Theories of personality development and its relevance to nursing practice

Theories of Personality Development and
relevance to nursing practice
AashishParihar
Lecturer
CollegeofNursing
AIIMS,Jodhpur

Theories of Personality Development and relevance to nursing
practice
Content-
• Psychoanalytic Theory- Freud’s
• Interpersonal Theory-Sullivan’s
• Theory of Psychosocial Development-Erikson’s
• Theory of object relations
• Cognitive Development Theory
• Theory of Moral Development
• A Nursing Model - Hildegard E. Peplau

Psychoanalytic Theory- Freud’s
Theory of Psychosocial Development-Erikson’s
• Built on Freudian theory, it is known as psychosocial development and
emphasizes a healthy personality as opposed to a pathologic approach.
• Each psychosocial stage has two components—the favorable and the unfavorable
aspects of the core conflict—and progress to the next stage depends on resolution
of this conflict.
• No core conflict is ever mastered completely but remains a recurrent problem
throughout life. No life situation is ever secure
• Erikson’s life-span approach to personality development consists of eight stages.
• Influence of social processes on the development of the personality
• Specific tasks associated with each stage must be completed for resolution of the
crisis and for emotional growth to occur

Trust vs. Mistrust (0-1 year)
• The first and most important attribute to develop for a healthy personality is basic
trust.
• Corresponding to Freud’s oral stage, it is a time of “getting” and “taking in” through
all the senses.
• It exists only in relation to something or someone; therefore, consistent, loving care
by a mothering person is essential for development of trust
• During the first year, babies depend on others for food, warmth and affection.
• They need to be able to blindly trust that they will receive these things fro m their
parents or caregivers.
• If needs are met consistently, infants will develop a secure attachment with parents
and will learn to trust environmental in general.
• basic trust in parents stems trust in the world, other people, and oneself.
• The result is faith and optimism.

• Mistrust develops when trust-promoting experiences are deficient or lacking
or when basic needs are inconsistently or inadequately met.
• If needs of babies are not met responsibly, infant will develop mistrust
towards people, environment and even themselves and view world as a
dangerous and unreliable place.

Achievement and Nonachievement of Task
• Achievement of the task results in self-confidence, optimism, faith in the
gratification of needs and desires, and hope for the future.
• Nonachievement results in emotional dissatisfaction with the self and others,
suspiciousness, and difficulty with interpersonal relationships.

Autonomy vs. Shame and Doubt(1-3 year)
• Corresponding to Freud’s anal stage, the problem of autonomy can be symbolized
by the holding on and letting go of the sphincter muscles
• The development of autonomy during the toddler period is centered on children’s
increasing ability to control their bodies, themselves, and their environment.
• They want to do things for themselves using their newly acquired motor skills of
walking, climbing, and manipulating and their mental powers of selecting and
decision making.
• Much of their learning is acquired by imitating the activities and behavior of others.
• Here a toddler tries to control their own bodies by toilet training and their
environment, by saying “NO”
• The goal of this stage to gain courage and independence while minimizing shame
and doubt.

• Negative feelings of doubt and shame arise when children are made to feel
small and self-conscious, when their choices are disastrous, when others
shame them, or when they are forced to be dependent in areas in which they
are capable of assuming control.
• Overprotective or ridiculing parents may cause children to doubt abilities and
feel shameful about their actions.

• Achievement of the task results in a sense of
self-control and the ability to delay
gratification, as well as a feeling of self-
confidence in one’s ability to perform.
Autonomy is achieved when parents
encourage and provide opportunities for
independent activities.
• Nonachievement results in a lack of self-
confidence, a lack of pride in the ability to
perform, a sense of being controlled by
others, and a rage against the self. The task
remains unresolved when primary caregivers
restrict independent behaviors, both
physically and verbally, or set the child up for
failure with unrealistic expectations.

Initiative vs. Guilt (3-5 year)
• The stage of initiative corresponds to Freud’s phallic stage and is
characterized by vigorous, intrusive behavior; enterprise; and a strong
imagination.
• Children explore the physical world with all their senses and powers.
• Children at this stage are eager to tackle new tasks and join in activities with
peers, while also developing conscience
• Through play children practice new skill and cooperating to achieve common
goal
• The child forms a superego by identifying with the same sex parent and
adopting the society’s moral and gender role standards.
• Here the key word in a child’s life changes from “NO” to “WHY”.

• Children sometimes undertake goals or activities that are in conflict with
those of parents or others, and being made to feel that their activities or
imaginings are bad produces a sense of guilt
• Parents who discourage children’s efforts towards initiative make contribute
toward child’s feelings of guilt and may negatively impact their self concept.

• Achievement of the task results in the ability to
exercise restraint and self-control of inappropriate
social behaviors. Assertiveness and dependability
increase, and the child enjoys learning and personal
achievement. The conscience develops, thereby
controlling the impulsive behaviors of the id.
• Nonachievement results in feelings of inadequacy
and a sense of defeat. Guilt is experienced to an
excessive degree, even to the point of accepting
liability in situations for which one is not responsible.
The child may view him- or herself as evil and
deserving of punishment.

Industry vs. Inferiority (6-12 year)
• The stage of industry is the latency period of Freud
• children are ready to be workers and producers.
• They want to engage in tasks and activities that they can carry through to
completion; they need and want real achievement.
• Children learn to compete and cooperate with others, and they learn the
rules.
• It is a decisive period in their social relationships with others.
• The ego quality developed from a sense of industry is competence.

• Feelings of inadequacy and inferiority may develop if too much is expected of
them or if they believe that they cannot measure up to the standards set for
them by others.
• Too much criticism of a child’s work at this stage can lead to long term feeling
of inferiority.

• Achievement of the task results in a sense of satisfaction and
pleasure in the interaction and involvement with others. The
individual masters reliable work habits and develops attitudes of
trustworthiness. He or she is conscientious, feels pride in
achievement, and enjoys play, but desires a balance between
fantasy and “real-world” activities. Industry is achieved when
encouragement is given to performance of activities and
responsibilities in the school and community, as well as those
within the home, and recognition is given for accomplishments.
• Nonachievement results in difficulty in interpersonal
relationships because of feelings of personal inadequacy. The
individual can neither cooperate and compromise with others in
group activities nor problem solve or complete tasks
successfully. He or she may become either passive and meek or
overly aggressive to cover up for feelings of inadequacy. If this
occurs, the individual may manipulate or violate the rights of
others to satisfy his or her own needs or desires; he or she may
become a “workaholic” with unrealistic expectations for
personal achievement.

Identity vs. Role confusion(13-20 year)
• Corresponding to Freud’s genital period, the development of identity is characterized by
rapid and marked physical changes.
• Children become overly preoccupied with the way they appear in the eyes of others
compared with their own self-concept.
• Adolescents struggle to fit the roles they have played and those they hope to play with
the current roles and fashions adopted by their peers, to integrate their concepts and
values with those of society, and to come to a decision regarding an occupation.
• Adolescents selectively accept or reject the many different aspects of herself/himself
and forms a more coherent and integrated sense of identity.
• Adolescents must achieve an identity in occupation, gender roles, politics and religion.
• An inability to solve the core conflict results in role confusion. The outcome of
successful mastery is devotion and fidelity to others and to values and ideologies.

• An inability to solve the core conflict results in role confusion. The outcome of successful mastery
is devotion and fidelity to others and to values and ideologies.
• Lack of direction and self definition
• Earlier Psychosocial conflicts not resolved.
• Society restricts choices
• Unprepared for challenges in life.

• Achievement of the task results in a sense of confidence,
emotional stability, and a view of the self as a unique individual.
Commitments are made to a value system, to the choice for a
career, and to relationships with members of both genders.
• Nonachievement results in a sense of self-consciousness, doubt,
and confusion about one’s role in life. Personal values or goals for
one’s life are absent. Commitments to relationships with others
are nonexistent or superficial and brief. A lack of self-confidence
is often expressed by delinquent and rebellious behavior.
Entering adulthood, with its accompanying responsibilities, may
be an underlying fear.

Intimacy vs. Isolation(20-30 year)
• Develop a relationship and joint identity with a partner.
• The important event is parenting and the important relationship are lovers,
friends and work connections.
• In this stage individual must develop intimate relationships through work
and social life.
• Intimacy is achieved when an individual has developed the capacity for giving
of oneself to another. This is learned when one has been the recipient of this
type of giving within the family unit.

• Inability to establish intimacy leads to social isolation.
• Failure to make such connection can lead to promiscuity, exclusivity and
isolation.
• The task remains unresolved when love in the home has been denied or
distorted during the younger years. One fails to achieve the ability to give of
the self without having been the recipient of such giving early on from
primary caregivers.

• Achievement of the task results in the capacity for mutual love and respect
between two people and the ability of an individual to pledge a total
commitment to another. The intimacy goes far beyond the sexual contact
between two people. It describes a commitment in which personal sacrifices
are made for another, whether it be another person, or if one chooses, a
career or other type of cause or endeavor to which an individual elects to
devote his or her life.
• Nonachievement results in withdrawal, social isolation, and aloneness. The
individual is unable to form lasting, intimate relationships, often seeking
intimacy through numerous superficial sexual contacts. No career is
established; he or she may have a history of occupational changes

Generativity vs. Stagnation(30-65 year)
• Contributing to the next generation by performing meaningful work, creative
activities, and raising a family.
• Important event is parenting and the important relationships are children
and the community.
• Generativity encompasses adult’s desire to leave a legacy to the next
generation.
• Through generativity adults promote and guide those who follow by
parenting, teaching, leading, doing things to benefit the community.

• Stagnation or self absorption develops when individuals sense that they have
done nothing for the next generation.
• Simply focusing on oneself is viewed as limited in terms of fulfillment.
• A feeling that arises when a person is self centered and unable to help society,
a dissatisfaction with the relative and lack of productivity.

• Achievement of the task results in a sense of gratification from personal and
professional achievements and from meaningful contributions to others. The
individual is active in the service of and to society.
• Nonachievement results in lack of concern for the welfare of others and total
preoccupation with the self. He or she becomes withdrawn, isolated, and
highly self-indulgent, with no capacity for giving of the self to others.

Ego Integrity vs. Despair(65 years to death)
• Moment of reflecting back on life.
• Understand and accept the meaning of temporary life.
• Those feeling proud of their achievement will feel sense of integrity.
• Sense of satisfaction with life well lived.
• Integrity develops when with wisdom over a lifetime and can look back and
see a life of meaning.

• On contrary Despair with life occurs with complaints about regrets, not
having enough time, not finding meaning in life or feels that life is wasted.
• despair results when life’s event cannot be seen positively and the older is
faced with a degree of devaluation and perhaps hostility.
• Which leads to frustration and regret.

• Achievement of the task results in a sense of self-worth and self-acceptance
as one reviews life goals, accepting that some were achieved and some were
• not. The individual derives a sense of dignity from his or her life experiences
and does not fear death, rather viewing it as another stage of development.
• Nonachievement results in self-contempt and disgust with how life has
progressed. The individual would like to start over and have a second chance
at life. He or she feels worthless and helpless to change. Anger, depression,
and loneliness are evident. The focus may be on past failures or perceived
failures. Impending death is feared or denied, or ideas of suicide may prevail.

Relevance to Nursing
• Erikson’s theory is particularly relevant to nursing practice in that it
incorporates sociocultural concepts into the development of personality.
• Erikson provided a systematic, stepwise approach and outlined specific tasks
that should be completed during each stage. This information can be used
quite readily in psychiatric/mental health nursing.
• Many individuals with mental health problems are still struggling to
accomplish tasks from a number of developmental stages.
• Nurses can plan care to assist these individuals in fulfilling the tasks and in
moving on to a higher developmental level.

Theory of object relations
• Focuses on the relationship between a mother (or caregiver) and the infant and
the effect of this relationship on the infant’s development of a sense of self.
• Believes that individuals are born with a drive to build interpersonal relationships
• The individual’s sense of self and others affects all subsequent interpersonal
relationships

In Object Relations, the main developmental task is differentiating between the
self and others
The three main stages of development are:
1. Autistic stage: newborn – 1 month
2. Symbiotic stage: 1 – 5 months
3. Separation-Individuation stage: 5 – 24 months
and further delineated phase III, the separation–individuation phase, into four sub
phases.
“Object” refers not only to literal objects, but to other people

Autistic Stage : newborn – 1 month
• The infant is focused entirely on him or herself
• Mostly unresponsive to external stimuli
• Does not perceive others as separate beings

Symbiotic Stage 1 – 5 months
• The infant begins to perceive the mother/caregiver as a “need-satisfying object”
• The infant feels unity with the mother, but begins to understand that the mother
is a separate being

Separation – Individuation Stage
The Separation-Individuation Stage is made up of four sub-stages
1. Differentiation: 5 – 9 months
2. Practicing: 9 – 14 months
3. Rapprochement: 14 – 24 months
4. Object Constancy: after 24 months

1. Differentiation: 5 – 9 months
• The infant’s attention shifts from being inwardly focused to outwardly focused
• The infant begins to separate from the caretaker (for example, learning to crawl)

2. Practicing Sub-Stage: 9 – 14 months
• The infant continues to separate from the caretaker
• More autonomous functioning
• The infant becomes more independently mobile and more active
• Ex. walking, playing, etc.

3. Rapprochement Sub-Stage: 14 – 24 months
• The baby begins to want to act independently
• The baby moves away from his or her mother/caregiver, but regularly comes back to make
sure that the caregiver is still there

4. Object Constancy Sub-Stage: after 24 months
• The baby has an internalized mental representation of his or her caregiver and understands
that the caregiver continues to exist even when they are not together

A transitional object is an object that the individual can mentally associate with a
specific person when that person is not physically present
Ex. a “security blanket” or for adults a piece of jewelry/heirloom

A Nursing Model - Hildegard E. Peplau
• Hildegard E. Peplau’s Interpersonal Relations in Nursing
• Regarded as “mother of psychiatric nursing”
• Born in 1909 , Pennsylvania
• Diploma from Pottstown Hospital School of Nursing,
• BA in interpersonal psychology from Bennington College Pennsylvania in
1931.
• MA in psychiatric nursing from Colombia University, New York in 1947
• Her Theory was published in 1953
• Framework for psychodynamic nursing

• Theory was influenced by Harry Stack Sullivan’s theory of interpersonal
relations.
• Middle range, descriptive, classification theory
• She led the way towards humane treatment of patients with behavior and
personality disorders.
• Nurses, she thought, could facilitate this through observation, description,
formulation, interpretation, validation, and intervention.
• She taught interpersonal concepts and interviewing techniques, as well as
individual, family, and group therapy.

Key concepts include the following:
• Nursing is a human relationship between an individual who is sick, or in need
of health services, and a nurse especially educated to recognize and to
respond to the need for help.
• Psychodynamic nursing is being able to understand one’s own behavior, to
help others identify felt difficulties, and to apply principles of human
relations to the problems that arise at all levels of experience.
• Roles are sets of values and behaviors that are specific to functional positions
within social structures. Peplau identified the following nursing roles:
 Resource person
 Counselor
 Teacher
 Leader
 Technical expert
 Surrogate

Phases of the nurse–client relationship are stages of overlapping roles or
functions in relation to health problems, during which the nurse and client
learn to work cooperatively to resolve difficulties. Peplau identified four
phases:
• Orientation
• Identification
• Exploitation
• Termination (Resolution)

Peplau’s Stages of Personality Development
• Peplau (1991) identified four psychological tasks that she associated with
the stages of infancy and childhood described by Freud and Sullivan.
• In the context of nursing, Peplau (1991) related these four psychological
tasks to the demands made on nurses in their relations with clients.
• An outline of the stages of personality development according to Peplau’s
theory is:
Learning to Count on Others
Learning to Delay Satisfaction
Identifying Oneself
Developing Skills in Participation

Learning to Count on Others (Infancy)
• Nurses and clients first come together as strangers. Both bring to the relationship
certain “raw materials,” such as inherited biological components, personality
characteristics (temperament), individual intellectual capacity, and specific cultural or
environmental influences.
• Peplau related these to the same “raw materials” with which an infant comes into this
world. The newborn is capable of experiencing both comfort and discomfort
• Clients with unmet dependency needs regress during illness and demonstrate
behaviors that relate to this stage of development.
• Peplau believed that, when nurses provide unconditional care, they help these clients
progress toward more mature levels of functioning. This may involve the role of
“surrogate mother,” in which the nurse fulfills needs for the client with the intent of
helping him or her grow, mature, and become more independent.

Learning to Delay Satisfaction (Toddlerhood)
• Psychosexually, it is compared to the anal stage of development, when a child learns
that, because of cultural mores, he or she cannot empty the bowels for relief of
discomfort at will, but must delay to use the toilet, which is considered more culturally
acceptable.
• When toilet training occurs too early or is very rigid, or when appropriate behavior is
set forth as a condition for receiving love and caring, tasks associated with this stage
remain unfulfilled. The child feels powerless and fails to learn the satisfaction of
pleasing others by delaying self-gratification in small ways
• He or she may also exhibit rebellious behavior by failing to comply with demands of
the mothering figure in an effort to counter the feelings of powerlessness
• The child may accomplish this by withholding the fecal product or failing to deposit it
in the culturally acceptable manner

• Peplau described the following potential behaviors of individuals who have failed to
complete the tasks of the second stage of development:
• Exploitation and manipulation of others to satisfy their own desires because they are
unable to do so independently
• Suspiciousness and envy of others, directing hostility toward others in an effort to
enhance their own self-image
• Hoarding and withholding possessions from others; miserliness
• Inordinate neatness and punctuality
• Inability to relate to others through sharing of feelings, ideas, or experiences
• Ability to vary the personality characteristics to those required to satisfy personal
desires at any given time

When nurses observe these types of behaviors in clients, it is important to :
• Encourage full expression and to convey unconditional acceptance.
• When the client learns to feel safe and unconditionally accepted, he or she is more
likely to let go of the oppositional behavior and advance in the developmental
progression.

Identifying Oneself (Early childhood)
• A child learns to structure self-concept by observing how others interact with him or
her.
• Roles and behaviors are established out of the child’s perception of the expectations of
others.
• When children have the impression that adults expect them to maintain more or less
permanent roles as infants, they perceive themselves as helpless and dependent.
• When the perceived expectation is that the child must behave in a manner beyond his
or her maturational level, the child is deprived of the fulfillment of emotional and
growth needs at the lower levels of development.
• Children who are given freedom to respond to situations and experiences
unconditionally (i.e., with behaviors that correspond to their feelings) learn to improve
on and reconstruct behavioral responses at their own pace.

• In the initial interaction, it is difficult for the nurse to perceive the “wholeness” of the
client, for the focus is on the condition that has caused him or her to seek help.
• Likewise, it is difficult for the client to perceive the nurse as a “mother (or father)” or
“somebody’s wife (or husband)” or as having a life aside from being there to offer
assistance with the immediate presenting problem.
• As the relationship develops, nurses must be able to recognize client behaviors that
indicate unfulfilled needs and provide experiences that promote growth
• Nurses must also be aware of the predisposing factors that they bring to the
relationship.
• Attitudes and beliefs about certain issues can have a deleterious effect on the client
and interfere not only with the therapeutic relationship but also with the client’s
ability for growth and development.

• Nurses must have knowledge and appreciation of their own concept of self to develop
the flexibility required to accept all clients as they are, unconditionally.
• Effective resolution of problems that arise in the interdependent relationship can be
the means for both client and nurse to reinforce positive personality traits and modify
those more negative views of self.

Developing Skills in Participation (Late childhood)
• During this stage, the child develops the capacity to “compromise, compete, and
cooperate” with others.
• Failure to develop appropriate skills at any point along the developmental progression
results in an individual’s difficulty with participation in confronting the recurring
problems of life
• It is not the responsibility of the nurse to teach solutions to problems, but rather to
help clients improve their problem-solving skills so that they may achieve their own
resolution.
• Nurses can assist clients to develop or refine these skills by helping them to identify
the problem, define a goal, and take the responsibility for performing the actions
necessary to reach that goal.

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