While we normally think of growth and development as a childhood concern, personal growth and development is a lifelong process with at least two major components: (1) the achievement of major developmental tasks, and (2) the ongoing process of becoming more resilient, adaptable, and capable of handling challenges.
Goal-directed health care takes both of these components of personal growth and development into consideration for every patient, at every age.
Major developmental tasks and the ages at which they tend to be accomplished include trust (vs. mistrust), autonomy (vs. shame and doubt), initiative (vs. guilt), competence (vs. inadequacy), identity (vs. role uncertainty), intimacy (vs. isolation), generativity (vs. stagnation), and ego integrity (vs. despair).
Each developmental task builds upon the prior ones, which means that the earliest tasks are the most critical ones. It is therefore entirely appropriate that pediatric care focuses heavily on this goal, and that social programs have been developed to insure that we all experience optimal growth and development during early childhood. Developmental tasks receive less attention in adults. However, if optimal development was viewed as a goal across the entire lifespan, clinicians could be even more helpful.
The field of adult education has identified some of the components of adaptability and resilience, which apply equally well to health and health care. Reframed for the health and health care context, they include: 1) health literacy and the knowledge and skills required for healthy living; 2) the motivation to maintain and improve health; 3) integration within a social network and the relational skills necessary to do that; and 4) the habits of self-assessment, reflection, goal-setting, and self-directed learning.
Edward Deci and Richard Ryan have proposed that optimal growth and development are most likely to occur when certain basic psychological needs are met. People are born needing to feel connected to others (relationship); we also need to believe we can accomplish achieve goals we set for ourselves (competence); and we need to feel that we can make personal decisions that matter (autonomy). The implications of these principles are explained nicely in a book by Daniel Pink called Drive: The Surprising Truth about what Motivates Us.
The goal-directed approach to health care supports all three of these key psychological needs. First, because goal-directed care would value your knowledge and contributions to the decision-making process, it would equalize power in the relationship between you and your doctor. It would also require that you and your doctor know more about each other than what is required by the problem-oriented model. Those factors would serve to strengthen the relationship over time. The goal-directed approach assumes that you are able to set and achieve goals, building your sense of competence. Finally, since the management decisions made with your doctor would be based upon your goals, your sense of autonomy would be supported.
The groundbreaking psychologist, Carl Rogers (1902-1987) found that counseling strategies were effective to the extent that the counselor demonstrated all of the following: 1) genuineness (openness and self-disclosure); 2) acceptance (unconditional positive regard), and 3) empathy (ability to listen and express an understanding of the person’s experience). He subsequently concluded that those same behaviors were necessary for optimal interpersonal interactions between all human beings.
Robert Carcuff later proposed that, in addition to the three Rogerian principles listed above, helping another person requires assisting them to set goals and devise strategies to achieve them. Because we are social beings and because we thrive when we are helping others, optimal human growth and development requires mastery of those same skills.