A.

PSYCHOSOCIAL
Self-concept
a. the mental image an individual has of oneself
b. dimensions of self-concept
i.

cognized self (self-knowledge)

a. "who am I?"
b. a conscious understanding of ones cognitive, effective, and physical abilities
c. consists of the following information about a person:
1. basic facts that usually are typically objective and unchangeable
a. e.g., age, race, height
2. qualities or traits that are typically subjective and changeable
a. e.g., generous, hot-headed, sexy

ii.

ideal self (self-expectation)

a. "who or what do I want to be?"
b. a conscious understanding of the self, one wants to be
c. closely related to goal-setting for the present and future
1. setting realistic goals can be healthy
a. e.g., maintaining a normal body weight
2. setting unrealistic goals can be unhealthy
a. e.g., being as thin as a fashion model

iii.

other self (social self)

a. "how do I perceive others perceiving me?"
b. a conscious understanding of how one sees oneself in relation to social situations

iv.

self-evaluation
a. "how well do I like me?"
b. a conscious assessment of ones overall worth
c. closely related to self-esteem
1. a positive assessment can lead to high self-esteem
a. e.g., liking how one looks in the mirror
2. a negative assessment can lead to low self-esteem
a. e.g., disliking how one looks in the mirror

c. components of self-concept
i.

body image
a. how an individual perceives the size, appearance, and functioning of the body and its parts

b. includes the following:

1. functioning of the body and its parts
a. e.g., gait, elimination, sexual response
2. things intimately connected to the body
a. e.g., make-up, clothing, hairstyle
3. devices required for functioning of the body
a. e.g., wheelchairs, canes, eyeglasses
c. develops in two ways
1. others attitudes and responses towards ones body
a. e.g., people may exhibit disgust when looking at a badly burned individual
2. ones own exploration of ones body
a. e.g., finding enjoyment in touching ones body, the ability to become sexually
aroused when stimulating oneself
d. influenced by cultural and societal values
1. e.g., tall and thin considered physical beauty in American society whereas short and
obese is not
ii.

self-esteem
a. how much an individual likes oneself
b. the fundamental criteria by which one determines how much an individual likes oneself:
1. power; the ability to influence people and events - the sense that my opinion counts
and will be listened to
2. meaning; the sense of being valued and worthwhile - my existence matters to others
3. competence; the ability to achieve personal goals - personal success
4. virtue; behaving in a manner consistent with personal values - adherence to a moral or
ethical standard
c. types of self-esteem
1. global self-esteem
a. how much one likes oneself as a whole
2. specific self-esteem
a. how much on likes a certain part of oneself
3. core self-esteem
a. ones consistent, overall appraisal of self
4. functional or situational self-esteem
a. ones changing appraisal of self in response to stressors
5. defensive self-esteem
a. protective self-esteem in which one reports high self-esteem in order to deny
negative information

iii.

personal identity
a. conscious sense of individuality and uniqueness that is continually evolving throughout life
b. concept of boundaries central to personal identity
1. body boundaries
a. e.g., that is your hand, this is my hand
2. ego boundaries
a. e.g., those are your thoughts or feelings, these are my thoughts and feelings

iv.

role performance
a. what an individual does in a particular position in relation to the behaviors expected of that
position
b. concept of choice important to role performance
1. ascribed roles do not allow one a choice as to whether or not to adopt a particular role
a. e.g., when a male or female child is born, he/she automatically has the role of
son or daughter
2. assumed roles do allow one a choice as to whether or not to adopt a particular role
a. e.g., when a male or female decides to become a nurse
c. common problems associated with role
1. role ambiguity; occurs when an individual lacks knowledge of role expectations
2. role strain; occurs when an individual perceives him/herself as inadequate or unsuited
for a role
3. role conflict; related to expectations concerning the role
a. intrapersonal role conflict; occurs when role expectations conflict with the
individuals personal values
i.

e.g., a nurse who opposes abortion being asked to care for a client
undergoing an abortion

b. interpersonal role conflict; occurs when an individuals expectations differ

from some significant others
i.

e.g., an adolescent male wants to play in a rock band, but his parents
value intellectual pursuits

c. interrole conflict; occurs when an individual is expected to fulfill two or more

roles simultaneously
i.

e.g., a working mother is told to leave work and get her sick child at
school

d. factors influencing self-concept

i.

biologic make-up
a. e.g., an individual whose biologic make-up is different than that of the predominant society
(e.g., black, obese, short, unattractive) may have difficulty securing or maintaining a positive
self-concept

ii.

culture, values, and beliefs

a. e.g., an individual who does not integrate American cultural practices, values, and beliefs, but
those of another culture, may have difficulty securing or maintaining a positive self-concept
iii.

coping and stress tolerance

a. e.g., an individual who utilizes inadequate coping patterns to adapt to stress or resolve conflict
(e.g., excessive use of denial, destructive behavior [overeating, excessive smoking/drinking,
overuse of over-the-counter medications, illicit drug use], projection of blame/responsibility,
hypersensitivity to criticism, grandiosity, rationalizing failures, high illness rate [high blood
pressure, ulcers, irritable bowel syndrome, frequent headaches/neckaches] may have difficulty
securing or maintaining a positive self-concept

iv.

previous experience
a. e.g., an individual whose past experiences have resulted in failure, rather than success, may
have difficulty securing or maintaining a positive self-concept

v.

locus of control
a. e.g., an individual who has an external locus of control, which attributes success to luck,
chance, or the influence of powerful others rather than personal behavior, may have difficulty
securing or maintaining a positive self-concept

vi.

stressful life events

a. e.g., an individual experiencing stressful life events (e.g., financial difficulties, problems on
the job, change or loss of a job, relationship concerns, sexuality concerns, divorce, moving),
particularly if cumulative, may have difficulty securing or maintaining a positive self-concept

vii.

incomplete crises of psychosocial development

a. e.g., an individual in the early adulthood years who has not completed the psychosocial
developmental task of this age group, Intimacy vs. Isolation, (e.g., remains alone and/or avoids
close interpersonal relationships) may have difficulty securing or maintaining a positive selfconcept

viii.

role transition
a. e.g., an individual who has experienced a developmental role transition (one commonly
associated with aging and growth), such as the transition from student to wage earner, may
have difficulty securing or maintaining a positive self-concept
b. e.g., an individual who has experienced a situational role transition (one commonly associated
with change in a relationship), such as death of a spouse, may have difficulty securing or
maintaining a positive self-concept

ix.

illness, trauma, surgery

a. e.g., an individual who has had an amputation of his/her extremity may experience alterations
in self-esteem, body image, personal identity, and role and, consequently, have difficulty
securing or maintaining a positive self-concept

e. common alteration in self-concept: body image disturbance

i.

the state in which one experiences or is at risk of experiencing a disruption in the perceptions, beliefs,
and knowledge possessed about ones own body structure, function, appearance, and limits

ii.

defining characteristics
a. negative verbal or behavioral response to actual or perceived change in body structure and/or
function
b. inability to look at or touch altered body site
c. avoidance or refusal of social contacts
d. verbalization of feelings of helplessness, hopelessness, powerlessness
e. lack of self-care

f.
iii.

depersonalization or excessive personalization of altered body part

interventions
a. provide privacy and assist the client to express feelings
b. support the client in expressing feelings of grief or anger relating to changed body image
c. spend time with client
d. provide reliable information about altered appearance and its effect on physical functioning
e. provide information about appropriate supportive devices or prostheses
f.

clarify any misunderstanding the client may have regarding appearance

g. support the client in efforts to view and touch changes in body appearance
h. support client in efforts to adapt to changes in physical functioning
i.

teach significant others necessary skills for assisting the client

j.

offer praise and encouragement to the client and significant others

k. teach client new self-care necessary for adaptation

l.

reinforce instruction on occupational and vocational skills necessary for adaptation

m. provide information on resources available for assistance

n. encourage the client to participate in social activities
o. praise and encourage the client and significant others
f.

common alteration in self-concept: self-esteem disturbance

i.

the state in which one experiences a disruption in self-perception or the unrealistic self-evaluation or
feelings about self or ones capabilities

ii.

defining characteristics
a. self-deprecating verbalizations
b. expressions of shame or guilt
c. rejection of positive feedback and/or exaggeration of negative feedback
d. social withdrawal
e. verbalizations of or behaviors indicating lack of self-confidence
f.

avoidance of new situations

g. inability to perform self-care

iii.

interventions
a. encourage client to identify personal strengths
b. recognize clients past accomplishments and knowledge
c. discourage client from focusing on past weaknesses and/or failures
d. maintain a caring and nonjudgmental attitude
e. provide information about activities and support groups that promote self-esteem

f.

assist the client to choose satisfying and rewarding activities

g. encourage participation in activities to promote self-esteem, e.g.:

1. exercise
2. support groups
3. social, creative, and recreational activities
4. self-help groups
5. community service
6. self-care activities
h. when prescribed, encourage clients participation in individual or group psychotherapy
i.

help the client determine factors that interfere with positive interpersonal relationships

j.

teach the client appropriate interaction techniques

k. teach significant others appropriate interaction techniques

l.

listen attentively

m. provide a supportive environment

n. acknowledge clients growth and accomplishments
g. common alteration in self-concept: personal identity disturbance
i.

the state in which one is unable to distinguish between the self and non-self

ii.

defining characteristics
a. confusion about sense of self, purpose, or direction in life, or sexual identification/preference
b. difficulty making decisions
c. poorly differentiated ego boundaries

iii.

interventions
a. ascertain the clients perception of the extent of threat to self
b. determine the speed of occurrence of threat to self
c. assess support systems
d. assist client to develop strategies to cope with threat to self
e. engage client in activities to help in identifying self as an individual
f.

provide accurate information about threat to self and potential consequence for client

g. assist client and significant others to acknowledge and integrate threat to self into future
planning
h. refer to appropriate support groups
i.

discuss options for dealing with issues of sexual gender

j.

allow client to deal with threat to self in small steps

k. maintain reality orientation without confronting clients irrational beliefs

l.

help client resolve gender dissonance

m. help client resolve cultural dissonance

h. common alteration in self-concept: altered role performance
i.

the state in which one experiences a change, conflict, or denial of role responsibilities or inability to
perform role responsibilities

ii.

defining characteristics
a. inability to perform new or usual roles
b. lack of knowledge about or difficulty in learning about role
c. different perception of role
d. inadequate problem-solving skills
e. confusion or frustration about role performance
f.

changes in usual patterns of responsibility

g. change in physical ability to perform role

iii.

interventions
a. assist the client to express feelings about role changes
b. support the client in grieving over the loss
c. help the client accurately assess role loss or change
d. help the client differentiate perceived from actual role requirements
e. provide resources for role-modelling or instructions regarding role change
f.

demonstrate role behaviors that the client needs to learn

g. provide for practicing new role behaviors

h. praise and encourage the client when success in new role performance is demonstrated