In a Clinical Substance Abuse Setting
In a Clinical Substance Abuse Setting
Erik Erikson’s psychosocial theory of development sought to explain the way personality develops. Like Freud, Erikson was certain childhood events shape adult personality. Unlike Freud, however, Erikson argued that development continues throughout the lifespan (Miller, 1983). Working on the foundation laid by Freud, Erikson developed the stage theory wherein the lifespan was divided into eight stages beginning at birth and continuing through late adulthood. Erikson theorized that each stage was defined by a “psychosocial crisis” (Weiten, 2005, p. 302). The first five stages occur through the lifespan through puberty. Each stage must be navigated and if the individual is successful in doing so, it builds a foundation and provides tools helpful in successfully navigating the next. It is in adulthood, following adolescence that the final three stages occur: intimacy vs isolation in young adulthood; generativity vs stagnation in midlife; and integrity vs despair as the final stage in late adulthood (Miller; Weiten).
Erikson’s theory accounted for continuous change in human development through the lifespan, a relatively new idea for the time. According to Erikson, people continue to develop and group throughout their lives based on their life challenges, relationships, and social environments (Miller, 1983). It provided continuity within an individual from the earliest stages of childhood until the last stage in late adulthood. Unfortunately, it established an ideal that is not universally realistic. It struggles to explain how there can be such drastic personality differences among people as it follows only generalized stages and does not account for individual differences in experience and the outcome those experiences create (Weiten, 2005).
Abraham Maslow also had a theory based on the establishment of foundational advancement. Known as Maslow’s hierarchy, it is imagined as a pyramid with what Maslow believed were human needs were arranged in a hierarchy. According to Maslow’s theory, only after the need below it is met, will the next be addressed (Kaur, 2013). Maslow arranged the needs, from the bottom up, as follows: physiological, safety, love and belonging, esteem, and self-actualization. According to Maslow, until the lowest level of need (physiological needs such as food and water) is met, safety will be disregarded. Once physiological needs are met, safety will be the next priority but love and belonging will be disregarded. In this pattern, Maslow argued that once all other needs are met, people will seek self-actualization: achieving their own, unique and highest potential (Kaur).
Maslow’s hierarchy theory shared many of the strengths and weaknesses all humanistic theories had. Developed in part as a response to previous theories suggesting people had practically no choice in how they behaved, humanist theory was based on the idea that a person’s subjective assessment of a situation influences them greater than an objective, observable reality or an unconscious repressed drive (Kaur, 2013). Maslow’s theory, following that course, suggested that once survival needs are met, people will be motivated to create social ties, improve their own lives, create lasting relationships and ultimately strive to achieve every potential success of which he is capable. Some critics argue, however, it is overly optimistic about human nature and the way a healthy personality is defined. But most importantly, the theory is all but impossible to test and therefore has limited empirical support (Kaur).
Patient
The patient is a 35-year old male who has been seen for pain management for the last ten years following an accident and surgery involving his back and pelvis. Over the course of his treatment, he has become addicted to opiates and admits to excessive use over the last two years. He lives alone in the last two years following a divorce from his wife of ten years; he has inconsistent contact with his two children, ages 10 and 8 who live with his former spouse. The patient reports minimal contact with his family of origin identifying a living father and two living brothers due to theft and deception to support his drug habit; the patient’s mother is deceased since six years ago. The patient states having used multiple different prescription medications and recently (within the last month) has begun using heroin. The patient states smoking and snorting, but denies IV use. The patient reports depressive symptoms on and off since the loss of his mother six years ago and his injury five years ago. The patient states his depressive symptoms worsened following his divorce; the patient has had no mental health referral and currently denies suicidal or homicidal ideation. The patient states “I just want to get my life back.” The patient reports a history of religious affiliation with no current involvement but is open to spiritual support. The patient has been assessed by medical staff and diagnosed with opioid dependence (304.00). The patient reports continuing in his job and adequate nutrition and shelter.
Theoretical Application
Erikson’s theory places the patient in the young adulthood stage which assumes the intimacy vs isolation conflict. Following this theory, the initial task would be to identify important existing or potential relationships in his life which would decrease the patient’s feelings of solitude and isolation. Furthermore, Maslow’s theory suggests that the patient’s physiological and safety needs are met. Following Maslow’s motivation theory, the patient should be motivated to seek love and belonging.
The patient will be supported in exploring his previous relationships with his wife, children, father and siblings. Effort will be made to identify efforts the patient can make to rebuild these relationships with the understanding that it may be unsuccessful and will require commitment and patience, and will be time consuming. The patient will next be asked to explore his previous religious affiliation and will be assisted in determining if returning to a church of his choice would offer positive spiritual support. The patient will be provided with contact information for local AA/NA support in the area and, if agreeable, will be matched with a volunteer mentor to accompany the patient to initial meetings. In addition to the theoretical application, using a broad approach in multiple areas of the patient’s life has been shown to be effective in addressing substance abuse issues in adolescents (Johnson et al., 1990)
The patient’s work in these areas will be supported in counseling in an initial effort to begin meeting patients need for love and belonging through unconditional positive regard and in an effort to place the patient in a healthy and supportive social group with whom the patient has a common bond (AA/NA) (Ouimette, Finney, & Moos, 1997). By rebuilding relationships, the patient will have the opportunity to correct the current stage of development and ultimately be prepared to move to Erikson’s middle adulthood stage more prepared for those challenges. Further, once the patient has achieved a more reliable and consistent satiation of the need for love and belonging based on Maslow’s hierarchy, treatment will become increasingly focused on the patient’s esteem, the next level in the hierarchy (Kaur, 2013).
References
Johnson, C., Pentz, M.A., Weber, M.D., Dwyer, J.H. Baer, N. MacKinnon, D.PFlay, B.R. (1990). Relative effectives of comprehensive community programming for drug abuse prevention with high-risk and low-risk adolescents. Journal of Consulting and Clinical Psychology, 58 (4).
Kaur, A. (2013). Maslow’s need hierarchy theory: Applications and criticisms. Global Journal of Management and Business Studies, 3 (10), pp. 1061-1064.
Miller, P. (1983). Theories of developmental psychology. San Francisco: W. H. Freeman and Company.
Ouimette, P. C., Finney, J. W., & Moos, R. H. (1997). Twelve-step and cognitive-behavioral treatment for substance abuse: A comparison of treatment effectiveness. Journal of Consulting and Clinical Psychology, 65 (2), pp. 230-240.
Weiten, W. (2005). Psychology: Themes and variations (6th ed.). Belmont, CA: Thomson Wadsworth.
