Psychological Approaches in The Care Setting
Rebecca Evans Thursday 11th February
Psychological Perspectives in Health and Social Care
Assignment 1: Psychological Approaches in
The Care Setting
- Understand psychological approaches to study.
- Be able to apply psychological approaches to Health and Social Care.
As part of this assignment, I aim to describe the application of behaviourist perspectives
in health and social care. I will then go on to describe the application of psychodynamic
perspectives in health and social care.
Finally, I will analyse the contribution of different psychological perspectives to the
understanding and management of challenging behaviour.
- Describe the principles of Operant Conditioning in health and social care and use these principles to explain why a child has persistent tantrums.
This type of learning was first developed by Burrhus Frederic Skinner, an American
Psychologist who worked mainly with rats and pigeons discovering main key principles of
learning new behaviours using the now famous “Skinner box”, he was able to condition the
animal to adapt to behaviour patterns.
The box contained a lever, which when pressed produced a food pellet into the box.
Initially, when the rat for example, was released in the box, it would run around sniffing
various objects until it accidently presses the lever to release the food pellet.
Gradually over a period of time, repeats this action and comes to learn that pressing the
lever will reward him with food. This is known as “reinforcing behaviour” and increases the
chance of the behaviour continuing.
There are two forms of reinforcing, positive and negative:-
- Positive Reinforcement – Occurs when as the result of following a certain behaviour
pattern, a reward is given.
- Negative Reinforcement – Occurs when behaviour patterns result in removing
For example:- to investigate negative reinforcement, Skinner installed a small electric
current onto the floor of the skinner box, by pressing the lever, the rat came to learn that the
current would be deactivated, thus proving negative reinforcement.
Relating to the Operant Conditioning theory to a human’s perspective, we will look at a
child with persistent tantrums.
A child’s behaviour is dictated primarily by the actions and teachings of their parents.
Children as emotions develop psychologically seek attention. If parents are not strong
willed and abler to stand firm, they will often give treats in an attempt to stop the tantrums
Over a short period of time however, this proves a positive reinforcement of the child’s
behaviour and they quickly learn that if they throw a tantrum they will be offered with a treat.
In comparison, negative reinforcement, can be seen by parents who teach their children that
tantrums are wrong, they are not rewarded with treats, but after a while come to realise that
the increased emotion, anxiety and tears relating to the emotional state brought on by a
tantrum does not happen when their behaviour improves.
- Describe the principles of Classical Conditioning and use these principles to explain why some patients are petrified of having injections.
This theory of learning was developed by Russian physiologist Ivan Pavlov. He was
working with dogs investing their digestive systems. Monitors attached to their stomachs and
mouths measured the rate at which saliva was produced.
One day he noted that a dog has began to salivate as the assistant entered the room with a
bowl of food and before it had tasted the food. Before this time, salivation was thought to be
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a reflexive response of food touching the tongue.
Pavlov thought the dog was salivating because it had learnt to associate the assistant with
food and as a result he developed the following theory.
Food automatically led to the response of salivation and as salivation is an automatic, not
learnt response, he called this an “Unconditional response” and the food, an “Unconditional
stimulus” as it is naturally provoked a response from the dog.
Pavlov then presented food as the time as ringing a bell to see if the dog would come to
associate the bell with food. The bell was termed a “Conditional stimulus” and over several
trials, the dog came to learn that the bell was associated with food.
Eventually, it began to salivate when only the bell had rung, by no food presented, it had
learnt that “conditioned response” of salivation to the conditioned stimulus of the ringing
Linking an explanation as to why some patients are petrified of having injections with
Pavlov’s theory of Classical Conditioning is by an unconditioned response to the sight of a
needle is a natural occurring event.
Unconditioned stimulus can be likened to the pain associated with the injection and a
conditioned stimulus can be likened to the affect the injection gives, for example:- relief of
pain, or nausea.
Gradually, as a result the patients develop a conditioned response learning that the pain of
the injection is followed by the relief of underlying symptoms and comes to accept the need
for the injection to treat such symptoms.
- Describe the application of Psychodynamic Perspectives in health and social care.
The psychodynamic approach to healthcare is associated with the Austrian psychologist,
“Sigmund Freud, who developed the theory of psychodynamic physiology and the treatment
known as psychoanalysis” (Stretch, B, 2007, Pg382).
Freud made aware of the idea that we are not always able to identify with all aspects of
our being. He suggests that awareness in our conscious mind is tiny in comparison with those
memories, feelings and past experiences locked away in a part of our mind he terms
Freud likened our conscious mind to that of a tip of an ice-berg with only a small part
available to awareness. The rest submerged in the unconscious part. He called the mind the
“Psyche” and divided it into three parts, the ID (the part we are born with consisting of all
raw emotions and our ability to feel. The ID operates on what he called the “pleasure
principle” wanting what it wants, when it wants it.
The superego (an aspect of the mind likened to a conscious) contains the values of rights
and wrongs we have been taught to believe in and also contains an image of our ideal self.
The ego is the part of the mind which develops around the age of three years old and its
function is to balance the demands of the ID and the superego. It is the most rational part of
the mind and seeks to do what is most helpful.
Another psychologist who agreed with many of Freud’s theories was Erik Erikson. Like
Freud, he believed that our behaviour developed through a series of conflicts.
However, he thought that our nature developed as a result of reacting to conflict
throughout our lives. Erikson in contrast to Freud believed that too much emphasis was put
on desire and individual needs and not enough on the need to be accepted by society and lead
a meaningful life.
Erikson believed that we moved through a “series of psychosocial crises” (Stretch, B,
2007, Pg385), with a different emphasis at each stage. For example; at
Stage 1 (age 0-1) - the infant is helpless and relies on others to provide its health need
both physically and emotionally. If the parent or carer meets the child’s needs in a
satisfactory way, the child learns a sense of trust. It develops self-confidence and believes the
world, a dependable an predictable place. If by contrast however, the carer is unresponsive,
lacks affection (maybe leaving the child to cry for long periods) the child will develop a basic
miss-trust of others.
In later years, personality development will show fear and suspicion and leave the child
withdrawn and unable to interact with others.
Stage 2 (age 1-3) – The child is now more mobile and beginning to sense a separation
from their parents, becoming independent and do things for themselves. Autonomy is
important at this stage allowing the child to experience things alone.
Supported, not criticised by parents they learn by failure or accidents etc, to be come
competent and develop feelings of self belief in comparison however, a child who is under
total control of parents and are often criticised will fail frequently and will feel shame.
Such children will feel powerless and may either become introverted and reject others or
become attention seeking and show bad social behaviour.
Stage 3 (age 3-6) – At this stage of a child’s development there is rapid social, physical
and intellectual development. Through interaction with others, new skills are developed and
an increased self-confidence is formed.
By welcoming a child’s curiosity about life to explore and learn new skills through play
and life experiences together with new physical new initiative is developed.
However, negativity at this stage such as parents ignoring questions about the world in
which they live and prevention of play and physical activities, will result in a reduction in the child’s curiosity about the world in which they live and confidence, competence and initiative will reduce, leaving the child with feelings of lack of self worth and guilt.
Stage 4 (age 6-12) – At this stage children become concerned with how things are made and how they work.
Teachers, parents and siblings all play a part at this stage of development. Children begin to compare themselves to their peers to assess their own achievements and this is essential in the development of self-worth.
A sense of “industry” is developed with the individual encouraged to undertake tasks of a realistic nature where success is likely this encourages high self esteem and a sense of competence.
However “Inferiority” results if the child is pushed into doing tasks they are not ready to do. A lack of guidance and encouragement, coupled with criticism for failure will lead the child with a low self esteem and overall negative self concept.
Stage 5 (ages 12-18) – Erikson likened the psychological turmoil of teenage years to “storm and stress” where ones self concept is affected by several factors:-
- Physical changes to the body causing an affected body image and which may have an effect on the individuals sense of self belief.
- Intellectual development which allows the individual to be aware of current levels of intelligence and the potential of what careers may lie ahead.
- Emotional development and the increasing independence from their family.
- Making decisions about personal behaviour, values and maybe the beginning of sexual activity.
The goal of the individual at this time is to secure a sense of self belief or “ego identity”
a consistent way in which the individual sees them.
- Over time this self worth will become consistent and not change.
- They will develop a feeling of “mutuality” – behaviour is agreeable to both society and also to the individual peer groups are important at this time enabling the individuals to become an integral part of society.
Being unable to adapt during this “storm and stress period” will leave the individual
unable to develop a sense of role of belonging in the community. They will find it hard to
work within a team and will not have set values to live to. As a result, they may feel unable
to live up to life’s demands upon them. They may develop a negative identity and thus
become one of life’s “loners” or at worse feel they cannot cope with life and choose to end it.
- Describe the value of the Humanistic approach to health and social care.
The humanistic approach to health care is understanding the human experience from the
perspective of the individual. It focuses on free will and individual choices. Psychologists
Carl Rogers and Abraham Maslow both identified with this approach.
Maslow, an American psychologist believed we are all seeking to become the best we
He delivered a theory called “Hierarchy of Needs” citing basic needs to be met before
fulfilment or “Self-Actualisation” as Maslow calls it can be achieved.
Carl Rogers on the other hand was interested with aspects of self-concept the way we see
In early years, this comes from what we are told by others “you are very pretty…How
kind you are…” etc. As we grow older our ability to think about ourselves develops and self
judgements are made... My work colleagues didn’t ask me out to lunch – maybe they don’t
like me – I did really well at work today – I am good at my job.
Self-esteem is slightly different and refers to how valuable we feel. A person who is
loved and supported will have a high esteem and feel important and valued.
In contrast, an individual with low esteem may feel of no value to others and feel
Humanistic psychology is used by Carl Rogers in the “unconditional positive regard” of
the counsellor to help individuals develop a more positive self belief. It refers to the idea that
the counsellor supports and understands feelings without judgement and that in time the
client comes to accept who they are an come to see themselves in a better and thus improved
One important feature of this approach is helping others develop empathy – listening to
the other person and become in tune with their emotions and respect the individual for who
they are. The more we respect the individual, the closer we can get to helping them.
By observing their body language we can learn to assess how they are feeling. Someone
anxious may show huge scared eyes and be sweaty and pale. Or they may be so scared they
appear indifferent to the observer.
By putting yourself in their situation and relating to an event in life that caused you to
feel this way can then help you identify even more with how they feel – the agony, the fear
and thus help the individual.
Task 5 & 6
- Analyse Joe’s behaviour in terms of each of the following: Behaviourist, Psychodynamic and Humanistic approaches in Psychology.
- Analyse how you think the three approaches stated above could help to manage Joes’ challenging behaviour.
- Behaviourist Approach to Joe’s Behaviour
The Behaviourist approach to Health and Social care seeks to understand behaviour that has been previously learnt, as a result of Classical Conditioning or Operant Conditioning.
In Joe’s case, it is apparent that his bad behaviour is proving to be a problem to all around him, to the extent that the home owner is now considering asking Joe to leave.
However, his demanding and aggressive attitude to staff and clients alike have up to this point been expected and indeed “indulged” by nursing staff and clients.
This can be likened to Ivan Pavlov’s theory of Classical Conditioning and the “unconditional response”. His behaviour up to this point has automatically given a relaxed response from staff and clients alike, allowing Joe to continue in the same way.
This behaviour can also be linked to the theories of Burrhus Fredric Skinner, an American psychologist who found that positive reinforcement happens as a result of “when consequence following a particular experienced is desirable” (Stretch, B, 2007, Pg375).
In Joe’s case, he has found that his inappropriate behaviour has led to him achieving what he wants. Clients and staff letting him get away with such poor behaviour up until this point has encouraged him to continue and indeed increase his demands and poor behaviour.
- Psychodynamic Approach to Joe’s Behaviour
The psychodynamic approach to Health and Social care can be related to Joe’s behaviour in the following way.
Freud links three parts to the unconscious mind he termed “the psyche”. The “Id” is the part of the psyche that we are born with and contains all the raw emotions we feel. It focuses on what we want, and the various instincts needed to achieve it. It tells us “I want it now”. In Joe’s case it can be related to his bad behaviour. Aggression, demanding behaviour and being argumentative are all traits of the Id. Hiding the television remote and his feelings that others should be discussing and not watching what he feels are “trashy” television programmes all point to his Id being dominant in his psyche.
Joe’s superego, another part of the conscious mind is likened to actual conscience and values of right and wrong. In Joe’s case, this is not effective as he feels that he is right and his wishes should be met at the detriment of others.
The third and final part of the psyche, the ego, tries to balance the demands of the Id and the superego. However, again Joe’s dominant Id comes to the fore. He is impulsive, careless of others’ feelings and does not think through the consequences of his actions.
Classically, he is inclined to aggression to people of dominant Id.
- Humanistic Approach to Joe’s Behaviour
The humanistic approach to Health and Social care describes the understanding of human experience from the individual’s position focusing on free will and the capability of making choices. Abraham Maslow and Carl Rogers are two psychologists associated with this approach.
Maslow, an American psychologist constructed his “Hierarchy of Needs” explaining requirements every human being needs in basic needs to eventually achieve self-actualisation (achieve full potential).
From information given, it is evident that Joe has not fulfilled the majority of his basic needs. I feel he is at the bottom of Maslow’s hierarchy he is getting the basic physical needs (food, drink, warmth, etc…). However, it can be seen that his safety and security is not achieved because he remains anxious, depressed and aggressive. Until such emotions are addressed Joe will not be able to develop accordingly to Maslow’s Hierarchy of Needs.
Joe can be likened more effectively to the theories of Carl Rogers, a psychologist “particularly interested in the concept of self” (Stretch, B, 2007, Pg388).
Self concept is the way in which we see ourselves involving physical and biological traits. He has two key terms he uses “internalise” in the way in which we perceive outside information and build our sense of self.
In Joe’s case, he has a low self worth and tries to compensate by being dominant and aggressive. He is generally depressed which reinforces the feelings of inadequacy.
Initially, staff and clients were supportive and friendly towards him which would help him value himself and increase self esteem.
However, increasing aggression, dominance and bad behaviour causes a reverse attitude by clients and staff alike and this in turn contributes to Joe’s poor behaviour affecting his self esteem in a negative way.
The prospect of being made to leave the home could leave Joe feeling troubled and unhappy and have a negative concept of his ideal self.
1. Stretch, B, BTEC National Health and Social Care Book 1, edited Whitehouse, M. (2007)
Here's what a teacher thought of this essay
This is a very good essay that includes excellent descriptions of some psychological theories. The behaviourist approach is described well as is Erikson's theory. The writer could extend the discussion of Freud and include far greater detail of the Humanistic approach. A very good attempt at application though. ****