Theoretical Models

of Personality Development
• Nurses must have a basic knowledge of human personality development to understand maladaptive behavioral
responses commonly seen in psychiatric clients.
• Psychosocial theories help explain human behavior—both mental health and mental illness. There are several
types of psychosocial theories, including psychoanalytic theories, interpersonal theories, humanistic theories,
behavioral theories, and existential theories.
Growth and development are unique with each individual and continue throughout the life span.
Personality is defined as the combination of character, behavioral, temperamental, emotional, and
mental traits that are unique to each specific individual.
Sigmund Freud, who has been called the father of psychiatry, believed the basic character has been
formed by the age of 5. Freud’s personality theory can be conceptualized according to structure and dynamics of
the personality. topography of the mind, and stages of personality development.
Freud’s structure of the personality includes the id, ego, and superego.
Freud classified all mental contents and operations into three categories: the conscious, the preconscious, and the
unconscious
Freud believed that human behavior is motivated by repressed sexual impulses and desires and that childhood
development is based on sexual energy (libido) as the driving force.
Erik Erikson studied the influence of social processes on the development of the personality.
Erikson described eight stages of the life cycle from birth to death. He believed that individuals struggled with
developmental “crises,” and that each must be resolved for emotional growth to occur
• Erik Erikson’s theories focused on both social and psychological developments across the life span. He proposed eight
stages of psychosocial development; each stage includes a developmental task and a virtue to be achieved (hope, will,
purpose, competence, fidelity, love, caring, and wisdom). Erikson’s theories remain in wide use today.
• Jean Piaget described four stages of cognitive development: sensorimotor, preoperational, concrete operations, and formal
operations.Jean Piaget has been called the father of child psychology. He believed that human intelligence progresses
through a series of stages that are related to age, demonstrating at each successive stage a higher level of logical
organization than at the previous stages.
• Harry Stack Sullivan’s theories focused on development in terms of interpersonal relationships. He viewed the therapist’s
role (termed participant observer) as key to the client’s treatment
Harry Stack Sullivan, author of the Interpersonal Theory of Psychiatry, believed that individual behavior and personality
development are the direct result of interpersonal relationships. Major concepts include anxiety, satisfaction of needs,
interpersonal security, and self-system
• Hildegard Peplau is a nursing theorist whose theories formed much of the foundation of modern nursing practice, including
the therapeutic nurse– patient relationship, the role of the nurse in the relationship, and the four anxiety levels
Hildegard Peplau provided a framework for “psychodynamic nursing,” the interpersonal involvement of the nurse with a client
in a given nursing situation.
Peplau identified the nursing roles of stranger, resource person, counselor, teacher, leader, technical expert, and surrogate.
• Peplau described four psychological tasks that she associated with the stages of infancy and childhood as identified by
Freud and Sullivan.
Peplau believed that nursing is helpful when both the patient and the nurse grow as a result of the learning that occurs in the
nursing situation.
• Abraham Maslow developed a hierarchy of needs stating that people are motivated by progressive levels of
needs; each level must be satisfied before the person can progress to the next level. The levels begin with
physiologic needs and then proceed to safety and security needs, belonging needs, esteem needs, and, finally,
self-actualization needs
• Margaret Mahler formulated a theory that describes the separation-individuation process of the infant
from the maternal figure (primary caregiver). Stages of development describe the progression of the child from
birth to object constancy at age 36 months
• Carl Rogers developed client-centered therapy in which the therapist plays a supportive role, demonstrating
unconditional positive regard, genuineness, and empathetic understanding to the client.
• B.F. Skinner was a behaviorist who developed the theory of operant conditioning in which people are
motivated to learn or change behavior with a system of rewards or reinforcement.
• Existential theorists believe that problems result when the person is out of touch with the self or the
environment. The person has self-imposed restrictions, criticizes him or herself harshly, and does not participate
in satisfying interpersonal relationships. Founders of existentialism include Albert Ellis (rational emotive
therapy), Viktor Frankl (logotherapy), Frederick Perls (gestalt therapy), and William Glasser (reality therapy).
• All existential therapies have the goal of returning the person to an authentic sense of self through emphasizing
personal responsibility for oneself and one’s feelings, behavior, and choices.
An understanding of psychosocial theories can help the nurse select appropriate and effective intervention
strategies to use with clients
Situation1
R.A., a 28-year-old veteran exposed to bomb blasts during combat in the Middle East, has symptoms of
posttraumatic stress disorder and neurocognitive problems. How can behavioral-cognitive and social theories be
applied to his condition? How does an understanding of psychosocial theories assist the nurse in selecting suitable
interventions to promote psychological and social functioning?
1. Mr. J. is a new client on the psychiatric unit. He is 35 years old. Theoretically, in which level of
psychosocial development (according to Erikson) would you place Mr. J.?
a. Intimacy vs. isolation
b. Generativity vs. self-absorption
c. Trust vs. mistrust
d. Autonomy vs. shame and doubt
2. Mr. J. has been diagnosed with schizophrenia. He refuses to eat, and told the nurse he knew he was
“being poisoned.” According to Erikson’s theory, in what developmental stage would you place Mr. J.?
a. Intimacy vs. isolation
b. Generativity vs. self-absorption
c. Trust vs. mistrust
d. Autonomy vs. shame and doubt
Exercises:
3.Janet, a psychiatric client diagnosed with borderline personality disorder, has just been hospitalized for threatening suicide. According to
Mahler’s theory, Janet did not receive the critical “emotional re_x0002_ fueling” required during the rapprochement phase of
development. What are the consequences of this deficiency?
a. She has not yet learned to delay gratification.
b. She does not feel guilt about wrongdoings to others.
c. She is unable to trust others.
d. She has internalized rage and fears of abandonment.
4.John is on the Alcohol Treatment Unit. He walks into the dayroom where other clients are watching a program on TV. He picks up the
remote and changes the channel and says, “That’s a stupid program! I want to watch something else!” In what stage of development is
John fixed according to Sullivan’s interpersonal theory?
a. Juvenile. He is learning to form satisfactory peer relationships.
b. Childhood. He has not learned to delay gratification.
c. Early adolescence. He is struggling to form an identity.
d. Late adolescence. He is working to develop a lasting relationship.
5. Adam has antisocial personality disorder. He says to the nurse, “I’m not crazy. I’m just fun-loving. I believe in looking out for myself.
Who cares what anyone thinks? If it feels good, do it!” Which of the following describes the psychoanalytical structure of Adam’s
personality?
a. Weak id, strong ego, weak superego
b. Strong id, weak ego, weak superego
c. Weak id, weak ego, punitive superego
d. Strong id, weak ego, punitive superego
6 Larry, who has antisocial personality disorder, feels no guilt about violating the rights of others. He does as he pleases without
thought to possible consequences. In which of Peplau’s stages of development would you place Larry?
• a. Learning to count on others
• b. Learning to delay gratification
• c. Identifying oneself
• d. Developing skills in participation
7. Danny has been diagnosed with schizophrenia. On the unit he appears very anxious, paces back and forth, and darts his head from
side to side in a continuous scanning of the area. He has refused to eat,making some barely audible comment related to “being
poisoned.” In planning care for Danny, which of the following would be the primary focus for nursing?
• a. To decrease anxiety and develop trust
• b. To set limits on his behavior
• c. To ensure that he gets to group therapy
• d. To attend to his hygiene needs
8. The nurse has just admitted Nancy to the psychiatric unit. The psychiatrist has diagnosed Nancy with major depressive disorder.
The nurse says to Nancy, “Please tell me what it was like when you were growing up.” Which nursing role described by Peplau is the
nurse fulfilling in this instance?
• a. Surrogate
• b. Resource person
• c. Counselor
• d. Technical Expert
9. The nurse has just admitted Nancy to the psychiatric unit. The psychiatrist has diagnosed Nancy with major depressive
disorder. The nurse says to Nancy, “What questions do you have about being here on the unit?” Which nursing role described
by Peplau is the nurse fulfilling in this instance?
a. Resource person
b. Counselor
c. Surrogate
d. Technical Expert
10. The nurse has just admitted Nancy to the psychiatric unit. The psychiatrist has diagnosed Nancy with major depressive
disorder. The nurse says to Nancy, “Some changes will have to be made in your behavior. I care about what happens to you.”
Which nursing role described by Peplau is the nurse fulfilling in this instance?
a. Counselor
b. Surrogate
c. Technical Expert
d. Resource Person
FILL-IN-THE-BLANK QUESTIONS
Write the name of the appropriate theorist beside the statement or theory. Names may be used more than
once.
1. The client is the key to his or her own healing. ____________________________________
2. Social and psychological factors influence development.______________________
3. Client-centered therapy ____________________________________
4. People make themselves unhappy by clinging to irrational beliefs.
____________________________________
5. Behavior is learned from past experience that is reinforcing. ____________________________________
6. Client-centered therapy ____________________________________
7. Gestalt therapy ____________________________________
8. Hierarchy of needs ____________________________________
9. Logotherapy ____________________________________
10. Rational emotive therapy ____________________________________
11. Reality therapy _______________________