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Discussion 6

Part A

As you keep in mind that this activity is in addition to the discussion topic thread, please complete for 15 extra credit points. What are the four domains of Emotional Intelligence? using this link share what competencies you believe are strengths and which ones can be developed.

Part B

List the components of a relational database and how they are used for Python programming.

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Discussion 6

Pressure Injury Management

©2020 American Association of Critical-Care Nurses

Background Hospital-acquired pressure injuries dispropor-
tionately affect critical care patients. Although risk factors
such as moisture, illness severity, and inadequate perfu-
sion have been recognized, nursing skin assessment data
remain unexamined in relation to the risk for hospital-
acquired pressure injuries.
Objective To identify factors associated with hospital-
acquired pressure injuries among surgical critical care
patients. The specific aim was to analyze data obtained
from routine nursing skin assessments alongside other
potential risk factors identified in the literature.
Methods This retrospective cohort study included 5101
surgical critical care patients at a level I trauma center and
academic medical center. Multivariate logistic regression
using the least absolute shrinkage and selection operator
method identified important predictors with parsimonious
representation. Use of specialty pressure redistribution
beds was included in the model as a known predictive
factor because specialty beds are a common preventive
Results Independent risk factors identified by logistic
regression were skin irritation (rash or diffuse, nonlocal-
ized redness) (odds ratio, 1.788; 95% CI, 1.404-2.274; P < .001),
minimum Braden Scale score (odds ratio, 0.858; 95% CI,
0.818-0.899; P < .001), and duration of intensive care unit
stay before the hospital-acquired pressure injury devel-
oped (odds ratio, 1.003; 95% CI, 1.003-1.004; P < .001).
Conclusions The strongest predictor was irritated skin, a
potentially modifiable risk factor. Irritated skin should be
treated and closely monitored, and the cause should be
eliminated to allow the skin to heal.(American Journal of
Critical Care. 2020;29:e128-e134)

Risk FactoRs FoR
Hospital- acquiRed
pRessuRe injuRy in
suRgical cRitical
caRe patients
By Jenny Alderden, PhD, APRN, CCRN, CCNS, Linda J. Cowan, PhD, APRN,
RN, FNP-BC, CWS, Jonathan B. Dimas, BSN, RN, CCRN, Danli Chen, MSTAT,
Yue Zhang, PhD, Mollie Cummins, PhD, RN, and Tracey L. Yap, PhD, RN,

1.0 HourC E
This article has been designated for CE contact
hour(s). See more CE information at the end of
this article.

e128 AJCC AMERICAN JOURNAL OF CRITICAL CARE, November 2020, Volume 29, No. 6 www.ajcconline.org

www.ajcconline.org AJCC AMERICAN JOURNAL OF CRITICAL CARE, November 2020, Volume 29, No. 6 e129

The relationship between
hospital-acquired pressure
injuries and skin status
remains mostly unexamined
in the critical care population.

atients admitted to the intensive care unit (ICU) are twice as likely as other acute care
patients to have a hospital-acquired pressure injury (HAPI) develop.1 A pressure injury
(PI) is defined as localized damage of the skin or underlying tissue as a result of pres-
sure or pressure in combination with shear.2 Patients who undergo surgery and who
are older than 65 years have a higher risk than younger patients of acquiring a PI in the

hospital.3,4 In the United States, PI costs attributed to patients exceed $26.8 billion annually,5
and having a HAPI develop results in a median 4-day increase in the length of stay.6

Determining the factors associated with HAPI
development in critical care patients is necessary to
enable risk-based preventive measures. Although
HAPIs are associated with known risk factors such
as decreased mobility, surgery duration, vasopressor
infusion, excessive moisture, altered perfusion, and
history of a prior PI, the relationship between HAPIs
and skin status remains mostly unexamined in the
critical care population.4,7-18 Assessing skin status
(including turgor, excessive dryness, irritation, skin
tears, and the loss of subcutaneous tissue) to iden-
tify potential HAPI prevention interventions is
particularly essential when caring for older patients
because of age-related changes. Such changes include
thinning skin, decreased subcutaneous tissue, flatten-
ing of the dermal-epidermal junction (decrease in rete
ridges), structural disorganization of collagen fibers
in the dermis, loss of vertical capillary loops, and
loss of elasticity.2

Using informatics to analyze the vast amounts
of electronic health record (EHR) data, such as skin
assessment data, routinely produced during care
delivery is an excellent way to identify risk factors
for HAPI development. Critical care nurses routinely
conduct head-to-toe skin assessments every 12 hours
and document changes in condition in the EHR. How-
ever, these large-scale real-world data have not been
fully examined in relation to HAPIs in the surgical
critical care setting.

The unprecedented quantities and diverse sources
of data collected during care delivery make this an
opportune time to conduct HAPI research. The pur-
pose of our study was to identify factors associated
with HAPI development among surgical critical care
patients. Our specific aim was to examine data
obtained from routine nursing skin assessments along
with other previously reported HAPI risk factors.

Design and Sample

This was a retrospective cohort study. We included
data from surgical critical care patients admitted con-
secutively to the surgical ICU (SICU) or cardiovascu-
lar surgical ICU (CVICU) at our study site, an urban
level I trauma center and academic medical center,
from 2014 through 2018. We included patients with
a PI present on
admission to the
hospital because
patients with prior
PIs are at increased
risk for subsequent
HAPIs.16 We did not
count community-
acquired PIs as
HAPIs because they
were not acquired in the hospital. However, if patients
with a community-acquired ulcer had a HAPI develop,
that subsequent PI was included in the analysis because
it was hospital acquired. The exclusion criterion was
a stay of less than 24 hours because of inadequate time
for a HAPI to be considered a facility-acquired PI.

Data Collection
Data were obtained via EHR query and retrieved

from our institution’s enterprise data warehouse for
critical care data. For patients with multiple hospital
admissions, we limited data collection to the first
SICU or CVICU admission. A biomedical informat-
ics team performed the query. Query results were
validated by a critical care nurse who verified infor-
mation obtained (including date and time stamps)

About the Authors
Jenny Alderden is an assistant professor and Mollie
Cummins is a professor, University of Utah College of
Nursing, Salt Lake City. Linda J. Cowan is associate
director, VISN 8 Patient Safety Center of Inquiry, James
A. Haley Veterans’ Hospital and Clinics, Tampa, Florida.
Jonathan B. Dimas is a PhD candidate, University of Utah
College of Nursing, and a clinical nurse and analyst,
University of Utah Health, Salt Lake City. Danli Chen is
a biostatistician II and Yue Zhang is an associate profes-
sor, Division of Epidemiology, University of Utah, Salt
Lake City. Tracey L. Yap is an associate professor, Duke
University School of Nursing, Durham, North Carolina.

Corresponding author: Jenny Alderden, PhD, APRN, CCRN, CCNS,
University of Utah College of Nursing, 10 S 2000 E, Salt Lake
City, UT 84112 (email: Jenny.Alderden@Nurs.Utah.Edu).

e130 AJCC AMERICAN JOURNAL OF CRITICAL CARE, November 2020, Volume 29, No. 6 www.ajcconline.org

Data from more than
5000 consecutive sur-

gical critical care
patients were analyzed


via the human-readable system EHR for 30 patients,
including 15 patients with HAPIs. A practicing criti-
cal care nurse and a certified wound nurse also man-
ually reviewed medical records, including data from
the notes and images, to obtain data that were miss-
ing or unclear in the query.

Outcome Variable
The outcome variable was the development of a

HAPI of any stage (stages 1 through 4, deep tissue
injury, or unstageable) according to the National Pres-
sure Injury Advisory Panel staging guidelines.2 We
included stage 1 HAPIs in our outcome because prior
studies showed that one-third of stage 1 HAPIs detected
among surgical critical care patients worsen to stage

2 or greater.19 A certified
wound nurse verified the PIs
in our sample to differentiate
potential cases of moisture-
related skin breakdown from
true HAPIs. In cases in which a
HAPI might be confused with
another source of injury, the
certified wound nurse made
the final decision as to the

presence or absence of the HAPI. We were able to
differentiate between community-acquired PIs and
HAPIs because each PI in our EHR has a unique
identification number with a date and time stamp.

Predictor Variables
We conducted a systematic review of the litera-

ture to identify predictor variables of interest.4 Possi-
ble predictor variables included vasopressor infusions
and their durations,17 blood gas and laboratory val-
ues,18,19 surgical time,20 levels of sedation and agita-
tion,21 and total score on the Braden Scale (a common
tool used by nursing staff to assess the risk of PI devel-
opment by examining moisture, mobility, sensory
perception, and friction/shear).22

We included comprehensive nursing skin assess-
ment data. At our facility, nurses undergo annual train-
ing in head-to-toe skin assessment and PI staging.
Nurses at our facility conduct a global head-to-toe skin
assessment twice daily and document the following
changes: excessively moist skin, excessively dry skin,
thin epidermis with loss of subcutaneous tissue, and
the presence of irritation (defined as a rash or diffuse,
nonlocalized, blanchable redness). Nurses also doc-
ument the presence of a skin tear. Table 1 lists the
predictor variables included in our analysis.

For patients who had a HAPI develop, we col-
lected data only for events occurring at least 24 hours

before HAPI detection. We chose this time frame to
capture events predictive of a HAPI rather than events
occurring at the same time as a HAPI.

Analysis was conducted with R, version 3.6.1

(R Foundation for Statistical Computing).23 We sum-
marized and compared the distributions of potential
prediction factors by HAPI status with a χ2 test for
categorical factors and a 2-sample t test (or its non-
parametric alternative, the Mann-Whitney U test)
for continuous and ordinal variables. We performed
multivariable logistic regression analysis with the least
absolute shrinkage and selection operator (LASSO)24
to identify the subset of potential predictors most
informative for predicting the likelihood of a HAPI
developing. The final model for outcomes was based
on the optimal penalty term using 10-fold cross-
validation criteria.

By imposing some penalty in the regression
model fitting, the LASSO approach can shrink the
coefficients of unimportant predictors to 0 while
retaining prominent predictors. A predictor has
predictability on the outcome only if its coefficient is
nonzero. The final models, therefore, include all
important predictors with parsimonious representa-
tion, enhanced interpretability, and improved pre-
diction precision. In this study, the variable specialty
bed was forced into the model as a known predic-
tion factor (even though our general SICU and
CVICU bed is a low-air-loss mattress) because some
of our patients were placed on other types of specialty
rental beds (eg, bariatric beds or specialty prone
positioning beds) because of body habitus or clini-
cal condition.25


The initial query produced 5102 patients. We
excluded 1 patient from the analysis because of incom-
plete demographic data, so the final sample size
was 5101. Demographic data are shown in Table 1.

Pressure Injury Outcomes
Of the 5101 patients in our sample, 399 (8%) had

at least 1 HAPI develop. Of the 399 patients with a
HAPI, 110 (28%) had a stage 1 HAPI develop; 182
(46%), stage 2 HAPI; 6 (2%), stage 3 HAPI; 1 (< 1%),
stage 4 HAPI; 33 (8%), unstageable HAPI; 62 (16%),
deep tissue injury; and 5 (1%), mucosal PI. Of the
110 stage 1 HAPIs, 44 (40%) worsened to a more
severe stage during the SICU or CVICU stay. The
most common PI location was the coccyx (n = 153

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Pull quote

[38%]), followed by the buttocks (n = 62 [16%]),
sacrum (n = 47 [12%]), extremity excluding heel
(eg, arms or legs; n = 46 [12%]), head or face
(n = 40 [10%]), other location (n = 32 [8%]), back
(n = 10 [3%]), and heel (n = 9 [2%]).

Pressure Injury Predictors
Univariate relationships between potential pre-

dictor variables and HAPI development are presented
in Table 1. From the soft-thresholding property of the

LASSO in linear models, the estimated regression
coefficient is biased toward 0. To mitigate these bias
problems, we report a more unbiased estimation of
regression coefficients from unpenalized multivari-
ate logistic regression using the selected factors in
the LASSO (Table 2).

The purpose of our study was to identify risk fac-

tors for HAPI development among SICU and CVICU


No. (%) of patientsa


(N = 5101)
With no HAPI

(n = 4702)
With a HAPI

(n = 399)

Table 1
Potential predictor variables and development of
hospital-acquired pressure injury

Abbreviations: HAPI, hospital-acquired pressure injury; ICU, intensive care unit.
a Unless otherwise indicated in first column.
b Irritated skin is defined as a rash or diffuse, nonlocalized, blanchable redness, not over a bony prominence.
c Riker Sedation-Agitation Scale.
d Calculated as weight in kilograms divided by height in meters squared.

Demographic data
Age, mean (SD), y 58 (17) 59 (16) 58 (16) .24
Sex, male 3302 (65) 3040 (65) 262 (66) .73
Race, White 4256 (83) 3934 (84) 322 (81) .14
Ethnicity, non-Hispanic 4452 (87) 4112 (87) 340 (85) .17
Length of hospital stay, mean (SD), d 12 (11) 11 (9) 28 (20) <.001
Length of ICU stay before HAPI, mean (SD), d 5 (7) 5 (6) 13 (13) <.001
Laboratory data, mean (SD)
Maximum lactate, mg/dL 4.0 (3.7) 3.9 (3.6) 5.6 (4.8) <.001
Maximum serum creatinine, mg/dL 1.9 (1.9) 1.8 (1.9) 2.7 (2.1) <.001
Maximum serum glucose, mg/dL 231 (148) 227 (141) 280 (210) <.001
Minimum hemoglobin, g/dL 8.9 (2.6) 9.1 (2.6) 7.7 (2.2) <.001
Minimum albumin, g/dL 3.1 (0.8) 3.2 (0.8) 2.7 (0.7) <.001
Minimum Pao

, mm Hg 54 (40) 55 (41) 47 (32) <.001

Minimum arterial pH 7.27 (0.11) 7.27 (0.10) 7.23 (0.13) <.001
Maximum Paco

, mm Hg 52 (14) 52 (13) 55 (16) <.001

Skin status
Thin epidermis/subcutaneous tissue loss 888 (17) 792 (17) 96 (24) <.001
Excessively dry skin 351 (7) 296 (6) 55 (14) <.001
Skin tear 641 (13) 534 (11) 107 (27) <.001
Excessively moist skin 816 (16) 712 (15) 104 (26) <.001
Irritated skinb 1394 (27) 1176 (25) 218 (55) <.001
Community-acquired pressure injury present at

167 (3) 120 (3) 47 (12) <.001

Duration of surgery, mean (SD), h
Longest single surgery 3.0 (2.6) 3.0 (3.2) 3.3 (2.5) .08
Total surgical time 3.7 (3.4) 3.6 (3.3) 4.6 (4.7) <.001
Duration of vasopressor infusion, mean (SD), h
Norepinephrine 9 (36) 7 (33) 30 (62) <.001
Epinephrine 8 (35) 7 (31) 23 (61) <.001
Phenylephrine 1 (8) 1 (14) 2 (20) .01
Dopamine 1 (14) 6 (13) 23 (19) .12
Vasopressin 11 (55) 9 (51) 37 (86) <.001
Other potential predictors
Minimum Braden Scale score, mean (SD) 13 (3) 13 (3) 12 (3) <.001
Minimum Riker score,c mean (SD) 2.8 (1.2) 2.87 (1.19) 2.15 (1.22) <.001
Admission body mass index,d mean (SD) 30.1 (12.4) 30.1 (12.5) 30.2 (10.7) .89
Nonstandard bed (eg, bariatric bed or other) 1390 (27) 1234 (26) 156 (39) .73
Comorbid diabetes 1756 (34) 1579 (34) 177 (44) <.001

e132 AJCC AMERICAN JOURNAL OF CRITICAL CARE, November 2020, Volume 29, No. 6 www.ajcconline.org

patients. Identifying risk factors is useful to improve
our understanding and care planning for patients
considered high risk and to recognize factors that
are potentially modifiable. In our study, candidate
predictor variables included the duration of vaso-
pressor infusion, blood gas values, surgery duration,
Braden Scale scores, nursing skin assessment data, and
laboratory values. In multivariable LASSO regression,
the most informative predictors for HAPI risk were
length of SICU or CVICU stay, the minimum Braden
Scale score, and skin irritation (defined as a rash or
diffuse, nonlocalized, blanchable redness).

A longer hospital stay is an established risk fac-
tor for HAPI because patients with longer stays gen-
erally experience a higher severity of illness and
longer exposure times than do patients with shorter
stays.9,10,14 Consistent with the results of prior stud-
ies, in our study the duration of ICU stay before HAPI
was an independent predictor for HAPI development,
although the effect was small.7,17,26

The Braden Scale, developed in 1987 for residents
of long-term care facilities,22 was found in a recent
meta-analysis to be a poor predictor of HAPI among
surgical patients.27 In our study, patients with lower

Braden Scale scores (ie, at
greater risk) were 14%
more likely to have a
HAPI develop than were
patients with higher Bra-
den Scale scores. The
clinical relevance of this
finding is uncertain
because the mean (SD)
minimum Braden Scale

score was 13 (3) in patients without a HAPI and
was 12 (3) in patients with a HAPI. On a scale with
possible scores ranging from 6 to 23, this absolute
difference is relatively small and the corresponding

standard deviation is large, so this finding may not
be actionable at a clinical level.28 Black29 specu-
lated that the lack of clinical utility of the Braden
Scale in this population is because of the dynamic
and evolving nature of critical care patients’ physio-
logical status. In the critical care population, a risk
assessment would need to be completed contem-
poraneously with changes in patient condition,
which would be difficult because of time and
workflow constraints.

The strongest predictor of HAPI was skin irrita-
tion, a potentially modifiable risk factor. In our study,
patients with skin irritation were 79% more likely
than those with no skin irritation to have a HAPI
develop. Skin irritation indicates an alteration in
skin integrity and therefore a decrease in tissue toler-
ance to mechanical and shearing forces, such as
those responsible for HAPI development.16,30 Skin
irritation may be caused by excessive skin dryness,
allergic reactions to medications, or prolonged expo-
sure to caustic substances acting as irritants, includ-
ing urine, feces, strong soaps, laundry chemicals,
and latex gloves. In all cases, skin irritation should
be treated and closely monitored and the cause
should be eliminated to allow the skin to heal.

Potential predictor variables not included in our
LASSO model merit consideration as well. Clinically
and statistically significant differences at the univari-
ate level were noted in variables measuring aspects
of perfusion, defined as the delivery of oxygen-rich
blood to tissue. The mean serum lactate level in the
HAPI group was markedly elevated, indicating tissue
hypoperfusion and hypoxia.31 Serum albumin (which
affects perfusion via colloid osmotic pressure) and
hemoglobin (oxygen-carrying capacity) were also
decreased in the HAPI group. In addition, patients
with HAPIs had clinically and statistically signifi-
cantly longer infusion durations for all vasopressors
than did patients without HAPIs.

Consistent with the results of a prior study,32
patients with HAPIs in our study experienced longer
surgical times, highlighting the importance of con-
sidering intraoperative events in HAPI risk. How-
ever, although surgical critical care patients are at
elevated risk for HAPI,3 little is known about intra-
operative factors associated with HAPI risk in the
surgical and cardiovascular surgical critical care pop-
ulation. In a study of patients undergoing urologic
procedures, duration of anesthesia and a diastolic
blood pressure of less than 50 mm Hg were predic-
tive of HAPI development, indicating that perfusion
during surgery may influence HAPI risk.33,34 Research
is urgently needed to identify intraoperative risk

Predictor variable Odds ratio (95% CI) P

Table 2
Results of LASSO logistic regressiona

Abbreviation: LASSO, least absolute shrinkage and selection operator.

a A total of 5019 patients (98%) were included in the logistic regression; 82
patients’ data were excluded from the analysis because of missing data.

b Irritated skin is defined as a rash or diffuse, nonlocalized, blanchable redness,
not over a bony prominence.

c Included in the model as a control factor because specialty beds were used

Intercept 0.278 (0.147-0.523) <.001
Irritated skinb 1.788 (1.404-2.274) <.001
Minimum Braden Scale score 0.858 (0.818-0.899) <.001
Duration of stay in intensive care unit

before hospital-acquired pressure injury
1.003 (1.003-1.004)


Specialty bedc 0.816 (0.634-1.044) .11

Of the 110 stage 1 HAPIs,
44 (40%) worsened to a

more severe stage during
the patient’s stay in the

intensive care unit.

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factors in surgical critical care patients33 and to
identify potentially modifiable risk factors.

Our study was limited by its retrospective design

because we accessed only data available in the EHR.
The subjectivity of clinician interpretation is also
a limitation; individual nurses’ definitions of skin
irritation may not exactly coincide. Furthermore, we
did not differentiate medical device–related HAPIs
from other HAPIs. Other predictor variables that
have been associated with HAPI in this population
were not selected because these variables could not
be obtained from the EHR. We did not include com-
pliance with PI prevention protocols (eg, repositioning
schedules) because the EHR is not a reliable source
of information about preventive interventions. For
instance, every 2 hours our EHR prompts nursing staff
to document a position change. However, the changes
might be faithfully documented every 2 hours but not
always performed.35 Finally, our sample was from a sin-
gle site with a predominantly White population, which
may also affect the generalizability of our results.35,36

Our results indicate that nursing staff should

consider changes in the epidermal layer, especially
skin irritation, to be influential risk factors for HAPI.
Skin irritation should be promptly treated by elimi-
nating the cause. The SICU and CVICU patients who
had HAPI develop in our study also exhibited poor
perfusion and longer surgical times. Future research
is needed to elucidate the relationship between per-
fusion, intraoperative events, and HAPI risk.

This research was funded by an American Association of
Critical-Care Nurses–Sigma Theta Tau Critical Care Grant.
This study was also supported by the University of Utah
Population Health Research Foundation, with funding in
part from the National Center for Research Resources and
the National Center for Advancing Translational Sciences,
National Institutes of Health (grant UL1TR002538).

For more about hospital-acquired pressure injuries,
visit the Critical Care Nurse website, www.ccnonline.org,
and read the article by Schroeder and Sitzer, “Nursing Care
Guidelines for Reducing Hospital-Acquired Nasogastric
Tube–Related Pressure Injuries” (December 2019).

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e134 AJCC AMERICAN JOURNAL OF CRITICAL CARE, November 2020, Volume 29, No. 6 www.ajcconline.org

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Notice to CE enrollees:

This article has been designated for CE contact hour(s). The evaluation demonstrates your knowledge of the
following objectives:

1. Identify independent risk factors for hospital-acquired pressure injuries.
2. Describe potential treatments for skin irritation.
3. Determine the clinical relevance of stage 1 pressure injuries in the surgical and cardiovascular surgical


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click the “CE Articles” button. No CE evaluation fee for AACN members. This expires on November 1, 2022.

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26. Sayar S, Turgut S, Doğan H, et al. Incidence of pressure ulcers
in intensive care unit patients at risk according to the Water-
low scale and factors influencing the development of pressure
ulcers. J Clin Nurs. 2009;18(5):765-774. doi:10.1111/j.1365-

27. He W, Liu P, Chen HL. The Braden Scale cannot be used alone
for assessing pressure ulcer risk for surgical patients: a
meta-analysis. Ostomy Wound Manage. 2012;58(2):34-40.

28. Anthony D, Papanikolaou P, Parboteeah S, Saleh M. Do risk
assessment scales for pressure ulcers work? J Tissue Viabil-
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29. Black J. Pressure ulcer prevention and management: a dire
need for good science. Ann Intern Med. 2015;162(5):387-388.

30. Yap TL, Rapp MP, Kennerly S, Cron SG, Bergstrom N. Com-
parison study of Braden Scale and time-to-erythema mea-
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31. Antinone R, Kress T. Measuring serum lactate. Nurs Crit Care.

32. Lu CX, Chen HL, Shen WQ, Feng LP. A new nomogram score
for predicting surgery-related pressure ulcers in cardiovas-
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33. Chello C, Lusini M, Schilirò D, Greco SM, Barbato R, Nenna
A. Pressure ulcers in cardiac surgery: few clinical studies,

difficult risk assessment, and profound clinical implications.
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34. Connor T, Sledge JA, Bryant-Wiersema L, Stamm L, Potter P.
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35. Yap TL, Kennerly SM, Simmons MR, et al. Multidimensional
team-based intervention using musical cues to reduce odds
of facility-acquired pressure ulcers in long-term care: a paired

Discussion 6

Classics in the History
of Psychology

An internet resource developed by

Christopher D. Green

York University, Toronto, Ontario

ISSN 1492-3713

(Return to Classics index)

A Theory of Human Motivation

A. H. Maslow (1943)

Originally Published in Psychological Review, 50, 370-396.

Posted August 2000


In a previous paper (13) various propositions were
presented which would have to be included in any theory of human motivation
that could lay claim to being definitive. These conclusions may be briefly
summarized as follows:

1. The integrated wholeness of the organism must be one of
the foundation stones of motivation theory.

2. The hunger drive (or any other physiological drive) was rejected
as a centering point or model for a definitive theory of motivation. Any
drive that is somatically based and localizable was shown to be atypical
rather than typical in human motivation.

3. Such a theory should stress and center itself upon ultimate or basic
goals rather than partial or superficial ones, upon ends rather than means
to these ends. Such a stress would imply a more central place for unconscious
than for conscious motivations.

4. There are usually available various cultural paths to the same goal.
Therefore conscious, specific, local-cultural desires are not as fundamental
in motivation theory as the more basic, unconscious goals.

5. Any motivated behavior, either preparatory or consummatory, must
be understood to be a channel through which many basic needs may be simultaneously
expressed or satisfied. Typically an act has more than one motivation.

6. Practically all organismic states are to be understood as motivated
and as motivating.

7. Human needs arrange themselves in hierarchies of pre-potency. That
is to say, the appearance of one need usually rests on the prior satisfaction
of another, more pre-potent need. Man is a perpetually wanting animal.
Also no need or drive can be treated as if it were isolated or discrete;
every drive is related to the state of satisfaction or dissatisfaction
of other drives.

8. Lists of drives will get us nowhere for various theoretical
and practical reasons. Furthermore any classification of motivations [p.
371] must deal with the problem of levels of specificity or generalization
the motives to be classified.

9. Classifications of motivations must be based upon goals rather than
upon instigating drives or motivated behavior.

10. Motivation theory should be human-centered rather than animal-centered.

11. The situation or the field in which the organism reacts must be
taken into account but the field alone can rarely serve as an exclusive
explanation for behavior. Furthermore the field itself must be interpreted
in terms of the organism. Field theory cannot be a substitute for motivation

12. Not only the integration of the organism must be taken into account,
but also the possibility of isolated, specific, partial or segmental reactions.
It has since become necessary to add to these another affirmation.

13. Motivation theory is not synonymous with behavior theory. The motivations
are only one class of determinants of behavior. While behavior is almost
always motivated, it is also almost always biologically, culturally and
situationally determined as well.

The present paper is an attempt to formulate a positive theory of motivation
which will satisfy these theoretical demands and at the same time conform
to the known facts, clinical and observational as well as experimental.
It derives most directly, however, from clinical experience. This theory
is, I think, in the functionalist tradition of James and Dewey, and is
fused with the holism of Wertheimer (19), Goldstein
(6), and Gestalt Psychology, and with the dynamicism
of Freud (4) and Adler (1). This fusion
or synthesis may arbitrarily be called a ‘general-dynamic’ theory.

It is far easier to perceive and to criticize the aspects in motivation
theory than to remedy them. Mostly this is because of the very serious
lack of sound data in this area. I conceive this lack of sound facts to
be due primarily to the absence of a valid theory of motivation. The present
theory then must be considered to be a suggested program or framework for
future research and must stand or fall, not so much on facts available
or evidence presented, as upon researches to be done, researches suggested
perhaps, by the questions raised in this paper.[p. 372]


The ‘physiological’ needs. — The needs that are usually taken
as the starting point for motivation theory are the so-called physiological
drives. Two recent lines of research make it necessary to revise our customary
notions about these needs, first, the development of the concept of homeostasis,
and second, the finding that appetites (preferential choices among foods)
are a fairly efficient indication of actual needs or lacks in the body.

Homeostasis refers to the body’s automatic efforts to maintain a constant,
normal state of the blood stream. Cannon (2) has described this process
for (1) the water content of the blood, (2) salt content, (3) sugar content,
(4) protein content, (5) fat content, (6) calcium content, (7) oxygen content,
(8) constant hydrogen-ion level (acid-base balance) and (9) constant temperature
of the blood. Obviously this list can be extended to include other minerals,
the hormones, vitamins, etc.

Young in a recent article (21) has summarized the
work on appetite in its relation to body needs. If the body lacks some
chemical, the individual will tend to develop a specific appetite or partial
hunger for that food element.

Thus it seems impossible as well as useless to make any list of fundamental
physiological needs for they can come to almost any number one might wish,
depending on the degree of specificity of description. We can not identify
all physiological needs as homeostatic. That sexual desire, sleepiness,
sheer activity and maternal behavior in animals, are homeostatic, has not
yet been demonstrated. Furthermore, this list would not include the various
sensory pleasures (tastes, smells, tickling, stroking) which are probably
physiological and which may become the goals of motivated behavior.

In a previous paper (13) it has been pointed out
that these physiological drives or needs are to be considered unusual rather
than typical because they are isolable, and because they are localizable
somatically. That is to say, they are relatively independent of each other,
of other motivations [p. 373] and of the organism as a whole, and secondly,
in many cases, it is possible to demonstrate a localized, underlying somatic
base for the drive. This is true less generally than has been thought (exceptions
are fatigue, sleepiness, maternal responses) but it is still true in the
classic instances of hunger, sex, and thirst.

It should be pointed out again that any of the physiological needs and
the consummatory behavior involved with them serve as channels for all
sorts of other needs as well. That is to say, the person who thinks he
is hungry may actually be seeking more for comfort, or dependence, than
for vitamins or proteins. Conversely, it is possible to satisfy the hunger
need in part by other activities such as drinking water or smoking cigarettes.
In other words, relatively isolable as these physiological needs are, they
are not completely so.

Undoubtedly these physiological needs are the most pre-potent of all
needs. What this means specifically is, that in the human being who is
missing everything in life in an extreme fashion, it is most likely that
the major motivation would be the physiological needs rather than any others.
A person who is lacking food, safety, love, and esteem would most probably
hunger for food more strongly than for anything else.

If all the needs are unsatisfied, and the organism is then dominated
by the physiological needs, all other needs may become simply non-existent
or be pushed into the background. It is then fair to characterize the whole
organism by saying simply that it is hungry, for consciousness is almost
completely preempted by hunger. All capacities are put into the service
of hunger-satisfaction, and the organization of these capacities is almost
entirely determined by the one purpose of satisfying hunger. The receptors
and effectors, the intelligence, memory, habits, all may now be defined
simply as hunger-gratifying tools. Capacities that are not useful for this
purpose lie dormant, or are pushed into the background. The urge to write
poetry, the desire to acquire an automobile, the interest in American history,
the desire for a new pair of shoes are, in the extreme case, forgotten
or become of sec-[p.374]ondary importance. For the man who is extremely
and dangerously hungry, no other interests exist but food. He dreams food,
he remembers food, he thinks about food, he emotes only about food, he
perceives only food and he wants only food. The more subtle determinants
that ordinarily fuse with the physiological drives in organizing even feeding,
drinking or sexual behavior, may now be so completely overwhelmed as to
allow us to speak at this time (but only at this time) of pure hunger drive
and behavior, with the one unqualified aim of relief.

Another peculiar characteristic of the human organism when it is dominated
by a certain need is that the whole philosophy of the future tends also
to change. For our chronically and extremely hungry man, Utopia can be
defined very simply as a place where there is plenty of food. He tends
to think that, if only he is guaranteed food for the rest of his life,
he will be perfectly happy and will never want anything more. Life itself
tends to be defined in terms of eating. Anything else will be defined as
unimportant. Freedom, love, community feeling, respect, philosophy, may
all be waved aside as fripperies which are useless since they fail to fill
the stomach. Such a man may fairly be said to live by bread alone.

It cannot possibly be denied that such things are true but their generality
can be denied. Emergency conditions are, almost by definition, rare in
the normally functioning peaceful society. That this truism can be forgotten
is due mainly to two reasons. First, rats have few motivations other than
physiological ones, and since so much of the research upon motivation has
been made with these animals, it is easy to carry the rat-picture over
to the human being. Secondly, it is too often not realized that culture
itself is an adaptive tool, one of whose main functions is to make the
physiological emergencies come less and less often. In most of the known
societies, chronic extreme hunger of the emergency type is rare, rather
than common. In any case, this is still true in the United States. The
average American citizen is experiencing appetite rather than hunger when
he says “I am [p. 375] hungry.” He is apt to experience sheer life-and-death
hunger only by accident and then only a few times through his entire life.

Obviously a good way to obscure the ‘higher’ motivations, and to get
a lopsided view of human capacities and human nature, is to make the organism
extremely and chronically hungry or thirsty. Anyone who attempts to make
an emergency picture into a typical one, and who will measure all of man’s
goals and desires by his behavior during extreme physiological deprivation
is certainly being blind to many things. It is quite true that man lives
by bread alone — when there is no bread. But what happens to man’s desires
when there is plenty of bread and when his belly is chronically filled?

At once other (and ‘higher’) needs emerge and these, rather than
physiological hungers, dominate the organism. And when these in turn are
satisfied, again new (and still ‘higher’) needs emerge and so on. This
is what we mean by saying that the basic human needs are organized into
a hierarchy of relative prepotency.

One main implication of this phrasing is that gratification becomes
as important a concept as deprivation in motivation theory, for it releases
the organism from the domination of a relatively more physiological need,
permitting thereby the emergence of other more social goals. The physiological
needs, along with their partial goals, when chronically gratified cease
to exist as active determinants or organizers of behavior. They now exist
only in a potential fashion in the sense that they may emerge again to
dominate the organism if they are thwarted. But a want that is satisfied
is no longer a want. The organism is dominated and its behavior organized
only by unsatisfied needs. If hunger is satisfied, it becomes unimportant
in the current dynamics of the individual.

This statement is somewhat qualified by a hypothesis to be discussed
more fully later, namely that it is precisely those individuals in whom
a certain need has always been satisfied who are best equipped to tolerate
deprivation of that need in the future, and that furthermore, those who
have been de-[p. 376]prived in the past will react differently to current
satisfactions than the one who has never been deprived.

The safety needs. — If the physiological needs are relatively
well gratified, there then emerges a new set of needs, which we may categorize
roughly as the safety needs. All that has been said of the physiological
needs is equally true, although in lesser degree, of these desires. The
organism may equally well be wholly dominated by them. They may serve as
the almost exclusive organizers of behavior, recruiting all the capacities
of the organism in their service, and we may then fairly describe the whole
organism as a safety-seeking mechanism. Again we may say of the receptors,
the effectors, of the intellect and the other capacities that they are
primarily safety-seeking tools. Again, as in the hungry man, we find that
the dominating goal is a strong determinant not only of his current world-outlook
and philosophy but also of his philosophy of the future. Practically everything
looks less important than safety, (even sometimes the physiological needs
which being satisfied, are now underestimated). A man, in this state, if
it is extreme enough and chronic enough, may be characterized as living
almost for safety alone.

Although in this paper we are interested primarily in the needs of the
adult, we can approach an understanding of his safety needs perhaps more
efficiently by observation of infants and children, in whom these needs
are much more simple and obvious. One reason for the clearer appearance
of the threat or danger reaction in infants, is that they do not inhibit
this reaction at all, whereas adults in our society have been taught to
inhibit it at all costs. Thus even when adults do feel their safety to
be threatened we may not be able to see this on the surface. Infants will
react in a total fashion and as if they were endangered, if they are disturbed
or dropped suddenly, startled by loud noises, flashing light, or other
unusual sensory stimulation, by rough handling, by general loss of support
in the mother’s arms, or by inadequate support.[1][p.

In infants we can also see a much more direct reaction to bodily illnesses
of various kinds. Sometimes these illnesses seem to be immediately and
se threatening and seem to make the child feel unsafe. For instance,
vomiting, colic or other sharp pains seem to make the child look at the
whole world in a different way. At such a moment of pain, it may be postulated
that, for the child, the appearance of the whole world suddenly changes
from sunniness to darkness, so to speak, and becomes a place in which anything
at all might happen, in which previously stable things have suddenly become
unstable. Thus a child who because of some bad food is taken ill may, for
a day or two, develop fear, nightmares, and a need for protection and reassurance
never seen in him before his illness.

Another indication of the child’s need for safety is his preference
for some kind of undisrupted routine or rhythm. He seems to want a predictable,
orderly world. For instance, injustice, unfairness, or inconsistency in
the parents seems to make a child feel anxious and unsafe. This attitude
may be not so much because of the injustice per se or any particular
pains involved, but rather because this treatment threatens to make the
world look unreliable, or unsafe, or unpredictable. Young children seem
to thrive better under a system which has at least a skeletal outline of
rigidity, In which there is a schedule of a kind, some sort of routine,
something that can be counted upon, not only for the present but also far
into the future. Perhaps one could express this more accurately by saying
that the child needs an organized world rather than an unorganized or unstructured

The central role of the parents and the normal family setup are indisputable.
Quarreling, physical assault, separation, divorce or death within the family
may be particularly terrifying. Also parental outbursts of rage or threats
of punishment directed to the child, calling him names, speaking to him
harshly, shaking him, handling him roughly, or actual [p. 378] physical
punishment sometimes elicit such total panic and terror in the child that
we must assume more is involved than the physical pain alone. While it
is true that in some children this terror may represent also a fear of
loss of parental love, it can also occur in completely rejected children,
who seem to cling to the hating parents more for sheer safety and protection
than because of hope of love.

Confronting the average child with new, unfamiliar, strange, unmanageable
stimuli or situations will too frequently elicit the danger or terror reaction,
as for example, getting lost or even being separated from the parents for
a short time, being confronted with new faces, new situations or new tasks,
the sight of strange, unfamiliar or uncontrollable objects, illness or
death. Particularly at such times, the child’s frantic clinging to his
parents is eloquent testimony to their role as protectors (quite apart
from their roles as food-givers and love-givers).

From these and similar observations, we may generalize and say that
the average child in our society generally prefers a safe, orderly, predictable,
organized world, which he can count, on, and in which unexpected, unmanageable
or other dangerous things do not happen, and in which, in any case, he
has all-powerful parents who protect and shield him from harm.

That these reactions may so easily be observed in children is in a way
a proof of the fact that children in our society, feel too unsafe (or,
in a word, are badly brought up). Children who are reared in an unthreatening,
loving family do not ordinarily react as we have described above (17).
In such children the danger reactions are apt to come mostly to objects
or situations that adults too would consider dangerous.[2]

The healthy, normal, fortunate adult in our culture is largely satisfied
in his safety needs. The peaceful, smoothly [p. 379] running, ‘good’ society
ordinarily makes its members feel safe enough from wild animals, extremes
of temperature, criminals, assault and murder, tyranny, etc. Therefore,
in a very real sense, he no longer has any safety needs as active motivators.
Just as a sated man no longer feels hungry, a safe man no longer feels
endangered. If we wish to see these needs directly and clearly we must
turn to neurotic or near-neurotic individuals, and to the economic and
social underdogs. In between these extremes, we can perceive the expressions
of safety needs only in such phenomena as, for instance, the common preference
for a job with tenure and protection, the desire for a savings account,
and for insurance of various kinds (medical, dental, unemployment, disability,
old age).

Other broader aspects of the attempt to seek safety and stability in
the world are seen in the very common preference for familiar rather than
unfamiliar things, or for the known rather than the unknown. The tendency
to have some religion or world-philosophy that organizes the universe and
the men in it into some sort of satisfactorily coherent, meaningful whole
is also in part motivated by safety-seeking. Here too we may list science
and philosophy in general as partially motivated by the safety needs (we
shall see later that there are also other motivations to scientific, philosophical
or religious endeavor).

Otherwise the need for safety is seen as an active and dominant mobilizer
of the organism’s resources only in emergencies, e. g., war, disease,
natural catastrophes, crime waves, societal disorganization, neurosis,
brain injury, chronically bad situation.

Some neurotic adults in our society are, in many ways, like the unsafe
child in their desire for safety, although in the former it takes on a
somewhat special appearance. Their reaction is often to unknown, psychological
dangers in a world that is perceived to be hostile, overwhelming and threatening.
Such a person behaves as if a great catastrophe were almost always impending,
i.e., he is usually responding as if to an emergency. His safety needs
often find specific [p. 380] expression in a search for a protector, or
a stronger person on whom he may depend, or perhaps, a Fuehrer.

The neurotic individual may be described in a slightly different way
with some usefulness as a grown-up person who retains his childish attitudes
toward the world. That is to say, a neurotic adult may be said to behave
‘as if’ he were actually afraid of a spanking, or of his mother’s disapproval,
or of being abandoned by his parents, or having his food taken away from
him. It is as if his childish attitudes of fear and threat reaction to
a dangerous world had gone underground, and untouched by the growing up
and learning processes, were now ready to be called out by any stimulus
that would make a child feel endangered and threatened.[3]

The neurosis in which the search for safety takes its dearest form is
in the compulsive-obsessive neurosis. Compulsive-obsessives try frantically
to order and stabilize the world so that no unmanageable, unexpected or
unfamiliar dangers will ever appear (14); They hedge
themselves about with all sorts of ceremonials, rules and formulas so that
every possible contingency may be provided for and so that no new contingencies
may appear. They are much like the brain injured cases, described by Goldstein
(6), who manage to maintain their equilibrium by avoiding
everything unfamiliar and strange and by ordering their restricted world
in such a neat, disciplined, orderly fashion that everything in the world
can be counted upon. They try to arrange the world so that anything unexpected
(dangers) cannot possibly occur. If, through no fault of their own, something
unexpected does occur, they go into a panic reaction as if this unexpected
occurrence constituted a grave danger. What we can see only as a none-too-strong
preference in the healthy person, e. g., preference for the familiar,
becomes a life-and-death. necessity in abnormal cases.

The love needs. — If both the physiological and the safety needs
are fairly well gratified, then there will emerge the love and affection
and belongingness needs, and the whole cycle [p. 381] already described
will repeat itself with this new center. Now the person will feel keenly,
as never before, the absence of friends, or a sweetheart, or a wife, or
children. He will hunger for affectionate relations with people in general,
namely, for a place in his group, and he will strive with great intensity
to achieve this goal. He will want to attain such a place more than anything
else in the world and may even forget that once, when he was hungry, he
sneered at love.

In our society the thwarting of these needs is the most commonly found
core in cases of maladjustment and more severe psychopathology. Love and
affection, as well as their possible expression in sexuality, are generally
looked upon with ambivalence and are customarily hedged about with many
restrictions and inhibitions. Practically all theorists of psychopathology
have stressed thwarting of the love needs as basic in the picture of maladjustment.
Many clinical studies have therefore been made of this need and we know
more about it perhaps than any of the other needs except the physiological
ones (14).

One thing that must be stressed at this point is that love is not synonymous
with sex. Sex may be studied as a purely physiological need. Ordinarily
sexual behavior is multi-determined, that is to say, determined not only
by sexual but also by other needs, chief among which are the love and affection
needs. Also not to be overlooked is the fact that the love needs involve
both giving and receiving love.[4]

The esteem needs. — All people in our society (with a few pathological
exceptions) have a need or desire for a stable, firmly based, (usually)
high evaluation of themselves, for self-respect, or self-esteem, and for
the esteem of others. By firmly based self-esteem, we mean that which is
soundly based upon real capacity, achievement and respect from others.
These needs may be classified into two subsidiary sets. These are, first,
the desire for strength, for achievement, for adequacy, for confidence
in the face of the world, and for independence and freedom.[5]
Secondly, we have what [p. 382] we may call the desire for reputation or
prestige (defining it as respect or esteem from other people), recognition,
attention, importance or appreciation.[6] These needs
have been relatively stressed by Alfred Adler and his followers, and have
been relatively neglected by Freud and the psychoanalysts. More and more
today however there is appearing widespread appreciation of their central

Satisfaction of the self-esteem need leads to feelings of self-confidence,
worth, strength, capability and adequacy of being useful and necessary
in the world. But thwarting of these needs produces feelings of inferiority,
of weakness and of helplessness. These feelings in turn give rise to either
basic discouragement or else compensatory or neurotic trends. An appreciation
of the necessity of basic self-confidence and an understanding of how helpless
people are without it, can be easily gained from a study of severe traumatic
neurosis (8).[7]

The need for self-actualization. — Even if all these needs are
satisfied, we may still often (if not always) expect that a new discontent
and restlessness will soon develop, unless the individual is doing what
he is fitted for. A musician must make music, an artist must paint, a poet
must write, if he is to be ultimately happy. What a man can be,
he must be. This need we may call self-actualization.

This term, first coined by Kurt Goldstein, is being used in this paper
in a much more specific and limited fashion. It refers to the desire for
self-fulfillment, namely, to the tendency for him to become actualized
in what he is potentially. This tendency might be phrased as the desire
to become more and more what one is, to become everything that one is capable
of becoming.[p. 383]

The specific form that these needs will take will of course vary greatly
from person to person. In one individual it may take the form of the desire
to be an ideal mother, in another it may be expressed athletically, and
in still another it may be expressed in painting pictures or in inventions.
It is not necessarily a creative urge although in people who have any capacities
for creation it will take this form.

The clear emergence of these needs rests upon prior satisfaction of
the physiological, safety, love and esteem needs. We shall call people
who are satisfied in these needs, basically satisfied people, and it is
from these that we may expect the fullest (and healthiest) creativeness.[8]
Since, in our society, basically satisfied people are the exception, we
do not know much about self-actualization, either experimentally or clinically.
It remains a challenging problem for research.

The preconditions for the basic need satisfactions. — There
are certain conditions which are immediate prerequisites for the basic
need satisfactions. Danger to these is reacted to almost as if it were
a direct danger to the basic needs themselves. Such conditions as freedom
to speak, freedom to do what one wishes so long as no harm is done to others,
freedom to express one’s self, freedom to investigate and seek for information,
freedom to defend one’s self, justice, fairness, honesty, orderliness in
the group are examples of such preconditions for basic need satisfactions.
Thwarting in these freedoms will be reacted to with a threat or emergency
response. These conditions are not ends in themselves but they are almost
so since they are so closely related to the basic needs, which are apparently
the only ends in themselves. These conditions are defended because without
them the basic satisfactions are quite impossible, or at least, very severely
endangered.[p. 384]

If we remember that the cognitive capacities (perceptual, intellectual,
learning) are a set of adjustive tools, which have, among other functions,
that of satisfaction of our basic needs, then it is clear that any danger
to them, any deprivation or blocking of their free use, must also be indirectly
threatening to the basic needs themselves. Such a statement is a partial
solution of the general problems of curiosity, the search for knowledge,
truth and wisdom, and the ever-persistent urge to solve the cosmic mysteries.

We must therefore introduce another hypothesis and speak of degrees
of closeness to the basic needs, for we have already pointed out that any
conscious desires (partial goals) are more or less important as they are
more or less close to the basic needs. The same statem

Discussion 6

Please answer this in a word document

Briefly discuss/answer any four of the following questions. 

  • What is the hotel development process and briefly discuss feasibility studies and its components?
  • Briefly discuss the Planning and Design process.
  • What are planning and design criteria for Hotel function space?
  • Briefly discuss considerations for maintenance and engineering space area in a hotel and its impact of on operations.
  • What are the reasons to renovate hotel physical plant?
  • Briefly discuss various types of renovations.
  • What is the main criteria in setting priorities and choosing Projects given?
  • Who are the members of design team and what are the phases of design process?
    • 15

    Discussion 6

    For this discussion, briefly describe one of the experiments* in our text and tell whether and how it does or does not align with the definition provided above. You will see that some of the examples/experiments/scenarios described in our textbook reveal a dark side of human nature. As we consider this from a Christian worldview perspective is there any hope for us?

    *Use any experiment described in our textbook. To help you get started, here are some examples you may search for: Conformity: Asch, Zimbardo, Milgram; Social Learning/Aggression: Bobo the Doll; Self-fulfilling Prophecy: Rosenthal & Jacobson

    • 34

    Discussion 6

    A 29-year-old female develops sepsis and, as a consequence, she experiences profound vasodilation.

    a) What effect does vasodilation have on the afterload? Explain why.

    b) What effect does vasodilation have on blood pressure? Explain why. How will her body try to bring her blood pressure back to homeostasis?

    Be detailed in your explanation and support your answer with facts from your textbook, research, and articles from scholarly journals. In addition, remember to add references in APA format to your posts to avoid plagiarism.

    • 5

    Discussion 6

    Discussion 6

    This week, critically think about the theories that were developed by Carl Rogers and Abraham Maslow as well as the humanistic approach. Familiarize yourself with the Module 6 objectives, introduction, videos, articles, and all other content in the module. For primary references, use our readings for the week, then utilize the Saint Leo Online Library for peer reviewed sources and to find relevance to the topic this week.

    1. Think about the content of our readings by Rogers and Maslow. Explain both Rogers and Maslow’s views on human behavior. How are their theories similar and how are they different?

    2. How have Rogers’ views on client-centered therapy and Maslow’s theories on motivation stood the test of time today? Which aspects of their views do you believe influenced the humanistic approach the least?


    Maslow, A. H. (1943). A theory of human motivation. Psychological Review, 50, 370-396. [The first published description of the “hierarchy of needs.”]

    Rogers, C. R. (1946). Significant aspects of client-centered therapy. American Psychologist, 1, 415-422

    Rogers, C. R. (1947). Some observations on the organization of personality. American Psychologist, 2, 358-368. [Rogers’ APA Presidential Address.]

    Discussion 6


    Read the article below and report on the interpretation of a research findings in the article attached. 

    1. Evaluate the discussion section of the article attached and identify if the following was addressed. (Note, you need to show evidence, do not just say yes or no. Post what the researcher indicated that supports that these elements were addressed in the discussion section. Add the page number where you found them)

    a) Four limitations and  Four strengths of the study variable(s) 

    b)hypothesis(es)/research questions 

    c) theoretical framework

    d) design

     e) sample  

    f) data collection procedures

    g) data analysis 



    j)recommendations for future research 

    2. After reviewing and evaluating the  “Discussion” section of the article, discuss the strength of the evidence supports a change in current practice (If you think it does, support your answer with evidence based literature. You describe what the article indicated and find another source to support why the strength of evidence support a change in current practice). 250-300 words

    Note: Please explain the answers, use the article below to reference this work. Also include the page number and the intext citation of this article in the questions above. Next don’t forget to include your reference page.

    Discussion 6

    A 29-year-old female develops sepsis and, as a consequence, she experiences profound vasodilation.

    a) What effect does vasodilation have on the afterload? Explain why.

    b) What effect does vasodilation have on blood pressure? Explain why. How will her body try to bring her blood pressure back to homeostasis?

    Be detailed in your explanation and support your answer with facts from your textbook, research, and articles from scholarly journals. In addition, remember to add references in APA format to your posts to avoid plagiarism.

      • 7

      Discussion 6

       Read the article below and report on the interpretation of a research findings in the article attached. 

      1. Evaluate the discussion section of the article attached and identify if the following was addressed. (Note, you need to show evidence, do not just say yes or no. Post what the researcher indicated that supports that these elements were addressed in the discussion section. Add the page number where you found them)

      a) limitations and strengths of the study variable(s) 

      b)hypothesis(es)/research questions 

      c) theoretical framework

      d) design

       e) sample  

      f) data collection procedures

      g) data analysis 



      j)recommendations for future research 

      2. After reviewing and evaluating the  “Discussion” section of the article, discuss the strength of the evidence supports a change in current practice (If you think it does, support your answer with evidence based literature. You describe what the article indicated and find another source to support why the strength of evidence support a change in current practice). 

      Discussion 6

      PSYC 312

      Discussion Assignment Instructions


      Throughout the term, you will participate in 3 class discussions. These discussions provide an opportunity for you to interact with your classmates in a way that demonstrates understanding of important course concepts, practical application, and Biblical integration. While a conversational tone is welcomed, writing should also demonstrate academic competence (well-organized, clear, and focused on the topic).


      1. The initial thread will include a response to the discussion prompt that includes at least two major concepts, the source of which is identified with an APA-formatted citation:

      a. At least one concept from our textbook.

      b. At least one concept from Scripture.

      2. The initial thread will also include an explanation of how the concept (from the textbook or Scripture) connects to the discussion topic.

      3. Practical application of these concepts should also be included.

      4. The reply posts may be more conversational but should still be focused on the discussion prompt/topic.

      5. To encourage the development and demonstration of your own thoughts, direct quotes are not allowed in our discussions (either the initial thread or the replies) except for brief quotes from Scripture. Please note that if you choose to include direct quotes they will not be considered in the final word count.


      1. The initial thread must include at least 300 but no more than 500 words.

      2. Two reply posts are required. Each reply must include at least 150 but not more than 250 words.

      3. The source of any information included that is not considered common knowledge must be identified with a citation.

      4. Each source cited must be included in a reference list at the end of your posts.

      5. At least two citations must be included in each initial thread (one from the textbook and one from Scripture).

      6. At least one textbook citation must be included in each reply post.

      7. Direct quotes should not be included except brief passages from Scripture.

      Additional Information

      This course utilizes the Post-First feature in all Discussions. This means you will only be able to read and interact with your classmates’ threads after you have submitted your thread in response to the provided prompt.

      Finally, although healthy discussion is encouraged, disrespect towards others (e.g., hostility, name-calling) is not acceptable and will be penalized. Refer to the Discussion Grading Rubric provided for specifics regarding how points are assigned for your thread and replies.

      Each thread is due by 11:59 p.m. (ET) on Thursday of the assigned Module: Week. Replies are due by 11:59 p.m. (ET) on Monday of the same Module: Week.

      Page 2 of 2

      Discussion 6

      Classics in the History of Psychology

      An internet resource developed by

      Christopher D. Green

      York University, Toronto, Ontario

      ISSN 1492-3173

      (Return to Classics index)

      Significant Aspects of Client-Centered Therapy [1]

      Carl R. Rogers (1946)

      University of Chicago

      First published in American Psychologist, 1, 415-422

      Posted March 2000

      In planning to address this group, I have considered and discarded several possible topics. I was tempted to describe the process of non-directive therapy and the counselor techniques and procedures which seem most useful in bringing about this process. But much of this material is now in writing. My own book on counseling and psychotherapy contains much of the basic material, and my recent more popular book on counseling with returning servicemen tends to supplement it. The philosophy of the client-centered approach and its application to work with children is persuasively presented by Allen. The application to counseling of industrial employees is discussed in the volume by Cantor. Curran has now published in book form one of the several research studies which are throwing new light on both process and procedure. Axline is publishing a book on play and group therapy. Snyder is bringing out a book of cases. So it seems unnecessary to come a long distance to summarize material which is, or soon ·n-ill be. obtainable in written form.

      Another tempting possibility, particularly in this setting, was to discuss some of the roots from which the client-centered approach has sprung. It would have been interesting to show how in its concepts of repression and release, in its stress upon catharsis and insight, it has many roots in Freudian thinking, and to acknowledge that indebtedness. Such an analysis could also have shown that in its concept of the individual’s ability to organize his own experience there is an even deeper indebtedness to the work of Rank, Taft, and Allen. In its stress upon objective research, the subjecting of fluid attitudes to scientific investigation, the willingness to submit all hypotheses to a verification or disproof by research methods, the debt is obviously to the whole field of American psychology, with its genius for scientific methodology. It could also have been pointed out that although everyone in the clinical field has been heavily exposed to the eclectic “team” approach to therapy of the child guidance movement, and the somewhat similar eclecticism of the Adolf Meyers — Hopkins school of thought, these eclectic viewpoint have perhaps not been so fruitful in therapy and that little from these sources has been retained in the non-directive approach. It might also have been pointed out that in its basic trend away from guiding and directing the client. the non-directive approach is deeply rooted in practical clinical experience, and is in accord with the experience of most clinical workers, so much so that one of the commonest reactions of experienced therapists is that “You have crystallized and put into words something that I have been groping toward in my own experience for a long time.”

      Such an analysis, such a tracing or root ideas, needs to be made, but I doubt my own ability to make it. I am also doubtful that anyone who is deeply concerned with a new development knows with any degree of accuracy where his ideas came from.

      Consequently I am, in this presentation. Adopting a third pathway. While I shall bring in a brief description of process and procedure. and while I shall acknowledge in a general way our indebtedness to many root sources, and shall recognize the many common elements shared by client-centered therapy and other approaches, I believe it will be to our mutual advantage if I stress primarily those aspects in which nondirective[*] therapy differs most sharply and deeply from other therapeutic procedures. I hope to point out some of the basically significant ways in which the client-centered viewpoint differs from others, not only in its present principles, but in the wider divergencies which are implied by the projection of its central principles. [p. 416]


      The first of the three distinctive elements of client-centered therapy to which I wish to call your attention is the predictability of the therapeutic process in this approach. We find, both clinically and statistically, that a predictable pattern of therapeutic development takes place. The assurance which we feel about this was brought home to me recently when I played a recorded first interview for the graduate students in our practicum immediately after it was recorded, pointing out the characteristic aspects, and agreeing to play later interviews for them to let them see the later phases of the counseling process. The fact that I knew with assurance what the later pattern would be before it had occurred only struck me as I thought about the incident. We have become clinically so accustomed to this predictable quality that we take it for granted. Perhaps a brief summarized description of this therapeutic process will indicate those elements of which we feel sure.

      It may be said that we now know how to initiate a complex and predictable chain of events in dealing with the maladjusted individual, a chain of events which is therapeutic, and which operates effectively in problem situations of the most diverse type. This predictable chain of events may come about through the use of language as in counseling, through symbolic language, as in play therapy, through disguised language as in drama or puppet therapy. It is effective in dealing with individual situations, and also in small group situations.

      It is possible to state with some exactness the conditions which must be met in order to initiate and carry through this releasing therapeutic experience. Below are listed in brief form the conditions which seem to be necessary, and the therapeutic results which occur.

      This experience which releases the growth forces within the individual will come about in most cases if the following elements are present.

      (1) If the counselor operates on the principle that the individual is basically responsible for himself, and is willing for the individual to keep that responsibility.

      (2) If the counselor operates on the principle that the client has a strong drive to become mature, socially adjusted. independent, productive, and relies on this force, not on his own powers, for therapeutic change.

      (3) If the counselor creates a warm and permissive atmosphere in which the individual is free to bring out any attitudes and feelings which he may have, no matter how unconventional, absurd, or contradictory these attitudes may be. The client is as free to withhold expression as he is to give expression to his feelings.

      (4) If the limits which are set are simple limits set on behavior, and not limits set on attitudes. (This applies mostly to children. The child may not be permitted to break a window or leave the room. but he is free to feel like breaking a window, and the feeling is fully accepted. The adult client may not be permitted more than an hour for an interview, but there is full acceptance of his desire to claim more time.)

      (5) If the therapist uses only those procedures and techniques in the interview which convey his deep understanding of the emotionalized attitudes expressed and his acceptance of them. This under standing is perhaps best conveyed by a sensitive reflection and clarification of the client’s attitudes. The counselor’s acceptance involves neither approval nor disapproval.

      (6) If the counselor refrains from any expression or action which is contrary to the preceding principles. This means reframing from questioning, probing, blame, interpretation, advice, suggestion, persuasion, reassurance.

      If these conditions are met. then it may be said with assurance that in the great majority of cases the following results will take place.

      (1) The client will express deep and motivating attitudes.

      (2) The client will explore his own attitudes and reactions more fully than he has previously done and will come to be aware of aspects of his attitudes which he has previously denied.

      (3) He will arrive at a clearer conscious realization of his motivating attitudes and will accept himself more completely. This realization and this acceptance will include attitudes previously denied. He may or may not verbalize this clearer conscious understanding of himself and his behavior.

      (4) In the light of his clearer perception of himself he will choose, on his own initiative and on his own [p. 417] responsibility, new goal which are more satisfying than his maladjusted goals.

      (5) He will choose to behave in a different fashion in order to reach these goals, and this new behavior will be in the direction of greater psychological growth and maturity. It will also be more spontaneous and less tense, more in harmony with social needs of others, will represent a more realistic and more comfortable adjustment to life. It will be more integrated than his former behavior. It will be a step forward in the life of the individual.

      The best scientific description of this process is that supplied by Snyder. Analyzing a number of cases with strictly objective research techniques, Snyder has discovered that the development in these cases is roughly parallel, that the initial phase of catharsis is replaced by a phase in which insight becomes the most significant element, and this in turn by a phase marked by the increase in positive choice and action

      Clinically, we know that sometimes this process is relatively shallow, involving primarily a fresh reorientation to an immediate problem, and in other instances so deep as to involve a complete reorientation of personality. It is recognizably the same process whether it involves a girl who is unhappy in a dormitory and is able in three interviews to see something of her childishness and dependence, and to take steps in a mature direction, or whether it involves a young man who is on the edge of a schizophrenic break, and who in thirty interviews works out deep insights in relation to his desire for his father’s death, and his possessive and incestuous impulses toward is mother, and who not only takes new steps but rebuilds his whole personality in the process. Whether shallow or deep, it is basically the same.

      We are coming to recognize with assurance characteristic aspects of each phase of the process. We know that the catharsis involves a gradual and more complete expression of emotionalized attitudes. We know that characteristically the conversation goes from superficial problems and attitudes to deeper problems and attitudes. We know that this process of exploration gradually unearths relevant attitudes which have been denied to consciousness. We recognize too that the process of achieving insight is likely to involve more adequate facing of reality as it exists within the self, as well as external reality; that it involves the relating of problems to each other, the perception of patterns of behavior; that it involves the acceptance of hitherto denied elements of the self, and a reformulating of the self-concept; and that it involves the making of new plans.

      In the final phase we know that the choice of new ways of behaving will be in conformity with the newly organized concept of the self; that first steps in putting these plans into action will be small but symbolic; that the individual will feel only a minimum degree of confidence that he can put his plans into effect, that later steps implement more and more completely the new concept of self, and that this process continues beyond the conclusion of the therapeutic interviews.

      If these statements seem to contain too much assurance, to sound “too good to be true,” I can only say that for many of them we now have research backing, and that as rapidly as possible we are developing our research to bring all phases of the process under objective scrutiny. Those of us working clinically with client-centered therapy regard this predictability as a settled characteristic, even though we recognize that additional research will be necessary to fill out the picture more completely.

      It is the implication of this predictability which is startling. Whenever, in science, a predictable process has been discovered, it has been found possible to use it as a starting point for a whole chain of discoveries. We regard this as not only entirely possible, but inevitable, with regard to this predictable process in therapy. Hence, we regard this orderly and predictable nature of nondirective therapy as one of its most distinctive and significant points of difference from other approaches. Its importance lies not only in the fact that it is a present difference. but in the fact that it points toward a sharply different future, in which scientific exploration of this known chain of events should lead to many new discoveries, developments. and applications.


      Naturally the question is raised, what is the reason for this predictability in a type of therapeutic procedure in which the therapist serves only a catalytic function? Basically the reason for the predictability [p. 418] of the therapeutic process lies in the discovery — and I use that word intentionally — that within the client reside constructive forces whose strength and uniformity have been either entirely unrecognized or grossly underestimated. It is the clearcut and disciplined reliance by the therapist upon those forces within the client, which seems to account for the orderliness of the therapeutic process, and its consistency from one client to the next.

      I mentioned that I regarded this as a discovery. I would like to amplify that statement. We have known for centuries that catharsis and emotional release were helpful. Many new methods have been and are being developed to bring about release, but the principle is not new. Likewise, we have known since Freud’s time that insight, if it is accepted and assimilated by the client, is therapeutic. The principle is not new. Likewise we have realized that revised action patterns, new ways of behaving, may come about as a result of insight. The principle is not new.

      But we have not known or recognized that in most if not all individuals there exist growth forces, tendencies toward self-actualization, which may act as the sole motivation for therapy. We have not realized that under suitable psychological conditions these forces bring about emotional release in those areas and at those rates which are most beneficial to the individual. These forces drive the individual to explore his own attitudes and his relationship to reality. and to explore these areas effectively. We have not realized that the individual is capable of exploring his attitudes and feelings, including those which have been denied to consciousness, at a rate which does not cause panic, and to the depth required for comfortable adjustment. The individual is capable of discovering and perceiving, truly and spontaneously, the interrelationships between his own attitudes, and the relationship of himself to reality. The individual has the capacity and the strength to devise, quite unguided, the steps which will lead him to a more mature and more comfortable relationship to his reality. It is the gradual and increasing recognition of these capacities within the individual by the client-centered therapist that rates, I believe, the term discovery. All of these capacities I have described are released in the individual if a suitable psychological atmosphere is provided.

      There has, of course, been lip service paid to the strength of the client, and the need of utilizing the urge toward independence which exists in the client. Psychiatrists, analysts, and especially social case workers have stressed this point. Yet it is clear from what is said, and even more clear from the case material cited. that this confidence is a very limited confidence. It is a confidence that the client can take over, if guided by the expert, a confidence that the client can assimilate insight if it is first, given to him by the expert, can make choices providing guidance is given at crucial points. It is, in short, the same sort of attitude which the mother has toward the adolescent. that she believes in his capacity to make his own decisions and guide his own life, providing he takes the directions of which she approves.

      This is very evident in the latest book on psychoanalysis by Alexander and French. Although many of the former views and practices of psychoanalysis are discarded, and the procedures are far more nearly in line with those of nondirective therapy, it is still the therapist who is definitely in control. He gives the insights. he is ready to guide at crucial points. Thus while the authors state that the aim of the therapist is to free the patient to develop his capacities, and to increase his ability to satisfy his needs in ways acceptable to himself and society; and while they speak of the basic conflict between competition and cooperation as one which the individual must settle for himself; and speak of the integration of new insight as a normal function of the ego, it is clear when they speak of procedures that they have no confidence that the client has the capacity to do any of these things. For in practice, “As soon as the therapist takes the more active role we advocate, systematic planning becomes imperative. In addition to the original decision as to the particular sort of strategy to be employed in the treatment of any case, we recommend the conscious use of various techniques in a flexible manner, shifting tactics to fit the particular needs of the moment. Among these modifications of the standard technique are; using not only the method of free association but interviews of a more direct character, manipulating the frequency of the interviews, giving [p. 419] directives to the patient concerning his daily life, employing interruptions of long or short duration in preparation for ending the treatment, regulating the transference relation-hip to meet the specific needs of the case, and making use of real-life experiences as an integral part of therapy” (1). At least this leaves no doubt as to whether it is the client’s or the therapist’s hour; it is clearly the latter. The capacities which the client is to develop are clearly not to be developed in the therapeutic sessions.

      The client-centered therapist stands at an opposite pole, both theoretically and practically. He has learned that the constructive forces in the individual can be trusted. and that the more deeply they are relied upon, the more deeply they are released. He has come to build his procedures upon these hypotheses, which are rapidly becoming established as facts; that the client knows the areas of concern which he is ready to explore; that the client is the best judge as to the most desirable frequency of interviews; that the client can lead the way more efficiently than the therapist into deeper concerns; that the client will protect himself from panic by ceasing to explore an area which is becoming too painful; that the client can and will uncover all the repressed elements which it is necessary to uncover in order to build a comfortable adjustment; that the client can achieve for himself far truer and more sensitive and accurate insights than can possibly be given to him; that the client is capable of translating these insights into constructive behavior which weigh his own needs and desires realistically against the demands of society; that the client knows when therapy is completed and he is ready to cope with life independently. Only one condition is necessary for all these forces to be released, and that is the proper psychological atmosphere between client and therapist.

      Our case records and increasingly our research bear out these statements. One might suppose that there would be a generally favorable reaction to this discovery, since it amounts in effect to tapping great reservoirs of hitherto little-used energy. Quite the contrary is true, however, in professional groups. There is no other aspect of client-centered therapy which comes under such vigorous attack. It seems to be genuinely disturbing to many professional people to entertain the thought that this client upon whom they have been exercising their professional skill actually knows more about his inner psychological self than they can possibly know, and that he possesses constructive strengths which make the constructive push by the therapist seem puny indeed by comparison. The willingness fully to accept this strength of the client, with all the re-orientation of therapeutic procedure which it implies, is one of the ways in which client-centered therapy differs most sharply from other therapeutic approaches.


      The third distinctive feature of this type of therapy is the character of the relationship between therapist and client. Unlike other therapies in which the skills of the therapist are to be exercised upon the client. in this approach the skills of the therapist are focussed upon creating a psychological atmosphere in which the client can work. If the counselor can create a relationship permeated by warmth, understanding, safety from any type of attack, no matter how trivial, and basic acceptance of the person as he is, then the client will drop his natural defensiveness and use the situation. As we have puzzled over the characteristics of a successful therapeutic relationship, we have come to feel that the sense of communication is very important. If the client feels that he is actually communicating his present attitudes, superficial, confused, or conflicted as they may be, and that his communication is understood rather than evaluated in any way, then he is freed to communicate more deeply. A relationship in which the client thus feels that he is communicating is almost certain to be fruitful.

      All of this means a drastic reorganization in the counselor’s thinking, particularly if he has previously utilized other approaches. He gradually learns that the statement that the time is to be “the client’s hour” means just that, and that his biggest task is to make it more and more deeply true.

      Perhaps something of the characteristics of the relationship may be suggested by excerpts from a paper written by a young minister who has spent several months learning client-centered counseling procedures. [p. 420]

      “Because the client-centered, nondirective counseling approach has been rather carefully defined and clearly illustrated, it gives the “Illusion of Simplicity.” The technique seems deceptively easy to master. Then you begin to practice. A word is wrong here and there. You don’t quite reflect feeling, but reflect content instead. It is difficult to handle questions; you are tempted to interpret. Nothing seems so serious that further practice won’t correct it. Perhaps you are having trouble playing two roles — that of minister and that of counselor. Bring up the question in class and the matter is solved again with a deceptive ease. But these apparently minor errors and a certain woodenness of response seem exceedingly persistent.

      “Only gradually does it dawn that if the technique is true it demands a feeling of warmth. You begin to feel that the attitude is the thing. Every little word is not so important if you have the correct accepting and permissive attitude toward the client. So you bear down on the permissiveness and acceptance. You will permiss[sic] and accept and reflect the client, if it kills you!

      [§]’But you still have those troublesome questions from the client. He simply doesn’t know the next step. He asks you to give him a hint, some possibilities, after all you are expected to know something, else why is he here! As a minister, you ought to have some convictions about what people should believe, how they should act. As a counselor, you should know something about removing this obstacle — you ought to have the equivalent of the surgeon’s knife and use it. Then you begin to wonder. The technique is good, but … does it go far enough! does it really work on clients? is it right to leave a person helpless, when you might show him the way out?

      “Here it secms to me is the crucial point. “Narrow is the gate” and hard the path from here on. So one else can give satisfying answers and even the instructors seem frustrating because they appear not to be helpful in your specific case. For here is demanded of you what no other person can do or point out — and that is to rigorously scrutinize yourself and your attitudes towards others. Do you believe that all people truly have a creative potential in them? That each person is a unique individual and that he alone can work out his own individuality? Or do you really believe that some persons are of “negative value” and others are weak and must be led and taught by “wiser,” “stronger” people.

      “You begin to see that there is nothing compartmentalized about this method of counseling. It is not just counseling, because it demands the most exhaustive, penetrating, and comprehensive consistency. In other methods you can shape tools, pick them up for use when you will. But when genuine acceptance and permissiveness are your tools it requires nothing less than the whole complete personality. And to grow oneself is the most demanding of all.”

      He goes on to discuss the notion that the counselor must be restrained and “self-denying.” He concludes that this is a mistaken notion.

      “Instead of demanding less of the counselor’s personality in the situation, client-centered counseling in some ways demands more. It demands discipline, not restraint. It calls for the utmost in sensitivity, appreciative awareness. channeled and disciplined. It demands that the counselor put all he has of these precious qualities into the situation, but in a disciplined, resfined manner. It is restraint only in the sense that the counselor does not express himself in certain areas that he may use himself in others.

      “Even this is deceptive, however. It is not so much restraint in any area as it is a focusing, sensitizing one’s energies and personality in the direction of an appreciative and understanding attitude.”

      As time has gone by we have come to put increasing stress upon the “client-centeredness” of the relationship, because it is more effective the more completely the counselor concentrates upon trying to understand the client as the client seems to himself. As I look back upon some of our earlier published cases — the case of Herbert Bryan in my book, or Snyder’s case of Mr. M. — I realize that we have gradually dropped the vestiges of subtle directiveness which are all too evident in those cases. We [p. 421] have come to recognize that if we can provide understanding of the way the client seems to himself at this moment, he can do the rest. The therapist must lay aside his preoccupation with diagnosis and his diagnostic shrewdness, must discard his tendency to make professional evaluations, must cease his endeavors to formulate an accurate prognosis, must give up the temptation subtly to guide the individual, and must concentrate on one purpose only; that of providing deep understanding and acceptance of the attitudes consciously held at this moment by the client as he explores step by step into the dangerous areas which he has been denying to consciousness.

      I trust it is evident from this description that this type of relationship can exist only if the counselor is deeply and genuinely able to adopt these attitudes. Client-centered counseling, if it is to be effective, cannot be a trick or a tool. It is not a subtle way of guiding the client while pretending to let him guide himself. To be effective, it must be genuine. It is this sensitive and sincere “client-centeredness” in the therapeutic relationship that I regard as the third characteristic of nondirective therapy which sets it distinctively apart from other approaches.


      Although the client-centered approach had its origin purely within the limits of the psychological clinic, it is proving to have implications, often of a startling nature, for very diverse fields of effort. I should like to suggest a few of these present and potential implications.

      In the field of psychotherapy itself, it leads to conclusions that seem distinctly heretical. It appears evident that training and practice in therapy should probably precede training in the field of diagnosis. Diagnostic knowledge and skill is not necessary for good therapy, a statement which sounds like blasphemy to many, and if the professional worker, whether psychiatrist, psychologist or caseworker, received training in therapy first he would learn psychological dynamics in a truly dynamic fashion, and would acquire a professional humility and willingness to learn from his client which is today all too rare.

      The viewpoint appears to have implications for medicine. It has fascinated me to observe that when a prominent allergist began to use client-centered therapy for the treatment of non-specific allergies, he found not only very good therapeutic results, but the experience began to affect his whole medical practice. It has gradually meant the reorganization of his office procedure. He has given his nurses a new type of training in understanding the patient. He has decided to have all medical histories taken by a nonmedical person trained in nondirective techniques, in order to get a true picture of the client’s feelings and attitudes toward himself and his health, uncluttered by the bias and diagnostic evaluation which is almost inevitable when a medical person takes the history and unintentionally distorts the material by his premature judgments. He has found these histories much more helpful to the physicians than those taken by physicians.

      The client-centered viewpoint has already been shown to have significant implications for the field of survey interviewing and public opinion study. Use of such techniques by Likert, Lazarsfeld, and others has meant the elimination of much of the factor of bias in such studies.

      This approach has also, we believe, deep implications for the handling of social and group conflicts, as I have pointed out in another paper (9). Our work in applying a client-centered viewpoint to group therapy situations, while still in its early stages, leads us to feel that a significant clue to the constructive solution of interpersonal and intercultural frictions in the group may be in our hands. Application of these procedures to staff groups, to inter-racial groups, to groups with personal problems and tensions, is under way.

      In the field of education, too, the client-centered approach is finding significant application. The work of Cantor, a description of which will soon be published, is outstanding in this connection, but a number of teachers are finding that these methods, designed for therapy, produce a new type of educational process, an independent learning which is highly desirable, and even a reorientation of individual direction which is very similar to the results of individual or group therapy.

      Even in the realm of our philosophical orientation, the client-cente

      Discussion 6

      Classics in the History of Psychology

      An internet resource developed by

      Christopher D. Green

      York University, Toronto, Ontario

      ISSN 1492-3173

      (Return to Classics index)

      Some Observations on the Organization of Personality

      Carl R. Rogers (1947)

      Address of the retiring President of the American Psychological Association the September 1947 Annual Meeting.

      First published in American Psychologist, 2, 358-368.

      Posted March 2000

      In various fields of science rapid strides have been made when direct observation of significant processes has become possible. In medicine, when circumstances have permitted the physician to peer directly into the stomach of his patient, understanding of digestive processes has increased and the influence of emotional tension upon all aspects of that process has been more accurately observed and understood. In our work with nondirective therapy we often feel that we are having a psychological opportunity comparable to this medical experience — an opportunity to observe directly a number of the effective processes of personality. Quite aside from any question regarding nondirective therapy as therapy, here is a precious vein of observational material of unusual value for the study of personality.

      Characteristics of the Observational Material

      There are several ways in which the raw clinical data to which we have had access is unique in its value for understanding personality. The fact that these verbal expressions of inner dynamics are preserved by electrical recording makes possible a detailed analysis of a sort not heretofore possible. Recording has given us a microscope by which we may examine at leisure, and in minute detail, almost every aspect of what was, in its occurrence, a fleeting moment impossible of accurate observation.

      Another scientifically fortunate characteristic of this material is the fact that the verbal productions of the client are biased to a minimal degree by the therapist. Material from client-centered interviews probably comes closer to being a “pure” expression of attitudes than has yet been achieved through other means. One can read through a complete recorded case or listen to it, without finding more than a half-dozen instances in which the therapist’s views on any point are evident. One would find it impossible to form an estimate as to the therapist’s views about personality dynamics. One could not determine his diagnostic views, his standards of behavior, his social class. The one value or standard held by the therapist which would exhibit itself in his tone of voice, responses, and activity, is a deep respect for the personality and attitudes of the client as a separate person. It is difficult to see how this would bias the content of the interview, except to permit deeper expression than the client would ordinarily allow himself. This almost complete lack of any distorting attitude is felt, and sometimes expressed by the client. One woman says:

      It’s almost impersonal. I like you — of course I don’t know why I should like you or why I shouldn’t like you. It’s a peculiar thing. I’ve never had that relationship with anybody before and I’ve often thought about it…. A lot of times I walk out with a feeling of elation that you think highly of me, and of course at the same time I have the feeling that “Gee, he must think I’m an awful jerk” or something like that. But it doesn’t really-those feelings aren’t so deep that I can form an opinion one way or the other about you.

      Here it would seem that even though she would like to discover some type of evaluational attitude, she is unable to do so. Published studies and research as yet unpublished bear out this point that counselor responses which are in any way evaluational or distorting as to content are at a minimum, thus enhancing the worth of such interviews for personality study.

      The counselor attitude of warmth and understanding, well described by Snyder (9) and Rogers (8), also helps to maximize the freedom of expression by the individual. The client experiences sufficient interest in him as a person, and sufficient acceptance, to enable him to talk openly, not only about surface attitudes, but increasingly about intimate attitudes and feelings hidden even from himself. Hence in these recorded interviews we have material of very considerable depth so far as personality dynamics is concerned, along with a freedom from distortion.

      Finally the very nature of the interviews and the techniques by which they are handled give us a rare opportunity to see to some extent through the eyes of another person-to perceive the world as it appears to him, to achieve at least partially, the internal frame of reference of another person. We see his behavior through his eyes, and also the psychological meaning which it had for him. We see also changes in personality and behavior, and the meanings which those changes have for the individual. We are admitted freely into the backstage of the person’s living where we can observe from within some of the dramas of internal change, which are often far more compelling and moving than the drama which is presented on the stage viewed by the public. Only a novelist or a poet could do justice to the deep struggles which we are permitted to observe from within the client’s own world of reality.

      This rare opportunity to observe so directly and so clearly the inner dynamics of personality is a learning experience of the deepest sort for the clinician. Most of clinical psychology and psychiatry involves judgments about the individual, judgments which must, of necessity, be based on some framework brought to the situation by the clinician. To try continually to see and think with the individual, as in client-centered therapy, is a mindstretching experience in which learning goes on apace because the clinician brings to the interview no pre-determined yardstick by which to judge the material.

      I wish in this paper to try to bring you some of the clinical observations which we have made as we have repeatedly peered through these psychological windows into personality, and to raise with you some of the questions about the organization of personality which these observations have forced upon us. I shall not attempt to present these observations in logical order, but rather in the order in which they impressed themselves upon our notice. What I shall offer is not a series of research findings, but only the first step in that process of gradual approximation which we call science, a description of some observed phenomena which appear to be significant, and some highly tentative explanations of these phenomena.

      The Relation of the Organized Perceptual Field to Behavior

      One simple observation, which is repeated over and over again in each successful therapeutic case, seems to have rather deep theoretical implications. It is that as changes occur in the perception of self and in the perception of reality, changes occur in behavior. In therapy, these perceptual changes are more often concerned with the self than with the external world. Hence we find in therapy that as the perception of self alters, behavior alters. Perhaps an illustration will indicate the type of observation upon which this statement is based.

      A young woman, a graduate student whom we shall call Miss Vib, came in for nine interviews. If we compare the first interview with the last, striking changes are evident. Perhaps some features of this change may be conveyed by taking from the first and last interviews all the major statements regarding self, and all the major statements regarding current behavior. In the first interview, for example, her perception of herself may be crudely indicated by taking all her own statements about herself, grouping those which seem similar, but otherwise doing a minimum of editing, and retaining so far as possible, her own words. We then come out with this as the conscious perception of self which was hers at the outset of counseling.

      I feel disorganized, muddled; I’ve lost all direction; my personal life has disintegrated.

      I sorta experience things from the forefront of my consciousness, but nothing sinks in very deep; things don’t seem real to me; I feel nothing matters; I don’t have any emotional response to situations; I’m worried about myself.

      I haven’t been acting like myself; it doesn’t seem like me; I’m a different person altogether from what I used to be in the past.

      I don’t understand myself; I haven’t known what was happening to me.

      I have withdrawn from everything, and feel all right only when I’m all alone and no one can expect me to do things.

      I don’t care about my personal appearance.

      I don’t know anything anymore.

      I feel guilty about the things I have left undone.

      I don’t think I could ever assume responsibility for anything.

      If we attempt to evaluate this picture of self from an external frame of reference various diagnostic labels may come to mind. Trying to perceive it solely from the client’s frame of reference we observe that to the young woman herself she appears disorganized, and not herself. She is perplexed and almost unacquainted with what is going on in herself. She feels unable and unwilling to function in any responsible or social way. This is at least a sampling of the way she experiences or perceives herself.

      Her behavior is entirely consistent with this picture of self. If we abstract all her statements describing her behavior, in the same fashion as we abstracted her statements about self, the following pattern emerges — a pattern which in this case was corroborated by outside observation.

      I couldn’t get up nerve to come in before; I haven’t availed myself of help.

      Everything I should do or want to do, I don’t do.

      I haven’t kept in touch with friends; I avoid making the effort to go with them; I stopped writing letters home; I don’t answer letters or telephone calls; I avoid contacts that would be professionally helpful; I didn’t go home though I said I would.

      I failed to hand in my work in a course though I had it all done: I didn’t even buy clothing that I needed; I haven’t even kept my nails manicured.

      I didn’t listen to material we were studying; I waste hours reading the funny papers; I can spend the whole afternoon doing absolutely nothing.

      The picture of behavior is very much in keeping with the picture of self, and is summed up in the statement that “Everything I should do or want to do, I don’t do.” The behavior goes on, in ways that seem to the individual beyond understanding and beyond control.

      If we contrast this picture of self and behavior with the picture as it exists in the ninth interview, thirty-eight days later, we find both the perception of self and the ways of behaving deeply altered. Her statements about self are as follows:

      I’m feeling much better; I’m taking more interest in myself.

      I do have some individuality, some interests.

      I seem to be getting a newer understanding of myself. I can look at myself a little better.

      I realize I’m just one person, with so much ability, but I’m not worried about it; I can accept the fact that I’m not always right.

      I feel more motivation, have more of a desire to go ahead.

      I still occasionally regret the past, though I feel less unhappy about it; I still have a long ways to go; I don’t know whether I can keep the picture of myself I’m beginning to evolve.

      I can go on learning — in school or out.

      I do feel more like a normal person now; I feel more I can handle my life myself; I think I’m at the point where I can go along on my own.

      Outstanding in this perception of herself are three things — that she knows herself, that she can view with comfort her assets and liabilities, and finally that she has drive and control of that drive.

      In this ninth interview the behavioral picture is again consistent with the perception of self. It may be abstracted in these terms.

      I’ve been making plans about school and about a job; I’ve been working hard on a term paper; I’ve been going to the library to trace down a topic of special interest and finding it exciting.

      I’ve cleaned out my closets; washed my clothes.

      I finally wrote my parents; I’m going home for the holidays.

      I’m getting out and mixing with people: I am reacting sensibly to a fellow who is interested in me — seeing both his good and bad points.

      I will work toward my degree; I’11 start looking for a job this week.

      Her behavior, in contrast to the first interview, is now organized, forward-moving, effective, realistic and planful. It is in accord with the realistic and organized view she has achieved of her self.

      It is this type of observation, in case after case, that leads us to say with some assurance that as perceptions of self and reality change, behavior changes. Likewise, in cases we might term failures, there appears to be no appreciable change in perceptual organization or in behavior.

      What type of explanation might account for these concomitant changes in the perceptual field and the behavioral pattern? Let us examine some of the logical possibilities.

      In the first place, it is possible that factors unrelated to therapy may have brought about the altered perception and behavior. There may have been physiological processes occurring which produced the change. There may have been alterations in the family relationships, or in the social forces, or in the educational picture or in some other area of cultural influence, which might account for the rather drastic shift in the concept of self and in the behavior.

      There are difficulties in this type of explanation. Not only were there no known gross changes in the physical or cultural situation as far as Miss Vib was concerned, but the explanation gradually becomes inadequate when one tries to apply it to the many cases in which such change occurs. To postulate that some external factor brings the change and that only by chance does this period of change coincide with the period of therapy, becomes an untenable hypothesis.

      Let us then look at another explanation, namely that the therapist exerted, during the nine hours of contact, a peculiarly potent cultural influence which brought about the change. Here again we are faced with several problems. It seems that nine hours scattered over five and one-half weeks is a very minute portion of time in which to bring about alteration of patterns which have been building for thirty years. We would have to postulate an influence so potent as to be classed as traumatic. This theory is particularly difficult to maintain when we find, on examining the recorded interviews, that not once in the nine hours did the therapist express any evaluation, positive or negative, of the client’s initial or final perception of self, or her initial or final mode of behavior. There was not only no evaluation, but no standards expressed by which evaluation might be inferred.

      There was, on the part of the therapist, evidence of warm interest in the individual, and thoroughgoing acceptance of the self and of the behavior as they existed initially, in the intermediate stages, and at the conclusion of therapy. It appears reasonable to say that the therapist established certain definite conditions of interpersonal relations, but since the very essence of this relationship is respect for the person as he is at that moment, the therapist can hardly be regarded as a cultural force making for change.

      We find ourselves forced to a third type of explanation, a type of explanation which is not new to psychology, but which has had only partial acceptance. Briefly it may be put that the observed phenomena of changes seem most adequately explained by the hypothesis that given certain psychological conditions, the individual has the capacity to reorganize his field of perception, including the way he perceives himself, and that a concomitant or a resultant of this perceptual reorganization is an appropriate alteration of behavior. This puts into formal and objective terminology a clinical hypothesis which experience forces upon the therapist using a client-centered approach. One is compelled through clinical observation to develop a high degree of respect for the ego-integrative forces residing within each individual. One comes to recognize that under proper conditions the self is a basic factor in the formation of personality and in the determination of behavior. Clinical experience would strongly suggest that the self is, to some extent, an architect of self, and the above hypothesis simply puts this observation into psychological terms.

      In support of this hypothesis it is noted in some cases that one of the concomitants of success in therapy is the realization on the part of the client that the self has the capacity for reorganization. Thus a student says:

      You know I spoke of the fact that a person’s background retards one. Like the fact that my family life wasn’t good for me, and my mother certainly didn’t give me any of the kind of bringing up that I should have had. Well, I’ve been thinking that over. It’s true up to a point. But when you get so that you can see the situation, then it’s really up to you.

      Following this statement of the relation of the self to experience many changes occurred in this young man’s behavior. In this, as in other cases, it appears that when the person comes to see himself as the perceiving, organizing agent, then reorganization of perception and consequent change in patterns of reaction take place.

      On the other side of the picture we have frequently observed that when the individual has been authoritatively told that he is governed by certain factors or conditions beyond his control, it makes therapy more difficult, and it is only when the individual discovers for himself that he can organize his perceptions that change is possible. In veterans who have been given their own psychiatric diagnosis, the effect is often that of making the individual feel that he is under an unalterable doom, that he is unable to control the organization of his life. When however the self sees itself as capable of reorganizing its own perceptual field, a marked change in basic confidence occurs. Miss Nam, a student, illustrates this phenomenon when she says, after having made progress in therapy:

      I think I do feel better about the future, too, because it’s as if I won’t be acting in darkness. It’s sort of, well, knowing somewhat why I act the way I do … and at least it isn’t the feeling that you’re simply out of your own control and the fates are driving you to act that way. If you realize it, I think you can do something more about it.

      A veteran at the conclusion of counseling puts it more briefly and more positively: “My attitude toward myself is changed now to where I feel I can do something with my self and life.” He has come to view himself as the instrument by which some reorganization can take place.

      There is another clinical observation which may be cited in support Of the general hypothesis that there is a close relationship between behavior and the way in which reality is viewed by the individual. It has many cases that behavior changes come about for the most part Imperceptibly and almost automatically, once the perceptual reorganization has taken place. A young wife who has been reacting violently to her maid, and has been quite disorganized in her behavior as a result of this antipathy says:

      After I … discovered it was nothing more than that she resembled my mother, she didn’t bother me any more. Isn’t that interesting? She’s still the same.

      Here is a clear statement indicating that though the basic perceptions have not changed, they have been differently organized, have acquired a new meaning, and that behavior changes then occur. Similar evidence is given by a client, a trained psychologist, who after completing a brief series of client-centered interviews, writes:

      Another interesting aspect of the situation was in connection with the changes in some of my attitudes. When the change occurred, it was as if earlier attitudes were wiped out as completely as if erased from a blackboard…. When a situation which would formerly have provoked a given type of response occurred, it was not as if I was tempted to act in the way I formerly had but in some way found it easier to control my behavior. Rather the new type of behavior came quite spontaneously, and it was only through a deliberate analysis that I became aware that I was acting in a new and different way.

      Here again it is of interest that the imagery is put in terms of visual perception and that as attitudes are “erased from the blackboard” behavioral changes take place automatically and without conscious effort.

      Thus we have observed that appropriate changes in behavior occur when the individual acquires a different view of his world of experience, including himself; that this changed perception does not need to be dependent upon a change in the “reality,” but may be a product of internal reorganization; that in some instances the awareness of the capacity for reperceiving experience accompanies this process of reorganization; that the altered behavioral responses occur automatically and without conscious effort as soon as the perceptual reorganization has taken place, apparently as a result of this.

      In view of these observations a second hypothesis may be stated, which is closely related to the first. It is that behavior is not directly influenced or determined by organic or cultural factors, but primarily (and perhaps only), by the perception of these elements. In other words the crucial element in the determination of behavior is the perceptual field of the individual. While this perceptual field is, to be sure, deeply influenced and largely shaped by cultural and physiological forces, it is nevertheless important that it appears to be only the field as it is perceived, which exercises a specific determining influence upon behavior. This is not a new idea in psychology, but its implications have not always been fully recognized.

      It might mean, first of all, that if it is the perceptual field which determines behavior, then the primary object of study for psychologists would be the person and his world as viewed by the person himself. It could mean that the internal frame of reference of the person might well constitute the field of psychology, an idea set forth persuasively by Snygg and Combs in a significant manuscript as yet unpublished. It might mean that the laws which govern behavior would be discovered more deeply by turning our attention to the laws which govern perception.

      Now if our speculations contain a measure of truth, if the specific determinant of behavior is the perceptual field, and if the self can reorganize that perceptual field, then what are the limits of this process? Is the reorganization of perception capricious, or does it follow certain laws? Are there limits to the degree of reorganization? If so, what are they? In this connection we have observed with some care the perception of one portion of the field of experience, the portion we call the self.

      The Relation of the Perception of the Self to Adjustment

      Initially we were oriented by the background of both lay and psychological thinking to regard the outcome of successful therapy as the solution of problems. If a person had a marital problem, a vocational problem, a problem of educational adjustment, the obvious purpose of counseling or therapy was to solve that problem. But as we observe and study the recorded accounts of the conclusion of therapy, it is clear that the most characteristic outcome is not necessarily solution of problems, but a freedom from tension, a different feeling about, and perception of, self. Perhaps something of this outcome may be conveyed by some illustrations.

      Several statements taken from the final interview with a twenty year old young woman, Miss Mir, give indications of the characteristic attitude toward self, and the sense of freedom which appears to accompany it.

      I’ve always tried to be what the others thought I should be, but now I am wondering whether I shouldn’t just see that I am what I am.

      Well, I’ve just noticed such a difference. I find that when I feel things, even when I feel hate, I don’t care. I don’t mind. I feel more free somehow. I don’t feel guilty about things.

      You know it’s suddenly as though a big cloud has been lifted off. I feel so much more content.

      Note in these statements the willingness to perceive herself as she is, to accept herself “realistically,” to perceive and accept her “bad” attitudes as well as “good” ones. This realism seems to be accompanied by a sense of freedom and contentment. Miss Vib, whose attitudes were quoted earlier, wrote out her own feelings about counseling some six weeks after the interviews were over, and gave the statement to her counselor. She begins:

      The happiest outcome of therapy has been a new feeling about myself. As I think of it, it might be the only outcome. Certainly it is basic to all the changes in my behavior that have resulted.

      In discussing her experience in therapy she states:

      I was coming to see myself as a whole. I began to realize that I am one person. This was an important insight to me. I saw that the former good academic achievement, job success, ease in social situations, and the present withdrawal, dejection, apathy and failure were all adaptive behavior, performed by me. This meant that I had to reorganize my feelings about myself, no longer holding to the unrealistic notion that the very good adjustment was the expression of the real “me” and this neurotic behavior was not. I came to feel that I am the same person, sometimes functioning maturely, and sometimes assuming a neurotic role in the face of what I had conceived as insurmountable problems. The acceptance of myself as one person gave me strength in the process of reorganization. Now I had a substratum, a core of unity on which to work

      As she continues her discussion there are such statements as:

      I am getting more happiness in being myself. I approve of myself more, and I have so much less anxiety.

      As in the previous example, the outstanding aspects appear to be the realization that all of her behavior “belonged” to her, that she could accept both the good and bad features about herself and that doing so gave her a release from anxiety and a feeling of solid happiness. In both instances there is only incidental reference to the serious “problems” which had been initially discussed.

      Since Miss Mir is undoubtedly above average intelligence and Miss Vib is a person with some psychological training, it may appear that such results are found only with the sophisticated individual. To counteract this opinion a quotation may be given from a statement written by a veteran of limited ability and education who had just completed counseling, and was asked to write whatever reactions he had to the experience. He says:

      As for the consoleing [sic] I have had I can say this, It really makes a man strip his own mind bare, and when he does he knows then what he realy [sic] is and what he can do. Or at least thinks he knows himself party well. As for myself, I know that my ideas were a little too big for what I realy [sic] am, but now I realize one must try start out at his own level.

      Now after four visits, I have a much clearer picture of myself and my future. It makes me feel a little depressed and disappointed, but on the other hand, it has taken me out of the dark, the load seems a lot lighter now, that is I can see my way now, I know what I want to do, I know about what I can do, so now that I can see my goal, I will be able to work a whole lot easyer [sic], at my own level.

      Although the expression is much simpler one notes again the same two elements — the acceptance of self as it is, and the feeling of easiness, of lightened burden, which accompanies it.

      As we examine many individual case records and case recordings, it appears to be possible to bring together the findings in regard to successful therapy by stating another hypothesis in regard to that portion of the perceptual field which we call the self. It would appear that when all of the ways in which the individual perceives himself — all perceptions of the qualities, abilities, impulses, and attitudes of the person, and all perceptions of himself in relation to others — are accepted into the organized conscious concept of the self, then this achievement is accompanied by feelings of comfort and freedom from tension which are experienced as psychological adjustment.

      This hypothesis would seem to account for the observed fact that the comfortable perception of self which is achieved is sometimes more positive than before, sometimes more negative. When the individual permits all his perceptions of himself to be organized into one pattern, the picture is sometimes more flattering than he has held in the past, sometimes less flattering. It is always more comfortable.

      It may be pointed out also that this tentative hypothesis supplies an operational type of definition, based on the client’s internal frame of reference, for such hitherto vague terms as “adjustment,” “integration,” and “acceptance of self.” They are defined in terms of perception, in a way which it should be possible to prove or disprove. When all of the organic perceptual experiences — the experiencing of attitudes, impulses, abilities and disabilities, the experiencing of others and of “reality” — when all of these perceptions are freely assimilated into an organized and consistent system, available to consciousness, then psychological adjustment or integration might be said to exist. The definition of adjustment is thus made an internal affair, rather than dependent upon an external “reality.”

      Something of what is meant by this acceptance and assimilation of perceptions about the self may be illustrated from the case of Miss Nam, a student. Like many other clients she gives evidence of having experienced attitudes and feelings which are defensively denied because they are not consistent with the concept or picture she holds of herself. The way in which they are first fully admitted into consciousness, and then organized into a unified system may be shown by excerpts from the recorded interviews. She has spoken of the difficulty she has had in bringing herself to write papers for her university courses.

      I just thought of something else which perhaps hinders me, and that is that again it’s two different feelings. When I have to sit down and do (a paper), though I have a lot of ideas, underneath I think I always have the feeling that I just can’t do it…. I have this feeling of being terrifically confident that I can do something, without being willing to put the work into it. At other times I’m practically afraid of what I have to do….

      Note that the conscious self has been organized as “having a lot of ideas,” being “terrifically confident” but that “underneath,” in other words not freely admitted into consciousness, has been the experience of feeling “I just can’t do it.” She continues:

      I’m trying to work through this funny relationship between this terrific confidence and then this almost fear of doing anything…. and I think the kind of feeling that I can really do things is part of an illusion I have about myself of being, in my imagination, sure that it will be something good and very good and all that, but whenever I get down to the actual

      Discussion 6

      1. Select at least five scientific articles for each of the topics below either from your text book or literature review and summarize the mechanism/s through which physical activity prevents/controls the listed chronic diseases in about 300-500 words. (With citation and references)

      (1) Physical activity and cancer

      (2) Physical activity and mental health

      Discussion 6

       An important step in a dissertation is the theoretical basis that might help explain and shed light on why the problem is happening. For example, if we want to know how different groups responded to the implementation of a new teaching strategy in higher education, you might consider theories related to adult learning. 

      Discuss the theoretical framework you think helps explains your topic and problem you will address in your dissertation. Remember, this will also be cited in the literature as well, so make sure to include scholarly resources from a peer reviewed journal. 

        • 8

        discussion 6

        Required Resources
        Read/review the following resources for this activity:

        · Textbook: Chapters 13, 14, and 15

        · Lesson

        · Minimum of 1 scholarly source (in addition to the textbook)

        For the initial post, address one of the following:

        Option 1: Middle East
        Examine the origins of the Arab-Israeli conflict from its beginnings some 4000 years ago and how it has evolved/devolved over the centuries to the current time? Analyze the role of the Balfour Declaration on Israel’s rebirth in 1948 and its effectiveness in helping Jewish people in their quest to reclaim their ancient homeland.

        Option 2: African Nation State Development
        Examine some of the main (internal or external) reasons why the African people were to develop into nation states later than most experts feel was appropriate/normal. Examine the role of European imperial powers in African nation state development.

        Writing Requirements

        · Minimum of 2 posts (1 initial & 1 follow-up)

        · Minimum of 2 sources cited (assigned readings/online lessons and an outside source)

        · APA format for in-text citations and list of references

        Follow-Up Post Instructions
        Respond to at least one peer. At least one of your responses should be to a peer who chose an option different from yours. Further the dialogue by providing more information and clarification.

        This activity will be graded using the Discussion Grading Rubric. Please review the following link:

        · Link (webpage): 
        Discussion Guidelines

        Discussion 6

        Part one: Identify different historical definitions of, causal explanations for, and responses to alcohol abuse
        Part two: Apply social learning theory to alcohol abuse
        Part three: Analyze the interactional contexts in which alcohol abuse most often occurs

        Discussion 6

        Discussion 6 250-300 words

        · Part I – Describe an example of an occurrence and discuss where your school/school district, etc., took action, created policy, etc., which was specific to upholding and protecting students Constitutional rights.

        · Part II – Describe an example of litigation involving your school regarding student Constitutional rights. Explain any change which followed (handbook revision, policy, etc.)

        Discussion 6



        In the helping profession, an intervention can be described as an action taken, a service provided, or a treatment technique used in an attempt to alleviate a problem. Clients/families come to human service professionals seeking help for all different types of reasons. The human service professional gathers information and uses that information to identify interventions that can help to alleviate the problem. The passion and desire that human service professionals have for helping others can be stressful and many times human service professional vicariously experience their clients’ problems and this can take a toll on the human service professional; therefore, it is essential that human service professionals be resilient themselves. Please use the assigned readings and use the Library to research peer-reviewed studies to support your post.

        Please respond to the following:

        • Discuss what it means for a human service professional to experience burnout and compassion fatigue.
        • What are some interventions a human service professional can utilize to reduce the risk of burnout and compassion fatigue as well as promote personal resilience?

        Discussion 6

        The discussion questions this week are from Chapter’s 14 & 15 (Jamsa, 2013). Each chapter 4 topics and use only 50-words max per topic to discuss and present your answer.

        Chapter 14 topics:

        · Define and describe the mobile web.

        · Describe the different generations of cell phones.

        · Describe how smartphones differ from ordinary cell phones.

        · Describe how web pages differ from apps and how apps differ from widgets.

        Chapter 15 topics:

        · Define business strategy. List five possible business strategies.

        · Discuss the purpose of the Capability Maturity Model.

        · Define auditing.

        · Define IT governance.

        Please write 2-3 pages with no plagiarism and need this document tomorrow Tuesday at 3 PM EST time.

        Discussion 6


        After reading Chp. 6 ppt, describe 3 different types of memory’s covered in the chapter. What are some things that you find useful in helping you remember things?

        Your discussions must be a minimum of 2 paragraphs. Please use proper grammar and punctuation. 

        Discussion 6.

        Discussion 6 250-300 words

        Part I – Describe an example of an occurrence and discuss where your school/school district, etc., took action, created policy, etc., which was specific to upholding and protecting students Constitutional rights.

        · Part II – Describe an example of litigation involving your school regarding student Constitutional rights. Explain any change which followed (handbook revision, policy, etc.)

        · Part III – After analyzing the 
        Teacher Code of Ethics

         Download Teacher Code of Ethics
        , discuss which code you think the new generation of teachers is most unaware of.

        Discussion 6


        Maury is a young clinical psychologist who is new to private practice, and is working on a fee-for-service basis, meaning he doesn’t take insurance.

        One of the clients he has been treating is a 20-year old man who was referred by his parents whom Maury had seen previously to consult on parenting for their younger child. This patient still depends on his parents financially, and they were writing the checks the client would bring to pay for therapy.

        After a few months in which good progress seemed to be made, the client suddenly grew dissatisfied and began devaluing Maury and the treatment; he unexpectedly quit therapy, still owing an unpaid balance of over $600.

        Maury had a good relationship with the client’s parents, and he is confident they would be happy to pay the balance. However, the client is an adult, and Maury does not have a signed Release of Information stating he can speak with the client’s parents.

        Discuss what Maury can do to recover the unpaid balance. What ethical issues and concerns should he keep in mind? How might he avoid such a situation in the future?

        Discussion 6

        Read the article “The most damaging food lie we have ever been told” in this week’s Readings and Resources and answer the following:

        • What food plan have you decided to follow (if any)? How will you decide which foods to include in your meals?
        • Share your thoughts on counting calories. Do you think this is a valid way to eat?
        • Write a brief description of any one “diet” (paleo, for example). Will this diet provide the body with all the micro and macronutrients that it needs?

        Hyman, M. (2021). The most damaging food lie we have ever been told. The Doctor’s Farmacy. 

        Discussion 6

        Marketing is an essential component of any business and entrepreneurs must have a good understanding of how to best market their business as well as themselves.

        Watch the video below and discuss your takeaways and thoughts about how an entrepreneur should utilize marketing in launching their business. Write 250 words

        Discussion 6


        Sustainability and the Supply Chain

        PowerPoint presentation to accompany

        Chopra and Meindl Supply Chain Management, 5e


        Copyright ©2013 Pearson Education, Inc. publishing as Prentice Hall.

        Copyright ©2013 Pearson Education, Inc. publishing as Prentice Hall.

        Copyright ©2013 Pearson Education, Inc. publishing as Prentice Hall.


        Copyright ©2013 Pearson Education, Inc. publishing as Prentice Hall.


        Copyright ©2013 Pearson Education, Inc. publishing as Prentice Hall.


        Copyright ©2013 Pearson Education, Inc. publishing as Prentice Hall.


        Copyright ©2013 Pearson Education, Inc. publishing as Prentice Hall.

        Learning Objectives

        Understand the importance of sustainability in a supply chain

        Discuss the challenge to sustainability posed by the tragedy of the commons

        Describe key metrics that can be used to measure sustainability for a supply chain

        Identify opportunities for improved sustainability in various supply chain drivers


        Copyright ©2013 Pearson Education, Inc. publishing as Prentice Hall.


        Copyright ©2013 Pearson Education, Inc. publishing as Prentice Hall.

        The Role of Sustainability
        in a Supply Chain

        The health and survival of every supply chain and every individual depends on the health of the surrounding world

        Expand the goal of a supply chain to others that may be affected by supply chain decision

        Factors driving focus on sustainability

        Reducing risk and improving the financial performance of the supply chain

        Attracting customers who value sustainability

        Making the world more sustainable


        Copyright ©2013 Pearson Education, Inc. publishing as Prentice Hall.


        Copyright ©2013 Pearson Education, Inc. publishing as Prentice Hall.

        The Tragedy of the Commons

        Dilemma arising when the common good does not align perfectly with the good of individual entities

        Getting any agreement on action is difficult because the optimal joint action is not individually optimal

        Need for intervention but considerable disagreement on the required form of intervention


        Copyright ©2013 Pearson Education, Inc. publishing as Prentice Hall.


        Copyright ©2013 Pearson Education, Inc. publishing as Prentice Hall.

        What Are Some Solutions
        to This “Tragedy”?

        No solution without taking away some of the freedom that participants

        Need to choose from options that are unlikely to be supported by all of their own free will


        Copyright ©2013 Pearson Education, Inc. publishing as Prentice Hall.


        Copyright ©2013 Pearson Education, Inc. publishing as Prentice Hall.

        What Are Some Solutions
        to This “Tragedy”?

        Mutual coercion – social arrangements or mechanisms coerce all participants to behave in a way that helps the common good

        Command-and-control approach

        Market mechanisms


        Proportional tax


        Copyright ©2013 Pearson Education, Inc. publishing as Prentice Hall.


        Copyright ©2013 Pearson Education, Inc. publishing as Prentice Hall.

        Key Metrics for Sustainability

        Energy consumption

        Water consumption

        Greenhouse gas emissions

        Waste generation

        Challenges with scope

        Absolute or relative measures of performance


        Copyright ©2013 Pearson Education, Inc. publishing as Prentice Hall.


        Copyright ©2013 Pearson Education, Inc. publishing as Prentice Hall.

        Sustainability and
        Supply Chain Drivers

        Opportunities identified by matching the four categories with supply chain drivers


        Significant consumers of energy and water and emitters of waste and greenhouse gases

        Separate the improvement opportunities into those that generate positive cash flows and those that do not


        Copyright ©2013 Pearson Education, Inc. publishing as Prentice Hall.


        Copyright ©2013 Pearson Education, Inc. publishing as Prentice Hall.

        Sustainability and
        Supply Chain Drivers


        Raw materials, work in process, finished goods and inventory sitting in typical landfill

        Life cycle assessment (LCA) can be used to assess a product’s environmental impacts

        Goal is to reduce harmful inventory and unlock the unused value in products when they are discarded


        Copyright ©2013 Pearson Education, Inc. publishing as Prentice Hall.


        Copyright ©2013 Pearson Education, Inc. publishing as Prentice Hall.

        Sustainability and
        Supply Chain Drivers


        Lower transportation costs also tends to reduce emissions and waste

        Product design a significant role in reducing transportation cost and emissions

        Reducing packaging and allowing greater density during transportation


        Copyright ©2013 Pearson Education, Inc. publishing as Prentice Hall.


        Copyright ©2013 Pearson Education, Inc. publishing as Prentice Hall.

        Sustainability and
        Supply Chain Drivers


        Majority of energy and water use and waste and emissions occurs in extended supply chain outside the enterprise

        Extended supply chain and work with their suppliers to improve performance

        Verifying and tracking supplier performance on sustainability is a major challenge


        Copyright ©2013 Pearson Education, Inc. publishing as Prentice Hall.


        Copyright ©2013 Pearson Education, Inc. publishing as Prentice Hall.

        Sustainability and
        Supply Chain Drivers


        Good information is a big challenge

        Absence of standards leads to claims of improvement that are not verifiable

        Leads to company-specific standards and an explosion of certifications and certifying agencies

        Use of consistent measures within a supply chain


        Copyright ©2013 Pearson Education, Inc. publishing as Prentice Hall.


        Copyright ©2013 Pearson Education, Inc. publishing as Prentice Hall.

        Sustainability and
        Supply Chain Drivers


        Consumption visibility and differential pricing by load or time of day may make a significant difference in the usage of energy

        Change customer’s willingness to pay for a product that is produced and distributed in a more sustainable manner but costs more

        Sustainability cannot be improved simply by focusing on reducing costs or the use of incentives


        Copyright ©2013 Pearson Education, Inc. publishing as Prentice Hall.


        Copyright ©2013 Pearson Education, Inc. publishing as Prentice Hall.

        Closed-Loop Supply Chains

        Supply chains cause significant harm to the environment when their output ends up in a landfill

        Improve sustainability by designing products that can be reused and recycled

        Must be supported by a supply chain that ensures recycling

        Economic interests of all the parties must be understood and aligned for the activities to be performed


        Copyright ©2013 Pearson Education, Inc. publishing as Prentice Hall.


        Copyright ©2013 Pearson Education, Inc. publishing as Prentice Hall.

        Summary of Learning Objectives

        Understand the importance of sustainability in a supply chain

        Discuss the challenge to sustainability posed by the tragedy of the commons

        Describe key metrics that can be used to measure sustainability for a supply chain

        Identify opportunities for improved sustainability in various supply chain drivers


        Copyright ©2013 Pearson Education, Inc. publishing as Prentice Hall.


        Copyright ©2013 Pearson Education, Inc. publishing as Prentice Hall.

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        Printed in the United States of America.


        Copyright ©2013 Pearson Education, Inc. publishing as Prentice Hall.


        Copyright ©2013 Pearson Education, Inc. publishing as Prentice Hall.