L ife S pan D evelopmental C risis. Learning Objectives Define the term life span Define the term life span Describe the specific situational and maturational

Life Span

Developmental

Crisis

Learning Objectives

Define the term life span Define the term life span

Describe the specific situational and Describe the specific situational and maturational crises of child, adolescent, maturational crises of child, adolescent, adult and old age. adult and old age.

Describe the common responses Describe the common responses associated with each developmental stage. associated with each developmental stage.

Plan general and specific psychosocial Plan general and specific psychosocial interventions for each group of interventions for each group of populations. populations.

Definitions Lifespan is potential maximum number of Lifespan is potential maximum number of

years a person can live (110- 125 years)years a person can live (110- 125 years)

Life expectancy is the average number of Life expectancy is the average number of years one can expect to live (72 years for years one can expect to live (72 years for men & 79 years for women)men & 79 years for women)

Centenarian is a word used to denote a Centenarian is a word used to denote a person who has reached 100 years of ageperson who has reached 100 years of age

Interpersonal views of development regarding Erick Erickson

Interpersonal views of development regarding Erick Erickson

Developmental theory

Developmental theory

Phase(approximate age span)

Developmental tasks

InfancyTrust versus mistrust

ToddlerAutonomy vs. shame and doubt

PreschoolInitiative vs. guilt

School ageIndustry vs. inferiority

AdolescentIdentity vs. identity diffusion

AdultIntimacy vs. isolation

Late adulthoodGenerativity vs. stagnation

Old ageIntegrity vs. despair

Life Span Development Life Span Development

Childhood period

Childhood period

Common situational and maturational crises may be due impaired parent child attachment

Common situational and maturational crises may be due impaired parent child attachment

Problems of disturbed attachment Problems of disturbed attachment

• The disruption and separations have been linked to:

• Development of grief, anger,• Denial, and despair, that may lead to

psychopathology.

Life Span Development cont’d.


Adolescent's needs: Needs to find and confirm his/her identity. Needs to accept his own body Needs to develop his own body Needs to develop positive self awareness, insight. Needs to be independent from adult dominant Needs to develop effective coping skills to handle the normal

changes going on his life.

Adolescent's crisis Adolescent's crisis

Life Span Development cont’d

Maturational crisis Maturational crisis

•Negative sexual body image •Negative self concept

•Low self-esteem

•Anxiety, tension, guilt

•Helplessness


Situational crisis Situational crisis

•Physical illness

•Substance abuse


Psychosocial intervention

for adolescent's crises

Psychosocial intervention

for adolescent's crises

The psychosocial aspects of primary care adolescent are best incorporated into the overall care of the adolescent.

Not just after specific behavioral problems arise.

The psychosocial aspects of primary care adolescent are best incorporated into the overall care of the adolescent.

Not just after specific behavioral problems arise.

The therapists must be acquainted with adolescent, as well as the adolescent's family, peers, and school. So the intervention will be divided into two main aspects:

•Providing individual care for adolescent.•Providing community care (family based care, and school-based strategies) for adolescent.

The therapists must be acquainted with adolescent, as well as the adolescent's family, peers, and school. So the intervention will be divided into two main aspects:

•Providing individual care for adolescent.•Providing community care (family based care, and school-based strategies) for adolescent.

Psychosocial intervention for adolescent's crises cont’d .

1.Providing individual care for adolescent :1.Providing individual care for adolescent :

a- Building self-esteem

•By maintaining eye contact, address the individual by her name, actively listening to her which make adolescent feels more acceptance and valued.

•Do not lecture or give advice, because adolescents heat lectures and advices.

Direct them toward problem solving and assuming responsibility for their own feelings. Convey respect by requesting rather than ordering and by thanking them for their help .Praise each small effort toward

success, and point out the adolescent's progress.

Psychosocial intervention for adolescent's crises cont’d.

b- Skill development b- Skill development

Applying the problem=solving process to actual

problems.• Help them in practicing appropriate social skills.

Working cooperatively within group, learning how to listen to others, and exploring new

methods for controlling anger and aggression.


Providing community care (family based care, and school-based strategies Providing community care (family based care, and school-based strategies

Sullivan (1991) cited research that gives us important information

about what works best:

•One-to-one individual attention. A responsible, invested adult in every young person's life is essential. This can be a parent, teacher, counselor, or health care provider, or another adult who is able to care what happens.

•Involvement of parents with adolescents' problems.


• Comprehensive programs that include social and mental health services, after

school child care, and primary health care should be developed.

• Community involvement in developing comprehensive solutions to complex problems.

Multiple agencies need to develop collaborative goals and plans, and pool

resources where appropriate.

Providing community care (family based care, and school-based strategies cont’d. Providing community care (family based care, and school-based strategies cont’d.

Life Span DevelopmentAdulthood’s

period

Adulthood’s period

Adult’s needs

•Needs to be more satisfied in his employment.

•Needs to be more sociable with other sex.

•Needs to be more independent .

•Needs to form a new family unit.

•Needs to be more confidence in himself.

•Needs to maintain a real intimacy with others.


Adulthood’s period cont’d.


Adult’s crisisAdult’s crisis

Maturational crisis

Situational crisis



A- Maturational crisisA- Maturational crisis

•Decision crisis

•Unplanned pregnancy •Occupational change

•Dependency problems •Parenthood issue problems. •Lack of meaningful work.



B- Situational crisisB- Situational crisis

•Physical disorders.

•Sexual abuse.

•Substance abuse

•Infertility •Divorce

Examples

•Death and dying, •Tasks of mourning,

•Divorce and separation

Adult’s crisis cont’d.

•Eight Typical Phases of Emotional Reaction:

•Emotional Reaction•Emotional Reaction

Reconciliation

Grief Remorse

Guilt Shame

Anger Denial

High Anxiety

Psychosocial intervention for adult's crises

To give appropriate support of the client in one of these crisis situation the helper

must understand the following:

To give appropriate support of the client in one of these crisis situation the helper

must understand the following:

•The stages of grief when a loss is experienced.

•The experience of normal grief.

•The principles and procedures for loss interventions

Life Span DevelopmentElderly

Population Elderly

Population Psychosocial theories of aging

• Psychological theories of aging explore the mental process, behavior and feelings of persons throughout the life span along with some the mechanisms people use to meet the challenges they face in old age. Sociological theories address the impact of society and the elderly on each other.

Elderly Population cont’d.

Examples Psychosocial theories of aging

1-Disengagement Theory1-Disengagement Theory

It views aging as a process in which society and the individual gradually withdraw or disengage, from each other, to the mutual satisfaction and benefits of both.

• The benefit to individuals is that they can reflect and be centered on themselves, having been freed from social roles.

• The value of disengagement to society is that some orderly means is established for the transfer of power from the old to the young making it possible to society to continue functioning after its individual members die


2- Developmental tasks theory (Erik Erickson, 1963):


• It proposes that healthy psychological aging is the result of the successful fulfillment of developmental tasks.

• The challenge or tasks of old age is to accept and find meaning in life; this gives ego integrity that aids in adjusting and coping with the reality of aging & mortality

• Feeling of anger, bitterness, depression, & inadequacy can result in inadequate ego integrity.



Cohort- based, Context, Maturity, Specific Challenge (CCMSC) model

• A geronto- psychotherapeutic life span approach by (Knight, 1996). It outlines 4

factors to be considered in psychotherapy

ConsiderationFactor

Individual cognitive performance, verbal fluency, education, normative course of life, life experience from a social historical view point

1. Cohort factors

Current environmental characteristics such as age – adapted accommodations, residential facilities, & spare time options. General & social health & long time care provision

2. Context effects

Person’s cognitive & emotional complexities, areas of expertise & competencies, including experience in family life & person’s accumulated interpersonal competencies

3. Maturity

Chronic diseases, disabilities, & grieving while experiencing deaths of relatives & friends, as well as the person dealing with their own end- of- life, including preparation for death.

4.Specific challenges

Cohort- based, Context, Maturity, Specific Challenge (CCMSC) model


Psychosocial NeedsPsychosocial Needs

In general they are six psychosocial needs

•For autonomy and independence •For dignity, credibility, and respect

•For identity and individuality•For communication

•For belonging •For touch


Common psychosocial problems of elderly population:

• Multiple losses compel older persons to expend enormous amounts of physical and emotional energy in grieving, adapting to the changes that result from loss, and recovering from stress inherent in these processes.

1- Loss (personal losses, social losses status or prestige change).

1- Loss (personal losses, social losses status or prestige change).

2- Life crises (widowhood, marital problems, sexual problems, retirement, financial worries, sensory loss).

3- Rejection.

4- Powerlessness


Common emotional reactions as expressed in old age:

1.Grief & mourning

Grief & mourning reaction scenario:

1- Loss

2-Inability to accept the loss

3-Shock of reality4-Physical feelings of emptiness, weakness, perhaps a feeling of suffocation, shortness of breath, & a tendency to deep sighing

5-Experience of great distress6-There may be a sense of unreality, including delusions & obsessive preoccupations with the image of the lost person

1- Loss

2-Inability to accept the loss

3-Shock of reality4-Physical feelings of emptiness, weakness, perhaps a feeling of suffocation, shortness of breath, & a tendency to deep sighing

5-Experience of great distress6-There may be a sense of unreality, including delusions & obsessive preoccupations with the image of the lost person


Common emotional reactions as expressed in old age:

Grief & mourning reaction scenario cont’d. :7- Experience of disorganization, anger, irritability, even toward friends & relatives.

8-Anxiety alternate with depression & despair

9-Acute grief ordinarily lasts a month or2 and then begins to lessen; on the average, it may be largely over in 6 to 12 months.10-Exaggerated grief reaction may occur

11-Morbid grief reactions are distortions or prolongations of typical grief (months or years)

7- Experience of disorganization, anger, irritability, even toward friends & relatives.

8-Anxiety alternate with depression & despair

9-Acute grief ordinarily lasts a month or2 and then begins to lessen; on the average, it may be largely over in 6 to 12 months.10-Exaggerated grief reaction may occur

11-Morbid grief reactions are distortions or prolongations of typical grief (months or years)


Common emotional reactions as expressed in old age cont’d. :

Guilt

Loneliness

Depression

Helplessness

Anxiety

Rage

Elderly Population cont’d.Common Emotional Problems of AgingCommon Emotional Problems of AgingLosses

Loss of relationships with peopleLoss of significant others and confidantsLoss of peer group and collegial relationshipsFinancial lossesLoss of possessions

Awareness of declining healthDeterioration of own healthDiscomforts and painConfinement and immobilityPhysical changesMonotony of daily encountersAbsence of personal privacyEnforced idleness

Common Emotional Problems of Aging cont’d.

PowerlessnessPowerlessness against others and the worldVulnerability: being a spectatorUnreliability of othersUnpredictability of others and "the fates"Indignities and dependenceBeing exposed to propagandaBeing "talked into" accepting something That isnot wontedHaving information withheldNot receiving accurate information

PowerlessnessPowerlessness against others and the worldVulnerability: being a spectatorUnreliability of othersUnpredictability of others and "the fates"Indignities and dependenceBeing exposed to propagandaBeing "talked into" accepting something That isnot wontedHaving information withheldNot receiving accurate information

Common Emotional Problems of Aging cont’d.

Powerlessness against timeNot knowing the duration of

confinementSensing a meaningless existenceSensing threats to life and health

Awareness of deathDeterioration of significant others' healthConfinementBurden of caring for othersRefectionFeeling forgottenBeing forgottenFeeling unworthy or unacceptable

Common Problems of Aging

Comparison of Dementia and DepressionDEMENTIA DEPRESSION

Onset •Insidious, indeterminate •Rapid

Duration •Long

•Short

Mood/behavior •Fluctuates

•Consistently depressed

Response •"Do not know" •Provides a close, but usuallyincorrect answer to question

Disabilities •Concealed•Highlight

Cognition•Relatively stable•Fluctuates greatly

Specific interventions related to Elderly Population

1- Assessment of psychosocial status 1- Assessment of psychosocial status

Three interrelated dimensions are usually considered in gathering information for a psycho-social assessment of an elderly person- These include:

(1) psychological state (2) developmental satisfaction (3) social effectiveness.

Three interrelated dimensions are usually considered in gathering information for a psycho-social assessment of an elderly person- These include:

(1) psychological state (2) developmental satisfaction (3) social effectiveness.

Assessment of psychosocial status cont’d.

Psychological State Psychological State

Psychological state can be thought of as being composed of five separate facets:

(l) The client's view of self(2) His thought content(3) Affect and mood(4) Stress management and coping styles (5) Behavior


Psychological State cont’d. Psychological State cont’d.

The questions and statements presented below may be helpful in determining an overall assessment of the client's view of self1. Tell me what it's like for you to be 72 (or whatever his age).2. Tell me about what aging is like.3. Tell me about what your aging has been like.4. What is the ideal old person like? Tell me what most old people are like.5. How are you like the ideal old person? How are you different?6. If you had to describe yourself in three words, what would they be?7. How do you feel about growing older?


Psychological State cont’d. Psychological State cont’d.

1. Tell me about the periods when you felt most successful. Do you think you were different then, or much as you are now?

2. Tell me about your greatest strengths

3. Tell ire about your happiest times. What about you makes you happy?

4. What was the most important thing you have done in your life? What personal characteristics of yours made it happen?


Social Effectiveness

The last facet of the psychosocial assessment of an older adult involves gathering data that can be used to determine the elderly individual's social effectiveness. The socially effective elderly person is one who is able to establish, maintain, and use social networks and interpersonal relationships to meet basic human needs

The last facet of the psychosocial assessment of an older adult involves gathering data that can be used to determine the elderly individual's social effectiveness. The socially effective elderly person is one who is able to establish, maintain, and use social networks and interpersonal relationships to meet basic human needs

Specific interventions related to Elderly Population

cont’d.

Life review therapyLife review therapy

This is a nursing intervention that assists the older adult in an individual basis to positively resolve Erickson’s major

developmental tasks for the older adult & gain integrity). The older adult examines his life critically & reviews all

aspects.

Technique of life review

A structured approach is taken with specific time allowed to focus on a review of the

different life periods, such as 1 to 2 weeks on childhood, 1 or 2 weeks on the teenage years &

so forth.

Specific interventions related to Elderly Population cont’d.

ReminiscenceThis is a nursing intervention that encourages the

elderly person to recall or remember past events with the purpose of attaining specific goal. It may be formal

(1 or twice a week) or informal with individuals or group E.g., the nurse use reminiscence to increase self-

esteem or life satisfaction.

Technique of Reminiscence1- Encourage the elderly person to reminisce or discuss memories & past experiences (successes & pleasurable events)

2- Or in a group setting with the nurse acting as a facilitator; participants discuss different topics from their past (significant events, birth of their children, travel, places they have lived, & holidays)

Specific interventions related to Elderly Population cont’d

Remotivation TherapyRemotivation Therapy

Goals Goals •Help achieve sense of belonging•Increase feelings of self-worth, self-reliance, and personal value•Assist individuals to maximize their potential through other-directed communication and stimulating interest in surrounding environment and people

Procedures

•Welcoming•Create a bridge to reality•Sharing the world we live in•The work of the world•Appreciation


Sensory stimulation and training

Goals Goals •Help put the regressed person back in touch with surroundings•Improve sensitivity and responsiveness to the environment•Increase discrimination abilityProcedure

s Structured experiences involving the five senses; e.g. visual, looking in the mirror; auditory, listening to tapes; tactile, touching textured objects, olfactory, smelling fragrant, spicy aromas, gustatory, tasting sweet, sour, bitter foods; kinesthetic, moving and dancing


Behavior modification and habit training

Goals Goals •Give maximum support to appropriate behavior and compensate for behavioral deficits•Increase functional levels of the elderly and also their sense of self-control•Reduce anxietyProcedures • Provide an environmental cue (stimulus) that targets, signals, or in some way helps the resident focus on the appropriate, expected behavior

• Provide a positive reinforcement (reward) for achievement of the expected behavior


Pet therapy

•Alleviate depression•Enhance self-image and identity•Help fulfill need to be loved and to love in return•Help restore emotional equilibrium

Goals Goals

Procedures

•Animals (such as dogs, cats, fish, and birds) are used as therapeutic catalysts

Learning Activities

Form groups of three students:1- Choose a target group of adolescents,

parents, teachers, or other significant caregivers.

2- With this target group identify an area of need that could be dealt with through planning a program of anticipatory guidance.

3- Plan and implement this program

Learning Activities

Identify the local community resources that provide supportive or mental health services to the elderly and their families. Visit oneagency and observe the types of services provided, the ages and types of clients served, the prevailing treatment focus of the agency (primary, secondary, tertiary prevention, palliation, and so on) and the prevailing attitudes of the health care providers toward the elderly.

Select one client over the age of 65 who is in a general hospital for treatment, of an acute or a chronic physical illness. Perform a comprehensive mental health assessment and then plan an intervention program with the client, the focus of which is primary prevention. Include consideration of personal resources, strengths, family and social networks, and community resources as you both plan the intervention program. Evaluate the plan of care.

Documents

L ife S pan D evelopmental C risis. Learning Objectives Define the term life span Define the term life span Describe the specific situational and maturational