego
View of Mental Health Problems and Mental Disorders
Breakdown of Ego functioning is viewed as Mental Illness
When the Ego can’t resolve unconscious conflicts between the Id and the Superego anxiety
increases.
As anxiety increases and becomes too much the ego is less and less able to function
Strengthening or restoring Ego functioning is goal.
This is done by bringing unconscious conflicts to conscious
Treatment
awareness. (free association, dream analysis, transference,
expressive media analysis)
High levels of training and expertise are required. Treatment
takes a long time if purely psychoanalytic.
OT
OT’s use some of these concepts to understand their patients but do not
use this theory extensively.
OT generally accepts that people are influenced by unconscious processes
outside of their awareness.
Identifying a defense mechanisms use by a client informs us that the
person is uncomfortable, anxious or experiencing a conflict. This
knowledge allows us to alter are approach to this client.
Please review page 24 regarding defense mechanisms
NEUROSCIENTIFIC AND
BIOLOGICAL THEORIES
There are many hypotheses and theories within this general group.
Behavior is solely related to physiological mechanisms.
Genetics
Assertions
Neuroanatomy
Biochemical
Infections- bacterial and viral
Hormonal
View of Mental
Health
disorders and
treatment
Mental disorders and abnormal behavior is caused by malfunctioning
within the individual often the brain
Treatment directly targets the psychopathology of the brain/ body
primarily using medications but also ECT, biofeedback and others.
OT’s role from this perspective
Monitor symptoms and side effects to provide MD more data
Assist pts. in coping with their feelings about tx. and the side effects
Support/develop pt’s health management skills
Provide and educate regarding CNS calming and stimulating activities for use by the
patient.
HUMANISTIC OR
CLIENT
CENTERED
THEORIES
Carl Rogers, Samual
Tuke, etc.
Emphasizes the value, worth and potential of people.
Looks beyond the diagnosis and behaviors to focus on the
View of people
person.
All persons have the potential to direct their own growth
no matter how sick they are.
The integrity of the therapist patient relationship is crucial
Illness occurs when a person is not aware of their own
Mental Health
feelings and choices
A non-directive approach that focuses on creating a safe,
problems and
supportive environment so the patient can realize their own
potential, feelings, and choices
treatment
Pt’s awareness if increased through relationship with the
therapist.
Other key concepts
Congruence
Therapist is authentic. Outer behavior matches therapist inner experience.
Unconditional Positive Regard
Genuine caring for the pt. Accepting the patient as they are. Does not mean approval of all behavior.
Accurate Empathy
Therapist's ability o understand sensitively and accurately [but not sympathetically] the client’s experience
and feelings in the here-and-now.
OT
These theories are foundation for client centered care.
Many of the communication techniques used in these theories are used
in OT
The qualities of the therapist patient relationship described are
attributes OT strive for in our therapeutic relationships.
Other Models and Approaches
Influencing OT Practice
Psychiatric Rehabilitation and Psychosocial Rehabilitation
Psychoeducation
Recovery Model
PSYCHIATRIC AND
PSYCHOSOCIAL
REHABILITATION
W. Anthony and others