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IS THERE A TYPICAL AGORAPHOBIC CORE STRUCTURE?
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Nigel J. Hopkins
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Formerly Consultant Clinical Psychologist, Sheffield
Health Authority, U.K.
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Abstract
Purpose. A heuristic PCT (Personal Construct Theory) model of
the development of panic and subsequent phobic avoidance identified the PCT
notion of ‘threat’ as a major causal variable (Hopkins, 1995). The formulation
of this model arose out of the clinical observation that suggested many women
diagnosed with agoraphobia had previously been focused on helping others, but
life events had disrupted these activities. This report describes an initial
assessment of the reliability of this clinical impression.
Method. The ‘self characterisations’ of twenty agoraphobic
women were compared to those of twenty non-agoraphobic women. The two groups
were found to display largely equivalent levels of anxiety and depression in
the absence of agoraphobic avoidance.
Results.The self-descriptions of the agoraphobic women
contained significantly more construct poles coded as ‘tenderness’ (Landfield) than were found in the
self-descriptions of the non-agoraphobic women.
Discussion. Further investigation is suggested that would improve
the reliability of the coding procedure and incorporate controls to aid
distinction between ‘state’ and ‘trait’ effects.
Key words: Agoraphobic avoidance, self-characterisation,
post-coding, reliability, core structure, attachment, and narrative.
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INTRODUCTION.
Hopkins (1995) suggests that the panic experience,
described by individuals who go on to become phobic of those circumstances they
perceive as being associated with the panic’s occurrence, is a consequence of
the PCT (Personal Construct Theory) notion of ‘threat’. ‘Threat’, is defined as
“the awareness of an imminent comprehensive change in core structure” (Kelly,
1955). In this study it is hypothesised to be created by the removal of the
opportunities to validate core structure, and especially ‘core role’, and this
could take place through the effects of life events, for example the loss of a
loved one or other major changes in the demands made upon the individual that
had given them a sense of purpose and a sense of significance.
Stefan (1977, p. 283) notes that core structure, which
posits an identity or meaning to behaviour, is superordinate in the PCT system.
He goes on to point out that core structure is not directly influenced by
experience, but responds to the success of its subordinate or first order
constructs in their prediction of events. As such core structure can be
vulnerable to deviations from the limits set by, for example, having a core
structure of being a Christian. They are now constrained to behave in a
Christian way and not in some other way. Their core structure will be largely
validated by Christian acts and not to such an extent by other acts. Individuals
at greater risk of experiencing ‘threat’ may have such a superordinate core
structure that limits their freedom to be otherwise.
The feelings associated with ‘threat’ may lead to
panic especially away from the familiar and more validating surroundings of
home. Travel away from home may involve decreases in validation and a loss of a
sense of purpose, threat is experienced, panic occurs and becomes anticipated
in unfamiliar and un-validating settings that are now avoided.
A ‘self characterisation’ (Kelly, 1955, p. 321) is a
very open-ended approach to the problem of obtaining a person’s own view of
their life, that is their ‘core structure’. It can identify individual
differences in self description that may have greater significance in relation
to the development of an understanding of an individual’s purposes than can be
obtained using a questionnaire. The latter asks each person the same questions,
thereby imposing the researcher’s own model of people onto the data. For
example, if asked, most people would claim to care about other people, but how
many would volunteer such information about themselves? The general research
question was “Do people displaying
agoraphobic avoidance characterise themselves differently to other patients who
experience similar levels of anxiety and depression in the absence of such
agoraphobic avoidance?”
In a sense a person’s self-characterisation is a form
of invitation to another person to interact with them in a certain way. A
written self-characterisation of the type described above is a particularly
formal type of self-presentation. Usually our public self-presentations are
delivered verbally and behaviourally. The constructs described in a
self-characterisation, and on show, are not merely descriptions of past events.
Instead, like all constructs, they serve to enable a person to anticipate the
future. In anticipating the future a person acts in particular ways and these
actions prompt a response from those around the person, and in this sense a
person’s predictions have a certain causal quality or effect not just on
others, but also on the actor themselves. The results of those predictions can
lead to a validation of construct systems or to an absence of validation,
invalidation and a loss of a sense of purpose, and even the loss of the
blueprint they had been following and which had structured their life.
This line of thinking lies behind Theodore Sarbin’s
foreword to Hallam’s 1985 book on anxiety. Sarbin advocates anxiety as a
construction or metaphor, suggesting that this and other metaphors need not be
restricted to those drawn from science and medicine but can include “game
playing, narrative, drama and rhetoric” (p. x). Sarbin uses the term ‘contextualism’
to describe this level of discourse and says that its “root metaphor is the
historical act”. “Actors who participate in this historical act are agents . .
. who engage in intentional actions not only to solve problems of a practical
nature, but also to maintain or enhance their identity. To this end they
construct their worlds” (Sarbin, in Hallam, 1985, p. xi). Hallam and Sarbin’s
view is paralleled by a more recent emphasis on personal narratives that relate
our life story (McAdams, 2008).
Sarbin believes that Hallam’s critical review supports
the conclusion that people should not be regarded as passive, but as active
agents. Causality should perhaps be sought in relation to the intentions of the
individual rather than in relation to processes within the organism. These
parallels with Kelly’s position are very strong. Sarbin and Hallam put forward
positions that can be seen in some respects as elaborations of Kelly’s theory.
Put in another way, by construing the world well we
learn about causality, how things and other people, work. We can use this information
to bring about desired effects. By construing ourselves in a certain way and by
communicating this self to others in the dramaturgical way that Kelly, Sarbin,
and Harre (1979) describe we create a context within which others are to some
extent constrained to act themselves. An agoraphobic person’s
self-characterisation may capture features of self-construction that
distinguish them from other people experiencing other types of painful
emotional state.
Were such differences found to exist between these
clinical groups in this study it was recognised that it would not be possible
to determine whether such measures were a function of the subject’s clinical
state or a reflection of more enduring pre-morbid characteristics or traits.
HYPOTHESES
Winter (1983) and Winter and Gournay (1987) utilised
Landfield’s (1971) system of construct pole classification in carrying out a
content analysis of the (bi-polar) constructs used in their study, and they
suggest that agoraphobics “submerge” the ‘low tenderness’ pole of Landfield’s ‘high-low
tenderness’ construct (that is, tend not to use this potentially available
classification). They further suggest that the agoraphobic person constricts
their perceptual field to avoid dealing with interpersonal conflict. This is in
line with other theorists, most notably Goldstein and Chambless (1978) and
Chambless and Goldstein (1980b, 1981, 1982). More recent work by Winter,
Gournay, and Metcalfe (1996), Winter et al. (2006), and Winter and Metcalfe
(2005) applies PCT therapeutic techniques that encourage experimentation aimed
in particular to the dilation of the perceptual field and on to subsequent
elaboration of the persons construct system. In addition to the submergence of the low tenderness
pole, another perhaps complementary tendency may also exist, namely that
agoraphobics elaborate the ‘high tenderness’ pole of this same dimension.
Dorothy Rowe drawing on clinical observation suggested
to the author that agoraphobic people are group oriented (Rowe, 1985). This
hypothesised gregarious nature may have significance in a possible link with a
need not to alienate themselves from others on whom they may depend for
validation. Hopkins (1995) suggested that one reason for this may lay in a
particular reliance the pre-agoraphobic person may have on the recognition or
validation of their self image by others, and through interaction with others,
lacking perhaps more than most people an ability to sustain their core
structure by more independent means. Perhaps this is because of the nature of
this other directed core structure, and perhaps for reasons that also relate to
the very development of such other directed core structure; in this respect
Guidano and Liotti (1983) and Liotti (1991) implicate the attachment process
(e.g. how should one behave in order to be valued by one’s primary carer?).
Perhaps, too, they have some block to seeing themselves as an assertive self
directed person as such assertion may create interpersonal conflict. That is,
such a construction of themselves may prove to be incompatible with others’
superordinate core structure.
Strodl and Noller (2003) examined the attachment
styles of agoraphobic participants using the five dimensions of attachment
measured by the Attachment Style
Questionnaire (Feeney, Noller and Hanrahan, 1994). They report that
‘preoccupation with relationships’ was associated with agoraphobic behaviour,
and catastrophic cognitions about bodily sensations partly mediated this
association. They also speculate on the possibility that interpersonal conflict
increases fears of abandonment and thus separation anxiety. Being unable to
construe interpersonal conflict due to their submergence of construct poles and
constriction of perceptual field, which Winter and Gournay (1987) note is
referred to by Kelly (1955, p.1139) as a ‘retreat to safety’, they are rendered
unable to deal with the ‘real’ issues that require changes to take place and
instead have catastrophic cognitions, and for example, misattribute their
feelings as signs of impending death and they can imagine a variety of
disorders that they fear are about to bring that event about. That they do
sense that they are about to come to an end gives further impetus to the idea
that they are experiencing Kellian ‘threat’.
Hopkins (1995) also hypothesised that when
experiencing agoraphobic avoidance, or immediately prior to having such an
experience, a person may have a proneness to rigidity or be ‘closed to
alternatives’, and to have a generally more judgmental stance when it comes to
surveying the world of others around them, reflecting perhaps a further aspect
of ‘submergence’ and the constriction of perceptual field identified by Winter
and Gournay (1987).
More positively, clinical experience suggests the
hypothesis that agoraphobics tend to describe themselves formerly as being
energetic people who were used to getting things organised and done. This may
relate to an aspect of assertiveness that does not involve interpersonal
conflict.
The hypotheses are:
1. Agoraphobics elaborate the ‘high tenderness’ pole,
and will therefore include more frequent statements to this effect in their self-characterisations
than will the contrast group.
2. Agoraphobics will portray themselves as being of an
especially sociable nature by using the ‘active social interaction’ category
frequently.
3. They will reveal signs of an underlying selectivity
to knowledge about life through their use of the ‘closed-minded’ construction
category.
4. They will describe themselves as energetic and organised
people who get things done (‘forcefulness’ and ‘organisation’ categories.)
METHOD
Participants
Over a period of two years forty of the general
practitioner referrals to a department of clinical psychology were of women who
were identified as belonging to one of two groups. One group of twenty was
confirmed by the author as meeting the DSM III criteria for ‘agoraphobia’. The
other group of twenty was not agoraphobic, but in other respects it was thought
to be likely, based on initial interview, and later confirmed by assessment,
that their symptoms would be of a similar type and level of intensity. Both
groups were free of any psychotic characteristics on clinical examination.
The mean ages of the two groups were: agoraphobics
mean = 38.96, S.D. = 12.73 (range 18 to 71); non-agoraphobics mean = 35.28
years, S.D. = 11.51 (range 24 to 59). [t (38) < 1.00, NS.].
(Note: The term ‘agoraphobia’ is used here to describe
the type of avoidance being displayed and ‘agoraphobic’ participant refers to
people in the study who are handicapped by this avoidance. The descriptions are
used to identify their main complaint, not to infer an underlying medical
condition.)
The assumption being made had the implication that
differences between the groups on non-symptom variables could be taken to
indicate the likelihood of an association with agoraphobia as opposed to being
a feature shared by all participants sharing equivalent symptoms of anxiety and
depression. Assessment provides reasonable confirmation that the above
assumption of symptom equivalence was correct:
Comparison of the scores of eighteen of the twenty agoraphobic
participants with fifteen of the twenty non-agoraphobic participants scores on
the Beck Depression Inventory found no significant difference, means = 17.46
and 17.68 respectively t (31) NS.
On scales of Social Avoidance and Distress there again
was no significant difference, mean Ag = 13.5 and mean NonAg = 14.75 t (31) NS.
On the Fear of
Negative Evaluation no significant difference was found with Agoraphobic means
= 17.60, Non-Agoraphobic means = 21.30 t (31) NS.
In the case of eighteen of these twenty agoraphobic
participants and fifteen of the Non-agoraphobic participant group the Crown
Crisp Experiential Index (CCEI) measures indicated differences on just two of
the scales, as expected on the ‘Phobia’ scale, Ag means =11.68, Non-Ag means
8.00 t (31) p<0.01 1 tail, and (unexpectedly) on the ‘Hysteria’ scale Ag =
5, Non-Ag = 8 t (31) p<0.05 2 tail.
On the CCEI ‘Anxiety’ scale both groups demonstrated
high levels mean Ags =12.13, mean Non-Ags =12.36. t (31) NS.
Summing of the six CCEI subscales gives an Agoraphobic
group mean = 53.56 and the Non-Agoraphobic group mean = 56.3 (t (31)=0.59 NS).
To assess and monitor levels of avoidance Johnston et
al’s (1984) Guttman Scale measure of agoraphobic avoidance was adapted for use.
Initial scores were Agoraphobics mean = 32.35, Non Agoraphobics mean = 17.40 t
(38) p<0.0005.
Procedure
The self characterisation was elicited by asking each participant
to respond to the following task:
“Write a
brief character sketch of yourself as if you were the principal character in a
play. Write sympathetically and
intimately as would a close friend, but perhaps no friend could know you as
well as this. Write in the third person thus: “He/she is the sort of person
who. . .” “(name) often wonders if he/she . . . etc.” It may help if you
imagine that you are the director of a play and are trying to describe the
character to a leading actor or actress, and your aim is to communicate the
essential qualities and characteristics of that character.”
Each Self Characterisation (SC) was started in the
presence of the author and some were completed on the day, others were
completed as homework and brought along the following week. Participants were
asked not to confer with friends or relatives prior to completing their SC as
it was important that this was their own view of themselves.
Scoring
Landfield (1965) has produced a method of construct ‘content
postcoding’ in which the two poles of each construct can be rated
independently. Sets of constructs from different people can be compared using
this technique and this allows freely elicited constructs to be used in studies
with all the advantages this brings and also allows for within group and
between group comparisons to be made in relation to construct content. Landfield
(1971) reports good interjudge reliability.
It was decided to use Landfield’s (1965) version of
his rating manual which involves twenty two rating categories. Applying
Landfield’s categories to a self characterisation script necessitates an
additional step in the process. This involved the identification of statements
that could be taken to identify a construct pole. Two graduate psychologists
employed as assistant psychologists in the clinical psychology department
carried out this initial task dividing the scripts from each participant group
between them equally and working independently. They then went on to apply the
method of categorisation set out in Landfield’s 1965 manual. These coders were
unaware of both the experimental hypotheses and the nature of the
investigator’s line of theorising. Their instructions were as follows: “Read the self-characterisation through to
gain an overview. Write out the self-characterisation again, putting each
adjectival statement onto a separate line. A single sentence may contain
several descriptions and each one needs to be rated separately. Below is an
example”. The directions in Landfield’s manual were discussed and the
raters asked to adhere to these instructions.
As the identification of construct poles within
self-characterisations was not part of Landfield’s study a check on inter-rater
reliability was incorporated into this study. Another psychology assistant was
asked to randomly select ten self-characterisations from each of the two
participant groups’ total of twenty. Using the same instructions she repeated
the analysis and her results were compared to those of the first raters. The
findings of this reliability check are set out in the results section below.
RESULTS
As the nature of the data provides reasonable grounds
for being cautious in making the assumption that it is normally distributed or
that the level of measurement achieved reached the criteria required for
interval or ratio scales, both requirements needing to be met if the
unambiguous use of parametric tests of significance is to be realised, the
distribution free method of chi-square was applied, along with the non-parametric
Mann-Whitney test.
Reliability
check of the post-coding procedure
Stage one of the Self-Characterisation post-coding
analyses involved the identification of individual construct poles from within
each self-characterisation, and a measure of the reliability of this procedure
would be the degree of agreement between raters in making these
identifications. The Cohen’s Kappa was used as an index of the extent of such
agreement:
The overall level of agreement between the two sets of
classifications was found to be Kappa = 0.59, which is only modest. In fact,
agreement was found to be Kappa = 0.60 for the Agoraphobic group and Kappa =
0.57 for the Contrast group, a two tailed test demonstrated that these levels
were not significantly different, ( t (18) =1.65 ,p>0.05,N.S.).
These figures as they stand suggest that the results
of this study require cautious interpretation. An analysis of the disagreements
show that they are largely a result of the rater carrying out the reliability
exercise tending to create more subdivisions within statements than did the two
earlier raters. This practice can lead to a duplication of construct poles and
Landfield’s manual instructions advise vigilance on this point (Landfield,
1965).
Stage two involved the post coding of these construct
poles in terms of Landfield’s categories and produced a correlation of 0.66 for
the comparison of all the pairs of rater’s scores for the total number of
categories in both groups of patients combined. For the agoraphobic group and
the contrast group considered separately the reliability coefficient was 0.74
and 0.60 respectively.
There was a fair degree of variation in the
reliability of rating the individual categories within and between the two sets
of patients. This variation may in part be due to the level of disagreement in
pole identification discussed above. The reliability coefficients for the five
categories of interest to this study are examined below:
The category of greatest importance (‘tenderness’
[17a]), as it relates to the study’s main hypothesis, has quite an acceptable
level of inter-rater reliability with a coefficient of 0.78 for the groups
combined, 0.84 for the agoraphobic group and 0.77 for the contrast group.
Similarly inter-rater reliability for ‘organisation’
and ‘forcefulness’ constructs was good (0.80 overall, 0.95 agoraphobics, 0.75
contrast, and 0.80 overall, 0.89 agoraphobics, 0.84 contrast respectively).
‘Active social interaction’ and ‘closed to
alternatives’ were less reliably identified however (0.53 overall, 0.57 for
agoraphobics, 0.91 for contrast, and 0.57 overall, 0.74 for agoraphobics, 0.48
for contrast group respectively).
The above results suggest that in general the
identification of construct poles within self-characterisations was moderately
reliable and their post-coding reliability, particularly in relation to the
main variables of interest, lay in the moderate to good range.
Hypothesis
1
As predicted, the agoraphobic patients described
themselves as being tender minded on the ‘tenderness (high)’ scale 17a, (‘any
statement denoting susceptibility to softer feelings towards others such as
love, compassion, gentleness, kindness, considerateness, or the opposite’- (low
is 17b).’ [Landfield, 1965, p. 12]), with a greater frequency than did the
non-agoraphobic patient contrast group. Medians = 2.85 and 1.65 respectively,
chi-square = 3.61, p<0.03, 1 tail (phi = .3, a medium effect), calculated
using Yates correction for small expected values and dichotomising the data
according to the median method described by McNemar (1962). [Median for both
groups combined =1.11]. A Mann-Whitney test, adjusted for ties, gives an exact
p = 0.0024 1 tail. There was no difference between the two groups in their
expression of the low-tenderness pole 17b. Agoraphobic median = 0.70,
non-agoraphobics = 0.76, chi-square = 0.45, p N.S. (1 tail with reference to
Winter and Gournay (1987) finding).
Hypothesis
2
In retrospect not surprisingly, given that they were
currently agoraphobic, and current active social interaction was greatly
reduced, the agoraphobic group did not use statements in relation to ‘active
social interaction’ at a level that distinguished them from non-agoraphobic
patients. Chi-square = 1.83, N.S 1 tail, but these statements were expressed
with a relatively high frequency by both groups (medians = 3.99 and 4.99
respectively). Even so, hypothesis 2 remains unconfirmed, due to the absence of
non-patient control data.
Hypothesis
3
Contrary to the hypothesis the agoraphobic group did not
produce significantly more statements classifiable as the construct pole
category ‘closed to alternatives’, [Category 10d, closed to alternatives: ‘Fit:
always realistic, avoidant, bigoted, conservative, dogmatic, inhibited,
narrow-minded, never angry, no emotions, one-track mind,
rigid, status quo,’ Landfield, 1965, p 9.] Chi-square =2.01, p N.S 1 tail.
Agoraphobic median = 1.59 and Contrast median = 0.99.
Hypothesis
4
The agoraphobic group did use many self descriptions
that involved ‘forcefulness (high)2a: ‘Any statement denoting energy, overt
expressiveness, persistence, intensity, or the opposite’- (low 2b
[Landfield,1965, p 4]), but so did the contrast group (medians = 4.59 and 3.39
respectively, chi-square = 1.5, p N.S. 1 tail). The ‘organisation (high)’ self
statements were used with low frequency by both groups (medians = 1.16 and 1.28
respectively, chi-square = 0.85, p NS 1 tail). Hypothesis 4 was therefore only
partly confirmed.
DISCUSSION
OF RESULTS
The ‘self now’ quality of a self characterisation
makes this analysis difficult, in that ‘trait’ qualities may be affected by ‘state’
processes, from both a behavioural and attitudinal viewpoint. Even so, the
confirmation of the agoraphobics’ greater tendency to perceive themselves as
tender minded, relative to the non-agoraphobic group, might reasonably be taken
to suggest that this self-description does reflect a pre-onset core
construction and possibly the most important core construct. If as Hopkins
(1995) suggests, the agoraphobic is experiencing ‘threat’ then PCT predicts
that the effect of ‘threat’ is to compel the client to “claw frantically for
(their) basic construct” (Kelly, 1963, p 167). The strong expression of this
construct here may then reflect an elaboration of this quality. Again cautious
interpretation is required due to lack of non-patient control data and the
modest level of inter-rater reliability.
The agoraphobics’ freely expressed descriptions of
themselves as being ‘forceful’ combine usefully with their ‘tender-mindedness’.
‘Forcefulness’ may not be a contradiction of ‘tenderness’ when applied in the
service of others for this is consistent with this study’s view of the
pre-agoraphobic person as helper and carer (Hopkins, 1995), but as has just
been argued, as these people are
currently agoraphobic the attribution of particular levels of these qualities
to them pre-morbidly, on the basis of this data, needs to be received with
caution.
Although the two groups were broadly equivalent on
type and level of symptomatology and therefore a reasonable control for this
source of possible causal linkage, a non-patient group could have been utilised
as an additional control. It would then have been possible to indicate whether
the agoraphobia group and the comparison group were more or less ‘tender minded’
or ‘forceful’ and so on, than a non-patient population.
In an effort to distinguish between ‘state’ and ‘trait’
characteristics the subjects could have been asked to produce two
self-characterisations one ‘as I am now’ and one ‘as I was formerly’, that is,
prior to the onset of agoraphobia. This may have led to a better demonstration
of the hypothesised differences between the two clinical groups especially in
the area of their social interaction and general effectiveness as individuals,
prior to the onset of their complaints.
The reliability of the construct pole identification
stage could be improved. In this study the reliability procedure took place at
too late a stage for the raters to meet and confer and arrive at a consensus
where there were differences in identification. In addition the training, of
the main study’s raters and the reliability rater themselves, in both
unitisation and subsequent coding was insufficient to achieve higher levels of
agreement. Reliance on the Landfield procedure alone does omit material of
interest within the context of the narrative, the identification of themes for
example, and the balance of meaning provided by the contrast pole is lost with
the separation of emergent poles from contrast poles in this coding process.
Further exploration of their use of these apparently
differentiating constructs and other constructs is required whilst the patients
are still agoraphobic and on their recovery. Such studies, reported on in
Hopkins (1995), were given direction and impetus by the encouraging result of
this first test of the PCT model of agoraphobia. A further analysis of
constructs using the repertory grid method and the sophisticated statistical
methods now available to describe the results will enable hypotheses to be
tested that relate not only to content but also to the structure of the
person’s construct system in its application both to themselves and to other
people in their lives.
SUMMARY
OF FINDINGS
The analysis of each person’s self-characterisation
utilised an adaption of Landfield’s (1965) method of construct ‘content
postcoding’, thus converting the idiosyncratic results of the
self-characterisations into a form that allows for comparisons to be made
between individuals and groups. The major finding was that, as predicted,
participants displaying agoraphobic avoidance describe themselves as being of a
‘nurturant’ or ‘tender-minded’ nature more frequently than equally depressed
and anxious participants not displaying agoraphobic avoidance. The limitations
of the results confirmed the need for additional control groups and reliability
procedures, but it was judged that the data did provide reason to undertake a
more detailed examination of the personal construction of agoraphobic people
that would look not only at construct content, but would explore the
possibility that differences exist at a structural level that may increase
their vulnerability.
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AUTHOR'S NOTE
This
study was carried out whilst the author was working as a Consultant Clinical
Psychologist at Sheffield’s Northern General Hospital. It is one aspect of a
broader investigation into the problems of panic and agoraphobia using a
Personal Construct Theory approach submitted to the Faculty of Medicine of the
University of Sheffield in part fulfillment of the degree of Doctor of
Philosophy.
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ABOUT
THE
AUTHOR |
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Nigel Hopkins: After completing training in Clinical
Psychology at Birmingham University England in 1971 I worked for the next
twenty-five years mainly with Adults. In 1996 I took up posts based in Forensic
settings. From 2005 I worked in Cornwall with adolescents in Residential Care,
and then, in Plymouth, I practised as the team psychologist. Starting out in
1971 with behavioural skills, and like many others supplementing these, first
with Rogerian approaches and then with Rational Emotive Therapies, I moved onto
Beck, and Cognitive Behavioural inspired ways of working. Around 1982 I began
to take a serious ‘look’ at Personal Construct Theory and, following
substantial training, made PCT my default starting point when putting case
formulations together.
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REFERENCE
Hopkins, N. J. (2012). Is there a typical agoraphobic core structure?
Personal
Construct Theory & Practice, 9, 19-27, 2012 (Retrieved from http://www.pcp-net.org/journal/pctp12/hopkins12.html)
Correspondence address: nigel.hopkins4@btinternet.com
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Received: 12
September
2012 – Accepted: 10 December 2012 –
Published: 28 December 2012
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