Clinical Psychology (PSY401)
The researcher can hypothesize that a variable ratio pattern of reinforcement will increase behavior
more rapidly than no reinforcement. This hypothesis could then be tested in relation to clinically
relevant behaviors, such as the development and maintenance of a child's disruptive or noncompliant
Hypotheses can also emerge directly from the findings of previous research. This includes studies
carried out by other researchers as well as an investigator's own previous work. Knowledge of prior
research is important to avoid pursuing the answers to questions that have already been resolved, to
learn from the tribulations and mistakes of others, and to draw on the findings of previous studies as an
important source of future hypotheses. Keeping abreast of research in psychology has become a
daunting task, however, as the field has grown to include thousands of active researchers publishing
their findings in hundreds of journals around the world. Computerized literature search programs such
as PsychLit, PsychInfo, and MedLine have been enormously helpful in expediting the process of
bringing oneself up to date on current research on a topic. But these methods are not a substitute for
reading broadly in many areas of psychology to develop hypotheses that reflect basic as well as applied
Some of the best examples of programmatic research in clinical psychology involve the use of basic
research on a clinical disorder to form the foundation for interventions to treat or prevent the problem.
For example, research on the factors that place children at risk for the development of aggressive and
violent behavior problems has led to the development of interventions in childhood to prevent the onset
of these problems.
MEASURING KEY VARIABLES
2. SELECTION OF MEASURES
Once a set of hypotheses has been developed, the next challenge for the researcher is to determine how
to measure the key variables, or constructs, that are the focus of the study. Measurement involves
assessment of characteristics of people's thoughts emotions, behavior, and physiology and the,
environments in which they function. A number of difficult decisions must be made with regard to the
measurement of people and environments. First, the aspects of the person or the environment that are
most central to the research goals and hypotheses must be determined.
A researcher however, cannot, measure everything that might be relevant to the question at hand.
Measurement of a large number of variables is impractical, because participants in research often cannot
or will not invest the amount of time that a researcher desires. In general, researchers should measure
only those factors that are most important to their hypotheses.
Second, specific methods must be selected to measure the variables of interest in the study. Assessment
methods used in clinical research include direct observations (e.g., observations of parents and children
interacting with each other); self-reports by participants in the research (e.g., self-reports of symptoms
of depression and anxiety); measures of physiological reactivity and recovery (e.g. heart rate variability,
skin conductance); and performance on structured experimental tasks (e.g., continuous performance
tasks). Each of the methods of measurement has its inherent strengths and weaknesses. For example,
self-reports from participants are necessary to assess certain aspects of thoughts and emotions because
there are aspects of private experience that are not accessible any other way.
On the other hand, self-reports are subject to certain types of problems, including biases in the ways that
individuals may want to present them-selves to others, the inability to accurately report on certain
aspects of one's own thoughts and emotions, and unwillingness to disclose certain types of information.
Observational methods are strong in terms of their objectivity and ability to measure behavior as it
occurs in response to specific events or conditions in the environment. Observations cannot be used,
however, to measure private thoughts and internal emotional states. One solution to the problems
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inherent in each form of measurement is to use different types of measures in the same study to
determine the degree to which the findings converge across different types of measurement as opposed
to findings that are unique to one type of measure.
Third, the researcher must determine if tried-and-true measures of these constructs have been developed
and used in previous research, or if new measures need to be constructed to pursue the goals of this
study. Whenever possible, researchers use measures that have established levels of reliability and
validity and (when appropriate) that have normative data available on populations that are similar to the
participants in the study. These factors provide a degree of assurance that the measure can be trusted -
that the results are to some degree consistent and accurate. In some instances, a researcher will want to
measure a variable for which an adequate instrument is not available. In these cases, the researcher is
faced with the task of developing and validating a new measure in order to carry out the study. It is not
acceptable, however, to simply employ a new measure or technique for the purposes of the study
without paying careful attention to establishing its reliability and validity.
An example of these difficult, decisions can be found in research on the nature of anxiety disorders.
Anxiety can be measured at a number of different levels, including the experience and emotions of the
individual (e.g., "I feel tense and anxious"), observations made by others of overt manifestations of
anxiety (e.g., "I could see his hands were shaking and I could hear a trembling in his voice"), and
measures of physiological arousal (e.g., elevated heart rate, blood pressure, skin conductance). None of
these approaches to measurement represents the "right" way to assess anxiety, and the issue is clouded
by the fact that the three approaches often yield different results.
For example, some individuals may experience high physiological arousal but do not report subjective
experiences of fear or anxiety, and conversely, some individuals with very low levels of arousal feel
very anxious. The failure of different types of measures to converge (i.e., to provide the same
information on the variable that is being measured) does not imply that any one of the measures is
invalid. However; it presents the researcher with a challenge in the interpretation of the different sources
3. SELECTING A RESEARCH DESIGN
Armed with a clear set of hypotheses and appropriate measures to assess the important variables under
investigation, a clinical psychologist is prepared to design a study. There are four basic types of research
designs (but many variations within each) from which to choose: descriptive designs, correlational
designs, experimental designs, and single-case designs. Generally, the two main methods of data
collection are survey method and observational method. Moreover, all these designs can be cross-
sectional (one point in time) or longitudinal (over the course of time). The choice of which design and
which data-collection method to use depends on the nature of the question being asked and on ethical
and practical limitations that may constrain the research. No one type of research design is inherently
superior to others - each is simply better suited to answer some questions than others.
There are two main categories of research methods, both with their own respective sub-categories.
1. SURVEY METHODS
2. OBSERVATIONAL METHODS
1. SURVEY RESEARCH METHODS
Survey methods are used to obtain people's responses and opinions regarding an issue or problem.
Types of survey include computerized on-line surveys, telephonic surveys, voting polls, personal
interviews, use of questionnaires etc.
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1. THE PURPOSE OF SURVEY RESEARCH METHODS
The aim of survey research is to measure certain attitudes and/or behaviors of a population or a sample.
The attitudes might be opinions about a political candidate or feelings about certain issues or practices.
Survey research focuses on naturally occurring phenomena. Rather than manipulating phenomena,
survey research attempts to influence the attitudes and behaviors it measures as little as possible. Most
often, respondents are asked for information.
3. TYPES OF DATA
Survey research is primarily quantitative, but qualitative methods are sometimes used, too.
Once in a while, a researcher may be able to gather data from all members of a population. For example,
if you want to know what a neighborhood thinks about a local land use issue, you may be able to
measure all residents of the neighborhood if it is not too big. However, most of the time, the population
is so large that researchers must sample only a part of the population and make conclusions about the
population based on the sample. Because of this, gaining a representative sample is crucial in survey
SOME COMMON SAMPLING STRATEGIES
SIMPLE RANDOM SAMPLING
Members of the population are drawn at random to be in the sample. Each member of the population has
an equal chance of being in the sample. Think of putting the names of all the possible survey
respondents into a hat and drawing them out one by one to build your sample.
STRATIFIED RANDOM SAMPLING
Strata (sub-groups) are identified and respondents selected at random from within the relevant strata.
For example, if I want to know the extent of certain health behaviors among the students at my college,
I would identify the relevant dimensions. These might be day or night students (since these are two
fairly distinct sub-populations) and major (since Letters, Arts, and Sciences majors tend to be different
from Business majors). Thus, I would have 4 sub-groups: day students in Business, day students in
Letters, Arts and Sciences, night students in Business, and night students in Letters, Arts and Sciences.
Then, I would randomly choose respondents from within each of these four groups. The step of
stratifying gives me a more targeted sampling strategy.
This imposes the constraint that the sample must reflect the same proportions of sub-groups as is found
in the population. For example, I could insist that my samples have the same proportion of traditional-
age students (18-22) and non-traditional students.
This is a procedure in which the sampling strategy does not give a representative sample. Examples
include convenience sampling, where the sample is made up of those whom it is most convenient to
survey, say one's friends or people who pass by a certain street corner; self-selected sampling, in which
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the respondents get to choose whether to be included in the survey, such as leaving questionnaires at a
table in a public place; and snowball sampling, in which previous respondents recruit subsequent
Note that although these non-probability sampling strategies do not yield representative samples, they
may still be useful to researchers in gaining a preliminary picture or as a pilot project.
5. POSSIBLE SOURCES OF BIAS IN SURVEY RESEARCH
Respondents tend to say what they think the researcher wants to hear.
Respondents tend to say "yes" more easily than "no."
Thinking about the questions tends to change respondents' opinions. For example, you may not have
thought much about environmental damage until a survey asks for your opinions on rainforest depletion.
Some people tend to answer more positively or in more extreme terms. If there is a consistent tendency
for one group to give more extreme responses and a consistent tendency for another group to give more
middle-of-the-road responses, we might mistakenly conclude they have different opinions. In fact, we
may only be observing a bias in their response tendencies.
2. OBSERVATIONAL METHODS
The most basic and pervasive of all research methods is observation. Experimental, case study, and
naturalistic approaches all involve making observations of what someone is doing or has done. Types of
observational methods include the following:
a. UNSYSTEMATIC OBSERVATION
Casual observation does little by itself to establish a strong base of knowledge. However, it is through
such observation that we develop hypotheses that can eventually be subjected to test. For example,
suppose a clinician notes on several different occasions that when a patient struggles or has difficulty
with a specific item on an achievement test, the effect seems to carry over to the next item and adversely
This observation leads the clinician to formulate the hypothesis that performance might be enhanced by
making sure each failure item is followed by an easy item on which the patient will likely succeed. This
should help build the patient's confidence and thus improve performance. To test this prediction, the
clinician might administer an experimental version of the achievement test, in which difficult items are
followed by easy items. It would then be relatively easy to develop a study that would test this
hypothesis in a representative sample of clients.
b. NATURALISTIC OBSERVATION
Though carried out in real-life settings, naturalistic observation is more systematic and rigorous. It is
neither casual nor free-wheeling, but carefully planned in advance. However, there is no real control
exerted by the observer, who is pretty much at the mercy of freely flowing events. Frequently,
observations are limited to a relatively few individuals or situations. Thus, it may be uncertain how far
one can generalize to other people or other situations. It is also possible that in the midst of observing or
recording responses, the observer may unwittingly interfere with or influence the events under study.
Clinical Psychology (PSY401)
An example of a study using the naturalistic observation method might be an investigation of patient
behavior in a psychiatric hospital. Perhaps a particular unit in this hospital is composed of patients who
are scheduled to undergo electroconvulsive therapy (ECT) that day. The clinician's job is to focus on ten
patients and observe each one for 2 minutes every half-hour. This observational study might yield
interesting data about the reactions of patients prior to ECT. But with only ten patients from this
particular hospital, can wide generalizations be made? Are these patients' reactions similar to those in
other hospitals or other units where the overall atmosphere may be very different? Or were the patients
aware of the observer's presence and could they have altered their customary reactions in order to
somehow impress him or her?
Investigators committed to more rigorous experimental methods sometimes condemn naturalistic
observation as too uncontrolled. But this judgment may be too harsh.
As with unsystematic observation, this method can serve as a rich source of hypotheses that can be
subjected to careful scrutiny later. Naturalistic observations do get investigators closer to the real
phenomena that interest them. Such observations avoid the artificiality and contrived nature of many
experimental settings. For example, regardless of their feelings about psychodynamic theory, most
acknowledge that Freud's clinical observation skills were extraordinary. Freud used his own powers of
observation to construct one of the most influential and sweeping theories in the history of clinical
psychology. It is important to recall that Freud had available no objective tests, no computer printouts,
and no sophisticated experimental methods. What he did possess was the ability to observe, interpret,
and generalize in an impressive fashion.
c. CONTROLLED OBSERVATION
To deal in part with the foregoing criticisms of unsystematic and naturalistic observation, some clinical
investigators employ controlled observation. While the research may be carried out in the field or in
relatively natural settings, the investigator exerts some degree of control over the events. Controlled
observation has a long history in clinical psychology. For example, it is one thing to have patients tell
clinicians about their fears or check off items on a questionnaire. However, Bernstein, and Nietzel
(1973) studied the nature of snake phobias by placing study participants in the presence of real snakes
and then varying the distance between participant and snake. This controlled observation enabled them
to gain some real insight into the nature of the participants' reactions. Controlled observation can also be
used to assess communication patterns between couples or spouses. Instead of relying on distressed
couples' self-reports of their communication problems, researchers may choose to actually observe
communications styles in a controlled setting.
Specifically, partners can be asked to discuss and attempt to resolve a moderate-sized relationship
problem of their choosing (for example, partner spends too much money on unnecessary things) while
researchers observe or videotape the interaction behind a one-way mirror. Although not a substitute for
naturalistic observation of conflict and problem solving in the home, researchers have found this
controlled observation method to be a useful and cost-effective means of assessing couples' interaction
d. CASE STUDIES
The case study method involves the intensive study of a client or patient who is in treatment. Under the
heading of case studies we include material from interviews, test responses, and treatment accounts.
Such material might also include biographical and autobiographical data, letters, diaries, life-course
information, medical histories, and so on. Case studies, then, involve the intensive study and description
of one person. Such studies have long been prominent in the study of abnormal behavior and in the
description of treatment methods. Their great value resides in their richness as potential sources of
understanding and as hypothesis generators. They can serve as excellent preludes to scientific
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Nothing will ever likely supplant the case study as a way of helping clinicians to under-stand that
unique patient who sits there before them. As Allport (1961) so compellingly argued, individuals must
be studied individually. Case studies have been especially useful for (1) providing descriptions of rare or
unusual phenomena or novel, distinctive methods of interviewing, assessing, or treating patients; (2)
disconfirming "universally" known or accepted information; and (3) generating testable hypotheses.
There is, of course, a downside to case study methods. For example, it is difficult to use individual cases
to develop universal laws or behavioral principles that apply to everyone. Likewise, one case study
cannot lead to cause-effect conclusions because clinicians are not able to control important variables
that have operated in that case. For example, one patient may benefit enormously from psychodynamic
therapy for reasons that have less to do with the therapy method than with the personality characteristics
of that patient. Only subsequent controlled research can pin down the exact causes of, or factors
CROSS-SECTIONAL VERSUS LONGITUDINAL APPROACHES
Another way of classifying research studies is by considering whether the studies are cross-sectional or
longitudinal in nature. A cross-sectional design is one that evaluates or compares individuals, perhaps of
different age groups, at the same point in time. A longitudinal design follows the same subjects over
The basic format of these two approaches is shown in the following figure. In this example, row
(a) illustrates the longitudinal design and column (b) the cross-sectional design.
Cross-sectional approaches are correlational, because the investigator cannot manipulate age nor can
participants be assigned to different age groups. Because there are different participants in each age
group, we cannot assume that the outcome of the study reflects age changes; it only reflects differences
among the age groups employed. These differences could be due to the eras in which participants were
raised rather than age by itself. For example, a group of 65-year-olds might show up as more frugal than
a group of 35-year-olds. Does this mean that advancing age promotes frugality? Perhaps. But it might
simply reflect the historical circumstance that the 65-year-olds were raised during the Great Depression
when money was very hard to come by.
Longitudinal studies are those in which we collect data on the same people over time. Such designs
allow us to gain insight into how behavior or mental processes change with age. In the interpretive
sense, longitudinal studies enable investigators to better speculate about time-order relationships among
factors that vary together. They also help eliminate the third variable problem that so often arises in
correlational studies. For example, suppose we know that states of depression come and go over the
years. If depression is responsible for the correlation between significant weight loss and decreased self-
confidence, then both weight loss and decline in self-confidence should vary along with depressive
There are, of course many variations in cross-sectional and longitudinal deigns. In the case of
longitudinal studies, however, the main problems are practical ones. Such studies are costly to carry out,
and they require great patience and continuity or leadership in the research program. Sometimes, too,
researchers must live with design mistakes made years earlier or put up with outmoded research and
assessment methods. Because longitudinal research is expensive in both time and money, it is not used
as often as it should be. For these reasons, research in the developmental aspects or psychopathology
has long suffered. Still, it is to be hoped that there will be a return to those strategies that deal with
psychopathology, treatment, or personality over extended periods of time, using a variety of measures.
Too often, we have been captives of a cross-sectional methodology that sometimes seems to focus
exclusively on 50-minute experiments. Such strategies have promoted a "snapshot" view of human
behavior and personality that has done little to help us understand the coherence and organization of
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4. SELECTING A SAMPLE
Who should participate in a study once it has been designed? Selection and recruitment of a sample is
important to the ultimate generalizability (external validity) of the research findings. If the sample is not
a representative sample of the larger population from which it is drawn, the results of the study may be
biased or influenced by the characteristics of the sample. For example, a sample may differ from the
general population in terms of demographic characteristics, such as sex, age, education level, income,
and ethnic or racial background. These characteristics may influence the findings of the study, because
the results may differ as a function of one or more of these characteristics.
In research with clinical samples, it is additionally important to determine the extent to which the
sample is representative of the clinical population to which the results are to be generalized.
5. TESTING HYPOTHESES
STATISTICAL VERSUS PRACTICAL SIGNIFICANCE
Once a study has been completed and the data are in hand, psychologists rely on the use of inferential
statistics to evaluate the degree to which the null hypothesis has been rejected. The specific type of
statistical procedure, which is used, depends on the research design that was employed. After a statistic
(such as a correlation coefficient) has been calculated, it can be determined whether the obtained
number is significant.
Traditionally, if it is found that the obtained value (or a more extreme value) could be expected to occur
by chance alone less than 5 times out of 100, it is deemed statistically significant. Such an obtained
value is said to be significant at the .05 Ievel, usually written as p < .05. The larger the statistical value,
the more likely it is to be significant. But when large numbers of participants are involved, even
relatively small statistical values can be significant. With 180 participants, a correlation of .19 will be
significant; when only 30 participants are involved, a correlation of .30 would fail to be significant.
Therefore, it is important to distinguish between statistical significance and practical significance when
interpreting statistical results. The correlation of .19 may be significant, but the magnitude of the
relationship is still quite modest. For example, it might be true that in a study involving 5000 second-
year graduate students in clinical psychology across the nation, there is a correlation of .15 between
their GRE scores and faculty ratings of academic competence. Even though the relationship is not a
chance one, the actual importance is rather small. Most of the variance in faculty ratings is due to factors
other than GRE scores.
In some cases, a correlation of .15 may be judged important, but in many instances, it is not. At the
same time, we should remember that accepting significance levels of .05 as non-chance represents a
kind of scientific tradition - it is not sacred. Other information may persuade us, in certain cases such as
clinical settings that significance levels of .07 or .09, for example, should be taken seriously.
In other words, clinical researchers need to look beyond the statistical significance of the findings to
understand the statistic's meaning for the people and problems that are the focus of clinical research.
6. INTERPRETING AND DISSEMINATING FINDINGS
The final step in the research process is to place the meaning or implications of a study in a broader
context. What are the implications of the findings for understanding the nature, causes, and course of
psychological problems? What are the implications for the prevention or treatment of psychopathology?
What do the results mean for establishing public policy related to mental health?
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A first step in the process of sharing the results of research is to submit them to review for publication in
peer-reviewed professional journals. Articles that are published in peer-reviewed scientific journals have
been evaluated by other researchers and experts in the field prior to publication. The review process
ensures that the work that is published meets certain accepted criteria for scientific quality. The most
rigorous journals in clinical psychology include Journal of Consulting and Clinical Psychology, Journal
of Abnormal Psychology, Behavior Therapy etc.
The findings of clinical research are not designed solely for advancing the science of clinical
psychology, however. Clinical research is also designed to improve the conditions of people with
psychological problems. Therefore, researchers have an obligation to translate their findings into
information that can be used for the general good. Research results should be communicated to the
public, to practicing psychologists, and to officials who formulate mental health policies and allocate
money for mental health programs. Practicing psychologists and their clients as well as policy makers
are hungry for information that will help them understand the nature, causes, and treatment of
SUMMARY AND CONCLUSIONS
The foundation of clinical psychology lies in the research that has been generated on the nature and
causes of psychopathology, the development of measures of personality and behavior, and the
evaluation of the effects of psychotherapy and other forms of intervention to relieve or prevent
psychological distress. The research process follows a series of steps that include the generation of
hypotheses, the choice of measures, the selection of a research design, the identification of a sample, the
testing of the hypothesis, and the interpretation and dissemination of findings. Clinical psychologists use
several different types of research designs, including single-case designs, descriptive methods,
correlational designs, and experimental methods. Using both correlational and experimental methods to
conduct studies in the laboratory and in the natural environment, clinical psychologists have made
significant contributions to the scientific study of human behavior.
Just like clinical practice and all other areas of psychology, psychological research, too, involves
important ethical considerations. Like patients, research participants have rights, and investigators have
responsibilities to them.
In 1992, the American Psychological Association published an expanded and updated set of ethical
standards for research with human participants (APA, 1992). We offer only a brief overview here. These
standards require that investigators:
Plan research according to recognized standards of scientific competence and ethical principles
Implement safeguards for the welfare of participants, others that may be affected by the
research, and animal subjects
Retain responsibility for ensuring ethical practices in research
Comply with pertinent federal and state law and regulations
Gain appropriate approval from host institutions or organizations before conducting research
Establish clear and fair agreements with their research participants so that the rights and
obligations of each party are clarified
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Obtain the informed consent of research participants, using language that is easily
understandable to them, and document their consent
Take great care, in offering inducements for research participation, that the nature of the
compensation (such as professional services) is made clear and that financial or other types of
inducements are not be so excessive as to coerce participation
Use deception as part of their procedures only when it is not possible to use alternative methods
Protect participants from any mental and physical discomfort, harm, and danger that might arise
during the research
Inform research participants of the anticipated use of the data and of the possibility of sharing
the data with other investigators or any unanticipated future uses
Minimize the invasiveness of research procedures
Provide participants with information at the close of the research to erase any misconceptions
that may have arisen
Treat animal subjects humanely and in accordance with federal, state, and local laws, as well as
with professional standards
Several of these points require further comment.
Good ethical practice as well as legal requirements demand that participants give their formal informed
consent (usually in writing) prior to their participation in research. Researchers inform the participants
of any risks, discomforts, or limitations on confidentiality. Further, researchers inform the participants
of any compensation for their participation. In the process, the researcher agrees to guarantee the
participant's privacy, safety, and freedom to withdraw. Unless participants know the general purpose of
the research and the procedures that will be used, they cannot fully exercise their rights.
Participant's individual data and responses should be confidential and guarded from public scrutiny.
Instead of names, code numbers are typically used to protect anonymity. While the results of the
research are usually open to the public, they are presented in such a way that no one can identify a
specific participant's data. Finally, clinical psychologists must obtain consent before disclosing any
confidential or personally identifiable information in the psychologist's writings, lectures, or
presentations in any other public media (such as a television interview).
Sometimes, the purpose of the research or the meaning of a participant's responses is withheld. Such
deception should be used only when the research is important and there is no alternative to the deception
(in other words, when veridical information would compromise participants' data). Deception should
never be used lightly. When it is used, extreme care must be taken that participants do not leave the
research setting feeling exploited or disillusioned. It is important that careful debriefing be undertaken
so that participants are told exactly why the deception was necessary. We do not want participants'
levels of interpersonal trust to be shaken. Clearly, it is very important how we obtain informed consent
when deception is involved.
Clinical Psychology (PSY401)
An example of the need for deception in a study might be an experiment in which it is predicted that the
viewing of gun magazines (or other materials associated with potential violence) will lead to increased
scores on a questionnaire measuring hostility. All participants are told that the experiment is one
focusing on short-term memory, and they will be completing a memory task on two occasions separated
by a 15-minute waiting period during which they will be reading magazine articles. All participants first
complete baseline measures (including the hostility questionnaire). Next, all participants complete a
computer-administered memory task. During the waiting period, the experimental group is told to read
selections from a gun magazine that is made available in the lab; the control group is told to read
selections from a nature magazine (neutral with regard to violent imagery). All participants later
complete the computer-administered memory task again. Finally, all participants complete the battery of
self-report instruments a second time.
We are not so much interested in the viability of this hypothesis as we are in the need for some
deception in the experiment. As you can see, to tell the participants the real purpose of the experiment
would likely influence their responses to the questionnaires (especially to the one measuring hostility).
Therefore, the investigator might need to introduce the experiment as one that is focusing on short-term
Because participants have a right to know why researchers are interested in studying their behavior, a
debriefing at the end of the research is mandatory. It should be explained to participants why the
research is being carried out, why it is important, and what the results have been. In some cases, it is not
possible to discuss results because the research is still in progress. But subjects can be told what kinds of
results are expected and that they may return at a later date for a complete briefing if they wish.
It hardly seems necessary to mention that investigators are under the strictest standards of honesty in
reporting their data. Under no circumstances may they alter obtained data in any way. To do so can
bring charges of fraud and create enormous legal, professional, and ethical problems for the
investigator. Although the frequency of fraud in psychological research has so far been minimal, we
must be on guard. There is no quicker way to lose the trust of the public than through fraudulent
Clinical Psychology (PSY401)
THE CONCEPT OF ABNORMAL BEHAVIOR & MENTAL ILLNESS
Clinical psychology is usually thought of as an applied field. Clinicians attempt to apply empirically
supported psychological principles to problems of adjustment and abnormal behavior. Typically this
involves finding successful ways of changing the behavior, thoughts, and feelings of clients. In this way,
clinical psychologists lessen their clients' maladjustment or dysfunction or increase their levels of
Before clinicians can formulate and administer interventions, however, they must first assess their
clients' symptoms of psychopathology and levels of maladjustment. Interestingly, the precise definitions
of these and related terms can be elusive. Further, the manner in which the terms are applied to clients is
sometimes quite unsystematic.
Clinical psychology has moved beyond the primitive views that defined mental illness as possession by
demons or spirits. Maladjustment is no longer considered a state of sin. The eighteenth and nineteenth
centuries ushered in the notion that "insane" individuals are sick and require humane treatment. Even
then, however, mental health practices could be bizarre, to say the least. Clearly, clinical psychologists'
contemporary views are considerably more sophisticated than those of their forebears. Yet many view
current treatments such as electroconvulsive therapy (ECT) with some skepticism and concern. Still
others may see the popularity of treatments using psychotropic medications (such as antipsychotic,
antidepressant, anti-manic, or anti-anxiety medications) as less than enlightened.
Finally, many forms of "psychological treatment" (for example, primal scream therapy, age regression
therapy) are questionable at best. All of these treatment approaches and views are linked to the ways
clinical psychologists decide who needs assessment, treatment, or intervention, as well as the rationale
for providing these services. These judgments are influenced by the labels or diagnoses often applied to
WHAT IS ABNORMAL BEHAVIOR?
Ask ten different people for a definition of abnormal behavior and you may get ten different answers.
Some of the reasons that abnormal behavior is so difficult to define are (1) no single descriptive feature
is shared by all forms of abnormal behavior, and no one criterion for "abnormality" is sufficient; and (2)
no discrete boundary exists between normal and abnormal behavior. Many myths about abnormal
behavior survive and flourish even in this age of enlightenment. For example, many individuals still
equate abnormal behavior with (1) bizarre behavior, (2) dangerous behavior, or (3) shameful behavior.
In this section, we will examine in some detail three proposed definitions of abnormal behavior: (1)
conformity to norms, (2) the experience of subjective distress, and (3) disability or dysfunction. We will
discuss the pros and cons of each definition. Although each of these three definitions highlights an
important part of our; understanding of abnormal behavior; each definition, by itself, is incomplete.
A. CONFORMITY TO NORMS: STATISTICAL INFREQUENCY OR VIOLATION OF
When a person's behavior tends to conform to prevailing social norms or when this particular behavior
is frequently observed in other people, the individual is not likely to come to the attention of mental
health professionals. However, when a person's behavior becomes patently deviant, outrageous, or
otherwise nonconforming, then he or she is more likely to be categorized as "abnormal." Let us consider
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THE CASE OF BILLY A
Billy is now in the second grade. He is of average height and weight and manifests no physical
problems. He is somewhat aggressive and tends to bully children smaller than himself. His birth. was a
normal one, and although he was a bit slow in learning to walk and talk, the deficit was not marked. The
first grade was difficult for Billy, and his progress was slow. By the end of the school year, he was
considerably behind the rest of the class. However, the school officials decided to pass him anyway.
They reasoned that he was merely a bit slow in maturing and would "come around" shortly. They noted
that his status as an only child, a pair of doting parents, a short attention span, and aggressiveness were
all factors that combined to produce his poor school performance.
At the beginning of the second grade, Billy was administered a routine achievement test, on which he
did very poorly. As a matter of school policy, he was referred to the school psychologist for individual
testing and evaluation. Based on the results of the Stanford-Binet Intelligence Scale, a Draw-a-Person
Test, school records, and a social history taken from the parents, the psychologist concluded that Billy
suffered from mental retardation. His IQ was 64 on the Stanford-Binet and was estimated to be 61 based
on the Draw-a-Person Test. Further, a social maturity index derived from parental reports of his social
behavior was quite low.
THE CASE OF MARTHA L
Martha seemed to have a normal childhood. She made adequate progress in school and caused few
problems for her teachers or parents. Although she never made friends easily, she could not be described
as withdrawn. Her medical history was negative. When Martha entered high school, changes began. She
combed her hair in a very severe, plain style. She chose clothing that was quite ill fitting and almost like
that worn 50 years ago. She wore neither makeup nor jewelry of any kind. Where before she would have
been hard to distinguish from the other girls in her class, she now easily stood out.
Martha's schoolwork began to slip. She spent hours alone in her room reading the Bible. She also began
slipping notes to other girls that commented on their immorality when she observed them holding hands
with boys, giggling, dancing; and so on. She attended religious services constantly; sometimes on
Sundays she went to services at five or six separate churches. She fasted frequently and decorated her
walls at home with countless pictures of Christ, religious quotations; and crucifixes.
When Martha finally told her parents that she was going to join an obscure religious sect and travel
about the country (in a state of poverty) to bring Christ's message to the country, they became concerned
and took her to a psychiatrist. Shortly afterward, she was hospitalized. Her diagnosis varied, but it
included such terms as schizophrenia, paranoid type; schizoid personality; and schizophrenia,
Both of these cases are examples of individuals commonly seen by clinical psychologists for evaluation
or treatment. The feature that immediately characterizes both cases is that Billy's and Martha's behaviors
violate norms. Billy may be considered abnormal because his IQ and school performance depart
considerably from the mean. This aspect of deviance from the norm is very clear in Billy's case, because
it can be described statistically and with numbers. Once this numerical categorization is accomplished,
Billy's assignment to the deviant category is assured. Martha also came to people's attention because she
is different. Her clothes, appearance, and interests do not conform to the norms typical of females in her
ADVANTAGES OF THIS DEFINITION
The definition of abnormality in terms of statistical infrequency or violation of social norms is attractive
for at least two reasons.
1. Cutoff Points: The statistical infrequency approach is appealing because it establishes cutoff points
that are quantitative in nature. If the cutoff point on a scale is 80 and individual scores a 75, the decision
to label that individual's behavior as abnormal is relatively straightforward. This principle of statistical
deviance is frequently used in the interpretation of psychological test scores. The test authors designate
a cutoff point in the test manual often based on statistical deviance from the mean score obtained by a
Clinical Psychology (PSY401)
"normal" sample of test-takers, and scores at or beyond the cutoff are considered "clinically significant"
(that is, abnormal or deviant).
2. Intuitive Appeal: It may seem obvious to us that those behaviors we ourselves consider abnormal
would be evaluated similarly by others. The struggle to define exactly what abnormal behavior is does
not tend to bother us because, as a Supreme Court justice once said about pornography, we believe that
we know it when we see lt.
PROBLEMS WITH THIS DEFINITION
Conformity criteria seem to play a subtle yet important role in our judgments of others. However,
although we must systematically seek the determinants of the individual's nonconformity or deviance,
should resist the reflexive tendency to categorize every nonconformist behavior as evidence of mental
health problems. Conformity criteria, in fact, have a number of problems.
1. Choice of Cutoff Points: Conformity oriented definitions are limited by the difficulty of establishing
agreed-upon cutoff points. As noted previously, a cutoff is very easy to use once it is established.
However, very few guidelines are available for choosing the cutoff point. For example, in the case of
Billy, is there some thing magical about an of 64?
Traditional practice sets the cutoff point at 70. Get an IQ below 70 and you may be diagnosed with
mental retardation. But is a score of 69 all that different from a score of 72? Rationally justifying such
arbitrary IQ cutoff points is difficult. This problem is equally salient in Martha's case. Are five
crucifixes on the wall too many? Is attendance at three church services per week acceptable?
2. The Number of Deviations: Another difficulty with nonconformity standards is the number of
behaviors that one must evidence in order to earn the label "deviant." In Martha's case, was it just the
crucifixes, or was it the total behavioral configuration-crucifixes, clothes, makeup, withdrawal, fasting,
and so on? Had Martha manifested only three categories of unusual behavior, would we still classify her
3. Cultural Relativity: Martha's case, in particular, illustrates an additional point. Her behavior was not
deviant in some absolute sense. Had she been a member of an exceptionally religious family that
subscribed to radical religious beliefs and practices, she might never have been classified as
maladjusted. In short, what is deviant for one group is not necessarily so for another. Thus, the notion of
cultural relativity is important. Likewise, judgments can vary, depending on whether family, school
authorities or peers are making them. Such variability may contribute to considerable diagnostic
unreliability, because even clinicians' judgments may be relative to those of the group or groups to
which they belong.
Two other points about cultural relativity are also relevant. First, carrying cultural relativity notions to
the extreme can place nearly every reference group beyond reproach. Cultures can be reduced to
subcultures and subcultures to mini-cultures. If we are not careful, this reduction process can result in
our judging nearly every behavior as healthy. Second, the elevation of conformity to a position of
preeminence can be alarming. One is reminded that so-called nonconformists have made some of the
most beneficial social contributions. It can also become very easy to remove those whose different or
unusual behavior bothers society. Some years ago in Russia, political dissidents were often placed in
mental hospitals. In America, it sometimes happens that 70-year-old Uncle Arthur's family is successful
in hospitalizing him largely to obtain his power of attorney. His deviation is that, at age 70, he is
spending too much of the money that will eventually be inherited by the family. Finally, if all these
points are not enough, excessive conformity has itself sometimes been the basis for judging persons
Clinical Psychology (PSY401)
B. SUBJECTIVE DISTRESS
We now shift the focus from the perceptions of the observer to the perceptions of the affected
individual. Here the basic data are not observable deviations of behavior, but the subjective feelings and
sense of well-being of the individual. Whether a person feels happy or sad, tranquil or troubled, and
fulfilled or barren are the crucial considerations. If the person is anxiety-ridden, then he or she is
maladjusted, regard-less of whether the anxiety seems to produce overt behaviors that are deviant in
THE CASE OF CYNTHIA S
Cynthia has been married for 23 years. Her husband is a highly successful civil engineer. They have two
children, one in high school and the other in college. There is nothing in Cynthia's history to suggest
psychological problems. She is above average in intelligence, and she completed two years of college
before marrying. Her friends all characterize her as devoted to her family. Of all her features, those that
seem to describe her best include her strong sense of responsibility and a capacity to get things done.
She has always been a "coper." She can continue to function effectively despite a great deal of personal
stress and anxiety. She is a warm person, yet not one to wear her feelings or her troubles on her sleeve.
She recently enrolled in a night course at the local community college. In that course, the students were
asked to write an "existential" account of their innermost selves. The psychologist who taught the course
was surprised to find the following excerpts in Cynthia's account:
"In the morning, I often feel as if I cannot make it through the day. I frequently experience headaches
and feel that I am getting sick. I am terribly frightened when I have to meet new people or serve as a
hostess at a party. At times I feel a tremendous sense of sadness; whether this is because of my lack of
personal identity, I don't know."
What surprised the instructor was that none of these expressed feelings were apparent from Cynthia's
overt behavior she appeared confident, reasonably assertive, competent, in good spirits, and outgoing.
THE CASE OF ROBERT G
In the course of a routine screening report for a promotion, Robert was interviewed by the personnel
analyst in the accounting company for which he worked. A number of Robert's peers in the office were
also questioned about him. In the course of these interviews, several things were established.
Robert was a very self-confident person. He seemed very sure of his goals and what he needed to do to
achieve them. Although hardly a happy-go-lucky person, he was certainly content with his progress so
far. He never expressed the anxieties and uncertainty that seemed typical of so many of his peers. There
was nothing to suggest any internal distress. Even his enemies conceded that Robert really "had it
These enemies began to be quite visible as the screening process moved along. Not many people in the
office liked Robert. He tended to use people and was not above stepping on them now and then to keep
his career moving. He was usually inconsiderate and frequently downright cruel. He was particularly
insensitive to those below him. He loved ethnic humor and seemed to revel in his prejudices toward
minority groups and those women who intruded into a "man's world." Even at home, his wife and son
could have reported that they were kept in a constant turmoil because of his insensitive demands for
their attention and services.
Cynthia and Robert are obviously two very different kinds of people. Cynthia's behavior is, in a sense,
quite conforming. Her ability to cope would be cause for admiration by many. Yet she is unhappy and
conflicted, and she experiences much anxiety. A clinical psychologist might not be surprised if she
turned up in the consulting room. Her friends, however, would likely be shocked were they to learn that
she had sought psychological help.
Clinical Psychology (PSY401)
In contrast, many of Robert's friends, associates, and family members would be gratified if he were to
seek help, since most of them have, at one time or another, described him as sick. But Robert is not at
odds with himself. He sees nothing wrong with himself, and he would probably react negatively to any
suggestion that he should seek therapy. Furthermore, his lack of motivation for therapy would probably
make it an unprofitable venture.
ADVANTAGES OF THIS DEFINITION
Defining abnormal behavior in terms of subjective distress has some appeal. It seems reasonable to
expect that individuals can assess whether they are experiencing emotional or behavioral problems and
can share this information when asked to do so. Indeed, many methods of clinical assessment (for
example, self-report inventories, clinical interviews) assume that the respondent is aware of his or her
internal state and will respond to inquiries about personal distress in an honest manner. In some ways,
this relieves the clinician of the burden of making an absolute judgment as to the respondent's degree of
PROBLEMS WITH THIS DEFINITION
The question is whether Cynthia, Robert, or both are maladjusted. The judgment will depend upon one's
criteria or values. From a strict standpoint of subjective report, Cynthia qualifies but Robert does not.
This example suggests that labeling someone maladjusted is not very meaningful unless the basis for the
judgment is specified and the behavioral manifestations are stated.
Not everyone whom we consider to be "disordered" reports subjective distress. For example, clinicians
sometimes encounter individuals who may have little contact with reality yet profess inner tranquility.
Nonetheless, these individuals are institutionalized. Such examples remind us that subjective reports
must yield at times to other criteria.
Another problem concerns the amount of subjective distress necessary to be considered abnormal. All of
us become aware of our own anxieties from time to time, so the total absence of such feelings cannot be
the sole criterion of adjustment. How much anxiety is allowed, and for how long, before we acquire a
label? Many would assert that the very fact of being alive and in an environment that can never wholly
satisfy us will inevitably bring anxieties. Thus, as in the case of other criteria, using phenomenological
reports is subject to limitations. There is a certain charm to the idea that if we want to know whether a
person is maladjusted, we should ask that person, but there are obvious pitfalls in doing so.
C. DISABILITY OR DYSFUNCTION
A third definition of abnormal behavior invokes the concept of disability or dysfunction. For behavior to
be considered abnormal, it must create some degree of social (interpersonal) or occupational problems
for the individual. Dysfunction in these two spheres is often quite apparent to both the individual and the
clinician. For example, a lack of friendships or of relationships because of a lack of interpersonal
contact would be considered indicative of social dysfunction, whereas the loss of one's job because of
emotional problems (such as depression) would suggest occupational dysfunction.
THE CASE OF RICHARD Z
Richard was convinced by his wife to consult with a clinical psychologist. Previous contacts with
psychiatrists had on one occasion resulted in a diagnosis of "hypochondriacal neurosis," and on another,
a diagnosis of "passive aggressive personality." Richard has not worked in several years, even though he
has a bachelor's degree in library science. He claims that he is unable to find employment because of his
health. He reports a variety of physical symptoms, including dizziness, breathlessness, weakness, and
"funny" sensations in the abdominal area. Making the rounds from physician to physician has enabled
him to build an impressive stock of pills that he takes incessantly. None of his physicians, however, has
been able to find anything physically wrong with him.
Clinical Psychology (PSY401)
As a child, Richard was the apple of his mother's eye. She doted on him, praised him constantly, and
generally reinforced the notion that he was someone special. His father disappeared about 18 months
after Richard was born. His mother died six years ago, and he married shortly after that. Since then, his
wife has supported both of them, thus enabling him to finish college. Only recently has she begun to
accept the fact that something may be wrong with Richard.
THE CASE OF PHYLLIS H
Phyllis is a college student. She is in her sixth year of undergraduate study but has not yet obtained a
degree. She has changed majors at least four times and has also had to withdraw from school on four
Her withdrawals from school have been associated with her drug habit. In two instances, her family
placed her in a mental hospital; on two other occasions, she served short jail sentences following
convictions on shoplifting charges. From time to time, Phyllis engages in minor crimes to support her
drug habit. Usually she can secure the money from her parents, who seem to have an uncanny knack for
accepting her outrageous justifications. She has been diagnosed with "antisocial personality disorder"
and with "drug dependence (cocaine)."
According to the disability/dysfunction definition, both of these cases would suggest the presence of
abnormal behavior. Richard is completely dependent on his wife (social dysfunction), and this, coupled
with his litany of somatic complaints and his inability to cope with stress, has left him unemployed
(occupational dysfunction). Phyllis's drug habit has interfered with her occupational (in this case,
ADVANTAGES OF THIS DEFINITION
Perhaps the greatest advantage to adopting this definition of abnormal behavior is that relatively little
inference is required. Problems in both the social and occupational sphere often prompt individuals to
seek out treatment. It is often the case that individuals come to realize the extent of their emotional
problems when these problems affect their family or social relationships as well as significantly affect
their performance at either work or school.
PROBLEMS WITH THIS DEFINITION
Who should establish the standards for social or occupational dysfunction, the patient, the therapist,
friends, or the employer? In some ways, judgments regarding both social and occupational functioning
are relative-not absolute-and involve a value-oriented standard. Although most of us may agree that
having relationships and contributing to society as an employee or student are valuable characteristics, it
is harder to agree on what specifically constitutes an adequate level of functioning in these spheres. In
short, achieving individual's social relationships and contributions as a worker or student may be
difficult. Recognizing this problem, psychopathologists have developed self-report inventories and
special interviews to assess social and occupational functioning in a systematic and reliable way.
To summarize, several criteria are used to define abnormal behavior. Each criterion has its advantages
and disadvantages, and no one criteria can be used as a gold standard. Some subjectivity is involved in
applying any of these criteria. As Phares has stated,
The inevitable conclusion is that a definition of abnormality (maladjustment, pathology, etc.) is possible
only with reference to a set of value judgments. To characterize someone as abnormal is to assert that he
needs treatment. In short, someone has decided that the patient needs help in changing his behaviors-a
relative, a court, or perhaps the patient himself. Once someone decides that the patient needs treatment,
then our psychiatrist or psychologist can deliver an opinion on how can best to effect the desired
Clinical Psychology (PSY401)
changes. But the decision for treatment as a function of abnormality must be based on someone's value
system-it does not reside in psychiatry or psychology.
Where Does This Leave Us?
As the previous discussion points out, all definitions of abnormal behavior have their strengths and
weaknesses. These definitions can readily incorporate certain examples of abnormal behavior, but
exceptions that do not fit these definitions are easy to provide. For example, all of us can think of an
"abnormal behavior" that would not be classified as such if we adopted the subjective distress criterion
(for example, spending sprees in mania), and we can think of a behavior that might be classified
incorrectly as abnormal if we adopted the violation of norms definition.
It is also important to note that abnormal behavior does not necessarily indicate mental illness. Rather,
the term mental illness refers to a large class of frequently observed syndromes that are comprised of
certain abnormal behaviors or features. These abnormal behaviors/features tend to co-vary or occur
together such that they often are present in the same individual. For example, major depression is a
widely recognized mental illness whose features (such as depressed mood, sleep disturbance, appetite
disturbance, and suicidal ideation) tend to co-occur in the same individual. However, an individual who
manifested only one or two of these features of major depression would not receive this diagnosis and
might not be considered mentally ill. One can manifest a wide variety of abnormal behaviors (as judged
by any definition), and yet not receive a mental disorder diagnosis.
Like abnormal behavior, the term mental illness or mental disorder is difficult to define. For any
definition, exceptions come to mind. Nevertheless, it seems important to actually define mental illness
rather than to assume that we all share the same implicit idea of what mental illness is.
The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric
Association, 1994), known as DSM-IV the official diagnostic system for mental disorders in the United
States, states that a mental disorder is conceptualized as:
"a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual
and that is associated with present distress (e.g., a painful symptom) or disability (i.e., impairment in
one or more important areas of functioning) or with a significantly increased risk of suffering, death,
pain, disability, or an important loss of freedom".
In addition, this syndrome or pattern must not be merely an expectable and culturally sanctioned
response to a particular event, for example, the death of a loved one. Whatever its original causes, it
must currently be considered a manifestation of a behavioral, psychological, or biological dysfunction in
the individual. Neither deviant behavior (e.g., religious, political, or sexual) nor conflicts that are
primarily between the individual and society are mental disorders unless the deviance or conflict is a
symptom of the dysfunction in the individual as described above.
Several aspects of this definition are important to note: (1) The syndrome (cluster of abnormal
behaviors) must be associated with distress, disability, or increased risk of problems; (2) a mental
disorder is considered to represent a dysfunction within an individual; and (3) not all deviant behaviors
or conflicts with society are signs of mental disorder.
The astute reader has probably noticed that the DSM-IV definition of mental disorder incorporates the
three definitions of abnormal behavior presented earlier. On the one hand, the DSM-IV definition is
more comprehensive than any one of the three individual definitions of abnormal behavior presented
earlier. On the other hand, the DSM-IV definition is more restrictive because it focuses on syndromes,
Clinical Psychology (PSY401)
or clusters of abnormal behaviors, that are associated with distress, disability, or an increased risk for
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