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Grounded Theory

5.2.5 – Grounded Theory

Grounded Theory

Description

Research is gathered about an area of interest and the theory emerges from this research as it is gathered and analysed. This is an inductive method.

(1) Identify an area of interest and find out where data for this can be gathered from.
(2) As the data is gathered, ‘codes’ and ‘categories’ can be identified.
(3) Patterns are identified from the codes and categories.
(4) The theory will develop around these patterns.
(5) Once the theory has developed, they begin to only code the relevent information for the theory
(6) Finally, they review the literature and develop the theory further.

For example Nathaniel (2007) was interested in nursing practice and used grounded theory to do this.

Evaluation

(+) Evidence is integrated into the theory, which increases the validity.
(-) If data is flawed or misinterpreted, this could reduce the validity. For example, they may have been biased when gathering the data and disregarded relevent, contradicting evidence. They may be forcing the data to fit with the theory.
(-) Reliability –> With the same evidence, other people may come to completely different conclusions.
(-) Takes a very long time to gather the data, especially in the beginning when the theory isn’t clear.

Vallentine et al (2010) (Interviews in Clinical Psychology)

5.2.3 – The use of interviews in clinical psychology, to include an example study (Vallentine et al., 2010)

The Use of Interviews

Interviews involve verbal questions between the psychologist and the patient. They can be structuredsemi-structured, and unstructured.

Vallentine et al. (2010)

Description

Aim

To investigate the usefulness of psychoeducation (teaching the patient and their family about their illness) in a high security setting (Broadmoor Hospital).

Procedure

Participants – 42 male patients at Broadmoor Hospital, all with schizophrenia or related disorders who have been identified as being likely to benefit from psychoeducation.

They were all given a semi-structured interview to be able to understand their experiences better and to improve the psychoeducational group, that they are a part of, in the future.

Following the interviews, a content analysis was carried out on their responses. The themes were: ‘what participants valued and why‘, ‘what was helpful about the group’, ‘clinical implications’ and ‘what was difficult/unhelpful’.

Results

Participants valued knowing and understanding their illness. The group allowed them to understand their illness and to understand other people’s experiences with the illness.
Increased confidence in dealing with their illness.

Conclusion

Psychoeducation group was useful for the participants. It helped them understand their illness, which they valued, and understand other people’s experience with the illness and finally increased their confidence with the illness.

Evaluation

Generalisability

(-) 42 male patients at Broadmoor Hospital. These are a specific group with unique qualities (considered dangerous) so it can’t be generalised to all schizophrenia sufferers. Additionally, it can’t be generalised to people suffering from other illnesses because schizophrenia sufferes might be different – they might benefit particularly well from the group. They were also patients which had been identified as being able to benefit from psychoeducation and therefore might not reflect other patients.

Reliability

(+) Inter-rater reliability –> interviews were recorded and can therefore be checked by other researchers, and can be coded again.

(-) Questions were not standardised for everybody –> lack of reliability because they received different questions.

(-) Content analysis –> Not reliable because not replicable. Each time it is done, different results will probably be found.

Applications

(+) Could help to identify how to improve psychoeducation and indicates that psychoeducation is useful.

Validity

(+) Use of a semi structured interview allowed detailed knowledge to be gained. Allows them to fully explain their opinions which allows the research to be better able to reflect the participants.

Ethics

N/A.

Lavarenne et al. (2013) (Example Case Study)

5.2.3 – The use of case studies, to include an example study (Lavarenne et al (2013)

The Use of Case Studies

Case studies involve studying a single person, or a small group, of individuals in depth. They often involve using a variety of methods and triangulating the results to form a conclusion.  In clinical psychology, these are often people with unique characteristics or experiences, or rare illnesses. The data gathered is often qualitative and detailed, allowing a detailed understanding to be gained.

This means that a full understanding of the patient can be gained (their condition, symptoms, life events, genetics, and a variety of other contributing factors), which can be useful to further our knowledge.

Lavarenne et al (2013)

Description

Aim

To investigate how people from the group form firm ego boundaries.

To investigate whether those with psychosis have weak ego boundaries.

Procedure

‘Thursday Group’ with 6 patients present, with fragile ego boundaries (schizophrenia / schizoaffective disorders).
The study describes one of these 45 minute sessions.
After the session, group leaders noted down key points about behaviour, expression, participation, emotions and comments.

Results
  • One member gave out cards to the other members.
    • Helped his ego boundary and the group’s.
    • One member couldn’t accept as he felt he was selling himself.
      • This member had delusions, thinkign he worked on a multinational
      • The member giving out took this rejection to heart. Weak ego boundary –> Can’t distinguish himself from the card.
    • One of them had an out of body experience and could not get the spirits back in his body – his boundary was extremely fragile.
Conclusion

Each member showed that they suffered from weak ego boundaries.
The group seemed to help strengthen their ego boundaries.

Evaluation

Generalisability

(-) 6 patients, all suffer differently from weak ego boundaries, not generalisable.

Reliability

(-) Gathered qualititative data after the session. This is not very replicable because each time it was done, very different data would be collected.

Applications

N/A

Validity

(+) Qualitative data –> Detailed data gathered about the participants.

(-) Internal validity –> Notes taken after the group and therefore are subject to the memories of the group leaders.

(-) Population validity –> Very unique individuals, all with different experiences and severity of schiziphrenia. Therefore, the results can’t be applied to another population.

Ethics

N/A.

 

Rosenhan (1973)

5.3.1 – Rosenhan (1973) – On being sane in insane places

Description (AO1)

Aim

To investigate whether psychiatrists could distinguish 8 sane pseudopatients from the insane.

To investigate the conditions in the mental hospitals.

Procedure

8 pseudopatients (5 men, 3 women) went to 12 different hospitals across 5 states in the US and reported hearing the words “empty”, “hollow” and “thud”. They chose a variety of hospitals: some old, some new, some underfunded, some wealthy, some public, some private.

Once admitted, they started acting completely normally and reporting that their symptoms had gone. They wanted to see how long it would take for the psychiatrists to realise that they weren’t insane.

Results

All of the pseudopatients were admitted with the diagnosis of schizophrenia, except one who was admitted with manic depression.

The pseudopatients spent an average of 19 days in the institution, with the shortest stay being 7 days and the longest being 52. None of the pseudopatients were declared sane, but all of those diagnosed with schizophrenia were released with a diagnosis of schizophrenia in remission.

Many of the other patients suspected that they were sane. However, the staff didn’t spot this, and many of them attributed their normal behaviour to their illness. For example, when the pseudopatients were taking notes, the psychiatrists recorded this as “writing behaviour” and saw it as a symptom of the illness.

The patients were depersonalised by the staff, meaning they were treated as being less than other humans. When the pseudopatients tried to talk to the staff, they were ignored 71% of the time. They were only given a verbal response 2% of the time.

Conclusion

After this study, he agreed with another hospital that he would send more pseudopatients and they would have to guess which ones they were. In reality he didn’t send any, and out of the 193 real patients who were admitted, 41 of them were suspected by at least 1 staff member as being a pseudopatient.

Rosenhan suggested that the label caused people to treat them differently, and to misinterpret their behaviour. He used the self-fulfilling prophecy to explain this.

Evaluation (AO3)

Generalisability

The sample was generalisable because they used a large variety of hospitals.

However, it was only conducted in the USA, meaning that the results may not be generalisable to the rest of the world, and also may not be generalisable to today because treatment has changed significantly since then.

Reliability

They didnt all follow standardised procedures. For example, one of the pseudopatients revealed he was going to become a psychologist.

11 of the 12 diagnoses were consistent, schizophrenia, and therefore it could be argued that it is reliable.

Applications

The research was used to change the world of psychological treatment. It helped to bring light to the conditions in which they were kept.

Validity

High ecological validity because it was in a realisitic setting.

Ethics

Deception –> The hospitals were not informed of the experiment.

They also could have taken the attention away from people who really were mentally ill, however, as they only had an average of 6.8 minutes per day per pseudopatient of interaction, it suggests that this was not true.

However, it could be argued that this experiment had a massive impact on psychological treatment and helped to improve the standards, meaning that it could be argued that the ethical issues were outweighed by the impact of the research.

Psychological Treatment for Schizophrenia – Family Therapy

5.1.4 – A psychological treatment for schizophrenia – family therapy

Description (AO1)

Aims to help the whole family support the sufferer by developing a support network for them.

It involves open and honest conversations between the whole family about the illness and the person’s experience and encourages the whole family to learn from the sufferer about the illness. The family is also encouraged to talk openly about their day to day concerns.

It’s often used in conjunction with drug therapy.

Evaluation (AO3)

(+) There is a large amount of evidence to support its effectiveness in reducing relapse rates.

(+) Goldstein & Miklowitz – family therapy and drug therapy reduces relapse rates more than just drugs.

(-) Needs the patient and the family to be both willing and motivated for it to be effective.

(-) Can be very difficult to talk about the illness which is paramount for this therapy.

(-) Not a treatment, but a way of coping with the illness.

Classification Systems for Mental Health (DSM and ICD)
DSM vs ICD

Classification Systems for Mental Health (DSM and ICD)

There are two classification systems which you need to know for the exam: the DSM and the ICD. Classification systems aim at categorising diseases and identifying the symptoms of them. This helps us diagnose disease, and are a great step forward from the four D’s, which we mentioned in the previous post.


Diagnostic and Statistical Manual of Mental Disorders (DSM)

The DSM is one of these classification systems, developed in the US in 1952. Although the specification states that you need to know the DSM-IVR or the DSM5, I’ll write about both here because it’s useful for the issue and debate of ‘how psychological understanding has developed over time’. 

DSM IVR
Description

The DSM IVR is a revised version of the DSM IV, released in 2000. The revolutionary aspect of this manual was the introduction of 5 “axes” on which a patient was measured. These included personality problemsgeneral medical conditionsenvironmental stress and global functioning. The psychologist would take all of these into account when diagnosing the patient.

Evaluation

The DSM-IVR attempted to tackle mental health diagnosis in a more holistic way by considering everything from general medical conditions, to environmental stress. This could be seen as a positive because it’s taking into account more of the contributing factors.

However, the axes made the manual much more difficult to use and less friendly to those who did use it. This explains why it lost popularity in comparison with the DSM-III and why they removed the axes in the DSM5.

DSM5
Description

The DSM5 removed the 5 axes and created a categorical system – similar to the previous DSM-III and the ICD. It’s also preparing to be revised much more frequently to ensure it stays up-to-date. It also removed unnecessary diagnoses and grouped together similar ones (Such as grouping autism into a spectrum). Additionally, it attempted to keep up with social advances, such as reflecting cultural differences (For example, in some cultures a panic attack is charactarised by difficulty breathing but in others it consists of uncontrollable crying).

Evaluation

Firstly, it can be commended for becoming more accessible and user-friendly by removing the confusing axes. This improves the usefulness of the classification system because if it’s easier to use, it’s more likely to be used correctly and lead to accurate diagnoses.

Additionally, the DSM5 was developed with the intention of standardising with the ICD – making them both easier to use together. This could be seen as an improvement of the reliability of the manual.

However, it’s been argued that the DSM5 was developed with the influence of large pharmaceutical corporations. This could have encouraged them to define more behaviours as abnormal to allow more drugs to be developed.

 


International Classification of Disease (ICD10)

Description

The ICD is a manual which covers all disease, not just mental illnesses. All of the mental illness come under the ‘F’ section. It then further categorises the illnesses into groups. For example: F32.0.00 is mild depression without somatic (physical) symptoms.

Evaluation

It could be said that the ICD10 is reliable due to its standardisation and clear definitions of diseases. It’s easy to use the manual to narrow down the symptoms to a specific diagnosis.

It’s also advantageous because it is continuously updated to reflect new updates in medicine. It has already been revised 10 times, and will continue to be revised in the future.


Validity and Reliability of Mental Illness Diagnosis

Validity

An advantage is that the DSM-IV in particular has become very holistic, ensuring that the psycholigist looks beyond whether the patient merely has the symptoms, but they also take into account their situation and background.

Additionally, both of the classification systems respond to the latest advances in research to provide accurate diagnoses in response to new research. For example, in both the ICD and DSM, homosexuality used to be listed as a mental illness.

The British Psychological Society (BPS) criticise the DSM because they feel it was designed to make patients fit the diagnosis, not to make the diagnoses fit the patient. They feel that the system should be built from the bottom up, starting with experiences, problems and symptoms.

Some people believe that the DSM has a tendancy to diagnose mental illnesses too easily. For example, Binge Eating Disorder will lead to people being diagnosed who are just greedy. This is expensive and can also harm the patient if the incorrect drugs are administered.

Reliability

An advantage of the ICD and DSM is that they clearly define what it means to have each mental illness and what defines each one. This can be useful in finding the correct treatment for each patient and is also useful in research to agree on what counts as anorexia beforehand, for example.

Brown et al (2001) tested the reliability of the DSM-IV and found that there was a high level of agreement between two psychologists in two seperate interviews.

Andrews et al (1999) found a 68% agreement between the DSM and ICD, which is relatively low. However it’s important to point out that this was in 1999, the latest revisions had not been released of either of them.

 

Diagnosis of Mental Disorders
Diagnosing Mental Disorders

Diagnosis of Mental Disorders

The Four D’s

There isn’t a clearly defined boundary between unusual behaviour and mental illness, what’s considered a mental illness can be quite subjective, and it can vary between people and cultures. To attempt to solve this, psychologists came up with four things to consider about a behaviour during mental disorder diagnosis. These are known as the 4 D’s: Deviance, Dysfunction, Distress and Danger.

‘D’ Description
Deviance  To what extent does the behaviour deviate from what is considered to be the social norm?
Dysfunction  To what extent does the behaviour interfere with the person’s daily functioning. Can they still continue their daily life unaffected?
Distress  To what extent does the behaviour cause the person distress and discomfort?
Danger  To what extent is the behaviour dangerous to themselves and others?

It should be noted that most psychologists would only consider any of these behaviours a mental illness if they persist over a long period of time. It could be said that everybody suffers from these types of behaviours at times.

Evaluation

The four D’s were a good first step to begin to standardise mental diagnosis, as they clarified what exactly should be considered about a person’s behaviour when deciding whether it’s a mental illness. However, the psychologist should consider all four of the issues during diagnosis, to ensure standardisation.

On the other hand, one major issue with this system is the subjectivity of it. What defines dysfunctional behaviour? What behaviour is considered abnormal? You’d receive different answers from different people, making it a very subjective way of definining a mental illness.

Finally, many mental illnesses are not rare at all, and therefore would not be considered ‘deviant’ behaviour, such as depression.