THEORIES OF PERSONALITY DEVELOPMENT
I. PSYCHOANALYTIC THEORY
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.
Structure of personality
Freud organized the structure of the personality into three major components: the id, ego, and superego.
They are distinguished by their unique functions and different characteristics.
Id
The id is the locus of instinctual drives—the “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.
Ego
The ego, also called the rational self or the “reality principle,” begins to develop between the ages of 4
and 6 months. The ego 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.
Superego
If the id is identified as the pleasure principle, and the ego the reality principle, the superego might be
referred to as the “perfection principle.” The superego, which develops between ages 3 and 6 years,
internalizes the values and morals set forth by primary caregivers. Derived out of a system of rewards and
punishments, the superego is composed of two major components: the ego-ideal and the conscience.
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. The conscience
is formed when the child is punished consistently for “bad” behavior. The child learns what is considered
morally right or wrong from feedback received from parental figures and from society or culture. When
moral and ethical principles or even internalized ideals and values are disregarded, the conscience
generates a feeling of guilt within the individual.
Topography of the Mind
Freud classified all mental contents and operations into three categories: the conscious, the preconscious,
and the unconscious.
■ The conscious includes all memories that remain within an individual’s awareness. It is the smallest of
the three categories. Events and experiences that are easily remembered or retrieved are considered to
be within one’s conscious awareness. Examples include telephone numbers, birthdays of self and
significant others, the 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.
■ The preconscious includes all memories that may have been forgotten or are not in present awareness
but with attention can be readily 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 sometime in the past. The preconscious 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.
■ The unconscious 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 and can be retrieved only through therapy, hypnosis, and with certain
substances that alter awareness and have the capacity to restructure repressed memories. Unconscious
material may also emerge in dreams and in seemingly incomprehensible behavior.
Dynamics of the Personality
Freud believed that 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. If an
excessive amount of psychic energy is stored in one of these personality components, behavior will reflect
that part of the personality. For instance, impulsive behavior prevails when excessive psychic energy is
stored in the id. Over-investment in the ego reflects self-absorbed, or narcissistic, behaviors; an excess
within the superego results in rigid, self-deprecating behaviors.
II. PSYCHOSEXUAL THEORY
Freud described
formation of the
personality
through five
stages of
psychosexual
development.
He placed much
emphasis on the
first 5 years of
life and believed
that
characteristics
developed
during these
early years bore
heavily on one’s adaptation patterns and personality traits in adulthood. Fixation in an early stage of
development will almost certainly result in psychopathology.
III. INTERPERSONAL THEORY
Harry Stack Sullivan (1953) believed that individual behavior and personality development are the direct
result of interpersonal relationships. Before the development of his own theoretical framework, Sullivan
embraced the concepts of Freud. Later, he changed the focus of his work from the intrapersonal view of
Freud to one with a more interpersonal flavor in which human behavior could be 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. Sullivan’s major concepts
include the following:
■ Anxiety 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 one’s inability to satisfy needs or
to achieve interpersonal security.
■ Satisfaction of needs is the fulfillment of all requirements associated with an individual’s
physiochemical environment. Sullivan identified examples of these requirements as oxygen, food, water,
warmth, tenderness, rest, activity, sexual expression—virtually anything that, when absent, produces
discomfort in the individual.
■ Interpersonal security 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.
■ Self-system is a collection of experiences, or security measures, adopted by the individual to protect
against anxiety. Sullivan identified three components of the self-system, which are based on interpersonal
experiences early in life:
■ 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. Feelings of horror, awe, dread, and loathing are experienced in response to these
situations, leading the child to deny these feelings in an effort to relieve anxiety. These feelings, having
then been denied, become “not me,” but someone else. This withdrawal from emotions has serious i
Sullivan stages of personality development
IV. THEORY OF PSYCHOSOCIAL DEVELOPMENT
Erik 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
“crises.” Specific tasks associated with each stage must be completed for resolution of the crisis and
for emotional growth to occur.
V. COGNITIVE DEVELOPMENT THEORY
Jean Piaget has been called the father of child psychology. His work concerning cognitive development in
children is based on the premise that human intelligence is an extension of biological adaptation, or one’s
ability to adapt psychologically to the environment. 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.
VI. NURSING MODEL : HILDEGARD PEPLAU
Peplau (1991) applied interpersonal theory to nursing practice and, most specifically, to nurse-client
relationship development. She provided 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”
■ 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 identifies the following nursing roles:
■ A stranger. A nurse is at first a stranger to the client.
■ A resource person is one who provides specific, needed information that helps the client understand
his or her problem and the new situation.
■ A counselor 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 nurse’s
interaction in the process of helping the client solve problems and make decisions concerning these
difficulties.
■ 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.
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 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 client’s initial impression has been clarified and when he or
she begins to respond selectively to those 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.
■ 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.
IMPORTANCE OF PERSONALITY THEORIES IN NURSING PRACTICE
1. 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.
2. The interpersonal theory has significant relevance to nursing practice. 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 achieve interpersonal security and a
sense of well-being. Nurses use the concepts of Sullivan’s theory to help clients achieve a higher
degree of independent and interpersonal functioning
3. Erikson’s theory is particularly relevant to nursing practice in that it incorporates sociocultural
concepts into the development of personality. Erikson provides a systematic, stepwise approach
and outlines 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 achieve tasks from a number of developmental stages. Nurses can
plan care to assist these individuals to fulfill these tasks and move on to a higher developmental
level
4. Nurses who work in psychiatry are likely to be involved in helping clients, particularly depressed
clients, with techniques of cognitive therapy. In cognitive therapy, the individual is taught to
control thought distortions that are considered to be a factor in the development and
maintenance of mood disorders. In the cognitive model, depression is characterized by a triad of
negative distortions related to expectations of the environment, self, and future. In this model,
depression is viewed as a distortion in cognitive development, the self is unrealistically devalued,
and the future is perceived as hopeless. Therapy focuses on changing “automatic thoughts” that
occur spontaneously and contribute to the distorted affect. Nurses who assist with this type of
therapy must have knowledge of how cognition develops in order to help clients identify the
distorted thought patterns and make the changes required for improvement in affective
functioning
5. Peplau’s model provides nurses with a framework to interact with clients, many of whom are fixed
in—or because of illness have regressed to—an 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.
