Lecture 3: Psychosocial Development

Lecture 3: Psychosocial Development Human Life Course Development Suzanne Rochester 2017

Eric and Joan Erikson(1902 – 1994)(1902-1997)

Stage 1:trust vs mistrust (age 0‐1) • Stage 2:autonomy vs shame and doubt • (age 1‐3) • Stage 3:initiative vs guilt (age 3‐5) • Stage 4:industry vs inferiority (age 6‐11) • Stage 5:identity vs role confusion (adolescence 12-18) • Stage 6:intimacy vs isolation (young adulthood 19-40) • Stage 7:generativity vs self-absorption (middle adulthood 40-65) • Stage 8:integrity vs despair (maturity/old age 65+) The ages given are approximate and represent the sensitive period for the development of the characteristics involved.

Erik Erikson’s theory of psychosocialdevelopment(1963) • Psychosocial because growth is a product of the person’s interaction with the environment, societal influences and their biological maturation • Personality development is explained as the ability of the ego (psyche) to deal with developmental life crises • Views experience as feeding into ego‐identity • Involves eight innately determined, sequential stages • Notion of ego strengths. Each stage offers new opportunities to develop strengths or ‘basic virtues’.

Erikson’s theory continued ……. • Each stage has two opposing forces that are active on the psyche and the person must resolve the potential crisis • successful resolution – person is able to integrate the psychological strengths of the age/stage into his/her life in a positive manner and so maintains emotional and psychological balance • unsuccessful resolution – inability to resolve the dilemmas of the age/stage delays maturation of the ego and may fixate the person at that level.

Infancy: Basic trust versus basic mistrust (0-1) • Basic task is to learn to trust • Negative counterpart is lack of trust • Basic virtues that arise from this stage are a sense of hope and a drive to form relationships

trust versus basic mistrust continued….. • Erikson views this first stage as the foundation for all later psycho-social development. When the psychic crisis is successfully resolved the infant emerges with a ‘sense of hope’ which should permeate the entire life cycle • The quality of the caregiver‐infant interaction has a direct impact. ‘…the amount of trust derived from earliest infantile experience does not seem to depend on absolute quantities of food or demonstration of love, but rather the quality of the maternal (sic) relationship’ (Erikson, 1965, p.241)

Toddler: autonomy vs shame and doubt (1-3) • Basic task is to learn to separate from mother and form first sense of autonomy • Negative counterpart is sense of shame and doubt in oneself • Basic virtues are self control and willpower

autonomy vs shame and doubt continued….. • If the infant has developed basic trust, he/she now begins to discover he/she can predict and have some control over events • Autonomy contributes to a sense of identity in which the child has courage to choose and guide his or her own actions • Erikson sees behaviours such as temper tantrums and refusal to cooperate, common at this age, as the child developing independence, hence ‘autonomy’.

Preschooler: initiative vs guilt(3-5) • Basic task is to learn to act on the world and initiate • Negative counterpart is sense of guilt • Basic virtue is direction and purpose

initiative vs guilt continued… • The child now recognises him/herself as a person in own right and this allows further exploration • As language and confidence grows she/he will initiate interactions with others and begin to see themselves as ‘grown up’ • The child now understands right from wrong and has a developing conscience

initiative vs guilt continued… • The child a growing sense of identity but she/he can still be ‘shamed’ and made to doubt themself by the coercive actions of significant others • He/she may have fears and anxieties unique to the age: • Fears about the body and body intactness • Fears associated with loss of control related to the child’s growing identity.

Developmental Theories and Stages of Development

How can we use this understanding in nursing practice Elaine Taylor (2008): Providing developmentally based care for preschoolers: • Use the child’s desire for learning in association with cognitive theory (preoperational stage) • Allow the child were possible to play with equipment • Cover any needle sites with a band aid • Explore perceptions and correct in simple terms • Support care givers to support their child • Provide simple reality based explanations and role play • Allow the child to make choices • Reassure the child that they are doing a good job • Allow the child to move around as much as possible • Provide their comfort items http://www.youtube.com/watch?v=FpT02esukOI&feature=related (Chelsea and Westminster Hospital 2011)

From Rothrock 2015

School age: industry vs inferiority (6-11) • Basic task is to learn to achieve with work and have a sense of being productive • Negative counterpart is sense of inferiority • Basic virtue is method and competence

industry vs inferiority continued…. • During this age the child masters the learning tools necessary to succeed in his culture and society • As he/she learns to adapt to the world he/she develops a distinctive personality and behaviours • Success (or mastery) gives a child the sense of accomplishment and good feelings. Eventually the rewards become internalised i.e. intrinsic rewards • Success builds self esteem and self concept • Gains competence in social interactions

Adolescent: identity vs role confusion (12-18) • Basic task is to form an identity that will carry into adulthood • Negative counterpart is role confusion • Basic virtue is fidelity and devotion

identity vs role confusion continued • Identity is the individual’s attempt to define him or herself as a unique person. It is the primary task of adolescence • Foreclosureoccurs if an adolescent accepts other’s views and values wholesale, without question. (Premature identity formation). • Negative identityis taking the opposite to one the adolescent is expected to adopt • Identity diffusion– few commitments, goals or values: apathetic about trying to find own identity • Moratorium– where person tries out and experiments with different persona before finding a compatible one Marcia 2002

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Young adult: intimacy vs isolation(19-40) • Basic task is to form meaningful relationships • Negative counterpart is lack of intimacy • Basic virtue is love and affiliation

intimacy vs isolation continued …. • The need for intimacy may be met at many levels • The basic concept is the sharing of self, whether in friendships or in life partnerships • These are based on quality of the person’s ability to contribute • Otherwise isolation occurs because the person is unable to truly give or contribute to a positive relationship

In Erikson’s view the achievement of true intimacyrequires a secure sense of personal identity • If the sense of identity is insecure then a mature relationship cannot develop as the ‘fusion with another (in an intimate relationship) becomes identity loss’ and plunges the self concept into confusion • In an attempt to avoid true intimacy of a deep relationship young adults may seek two exits as substitutes: • Idealized view of the beloved figure in which the person subjugates themselves to another’s identity • Self contained isolation in which person retreats from relationships and would rather put up with loneliness rather than risk intimacy.

Middle adulthood: generativity vsstagnation (40-65) • Basic task is to be content and productive in work and personal relationships • Negative counterpart is total absorption with self and own needs • Basic virtue is caring and production

generativity vsstagnation continued … • Generativityis expressed in many ways; it is looking outward from self, such as concern for welfare of others • A time when people want to leave something of lasting value, achieved through work or parenthood • Without a sense of generativity, life is purposeless and seems empty • According to Erikson the healthy resolution of this crisis consists of an abundance of generativity with just enough self interest to ensure basic survival • This task needs a positive outcome to meet final life tasks

Old age: integrity vs despair(65+) • Basic task is integrity that comes with the acceptance of the way one has lived one’s life • Negative counterpart is despair • Basic virtues are wisdom and renunciation

integrity vs despair continued • As the person moves into old age he may reflect on its meaning and purpose • Erikson suggests that this life reviewis one way in which he may come to terms with the ending of life • Where he still has unresolved psychological conflict or regrets over what might have been this is experienced as psychic pain • Dissatisfaction with his life course and regret for past actions leads to feelings of despair.

‘One of the greatest difficulties for younger persons (including mental health personnel) is to listen thoughtfully to the reminiscences of older people. We have been taught that this nostalgia represents living in the past and Preoccupation with self and that it is generally boring, meaningless and time consuming. Yet it is a natural healing process that represents one of the underlying human capacities on which all of psychotherapy depends. The life review as a necessary and healthy process should be recognised in daily life as well as used in the mental health care of older people.’ Butler and Lewis (1982)

Life stages of women with ovarian cancer (Cesario et al. 2010) • Young adulthood • Not being able to have children • Impact on relationships • Getting back to normal • Recurrence of cancer and death • Middle Adulthood • Not being able to complete childbearing • Work-related issues • Finances • Recurrence of cancer and death • Older Adult • Not being able to watch grandchildren grow • Leaving a partner • No worries at peace • Recurrence of cancer and death

Implications of Erikson’s theory • Importance of relationships with significant others in the development of the person and the personality • Research on development of children in first 5 years of life has supported Erikson’s early stage theory • Insights into the meanings behind human behaviour • A perspective on ‘living well’ Critique Comparison with Freud Thank you

Lecture 3: Psychosocial Development