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
Trust vs Infancy Erikson’s life course theory Mistrust Early Autonomy vs Childhood shame, doubt ❖ Commonly taught theory Initiative vs Play Age guilt in social work Industry vs School Age inferiority ❖ One of the only theories Identity vs role Adolescence to specifically consider confusion the experiences of older Young Intimacy vs adults Adulthood isolation Generativity vs Adulthood stagnation Integrity vs Old Age despair 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 older adults with depression
Meth thod • Ethical approval was granted by the University of Participants 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 CPN participants that the researcher was conducting the (1) study separately to their role as an employee. Social Doctor • This was a qualitative study. worker (1) (3) • Eight mental health practitioners were recruited via email from an older adults’ mental health team in an Support outer London Borough. A sampling frame was Worker (1) planned but not used. Occupational • Semi-structured Interviews were carried out, the interviews were transcribed. Data was anonymised. Therapist (2) • Framework analysis was used to identify key themes. • NVIVO was used to aid analysis.
Fin 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
• 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 Und nderstandin ings death were seen by some participants as causes of depression. of of cau auses of of • One participant gave a narrative which was depressio de ion 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)
• All participants named some benefits to Erikson’s theory, including that it provides a framework for understanding service users’ experiences. Bene enefits an and • However, the perceived benefits were outweighed by participants’ significant Crit ritic icis isms of of criticisms, including that it is too prescriptive , and doesn’t account for broad range of Erikson’s experiences of older people, or different generational experiences. Theory The ry • 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)
• Despite not being asked to do so , most of the participants suggested changes which would Sug uggested improve Erikson’s theory. • Suggested changes always reflected the cha changes to o criticisms of the theory. Erikson’s • More stages in later adulthood are needed. These should either be repetitions of earlier theory the ry stages, or new stages. • Culture needs to be considered in teaching. “It’s unfinished based on the world today” (Participant 4).
• Participants have informal discussions about the past with service users. • Most see discussing the past as part of their Discussio ions role. • Perceived benefits are in line with Erikson’s about the abo the pas past theory. • Participants are worried about the potential to “People are so often seen cause harm. 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
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 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].
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