Clinical Psychology


What is Clinical Psychology?


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What is the STATISTICAL DEFINITION of abnormality?

Behaviour that is classed as STATISTICALLY RARE, - e.g IQ


  • Helped form the basis for diagnosing severe learning disability 


  • Fails to take into account DESIRABLE behaviours
  • What is rare in some cultures is common in others - e.g anxiety is common but classed as abnormal

IQ graph (

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What is the SOCIAL NORMS definition of abnormality

Behaviour which conforms to social norms is 'normal' + behaviour that doesn't is classed as 'abnormal' , - e.g wearing a chicken suit out in public


  • Drastically deviating from the norm enables individuals to get HELP


  • Not always useful as breaking social norms can be WORTHWHILEE.G Rosa Parks 
  • Norms change over TIME
  • Definition of abnormality can VARY between the wider cultures and sub-groups.
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What is measured is what is claimed to be measured.


E.g - depression is hard to diagnose and using a list of symptoms may take into account the whole experience of depression, so may lack construct validity.


When what was done in one study is repeated and the same results are found.


The DSM - does one clinician give the same diagnosis as the second? (Brown = 67% agreement rate / Beck = 54% agreement rate)


A psychotic disorder that affects around 1% of the population.

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Primary Data

FIRST HAND from source, usually gathered by the use of questionnaires,                                     observations, content analysis and experiments.


  • OPERATIONALISATION is done with the research aim in mind, so there is likely to be validity with regard to the aim.
  • More credible than secondary data, they're gathered for the purpose with chosen research methods, designs etc in mind


  • Expensive compared with secondary data because data is gathered from the start
  • Limited to time, place + number of participants.
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Secondary Data

Data that has already been gathered by someone and are used by someone else - e.g government statistics from a census can inform researchers about the number of females living alone


  • Cheap
  • Good quantity - detail from quantitative data
  • Different sources - heightens reliability and validity


  • May not be valid for the purpose of the study
  • Subjectivity
  • Relevance to time period?
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Animal Studies in Schizophrenia

Can either be ETHOLOGICAL or LABORATORY (Natural / Artificial)

RANDRUP + MUNKVAD (1966) - Wanted to investigate chemical imbalance in the brain. They injected rats with amphetamines and all symptoms of schizophrenia were reported. "Stereotypy" shown by rats - abnormal mouth movements, gnawing of a caged bar, sniffing at a fixed location. They repeated this on different animals and found the same results = therefore supports the theory of chemical imbalance.


  • Easier to control than humans
  • Genetic similarities - Evolutionary continuity
  • Animals can be used for experiments as it's more ethical than humans


  • Antrhopomorphic - thinking animals behaviour is due to the same type of thinking as humans.
  • Can't assess their level of suffering  = ethical issues
  • Ecological validity (laboratory experiments)
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Twin Studies in Schizophrenia

Are behaviours shared by those who are genetically similar? Psychologists measure concordance rates.

GOTTESMANN AND SHIELDS (1966) - Looked at how far schizophrenia was genetic. Used 392 patients, and looked at 16 years of records to obtain information. Blood and visual tests were used to check whether they were MZ or DZ. They found a 35%-58% concordance rate for MZ twins. 9%-26% for DZ = this shows a genetic basis for schizophrenia.


  • Reliable as there is a large volume of data (Kindler 2000 used a sample of 1588 twins)
  • Suggests that genetic components may be involved in a wide range of psychological phenomena - e.g mental health


  • Adults tend to treat MZ more similarly than DZ as they look alike - similar environment = similarities.
  • May not be representative of the development of non-twins = non generalisable
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The DSM - Diagnosis of Mental Disorders

Looks at the pattern of symptoms, including the distress the person is experiencing. 5 axis : 1) Clinical disorders. 2) Personality conditions. 3) General medical conditions. 4) Environmental factors. 5) Overall rating.

One reason why the DSM revisions have been necessary : HOMOSEXUALITY 


  • Allows a common diagnosis, "Stood the test of time"
  • Reliability of DSM-II and DSM-III (Goldstein 1988)
  • Culture bound syndromes have been added - penis panic 


  • Seen as a confirmation of the medical state of mental disorder, as sufferers are 'patients' and 'treatment' is suggested. - It might be said that some mental disorders are simply a way of living.
  • Reductionist, a holistic approach might be more valid
  • Questionnaires and interviews profuce the findings they're searching for - diagnosis is self fulfilling
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Studies looking into the DSM


GOLDSTEIN 1988 - Effect of gender on the experience of schizophrenia and also re-diagnosed 199 patients successfully - high level of agreement and inter-rater reliability.

BROWN ET ALL 2001- Anxiety and mood disorders in 362 outpatients. Underwent 2 independent interviews - good reliability with inter-rater reliability 


KIM-COHEN ET AL 2005 - Looked at conduct disorder in 5 year olds. Used mothers responses to an interview, teachers responses to a questionnaire and self report data. This all led to a diagnosis of conduct disorder = diagnosis was valid.

HOFFMANN 2002 - Diagnosis of alcohol abuse regarding prison inmates. The DSM was shown to be valid and the interview data supported the idea that dependence > abuse.

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Culture regarding the DSM

Outline the argument 'culture does not affect diagnosis'

- The DSM was developed in the USa yet is used widely in many other cultures. "Mental disorders are scientific".

Outline the argument 'culture does affect diagnosis'

"A spiritual model", e.g hearing voices could be classed as a symptom as schizophrenia, or possession by spirits in other cultures. A clinician from one culture must be aware that a patient from another culture is guided by their own frame of reference.

Outline culture-bound syndrome(s):

PENIS PANIC: "Genital retraction syndrome! - Fear of retracting into their own bodies, typically associated with witchcraft

KURU : Incurable brain disease (headaches and shaking). Not a mental disorder, but it's symptoms are similar to a mental disorder.

Cultural differences = hearing voices / more catatonia in other cultures (availability of treatment)

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Evaluation regarding culture

How might it be possible to OVERCOME cultural bias in diagnosis?

Take emphasis off features that might be affected by culture - focus on UNIVERSAL symptoms. Move away from emphasis on first-rank symptoms and interpretation. Focus on NEGATIVE symptoms as they're more OBJECTIVELY measured.

STRENGTHS of cultural issues, diagnosis and the DSM:

  • Culture-bound syndromes
  • Removal of focus from bizarre symptoms 

WEAKNESSES of cultural issues, diagnosis and the DSM:

  • Cultural Bias
  • Focus on POSITIVE symptoms
  • Cultural differences should be considered seperately 
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Main Features / Symptoms of Schizophrenia:

  • Hallucinations
  • Delusions
  • Thought Insertion / Withdrawal
  • Disorganised speech + behaviour
  • Excessive motor activity
  • Flat Emotions
  • Social Withdrawal
  • Lack of speech
  • Apathy
  • Men = mid 20's
  • Women = early 30's
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Biological Explanation of Schizophrenia

DOPAMINE HYPOTHESIS: the idea that the presence of an excess number of dopamine receptors at the synapse contributes to schizophrenia. An increase of dopamine in one site of the brain contributes to positive symptoms, and in another site contributes to negative symptoms - found by brain lesioning and genetic inheritance.

GRILLY 2002 - Patients with parkinson's disease have low levels of dopamine. Some patients who were taking the drug l-dopa to raise their dopamine level developed schizophrenia-type symptoms.


  • Phenothiazines block dopamine receptors and reduce symptoms - supports the conclusion that dopamine is a cause
  • Brain Differences may link with dopamine sensitivity - e.g % of grey matter, differences in lobes.


  • Social and environmental factors?
  • Amphetamines only produce positive symptoms - Dopamine hypothesis isn't sufficient
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Social Class explanation of Schizophrenia

SOCIAL DRIFT - Those who developed schizophrenia didn't achieve well in their education as children, had problems in adolescence and had difficulties with keeping a job (one study that compared the social class of schizophrenic men with the social class of their fathers, found that though the schizophrenic men were in the lower classes, their fathers generally were not.). Immigrant population tends to be disadvantages with regards to education, housing and overcrowding resulting in higher levels of schizophrenia.


  • Environmental triggers are taken into account - yet other causes such as genetic and neurotransmitter functioning - it is possible that both explanations are useful.
  • The ideas support the facts that there are more schizophrenics in inner-city areas and in lower classes, and both the social drift and social adversity ideas explain a possible link between the disorder and class


  • Those in lower socioeconomic groups, living alone, unemployed and living in poverty might be more likely to be diagnosed - suggesting a diagnosis problem not enviromental
  • It might be that poverty, unemployment and lack of social support are stressors and stress may be a cause of schizophrenia.
  • It is hard to separate environmental factors to see if they cause schizophrenia or vice versa.
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Drug Treatment for Schizophrenia

Focusses on changing the neurotransmitters and getting back into balance. Anti-psychotic drugs have been developed, these fit into the dopamine receptors in the brain, blocking the dopamine and stopping it being picked up therefore minimising it's effects. Each patient is only put on ONE anti-psychotic drug at a time.


  • Drugs are thought to be ''better'' (pre 1950's) treatments as they're seen as more ethical and effective
  • Drug treatment rests on strong biological evidence about the cuases of schizophrenia so is underpinned by theory, which helps in considering it's effectiveness (dopamine receptors)


  • Schizophrenic patients often do not continue to take the drugs that are prescribed for them in 50% of cases.
  • "Chemical strait-jacket", and some people think that such control by society is unacceptable.
  • Drugs have side-effects that are unpleasant and can themselves require medication.
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Psychosocial Treatment for Schizophrenia

ASSERTIVE COMMUNITY THERAPY (ACT) - used to help patients who have frequent relapses and bouts of hospitalisation. Used by community mental health services with clients who have difficulties in a number of areas e.g meeting personal goals. Focusses on people who need the most help. Helps with independence, rehab and recovery. Treatment of the patient in real-life settings. A commitment to spend as much time with the person as necessary in other to rehabilitate and support them.  Strengths:

  • BOND ET AL 2001 summarised 25 controlled studies that looked at the effectiveness of ACT - called an evidence based treatment because there is evidence for it's effectiveness. concluded that ACT was highly effective because it engaged clients, prevented re-hospitalisations, increased housing stability and overall quality of life.


  • Do not seem to have an effect on actual functioning, such as reducing positive and negative symptoms.
  • Works best in heavily populated areas - adequate staffing is required to undertake this hands-on therapy
  • GOMORY 2001 pointed out that the client is offered little choice and surrenders all responsility for making decisions and taking care of themselves.
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Psychosocial Treatment for Schizophrenia

ASSERTIVE COMMUNITY THERAPY - used to help patients who have frequent relapses and bouts of hospitalisation. Used by community mental health services with clients who have difficulties in a number of areas e.g meeting personal goals. Focusses on people who need the most help. Helps with independence, rehab and recovery. Treatment of the patient in real-life settings. A commitment to spend as much time with the person is necessary in other to rehabilitate and support them.                      


  • BOND ET AL 2001 summarised 25 controlled studies that looked at the effectiveness of ACT - called an evidence based treatment because there is evidence for it's effectiveness. concluded that ACT was highly effective because it engaged clients, prevented re-hospitalisations, increased housing stability and overall quality of life.      


  • Works best in heavily populated areas - adequate staffing is required to undertake this hands-on therapy
  • GOMORY 2001 pointed out that the client is offered little choice and surrenders all responsibility for making decisions and taking care of themselves.
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Unipolar Depression

  • A mood disorder characterised by varying degrees of sadness, disappointment, loneliness, hopelessness and guilt.
  • Affects around 3.5 million sufferers in the UK.
  • Depressed mood nearly everyday.
  • Diminished interest in pleasurable activities.
  • Weight loss/gain.
  • Fatigue or loss of energy.
  • Worthlessness / guilt.
  • Thoughts of death.
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Unipolar Depression - Monoamine Hypothesis

THE MONOAMINE HYPOTHESIS - Monoamines (serotonin, noradrenaline, dopamine) are believed to regulate mood. Evidence suggests that low levels of noradrenaline cause depression and high levels of mania (noradrenaline is needed for alertness, energy, anxiety and attention to life. LOW SEROTONIN  = LOW NORADRENALINE. LOW DOPAMINE + LOW NORADRENALINE = DEPRESSIVE MOODS. This hypothesis works alongside drug treatment and is prescribed based on the monoamine in question.


  • A lot of evidence, particularly in treatment
  • Further evidence from the prevention of the inhibition of monoamines


  • Much of the research is from animal studies - therefore creating a problem regarding generalisability
  • Drugs can relieve but not adjust imbalances
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Unipolar Depression - Cognitive Approach


  • 1) The cognitive triad = three areas Beck considered suffered negative auto thoughts                                                  (
  • 2) Cognitive Errors - faulty thought patterns and negative/unrealistic tasks.
  • 3) Schemata - patterns of maladaptive thoughts.

The way to overcome depression according to Beck is to change the maladaptive thoughts by considering alternatives (cognitive, affective, physiological, motivational + behavioural).


  • Backed by both self-report data and other test measures.
  • Biased negative thought patterns seemed to disappear.


  • Difficult to distinguish between thinking that causes and thinking that is caused.
  • Strict evidence that shows negative thinking precisely causes depression is hard to find
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CBT for treating Unipolar Depression

The aim of CBT is to help you think less negatively, so that instead of feeling hopeless and depressed, you cope better with and even start to enjoy the situations you face. In CBT you set GOALS with your therapist and carry out tasks between sessions. A course typically involves around 6-15 sessions, which last about an hour each.

  • First stage = drawing up schedule of activities and become more active and confident.
  • Second stage = recognise your own negative thoughts and record them.
  • Third stage = involves helping you recognise the illogical thinking process.
  • Last stage = therapist helps to change the negative thoughts.


Backed up by self-report data. BUTLER ET AL 2006 suggests it's highly effective.


HOLMER 2002 - less effective than drugs. Difficult to distinguish whether it causes depression or is a cause of.

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Drug Therapy for treating Unipolar depression:

Most work by increasing your level of serotonin. MAOI : prevents the break down of monoamines. Drugs must be gradually stopped to avoid wthdrawal symptoms.


  • Very Scientific Approach
  • Constantly undergoing further research
  • People using drug therapy can also use other therapies such as CBT


  • People may forget to take the drugs
  • Can become drug dependent
  • Doesn't address root cause - it simply corrects chemical imbalance
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Token economy Programme

Treatment is based on operant conditioning as it involved a system of rewards and punishments for behaviours. Rewards are usually tokens which when collected can be traded in for something bigger desired by the individual. Staff must stay committed and reward appropriate and consistant number of tokens for each behaviour. The behaviour must be something the individual finds complex and challenging.


  • Appears to be effective, atleast to an extent. Long term schizophrenia patients were rehabilitated for at least 1 year.
  • Programme rests on clear behaviour management principles and underpinned by well researched theory


  • Needs to be a strong team for the token economy programme because rewards must be consistant and clear and requires high level of management - there's an issue with power in that staff and administrators have much power over the patient
  • Problems with transferring the programme to outside environment (recidivism) e.g out of institution
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Psychodynamic Approach - Dream Analysis

Uncover the MANIFEST (real) content and the LATENT (hidden) content.

Psychoanalyst sits slightly behind the client --> the analysand is the main focus.

  • Condensation = when 2 or more idea's are joined into one
  • Displacement = When someone or something that is giving concern is displaced onto something else
  • Secondary Elaboration = when the unconscious mind puts things together so they seem logical when analysed 
  • Features of dream analysis include confronting defence mechanisms


  • Seems to be a good way of uncovering unconscious thoughts and wishes
  • Bought in CBT - Other effective branches of psychotherapy 


  • Not a quick cure - need to invest time and money
  • Use of case studies
  • Ethical issues due to the power difference 
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Rosenhan's 1973 - "Being sane in insane places"

  • If 8 sane people who gained admission into 12 different hospitals would be 'found out' as sane.
  • 8 pseudo patients, given pseudonyms to save embarrassment
  • "empty...hollow...thud"
  • Stopped stimulating symptoms on admission
  • given med they didnt swallow
  • responded to staff and chatted with patients
  • Never detected - no doubts from the staff, yet other patients knew they were pseudo
  • Average spend of days = 19 (7 --> 52)

Can diagnosis be reversed?

  • "In the next 3 months, ___ pseudo patients would attempt to be admitted"
  • Staff asked to rate the likelihood of being a pseudo-patient on a scale of 1-10
  • Judgements given on 193 patients: 41 judged with high confidence. 23 considered suspects.
  • One labelled schizophrenic there is nothing the pseudo-patient can do to overcome the tag
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Rosenhan's 1973 - "Being sane in insane places" Ev


  • GENERALISABILITY- Generalising findings is possible due to the number of varied hospitals used
  • RELIABILITY- By using 8 people in 12 hospitals the study was replicated and the same results were found


  • VALIDITY - Not surprising that the patients were wrongly identified as they claimed to have a standard symptom of schizophrenia ; lies are likely to guide the results, studies were NOT natural nor valid
  • Institutions have changed their working practices considerably - may be wrong to conclude.
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Goldstein's 1988 study - 'Gender Differences in th

  • Look at gender differences with regrd to the rehospitalisation of schizophrenia + to look into the reliability of the DSM
  • 90 patients out of a possible 169 ages 18-45
  • 'Schizophrenics' rediagnosed with the DSM-III
  • Gathered info about + & - symptoms 
    • Premorbid functioning
    • Social functioning 
    • Cause of illness
  • 5 YEARS
    • Mean number of men rehospitalised = 1.4
    • Mean number of women rehospitalised = 0.59
  • 10 YEARS
    • Mean number of men rehospitalised = 2.24
    • Mean number of women rehospitalised = 1.12
  • 13% of the gender effect on re-hospitalisation was due to PMF, although only accounted for 4.3% of the effect on gender on length of stays. 
  • Rehospitalisation was affected more by pre-morbid functioning
  • Length of stay was affected more by social functioning
  • Women had a better outcome and experience
  • The DSM is reliable
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Goldstein's 1988 study - 'Gender Differences in th


  • Another study using a larger sample in Germany found the same results - Reliability!
  • DSM-III - the DSM is useful, reliability of the hypothesis was checked
  • Having other evidence that supports the findings suggests that it is valid to say there are gender differences and premorbid factors appear to be implicated


  • Age limit of 45 - the course of schizophrenia for women might be less severe only for woman under 45
  • Small sample from a limited area and similar cultural background
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Brown et al's 1986 study into self-esteem and depr

  • Hypothesis based around 
    • Crisis support, self-esteem, lack of support, husband
  • 395/435 women aged 18-50 - must have a husband with a manual job and a child under the age of 18 living at home
  • First contact found 40 with depression, making 355
  • Second contact 12 months later
  • Done by experienced interviewers 
  • 89% agreed to a follow-up interview 
    • 50 more cases of depression (303)
  • 33% = negative evaluation of self
  • 91% had experiences a severe event 
  • 44% developed depression as a result of no support
  • Marriage / A close tie - lower chance of depression
  • Provoking agent seems to be necessary for the onset of depression.
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Brown et al's 1986 study into self-esteem and depr


  • Inter-rater reliability - Strengthens the results arising from the data 
  • Data is likely to be valid as they were gathered carefully by trained interviewers using a semi-structured interview - allows detailed information to be explored.
  • Random sample eliminates bias 


  • Generalisability - Working class women with atleast 1 child still at home; can't apply findings to MEN, women in other classes, or women without children.
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