Psychosocial Stage Theory as a Model for Treating Homeless Veterans 

Introduction

Erikson (1950) outlined eight stages of psychosocial development across the developmental lifespan. Within each stage arose a “crisis” that the individual needed to resolve before proceeding cleanly into the next. Unresolved resolution at any stage led to a psychological arrest that hindered the negotiation of the following stages: trust versus mistrust, autonomy versus shame, initiative versus guilt, industry versus inferiority, identity versus role confusion, intimacy versus isolation, generativity versus stagnation, and ego integrity versus despair. The first four stages are relative to infant, childhood, and adolescent development, while the last four are specific to adulthood.

Over 75 years later, psychosocial stage theory continues to be researched and cited in the literature and taught regularly in undergraduate and graduate programs  (Maehler & Hernandez-Torrano, 2025). However, Erikson’s theory has not been without its critics, who have pointed to limitations of conceptual stage models, his use of a naturalistic observational method, cross-cultural considerations, increases in marital infidelity, and generalizability to women (Cherry, 2025; Jung, 2019; Saachie, 2022; Sorell & Montgomery, 2009; Syed & Fish, 2018). In response to these and other contemporary developments, developmental theorists have expanded and refined aspects of Erikson’s framework by examining the impact of technology and social media (Cote, 2018) and the extension of adolescence into young adulthood (Kay, 2018). These revisions have helped modernize Erikson’s (1950) conceptualization of identity development.

Homelessness Among Veterans

Nichter et al. (2023) reported that one in every 10 veterans has experienced homelessness post-service. They estimated that approximately 30,000+ homeless veterans seek nightly shelter. A recent analysis of the Ending Homeless Veteran’s Initiative Project revealed homelessness among veterans decreased by 55.3% compared to 8.6% among the general population during the same 16-year study period (O’Toole et al., 2024). The results point to the benefits of federal funding for housing homeless veterans and the need for continued attention and resources.  

The Clinical Application of Psychosocial Theory

Orenstein and Kaur (2026) suggested that practitioners can use psychosocial theory to help clients work through difficult periods of adjustment. Karunarathna et al. (2024) pointed to the use of psychosocial theory as a conceptual guide to help clients work through significant life transitions, such as recovery from a psychotic break, trauma, substance abuse, or, for purposes of this paper, the treatment of homeless veterans.

Application of the Model to Homeless Veterans

What follows is a discussion of how the model can be applied to veterans participating in transitional housing and how therapy is adjusted to meet their evolving needs at each particular stage of development. 

Trust versus Mistrust

The initial stage of trust relates to the experience of becoming homeless after being enlisted in service. Veterans may feel the military and/or the veteran’s administration system has created barriers that inhibit accessing consistent and effective services (Ein et al., 2024; Yok-Fong et al., 2025). This may result in a general skepticism of those who offer assistance, particularly in homeless or transitional living centers where veterans may have had prior negative experiences with mental health and social service providers.

Establishing a certain level of trust in the housing program is the first step toward effective treatment. The goal for the clinician is to build upon this foundation of safety and reliability to foster therapeutic engagement and connection. Trust may be difficult to establish as some veterans struggle to trust their own judgement, let alone that of a stranger. These challenges may be further amplified when veterans have experienced unresolved trauma before, during, or after military service.

A supportive, existential/humanistic approach may be most suited during the trust phase.  The existential/humanistic perspective speaks to the development of a collaborative working relationship between the veteran and the therapist (Guigno et al., 2017). This makes the veteran an active participant in the process and may guard against treatment drop-out (Wells, et al., 2022). The psychologist’s role is to enter the veteran’s unique lived experience, rather than imposing a predetermined therapeutic agenda on them. Central to this process is the psychologist’s capacity to embody an empathic stance and to model emotion regulation, particularly for veterans who have served in combat. This creates a safe psychotherapeutic space to work through forms of hypervigilance, avoidance, and resistance. Unresolved forms of trust create the basis for psychosocial maladjustment that carries into the next stages.

Autonomy versus Shame

The autonomy stage reflects a period in which veterans step from the basic structure of group home living and allow themselves to become vulnerable and open to opportunities including social service, individual, and supportive group psychotherapies. This is similar to the toddler stepping away from the primary caregivers to actively explore a new and uncertain world.

This is a big move for veterans who may have previously felt judged or misunderstood by a civilian therapist with no prior military experience. The therapist wants to avoid such pitfalls while promoting this vulnerable move to become active agents in their lives. At this stage, and in fact, at every stage of working with this vulnerable population, effort should be made to promote autonomous movement and guard against inadvertently shaming the veteran.

To avoid the potential for adverse interactions, clinicians should engage without drawing assumptions, let the veteran have a voice, recognize and respect the civilian/military differential, and seek consultation when needed during this vulnerable point in therapy.

Initiative versus Guilt

In this stage, the veteran begins taking more initiative in their therapies and tasks of daily living. This can be subjectively perceived as a series of small, successive wins (Orenstein & Kaur, 2026) that promote internalized feelings of self-efficacy. The current author refers to this period as the “I can do it” phase.  

As the veteran demonstrates greater initiative, the clinician may respond with a more active approach that matches the veteran’s initiative. This might include the introduction of cognitive restructuring assignments, mindfulness exercises, and problem-solving training with a client who is now more actively working on themselves with a renewed sense of hope and vigor. Guilt may arise when veterans see others making the most of opportunities and realize they could have made more of the ones offered to them. The guilt may be related to squandering opportunities. Some may become motivated to seek out or re-engage in treatment and should be met with ongoing support and encouragement.

Industry versus Inferiority

In the stage of industry, the veteran is working actively within all aspects of the program. They are following through with appointments, job interviews, and potential long-term housing options, building more successive wins that lead to feelings of self-mastery and empowerment. Stated differently, the veteran is actively working toward independence.

The goal of the therapist is to keep the momentum of the industrious veteran who is engaged in the process of becoming. As veterans assume greater responsibility for their lives, treatment may focus on cultivating awareness of personal choice and self-agency. This includes exploring how past decisions may have contributed to negative outcomes previously attributed to external circumstances, while also recognizing the choices that have facilitated progress toward their current goals. Role plays may be used to practice interpersonal situations involving employment, veteran administration assessments, and the reintroduction of estranged loved ones into their lives.

The therapist must work hard to guard against activating feelings of inferiority by inadvertently setting the veteran up for failure. This can be accomplished by carefully assessing the veteran’s cognitive and emotional capacity, current level of readiness, and need for appropriate scaffolded challenges that foster mastery rather than reinforce self-doubt. Feelings of inferiority may emerge among veterans who see others reaching their goals and question why they are not; perhaps questioning themselves in the process. Such feelings may be intensified by prior experiences including trauma, homelessness, institutional barriers, stigma, or repeated setbacks that have undermined their confidence in their own abilities. Consistent with Erikson’s conceptualization, clinicians can address these individual contextual dynamics to help veterans cultivate industry.

Identity versus Role Confusion

The stage of identity describes the process of homeless veterans redefining their identities. The development of an emerging identity is significant as it has been linked to higher levels of intimacy, generativity, and integrity across adulthood (Mitchell et al., 2021). 

Veterans begin the process of rediscovering their authentic selves, which have long been mired in “default” identities, defined here as inauthentic or foreclosed identities developed to please, impress, or gain acceptance from others. Obtaining and maintaining employment might spur an identity based on their roles at work, meaningful relationships, community involvement, and other forms of community integration that foster a stronger sense of purpose and self. Rather than viewing themselves solely through the lens of homelessness or military service, veterans can begin to cultivate a more integrated and authentic identity grounded in their strengths, aspirations, and personal values. 

The therapist’s role is to facilitate identity development. This might include a deeper emotional or existential examination of identities that were imposed upon them or adopted throughout their lives before, during, and after military service. The therapist gently challenges the use of previously identified default selves that may have served a functional purpose at one point but have since limited or become harmful to growth and development. 

The veteran is encouraged to get in touch with their strengths, challenge prior self-narratives, and settle into their authentic selves. They may speak to their default selves through two-chair, or empty chair work. They may write letters to their default selves. Reflection on their journey through homelessness may lead to a redefinition of their military service, from a homeless veteran to a proud veteran. Those who do not participate in redefining their identities remain stuck living in and replaying outdated narratives.

Intimacy versus Isolation

The intimacy phase represents the newly defined veteran finding intimacy and meaning in relationships with co-workers, case managers, peers, and therapists. They have become intimately involved as active participants in their own lives, becoming genuinely connected to who they are and to their treatment. 

Veterans may begin processing more vulnerable emotional concerns related to early family dynamics, trauma experienced during military service, or a deeper dive into their subjective emotional experiences related to substance use or homelessness. Within treatment, the therapeutic relationship may serve as a corrective emotional experience through which veterans learn to tolerate vulnerability, develop trust, and engage more authentically with others. Without the development of intimacy, veterans may withdraw from opportunities for connection and support. Such isolation may contribute to the reemergence of developmental struggles related to shame, guilt, self-doubt, or role confusion that had previously been managed or partially resolved.

Generativity versus Stagnation

The generative veteran is one who renegotiated the prior developmental stages in a way that resulted in feeling confident, fulfilled, and settled within themselves. Compared to their potentially stagnant counterparts, they become eager to take on the role of mentor to those earlier in the process of transitional living. When invited or asked to speak at meetings and conferences, they are eager to share their stories of success. Generativity may also be expressed through meaningful community integration, including volunteer work, advocacy efforts, employment, caregiving, family roles, or other meaningful contributions.

Therapy at this phase may have moved into a maintenance phase for the generative veteran. The therapist takes a more supportive role, available to provide accountability and reassurance to maintain the confidence and direction needed to maintain treatment gains.

In contrast, veterans who continue to struggle with feelings of guilt, inferiority, isolation, and limited intimacy may lack the confidence, motivation, or emotional wherewithal to assume such roles. Their road ahead may feel bleak and colored with pessimism and regret, while their counterparts emerge with a newfound sense of hope and meaning.

Ego Integrity versus Despair

Generative veterans may then transition into living with a sense of ego integrity. They served. They became homeless. They overcame the most difficult of obstacles. They learned to trust, became autonomous, and took initiative. They worked industriously, redefined their identities, and now live in their authentic selves with intimate relations. Some achieved meaningful community integration by forming relationships with members of the community that facilitated their growth and development. For example, this may have occurred by volunteering at a veteran’s 5K or working in the commissary. Many derive purpose from continuing to share their experiences with other veterans, mentoring peers, or contributing to their communities.  

Ego integrity emerges as veterans develop the capacity to look back on their lives with acceptance, integrating both successes and failures into a coherent life narrative. Through this process, they may find meaning in suffering, develop compassion for themselves and others, and experience a sense of fulfillment despite life’s imperfections. Therapy for veterans achieving ego integrity may be terminated or moved to maintenance as the veteran transitions to permanent housing.

 In contrast, those who fall into despair may remain isolated, stagnant, and stuck in group home living. They may become preoccupied with regret, resentment, or perceived failures. Rather than integrating their experiences into a meaningful narrative, they may experience hopelessness, bitterness, social withdrawal, or a sense that their lives have lacked purpose or value.

Concluding Remarks

The paper outlined a model to conceptualize, facilitate, and foster internalized behavioral change and community integration embedded within psychosocial stage theory. It starts with a basic establishment of trust within the veteran and between the veteran, the therapist, and the housing program. Once established, the opportunity to negotiate a path toward independence comes into reach. The role of the therapist was discussed, highlighting the unique challenge of meeting the needs of the evolving veteran as he, she, or they progress from homelessness to ego integrity. 

There are a couple of final points to note. First, psychosocial stage theory is not as sequential as originally developed (Cherry, 2025). At any point, the individual can revisit and resolve prior unresolved crises (Mitchell et al., 2021). As events evolve across the life span, opportunities arise to revisit unresolved feelings of isolation, guilt, inferiority, or stagnation. For veterans, this means that opportunities for growth and development remain available throughout the lifespan. Even when developmental conflicts have not been fully resolved, future life experiences, relationships, and therapeutic interventions may provide renewed opportunities for reflection, growth, and integration.

Second, just as the psychosocial stages are not definitively sequential, neither is the treatment outlined in this model. At any point, the veteran may be working on themes related to any of the stages, and the therapist must remember to adjust to meet the veteran where he, she, or they are during any given moment in the process of psychotherapy.

Ultimately, the model provides a framework for understanding how veterans may progress from homelessness toward greater purpose, connection, and psychological well-being. Veterans who invest in this process transform from feeling hopeless, uncertain, and helpless to becoming autonomous, taking initiative, developing into their authentic selves, and achieving meaningful community integration with a sense of ego integrity. Working from Erikson’s psychosocial stage theory, clinicians can anticipate and adjust their approach to the ever-changing demands of treatment. In this way, the model offers clinicians a framework for supporting veterans as they move from homelessness toward greater purpose, connection, and psychological well-being.