IDENTITY SEARCH: SPECIAL MEDIA INTEREST IN A CLINICAL LEARNING DISABILITIES POPULATION A thesis submitted in partial fulfilment for the degree of Doctorate in Clinical Psychology Stuart Whomsley Centre for Applied Psychology (Clinical Section) University of Leicester October 2000 1 UMI Number: U135665 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a complete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. Dissertation Publishing UMI U135665 Published by ProQuest LLC 2013. Copyright in the Dissertation held by the Author. Microform Edition © ProQuest LLC. All rights reserved. This work is protected against unauthorized copying under Title 17, United States Code. ProQuest LLC 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, Ml 48106-1346 Acknowledgements I am grateful to the following people for their help with the current research. My thanks go to the participants for their time and insights. Jennifer Clegg provided knowledge and support. Meena O’ Neil was a generous, committed reader and co-assessor of clinician transcripts. Jo Theasby remained a good humoured and precise transciber. Fred Fumiss provided some fresh ideas. Carol Sherrard and Konstantine Loumidis improvered the overall quality of this document. Harriet Crofts was a courageous proof-reader demonstrating her understanding of grammar, syntax and how to make things flow. 2 CONTENTS Abstract 7 Introduction 8 Terminology, the informative value of media interests, theoretical 8 and methodological positions Terminology: special media interest and learning disabilities 8 The informative value of media interests 10 Theoretical and methodological positions 12 The research area 14 Self, identity and learning disabilities 14 Development: lifecycles and transitions 22 Significant people and the mediation of media use 27 Media effects in people with learning disabilities 30 Special media interests: (i) Social roles; (ii) Heroes/heroines; (iii) Violence 35 The therapeutic utility of special media interests: 45 (i) Different theoretical orientations in clinical psychology; (ii) The cognitive-behavioural orientation; (iii) The psychoanalytic orientation; (iv) The family therapy orientation Methodological literature review 59 Choice of method 59 Research interviews 62 The grounded theory method 64 Validity: (i) Triangulation; (ii) Constant comparison; 67 (iii) Extemalisation; (iv) Co-assessment of transcripts Aims 73 3 The research aims 73 The advantages and disadvantages of predefined aims 74 Method 75 Participants 75 A clinical population 75 Clinician participants 80 Recruitment of participants 80 Triangulation 83 Case notes: a complementary source of information 83 Interview procedure 84 Further analysis 87 Validity controls 93 Results 93 The seven major categories 93 Categories mentioned for each person 119 Discussion 121 Methodological issues discussed 121 Research interviews assessed: (i) Adjustment; (ii) Timing and preparedness; 121 (iii) Negative procedural effects; (iv) Other interviewees Additional method: (i) Negative case analysis 125 (ii) The formation of the seven major categories (iii) The levels of explanation offered by the seven major categories Analysis assessed: (i) Exploration for a core category 129 (ii)Theory building; (iii) Validity; (iv) Generalisation Results summary and discussion overview 135 4 Results summary 135 Discussion overview: the meanings of special media interests 136 The clinical utility of special media interests 141 A framework for enquiry into special media interests 141 Advice for clinicians working with special media interests: 152 (i) Previous clinicians decision making about special media interests (ii) The conceptualisation of an interest at the start of therapy (iii) The narrative of the life of a special media interest (iv) Special media interests: good or bad? Psychological problems 156 Personal features 156 Obsession 157 Adverse experiences 159 Roles 160 Conversations that make you go mad 162 Transitions, transformation and transcendence 163 Transitions 163 Transformation 166 Transcendence 167 Media engagement 169 Media effects 169 Wrestling with reality 171 Significant people and the mediation of media use 173 Heroes/heroines 175 Violence 177 5 Messengers 179 Messengers for the learning disabilities population 179 Embodiment 182 Voices 184 A comparison to race 186 Self-pluralism for people with learning disabilities 188 Changing stories 190 Conclusions 192 Conclusions on the research aims 192 New directions: (i) Development of theory; 193 (ii) Qualitative research and people with learning disabilities Recommendations: (i) For clinicians; (ii) For families and care staff; 195 (iii) For people with learning disabilities F uture research 198 References 200 Appendices 230 A) Research and ethics submission 230 B) Consent forms 238 C) Interview schedules 240 D) Transciber guidelines 245 E) Memos 246 F) Conceptual categories 268 G) Properties and dimensions of conceptual categories 301 H) Comparison of categories 316 6 ABSTRACT The current research investigated the strong interests in media characters or narratives for a group of adults with learning disabilities seen by clinicians for behavioural and mental health problems. These interests were termed “Special Media Interests”. Six people with learning disabilities and a special media interest were interviewed (four interviewed once, two interviewed twice). Independently, seven clinicians were interviewed: clinicians (n=5) whose clients had been interviewed and clinicians (n=2) whose clients (n=3) were not interviewed. There were seventeen interviews in total. A grounded theory method was utilised to analyse the interviews and the findings of this analysis were as follows. People with learning disabilities and special media interests made comparisons of themselves to their interest: parallels were drawn, transformational desires expressed and the transition from child to adult focused upon. Comparisons necessitated people with learning disabilities and special media interests reality testing media representations. Indicators of both interest control and indicators of the strength of interest were found. Special media interests were considered to have both positive and negative consequences. There were indications of individual features characteristic of those with special media interests as well as the features of media interests that make them attractive. The findings of the current research are set within a context of special media interests as being of therapeutic utility in clinical work and as informative about the lives of people with learning disabilities: in these interpretations the conceptualisation of self-pluralism was important. A framework of enquiry for clinicians to explore and assess their clients’ special media interests is presented. 7 INTRODUCTION Terminology, the informative value of media interests, theoretical and methodological positions Terminology: special media interest and learning disabilities The current research introduced a new term “Special media interest” into the literature as the first stage in describing and then theorising a clinically noted phenomenon. The term was defined as follows. “Special” denoted that the interest provided a strong focus in the person’s life and was of great importance to them. “Media” included the mediums of television, film, radio, recorded music and the printed word. The “interest” included characters or narratives portrayed in the media: a character of interest was either a fictional creation or a real person who was a media celebrity, whilst a narrative was either a specific story or a genre. The population addressed in the current research were people with learning disabilities with special media interests. A diagnosis of learning disabilities is based upon an assessment with the psychometric tests of the Weschler Adult Intelligence Scales, version three (WAIS-III), (Wechsler, 1997), combined with an assessment of functional ability, via for example the Vineland (Sparrow, Balia & Cicchetti, 1984). A diagnosis of learning disabilities needs performance at levels significantly below the general population with: (a) a score of below 70 on the WAIS-III, ie. two standard deviations below the general population mean, and (b) a substantial impairment in functional and adaptive behaviour (American Psychiatric Association, 1994), and (c) the onset of difficulties demonstrated before adulthood. 8 The term in the current research "People with learning disabilities" was adopted out of convention; the population defined in the above paragraph are in academic psychology departments and professional health service departments in the United Kingdom most commonly referred to as "People with learning disabilities". However, the terminology used to refer to this population is problematic and open to change1. Terms used in the past in academic and professional circles, such as: “moron”, “cretin”, “idiot”, “feeble minded”, are no longer acceptable; and the terms of today may be considered unacceptable in the future. Terms suggested by professionals and considered inoffensive may be adopted by both the general population and the population to whom they refer and subsequently the words may be imbued with new meaning. Terms gain associated meanings that were not intended at their conceptualisation. Both structural