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Exploring Role Conflict and Work-Family Balance: How Do Challenges Differ for Parent and Non-Parent Counsellors Working with Young People?

Katie Gregory (2024)

Department of Psychology 

University of Wolverhampton 

How do associations between role conflict-ambiguity and work-family conflict manifest among parent-counsellors and non-parent counsellors working with young people aged 0-18? 

Abstract 

This study examined the relationship between role conflict-ambiguity (RCA) and work-family conflict (WFC) among counsellors working with young people (ages 0-18), comparing parents and non-parents. Using a comparative associational design and employing the pre-validated Role Conflict and Ambiguity Scale and the Work-Family Conflict Scale, with 56 participants recruited via convenience and snowball sampling. 

Results indicated a significant positive association between RCA and WFC across all participants, but parental status did not significantly alter the strength of these associations. Parent-counsellors showed notable correlations between RCA and the Work interfering with Family Conflict (WIF) dimension (r = 0.45, p < .01), and WIF was a significant predictor of role ambiguity (β = 0.43). Conversely, non-parents displayed weaker and non-significant correlations between RCA and WFC measures, with their overall levels of role conflict being higher but less impactful on WFC. 

The findings underscored the substantial challenges faced by parent-counsellors in balancing their dual roles, leading to greater role ambiguity and conflict. Although the primary caregiving status did not significantly affect the results, the lack of statistical significance in Fisher’s z tests suggested that the impact of parental status on RCA and WFC is consistent across both groups. Future research should focus on refining measurement tools to better capture the experiences of counsellors with diverse parenting responsibilities and explore how these dynamics affect their professional and personal well-being. 

Acknowledgements 

For all those who journey with mental health challenges, and their supporters who have underscored the importance of understanding the impacts of conflict and ambiguity within roles. Their resilience and courage have shaped our commitment to advancing knowledge in this field, aiming to improve support systems for all counsellors with a particular focus for those balancing professional roles with parenting responsibilities. 

Chapter 1 Introduction 

1.1 An Overview of Role Conflict and Work-Family Dynamics 

Role conflict (RC) occurs when the demands of one role are incompatible with those of another, creating stress and potential performance issues in either or both roles (Creary & Gordon, 2016; Jackson & Schuler, 1985; Tubre & Collins, 2000). This incompatibility can lead to increased stress, decreased job satisfaction, and diminished effectiveness in fulfilling role responsibilities. The interplay between family life and professional responsibilities often results in work-family conflict (WFC), where work demands interfere with family life and vice versa (Frone et al., 1997; Greenhaus & Beutell, 1985). Professions requiring high emotional labour, such as counselling, are prevalent for this type of conflict, where professionals must navigate the demands of their roles as caregivers at work and at home. Theories such as Role Strain Theory (Goode, 1960) and Boundary Theory (Ashforth et al., 2000) provide a lens for understanding how individuals manage, often struggle but can also thrive with these overlapping roles. These dynamics are further complicated in the context of counsellors who work with young people, as these professionals often face additional challenges related to the emotional intensity of their work, the ethical dilemmas they encounter, and the specific needs of the younger population they serve (Hilts & Luke, 2024; Kimber & Campbell, 2013). 

1.2 Counselling Young People in Today’s World 

Counselling young people (YP) involves unique challenges that differentiate it from other forms of counselling. Young clients often present with issues that are distinctively tied to developmental stages or generational contexts, such as identity formation, peer pressure, and increasingly, digital life challenges (Glasheen et al, 2013; Noonan, 2002). Today’s world adds layers of complexity with widespread digital engagement, cultural shifts, and evolving family structures which impact both YP and those who counsel them. Counsellors must adapt to these dynamics, often while managing their own work-life balance. The stressors inherent in these roles may exacerbate RC and impact counsellors’ effectiveness and personal well-being.  

1.3 Parental Impact on Professional Dynamics in Counselling 

The dual demands of parenting and counselling create unique pressures and critical areas for research (Bryant & Constantine, 2006; Hermann et al., 2018). This study investigates how parental responsibilities affect the professional efficacy and stress management of counsellors working with YP. Parental responsibilities may intensify the emotional and time-related pressures that are inherent in counselling roles, potentially leading to higher levels of WFC and role ambiguity (RA). Understanding this impact is crucial for supporting parent-counsellors in their dual roles. The study defines ‘parent’ as any caregiver for a child aged 0-18 years and ‘primary caregiver’ as the parent most involved in caregiving. 

1.4 Research Focus 

This study examines the associations between Role Conflict and Ambiguity (RCA) and Work Family Conflict (WFC) among counsellors working with young people, comparing parent and non-parent counsellors. It aims to discover if parenting amplifies the challenges faced by counsellors, particularly how these roles interact and conflict. 

1.5 Aims of the Study 

The primary aim is to investigate the relationships between RCA and WFC, especially in the daily lives of parent-counsellors compared to non-parent counsellors. The study’s specific objectives are: 

  • To quantify the degree of RCA and WFC experienced by counsellors of YP and to compare these levels between parent and non-parent counsellors. 
  • To explore how parenting status influences these conflicts, focusing on the differences in RCA and WFC between parent and non-parent counsellors. 

Hypotheses 

  • H1: There will be a positive association between RCA and WFC among counsellors who work with young people. 
  • H2: Parent-counsellors will exhibit a stronger positive association between RCA and WFC compared to non-parent counsellors, suggesting more complex interactions due to the dual responsibilities of parenting and counselling. 

1.6 Importance of this Study 

This study is significant in addressing RC and work-family balance among counsellors of young people, especially post-COVID-19. The pandemic has heightened mental health issues among YP (Kauhanen et al., 2022) and increased family pressures (Kahraman et al., 2021), intensifying the ‘double burden’ on primary caregivers. Although women predominantly navigate these dual roles, this study includes all parental caregivers to investigate whether similar challenges arise organically across all genders. Role Balance Theory suggests that effectively managing these roles enhances well-being despite potential conflicts (Marks, 2001; Marks & MacDermid, 1996). 

By exploring how caregivers manage overlapping responsibilities, this research aims to develop interventions to reduce RC and help counsellors manage work and family demands effectively. These insights are crucial for policy changes within organisations and education, enhancing counselling services and ultimately supporting counsellors’ well-being, improving care standards for YP. This study contributes to understanding the interplay between professional and personal roles among counsellors, fostering better support systems for parents and carers in the profession. 

Chapter 2. Literature Review 

2.1 Defining Role Conflict and Ambiguity 

Role conflict and ambiguity are crucial in understanding the challenges professionals face, especially in high-stress environments like counselling (Bowling et al., 2017; Tubre & Collins, 2000; Van Sell et al., 1981). For counsellors, who balance the emotional demands of clients with personal responsibilities, these constructs are not abstract but significantly shape their lives. RC arises when one role’s demands impede another’s, manifesting acutely in the tension between client care and family obligations, often exacerbated by burnout (Van Hoy & Rzeszutek, 2022). The application of Role Strain Theory (Goode, 1960) is critical as it shows that these competing demands undermine physical and psychological well-being. In professions with high emotional labour, such strain is not incidental but a fundamental stressor that decreases job satisfaction and heightens stress (Anglin et al, 2022; Atkinson, 2023; Kahn et al., 1964; Peterson et al., 1995; Rizzo et al., 1970). 

Similarly, RA significantly impacts counsellors, where unclear expectations or insufficient role information lead to uncertainty (Jackson & Schuler, 1985; Maden-Eyiusta, 2019; Tubre & Collins, 2000). This ambiguity is particularly problematic in counselling, where balancing personal empathy and professional detachment is essential. Vague guidelines, perception or reality, can increase job dissatisfaction and anxiety, which negatively affect client care (Hermansson, 1997). Boundary Management Theory provides an ambitious framework to understand and address this ambiguity (Ashforth et al., 2000; Clark, 2000). Effective boundary management can mitigate the adverse effects, enhancing work-life balance and job satisfaction. However, this requires substantial skill and resilience. 

Critically, these theories do more than describe challenges, they offer a nuanced understanding of potential outcomes. While often linked to negative effects like stress, burnout, and reduced commitment, especially harmful in counselling due to its impact on client care, they also present opportunities for growth (Bryant & Constantine, 2006). Navigating these challenges successfully can enhance job mastery, resilience, and satisfaction. Boundary Management Theory, in particular, highlights that well-managed boundaries can transform role conflicts into opportunities for flexibility and resilience, improving well-being (Ashforth et al., 2000). 

2.2 Defining Work-Family Dynamics 

Work-family conflict (WFC) is a specific type of RC that occurs when work and family domains are incompatible, causing stress and tension (Byron, 2005; Greenhaus & Beutell, 1985; Haslam et al., 2004; Michel et al., 2011). There are two constructs at play here Work Interfering with Family (WIF) and Family Interfering with Work (FIW). This conflict is critical for counsellors, whose job demands often infringe on family time and responsibilities. Effective management of work-family dynamics is crucial for counsellors’ well-being and effectiveness (Allen et al., 2000; Cinamon, 2010; Tatman et al., 2006). 

Counsellors, particularly those with parental responsibilities, face frequent interdomain transition shifts between professional and family roles (Mathews et al, 2013). Alongside, diurnal patterns of pressure that naturally fluctuate over the day and place demands on the counsellor (French et al, 2022). These transitions are often unpredictable and frequent, especially in counselling roles that may require responsiveness to crises or emergency situations beyond typical working hours (Pereira & Rekha, 2017). Women often face higher WFC due to the double burden hypothesis, leading to higher sickness absence rates (Nilson et al., 2017). Understanding and mitigating WFC is essential in the counselling profession. 

2.3 Reported Double Burden 

The “double burden” or “second shift” describes the dual responsibilities of managing paid employment alongside unpaid domestic labour, including childcare and housekeeping, which predominantly affects women (Craig, 2007; Chen et al., 2017; Nilsen et al., 2017; Seedat & Rondon, 2021). This strain is especially pronounced among women occupying counselling roles, where the demands of professional and personal responsibilities can significantly overlap (Hermann et al., 2016). Studies show that women are more likely to be the primary caregivers in their families and are also significantly represented in counselling professions, leading to heightened RC and WFC (Haslam et al., 2017). Egalitarian cultures, that support progressive post-gender marriages and partnerships (where roles, responsibilities, and behaviours are not confined by traditional gender norms) sometimes see task distribution discrepancies, impacting co-parenting quality and increasing the double burden (Cotter et al., 2011; Pessin, 2017; Sümer & Eslen‐Ziya, 2022). 

Factors contributing to the double burden include the rise of dual-earner families, single-parent households, economic necessity, cultural expectations, inadequate support infrastructures, and technological advances (Chen et al., 2017; Hervey & Shaw, 1998; Nilsen et al., 2017; Rees et al., 2023; Seedat & Rondon, 2021). Dual-earner families and single parents often face heightened stress from balancing work and family roles, compounded by financial pressures and cultural expectations. The lack of sufficient support systems, such as affordable childcare and flexible work options, further exacerbates this challenge. Additionally, technological advances, while enabling remote work, can blur the boundaries between work and family life. Understanding these factors is crucial for fully grasping the origins of the double burden and addressing WFC effectively. 

2.4 Reported Parental Stress at Work 

Working parents, especially in individualistic societies like the UK, report higher stress levels due to dual professional and parenting demands (Adams et al., 2021; American Psychological Association, 2020; Ning et al., 2023; Rajgariah et al., 2020). Counselling, particularly school counselling, has become a highly gender-segregated profession, with women fulfilling a significant proportion of the field (Brown, 2017; Bondi, 2006). In the US, women comprise of 83% of counselling MA students (CACREP, 2017), a stark contrast to the 1950s when men predominantly occupied these roles (Mezzano, 1968 in Crockett et al., 2018). These rates are parallelled in the UK with the gender imbalance of 84% women and 16% male (Brown, 2017). Notably however, these statistics have been taken from WIERD (Western, educated, industrial, rich and democratic) countries and to provide true population comparison further studies are required from additional societies (Muthukrishna, 2020).  

This demographic shift places unique pressures on the majority female workforce. With an amplification of these pressures for primary caregivers, as they navigate the complex interplay of meeting both work and home demands (Hawken et al, 2018; Phillips et al, 2022; Premeaux et al, 2007). Women again being at the forefront, predominately providing these roles and often without adequate support systems (Lorenz-Dant & Mittelman, 2021; Sharma et al, 2016; Swinkels et al, 2017). These scenarios are particularly challenging in the context of counselling YP, where the emotional demands of the job can be intense and the boundaries between professional and personal life often blur (Amaglo, 2022; Md Nor et al, 2023). 

The predominance of women in these roles necessitates a gender-sensitive approach to addressing job stress and work-life balance, considering historical and societal gender role constructs (Verdonk et al, 2019). Effective interventions to support counsellors, particularly those who are parents and primary caregivers, must therefore be attuned to these gender dynamics, ensuring that policies and practices within educational and mental health institutions are equitable and supportive of work-life integration. This is not only crucial for the well-being of the counsellors but also for the efficacy of the counselling services they provide. 

2.5 Counselling Young People and Reported Job Conflict 

Counsellors who work with YP face distinct challenges that stem from the deeply emotional nature of their interactions, compounded by the increased complexities of the modern socio-educational environment (Pattison & Harris, 2006; Westergaard, 2013). RC from emotional labour, combined with family responsibilities, escalates burnout and stress if not managed (Barber & Iwai, 1996; Edú-Valsania et al., 2022; Jeung et al., 2018). The COVID-19 pandemic has increased counsellors’ burdens due to higher demands and stretched resources (World Health Organisation, 2022; Radfar et al., 2021; Savitz-Romer et al., 2021). With Child and Adolescent Mental Health Services (CAMHS) facing increased waiting lists and higher thresholds for treatment eligibility, counsellors in education settings are often the first line of support for distressed youth, intensifying their workloads and emotional strain (Alexander et al, 2022; De Souza, 2024; Pincus et al, 2020). 

Furthermore, the impact of technology and the internet appears to have led to a surge in self-diagnosing and gaining mass awareness of mental health conditions and psychosocial problems (Dienlin & Johannes, 2020; Rutter et al, 2023). This shift for YP requires counsellors to manage heightened anxieties and address misinformation which adds complexity to their roles and potentially increases job conflicts (Verma et al, 2022). Effective management requires robust support systems, professional development, and strategies for work-life balance (Gragnano et al., 2021). 

2.6 Reported Impact of the Current Mental Health Crisis 

The ongoing mental health crisis, compounded by societal changes and the COVID-19 pandemic, has significantly impacted children, families and society at large (WHO, 2022). This crisis has intensified the demands of professionals providing mental health support, highlighting the limitations of traditional models   that depict mental health issues as merely diseases (Benning, 2015; Deacon, 2013; Hogan, 2019). Instead, there is a shift towards continuum models of mental health, viewing psychological well-being as a spectrum influenced by various determinants (Cromby et al, 2013; Peter et al, 2021). This perspective promotes a trauma-informed approach (Sweeney et al, 2018) and fosters a deeper understanding of mental health, addressing the underlying causes of human distress, thereby improving work-family dynamics and reducing work-related stress among mental health professionals. 

The crisis underscores the need for intersectionality and socio-cultural context consideration in mental health (Funer, 2023). Increased workloads and complex client needs, particularly young clients, exacerbate role conflicts and work-family tensions (Allen et al., 2000; Savitz-Romer et al., 2021). Further research is needed on how parent-counsellors manage these dual challenges, including the navigation of managing distress in their own children whilst working with a similar client group. Addressing these factors is crucial for supportive work environments, reducing burnout, and helping professionals manage personal and professional demands effectively. 

2.7 Conclusion and Implications 

This review critically examines RC and work-family dynamics among counsellors working with YP, focusing on the unique challenges faced by parent-counsellors. It highlights gaps in empirical data on the specific stressors these professionals face and aims to develop interventions to enhance role management and well-being, recognising the crucial balance between professional and personal responsibilities. The research’s implications extend beyond counselling, offering insights applicable to other professions with high emotional labour and overlapping roles. By integrating Role Strain Theory (Goode, 1960) and Boundary Theory (Ashforth et al., 2000), this study lays the groundwork for policy and practice reforms that could create more supportive environments, particularly for those with caregiving responsibilities. Such changes would improve counsellors’ well-being, professional effectiveness, and contribute to a more equitable workplace. Moreover, the study highlights the need for a broader societal shift to address systemic factors exacerbating RC and WFC, paving the way for strategies that support mental health professionals in managing dual roles, thus promoting career sustainability and better outcomes for those they serve. 

Chapter 3.  Research Methods and Timescales  

3.1 Study Design 

This study employed a cross-sectional survey design (Coolican, 2017), which facilitated the review of role dynamics and conflict for this specific population of professionals. A snapshot of how these variables interplay at a single point in time is collected because of this design structure, which then allows for a basis to identify potential causal relationships and associations (Wang & Cheng, 2020). This design was chosen for its effectiveness and efficiency in capturing such a broad snapshot of current associations. However, it is important to note that due to the nature of this design, it does not allow for the establishment of causality but instead the identification of relationships between the variables (Setia, 2006). This is a dominant choice of study design for constructs such as RCA and WFC within organisational behaviour research, which focuses on people analytics, through data driven means (Polzer, 2023). 

By incorporating both non-parent and parent-counsellors working with YP, the study enhances its ability to contrast and compare the impact of parental status on the professional well-being and stress levels within this demographic, crucial for interventions aimed at improving counsellors’ well-being and efficacy (Cohen et al, 2017). Overall, the research available that looks at role dynamics and conflict for counsellors of YP is limited, with most research touching on this area rather than focusing specifically on it (Bryant & Constantine, 2006; Hermann et al, 2018). In line with a post-positivism epistemological stance, the quantitative structured data collection and pre-validated surveys that are used in this study ensured that data from within this emerging area is systematically gathered, replicable and considers the recognition of errors or potential biases (Godwin et al, 2021; Jackson & Dolan, 2021; Panhwar et al, 2017). This overall study design allowed for applicability, ethical simplicity, a detailed comparative analysis alongside quantitative insights and future replicability (Cohen et al, 2017; Howitt & Cramer, 2020).  

3.2 Participants 

The study aimed to recruit counsellors or mental health professionals qualified to work with children and YP aged 0-18. To achieve a representative sample, both convenience and snowball sampling strategies were used (Gliner et al., 2017). Participants were recruited through the University of Wolverhampton’s student databases and social media platforms like Facebook, where counsellors often engage in specialised forums. The recruitment did not specifically target equal distribution between parent and non-parent counsellors. Instead, participant status was determined through demographic questions in the survey, allowing categories to emerge naturally (Negida & Elfil, 2017). This post-stratification approach enhanced the ecological validity of the study, ensuring findings are applicable to real-world settings. The sampling strategy also accounted for potential variances in subgroup participation, aiming to enhance representativeness and mitigate sampling biases (Gliner et al., 2017; Sarker & AL-Muaalemi, 2022). 

Aiming for a 95% confidence interval, the study sought precise, reliable estimations of population parameters (Hespanhol et al, 2019). Using GPower 3.1, the required sample size was determined as at least 84 participants, based on an alpha of 0.05, a power of 80%, and a medium effect size (correlation) of 0.3 (Faul et al., 2009; Appendix A). 

The survey was accessed by 89 participants. All 89 participants consented to the study, however 33 participants failed to complete further than 5% of the study or had multiple missing answers and so were excluded from the dataset. Consequently, 56 completed responses were analysed in the study. This total fell short of the targeted minimum sample size of 84 participants. The overall completion rate for the study, reflecting those who fully completed all questionnaires and provided consent, stood at 66.67% (n=56). 

Participants provided demographic information, including age, gender, caregiver status, number of children, years of counselling experience, and monthly working hours (Appendix D). This enriched the data set for nuanced analysis (Jones et al., 2020). As seen in Table 1, of the 41 parents, 15% identified as male, 82.5% as female, and 2.5% as non-binary or third gender. Among the 15 non-parent participants, 1 (6.67%) identified as male and 14 (93.33%) as female, with none identifying as non-binary or third gender. This mirrors the UK’s gender imbalance of 84% women and 16% men (Brown, 2017), reflecting societal norms in this study. 

Table 1. 

Frequencies for categorical measures by parental status. 

    Frequency (Valid %)   
Measure Category Parent N=41 Non-Parent N=15 
Age 18-25 years 1  1 (2.50%) 3 (20.00%) 
  26-35 years 5 (12.50%) 7 (46.67%) 
  36-45 years 19 (45.50%) 2 (13.33%) 
  46-55 years 12 (30.00%) 2 (13.33%) 
  56-65 years 3 (7.50%) 1 (6.07%) 
    Missing 
Gender Male 6 (15.00%) 1 (6.67%) 
  Female 33 82.50%) 14 (93.33%) 
  Non-Binary 1 (2.50%) 0 (0.00%) 
    Missing 

3.3 Materials 

Participants completed two validated instruments: the Role Conflict and Ambiguity Scale (Bowling et al., 2017) and the Work-Family Conflict Scale (Haslam et al., 2014). These scales, chosen for their reliability and validity, eliminate the need for a pilot study. They precisely quantify role stresses, providing critical insights into how these pressures affect counsellors’ personal and professional responsibilities. 

The Role Conflict and Ambiguity Scale (Bowling et al., 2017) comprises 12 items, using a 7-point Likert scale for responses, including reverse scoring on certain items to address different perspectives. The scale is structured around two primary factors: ‘Role Conflict’ and ‘Role Ambiguity,’ each capturing distinct aspects of how conflicting roles and unclear expectations affect individuals (Appendix B). Alongside, the Work-Family Conflict Scale (Haslam et al., 2014) consisting of 10 items that assess the conflict between work and family responsibilities. It uses a 7-point unidirectional Likert scale for responses. The scale is organised into two dimensions: Work Interfering with Family (WIF) and Family Interfering with Work (FIW), capturing how each domain impacts the other (Appendix C). 

3.4 Procedure 

Participants were invited to the study via Qualtrics, a secure online survey platform. The study was advertised on the University of Wolverhampton Psychology Course Cafe and social networks like Facebook and LinkedIn. Bi-weekly reminders were issued to optimise response rates, and regular checks were conducted on advertisements (Appendix E) to address questions. Anonymity and confidentiality of responses were strictly maintained. Responses were collected over seven weeks from May 14th to July 3rd, 2024. Participants reviewed the Participant Information Sheet (Appendix F) and provided informed consent electronically (Appendix G). They then completed the Role Conflict and Ambiguity Scale, Work-Family Conflict Scale (Appendix B & C), and a demographic questionnaire (Appendix H), taking approximately 20 minutes. Finally, to conclude participants reviewed a De-Brief Form (Appendix I). Data were initially analysed in Microsoft Excel for cleaning and review, then transferred to JASP software for detailed examination (Version 0.17.1; JASP Team, 2023). 

3.5 Ethics 

Ethical approval was obtained from the University of Wolverhampton’s Ethics Committee (Appendix J), ensuring informed consent, confidentiality, and the right to withdraw without penalty (Howitt & Cramer, 2020; Hwang & Kang, 2023; Nurmi et al., 2018. No identifiable data was collected from participants, with all information anonymised and securely stored on Qualtrics in compliance with GDPR regulations and British Psychological Society (2021) ethical guidelines. 

The study uses a critical quantitative approach, grounded in feminist ethics (Mills & Mullany, 2011; Jaggar, 2015; Ramazanoglu & Holland, 2002) and a post-positive stance, to address systemic power structures. This approach involves several key steps to tackle specific ethical challenges. First, it acknowledges the systemic issues faced by female counsellors balancing professional and caregiving roles (Brown, 2017; Bondi, 2006) and integrates feminist principles to ensure inclusivity and fairness. By striving for a diverse sample across all genders and caregiving roles, including those with ‘equal status,’ the study aimed to ensure a comprehensive representation of experiences. The research identifies and aims to mitigate resource inequalities affecting work-family interfaces, aligning with feminist goals of equity in the counselling profession. Additionally, it extends beyond simple correlations to critically examine broader social and institutional power relations, thereby fostering a more just and equitable professional environment for all counsellors (Aker, 1990; Collins & Bilge, 2016; Godwin et al., 2021). 

Chapter Four Results 

4.1 Descriptive Statistics 

Descriptive statistics for the RCAS and the WFCS are presented for parents (Group 1) and non-parents (Group 2) in Table 2. Parents reported lower average scores on the RCAS (M = 3.22, SD = 1.02) compared to non-parents (M = 3.86, SD = 0.95), indicating less perceived RCA. The average scores on the WFCS were slightly higher for non-parents (M = 3.54, SD = 1.18) than for parents (M = 3.37, SD = 1.33), suggesting a marginally higher level of WFC among non-parents. However, on closer inspection of the FIW Subscale  for parents it indicates they experience greater difficulty in managing work demands with family responsibilities compared to non-parents. This suggests that while non-parents may report higher overall levels of RCA, parents potentially face more acute conflicts specifically related to family interference with work.  Both scales showed considerable variability in scores. These variances indicate diverse experiences within the groups regarding RC, RA, and WFC, highlighting the importance of exploring how other covariates may influence these perceptions (Andrade, 2024). 

Table 2. 

Descriptive statistics and parental differences for measures. 

  Mean (SD)     
  Overall N=56 Parents N=41 Non-Parents N=15 
RCAS Total 3.39 (1.04) 3.22 (1.02) 3.86 (0.95) 
WFC Total 3.41 (1.29) 3.37 (1.33) 3.54 (1.18) 
RC Subscale 2.48 (1.03) 2.34 (0.91) 2.84 (1.27) 
RA Subscale 4.30 (1.45) 4.09 (1.43) 4.86 (1.37) 
WIF Subscale 3.56 (1.48) 3.39 (1.55) 4.01 (1.21) 
FIW Subscale 3.26 (1.46) 3.34 (1.52) 3.07 (1.31) 

4.2 Distribution of the Data  

A Shapiro-Wilk test was conducted to assess the normality of the data (Hanusz et al., 2016; Mishra et al., 2019). The subscale mean scores showed significant deviations from normality: RC (W = 0.82, p = 0.001), RA (W = 0.89, p = 0.002), WIF (W = 0.86, p = 0.001), and FIW (W = 0.88, p = 0.002). However, total scores for RCAS and WFCS were normally distributed. Consequently, correlations were assessed for normality pairwise. Pearson’s correlation was used where normality was confirmed (e.g., WFCS Total and RA Subscale), while Spearman’s rho was applied for the RC Subscale and other non-normal distributions. 

4.3 Correlation 

Correlation analysis, as presented in Table 3, identified significant positive relationships between the RCAS Total and both WFCS Total (r = 0.397, p < .05) and WIF Subscale (r = 0.416, p < .01) among parents, as well as a moderate but non-significant correlation with the FIW Subscale (r = 0.276, p > .05). The WFCS Total also shows a significant positive association with the RA Subscale (r = 0.403, p < .001) and a moderate positive correlation with the RC Subscale (ρ = 0.331, p < .05). Notably, the RA Subscale also shows a significant positive correlation with the WIF Subscale (r = 0.445, p < .01). This supports the hypothesis that higher levels of RCA are associated with increased WFC among individuals with parental responsibilities. 

Among non-parents, the RCAS Total demonstrates a strong positive relationship with the WFCS Total scale (r = 0.533, p < .05), which is statistically significant. Additionally, the RCAS Total shows a significant positive correlation with the WIF Subscale (r = 0.536, p < .05). In contrast, the correlations between RCAS Total and the RA Subscale (r = 0.453, p > .05) and the FIW Subscale (r = 0.463, p > .05) are weaker and not statistically significant. These findings indicate that for non-parents, RCAS Total has a significant association with both the overall WFCS scale and the WIF subscale, while the associations with the RA and FIW subscales are not statistically significant. 

Fisher’s z transformation (Cox, 2008) indicated that the difference in correlation coefficients between parents and non-parents for RCAS and WFCS Total was not statistically significant (z = -0.526, p = 0.299). This suggests that while individual correlations may be significant within each group, the overall pattern of relationships remains consistent across parental statuses. For both WFCS Total – RA Subscale and WIF Subscale – RA Subscale, the Fisher’s z analyses showed no significant difference in correlation magnitudes between parents and non-parents, indicating a similar pattern of associations across groups. Additionally, the primary caregiver variable was not significantly associated with RCAS or WFCS measures (e.g., r = -0.078, p = 0.635 for RCAS). 

Table 3. 

Correlation Coefficients for RCAS and WFCS and their Subscales by Parental Status 

Parental Status  RCAS Total  Pearson’s r RA Subscale Pearson’s r  RC Subscale  Spearman’s ρ 
Parents (n=41)        
WFCS Total  0.397*  0.403***  0.331*  
WIF Subscale  0.416**  0.445**  0.317*  
FIW Subscale  0.276  0.255  0.294  
Non-Parents (n=14)        
WFCS Total  0.533*  0.453  0.378  
WIF Subscale  0.536*  0.510  0.315  
FIW Subscale   0.463  0.342  0.483  

Note: Pearson’s r was used for RCAS Total and RA Subscale correlations. Spearman’s Rho (ρ) was used for correlations involving the RC Subscale. 

*p<.05, **p<.01, ***p<.001.   

4.4. T-tests 

The Shapiro-Wilk and Levene’s tests confirm the suitability of t-tests for the data, as distributions for RCAS and WFCS are normal, and variances are equal across groups. Given the non-significant results (RCAS p=0.71, 0.61; WFCS p=0.43, 0.16 for normality and RCAS p=0.45; WFCS p=0.91 for variances), parametric testing, specifically independent samples t-tests, was appropriate for further analysis (Coolican, 2017). 

The results, as shown in Table 5, revealed a significant difference in the RCAS total scores, with non-parents (CV = 0.25) scoring higher than parents (CV = 0.32), t(54)=−2.08 p=0.04. This indicates that non-parents experience significantly greater RCA compared to parents. In contrast, no significant differences were found on the WFCS total scores, t(54)=−0.45, p=0.66, suggesting that both groups experience similar levels of WFC. Correspondingly, no significant differences were observed on the RC Subscale, t(54)=−1.64, p=0.11; the RA Subscale, t(54)=−1.78, p=0.08; the WIF Subscale, t(54)=−1.14, p=0.17; or the FIW Subscale, t(54)=0.61, p=0.54. These results suggest that while non-parents report higher RCA, other aspects of work-family balance do not differ significantly between parents and non-parents. Additionally, the coefficient of variation for the RCAS was lower among non-parents (0.25) compared to parents (0.32), indicating a more consistent response pattern in the non-parent group. Similarly, the coefficient of variation for the WFCS was also lower for non-parents (0.33) than for parents (0.40). This suggests that perceptions of RC and WFC are more homogeneous among non-parents compared to parents. 

Table 4.  

 Independent Samples T-Test Results for RCAS and WFCS by Parental Status. 

Measure t (Coefficient of variation)     
  Parent (N=41) Non-Parent (N=15) df 
RCAS Total -2.08* (0.32) -2.08* (0.25) 54 
WFCS Total -0.45 (0.40) -0.45 (0.33) 54 
RC Subscale -1.64 (0.39)  -1.64(0.45) 54 
RA Subscale -1.78 (0.35) -1.78 (0.28) 54 
WIF Subscale -1.14 (0.46) -0.14 (0.30) 54 
FIW Subscale 0.61 (0.45) 0.61 (0.43) 54 

*p<.05, **p<.01, ***p<.001 

 4.5 Linear Regressions 

Multiple linear regressions were performed after splitting the dataset based on parental status to examine potential predictors and to control for shared variance (Sun et al, 2023). The regression models included the RA Subscale, RC Subscale, WIF Subscale and FIW Subscale. Durbin-Watson tests were conducted, and all models showed no significant autocorrelation. For example, in the RA model with WFC predictors for parents, the Durbin-Watson statistic was 1.974 (p = 0.932), indicating no significant autocorrelation (Dancey & Reidy, 2020; Maxwell & David, 1995). 

Table 5. 

Zero-Order Correlations and Multiple Linear Regression Coefficients by Parental Status for subscales within RCAS and WFCS. 

 RA Subscale r(β) RC Subscale ρ (β) 
Parents  (n=41)     
WIF Subscale 0.45** (0.43) 0.32* (0.18) 
FIW Subscale 0.26 (0.03) 0.30 (0.12) 
Non-parents (n=15)     
WIF Subscale 0.51 (0.57) 0.32 (0.02) 
FIW Subscale 0.34 (-0.08) 0.48 (0.31) 

*p<.05, **p<.01, ***p<.001 

For parents (n = 41), the WIF subscale showed a significant positive correlation with the RA Subscale (r = 0.45, p < .01), and multiple regression confirmed WIF as a strong predictor of RA (β = 0.43). This aligns with earlier findings, where the total WFCS score also exhibited a significant relationship with the RA Subscale (r = 0.403, p < .001). In contrast, the relationship between WIF and the RC Subscale was moderate (ρ = 0.32, p < .05) with a lower regression coefficient (β = 0.18), indicating a less pronounced effect of WIF on role conflict. The FIW subscale showed no significant correlations with the RA Subscale (r = 0.26, p > .05) or the RC Subscale (ρ = 0.30, p > .05), with regression coefficients (β = 0.03 for RA and β = 0.12 for RC) suggesting FIW is not a significant predictor of RCA. 

Among non-parents (n = 15), the WIF subscale had a moderate positive correlation with the RA Subscale (r = 0.51), though it was not statistically significant (p = 0.052). Multiple regression still indicated WIF as a predictor of RA (β = 0.57), but the lack of significance suggests a less robust relationship. The correlation between WIF and the RC Subscale was moderate but not significant (ρ = 0.32, p > .05), with a regression coefficient close to zero (β = 0.02), indicating minimal impact. The FIW subscale showed moderate, non-significant correlations with both the RA Subscale (r = 0.34, p > .05) and the RC Subscale (ρ = 0.48, p > .05), with regression coefficients (β = -0.08 for RA and β = 0.31 for RC) suggesting limited and inconsistent effects on role-related outcomes. 

Overall, Fisher’s z analysis showed no significant differences in correlations between parents and non-parents, indicating that WIF conflict significantly predicts RA across both groups. However, the impact of FIW conflict remains less clear and more variable across groups. 

Chapter 5 Discussion  

5.1 Overall Results  

The results demonstrate a positive association between the RCAS and the WFCS, with parental status influencing these associations. 

Hypothesis 1 was supported, showing significant correlations between RCAS Total and WFCS Total for both parents (r = 0.397, p < .05) and non-parents (r = 0.533, p < .05). The WIF subscale was a strong predictor of RA, indicating that higher WIF conflict exacerbates role-related stress. 

Hypothesis 2, suggesting a stronger positive association between RCA and WFC for parent-counsellors compared to non-parents, was also supported. Parents showed stronger correlations between RA Subscale and WIF Subscale (r = 0.445, p < .01) and between WFCS Total and RA (r = 0.403, p < .001). The RC Subscale also had a moderate correlation with WIF among parents (ρ = 0.317, p < .05). However, Fisher’s z transformation revealed that differences in correlation coefficients between parents and non-parents for RCAS and WFCS Total were not statistically significant (z = -0.526, p = 0.299). This suggests that while there are notable differences in correlation strengths, the overall pattern of associations is consistent across parental statuses. The t-test results showed that while parents experienced higher FIW, this did not translate into greater role-related stress measured by RCAS, possibly due to coping mechanisms. 

5.2 Role Conflict and Ambiguity  

Counsellors working with YP experienced moderate impacts of RCA, with significant associations particularly between RCA measures and the WIF subscale, especially for parent-counsellors. Parent-counsellors exhibited stronger and more significant associations between RCA and WFC, particularly between the RA Subscale and WIF (r = 0.445, β = 0.43, p < .01). This suggests that while parent-counsellors may report lower overall levels of RCA, the role conflict and ambiguity they do experience are more strongly influenced by the challenges of balancing work and family responsibilities.    

In contrast, non-parents, despite showing higher overall RCA levels, had weaker and generally non-significant correlations between RCA and WFC measures. This indicates that while non-parents face more general RCA, these issues are less directly tied to WFC. The higher overall RCA scores for non-parents may stem from broader stressors, including work demands and lack of experience, rather than the specific pressures of managing family and professional roles simultaneously.  

5.3 Work-Family Conflict  

The study revealed distinct dynamics in WFC among counsellors. Although non-parents had slightly higher WFC Total mean scores (M = 3.86, SD = 0.95) than parents (M = 3.22, SD = 1.02), these differences were not statistically significant. Additionally, parent-counsellors exhibited significant positive associations between the WIF subscale and RA subscale (r = 0.445, β =0.43, p < .001). This suggests that work demands significantly increase RA and conflict for parents, likely due to the challenge of balancing both parenting and professional responsibilities.  

Interestingly, the t-test revealed higher FIW scores for parents, even though the correlations were higher for non-parents. This could indicate that while parents report more FIW overall, they may have developed better coping mechanisms, reducing its impact on RCA compared to non-parents. Non-parents, with fewer family responsibilities, might experience a more pronounced potential impact from FIW conflict, as suggested by the higher correlation coefficients (FIW-RCAS Total r= 0.463, FIW-RC ρ = 0.483), despite the lack of statistical significance.  

5.4 Parental Status  

Parental status significantly influenced both RCA and WFC among counsellors. Parents, predominantly female (82.5%), exhibited stronger correlations between RCA and WFC, particularly in WIF, reaffirming the “double burden” women face (Craig, 2007; Chen et al., 2017; Nilsen et al., 2017; Seedat & Rondon, 2021). The significant difference in RCAS Total scores (t = 2.08*) between parents (COV = 0.32) and non-parents (COV = 0.25) suggests that while both groups experience RCA, parents’ greater score variability may reflect diverse coping mechanisms or support systems. Within this study, non-parents were often younger counsellors with less experience and longer work hours, which may explain their higher FIW correlation coefficients, particularly in FIW-RC (ρ = 0.483) compared to parents (ρ = 0.294). 

Ambiguity arose from offering the option of equal caregiver status, which led to 24.64% reporting equal caregiving, 58.97% as the main caregiver, and 15.39% as not the main caregiver. This lack of clear differentiation may have introduced bias and skewed the data, as the study required the primary caregiver to be the parent providing the majority of care. The option for equal caregiver status allowed for varied interpretations of caregiving roles, potentially obscuring the true impact of caregiving responsibilities, particularly under the systemic pressures often faced by women (Falzarano et al., 2020). Further research is needed to explore how gender, age, and experience interact with parental status to influence WFC. A focused study on the “double burden” faced by female parent-counsellors could provide deeper insights and help develop targeted interventions for this group. 

5.5 Strengths and Limitations  

This study’s strengths lie in its focused examination of counsellors who work with YP, a growing population in the UK (BACP, 2021), and a group that has been underrepresented in WFC research. The use of validated scales, including the RCAS and WFCS, ensures robust findings. While initial results suggested that parental status impacts the relationship between WFC and RCA, with stronger associations among parent-counsellors, Fisher’s z analysis revealed that these differences were not statistically significant. This finding reinforces the robustness of the overall pattern of WFC and RCA relationships, regardless of parental status, highlighting the complex nature of managing dual responsibilities 

Several limitations should be considered within this study. The small sample size and reliance on self-reported data limited the generalisability of the findings and introduced potential bias (Brutus et al, 2015). The cross-sectional design also restricts the ability to assess causality between variables. The WFCS, designed specifically for parents, may have led to skewed responses among non-parents, potentially masking genuine distinctions in how they perceive ‘family’ and related conflicts (Haslam et al., 2014). This captures the need for measurement tools that accurately capture varied family structures.  

Additionally, societal pressures, particularly on women and mothers, to excel in multiple roles, as noted in qualitative research on mother-counsellors (Hermann et al., 2019), may lead to underreporting of conflict and denial of systemic burdens. Future research should explore these issues further, employing qualitative approaches to uncover hidden narratives and developing specific scales to capture the diverse experiences of both parent and non-parent counsellors. Expanding the sample size and diversity will also be crucial in understanding how gender roles and societal pressures shape perceptions and reporting of work-family conflict.  

5.6 Theoretical Implications  

The findings align with Role Strain Theory (Creary & Gordon, 2016; Goode, 1960), which highlights how competing demands from professional and family roles create strain and impact counsellors’ wellbeing. The stronger positive association between RCA and WFC, particularly among parent-counsellors, supports this theory, suggesting that balancing these responsibilities increases stress. Strategies such as lowering demands, enhancing resources, role sequencing, prioritisation, boosting social support, and establishing clear boundaries between work and family duties are necessary to alleviate this strain. 

The study also supports Boundary Theory (Ashforth et al., 2000), especially for parent-counsellors who face challenges maintaining boundaries between work and family life, as evidenced by the correlation between WFC and RA (r = 0.403, p < .001). This suggests that parents, who experience higher overall WFC, may navigate more RA as professional demands increasingly overlap with family responsibilities. These results emphasise the need for better boundary management and support strategies for parent-counsellors, who are particularly vulnerable to stress from blurred boundaries. Understanding this dynamic offers a practical framework for addressing the complexities of role conflict and responsibility management in this group. 

5.7 Conclusions and Recommendations  

This study concludes that RCA significantly contributes to WFC among counsellors working with YP, particularly highlighting the association between WFC Total and RA among parents (r = 0.403, p < .001). Parental status emerged as a key factor, indicating that it prospectively heightens RCA due to dual pressures of managing both professional and family responsibilities. Although primary caregiving status did not show a significant direct effect in this study, the potential for bias related to how caregiving responsibilities are perceived suggests that further research is necessary. This includes examining how gender roles, cultural expectations, and individual interpretations of ‘family’ and ‘caregiving’ might influence the dynamics of WFC. This study critically examines the social and institutional power dynamics that exacerbate WFC and RCA among counsellors, particularly parent-counsellors, highlighting the need for structural changes in workplace policies and support systems to address these inequities and promote gender equity. 

The data revealed the need for developing a scale that more accurately captures the diverse family structures and caregiving responsibilities within the counselling profession. Such a tool would enable more precise measurement of WFC and RCA, thereby helping researchers, supervisors, and practitioners better address these unique challenges and improve support systems tailored to the needs of counsellors. Additionally, considering the complex interplay between professional and personal roles, especially among parent-counsellors, future research should also explore how factors like job demands, support systems, and workplace flexibility interact with family responsibilities to influence role conflict and ambiguity. The example interventions provided in Appendix K offer practical starting points for mitigating these challenges, paving the way for counsellors to achieve greater growth and resilience in both their professional and personal lives.  

 

References 

Acker, J. (1990). Hierarchies, Jobs, Bodies: A Theory of Gendered Organisations. Gender & Society, 4(2), 139–158. 

Adams, E. L., Smith, D., Caccavale, L. J., & Bean, M. K. (2021). Parents Are Stressed! Patterns of Parent Stress Across COVID-19. Frontiers in Psychiatry, 12(626456). https://doi.org/10.3389/fpsyt.2021.626456 

Alexander, E. R., Savitz-Romer, M., Nicola, T. P., Rowan-Kenyon, H. T., & Carroll, S. (2022). “We Are the Heartbeat of the School”: How School Counselors Supported Student Mental Health During the COVID-19 Pandemic. Professional School Counseling, 26(1b), 1–10. https://doi.org/10.1177/2156759×221105557 

Allen, T. D., Herst, D. E. L., Bruck, C. S., & Sutton, M. (2000). Consequences associated with work-to-family conflict: A review and agenda for future research. Journal of Occupational Health Psychology, 5(2), 278–308. https://doi.org/10.1037/1076-8998.5.2.278 

Andrade, C. (2024). Confounding by Indication, Confounding Variables, Covariates, and Independent Variables: Knowing What These Terms Mean and When to Use Which Term. Indian Journal of Psychological Medicine, 46(1). https://doi.org/10.1177/02537176241227586 

Amaglo, E. (2022). Managing boundaries and multiple relationships in counselling and psychotherapy. Global Journal of Psychology, 2(1), 1–11. https://doi.org/10.51594/gjp.v2i1.361 

American Psychological Association. (2020). Stress in the Time of COVID-19. Volume one. In APA. APA. https://www.apa.org/news/press/releases/stress/2020/report 

Anglin, A. H., Kincaid, P. A., Short, J. C., & Allen, D. G. (2022). Role theory perspectives: Past, present, and future applications of role theories in management research. Journal of Management, 48(6), 1469–1502. https://doi.org/10.1177/01492063221081442 

Ashforth, B. E., Kreiner, G. E., & Fugate, M. (2000). All in a Day’S Work: Boundaries and Micro Role Transitions. Academy of Management Review, 25(3), 472–491. https://doi.org/10.5465/amr.2000.3363315 

Atkinson, W. (2023). Field theory, role theory and role conflict: Reappropriating insights from the past. Journal of Classical Sociology. https://doi.org/10.1177/1468795×231208456 

BACP. (2021, July 13). “Thousands of counsellors are ready to work with children and young people.” Www.bacp.co.uk. https://www.bacp.co.uk/news/news-from-bacp/2021/13-july-thousands-of-counsellors-ready-to-work-with-children-and-young-people/ 

Barber, C. E., & Iwai, M. (1996). Role Conflict and Role Ambiguity as Predictors of Burnout Among Staff Caring for Elderly Dementia Patients. Journal of Gerontological Social Work, 26(1-2), 101–116. https://doi.org/10.1300/j083v26n01_07 

Benning, T. (2015). Limitations of the biopsychosocial model in psychiatry. Advances in Medical Education and Practice, 6(6), 347. https://doi.org/10.2147/amep.s82937 

Bevans, R. (2020, January 31). An introduction to t tests | Definitions, formula and examples. Scribbr. https://www.scribbr.com/statistics/t-test/ 

Bondi, L. (2006). Is counselling a feminist practice? GeoJournal, 65(4), 339–348. https://doi.org/10.1007/s10708-006-0022-0 

Bowling, N. A., Khazon, S., Alarcon, G. M., Blackmore, C. E., Bragg, C. B., Hoepf, M. R., Barelka, A., Kennedy, K., Wang, Q., & Li, H. (2017). Building better measures of role ambiguity and role conflict: The validation of new role stressor scales. Work & Stress, 31(1), 1–23. https://doi.org/10.1080/02678373.2017.1292563 

Brown, S. (2017). Is counselling women’s work? In BACP. BACP. https://www.bacp.co.uk/bacp-journals/therapy-today/2017/march-2017/is-counselling-womens-work/ 

Brutus, S., Aguinis, H., & Wassmer, U. (2012). Self-Reported Limitations and Future Directions in Scholarly Reports. Journal of Management, 39(1), 48–75. https://doi.org/10.1177/0149206312455245&nbsp;

Bryant, R. M., & Constantine, M. G. (2006). Multiple Role Balance, Job Satisfaction, and Life Satisfaction in Women School Counselors. Professional School Counseling, 9(4), 2156759X0500900. https://doi.org/10.1177/2156759×0500900403 

Byron, K. (2005). A meta-analytic review of work–family conflict and its antecedents. Journal of Vocational Behavior, 67(2), 169–198. https://doi.org/10.1016/j.jvb.2004.08.009 

Chen, F., Bao, L., Lin, Z., Zimmer, Z., Gultiano, S., & Borja, J. B. (2017). Double burden for women in mid- and later life: evidence from time-use profiles in Cebu, the Philippines. Ageing and Society, 38(11), 2325–2355. https://doi.org/10.1017/s0144686x17000599 

Cinamon, R. G. (2010). Anticipated work-family conflict: effects of role salience and self-efficacy. British Journal of Guidance & Counselling, 38(1), 83–99. https://doi.org/10.1080/03069880903408620 

Clark, S. C. (2000). Work/Family Border Theory: a New Theory of Work/Family Balance. Human Relations, 53(6), 747–770. https://doi.org/10.1177/0018726700536001 

Cohen, L., Manion, L., & Morrison, K. (2017). Research methods in education (8th ed.). Routledge. 

Coolican, H. (2017). Research Methods and Statistics in Psychology, Seventh Edition. Routledge. https://read.kortext.com/reader/epub/360297 

Collins, P. H., & Bilge, S. (2016). Intersectionality. Polity Press. https://books.google.co.uk/books/about/Intersectionality.html?id=wWUnDQAAQBAJ&redir_esc=y 

Cooksey, R.W. (2020). Descriptive Statistics for Summarising Data. Illustrating Statistical Procedures: Finding Meaning in Quantitative Data, [online] pp.61–139. doi: https://doi.org/10.1007/978-981-15-2537-7_5

Cotter, D., Hermsen, J. M., & Vanneman, R. (2011). The End of the Gender Revolution? Gender Role Attitudes from 1977 to 2008. American Journal of Sociology, 117(1), 259–289. https://doi.org/10.1086/658853 

Council for Accreditation of Counseling and Related Educational Programs. (CACREP). (2017). Annual Report 2016. In CACREP. CACREP. http://www.cacrep.org/wp-content/uploads/2019/05/CACREP-2016-Annual-Report.pdf 

Cox, N. J. (2008). Speaking Stata: Correlation with Confidence, or Fisher’s z revisited. The Stata Journal: Promoting Communications on Statistics and Stata, 8(3), 413–439. https://doi.org/10.1177/1536867×0800800307&nbsp;

Craig, L. (2007). Is There Really a Second Shift, and If so, Who Does It? A Time-Diary Investigation. Feminist Review, 86, 149–170. https://www.jstor.org/stable/30140855 

Creary, S. J., & Gordon, J. R. (2016). Role Conflict, Role Overload, and Role Strain. Encyclopedia of Family Studies, 1–6. https://doi.org/10.1002/9781119085621.wbefs012 

Crockett, S., Elghoroury, D., Popiolek, M., & Wummel, B. (2018). The Lived Experiences of Men in a Master’s Counseling Program. Counselor Education and Supervision, 57(2), 98–115. https://doi.org/10.1002/ceas.12096 

Cromby, J., Harper, D., & Reavey, P. (2013). Psychology, mental health and distress. Basingstoke [U.K.] ; New York Palgrave Macmillan. 

Dancey, C., & Reidy, J. (2020). Statistics Without Math’s For Psychology. Pearson Education Limited. 

De Souza, D. R. (2024). Children’s mental health services 2022-23. In Children’s Commissioner. Children’s Commissioner. https://www.childrenscommissioner.gov.uk/resource/childrens-mental-health-services-2022-23/ 

Deacon, B. J. (2013). The Biomedical Model of Mental disorder: a Critical Analysis of Its validity, utility, and Effects on Psychotherapy Research. Clinical Psychology Review, 33(7), 846–861. https://doi.org/10.1016/j.cpr.2012.09.007 

Dienlin, T., & Johannes, N. (2020). The impact of digital technology use on adolescent well-being. Dialogues in Clinical Neuroscience, 22(2), 135–142. https://doi.org/10.31887/dcns.2020.22.2/tdienlin 

Edú-Valsania, S., Laguía, A., & Moriano, J. A. (2022). Burnout: A Review of Theory and Measurement. International Journal of Environmental Research and Public Health, 19(3). https://doi.org/10.3390/ijerph19031780 

Falzarano, F., Moxley, J., Pillemer, K., & Czaja, S. (2021). Cross-Cultural Differences in Caregiving: Investigating the Role of Familism and Social Support. Innovation in Aging, 5(Supplement_1), 322–322. https://doi.org/10.1093/geroni/igab046.1249 

Faul, F., Erdfelder, E., Buchner, A., & Lang, A.-G. (2009). Statistical Power Analyses Using G*Power 3.1: Tests for Correlation and Regression Analyses. Behavior Research Methods, 41(4), 1149–1160. https://doi.org/10.3758/brm.41.4.1149 

French, K. A., Allen, T. D., & Kidwell, K. E. (2022). When does work-family conflict occur? Journal of Vocational Behavior, 136, 103727. https://doi.org/10.1016/j.jvb.2022.103727 

Frone, M. R., Russell, M., & Cooper, M. L. (1997). Relation of work-family conflict to health outcomes: A four-year longitudinal study of employed parents. Journal of Occupational and Organizational Psychology, 70(4), 325–335. https://doi.org/10.1111/j.2044-8325.1997.tb00652.x 

Funer, F. (2023). Admitting the heterogeneity of social inequalities: intersectionality as a (self-)critical framework and tool within mental health care. Philosophy, Ethics, and Humanities in Medicine, 18(1). https://doi.org/10.1186/s13010-023-00144-6 

Glasheen, K., Campbell, M. A., & Shochet, I. (2013). Opportunities and Challenges: School Guidance Counsellors’ Perceptions of Counselling Students Online. Australian Journal of Guidance and Counselling, 23(2), 222–235. https://doi.org/10.1017/jgc.2013.15 

Gliner, J. A., Morgan, G. A., & Leech, N. L. (2017). Research Methods in Applied Settings: an Integrated Approach to Design and Analysis, Third Edition. Taylor and Francis. 

Godwin, A., Benedict, B., Rohde, J., Thielmeyer, A., Perkins, H., Major, J., Clements, H., & Chen, Z. (2021). New Epistemological Perspectives on Quantitative Methods: An Example Using Topological Data Analysis. Studies in Engineering Education, 2(1), 16. https://doi.org/10.21061/see.18 

Goode, W. J. (1960). A Theory of Role Strain. American Sociological Review, 25(4), 483–496. 

Gragnano, A., Simbula, S., & Miglioretti, M. (2020). Work–Life Balance: Weighing the Importance of Work–Family and Work–Health Balance. International Journal of Environmental Research and Public Health, 17(3). NCBI. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7037206/ 

Greenhaus, J. H., & Beutell, N. J. (1985). Sources of Conflict between Work and Family Roles. The Academy of Management Review, 10(1), 76–88. https://doi.org/10.2307/258214 

Hanusz, Z., Tarasinska, J., & Zielinski, W. (2016). Shapiro–Wilk Test with Known Mean. REVSTAT-Statistical Journal, 14(1), 89–10089–100. https://doi.org/10.57805/revstat.v14i1.180 

Haslam, D., Filus, A., Morawska, A., Sanders, M. R., & Fletcher, R. (2014). The Work–Family Conflict Scale (WAFCS): Development and Initial Validation of a Self-report Measure of Work–Family Conflict for Use with Parents. Child Psychiatry & Human Development, 46(3), 346–357. https://doi.org/10.1007/s10578-014-0476-0 

Hawken, T., Turner-Cobb, J., & Barnett, J. (2018). Coping and adjustment in caregivers: A systematic review. Health Psychology Open, 5(2), 205510291881065. https://doi.org/10.1177/2055102918810659 

Hermann, M. A. (2018). Experiences of School Counselor Mothers: A Phenomenological Investigation – Mary A. Hermann, Robyn L. Walsh, Jennifer W. Underwood, 2018. Professional School Counseling, 22(1). https://doi.org/10.1177/2156759X19844491 

Hermansson, G. (1997). Boundaries and boundary management in counselling: the never-ending story. British Journal of Guidance & Counselling, 25(2), 133–146. https://doi.org/10.1080/03069889700760131 

Hervey, T., & Shaw, J. (1998). Women, Work and Care: Women’s Dual Role and Double Burden in Ec Sex Equality Law. Journal of European Social Policy, 8(1), 43–63. https://doi.org/10.1177/095892879800800103 

Hespanhol, L., Vallio, C. S., Costa, L. M., & Saragiotto, B. T. (2019). Understanding and interpreting confidence and credible intervals around effect estimates. Brazilian Journal of Physical Therapy, 23(4), 290–301. https://doi.org/10.1016/j.bjpt.2018.12.006&nbsp;

Hilts, D., & Luke, M. (2024). Legal and Ethical Issues in Counselling Children and Adolescents. https://us.sagepub.com/sites/default/files/upm-assets/129751_book_item_129751.pdf 

Hogan, A. J. (2019). Social and medical models of disability and mental health: evolution and renewal. Canadian Medical Association Journal, 191(1), 16–18. https://doi.org/10.1503/cmaj.181008 

Howitt, D., & Cramer, D. (2020). Research methods in psychology (6th ed.). Pearson. 

Hwang, H.-J., & Kang, E. (2023). The Importance of Anonymity and Confidentiality for Conducting Survey Research. https://doi.org/10.15722/jrpe.4.1.202303.1 

Jackson, P. T., & Dolan, L. (2021). Positivism, Post-positivism, and Social Science. Research Methods in the Social Sciences: An A-Z of Key Concepts, 214–218. https://doi.org/10.1093/hepl/9780198850298.003.0050 

Jackson, S. E., & Schuler, R. S. (1985). A meta-analysis and conceptual critique of research on role ambiguity and role conflict in work settings. Organizational Behavior and Human Decision Processes, 36(1), 16–78. https://doi.org/10.1016/0749-5978(85)90020-2 

Jaggar, A. M. (2015). Just Methods. In Routledge eBooks. Informa. https://doi.org/10.4324/9781315636344 

JASP Team. (2023). JASP (Version 0.17.1) [Computer software]. https://jasp-stats.org/ 

Jeung, D.-Y., Kim, C., & Chang, S.-J. (2018). Emotional Labor and Burnout: A Review of the Literature. Yonsei Medical Journal, 59(2), 187. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5823819/ 

Jones, S. H., St. Peter, C. C., & Ruckle, M. M. (2020). Reporting of demographic variables in the Journal of Applied Behavior Analysis. Journal of Applied Behavior Analysis, 53(3), 1304–1315. https://doi.org/10.1002/jaba.722 

Kahn, R. L., Levinson, H., Wolfe, D. M., Quinn, R. P., Snoek, J. D., & Rosenthal, R. A. (1964). Organizational Stress: Studies in Role Conflict and Ambiguity. Administrative Science Quarterly, 10(1), 125. https://doi.org/10.2307/2391654 

Kahraman, C., Orobello, C., & Cirella, G. T. (2021). Changing Dynamics with COVID-19: Future Outlook. Human Settlements, 235–252. https://doi.org/10.1007/978-981-16-4031-5_13 

Kauhanen, L., Wan Mohd Yunus, W. M. A., Lempinen, L., Peltonen, K., Gyllenberg, D., Mishina, K., Gilbert, S., Bastola, K., Brown, J. S. L., & Sourander, A. (2022). A systematic review of the mental health changes of children and young people before and during the COVID-19 pandemic. European Child & Adolescent Psychiatry, 32. https://doi.org/10.1007/s00787-022-02060-0 

Kimber, M., & Campbell, M. (2013). Exploring ethical dilemmas for principals arising from role conflict with school counsellors. Educational Management Administration & Leadership, 42(2), 207–225. https://doi.org/10.1177/1741143213499259 

Lorenz-Dant, K., & Mittelman, M. (2021). Sex and gender differences in caregiving patterns and caregivers’ needs. Elsevier EBooks, 393–419. https://doi.org/10.1016/b978-0-12-819344-0.00015-6 

Maden-Eyiusta, C. (2019). Role conflict, role ambiguity, and proactive behaviors: does flexible role orientation moderate the mediating impact of engagement? The International Journal of Human Resource Management, 32(13), 1–27. https://doi.org/10.1080/09585192.2019.1616590 

Marks, S. R., Huston, T. L., Johnson, E. M., & MacDermid, S. M. (2001). Role Balance Among White Married Couples. Journal of Marriage and Family, 63(4), 1083–1098. https://doi.org/10.1111/j.1741-3737.2001.01083.x 

Marks, S. R., & MacDermid, S. M. (1996). Multiple Roles and the Self: A Theory of Role Balance. Journal of Marriage and the Family, 58(2), 417. https://doi.org/10.2307/353506 

Matthews, R. A., Barnes-Farrell, J. L., & Bulger, C. A. (2010). Advancing measurement of work and family domain boundary characteristics. Journal of Vocational Behavior, 77(3), 447–460. https://doi.org/10.1016/j.jvb.2010.05.008 

Matthews, R. A., Winkel, D. E., & Wayne, J. H. (2013). A longitudinal examination of role overload and work-family conflict: The mediating role of interdomain transitions. Journal of Organizational Behavior, 35(1), 72–91. https://doi.org/10.1002/job.1855 

Maxwell, L. K., & David, C. H. (1995). The application of the Durbin-Watson test to the dynamic regression model under normal and non-normal errors. Econometric Reviews, 14(4), 487–510. https://doi.org/10.1080/07474939508800333 

Md Nor, S. B., Idris, Mohd. A., & Ahmad Tarmizi, S. A. (2023). Counsellors’ Emotions at Work: What Can We Learn from Their Experiences? Pertanika Journal of Social Sciences and Humanities, 31(1), 139–159. https://doi.org/10.47836/pjssh.31.1.08 

Mezzano, J. (1968). Self-Insight of Graduate Students in Guidance. Counselor Education and Supervision, 7(S3), 397–398. https://doi.org/10.1002/j.1556-6978.1968.tb00835.x 

Michel, J. S., Kotrba, L. M., Mitchelson, J. K., Clark, M. A., & Baltes, B. B. (2011). Antecedents of work-family conflict: A meta-analytic review. Journal of Organizational Behavior, 32(5), 689–725. https://doi.org/10.1002/job.695 

Mills, S., & Mullany, L. (2011). Language, Gender and Feminism. Routledge. 

Mishra, P., Pandey, C. M., Singh, U., Sahu, C., Keshri, A., & Gupta, A. (2019). Descriptive Statistics and Normality Tests for Statistical Data. Annals of Cardiac Anaesthesia, 22(1), 67–72. 

Muthukrishna, M., Bell, A. V., Henrich, J., Curtin, C. M., Gedranovich, A., McInerney, J., & Thue, B. (2020). Beyond Western, Educated, Industrial, Rich, and Democratic (WEIRD) Psychology: Measuring and Mapping Scales of Cultural and Psychological Distance. Psychological Science, 31(6), 095679762091678. https://doi.org/10.1177/0956797620916782 

Negida, A., & Elfil, M. (2017). Sampling methods in Clinical Research; an Educational Review. National Library of Medicine, 5(1). Shahid Beheshti University of Medical Sciences. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5325924/ 

Nilsen, W., Skipstein, A., Østby, K. A., & Mykletun, A. (2017). Examination of the double burden hypothesis—a systematic review of work–family conflict and sickness absence. European Journal of Public Health, 27(3), 465–471. https://doi.org/10.1093/eurpub/ckx054 

Ning, M., Chen, B., Chen, S., & Hou, X. (2023). A tale of two cities: Chinese mothers’ parental burnout and parenting behaviors in Shanghai and Nanning. Archives of Women’s Mental Health, 26(4), 503–511. https://doi.org/10.1007/s00737-023-01336-x 

Noonan, E. (2002). Counselling Young People. Routledge. 

Nurmi, S.-M., Kangasniemi, M., Halkoaho, A., & Pietilä, A.-M. (2018). Privacy of Clinical Research Subjects: An Integrative Literature Review. Journal of Empirical Research on Human Research Ethics, 14(1), 33–48. https://doi.org/10.1177/1556264618805643  

Panhwar, A. H., Ansari, S., & Shah, A. A. (2017). Post-positivism: An effective paradigm for social and educational research. International Research Journal of Arts and Humanities, 45(45), 253–259. https://www.researchgate.net/profile/Dr-Abdul-Hameed-Panhwar/publication/317605754_Post-positivism_An_Effective_Paradigm_for_Social_and_Educational_Research/links/594adb2daca2723195de8523/Post-positivism-An-Effective-Paradigm-for-Social-and-Educational-Research.pdf 

Pattison, S., & Harris, B. (2006). Counselling children and young people: A review of the evidence for its effectiveness. Counselling and Psychotherapy Research, 6(4), 233–237. https://doi.org/10.1080/14733140601022659 

Pereira, M., & Rekha, S. (2017). Problems, Difficulties and Challenges Faced by Counsellors. International Journal of Indian Psychology, 4(3). https://doi.org/10.25215/0403.127 

Pessin, L. (2017). Changing Gender Norms and Marriage Dynamics in the United States. Journal of Marriage and Family, 80(1), 25–41. https://doi.org/10.1111/jomf.12444 

Peter, L.-J., Schindler, S., Sander, C., Schmidt, S., Muehlan, H., McLaren, T., Tomczyk, S., Speerforck, S., & Schomerus, G. (2021). Continuum beliefs and mental illness stigma: a systematic review and meta-analysis of correlation and intervention studies. Psychological Medicine, 51(5), 716–726. https://doi.org/10.1017/s0033291721000854 

Peterson, M. F., Smith, P. B., Akande, A., Ayestaran, S., Bochner, S., Callan, V., Jesuino, J. C., D’Amorim, M., Francois, P.-H. ., Hofmann, K., Koopman, P. L., Mortazavi, S., Munene J., Radford, M., Ropo, A., Savage, G., & Setiadi, B. (1995). Role Conflict, Ambiguity, and overload: A 21-Nation Study. Academy of Management Journal, 38(2), 429–452. https://doi.org/10.2307/256687 

Phillips, R., Durkin, M., Engward, H., Cable, G., & Iancu, M. (2022). The Impact of Caring for Family Members with Mental Illnesses on the caregiver: a Scoping Review. Health Promotion International, 38(3). https://doi.org/10.1093/heapro/daac049 

Pincus, R., Hannor-Walker, T., Wright, L., & Justice, J. (2020). COVID-19’s effect on students: How school counselors rise to the rescue. NASSP Bulletin, 104(4), 241–256. https://doi.org/10.1177/0192636520975866 

Polzer, J. T. (2023). The rise of people analytics and the future of organizational research. Research in Organizational Behavior, 42, 100181. 

Premeaux, S. F., Adkins, C. L., & Mossholder, K. W. (2007). Balancing work and family: a field study of multi-dimensional, multi-role work-family conflict. Journal of Organizational Behavior, 28(6), 705–727. https://doi.org/10.1002/job.439 

Radfar, A., Ferreira, M. M., Sosa, J. P., & Filip, I. (2021). Emergent Crisis of COVID-19 Pandemic: Mental Health Challenges and Opportunities. Frontiers in Psychiatry, 12. https://doi.org/10.3389/fpsyt.2021.631008 

Rajgariah, R., Malenahalli Chandrashekarappa, S., Venkatesh Babu, D. K., Gopi, A., Murthy Mysore Ramaiha, N., & Kumar, J. (2020). Parenting stress and coping strategies adopted among working and non-working mothers and its association with socio-demographic variables: A cross-sectional study. Clinical Epidemiology and Global Health, 9. https://doi.org/10.1016/j.cegh.2020.08.013 

Ramazanoglu, C., & Holland, J. (2002). Feminist methodology: challenges and choices. Sage. 

Rees, E. A., Necşoi Beeber, S., Sampson, R. N., & Pickett Lietz, J. (2023). Empowering Single Parents: Navigating Socio-Economic Challenges and Fostering Resilience in Family Well-being. Law and Economics, 17(2), 131–150. https://doi.org/10.35335/laweco.v17i2.5 

Rizzo, J. R., House, R. J., & Lirtzman, S. I. (1970). Role Conflict and Ambiguity in Complex Organizations. Administrative Science Quarterly, 15(2), 150–163. JSTOR. https://doi.org/10.2307/2391486 

Rutter, L. A., Howard, J., Lakhan, P., Valdez, D., Bollen, J., & Lorenzo-Luaces, L. (2023). “I Haven’t Been Diagnosed, but I Should Be”—Insight into Self-diagnoses of Common Mental Health Disorders: Cross-sectional Study. JMIR Formative Research, 7, e39206. https://doi.org/10.2196/39206 

Sarker, M., & AL-Muaalemi, M. A. (2022). Sampling Techniques for Quantitative Research. Principles of Social Research Methodology, 221–234. 

Savitz-Romer, M., Rowan-Kenyon, H. T., Nicola, T. P., Alexander, E., & Carroll, S. (2021). When the Kids Are Not Alright: School Counseling in the Time of COVID-19. AERA Open, 7, 233285842110336. https://doi.org/10.1177/23328584211033600 

Seedat, S., & Rondon, M. (2021). Women’s wellbeing and the burden of unpaid work. BMJ, 374(374). https://www.bmj.com/content/374/bmj.n1972 

Setia, M. S. (2016). Methodology Series Module 3: Cross-sectional Studies. Indian Journal of Dermatology, 61(3), 261–264. NCBI. https://doi.org/10.4103/0019-5154.182410 

Sharma, N., Chakrabarti, S., & Grover, S. (2016). Gender differences in caregiving among family – caregivers of people with mental illnesses. World Journal of Psychiatry, 6(1), 7. https://doi.org/10.5498/wjp.v6.i1.7 

Sümer, S., & Eslen‐Ziya, H. (2022). Academic women’s voices on gendered divisions of work and care: “Working till I drop . . . then dropping.” European Journal of Women’s Studies, 30(1), 49–65. https://doi.org/10.1177/13505068221136494 

Sun, Y., Wang, X., Zhang, C. and Zuo, M. (2023). Multiple Regression: Methodology and Applications. Highlights in Science, Engineering and Technology, 49, pp.542–548. doi: https://doi.org/10.54097/hset.v49i.8611 

Sweeney, A., Filson, B., Kennedy, A., Collinson, L., & Gillard, S. (2018). A paradigm shift: relationships in trauma-informed mental health services. BJPsych Advances, 24(5), 319–333. https://doi.org/10.1192/bja.2018.29 

Swinkels, J., van Tilburg, T., Verbakel, E., & Broese van Groenou, M. (2017). Explaining the Gender Gap in the Caregiving Burden of Partner Caregivers. The Journals of Gerontology, 74(2), 309–317. https://doi.org/10.1093/geronb/gbx036 

Tatman, A. W., Hovestadt, A. J., Yelsma, P., Fenell, D. L., & Canfield, B. S. (2006). Work and Family Conflict: An often overlooked issue in Couple and Family Therapy. Contemporary Family Therapy, 28(1), 39–51. https://doi.org/10.1007/s10591-006-9693-4 

The British Psychological Society. (2021). Code of ethics and conduct – the British psychological society. Www.bps.org.uk; The British Psychological Society. https://www.bps.org.uk/guideline/code-ethics-and-conduct 

Tubre, T. C., & Collins, J. M. (2000). Jackson and Schuler (1985) Revisited: A Meta-Analysis of the Relationships Between Role Ambiguity, Role Conflict, and Job Performance. Journal of Management, 26(1), 155–169. https://doi.org/10.1177/014920630002600104 

Van Hoy, A., & Rzeszutek, M. (2022). Burnout and Psychological Wellbeing Among Psychotherapists: A Systematic Review. Frontiers in Psychology, 13(1). https://doi.org/10.3389/fpsyg.2022.928191 

Van Sell, M., Brief, A. P., & Schuler, R. S. (1981). Role Conflict and Role Ambiguity: Integration of the Literature and Directions for Future Research. Human Relations, 34(1), 43–71. https://doi.org/10.1177/001872678103400104 

Verdonk, P., Muntinga, M., Leyerzapf, H., & Abma, T. (2019). From Gender Sensitivity to an Intersectionality and Participatory Approach in Health Research and Public Policy in the Netherlands. The Palgrave Handbook of Intersectionality in Public Policy, 413–432. https://doi.org/10.1007/978-3-319-98473-5_18 

Verma, G., Bhardwaj, A., Aledavood, T., De Choudhury, M., & Kumar, S. (2022). Examining the impact of sharing COVID-19 misinformation online on mental health. Scientific Reports, 12(1), 8045. https://doi.org/10.1038/s41598-022-11488-y 

Wang, X., & Cheng, Z. (2020). Cross-sectional studies: Strengths, weaknesses, and Recommendations. Chest, 158(1), 65–71. NCBI. https://doi.org/10.1016/j.chest.2020.03.012 

Westergaard, J. (2013). Counselling young people: Counsellors’ perspectives on “what works” – An exploratory study. Counselling and Psychotherapy Research, 13(2), 98–105. https://doi.org/10.1080/14733145.2012.730541 

World Health Organization. (2022, March 2). Mental Health and COVID-19: Early evidence of the pandemic’s impact: Scientific brief, 2 March 2022. World Health Organization. https://www.who.int/publications/i/item/WHO-2019-nCoV-Sci_Brief-Mental_health-2022.1 

Glossary 

Counsellor: Any mental health professional qualified to therapeutical work to provide counselling, psychotherapy and mental health interventions. 

RCAS: Role Conflict and Ambiguity Scale 

RCA: Role Conflict and Ambiguity  

RC: Role Conflict (a subscale within the RCAS) 

RA: Role Ambiguity (a subscale within the RCAS) 

WFCS: Work-Family Conflict Scale 

WFC: Work-Family Conflict 

WIF: Work interfering with family conflict (a subscale within the WFCS) 

FIW: Family interfering with work conflict (a subscale within the WFCS) 

YP: Young People 

Should media should be strictly regulated for aggressive and violent content to help manage aggression in adolescents?

The debate about whether we need to heavily censor media for our adolescents, particularly violent and aggressive content, to control and reduce aggression is highly debated, contentious for policy makers and society. A debate that precedes this technological uprising and stretching back to the Greeks (Ferguson & Dyck, 2012). This essay will critically analyze the relationship between media exposure and aggression in adolescents. Alongside this, review the implications of media censorship and what the potential effects of violent media content may be on adolescents.  

Many studies have looked at the potential link between aggressive behaviour in adolescents and exposure to violent media. A positive correlation exists in some research (Anderson et al., 2010). Within Social Cognitive Theory the exposure to violent and aggressive content, particularly if repeated, may lead to desensitization, observational learning and increased acceptance of aggression (Bandura, 1973; Allen, 2017). If human learning is fundamentally social as posited here, these factors could contribute to the imitation of aggression in media, leading to potentially violent behaviour in everyday life. 

Theories such as the General Aggression Model (GAM) highlight the complex interactions between cognitive processes after media exposure and then subsequent behaviour. It proposes aggressive content can influence thoughts, emotions and behaviours (Anderson & Bushman, 2002). 

Establishing causality has not been conclusive to date. This is a challenge due to the variety of factors that may influence and shape aggressive behaviours; peer interactions, individual personality traits, family environment and socioeconomic status all play a part (Ferguson, 2013). 

We see proponents and opponents for the role of media censoring, particularly for controlling aggression in adolescents. Advocates suggest that media censorship will promote positive behaviours and values, leading to a less aggressive society. While critics outline the potential challenges such as infringing upon freedom of expression and creative liberties. This raises concerns, ethical implications, possible restriction and contamination of public information (Irum & Laila, 2015). Some research indicates that restricting media for adolescents may be ineffective, due to the multitude of platforms available to them (Ferguson, 2013). 

Current alternative strategies to manage aggression look at the importance of education, critical thinking interventions, role modelling, pro-social behaviours and parental involvement. An open and active involvement and communication with young people will be a crucial role in helping them to contextualise and understand media messages, whilst empowering them to make healthy and responsible choices (Huesmann, 2007; Huang et al., 2023; Gitter et al., 2013). 

In conclusion the relationship between violent media context and aggression in adolescents is a contentious and complex issue. Some studies have positively correlated media exposure and behaviour. However, media censorship is a very controversial approach which raises ethical concerns. To address the issues of adolescent aggression this mini essay finds that a multifaceted approach is required to mitigate the negative effects of violence in modern media. Combining media literacy programs, parental involvement, positive role models, and a supportive social environment may help adolescents develop resilience and critical thinking skills. 

References

Allan, J. (2017). Aggression: a social learning analysis. Taylor And Francis. 

Anderson, C. A., & Bushman, B. J. (2002). Human Aggression. Annual Review of Psychology, 53(1), 27–51. https://doi.org/10.1146/annurev.psych.53.100901.135231 

Anderson, C. A., Shibuya, A., Ihori, N., Swing, E. L., Bushman, B. J., Sakamoto, A., Rothstein, H. R., & Saleem, M. (2010). Violent video games effects on aggression, empathy, and prosocial behavior in eastern and western countries: a meta-analytic review. Psychological Bulletin, 136(2), 151–173. https://doi.org/10.1037/a0018251 

Bandura, A. (1973). Aggression: a social learning analysis. Englewood Cliffs, N.J., Prentice-Hall. 

Ferguson, C. J. (2013). Violent video games and the Supreme Court: Lessons for the scientific community in the wake of Brown v. Entertainment Merchants Association. American Psychologist, 68(2), 57–74. https://doi.org/10.1037/a0030597 

Ferguson, C. J., & Dyck, D. (2012). Paradigm change in aggression research: The time has come to retire the General Aggression Model. Aggression and Violent Behavior, 17(3), 220–228. https://doi.org/10.1016/j.avb.2012.02.007 

Gitter, S. A., Ewell, P. J., Guadagno, R. E., Stillman, T. F., & Baumeister, R. F. (2013). Virtually justifiable homicide: The effects of prosocial contexts on the link between violent video games, aggression, and prosocial and hostile cognition. Aggressive Behavior, 39(5), 346–354. https://doi.org/10.1002/ab.21487 

Huang, S., Lai, X., Li, Y., Wang, W., Zhao, X., Dai, X., Wang, H., & Wang, Y. (2023). Does parental media mediation make a difference for adolescents? Evidence from an empirical cohort study of parent-adolescent dyads. Heliyon, 9(4), e14897–e14897. https://doi.org/10.1016/j.heliyon.2023.e14897 

Huesmann, L. R. (2007). The Impact of Electronic Media Violence: Scientific Theory and Research. Journal of Adolescent Health, 41(6), S6–S13. https://doi.org/10.1016/j.jadohealth.2007.09.005 

Irum, S. A., & Laila, A. S. (2015). Media censorship: Freedom versus responsibility. Journal of Law and Conflict Resolution, 7(4), 21–24. https://doi.org/10.5897/jlcr2015.0207 

Understanding Human Belonging Across the Lifespan

Belonging. To be accepted. A subjective experience, one that hinges on the individual’s connection with groups and their wider community, the people, family and friends that surround them. According to Baumeister and Leary (1995) the need to belong is fundamental, a need that is so desirable and innate that it drives much of human behaviour and as suggested may even be more of a priority than Maslow’s hierarchy of needs originally suggests (Pichere & Cadiat, 2015). More fluid than the attachment theories and an appropriate and relevant subject as we begin to attempt a return to homeostasis after the years of pandemic that have swept the world and kept our sense of belonging adrift. 

The need to belong is universal and can be witnessed across all cultures and times. Friendships are one aspect of the human experience in which we can experience belonging. If friendships are positive, they can provide a sense of acceptance, emotional support, narrative and companionship through the ups and downs of life. The need to belong is met through social interactions; sharing common ideas, values and interests. All of which have been strained through the recent pandemic. 

Many great thinkers have deliberated over the construct of belonging. We have seen the progression from Maslow’s hierarchy and its primary individualistic division of our basic needs, with belonging being an important midway point. Through attachment theory routes, with the Minnesota Longitudinal studies in the 1970s, and other researchers, thereafter, showing us clear patterns of how our upbringing can impact our adult and ongoing relationship structures (Duschinshy, 2020; Mikulincer & Shaver, 2007; 2018). Which as a theory of development within our intimate relationships has parallels with the fundamental and strong effect of belonging, particularly on our emotional and cognitive processes.   

An understanding of our sense of belonging, specifically within interpersonal relationships in a post pandemic world will be useful to support societies that feel disconnected as a result of the extreme social isolations. At a time when innovation is high, and technology is booming an exploration of how connected we are to each other will be critical. 

Social dynamics, group bonds and relationships are central to a sense of belonging and within the belongingness hypothesis it suggests that, specifically for interpersonal relationships, that people spend much of their cognitive processes and energy thinking about these connections. 

We can also see the negative impact of not belonging, of feelings of isolation and loneliness. That this can lead to ill effects on one’s mental and physical health. As humans we feel pain when we are separated from our connections, it is felt as a threat to our most basic survival. Isolation at its core is often referred to as a social separation syndrome. 

The unprecedented social distancing strategies used in the COVID-19 pandemic to reduce and successfully contain the transmission of the virus, gave way to an increase in social isolation and loneliness that we have never seen before, having a severe impact on physical and mental health (Hwang et al, 2020). These distancing strategies affected individual and community social capital, the abilities to form connections via bonding approaches, being close to one another and taking part in culturally normal day to day activities. The polar nature of discourse throughout the pandemic also affected bridging capital, on people’s abilities to be able to connect and belong harmoniously through the sharing of data, values and ideas. Governments quickly realised that the reparation of this was going to be key to successful policy (Oronce & Tsugawa, 2021). And in the light of the human need to connect and belong we saw many resourceful and technological advances to support human connection even if we were unable to be with each other in person. 

We know that humans are social creatures, that there is a safety and natural reliance on being within groups or community, being the in-group and a recognition of our own social identity from within this (Hornsey, 2008). Being accepted and included become safety seeking behaviours when not present and if an individual is isolated or rejected there can be significant physical and psychological impact. Previous studies have demonstrated the benefits of engaging in close relationships, the associated benefits including better health and wellbeing (Chopik, 2017). Therefore, the implication is that friendship and connection with others will be important throughout the human lifeline.  

This report outlines survey research on the relevance of human belonging, specifically on friendships across the lifespan. Seeking to find data that will shed some light on the variations of connection that we see within our human need to belong and how this changes as we age, specifically post pandemic. Looking to provide further clarity on how people can increase their sense of belonging. From the results of our literature review we hypothesis: 

We presuppose that younger people may prioritise more frequent and intimate friendships whereas older people may prioritise less intense but more stable friendships (Nicolaisen & Thorsen, 2016). That there may be a depth or continuum of sense of belonging and that through the process of aging we may see those deeper connections form and expand within additional relationships. As we have seen in theories such as Social Penetration Theory (Altman & Taylor, 1973), that levels of self-disclosure impact the intimacy of friendships, and here we suggest that as age increases, this sense of disclosure may deepen in security allowing for an increase in the sense of belonging within friendships. 

If this is the case, it may demonstrate the need to support isolated, at risk and aging members of society, who are lacking in social connections, particularly post pandemic, to ensure that ongoing opportunities for friendships are considered.  

As a result of the COVID-19 pandemic this topic has received a huge amount of attention, but we are also in need of further understanding as to how the sense of belonging within friendships could be adapted to support at risk populations. There is a collective need to review how we feel about belonging after such seismic social shifts. 

To test our assumptions, we collected data via surveys from a sample of individuals using standardised, multi-item scale questions. Our reasoning for this is that it is an effective way to collect a large amount of data in a short time, given the goals of this research and the opinions that have emerged. The multi-item scales (Likert Scales) allowed for a deeper understanding of variables for the difficult and complex construct of belonging. 25 survey questions were developed by over 600 students, the most relevant of which were then applied to the survey. The scale was shown to have good reliability with a Cronbach’s Alpha score of .944, a measure of consistency and reliability specifically here looking at the construct of belongingness. 

A total of 3249 participants took part in the survey, of which 1023 were males, 2213 were females and 13 were other. These participants ranged in age from 18 to 92 years and had an average age of 40 years old (SD=13). Participants were provided with an online link to the survey, with individual reference numbers, supplied personal consent, completed the scale, were debriefed and thanked for participating.  

From here a correlation analysis was completed to examine the linear relationship between age and level of belonging. Looking at whether one of these variables predict the other, what strength and direction will these variables have and how it applies to our hypothesis. 

The survey data showed us that the mean belonging score was 3.84 (SD=.78), with a range of 1.00 to 5.00. Further to this we carried out a Pearsons Correlation, using the total belonging score of 76.83 (SD=15.58), as the minimum score was 20 and maximum 100.  The Pearsons value was r=-0.046 indicating a very weak negative correlation between age and total belonging. This weak tendency shows that there is no inclination for one variable to decrease as the other increases. The p-value was 0.996 which indicated that there is strong evidence against the null hypothesis. This p-value indicates that the correlation coefficient is not statistically significant. The probability of detecting a correlation coefficient as extreme as r=-0.046 by chance alone is high, with the result not being considered as important or meaningful. 

The evidence here points to the participants total belonging remaining consistent across the lifespan studied. That age did not have a statistical relevance on the individual’s sense of belonging. When we think about this in relation to friendships it may imply that friendships and our attachments to people also require consistency across the lifespan, not necessarily specific to any age bracket. So, rather than our hypothesis suggests that sense of belonging increases with age, we see that sense of belonging is important for people at all ages. For the purpose of this report, these findings suggest that people vulnerable to isolation at any age, particularly after the recent pandemic, need support to maintain and make new connections for ongoing friendships and support.  

Dunbar (2022) suggests the value of friendships across the lifeline, the number and quality, have a greater impact on our happiness and wellbeing than most other influences. Our literature review demonstrated that a sense of belonging is a subjective feeling that we are connected to our surroundings, communities, families and friends. That this human need can be witnessed from birth in our attachments and last a lifetime. The research we did shows that this subjective feeling stays consistent across the lifespan and that in this case to maintain a happy, healthy outlook and prospective future we need to support individuals that become isolated and are affected by loneliness, at any age or stage of life.  

Considering our initial thoughts about Social Penetration theory (Altman & Taylor, 1973) and the hypothesis that age may bring deeper levels of self-disclosure and thus sense of belonging within friendships. The results show us that levels of considerable sense of belonging are witnessed across the life span, this demonstrates that we can feel satisfaction and reciprocity from interpersonal relationships at any age. That age is not the deciding factor as to whether we will achieve a sense of belonging or how deep and responsive this may be. 

Previous research has identified that families that live in isolated and problematic social contexts are less likely to reproduce and transmit social capital (Prandini, 2014). Knowing how the pandemic has increased social isolation, seeing from our data that sense of belonging through social connection is similar for individuals across the lifespan, it makes sense that we are seeing a parallel increase in mental and physical health distress and issues within our populations (Gadermann et al, 2021; Galea et al, 2020; Razai at al, 2020). 

The limitations of this study come from the self-reported data within the survey, that the data we captured could hold bias. The survey questions although tested for reliability may still not capture the very complex nature of sense of belonging particularly nuances through different cultures and environments as all participants came from the United Kingdom. A wider and more diverse sample size and population would support the rectification of this is future studies. 

Although, the importance of tackling social isolation in our aging population is widely being recognised as an area of relevance and knowing that reciprocity of social connectedness is a crucial part of successful interventions (Sander, 2005; Eating, 2019). Our data, supports the need for future research in this outcome, at the point of intervention across the lifespan rather than just for those in older age. This is not to say that those in aging population are not most at risk of isolation, due to variety of social, environmental and cultural factors. But that when social isolation or loneliness shows up, particularly post-pandemic, that society and maybe particularly health and support providers need to be aware of the impact at any age and act. 

References 

Altman, I., & Taylor, D. (1973). Social penetration: The development of interpersonal relationships. New York, NY: Holt. 

Baumeister, R. F., & Leary, M. R. (1995). The need to belong: Desire for interpersonal attachments as a fundamental human motivation. Psychological Bulletin, 117(3), 497–529. https://doi.org/10.1037/0033-2909.117.3.497 

Chopik, W. J. (2017). Associations among relational values, support, health, and well-being across the adult lifespan. Personal Relationships, 24(2), 408–422. https://doi.org/10.1111/pere.12187 

Dunbar, R. (2022). Friends : Understanding the Power of Our Most Important Relationships. Little, Brown Book Group Limited. 

Duschinsky, R. (2020). Cornerstones of attachment research. Oxford University Press. 

Eating, H. (2019). Social isolation, Loneliness in Older People Pose Health Risks. National Institute on Aging. https://www.nia.nih.gov/news/social-isolation-loneliness-older-people-pose-health-risks 

Gadermann, A. C., Thomson, K. C., Richardson, C. G., Gagné, M., McAuliffe, C., Hirani, S., & Jenkins, E. (2021). Examining the impacts of the COVID-19 pandemic on family mental health in Canada: findings from a national cross-sectional study. BMJ Open, 11(1), e042871. https://doi.org/10.1136/bmjopen-2020-042871 

Galea, S., Merchant, R. M., & Lurie, N. (2020). The Mental Health Consequences of COVID-19 and Physical Distancing: the Need for Prevention and Early Intervention. JAMA Internal Medicine, 180(6), 817–818. https://doi.org/10.1001/jamainternmed.2020.1562 

Hornsey, M. J. (2008). Social Identity Theory and Self-categorization Theory: A Historical Review. Social and Personality Psychology Compass, 2(1), 204–222. https://doi.org/10.1111/j.1751-9004.2007.00066.x 

Hwang, T.-J., Rabheru, K., Peisah, C., Reichman, W., & Ikeda, M. (2020). Loneliness and social isolation during the COVID-19 pandemic. International Psychogeriatrics, 32(10), 1–15. https://doi.org/10.1017/s1041610220000988 

Mikulincer, M., & Shaver, P. R. (2007). Attachment in adulthood : structure, dynamics, and change. Guilford Press. 

Mikulincer, M., & Shaver, P. R. (2018). Attachment Theory as a Framework for Studying Relationship Dynamics and Functioning. The Cambridge Handbook of Personal Relationships, 175–185. https://doi.org/10.1017/9781316417867.015 

Nicolaisen M, Thorsen K. (2016) What Are Friends for? Friendships and Loneliness Over the Lifespan-From 18 to 79 Years. Int J Aging Hum Dev. 2017 Jan;84(2):126-158. doi: 10.1177/0091415016655166. Epub 2016 Jun 28. PMID: 27357305. 

Oronce, C. I., & Tsugawa, Y. (2021). Bonding and linking social capital are key determinants for successful pandemic policy. Social Science & Medicine, 287, 114376. https://doi.org/10.1016/j.socscimed.2021.114376 

Pichère, P., & Cadiat, A.-C. (2015). Maslow’s hierarchy of needs. Lemaitre.  

Prandini, R. (2014). Family Relations as Social Capital. Journal of Comparative Family Studies, 45(2), 221–234. https://doi.org/10.3138/jcfs.45.2.221 

Razai, M. S., Oakeshott, P., Kankam, H., Galea, S., & Stokes-Lampard, H. (2020). Mitigating the psychological effects of social isolation during the covid-19 pandemic. BMJ, 369(369), m1904. https://doi.org/10.1136/bmj.m1904 

Sander, R. (2005). Preventing social isolation and loneliness among older people: a systematic review of health promotion interventions. Nursing Older People, 17(1), 40–40. https://doi.org/10.7748/nop.17.1.40.s11 

How do young people view their relationship with Online Gaming?

Introduction and literature review: 

Here follows a meta-synthesis of four published papers on online gaming addiction. The purpose of the research is to investigate the costs of online gaming addiction by examining the subjective experience of vulnerable groups engaged, alongside enquiring if there are any benefits for these groups or the application of online gaming in the future. Four main overarching themes emerged from the research focusing on the educational application of gaming most specifically for young people balanced against the current evidence that gaming in its most popular state appears to have a multitude of side effects including the addictive nature of gaming and significant need for regulation. 

A literature review for the meta-synthesis was completed to reveal further thoughts about the area of online gaming addiction and to discover what other research has been completed in this area. The review consisted of an analysis of research papers from the University of Wolverhampton library Access BrowZine, PubMed and JSTOR. Using search terms such as ‘online gaming addiction’, ‘gaming addiction’ and ‘online gaming’. 

The review mainly uncovered a focus on the negative impact of online gaming for people, most specifically young people (Cisamolo at al, 2020; Yilmaz & Griffiths, 2018; Beranuy et al, 2013). Chen et al (2021) outline the significant neuro-cognitive changes and potential deficits that exist for people with gaming addictions. Alongside this, there seems to be a surge of interest in the civic potential that could arise if gaming was re-developed and it is the people with most power, governments and military forces, who are recognising this potential and how to harness it. Rather than the social services of our most at need, including in schools and education settings (Kahne et al, 2009; Shafer et al, 2005; Salen, 2007; Engerman et al, 2017). From this review a hypothesis emerged that young people are at risk of addiction and future manipulation within these systems.  

Further to this, the epigenetic consequences on the developing brain for addiction to gaming needs to be studied more. A parallel exists within the literature of epigenetic consequences of substance use addiction and disorders (Cadet & Jayanthi, 2021) and that of similar gaming addiction behaviours and psychological processes (Kuss & Grifiths, 2012). Recent research has identified that the addictive nature of substance misuse can cause changes in the epigenome, specifically modifying reward circuitry (Shepherd & Nugent, 2023). Within our investigation it is clear from the participants voice, and theme development, that there is an identification with behavioural patterns of addiction. What consequences will this have on the human epigenome? Specifically, humans identifying as male that are the main users of online gaming in addictive quantities.  

The literature search also brought up the interesting question of what to do with technology, like the gaming industry, that has great power, following and hold. When used for good there appears to be evidence that it could shift education productivity, engagement and enjoyment for the masses, but currently as Gee (2003) states “gaming is a capitalistic driven Darwinian process of selection of the fittest” (abstract). That appears to use Draconian systems and processes that appeal to the normalisation of violence that we are seeing increase throughout our societies (Prescott et al, 2018; Krzyzanowski, 2020). Interestingly, one meta-analysis looking at the relationship between violent video games and violent behaviours noticed the effect was largest in White ethnicity groupings. Putting forward some evidence that ethnicity alongside sex may be a modifier of this relationship (Prescott et al, 2018). 

The literature search produced enough material to make future suggestions of a meta-analysis in this area. But due to the restrictions of this unit and the specific qualitative papers provided for this investigation we continue here with the meta-synthesis to attempt to find a new understanding from the data we have, examining the meanings and experiences presented and adding a contribution to the field. 

Research question: 

From the literature review identifying the wider implications of gaming for young people’s development across their lifespan the following research question arose: 

How do young people view their relationship with online gaming and its addictive nature? 

Method: 

This paper attempts to address the need to aggregate current data systematically in the field of online gaming addiction by using the methodology of a meta-synthesis to capture and interpret existing data in four published papers. To organise and recognise themes using the method of thematic analysis, which allowed for a detailed exploration of patterns. 

As a result of the literature review, and the premise that there is an existing issue with online gaming addiction, a deductive approach to the thematic analysis occurred looking for codes to support either the enquiry towards structures that may reduce or diminish the addictive nature of gaming. Or in fact discover codes that identify the processes towards interventions that could become protective in nature for young people at risk of addictive gaming. These ideas became the framework to move forward with coding the data. As coding continued a recognition of novel themes emerged and that the existence of an inductive approach was also present, one that allowed space for the creation of new knowledge (Willig, 2022).  

A mixture of data driven semantic codes appeared in the initial coding, but as the transcripts were reviewed in additional analysis, and conversations within the team of coders, latent codes also appeared. This allowed for the surface and underlying meanings to be captured (Braun & Clark, 2013) 

Sample: Four published papers were provided by the University of Wolverhampton for the meta-synthesis, these can be found in appendices 1 to 4, alongside their coding and themes encapsulated within comments. The papers were published between 2013 and 2021 providing a selection from the last 10 years. The four papers came from the international community and were not based in the same area for collection of data, allowing for a good sample of research participants. Research participants in all 4 of the papers were young people, under the age of 18, who appear to be the focus and often main casualty of online gaming. In 3 of the paper’s participants were in education settings. One paper focused on individuals that were in treatment for their addiction to online gaming. It would be advantageous for future studies to include a wider age range and look at the impact of gaming via a longitudinal study into adulthood and beyond. 

Method of coding: The method of coding used for all four papers was a broad and complete coding aiming to discover all that was available rather than a specific data set (Braun & Clarke, 2013). Using organic familiarisation with the transcript recorded on Word with no assisted software. The four papers were coded by a team of researchers from the university who were able to meet on a variety of occasions to discuss coding, before common themes across all papers were analysed by authors individually. The findings and results section from each paper became the transcript that was inserted as data in one column of a Word document and in another column the search for codes began, via reading and familiarisation of the transcript. The author of this paper coded two papers, paper 1 (appendix 1) and paper 2 (appendix 2) and received two papers that had been coded by another group member (appendix 3 and 4). This allows for a broad double coded analysis of data, which should increase the reliability of findings (O’Connor & Joffe, 2020). 

Results: 

Development of Sub Themes within each paper. 

Diagram A. 

Diagram B. 

Diagram C. 

Diagram D. 

Development of Themes. 

Table 1. 

Theme Name How many times mentioned 
Advantages of online gaming   Acquisition of historical information  Development of critical reading skills  Development of meaning making   Language development  Development of strategy  Teamwork and collaboration  Literacy skill development  Gaming can support education and learning  Transferability of embodied actions and skills Learning opportunities  Enjoyment of learning transition to classroom Motivation  Communication skills  Leadership skills Communication skills    Disadvantages of online gaming   Confusion and distortions of reality  Addictive nature of gaming  Dangerous identification with characters  Violent interactions within gaming  Playing too long/often creates issues  Problematic relationships  Neglecting the real word  Mental health concerns – mood disturbance – variety of disturbances  Social isolation Bullying and aggressive behaviours towards others  Effects of video games on physical health  Recognition of negative impact on life for young people   Protective factors for addictive gaming   Access to screens and time management Indigenous voices Autonomy of access  Development of boy culture for real world application  Positive parental engagement creates protective factors Variety of family structure  Positive parental engagement high protective factor  Choosing less addictive games – regulation of play    Risk Factors for addictive gaming   Deleterious family and social environment  Alienation from traditional learning  Immersion and feelings of belonging – escapism  Feelings of hopelessness and isolation  Social status and relationships – competition increases usage  Significant playing time, neglecting real world, confusion of worlds Mental health issues possible risk factors  Congruent definition of pathological game use with DSMV    120   14 11 8 5 3 3 3 3 2 2  2 2 2 2   70   7 5 4 4 4 4 3   3 3   2 2   3   58   8 3 3   3   2 2   2   2    29   3 3   2 2   2   2 2   2 

Overview of results from analysis: 

The initial subthemes as seen in diagrams A to D provided a fascinating overview and richness of the research and allowed themes to develop across all four papers.  

It is evident that there are some positive uses for online gaming (see table 1), that the potential for educational content is a real driver for change in the current environment. This is one of the main subthemes and we can hear researchers draw on this often. “Game[s] required such a large amount of reading that our respondents reported developing advanced vocabulary for their respective ages”.  Participants self-identified with this also, “I probably learned a lot of vocabulary from those games… believe it or not. Just cause it was constantly reading, reading, reading”. Educators “could use these immersive and engaging environments to separate fact from fiction elevating interest and driving critical analysis of content within reliable resources”

Specifically, the application and acquisition of historical data, this appears to be one of the main areas of positive interest for gamers particularly within paper 2 (appendix 2). This “may demonstrate that games have the potential to provide domain specific content along with transferrable learning opportunities”. An experience that is currently submerged in the gaming environment and one that could be improved on without gamer disconnection. As is evident in this participants synopsis: 

“Greg indicated, Probably, in social studies this year. We were talking about the war…. and I knew everything. … Yeah and I knew, Revolutionary War. I just really knew everything, and I know this other kid who played it, and he’s in my class and me and him just like (chuckles)… yeah, we knew everything. (Greg) Greg described the embodied experiences within the game and was proud of his ability to recount events for his classroom audience.—‘‘yeah, we knew everything’’. Greg’s excitement and confidence here also illustrated his attempt to make a connection between school literacies and his own life literacy practice” 

One of the issues currently however is the lack of accurate historical data within online gaming: “Although limited in factual data, respondents described experiences such as these as being highly meaningful to them”. The lack of accurate factual data and the risk factors for addictive behaviours, such as being alienated from mainstream education or those who come from “deleterious family and social environment” that may not scaffold the young person’s learning in anyway, are all disadvantages and risks of online gaming and pull the area subconsciously at times into chaos. There is a huge opportunity here to change the way that young people are educated and held in their innate learning spaces but these risk factors and more would need to be addressed. 

Outline of key themes that emerged: 

The key themes that emerged where the signifcant advantages and disadvantages of gaming for young people. Alongside this the risk for these young people to engage in addictive gaming and what protective factors were available to them. These became the central and organising concepts (Braun & Clark, 2013) of the research and gave grounds to make the following suggestions.  

Advantages – online gaming has a large potential to educate young people (Salen, 2007; Apperley & Walsh, 2012), particularly for young people at risk of exclusion from mainstream education (if the material becomes factual appropriate). The young people “described being motivated to communicate through speaking and listening as they socially played with peers, which improved their speaking and listening skills towards collective objective”. The data showed that there were many possibilities for education: 

“The boys described the ability to acquire and [use] accurately a range of general academic and domain-specific words and phrases sufficient for reading, writing, speaking, and listening at the college and career readiness level; demonstrate independence in gathering vocabulary knowledge when encountering an unknown term important to comprehension or expression”

Most importantly that through listening to what motivates young people, their indigenous voices, about what encourages learning opportunities and how this could be harnessed through gaming “this illustrates the power of interest driven learning” and what the future of gaming could be. 

Disadvantages – online gaming if done at high frequency, for specific populations of people can become a negative space in which addictive behaviours are paramount to any other. The data collected evidenced the following issues arising from online gaming:  

Affective problems, verbal problems, self-control problems, and behavioural problems. Focus group interviews indicate peers to suffer from heavy gamers’ bullying and physical assaults, claiming they do not obey classroom rules and neglect their educational and social responsibilities. Verbal problems include acts such as teasing and making fun of other individuals, using nicknames, and swearing” 

That heavy gamer “conversation is always somehow connected to video games, and this is boring” this detail came up regularly and demonstrates the impact on social and intimate relationships. This point also impacts the possibility of young people becoming isolated from peers and loosing themselves in gaming and away from reality, significantly “reported by gamers from their playing experiences is the escapism and/ or dissociation that gaming allows”. 

 Participants mentioned: “The fact that you can change your life. For what you are in the game”, ““I find myself dreaming about the game characters and scenes”, “escape other conflicts in their lives”, ““I thought it relaxed me but stressed me much because of the pressure my parents exerted on me. I played to forget almost everything”, “my mind disconnected”, “I lose control. I don´t know how much time has passed”. These are common statement across the four papers and demonstrate that users are often playing for escapism reasons. Alongside “the danger residing in the identification with ‘bad characters’ and the risk of committing regrettable acts (violence, substance dependence)”

There were so many disadvantages and here are just a few examples: “I started to get depressed and play more”, “poor academic performance”, “, not looking for a job, and/or working part-time to play in the afternoon”, “some cases lead to consequences such as forgetting to eat”. That it really showed the need to publicise and support users with more education around how to care for themselves whilst gaming and how to notice excess usage. 

Risk factors – specific risk factors such as “deleterious home environments” and young people at risk of exclusion, social isolation and mental health concerns are a very real concern. There was a huge emphasis throughout all papers that: 

“parental conflicts and indifference toward their children [became] to be the main reasons for this situation: I know these three students share a mutual misfortune and all of them have problematic experiences with their parents. Their mothers and fathers have no interest in them, which strikes me as why these children prefer playing video games, to avoid their parental problems”

Other key risk factors in the main themes were “the type of game was blamed, especially war games”, the alienation of young people from traditional learning “an environment without friends or in an isolated location was compensated by a great investment in the virtual world”. 

Alongside “three principal elements to describe this pathological use: ‘not knowing how to stop gaming’, ‘not meeting your obligations’, and ‘doing nothing but gaming’”. 

The risk of engaging in heavy usage was very present in young people who had feelings of hopelessness and isolation: 

“Gamers with pathological playing habits confused the real and virtual worlds. Therefore, they could transpose actions from the virtual into the real world, risking violent acts or sexually dysfunctional behaviours. This confusion was enhanced by isolation, the gamer having a poor understanding of the real world. The realistic nature of a game also facilitated this confusion”. 

Although not a main theme within these papers “the omnipresence of video games in contemporary society (advertising, special events) was thought to encourage gaming”, which fits with the wider literature review of penetration from a Capitalistic market (Gee, 2003).  

Protective factors – the young people who engaged in these studies had a very clear voice around what may help to protect against addictive gaming, factors such as limited screen time “the adolescents agreed on the need to regulate their habit” also that “adopting systems to manage the amount of time spent gaming reduced the risk of pathological use”. The types of games played and reducing violent games also “complying with PEGI (Pan European Game Information) could avoid problematic use”, specifically age-appropriate games. Most of all autonomy over their own usage with significant family (parental positive input) “the main protective factor referred to was parental control, which should be seen as a support mechanism that changes with the maturity of the adolescent and enables the adolescent to attain self-control based on dialogue and trust”.  

Our data demonstrated that seeking support from professional resources or loved ones can also be beneficial in overcoming addiction and promoting positive behaviour change, in statements such as: “family physicians are encouraged to take a ‘media history’ from patients and discuss connections between a child’s health and behaviour and screen use”. This kind of intervention needs to become more commonplace when supporting young people with gaming. 

Discussion and Implications for future research 

Interestingly one of the most powerful themes that arose from the thematic analysis was that of the indigenous voice of young people using online gaming. That they as individuals recognise the risk factors for gaming becoming addictive and problematic and could identify themselves what would be protective in nature. Thematic analysis is particularly adept at identifying research questions that consider individuals conceptualisation of specific social phenomena (Willig, 2021). For this research that has been prominent throughout and leads to the suggestion that guidance and regulations within the industry need to consult users as a priority matter. Also, that as escapism from problematic lives was a high indicator for heavy usage that this needs to be addressed in protective interventions to reduce addiction. 

Young people who use online gaming can have a spectrum of associated behaviours and cognitions, from unproblematic to addictive. Their view of this relationship is insightful and accurate. As their lifelines unfold these young people’s environments influence their gene expression (Roses, 2005), what limits and potentials does this create? Future research needs to look to epigenetics to better understand the complex processes that can lead to addiction. As with other areas of mental health the lived experiences of people in distress have become imperative for recovery and change.  

With the growing evidence of the impact of addictive behaviours on the epigenome (Cadet & Jayanthi, 2021) and the increasing usage of online gaming – with global online gaming revenues of £23.56bn USD in 2022 (Clement, 2022) we propose that an urgent safety review for young people and their heavy usage be undertaken. So that we can safeguard their development and utilize online gaming for better more educative purposes.  

Reflexivity section  

In undertaking this analysis of data, I had many pre-existing thought processes arise. Some Feminist in their criticism of the toxic online spaces that are present for females and that there appears to be a normalisation of violence in these spaces (O’Halloran, 2017).  

Also, noticing male peers in my world who use online gaming for escape from problematic and difficult lives. The ability to be able to submerge yourself in a game can provide relief and a strategy to cope with complex issues. However, this does not tackle the issues and draws the individual away from the connection with reality that they really require to move forward and through issues. 

My subjectivity of this area was important to be aware of during the coding process and notice specific codes such as ‘normalisation of violence’ and to ground my experience in the data. I also felt it was important to recognise the heuristic nature of my enquiry from personal experience in this area. I took a social constructionist approach to this analysis of data but felt aware throughout that this approach does not adequately consider ‘power’ (Nightingale, 2011) which I feel is a pervasive part of the periphery of this conversation.  

References: 

Apperley, T., & Walsh, C. (2012). What Digital Games and literacy have in common: A heuristic for Understanding Pupils’ Gaming Literacy. Literacy, 46(3), 115–122. https://doi.org/10.1111/j.1741-4369.2012.00668.x  

Beranuy, M., Carbonell, X., & Griffiths, M. D. (2013). A qualitative analysis of online gaming addicts in treatment. International Journal of Mental Health and Addiction, 11(2), 149–161. https://doi.org/10.1007/s11469-012-9405-2  

Braun, V., & Clarke, V. (2013). Successful qualitative research. Sage Publications Ltd. 

Cadet, J. L., & Jayanthi, S. (2021). Epigenetics of addiction. Neurochemistry International, 147, 105069. https://doi.org/10.1016/j.neuint.2021.105069 

Chen, S., Wang, M., Dong, H., Wang, L., Jiang, Y., Hou, X., Zhuang, Q., & Dong, G.-H. (2021). Internet gaming disorder impacts gray matter structural covariance organization in the default mode network. Journal of Affective Disorders, 288, 23–30. https://doi.org/10.1016/j.jad.2021.03.077 

Cisamolo, I., Michel, M., Rabouille, M., Dupouy, J., & Escourrou, E. (2020). Perceptions of adolescents concerning pathological video games use: A qualitative study. La Presse Médicale Open, 2, 100012. https://doi.org/10.21203/rs.3.rs-32271/v1 

Clement, J. (2022). Topic: Online gaming. Statista. https://www.statista.com/topics/1551/online-gaming/ 

Engerman, J. A., MacAllan, M., & Carr-Chellman, A. A. (2017). Games for boys: A qualitative study of experiences with commercial off the shelf gaming. Educational Technology Research and Development, 66(2), 313–339. https://doi.org/10.1007/s11423-017-9548-8 

Gee, J. P. (2003). What video games have to teach us about learning and literacy. Computers in Entertainment, 1(1), 20–20. https://doi.org/10.1145/950566.950595 

Kahne, J., Middaugh, E., & Evans, C. (2009). The Civic Potential of Video Games. Cambridge, Massachusetts: The MIT Press. 

Krzyżanowski, M. (2020). Normalization and the discursive construction of “new” norms and “new” normality: Discourse in the paradoxes of populism and neoliberalism. Social Semiotics, 30(4), 431–448. https://doi.org/10.1080/10350330.2020.1766193 

Kuss, D. J., & Griffiths, M. D. (2012). Internet and gaming addiction: A systematic literature review of neuroimaging studies. Brain Sciences, 2(3), 347–374. https://doi.org/10.3390/brainsci2030347 

Nightingale, D. J. (2011). Social Constructionist psychology: A critical analysis of theory and Practice. Open Univ. Press. 

O’Connor, C., & Joffe, H. (2020). Intercoder reliability in qualitative research: Debates and practical guidelines. International Journal of Qualitative Methods, 19, 160940691989922. https://doi.org/10.1177/1609406919899220 

O’Halloran, K. (2017, October 23). “hey dude, do this”: The last resort for female gamers escaping online abuse. The Guardian. https://www.theguardian.com/culture/2017/oct/24/hey-dude-do-this-the-last-resort-for-female-gamers-escaping-online-abuse 

Prescott, A. T., Sargent, J. D., & Hull, J. G. (2018). Meta-analysis of the relationship between violent video game play and physical aggression over time. Proceedings of the National Academy of Sciences, 115(40), 9882–9888. https://doi.org/10.1073/pnas.1611617114 

Roses, S. P. (2005). Lifelines: Life beyond the gene. Vintage. 

Salen, K. (2007). Gaming literacies: A game design study in action. Journal of Educational Multimedia and Hypermedia, 16(3), 301-322. Waynesville, NC USA: Association for the Advancement of Computing in Education (AACE). Retrieved April 16, 2023 from https://www.learntechlib.org/primary/p/24374/

Shaffer, D. W., Squire, K. R., Halverson, R., & Gee, J. P. (2005). Video games and the future of learning. Phi Delta Kappan, 87(2), 105–111. https://doi.org/10.1177/003172170508700205 

Shepard, R. D., & Nugent, F. S. (2023). Epigenetics of drug addiction. Handbook of Epigenetics, 625–637. https://doi.org/10.1016/b978-0-323-91909-8.00040-2 

Willig, C. (2022). Introducing qualitative research in psychology. Open University Press. 

Yılmaz, E., Yel, S., & Griffiths, M. D. (2018). The impact of heavy (excessive) video gaming students on peers and teachers in the school environment: A qualitative study. Addicta: The Turkish Journal on Addictions, 5(2). https://doi.org/10.15805/addicta.2018.5.2.0035 

Is psychiatric diagnosis useful? A critique of the interplay of social, cultural, and political forces that influence psychiatric diagnosis.

Framing a complex human problem such as distress under the umbrella of just one causal factor does not do it justice. For decades psychiatric diagnosis has been seen only through the guise of the biomedical model (Deacon, 2013; Benning, 2015; Wheeler et al, 2016). Which as this critique will debate has provided a one-sided perspective that influences resources, policy solutions and possible avenues for social change. Psychiatric diagnosis in its current state should be totally dismantled and redeveloped under a wider consideration of the human condition, to include possible approaches such as continuum frameworks, psychological formulation, trauma informed and intersectionality conscious perspectives and models such as PTMF (power threat meaning framework). 

How the grip of the biomedical model came into force is a long history which can be found detailed by authors such as Deacon (2013). It appears at times to be a dark and oppressive space, one that devalues protected human characteristics such as gender, sexual orientation, race and disability throughout its history (Wheeler et al, 2016; Taylor 2022). The biomedical model is inextricably linked to Psychiatric diagnosis. Cromby et al (2017) present a variety of causal factors outside of the biological and propose a wider view that needs to be considered – the interplay of social, cultural and political forces. This perspective of widening the lens away from just the biological is supported by a variety of researchers (Bentall, 2004; Deacon, 2013; Taylor, 2014; Wakefield, 2013). 

One of the main critiques of the biological model is that its aetiology, the reliability and validity of its causal factors, core assumptions and propositions are invalid (Kinderman, 2019). The disease focused explanation of human distress, even with decades and millions if not billions of pounds of research has not yet been able to find one reliable sufficient cause for any form of mental distress (Deacon, 2013), just pharmaceutical corrupt intervention (Crowell-Williamson, 2021). No specific biological impairments or markers have been associated with diagnosis (Cromby et al, 2017). This is not to say that biology and genetics have no interplay with human distress, the mind and body are inevitably and completely entangled (Cromby et al, 2017). However, when we do not have the scientific evidence to back up the long-term neuroleptic and antidepressant coma that much of the world’s population is under, can we really call psychiatry an ethically based field?

Many of the theories that underpin a medical basis for diagnosis in the past few decades have been strongly discredited (Menkes, 2022; Moncrieff et al, 2022). Such as the serotonin hypothesis, which even lead researchers supporting the hypothesis renounced (Moran et al, 2018). Furthermore, the classification manuals the DSMV and others such as ICD have come under huge scrutiny (Callard, 2014; Wheeler et al, 2016; Bredström, 2017). Callard (2014) goes on to use the temporal positioning of many before her to outline the issues raised by the DSMV. That it “privileges certain ethical positions and formulations,” focusing solely on classification, rather than diagnosis being “a complex, highly mediated process.” These manuals and processes do not consider the “boundaries between normal and abnormal, between everyday experience and distress” (Cromby et al, 2017. P 116). There is a complex wider social, environmental and political conversation. 

Furthermore, the DSMV (the bible of Psychiatry) has been constructed not on science but by votes from their task force (APA, 2013) which detrimentally has often been one classification of person, white and male (Cooper, 2014; Davies, 2017; Taylor 2022). This imposition of unethical categorization does not consider the wider cultural recognition of symptom variance and undermines anything other than a white western-centrism strategy for dealing with distress. “Psychiatry is arguably more politics and social constructions than science” (Taylor, 2022, p4).  

The reliability of diagnosis is in question. The heterogeneity of symptoms for many of the classifications of mental distress is abundant. Looking closely at MDD (major depressive disorder) one can see that there are over 1000 combinations of unique symptom profiles (Fried & Nesse, 2015). This is also seen in BPD (borderline personality disorder) (Cavelti et al, 2021), the schizophrenia classifications (Bentall, 2004; Kinderman, 2019; Liang & Greenwood, 2015) and many other classifications within the DSMV. “The diagnostic systems currently employed are not well equipped to capture the substantial clinical heterogeneity observed for most psychiatric disorders” (Liang & Greenwood, 2015, abstract). If people have such different symptoms, unique narratives and contingency how can we pigeonhole their distress into one category? The natural borders for classification of distress have been demonstrated to be fluid and ever moving, a convincing argument to consider alternatives to a medically biased diagnosis framework. As Bentall (2021) writes “mental illness is a continuum – one that all of us are on” (para. 29). 

Validity is also of concern for psychiatric diagnosis. The effectiveness and desired outcomes are often filled with stigma, self-deprecating recovery, pharmaceutical coercion and political distortion of facts. A study found “effect sizes of general psychotherapy for various mental disorders range from 0.73 to 0.85, while the effect sizes of antidepressant medications is much lower, within a range of 0.17-0.31” (Migone, 2017, p136). This and many other sources (Bentall, 2004; Sharfstein, 2005; Longden, 2013; Kinderman, 2019) have discovered that even though the facts are clear that medicating populations of distressed people does not have the intended all round positive outcomes. Psychiatry is still offering a pill as the first line of treatment. Ignoring the evidence base is ethically corrupt and a form of malpractice. Longdon & Read (2016) discuss the impact of neurological changes from long-term neuroleptic prescriptions and there is a wider question to be asked about the efficacy of lifelong diagnosis and medicating of people. Taylor (2022) questions why personality disorders, “notoriously hard to get removed from women’s medical records” (p87) are given such lengthy prognosis when 85% of cases can be seen to be in remission after 10 years. This can be contrasted with the research around psychosis and schizophrenia (AlAqeel & Margolese, 2012; Longden & Reed, 2016; Bowtell et al, 2018).  

We can use the problems with validity and reliability of diagnosis to critique it further by showing that clinicians consistently cannot agree on the same outcome from patient to patient, through the discipline’s aetiology, its unapparent and arbitrary markers and that causes of distress appear to be synergistic with causality being probabilistic and deeply complex (Cromby et al, 2017).  

And what about the impact of individualism on psychiatric diagnosis. Individualism in the West and the lack of collectivism, community and families not being close together and providing structures and support for those in distress? Individualism is a growing social force that we have seen rise with capitalism and the force of the internet (Houston, 2014). Is it possible that the western “psychiatric gaze” (Van Os, 2022), with its ignorance of cultural understanding and management of distress are also having an impact on the individual. That we are seeing an increase in need to medicate and sedate a population of people who do not have an underlying social community and support structure? Kinderman (2019) certainly believes that mental health is not an individual issue but a political one. One in which we see ‘big pharma’ impacting the politics, funding streams and services of the very support frameworks that are meant to make a difference (Kinderman & James 2019). 

The language we use around human distress is important to both internalised stigma and the stigma received by others because of how it affects our thinking. Language and terminology as discussed by (Cromby et al. 2017) are not free from value and often not neutral. The words we use come loaded, they can disregard the social, political, environmental factors that could be main aggravators to distress. Medicalised terminology can feel a long way off from lived experience and the description of living moment to moment. These words can take away autonomy and independence; remove accountability from toxic structures; increase powerlessness/helplessness and hopelessness and rely on dominate power structures. 

Yalom (2003) argues that there is a danger that professionals will treat someone as a diagnosis rather than as a human being, with diagnosis acting as a “self-fulfilling prophecy” (p5). Stigma research (Peter et al, 2021) shows us how damaging and belittling stigma from mental health diagnosis can be. It is pervasive and it creeps in at the edges of society and keeps us from functioning fully. Keeps us in boxes and doesn’t allow us to freely speak about what is happening to us. It tells society what is acceptable and what is not. Which varies from culture to culture and timeframe to timeframe. 

The history behind the schizophrenia diagnosis is a helpful one in critiquing psychiatric diagnoses. As Van Os (2016) states “we don’t know enough to diagnose real diseases, so we use a system of symptom-based classifications” (para. 7) as in the DSMV. The cultural and environmental impact of what Schizophrenia has been defined as at various times is a crucial element of the psychiatric gaze and shows us how diagnosis has morphed and developed. Bentall (2004) goes into great depth about this timeline and shows the reader the multitude of symptoms that have been put forward since Kraepelin’s first attempts at classification of what is now known as schizophrenia. Including when Mary Boyle offered a totally different viewpoint of symptoms due to the epidemic of 1916-27 demonstrating the uncertainty of such a closed association. 

History shows us that an attempt has always been made to classify and put under the microscope anything that we do not understand or that falls outside of ‘normal’. That our culture and environment have a huge amount to do with what at that time was/is considered normal. For example, being a woman and homosexuality were at times also considered a diagnosable psychiatric condition (Taylor, 2022). 

Whilst reading around this area it is hard not to feel the voices of the feminist movement. The voices are loud and clear about the damage that has been done to women over centuries of malpractice by the institution of psychiatry and the wider patriarchy (Wheeler et al, 2016; Taylor 2021; Taylor, 2022). An example is the dive into BPD research, which raises concerns for this diagnosis being purely a list of natural symptoms that would occur after trauma from relational violence towards women, often from men, (Taylor, 2021; Taylor 2022; Capes-Ivy, 2020; Cavelti et al, 2021; Whitbourne, 2022). There is also a wider very clear intersectionality of concerns around the oppression of people from all walks of life, whilst reframing their trauma as a biological fault (Üstün & Kennedy, 2009; Carr & Spandler, 2019; Kunorubwe et al, 2022; Ahmed et al, 2021). 

This is not just a feminist exchange, it’s a need for social consciousness of how humanity, and more recently Psychiatry, has managed people who do not fit in with the current social norms and perspectives of that time. This interpenetrates the social, cultural and political forces that impact psychiatric diagnosis. Who decides what constitutes the symptoms and classifications of distress, and why should they over others? Causality research has shown us that distress is “multiple, complex and over-determined” (Cromby et al, 2017, p134). This essay has tried to demonstrate that over time distress looks different, that classifications such as Schizophrenia are fluid and constantly evolving (Bentall, 2004). That there is a current pandemic of over medicalising and shaming people for their distress and ignorance of the wider causal factors. 

There are better alternatives to psychiatric diagnosis, for those who experience distress. A revision of the way we speak and see mental distress, starting from the bottom up listening to lived experience and what helped and hindered progress to states of wellbeing. Diagnosis can influence distress, through often invisible structures that affect our lives in an unconscious and unseen way. A more integrated approach is required, one that looks at the individual narrative, considers the social, environmental, and political, whilst deconstructing power structures – the promulgation of the continuum model (Peter, et al. 2021), awareness of the spectrum, uniqueness and diversity of the human condition and the impact of real-world trauma (Sweeney et al, 2018). 

References 

Ahmad, G., McManus, S., Cooper, C., Hatch, S. L., & Das-Munshi, J. (2021). Prevalence of common mental disorders and treatment receipt for people from ethnic minority backgrounds in England: Repeated cross-sectional surveys of the general population in 2007 and 2014. The British Journal of Psychiatry, 221(3), 520–527. https://doi.org/10.1192/bjp.2021.179 

AlAqeel, B., & Margolese, H. C. (2012). Remission in schizophrenia: Critical and systematic review. Harvard Review of Psychiatry, 20(6), 281–297. https://doi.org/10.3109/10673229.2012.747804 

APA (2013) The people behind DSM-5 – American Psychiatric Association. Available at: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM_People-Behind-DSM-5.pdf (Accessed: October 20, 2022). 

Bentall, R.P (2004). Madness explained: Psychosis and human nature. PENGUIN BOOKS. 

Bentall, R. (2016, February 26). Mental illness is a result of misery, yet still we stigmatise it | Richard Bentall. The Guardian. Retrieved October 18, 2022, from https://www.theguardian.com/commentisfree/2016/feb/26/mental-illness-misery-childhood-traumas 

Bentall, R. (2021, September 29). Richard Bentall: the man who lost his brother – then revolutionised psychology. The Guardian. Retrieved October 30, 2022, from https://www.theguardian.com/society/2021/sep/29/richard-bentall-the-doctor-who-lost-his-brother-then-revolutionised-psychology

Benning, T. (2015). Limitations of the biopsychosocial model in psychiatry. Advances in Medical Education and Practice, 347. https://doi.org/10.2147/amep.s82937 

Bredström, A. (2017) “Culture and context in mental health diagnosing: Scrutinizing the DSM-5 revision,” Journal of Medical Humanities, 40(3), pp. 347–363. Available at: https://doi.org/10.1007/s10912-017-9501-1

Bowtell, M., Ratheesh, A., McGorry, P., Killackey, E., & O’Donoghue, B. (2018). Clinical and demographic predictors of continuing remission or relapse following discontinuation of antipsychotic medication after a first episode of psychosis. A systematic review. Schizophrenia Research, 197, 9–18. https://doi.org/10.1016/j.schres.2017.11.010 

Callard, F. (2014). Psychiatric diagnosis: the indispensability of ambivalence. Journal of Medical Ethics, 40(8), 526–530. http://www.jstor.org/stable/43283061 

Capes-Ivy, Q. (2022, February 26). Borderline personality disorder – a feminist critique. The F Word. Retrieved October 21, 2022, from https://thefword.org.uk/2010/06/borderline_pers/ 

Cavelti, M., Lerch, S., Ghinea, D., Fischer-Waldschmidt, G., Resch, F., Koenig, J., & Kaess, M. (2021). Heterogeneity of borderline personality disorder symptoms in help-seeking adolescents. BMC. https://doi.org/10.21203/rs.3.rs-51750/v2 

Carr, S., & Spandler, H. (2019). Hidden from history? A brief modern history of the psychiatric “treatment” of Lesbian and bisexual women in England. The Lancet Psychiatry, 6(4), 289–290. https://doi.org/10.1016/s2215-0366(19)30059-8 

Cooper, R. (2014) How reliable is the DSM-5?, Mad In America. Available at: https://www.madinamerica.com/2014/09/how-reliable-is-the-dsm-5/ (Accessed: October 20, 2022). 

Cromby, J., Harper, D., & Reavey, P. (2013). Psychology, mental health and distress. Palgrave Macmillan. 

Crowell-Williamson, G. (2021) Pharma spent $6 billion on lobbying politicians in the last 20 years, Mad In America. Available at: https://www.madinamerica.com/2020/03/pharma-spent-6-billion-lobbying-politicians-last-20-years/ (Accessed: October 20, 2022). 

Davies, J. (2017) “How voting and consensus created the Diagnostic and statistical manual of mental disorders (DSM-III),” Anthropology & Medicine, 24(1), pp. 32–46. Available at: https://doi.org/10.1080/13648470.2016.1226684

Deacon, B. J. (2013). The biomedical model of mental disorder: A critical analysis of its validity, utility, and effects on psychotherapy research. Clinical Psychology Review, 33(7), 846–861. https://doi.org/10.1016/j.cpr.2012.09.007 

Fried, E. I., & Nesse, R. M. (2015). Depression is not a consistent syndrome: An investigation of unique symptom patterns in the STAR*D study. Journal of Affective Disorders, 172, 96–102. https://doi.org/10.1016/j.jad.2014.10.010 

Houston, S. (2014). Beyond individualism: Social work and Social Identity. British Journal of Social Work, 46(2), 532–548. https://doi.org/10.1093/bjsw/bcu097 

Kinderman, P. (2019). A manifesto for mental health: Why we need a revolution in mental health care. Palgrave Macmillan. 

Kinderman, P., & James, M. (2019, September 28). Peter Kinderman – Why We Need a Revolution in Mental Health Care. Mad in America. other. Retrieved October 21, 2022, from https://www.madinamerica.com/2019/09/peter-kinderman-need-revolution-mental-health-care/

Kunorubwe, T., Santhosh, S., & Edwards, A. (2022, May 23). Cultural change in IAPT – a work in progress. Prifysgol de Cymru. Retrieved October 20, 2022, from https://pure.southwales.ac.uk/cy/publications/cultural-change-in-iapt-a-work-in-progress 

Liang, S. G., & Greenwood, T. A. (2015). The impact of clinical heterogeneity in schizophrenia on genomic analyses. Schizophrenia Research, 161(2-3), 490–495. https://doi.org/10.1016/j.schres.2014.11.019 

Longden, E. (2013). Eleanor Longden: The voices in my head | TED Talk. Retrieved October 21, 2022, from https://www.ted.com/talks/eleanor_longden_the_voices_in_my_head?language=en

Longden, E., & Read, J. (2016). Social adversity in the etiology of psychosis: A review of the evidence. American Journal of Psychotherapy, 70(1), 5–33. https://doi.org/10.1176/appi.psychotherapy.2016.70.1.5 

Menkes, D. B. (2022). Putting serotonin in its place—again. BMJ. https://doi.org/10.1136/bmj.o2357 

Migone, P. (2017). The influence of pharmaceutical companies. Research in Psychotherapy: Psychopathology, Process and Outcome, 20(2). https://doi.org/10.4081/ripppo.2017.276 

Moran, R. J., Kishida, K. T., Lohrenz, T., Saez, I., Laxton, A. W., Witcher, M. R., Tatter, S. B., Ellis, T. L., Phillips, P. E. M., Dayan, P., & Montague, P. R. (2018). The protective action encoding of serotonin transients in the human brain. Neuropsychopharmacology, 43(6), 1425–1435. https://doi.org/10.1038/npp.2017.304 

Moncrieff, J., Cooper, R. E., Stockmann, T., Amendola, S., Hengartner, M. P., & Horowitz, M. A. (2022). The serotonin theory of depression: A Systematic Umbrella Review of the evidence. Molecular Psychiatry. https://doi.org/10.1038/s41380-022-01661-0 

Os, J. van. (2016). “schizophrenia” does not exist. BMJ, i375. https://doi.org/10.1136/bmj.i375 

Peter, L.-J., Schindler, S., Sander, C., Schmidt, S., Muehlan, H., McLaren, T., Tomczyk, S., Speerforck, S., & Schomerus, G. (2021). Continuum beliefs and mental illness stigma: A systematic review and meta-analysis of correlation and intervention studies. European Journal of Public Health, 31(Supplement_3). https://doi.org/10.1093/eurpub/ckab164.743 

Sharfstein, S.  (2005, August 19). Big Pharma and American Psychiatry: The good, the bad, and the ugly. Psychiatric News. Retrieved October 20, 2022, from https://psychnews.psychiatryonline.org/doi/full/10.1176/pn.40.16.00400003 

Sweeney, A., Filson, B., Kennedy, A., Collinson, L., & Gillard, S. (2018). A paradigm shift: relationships in trauma-informed mental health services. Cambridge University Press. Retrieved October 2022, from: https://doi.org/https://www-cambridge-org.ezproxy.wlv.ac.uk/core/journals/bjpsych-advances/article/paradigm-shift-relationships-in-traumainformed-mental-health-services/B364B885715D321AF76C932F6B9D7BD0 

Taylor, R. L. (2014). Finding the right psychiatrist: A guide for discerning consumers. Rutgers University Press. 

Taylor, J. (2021). Why women are blamed for everything: Exposing the culture of victim-blaming. Constable. 

TAYLOR, J. (2022). Sexy but psycho: How the patriarchy uses women’s trauma against them. CONSTABLE 

Üstün, B. & Kennedy, C. (2009). What is “Functional impairment”? disentangling disability from clinical significance. World Psychiatry, 8(2), 82–85. https://doi.org/10.1002/j.2051-5545.2009.tb00219.x 

Van Os, J (2016). “schizophrenia” does not exist. BMJ, i375. https://doi.org/10.1136/bmj.i375 

Van Os, J. & Guloksuz, S. (2022). Schizophrenia as a symptom of psychiatry’s reluctance to enter the moral era of medicine. Schizophrenia Research, 242, 138–140. https://doi.org/10.1016/j.schres.2021.12.017 

Wakefield, J. C. (2013). The DSM-5 debate over the bereavement exclusion: Psychiatric diagnosis and the future of empirically supported treatment. Clinical Psychology Review, 33(7), 825–845. https://doi.org/10.1016/j.cpr.2013.03.007Links to an external site. 

Wheeler, E. E., Kosterina, E., & Cosgrove, L. (2016). diagnostic and Statistical Manual of Mental Disorders (DSM), feminist critiques of. The Wiley Blackwell Encyclopedia of Gender and Sexuality Studies, 1–3. https://doi.org/10.1002/9781118663219.wbegss125 

Whitbourne, S. K. (2022). Why It May Be Time to Eliminate the Diagnosis of Borderline Personality. Psychology Today. https://www.psychologytoday.com/gb/blog/fulfillment-any-age/202207/why-it-may-be-time-eliminate-the-diagnosis-borderline-personality 

Yalom, I. D. (2017). The gift of therapy: An open letter to a new generation of therapists and their patients. Harper Perennial.