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

adults with depressionKatie Arundel

Theory 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 InfancyTrust vs Mistrust

Early Childhood

Autonomy vs shame, doubt

Play AgeInitiative vs

guilt

School AgeIndustry vs inferiority

AdolescenceIdentity vs role

confusion

Young Adulthood

Intimacy vs isolation

AdulthoodGenerativity vs

stagnation

Old AgeIntegrity 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)

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 theory

❖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 this study 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 older adults with depression

Method• 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 outer 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

Findings

Four major themes or categories were identified:

• Understandings of causes of depression in older adults

• Benefits and criticisms of Erikson’s theory

• Suggested changes to Erikson’s theory

• Discussions of the past

Understandings of causes of depression

• 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 of 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

own mortality, to think about

your own life so far.”

(Participant 3)

Benefits and Criticisms of

Erikson’s Theory

• 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 outweighed 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 of 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)

Suggested changes to

Erikson’s theory

• 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).

Discussions about the 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

old 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

Discussion

• 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.

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 older 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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