Volume 1: Research The role of parenting in the development of narcissism & Parental illness perceptions of ADHD Justin Savage A thesis submitted to The University of Birmingham For the Degree of DOCTORATE IN CLINICAL PSYCHOLOGY Department of Clinical Psychology School of Psychology The University of Birmingham September 2011 University of Birmingham Research Archive e-theses repository This unpublished thesis/dissertation is copyright of the author and/or third parties. The intellectual property rights of the author or third parties in respect of this work are as defined by The Copyright Designs and Patents Act 1988 or as modified by any successor legislation. Any use made of information contained in this thesis/dissertation must be in accordance with that legislation and must be properly acknowledged. Further distribution or reproduction in any format is prohibited without the permission of the copyright holder. Table of Contents VOLUME 1: RESEARCH The role of parenting and overindulgence in the development of narcissism: A review of the literature.........................................................................................................Page 1 Abstract ............................................................................................................. Page 2 Introduction ....................................................................................................... Page 3 Methodology ..................................................................................................... Page 9 Review of papers ............................................................................................. Page 14 Discussion ................................................................................................. …. Page 27 References ....................................................................................................... Page 32 Empirical Paper: Parental illness representations of ADHD: Relationships to coping, wellbeing and stress ......................................................................................... Page 37 Abstract ............................................................................................................... Page 38 Introduction ......................................................................................................... Page 39 Method ................................................................................................................ Page 47 Data Analysis ...................................................................................................... Page 51 Results ................................................................................................................. Page 52 Discussion ........................................................................................................... Page 69 References ........................................................................................................... Page 75 Executive Summary ........................................................................................ Page 83 ii APPENDICES Literature Review Appendix 1: European Journal of Personality: Instructions for Authors..................Page 88 Empirical Paper Appendix 2: Journal of Health Psychology: Instructions for authors. .............. Page 89 Appendix 3: Reliability and normality testing ................................................... Page 90 Appendix 4: NHS ethical approval ..................................................................... Page 91 Appendix 5: R&D permissions ........................................................................... Page 93 Appendix 6: Participant information sheet ........................................................ Page 98 Appendix 7: Participant consent form ............................................................. Page 100 Appendix 8: Details form.................................................................................. Page 101 Appendix 9: Illness perception Questionnaire ................................................. Page 103 Appendix10: The Brief Cope Questionnaire .................................................... Page 110 Appendix 11: The General Wellbeing Index ................................................... Page 111 Appendix 12: The Parenting Stress Scale ......................................................... Page 114 Appendix 13: The Strengths and Difficulties Questionnaire ............................ Page 115 iii LIST OF TABLES Literature Review Table 1: Methodological Quality Assessment Table .......................................... Page 10 Empirical Paper Table 1: Illness perception scales. ...................................................................... Page 49 Table 2: IPQ-R subscales .................................................................................... Page 53 Table 3: Symptoms parents attribute to ADHD .................................................. Page 54 Table 4: IPQ-R inter-correlations ....................................................................... Page 55 Table 5: Parental coping styles ........................................................................... Page 56 Table 6: Descriptive statistics of outcome measures .......................................... Page 57 Table 7: Intercorrelations of wellbeing measures and children’s difficulties ..... Page 58 Table 8: Bootstrapped Pearson’s r correlation coefficients between parental illness perceptions of ADHD, parental wellbeing and stress ................ Page 59 Table 9: Bootstrapped Pearson’s r correlation coefficients between parental illness perceptions of ADHD and parental coping strategies ............... Page 61 Table 10: Bootstrapped Pearson’s r correlation coefficients between parental coping strategies, parental wellbeing and stress, and children’s level of difficulty ....... Page 62 Table 11: Direct and indirect relationship between illness perceptions and wellbeing ..................................................................................................... Page 64 iv Table 12: Direct and indirect relationship between illness perceptions and parental stress .............................................................................................. Page 67 LIST OF FIGURES Empirical Paper Figure 1: The Self-regulation Model .................................................................. Page 42 Figure 2: Hypothesised direct and indirect relationship between illness perception and general wellbeing. ........................................................... Page 63 Figure 3: Hypothesised direct and indirect relationship between illness perceptions and parental stress. ............................................................... Page 66 Figure 4: Significant relationships between illness perceptions and parental outcomes......................................................................................... Page 69 v VOLUME 2: CLINICAL Psychological Models: Page 1 A psychodynamic and cognitive-behavioural formulation of Dan, a 50 year old man presenting with anger management problems, anxiety and unresolved grief. (Adult placement). Service Evaluation: Page 20 A Community Mental Health Team’s Perspective on Their Ability to Work with and Meet the Needs of People with Borderline Personality Disorder (Adult Placement). Case Study: Page 45 The 70 Year Old Man with Intrusive Thoughts of Killing Himself. (Older Adult Placement). Single-Case Experimental Design: Page 64 A 15 year-Old Boy with Compulsive Handwashing. (Child placement). Case Study Presentation: Page 84 Assessment and Intervention of a Man with Downs Syndrome and agoraphobia (Learning Disability Placement). vi APPENDICES Appendices: Service Evaluation Page 85 Appendices: Case Study Page 101 Appendices: Single Case Experimental Design Page 102 LIST OF TABLES Service Evaluation Table 1: Results from the survey items on feelings about BPD Page 25 Table 2: Survey results on specific working practices Page 26 Case Study Table 1: ORS and SRS scores breakdown Page 58 LIST OF FIGURES Psychological Models (CPR 1) Figure 1: Triangles of anger Page 8 Figure 2: Triangle of Grief Page 10 Figure 3: The Cognitive behavioural model Page 14 Service Evaluation (CPR 2) Page 31 Figure 1: Transtheoretical Model (Prochaska and DiClemente, 1982) Page 41 vii Case Study (CPR 3) Figure 1: An integrative formulation based on Carr (1999) Page 52 Figure 2: Anxiety reinforcement graph / Behavioural formulation Page 53 Figure 3: ORS and SRS totals graph Page 57 Single-Case Experimental Design (CPR 4) Figure 1: Transtheoretical Model (Prochaska and DiClemente, 1982) Page 71 Figure 2: The maintenance cycle of Ibrahim’s handwashing Page 72 Figure 3: Handwash frequency across phases Page 78 viii Literature Review The role of parenting and overindulgence in the development of narcissism: A review of the literature Department of Clinical Psychology School of Psychology The University of Birmingham September 2011 Word count: 8,420 (excluding abstract, references, tables and figures) 1 Abstract This review explores the relationship between parenting and the development of narcissism with a specific focus on the role of overindulgence. 13 empirical studies were identified for the review. A quality assessment was completed for each study. The papers are examined for the strength of their findings and the constructs they purport to measure are considered in relation to each other and overindulgence. A distinction is also drawn between ‘healthy’