Topic 5: Clinical psychology — Edexcel A-Level Psychology
Test yourself on Topic 5: Clinical psychology with PEARSON EDEXCEL A-Level practice questions.
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Topic 5: Clinical psychology explained
This topic asks you to hold explanation and treatment together, for schizophrenia and for one further disorder from depression, anorexia nervosa or obsessive compulsive disorder.
Read the full explanation
On the biological side, chlorpromazine reduces dopamine transmission and sedates, while clozapine acts on dopamine and serotonin, is reserved for cases that resist other drugs, and requires regular blood tests because of the risk of agranulocytosis. Leucht and colleagues (2012) pooled trials and found relapse within a year in roughly a quarter of patients kept on antipsychotics against nearly two thirds on placebo. Talking treatment runs from Rogerian counselling, built on empathy, congruence and unconditional positive regard, to cognitive behavioural therapy.
Individual differences and developmental psychology must be considered when learning about links between personality factors and mental disorders and genetic influences (nature) or environmental influences (nurture) within different explanations for mental health disorders.
Two approaches are being pulled into clinical work here. From individual differences comes the question of whether stable traits raise risk, with high neuroticism repeatedly predicting later depression and perfectionism and low self esteem featuring in accounts of anorexia nervosa. From developmental psychology comes the question of what early experience does, with Varese and colleagues (2012) pooling studies to find childhood adversity associated with roughly a threefold rise in psychosis risk. Twin work by Gottesman and Shields gave concordance for schizophrenia far higher in identical than in non-identical pairs but well short of complete, and Tienari and colleagues (2004) found adopted children of mothers with schizophrenia developed it mainly in disturbed adoptive families.
Your focus
- Students must show understanding that clinical psychology is about explaining and treating mental health issues, and of the different ways of treating them, including counselling and drug treatments.
- Individual differences and developmental psychology must be considered when learning about links between personality factors and mental disorders and genetic influences (nature) or environmental influences (nurture) within different explanations for mental health disorders.
Topic 5: Clinical psychology exam tips
Marking Points
- Say what clinical psychology actually does, which is to assess, formulate, classify using a recognised system, treat and then evaluate outcome, and distinguish the clinical psychologist from the psychiatrist, who is medically qualified and prescribes.
- Describe one drug treatment at the level of the mechanism and the regime: chlorpromazine as a dopamine antagonist that reduces positive symptoms, clozapine as an atypical drug with a different side effect profile and mandatory blood monitoring.
- Describe a talking treatment accurately, with Rogers' core conditions for counselling, or cognitive behavioural therapy identifying, testing and reframing beliefs, noting that current guidance recommends therapy alongside medication rather than instead of it.
- Quote effectiveness evidence and its limits, using the Leucht meta-analysis on relapse, and then the problems of drop out, adherence, side effects such as tardive dyskinesia after long use, short follow up and publication bias.
- State what each treatment does not do, since drugs manage symptoms rather than causes and do nothing about poverty, isolation or trauma, while counselling depends on engagement and is hard to deliver during acute psychosis.
- Use the genetic evidence with numbers and with its limits, saying that pooled twin concordance for schizophrenia is far higher in monozygotic than in dizygotic pairs yet nowhere near complete, which rules out a purely genetic account.
- Use the adoption evidence for interaction, since Tienari and colleagues found genetic risk mattered mainly where adoptive family functioning was poor, which is diathesis-stress with data rather than as a slogan.
- Bring personality in as a measurable individual difference, naming neuroticism as a predictor of depression and perfectionism and control as features described in anorexia nervosa, and note that trait measures are self report and taken after onset in many studies.
- Give the developmental strand its own evidence, using the Varese meta-analysis on childhood adversity and psychosis, and attachment or early loss accounts of later depression.
- Evaluate the methods, questioning the equal environments assumption in twin studies, the prenatal environment shared before adoption, direction of causation between trait and disorder, and the social sensitivity of telling families that risk runs in the genes.
Examiner Tips
- 💡Questions often pair one biological and one psychological treatment and ask you to compare, so keep a shared framework of effectiveness, side effects, appropriateness and ethics.
- 💡Paper three rewards applying treatment knowledge to a described patient, so practise picking the treatment that fits the symptoms and the setting in the stem.
- 💡When the command word is evaluate, do not describe the therapy for half the answer; two sentences of description is enough before the evidence begins.
- 💡Pearson asks you to bring earlier topics into clinical psychology, so name the approach explicitly and then show its contribution rather than just alluding to it.
- 💡Diathesis-stress is the safest conclusion for an extended answer, but it only earns credit when supported by a named interaction study.
- 💡Watch for questions that give a case history, where the marks come from linking the described family history and life events to the explanation.
Common Mistakes
- Writing that antipsychotics cure schizophrenia, rather than that they reduce symptoms and lower relapse while they are taken.
- Describing counselling as simply listening and giving advice, when the credit is for the named conditions of the therapeutic relationship or the specific cognitive techniques.
- Evaluating a therapy only through ethics and never through outcome evidence, comparison groups or follow up.
- Confusing a clinical psychologist with a psychiatrist and awarding prescribing powers to the wrong profession.
- Reporting twin concordance as proof that a disorder is genetic, when identical twins share an environment as well as their genes and concordance is always incomplete.
- Describing a personality trait as if it were a diagnosis, or treating a correlation between neuroticism scores and depression as evidence that the trait causes the disorder.
- Treating nature and nurture as rival boxes when the marks are for explaining how a vulnerability and a stressor combine.
- Bolting the individual differences and developmental labels onto the answer without showing what each approach actually contributes to the explanation.