Reading F

As psychotherapy becomes increasingly focused on relief of symptoms, the contemporary therapist may wonder about the utility of a comprehensive theory of personality in guiding therapeutic practice. It is important that such a theory be testable and validity established. Erik Erikson’s conceptualization of life-span personality development is such a theory and, in this paper, we argue for its usefulness as a framework for clinical assessment, case formulation and therapeutic intervention. While relevant construct validity studies will be noted throughout, this essay will focus primarily on application of the theory to psychotherapy.

Just as one becomes most aware of one’s identity when that identity is under threat, one becomes most aware of one’s theoretical basis for psychotherapy when one feels most challenged with a patient. This happens when the therapeutic process, for both therapist and patient, gets stalled. The therapist at this point usually asks him/herself: “What is really going on here?” And that initiates a process of reflection upon one’s understanding of the patient. All psychotherapists who stay open to their experience of their patients at some point confront a situation that their previous framework of understanding fails to assimilate. If the theory’s compass is narrow, then the sooner this can and should happen. On the other hand, if the theory is too broad, it lacks the specificity necessary either to give the therapist some direction or to be validated empirically. We are proposing Erikson’s theory of ego growth as an alternative to these extremes.

Erikson’s theory covers the entire life span and details expectable psychosocial crises and outcomes at different periods of life. It affords a way of locating people in their developmental trajectory and understanding their “symptoms” or life difficulties as reflecting blockages in their growth. Erikson’s theory of personality is inherently psycho-social, conceptualizing the links between inner and outer reality, a project also taken up by social psychologists, social theorists and, more recently, relational psychoanalysts (see Seligman and Shanock, 1995, for an integration of Eriksonian theory and relational psychoanalysis). We shall describe this theory briefly in the next section, offer some evidence for its empirical validation, and discuss some of its implications for psychotherapy.

Erikson’s psychosocial developmental theory is epigenetic, suggesting a synchrony between individual growth and social expectations. At each of eight chronological periods in the lifespan, there are physical changes to which one’s social environment responds with particular expectations and supports in the form of cultural practices and institutions. It is assumed that the resolution of psycho-social stages will be positive given “an average expectable environment” (Hartmann, 1964). For example, at school age, when the child is physically, mentally, and emotionally capable, she is expected to begin to the learn the technology of her culture (e.g., in literate societies, reading, writing, number skills, etc.), and this learning process is supported by the social provision of elementary schools. Whereas the child’s “work” in the previous stage was “play,” the child’s work is now learning-to-work (see Kowaz & Marcia, 1991). From the interaction of individual needs and abilities, met by social demands and rewards, there emerge different ego strengths at different ages. In this example, that strength is a sense of Industry – the child’s conviction that working hard is worthwhile and that perseverance in some chosen areas will yield more than mediocrity. The failure to achieve a sense of Industry leaves a lingering sense of Inferiority (see Figure 1).

Psychosocial Stages
Old Age								Integrity and Despair
Adulthood							Generativity and Stagnation, Self-absorption
Young Adulthood						Intimacy and Isolation
Adolescence					Identity and Identity Diffusion
School Age				Industry and Interiority
Play Age			Initiative and Guilt
Early Childhood		Autonomy and Shame, Doubt
Infancy	Basic Trust and Basic Mistrust

^{Figure 1: Psychosocial Stages}

Each of the stages of ego growth furnishes a necessary contribution to the resolution of the succeeding stage. It would be a mistake to staircase of achievement and it is important not to underestimate the importance of the “negative” poles of the psychosocial resolutions. In old age, for example, it is necessary to experience both the thesis of Integrity as well as the antithesis of Despair in order to formulate one’s own synthesis.

Although it may appear that the diagram is a chart of individual development, each stage of growth occurs within both a social context and also within an intergenerational context. For example, the child’s ego development in the first four childhood stages emerges in the context of adults’ development of Intimacy, Generativity, and Integrity. Children confirm parents in parents’ sense of Generativity as much as parents provide necessary supportive conditions for children’s growth. Teachers need students for confirmation in their experiences of Identity and Generativity, just as students need teachers for developing their senses of Industry and Identity. Elders need their adult children to confirm them in their sense of meaningful Integrity while their adult children benefit from grandparents’ support of their Generative parenting.

The fact that the developmental diagram contains not just eight psychosocial stages but 64 has significant implications for psychotherapy. Were the empty squares to be filled in, we would see clearly that each stage occurs at every other stage. Each square in the chart represents both a contribution from a preceding stage as well as an opportunity (and necessity) to resolve that issue anew. For example, Basic Trust, an infancy issue, emerges again at adolescence when Identity is the main focus, this time taking the form of a “trust of time” (Erikson, 1968). The diagram also suggests the possibility of precocious resolution of stages-to-come. For example, Generativity, the primary issue of adulthood, also exists in a prefiguring form during late adolescence, coexisting with the central adolescent concern of Identity. Hence, at Identity in late adolescence, there is a new Trust issue to be resolved as well as a contribution of accrued Trust from preceding stages. Concurrently at late adolescence, a Generativity issue is also present. The presence of all developmental stages, in some form, at any one stage allows for both the remediation of past insufficiently resolved developmental issues as well as the precocious resolution of stages-to-come before their time of major ascendancy. An illustration of the latter is found in a movie of the last decade, Juno, which concerned a teenage girl who finds herself pregnant. In terms of her psychosocial development, she is at the beginning of dealing with issues of Identity vs. Identity Diffusion, and doing this with whatever strengths or deficits she carries from the earlier stages. At the same time, her pregnancy thrusts her prematurely into later developmental issues which she must confront despite her unreadiness to do so. She must deal with issues of Identity (she says in response to her father, “I don’t exactly know what kind of girl I am”); Intimacy (what to do with her boyfriend—what kind of relationship are they to have—with or without the baby?); and Generativity (what to do with the baby in her belly who is daily growing?). As Juno says, “I think that I’m dealing with issues way beyond my maturity level.” And, of course, she is. But the theory suggests that there are possibilities for some kind of resolution of later Intimacy and Generativity issues even at adolescence when the “main event” is Identity.

Precocious resolution of stages-to-come is less common in therapists’ experience of patients than legacies of incomplete prior stage resolution at a particular life period. For example, problems in Intimacy may have their origin in issues of Basic Trust; problems in Identity may involve incompletely resolved Autonomy and Initiative matters. It is assumed that given “an average expectable environment,” the epigenetic psychosocial stages will be resolved more or less positively. When they are not, the diagram suggests where the therapist might look for previously unresolved stages. In addition, the diagram indicates that the opportunity for the resolution of these stages exists in the present, within the context of the current predominant developmental issue. Trust may be confronted again during the adolescent Identity period, Generativity at elder age Integrity. An elder, despairing of the failed chances to mentor successfully members of the upcoming generation during his middle adult years, can revisit the Generativity phase during Integrity.

The foregoing descriptions of both precocious resolution of stages as well as remediation of previous stages may appear optimistic. This optimism is tempered when one considers that social customs and institutions have been evolved to accommodate fairly specific ages, with certain recognizable body configurations, abilities, and needs characteristic of a given life span period. Psychosocial stage resolution occurs within especially attuned social contexts. When a chronological period has passed, social support is not so available as it was at the appointed time. Psychotherapists know what it is like to sit across from a well-dressed, sophisticated, apparently competent adult, and see a little boy. The problem is that the world will not have much patience with that “little boy” and will not be configured to promote his development. The time when it could be expected to provide an appropriate context for his development is long gone. And when a therapist is treating such a person, the challenge is to address the little boy while respecting the adult man who is present in the room. It is difficult to address, say, Autonomy when the “toddler-hood” conditions for the optimal resolution of this stage are no longer present. Thus, given that the patient’s current position is that of one who must resolve previously unresolved developmental issues in a largely non-supportive social context, the psycho-therapist’s job is to provide a better-than-average expectable environment.

Erikson’s scheme furnishes a road map of development with reasonably expectable attainments in ego growth and equally expectable hindrances and alternatives. Ego growth within this theory, as in classical psychoanalytic theory, emerges from conflict that is both inner and outer and that is either facilitated or blocked by social contexts in which the individual must necessarily live. Psychosocial development occurs as the person negotiates the life cycle journey, sometimes aided, sometimes hindered by his interpersonal world. The heroics involved in this lifelong passage are the modest and necessary “heroics of everyday life.”

Research in Erikson’s Theory: The Status Approach

Age:	Late adolescence	Young adulthood	Middle age	Old age
Stage:	Identity/ Identity Diffusion	Intimacy/ Isolation	Generativity/Stagnation	Integrity/Despair
Criteria:	Exploration, Commitment	Depth and commitment in relationship	Involvement and inclusivity in care for self and other	Commitment to values and beliefs; continuity with past and others; positive detachment
Statuses:	Identity Achievement Moratorium Foreclosure Identity Diffusion	Intimate Pre-Intimate Pseudo- Intimate Stereotyped Isolated	Generative Pseudo-Generative: agentic, communal Conventional Stagnant, Self-Absorbed	Integrated Pseudo-Integrated Non-Exploratory Despairing

^{Figure 2: Statuses in psychosocial stages}

Empirical research aimed at validating Erikson’s theory has been ongoing for close to fifty years. Although some investigators have pursued questionnaire approaches, the strategy to be described in the following section might be called the status approach. We believe that our methodology is consistent with the necessary complexity of Erikson’s (the psychoanalyst) intent. Hence, we have employed a semistructured interview technique to capture participants’ own descriptions of their ways of dealing with a particular psychosocial issue. In addition, we have used scoring manuals to ensure objectivity and reliability. And as we spoke with individuals, we found, as well as Erikson’s polar alternatives, a variety of typical styles at each stage, called statuses. This provides a more fine-grained, experience-near approach to theory validation than more circumscribed questionnaires, which usually yield only high–low distinctions. Once these statuses could be described, criteria for participants’ placement in them were specified, and scoring manuals were developed so that individuals’ statuses could be determined reliably. The statuses were then validated against a variety of theoretically-relevant dependent measures. Often, this process resulted in a refinement of the statuses and modifications to scoring manuals. The adolescent and adult statuses are presented in Figure 2. Their descriptions and some psychotherapeutic implications follow.

Identity

Issues of identity first become predominant at late adolescence because this is when the necessary physiological, cognitive, and social expectational factors are present. Societies expect, and adolescents expect of themselves, that the young person will make occupational and ideological commitments that will bridge the gap between dependent childhood and mutually-interdependent adulthood. This development occurs, hopefully, within a confirming context – one which acknowledges the individual’s unique abilities and needs and provides appropriate demands and rewards. In each psychosocial stage after late adolescence, identity will be reworked with respect to resolution of the new lifespan issue (Marcia, 2002). The first identity is not the last. Following Piagetian principles of assimilation, disequilibration, and accommodation, subsequent identity reformulation occurs as one moves through Intimacy and beyond.

The four identity statuses are based on the dual criteria of exploration (active search among alternatives) and commitment (demonstrated investment) in important life areas including occupational choice, ideology (religious and political beliefs), and ideas about relationships (sexuality, sex roles, etc.). Each of the statuses has implications for psychotherapy with late adolescents (emerging adults) as well as for adults.

Identity Achievement

These persons have explored alternatives and made occupational, ideological and relational value commitments toward the end of adolescence. The process of identity formation requires sufficient personality structuralization and management of internal conflict for the individual to be able to attempt joining the self to a larger purpose. Young people burdened by unresolved residues of previous stages of development find it hard to finish being children. What they most deeply want is what they needed much earlier on and the prospect of growth appears terrifying rather than inviting. An Identity Achieved individual is reasonably integrated and self-aware possessing an inner world and a sense of self, having adequate defenses against overwhelming anxiety (for reviews of empirical research on the identity statuses see Marcia, Waterman, Matteson, Archer, and Orlofsky, 1993; Schwartz, Luyckx, & Vignoles, 2011). Late adolescents who have settled identity issues are less likely to seek psychotherapy than those in the other identity statuses, though some are people who have benefited from earlier psychotherapy that has helped them to resolve their identity concerns (Josselson, 1996). They may come to a counselor seeking factual information.

Moratorium

People in the Moratorium status are currently in an identity crisis. They are struggling to find positions to commit to. For people in the Moratorium status, guilt and anxiety can become so overwhelming that the clear thinking necessary to exploration becomes clouded or blocked. Or the young person in a Moratorium phase may become stuck and despairing of ever finding a social choice that “feels right.” Although the presence of excessive guilt, anxiety, or depression within the Moratorium group may signal pathological processes at work, some internal struggle that creates these affects is developmentally necessary and should be validated, not “solved” by the therapist. Of course, sometimes it is difficult to distinguish the pathological from the developmentally necessary, but this is a distinction the therapist should at least be trying to assess. It is a challenge to sit through the obvious pain these persons experience and not try to intervene. But the last thing individuals in a Moratorium phase need is an overly “helpful” therapist. They are under-going a meaningful, though uncomfortable, crisis which the thoughtful therapist can help them to contain and explore. Longitudinal research shows that, with time, people in a Moratorium status either go on to make meaningful commitments or give up the struggle and return to earlier, Foreclosed positions (Josselson, 1987a, 1996; Kroger, Martinussen, & Marcia, 2010). Recognition of the developmental importance of a Moratorium period, fraught though it may be with anxiety and sometimes depression, is essential for therapists working with people in this age group.

Foreclosure

Foreclosures are strongly commit-ted to their identity positions, but they have adopted unquestioningly beliefs and values that have been bestowed upon them by authority figures. If Foreclosures come to therapy, it is because some aspect of their rather inflexible life plan is not yielding to their control and their neatly constructed world seems in danger of disintegrating. Often, they seek help in changing a recalcitrant partner or support for their difficulties in working with people who frustrate them. Their wish is usually to change external conditions rather than themselves. While Foreclosures’ self-esteem may sometimes be brittle, it is firmly embedded in whatever belief system or set of goals they have carried forth from childhood. Directly challenging these commitments will be met with defensiveness and rage; the patient will likely simply leave the therapy. For some, Foreclosure can be adaptive. As found in longitudinal studies, some women, whose primary identity commitments are to care and preserving tradition, plan to return to or remain in the (physical or psychological) communities in which they were raised and root their identity as bearers of culture (Josselson, 1987a). Psychotherapy with a Foreclosure requires the therapist to establish an initial alliance with the patient based upon some values which both genuinely share. These might include “hard work,” “loyalty,” “principled behavior,” and so forth. From this initial alliance, the therapist can then work toward a gradual loosening of the Foreclosure’s rigid, impermeable stance. The idea of “optimal disequilibration” is important here: just enough challenge to set the person thinking. The therapist can then provide support as the Foreclosure enters a Moratorium phase. The general therapeutic approach is to gently aid the patient to reformulate beliefs and occupational goals more in line with the patients’ own needs and abilities rather than those of early authority figures. In psychodynamic terms: to recon-struct an ego ideal, with implications for a less punitive conscience. When attempting to challenge a Foreclosure’s entrenched position, it is important to proceed gently and cautiously. A too-abrupt disequilibration can leave the patient with no internal standards for positive self-evaluation and, hence, empty and despairing.

Identity Diffusion

Although there are varieties of Identity Diffusion, they have in common a lack of commitment and meaningful exploration. Time perspective is often distorted asthe past is largely forgotten and the future is foreshortened. At higher adaptive levels, Diffusions are, like Ibsen’s Peer Gynt, whatever it seems advantageous for them to be in the moment (Marcia, 1998). At more pathological levels, they are emotionally remote, solitary, and almost schizoid. They may present in therapy as seriously depressed or with borderline characteristics, although they should not be mistaken for borderlines whose difficulties lie developmentally earlier and are more serious. Although Kernberg (2006) sees identity diffusion as an aspect of borderline personality organization, the kind of Identity Diffusion that Erikson described (and later called Role Confusion) may share some of the failures of internalization and personality integration characteristic of borderline personality but is less extreme and less disruptive. Put succinctly, all borderlines are identity diffuse, but all Identity Diffusions are not borderline (Marcia, 2006).

Young people in states of Identity Diffusion find it impossible to locate themselves meaningfully in a social matrix and may drift from one endeavor to another, unable to integrate a sense of purposefulness or coherence. The challenges of adolescence often lay bare previous structural defects, particularly as the adolescent attempts the integrative work of identity formation. Then, splits in the personality, unconnected regions of memory and experience cannot be integrated. To para-phrase Yeats, there is no center that can hold. The fate of such Identity Diffusions often rests on the availability of external supports which buttress the fragile ego organization.

In terms of therapy, we shall speak here of only two types of Diffusions: the “carefree” and the “disturbed.” The carefree Diffusion usually comes to therapists’ attention because someone else has become disturbed by them: teachers or parents who feel that they are “just not living up to their potential” or “just seem to have no direction.” This kind of Diffusion does not want to be in therapy. The initial sessions may constitute a kind of “shock therapy” wherein the therapist offers a few challenging statements that may get the carefree Diffusion’s attention and create the anxiety necessary for them to begin to question their uncaring stance toward themselves and others. If the therapist is successful in creating some anxiety to power the therapy, then the door is open for empathy and a therapeutic alliance. At that point the long process of reconstructive work can begin. The therapist must be prepared to become the caring and selectively supportive parent the Diffusion has lacked.

The “disturbed” Diffusion comes into therapy not just anxious, but usually depressed and despairing also. Identity diffusion is often experienced as a sense of meaningless-ness, as the individual is unable to find a place in an ordered universe. These deficits may be the result of objectively inadequate facilitating environments or some constitutional deficiencies which interfere with attachment, bonding, and the formation of internal representations.

Insecure early attachment may be a risk factor for identity diffusion both in those with borderline personality and for those Erikson had in mind. Without psychotherapy, the fate of such people rests then largely on external factors. Some are fortunate and find protectors, other people who will save them from themselves. Others find external structures, environments which control them rather than hold them. Unable to use holding to grow, such people simply find external authority to merge with. Those less fortunate find that their underlying personality disorganization worsens as the splits deepen and the fabric continues to shred (Josselson, 1987a,b, 1996).

Psychotherapy with people diffuse in identity necessitates becoming a figure whom the Diffusion can internalize. Object relations and self psychological approaches are useful here. One cannot count upon the internal resources possessed by the other three identity statuses. The therapist’s work is to build upon a self that may be susceptible to fragmentation or to repair an already possibly fragmented self – and eventually to help the individual go on to build an identity. Although Diffusions may have moments of seeming lively and vital, their responsiveness is the responsiveness to impulse and sensation rather than reactions which derive from a core sense of self. Asked what she hoped to do with her life, for example, one college senior woman, classified as Diffuse in identity, said, “I don’t know. But when the time comes, I’ll do something.” Another woman, interviewed as a college senior and again at age 34 said, “When I was in college, I thought, I’ll grow up, I’ll get married, I’ll get a job and here I am 34 years old and I’m still thinking, I’ll grow up, I’ll get a job, I’ll get married” (Josselson, 1987a).

Identity Development and Psychotherapy

In a longitudinal study of identity formation in 30 women who had been randomly select-ed from college rolls when they were college seniors, 18 had had at least some contact with mental health professionals by the time they were in their mid-40s Eriksonian Personality Research 5 (Josselson, 1996). Only two had sought psychotherapy by the time of the college interview. Although this was a surprisingly high number of people seeking therapy, the period of time, 1970–1995, was one in which it was culturally common to turn to psychotherapy to explore distress.

After college, all but one of the Diffusions, two-thirds of the Moratoriums, and half of the Foreclosures availed themselves of psychotherapy in one form or another. (Only one of the Identity Achievers sought help.) Six had only very brief contact for support in a life crisis: for help in family conflicts or problems with mood. In these cases, the therapy addressed the immediate need but did not attempt to offer these women the opportunity to consider larger revisions of themselves or their lives.

More intensive psychotherapy had a life-changing impact on eight others, most frequently to help them work through problems in Intimacy or to rework Identity concerns closer to midlife. It was with the Diffusions that therapeutic intervention was least successful, largely, it seems, because only the symptoms of anxiety and depression were treated. The relationship of these symptoms to identity issues seems to have been only tangentially explored. At the same time, it is likely that Diffusions are the most difficult patients.

Where therapy was successful, it was most useful, not in the relief of symptoms, but in helping women get perspective on and insight into themselves. Therapy served to enliven what in them seemed frozen or paralyzed, helped them draw on parts of themselves that had been dormant or underdeveloped, and freed them of fetters from the past enough so they could meet the expectable developmental challenges of the future. Psychotherapy, in focusing patients on creating a coherent narrative of their lives that relates inner and outer reality, is always in some sense dealing with issues of identity (Josselson, 2004). Understanding the obstacles to formulating a workable and meaningful sense of identity is often a primary therapeutic task regardless of life cycle stage.

Of all of the Eriksonian stages, Identity vs. Role Confusion is the most researched. Marcia’s heuristic typology of identity statuses has prompted over 600 studies from which has emerged a fairly detailed portrait of these forms of managing the identity challenge. Josselson’s (1996) longitudinal study of 30 women over 35 years has offered some understanding of the fate of women who began their adult lives in one or the other of these identity categories.

Intimacy

The intimacy statuses (Intimate, Pre-Intimate, PseudoIntimate, Stereotyped and Isolated) are based upon the criteria of depth and commitment in relationships (Orlofsky, Marcia, & Lesser, 1973; Marcia et al., 1993). A description of the statuses follows.

Intimate

Having determined who one is, and is to be, during the previous late adolescent period, the young adult now faces the task of sharing this newly-minted identity with at least one other person and selected companions. Intimacy refers to a relationship characterized by depth of expression of feeling, care, and concern for the other, and commitment. The risk is that in sharing oneself deeply with another, one can lose oneself unless one’s new identity is sufficiently strongly flexible to permit it to be temporarily lost in merger and then recovered. People in the Intimate status would most likely seek out relationship enhancement therapeutic contexts if they feel their relationships to be in some jeopardy. As with all of the adult psychosocial stages, Intimacy involves a dance between the positive and negative poles. There is no true Intimacy without the capacity to visit Isolation, just as there is no genuine Identity without the integration of some Diffusion, nor Generativity without healthy Self-absorption, nor true Integrity without the necessary experience of Despair. Recent advances in relational psychoanalysis similarly theorize a hierarchy of intimate relating, the highest level of which is intersubjectivity (Mitchell, 2000; Stolorow & Atwood, 2002) in which the individual co-creates an authentic relationship with some-one who is a subject in his or her own right.

Pre-Intimate

Pre-Intimate individuals are simi-lar to Intimate ones in that they have the capacity for intimacy but are frequently not in a relationship where these capabilities can be expressed. Often they despair of “finding someone.” The temptation is for the therapist to become a kind of dating advisor: “Why don’t you go to museums (church, discussion groups, the Internet, etc.”). Usually the individual has thought about anything the therapist might come up with and can benefit more from the therapist’s encouragement to do what is enjoyable and meaningful for them, consistent with their identity, and convey optimism that relation-ships are likely to be found within these contexts. At the same time, it is important to determine if it is defensiveness or anxiety, rather than lack of opportunity that may be obstacles to realizing an intimate relationship.

Pseudo-Intimate

Persons designated as Pseudo-Intimate are in a societally recognized context for intimacy such as marriage, but the content of the relationship is superficial and routine, devoid of deep contact. Commitment is superimposed upon the relationship rather than emerging organically from it. Such relationships sometimes break up at middle age, when one of the partners says something like: “He (she) never really understood me,” or “I never really loved him (her).” Often, the break-up comes as a shock to one of the partners who had thought that things were going along just fine. Such ruptures affect not only one’s sense of Intimacy, but often the more fundamental level of their identity. What looks like a tragedy, however, can become an opportunity for the individual to explore, perhaps for the first time, what their deeper feelings are and what they are truly seeking in a nonsuperficial relationship. As with all stages succeeding Identity, psycho-therapy always involves not just addressing the current stage issue, but its impact on Identity as well. Any progress in Intimacy, Generativity, or Integrity involves a disequilibration of the existing identity structure and the necessity for its reconstitution to accommodate the new sense gained of oneself.

Stereotyped

The Stereotyped individual operates according to lowest-common-denominator social patterns and perceptions. Their relationships are “dating” ones and they are likely to make statements such as: “Well, you know what men (women) are like.” They are consumers of how (or how not)-to-do-it relationships guidebooks. They are prone to entering into a Pseudo-Intimate relationship. Hopefully, before this happens, they may seek help for a way out of their essential loneliness. The therapist in this case can work on deepening emotional experience and on increasing cognitive complexity concerning relationships. The therapeutic relationship itself can become a model for psychological intimacy.

Isolate

The lyrics from a now somewhat dated Simon and Garfunkel song, “I am a rock, I am an island . . . I touch no one and no one touches me,” describe the position of the Isolate. Relationships are either nonexistent or emotionally arid. Typically, the origin of difficulties at this level lies in earlier psycho-social stages. Often there is insufficient Identity to provide a scaffolding for Intimacy, and those identity difficulties may have their origin in childhood issues of Trust and Autonomy. In doing therapy with an Isolate, as with a Diffusion, the clinician must be prepared for fairly lengthy reconstructive work best supported by object relational theory. Quick fixes are unlikely to be successful and the ensuing discouragement may leave the patient more distressed than when he/she entered treatment.

Working with developmental lapses in resolution of the Intimacy stage, the therapist must work with the patient to restructure his or her relational world and to create together new ways of interacting that allow the patient to broaden the range of self-experiences that lead beyond Stereotyped and Pseudo-Intimate forms of Intimacy with their ritualized inter-personal habits that have become “safe” and familiar, yet are maladaptive. Often patients present with symptoms not directly related to relational difficulties, but in almost all cases impacting on them. Making an assessment of their relational style in terms of the resolution of stage-specific issues of Intimacy can lead to meaningful routes of therapeutic intervention.

Generativity

The criteria for the Generativity statuses reflect involvement and inclusivity in care for self and others (Bradley, 1997; Bradley & Marcia, 1998). The Generativity status interview seeks to establish the extent of an individual’s caring behaviour as well as the breadth or narrowness of the group of people who qualify for one’s care. (See also the chapters in McAdams and de Saint Aubin [1998], especially the chapter by Stewart and Van de Water [1998] for a conceptualization of different phases of Generativity.)

Generative

Generativity refers to care for the life cycles of others. These may be one’s own and others’ children, valued creations, one’s community, one’s aging parents, and so forth. One’s self also qualifies for care, so that Generativity implies a balance of care for self and others. The danger confronting the Generative individual is overfunctioning. The better one becomes at care, the more is expected by others and of oneself, hence, the necessity for the integration of care of self and others. Frequently, Generative persons come to treatment complaining of “burn-out.” In these cases, the therapist must point out that there can be no effective care for others without care for oneself, and then go on to deal with the impact of that realization upon the patient’s sense of Generative identity. Another difficulty that Generative persons may encounter is “blocked Generativity” wherein the usually Generative individual may find her/himself temporarily lacking in projects or persons to nurture. The “empty nest” or unemployment may impede the customary generative rewards and result in depression. The therapist may aid in helping this person to explore new outlets for their established generative capacity.

Pseudo-Generative

Agentic and Communal. Both of these statuses appear to be generative, but their generativity is somewhat more self-focused than that of the truly Generative individual, and the criteria for inclusion of others are narrower. Agentically Pseudo-Generative persons lavish care upon those others who are essential to the realization of their own goals or projects. They care for their associates only so long as those persons are “on track” and “pulling their load”—all with reference to the Agentic person’s own agenda. Communally Pseudo-Generative individuals appear nurturant and self-sacrificing, but there is always a covert due bill: they require expressions of gratitude and appreciation for their efforts. When these are not forthcoming, the care ceases, and there may be bitter recriminations and mutual disappointment. Both Agentic and Communal persons are likely to appear for therapy hurt and bewildered when their caring efforts are frustrated or unappreciated: they gave so much and received so little in return. The therapist can offer them insight into that part of their care that is self-focused and gently help them to take the interpersonal risks necessary to break up their rigid patterns so that they become more genuinely generative and reap more realistically some of their hoped-for appreciation and mutuality.

Conventional

Conventional individuals restrict their scope of caring to those others who believe and behave consistently with the Conventionally generative person’s prescriptions. When others stray from these, they are disqualified from care. Conventional persons often come into therapy when they are hurt and disappointed by loved ones whom they have alienated and by whom they have been rejected. Wishing “only the best” for them, they cannot understand their rejection. Be-cause their values are often the unexamined ones of the Foreclosure, therapy with Conventionally generative persons is similar to that with Foreclosures except that now the focus is inter- as well as intra-personal. Working successfully with these individuals involves not just facilitating a change in relational style, but also a change in identity. Their values are likely to be examined, per-haps for the first time, and, thereby, become more flexible.

Stagnant, Self-Absorbed

There is a sterility to these individuals who are uninvolved with others and with personally meaningful pro-jects. Erikson suggested that there is a type of Self-Absorbed person who lavishes care on themselves as if they were their one and only beloved child. A Stagnant respondent de-scribed himself in an interview as “a washed-up piece of driftwood.” Working with the Stagnant person involves addressing simultaneously at least Identity, Intimacy, and Generativity. The absence of an attitude of care suggests an unsatisfactory resolution of the Intimacy stage preceding Generativity and likely further back to a shaky or absent Identity. In short, the therapist may mistakenly seek to help the Self-Absorbed person to find a “project,” but the effective-ness of this superficial approach is usually short-lived. An attitude of genuine care cannot be superimposed on a personality structure inadequate to bear it. What is required for Generativity is the strength of an inner Identity and the emotional income from Intimate relationships. The Stagnant person may come to acquire these through psychotherapeutic work that is likely to be lengthy.

Although patients rarely consult psychotherapists for difficulties with Generativity, we often have opportunities to assist patients in considering their forms of Generativity. Stagnant forms of Generativity are likely to produce depression, apathy, and emptiness. As with the challenges of identity, there is often room for exploration and enlargement of the realms of possibility for expression of generative concern. Frequently, therapists help patients become better parents (or parent figures) if there is an opportunity to enlarge their view of care from control to providing support, allowing others to explore their own paths and also to develop other forms of generativity in their own lives. It is useful for therapists to wonder with their patients how they are being creative in their lives or mentoring the next generation in their work.

Integrity

The criteria for the Integrity statuses are commitment to values and beliefs, a sense of continuity with one’s past and with the life cycles of other persons, and positive (non-egoistic) detachment (Hearn et al., 2012).

The life cycle stages of Basic Trust, Identity, and Integrity are, arguably, the most crucial and/or difficult of the psychosocial stages. Trust is foundational for all future stages and its difficult aspect is that it is so dependent upon caretaking by others. Identity furnishes the personality structure that will see the individual through the rest of her/his life after adolescence and it often involves a difficult struggle with uncertainty. Integrity is the life cycle stage wherein the person is challenged by progressive and inevitable loss and by the general lack of social institutions provided for its resolution. All the other stages have a sense of building toward a future; Integrity requires the acceptance of both the past and of the end. How does one maintain Integrity when inner and outer structures are disintegrating? How does one retain a vital sense of oneself when those chosen and cherished others in whom one has invested oneself and to whom one looks for empathetic resonance, are departing with increasing frequency? Often the work contexts within which one constructed a meaningful life are no longer available and the narcissistic income is curtailed. Also, that “confirming context” for one’s identity is gone. A common complaint of parents at Generativity is that children don’t come with user manuals. Certainly old age does not. Stereotypes are not guides and many find themselves living past the age of their parents with no models to emulate. One shrinks and becomes physically less visible. One also shrinks in role and status and becomes less visible socially. Confronted with dwindling social and physical capital, one is thrown back onto one’s own inner resources (Erikson, Erikson, & Kivnick, 1986).

“It is through this last stage that the life cycle weaves back upon itself in its entirety, ultimately integrating mature forms of hope, will, purpose, competence, fidelity, love and care” (Erikson, Erikson & Kivnick, 1986, pp. 55-56), the virtues of the seven earlier stages. People in any of the Integrity statuses (Integrated, Pseudo-Integrated, Non-Exploring, Despairing) that follow might benefit from an existential approach to therapy focused on meanings and talking frankly about death (Yalom, 1980; Yalom & Josselson, 2010).

Integrated

Even though, Lear-like, one is increasingly alone and buffeted by winds of Despair, still the older person has opportunities for psychosocial growth. There is the time and social permission to stop the endless “doing” of Generativity and learn the “being” of Integrity. With less time left, one can become increasingly selective about how one fills it. It seems that at old age, one becomes more definably, for better or worse, whom one has always been (Hearn et al., 2012). If one has sufficient health and resources, one has at last the freedom from caring for the life cycles of others to be what one has most wanted to be. Integrated persons are committed to a set of beliefs, feel connected to others in the present and the past, and have that kind of caring detachment others experience as “wisdom,” the Eriksonian virtue of this stage. There is a sense of wholeness and completeness to the Integrated person, until physical and/or mental decline invariably set in. There is no Integrity without the integration of some feelings of Despair as one contemplates the end of it all. Integrated persons need someone to listen to their (own, singular) story, to bear witness with them to the way in which they traversed their one and only life cycle.

Pseudo-Integrated

These people seem to be patching their lives together with quasi-philosophical slogans which help to suppress the threatening emergence of feelings of disillusionment, disgust, and despair. They maintain a brittle façade of uplifting bromides. Unless their defenses stop working well, and the dike is threatened, Pseudo-Integrated persons do not usually seek therapy. If they do, it might be best to employ crisis intervention techniques, helping them to return to their pre-crisis mode of functioning via shoring up the defenses. If people are in elder care facilities, they might profit from life review approaches that encourage aging people to sift through their memories and come to understand them in new ways, making new meaning of their lives (Haber, 2006; Kenyon, Clark, & de Vries, 2001; Randall & McKim, 2008). Coming to terms with what their life has been can give people greater capacity to accept their present lives, cope with their challenges, and create a more satisfying balance between Integrity and Despair.

Non-Exploratory

Individuals in this status live largely unexamined, although usually satisfying, lives. They seem solid in their commitments and their relationships. They know who they are, which is usually who they have been ever since late childhood. They are Foreclosures grown older, with all of the strengths and weaknesses of that identity status. They do not reflect much on the history and meaning of their lives except according to familiar and unexamined criteria. People in this status are unlikely to present for psychotherapy.

Despairing

Challenges unmet, risks untaken, hearts not opened, the Despairing face the ending period of their life with regrets, self-reproaches, self-disgust. They cannot confirm either their own life cycles or those of others, nor do they feel any sense of affirmation, affiliation with others, or affection. They do not want any more of life and are frequently angry at the cruel trick that their life has played upon them. In contrast to the sunnily optimistic “fix-it” mentality of much of Western technological society, there is little to be done for these people unless one can engage them in relationship. Sometimes they may respond to spiritual counseling.

Inter-Relationship of Statuses

There is likely a developmental trajectory from Identity Achievement to an Intimate status at young adulthood (this has been established empirically – see Orlofsky et al., 1973), to a Generative status at adulthood, and thence, to an integrated status in old age. There is some empirical evidence for a relationship between Identity Achievement and Integrity (Hearn et al., 2012). Similarly there is an hypothesized linkage from a Foreclosed Identity to a Stereotyped style of Intimacy, to Conventional Generativity, and, thence, to Non-Exploratory Integrity. All have in common a particular kind of defensive process: one based upon a fear of considering alternatives, of exploring, and a consequent need to block out information that would disconfirm current beliefs and life decisions (Berzonsky, 2011). This fear likely goes back to early childhood in which physical exploration may have been met with shaming and withdrawal of love. The process involved in these status linkages of psycho-social stage resolutions may be described in Piagetian terms as preferences for accommo-dation or assimilation that are cognitively expressed while being emotionally based. Similarly, there is likely a connection between Identity Diffusion, Isolation at Intimacy, Stagnation and Self-Absorption at Generativity, and Despair at Integrity.

Case Examples

Josh

Josh came into the university psychological clinic complaining of test anxiety. Even when he felt that he had thoroughly studied the exam material, he froze when confronted with the questions and could neither gather his thoughts nor express them coherently. Therapists, depending on their theoretical orientation, might approach this problem in a variety of ways. If the therapist employs a symptom reduction model, she will focus on the anxiety and its parameters. If she uses a more broadly developmental approach, she will also be interested in the subject area of the exams and its meaning for Josh. Doing so, she would find that Josh, a sophomore, is on a pre-med track, guided there by his parents who have his life fairly well planned out for him. A problem is that he has always been fascinated, not with medicine, but with birds. From his pre-teenage years, he has watched birds, drawn them, learned their names and their songs. He has harbored a desire to become an ornithologist, a wish he cannot share with his easy-to-disappoint parents. Thus, when he faces exams in his pre-med pre-req courses, he does so with feelings of oppression, conflict – and, finally, anxiety. Not only have his well-meaning parents decided what area he is to study, they have subtly made their love and approval contingent upon superior performance in this area.

Is the focus of treatment here to be test anxiety or identity? Should the therapist undertake to reduce the symptom of test anxiety? Might not anxiety in this context be viewed as a positive and necessary step in Josh’s psychosocial development?

When he came into the counseling center complaining of “test anxiety,” his therapist listened carefully and, informed by develop-mental personality theory, pieced together a tentative formulation that went well beyond anxiety reduction. She saw a young man possibly emerging from a Foreclosed identity who might be set to embark upon a Moratorium period. She knew that the process which they would likely undergo together would be stressful She listened attentively and impartially to his recounting of his life, his dreams for himself, his parents’ and grandparents’ dreams for him, and his fear of an uncertain future should he depart from his established trajectory.

Where the therapist has an appreciation for the challenges of identity formation, psychotherapy can, and does, catalyze the identity formation process. It helps people to sort themselves out and supports them in doing what they want but fear to do. At very least, it offers them new language and perspective with which to understand themselves. Thoughtful revision of one’s life always involves coming to a better understanding of oneself. As people grow, most begin to see their own repetitive patterns. And this consciousness illuminates the undergirding of past choices and liberates the future from the bondage of the past.

Understanding the varieties of later stage resolutions assists us in analyzing what may have happened in Josh’s family. Where were his parents in terms of their predictable life cycle crises in ego growth? There is inevitably intergenerational mutuality involved in the resolution of these crises. Josh’s father, a child of immigrants, was the high school star quarterback and an honor student. His mother, Joan, from a long established Mid-west middle-class family, was captain of the cheerleading squad. This “golden couple” went to the same state university together. John embarked upon his pre-med courses, but before his senior year the economy collapsed, his scholarship was canceled, and he was forced to declare a liberal arts major in order to graduate quickly and get a job. John and Joan married soon after graduation. Both of them worked – Joan teaching in elementary school and John selling insurance. John eventually rose to a middle management position in the insurance company. Mean-while, Josh was born when both parents were in their early 30s. He was much welcomed by parents and grandparents. He was to be Joan and John’s only child and he became the repository of their delayed dreams. As Joan was fond of saying: “We put all our eggs into one basket.”

The whole family saw Josh as the perfect child with only one notable peculiarity: he was an avid birdwatcher. His parents considered this as a bit aberrant and a distraction from the life they had envisioned for him: to fulfill his father’s suspended dream by becoming a successful physician. They treated the birdwatching as simply a pleasant, though frivolous, hobby.

Using the Eriksonian framework, we might wonder how Josh’s parents resolved their Intimacy and Generativity issues. To all appearances, John and Joan were “happily married.” Conflict was almost absent, as if they had agreed to never disagree, suggesting a Pseudo-Intimate style of Intimacy. The therapist recognized that if Josh were to switch out of pre-med, into ornithology, this would impact his parents’ own identities, their sense of Generativity, and possibly the nature of their Intimate relationship with each other. Crises in one part of a system beget crises throughout the system. Given the embeddedness of Josh with his parents, the changes wrought with Josh as he begins to formulate his new identity would surely have an effect on his parents’ further psycho-social development. There might come a time in the therapy when the therapist would want to invite his parents into a session with Josh to explore the meanings of his choices for their own developmental histories.

Arnold

Arnold is a 45-year-old economist who seeks therapy because, having gained some fame in his profession, he fears doing TV interviews which he is often asked to do. Although he has been highly successful, he is not sure how meaningful his work is to him, and he feels a pervasive “sense of doom.” Arnold has been divorced for three years and has had brief relationships with other women but these have been friendly connections mainly for sex. He is intensely engaged in raising his 6-year-old son. The only passion in his life is bodybuilding. The “sense of doom” respond-ed well to medication and gave Arnold some relief such that he “felt better” but the question of where he was going in his life remained.

Arnold seemed to have chosen his occupational path on his own terms and was highly successful in his work, but he seemed to be in a period of exploration in regard to what he wished to accomplish. Was this a Generativity concern or one of Identity? His involvement with his son suggested that he was, in Eriksonian terms, tending to the next generation. Although he said that he was satisfied with his relationships and did not wish to have another exclusive relationship, there seemed to be some dilemmas around Intimacy. Arnold cried easily whenever he thought about his divorce, but his grief centered around the loss of the structure of family rather than about loss of the relationship with his wife.

Indeed, as the therapist explored his life more, it emerged that he had never had an intimate relationship with Lynn, whom he met in graduate school. They kind of “fell in” together, married, had a child and then she met another man and initiated divorce. Arnold had never been able to share himself deeply with her and never understood her; he had mainly tried to manage or comply with her demands. Nor did he understand why she had, in effect, left him. His reluctance to enter a new relationship related to his fear of having another divorce. Arnold, then, seemed to exemplify the Pseudo-Intimate intimacy status. Although he seemed to have adequately resolved the Identity and Generativity stages, his having only superficially dealt with issues of Intimacy were now blocking his further developmental progress. This was a clue to place the therapeutic focus on his capacity to be close to and share himself with others and led Arnold to come to a different under-standing of his early development with devoted but emotionally absent parents. In the therapeutic relationship, he began to experiment with expressing his feelings and to experience emotional closeness with his therapist.

As the therapy progressed still more, it emerged that Arnold’s “falling in” with his wife in graduate school was a way of not having to make identity-related decisions. He left these to her – deciding where he would work and how. The therapist began to understand that what appeared at first to be Identity Achievement was more akin to Identity Diffusion, despite Arnold’s professional success. Although Arnold was not about to rethink his career choice in his mid-40s, he did begin thinking more, in therapy, about what kind of economist he wanted to be and he also began exploring his spirituality. Although not directly related to his initial symptoms, this therapeutic work led to a more robust sense of identity which showed in his feeling of greater “presence” in his life. Arnold also began to be able to tolerate, with therapeutic support, a sense of vulnerability as he entered into new romantic relationships.

Florian

When Florian entered therapy around age 35, he presented as attractive, slim, dark, and extraordinarily self-absorbed. Given that he was in a helping health profession, the latter quality was unexpected. A colleague filling in for his primary therapist described him as “the most narcissistic man I’ve ever met.” He was not married and his sexual orientation seemed ambiguous. His relationships with women were shallow and somewhat exploitative, an Intimacy status mixture of Stereotyped and Isolate. His stated concern was anxiety over self-presentation: he found himself too emotionally reactive with colleagues and patients.

The untypically long treatment, almost 15 years, provided an opportunity to learn something about the unfolding of the Eriksonian stages as they appeared in the therapy. The first five years of on-and-off therapy were spent largely in the therapist’s absorbing Florian’s often tedious self-laudatory paeans coupled with occasional contempt for the therapist. During this period, he came to be able to use what he learned from a holding, mirroring therapeutic relationship to control his emotional lability and to request occasional “guidance.” He struggled with developing some Basic Trust in the therapist. This issue was largely settled when, after 5 years of sporadic work together, Florian was seriously injured in an Icarus-like fall while hang-gliding and the therapist made some unaccustomed “house calls” as he lay immobilized in his apartment.

Only after about 8 years of periodic meetings did Florian settle into regular sessions and deeper exploration. At some point during this time, given his interest in music, the therapist suggested that he might like to join a choir. Knowing of his therapist’s interest in music, he blurted out: “But I don’t want to be like you!” This cri de coeur spoke of early difficulties with Autonomy which, in terms of his current situation, were still problematic. Therapist and patient began to under-stand that Florian had not really chosen his profession but was pushed into it by his mother and a family friend. He would have preferred something in the arts. His father was disparaging and unsupportive of him while he was growing up (a common precondition for Identity Diffusion) and often shamed him. As we traced Florian’s psychosocial history over many months, we found a toddlerhood marked by a preponderance of Shame, an early childhood Initiative period overstimulated by a doting mother and undersupported by an emotionally absent and competitive father. Industry was fairly intact. But Identity resolution was plagued by the old Autonomy issues, exacerbated by new shaming incidents, and he found himself unable to resist his parents’ pressure to enter a prestigious profession whose daily demands for caring for others he found onerous. With insufficient internal Identity resources, Intimacy at young adulthood became problematic and he was not able to pursue steadfastly the “one woman” whose loss he regrets to this day. His view of women was that they are primarily exploitative. He was skeptical that he could be genuinely cared for.

Now, at adulthood and facing Generativity from an essentially Self-Absorbed position, he is beginning to become caring of his patients. He still finds the day-to-day clinical work tedious, but on a recent professional questionnaire, he cited as his “most valued achievement” a patient whom he had treated successfully. He is becoming self-reflective; his self-inflation and contempt for the therapist have diminished greatly. Although he resents the imposition of mundane necessities such as financial recordkeeping, he has begun to act realistically in his self-interest and procrastinates less. Having grown up in a very “serious” household, he has a hearty appetite for “play” which takes the form of building flying model airplanes, now that hang-glidiing is unavailable. He is embarking on a self-improvement program of diet, decreased drinking, and increased exercise. He is doing some realistic financial planning so that he can build a vacation home for himself, and he has begun to approach some eligible women.

The therapeutic work with Florian may be construed as 15 years of reparenting: starting at his current adult Generativity position as a competent professional, we have journeyed back to the loveless young man at Intimacy, to the lonely adolescent unable to forge his own Identity, and, finally, to early childhood – engaging, encouraging, and supporting a healthy sense of Autonomy. The quest itself was possible only once he was able to establish some Basic Trust in the therapist. His current advances in Generativity may spring largely from his identification with his therapist’s steadfastly caring stance with him.

Case Formulation Summary

Although the “symptoms” in each of the above cases are related to anxiety, the developmental context of each is quite different. Each of these patients needed help with different developmental challenges and an Eriksonian framework helps to clarify what these challenges may be. Erikson’s theory does not tell us how to intervene in terms of specific therapeutic techniques, but it does tell us where. For Josh, the point of intervention was in the present, with his current identity crisis. In Arnold’s case, the theory points us to unresolved issues of Identity and Intimacy in an adult man who seems to have managed well with Generativity concerns. It suggests that perhaps for him it is some unresolved Identity issues that led him not to fully engage the Intimacy stage issues when they were developmentally ap-propriate. Florian faced numerous incompletely resolved life cycle issues and his already lengthy therapeutic journey continues as the therapist strives to provide a “better-than-average” developmental context (i.e., psychotherapy) in which previously unresolved issues can be re-addressed and resolved.

Conclusion

Erikson’s is the most comprehensive and empirically validated theory of development, but it does not furnish specific interventions when development goes awry. These interventions are up to the therapist to acquire and may be drawn from areas as diverse as gestalt, CBT, object relations, self psycho-logy, narrative therapy, psychodrama, and so forth. What Erikson’s theory provides is a developmental overview, a descriptive language for where the individual stands currently within a psychosocial developmental context, where he/she might have gotten “stuck” in the past, and where she/he is heading. The theory also furnishes realistic developmental goals. It can refocus a therapist’s perspective from considering only pathology and the past to include also the formation of ego skills and strengths needed to move toward a specific future. Any techniques employed within this framework must be tailored to account for the patient’s age and psychosocial stage.

Therapists informed by Eriksonian stage theory tend to look at where the patient is in the life cycle and how well he or she is adapting to the “normative” crisis of his or her age group (Erikson, 1964) within the context of his or her social position. Internal conflict remains of concern but early conflicts are understood in the context of the immediate psychosocial world. Patients’ senses of their personal history change as the developmental stages unfold and the meanings they make of early (or later) experiences change to reflect current challenges and necessities (Josselson, 2009).

The Eriksonian framework provides a holistic view of the patient, and the compendium of empirical validation has provided some necessary scientific justification for its utility (Singer, 2005). The overarching therapeutic stance from this point of view is that the therapist becomes “the guardian of lost life stages: ideally speaking, our work should at least provide a meaningful moratorium, a period of delay in further commitment” (Erikson, 1964, p. 97).

In terms of research, defining the focus of therapy as problems in living or develop-mental stage resolution provides a different framework for “counting” treatment out-comes than does symptom abatement. In addition, Erikson’s language about the stages is experience-near enough for use with patients who may value growth in Identity, Intimacy, Generativity, and Integrity as goals that stress virtues rather than emphasize pathology. Future research might assess the status of development in the Eriksonian stages before and after psychotherapy as a way of demonstrating the therapeutic action that propels stalled development. Erikson’s theory locates the individual in his social world and directs the therapist’s attention to how the patient navigates and negotiates that world.