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11/30/2017

HB Consad II
College of Nursing & Health Sciences
Palawan State University
Puerto Princesa City

At the end of the lesson, students will be able


to
Identify and differentiate different personality
theories
Identify behavioral disorders relating to the
personality type of the patients

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Definition of personality
Importance of understanding personality
Psychoanalytic theory (Freud)
Interpersonal Theory (Sullivan)
Psychosocial Development (Erikson)
Object Relations Theory (Mahler)
Nursing Model Theory (Peplau)

Black and Andreasen (2011) define


personality as the characteristic way in which
a person thinks, feels, and behaves; the
ingrained pattern of behavior that each
person evolves, both consciously and
unconsciously, as his or her style of life or
way of being (p. 612).

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Nurses must have a basic knowledge of


human personality development to
understand maladaptive behavioral responses
commonly seen in psychiatric clients.
Developmental theories identify behaviors
associated with various stages through which
individuals pass, thereby specifying what is
appropriate or inappropriate at each
developmental level.

Specialists in child development believe that


infancy and early childhood are the major life
periods for the origination and occurrence of
developmental change.
Specialists in life-cycle development believe
that people continue to develop and change
throughout life, thereby suggesting the
possibility for renewal and growth in adults.

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Sigmund Freud
(1961)

called the father of psychiatry


is credited as the first to identify
development by stages.
He considered the first 5 years of a childs life
to be the most important, because he
believed that an individuals basic character is
formed by the age of 5.

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is the locus of instinctual drivesthe


pleasure principle.
Present at birth, it endows the infant with
instinctual drives that seek to satisfy needs
and achieve immediate gratification.
Id-driven behaviors are impulsive and may be
irrational

id
ego, and
superego

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also called the rational self or the reality principle


begins to develop between the ages of 4 and 6
months.
It experiences the reality of the external world,
adapts to it, and responds to it.
As the ego develops and gains strength, it seeks to
bring the influences of the external world to bear
upon the id, to substitute the reality principle for the
pleasure principle (Marmer, 2003).
A primary function of the ego is one of mediator, that
is, to maintain harmony among the external world,
the id, and the superego.

referred to as the perfection principle


develops between ages 3 and 6 years,
internalizes the values and morals set forth
by primary caregivers
Derived from a system of rewards and
punishments, the superego
is composed of two major components: the
ego-ideal and the conscience.

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When a child is consistently rewarded for


good behavior, the self-esteem is
enhanced, and the behavior becomes part of
the ego-ideal; that is,
it is internalized as part of his or her value
system.

is formed when the child is consistently


punished for bad behavior.
The child learns what is considered morally
right or wrong from feedback received from
parental figures and from society or culture.

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Freud classification of mental contents and


operations
the conscious
the preconscious, and
the unconscious.

includes all memories that may have been


forgotten or are not in present awareness but,
with attention, can readily be recalled into
consciousness.
Examples include telephone numbers or
addresses once known but little used and
feelings associated with significant life events
that may have occurred at some time in the past.
It enhances awareness by helping to suppress
unpleasant or nonessential memories from
consciousness.
It is thought to be partially under the control of
the superego, which helps to suppress
unacceptable thoughts and behaviors.

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includes all memories that remain within an


individuals awareness.
the smallest of the three categories.
Events and experiences that are easily
remembered or retrieved are considered to be
within ones conscious awareness.
Examples include telephone numbers, birthdays
of self and significant others, dates of special
holidays, and what one had for lunch today.
The conscious mind is thought to be under the
control of the ego, the rational and logical
structure of the personality.

includes all memories that one is unable to bring


to conscious awareness.
It is the largest of the three topographical levels
Unconscious material consists of unpleasant or
nonessential memories that have been repressed
can be retrieved only through therapy, hypnosis,
and with certain substances that alter the
awareness and have the capacity to restructure
repressed memories.
Unconscious material may also emerge in dreams
and in seemingly incomprehensible behavior.

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Psychic energy is the force or impetus required for


mental functioning.
Originating in the id, it instinctually fulfills basic
physiological needs.
Freud called this psychic energy (or the drive to fulfill
basic physiological needs such as hunger, thirst, and
sex) the libido.
As the child matures, psychic energy is diverted from
the id to form the ego and then from the ego to form
the superego.
Psychic energy is distributed within these three
components, with the ego retaining the largest share
to maintain a balance between the impulsive
behaviors of the id and the idealistic behaviors of the
superego.

Behavior reflected if excessive amount of


psychic energy is stored in one of personality
components
id-impulsive behavior
Ego- reflects self-absorbed, or narcissistic,
behaviors;
Superego- rigid, self-deprecating behaviors.

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Are used to describe the forces within the id,


ego, and superego that are used to invest
psychic energy in external sources to satisfy
needs.
Cathexis is the process by which the id
invests energy into an object in an attempt to
achieve gratification.
Anticathexis is the use of psychic energy by
the ego and the superego to control id
impulses

Id- the individual who instinctively turns to


alcohol to relieve stress.
Ego would attempt to control the use of
alcohol thru rational thinking, as, I already
have ulcers from drinking too much. I will call
my AA sponsor for support. I will not drink.
The superego would exert control with such
thinking as, I shouldnt drink. If I drink, my
family will be hurt and angry. I should think
of how it affects them. Im such a weak
person.

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Freud described formation of the personality


through five stages of psychosexual
development

behavior is directed by the id,


the goal is immediate gratification of needs.
The focus of energy is the mouth, and
behaviors include sucking, chewing, and
biting.
sense of security and the ability to trust
others are derived from the gratification of
fulfilling basic needs during this stage.

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The major task in the anal stage is gaining


independence and control, with particular
focus on the excretory function.
When toilet training is strict and rigid, the
child may choose to retain the feces,
becoming constipated.
Adult retentive personality traits influenced
by this type of training include stubbornness,
stinginess, and miserliness.

An alternate reaction to strict toilet training is for


the child to expel feces in an unacceptable
manner or at inappropriate times.
Far-reaching effects of this behavior pattern
include malevolence, cruelty to others,
destructiveness, disorganization, and untidiness.
Toilet training that is more permissive and
accepting attaches the feeling of importance and
desirability to feces production. The child
becomesextroverted, productive, and altruistic.

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the focus of energy shifts to the genital area.


Discovery of differences between genders
results in a heightened interest in the
sexuality of self and others.
Oedipus complex (males) or Electra complex
(females) occurred during this stage of
development.

Oedipus and Electra complexes as the childs


unconscious desire to eliminate the parent of
the same gender and to possess the parent of
the opposite gender for him or herself
Guilt feelings result with the emergence of
the superego during these years.
Resolution of this internal conflict occurs
when the child develops a strong
identification with the parent of the same
gender and internalizes that parents
attitudes, beliefs, and value system.

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During the elementary school years, the focus


changes from egocentrism to one of more
interest in group activities, learning, and
socialization with peers.
Sexuality is not absent during this period but
remains obscure and imperceptible to others.
The preference is for same-gender
relationships, even rejecting members of the
opposite gender.

the maturing of the genital organs results in a


reawakening of the libidinal drive.
The focus is on relationships with members of
the opposite gender and preparations for
selecting a mate.
The development of sexual maturity evolves from
self-gratification to behaviors deemed acceptable
by societal norms.
Interpersonal relationships are based on genuine
pleasure derived from the interaction rather than
from the more self-serving implications of
childhood associations.

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Knowledge of the structure of the personality can


assist nurses who work in the mental health
setting.
The ability to recognize behaviors associated
with the id, the ego, and the superego assists in
the assessment of developmental level.
Understanding the use of ego defense
mechanisms is important in
making determinations about maladaptive behaviors,
in planning care for clients to assist in creating change
(if desired), or in helping clients accept themselves as
unique individuals.

Harry Stack Sullivan


(1953)

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believed that individual behavior and


personality development are the direct result
of interpersonal relationships
His ideas, which were not universally
accepted at the time
have been integrated into the practice of
psychiatry through publication only since his
death in 1949

Anxiety
Satisfaction of needs
Interpersonal security
Self-system

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is a feeling of emotional discomfort, toward


the relief or prevention of which all behavior
is aimed. Sullivan believed that anxiety is the
chief disruptive force in interpersonal
relations and the main factor in the
development of serious difficulties in living.
It arises out of ones inability to satisfy needs
or achieve interpersonal security.

is the fulfillment of all Identified examples of


these requirements as
requirements oxygen,
associated with an food,
individuals water,
warmth,
physiochemical tenderness,
environment. rest,
activity,
sexual expression
virtually anything that,
when absent, produces
discomfort in the
individual.

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is the feeling associated with relief from


anxiety.
When all needs have been met, one
experiences a sense of total well-being,
which Sullivan termed interpersonal security.
He believed individuals have an innate need
for interpersonal security.

is a collection of experiences, or security


measures, adopted by the individual to
protect against anxiety.

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The good me is the part of the personality that


develops in response to positive feedback from the
primary caregiver. Feelings of pleasure, contentment,
and gratification are experienced. The child learns
which behaviors elicit this positive response as it
becomes incorporated into the self-system.
The bad me is the part of the personality that
develops in response to negative feedback from the
primary caregiver. Anxiety is experienced, eliciting
feelings of discomfort, displeasure, and distress. The
child learns to avoid these negative feelings by
altering certain behaviors.
The not me is the part of the personality that
develops in response to situations that produce
intense anxiety in the child.

Infancy: Birth to 18 Months


During this beginning stage, the major
developmental task for the child is the
gratification of needs.
This is accomplished through activity
associated with the mouth, such as crying,
nursing, and thumb sucking.

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Childhood: 18 Months to 6 Years


the child learns that interference with
fulfillment of personal wishes and desires
may result in delayed gratification.
He or she learns to accept and feel
comfortable with it, recognizing that delayed
gratification often results in parental
approval, a more lasting type of reward.
Tools of this stage include the mouth, the
anus, language, experimentation,
manipulation, and identification.

Juvenile: 6 to 9 Years
The major task of the juvenile stage is
formation of satisfactory relationships within
the peer group.
This is accomplished through the use of
competition, cooperation, and compromise.

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Preadolescence: 9 to 12 Years
The tasks of the preadolescence stage focus
on developing relationships with persons of
the same gender.
Ones ability to collaborate with and show
love and affection for another person begins
at this stage.

Early Adolescence: 12 to 14 Years


During early adolescence, the child is struggling
with developing a sense of identity separate and
independent from the parents. The major task is
formation of satisfactory relationships with
members
of the opposite gender. Sullivan saw the
emergence
of lust in response to biological changes as a
major force occurring during this period.

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Late Adolescence: 14 to 21 Years


The late adolescence period is characterized
by tasks associated with the attempt to
achieve interdependence within the society
and
the formation of a lasting, intimate
relationship with a selected member of the
opposite gender.
The genital organs are the major
developmental focus of this stage.

Relationship development, which is a major


concept of this theory, is a major psychiatric
nursing intervention.
Nurses develop therapeutic relationships with
clients in an effort to help them generalize this
ability to interact successfully with others.
Knowledge about the behaviors associated with
all levels of anxiety and methods for alleviating
anxiety helps nurses to assist clients in achieving
interpersonal security and a sense of well-being.
Nurses use the concepts of Sullivans theory to
help clients achieve a higher degree of
independent and interpersonal functioning.

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studied the influence of social processes on


the development of the personality.
He described eight stages of the life cycle
during which individuals struggle with
developmental crises.
Specific tasks associated with each stage
must be completed for resolution of the crisis
and for emotional growth to occur.

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Trust Versus Mistrust: Birth to 18 Months


The major task is to develop a basic trust in the
mothering figure and be able to generalize it to
others.
Achievement of the task
results in self-confidence, optimism, faith in the
gratification of needs and desires, and hope for the future.
The infant learns to trust when basic needs are met
consistently.
Nonachievement
results in emotional dissatisfaction with the self and others,
suspiciousness, and difficulty with interpersonal
relationships. The task remains unresolved when primary
caregivers fail to respond to the infants distress signal
promptly and consistently.

Autonomy Versus Shame and Doubt: 18 Months to 3 Years


Major Developmental Task
The major task is to gain some self-control and
independence within the environment.
Achievement of the task results
in a sense of self-control, the ability to delay gratification, and a
feeling of self-confidence in ones ability to perform. Autonomy is
achieved when parents encourage and provide opportunities for
independent activities.
Non-achievement 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.

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Initiative Versus Guilt: 3 to 6 Years


Major Developmental Task
to develop a sense of purpose and the ability to initiate
and direct ones own activities.
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. Initiative is achieved
when creativity is encouraged and performance is
recognized and positively reinforced.

Initiative Versus Guilt: 3 to 6 Years


Major Developmental Task
to develop a sense of purpose and the ability to initiate
and direct ones own activities.
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.
The task remains unresolved when creativity is stifled
and parents continually expect a higher level of
achievement than the child produces.

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Industry Versus Inferiority: 6 to 12 Years


Major Developmental Task-to achieve a sense of self-
confidence by learning, competing, performing
successfully, and receiving recognition from
significant others, peers, and acquaintances.
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 realworld activities.
Industry is achieved when the individual is encouraged to
participate in activities and to assume responsibilities in the
school and community, as well as in the home, and he or
she receives recognition for accomplishments.

Industry Versus Inferiority: 6 to 12 Years (cont.)


Nonachievement results in
difficulty in interpersonal relationships because of feelings of
personal inadequacy
individual can neither cooperate and compromise with others in
group activities nor problem-solve or complete task successfully.
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;
may become a workaholic with unrealistic expectations for
personal achievement.
This task remains unresolved when parents set unrealistic
expectations for the child, when discipline is harsh and tends to
impair self-esteem, and when accomplishments are consistently
met with negative feedback.

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Identity Versus Role Confusion: 12 to 20 Years


Major Developmental Task-At this stage, the goal is to
integrate the tasks mastered in the previous stages into a
secure sense of self.
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.
Identity is achieved when adolescents are allowed to experience
independence by making decisions that influence their lives.
Parents should be available to offer support when needed but
should gradually relinquish control to the maturing individual in
an effort to encourage the development of an independent sense
of self.

Identity Versus Role Confusion: 12 to 20


Years (cont.)
Nonachievement results in
a sense of selfconsciousness, doubt, and confusion
about ones role in life.
Personal values or goals for ones life are absent.
Long-term commitments to relationships with
others are nonexistent.
A lack of self-confidence is often expressed by
delinquent and rebellious behavior.
Entering adulthood, with its accompanying
responsibilities, may be an underlying fear

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Intimacy Versus Isolation: 20 to 30 Years


Major Developmental Task- is to form an intense, lasting relationship or
a commitment to another person, a cause, an institution, or a creative
effort (Murray, Zentner, & Yakimo, 2009).
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, a career, or other type
of cause or endeavor to which an individual elects to devote
his or her 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.

Intimacy Versus Isolation: 20 to 30 Years (cont.)


Non-achievement 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 (or may fear change and thus remain in an
undesirable job situation).
The task remains unresolved when love in the home has been
absent or distorted through the individuals younger years
(Murray et al, 2009).
One fails to achieve the ability to give of the self without having
been the recipient early on from primary caregivers.

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Generativity Versus Stagnation or Self-Absorption: 30 to 65


Years
Major Developmental Task-stage is to achieve the life goals
established for oneself while also considering the welfare of
future generations.
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.
Generativity is achieved when the individual expresses
satisfaction with this stage in life and demonstrates
responsibility for leaving the world a better place in which
to live.

Generativity Versus Stagnation or Self-Absorption:


30 to 65 Years (cont.)
Non-achievement results in
lack of concern for the welfare of others and total
preoccupation with the self.
The individual becomes withdrawn, isolated, and
highly self-indulgent, with no capacity for giving
of the self to others.
The task remains unresolved when earlier
developmental tasks are not fulfilled and the
individual does not achieve the degree of
maturity required to derive gratification out of a
personal concern for the welfare of others.

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Ego Integrity Versus Despair: 65 Years to Death


Major Developmental Task- is to review ones life and derive
meaning from both positive and negative events while
achieving a positive sense of self.
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.
Ego integrity is achieved when individuals have
successfully completed the developmental tasks of the
other stages and have little desire to make major changes
in how their lives have progressed.

Ego Integrity Versus Despair: 65 Years to Death (cont.)


Non-achievement results in
a sense of 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.
The task remains unresolved when earlier tasks are not
fulfilled: self-confidence, a concern for others, and a
strong sense of self-identity were never achieved.

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it incorporates sociocultural concepts into the


development of personality.
it provides a systematic, stepwise approach and
outlines specific tasks that should be completed
during each stage.
The information can be used quite readily in
psychiatric/mental health nursing.
Many individuals with mental health problems are
still struggling to achieve tasks from a number of
developmental stages.
Nurses can plan care to assist these individuals
to complete these tasks and move on to a higher
developmental level.

Mahler (Mahler,
Pine, & Bergman,
1975)

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Formulated a theory that describes the


separation-individuation process of the infant
from the maternal figure (primary caregiver).
She described this process as progressing
through three major phases, and she further
delineated phase III, the separation-
individuation phase, into four subphases

Phase I: The Autistic Phase (Birth to 1 Month)


In the autistic phase, also called normal
autism, the infant exists in a half-sleeping,
half-waking state and does not perceive the
existence of other people or an external
environment.
The fulfillment of basic needs for survival and
comfort is the focus and is merely accepted
as it occurs.

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Phase II: The Symbiotic Phase (1 to 5 Months)


Symbiosis is a type of psychic fusion of
mother and child.
The child views the self as an extension of
the mother but with a developing awareness
that it is she who fulfills the childs every
need.
Mahler suggested that absence of, or
rejection by, the maternal figure at this phase
can lead to symbiotic psychosis.

Phase III: Separation-Individuation (5 to 36 Months)


This third phase is called the psychological birth of
the child.
Separation is defined as the physical and
psychological attainment of a sense of personal
distinction from the mothering figure.
Individuation occurs with a strengthening of the ego
and an acceptance of a sense of self, with
independent ego boundaries.
Further divided into four subphases through which
the child evolves in his or her progression from a
symbiotic extension of the mothering figure to a
distinct and separate being

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Subphase 1Differentiation (5 to 10 Months)


The differentiation phase begins with the childs
initial physical movements away from the
mothering figure.
A primary recognition of separateness
commences.
Subphase 2Practicing (10 to 16 Months)
With advanced locomotor functioning, the child
experiences feelings of exhilaration from
increased independence.
He or she is now able to move away from, and
return to, the mothering figure. A sense of
omnipotence is manifested.

Subphase 3Rapprochement (16 to 24 Months)


is extremely critical to the childs healthy ego
development.
the child becomes increasingly aware of his or her
separateness from the mothering figure, while the
sense of fearlessness and omnipotence diminishes.
The child, now recognizing the mother as a separate
individual, wishes to re-establish closeness with her
but shuns the total re-engulfment of the symbiotic
stage.
The child needs the mothering figure to be available
to provide emotional refueling on demand.

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Subphase 3Rapprochement (16 to 24 Months)


Critical to this subphase
is the mothering figure is available to fulfill
emotional needs as they are required, the child
develops a sense of security in the knowledge
that he or she is loved and will not be
abandoned.
if emotional needs are inconsistently met or if
the mother rewards clinging, dependent
behaviors and withholds nurturing when the child
demonstrates independence, feelings of rage and
fear of abandonment develop and often persist
into adulthood.

Subphase 4Consolidation (24 to 36 Months)


With achievement of the consolidation subphase,
a definite individuality and sense of separateness
of self are established.
Objects are represented as whole, with the child
having the ability to integrate both good and
bad.
A degree of object constancy is established as
the child is able to internalize a sustained image
of the mothering figure as enduring and loving
while maintaining the perception of her as a
separate person in the outside world.

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helps the nurse assess the clients level of


individuation from primary caregivers.
The emotional problems of many individuals can
be traced to lack of fulfillment of the tasks of
separation-individuation.
Examples include problems related to
dependency and excessive anxiety.
The individual with borderline personality
disorder is thought to be fixed in the
rapprochement phase of development, harboring
fears of abandonment and underlying rage.
This knowledge is important in the provision of
nursing care to these individuals.

Hildegard E. Peplau

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applied interpersonal theory to nursing


practice and, most specifically, to nurse-
client relationship development
She established a framework for
psychodynamic nursing, the interpersonal
involvement of the nurse with a client in a
given nursing situation.
Peplau stated, Nursing is helpful when both
the patient and the nurse grow as a result of
the learning that occurs in the nursing
situation

correlated the stages of personality development


in childhood to stages through which clients
advance during the progression of an illness.
viewed these interpersonal experiences as
learning situations for nurses to facilitate forward
movement in the development of personality.
She believed that when there is fulfillment of
psychological tasks associated with the nurse-
client relationship, the personalities of both can
be strengthened.

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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
respond to the need for help.
Psychodynamic nursing
is being able to understand ones 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.

A stranger. A nurse is at first a stranger to the


client. The client is also a stranger to the nurse.
A resource person is one who provides specific,
needed information that helps the client
understand his or her problem and the new
situation.
A counsellor is one who listens as the client
reviews feelings related to difficulties he or she is
experiencing in any aspect of life. Interpersonal
techniques have been identified to facilitate the
nurses interaction in the process of helping the
client solve problems and make decisions
concerning these difficulties.

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A teacher is one who identifies learning needs


and provides information to the client or family
that may aid in improvement of the life situation.
A leader is one who directs the nurse-client
interaction and ensures that appropriate actions
are undertaken to facilitate achievement of the
designated goals.
A technical expert is one who understands
various professional devices and possesses the
clinical skills necessary to perform the
interventions that are in the best interest of the
client.
A surrogate is one who serves as a substitute
figure for another.

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
Resolution

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Orientation
is the phase during which the client, nurse, and family
work together to recognize, clarify, and define the existing
problem.
Identification
is the phase after which the clients initial impression has
been clarified and during which he or she begins to
respond selectively to persons who seem to offer the help
that is needed. Clients may respond in one of three ways:
(1) on the basis of participation or interdependent relations with
the nurse,
(2) on the basis of independence or isolation from the nurse, or
(3) on the basis of helplessness or dependence on the nurse
(Peplau, 1991).

Exploitation
is the phase during which the client proceeds to take
full advantage of the services offered to him or her.
Having learned which services are available, feeling
comfortable within the setting, and serving as an
active participant in his or her own health care, the
client exploits the services available and explores all
possibilities of the changing situation.
Resolution
occurs when the client is freed from identification
with helping persons and gathers strength to assume
independence. Resolution is the direct result of
successful completion of the other three phases.

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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.

Learning to Delay Satisfaction (toodlerhood)


Peplau related this stage to that of toddlerhood, or the first step
in the development of interdependent social relations.
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 for use of 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 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.

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Peplau cites Fromm (1949) in describing 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

Identifying Oneself (early childhood)


A concept of self develops as a product of interaction with
adults (Peplau, 1991, p. 211). A child learns to structure self-
concept by observing how others interact with him or her.
Roles and behaviors are established out of the childs perception
of the expectations of others.
When children perceive 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 are
appropriate to their feelings) learn to improve and reconstruct
behavioral responses at their own pace.

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Developing Skills in Participation (late childhood)


Peplau cited Sullivans (1953) description of the juvenile stage of
personality development (ages 6 through 9). During this stage,
the child develops the capacity to compromise, compete, and
cooperate with others.
These skills are considered basic to ones ability to participate
collaboratively with others. If a child tries to use the skills of an
earlier level of development (e.g., crying, whining, or
demanding), he or she may be rejected by peers of this juvenile
stage.
As this stage progresses, children begin to view themselves
through the eyes of their peers. Sullivan called this consensual
validation.
Preadolescents take on a more realistic view of the world and a
feeling of their place in it. The capacity to love others (besides
the mother figure) develops at this time and is expressed in
relation to ones self-acceptance.

It provides nurses with a framework to interact


with clients, many of whom are fixed inor,
because of illness, have regressed toan earlier
level of development.
She suggested roles that nurses may assume to
assist clients to progress, thereby achieving or
resuming their appropriate developmental level.
Appropriate developmental progression arms the
individual with the ability to confront the
recurring problems of life.
Nurses serve to facilitate learning of that which
has not been learned in earlier experiences.

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Growth and development are unique to 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.
Freuds personality theory can be conceptualized
according to the structure and dynamics of the
personality, topography of the mind, and stages
of personality development.

Freuds 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.
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.

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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
struggle with developmental crises and that
each must be resolved for emotional growth to
occur.
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.

Hildegard Peplau provided a framework


forpsychodynamic 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.

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Townsend, Mary C., (2014). Essentials of


psychiatric mental health nursing : concepts
of care in evidence-based practice, 6th ed.

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