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Cherryl Velasco Francia, M.D., D.P.B.P.

Psychiatry and Behavioral Medicine





            1. To define and describe Freud’s oral stage of psychosexual development

            2. To discuss Erikson’s proposed stage one of the life cycle

            3. To discuss Mahler’s developmental stages

            4. To discuss Winnicott’s theory of Good Enough Mothering

            5. To define attachment

            6. To discuss and compare attachment theories according to Harlow, Bowlby and Ainsworth

            7. To discuss the sensorimotor stage of cognitive development of Piaget

            8. To discuss the psychopathology that results in fixation at the infantile stage


Freud’s Oral Stage


          First 18 months of life

          Infant’s needs, perceptions and modes of expression primarily centered to oral zone

          oral sensations - hunger , thirst, swallowing,

          oral triad - wish to eat, sleep, relax at the end of sucking

          Objective : establish a trusting dependence on nursing and sustaining objects

          successful resolution: trust, self-reliance, independence

          excessive gratification and deprivation : excessive optimism, pessimism, narcissism and demandingness, excessive dependence, envy and jealousy


Erik Erikson’s Stage One of the Epigenetic Principle


          Trust versus mistrust

          Trust is the expectation that one’s needs will be taken care of and that the world or outer providers can be relied upon

          trust-inducing mother attends to primary needs of the infant

          consistency and sameness of experiences

          trust shown by ease of feeding, depth of sleep, smiling,  bowel relaxation ==> hope, optimism and confidence ==> willing to let go of mother without anxiety or rage (mental image of mother has formed)

          impaired trust --> mistrust : anaclitic depression, hopelessness, dysthymia, schizoid personality, schizophrenia, substance related disorders, starved for sensual and visual stimulation


Margaret Mahler’s Developmental Stages


          Normal Autism

          Normal Symbiosis





         object constancy


Margaret Mahler’s Normal Autistic Stage


          0-1 month; undifferentiated

          sleep-wake cycle

          primitive hallucinatory orientation

          task:   achieve a balance, homeostasis or equilibrium outside the womb

          infant cannot differentiate between its own attempts to reduce tension and the actions of the mother to reduce tension


Margaret Mahler’s Normal Symbiotic Stage


          Second month of life

          autistic shell begins to crack

          mother and child as dual entity

          infant has dim awareness of the need-satisfying object

          hallucinatory or delusional omnipotent fusion of mother and child


Margaret Mahler’s Separation-Individuation Stage


          Separation- psychological differentiation, and distancing, disengagement from the mother

          Individuation - evolving intrapsychic autonomy

          child achieves separate functioning in the process of and with the emotional availability of the mother


Margaret Mahler’s Separation-Individuation (Differentiation) Stage


          4-5 months :baby distances its body slightly from mother and begins to break away

          developing motor skills

          7-8 months : checking back to the mother as point of orientation;  scan and compare familiar from unfamiliar objects



Margaret Mahler’s Separation-Individuation (Practicing) Stage


          10-18 months

          crawling, standing, free upright walking

          child ventures away from mother and gets absorbed in her own activities, oblivious  to mother’s presence;  “ no period”

          explores outside world

          culminates in free walking


Margaret Mahler’s Separation-Individuation (Rapprochement) Stage


          18-24 months

          child moves away from mother and comes back for reassurance

          child realizes his helplessness and dependence, the need for independence alternates with the need for closeness

          child accepts physical separation and shares activities with mother


Margaret Mahler’s Separation-Individuation (Object-Constancy) Stage


          2-5 years

          child gradually comprehends and reassured of the permanence of mother and other important people, even when not in their presence


         1. Attain object constancy

         2. Consolidate individuality




          Emotional tone between child and caregiver evidenced by the infant’s seeking and clinging to the caregiving person, usually the mother

          promotes proximity to the desired person

          secure attachment = healthy relationships

          bonding - mother’s feelings for her infant


Attachment: John Bowlby


          crucial to health development

          warm intimate and continuous relationship with the mother in whom both find satisfaction and enjoyment

          develops gradually ==> security

          to be with a preferred person perceived as stronger, wiser and able to reduce anxiety



Attachment:   Harry Harlow


            Demonstrated the emotional and behavioral effects of isolating monkeys from birth and keeping them from forming attachments à isolates became withdrawn, unable to relate to peers, unable to mate and care for their offspring


Attachment: Mary Ainsworth


E       Interaction between mother and baby

E       sensitive responsiveness to baby’s signals,  close bodily contact à healthy growth and self-reliance

E       attachment reduces tension and anxiety

E       secure base effect


Phases of Attachment


*      Preattachment (0-12 weeks): baby orients to mother, follows or turns to mother’s voice

*      Attachment in the making (8wks-6mos): attached to more people in the environment

*      Clear-cut Attachment (6-24mos) baby cries,  distressed when separated from mother

*      Last phase (25mos-3 y.o.) tolerates separation  from mother without so much anxiety


Donald Winnicott


C         Environment has a vital role in the formation of self

C         Good Enough Mothering

C         infant depends on provisions of the environment and environment adapts itself to the changing needs of the infant.


Jean Piaget’s Sensorimotor Stage of Cognitive Development


          Infants begin to learn through sensory observation

          gain control of motor functions through activity, exploration,manipulation of the environment

          biology and experience à learned behavior

          Objective : object permanence

          object permanence : ability to understand that objects have an existence independent of the child’s involvement of them

          object - not inhuman things but someone toward whom desire or action is directed; that with which a subject relates


Piaget’s Sensorimotor Period of Cognitive Development


            0–2 mos: inborn motor and sensory reflexes (sucking, grasping, looking) to interact and accommodate to external world


            2–5 mos: Primary Circular Reaction –

            coordinates activities of own body and senses

            subjective reality

            does not seek stimuli outside visual field

            displays curiosity


            5–9 mos: Secondary Circular Reaction

            seeks out new stimuli in the environment

            anticipate consequences of behavior

            act purposefully to change environment

            intentional behavior


            9-12 mos: early signs of object  permanence

            vague concept that objects exist apart from self plays peekaboo; imitates novel behaviors


            12–18 mos: Tertiary Circular Reaction – seeks out new experiences

            produces novel behaviors


            18–24 mos: Symbolic thought

            symbolic representations of event and objects shows signs of reasoning attains object permanence