ST BAKHITA HEALTH

TRAINING INSTITUTE
MENTAL HEALTH NURSING
NMT 06211
 SESSION 01
CONCEPTS OF PERSONALITY
DEVELOPMENT IN RELATION TO
MENTAL HEALTH
 Learning Tasks
• At the end of this session a learner expected
to be able to:
• Define personality development
• Explain structure of personality
• Describe stages of psychosexual development
(Freud’s theory)
• Describe stages of psychosocial development
(Erickson theory)
• Describe stages of cognitive development
(Piaget theory)
 Definition of Personality
Development
• Personality development 
is the development of the organized pattern of
behaviors and attitudes that makes a person
distinctive. 
• Personality development occurs by the
ongoing interaction of temperament , character,
and environment.
• Personality is what makes a person a unique
person, and it is recognizable soon after birth.
• A child's personality has several
components: temperament, environment,
and character.
• Temperament is the set of genetically
determined traits that determine the child's
approach to the world and how the child learns
about the world.
• Character—the set of emotional, cognitive,
and behavioral patterns learned from
experience that determines how a person
thinks, feels, and behaves.
• A person's character continues to evolve
throughout life, although much depends on
inborn traits and early experiences. Character
is also dependent on a person's moral
development 
 • LEVELS OF THE MIND ( PSYCHIC
LEVELS)
• Freud said mind topographic follow into 3
levels of consciousness.
• Conscious level
• The conscious part is aware of here and now as it
relate to the individual and his environment.
• It function only when the individual is awake
• It is concerned with thoughts, feelings, and
sensations
• It directs the individual as he behaves in a
rational, thoughtful way
• The preconscious or subconscious level
• Is that part of the mind in which ideas and
reactions are stored and partially forgotten.
• It reduces the burden of the conscious mind with a
multiple of facts that are infrequently used and
currently not in demand
• It acts as a watchman, since it prevents certain
unacceptable, disturbing unconscious memories
from reaching the conscious mind
• Material of this store house can be brought into
conscious awareness if the individual concentrates
on recall.
• The unconscious mind
• Is the largest part of the mind
• It is a store house for all memories, feelings,
and responses experienced by the individual
during his entire life.
• This information cannot be recalled at will.
• It demonstrates its awareness through dreams,
slips of tongue, unexplained behavioral
responses, jokes and lapses of memory.
• Psychotic symptoms are expressions of
unconscious thoughts or feelings.
• Material stored in the unconscious has a
powerful influence of behaviour.
• The individual is aware of the ideas
themselves, but may continue to experience an
emotional reaction as if material were in
conscious mind.
 Structure of personality
• Personality Structure Freud (1960)
delineated three major and distinct but
interactive systems of the personality:
1) The id,
2) The ego, and
3) The superego.
The id, ego, and superego: According to Freud’s
structural model, the personality is divided into the
id, ego, and superego. On this diagram, the smaller
portion above the water signifies the conscious
mind, while the much larger portion below the
water illustrates the unconscious mind.
• Sigmund Freud ‘s psychoanalytic theory
of personality argues that human behavior
is the result of the interactions among
three component parts of the mind: the id,
ego, and superego.
• Id.
• At birth we are all id. The id is the source of all
drives, instincts, reflexes, needs, genetic
inheritance, and capacity to respond, as well as all
the wishes that motivate us.
• The id cannot tolerate frustration and seeks to
discharge tension and return to a more
comfortable level of energy.
• The id lacks the ability to problem solve; it is
not logical and operates according to the pleasure
principle. The only needs that count are its own.
A hungry, screaming infant is the perfect
example of id.
• Ego
• Within the first few years of life as the child
begins to interact with others, the ego
develops. The ego is the problem solver and
reality tester.
• It is able to differentiate subjective
experiences, memory images, and objective
reality and attempts to negotiate with the
outside world.
• The ego follows the reality principle, which says
to the id, “You have to delay gratification for
right now,” and then sets a course of action.
• For example, a hungry man feels tension arising
from the id that wants to be fed. His ego allows
him not only to think about his hunger but to
plan where he can eat and to seek that
destination.
• This process is known as reality testing because
the individual is factoring in reality to implement
a plan to decrease tension.
• Superego
• The superego, the last portion of the
personality to develop, represents the moral
component of personality.
• The superego consists of the conscience (all
the “should nots” internalized from parents)
and the ego ideal (all the “shoulds”
internalized from parents).
• The superego represents the ideal rather than
the real; it seeks perfection, as opposed to
seeking pleasure or engaging reason.
• There are two aspects of the super ego;-
• Conscience
• Is the part that punishes the individual through
guilty and anxiety when his behavior deviates
from the strict standards of the super ego.
• Ego ideal -Rewards the individual through
feelings of euphoria and wellbeing when his
behavior is desirable.
• In a mature and well-adjusted individual,
the three systems of the personality—the
id, the ego, and the superego work
together as a team under the
administrative leadership of the ego.
• If the id is too powerful, the person will
lack control over impulses; if the
superego is too powerful, the person may
be self-critical and suffer from feelings of
inferiority.
 THE EFFECT OF ID, EGO, AND SUPEREGO.

• If the individual does not develop an ego that is strong

enough to arbitrate effectively between id and the
superego he will develop intrapersonal and
interpersonal conflicts.
• When the id is not controlled effectively, the
individual function in antisocial, careless ways
because his primitive impulses are expressed freely.
• If the super ego is so strong that the individual’s life is
dominated by its restrictions on behavior, he is likely
to be inhibited, repressed, unhappy and guilt ridden.
• Therefore a mature effective, stable adult
life is dependent on the development of
an ego powerful enough both to deal with
and to adequately test reality to mediate
successfully between the demands of the
id and superego.
 Stages of Psychosexual
Development - Freud’s theory
• Freud believed that personality develops
through a series of childhood stages in
which the pleasure-seeking energies of
the id become focused on certain
erogenous areas.
• An erogenous zone is characterized as an
area of the body that is particularly
sensitive to stimulation.
• The five psychosexual development
stages, are
1) Oral Stage
2) Anal Stage
3) Phallic Stage
4) Latent Stage
5) Genital Stage
• The Oral Stage –
• This stage ranges from birth to 1 Year
Erogenous Zone: Mouth
• During the oral stage, the infant's primary
source of interaction occurs through the
mouth, so the rooting and sucking reflex is
especially important. The mouth is vital
for eating, and the infant derives pleasure
from oral stimulation through gratifying
activities such as tasting and sucking.
• Because the infant is entirely dependent upon
caretakers (who are responsible for feeding the
child), the child also develops a sense of trust
and comfort through this oral stimulation.
• The primary conflict at this stage is the weaning
process--the child must become less dependent
upon caretakers.
• If fixation occurs at this stage, Freud believed
the individual would have issues with
dependency or aggression. Oral fixation can
result in problems with drinking, eating,
smoking, or nail biting.
• The Anal Stage
• Age Range: 1 to 3 years
Erogenous Zone: Bowel and Bladder
Control
• During the anal stage, Freud believed that the
primary focus of the libido was on controlling
bladder and bowel movements. The major
conflict at this stage is toilet training--the child
has to learn to control his or her bodily needs.
Developing this control leads to a sense of
accomplishment and independence.
• According to Freud, success at this stage is
dependent upon the way in which parents approach
toilet training. Parents who utilize praise and
rewards for using the toilet at the appropriate time
encourage positive outcomes and help children feel
capable and productive. Freud believed that positive
experiences during this stage served as the basis for
people to become competent, productive, and
creative adults.
• However, not all parents provide the support and
encouragement that children need during this stage.
Some parents instead punish, ridicule or shame a
child for accidents.
• According to Freud, inappropriate parental
responses can result in negative outcomes. If
parents take an approach that is too lenient,
Freud suggested that an anal-expulsive
personality could develop in which the
individual has a messy, wasteful, or destructive
personality. If parents are too strict or begin
toilet training too early, Freud believed that an
anal-retentive personality develops in which
the individual is stringent, orderly, rigid, and
obsessive.
• The Phallic Stage
• Age Range: 3 to 6 Years
Erogenous Zone: Genitals
• Freud suggested that during the phallic
stage, the primary focus of the libido is
on the genitals. At this age, children also
begin to discover the differences between
males and females.​
• Freud also believed that boys begin to view
their fathers as a rival for the mother’s
affections. The Oedipus complex describes
these feelings of wanting to possess the mother
and the desire to replace the father. However,
the child also fears that he will be punished by
the father for these feelings, a fear Freud termed
castration anxiety.
• The term Electra complex has been used to
describe a similar set of feelings experienced by
young girls. Freud, however, believed that girls
instead experience penis envy.
• Eventually, the child begins to identify with the
same-sex parent as a means of vicariously
possessing the other parent. For girls, however,
Freud believed that penis envy was never fully
resolved and that all women remain somewhat
fixated on this stage. Psychologists such as
Karen Horney disputed this theory, calling it
both inaccurate and demeaning to women.
Instead, Karen Horney(1885-1952) proposed
that men experience feelings of inferiority
because they cannot give birth to children, a
concept she referred to as womb envy.
• The Latent Period
• Age Range: 6 to Puberty
Erogenous Zone: Sexual Feelings Are
Inactive
• During this stage, the superego continues to develop
while the id's energies are suppressed. Children
develop social skills, values and relationships with
peers and adults outside of the family.
• The development of the ego and superego contribute
to this period of calm. The stage begins around the
time that children enter into school and become more
concerned with peer relationships, hobbies, and other
interests.
• The latent period is a time of exploration in which
the sexual energy repressed or dormant. This
energy is still present, but it is sublimated into
other areas such as intellectual pursuits and social
interactions. This stage is important in the
development of social and communication skills
and self-confidence.
• As with the other psychosexual stages, Freud
believed that it was possible for children to
become fixated or "stuck" in this phase. Fixation at
this stage can result in immaturity and an inability
to form fulfilling relationships as an adult.
• The Genital Stage
• Age Range: Puberty to Death
Erogenous Zone: Maturing Sexual
Interests
• The onset of puberty causes the libido to
become active once again. During the final
stage of psychosexual development, the
individual develops a strong sexual interest
in the opposite sex. This stage begins
during puberty but last throughout the rest
of a person's life.
• Where in earlier stages the focus was solely on
individual needs, interest in the welfare of others
grows during this stage.
• If the other stages have been completed
successfully, the individual should now be well-
balanced, warm, and caring. The goal of this
stage is to establish a balance between the various
life areas.
• Unlike the many of the earlier stages of
development, Freud believed that the ego and
superego were fully formed and functioning at
this point.
• Younger children are ruled by the id,
which demands immediate satisfaction of
the most basic needs and wants.
• Teens in the genital stage of development
are able to balance their most basic urges
against the need to conform to the
demands of reality and social norms.
 Implications for Psychiatric
Mental Health Nursing
• Freud’s theory has relevance to
psychiatric mental health nursing practice
at many junctures. First, the theory offers
a comprehensive explanation of complex
human processes and suggests that the
formation of a patient’s personality is
strongly influenced by childhood
experiences.
• Freud’s theory of the unconscious mind is
particularly valuable as a baseline for
considering the complexity of human
behavior.
• By considering conscious and
unconscious influences, a nurse can
identify and begin to think about the root
causes of patient suffering.
• Freud emphasized the importance of
individual talk sessions characterized by
attentive listening, with a focus on
underlying themes as an important tool of
healing in psychiatric care.
 Stages of Psychosocial Development
(Erickson theory)
• Erik Erikson (1902-1994), an American
psychoanalyst, was also a follower of Freud;
however, Erickson (1963) believed that
Freudian theory was restrictive and negative in
its approach.
• He also stressed that an individual’s
development is influenced by more than the
limited mother-child-father triangle and that
culture and society exert significant influence
on personality.
• According to Erickson, personality was not set
in stone at age 5, as Freud suggested, but
continued to develop throughout the life span.
• Erickson described development as occurring
in eight predetermined and consecutive life
stages (psychosocial crises), each of which
consists of two possible outcomes (e.g.,
industry vs. inferiority).
• The successful or unsuccessful completion of
each stage will affect the individual’s
progression to the next.
• For example, Erickson’s crisis of industry
versus inferiority occurs from the ages of
7 to 12. During this stage, the child’s task
is to gain a sense of personal abilities and
competence and to expand relationships
successfully at a later time.
Stage Psychosocial Crisis Basic Virtue Age

1. Trust vs. Mistrust Hope 0 - 1½

2. Autonomy vs. Shame Will 1½ - 3

3. Initiative vs. Guilt Purpose 3-5

4. Industry vs. Inferiority Competency 5 - 12

5. Identity vs. Role Confusion Fidelity 12 - 18

6. Intimacy vs. Isolation Love 18 - 40

7. Generativity vs. Stagnation Care 40 - 65

8. Ego Integrity vs. Despair Wisdom 65+

Developmental stage Developmental task

Infancy Trust vs mistrust

-oral needs of primary importance
-adequate mothering necessary

-acquisition of hope
Toddler Autonomy vs shame
-anal needs of primary importance
-father emerges as important figure

-acquisition of will
Early childhood Initiative vs guilty
-genital needs of primary importance
-family relationships contribute to early sense of responsibility and
conscience

-acquisition of purpose
Developmental stage Developmental task
Middle childhood Industry vs inferiority
-active period of socialization as he moves from
family to society

- acquisition of competence
Adolescence Identity vs. Role Confusion

-search for self in which peers play important part

-psychosocial moratorium is provided by the society

- acquisition of fidelity
Adult hood Intimacy vs isolation
-characterized by increasing importance of
human closeness’ and sexual fulfillment

- acquisition of love
Developmental stage Developmental task
Middle age Generativity vs self
absorption(stagnation)
-characterized by productivity,
creativity, parental responsibility and
concern for new generation
-acquisition of care

Old age Integrity vs despair

-characterized by unifying philosophy
of life and more profound love for
mankind
-acquisition of wisdom
1. Trust vs. Mistrust
• During this stage, the infant is uncertain about
the world in which they live. To resolve these
feelings of uncertainty, the infant looks
towards their primary caregiver for stability
and consistency of care.
• If the care the infant receives is consistent,
predictable and reliable, they will develop a
sense of trust which will carry with them to
other relationships, and they will be able to
feel secure even when threatened
• Success in this stage will lead to the
virtue of hope. By developing a sense of
trust, the infant can have hope that as new
crises arise, there is a real possibility that
other people will be there as a source of
support. Failing to acquire the virtue of
hope will lead to the development of fear.
• For example, if the care has been harsh or
inconsistent, unpredictable and unreliable,
then the infant will develop a sense of mistrust
and will not have confidence in the world
around them or in their abilities to influence
events.
• This infant will carry the basic sense of
mistrust with them to other relationships. It
may result in anxiety, heightened insecurities,
and an over feeling of mistrust in the world
around them.
• 2. Autonomy vs. Shame and Doubt
• Autonomy versus shame and doubt is the
second stage of Erik Erickson's stages of
psychosocial development.
• This stage occurs between the ages of 18
months to approximately 3 years.
• The child is developing physically and
becoming more mobile, and discovering that he
or she has many skills and abilities, such as
putting on clothes and shoes, playing with toys,
etc. Such skills illustrate the child's growing
sense of independence and autonomy.
• For example, during this stage children
begin to assert their independence, by
walking away from their mother, picking
which toy to play with, and making
choices about what they like to wear, to
eat, etc.
• Erickson states it is critical that parents allow
their children to explore the limits of their
abilities within an encouraging environment
which is tolerant of failure.
– For example, rather than put on a child's
clothes a supportive parent should have the
patience to allow the child to try until they
succeed or ask for assistance. So, the
parents need to encourage the child to
become more independent while at the
same time protecting the child so that
constant failure is avoided.
• 3. Initiative vs. Guilt Age
• Initiative versus guilt is the third stage of
Erik Erickson's theory of psychosocial
development. During the initiative versus
guilt stage, children assert themselves more
frequently.
• These are particularly lively, rapid-
developing years in a child’s life. According
to Bee (1992), it is a “time of vigor of action
and of behaviors that the parents may see as
aggressive."
• During this period the primary feature involves
the child regularly interacting with other
children at school. Central to this stage is play,
as it provides children with the opportunity to
explore their interpersonal skills through
initiating activities.
• Children begin to plan activities, make up
games, and initiate activities with others. If
given this opportunity, children develop a sense
of initiative and feel secure in their ability to
lead others and make decisions.
• Conversely, if this tendency is squelched, either
through criticism or control, children develop a
sense of guilt. They may feel like a nuisance to
others and will, therefore, remain followers,
lacking in self-initiative.
• The child takes initiatives which the parents will
often try to stop in order to protect the child. The
child will often overstep the mark in his
forcefulness, and the danger is that the parents
will tend to punish the child and restrict his
initiatives too much.
• It is at this stage that the child will begin to ask
many questions as his thirst for knowledge
grows. If the parents treat the child’s questions
as trivial, a nuisance or embarrassing or other
aspects of their behavior as threatening then
the child may have feelings of guilt for “being
a nuisance”.
• Too much guilt can make the child slow to
interact with others and may inhibit their
creativity. Some guilt is, of course, necessary;
otherwise the child would not know how to
exercise self-control or have a conscience.
• 4. Industry vs. Inferiority
• Erickson's fourth psychosocial crisis,
involving industry vs. inferiority occurs
during childhood between the ages of five
and twelve.
• Children are at the stage where they will
be learning to read and write, to do sums,
to do things on their own. Teachers begin
to take an important role in the child’s life
as they teach the child specific skills.
• It is at this stage that the child’s peer group will
gain greater significance and will become a major
source of the child’s self-esteem. The child now
feels the need to win approval by demonstrating
specific competencies that are valued by society
and begin to develop a sense of pride in their
accomplishments.
• If children are encouraged and reinforced for their
initiative, they begin to feel industrious
(competent) and feel confident in their ability to
achieve goals. If this initiative is not encouraged,
if it is restricted by parents or
• teacher, then the child begins to feel
inferior, doubting his own abilities and
therefore may not reach his or her
potential.
• If the child cannot develop the specific
skill they feel society is demanding (e.g.,
being athletic) then they may develop a
sense of inferiority.
• 5. Identity vs. Role Confusion
• The fifth stage is identity vs. role
confusion, and it occurs during
adolescence, from about 12-18 years.
During this stage, adolescents search for
a sense of self and personal identity,
through an intense exploration of
personal values, beliefs, and goals.
• During adolescence, the transition from
childhood to adulthood is most important.
Children are becoming more independent,
and begin to look at the future in terms of
career, relationships, families, housing.
• The individual wants to belong to a society
and fit in.
• This is a major stage of development where
the child has to learn the roles he will
occupy as an adult.
• It is during this stage that the adolescent will
re-examine his identity and try to find out
exactly who he or she is.
• Erickson suggests that two identities are
involved: the sexual and the occupational
• According to Bee (1992), what should happen
at the end of this stage is “a reintegrated sense
of self, of what one wants to do or be, and of
one’s appropriate sex role”. During this stage
the body image of the adolescent changes.
• Erickson claims that the adolescent may feel
uncomfortable about their body for a while
until they can adapt and “grow into” the
changes. Success in this stage will lead to the
virtue of fidelity.
• Fidelity involves being able to commit one's
self to others on the basis of accepting others,
even when there may be ideological differences.
• During this period, they explore possibilities
and begin to form their own identity based upon
the outcome of their explorations. Failure to
establish a sense of identity within society ("I
don’t know what I want to be when I grow up")
can lead to role confusion. Role confusion
involves the individual not being sure about
themselves or their place in society.
• 6. Intimacy vs. Isolation
• Intimacy versus isolation is the sixth stage of Erik
Erikson's theory of psychosocial development.
This stage takes place during young adulthood
between the ages of approximately 18 to 40 yrs.
• During this period, the major conflict centers on
forming intimate, loving relationships with other
people.
• During this period, we begin to share ourselves
more intimately with others. We explore
relationships leading toward longer-term
commitments with someone other than a family
member
• Successful completion of this stage can result
in happy relationships and a sense of
commitment, safety, and care within a
relationship.
• Avoiding intimacy, fearing commitment and
relationships can lead to isolation, loneliness,
and sometimes depression. Success in this
stage will lead to the virtue of love.
• 7. Generativity vs. Stagnation
• Generativity versus stagnation is the seventh of
eight stages of Erik Erikson's theory of
psychosocial development. This stage takes place
during middle adulthood (ages 40 to 65 yrs).
• Generativity refers to "making your mark" on the
world through creating or nurturing things that
will outlast an individual.
• People experience a need to create or nurture
things that will outlast them, often having
mentees or creating positive changes that will
benefit other people.
• We give back to society through raising our children,
being productive at work, and becoming involved in
community activities and organizations. Through
generativity we develop a sense of being a part of the
bigger picture.
• Success leads to feelings of usefulness and
accomplishment, while failure results in shallow
involvement in the world.
• By failing to find a way to contribute, we become
stagnant and feel unproductive. These individuals
may feel disconnected or uninvolved with their
community and with society as a whole. Success in
this stage will lead to the virtue of care.
• 8. Ego Integrity vs. Despair
• Ego integrity versus despair is the eighth and
final stage of Erik Erickson’s stage theory of
psychosocial development. This stage begins at
approximately age 65 and ends at death.
• As we grow older (65+ yrs) and become senior
citizens, we tend to slow down our productivity
and explore life as a retired person.
• It is during this time that we contemplate our
accomplishments and can develop integrity if
we see ourselves as leading a successful life.
• Erickson described ego integrity as “the
acceptance of one’s one and only life cycle as
something that had to be” and later as “a sense
of coherence and wholeness”
• Erik Erickson believed if we see our lives as
unproductive, feel guilt about our past, or feel
that we did not accomplish our life goals, we
become dissatisfied with life and develop
despair, often leading to depression and
hopelessness.
• Success in this stage will lead to the virtue of
wisdom. Wisdom enables a person to look
back on their life with a sense of closure and
completeness, and also accept death without
fear.
• Wise people are not characterized by a
continuous state of ego integrity, but they
experience both ego integrity and despair.
• Implications for Psychiatric Mental Health
Nursing
• Analysis of behavior patterns using Erikson’s
framework can identify age-appropriate or
arrested development of normal interpersonal
skills.
• A developmental framework helps the nurse
know what types of interventions are most likely
to be effective.
• For example, children in Erikson’s initiative
versus-guilt stage of development respond best if
they actively participate and ask questions.
• Older adults respond to a life- review strategy
that focuses on the integrity of their life as a
tapestry of experience.
• In the therapeutic encounter, individual
responsibility and the capacity for improving
one’s functioning are addressed. Treatment
approaches and interventions can be tailored to
the patient’s developmental level.
 Stages of Cognitive Development -Piaget
theory
• Jean Piaget's theory(1896-1980) of cognitive
development suggests that children move
through four different stages of mental
development.
• His theory focuses not only on understanding
how children acquire knowledge, but also on
understanding the nature of intelligence.
• Piaget's stages are:
• Sensorimotor stage: birth to 2 years
• Preoperational stage: ages 2 to 7
• Concrete operational stage: ages 7 to 11
• Formal operational stage: ages 12 and up
• Piaget believed that children take
an active role in the learning process,
acting much like little scientists as they
perform experiments, make observations,
and learn about the world.
• The Sensorimotor Stage -Ages: Birth to 2 Years
• Major Characteristics and Developmental Changes:
• The infant knows the world through their movements
and sensations.
• Children learn about the world through basic actions
such as sucking, grasping, looking, and listening.
• Infants learn that things continue to exist even though
they cannot be seen (object permanence).
• They are separate beings from the people and objects
around them.
• They realize that their actions can cause things to
happen in the world around them.
• During this earliest stage of cognitive
development, infants and toddlers acquire
knowledge through sensory experiences and
manipulating objects.
• A child's entire experience at the earliest period
of this stage occurs through basic reflexes,
senses, and motor responses.
• It is during the sensorimotor stage that children
go through a period of dramatic growth and
learning. As kids interact with their
environment, they are continually making new
discoveries about how the world works.
• The Preoperational Stage Ages: 2 to 7 Years
• Major Characteristics and Developmental
Changes:
• Children begin to think symbolically and learn
to use words and pictures to represent objects.
• Children at this stage tend to be egocentric and
struggle to see things from the perspective of
others.
• While they are getting better with language and
thinking, they still tend to think about things in
very concrete terms.
• The foundations of language development
may have been laid during the previous
stage, but it is the emergence of language
that is one of the major hallmarks of the
preoperational stage of development.
• Children become much more skilled at
pretend play during this stage of
development, yet still think very concretely
about the world around them. 
• At this stage, kids learn through pretend
play but still struggle with logic and
taking the point of view of other people.
• They also often struggle with
understanding the idea of constancy.
• Preoperational Stage of Cognitive
Development in Young Children
• The Concrete Operational Stage-Ages: 7 to 11
Years
• Major Characteristics and Developmental Changes
• During this stage, children begin to thinking
logically about concrete events.
• They begin to understand the concept of
conservation; that the amount of liquid in a short,
wide cup is equal to that in a tall, skinny glass, for
example.
• Their thinking becomes more logical and
organized, but still very concrete.
• Children begin using inductive logic, or
reasoning from specific information to a
general principle.
• While children are still very concrete and
literal in their thinking at this point in
development, they become much more adept
at using logic.
• The egocentrism of the previous stage begins
to disappear as children become better at
thinking about how other people might view a
situation.
• The Formal Operational Stage - Ages:
12 and Up
• Major Characteristics and Developmental
Changes:
• At this stage, the adolescent or young
adult begins to think abstractly and
reason about hypothetical problems.
• Abstract thought emerges.
• Teens begin to think more about moral,
philosophical, ethical, social, and political
issues that require theoretical and abstract
reasoning.
• Begin to use deductive logic, or reasoning
from a general principle to specific
information.
• This final stage of Piaget's theory
involves an increase in logic, the ability
to use deductive reasoning, and an
understanding of abstract ideas.
• At this point, people become capable of
seeing multiple potential solutions to
problems and think more scientifically
about the world around them.
• The ability to thinking about abstract
ideas and situations is the key hallmark
of the formal operational stage of
cognitive development.
• The ability to systematically plan for the
future and reason about hypothetical
situations are also critical abilities that
emerge during this stage. 
 Key Points
• Freud’s theory has relevance to psychiatric
mental health nursing practice at many
junctures. The theory offers a
comprehensive explanation of complex
human processes and suggests that the
formation of a patient’s personality is
strongly influenced by childhood
experiences.
• Erikson’s developmental model is an
essential component of patient
assessment. Analysis of behavior patterns
using Erikson’s framework can identify
age-appropriate or arrested development
of normal interpersonal skills.
• Piaget believed that children take
an active role in the learning process,
acting much like little scientists as they
perform experiments, make observations,
and learn about the world.