Developmental Theories and Therapies

Core Concepts

Erikson's psychosocial theory — the nursing workhorse

Erik Erikson described eight stages spanning the entire lifespan, each centered on a psychosocial crisis — a tension between two opposing tendencies that the person works through in relationships with others:

Erikson's theory is widely used in nursing because it covers the whole lifespan, is relational (development happens with and through others — exactly how nurses work), and allows for revisiting: an unresolved crisis can be reworked later in life. The ages are approximate; culture and circumstances shift timing.

Piaget's cognitive-developmental theory

Jean Piaget described four stages of intellectual growth: sensorimotor (birth to about 2 years; learning through senses and actions; object permanence develops), preoperational (about 2–7; language grows, but thinking is egocentric and not yet logical), concrete operational (about 7–11; logical thinking about concrete objects; conservation develops), and formal operational (about 11 and up; abstract and hypothetical reasoning). Piaget built his theory largely from careful observation of his own children — a method that produced rich detail from very small samples, and later research shows abilities emerge more gradually and vary more across cultures than the classic stages suggest. The nursing takeaway is practical: teaching must match cognitive level. A 6-year-old in concrete operations needs demonstrations and concrete language, not abstract warnings.

Freud's psychosexual theory — an important historical anchor

Sigmund Freud proposed psychosexual stages (oral, anal, phallic, latency, genital), a personality structure of id, ego, and superego, and defense mechanisms — unconscious mental processes that protect against anxiety, such as denial, projection, rationalization, displacement, and sublimation. Freud's evidence came largely from case studies of a small number of patients in a particular cultural moment, and the theory has been heavily criticized for weak empirical support, biological determinism, and views about women that modern readers reject. Its lasting contribution to nursing is partly vocabulary: defense mechanisms remain useful as descriptions of coping patterns, and the idea that early experience shapes later life is still influential even though the specific stages are not.

Kohlberg's moral development — and Gilligan's critique

Lawrence Kohlberg described three levels of moral reasoning: preconventional (rules are external; avoid punishment, gain reward), conventional (maintain relationships and social order), and postconventional (abstract ethical principles). His research relied mostly on male participants reasoning about hypothetical dilemmas. Carol Gilligan argued that this framework undervalued an ethics of care — a relational, responsibility-focused style of moral reasoning more often emphasized by women — and that the framework described one perspective rather than a universal hierarchy. Nurses see moral development in how children understand rules and in how people of all ages reason about treatment decisions.

Attachment theory — Bowlby and Ainsworth

John Bowlby proposed that early caregiving relationships shape "internal working models" of self and others; Mary Ainsworth's Strange Situation studies classified infant attachment patterns (secure, anxious, avoidant, and disorganized — categories since refined and debated). The work grew out of post-World War II observations of separated and institutionalized children, and those early deprivation studies carried real ethical questions about studying children in distressing conditions — worth remembering when evaluating the evidence. Attachment concepts help nurses understand clients whose early relational experiences shaped their expectations of care, but an attachment pattern is not a fixed destiny: later relationships and experiences can revise it.

Using developmental theories in practice

• Regression is expected. Hospitalization, illness, and stress commonly push people toward earlier patterns of dependence. The nurse supports the client's coping, reassures families that this is common, and helps the client regain mastery at their own pace.
• Match teaching to the level. Use concrete, demonstration-based teaching for children and for adults who prefer it; abstract explanations suit formal-operational thinkers. Health literacy matters more than age alone.
• Screen, don't diagnose. Nurses observe milestones and use facility-approved screening; diagnosing developmental delay or disorder is outside nursing scope and varies by jurisdiction.
• Respect individual and cultural variation. Stage theories describe common patterns, not universal timetables; family, culture, and life circumstances shape every stage.

Common Confusions