Geries Shaheen • March 25, 2023

Understanding Erikson's Stages of Psychosocial Development

Erik Erikson's theory of psychosocial development is a widely accepted and highly regarded framework for understanding human development from infancy to old age. Erikson believed that individuals go through eight distinct stages of development, each with its unique set of psychosocial challenges and opportunities. In this article, we will explore each of Erikson's stages of psychosocial development and discuss ways to utilize this model in mental health counseling sessions.


Stage 1: Trust vs. Mistrust (Birth to 18 Months)

The first stage of psychosocial development occurs from birth to 18 months. At this stage, infants learn to trust or mistrust their environment and caregivers based on how their needs are met. If their needs are consistently met with warmth, comfort, and care, they develop a sense of trust in the world. Conversely, if their needs are neglected or met inconsistently, they may develop a sense of mistrust.

Counseling Application: In therapy, it's essential to establish a safe and nurturing environment to build trust with clients. As a therapist, it's crucial to show warmth, empathy, and non-judgmental support. By providing a safe and caring environment, clients can begin to build trust and feel comfortable opening up.


Stage 2: Autonomy vs. Shame and Doubt (18 Months to 3 Years)

During this stage, toddlers begin to develop a sense of autonomy and independence. They want to do things on their own and assert their independence. If caregivers encourage this behavior, toddlers develop a sense of autonomy. Conversely, if caregivers are overly restrictive or critical, toddlers may develop shame and doubt about their abilities.

Counseling Application: In therapy, it's crucial to acknowledge clients' need for autonomy and independence. Encourage clients to make their own decisions and take charge of their lives. Help them explore their strengths and abilities and provide positive reinforcement to build their confidence.


Stage 3: Initiative vs. Guilt (3 to 6 Years)

During this stage, children begin to explore their world and develop a sense of initiative. They want to try new things and take on new challenges. If caregivers support and encourage this behavior, children develop a sense of initiative. Conversely, if caregivers are overly critical or dismissive, children may develop a sense of guilt.

Counseling Application: In therapy, it's crucial to help clients explore new possibilities and take on new challenges. Encourage them to set goals and work towards achieving them. Help them develop a sense of accomplishment and pride in their achievements.


Stage 4: Industry vs. Inferiority (6 to 12 Years)

During this stage, children begin to develop a sense of industry and competence. They want to learn new skills and take on more significant challenges. If caregivers support and encourage this behavior, children develop a sense of industry. Conversely, if caregivers are overly critical or dismissive, children may develop a sense of inferiority.

Counseling Application: In therapy, it's crucial to help clients develop a sense of competence and achievement. Encourage them to explore new skills and interests, and provide positive reinforcement for their efforts. Help them develop a sense of pride and accomplishment in their achievements.


Stage 5: Identity vs. Role Confusion (12 to 18 Years)

During this stage, adolescents begin to explore their identity and establish a sense of self. They try on different roles and experiment with different behaviors to discover who they are. If caregivers support and encourage this behavior, adolescents develop a sense of identity. Conversely, if caregivers are overly critical or dismissive, adolescents may experience role confusion and a lack of direction.

Counseling Application: In therapy, it's crucial to help clients explore their identity and develop a sense of self. Encourage them to explore their interests and passions, and help them identify their values and beliefs. Assist them in developing a sense of direction and purpose in life. Validate their experiences and provide a supportive environment for them to express themselves.


Stage 6: Intimacy vs. Isolation (18 to 40 Years)

During this stage, young adults begin to establish intimate relationships with others. They seek emotional and physical connections with others and form lasting bonds. If young adults are successful in developing these relationships, they experience intimacy. If they fail to establish these connections, they may feel isolated and alone.

Counseling Application: In therapy, it's crucial to help clients develop healthy and meaningful relationships with others. Provide support and guidance in navigating the challenges of intimate relationships. Encourage clients to communicate effectively, set boundaries, and practice self-care.


Stage 7: Generativity vs. Stagnation (40 to 65 Years)

During this stage, middle-aged adults begin to focus on their contribution to society and the next generation. They seek to make a positive impact on the world and leave a lasting legacy. If they are successful in these endeavors, they experience generativity. If they fail to make a meaningful contribution, they may feel a sense of stagnation.

Counseling Application: In therapy, it's crucial to help clients explore their values, passions, and goals. Encourage them to find ways to make a positive impact on their community and the world. Assist them in developing a sense of purpose and fulfillment in their lives.


Stage 8: Integrity vs. Despair (65 Years and Older)

During this stage, older adults reflect on their lives and seek to find meaning and purpose in their experiences. They may experience a sense of satisfaction and fulfillment if they have lived a meaningful life. Alternatively, they may experience despair if they feel that their life has been wasted.

Counseling Application: In therapy, it's crucial to help clients reflect on their lives and find meaning and purpose in their experiences. Encourage them to focus on their strengths and accomplishments and find ways to continue to make a positive impact on the world. Provide support and guidance in navigating the challenges of aging and help them find ways to maintain their independence and quality of life.


Erikson's theory of psychosocial development provides a comprehensive framework for understanding human development across the lifespan. By understanding the challenges and opportunities of each stage, mental health therapists can provide tailored interventions to support clients' growth and development. Utilizing this model in therapy sessions can help clients develop a sense of self-awareness, purpose, and fulfillment in their lives.

Erikson's theory proposes that at each stage of life, individuals face a specific psychosocial crisis that must be resolved in order to progress to the next stage. When individuals successfully resolve the crisis, they develop a specific virtue or strength that enables them to navigate future challenges.


Here are the virtues attained from each stage:


Trust vs. Mistrust (Birth to 18 months) - The virtue of hope: If infants receive consistent and responsive care from their caregivers, they develop a sense of trust in the world around them. This trust allows them to feel hopeful and optimistic about the future.


Autonomy vs. Shame and Doubt (18 months to 3 years) - The virtue of will: If toddlers are encouraged to explore their environment and make choices for themselves, they develop a sense of autonomy and independence. This allows them to develop a strong sense of will and self-control.


Initiative vs. Guilt (3 to 6 years) - The virtue of purpose: If young children are encouraged to take initiative and explore their environment, they develop a sense of purpose and direction in life. This allows them to feel a sense of accomplishment and pride in their achievements.


Industry vs. Inferiority (6 to 12 years) - The virtue of competence: If children are encouraged to master new skills and succeed in academic and social endeavors, they develop a sense of competence and confidence. This allows them to feel capable and successful in future endeavors.


Identity vs. Role Confusion (12 to 18 years) - The virtue of fidelity: If adolescents successfully navigate the challenge of developing a sense of identity, they develop a sense of fidelity or loyalty to themselves and others. This allows them to develop a clear sense of values and beliefs that guide their decision-making in adulthood.


Intimacy vs. Isolation (18 to 40 years) - The virtue of love: If young adults are successful in developing meaningful and intimate relationships with others, they develop a sense of love and connection. This allows them to form lasting bonds with others and experience deep emotional fulfillment.


Generativity vs. Stagnation (40 to 65 years) - The virtue of care: If middle-aged adults are successful in making a positive contribution to society and the next generation, they develop a sense of care and concern for others. This allows them to feel fulfilled and satisfied with their accomplishments.


Integrity vs. Despair (65 years and older) - The virtue of wisdom: If older adults reflect on their lives and find meaning and purpose in their experiences, they develop a sense of wisdom and acceptance. This allows them to feel at peace with their life's journey and to share their insights with future generations.


By developing these virtues, individuals are better equipped to navigate the challenges of life and to find fulfillment and purpose in their experiences. Mental health therapists can help clients develop these virtues by providing guidance and support as they navigate each stage of development.


Regression is a common phenomenon that occurs when individuals revert to earlier patterns of behavior or thought in response to stress, anxiety, or other challenges. When individuals regress, they may exhibit symptoms that are typical of earlier stages of development, even if they have already progressed through those stages. Here are some common symptoms related to regression:


Withdrawal: Individuals who regress may withdraw from social situations, become isolated, and avoid social interactions.


Tantrums: Regression may manifest as temper tantrums or outbursts of emotion that are typical of earlier developmental stages.


Sleep disturbances: Regression may cause sleep disturbances, such as difficulty falling or staying asleep, nightmares, or night terrors.


Regression in daily habits: Clients may stop doing things they were previously able to do, such as brushing their teeth, taking showers or dressing themselves.


Regression in communication: Clients may use baby talk or simple language or lose their vocabulary altogether.


Anxiety: Regression can cause anxiety or fear related to a particular situation or object, such as separation anxiety or fear of the dark.


Helplessness: Clients may feel helpless and dependent, expecting others to do everything for them.


For example, a client who is struggling with intimacy in their relationships may regress to stage 5 (Identity vs. Role Confusion) and struggle with developing a sense of self. This can prevent them from successfully navigating stage 6 (Intimacy vs. Isolation) and developing meaningful connections with others. If left unresolved, the client may continue to struggle with intimacy and become stuck in earlier stages of development.


In post-traumatic stress disorder (PTSD), regression is often seen as a way for the client to cope with the traumatic experience. A study found that 53% of patients with PTSD experienced symptoms of regression, such as avoidance or withdrawal.


Similarly, a study on depression found that 42% of patients exhibited regressive behavior, such as clinging to others or exhibiting temper tantrums. In borderline personality disorder, regression is seen as a maladaptive coping mechanism that can lead to impulsive or self-destructive behaviors.


It's important for mental health therapists to be aware of these common symptoms related to regression and to help clients overcome them in therapy. By addressing regression, therapists can help clients progress through each stage of development and develop the virtues associated with each stage, leading to greater personal growth and fulfillment. It's essential for therapists to recognize when clients are regressing and provide support and guidance to help them move forward. Here are some ways therapists can help clients overcome regression:


  1. Validate the Client's Experience: It's important for therapists to acknowledge and validate the client's feelings and experiences. This can help build trust and provide a safe space for the client to express themselves.



2. Help Clients Identify Triggers: Identifying triggers that cause clients to regress can help them anticipate and prepare for potential setbacks. This can help clients develop coping mechanisms and prevent them from becoming stuck in earlier stages.


3. Encourage Clients to Practice Self-Care: Encouraging clients to practice self-care can help them manage stress and anxiety that can lead to regression. This can include activities such as exercise, mindfulness, and relaxation techniques.


4. Provide Tools for Growth: Providing clients with tools and techniques to manage stress and anxiety can help them progress through each stage of development. This can include cognitive-behavioral therapy, interpersonal therapy, and other evidence-based interventions.


By addressing regression in therapy, therapists can help clients overcome obstacles and progress through each stage of development, developing the virtues associated with each stage. This can help clients live a more fulfilling and purposeful life, and achieve a sense of self-awareness and personal growth.


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Geries Shaheen is a Licensed Professional Counselor and Nationally Certified Counselor operating in and around St. Louis Missouri. Geries holds his MA in Professional Counseling from Lindenwood University, BA in Intercultural Studies from Lincoln Christian University, and holds a certificate in Life Coaching, Geries provides life coaching services to clients online globally. Geries is EMDR trained and DBT Certified, practicing from a TIC lens.The body content of your post goes here. To edit this text, click on it and delete this default text and start typing your own or paste your own from a different source.

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Provisionally Licensed Therapist Intro Script

By Geries Shaheen • October 22, 2026
For a new client (and therapist), the first session can carry plenty of unspoken questions: What am I expected to share? Who will hear about it? What if I’m not ready to talk? Before exploring what brought someone through the door, therapists have an opportunity to make the process clearer, and invite the client into a working partnership. A thoughtful introduction brings together warmth, informed consent, professional boundaries, and client choice. For provisionally licensed counselors, it also means explaining supervision in a way that feels transparent and reassuring. The template below offers a starting point for that conversation. Adapt it to your voice, your practice’s policies, and the person sitting across from you, leaving room for questions along the way. “Hi, I’m _____, a provisional licensed professional counselor in Missouri. I’m glad we could find a time to meet. “You mentioned _____ in your intake paperwork. Today, I’d like to understand those concerns in your own words, learn what you hope will change, and talk together about how I can help. “Before we begin, I want to review a few things about counseling. I practice under the clinical supervision of _____, LPC. My supervisor reviews my clinical work, and we may discuss your care and review relevant records as part of that supervision. “Counseling can help you understand patterns, develop skills, and work toward changes that matter to you. Sometimes discussing difficult experiences brings up uncomfortable feelings. You can tell me when something feels overwhelming, ask to pause, or let me know when an approach is not helping. “Your privacy matters. What you share is confidential, with certain limits explained in our consent paperwork. These include legally required reports of suspected abuse or neglect, situations involving serious safety concerns that may require protective action, and disclosures required by applicable law or a court order. If a legal request for information comes in, we review the requirements before responding. Whenever possible and appropriate, I will discuss a necessary disclosure with you first. “You can talk openly about thoughts of suicide or harming yourself. Having those thoughts does not automatically mean hospitalization; I will ask questions so we can understand your safety needs and determine the appropriate support. “I use _____ approaches. I’ll explain what I recommend, why it may help, and any relevant risks or alternatives. You can ask questions, decline an intervention, and give me feedback. “You’re in the captain’s chair when it comes to your goals and choices. My role is to bring structure, clinical guidance, and attention to safety. We’ll develop a treatment plan together and revisit it as your needs change. If we find that another therapist or service would better meet your needs, we can discuss that and appropriate referrals. “[Review session arrangements, fees, communication boundaries, emergency procedures, and any setting-specific confidentiality policies.] “What questions or concerns do you have about what we’ve reviewed? Are you comfortable proceeding? “What brings you here at this point in your life, and what would you most like help with?” Additional checkboxes: For the remaining first-session checklist, I would add: ☐ Session length, frequency, fees, insurance, and cancellation expectations. ☐ How to contact the therapist, expected response times, and what to do during an emergency or outside office hours. ☐ How records are maintained, who can access them, and any applicable billing disclosures. ☐ Questions, understanding, and documented consent to proceed. ☐ When applicable: telehealth location/privacy/disconnection procedures; guardian involvement and minor confidentiality; couples/group confidentiality policies; mandated treatment and what gets reported to the referring party. ☐ Separate explanation and consent for recording or observation, if used. A clear introduction sets the stage. How you manage the rest of the session helps turn those words into a therapeutic experience. Here are ten practical tips for keeping initial sessions welcoming, purposeful, and within the allotted time. Set a flexible agenda together. Briefly explain what today will include: introductions, informed consent, understanding the client’s concerns, and identifying next steps. Ask what the client most wants to make sure you address. Maintain a steady cadence. Give clients room to think, feel, and respond while keeping an eye on the clock. Use gentle transitions rather than rushing through questions or allowing the opening discussion to consume the entire session. Make time checks collaborative. Try, “We have about twenty minutes left. What feels most important to spend that time on?” This helps clients participate in prioritizing the conversation. Prepare the client for the ending. Offer a reminder about ten minutes before the session ends, then begin closing with enough time to summarize, check emotional readiness, and discuss next steps. A predictable ending helps prevent the client from feeling abruptly cut off. Be thoughtful about opening difficult material late in the session. If a significant concern emerges near the end, acknowledge its importance and assess immediate needs. Collaborate on what can be addressed today and what needs dedicated time next session. Safety concerns require appropriate assessment and action regardless of the clock. Take concise, precise working notes. Capture clinically relevant themes, meaningful changes, interventions provided, the client’s response, and follow-up needs. Brief phrases can support accurate progress-note writing later without turning the session into a transcription exercise. Store all notes according to practice policy and privacy requirements. Keep your attention with the client. Explain why you may jot down a few notes, maintain natural eye contact, and pause writing during emotionally significant moments. Your notes should support your presence in the room. Check understanding in small pieces. Pause during the introduction and informed-consent discussion. “What questions does that bring up?” often invites more conversation than “Does that make sense?” Give the client space to clarify concerns before moving on. Reflect before moving to solutions. Summarize what you understand and ask whether you have it right. Initial sessions can feel crowded with assessment tasks; a brief reflection helps the client feel heard and keeps your clinical understanding grounded in their experience. Close with a shared summary and a clear next step. Identify the main themes, ask what felt useful or difficult, and agree on the next focus. Confirm scheduling and any between-session plan. Complete the progress note promptly afterward, while your recollection is fresh. Use OARS to keep the conversation collaborative. Incorporate open-ended questions, affirmations, reflections, and summaries throughout the session. Balance questions with reflections so the client feels heard rather than interviewed. Affirm specific strengths and efforts, and use summaries to check your understanding and transition between topics. Maintain an ongoing mental status lens. Quietly observe the client’s presentation throughout the session, including appearance, behavior, speech, mood and affect, thought process, attention, and orientation. Integrate these observations naturally rather than treating the Mental Status Examination (MSE) as a separate interrogation. Ask direct questions when clarification is needed, and document only what you observed or assessed; areas such as thought content, perception, and safety cannot be established through observation alone. Begin developing a diagnostic formulation. Organize the information gathered into possible explanations for the client’s concerns. Consider symptom duration, severity, functional impact, history, cultural context, and potential medical or substance-related contributors. Keep early impressions tentative, distinguish the client’s report from your observations, and identify what additional assessment is needed. Bring diagnostic questions and competing explanations to supervision rather than rushing to a conclusion. The first session does not need to answer every question or uncover every part of a client’s story. It should give the client a clearer understanding of counseling, an opportunity to feel heard, and a voice in what happens next. For developing therapists, balancing connection, assessment, documentation, and time takes practice. Use this introduction and these tips as a flexible guide, then bring your questions and observations to supervision. Notice what helped the conversation flow, where you felt rushed, and what you want to approach differently next time. Aim to end the session with the client knowing three things: what to expect, how they can participate, and that their concerns have been taken seriously. Geries Shaheen is a Licensed Professional Counselor and Nationally Certified Counselor operating in and around St. Louis Missouri. Geries holds his MA in Professional Counseling from Lindenwood University, BA in Intercultural Studies from Lincoln Christian University, and holds a certificate in Life Coaching, Geries provides life coaching services to clients online globally. Geries is EMDR trained and DBT Certified, practicing from a TIC lens.

DSM-6: What We Know, What’s Being Discussed, and What Licensed Professional Counselors Should Understand

By Geries Shaheen • August 11, 2026
Conversations about DSM-6 are growing louder in professional spaces . Industry leaders, researchers, and clinicians are sharing insights about what the next revision of the Diagnostic and Statistical Manual of Mental Disorders may look like. Some projections suggest a potential release window around 2029 to 2030 , though the American Psychiatric Association has not formally confirmed a publication date. For Licensed Professional Counselors, it is important to distinguish between confirmed information and thoughtful speculation. What follows is a grounded overview of both.  What Is Officially Confirmed There has been talks of the next DSM potentially being names something totally different, as well as potentially being a living breathing document housed online rather than a printed material. This has led to thoughts that it will include a full structural overhaul as it aims to find a balance between psychiatric insight as well as lived experience data. At the moment, there has been no official announcement of: A finalized DSM-6 release date A confirmed structural overhaul A change in name Adoption of biomarkers as diagnostic requirements The APA has historically used multi-year committee processes for revision, as documented during the development of DSM-5 (Regier et al., 2013, American Journal of Psychiatry). Any specific timeline, including projections of 2029 to 2030, remains speculative unless formally announced by the APA. Documented Criticisms of the DSM Many of the concerns you listed are well documented in peer-reviewed literature, including in the American Journal of Psychiatry. Historically cited critiques include: • The DSM uses a categorical model, which may not fully capture dimensional or nuanced symptom presentations. • Emphasis on diagnostic reliability has sometimes been prioritized over diagnostic validity. • Limited integration of biological markers despite advances in neuroscience. • Heavy reliance on expert consensus panels. • Concerns about Western cultural bias in diagnostic framing. These critiques have appeared in academic discussions surrounding DSM-5 and broader psychiatric nosology debates (Hyman, 2010; Regier et al., 2013). What is important to note is that these criticisms are part of ongoing scholarly dialogue. They do not automatically predict specific DSM-6 changes. Themes Being Discussed in Professional Circles While not formally confirmed, several themes are widely discussed among researchers and leaders: 1. Greater Dimensional Integration DSM-5 already introduced cross-cutting symptom measures and severity scales. Continued movement toward dimensional models is supported in academic literature (Krueger & Markon, 2014). A future DSM may further integrate dimensional frameworks alongside categorical diagnoses. 2. Stronger Alignment with ICD There has been ongoing effort to harmonize DSM diagnostic codes with the International Classification of Diseases, maintained by the World Health Organization. Future revisions may continue this integration to improve global diagnostic consistency. 3. Inclusion of Biomarkers Despite significant neuroscience research, no current psychiatric diagnosis relies on validated biomarkers. The National Institute of Mental Health developed the Research Domain Criteria (RDoC) framework to explore biologically informed models. However, RDoC remains a research framework and is not a diagnostic manual. Any integration of biomarkers into DSM-6 would require strong empirical validation, and no official confirmation currently exists that biomarkers will be required for diagnosis. 4. Cultural and Social Determinants DSM-5-TR expanded cultural formulation tools and updated language related to gender and diversity. Ongoing discourse suggests future editions may further incorporate cultural, socioeconomic, and environmental determinants of mental health. 5. Lived Experience Input There is broader movement in healthcare toward incorporating lived experience perspectives. While stakeholder feedback has been part of past revisions, there has been no formal announcement detailing the extent of lived experience integration for DSM-6. The direction of greater inclusivity aligns with contemporary healthcare standards but remains under development. Autism and Potential Diagnostic Shifts Speculation regarding updates to Autism Spectrum Disorder criteria reflects ongoing research around gender differences, masking, and underdiagnosis in women and people of color. Research literature supports the idea that autism presentations may differ across populations. However, there is currently no official confirmation that DSM-6 criteria changes will create a diagnostic surge. Any future criteria updates would require field trials and empirical validation before implementation. Committee Structures The APA historically forms workgroups and task forces organized by diagnostic categories and thematic areas. Planned improvement committees include the "Structure and Dimensions committee", "Functioning and Quality of life committee" "Biomarkers and Biological factors committee" " Socioeconomic, cultural, and environmental determinants of mental health committee". What LPCs Should Do Now Continue practicing under DSM-5-TR standards. Strengthen dimensional assessment skills and measurement-based care. Stay informed through official APA channels and peer-reviewed publications. Approach social media claims with professional caution. :) It is reasonable to expect that DSM-6 will aim to reflect scientific advances, cultural responsiveness, and improved diagnostic validity. However, until the American Psychiatric Association releases formal statements, timelines, or draft criteria, any detailed structural predictions remain speculative. For Licensed Professional Counselors, preparation is less about anticipating dramatic changes and more about maintaining strong assessment practices, cultural competence, and evidence-based treatment planning. Geries Shaheen is a Licensed Professional Counselor and Nationally Certified Counselor operating in and around St. Louis Missouri. Geries holds his MA in Professional Counseling from Lindenwood University, BA in Intercultural Studies from Lincoln Christian University, and holds a certificate in Life Coaching, Geries provides life coaching services to clients online globally. Geries is EMDR trained and DBT Certified, practicing from a TIC lens.
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