The Modeling and Role-Modeling paradigm was derived from Helen Erickson’s personal and professional beliefs and values applied in extensive clinical practice, as well as the work of Nightingale and teachings of Milton Erickson.According to the MRM model, all people:
- are holistic with dynamic, unending mind-body-spirit interactions;
- have an inherent need for dignity, esteem, and self-esteem; and
- have an innate ability to grow, develop, cope, adapt, and heal.
The nurse’s role is to nurture and facilitate these natural abilities through tailored caring processes.
The nurse-client relationship is a dynamic trusting, functional relationship. Such relationships are created through meaningful interactions that potentiate merging energy fields to function in synchrony as one. Meaningful interactions are achieved through purposeful verbal and non-verbal communications.
The intent of communications and the relationship is to facilitate mobilization of available resources needed to cope and to nurture development of new resources needed for growth. The desired positive outcome is the client’s sense of wellbeing at any stage of life.
Since communications are ongoing, sequential, and influenced by one’s perceptions, all interactions have the potential to positively effect change in the whole at any and all times. The opposite is also true. Communications can have a negative effect by creating more dissonance and stress in the client. Therefore, it is important to:
- Always identify the client as the primary source of information;
- Remember to approach individuals with unconditional acceptance of their human need for dignity, worthiness, and potential for growth and healing; and
- Understand that the nurse’s role is to facilitate and nurture these needs and potentialities.
Meaning of Modeling & Role-Modeling (MRM)
The theory’s title, Modeling & Role-Modeling (MRM), was coined during a discussion among interested University of Michigan (U-M) doctoral students. Erickson rejected the title, “Erickson’s Self-care,” and other similar suggestions. She stated that the work should be remembered for what it stands for—listening to the client, understanding the client’s worldview, and basing care on those understandings. She did not want the theory (and book) to emphasize the author’s name, charisma, and so forth.
The language, Modeling and Role-Modeling was derived from an answer to a question posed by Helen Erickson to Milton Erickson (her father-in-law). She asked, Where should I start? He responded, “Model and then role-model” which was followed by a statement indicating that it was useless to do anything that matters if you don’t start by modeling their world. Only after modeling their clients’ worldviews, can nurses plan strategies that help them live the lives they want with meaningful roles—i.e. role-modeling.
The MRM Logo and Its Meaning
The original logo of MRM, designed in 1981 by consensus among Erickson, Tomlin and Swain, shows nurse and client in an environment that exists in the universe, allowing for future growth and expansion of the paradigm.
Meaning of Logo:
- The two persons, arms interconnected, represent the human need for mutuality and reciprocity, or in simple language, connections with others without losing one's self (this is affiliated-individuation [A-I]).
- The hand represents the nurse's (or care provider's) role as a facilitator not a regulator. The nurse’s job is to help people heal and grow at their own rate and in their own time.
- The arm represents the ability to facilitate another person across time and space. When we work with people, as described in MRM, we often "seed" growth that is not immediately observed; however, change may occur as a result of something we communicate. Thus, our ability to affect another person's life over time and space is extremely important. As Watzlawick (1967) says, "You cannot not communicate." Therefore, if either member of the dyad perceives that a communication has occurred, even when one is not intended, it has the potential to have an effect. In the long run this can be helpful or not, depending on the individual's perception. Thus, the logo has a long arm.
MRM practice is guided by a set of practice principles that are aligned with the aims of practice and outcome expectations or intervention goals. (Specific details are available in Erickson, Tomlin & Swain, 1983/2009: Modeling and Role-Modeling: A Theory and Paradigm for Nursing (pp.169 -171) and expanded on in Erickson, H. (Ed) 2006: Modeling and Role-Modeling: A View from the Client’s Worldview.
The assessment intent is to gain information that will help the nurse understand the client’s perspective of the root of the problem, what has caused it, and what will help. The intervention intent is to facilitate growth and healing. The outcome is a higher level of wellbeing, a sense of hope, and a projection of self into the future. This is true in all cases including when the client is taking the last breath.
Information needed for practice is acquired by asking the client questions about four domains:
- Description of the Situation: We want to know what has happened in the individual’s life that precipitated the encounter with the healthcare system: What caused it, and to what is it related? And, what can be done about it?
- Expectations: What does the individual they think will happen: Today, next day/week?
- Resource Potential: What will help? Who can do that? How able is the individual to problem-solve?
- Goals and life tasks. What would the individual like to see happen in the immediate and long-term life journey?
Data collection always starts with the primary source of information—the client.
Patterning of Data
Once acquired, patterns in the information are explored to identify the individual’s ability to cope with current and emerging stressors and the resources the person has acquired that will facilitate healthy coping and adaptation. Data are organized around two key constructs: Adaptive Potential and Affiliated-Individuation status. (See Theoretical Foundations below).
Aims of Interventions/Interactions
As nurses seek patterns of information, they initiate formulation of strategies to ensure that individuals have the resources needed to cope with ongoing stress and emerging stressors and reinforce their need for affiliated-individuation. Specific intervention/interaction aims are designed to focus planning and implementation of caring actions. These are:
- Nurse self-prepares before interaction to create sacred space and initiate person-centered holistic caring
- Establish a trusting, functional relationship
- Promote a positive orientation
- Promote a sense of perceived control
- Affirm and promote strengths
- Mutually set health-directed goals
The theory of MRM was synthesized from practice, empirical studies, and several foundational theories. Theories include, but are not exclusive to, the work of Milton Erickson, Selye, Engel, Seligman, Maslow, Erikson, Piaget, Winnicott, Bowlby, Lindemann, and others. The synthesized knowledge and skills from these varied sources provides a base for tailoring caring processes within the MRM theory and paradigm.
Two key constructs in MRM provide guidance for nurses as they proactively aim to facilitate growth, development, coping, and healing: Adaptation Potential and Affiliated-Individuation.
Humans encounter stressors in every-day life; some are associated with inherent processes, while others are due to human interactions and serendipitous events that occur in our life journey. Stressors stimulate cascades of mind-body-spirit stress responses; coping with both the stressor and respondent stress processes is required to break the chain. The coping process produces resources needed to interrupt the stressor-stress(or)-stress cascade, but those resources are often short-lived, and leave the individual vulnerable to the stressor that initiated the response in the beginning.
In comparison, adaptation involves change, often occurring at the cellular level. Adaptation has the potential of producing new resources that buffer the individual from further effects of the same or similar stressors. Without healthy adaptation, people are vulnerable and may:
- Have difficulty coping, which compromises their inherent defense mechanisms (e.g. immune system abilities). This in turn, restricts adaptation and endangers growth and healing; or,
- Use maladaptive resources, which initiates coping patterns that often result in increased vulnerability, illness, sickness, or disease.
While nurses have always been able to identify when clients are stressed, a tool was needed to determine their ability to mobilize resources needed to facilitate coping. The Adaptive Potential Assessment Model (APAM) was developed so nurses can make these distinctions. It does not assess the nature of the resources, but rather it distinguishes (a) between those in stress from those who are not (Arousal or Impoverishment), and (b) the ability of those in stress to mobilize resources needed to cope in such a way that healthy adaptation can be enhanced (Equilibrium). This work was an extrapolation and synthesis of the work of Selye, Engel, and Seligman.
Affiliated-Individuation (A-I), discovered by serendipity from research and practice and coined by H. Erickson, is the human’s life-time need for a balance between the inherent drive for a meaningful affiliation with another(s) and the inherent drive for a unique, autonomous self-identity. This balance between the two drives occurs at the same time, changes across the life-span, and effects current and future relationships, personal growth, and self-fulfillment.
A-I is dependent on the interface among one’s: (a) need status, (b) nature and adequacy of available attachment objects, and (c) developmental residual acquired from task resolution. Each is necessary to facilitate healthy coping, adaptation, and change inherent in the human being.
Basic needs are those that affect the individual’s inherent abilities to survive and grow while growth needs affect the individual’s drive for growth and self-fulfillment. Tension is created when basic needs are unmet; anxiety follows if the unmet status is prolonged. Basic need satisfaction relieves the tension/anxiety. There is often a tension between a need to know and fear of knowing when confronted with unmet basic needs.
Unmet growth needs emerge when basic needs have been met to a minimally healthy degree. The drives for satisfaction of growth needs include interest, curiosity, satisfaction, and self-fulfillment. Satisfaction of growth needs creates a tension associated with need for more and continues until the individual moves on to another object that stimulates their interest, curiosity, etc. This work is extrapolated from Maslow’s theory of human needs.
Attachment-Loss-Attachment Processes (ALAP)
Living or inanimate human and non-human objects that meet our needs over time become “attachment objects.” We need these to cope, survive, grow, adapt, and thrive. Because humans also experience normal developmental processes, the nature of the objects changes with time. For example, the experience of being cuddled in a soft, warm blanket may meet safety needs in an infant while a lucky stone in the pocket of a five-year-old boy may be more effective. Objects vary by individual, life experiences, and current resources; only the individual knows what will meet his/her needs.
Loss of an object can be real, threatened or perceived. Loss always results in a grieving process, normally limited to 12-15 months with unique, sequential stages. Resolution of the loss will affect one’s ability to create new resources or move into a morbid-grieving process. Letting go of the lost object makes room for adaptation and attachment to a new object or the same object in a new way. Giving up on the object results in morbid-grief.
The ALAP is inherent; humans must have repeated experiences attaching, letting-go, and moving on to new attachments to grow, resolve developmental tasks, and move forward in the self-actualization drive. Nevertheless, these phases can be difficult for some; , so they hang onto the object or give-it-up, failing to build resources needed for developmental tasks. This work is an extrapolation and synthesis of the work of Bowlby, Winnicott, Lindemann, and others.
Humans also have an inherent drive to work through specific tasks related to a chronological sequence of developmental stages in life. One’s ability to mobilize resources needed to address the age-related sequential task determines the residual that is laid down; this residual that can provide resources for future task-work and/or interfere with one’s inherent need to grow. The process is epigenetic, which means that each previous task is reworked within the context of the current task and uses previous residual as a building block. This creates opportunities for individuals to grow, adapt, and heal or reinforce negative outcomes from previous task work. The degree to which inherent needs have been met will affect one’s ability to resolve the challenges associated with developmental tasks. This work is extrapolated from and synthesized from the work of Erikson and Piaget.
NOTE: Taxonomies for Needs and Developmental residual are provided in Modeling and Role-Modeling: A View from the Client’s World (H. Erickson, Ed., 2006). Theoretical linkages used to create patterns of information (i.e. linking key concept in MRM) are described more fully in publications.
The MRM theory postulates that there are inherent, dynamic relations among need satisfaction, need assets, attachment-objects, loss-resolution, and developmental residual that effect one’s ability to mobilize resources needed to foster a healthy state of affiliated-individuation across the life-span. These vary with individual, life circumstances and availability of perceived resources.
Selected theoretical propositions that guide MRM practice and research based on MRM are listed below.
- The ability to contend with new stressors is directly related to the ability to mobilize resources needed to cope.
- The ability to mobilize resources is directly related to need deficits and assets.
- Distressors are related to unmet basic needs; stressors are related to unmet growth needs.
- Objects that repeatedly facilitate the individual’s need-satisfaction results in attachment to the object.
- Secure attachment results in feelings of worthiness measured as self-esteem and esteem.
- Feelings of worthiness result in futurity.
- Real, threatened, or perceived loss of an attachment object results in a grief process.
- The nature of the grief process depends on one's perceptions of control over the loss.
- An alternative object must be perceived as available in order for the individual to resolve the grief process and attach to an alternative attachment object.
- Prolonged grief processes result in morbid grief.
- Morbid grief is related to multiple unmet needs.
- Unmet needs interfere with growth and healing processes.
- Repeated basic need satisfaction is prerequisite to working through developmental tasks and resolution of related developmental crises.
- Morbid grief is always related to need deficits.
All people are alike in some ways and different in other ways. Some commonalities exist among people as holistic beings, including their basic needs, developmental stages and drive for affiliated-individuation. Differences among people include their genetic endowment, unique model of the world, how they adapt to stress, and self-care.
Similarities Among People
Holism: Belief that people are more than the sum of their parts; that body, mind, emotion and spirit function as one unit, affecting and controlling the parts in dynamic interaction with one another; thus, conscious and unconscious processes are equally important.
Affiliated-Individuation: Concept unique to MRM theory based on belief that all people have an instinctual drive to be accepted and dependent on support systems throughout life, while also maintaining sense of independence and freedom. Differs from concept of interdependence.
- Basic and Growth Needs: Drawn from the work of Maslow, basic needs are secondary to inherent drives to attain resources required for survival, growth and healing; growth needs emerge after basic needs have been satisfied to some extent. Fulfillment of growth needs results in thriving-related growth.
- Attachment-Loss-Attachment Processes: Living or inanimate human and non-human objects that meet our needs over time become attachment objects
- Psychosocial Stages: The inherent, chronological and sequential stages of human development, each associated with a specific task that mandates resolution and results in residual that either facilitates or prohibits future task-work.
- Cognitive Stages: Based on Piaget's theory, thinking abilities also develop in a sequential order and it is useful to understand the stages to determine what developmental stage the client might have had difficulty with or needs to work on. Thus, with client education, keep information simple for a client in the cognitive stage of concrete operations (develops age 7-11) or working on early epigenetic stages of psychosocial development (trust through industry).
Differences Among People
Genetic Endowment: Each human is composed of a set of genes /chromosomes that predispose them to certain characteristics that vary in humans such as skin tones, hair color, height, and so forth. These characteristics may influence the individual’s difference in society, but in many cases do not. Research has shown that our life experiences can effect the opening or closing of the genetic gates, resulting in greater or lesser influence.
Inherent Endowment: Those processes common to all human beings, such as propensity to grow, develop, heal and to fulfill one’s natural ability.
Model of the World: A person's perspective of his or her own situation, what it is related to, and what will help it. These perspectives are based on one’s past life experiences, sense of the present moment in time, and projections for the future.
Adaptation: A process essential for sustaining life, preparing the individual for the inherent changes in life, and fulfilling their potential. Adaptation is the result of healthy coping with current stress and emerging stressors.
Adaptive Potential: The individual’s ability to mobilize the resources needed to contend with current stress and emerging stressors.
- The Adaptive Potential Model: A tool containing three independent states that is used to specify one’s ability to cope with ongoing stress and/or new stressors in the moment.
- Arousal is the state experienced immediately after encountering a stressor and while in an early stress state. It is marked by feelings of tenseness and anxiousness; an elevated blood pressure, pulse and/or respirations; and elevated verbal expression of anxiety.
- Impoverishment occurs when inadequate and/or insufficient resources are available to resolve the stress state. Impoverishment is marked by feelings of anxiousness, fatigue, sadness, helplessness, and/or depression. Verbal expression of anxiety is usually reduced or absent, and biophysical markers of stress are usually elevated; however, prolonged impoverishment can result in feelings of hopelessness at which time the signs and symptoms can be diminished.
- Equilibrium has two possibilities: adaptive and maladaptive equilibrium. The first occurs when the resources effectively resolve the stress(or) stimuli; the second occurs when ineffective resources are used. The second results in less effective potential coping and adaptation.
Stress: An inherent response to stressors that initiates cascades of interacting mind-body-spirit responses throughout the human body, mind, and spirit. Often considered a coping response.
- Stressor: Any stimuli that effects a stress response.
Self-Care This inherent ability includes three interacting characteristics--SCK, SCR, and SCA--that effect one’s ability to mobilize resources needed for daily coping.
- Self-Care Knowledge (SCK) is often defined as one’s worldview or perspectives. SCK is information, known at some level, that individuals have concerning: (a) their ability to cope, and what promotes or interferes with their health and wellness; (b) what has caused an illness or contributed to a current problem; and (c) what is needed to promote coping, healing, growth and self-fulfillment. SCK contains holistic mind-body-spirit data used to model the client’s world.
- Self-Care Resources (SCR) include internal and external sources that facilitate coping with ongoing stress and new stressors. Sustainable SCRs are developed over time as basic needs are met through healthy attachment objects and as developmental tasks are achieved. Short-term SCR can be built instantly through trusting, functional nurse-client relationships. Reinforcement of SCR facilitates development of need assets, sustainable over time.
- Self-Care Action (SCA) includes all conscious and unconscious behaviors effected to cope with unmet needs or reinforce need assets.