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Erikson’s life course theory: practitioners’ perspectives on its utility in work with older adults with depression

Katie Arundel

Theory ry in in practice

Social workers and healthcare professionals are taught to use theories to inform their practice (British Association of Social Workers, 2018; Nursing and Midwifery Council, 2018). Older adults with depression have unique experiences (Fiske et al 2010). We need theory to understand these unique experiences. Confidence on the utility of theories is needed

Erikson’s life course theory

Infancy

Trust vs Mistrust

Early Childhood

Autonomy vs shame, doubt

Play Age

Initiative vs guilt

School Age

Industry vs inferiority

Adolescence

Identity vs role confusion

Young Adulthood

Intimacy vs isolation

Adulthood

Generativity vs stagnation

Old Age

Integrity vs despair

❖Commonly taught theory in social work ❖One of the only theories to specifically consider the experiences of older adults

Adapted from: Erikson and Erikson (1997)

In Integrity versus despair

• Predicts that those who do not resolve the crisis will

experience depression

• Supported by small scale studies (Chimich and

Lekolaichuk, 2004; Rylands and Rickwood, 2001)

• Life review therapy: intervention to resolve the eighth
• crisis. More effective than the informal reminiscence

therapy (Rubin et al, 2019)

• Suggested as an intervention to be used by social

workers and other mental health professionals (Ingersoll-Dayton and Bommarito, 2006)

• In a different setting, practitioners were using

techniques from life-review therapy without knowing where they were from (Trueman and Parker 2006).

Criticisms of Erikson’s the theory ry

❖Not culturally adaptable (Sneed et al, 2006) ❖Does not consider older people’s development in much depth (Agronin, 2014) ❖Not sufficient to explain depression in older adults ❖Correlation versus causation

Why is s thi this stu tudy ne needed?

• There are possible benefits to using

Erikson’s theory in work with older adults with depression

• There may also be significant limitations
• There is no literature on practitioners’

perspectives on its utility

• Therefore the research topic is: Erikson’s

life course theory: practitioners’ perspectives on its utility in work with

• lder adults with depression

Meth thod

• Ethical approval was granted by the University of

York, the NHS Health Research Authority and by the Research and Development department of the NHS Trust in which the study took place.

• As the researcher was a social worker in team which

the research took place, it was made clear to participants that the researcher was conducting the study separately to their role as an employee.

• This was a qualitative study.
• Eight mental health practitioners were recruited via

email from an older adults’ mental health team in an

• uter London Borough. A sampling frame was

planned but not used.

• Semi-structured Interviews were carried out, the

interviews were transcribed. Data was anonymised.

• Framework analysis was used to identify key themes.
• NVIVO was used to aid analysis.

Social worker (3) Occupational Therapist (2) Support Worker (1) Doctor (1) CPN (1)

Participants

Fin Findings

Four major themes or categories were identified:

• Understandings of causes of depression in
• lder adults
• Benefits and criticisms of Erikson’s theory
• Suggested changes to Erikson’s theory
• Discussions of the past

Und nderstandin ings

• f
• f cau

auses of

• f

de depressio ion

• Change experienced in old age were seen by all

participants as by far the biggest cause of depression.

• Reflections on life so far, and proximity of

death were seen by some participants as causes

• f depression.
• One participant gave a narrative which was

consistent with Erikson’s theory.

• All participants had a very limited knowledge of

theories about older adults.

“I think it’s natural when you’re thinking about your

• wn mortality, to think about

your own life so far.” (Participant 3)

Bene enefits an and Crit ritic icis isms of

• f

Erikson’s The Theory ry

• All participants named some benefits to

Erikson’s theory, including that it provides a framework for understanding service users’ experiences.

• However, the perceived benefits were
• utweighed by participants’ significant

criticisms, including that it is too prescriptive, and doesn’t account for broad range of experiences of older people, or different generational experiences.

• There was disagreement about the eight stage
• f the theory, although most agreed that it

could explain a cause of depression.

“I think you can have a lot of integrity and also despair” (Participant 6)

Sug uggested cha changes to

• Erikson’s

the theory ry

• Despite not being asked to do so, most of the

participants suggested changes which would improve Erikson’s theory.

• Suggested changes always reflected the

criticisms of the theory.

• More stages in later adulthood are needed.

These should either be repetitions of earlier stages, or new stages.

• Culture needs to be considered in teaching.

“It’s unfinished based on the world today” (Participant 4).

Discussio ions abo about the the pas past

• Participants have informal discussions about

the past with service users.

• Most see discussing the past as part of their

role.

• Perceived benefits are in line with Erikson’s

theory.

• Participants are worried about the potential to

cause harm.

“People are so often seen when they’re old, as ‘another

• ld person’ … people forget

that they’ve had a whole life before them … it helps them to get out of that.” (Participant 1)

Limitations

No service user perspectives Small-scale, in a single location Analysis method (Srivastava and Thomson, 2009) Reduces Erikson’s theory

Dis iscussion

• Although there were some similarities, Erikson’s theory does

not account for the causes of depression which participants thought were most important. The theory needs to be adapted to be useful in practice with older adults with depression.

• Participants’ criticisms of Erikson’s theory are in line with

current research (Hearn et al, 2012; Wiesmann and Hannich, 2011).

• Life review therapy would be a more effective intervention

for depression than the current informal discussions, and should be taught alongside the adapted Erikson’s theory.

Im Implications

• Teaching on Erikson’s theory needs to

consider the development of older adults.

• Knowledge of theories concerning older

adults amongst professionals needs to be improved.

• Social work education needs to consider
• lder people (Milne et al, 2013).
• A critical appraisal of other commonly

taught theories is needed.

References

• Agronin, M. E. (2014). From Cierco to Cohen: developmental theories of aging, from antiquity to the present.

The Gerontologist, 54(1), 30-39.

• British Association of Social Workers. (2018). Capabilities Statement for social workers in England who work

with older people. [online]. Available at: https://www.basw.co.uk/system/files/resources/Capabilities%20Statement%20older%20people%20ONLINE. pdf [Accessed 18th July 2019]

• Chimich, W. T.., and Nekolaichuk, C. L. (2004). Exploring the links between depression, integrity, and hope in

the elderly. Canadian Journal of Psychiatry: Special Geriatric Psychiatry Section, 49(7), 428–433.

• Erikson, E. and Erikson, J. (1997). The life-cycle completed: a review – Extended version with new chapters by

Joan M. Erikson. New York: Norton.

• Fiske, A., Loebach Wetherell, J. and Gatz, M. (2010). Depression in Older Adults. Annual Review of Clinical

Psychology, 5, 363-389.

• Hearn, S., Saulnier, G., Strayer, J., Glenham, M., Koopman, R. and Marcia, J. E. (2012). Journal of Adult

Development, 19(1), 1-20.

• Ingersoll-Dayton, B. and Bommarito, A. (2006). Reminiscence and Life Review. In: Handbook of Social Work

in Health and Aging. Editor: Berkman, B. and D’Ambruso, S. Oxford University Press: New York.

• Milne, A., Sullivan, M. P., Tanner, D., Richards, S., Ray, M., Lloyd, L., Beech, C. and Phillips, J. (2013). Social

work with older people: a vision for the future. The Royal College of Social Work (2013). [Online]. Available at: http://www.cpa.org.uk/cpa-lga-evidence/College_of_Social_Work/Milneetal(2014)- Socialworkwitholderpeople-avisionforthefuture.pdf [Accessed 21st July 2019].

References

• Rylands, K. J. and Rickwood, D. J. (2001). Ego integrity vs despair: the effect of “accepting the past on

depression in older women. International Journal of Aging and Human Development, 53(1), 75-89.

• Sneed, J. R., Schwartz, and Cross, W. E. (2006). A multicultural critique of identity status theory and research:

A call for integration. Identity, 6(1), 61-84.

• Social Work England (2019). Consultation on qualifying education and training standards. [Online]. Available

at: https://socialworkengland.org.uk/wp-content/uploads/2019/03/QUALIFYING-EDUCATION-AND- TRAINING-STANDARDS_FINAL_21022019_01.pdf [Accessed 18th July 2019].

• Srivastava, A. and Thomson, S. B. (2009). Framework Analysis: a qualitative methodology for applied policy
• research. Journal of Administration and Governance, 4(2), 72-79.
• Trueman, I. and Parker, J. (2006). Exploring community nurses' perceptions of life review in palliative care.

Journal of Clinical Nursing, 15(2), 197-207.

• Weismann, U. and Hannich, H. J. (2011). A salutogenic analysis of developmental tasks and ego integrity vs.
• despair. International Journal of Aging and Human Development. 73(4), 351-369.
• Nursing and Midwifery Council. (2018). Mental Health Nursing: Field Specific Competencies. [Online].

Available at: https://www.nmc.org.uk/globalassets/sitedocuments/registration/overseas/mental-health- nursing---field-specific-competencies2.pdf [Accessed 11th August 2019].

• Rubin, A., Parrish, D. E. and Miyawaki, C. E. (2019). Benchmarks for evaluating life review and reminiscence

in alleviating depression among older adults. Social Work, 64(1), 61-72.

Thank you for listening

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