child rearing.

[mital82]

question. during a routine well visit for her 6 month old son. a mother expresses concern regarding the development of her son. "he seems fine, physically." she says, "but i worry, i just want to help him come out all rihgt." she goes on to ask what is most important issue she should focus on in the childs upbringing. in the couse of counselling this mother, the physicians best response i to emphasize the importance of:

a. techniques of discipline used.
b. support for the childs drive for independence.
c. the pervasive emotional tone expressed bythe parents.
d. cohesiveness of the marital unit.
e. fostering cooperaqtive behavior among siblings.

[usmlethinking]

Originally Posted by mital82

question. during a routine well visit for her 6 month old son. a mother expresses concern regarding the development of her son. "he seems fine, physically." she says, "but i worry, i just want to help him come out all rihgt." she goes on to ask what is most important issue she should focus on in the childs upbringing. in the couse of counselling this mother, the physicians best response i to emphasize the importance of:

a. techniques of discipline used.
b. support for the childs drive for independence.
c. the pervasive emotional tone expressed bythe parents.
d. cohesiveness of the marital unit.
e. fostering cooperaqtive behavior among siblings.

Are you asking for Erikson's stages of development? 6 month old = trust versus mistrus so the answer must be b. suport for the child's drive for independence.


In Erickson’s life cycle model, there were eight fundamental developmental tasks--really basic human issues--that could be relevant at any point in life; but different issues tend to be focal at different critical periods throughout life. The positive but balanced resolution of these dilemmas allows the ego to acquire new qualities or virtues, which themselves then become the foundations for further development.

The first task is trust versus mistrust. For this first task, the critical period tends to be infancy, so this corresponds to Freud’s oral stage and the issue is somewhat similar because the reality is that you are dependent and so the question is: can I trust you, you being my caretakers and, by extension, the larger world in which I have found myself. If on balance your answer is yes, then you have acquired the ego quality of virtue of hope. Now the answer is unlikely to be an unqualified yes because there will be many moments in which your needs are not being met, in which people are not taking your best interest at heart and indeed its probably best that as one moves through life, you’re not always unconditionally trusting; however, if on balance you come into situations feeling more trust than mistrust, then you at least have hope that will empower you to approach new situations.


When one moves into the toddler years. The fundamental issue switches from trust versus mistrust to autonomy versus shame and doubt. So the critical period tends to correspond to what Freud called the anal stage. But the issue is defined in a broader way here in the psychosocial model than in Freud’s psychosexual model. Here the question, perhaps, can phrased as: "Can I do it", and really "Can I do it like the big people do". Where the psychoanalytic focus was can I master toilet training, the psychosocial focus is on everything; picking up forks and spoons and being able to throw and catch a ball and so forth and the toddler every day of it’s life is being faced with challenges of this sort and therefore is asking and getting answers to the question can I do it. Now here we see the importance of what Erickson called the epigenetic principle, which just means that each preceding stage creates the foundation for the subsequent stage. Ideally the outcome of the preceding trust versus mistrust stage is the virtue of hope that will provide the foundation for the autonomous exploration necessary to adequately answer this question "can I do it". It requires the toddler putting him or herself out there into new situations. Even if the ball rolls past you once, you go and you try again. If the fork slips out of your hand, you pick it up again. What keeps you going back is that sense of hope, sense that this really is a world that means you well and therefore you feel comfortable moving out into the world with these newfound skills. If on balance you’re answering this question of can I do it in the direction of yes, I can be autonomous, as opposed to no filled with self-doubt and shame, then you will have acquired the ego quality of will. Again what we’re looking for is a positive but balanced resolution, not that you always think that you can do everything well because it’s simply not true, but that you think on balance you can do things pretty well or well enough that you have more of a sense of competence and autonomy than a sense of shame and doubt.


The third task is initiative versus guilt. The critical period tends to be during the pre-school years, corresponding to the years Freud had for his psychosexual phallic stage. The issue now is can I exert my will and initiate activities without getting punished or rejected. As an infant there is very little expectations that one does anything. As a toddler, the expectations increase, but they’re still fairly minimal. As one enters the pre-school years, parents, other adults, society in general begin to expect that you can follow rules--that with all of your newfound abilities, you also show a corresponding level of self-control and self-restraint and this is what makes the critical issue are you gonna get in trouble for what you do. The relevant research area here is that of parenting and in particular the research on parenting during these years suggests that authoritative reciprocal parenting may be the one that best facilitates being able to have a positive resolution of this critical issue. Authoritative reciprocal parenting is one in which rules are discussed with the child in a very clear way, the rules are applied consistently, the underlying rationale is explicated, it’s shown that the underlying rationale for a rule is based on concern for everybody involved. If the rule is, for example, sharing or a particular bed time or limits on where the child can or cannot go, what the child can or cannot do, then the underlying rationale is explained and input is encouraged from the child. The parent is ultimately the one to make the decision, but the parent shows respect for the perspective being put forth by the child. We find that there is a clear correlation between the internalization of rules, that is the actual following of rules when nobody is around to punish you, the capacity for self-control as one moves outside of the home environment to peer environment, school environment, so authoritative reciprocal parenting is associated with these positive outcomes for children. The one concern again I have about this research is that correlation does not mean causation, so we remain unsure whether or not it’s that authoritative reciprocal parenting is causing children to better be able to handle this issue of learning the rules and following the rules or whether it’s children that are better able to listen to instructions, follow rules, get along with adults in general are the ones that allow for authoritative reciprocal parenting to occur. If they’re not listening well or are too impulsive to follow the rules, even if they’ve heard the rules, end up getting treated in a different way. They get more physical punishment, they don’t get long discussions, they don’t get the opportunity to have input, so its not clear what direction the causal influence is flowing from--from parents to children or from children to the caregivers and the teachers and so forth. In any case, for whatever the reason, if the child can come through this stage answering the question more in the yes direction; yes I can exert my will, initiate it, can do things without getting punished or rejected, then they come through this stage with a sense of purpose, that is, they have a sense that they can have a place in the world where their ideas and their wishes have a place and can be expressed in a way that will be socially accepted.


The fourth task, industry versus inferiority, tends to become focal as the child moves into the school age years, the elementary school years, ages six through puberty. This corresponds to what Freud calls the latency stage and the issue is really quite similar to one Freud identified: Can I master culturally valued skills. In school, these might be reading, writing, arithmetic, athletics, and, with peers, forming friends, being able to negotiate what one does with friends, and some of the conflictual moments or rejections that might occur with friends. So these are the concerns that tend to be focal to children in elementary school and entering into junior high school years. If the answer to this question is generally yes, then one can arrive at the ego quality or virtue of competence, a sense that there are things that I am good at, I do have a place in the world. Not that one is always answering "yes". Certainly one’s not good at everything--at reading, writing and arithmetic and friendships and athletics--but the crucial thing appears to be that the child can find at least one domain valued by him or herself and by others in which the child shows competence; whether it be in school or in athletics or in friendships and so forth, there is a domain in which the child has competencies that are valued by the larger culture and, if so, they will come through with this ego quality of competence that will be so critical for them mastering the subsequent stages that we’ll be talking about next time that occur in adolescence and adulthood.


Task five, identity versus role confusion. The critical period tends to be in adolescence. By critical period we mean the time during which it tends to become focal and salient; but this is an issue that people will deal with throughout life. What is the issue? Again to phrase it as a question, the question the ego would be asking is: is there a role to which I can commit myself and that others will value. The preceding stage, competence, remember the question was: do I have the capabilities that are important in the culture and therefore that others might value. Now the question is: is there a larger role, place or niche for me. If one can come to the answer yes overall--although it might not always fit perfectly, and that fit may shift over time--if overall you have a sense that there is a place and that you can commit to that particular path in life, you’ve gained the ego quality or virtue of fidelity. Fidelity essentially means that you are being true to yourself, to who you are, and being committed to that truth.


The sixth task is intimacy versus isolation. Erickson suggested that this often becomes critical in early adulthood and in particular after you go through the focus on identity formation. The issue is can I commit to mutual independence with another person and the reason why Erickson thought this should follow the stage of identity is as follows: mutual interdependence requires that you allow another person to support your identity. You allow the other person to help nurture your dreams, but for this to happen, you have to have an identity, you have to have a clear set of goals and dreams and values and beliefs that the other person can be supportive of. Conversely, interdependence, if mutual, requires your supporting the other person’s identity and so your identity needs to be resilient rather than rigid so as to allow you to let some of those dreams go, because if you are sharing a life with another person, it’s not always going to go your own way. You have to sometimes know what to let go and this means having a mature sense of who you are and what are the critical values. It also means that you have to be able to let the other person be different. Their particular path in life, their belief systems and their values are not always going to be in parallel with yours and that you have the flexibility to let the other person be different while also sharing a life with you. If you are able to answer this question as generally yes, I can commit to this mutual interdependence with another person, then you’ve acquired the ego quality of love.


The seventh task is generativity versus stagnation, sometimes also called productivity versus stagnation. The critical period tends to be in middle adulthood and this means it’s a very broad range of ages. A stage that can span a number of decades. The issue is can I make a worthwhile difference, can I pass myself on, my hope, my will, my purpose, my competence, my fidelity, my love; all of these virtues that I’ve acquired up to now, what am I going to do with them and can I pass those on to future generations (my children, your children, other people that I can help mentor) or create social institutions that pass those on. The question is what am I going to generate or produce that will well live on beyond myself. Essentially what we’ve seen over the preceding couple of stages is the expansion of the care that you’re showing. The identity task is focused on the self and showing fidelity towards oneself. With intimacy, you’re now caring about another person and giving of yourself in order to nurture that other person, leading to the capacity for love. But now the question is can one stretch your arms wider to embrace a more encompassing caring, encompassing not just particular individuals but the future of the society in which you’re a part. If you answer this yes, I can make a worthwhile difference, then you’ve acquired the ego quality of care. Alternatively, if more often you're focused still on yourself, then you’ll stagnate.

The final task is ego integrity versus despair. The critical period tends to be later adulthood or whenever you feel like your life is drawing to a close, that the productive years are more behind you than ahead of you. This question that will become more focal is: can I affirm my life and accept my death or does my life and the ego running through it lack meaning and fullness. You may not be surprised to know that Erickson suggested that the way in which you dealt with the preceding stages will in some ways predict in how you answer this final question. If as you met each of those preceding developmental tasks, the resolution was more on the positive side, that you felt hope and autonomy and initiative and competence and fidelity and love and care, that you kept moving forward and engaging the world in a positive way and expanding the types of concerns you had and the way you were giving to the world, that when you come to this later point in your life, you will have more of a sense that this was a good life for you to have lived and that at the critical junctures you tended to take the better path. If not, you’ll be filled with despair, because those choices made poorly cannot now be undone because now, as you’re approaching these final years, it’s too late. But if on the whole you have a sense of acceptance--despite the inevitable mistakes--acceptance of the way your life was lived, and you can see life in it’s totality (the way in which each of those critical junctures led to subsequent critical junctures in life) you will gain the ego quality of wisdom.

[mital82]

thanxs usmle thinking for such a nice explanation concerning feuds stage but i still not got why should it be b. because a child of 6months cannot go for independence instead he would be more wanting his parents around him. should not it be c. thanx for everyting.

[usmlethinking]

Originally Posted by mital82

thanxs usmle thinking for such a nice explanation concerning feuds stage but i still not got why should it be b. because a child of 6months cannot go for independence instead he would be more wanting his parents around him. should not it be c. thanx for everyting.

I agree with you on answer c. the pervasive emotional tone expressed bythe parents.

Answer b is more like autonomy vs. shame.