ALCOHOLISM AND ADDICTIONS IN THE FAMILY AND SOCIETY

INSTRUCTOR: JEAN BASILE LMSW, CASAC

Statistics

22.2 million people are addicted to alcohol & other drugs15.4 million to alcohol alone3.6 million to illicit drugs – no alcoholAddiction to alcohol & drugs is a chronic, progressive illness that is fatal if untreated & is

genetically predisposed.$400 billion annual cost of alcohol & drug problems such as productivity, accidents etc..85,000 annual deaths due to alcohol

Impact on Family & ChildrenAddiction to alcohol & drugs is a family disease18$ of adults (1 in 5) have alcoholism in the family38% of adults have 1 relative with alcoholism76 million (4 out of 10) are affected by alcoholism10 million are married to someone w/ alcoholism27 million Children of Alcoholics (COA’s) and it is estimated that 11 million are under the age

of 1813-25% of children of Alcoholics develop alcoholism.

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The Definition of Addiction

• An addiction is a persistent behavioral pattern marked by physical and/or psychological dependency that causes significant disruption and negatively impacts the quality of life. Addictions are frequently linked to substance abuse, particularly psychoactive drugs such as narcotics, stimulants, and sedatives etc. It also encompass apparent compulsive behaviors.

• In the medical model, an addiction is a chronic neurobiological disorder that has genetic, psychosocial, and environmental dimensions and is characterized by one of the following: the continued use of a substance despite its detrimental effects, impaired control over the use of a drug (compulsive behavior), and preoccupation with a drug's use for non-therapeutic purposes (i.e. craving the drug).

DEPENDENCE VERSUS ABUSE DIAGNOSIS• Answering ‘Yes’ to at least 3 of the following seven questions meets the medical definition of

addiction/dependence based on the of American Psychiatric Association (DSM-IV) and the World Health Organization (ICD-10) criteria.(1) . Most questions have more than one part, because everyone behaves slightly differently in addiction. You only need to answer yes to one part for that question to count as a positive response.

• Tolerance. Has your use of drugs or alcohol increased over time?• Withdrawal. When you stop using, have you ever experienced physical or emotional withdrawal? Have you

had any of the following symptoms: irritability, anxiety, shakes, sweats, nausea, or vomiting?• Difficulty controlling your use. Do you sometimes use more or for a longer time than you would like? Do you

sometimes drink to get drunk? Do you stop after a few drink usually, or does one drink lead to more drinks?• Negative consequences. Have you continued to use even though there have been negative consequences to

your mood, self-esteem, health, job, or family?• Neglecting or postponing activities. Have you ever put off or reduced social, recreational, work, or

household activities because of your use?• Spending significant time or emotional energy. Have you spent a significant amount of time obtaining,

using, concealing, planning, or recovering from your use? Have you spend a lot of time thinking about using? Have you ever concealed or minimized your use? Have you ever thought of schemes to avoid getting caught?

• Desire to cut down. Have you sometimes thought about cutting down or controlling your use? Have you ever made unsuccessful attempts to cut down or control your use?

• If you answered yes to at least 3 of these questions, then you meet the medical definition of addiction. This definition is based on the of American Psychiatric Association (DSM-IV) and the World Health Organization (ICD-10) criteria.(1)

• www.AddictionsAndRecovery.org

• Some people aren't addicted to drugs or alcohol, but abuse them. The American Psychiatric Association (DSM-IV) definition of substance abuse is at least one of the following four criteria.

• Continued use despite social or interpersonal problems.• Repeated use resulting in failure to fulfill obligations at

work, school, or home.• Repeated use resulting in physically hazardous situations.• Use resulting in legal problems.• However, the term addiction has spread to include

psychological dependence which refers to behaviors that are not generally recognized by the medical community but a recurring compulsion which an individual to engages in a specific activity, despite harmful consequences to the users individual health, mental state, or social life.

• Many people now feel that there should be accommodation made to include psychological dependency on such things as gambling, food, sex, pornography, computers, work, exercise, spiritual obsession (as opposed to religious devotion), pain, self injury, and shopping. These behaviors count as 'addictions' as well and cause guilt, shame, fear, hopelessness, failure, rejection, anxiety, or humiliation symptoms associated with, among other medical conditions, depression and anxiety. Although, the above mentioned are things or tasks which, when used or performed, do not fit into the traditional view of addiction and may be better defined as an obsessive–compulsive disorder, withdrawal symptoms may occur with abatement of such behaviors. It is said by those who adhere to a traditionalist view that these withdrawal-like symptoms are not strictly reflective of an addiction, but rather of a behavioral disorder; however are treated therapeutically as addictions.

• Addiction may affect each family member or friend differently. Children of an addict may feel guilty and responsible for the problem and may feel different from their peers. These children often experience depression and low self-esteem. Many of them attempt to deflect attention from the addiction by either acting too perfect (such as obsessing over impeccable grades) or by acting out with behaviors such as lying, stealing, fighting, or truancy.

• Friends of an addict may become hurt or angry as the addicted person turns away from them to seek friends with similar patterns of using, or isolates himself from previous interests and activities. Friends may also deny that there is a problem, and join the addict in binge drinking, or encouraging them to use drugs, or making excuses to a boss, teacher, or other friends.

• An addict’s spouse tends to become more preoccupied with the problems of the user than with her own health and well-being. The spouse very often denies her own interests, hobbies, and friends in order to focus on the ill person. Much time and effort is spent trying to keep things under control by protecting the addict from the consequences of abusing substances. A wife may hide alcohol from her addicted husband or call in sick when he is under the influence or hung over. A husband may offer unwanted advice or try to problems solve. Spouses frequently deny that the problem is serious, justifying it by convincing themselves that “things aren’t that bad – everyone has problems”. Ultimately, the spouse may suffer from low self-esteem, anger, and depression.

• When an addiction first begins, it’s normal for friends and family to rationalize the dependency and protect the dependent person. But over time, this behavior can negatively affect everyone involved. Family members, and even close friends, of an addict need treatment and or self help groups in order to begin to improve their own lives.

• How Addiction Affects You and Your Family-from AlAnon Addiction is not just about the drinking, drug or food use, it also profoundly affects their thinking and behavior. Ultimately it affects every aspect of their lives including their loved ones. Over time it gradually affects thinking and behavior until you reach the point where you wonder how you got to be the person you've become. You become preoccupied with the addict's drinking, eating or using either by obsessing about it and ways to control it, or by trying to numb yourself to it and its effects. You begin to question yourself and your perceptions of what's normal. You may feel like and even be accused of being the “crazy” one. This sometimes paralyzes us from taking action regarding our loved ones addiction. You tolerate negative behavior and find yourself behaving in ways that you later regret; all the while hoping the situation will get better even as it continues to get worse. Does this sound familiar? As a result of the denial, which is the hallmark of the disease, you tell yourself it's not that bad. You cover up for the addict or try to punish them for their behavior. Your life becomes centered around the addiction. When this occurs it limits your ability to be emotionally available to your children or other loved ones in your life, they too become casualties of the disease. You reach a point where you're not certain how or why things have changed, but it has and the love and caring in your family has been lost, and you settle for less.

• The good news is the addiction is treatable for you, your family, and the addict in your life. You don't have to go on living your life controlled by the addiction.

• About Alcoholism Alcoholism is a primary, chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. The disease is often progressive and fatal. It is characterized by continuous or periodic: impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking, most notably denial.

The disease persists over time. Physical, emotional, and social changes are often cumulative and may progress as drinking continues. Alcoholism causes premature death through overdose, health complications involving the brain, liver, heart and many other organs, and by contributing to suicide, homicide, motor vehicle crashes, and other traumatic events.

Preoccupation with alcohol use indicates excessive, focused attention given to the drug alcohol, its effects, and/or its use. The importance placed on alcohol by the individual often leads to a diversion of energies away from important life concerns such as work, hobbies, family and children.

• About Alcoholism Alcoholism is a primary, chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. The disease is often progressive and fatal. It is characterized by continuous or periodic: impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking, most notably denial.

The disease persists over time. Physical, emotional, and social changes are often cumulative and may progress as drinking continues. Alcoholism causes premature death through overdose, health complications involving the brain, liver, heart and many other organs, and by contributing to suicide, homicide, motor vehicle crashes, and other traumatic events.

Preoccupation with alcohol use indicates excessive, focused attention given to the drug alcohol, its effects, and/or its use. The importance placed on alcohol by the individual often leads to a diversion of energies away from important life concerns such as work, hobbies, family and children.

• Alcohol-related problems or impairments include: physical health (e.g., alcohol withdrawal syndromes, liver disease, gastritis, anemia, neurological disorders); psychological functioning (e.g., impairments in cognition, changes in mood and behavior); interpersonal functioning (e.g., marital problems and child abuse, impaired social relationships); occupational functioning (e.g., scholastic or job problems); and legal, financial, or spiritual problems.

Denial includes a range of psychological maneuvers designed to reduce awareness (by themselves and others) of the fact that alcohol use is the cause of an individual's problems rather than a solution to those problems. Denial becomes an integral part of the disease and a major obstacle to recovery.

Source: National Council on Alcoholism and Drug Dependence, Inc.• Post-Acute Withdrawal Syndrome

Post Acute Withdrawal Syndrome (PAWS) is a set of impairments that occur immediately after withdrawal from alcohol or other substances. The condition lasts from six to eighteen months after the last use and is marked by a fluctuating but incrementally improving course. It has importance to the recovering addict's ability to profit from recovery, treatment, function effectively on the job, interact with family and friends, and regain emotional health. Read more about PAWS

• Erikson's Theory of Psychosocial Development Psychosocial Development in Infancy and Early Childhood By Kendra Cherry, About.com Guide

• What is Psychosocial Development?• Erik Erikson’s1 theory of psychosocial development is one of the best-known theories of

personality in psychology2. Much like Sigmund Freud3, Erikson believed that personality develops in a series of stages. But, unlike Freud’s theory of psychosexual stages4, Erikson’s theory describes the impact of social experience across the whole lifespan.

One of the main elements of Erikson’s psychosocial stage theory is the development of ego identity.1 Ego identity is the conscious sense of self that we develop through social interaction. According to Erikson, our ego identity is constantly changing due to new experiences and information we acquire in our daily interactions with others. In addition to ego identity, Erikson also believed that a sense of competence also motivates behaviors and actions. Each stage in Erikson’s theory is concerned with becoming competent in an area of life. If the stage is handled well, the person will feel a sense of mastery, which is referred to as ego strength or ego quality.2 If the stage is managed poorly, the person will emerge with a sense of inadequacy.

In each stage, Erikson believed people experience a conflict5 that serves as a turning point in development. In Erikson’s view, these conflicts are centered on either developing a psychological quality or failing to develop that quality. During these times, the potential for personal growth is high, but so is the potential for failure.

• Psychosocial Stage 1 - Trust vs. Mistrust• The first stage of Erikson’s theory of psychosocial development occurs between birth and one year

of age and is the most fundamental stage in life.2

• Because an infant is utterly dependent, the development of trust is based on the dependability and quality of the child’s caregivers.

• If a child successfully develops trust, he or she will feel safe and secure in the world. Caregivers who are inconsistent, emotionally unavailable, or rejecting contribute to feelings of mistrust in the children they care for. Failure to develop trust will result in fear and a belief that the world is inconsistent and unpredictable.

• Psychosocial Stage 2 - Autonomy vs. Shame and Doubt• The second stage of Erikson's theory of psychosocial development takes place during early

childhood and is focused on children developing a greater sense of personal control.2

• Like Freud, Erikson believed that toilet training was a vital part of this process. However, Erikson's reasoning was quite different then that of Freud's. Erikson believe that learning to control one’s body functions leads to a feeling of control and a sense of independence.

• Other important events include gaining more control over food choices, toy preferences, and

clothing selection.

• Children who successfully complete this stage feel secure and confident, while those who do not are left with a sense of inadequacy and self-doubt.

• Psychosocial Stage 3 - Initiative vs. Guilt• During the preschool years, children begin to assert their power and control over the world

through directing play and other social interaction.• Children who are successful at this stage feel capable and able to lead others. Those who fail to

acquire these skills are left with a sense of guilt, self-doubt and lack of initiative.3

• Psychosocial Stage 4 - Industry vs. Inferiority• This stage covers the early school years from approximately age 5 to 11.

• Through social interactions, children begin to develop a sense of pride in their accomplishments and abilities.

• Children who are encouraged and commended by parents and teachers develop a feeling of competence and belief in their skills. Those who receive little or no encouragement from parents, teachers, or peers will doubt their ability to be successful.

• Psychosocial Stage 5 - Identity vs. Confusion• During adolescence, children are exploring their independence and developing a sense of self.

• Those who receive proper encouragement and reinforcement through personal exploration will emerge from this stage with a strong sense of self and a feeling of independence and control. Those who remain unsure of their beliefs and desires will insecure and confused about themselves and the future.

• Psychosocial Stage 6 - Intimacy vs. Isolation• This stage covers the period of early adulthood when people are exploring personal relationships.

• Erikson believed it was vital that people develop close, committed relationships with other people. Those who are successful at this step will develop relationships that are committed and secure.

• Remember that each step builds on skills learned in previous steps. Erikson believed that a strong sense of personal identity was important to developing intimate relationships. Studies have demonstrated that those with a poor sense of self tend to have less committed relationships and are more likely to suffer emotional isolation, loneliness, and depression.

• Psychosocial Stage 7 - Generativity vs. Stagnation• During adulthood, we continue to build our lives, focusing on our career and family. • Those who are successful during this phase will feel that they are contributing to the world by being active in

their home and community. Those who fail to attain this skill will feel unproductive and uninvolved in the world.

• Psychosocial Stage 8 - Integrity vs. Despair • This phase occurs during old age and is focused on reflecting back on life.

• Those who are unsuccessful during this phase will feel that their life has been wasted and will experience many regrets. The individual will be left with feelings of bitterness and despair.

• Those who feel proud of their accomplishments will feel a sense of integrity. Successfully completing this phase means looking back with few regrets and a general feeling of satisfaction. These individuals will attain wisdom, even when confronting death.

Psychosexual Development

• According to Sigmund Freud1, personality is mostly established by the age of five. Early experiences play a large role in personality development and continue to influence behavior later in life.

• Freud's theory of psychosexual development is one of the best known and one of the most controversial. Freud believed that personality develops through a series of childhood stages during which the pleasure-seeking energies of the id2 become focused on certain erogenous areas. This psychosexual energy, or libido is described as the driving force behind behaviors.

• If these psychosexual stages are completed successfully, the result is a healthy personality. If certain issues are not resolved at the appropriate stage, fixation4 can occur. A fixation is a persistent focus on an earlier psychosexual stage. Until this conflict is resolved, the individual will remain "stuck" in this stage. For example, a person who is fixated at the oral stage may be over-dependent on others and may seek oral stimulation through smoking, drinking, or eating.

• The Oral Stage• During the oral stage1, the infant's primary source of interaction occurs through the mouth, so the

rooting and sucking reflex is especially important. The mouth is vital for eating, and the infant derives pleasure from oral stimulation through gratifying activities such as tasting and sucking. Because the infant is entirely dependent upon caretakers (who are responsible for feeding the child), the infant also develops a sense of trust and comfort through this oral stimulation.

The primary conflict at this stage is the weaning process--the child must become less dependent upon caretakers. If fixation occurs at this stage, Freud believed the individual would have issues with dependency or aggression. Oral fixation can result in problems with drinking, eating, smoking, or nail biting.

• The Anal Stage• During the anal stage1, Freud believed that the primary focus of the libido was on controlling bladder and bowel movements. The major

conflict at this stage is toilet training--the child has to learn to control his or her bodily needs. Developing this control leads to a sense of accomplishment and independence.

According to Freud, success at this stage is dependent upon the way in which parents approach toilet training. Parents who utilize praise and rewards for using the toilet at the appropriate time encourage positive outcomes and help children feel capable and productive. Freud believed that positive experiences during this stage served as the basis for people to become competent, productive, and creative adults.

However, not all parents provide the support and encouragement that children need during this stage. Some parents' instead punish, ridicule, or shame a child for accidents. According to Freud, inappropriate parental responses can result in negative outcomes. If parents take an approach that is too lenient, Freud suggested that an anal-expulsive personality could develop in which the individual has a messy, wasteful, or destructive personality. If parents are too strict or begin toilet training too early, Freud believed that an anal-retentive personality develops in which the individual is stringent, orderly, rigid, and obsessive.

• The Phallic Stage• During the phallic stage1, the primary focus of the libido is on the genitals. Children also discover the differences between males and

females. Freud also believed that boys begin to view their fathers as a rival for the mother’s affections. The Oedipus complex2 describes these feelings of wanting to possess the mother and the desire to replace the father. However, the child also fears that he will be punished by the father for these feelings, a fear Freud termed castration anxiety.

The term Electra complex3 has been used to described a similar set of feelings experienced by young girls. Freud, however, believed that girls instead experience penis envy.

Eventually, the child begins to identify with the same-sex parent as a means of vicariously possessing the other parent. For girls, however, Freud believed that penis envy is never fully resolved and that all women remain somewhat fixated on this stage. Psychologists such as Karen Horney4 disputed this theory, calling it both inaccurate and demeaning to women. Instead, Horney proposed that men experience feelings of inferiority because they cannot give birth to children.

• The Latent Period• During the latent period, the libido interests are suppressed. The development of the ego and superego contribute to this period of calm.

The stage begins around the time that children enter into school and become more concerned with peer relationships, hobbies, and other interests.

The latent period is a time of exploration in which the sexual energy is still present, but it is directed into other areas such as intellectual pursuits and social interactions. This stage is important in the development of social and communication skills and self-confidence.

• The Genital Stage• During the final stage of psychosexual development, the individual develops a strong sexual interest

in the opposite sex. Where in earlier stages the focus was solely on individual needs, interest in the welfare of others grows during this stage. If the other stages have been completed successfully, the individual should now be well-balanced, warm, and caring. The goal of this stage is to establish a balance between the various life areas.

• The Conscious and Unconscious Mind: The Structure of the Mind According to Freud By Kendra Cherry, About.com Guide

• Many of us have experienced what is commonly referred to as a Freudian slip1. These misstatements are believed to reveal underlying, unconscious thoughts or feelings.

Before we can understand Freud's theory of personality, we must first understand his view of how the mind is organized.

According to Freud, the mind can be divided into two main parts: • The conscious mind2 includes everything that we are aware of. This is the aspect of our mental

processing that we can think and talk about rationally. A part of this includes our memory, which is not always part of consciousness but can be retrieved easily at any time and brought into our awareness. Freud called this ordinary memory the preconscious.3

• The unconscious mind4 is a reservoir of feelings, thoughts, urges, and memories that outside of our conscious awareness. Most of the contents of the unconscious are unacceptable or unpleasant, such as feelings of pain, anxiety, or conflict. According to Freud, the unconscious continues to influence our behavior and experience, even though we are unaware of these underlying influences.

• The Structural Model of Personality - The Id, Ego, and Superego5

• By Kendra Cherry, About.com Guide• According to Sigmund Freud's1 psychoanalytic theory of personality, personality is composed

of three elements. These three elements of personality--known as the id, the ego and the superego--work together to create complex human behaviors.

• The Id2

• The id is the only component of personality that is present from birth. This aspect of personality is entirely unconscious and includes of the instinctive and primitive behaviors. According to Freud, the id is the source of all psychic energy, making it the primary component of personality.

The id is driven by the pleasure principle3, which strives for immediate gratification of all desires, wants, and needs. If these needs are not satisfied immediately, the result is a state anxiety or tension. For example, an increase in hunger or thirst should produce an immediate attempt to eat or drink. The id is very important early in life, because it ensures that an infants needs are met. If the infant is hungry or uncomfortable, he or she will cry until the demands of the id are met.

However, immediately satisfying these needs is not always realistic or even possible. If we were ruled entirely by the pleasure principle, we might find ourselves grabbing things we want out of other people's hands to satisfy our own cravings. This sort of behavior would be both disruptive and socially unacceptable. According to Freud, the id tries to resolve the tension created by the pleasure principle through the primary process,4 which involves forming a mental image of the desired object as a way of satisfying the need.

• The Ego5

• The ego is the component of personality that is responsible for dealing with reality. According to Freud, the ego develops from the id and ensures that the impulses of the id can be expressed in a manner acceptable in the real world. The ego functions in both the conscious6, preconscious7, and unconscious8 mind.

The ego operates based on the reality principle9, which strives to satisfy the id's desires in realistic and socially appropriate way. The reality principle weighs the costs and benefits of an action before deciding to act upon or abandon impulses. In many cases, the id's impulses can be satisfied through a process of delayed gratification--the ego will eventually allow the behavior, but only in the appropriate time and place.The ego also discharges tension created by unmet impulses through the secondary process10, in which the ego tries to find an object in the real world that matches the mental image created by the id's primary process.

• The Superego11

• The last component of personality to develop is the superego. The superego is the aspect of personality that holds all of our internalized moral standards and ideals that we acquire from both parents and society--our sense of right and wrong. The superego provides guidelines for making judgments. According to Freud, the superego begins to emerge at around age five.

There are two parts of the superego: • The ego ideal12 includes the rules and standards for good behaviors. These behaviors include those which are approved of by parental

and other authority figures. Obeying these rules leads to feelings of pride, value, and accomplishment. • The conscience13 includes information about things that are viewed as bad by parents and society. These behaviors are often forbidden

and lead to bad consequences, punishments, or feelings of guilt and remorse.• The superego acts to perfect and civilize our behavior and suppress all unacceptable urges of the id and struggles to make the ego act

upon idealistic standards rather that upon realistic principles. The superego is present in the conscious, preconscious, and unconscious. • The superego acts to perfect and civilize our behavior. It works to suppress all unacceptable urges of the id and struggles to make the

ego act upon idealistic standards rather that upon realistic principles. The superego is present in the conscious, preconscious, and unconscious.

• The Interaction of the Id, Ego, and Superego• With so many competing forces, it is easy to see how conflict might arise between the id, ego, and superego. Freud used the term

ego strength14 to refer to the ego's ability to function despite these dueling forces. A person with good ego strength is able to effectively manage these pressures, while those with too much or too little ego strength can become too unyielding or too disrupting.

According to Freud, the key to a healthy personality is a balance between the id, the ego, and the superego.

• Piaget's Theory• Stages of Cognitive Development• By Kendra Cherry, About.com Guide• Jean Piaget's Background• Jean Piaget concluded that children were not less intelligent than adults, they simply think differently. Albert Einstein called

Piaget’s discovery "so simple only a genius could have thought of it."• Piaget's stage theory describes the cognitive development of children. Cognitive development involves changes in cognitive

process and abilities. In Piaget’s view, early cognitive development involves processes based upon actions and later progresses into changes in mental operations.

• Key Concepts• Schemas - A schema describes both the mental and physical actions involved in understanding and knowing. Schemas are

categories of knowledge that help us to interpret and understand the world. In Piaget's view, a schema includes both a category of knowledge and the process of obtaining that knowledge. As experiences happen, this new information is used to modify, add to, or change previously existing schemas. For example, a child may have a schema about a type of animal, such as a dog. If the child's sole experience has been with small dogs, a child might believe that all dogs are small, furry, and have four legs. Suppose then that the child encounters a very large dog. The child will take in this new information, modifying the previously existing schema to include this new information.

• Assimilation - The process of taking in new information into our previously existing schema’s is known as assimilation. The process is somewhat subjective, because we tend to modify experience or information to fit in with our preexisting beliefs. In the example above, seeing a dog and labeling it "dog" is an example of assimilating the animal into the child's dog schema.

• Accommodation - Another part of adaptation which involves changing or altering our existing schemas in light of new information. Accommodation involves altering existing schemas, or ideas, as a result of new information or new experiences. New schemas may also be developed during this process.

• Equilibration - Piaget believed that all children try to strike a balance between assimilation and accommodation. As children progress through the stages of cognitive development, it is important to maintain a balance between applying previous knowledge (assimilation) and changing behavior to account for new knowledge (accommodation). Equilibration helps explain how children are able to move from one stage of thought into the next.

• More About Piaget's Stages of Cognitive Development• The Sensorimotor Stage2

• The Preoperational Stage3

• The Concrete Operational Stage4

• The Formal Operational Stage5

• Characteristics of the Sensorimotor Stage:• The first stage of Piaget’s theory lasts from birth to approximately age two and is centered on the infant trying to make

sense of the world. During the sensorimotor stage, an infant’s knowledge of the world is limited to their sensory perceptions and motor activities. Behaviors are limited to simple motor responses caused by sensory stimuli. Children utilize skills and abilities they were born with, such as looking, sucking, grasping, and listening, to learn more about the environment.

• Substages of the Sensorimotor Stage:• The sensorimotor stage can be divided into six separate substages that are characterized by the development of a new

skill. • Reflexes (0-1 month):• During this substage, the child understands the environment purely through inborn reflexes such as sucking and looking.• Primary Circular Reactions (1-4 months):• This substage involves coordinating sensation and new schemas. For example, a child may such his or her thumb by

accident and then later intentionally repeat the action. These actions are repeated because the infant finds them pleasurable.

• Secondary Circular Reactions (4-8 months):• During this substage, the child becomes more focused on the world and begins to intentionally repeat an action in order to

trigger a response in the environment. For example, a child will purposefully pick up a toy in order to put it in his or her mouth.

• Coordination of Reactions (8-12 months):• During this substage, the child starts to show clearly intentional actions. The child may also combine schemas in order to

achieve a desired effect. Children begin exploring the environment around them and will often imitate the observed behavior of others. The understanding of objects also begins during this time and children begin to recognize certain objects as having specific qualities. For example, a child might realize that a rattle will make a sound when shaken.

• Tertiary Circular Reactions (12-18 months):• Children begin a period of trial-and-error experimentation during the fifth substage. For example, a child may try out

different sounds or actions as a way of getting attention from a caregiver. • Early Representational Thought (18-24 months):• Children begin to develop symbols to represent events or objects in the world in the final sensorimotor substage. During

this time, children begin to move towards understanding the world through mental operations rather than purely through actions.

• Characteristics of the Preoperational Stage:

The preoperational stage occurs between ages two and six. Language development is one of the hallmarks of this period. Piaget noted that children in this stage do not yet understand concrete logic, cannot mentally manipulate information, and are unable to take the point of view of other people, which he termed egocentrism.

• During the preoperational stage, children also become increasingly adept at using symbols, as evidenced by the increase in playing and pretending. For example, a child is able to use an object to represent something else, such as pretending a broom is a horse. Role playing also becomes important during the preoperational stage. Children often play the roles of "mommy," "daddy," "doctor," and many others.

• Egocentrism:Piaget used a number of creative and clever techniques to study the mental abilities of children. One of the famous techniques egocentrism involved using a three-dimensional display of a mountain scene. Children are asked to choose a picture that showed the scene they had observed. Most children are able to do this with little difficulty. Next, children are asked to select a picture showing what someone else would have observed when looking at the mountain from a different viewpoint.

• Invariably, children almost always choose the scene showing their own view of the mountain scene. According to Piaget, children experience this difficulty because they are unable to take on another person's perspective.

• Conservation:Another well-known experiment involves demonstrating a child's understanding of conservation. In one conservation experiment, equal amounts of liquid are poured into two identical containers. The liquid in one container is then poured into a different shaped cup, such as a tall and thin cup, or a short and wide cup. Children are then asked which cup holds the most liquid. Despite seeing that the liquid amounts were equal, children almost always choose the cup that appears fuller.

• Piaget conducted a number of similar experiments on conservation of number, length, mass, weight, volume, and quantity. Piaget found that few children showed any understanding of conservation prior to the age of five.

• Characteristics of Concrete Operations:• The concrete operational stage begins around age seven and continues until approximately age eleven. During this time, children gain

a better understanding of mental operations. Children begin thinking logically about concrete events, but have difficulty understanding abstract or hypothetical concepts.

• Logic:• Piaget determined that children in the concrete operational stage were fairly good at the use of inductive logic. Inductive logic

involves going from a specific experience to a general principle. On the other hand, children at this age have difficulty using deductive logic, which involves using a general principle to determine the outcome of a specific event.

• Reversibility:• One of the most important developments in this stage is an understanding of reversibility, or awareness that actions can be reversed.

An example of this is being able to reverse the order of relationships between mental categories. For example, a child might be able to recognize that his or her dog is a Labrador, that a Labrador is a dog, and that a dog is an animal.

• Characteristics of the Formal Operational Stage:• The formal operational stage begins at approximately age twelve to and lasts into adulthood. During this time, people develop the ability to

think about abstract concepts. Skills such as logical thought, deductive reasoning, and systematic planning also emerge during this stage.• Logic:• Piaget believed that deductive logic becomes important during the formal operational stage. Deductive logic requires the ability to use a

general principle to determine a specific outcome. This type of thinking involves hypothetical situations and is often required in science and mathematics.

• Abstract Thought:• While children tend to think very concretely and specifically in earlier stages, the ability to think about abstract concepts emerges during the

formal operational stage. Instead of relying solely on previous experiences, children begin to consider possible outcomes and consequences of actions. This type of thinking is important in long-term planning.

• Problem-Solving:• In earlier stages, children used trial-and-error to solve problems. During the formal operational stage, the ability to systematically solve a

problem in a logical and methodical way emerges. Children at the formal operational stage of cognitive development are often able to quickly plan an organized approach to solving a problem.

• Piaget's Theory For Parents• LifeScript Connect Contributor• Piaget’s theory of cognitive development was established by Swiss psychologist Jean Piaget (1896-1980), who believed strongly that the

growth of intelligence in children occurred in stages. He helped to pioneer the field of developmental psychology in general, and cognitive development in particular. The primary objective for this field of study was to explore the ways in which children grow and learn about the world around them, and then learn to interact with others within it. Piaget’s theory differed from empiricist theories of development, which suggest that children learn through experience, and nativist theories that maintain we are born with innate knowledge that gradually comes to maturation. Piaget’s theory focused on the building block approach, whereby children learned how to interact with the world by moving through four distinct phases. During this time, they would master certain skills gradually, rather than all at once or in some cases, not at all.

Jean Piaget won the Erasmus Prize for his theory of cognitive development, which is based on the following four stages:

1. Sensorimotor stage, ages 0-2• 2. Preoperational stage, ages 2-7• 3. Concrete operational stage, ages 7-11• 4. Formal operational stage, ages 11 to adulthood

Each stage represents a key aspect of a child’s mental or cognitive developmental processes. Below is a basic description for each of these developmental stages.

Duplicate - Piaget

• Piaget’s theory of cognitive development was established by Swiss psychologist Jean Piaget (1896-1980), who believed strongly that the growth of intelligence in children occurred in stages. He helped to pioneer the field of developmental psychology in general, and cognitive development in particular. The primary objective for this field of study was to explore the ways in which children grow and learn about the world around them, and then learn to interact with others within it. Piaget’s theory differed from empiricist theories of development, which suggest that children learn through experience, and nativist theories that maintain we are born with innate knowledge that gradually comes to maturation. Piaget’s theory focused on the building block approach, whereby children learned how to interact with the world by moving through four distinct phases. During this time, they would master certain skills gradually, rather than all at once or in some cases, not at all.

Jean Piaget won the Erasmus Prize for his theory of cognitive development, which is based on the following four stages:

1. Sensorimotor stage, ages 0-2• 2. Preoperational stage, ages 2-7• 3. Concrete operational stage, ages 7-11• 4. Formal operational stage, ages 11 to adulthood

Each stage represents a key aspect of a child’s mental or cognitive developmental processes. Below is a basic description for each of these developmental stages.

• 1. Sensorimotor StageIn the earliest stage of development, children experience six sub-stages of spatial and sensory learning and growth.

The first sub-stage as outlined is the reflex schema stage comprises the first six weeks of life. According to Gruber and Vaneche, this stage is characterized by the development of three key reflexes. One is the ability to suck, which is required for nursing activity that allows the child to access and drink milk or other fluids.

• Another reflex is following moving objects with the eyes as the infant begins to notice things around him. The third is the palmar reflex, which is manifested in the baby’s grasp of objects placed in its palm.

The second sub-stage takes place between six weeks and four months of age. According to Gruber, this is the circular or reaction stage when infants begin to repeat motions that will become habits, such as moving a hand or foot in a similar movement from time to time. Passive reactions, called classical or operant conditioning, emerge at this stage, as well.

The third sub-stage occurs when the infant is between five and nine months old. This is called the secondary circular reactions stage; coordination begins to develop between comprehension and vision. Three new skills become evident. One is the repeated reaching toward an object. The second is a secondary repeating motion respecting an external object. Lastly, an awareness of distinguishing methods and means of accomplishing a task also becomes apparent. A budding logic is evidenced and the child understands there is more than one way to do things.

With the dawn of the fourth sub-stage comes what Piaget believed to be the seeds of intelligence, or the coordination between means and ends. Goal orientation reveals a baby’s primitive planning to reach goals in a series of steps.

The tertiary reactions phase in the fifth sub-stage is established between twelve and eighteen months. The child learns to explore the world and conduct small experiments to learn how things work.

• In the sixth phase, the inventions of new means via mental combinations mark the beginning of actual insight, or creativity. Children will try new ideas and work on achieving their goals using complex and innovative methods. They no longer resort to simply crying to get their way. The eighteen-month-old child is capable of cajoling, sweet-talking or even exploitation to obtain what she wants. She has discovered that means are not concrete and can be manipulated to achieve desired results.

Imitation becomes an essential behavior that leads to mental symbolism. As the eye discerns the shape of an object and studies the function of that object, clarity is gained about what the object represents as well as what might be expected of it.

• 2. Preoperational Stage• Piaget’s theory denotes the preoperational stage as the second level of cognitive development. Late in the second year

of a child’s development, mental function changes to reveal a higher-order thinking skill. In this stage a child takes action on a particular object. This stage occurs between the ages of two and seven, and includes the following processes:

-Animism is demonstrated when children attribute living qualities to inanimate objects, like toys.

-Centration involves a child’s response to one aspect of a situation or object, such as the height versus the height and diameter of an object.

-Classification allows a child to combine similar objects in basic clusters according to shared criteria like size and color.• -Egocentrism is the child’s self-preoccupation and personal view that does not readily accept another person’s view.

-The inability to conserve reflects a child’s difficulty with concepts of volume, mass and number. For example, a wide cup and a tall cup holding the same amount of liquid could look different to a child eying the difference in height.

START HERE TO SEND: • -Intuitive thought reveals belief in something without understanding why one believes in it. This is a critical area for the

development of trust and faith in what others tell the child.

-Serialization is the ability to organize things by progression, such as by size, numerical values or color shadings.

-Symbolic functioning represents the ability to understand the meaning of something that is not physically there.

In understanding the skill acquisition of the preoperational stage, it becomes clear why the tasks typically associated with pre-school, kindergarten and the lower primary grades focus less on language development skills and more on the learning of colors, symbol identification such as the alphabet and numbers, and shapes.

• 3. The Concrete Operational Stage• The third stage of Piaget’s theory of cognitive development, the concrete operational stage, occurs between the ages of

seven and eleven, and illustrates logical thought processes.

-Conservation evolves so that a child retains the understanding of quantity, length or numbers associated with an object or process.

-Decentering is a child’s ability to comprehend multiple aspects of a problem while solving it.

-Elimination of egocentrism lets a child understand another person’s perspective, whether or not they are in agreement.• -Reversibility is the understanding that an object or number can change and then reverse into its original state.

The concrete operational stage is often the period of a child’s development when he understands the concepts of fairness, sharing, empathy, and compassion for another person’s plight. She learns to focus more on alternative perspectives and can see other possibilities to the problems or situations she faces.

• Formal Operational StagePiaget’s fourth and last stage of cognitive development begins at age 11 and continues into adulthood. This is the phase where children entering puberty begin to think abstractly and create meaning from available data. This critical fourth stage is responsible for creating global problem solvers and creative thinkers who can analyze a situation and not be confined by concrete ideas or previously accepted logic. Successful completion of the formal operational stage is evidenced by appreciation for dissenting views, a general lack of discrimination, creative viewpoints, and a confidence in one’s differences from the mainstream. These are the children who are marching to the beat of their own drum, even at an early age, or are comfortable coloring outside the lines not because they haven’t mastered their sensorimotor skills, but rather because they like the way the new lines look. As could be surmised, some experts believe that many people fail to successfully complete this stage to varying degrees. Many adults are bound by a rigid sense of order or sequential thinking that prohibits alternative solution development or limits their creative processes.

• Each of the four stages comprises new learning that builds upon prior skills and abilities. The four stages are believed to be universal rather than cultural, and follow the same sequence of development despite the variance of timing or geographic relevance.

• Hierarchy of Needs: The Five Levels of Maslow's Hierarchy of Needs By Kendra Cherry, About.com Guide

• Maslow's Hierarchy of Needs -J. Finkelstein• Psychologist Abraham Maslow first introduced his concept of a hierarchy of needs in his 1943

paper "A Theory of Human Motivation"1 and his subsequent book, Motivation and Personality.2 This hierarchy suggests that people are motivated to fulfill basic needs before moving on to other needs.

• Maslow’s hierarchy of needs is most often displayed as a pyramid. The lowest levels of the pyramid are made up of the most basic needs, while the more complex needs are located at the top of the pyramid. Needs at the bottom of the pyramid are basic physical requirements including the need for food, water, sleep and warmth. Once these lower-level needs have been met, people can move on to the next level of needs, which are for safety and security.

• As people progress up the pyramid, needs become increasingly psychological and social. Soon, the need for love, friendship and intimacy become important. Further up the pyramid, the need for personal esteem and feelings of accomplishment take priority. Like Carl Rogers, Maslow emphasized the importance of self-actualization, which is a process of growing and developing as a person to achieve individual potential.

• Types of Needs• Maslow believed that these needs are similar to instincts and play a major role in motivating

behavior. Physiological, security, social, and esteem needs are deficiency needs (also known as D-needs), meaning that these needs arise due to deprivation. Satisfying these lower-level needs is important in order to avoid unpleasant feelings or consequences.

• Maslow termed the highest-level of the pyramid as growth need (also known as being needs or B-needs). Growth needs do not stem from a lack of something, but rather from a desire to grow as a person.

• Five Levels of the Hierarchy of Needs• There are five different levels in Maslow’s hierarchy of needs:• Physiological Needs

These include the most basic needs that are vital to survival, such as the need for water, air, food and sleep. Maslow believed that these needs are the most basic and instinctive needs in the hierarchy because all needs become secondary until these physiological needs are met.

•Security NeedsThese include needs for safety and security. Security needs are important for survival, but they are not as demanding as the physiological needs. Examples of security needs include a desire for steady employment, health insurance, safe neighborhoods and shelter from the environment.

•Social NeedsThese include needs for belonging, love and affection. Maslow considered these needs to be less basic than physiological and security needs. Relationships such as friendships, romantic attachments and families help fulfill this need for companionship and acceptance, as does involvement in social, community or religious groups.

•Esteem NeedsAfter the first three needs have been satisfied, esteem needs becomes increasingly important. These include the need for things that reflect on self-esteem, personal worth, social recognition and accomplishment.

•Self-actualizing NeedsThis is the highest level of Maslow’s hierarchy of needs. Self-actualizing people are self-aware, concerned with personal growth, less concerned with the opinions of others and interested fulfilling their potential.

• CHARACTERISTICS OF A DYSFUNCTIONAL FAMILY• A family passes through predictable stages and develops methods of

taking care of its members and coping with environmental demands. Members of dysfunctional families can become locked in self-perpetuating pathological patterns during a transition. Common characteristics of such families include the following: -- One or more symptomatic members. -- Blurred generational boundaries. -- Confused communication patterns. -- Overprotection. -- Enmeshment, lack of autonomy or privacy. -- Denial of conflict except as it involves symptomatic member. -- Inability to resolve conflict. -- Submerged tension. -- Scapegoating. -- Low toleration for stress and physical illness. -- Fragmented, disjointed, isolated individuals. – Non-cohesive, noncommittal, pseudo-closeness. -- Schisms, with two or more alliances in conflict. -- Skewed relationships, isolation of one family member. -- Extreme positions by all members in an effort to differentiate. -- Lack of respect for individual differences.

• Family dysfunction may seriously interfere with children's developmental processes. Parents in such families are usually immobilized by pain from their past, fear of the present, and resistance to change.

Addiction in the family

• Here are a few ways that addiction impacts a family. • Addicted parents are distracted. An addicted person is much more interested in their substance – alcohol, drugs,

cigarettes, or shopping – than they are with almost anything else. Children need attention and reflection from their parents. If a parent’s attention is focused on something other than the child, the child might never get the reflection he or she needs to develop a healthy sense of self. Further, human predators (sexual and physical abusers, pornographers, kidnappers, etc.) prey almost primarily on children whose parents are distracted. Further, distracted parents are less likely to notice the change in their children after a human predator has hurt them.

• An addict uses up family resources. Often when a person becomes addicted, the family rallies to help the addict

get back on track. They might pay for alcohol and drug treatment and attorneys to clean up the wreckage created by the addiction. They might spend month’s worrying, caring, and attempting to help their family member “recover”. Still, every family has finite resources and addiction is not something that is easily solved. More times than not, as the addict works through their individual recovery including multiple relapses, legal involvement, loss of work or what ever path his addiction takes. Eventually, a family’s resources – including money, patience, kindness and time – are used up. In the meantime, as the family focuses on rescuing an addicted person, family resources are taken from other children, siblings and relationships. This leaves children without their parent’s attention, siblings disconnected from sibling support, and parents separated from each other. Families, who use all their resources helping the addict, are left with only exhaustion, frustration and financial strain.

• For every addict there is a codependent. Codependent people are the nicest people you will ever meet. They are giving and loving. In fact, that’s the problem. A codependent person will give of herself until all of her personal resources are gone. Often she will change herself to become what she believes you want her to be. Inside, a codependent person usually feels invisible, unworthy and completely alone. She might believe that she will only be loved for what she does, instead of who she is. She will then exhaust herself doing and never understand if someone loves her. Her internal world is filled with resentment, self-loathing, shame and anxiety. At her worst, she must control every person, place and thing in her life. Who becomes codependent? Children of addicts and alcoholics

• Playing a role for life • Addicted families organize around addiction. Children know to look for their parents at the bar.

Wives work to support their alcoholic husbands. Husbands buy drugs to keep their addicted wives “happy”. Children who grow up in alcoholic and addicted families learn to behave in predictable roles to keep the family functioning. Addicted family roles include: the scapegoat, little parent, hero, mascot, chief enabler, and lost child. For more information on these family roles, please click here

• Most children, who grow up playing one of these family roles, continue in that role as adults. Children who played the role of mascot become adults who struggle for someone to take them seriously. Many family heroes get to the end of medical school, law school or business school and wonder “is this all there is?”. The child who is the family scapegoat will grow up to be scapegoated at work. Lost children often disappear from families never to return. And little parents often choose not to have children, significant relationships or long term work because they are exhausted from raising their siblings.

• These roles are most often seen in the workplace because we tend to recreate our childhood environments at work. Lost children are usually the people who get “forgotten” on their birthday and overlooked for promotions. The work hero is the person who strives to be the very best employee the company has ever had. While the mascot’s ideas are never taken seriously, he does continue to facilitate

• fun and games. Of course, the little parent sends around birthday cards and arranges the work picnic. We have all seen the chief enabler working late, never saying “no” and facilitating even the most unreasonable deadline. Remember that guy that “needed to be fired” so that everyone else’s job was better? Well, after he was fired, someone else took his place as the scapegoat. It happens every time.

• Children of alcoholics and addicts will continue to act out their family role as adults. If you see yourself in any of these descriptions, you are probably continuing to act out your childhood role as an adult. This only leads to disrupted relationships, difficulties at work and long term unhappiness. Further, many people suffer and stay stuck rather than shift their family role.

Minuchin, Salvador: structural family therapy Directive, change-oriented through changing the family structure (transaction-governing rules of a family). A symptom services and is rooted in dysfunctional transactions, structure (boundaries).

• Key concepts:• Enmeshment encourages somatization, and disengagement, acting out. High resonance.• Ecological context: the family's church, schools, work, extended family members.• Sick child: family conflict defuser.• Common boundary problem: parents confuse spouse functions with parent functions.• Generic and idiosyncratic rules that regulate transactions govern structure.• Boundaries: can be diffuse (enmeshed), rigid (disengaged), or clear.• Power: determined by authority and responsibility for acting on it.• Coalitions: can be stable or detouring.• Families are constantly in transition, and transitional anxieties and lack of differentiation are sometimes mislabeled pathological.• A family will either dismiss the therapist's probes, assimilate to previous transaction patterns, or respond as to a novel situation, in which

case stress increases and the probe is restructuring.• Rigid triad: where parents habitually use a child to lightningrod conflict. Rigid boundary around the triad; common when the children have

severe psychosomatic problems.• A dysfunctional family is one that responds to inner or outer demands for change by stereotyping its functioning.• Clients move for three reasons: they are challenged in their perception of their reality, given alternative possibilities that make sense, or

self-reinforcing new relationships appear once they've tried out new alternatives. People need some support within a family to move into the unknown.

• Four sources of family stress: one member with extrafamilial forces, whole family with extrafamilial forces, transition points in the family's evolution, idiosyncratic problems.

• Sets: repeated family reactions to stress. Spontaneous sets: interpreted like enactments.• Goals: clear boundaries as gatekeepers, clear lines of authority, systems and subsystems (the parental one is where pathology begins),

increase flexibility to alternative transactions, help negotiate family life cycle transitions. Family mapping via diagram of current structure. Interventions include joining and accomodating (same process: joining emphasizes therapist's outer adjustment to family, accomodating therapist's inner adjustment; adopting family's affective style; joining from a distant position = teaching, advice), mimesis (imitation, or joining from a close position), tracking (of family communications and behavior, or joining from a median position), enactments that simulate transactions to be changed, detriangulation of IP by forming a coalition with him against a parent, maintenance (of the family's current structure), marking boundaries (when they are strengthened, the subsystem's functioning will increase), mimic IP to show that he's like the powerful therapist rather than deviant, make the IP a cotherapist to the overfunctioner, reframing in terms of structure or interaction, unbalancing by escalating stress, general restructuring techniques (e.g., rearranging how they sit, blocking certain transactions, working as a family insider). Not very insight- or multigeneration-oriented.

Satir, Virginia: humanistic family therapy• One of the founders of the MRI communications school. Emphasized the importance of giving families hope and building self-esteem in family

members.• Key concepts:• Turn roles into relationships, rules into guidelines.• Our similarities unite us, and our differences make us grow.• A symptom may be distorting self-growth by trying to alleviate family pain; symptoms are a light on the dashboard or a ticket into therapy. Broken

families follow broken rules. Pathology is a deficit in growth. What growth price does each part of the system pay to keep the overall balanced? "Rupture point": where coping skills fail and family needs to change.

• Primary triad (mother, father, child) is source of self-identity.• Mind, soul, body triad: a current basis of self-identity.• Self, the core, has eight levels: physical, intellectual, emotional, sensual, interactional, contextual, nutritional, and spiritual. A good therapist works

on all levels. • Five communication stances: placater, blamer, super-reasonable, irrelevant, and congruent (or leveling) communicator. The first four are mostly

poses covering lack of self-worth.• Three parts to every communication: me, you, context. Dysfunctional communications leave one of these out of account.• Games: rescue games, coalition games, lethal games, growth games.• The five freedoms: to see and hear what is here instead of what should be, was, or will be; to say what one feels and thinks, instead of what one

should; to feel what one feels, instead of what one ought; to ask for what one wants, instead of always waiting for permission; to take risks in one's own behalf, instead of choosing to be only "secure" and not rocking the boat.

• Maturation: development of a clear identity and power of choice; self-relatedness; ability to communicate with others. Coping skills increase with self-esteem.

• "Threat and Reward" (rule-makers/followers; rigid roles) vs. "Seed" (innate growth potential) worldviews.• Five components of self-esteem: security, belonging, competence, direction, selfhood.• In a dysfunctional family, symptomatic behavior makes sense. It is also covertly rewarded.• Interventions: reduce individual and family pain. Family life chronology (three generations). Communication work and esteem building. Growth.

Identification of family roles, and turning these into relationships. Family reconstruction: an exercise in which roles in significant family historical events are directed by the Explorer, who is led by the Guide. Look at implicit premises that guide perceptions and interactions. Analysis of how family members handle differentness. Cut games, straighten transactions. Self-manifestation (congruence) analysis. Model analysis of which models have impacted early on. Expand experiencing and choice-making. Parts party: awareness and exercise of mind and body. Sculpting (group posture) technique. Labeling assets. Use of drama, metaphor, art, stories, self.

• Criteria for termination: when family members can complete transactions, check, ask; can interpret hostility; can see how others see them; can see how they see themselves; can tell each other how he manifests himself; can tell other member what he hopes, fears, expects from the other; can disagree; can make choices; can learn through practice; can free selves from harmful effects of past models; can give a clear message, be congruent.

• Second-order change: a change that fundamentally impacts the system, thereby taking it to a new level of functioning.