Theoretical Models: Psychological, Nursing, and Developmental

Must know

• Freudian Structures and Defenses1856 to 1939: Sigmund Freud developed psychoanalysis, conceptualizing personality through an iceberg model that divides the mind into conscious, preconscious, and unconscious realms.

  • 1856 to 1939: Sigmund Freud developed psychoanalysis, conceptualizing personality through an iceberg model that divides the mind into conscious, preconscious, and unconscious realms.
  • Id: The primitive structure present from birth, located entirely within the unconscious mind, operating strictly on the pleasure principle.
  • Ego: The rational structure operating on the reality principle, acting like a horseback rider guiding a horse to keep the impulsive id in line.
  • Superego: The moral compass that develops as societal standards are learned, governing the internal sense of right from wrong.
  • Defense mechanisms: Unconscious psychological processes that shield the ego from anxiety and keep people from acting directly on unmediated id impulses.
  • Five psychosexual stages: Development moves through the oral (birth to 18 months), anal (18 months to 3 years), phallic (3 to 6 years), latency (6 to 12 years), and genital (puberty onward) stages.
• Freudian Structural Model and ConsciousnessThe conscious mind sits above the waterline, containing thoughts, feelings, and perceptions actively present in awareness.

  • The conscious mind sits above the waterline, containing thoughts, feelings, and perceptions actively present in awareness.
  • The preconscious mind rests at the waterline, holding memories and knowledge that can readily be brought into conscious awareness when needed.
  • The unconscious mind lies completely below the waterline, housing instinctual drives, repressed conflicts, and forgotten memories that remain inaccessible without specialized psychoanalytic techniques.
  • The id is present from birth and resides completely below the waterline in the unconscious mind. It functions on the pleasure principle, demanding immediate gratification of instinctual needs, primitive drives, and bodily desires regardless of social consequences.
  • The ego develops from the id and operates on the reality principle. The ego acts as a realistic mediator, analogous to a horseback rider managing a powerful horse. It regulates the raw impulses of the id, delaying gratification until a suitable and realistic outlet is available. A strong ego maintains balance among the id, external reality, and the superego.
  • The superego represents internalized moral standards, societal rules, and parental values, establishing a sense of right from wrong. It serves as an internal judge, rewarding proper behavior with self-approval and punishing unacceptable thoughts with guilt.
• Psychosexual DevelopmentOral stage (birth to 18 months): Eogenous zone is the mouth, centered on sucking, biting, and feeding. Fixation produces adult traits of dependency, passivity, excessive eating, drinking, or smoking.

  • Oral stage (birth to 18 months): Eogenous zone is the mouth, centered on sucking, biting, and feeding. Fixation produces adult traits of dependency, passivity, excessive eating, drinking, or smoking.
  • Anal stage (18 months to 3 years): Erogenous zone is the anus, focused on bowel control and sphincter regulation during toilet training. Fixation results in either anal-retentive traits (extreme neatness, stinginess, and rigidity) or anal-expulsive traits (messiness, carelessness, and emotional outbursts).
  • Phallic stage (3 to 6 years): Erogenous zone is the genitals. Children experience the Oedipus complex (in boys) or Electra complex (in girls), involving unconscious desire for the opposite-sex parent and competition with the same-sex parent. This stage peaks at 5 years of age. Resolution occurs by identifying with the same-sex parent, establishing the superego. Fixation results in authority conflicts, sexual identity confusion, or excessive vanity.
  • Latency stage (6 to 12 years): Sexual energy remains dormant. Focus shifts entirely to peer relationships, social skills, academic achievements, and athletic activities. Fixation leads to social inadequacy or difficulty bonding with peers.
  • Genital stage (puberty through adulthood): Erogenous focus returns to the genitals, directed toward mature sexual intimacy, stable romantic relationships, and constructive societal contributions.
• Adlerian Individual PsychologyAlfred Adler lived from 1870 to 1937 and established Individual Psychology as a core psychodynamic and neo-Freudian framework.

  • Alfred Adler lived from 1870 to 1937 and established Individual Psychology as a core psychodynamic and neo-Freudian framework.
  • Recognized feelings of inferiority as the primary driving force in human development and behavior.
  • Asserted that human motivation centers on a continuous striving for superiority, self-improvement, and mastery.
  • Framed human actions and psychological motivation around social relatedness and interpersonal connection rather than isolated biological drives.
  • Emphasized that individuals must assume personal responsibility for their own psychological growth and live a purposeful life.
  • Utilized consciousness raising in psychodynamic psychotherapy to help patients resolve internal and interpersonal conflicts.
• High-Yield SignpostsIn Adlerian psychodynamic psychotherapy, the first-line focus is raising consciousness regarding feelings of inferiority, examining birth order dynamics, and fostering social relatedness so the patient assumes personal responsibility for purposeful growth.

  • In Adlerian psychodynamic psychotherapy, the first-line focus is raising consciousness regarding feelings of inferiority, examining birth order dynamics, and fostering social relatedness so the patient assumes personal responsibility for purposeful growth.
  • Do not confuse Sigmund Freud's concepts with Alfred Adler's concepts on the exam. Test writers will attempt to attribute birth order or striving for superiority to Freud. Remember that Freud focuses on unconscious id, ego, and superego conflicts and psychosexual stages, whereas Adler focuses on social relatedness, feelings of inferiority, and birth order.
  • When evaluating patients presenting with severe feelings of inferiority, low self-worth, or interpersonal distress, always perform a safety assessment for depression and suicidal ideation before proceeding with psychotherapeutic growth goals.

  Board trap. Do not confuse Sigmund Freud's concepts with Alfred Adler's concepts on the exam. Test writers will attempt to attribute birth order or striving for superiority to Freud. Remember that Freud focuses on unconscious id, ego, and superego conflicts and psychosexual stages, whereas Adler focuses on social relatedness, feelings of inferiority, and birth order.

  Safety. When evaluating patients presenting with severe feelings of inferiority, low self-worth, or interpersonal distress, always perform a safety assessment for depression and suicidal ideation before proceeding with psychotherapeutic growth goals.

• Rogers and Maslow: Self-ActualizationCarl Rogers established person-centered therapy, a core humanistic model founded on unconditional positive regard, therapist genuineness, and accurate empathy.

  • Carl Rogers established person-centered therapy, a core humanistic model founded on unconditional positive regard, therapist genuineness, and accurate empathy.
  • Abraham Maslow formulated the humanistic hierarchy of needs, establishing that primitive physiological survival and safety needs must be satisfied before energy can shift to higher psychological needs like self-esteem and self-actualization.
  • Self-actualization represents the highest humanistic growth task across both models, defined as realizing one's full human potential once foundational needs are secure.
  • William Miller adapted Rogers' person-centered framework into motivational interviewing, preserving nonjudgmental acceptance while directing behavior change.
  • Board exam items test Maslow's hierarchy by requiring the PMHNP to prioritize physical safety, food, and basic stability before introducing complex psychotherapy or self-actualization goals.
  • Person-centered therapy positions the therapeutic relationship itself as the primary vehicle for psychological healing rather than directive techniques or unconscious interpretation.
• Carl Rogers and Person-Centered TherapyIn person-centered care, the initial and primary intervention is establishing unconditional positive regard, genuine warmth, and accurate empathy to build a secure therapeutic relationship.

  • Unconditional positive regard: Communicating deep acceptance regardless of patient behavior or history.
  • Genuineness: Authenticity and congruence from the clinician during therapeutic encounters.
  • Accurate empathy: Demonstrating true emotional understanding of the patient's internal experience.
  • Relationship building: Using the therapeutic alliance as the main therapeutic agent.
  • In person-centered care, the initial and primary intervention is establishing unconditional positive regard, genuine warmth, and accurate empathy to build a secure therapeutic relationship.
  • Test writers often create distractors that frame motivational interviewing as a purely behavioral technique. Remember that its underlying ethos directly stems from Carl Rogers' person-centered humanistic framework.

  Board trap. Test writers often create distractors that frame motivational interviewing as a purely behavioral technique. Remember that its underlying ethos directly stems from Carl Rogers' person-centered humanistic framework.

• Abraham Maslow and the Hierarchy of Needs1. Physiological needs: Food, water, sleep, and basic physical survival.

  • 1. Physiological needs: Food, water, sleep, and basic physical survival.
  • 2. Safety needs: Physical safety, shelter, security, and stability.
  • 3. Psychological needs: Belonging, affection, intimacy, and self-esteem.
  • 4. Self-actualization: Fulfilling personal potential, personal growth, and peak self-fulfillment.
  • According to Maslow's hierarchy, basic physiological survival and immediate physical safety must be established before attempting higher-level psychotherapeutic interventions, cognitive restructuring, or self-actualization work. Attempting complex therapy while a patient lacks food, shelter, or physical safety is clinically inappropriate and unsafe.

  Safety. According to Maslow's hierarchy, basic physiological survival and immediate physical safety must be established before attempting higher-level psychotherapeutic interventions, cognitive restructuring, or self-actualization work. Attempting complex therapy while a patient lacks food, shelter, or physical safety is clinically inappropriate and unsafe.

• Sample Question 1F. Family systems

  • F. Family systems
  • G. Person-centered
  • I. Interpersonal
• Sample Question 2F. Family systems

  • F. Family systems
  • G. Person-centered
  • I. Interpersonal
• Sample Question 3C. Person-centered

  • C. Person-centered
• Gestalt and Existential TherapyExistential therapy was established by Viktor Frankl, Rollo May, and Irvin Yalom to address human existence, choice, freedom, and personal responsibility.

  • Existential therapy was established by Viktor Frankl, Rollo May, and Irvin Yalom to address human existence, choice, freedom, and personal responsibility.
  • Logotherapy, created by concentration camp survivor Viktor Frankl, is therapy through meaning designed to resolve existential crises.
  • Irvin Yalom expanded existential practice through group psychotherapy and published ten clinical case studies in Love's Executioner.
  • Gestalt therapy was developed by Fritz Perls (1893 to 1970) to achieve personal wholeness and bring emotional completion to unmet needs.
  • Gestalt therapy emphasizes holism and focuses on present here and now awareness rather than past historical conflicts.
  • The empty third chair technique is a core Gestalt experiential tool used to resolve unfinished business through direct dialogue.
• Existential TherapyTheorists: Viktor Frankl, Rollo May, and Irvin Yalom.

  • Theorists: Viktor Frankl, Rollo May, and Irvin Yalom.
  • Core philosophy: Centers on human existence, individual choice, personal freedom, and taking responsibility for one's life path.
  • Existential crisis: Occurs when a person is confronted with the reality of their choices, freedom, and personal responsibility.
  • Being in the world: Asserts that the individual and their surrounding world are completely inseparable.
  • Logotherapy: Formulated by Viktor Frankl as a specialized approach providing therapy through finding personal meaning.
  • Clinical contributions: Irvin Yalom advanced group therapy dynamics and documented existential clinical formulations during an era preceding widespread psychotropic prescribing.
• Gestalt TherapyTheorist: Fritz Perls.

  • Theorist: Fritz Perls.
  • Core philosophy: Stresses holism, which is the process of forming a unified whole and bringing completion to unsatisfied emotional needs.
  • Temporal focus: Concentrates on present here and now awareness rather than analyzing past historical childhood events.
  • Relationship style: Characterized by empathy, authentic dialogue, and active therapeutic challenging.
  • Empty third chair technique: Utilizes an empty chair in the therapy room for direct experiential dialogue with a missing person or unintegrated aspect of self to resolve unfinished business.
• Exam Modifiers and SignpostsExistential and Gestalt therapies are primary options for patients experiencing existential crises, loss of purpose, or unfulfilled personal potential who possess intact reality testing and cognitive stability.

  • First-line. Existential and Gestalt therapies are primary options for patients experiencing existential crises, loss of purpose, or unfulfilled personal potential who possess intact reality testing and cognitive stability.
  • Board trap. Do not confuse Gestalt therapy with Freudian psychoanalysis. Psychoanalysis examines unconscious past psychosexual development, whereas Gestalt therapy focuses on present here and now holism and experiential completion.
  • Safety alert. Patients expressing existential despair must be evaluated for active suicidal ideation and major depressive disorder before pursuing deep existential exploration or Gestalt challenging.

  Board trap. Do not confuse Gestalt therapy with Freudian psychoanalysis. Psychoanalysis examines unconscious past psychosexual development, whereas Gestalt therapy focuses on present here and now holism and experiential completion.

  Safety. Patients expressing existential despair must be evaluated for active suicidal ideation and major depressive disorder before pursuing deep existential exploration or Gestalt challenging.

• Existential Therapy vs. Gestalt TherapyThink Existential when: The stem highlights Viktor Frankl, logotherapy, search for meaning, freedom, choice, or Irvin Yalom.

  • Think Existential when: The stem highlights Viktor Frankl, logotherapy, search for meaning, freedom, choice, or Irvin Yalom.
  • Think Gestalt when: The stem highlights Fritz Perls, holism, forming wholeness, present here and now focus, or the empty third chair technique.
  • Priority difference: Existential therapy centers on finding purpose and choices, while Gestalt therapy centers on present emotional integration and completing unmet needs.
  • Board rule: Existential therapy resolves existential crises through meaning, whereas Gestalt therapy resolves unfinished business through present experiential dialogue.