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Unit I
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Foundations of Mental Health Nursing
Each of Erikson’s stages has two components: the successful and unsuccessful sides of the core conflict. At each
developmental crisis point, the person either masters the
developmental task successfully or fails to do so, with a
negative outcome. For example, an adolescent either
achieves the developmental task of identity or has the
negative outcome of role confusion. Figure 3-5 ■ shows a
group of adolescent boys who demonstrate their sense of
identity with their peer group through their choice of
clothing styles. Each step forward in development brings
anxiety as the person moves out of old comfortable ways
into new challenges and new ways of thinking about the
self. Table 3-2 ■ provides a summary of Erikson’s stages
of psychosocial development.
Figure 3-5. ■ Adolescents demonstrate peer group identity
through clothing styles. Source: Will Hart.
TABLE 3-2
Erikson’s Stages of Psychosocial Development
FAVORABLE
OUTCOMES
DEVELOPMENTAL
CONFLICT
AGE
CHARACTERISTICS
Trust versus
Mistrust
Birth to 1
year
Trust is developed when the infant’s needs are adequately and consistently
met; parents are reliable. Mistrust happens when basic needs are inconsistently met.
Faith, hope,
optimism
Autonomy versus
Shame and Doubt
1–3 years
Autonomy is centered on children’s ability to control their bodies and the
environment.The use of their developing physical skills (toilet training,
walking, manipulating objects) is important. Shame and doubt develop
when the child is shamed or forced to be dependent in areas in which he
or she is capable of independence.
Self-control,
will
Initiative versus
Guilt
3–6 years
Children at this stage are active and have powerful imagination.They
develop a sense of initiative when they are able to pursue and reach their
goals and to achieve a sense of purpose.They develop a conscience at this
stage. Guilt develops when they are thwarted in their efforts or feel that
their goals are bad.
Purpose,
direction
Industry versus
Inferiority
6–12 years
Interactions outside the family take on more importance. Industry happens
when children are able to take on activities and projects that they can
complete; achievement is important.They learn to cooperate and compete
with others by the rules. Inferiority occurs when children fail to develop
friendships or if they believe they cannot measure up to the expectations
of others.
Competence
Identity versus Role
Confusion
12–18
years
This is the stage associated with adolescence. Identity is characterized by
integration of personal values with those of society, a clear sense of self in
multiple roles, and by making choices about the future. Role confusion
results from failure to establish an individual identity separate from the
family and having no peer relationships or plans for an occupation.
Fidelity
Intimacy versus
Isolation
Early
adulthood
Intimacy develops when the person creates mature relationships, especially a love relationship with a partner. Isolation is the inability to create
strong social ties without losing the self, or the inability to create intimate
relationships at all.
Love
(continued)
SECOND REVISED
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Chapter 3
Personality Theory
37
TABLE 3-2
Erikson’s Stages of Psychosocial Development (continued)
DEVELOPMENTAL
CONFLICT
FAVORABLE
OUTCOMES
AGE
CHARACTERISTICS
Generativity versus
Stagnation
Adulthood
Generativity is a desire to improve society by one’s own efforts.The person
values work and helping others.This may take the form of raising children
or community service with the goal of making the world a better place.
Stagnation is characterized by the feeling that life is meaningless.The person in stagnation does not have concern for the flourishing of others.
Caring
Ego Integrity versus
Despair
Maturity
When a person has developed wisdom over a lifetime of experiences and
can look back to see a life of meaning and integrity they have achieved
integrity, especially when they can pass this wisdom to younger generations. Despair is characterized by a sense of not accomplishing one’s goals
or maintaining one’s values, and it is too late to do anything about it.
Wisdom
These conflicts are never solved completely but continue to be a challenge throughout life. For example, people who satisfactorily achieve a sense of trust (the first
developmental task) will still be challenged to develop
trust again in new situations, such as hospitalization.
Initial success at trusting is a very important foundation
for success in future challenging situations.
MARGARET MAHLER
Margaret Mahler proposed her ego theory in the 1970s.
Her approach focuses on separation-individuation and is
called an “object relations” theory. Object relations means
that the person learns about the self through interaction
with others. She believed that forming ties with the
mother was critical for a child to develop psychological
health.
Initially, an infant begins with total dependence on
the mother and then matures to discover a sense of
self and individual perspective on the world. During
Mahler’s ambivalence phase, the child begins the process
of individuation-separation. In this phase the child has
temper tantrums, moodiness, and strong reactions to
separation from parents. The child is ambivalent, wanting both to be with the parent and to be separate. At 2
to 3 years of age, the child discovers that the parent is a
separate individual or “object.” With this revelation
comes the ability to see others as separate individuals.
Individuation allows the child to develop a sense of
being a separate person who has empathy for the feelings
of others. Mahler added the importance of mothering
skills to the information known about healthy emotional
development.
PSYCHOTHERAPY BY THE EGO
THEORISTS
The goal of psychotherapy according to the ego theorists
is to establish increasing levels of independence by assisting the ego or self to overcome developmental obstacles.
The blocks to development in these theories often occur
during the toddler period.
The therapeutic process includes the client talking
with the therapist and working to develop insight into
reasons for anxiety. The emphasis is on clients studying
their own stories and understanding their own inner
motivations and self-concept.
Play therapy is frequently used with children who are
experiencing trauma or grief. Melanie Klein, a British
psychiatrist, developed play therapy. In this therapy, toys
or arts and crafts are used in the same way that dream
analysis or free association are used by the ego theorists
with adults. Children express their feelings and work out
their conflicts in play.
NURSING IMPLICATIONS
Erikson’s psychosocial development theory is perhaps the
most commonly accepted theory of personality development. It is widely used in nursing as a basis for assessing
clients’ developmental level, for identifying developmental needs, and for planning nursing interventions to
promote the development of clients. For example, if a
pediatric client in the stage of Industry versus Inferiority
is hospitalized, what kind of activities would the nurse
provide for this client? The activity should promote the
child’s achievement of the developmental task of Industry.
This developmental task requires the child to do projects