University College London

Qualitative Methods MSc Research Methods in Psychology

Student: RM 1008 6/27/2011

Introduction

Interrogations of psychology and its relevance in the process of mental health are common

in modern society. The social representations built by people around questions such as:

“who are psychologists?”; “what does a psychologist do?” and “why people consult

psychologists” are crucial in order to reach a holistic understanding regarding conceptions

about psychologists. The answers to these questions can lead to a greater understanding of

psychology in society, and facilitate the development of frontline services to create realistic

and coherent social policies that increase individuals’ quality of life, wellbeing and mental

health within the community. The constructions of social representations of psychologists

do not exist exclusively in the mind of the individual. These perceptions permeate people’s

interactions and behavioural psychology within the community. This happens through

people’s verbalizations that come from what they listen, read or hear from the mass media,

from their life experiences and their relationships. Also, it is important to consider that

different economic and social contexts create specific demographics within the application

of psychology within the greater community.

This study aims to investigate how individuals from a low socio-economic background in the

Greater London area define ‘the psychologist’, and how this profession is conceived outside

a clinical context. It will assess the meanings that people with no prior experience of visiting

psychologists assign to this specialist. The Social Representations Theory (SRT) is used as

epistemological framework with which the data is analysed. According to Tilford et al.

(1997) mental health is one of the most important causes of illness in the UK, therefore

better and more integrative comprehension of social representations of psychologists and

their work could represent a valuable step in the mental health promotion and also a crucial

information for clinicians regarding the ideas, preconceptions and fears that people have

around them.

Background

Mental health is a main cause of disability, illness, social and family disfunctions in the UK;

some of the more common problems presented are: suicide (especially amongst young

men); depession and anxiety. In general, both anxiety and depression (clasify into the

common mental disorders: CMDs) in low socio-economic communities is often left

undiagnosed and untreated, due to ignorance of the disease. (Tilford,1997; Office of

national statistics, 2006; McManus et al., 2009). Despite that mental health represents a

real public health problem, The Adult Psychiatry Morbidity Survey of 2007 provides statistics

to indicate that few sufferers seek treatment for their condition. For instance, participants

were asked whether they were acceding to any kind of therapy or counselling for an

emotional problem. The results showed that just ten per cent of the population with CMD

was having a counselling or therapy process by the time of the survey. Additionally, around

one person in six had experienced CMD within 7 days of the survey being conducted,

without consulting or receiving any treatment (McManus et al., 2009). Some other

epidemiological information has shown that just 2 per cent of people affected by mental

health problems will be in contact with mental health services in the course of a year.

Additionally, there is an association between diagnosis and access to psychotherapy or

talking treatments: 78 per cent of subjects taking antidepressants had been also treated in

psychotherapy compared with 54 per cent of people who are not. (Goldberg & Galer,

1991).

The causes of this phenomenon are diverse and interconnected, however some researchers

have shown that factors such as gender, socio economic level, availability and accessibility

of the services, can influence it. (Bird, 2007; Willis & DePaulo, 1991). Official figures in

England have shown that 14 per cent of men and 20 per cent of women have suffered or

suffer of some type of mental illness. (Prescott & Primatesta, 1998). Also some other

numbers showed that 18 per cent of women have a neurotic disorder, anxiety, phobias and

panic attacks. Just 11 per cent of men have presented them, however, men are three times

more prone to develop alcohol dependence and twice as likely to be drugs dependent.

(Office of National statistics, 1996). NHS psychotherapy services also established that people

from ethnic minorities, the homosexual community, the elderly and people with chronic

illness’ are less likely to accede to mental health services (Department of Health, Office for

National Statistics, 2004). However, despite figures of past years; the last NHS mental health

bulletin for 2009/10 has illustrated an exponential growth in the use of psychological

services. First, NHS mental health services in 2009-2010 were used by 1.25 million of people,

the highest number in six years. Second, ethnic minorities now have an important

percentage of access to mental health services (approx. 3,800 per 100,000 people). Also

psychological in-patients have increased by 5.1 per cent - the first increase in five years.

(Office of National Statistics, 2010). This fact means that a process of change is happening.

People’s social representations of mental health and mental health services has been

transforming since the last six years. As Rose, et al. (1995) suggests, because of the fact that

social representations are originated in an interplay between communicative practices of

everyday life and historical social knowledge, there is a constant transformation and tension

between the stabilised social order and the new ideas generated in this interactive process.

In this sense, it is fundamental to explore and make an effort to understand this

phenomenon as a whole; why people have been reluctant to consult psychologists, despite

their psychological distress? Why, if the services are available, people do not seek help?

What is the social story behind this new u-turn, regarding the new statistics that show an

increase in the amount of people who consult psychologists and seek treatment?

The social Representations approach.

Given the nature of this study, Social Representation Theory is the most appropriate

epistemological frame to analyse the meanings that people assign to “the psychologist” and

to study this interesting change in individuals’ attitudes towards mental health and mental

health services. Broadly speaking, the social representations theory, gives us a “framework

of concepts and ideas to study psycho-social phenomena in modern societies.” (Wagner et

al., 2007, p.2). It holds that the psychological phenomena cannot be understood out of their

social, historical and cultural context (Wagner et al., 2007). According to Moscovici (1973),

social representations could be understood as a collection of beliefs, social traditions and

collective knowledge that survive in people’s minds. The theory works as a hypothesis for

research that seeks to understand how modern societies develop and circulate knowledge

(Giddens, 1991). Meanwhile, a social representation can be thought as the set of thoughts

and feelings co-constructed by people in their daily life. They can be expressed verbally,

through interactions or symbolically and together form sense units useful to connect the

members of the community. According to Moscovici (1961), social representation has two

functions, to establish order enabling people to control their context and to make

communication simpler. Therefore, the meaning that people assign to “the psychologist” in

a community could be very well framed and understood through Social Representations

Theory.

Moscovivi (1961) formalized the construction process in terms of two mechaninsms:

objectivation and anchoring. Anchoring could be understood as the process that allows new

or strange information to be assimilated, communicated and talked about within a

particular community. In the case of psychology, individuals tend to associate it with

psychiatry (Johnston, 2000), perhaps because of the similarities between the two fields and

because psychiatry, to some extent, is an older science that people define easily. A similar

process to anchoring known as conventionalisation, that illustrates the process by which

people understand unfamiliar words or ideas in relation to more habitual representations

(Bangerter & Lehmann, 1997). Correspondingly, objectivation describes a process where

information is chosen and detached from their original setting and adapted considering the

norms and cultural standards of each community (Moscovici, 1961)

Some approximations to the phenomena of the social representations of the psychologist

have been done in different contexts. Bosseto (2006) for example, found that most

Brazilians (from low socio-economic backgrounds) do not have a clear representation of

“the psychologist/psychology” because these concepts do not form part of their normal life.

For them, ‘the psychologist’ is someone distant from the community and for that reason it is

difficult to make clear representations of him or her. In general, representations presented

by the subject are often informed by the depiction of psychologists in the mass media (e.g.

TV). Moreover, verbal representations are related with expressions such us “something

mental…” or “the psychologist works in the school” (p.147). The representation of the

psychology and the ideas about what must be a psychologist was expressed as follows. “It is

for people that have brain problems, I think… no? There are many people that have that

thing in their brain and then they have to go to be treated by those doctors…no?” (Bosseto,

2006, p.144).

Similarly, Souza & Trindale (1990) found that 73% of people from low socio-economic

backgrounds do not have any representation about what a psychologist is or what they do.

On the other hand, all participants from middle class affirmed to have some information

about psychologist or psychology. According to Souza and Trindale (1990) there are three

aspects that contribute with the lack of knowledge among people from low socio-economic

backgrounds. First, the impossibility to access the psychological services, generally because

of lack of funds; second, the slow inclusion of psychologists into the public sector and third,

the type of information that mass media gives, that normally is the only one that people

from this social level can access.

On the other hand, the survey of attitudes towards mental illness among adults in England

(2011) showed that people’s beliefs of mental illness and psychological attention is

changing. Nowadays more people believe that ‘mental illness is an illness like any other';

same as the amount of people that think it will not be uncomfortable to tell a friend that

they are visiting a psychologist. Moreover, respondents believe that people with mental

illness face stigma and discrimination. Also people tend to acknowledge schizophrenia and

depression as type of mental illness. (Prior, 2011).

The present study investigates the social representations of “the psychologist” among

Londoners from lower socio economic status and attempts to make a first understanding of

this process of change around this “new mentality” related to psychology and the seeking

for psychological help. Given that mental disorders and psychological distress are

widespread across the world disabling people, it is crucial to listen and to understand the

discourses that people build around the topic, in order to inform how social policies can to

direct their efforts to more coherent and ecological campaigns that can give real answers to

the problem of mental health. Also relevant information regarding people’s resistances, pre-

conceptions, gender differences, motivations, among others, can help clinicians in the

comprehension of their work and in the understanding of their patients. In short, this study

aims to identify, what meanings build Londoners from lower socio-economic status to the

concept of the “psychologist”?

Method

Sample

A purposive projected sample of 32 lower socio economic status Londoners was recruited.

Participants were invited to take part from social clubs, community centres and working

men’s clubs. The recruitment process followed specific intentions regarding the

characteristics of the sample: 1. Age 25-35 or 65-75; 2. Readers of tabloids (only); 3. Have

not had previous direct contact with a psychologist; 4. White British ethnicity (self-reported)

with English as their first language. The sample was exactly divided in terms of age

(older/younger) and gender (female/male), this means that quarter of the sample was

constituted by younger females, older females, younger males and older males respectively.

All these procedures followed the sample’s size criteria formulated by Joffe (2011).

Specific demographic characteristics were as follows: the mean age for younger females was

30, (s.d. 2.3); older females 69 (s.d. 2.5); younger males 28 (s.d 3.8) and older males 70 (s.d.

3.4). In terms of social status, as mentioned above newspaper readerships were used as

socio economic marker (Wing Chan & Goldthorpe, 2007). Respondents informed reading

regularly tabloid newspapers such as: The sun, 21; The Mirror, 13 and The Daily Mail, 7. In

terms of level of education, 26 (81.25%) had left school; had GCSE level qualifications: 5

(15.62%) had further training: teaching certification, secretarial college, 1 (3.12%)

participant had a degree; 24 (75%) work in or have worked in unskilled or semiskilled jobs;

and finally 8 participants (25%) work in or were retired from professional jobs.

Data Collection

The data were collected using semi-structured interviews and all the interviews were tape-

recorded and the average duration was 30 minutes. Interviews took place in calm and no

noisy area in the community centres or clubs. The interviews’ open questions attempted to

assess participant’s meaning for the concept of “the psychologist”, followed the suggestions

made by Wilkinson et al. (2004). Five topics were proposed to participants, however for

effects of this study just two were used: 1. “When I say the word psychologist, tell me what

goes to your mind?” 2. “If you heard that someone you knew had seen a psychologist, what

would be your reaction?”

Data Analysis

The qualitative method selected to analyse the data was Thematic Analysis (TA), because it

is the more appropriated technique in terms of the study’s research question and type of

data. (Joffre, 2011) Thematic analysis helps to identify, analyse, interpret and report

patterns (themes) within data. “Thematic analysis involves the searching across a data set –

be that a number of interviews or focal groups, or a range of texts – to find repeated

patterns of meaning.”(Braun & Clarke, 2006, p.86) The data analysis exhaustively followed

the six steps guide when using TA as a research method recommended by Braun & Clarke

(2006) and the Joffe’s thematic Analysis students’ guide. (2011). Data were analysed using

the software package ATLAS.ti, 6.0. (Muhr, 1993) This software helps researchers to

systematically analyze data. ATLAS.ti, offers applications that allow the user to code, locate,

organise, annotate findings and found relationships between data. In addition, it gives the

possibility to visualize material with special tools which whit designed networks and graphs.

Phase 1

A first reading through the interviews was made. This first reading did not have any

intention more than familiarise the researcher with the content of the interviews. Then a

second in-depth and active reading with a clear target: look for meanings, repetitions and

concepts. In this step, the researcher took notes of some roughly ideas and stabilised a “pre-

coding frame”. No pre readings regarding the research question were made in order to

avoid any preconception or engage with others’ ideas.

Phase 2

Using ATLAS.ti, a third data reading was done. This phase, comprised a systematic work

which resulted in a first coding frame. Coding frame basically consists in a structured and

intentional organization of the set of data into meaningful groups: “codes” that capture

interesting features of the data that could form potential patterns. There was not restriction

in the number of codes permitted, according to Braun & Clarke’s recommendations “code

for as many potential themes/patterns as possible (time permitting).” (Braun & Clarke,

2006, p. 89) As a result of this work 84 codes were coded. Then the codes list was checked

and analyzed. Here a frequency list was used as a strategy. The codes were also collated and

collapsed resulting in a 34 elements (codes) list. At this level the whole set of interviews

were reading again in order to check the reliability – the extent to which the codes are able

to describe the data- some possible themes were detected here and the coding frame was

built in accordance to Joffe (2011) recommendations.

Phase 3

At this stage, the analysis was focused in the searching for themes (patterns). Codes were

evaluated again and combined in different ways forming families; 5 families resulted after

this work: confusion, reactions towards psychotherapy, the process, concept of

psychologists and people’s problems. Families were systematized using ATLAS. ti

applications. After that, family networks were graphed. Besides, a complete network

between families was performed again using ATLAS. ti functions. (See fig 1) At this stage,

some codes were discarded, collapsed or placed in a new code called “miscellaneous”. The

34 codes list was converted in a 24 elements list. A new frequency table was done and first

questions were made to the data, such us: “is it the positive image of psychologists more

likely in females?” or “have older people more preventions about people how visit

psychologists?”

Phase 4

This part of the data analysis involved a refinement of the potential themes. Looking for

example for frequencies and connections between themes - in general a good theme does

not have connections with another theme-. The criteria of internal homogeneity and

external heterogeneity were used. The chunks of interviews related to each pattern were

reviewed, in order to check whether they fit the bulk of interviews. After this revision, a new

thematic map surged. See fig. 1

Fig. 1

Phase 5

In this phase researchers have to refine and define the themes. Define means to identify

the core of each theme -which part of the whole story is telling- and to contrast it against

the data; similarly, refine means to scope each theme and not to try to “get a theme to do

too much or to be too diverse and complex” (Braun & Clark, 2006, p. 92). In this phase, an

adequate and meaningful name was decided for each theme and an individual report was

written, this report was as detailed as possible and an example of interview was chosen.

This exercise represented a crucial point in the study, because themes were completely

visualised resulting in a more comprehensive understanding of the data. As a result some

initially considered themes were collapsed into other more general themes and some codes

were placed in a more relevant theme; other codes were collapsed into others or simply

were leave them outside of the analysis. See fig 2

Fig.2

Phase 6.

This phase mainly consisted of the evaluation of the whole procedure and the written of the

final report.

Results

Results are stated in sections that describe the main questions above mentioned concerning

the meanings about “the psychologist”, what psychologists do, and why do people consult

psychologists. Each section is composed by a network graph which synopsizes the main

elements of the theme and their mutual relationships, showing as well their apparition

frequencies. Then, each theme’s element is explained and exemplified by an excerpt of

interview. The hierarchical level of each element in the network indicates its prevalence in

the interviews. Gender and age differences were made within every theme and are

mentioned when they are significant. It is important to mention that the themes are also

organised from more to less prevalent within the interviews.

Theme 1: How are they...?

I think its something to do with the way people think. I’m not sure really. I think it’s the way people think or the way people react to when they hear the word ‘psychology’. I think its something to do with people’s minds, what they think. I think its … well I’m not really sure …it’s a subject I’ve not really come across. I still think its to do with the way people think. The word psychology … it seems to me its people want to know the way people think. (Male, 66)

Fig. 3

Two third parts of the participants represented the Psychologist/ psychology as someone or

something related with people’s mind. In general the concept regarding the person of

psychologist is interwoven by the idea of mind. For respondents, psychologists try to

examine, investigate or test people’s mind. One person expressed that psychologist is

someone who tries to read people’s mind.

Associated with the idea of “mind”, participants also place psychologists into the medical

context. Londoners interviewed think that psychologists are a kind of specialists for the

mind, “doctors for the mind”. It is interesting to notice that people tend to differentiate the

doctors in charge of physical problems and those that take care about mental problems:

psychologists or psychiatrists. For participants a psychologist as a doctor who helps people

with their mental problems or mental illness, but at the same time they do not know

precisely what the role of the psychologist is. This confusion is related with the difference

between psychologists and psychiatrists; 40% of participants showed a level of confusion

differentiating these two concepts. For some participants, these two professionals are

almost “the same thing” because both, psychologists and psychiatrists work in the same

field or subject and treat people. Another part of respondents sense a difference between

these psychologists and psychiatrists, but actually they cannot make it explicit. One person

thinks for sure psychiatrists and psychologists have opposite roles: psychiatry is more

related with sickness and ill people, meanwhile psychologist analyse “normal- common”

people.

There is a widespread feeling of uncertainty defining the word “psychologist”. Sixty five

percent of participants manifest explicitly a sense of doubt and lack of clarity around the

meaning of psychologist or the kind of work that a psychologist develops: “Its somebody

that you don’t really understand. You don’t really know what they do” (Male, 35). In few

cases people manifest that this lack of knowledge and clarity is generated because of

absence of direct contact with psychologists. “Psychology … I don’t really know what it

means. I’ve never come across it. I’ve heard of it, but not to … (Female, 70).

People widely associate the psychologist with problems; respondents believe that

psychologists are those in charge to treat people’s problems. When defining the term “the

psychologist” respondents spontaneously think about people’s problems.

Linked to the idea of the psychologists as doctors, a quarter of respondents believe that

psychologists also try to assess/investigate/test the way that people think or feel. Again

there is not a clear idea, people just mention that psychologists work or want to know how

people think or feel. It is remarkable that younger people have a prevalent shorter pattern

of answers. “Person who studies human behaviour” (Female, 31).

Respondents locate the psychologist in a higher level. Psychologists are conceptualized as

wise people. Respondents think that psychologists have a special knowledge that allow

them to give people advice or answers. The psychologist in some way is viewed as someone

with special skills. This perception is more prevalent between older male respondents.

Contrary to this opinion, another portion of the sample thinks that psychologists’ work is

not essential. For them, someone else, such as family, friends or themselves is able to sort

the problems out. People think that in some extent, psychologist labour consists on listen to

others’ problems and give them advice and this labour can be executed by anyone.

Theme 2: The process

People can’t cope any more or they’re very sort of unhappy in their lives sort of thing. Haven’t really had much to do with it. That’s what I would think. They’ve had a lot of sadness, a lot of trouble in their life, and they can’t sort of handle it probably, could you not think? For instance, my young nephew, when his wife left him, he had a terrible time. He committed suicide because of it. He couldn’t handle it, but he wouldn’t go to a psychiatrist or a psychologist. And that’s what I would think would be in their minds. This terrible stuff that’s happened. (Female, 69)

Fig. 4

More than half of participants spontaneously linked the timing to consult psychologists as

the moment when people cannot cope with their problems anymore. The start time to

begin visiting psychologist is given by a broken point, when there is no any other resource,

when people is ill (mentally), when they cannot looking after themselves, when the doctor

(normally the GP doctor) was not able to help, then people consult the psychologist.

Specifically, people widely linked depression “lot of sadness” as one of the reasons to

consult psychologist, respondents also mentioned family problems, learning disabilities,

phobias, nervous, dementia, distress and behavioural problems, as some of the reasons to

consult. Twenty five percent of respondents also verbalise that in order to accede to

psychological services, generally the first step is to consult the doctor from the GP who

refers patients to the psychologist. Close related with the idea that people start seeing a

psychologist when they cannot cope with their problems, it is common to find the

supposition that something has to be wrong with the mind of people who are visiting

psychologists. It is possible to perceive a feeling of suspect about the mental state of people

who is having a therapy among Londoners.

What’s wrong with him … or her? What’s the matter with them? Why did you need to go and see a psychologist? It must be something pretty deep if you’re going to go and see a psychologist. Their mind isn’t right or there’s something from like when they were a kid or something, or what their mum and dad done, or what they experienced as a child. I don’t mean … to take it into adulthood or something like that. (Male, 26)

The majority of respondents understood the psychotherapy as a context where people go to

talk about their difficulties and their life. In this process, psychologist asks questions mainly

about people’s past in order to find where the problem is and then offer advice. It is

interesting that two respondents associate psychologists with the figure of a man, and with

the idea of been lying in a coach.

Theme 3: Reactions Towards Psychotherapy.

Its, its just, well … it’s, it’s the equivalent of if somebody has … umm … cancer or diabetes or something like that, I mean, you get, well they’ve got a problem, so they go to someone that can help them. You don’t feel bad about someone … you don’t not talk to someone cos they got cancer or diabetes, so in the same way, if someone’s got to go and see a psychologist/psychiatrist you don’t, y’know, go “Oh dear! You’re a terrible person! I’m not going to speak to you!” You just … well, yeah … normal person … if I can help, I will. (Male, 25)

Fig. 5

Reactions towards psychotherapy are clearly divided into three categories: neutral (it is

natural), positive and negative reactions. Almost half of participants manifest that go to see

psychologists it is normal. Some respondents believe that consult psychologists is something

similar to consult any other specialist. If someone needs psychological help the normal

behaviour is to consult her or him. People do not value the fact to see a psychologist as

something good or bad, for almost half of participants this fact is valuated as neutral. The

12% percent of participants believe that psychotherapy is a good idea and explicitly declare

their pleasure towards the idea of seeing psychologists. Same people have a good image

about psychologists, especially women; they think psychologists make well and that they

really can help others with their problems. These people manifest sympathy and respect for

psychologists’ work. As opposite, there are also a small proportion of people that consider

psychologists as someone harmful. They judge as a bad idea to consult psychologists.

Discussion This study suggests that the conceptualization of “the psychologist” for Londoners from

lower socio-economic status is characterized by lack of clarity, questioning and uncertainty.

The social representation around “the psychologist” is unclear, basically because the

psychologist does not form part of people’s life. The psychologist/ psychology are

understood as someone/something distant from the community members, reason why it

could be difficult for the individuals to represent them. Additionally, the tendency to

associate the psychologist with the medical field makes still more distant the figure of “the

psychologist”.

Londoners from lower socio-economic status tend to define psychologists as doctors

specialists in the understanding, evaluation or treatment of the mind, specifically, mind’s

problems. Also, the figure of the psychologist is close related with the idea of problems.

Psychologist is someone who treats people’s problems, and help people to deal with their

problems, therefore the main reason/motivation to seek help from a psychologist is to have

problems, but special problems: those with which people cannot deal with. In this sense the

image of the psychologist is in some extent, not just the image of the medical specialist, it is

also the image of the emergencies specialist. Psychological process it is still associated with

the psychoanalysis’ process, where people talk, analyst listen to them, asks questions and

then finds the problem.

Some of the anchors for Psychologist representation are related with the feeling of

confusion between psychiatrist and psychologists. Historically, people have more references

from the figure of the psychiatrist that is why, members of the community build the concept

of the psychologist over their pre-existent system of thoughts about psychiatry. It is possible

that part of the negative image and feelings of fear around the psychologist are linked to a

pre-established concept of the psychiatrist. The process of insertion of this new information

and the signification of this new “actor” (the psychologist) within the community, in opinion

of the researcher is been building so far; consequently a continuous and fast process of

change can be evidenced. As mentioned in the first section of this paper the new National

Survey related to people’s attitudes towards psychologists and mental health services in

England (Prior, 2011), showed an increment in the level of people consulting psychologist, a

better and more positive attitudes towards psychologists and mental health services and a

higher level of trust on psychologists. Having in account that the data used in the present

study was collected on latest 90’s, it is possible to evidence how the social construction of

the psychologist has had a real and systematic process of change. Nowadays the

psychologist is seen as a person less distant and more useful for the members of the

community. Although it is not a prevalent or concrete theme within the data, it is possible to

perceive this process of change within the interviews.

Further researches on this topic could be focus on the difference between socio-economic

classes. Also could be interesting to go deep in the social representations that people build

around the concept of “mind”, during this study was clear this core element but it was not

clear their meaning. Moreover, having in account that reality is a mutual construction it

could be important to explore the social construction that psychologists make around their

own profession, this with the objective to understand the part of the story that they have to

tell about psychology and psychologists. Finally, it is possible that the method used to

interview participants in this study would be biased because was a clinician who

interrogates people; this situation could generate a feeling of fear within the participants

avoiding a total openness. For future studies it is recommended to use the methodology to

accede information and interview proposed by Joffe (2011).

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