PSYCHODYNAMICTHEORIES Made By: Akshat Sachdeva BDS Final Year 1 REFERENCES 1. Textbook of Pedodontics by Shobha Tandon (2nd edition). 2. Textbook of Pediatric Dentistry by Nikhil Marwah (3rd edition). 3. Illustrated Pediatric Dentistry by P.R. Chockalingam (1st edition). 4. Pediatric Dentistry: Infancy through childhood by Pinkham (4th edition). 2 Psychology: Science dealing with human nature, function and phenomenon of his soul in the main. Child Psychology: Science or study of child’s mind and how it functions. It also deals with the mental power or an interaction between the conscious and subconscious elements in a child. 3 Psychodynamic Theories comprise of three theories: 1. Psychosexual theory/Psychoanalytical theory by Sigmund Freud (1905). 2. Psychosocial Theory/Model of personality development by Erik Erikson (1963). 3. Cognitive theory by Jean Piaget (1952). 4 PSYCHOANALYTICAL THEORY Sigmund Freud was the originator of the psychoanalytical approach. He attempted to explain by understanding the mind at its different levels, its motivation and conflicts. He described human mind with the help of two models: 1. Topographic model. 2. Psychic model/psychic triad. 5 TOPOGRAPHIC MODEL According to this model, human mind consists of conscious, preconscious and subconscious mind. Conscious mind: Where we are paying attention at the moment. Includes only our current thinking processes. Preconscious mind: Involves ordinary memory and knowledge. Things of which we are aware, but where we are not paying attention at all moments. Subconscious/Unconscious mind: Where process and content are out of direct reach of the conscious mind. That part of our mind which thinks and acts independently. Freud described human mind is like an iceberg. Only 10% is visible (conscious) and other 90% is beneath (unconscious). 6 Source: indiandentalacademy.com 7 PSYCHIC MODEL/PSYCHIC TRIAD Composed of three parts: 1. Id: • Basic structure of personality. • Serves as a reservoir of instincts. • Present at birth, impulse ridden. • Strives for immediate pleasure (pleasure principle). 8 2. Ego: • Develops out of Id in 2nd to 6th month of life when infant begins to distinguish between itself and outside world. • Governed by reality principle. • Concerned with memory and judgment. • Developed after birth, expands with age. • Delays, modifies and controls Id impulses on a realistic level (reality principle). 9 3. Super Ego: • Prohibition learned from environment (more from parents and authorities). • Acts as a sensor of acceptability of thoughts, feelings and behavior. • Determined by regulations imposed upon child by parents, society and culture (ethics and morals). • Internalized control which produces the feeling of shame and guilt. 10 In a healthy person, Ego is the strongest. • Satisfies needs of Id. • Does not upset Super Ego. • Takes into consideration the reality of every situation. Source: Indiandentalacademy.com 11 EGO DEFENSE MECHANISMS • Tactics which the ego develops to help deal with Id and super ego. • Unconsciously blocks the impulses or distorting them into a more acceptable, less threatening form. 1. Displacement: • Transfer of desires or impulses onto a substitute person or object. • Eg: student scolded by teacher may shout at juniors or slam a door. 2. Reaction formation: • Person displays behavior that is exactly opposite of an impulse. • Eg: laughing when unable to control temper to prevent anxiety. 12 3. Regression: • Individual attempts to avoid current anxiety by withdrawing behavior patterns of an earlier age. • It is the age – inappropriate response, eg: nail biting. 4. Repression: • Can take two forms: • Expulsion of thought and memories that might provoke anxiety from conscious mind (primary repression). • Process by which hidden Id impulses are blocked from ever reaching consciousness (primal repression). • Repressed memories are not deactivated; they continue to affect a person’s behavior later in adulthood. 5. Projection: • Characteristics or desires that are unacceptable to a person’s ego and projected onto someone else. 13 6. Denial: • Person may deny some aspect of reality, eg: patient with big ulcer in mouth diagnosed as cancer may not be able to tackle the situation and may consult some other dentist for denial of the diagnosis. 7. Identification: • Incorporating an external object (usually another person) into one’s own personality, i.e. to think, act and feel like someone else. 8. Rationalization: • Attempt to explain our behavior to ourselves and others, in ways that are rational and acceptable. 14 STAGES OF DEVELOPMENT Sigmund Freud described six stages of psychosexual development: 1. Oral Stage: • Oral cavity: erogenous zone. • Dependent stage. • Satisfaction of oral desires. • If child’s needs are not met, following traits may develop: excessive optimism, pessimism, demandingness, envy, jealousy. 15 2. Anal Stage: • Erogenous zone: Anus. • Toilet training. • Maturation of neuromuscular control occurs. • Development of personal autonomy and independence. • Child realizes his control over needs and practices it with a sense of shame. • Characterized by various abnormal behaviors like: disorderliness, stubbornness, willfulness, abstinence. 16 3. Urethral Stage: • Transition between anal and phallic stage. • Child derives pleasures from exercising control over urinary sphincter. • Child realizes the increasing voluntary control which provides him with the sense of independence and autonomy. • Loss of urethra control results in shame. 17 4. Phallic Stage: • Begins during 3rd year till 5th year. • Oedipus complex (boy – mother). • Electra complex (girl – father). • Increase in genital masturbation accompanied with unusual fantasies about opposite gender. • Child realizes sexual qualities without embarrassment. • If above mentioned characteristics are not resolved, the balance between male and female roles do not develop. 18 5. Latency Stage: • Resolution of any defects occurs. • Maturation of ego takes place. • Consolidation of sex roles occurs. • Greater degree of control over instinctual impulses. • Child starts adapting to the adverse environment. • Lack of inner control results in immature behavior and decreased skill development. 19 6. Genital Stage: • Extends to young adulthood. • Sense of identity develops. • Child has mature personality. • Helps to separate dependence on parents. • Realizes his goals for reproduction and survival. • Acceptance of adult role, functions with social expectations and cultural values. 20 Advantages of Freud’s Theory: • One of the earliest and most comprehensive theories of life long psychological development. Disadvantages of Freud’s Theory: • He formulated his theory by extensive studies on adult psychological patients and hence its extrapolation to children is not very justified. • Theory is based on obsessed observations of the psychologist. 21 PSYCHOSOCIAL THEORY • Erik Erikson concentrated on child’s development covering the entire span of life cycle from infancy to childhood through old age. • Emphasized the conscious self as much as unconscious instincts. • He described 8 stages of life cycle. • Each stage demands resolution before the next stage can be satisfactorily negotiated. 22 1. Basic Trust v/s Basic Mistrust: • Infant forms first trusting relationship. • Child has optimism if well – handled. • Badly handled, he becomes mistrustful and insecure. • Preferable to do dental treatment in presence of parents. • Trust: Mistrust ratio should be maintained by dentist. 23 2. Autonomy v/s Shame: • Child begins to push for independence. • Emerges from this stage sure of himself and proud rather than ashamed. • Autonomy includes stormy self – will, tantrums, stubbornness, negativism. • Child retreats to mother in threatening situations. • Child takes pleasure in doing tasks by himself. 24 3. Initiative v/s Guilt: • Child becomes more assertive and resulting conflict causes guilt. • Developing healthy child learns to imagine, cooperate with others, lead and follow. • Immobilized by guilt, he is fearful, continues to depend on adults. • Independence has to be reinforced. • Child should be encouraged and taught about various things in dental setup. 25 4. Industry v/s Inferiority: • Child learns basic cultural skills, most importantly school skills. • Child is trusting, autonomous and full of initiative will learn easily to be industrious. • Shame and guilt filled child experiences defeat and inferiority. • Child drive for sense of industry and accomplishment, cooperation can be obtained. • Cooperation depends on whether child understands what is needed to please the dentist/parent. 26 5. Identity v/s Role Confusion: • Adolescent learns how to answer happily the question of “Who am I?” and what shall he become. • Even the best adjusted adolescents experience role confusion. • Behavior management can be challenging. • Approval of peer group for any dental treatment is extremely important. 27 6. Intimacy v/s Isolation: • Young adult for the first time can experience true intimacy – that makes possible good marriage or genuine friendship. • External appearances are very important. • Helps in attainment of intimate relation. • Young adults seek orthodontic treatment to correct dental appearance. • This is characterized as internal motivation. 28 7. Generativity v/s Stagnation: • Adulthood demands generativity both in sense of marriage and parenthood, and in the sense of working productively and creatively. 8. Integrity v/s Despair: • Mature adult develops the peak of adjustment: integrity. • He is independent, works hard, found a well defined role and dares the new. 29 Merits of Erikson’s Theory: 1. Easy to apply at any stage of development since it is based on age – wise classification. 2. Simple and comprehensive to understand. Demerits of Erikson’s Theory: 1. Based on the extreme ends of personality. 30 COGNITIVE THEORY • Jean Piaget formulated his theory on how children and adolescents think and acquire knowledge. • Directly observed children by questioning them about their thinking. • According to Piaget, the environment does not shape child behavior, but the child and adult actively seek to understand the environment. 31 This process made of 3 functional variants: 1. Assimilation: Concerns with observing, recognizing, taking up an object and relating it with earlier experiences or categories. 2. Accommodation: Accounts for changing concepts and strategies as a result of new assimilated information. 3. Equilibrium: Changing basic assumptions following adjustments in assimilated knowledge so that the facts fit better. The sequence of development has been categorized into 4 major stages: 32 1. Sensorimotor Stage (0 – 2 years): • Stage of practical intelligence. • Child does not have the capacity to represent objects or people. • Simple reflexes begin to coordinate as maturation progresses. • Variety of elementary schemes develop by 10th month. • Child begins to interact with the environment and can be given toys while sitting on dental chair. 33 2. Pre – operational Stage (2 – 6 years): • Child uses symbols in language and play. • Unaware of other’s perspective. • Focuses attention on how things appear. • Solves problems as a result of intuitive thinking. • Likes to explore things and make new observations. • Correlates things with other objects to which they are more used to. • Child is explained about the instrument and allowed to deal with it. • Child assimilates new experiences and accommodates original strategies. 34 3. Concrete Operation Stage (6 – 12 years): • Thinking process becomes logical. • Develops the ability to use complex mental operations like addition and subtraction. • Able to understand other’s point of view. • Concrete operations develop based on the level of understanding achieved. • Child has achieved level of understanding and gets involved in the treatment. 35 4. Formal Operation Stage (11 – 15 years): • Development of reasoning capacity. • Child now a teenager can think more abstractly. • Can imagine possibilities inherent in a problem. • Uses inductive or deductive logic to solve problems and make decisions. • Thinks of ideas and develops a vast imagination. • Peer influence increases. • Acceptance from peers can be used for motivation for dental treatment. 36 Merits of Piaget’s Theory: 1. Most comprehensive theory of cognitive development. Demerits of Piaget’s Theory: 1. Underestimates children’s abilities. 2. Overestimates age differences in thinking. 3. Vagueness about the process of change. 4. Underestimates role of social environment. 37 THANK YOU! 38