Behavioral Lifespan Theory


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Behavioral Lifespan Theory

  1. 1. Behavioral lifespan Psychoanalytic child development theories Presented by: Vivian Gutierrez LCSW
  2. 2. Course Objectives <ul><li>Recognition of life cycle theories </li></ul><ul><li>Understanding age appropriate behavior/cognition/adaptation </li></ul><ul><li>Understand the child/adult perspective on dying </li></ul><ul><li>Bio psychosocial impact of normal sexual development </li></ul>
  3. 3. Mental health professionals <ul><li>Psychiatrist-MD </li></ul><ul><ul><li>Medication based therapy </li></ul></ul><ul><ul><li>Focus on DSM diagnosis </li></ul></ul><ul><li>Psychologist-PHD </li></ul><ul><ul><li>therapist-focus on research and psychotherapy, testing, neurological, developmental </li></ul></ul><ul><li>LCSW-licensed clinical social worker </li></ul><ul><ul><li>Focus on individual in context of his environment </li></ul></ul><ul><li>LFTH-licensed family therapist </li></ul><ul><ul><li>Focus on family and marital counseling </li></ul></ul><ul><li>LMHC-licensed mental health counselor </li></ul><ul><ul><li>Focus on mental health diagnosis, treatment </li></ul></ul>
  4. 4. Epigenetic principle <ul><li>Life cycle theory holds that development occurs in successive defined stages. If a stage is not resolved, subsequent stages reflect failure in maladjustment. </li></ul>
  5. 5. Crisis Points in life cycle theory <ul><li>Each stage is characterized by crisis </li></ul><ul><li>Crisis requires person to adapt </li></ul><ul><li>A crisis is a biopsychosocial event that consists of </li></ul><ul><ul><li>biological, psychological, and social factors </li></ul></ul>
  6. 6. Contributions to the life cycle theory <ul><li>Sigmund Freud- </li></ul><ul><ul><li>Characterized by theory of sexuality </li></ul></ul><ul><li>Carl Jung </li></ul><ul><ul><li>Process of individuation </li></ul></ul><ul><li>Harry Stack Sullivan </li></ul><ul><ul><li>Environment/interaction determine personality </li></ul></ul><ul><li>Erik Erikson </li></ul><ul><ul><li>8 stages of psychosocial development </li></ul></ul><ul><li>Jean Piaget </li></ul><ul><ul><li>Cognitive development theory </li></ul></ul><ul><li>Daniel Levinson </li></ul><ul><ul><li>Four major life stage theory </li></ul></ul><ul><li>George Vaillant </li></ul><ul><ul><li>Belief that maturation comes from within </li></ul></ul><ul><li>Bernice Neugarten </li></ul><ul><ul><li>Study of life cycles in women </li></ul></ul>
  7. 7. Sigmund Freud <ul><li>Focused on the childhood period </li></ul><ul><li>Was organized around libido theory </li></ul><ul><li>Believed that development stages corresponded to sexual energy associated with the mouth, anus, and genitalia. </li></ul><ul><li>Psychoanalysis is considered to have three aspects </li></ul><ul><ul><li>Method of investigation </li></ul></ul><ul><ul><li>Therapeutic technique </li></ul></ul><ul><ul><li>Body of theory/scientific information </li></ul></ul>
  8. 8. Psychosexual Development Id: Pleasure seeking energies focusing on erogenous areas Libido: psychosexual energy ;the driving force behind behavior Fixation=a persistent focus on an early psychosexual stage Psychosexual theory developmental example: A patient fixated at the oral stage may be over dependent and seek oral stimulation, eating, drinking, smoking
  9. 9. Sigmund Freud <ul><li>Oral stage </li></ul><ul><ul><li>1-18mths needs are centered in the mouth tongue, and lips. </li></ul></ul><ul><li>Objectives </li></ul><ul><ul><li>Establish trust/gratification </li></ul></ul><ul><li>Pathological traits </li></ul><ul><ul><li>Excess or deprivation can result in extreme optimism, narcissism, depressive states, demandingness, or excessive dependence, envy and jealousy related to oral traits. </li></ul></ul>
  10. 10. Sigmund Freud <ul><li>Anal stage </li></ul><ul><ul><li>Maturation of control of sphincter. Age 1-3, struggle of aggression vs ambivalence, reaction-formation, shame & disgust </li></ul></ul><ul><li>Objectives </li></ul><ul><ul><li>Striving for independence, separation from dependence on parents, autonomy </li></ul></ul><ul><li>Pathological traits: </li></ul><ul><ul><li>Defensive Posture-Maladaptive traits </li></ul></ul><ul><ul><ul><li>orderliness, obstinancy, frugality, </li></ul></ul></ul><ul><ul><li>When defenses are less effective: </li></ul></ul><ul><ul><ul><li>Stubborness, messiness, rage, defiance, OCD </li></ul></ul></ul>
  11. 11. Sigmund freud <ul><li>Phallic stage </li></ul><ul><ul><li>3-5yr, sexual interest stimulation of genitals </li></ul></ul><ul><ul><li>Oedipal conflict wanting to possess the mother- castration anxiety, Electra complex: penis envy </li></ul></ul><ul><li>Objectives </li></ul><ul><ul><li>Lays foundation of gender identity, character development based on oedipal conflict resolution </li></ul></ul><ul><li>Pathology: patterns of identification that development after resolution of phallic stage </li></ul>
  12. 12. Sigmund freud <ul><li>Latency stage </li></ul><ul><ul><li>Ages 6-11, Superego develops after oedipal complex resolution, </li></ul></ul><ul><li>Objectives </li></ul><ul><ul><li>Consolidation of sex role identity, control of impulse, developing relationships outside family </li></ul></ul><ul><li>Pathology </li></ul><ul><ul><li>Lack or excess of inner controls </li></ul></ul>
  13. 13. Sigmund freud <ul><li>Genital stage </li></ul><ul><ul><li>Ages 11-13,libido drives produce regression in personality organization </li></ul></ul><ul><li>Objectives </li></ul><ul><ul><li>Separation from dependence to parents/mature sense of personal identity, integrate adult roles </li></ul></ul><ul><li>Pathology </li></ul><ul><ul><li>Defects of emerging adult personality </li></ul></ul><ul><ul><li>Identity diffusion-inability to resolve adolescent issues </li></ul></ul>
  14. 14. Sigmund frued -psychic apparatus <ul><li>Id-instinctual drives </li></ul><ul><li>Ego- executive organ if the mind, controls perception, reality, </li></ul><ul><li>Superego-establishes and maintains persons moral conscience, continues scrutiny of the person’s behavior </li></ul>
  15. 15. Erikson's psychosocial crisis stages (syntonic v dystonic) Freudian psycho- sexual stages life stage / relationships / issues basic virtue and second named strength (potential positive outcomes from each crisis) maladaptation / malignancy (potential negative outcome - one or the other - from unhelpful experience during each crisis)   1. Trust v Mistrust Oral infant / mother / feeding and being comforted, teething, sleeping Hope and Drive Sensory Distortion / Withdrawal   2. Autonomy v Shame & Doubt Anal toddler / parents / bodily functions, toilet training, muscular control, walking Willpower and Self-Control Impulsivity / Compulsion 3. Initiative v Guilt Phallic preschool / family / exploration and discovery, adventure and play Purpose and Direction Ruthlessness / Inhibition 4. Industry v Inferiority Latency schoolchild / school, teachers, friends, neighbourhood / achievement and accomplishment Competence and Method Narrow Virtuosity / Inertia 5. Identity v Role Confusion Puberty and Genitality adolescent / peers, groups, influences / resolving identity and direction, becoming a grown-up Fidelity and Devotion Fanaticism / Repudiation 6. Intimacy v Isolation (Genitality) young adult / lovers, friends, work connections / intimate relationships, work and social life Love and Affiliation Promiscuity / Exclusivity 7. Generativity v Stagnation n/a mid-adult / children, community / 'giving back', helping, contributing Care and Production Overextension / Rejectivity 8. Integrity v Despair n/a late adult / society, the world, life / meaning and purpose, life achievements  Wisdom and Renunciation Presumption / Disdain
  16. 16. Erik erikson- eight stages <ul><li>1-trust vs mistrust: age birth-1 yr </li></ul><ul><li>2-autonomy versus shame/doubt: age1-3 </li></ul><ul><li>3- initiative vs guilt: age 3-5 yr </li></ul><ul><li>4-industry vs inferiority, age 6-11 </li></ul><ul><li>5- ego identity vs role confusion, age 11-adolescence </li></ul><ul><li>6-intimacy vs isolation, ages 21-40 </li></ul><ul><li>7-generativity vs stagnation, ages 40-65 </li></ul><ul><li>8- ego integrity vs despair. Age 65+ </li></ul>
  17. 17. Erik erikson <ul><li>Freuds psychosocial oral, anal, phallic </li></ul><ul><li>n/a </li></ul><ul><li>Erikson, trust, autonomy,industry and identity </li></ul><ul><li>Intimacy generativity, integrity </li></ul>
  18. 18. Normal child development age Motor/sensory Adaptive Personal/social behavior Birth-4wks Hand to mouth reflex, rooting reflex Differentiates sound, visual tracking, fixed focal distance 8 inches Moves head laterally Aticipatory feeding appproach 4days Regards moving objects Responds to mothers face, eys voice, few hous of life, indpendent play until 2yrs Quiets when picked up, Impassive face 4 wks Tonic neck reflex Hands fisted Hold head for seconds Visual fixation 12wks Follow moving objects, shows no interest. And drops objects immediately Regrds face and diminshes activitity Responds to speech Smiles to mother
  19. 19. Childhood development Age Motor behavior Adaptive behavior Personal/social behavior 16 week Symmetrical postures Holds head balanced Lifts head 90 degrees Visual accommodation Follows slowly moving object Arms move towards dangling object Spontaneous smiles, aware of strange situations 28 week Sits steadily, leans forward on hands, bounces actively when placed in standing position One hand approach and grasps a toy Bangs and shakes rattle, transfers toys Takes feet to mouth, pats mirror image, starts to imitate mothers sounds
  20. 20. Child development Age Motor/sensory development Adaptive behavior Personal/social behavior 40 wks Sits alone Creeps, pulls self to standing position, points with index finger Matches two objects at midline, attempts to scribble Separation anxiety, when taken away from caregiver Responds to social play, peekaboo, pata cake, holds bottle 52 wks Walks with one hand held, Stands alone Seeks novelty Cooperates dressing
  21. 21. Child development Age Motor/sensor behavior Adaptive Persoanl/social 15 wks Toddles,creeps up stairs Points or vocalizes wishes, throws objects in play or refusal 18mth Coordinated walking, hurls ball, walks upstairs w/one hand held Builds a tower of ¾ cubes, scribbles imitates writing Feeds self, pulls toys, carries toys, hugs toys ,imitates others 2yrs Runs w/o falling, Kicks large ball Goes up/down stairs, fine motor skills increase Builds tower6/7 cubes Pull on clothes, Refers to self by name, says no separation anxiety, parallel play
  22. 22. Child development Age Motor/sensory Adaptive Personal/ social behavior 3yr Rides tricycle, jumps from bottom steps, alternatives feet going up stairs Builds tower of 9/10 cubes, copies cross &circle Puts on shoes, unbottons feeds self well, understands taking turns 4yr Stands on one foot for up to 8 seconds Copies a cross, repeats 4 digits, counts three objects with correct pointing Washes/dries face, brushes teeth,joint play
  23. 23. Child development Age Motor/sensory Adaptive Personal/ social 5yr Skips, using feet alternately, has complete sphincter control Copies a square, draws a body, counts up to 10 objects Dresses/undresses, prints letters, plays physical games 6yr Rides two wheel bicycle Prints own name, copies triangle Ties shoelaces
  24. 24. Emotional development Birth Pleasure, surprise, disgust, distress 6-8 wks Joy 3-4 mths Anger 8-9 mths Sadness, fear 12-18 mths Tender affection, shame 24 mths Pride 3-4 yrs Guilt, envy 5-6 yrs Insecurity,humility,confidence
  25. 25. General principles <ul><li>Toddler </li></ul><ul><ul><li>Language/cognitive </li></ul></ul><ul><ul><ul><li>makes needs known, displays affection, comfort w family, </li></ul></ul></ul><ul><ul><ul><li>Fear of strangers </li></ul></ul></ul><ul><ul><li>Sexual orientation </li></ul></ul><ul><ul><ul><li>Child identifies w/social, family norms. Gender identity </li></ul></ul></ul><ul><ul><li>Sphincter control and sleep </li></ul></ul><ul><ul><ul><li>Child masters social demands for toilet training </li></ul></ul></ul><ul><ul><ul><li>Child fears darkness </li></ul></ul></ul>
  26. 26. General principle <ul><li>Preschool </li></ul><ul><ul><li>Thinking is egocentric </li></ul></ul><ul><ul><li>Do not understand cause and effect relationship </li></ul></ul><ul><li>Middle years </li></ul><ul><ul><li>Language express complex ideas </li></ul></ul><ul><ul><li>Child begins to think abstractly </li></ul></ul><ul><ul><li>Development of superego </li></ul></ul><ul><ul><li>Peer relationship of major importance </li></ul></ul><ul><li>Adolescence </li></ul><ul><ul><li>Rapid acceleration of skeletal growth </li></ul></ul><ul><ul><li>Beginning of sexual development </li></ul></ul><ul><ul><li>Cognitive development accelerates </li></ul></ul><ul><ul><li>Personality development </li></ul></ul><ul><ul><li>Moving towards independence </li></ul></ul>
  27. 27. Eliciting and evaluating developmental factors of your patients <ul><li>Age appropriate developmental factors </li></ul><ul><ul><li>Adulthood- options for occupations and marriage or lifestyle choices regarding relationships are made </li></ul></ul><ul><ul><li>Persons in their 30’s become increasingly independent and autonomous </li></ul></ul><ul><ul><li>In 30’s disillusionment over present choices can lead to crisis related experiences </li></ul></ul><ul><ul><li>Erik Erikson-20;-40 </li></ul></ul><ul><ul><ul><li>stage of intimacy -versus self absorption(adolescence) </li></ul></ul></ul><ul><ul><ul><li>Establishing long term friendships </li></ul></ul></ul><ul><ul><ul><li>Intimacy in sexual relationships </li></ul></ul></ul><ul><ul><ul><li>Combining love and sex </li></ul></ul></ul><ul><ul><ul><li>Healthy adaptation of work, creativity, healthy relationships </li></ul></ul></ul><ul><ul><ul><li>Parenthood </li></ul></ul></ul>
  28. 28. Adulthood <ul><li>Adulthood stage 1 </li></ul><ul><ul><li>Age 20 -40 </li></ul></ul><ul><ul><li>Biological development </li></ul></ul><ul><ul><li>Assumption of social roles </li></ul></ul><ul><ul><li>Evolution of adult self and life structure </li></ul></ul><ul><li>Quest for intimacy </li></ul><ul><li>Quest for authority, self sufficiency, autonomy </li></ul><ul><li>Parenthood </li></ul><ul><li>Adulthood stage 2 </li></ul><ul><ul><li>Age 40-65 </li></ul></ul><ul><ul><li>Process of reviewing the past </li></ul></ul><ul><ul><li>Reevaluating occupation choices </li></ul></ul><ul><ul><li>Chance for both genders to reestablish connections with their less developed sides </li></ul></ul><ul><ul><li>Animus/anima(jung) </li></ul></ul><ul><ul><li>Sexuality issues </li></ul></ul><ul><ul><li>Empty nest syndrome </li></ul></ul>
  29. 29. Death and dying <ul><li>Elisabeth Kübler-Ross's 'Grief Cycle‘ </li></ul><ul><li>Shock/denial </li></ul><ul><li>Anger </li></ul><ul><li>Bargaining </li></ul><ul><li>Depression </li></ul><ul><li>Acceptance </li></ul><ul><li>Caring for the dying patient </li></ul><ul><li>DNR=living will </li></ul><ul><li>Euthanisia </li></ul><ul><li>Grief mourning/bereavement </li></ul>
  30. 30. Child abuse <ul><li>Traumatic Child abuse- </li></ul><ul><ul><li>substantiated cases 2000 </li></ul></ul><ul><ul><ul><li>Child maltreatment-879,000 </li></ul></ul></ul><ul><ul><ul><li>Neglect- 64% </li></ul></ul></ul><ul><ul><ul><li>Physical-20% </li></ul></ul></ul><ul><ul><ul><li>Sexual-25-40% </li></ul></ul></ul><ul><ul><ul><li>Psychological 10% </li></ul></ul></ul><ul><ul><li>Correlation with life long struggles in relationships, stable job performance, anger mgmt issues, child rearing-hyper vigilance, estranged relationships w/family nucleus, extended family. </li></ul></ul>
  31. 31. Adverse childhood experience <ul><li>CDC Studies document that childhood abuse and family dysfunction lead to chronic diseases including </li></ul><ul><ul><li>Heart disease obesity depression suicide Substance abuse cancer Chronic lung liver disease </li></ul></ul><ul><ul><li>Sexually transmitted diseases risky behaviors auto immune </li></ul></ul><ul><li>Abused children have increased psychological, physical damage and demonstrate violence and higher rates of incarceration </li></ul>
  32. 32. Determining Early adverse or protective experiences in your patients <ul><li>Child abuse </li></ul><ul><li>Sexual abuse </li></ul><ul><li>Witnessing domestic violence </li></ul><ul><li>Instability of home </li></ul><ul><li>Abandonment </li></ul><ul><li>Acculturation </li></ul>
  33. 33. Instability of home <ul><li>Frequent movement </li></ul><ul><ul><li>From town to town, home of relatives, various care givers </li></ul></ul><ul><li>Parents with substance abuse </li></ul><ul><ul><li>Can develop parentified children </li></ul></ul><ul><ul><li>Emotionally disturbed children </li></ul></ul><ul><li>Divorced families </li></ul><ul><ul><li>If a difficult divorce occurred the child can be caught up in feelings of guilt related to the divorce. </li></ul></ul>
  34. 34. Abandonment <ul><li>Feelings of low self worth. </li></ul><ul><ul><li>Research demonstrates that children whom are orphaned have lower feelings of self image. </li></ul></ul><ul><li>Absence of proper role models. </li></ul><ul><ul><li>Adults that were not in healthy families never had role models of appropriate social behavior. </li></ul></ul><ul><li>Fear and insecurity. </li></ul><ul><ul><li>Children that were in temporary housing situations, institutionalized housing, moving from extended family to another; are in fear of basic needs for survival. </li></ul></ul><ul><li>Anxiety related issues </li></ul><ul><ul><li>Generalized anxiety disorder; overwhelming difficulty in coping with life issues. </li></ul></ul>
  35. 35. Acculturation <ul><li>Children become parentified too early </li></ul><ul><ul><li>Language barriers raise children to a level of adulthood in order to interpret for parents. </li></ul></ul><ul><li>Are raised trying to become part of the mainstream </li></ul><ul><li>Parents are usually rigid and have old fashioned beliefs systems </li></ul><ul><li>Double standards for woman and men </li></ul><ul><li>Loss of extended family </li></ul><ul><li>Coping with parents feelings of isolation and loss </li></ul><ul><li>Economic barriers </li></ul><ul><li>Fear of deportation and or documentation issues. </li></ul><ul><li>Children are torn between pleasing parents and following cultural norms or following goals of self autonomy. </li></ul><ul><li>Romantically secretive if partners are not from the same culture. </li></ul>
  36. 36. Child abuse <ul><li>Patient uncomfortable discussing childhood experiences. </li></ul><ul><ul><li>Does the person demonstrate? </li></ul></ul><ul><ul><ul><li>Fear associated with questioning about childhood? </li></ul></ul></ul><ul><ul><ul><li>Provide information of a traumatic set of family experiences? </li></ul></ul></ul><ul><ul><ul><li>Emphasize a history of being overprotective as a parent themselves? </li></ul></ul></ul><ul><ul><ul><li>Co dependency-is the pt protective of their spouse or partner, parents or siblings. </li></ul></ul></ul><ul><ul><ul><li>Do they have poor recall of childhood experiences? </li></ul></ul></ul><ul><ul><ul><li>Do they express a childhood of perfection? </li></ul></ul></ul><ul><ul><ul><ul><li>Perfect parents perfect setting </li></ul></ul></ul></ul><ul><ul><ul><ul><li>No dysfunction great support </li></ul></ul></ul></ul>
  37. 37. Sexual abuse <ul><li>Does the patient have problems related to their sexuality? </li></ul><ul><ul><li>Performance issues </li></ul></ul><ul><ul><li>Multiple divorces </li></ul></ul><ul><ul><li>History of promiscuity </li></ul></ul><ul><ul><li>Sexually transmitted diseases. </li></ul></ul><ul><ul><li>Are they emotionally detached from their partners </li></ul></ul><ul><ul><li>Are they secretive with their partners </li></ul></ul><ul><ul><li>Frigidity </li></ul></ul><ul><ul><li>Make excuses to avoid sexual encounters </li></ul></ul><ul><ul><li>Have they been involved in abusive relationships </li></ul></ul>
  38. 38. Domestic violence <ul><li>Abusive relationships in their family of origin can create </li></ul><ul><ul><li>Violent behavior </li></ul></ul><ul><ul><li>Codependent behavior </li></ul></ul><ul><ul><li>Substance abuse </li></ul></ul><ul><ul><li>Feelings of unworthiness </li></ul></ul><ul><ul><li>Hopelessness </li></ul></ul><ul><ul><li>Difficulty in relationships </li></ul></ul>
  39. 39. Early family experience <ul><li>Family of origin </li></ul><ul><li>Explore family history (siblings, location, frequency of visits etc) </li></ul><ul><li>Status of relationships with family members </li></ul><ul><ul><li>Acculturation? </li></ul></ul><ul><ul><ul><li>How long family has lived here? </li></ul></ul></ul><ul><ul><ul><li>Where is the extended family? </li></ul></ul></ul><ul><ul><ul><li>What stressors did this person grow up with? </li></ul></ul></ul><ul><li>Socio economic experience? </li></ul><ul><li>Cultural identification? </li></ul><ul><li>. </li></ul>
  40. 40. Early family experience <ul><li>Prior experience with family illness? </li></ul><ul><ul><li>Has the patient made certain conclusions about illness, intervention, quality of life issues? </li></ul></ul><ul><ul><li>Have they experienced loss? </li></ul></ul><ul><li>Prior experience with the healthcare system? </li></ul><ul><ul><li>Determine their ability to navigate the complexity of the healthcare system. </li></ul></ul><ul><ul><li>Direct them to social services that can assist them with understanding disease processes, and engaging in their own healing. </li></ul></ul><ul><ul><li>Direct them to a mental health professional that can serve to assist them emotionally when overwhelming health crisis in inevitable </li></ul></ul>