40.2 Theories Related to Growth and Development

Erikson’s Developmental Theory

Erik Erikson was one of the first formal life-stage theorists. In his work published in 1963, Erickson’s psychosocial development theory explained social aspects of human development from infancy through adulthood, including personality development through the life span. He described the idea that an individual’s sense of self is affected by how they interact with others. Erikson believed that humans are motivated by a need to achieve competence during the eight stages of development. Competence at any stage is achieved by resolving a specific developmental task or conflict, which leads to a healthy personality. Conversely, failure to master the developmental tasks in each stage may produce an internal sense of inadequacy.

According to Erikson (1963), individuals progress through a predictable series of developmental stages, as summarized in Table 38.2. People in early adulthood are concerned with intimacy versus isolation. After developing a sense of self in adolescence, individuals are ready to share their lives with others. A strong sense of self and a positive self-concept are essential for developing healthy intimate relationships and avoiding feelings of loneliness and emotional isolation.

During middle adulthood, the social task is generativity versus stagnation. Generativity involves finding one’s life’s work and contributing to the development of others through productive activities. For some, this may include volunteering, mentoring, or raising children; for others, it may include making career choices or addressing societal needs. For example, someone who feels called to help marginalized or at-risk populations may pursue a career in social work. An individual may identify a societal need or problem and start their own business to address this need. Those who do not master this task may experience stagnation, having little connection with others and little interest in productivity and self-improvement.

Understanding Erikson’s theory is key to developing a patient-centered nursing practice. The complex dynamics of human personality development through the life span directly affect health and wellness at each stage. For nurses, understanding the highly variable aspects of human development allows them to create individualized care plans regardless of the age or stage of the individual. Typically, progression through Erikson’s developmental stages happens in a predictable sequence; however, individuals may revisit earlier tasks or work through multiple tasks simultaneously depending on their specific life circumstances. This is particularly true for the adult population, as it spans a wide range of ages. For example, a young adult living away from home of origin for the first time may struggle with identity versus role confusion while working to develop interpersonal relationships through the task of intimacy versus isolation. For young adult and middle-aged adult populations, nurses may incorporate stage-specific interventions, such as the following:

• encouraging physical activity based on specific hobbies and passions
• connecting individuals with in-person social support groups
• encouraging learning new activities or career changes as desired
• educating individuals on healthy eating for long-term disease prevention
• providing referrals for behavioral health support services for individuals and families
• showing respect for a wide variety of family structures

Levinson’s Theory of Adult Development

Life span development theories have evolved over the years. In the 1970s and 1980s, psychologist Daniel Levinson suggested his theory on adult development. While he began with a study evaluating primarily males, he later expanded his research and theory to include females. Like Erikson, Levinson’s theory of adult development suggests that adults work through tasks as they progress through developmental stages. However, unlike Erikson’s psychological theory, Levinson believed that life structure changes occurred due to changes in an individual’s physiology, psychology, and societal roles (Agronin, 2014). He believed that transitions between these five stages include significant disturbance, which leads individuals to modify, build, or change their internal character or external life structure over several years. Levinson further breaks down the young and middle adult years into transition periods (Figure 40.3).

Figure 40.3 Levinson’s model shows the alternation between transition and stabilization in adult development. (attribution: Copyright Rice University, OpenStax, under CC BY 4.0 license)

In explaining these transitions (Table 40.2), Levinson focused on the concept of life structure. Life structure is how individuals interact with their social and cultural environment as well as how they see themselves within this structure throughout their lives. Levinson’s theory is based on the idea that individuals move through periods of stability and transition during each stage of life.

For nurses, Levinson’s theory gives insight into the many struggles experienced by young and middle-aged adults. Nurses can express compassion for individuals struggling in these stages by acknowledging the universality of change during this developmental period. Nurses can also encourage individuals to seek stability through internal reflection and maintaining healthy psychological and physical practices to maximize their well-being. Normalizing behavioral health services to help individuals through these transitions is also a crucial responsibility of nurses.

Vaillant’s Theory of Adult Development

Another psychosocial theorist, George Vaillant, built on the established theories of Erikson and Levinson. Vaillant analyzed research data to support his theory about adult development. His theory begins with adolescence and intersects with and adds elements to Erikson’s theory. Vaillant’s theory of adult development is based on educational and physical health measures, proposing that higher education levels directly affect self-care and health monitoring over the adult life stage. Additionally, he proposed that these factors directly influence overall health and success in the aging process (Nolan & Kadavil, 2003). Vaillant’s theory is often conceptualized as an expanding set of concentric circles as adults move to complete sequential tasks of development (Figure 40.4). He included six stages, two of which are additions to Erikson’s theory:

• identity
• intimacy
• career consolidation
• generativity
• keeper of meaning
• integrity

Figure 40.4 Vaillant’s theory suggests concentric growth in the completion of developmental tasks. (attribution: Copyright Rice University, OpenStax, under CC BY 4.0 license)

Vaillant’s additions to Erikson’s theory include career consolidation (which falls just after the development of intimacy and before generativity) and becoming keeper of the meaning (which comes after generativity and before achieving integrity).

Vaillant’s idea of career consolidation is essential in understanding young and middle-age development. Career consolidation involves the task of finding contentment and satisfaction in career aspirations. Vaillant used commitment, compensation, contentment, and competence to describe the goals in the career consolidation stage. This stage allows individuals to internalize lifetime learning and offer specific contributions to society and the next generation. Career consolidation is an individual’s sense of well-being in their role and transitioning from a mentee to a mentor (Malone et al., 2016).

In caring for young and middle-aged adults, nurses should remember the importance of developing a sense of contentment and competence during these life stages. The application of Vaillant’s theory in nursing care can be twofold.

Nurses can support individuals in their journey to maintain health in middle adulthood. Individual health can be considered an offshoot of career consolidation with a focus on commitment to both mental and physical health. This includes compensation as a response to unexpected changes and the ability to grow physically and mentally from these changes. It also includes contentment in life choices or continual work toward better life choices, competence in evaluating one’s health, and deciding on changes and implementing them.

Nurses may also apply Vaillant’s career consolidation theory to nursing practice in ways that improve their own and others’ health. Nurses applying Vaillant’s career consolidation theory will have continued and renewed commitment to promoting health in the populations they serve. They receive compensation for the intangible rewards of helping others. They show a sense of contentment in encouraging the newest generation of nurses and a sense of integrity in serving this population by offering education and mentorship. Their competence and expertise empower them based on their clinical experience, and they can adapt and expand their nursing knowledge from this strong base.

Neugarten’s Theory of Adult Development

Contrary to the developmental theories proposed by Erikson, Levinson, and Vaillant, Bernice Neugarten, an American theorist, introduced a distinctive perspective in the 1960s centered on the concept of a “social clock.” Neugarten’s theory of adult development defines the “social clock” theory as a culturally determined timeline prescribing when individuals should achieve certain milestones and life events, such as marriage, parenthood, career advancement, and retirement. Neugarten’s theory emphasizes how individuals’ adherence to, or deviation from, these societal expectations can shape their developmental trajectory and psychological well-being. She suggested that individuals may experience stress or satisfaction depending on how closely their personal life timelines align with societal norms (Ferraro, 2014).

These age norms, as manifested through outward behaviors like dress, actions, family dynamics, and lifestyle choices, are subject to change based on cultural values and beliefs. The notion of the “social clock” encompasses diverse cultural values associated with gender, social class, spirituality, occupation, and ethnicity that shape individuals’ life choices and behaviors. Neugarten viewed these norms as subtle forms of social control, influencing individuals’ major life decisions in accordance with societal expectations.

Questions remain around the effects of adhering to these cultural age norms on individuals’ overall happiness and contentment throughout their lives. While these norms may evolve across generations, they remain entrenched in distinguishing between older and younger adults. Neugarten proposed that cultural age norms contribute to age grading within society, wherein individuals are categorized and judged based on their age, often resulting in the assignment of specific roles and responsibilities associated with particular age groups.

Neugarten raised critical inquiries regarding the appropriateness of these entrenched social norms, exploring strategies to challenge their influence and assessing their long-term impact on individual well-being, especially when one’s life trajectory diverges from the conventional social clock. By questioning the rigidity of these norms, she sought to understand how they shape individuals’ choices, opportunities, and sense of self over time. Neugarten explored strategies for challenging the influence of these norms, recognizing the importance of empowering individuals to navigate their own life paths rather than conforming to predetermined societal expectations. She also examined the long-term impact of adhering to or deviating from these norms on individual well-being. She was particularly interested in understanding how diverging from the conventional social clock might affect individuals’ psychological adjustment, social relationships, and overall life satisfaction. By questioning whether strict adherence to age-appropriate behaviors might inadvertently limit individual development, Neugarten highlighted the potential for these norms to function as a form of social control, constraining individuals’ autonomy and inhibiting their ability to pursue authentic and fulfilling lives.

Kegan’s Constructive Developmental Theory

A contemporary theorist on adult cognitive development is Robert Kegan, a former Harvard psychologist. In 1982 and 1994, he developed the constructive developmental theory (CDT). While previous theories focused on action and responses to age-related stages and social norms, the CDT theory focuses on adult thought processes. Kegan’s constructive developmental theory explains that individuals change their thought processes over time as their cognitive development progresses. The tiered structure of the CDT theory implies that individuals progress through various levels of cognitive development, with each stage representing a greater understanding of oneself and others. This advancement involves the capacity to reflect on one’s thoughts and behaviors objectively, gaining insight into personal motivations and social dynamics.

Kegan’s CDT focuses on the importance of adult thought processes in daily life, family life, work interactions, learning environments, and spiritual awareness. Higher cognitive thinking allows individuals to interact constructively by understanding themselves and others in a broader sense. The stages of Kegan’s CDT assume that individuals progressively mature in their cognitive processes over time and derive meaning from experiences that also affect how they understand their lives and interactions with others (Table 40.3). Kegan used two critical definitions when explaining his theory. He explained that rather than adding new insight or learned tasks, adults progress through a transformation in which they change their thinking and understanding of the world around them. He also described a subject–object shift in which individuals move from simply understanding their character traits and interactions with the world (subject) to acquiring the ability to reflect on their traits and interactions and engage with themselves and others (object).