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p Sigmund Freud (1961), who has been called the father
of psychiatry, is credited as the first to identify
development by stages. He considered the first 5 years
of a child¶s life to be the most important, because he
believed that an individual¶s basic character had been
formed by the age of 5.
p Freud¶s personality theory can be conceptualized
according to :
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p Structure of the Personality : Freud organized the
structure of the personality into three major
components:
Ê
 he           
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.

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| o
 he          

 begins to develop between the ages of 4

and 6 months. he ego experiences the reality of the
external world, adapts to it, and responds to it , it
seeks to bring the influences of the external world to
bear upon the id, to substitute the reality principle for
the pleasure principle . A primary function of the ego
is one of mediator to maintain harmony among the
external world, the id, and the superego.

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 Supere o
p he     to as the ³perfection
principle.´ which 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.
p he superego is composed of two major components: the
            

rewarded for ³good´ behavior, self-esteem is enhanced, and

the behavior becomes part of the ego ideal. he conscience is
formed when the child is consistently punished for ³bad´
behavior. he child learns what is considered morally right or
wrong from feedback received from parental figures and from
society or culture.
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p      
p Freud classified all mental contents and operations into three
categories:
1- he        within an individual¶s
awareness. Events and experiences that are easily remembered
.Examples : telephone numbers, birthdays of self and significant
others. he conscious mind is thought to be under the control of
the ego, the rational and logical structure of the personality.
2- he       
 been forgotten or
are not in present awareness but can be recalled into
consciousness. Examples : telephone numbers or addresses once
known but little used . It is thought to be partially under the control
of the superego, which helps to suppress unacceptable thoughts
and behaviors.
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p      
3- he          to
bring to conscious awareness. Which consists of
unpleasant or nonessential memories that have been
      
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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p èynamics of the Personality
p Freud believed that 
 
    
required for mental functioning. Originating in the id, it
instinctually fulfills basic physiological needs. Freud called this
psychic energy the libi o.
p As the chil matures, psychic ener y 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. If an
excessive amount of psychic energy is stored in one of these
personality components, behavior reflects that part of the
personality. For instance, impulsive behavior prevails when
excessive psychic energy is stored in the id. Overinvestment in
the ego reflects self-absorbed, or narcissistic, behaviors; an
excess within the superego results in rigid, self deprecating
behaviors.
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A e Sta e èevelopmental Task

Yelief from anxiety through oral

Birth±18 months wral
gratification of needs
Learning independence and control,
18 months ± 3 years Anal
with focus on the excretory function
Identification with parent of the
3±6 years Phallic same sex; development of sexual
identity; focus on genital organs
Sexuality repressed; focus on
6±12 years Latency
relationships with same sex peers
Libido reawakened as genital organs
mature; focus on relationships with
13±20 years Genital member of the opposite sex
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p ënowledge of the structure of the personality can
assist nurses who work in the mental health setting :
1. he ability to recognize behaviors associated with the
id, the ego, and the superego .
2. Assists in the assessment of developmental level.
3. Understanding the use of ego defense mechanisms in
making determinations about maladaptive behaviors.
4. Assist nurses in planning care for clients to assist in
creating change (if desired), or in helping clients
accept themselves as unique individuals.

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p Sullivan (1953) believed that individual behavior and
personality development are the direct result of
interpersonal relationships. Sullivan embraced the
concepts of Freud. Later, he changed the focus of his
work from the     !  
        
   observed in social interactions with
others. 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.

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relief or prevention of which all behavior is aimed. Sullivan
believed that anxiety is the ³chief disruptive force in
interpersonal relations and the main factor in the
development of serious difficulties in living.´ It arises out of
one¶s inability to satisfy needs or achieve interpersonal
security.
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associated with an individual¶s physiochemical environment.
Sullivan identified examples of these requirements as
oxygen, food, water, warmth, tenderness, rest, activity,
sexual expression²virtually anything that, when absent,
produces discomfort in the individual.

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 from anxiety. When all needs have been met, one
experiences a sense of total well-being, which Sullivan
termed   
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have an innate need for interpersonal security.
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measures, adopted by the individual to protect

against anxiety.
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A.The ³ oo 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. he child learns which
behaviors elicit this positive response as it becomes incorporated into
the self system.
B.The ^+ !,       
 develops in response
to negative feedback from the primary caregiver. Anxiety is
experienced, eliciting feelings of discomfort, displeasure, and distress.
he child learns to avoid these negative feelings by altering certain
behaviors.
M.The ^  !,       
  in response
to situations that produce intense anxiety in the child. Feelings of
horror, awe, to these situations, leading the child to deny these feelings
in an effort to relieve anxiety. hese feelings, having then been denied,
become ³not me,´ but someone else. his withdrawal from emotions
has serious implications for mental disorders in adult life.
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  !
A e Sta e ?ajor èevelopmental Tasks
Yelief from anxiety through oral gratification
Birth±18 months Ênfancy
of needs
Learning to experience a delay in personal
18 months±6 years Mhil hoo gratification without undue anxiety
Learning to form satisfactory peer
6±9 years Juvenile
relationships
Learning to form satisfactory relationships
9±12 years Prea olescence with persons of same gender initiating feelings
of affection for another person
Learning to form satisfactory relationships
|arly
12±14 years with persons of the opposite gender;
a olescence
developing a sense of identity
Establishing self-identity; experiencing
Late satisfying relationships; working to develop a
14±21 years
a olescence lasting, intimate opposite-gender relationship
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p Yelationship development is a major concept of this
theory, and is also a major psychiatric nursing
intervention.
p Nurses develop therapeutic relationships with clients in
an effort to help them generalize this ability to interact
successfully with others.
p With knowledge about the behaviors associated with all
levels of anxiety nurses can help clients achieve
interpersonal security and a sense of well-being.
p Nurses use the concepts of Sullivan¶s theory to help
clients achieve a higher degree of independent and
interpersonal functioning.

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p Erikson (1963) 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 ³crises.´
Specific tasks associated with each stage must be
completed for resolution of the crisis and for
emotional growth to occur.

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  !
 Sta e ?ajor èevelopmental Td

Ênfancy
Trust versus o develop a basic trust in the mothering figure and be able to
(Birth±18 generalize it to others
mistrust
months)
|arly chil hoo Autonomy o gain some self-control and independence within the
(18 months±3 versus shame environment
years) an oubt
Late chil hoo Ênitiative o develop a sense of purpose and the ability to initiate and
(3±6 years) versus uilt direct own activities
Ên ustry o achieve a sense of self-confidence by learning, competing,
School a e
(6±12 years)
versus performing successfully, and receiving recognition from
inferiority significant others, peers, and acquaintances
A olescence Ê entity versus o integrate the tasks mastered in the previous stages into a
(12±20 years) role confusion secure sense of self
Youn Êntimacy o form an intense, lasting relationship or a commitment to
a ulthoo versus another person, cause, institution, or creative effort
(20±30 years) isolation
Generativity o achieve the life goals established for oneself, while also
A ulthoo
versus considering the welfare of future generations
(30±65 years)
sta nation
wl a e o review one¶s life and derive meaning from both positive and
| o inte rity ¬‰
(65 years - negative events, while achieving a positive sense of self worth
versus espair
eath)


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p ?ahler (?ahler, Pine, & Bergman, 1975) formulated
a theory that describes the separation±individuation
process of the infant from the maternal figure
(primary caregiver).
p She described the process as progressing through
three major phases, and further delineated phase III,
the separation±individuation phase, into four
subphases.

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A e Phase/ Subphase ?ajor èevelopmental Tasks
Fulfillment of basic needs for survival and comfort
Birth±1 month Ê. Normal autism

ÊÊ. Symbiosis Development of awareness of external source of need

1±5 months ÊÊÊ. Separation fulfillment
Ên ivi uation
5±10 months Commencement of a primary recognition of
a. èifferentiation separateness from the mothering figure

Increased independence through locomotors

10±16 months functioning; increased sense of separateness of self
b. Practicin
maintain feeling of security

16±24 months Acute awareness of separateness of self; learning to

c. Rapprochement seek ³emotional refueling´ from mothering figure to

Sense of separateness established; on the way to

24±36 months object constancy (i.e., able to internalize a sustained
. Monsoli ation image of loved object/person when it is out of sight);
resolution of separation anxiety ½

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p Peplau (1991) applied interpersonal theory to nursing practice
and, most specifically, to nurse±client relationship
development. She established a framework for psycho ynamic
nursin , the interpersonal involvement of the nurse with a
client in a given nursing situation.
p Peplau correlated the stages of personality development in
childhood to stages through which clients advance during the
progression of an illness. She also 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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Learning to communicate in various
Learnin to count on ways with the primary caregiver to have
Ênfancy
others comfort needs fulfilled

Learnin to elay Learning the satisfaction of pleasing

satisfaction others by delaying self-gratification in
To lerhoo small ways

Learning appropriate roles and

Ê entifyin oneself behaviors by acquiring the ability to
|arly chil hoo perceive the expectations of others

Learning the skills of compromise,

competition, and cooperation with
èevelopin skills in others; establishing a more realistic view
Late chil hoo participation of the world and a feeling of one¶s place
in it
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p Early observation of negative content of depressed
people¶s dreams
p Beck's background was in psychoanalytic psychiatry.
p He developed theories and inventories instrumental to
cognitive therapy research and practice, particularly
for the treatment of depression through challenging
faulty attributions or unhelpful thinking patterns.

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Depressed people have a negative view of:
p hemselves
p he world
p he future
èepresse people have ne ative schemas or frames
of reference throu h which they interpret all
events an experiences .
Schemas in psychology and cognitive science, is a
mental structure that represents some aspect of the
world.

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Identify and changing maladaptive thoughts
p First sessions: therapist explains cognitive theory of
emotional disorders (negative cognitions contribute to
distress).
p ?iddle Sessions: Client is taught to identify, evaluate
and replace negative automatic thoughts were more
positive cognitions.
p herapist is a collaborator (fellow scientists in therapy)
p Final Sessions: solidify gains, focus on prevention of
recurrence.

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1. Behavioral coping strategies .
2. Problem solving skills
3. Assertiveness training

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p Identified as a well established treatment for the

treatment of unipolar depression.
p As effective (and sometimes more effective than)
alternate forms of treatment for depression including
antidepressant medication.
p However (despite focus on prevention of relapse) 2/3
of patients who receive cognitive therapy have another
episode of depression within two years.

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p Outcome not predicted by level of intelligence

1. Patient with lower levels of dysfunctional thinking
benefit the most (paradoxically)
2. Interpersonally avoidant patients do better in CB
(rather than interpersonal psychotherapy)
3. Patients with more obsessional styles do better in
Interpersonal Psychotherapy

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 Empirically supported treatment for :

1. Depression
2. Generalized anxiety disorder
3. Obsessive compulsive disorder
4. Panic disorder

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