BMS2-K13

Schools of Psychiatry,
Intellegence, Leadership
Elmeida Effendy- Mustafa M Amin
Department of Psychiatry
Medical Faculty USU

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 Introduction
• A group of student came late at the
morning lecturer & the lecturer
prohibited them to follow the lecture
• The students reaction are : grumbling,
angry, go home, etc

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• Freudian Sigmund Freud
Psychoanalysis
• Individual Psychology Alfred Adler
• Analitical Psychology Carl Gustav
Jung
• British psychoanalytic schools : The
Klenian School : Melanie Klein,
Wilfred Bion, Donald W Winnicott

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• Psychoanalytic object relation theory
: Fairbairn, Michael Balint
• The trait approach : genetics of
personality : Gordon Allport,
Raymond Cattell
• Interpersonal Harry Stack
Sullivan, Karen Horney, Erich Fromm,
et al

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• Ego Psychoanalysis Anna Freud,
Heinz Hartmann, David Rappaport,
Erik Erikson et al
• Psychobiologic Adolf Meyer
• Learning Theory Watson, Wolpe,
Pavlov, et al Behavior Therapy

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• Life span approach : Erik Erikson
• Humanistic approach : Abraham Maslow,Carl
Rogers
• Attachment Theory : John Bowlby, Mary
Ainsworth
• Hollistic Eclectical Kusumanto Setyonegoro

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 Classic
Psychoanalysis

• Sigmund Freud : founder of classic

psychoanalysis
• In his view, symptoms,thoughts,feelings
&behavior could all be viewed as the final
common pathways of meaningful
psychological process, many of which
were unconscious

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 Psychoanalysis
• Topographical Model of the Mind
1. Unconscious
2. Pre conscious
3. Conscious

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 Unconscious
✪ All of the drive that tries to discharge & all
the things that not remembered by the
individu
✪ Those element can’t reach the conscious
level again
✪ Primary process thinking fulfill the need
of instinctual drive without delaying it &
without thinking about
• the reality

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• Unconscious memory no connection
with the reality (except if there are
words or events that interdependent
with the memory which fall into
oblivion)
• Limited for the pleasurable needs

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 Pre conscious
✶Door to the conscious & unconscious
✶Secondary thinking process avoiding
the unsatisfy, delaying the instinctual
drive, considering the external reality,
rational & according to condition
✶Pre conscious = unconscious that easy to
recall to become conscious

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 Conscious
´ Perceptual apparatus that receive
stimuli from outside
´ Part of mental life that been aware by
the individu
´ Attention cathexis Tracking pre
conscious & instructing attention for
pre conscious
´ Preconscious process to become
conscious hypercathexis

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• Structural Theory of the Mind
1. Id
2. Ego
3. Super Ego

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 Id
 Basic instinctual drive since birth
 Pleasurable principal
 Unconscious
 Id ego & superego (energy &
development)

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 Ego
Í Personality executive part
Í Relationship between id & ego
Í Reality principle
Í Conscious, pre conscious & unconscious
Í Secondary process
Í Ego defense unconscious

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 Superego
. Superego ego conscience
ego ideal
◎Ego that experienced particular
specialization
◎Conscious & unconscious
◎Moral
◎Oedipal conflict
◎Ego conscience right or wrong
◎Ego ideal things that been dream by the
individu inner feeling

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 The Neopsychoanalytic
Approach
• Alfred Adler
• Carl Gustav Jung
• Karen Horney

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 Adlerian School
• Alfred Adler (1870-1930):Individual psychology
• Masculine protest :the tendency to move from
a passive, feminine role to a masculine active
role
• Inferiority complex: sense of inadequacy&
weakness that is universal & inborn
• Birth order results in lifelong influence on
character % lifestyle

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 Jungian School
• Carl Gustav Jung (1875-1961) :analytical
psychology
• Unconscious
– Personal:acquisitions of personal life, everything
forgotten,repressed,subliminally perceived, thought,felt
– Collective :inherited possibility of psychic functioning in
general, i.e : structure of the brain
•

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• 2 types of personality organizations
– Introverts:focus on their inner worldof
thoughts,intuitions,emotions & sensations
– Extroverts :more oriented toward the outer world,
other persons & material goods
• Each person has a mixture of both components
• Persona,the mask covering personality : the
face a person presents to the outside world
• Anima :man’s undeveloped feminity
• Animus : woman’s undeveloped masculinity

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 Karen Horney (1885-1952)
• person’s current personality attributes
result from the interaction between
the person & the environment& are not
solely based on infantile libidinal
strivings carried over from childhood
• Holistic psychology

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 Psychobiologic

• Adolf Meyer :
1. Learning living human observed the
whole thing about the man
2. The whole thing from the man
integration from the arranged function
hierarchyly
o Individu & its behavior interaction
from various factor : .. dynamic,
somatic, psychologic & social process

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• When facing a case : dynamic,
genetic, psychobiologic, objective &
common sense principality
• Objective : human behavior can be
observe objectively

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• Common sense :
a. Human must be critical
b. according to order which have been
agreed on.
c. Theory which have been agreed on
have to be applied according to
requirement of public society.

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 The Interpersonal &
Cultural Approach
• Erich Fromm
• Harry Stack Sullivan
• Henry Murray

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Erich Fromm (1900-1980)
• 5 character types that are common to &
determined by, Western culture:
– 1.receptive personality :passive
– 2.exploitative personality : manipulative
– 3.marketing personality: opportunistic & changeable
– 4.hoarding personality: saves & stores
– 5.productive personality :mature& enjoy love & work

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 Harry Stack Sullivan
(1892-1949)
• Prototaxic mode: undifferentiated thought that
cannot separate the whole into parts or use
symbols. Occurs in infancy & schizophrenic patients
• Parataxic mode: events are causally related because
of temporal or serial connection
• Syntaxic mode: logical, rational & most mature type
of cognitive functioning of which person is capable

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 Henry Murray (1893-1988)
• Personology : study of human behavior
• Focused on motivation, a need that is
aroused by internal or external
stimulation
• Thematic Apperception Test (TAT)

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 Behavioral Theory
• Something that resulted from
learning process learn ought to earn
to be improve by learning process too.
• Behavioral theory :
1. Classical conditioning therapy
2. Operant conditioning therapy

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 Classical conditioning therapy (dealing
with reflectory behavior)

a. Reciprocal inhibition : patient conduct

behavior which as reciprocal from the
arising out physical symptom
reducing or overcoming the anxiety
b. Desensitization : patient alternately
think of or write down what the
scariest thing until the less fearful

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• c. Aversive conditioning : giving
unpleasant stimuli for the patient
when they do something inappropriate

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 Operant conditioning theory

• Changing /eliminating behavior that

had been done voluntarily = behavior
modification

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 Learning Theory
• Classical conditioning
– Ivan Petrovich Pavlov

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• Operant conditioning
– BF Skinner

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• Social learning
– Albert Bandura
– Julian Rotter

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 The Trait Approach: The
Genetics of Personality
• Gordon Allport
• Raymond Cattell

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Gordon Allport (1896-1967)
• The founder of humanistic school of psychology
• Propriem: strivings related to maintenance of self
identity & self esteem
• Traits :chief units of personality structure
• Personal dispositions : individual traits that represent
the essence of an individual’s unique personality
• Maturity :capacity to relate to others with warmth
&intimacy & an expended sense of self

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 Raymond Cattell
(1905-1998)
• Introduced the use of multivariate
analysis & factor analysis-statistical
procedures that simultaneously
examine the relations among multiple
variables & factors to the study of
personality

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 Life span approach :Erik Erikson

• 8 stages of the life cycle

– 1. Trust vs Mistrust (0-18 months)
– 2. Autonomy vs Shame & doubt(18 months-3 years)
– 3. Initiative vs Guilt ( 3-5 years)
– 4. Industry vs Inferiority ( 5-13years)
– 5. Identity vs Role Confusion (13-21years)
– 6. Intimacy vs Isolation (21-40 years)
– 7. Generativity vs Stagnation (40-60 years)
– 8. Integrity vs Despair (60 years –death)

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 Hollistic Eclectic
Kusumanto Setyonegoro

o Eclectic = accepting all real correct fact

and reality and there is relation with the
patient suffer
o Hollistic = to exert to look into all
manpower energy as a unique individual in
its struggle for the perfect recovering
of physical and mental health.

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• Ability to assimilate factual
knowledge, to recall either recent
or remote events, to reason
logically, to manipulate concepts
(either number or words), to
translate the abstract to the literal
and the literal to the abstract, to
analize & synthesize forms, & to
deal meaningfully & accurately with
problems & priorities deemed
important in a particular setting

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 Intelligence Testing
• 1905 : Alfred Binet introduced the
concept of the mental age (MA),
which is the average intellectual level
of a particular age

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• The intelligence quotient is the ratio of
MA to CA (chronological age), multiplied
by 100 to eliminate the decimal point : it
is represented by the following equation

IQ = MA X 100
– CA

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Classification of Intelligence by IQ Range
• Profound mental retardation : below 20 or 25
• Severe mental retardation : 20-25 to 35-40
• Moderate mental retardation : 35-40 to 50-55
• Mild mental retardation : 50-55 to about 70
• Borderline : 70-79
• Dull normal : 80 to 90
• Normal : 90-110
• Bright normal : 110 to 120
• Superior : 120 to 130
• Very superior : 130 and above

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• Things to know :
• Definition of leadership
• Leadership’s trait
• Leadership’s styles

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• Doctors / psychiatrists entering
public mental health systems are
frequently dismayed to find that they
are not automatically considered the
leaders of their teams

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• Leadership is a difficult attribute to
define and teach
• Leadership : the engine that drives
changes
• It involves not only the knowledge of
what needs to be done to accomplish the
organization’s goals but also the ability
to communicate that knowledge to a
wide array of staff members and others

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• It includes the ability to see that
what happens in one part of the
organization will affect all other
parts eventually

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• The vast majority of directorships of
public mental health programs are held by
members of the major mental health
professions
• For any discipline, special skills are
required to achieve high-level management
and leadership positions

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• Some of those skills are best
gained by additional training,
some can be acquired only by
experience under the tutelage
of a good mentor, and others
require a combination of
experience and education
• Once can gain the necessary
education without pursuing
further degrees in public
administration or management
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• Such degrees can be helpful after on-
the –job training, but it is often more
efficient to undertake an appropriate
reading program and avail oneself of
the many short courses on specific
topics available in most communities

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 Management Skills
• To be a successful public mental health
administrator, one must have a basic
understanding of how communities are
organized, how they choose their
leadership, and how the formal and
informal power structures work

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• Administrators must know how to frame
their programs in a manner that will be
acceptable to the powers that be
• Without that acceptance, the program
conceptualizations will go for naught
• To be successful un what arena, one must be
aware of prevailing public attitudes, where
support can be found, the opinions of key
community leaders, and when one is wasting
time

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• Abilities in the areas of public
speaking and salesman ship are
helpful, and neither are learned in
most psychiatric training programs

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 Technical Skills
• Political skills and agility may be hard to
learn in a formal manner, but the skills
that concern public administration and
management are not.
• They deal with budget, personnel
management, organization, control and
leadership

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• To manage a public mental health
program, one must learn how to read
and manage the budget process and how
to read and manage the final product.
• The budget is where all the plans for
the program come to fruition or fail

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• Planning and budgeting are inseparable
functions
• Every governmental jurisdiction has
its own budgeting process, but they
are similar and are easily to
understood if one takes the time to
familiarize oneself with the major
players and to participate in the
process

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Leadership’s styles

1939 a group of researchers led by

psychologist Kurt Lewin :
• Authoritarian/ autocratic
• Participative/ democratic
• Delegative /laissez -fair

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Authoritarian (Autocratic ) leaders :
I want both of you
• Make decisions without consulting their team
members, even if their input would be useful
• Can be appropriate when you need to make
decisions quickly,when there’s no need for
team input and when team agreement isn’t
necessary for a successful outcome.
• Can be demoralizing, and can lead to high
levels of absenteeism & staff turnover
• Abuse of this style is usually viewed as
controlling,bossy and dictatorial

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Participative (Democratic) leaders
Let’s work together to solve this
• Make the final decisions, but they include
team members in the decision-making
process
• They encourage creativity and people are
often highly engaged in projects
&decisions
• Team members tend to have high job
satisfaction & high productivity

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Delegative (Laissez –faire) leadership :
You two take care of the problem while
I go
• Leaders give their team members a lot of
freedom in how they work & how they set their
deadlines
• Offer little or no guidance to group members
and leave decision making up to group members
• They provide support with resources and advice
if needed, but otherwise they don’t get involved

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• Can be effective in situations where
group members are highly qualified in an
area of expertise, it often leads to
poorly defines roles and a lack of
motivation

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• Children under delegative leadership,
also known as laissez –fair leadership
were the least productive of all 3
groups.
• Children in this group also made more
demands on the leader, showed little
cooperation & were unable to work
independently

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Use :
• Authoriarian style: if a group member
lacks knowledge about a certain
procedure
• Participative style : with group
members who understand the
objectives & their role in task
• Delegative style : if the group member
knows more than you do about the task

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• Good leaders use all 3 styles, with 1 of
them normally dominant, bad leaders tend
to stick with the one style of autocratic
• Great leaders need to adapt & change
based upon the objectives, need of goup
members, & situational factors

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