CLIENTS NEED FOR APPROVAL AS A FACTOR AFFECTING PROCESS AND OUTCOME OF PSYCHOTHERAPY Thesis for the Degree Of M. A. MICHIGAN STATE UNIVERSITY PETER TODD HAMPTON 1958 L 7 p p A R Y THEE-3‘5 . ‘ . Mlchgfin State University .- m3.“ BY A ‘3 TIME & SflNS' 1‘; T 300K BRIBERY INC. A. Fww amulzns 3‘, n:m1.::::::::.:| v _.,‘—_.—.w...,_. “ A; ABSTRACT CLIENT'S NEED FOR.APPROVAL AS A FACTOR AFFECTING PROCESS AND OUTCOME OF PSYCHOTHERAPY By Peter Todd Hampton This study examined the effect of client's need for approval (nApp). as measured by the Marlowe-Crowne Social Desirability Scale (M-C SD), on psychotherapy. The main experimental sample consisted of 26 undergrad- uate students engaged in personal-emotional counseling at the Michigan State University Counseling Center. Of these students, 14 scored high on the M—C SD and 12 scored low. For this sample the relation of client nApp to: a) client depth of self—exploration, b) therapist warmth offered to the client, and c) client gain from therapy was examined. Client depth of self-exploration was determined from: a) a recording of the third therapy interview (or in a few cases the first or the second) rated for client 1 Peter Todd Hampton self-exploration using the Truax and Carkhuff Depth of Self-Exploration Scale, and b) therapist ratings of client defensiveness on a five—point scale. Therapist warmth offered the client was rated from the recorded therapy interview using Carkhuff's Scale for the Measure— ment of Respect or Positive Regard in Interpersonal Pro- cesses. Client gain from therapy was determined by: a) changes on the number of deviant signs score of the Tennessee Self—Concept Scale before and after therapy, and b) therapist ratings of client gain on a five—point scale. A second eXperimental sample consisted of 60 stu- dents who came to the Counseling Center for counseling on personal-emotional problems and 243 students in an elementary psychology course. The mean M—C SD scores of these two groups were compared to see if there was a tendency for students coming to the Counseling Center to have a low need for approval. A questionnaire was also administered to the psy- chology class students to determine if the students who reported that they would go to the Counseling Center or 2 Peter Todd Hampton to a private psychologist if they had an emotional prob- lem would have lower nApp than the students who reported they would go nowhere. The results of this study indicated that there was no difference between: a) the self-exploration of high and low nApp clients, b) the therapist warmth offered to high and to low nApp clients, and c) the amount of gain in therapy of high and low nApp clients. There was also no difference in the mean nApp score of clients com- ing to the Counseling Center and students in the psy— chology class. Finally, the students in the psychology class who stated that they would go to the Counseling Center or to a private psychologist if they had emotional problems had a significantly higher mean nApp score than the students who stated they would go nowhere. This is the reverse of what was predicted. The data of the study was examined to discover possible explanations for the failures of the hypotheses. It was discovered that experienced therapists (therapists with a Ph.D.) offered significantly more warmth to high than to low nApp clients, while ineXperienced therapists 3 Peter Todd Hampton (therapists without the Ph.D.) offered significantly more warmth to low than to high nApp clients. An analysis of available data also revealed that high nApp clients were rated as significantly less mature by their therapists than low nApp clients. The relation of these findings and others to the failure of the hypotheses and to the findings of previous research was discussed. Implica— tions for further research were mentioned. Thesis Committee nggflflttw~tL,w Dr. Gary Stollak Date: flaaé /?é/ Dr. Dozier Thornton Dr. Donald Grummon, Chairman CLIENT'S NEED FOR APPROVAL As A FACTOR AFFECTING PROCESS AND OUTCOME OF PSYCHOTHERAPY BY Peter Todd Hampton A THESIS Submitted to Michigan State University in partial fulfillment of the requirements for the degree of MASTER OF ARTS Department of Psychology 1968 f I T Ff/ 4 ”A " I" [51’] L {/7 / I ' ACKNOWLEDGEMENTS I am sincerely grateful to all who assisted me in this research. My special thanks is given to Dr. Donald Grummon, whose insight, patience, and active con- cern were most instrumental in the conduct of this re- search. The constructive criticisms of Dr. Gary Stollak and Dr. Dozier Thornton were also greatly appreciated; and I am indebted to the therapists and staff of the Counseling Center whose cOOperation made this study pos- sible. I would also like to express my appreciation to my co—worker, Andrea Farkas, who assisted in the data collection and analysis and who was very supportive dur- ing the more trying times of the research. Finally, I am grateful to Janet Cline for her encouragement and for her assistance in rating tapes. ii ACKNOWLEDGEMENTS LIST OF TABLES LIST OF APPENDICES INTRODUCTION METHOD . . . RESULTS. . . DISCUSSION SUMMARY. REFERENCES APPENDICES . TABLE OF CONTENTS Page . . . . . . . ii . . . . . . . . . iv . . . . . . . . . . vi . . . . . . . . l . . . . . . . . . . . 8 . . . . . . . . . . . 14 . . . . . . . . . . 22 . . . . . . . . 38 . . . . . . . . . 41 iii Table LIST OF TABLES Comparison of Mean Rating of Self-Exploration for Clients High and Low in Need for Approval. . . . . . . . . . . . . . . . . . Relation of Client's Need for Approval to Therapist Ratings of Client Defensiveness . Comparison of the Mean Rating of Therapist Warmth Extended to High and to Low Need Approval Clients. . . . . . . . . . . . . . Comparison of Experienced and IneXperienced Counselors' Mean Level of Positive Regard Offered to High and to Low Need Approval Clients . . . . . . . . . . . . . . . . . . Relation of Clients' Need for Approval and Therapist Ratings of Client Gain in Therapy Analysis of Covariance for High and Low nApp Clients' Post-Therapy Mean Number-of— Deviant-Signs Scores. . . . . . . . . . . . Comparison of Mean Marlowe-Crowns Social Desirability Scores of Clients Coming to the Counseling Center and Students in an Elementary Psychology Class . . . . . . . . Comparison of the Mean Marlowe—Crowne Social Desirability Scores of Students Stating They Would Go to the Counseling Center if They Had an Emotional Problem and Students Stating They Would Go Nowhere . . . . . . . iv Page 14 15 16 17 18 19 20 21 LIST OF TABLES (continued) Table Page 9. Relation of Client Need for Approval to Therapist Ratings of Client's Dependency. . 28 10. Relation of Client Need for Approval to Therapist Ratings of Client's Maturity. . . 28 ll. Correlations Between Pre- and Post-Therapy NDS Scores, and Variances of the Differ- ences Between These Scores. . . . . . . . . 32 LIST OF APPENDICES Appendix Page A. THE MARLOWE-CROWNE SOCIAL DESIRABILITY SCALE . . . . . . . . . . . . . . . . . 44 B. QUESTIONNAIRE [Administered in the Elementary Psychology Class]. . . . . . 47 C. COUNSELOR'S POST-THERAPY RATING SCALES . . 48 D. RAW DATA FOR THE COUNSELING CENTER CLIENT SUBJECTS. . . . . . . . . . . . . . . . 50 vi CLIENT'S NEED FOR APPROVAL AS A FACTOR AFFECTING PROCESS AND OUTCOME OF PSYCHOTHERAPY INTRODUCTION This study examined the effect of Clients' need for approval on psychotherapy by examining its relation to: a) students' tendencies to seek counseling for personal-social problems, b) the defensiveness and depth of self—exploration of the client in therapy, c) the level of positive regard offered the client by the ther- apist, and d) the amount of improvement the client achieved through psychotherapy. A study such as this which assesses the relation of one client personality-trait to psychotherapy can serve as an element of the larger picture of how psychotherapy can help persons with intrapsychic problems. If we can determine what personality traits affect psychotherapy and how they do, then we can begin to specify what cli— ents are good or bad prospects for psychotherapy, and l what therapeutic techniques or procedures are most pro- ductive with which clients. A number of studies have indicated that Clients' need for approval (nApp), as measured by the Marlow—Crowne Social Desirability Scale (M—C SD) (Crowne and Marlowe, 1964), is a factor affecting psychotherapy process and outcome. Strickland and Crowne (1963) discovered that clients scoring high on the MrC SD terminated therapy earlier and were rated by their therapists as less im- proved and more defensive than clients scoring low on the M-C SD.l Crowne and Marlowe (1964) describe persons with a high need for approval as having low self-esteem and as maintaining defensive, encapsulated pictures of themselves. (High nApp subjects are more persuasible in much the same manner as are persons of low self-esteem (Salman, 1962); they defend against exhibiting anger in an anger-inducing experimental situation (Conn and Crowne, 1964); and they reSpond less productively and more de- fensively on the Thematic Apperception Test, the Rorschach, and the Rotter Incomplete Sentences Blank (Tutko, 1962). 1High scores in the M-C SD indicate high need for approval. In their study, Strickland and Crowne (1963) con- cluded that the defensiveness of the high nApp subjects caused them to be threatened by the demands of psycho- therapy for personal revelation. This led them to an avoidant means of resistance--the premature termination of therapy. Lamb and Fretz (1964) replicated the Strick— land and Crowne finding that clients high in nApp termi- nated therapy prematurely; and, in addition, their anal— ysis of the content of the therapy interviews suggested that high nApp clients were more defensive than low nApp clients. Crowne and Marlowe (1964) characterize high nApp persons as being generally somewhat disliked by other persons. In the Strickland and Crowne study there was a correlation of -.35 (p > .05) between therapist rating of liking the client and the magnitude of the client's M—C SD score. Therapist's rating of liking the client also correlated with his rating of the client's improve- ment in therapy (.40, p < .05). These relationships raise the question of whether the high nApp client's early termination and lack of improvement in therapy is due solely to his defensiveness or if perhaps it also results from therapists' differential responding to high and to low nApp clients. It is likely that therapists will respond differently to clients-they like than to clients they do not like, and the Strickland and Crowne study suggests that high nApp clients are liked less by their therapists. The relation of client nApp to client defensive— ness and to therapist liking of the client suggests the possibility of determining the effects of nApp on therapy by examining how client nApp influences conditions which have been demonstrated to facilitate constructive person- ality changes in persons with intrapsychic problems. A substantial body of research which grew out of Rogers' (1957) delineation of the necessary and sufficient condi- tions of therapeutic personality change has indicated that client self-exploration and therapist empathy, genuineness, and warmth are factors which should be present at a high level in the therapy relationship if the therapy is to produce constructive personality changes in the client. (Much of this research is summarized by Truax and Cark- huff, 1967 and by Carkhuff, 1967). It seems possible that unfavorable therapy outcome and termination results for clients high in nApp may result from the high nApp client's low level of depth of self—exploration due to his defensiveness, and from a low level of therapist em- pathy, genuineness, or warmth due to the therapist's‘ lesser liking of the high nApp client. This study will investigate the relation of nApp to only one of the three three therapist factors—-warmth, since this factor would seem to be the one most likely to be affected by ther- apist liking of the client. Hypotheses to be Tested The three main hypotheses to be tested are that client need for approval as measured by the M-C SD is inversely related to (a) depth of client self-exploration, (ID level of positive regard or warmth offered the client by the therapist,1 and(c) amount of improvement exhibited by the client in therapy. Another hypothesis about the effect of nApp on counseling clients is (d) that students seeking counseling fi— 1The words positive regard and warmth are used synonymously in this study. for personal-emotional problems will have lower nApp scores on the M-C SD than students not seeking such counseling. This hypothesis is derived from Crowne and Marlowe's gen- eral description of the high nApp person as a person who maintains a defensive, encapsulated picture of himself and who is extremely sensitive to the social desirability as- pects of any behavior. Such a person could be unlikely to admit to a need for personal-emotional counseling, or to engage in it, since either of these behaviors might be seen as being somewhat socially undesirable—-as having con- notations of the person's being neurotic or unable to solve his own personal problems.1 A final hypothesis is (e) that on a questionnaire (see Appendix B) asking where they would go for help with emotional problems, students with high nApp will indicate less often than students with low nApp that they would go to a counselor or to a private psychologist and will in- dicate more often that they would go nowhere. Like hypoth- esis (d) this hypothesis is derived from the supposed 1Although the high nApp person might present his problems as being of an educational-vocational nature, Since seeking counseling for such problems is deemed more acceptable by society. unwillingness of the high nApp subject to admit to a need for person-emotional counseling or to engage in it. METHOD Subjects The subjects were 5 male and 21 female under- graduate students who sought counseling for personal- emotional problems at the Michigan State University Counseling Center. The age range of the client sample was from 18 to 28, with a mean of 20.4 years. From the beginning of March to the middle of April almost every new student coming to the Counseling Center was requested to take the M-C SD before his intake interview. Of the 60 students who sought counseling for personal-emotional problems during this period, the 15 scoring highest on the M—C SD and the 15 scoring lowest were asked to par- ticipate in this research. Of these 30 clients, 11 both began therapy and agreed to participate in this research. Another 15 subjects who were in therapy before March and who had M-C SD scores in the same high or low range as the first 11, are also included in the experimental sample. Thus the sample consists of 26 subjects, 14 who score low 8 on the M-C SD (mean score of 6.6) and 12 who score high on the M-C SD (mean score of 19.1).1 To test hypotheses (e) and (f), 243 students from an elementary psychology class were used as the sample of students not seeking counseling. Students in this class are enrolled in almost all the divisions of the university, and thus the sample can be considered fairly representa- tive of the undergraduate student body at Michigan State University. Independent Variable The independent variable in this study is need for approval as measured by the M—C SD. The Marlowe—Crowne Social Desirability Scale (see Appendix A) is a 33-item true-false questionnaire assessing the degree to which individuals avoid self— criticism and depict themselves in improbably favorable terms. In this study low nApp was defined as scores of 9 or less on the M-C SD, and high nApp as scores of 16 or *In comparison, the mean score of the patients in the Strickland and Crowne study was 11.9 with a standard deviation of 6.5. 10 more. These cutoff scores delimit the lower and upper 25%.of scores of students coming to the Counseling Center for personal-emotional counseling. Dependent Variables Depth of Self-exploration.——To measure this var— iable, Truax and Carkhuff's (1967) Depth of Self-Exploration Scale was used to rate recorded therapy interviews. Rat— ings on this scale range from a low of 0 where there is no personally relevant material discussed and no Oppor- tunity for it to be discussed to a high of 9 where the client is deeply exploring and being himself, or is achiev- ing a new perceptual base for his conception of himself or the world. A therapist rating of client defensiveness on a five-point scale (see Appendix C) was used as a second measure of client depth of self—exploration. Positive regard or warmth.--The level of positive regard or warmth offered the client by the therapist was rated from recorded therapy interviews using Carkhuff's (1967) Scale for the Measurement of Respect or Positive 11 Regard in Interpersonal Processes. Ratings on this scale range from a low of l where the counselor communicates clear negative regard and disrespect to a high of 5 where he communicates a deep caring for the client. Amount of improvement.--The client's amount of improvement was determined by two independent measures: a) therapist's ratings of client's gain from counseling (see Appendix C), and b) pre— to post-therapy changes on the number of deviant signs score (NDS) of the Tennessee Self-Concept Scale (TSCS) (Fitts, 1965). The TSCS con- sists of 100 self—descriptive statements. The subject uses these to portray his own picture of himself by rat— ing the item's degree of applicability to him on a five- point scale which ranges from "completely false" to "com- pletely true." The items of the TSCS are organized into a number of subscales such as the neurosis scale, the general mal— adjustment scale, the personality disorder scale and others. The NDS score is a count of the number of deviant features on all the subscale scores. It is the Scale's best index of psychological disturbance--identifying de- viant individuals with about 80%.accuracy (Fitts, 1965). 12 The difference between the pre- and post-therapy NDS score has been used in previous research as a measure of client improvement through psychotherapy (Ashcraft & Fitts, 1964). Procedure 1. Before their first therapy interview the clients took the M-C SD and TSCS. The high and low scorers on the M-C SD were se- lected to participate in the research as outlined above. When possible the third therapy interview was tape- recorded. However due to early client termination and to inaudible tape recordings, six cases were rated on the second interview and two on the first. The therapy interview was rated for the level of depth of self-exploration engaged in by the client and for the level of positive regard offered the client by the therapist. The mean rating of eight two—minute segments Spread throughout the inter— view was used as the rating for that interview. 13 The intercorrelation between two raters on five practice tapes rated for client depth of self explor- ation was .98 (p < .01). The intercorrelation on seven practice tapes rated for therapist level of positive regard was .85 (p < .01). At the termination of therapy the client was again administered the TSCS. The therapist also completed the rating scales judging client defensiveness and amount of improvement in therapy. To test hypotheses "(d)" and "(e)." the M—C SD and the short questionnaire of Appendix B were adminis- tered to the students of the elementary psychology course . RESULTS1 Table 1 compares the mean rating of self-exploration for clients high and low in nApp. The difference in mean ratings is insignificant at the .10 level. TABLE 1 Comparison of Mean Rating of Self-Exploration for Clients High and Low in Need for Approval m j _—___ ——===:=== Clients N M SD High in nApp 12 4.90 1.10 Low in nApp 14 5.36 .69 t 1.24* *p > .10. one-tailed test. Therapist ratings of client defensiveness were ob- tained for 12 of the low nApp clients and for 9 of the high nApp clients. Table 2 shOws the relation of nApp to rated — fl The raw data for the Counseloring Center client subjects of this study is presented in Appendix D. 14 15 TABLE 2 Relation of Client”s Need for Approval to Therapist Ratings of Client Defensiveness ======—— ‘—:::' _= Defensiveness nApp *” Low High Low 8 4 High 6 3 Fisher Exact Test. p > .05. client defensiveness. Therapist ratings of "very little." "some." and "moderate" defensiveness were grouped together as low defensiveness. while ratings of "fairly great." and "very great." were grouped tOgether as high defensiveness. A Fisher exact test (Siegel. 1956) on these results is insig- nificant at the .05 level. Thus in this sample nApp was not significantly related to depth of self-exploration nor to rated defensiveness; hypothesis "a" was not confirmed. A comparison of the mean rating of therapist warmth extended to high and to low nApp clients is presented in Table 3. The difference in mean ratings is insignificant at the .10 level. thus hypothesis ”b" was not confirmed. 16 TABLE 3 Comparison of the Mean Rating of Therapist Warmth Extended to High and to Low Need Approval Clients m; ____ 2!” Clients N M SD High nApp 12 3.34 .66 Low nApp 14 3.45 .35 t .55* *p > .10. one—tailed test. Previous research (Carkhuff and Alexik. 1967; Alexik and Carkhuff. 1967) has demonstrated that "high functioning" counselors (counselors previously determined to be very warm. empathetic. and genuine) increase warmth when the client de- creases self-exploration while "low functioning" counselors decrease warmth. For this reason the counselors of the pres- ent study were dichotomized into experienced therapists (counselors with the Ph.D.) and inexperienced therapists (counselors without the Ph.D.--practicum students or interns). The difference in warmth offered to high and low nApp clients was calculated within each group. Table 4 compares the mean level of positive regard offered to high and low nApp clients by experienced and 17 TABLE 4 Comparison of Experienced and Inexperienced Counselors' Mean Level of Positive Regard Offered to High and to Low Need Approval Clients Counselors Clients Experienced Inexperienced N M SD N M SD High nApp 7 3.64 .24 4 2.82 .45 Low nApp 7 3 22 17 8 3.63 .24 t 2.80** 3.12* *p < .OSTuEWOQEailed test." **p < .01. inexperienced counselors. two—tailed test. The inexperienced counselors offered significantly (p < .05) more warmth to the low than to the high nApp clients. while the experienced therapists offered significantly (p < .01) more warmth to the high than to the low nApp clients. The relation of client nApp and therapist rating of client success. or gain in therapy is shown in Table 5. Therapist ratings of "little or no gain" and "below average gain" were grouped as little gain. while ratings of "average 18 TABLE 5 Relation of Clients‘ Need for Approval and Therapist Ratings of Client Gain in Therapy Gain Clients Little Much Low nApp 4 10 High nApp 6 6 Fisher Exact test. p > .05. gain." "above average gain.“ and "markedly above average gain" were grouped as much gain. A Fisher exact test on these results is insignificant at the .05 level. Client nApp was not significantly related to therapist ratings of client gain in therapy. Client nApp was also not significantly related to the other measure of Client improvement in therapy--that is. to the TSCS NDS score. Due to scheduling difficulties and to early terminations. the TSCS was obtained both before and after therapy on only 6 of the high nApp clients and 10 of the low nApp clients. Table 6 compares the relation between the mean pre- therapy TSCS NDS scores of the high and low nApp clients 19 TABLE 6 Analysis of Covariance for High and Low nApp Clients' Post—Therapy Mean Number-of-Deviant-Signs Scores Source of Variation df MS F Unadjusted Need for Approval 1 151 1.36* Error 14 111 Total 15 Adjusted Need for Approval 1 47 .42* Error 13 111 Total 14 *p > .10. when the groups are matched on their pre-therapy NDS scores through an analysis of covariance. (The correlation between the pre and post-NDS scores in the high nApp group was .88. and in the low nApp group .05; hence the procedure described by Edwards (1960) was used to determine if there was a sig- nificant difference between the group regression coefficients which would have precluded the use of analysis of covariance on this data. The 3 of this test was insignificant. (§.= 1.72. df = 1.12). and the analysis of covariance was per- formed. 20 The analysis of covariance for the difference between the post-therapy mean NDS scores for the high and low nApp groups was insignificant at the .10 level. Since neither of the criteria of client improvement in therapy was signifi- cantly related to nApp. hypothesis "c" was not confirmed. The mean M-C SD score of clients coming to the Coun- seling Center with personal-emotional problems and the mean score of students in an elementary psychology class are shown in Table 7. The difference between these means is insignifi— cant at the .10 level. Students seeking counseling for per- sonal—emotional problems were no different in nApp than stud— ents not seeking such counseling. Hypothesis "d" was not confirmed. TABLE 7 Comparison of Mean Marlow-Crowne Social Desirability Scores? of Clients Coming to the Counseling Center and Students in an Elementary Psychology Class Subjects N M SD Clients 60 12.33 6.65 Students 243 13.21 5.31 t 1.08* *p > .10. two—tailed test. 21 Data relating to hypothesis "e" consisted of the ques- tionnaire responses of 215 students in the psychology class sample who completed the form. Of these students 28 indicated that they would go nowhere if they developed emotional prob- lems during the school year. and 26 reported that they would go to the Counseling Center or to a private psychologist or psychiatrist. Table 8 compares the mean M-C SD score of these two groups. The mean M—C SD score of the students stating they would go nowhere is significantly lower (p < .05) than the mean score of the students stating they would go to the Counseling Center or to a private psychologist or psychia— trist. This significant difference is in a direction oppo— site to that predicted. Hypothesis "e" was not confirmed. TABLE 8 Comparison of the Mean Marlow-Crowne Social Desirability Scores of Students Stating They Would Go To the Counseling Center if They Had an Emotional Problem and Students Stating They WOuld Go Nowhere Students N M SD 7 a b Who would go to the CC 26 14.65 6.05 Who would go nowhere 28 11.18 4.89 t 2.33* *p < .05. two-tailed test. aAbbreviated CC = Counseling Center bIncludes two subjects who stated they would go to a private psychologist or psychiatrist. DISCUSSION Need for Approval and Client Defensiveness It seems clear that client nApp was not related to client defensiveness or depth of self-exploration in this sample since neither of two independently obtained measures of defensiveness and depth of self-exploration was affected by whether the client was high or low in nApp. The difference between this finding and the high correlation between nApp and defensiveness in the Strickland and Crowne (1963) study may be due to the studies' different methods of obtaining subjects. In the Strickland and Crowne study all patients coming to an outpatient clinic were included in the study. In the present study clients were asked after their intake interview, or later by phone or mail, if they would participate in this re- search. Many declined. In fact, difficulty was encountered in trying to obtain enough subjects for the high nApp group. Since defensiveness or degree of self-exploration is probably a multi-determined behavior, it is possible that some clients high in defensiveness due to their high nApp may have refused to participate in research which required tape recording of their early therapy sessions. On the other hand, some high nApp clients whose defensiveness was 22 23 ameliorated by other factors may have agreed to participate in the research. Hence it is possible that the voluntary nature of client participation in this research may have re- sulted in a sample of subjects whose nApp does not bear the same relationship to defensiveness as does that of counsel- ing clients in general. Unfortunately in this study data were not kept on the percentage of high and of low nApp sub- jects declining to participate in the research. This could have served as another index of defensiveness and its rela- tion to nApp. Another reason why high nApp subjects were not more defensive in this sample. may be that they resolved the con- flict between maintaining a defensive. self-aggrandizing con- ception of themselves and meeting the demands of therapy for personal revelation by giving up their defensiveness. That is their need for the therapist's approval may have been stronger than their need to present themselves in an unre- alistically favorable light. Newberry (1967. pp. 339-400) describes this possibil- ity. In a study using introductory psychology students as subjects, Newberry did not find the direct relationship he expected between nApp (as measured by the M-C SD) and 24 defensiveness (as measured by the Minnesota Multiphasic Per- sonality Inventory_§ scale. the Rotter Incomplete Sentences Blank. and Goughgs Defensiveness Scale). As a possible ex- planation of the absence of the relationship between nApp and defensiveness in this study. Newberry suggests: Either (or both) of two types of behavior could have been operating here. First. the de— fensiveness could have taken an internally ori- ented form. where the high nApp subjects would have presented themselves in a favorable light because they have a highly vulnerable self— concept which must be protected at all costs; they cannot admit their deficiencies to anyone. even to themselves. This appears to be the type of defensive person described by Strickland and Crowne (1963) . . . . Second. the defensiveness could have taken an externally oriented form where subjects would have tried to please or impress the experimenter .simply to insure that he would display approval. Their need to protect a vulnerable self-concept may have been lower than the need to obtain ex- ternal gratification of approval needs . . . . It is also possible that individuals may choose either of the forms if the person with whom they are interacting provides them with a greater Opportunity to use one form rather than another. In this case. the defense could be viewed as a reaction to the environmental con- text rather than a "built-in" attribute of the subjects. In the present study the high nApp clients may have felt that they could gain approval by engaging in self— exploration and abandoning their defensiveness. Perhaps the psychologist therapists of this study provided clients 25 with a greater opportunity to exhibit this behavior than did the psychiatrist therapists of the Strickland and Crowne study. A final factor which might possibly account for the difference in defensiveness of subjects in this study and subjects in the Strickland and Crowne study might be the type of subjects tested. The clients in this study were college students in an age range of 18 to 28 (mean age = ~20.4). They had personal-emotional problems. but few of them were severely disturbed. The clients in the Strickland and Crowne study were patients at an outpatient psychiatric clinic. Their age range was from 20 to 54 (mean age = 33.7). and theirdiagnoses included prepsychotic and psychotic desig- nations. Thus the clients in the present Study were younger. less severely disturbed. and probably more educated than the subjects of the Strickland and Crowne study. It is possible that nApp dOes not have the same relation to defensiveness in this type of sample that it does in a sample composed of older. more severely disturbed. less educated subjects. 26 Client Need for Approval and Therapist Warmth Client need for approval was not significantly re- lated to therapist warmth over the sample as a whole. This however seems due to the fact that experienced and inex- perienced therapists reacted to client nApp in opposite man- ners and thus the differences cancelled out. The question remains as to what characteristic associated with nApp caused the experienced therapists to give high nApp clients more warmth but caused the inexperienced therapists to give low nApp clients more warmth. It was not defensiveness or depth of self-exploration because the high and low nApp clients did not differ on these variables. A variety of additional post-therapy therapist rat- ings were available on 9 of the high nApp clients and on 13 of the low nApp clients since these subjects were involved in other research. Two of these ratings which seemed re- lated to nApp were the therapist ratings of client dependency and the therapist estimate of the client's maturity (see Appendix C). Persons high in nApp might exhibit more dependency on the therapist. since they have such a strong need to be 27 approved of. since their self-evaluation is so entwined with others' evaluations of them. Persons high in nApp might also be considered less mature than persons low in nApp. Like children whose estimate of themselves is derived from their parents“ evaluations of them. high nApp persons have not yet matured to evaluating themselves except through the eyes of others. Therapists may react negatively toward Clients' clinging dependency or toward their childishness and lack of maturity. Inexperienced therapists might exhibit this nega- tive reaction by extending only a low level of positive re- gard to the client. while experienced therapists might recog- nize their negative reaction and try eSpecially hard to be warm to the client-~in much the same manner that high func- tioning counselors of the Carkhuff and Alexik (1967) study were more warm to clients who decreased their level of self- exploration. Tables 9 and 10 show the relation between nApp and therapist ratings of client dependency and between nApp and therapist estimate of client's maturity. For both rating scales therapist ratings of "very little" or "some" are classified in the tables as low dependency or maturity and ratings of "moderate." "fairly great." or ”very great" are 28 TABLE 9 Relation of Client Need for Approval to Therapist Ratings of Client’s Dependency Dependency nApp Low High Low 4 9 High 2 7 Fisher Exact Test. p > .05. TABLE 10 Relation of Client Need for Approval to Therapist Ratings of Client's Maturity Maturity nApp Low High Low 2 11 High 7 2 Fisher Exact Test. p < .01. 29 classified as high. A Fisher exact test on the relation be- tween nApp and therapist ratings of client dependency is in- significant at the .05 level. The high nApp clients were not judged to be more dependent that the low nApp clients. A Fisher exact test on the relation between nApp and therapist ratings of client maturity is significant at the .01 level. Therapists judged the high nApp clients to be significantly less mature than the low nApp clients. Some support for the prOposition that high nApp cli— ents“ lesser maturity annoyed their therapists is illustrated in the remarks of two therapists describing their high nApp clients: a) "Immaturity--a boyish way of dependently reSpond- ing. It turned me off-—." and b) "somewhat immature and ex- ternalized. Boring but bearable—-accurately reflects her de— velopmental age (13-15)." Each of these two experienced therapists was aware of this negative reaction to his cli- ent's immaturity. and each was rated above average in the level of warmth he extended to the client. Thus it does seem possible that in general counselors are annoyed by high nApp Clients' lack of maturity. and that experienced counselors recognize this and try to overcome it by offering more warmth to the client. while inexperienced counselors display their 30 annoyance by offering less warmth to the high nApp client. Although this interpretation can be made only very tenta— tively. it does seem worthy of further investigation. Need for Approval and Client Gain from Therapy» It is not surprising that high nApp clients were neither more nor less successful in therapy (as measured by therapist ratings of success and by changes on the NDS score of the TSCS). The high nApp subjects were no more defensive than the low nApp subjects, and their therapists were no less warm than the therapists of the low nApp sub- jects. Thus in this study nApp was not directly related to the two factors which might have affected the Clients' degree of success in therapy. It should be noted that in the Strickland and Crowne (1963) study the —.35 correlation between client nApp and therapist ratings of client's gain in therapy was insignif- icant at the .05 level. The present study. then. is the second study which found no significant relation between client nApp and client success in therapy. The outcome 31 measures of both studies do. however. indicate a trend for high nApp clients to be less successful in therapy. Need for approval alone may not be a strong enough factor to affect the outcome of therapy in a statistically significant manner; however. in conjunction with other per— sonality traits it might well exert an important effect. Client personality changes achieved in psychotherapy cer— tainly have many determinants. but each of these determinants may account for only a small portion of the change which occurs. In predicting therapy-induced personality change maYbe several or even many of these determinants should be taken into consideration. For instance in a multiple regres- sion equation with other predictor variables nApp scores might increase therapy-outcome prediction accuracy. even though nApp scores alone are not significantly (statistic- ally) related to the outcome measure scores. Although nApp was not related to the mean corrected post-therapy TSCS NDS scores. it was related to the correla— tion between pre- and post-therapy unadjusted NDS scores and to the variance of the difference between these scores. Table 11 presents these results. 1See Appendix D for a listing of these scores and their differences. 32 TABLE 11 Correlations between Pre- and Post-Therapy NDS Scores. and Variances of the Difference Between These Scores Clients r $2 High nApp .88 22.9 Low nApp .05 262.0 F 11.9* *p < .02. two—tailed test. There was a high correlation between the pre- and post-therapy NDS scores of the high nApp group. and no corre— lation between these scores for the low nApp group. Also the variance of the difference between pre— and post-therapy NDS scores of the low nApp clients was significantly greater than that of the high nApp clients. These different relationships may be due not to different personality changes in the clients after therapy. but to the different effects of nApp on the high and on the low nApp subjects' answering of the TSCS. The high nApp client's tendency to describe himself in a favorable. socially desirable manner might have de- creased his NDS score on the pre-therapy TSCS. Since the Strickland and Crowne (1963) study indicates that nApp is 33 not changed by psychotherapy. nApp would also decrease the post-therapy NDS score of the high nApp clients. The lower pre- and post-therapy NDS scores (see Appendix D) of the high nApp clients suggest that perhaps this occurred. Since high nApp affects both pre- and post-therapy NDS scores. these scores should be correlated and they are. For the low nApp client. however. nApp should not affect his tendency to give straight—forward responses to the TSCS. Any changes in the client caused by psychotherapy would be reflected in the low nApp client's pre- and post— therapy NDS scores. while such changes might be masked for high nApp clients by their test-taking attitude. There is less reason for the pre- and post—therapy NDS scores of the low nApp clients to be correlated since the correlation would be confounded by differing effective- ness or skillfulness of different therapists. Also the low nApp group's variance of the difference between pre- and post-therapy NDS scores may be larger because this difference reflects positive change. negative change. and no change from therapy. while the high nApp Clients' difference scores re- flect the close correlation between their pre- and post- therapy scores-~a correlation possibly caused by the Clients' 34 test-taking attitude. These considerations raise the ques- tion of whether the TSCS or any other self-report measure can be used as a criteria measure of therapy success for high nApp clients. Self—report measures of these clients may assess a social desirability test—taking attitude rather than the psychological traits of interest. Need for Approval_and_Tendency to Seek Therapy The lack of a significant difference between the mean M-C SD scores of the in-therapy and not-in-therapy groups in- dicates that nApp had no consistent influence on the tendency of students to seek counseling for personal-social prOblems. It is possible that nApp has no effect at all on this tend- ency. or it may have varying and inconsistent effects. For instance in one case high nApp might cause a student to re- frain from seeking counseling because he considers it a so- cially unapproved behavior. while in another nApp might cause a student to seek counseling because of the importance it (high nApp) focuses on disapproval which certain of his be- haviors may elicit from his associates. This later behavior pattern could be the cause of the difference between the mean 35 nApp scores of those students who stated on the questionnaire that they would go to the Counseling Center or to a psycholo- gist if they found themselves having emotional problems. and the mean nApp score of those students who reported they would go nowhere. The higher mean nApp score of those students who re- ported they would go to the Counseling Center or to a private psychologist may reflect the felt or expected disapproval which they believe emotional problems will bring on them from others. and which they would try to eliminate by entering psychotherapy. This higher mean score may also be a result of the testing situation. The subjects were students in a psychology class. They realized they were taking part in a psychological study. The high nApp subjects may have re— ported that they would go for help to the Counseling Center or to a private psychologist. because they judged this to be the socially desirable answer in this situation (i.e. When tested in a psychology class by a psychology graduate stud— ent. the "correct" answer to the question "Where would you go if you find yourself having emotional problems?" is: "to a psychologist." or some similar answer). 36 Further Research The present study has examined the effect of nApp on psychotherapy by examining its relation to: a) the tendency to seek counseling for personal-social problems. b) the de- fensiveness and depth of self—exploration the client exhibits in therapy. c) the level of positive regard offered the client by the therapist. and d) the amount of improvement the client makes through psychotherapy. Since there was no consistent relationship between nApp and tendency to seek counseling. further research can prObably be most profitably focused on the relation of Client nApp to: client success in therapy. client defensiveness in therapy. and therapist warmth offered to the client in therapy. The effectiveness of M-C SD scores used in conjunction with other variables in predicting personality change in ther- apy might be examined. Also the effect of nApp on self-report measures used as criteria of success in therapy should be in— vestigated. Some self—report tests like the MMPI with its‘g and L scales have correction factors which may adjust scores for the effect of social desirability or need for approval. Other tests. however. do not; and these later measures may be inappropriate as tests of personality change in high nApp subjects. 37 The question of why high nApp subjects in this study were not more defensive than low nApp subjects as in the Strickland and Crowne (1963) study needs to be answered. The effect of voluntary client research participation on this difference in findings could be assessed in future re— search by calculating the percentage of high and of low nApp subjects who decline to participate and using this as a meas- ure of defensiveness. This study's findings concerning the relation of nApp to level of warmth offered the client by experienced and in- experienced therapists needs to be replicated. In addition. further information on the relation of nApp to client matur- ity would be of interest. especially as to what particular aSpects of client maturity or nonmaturity are related to nApp and in turn to therapist reaction toward the client. A final aspect of nApp to be investigated in future research could be its relation to success of therapy with experienced and inex— perienced therapists. If inexperienced therapists extend less warmth to high than to low nApp clients. their low nApp clients might improve more. However if experienced therapists extend more warmth to high than to low nApp clients. their high nApp clients might improve more. SUMMARY This study examined the effect of client's need for approval (nApp). as measured by the Marlowe-Crowne Social Desirability Scale (M-C SD), on psychotherapy. The main experimental sample consisted of 26 undergrad- uate students engaged in personal-emotional counseling at the Michigan State University Counseling Center. Of these students, 14 scored high on the M—C SD and 12 scored low. For this sample the relation of client nApp to: a) client depth of self—exploration, b) therapist warmth offered to the client, and c) client gain from therapy was examined. Client depth of self—exploration was determined from: a) a recording of the third therapy interview (or in a few cases the first or the second) rated for client self-exploration using the Truax and Carkhuff Depth of Self-Exploration Scale, and b) therapist ratings of cli- ent defensiveness on a five—point scale. Therapist warmth offered the client was rated from the recorded therapy interview using Carkhuff's Scale for the Measurement of 38 39 Respect or Positive Regard in Interpersonal Processes. Client gain from therapy was determined by: a) changes on the number of deviant signs score of the Tennessee Self—Concept Scale before and after therapy, and b) ther- apist ratings of client gain on a five—point scale. A second experimental sample consisted of 60 stu- dents who came to the Counseling Center for counseling on personal-emotional problems and 243 students in an ele- mentary psychology course. The mean M—C SD scores of these two groups were compared to see if there was a tendency for students coming to the Counseling Center to have a low need for approval. A questionnaire was also administered to the psy— chology class students to determine if the students who reported that they would go to the Counseling Center or to a private psychologist if they had an emotional prob— lem would have lower nApp than the students who reported they would go nowhere. The results of this study indicated that there was no difference between: a) the self-exploration of high and low nApp clients, b) the therapist warmth of- fered to high and to low nApp clients, and c) the amount 40 of gain in therapy of high and low nApp clients. There was also no difference in the mean nApp score of clients coming to the Counseling Center and students in the psy- chology class. Finally, the students in the psychology class who stated that they would go to the Counseling Center or to a private psychologist if they had emotional problems had a significantly higher mean nApp score than the students who stated they would go nowhere. This is the reverse of what was predicted. The data of the study was examined to discover possible explanations for the failures of the hypotheses. It was discovered that experienced therapists (therapists with a Ph.D.) offered significantly more warmth to high than to low nApp clients, while inexperienced therapists (therapists without the Ph.D.) offered significantly more warmth to low than to high nApp clients. An analysis of available data also revealed that high nApp clients were rated as significantly less mature by their therapists than low nApp clients. The relation of these findings and others to the failure of the hypotheses and to the findings of previous research was discussed. Implica- tions for further research were mentioned. REFERENCES Alexik, M. & Carkhuff, R. R. The effects of the manipu- lation of client depth of self-exploration upon high and one low functioning counselor. Journal of Clinical Psychology, 1967, 23, 210-212. Ashcraft, C. & Fitts, W. H. Self-concept change in psy- chotherapy. Psychotherapy. 1964, 1, 115-118. Carkhuff, R. R. The counselor's contribution to facili- tative processes. Urbana, Ill.: Parkinsen, 1967. Carkhuff, R. R. & Alexik, M. Effect of client depth of self-exploration upon high and low functioning counselors. Journal of Counseling Psychology, 1967, 12, 350—355. Conn, L. K. & Crowne, D. P. Instigation to aggression, emotional arousal, and defense emulation. Jour— nal of Personality, 1964, 32, 163—179. Crowne, D. P. & Marlowe, D. The approval motive. New York: John Wiley, 1964. Edwards, A. L. Experimental design in psychological re- search. New York: Rinehart, rev. ed., 1960. Fitts, W. H. Tennessee Self—Concept Scale. Nashville: Counselor Recordings & Tests, 1965. Lamb, C. W. & Fretz, B. R. Motivation for treatment in an outpatient clinic: A pilot study. Newsletter for Research in Psychology. 1964, p, 14-15. Newberry, L. A. Defensiveness and need for approval. Journal of Consulting Psychology. 1967, 31, 396- 400. 41 42 Rogers, C. R. The necessary and sufficient conditions of therapeutic personality change. Journal of Consulting Psychology. 1957, 21, 95-103. Salman, A. R. The need for approval, improvisation, and attitude change. UnpubliShed master's thesis, Ohio State University, 1962. Siegel, S. Nonparametric statistics for the behavioral sciences. New York: McGraw-Hill, 1956. Strickland, B. & Crowne, D. P. Need for approval and the premature termination of psychotherapy. Journal of Consulting Psychology. 1963, g1, 95-101. Truax, C. B. and Carkhuff, R. R. Toward effective coun- seling and psychotherapy: training and practice. Chicago: Aldine, 1967. Tutko, T. A. Need for social approval and its effect on reSponses to projective tests. Unpublished doc- toral dissertation, Northwestern University, 1962. APPEND ICES 10. 11. 12. 13. 14. Appendix A THE MARLOWE-CROWNE SOCIAL DESIRABILITY SCALE Before voting I thoroughly investigate the qualifica— tions of all the candidates. I never hesitate to go out of my way to help someone in trouble. It is sometimes hard for me to go on with my work if I am not encouraged. I have never intensely disliked anyone. On occasion I have had doubts about my ability to succeed in life. I sometimes feel resentful when I don't get my way. I am always careful about my manner of dress. My table manners at home are as good as when I eat out in a restaurant. If I could get into a movie without paying and be sure I was not seen I would probably do it. On a few occasions, I have given up doing something because I thought too little of my ability. I like to gossip at times. There have been times when I felt like rebelling against people in authority even though I knew they were right. No matter whom I'm talking to, I'm always a good listener. I can remember "playing sick" to get out of something. 44 45 Appendix A——Cont. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. There have been occasions when I took advantage of someone. I'm always willing to admit it when I make a mistake. I always try to practice what I preach. I don't find it particularly difficult to get along with loud mouthed, obnoxious people. I sometimes try to get even rather than forgive and forget. When I don't know something I don't at all mind admit- ting it. I am always courteous, even to people who are disagree- able. At times I have really insisted on having things my own way. There have been occasions when I felt like smashing things. ' I would never think of letting someone else be punished for my wrongdoings. I never resent being asked to return a favor. I have never been irked when peOple eXpressed ideas very different from my own. I never make a long trip without checking the safety of my car. There have been times when I was quite jealous of the good fortune of others. I have almost never felt the urge to tell someone off. 46 Appendix A--Cont. 30. I am sometimes irritated by people who ask favors of me. 31. I have never felt that I was punished without cause. 32. I sometimes think when people have a misfortune they only got what they deserved. 33. I have never deliberately said something that hurt some- one's feelings. Appendix B QUESTIONNAIRE If you would find yourself having emotional problems during the school year, where would you be apt to go? (Circle only one) Instructor Counselor (in Counseling Center) Resident Assistant Health Center (Mental Hygiene Clinic) Parents Other students Clergymen Private psychologist or psychiatrist Nowhere Family physician 47 Appendix C COUNSELOR'S POST-THERAPY RATING SCALESl Directions: Circle the number (no "in between" ratings please) which best describes the client. Please try to rate every item even though your judgment may be quite tentative. How- ever, if you feel you have no basis at all for making a rating, you may circle the "X" at the right of each item. 1. Defensiveness during the interview: 1 2 3 4 5 Very 'Some Moderate Fairly Very Little Great 2. Your estimate of how much this client did gain from counseling: l 2 3 4 5 Little or Below Average Above . Markedly No Gain Average Gain Average Above Gain Gain Average 3. Amount of dependency client had upon his therapist: 1 2 3 4 .§ Very Some Moderate Fairly Very Little Great Great 4. Estimate of client's maturity for his age: l 2 3 4 5 Very Some Moderate Fairly Very Little (or average) Great Great 1Only the scales which were used in this re- search are reproduced here. 48 M-C SD Df DP Ex T W' TSCS NDS Pre Post ll Abbreviations of Appendix D subject Marlowe-Crowne Social Desirability Scale defensiveness rating improvement rating dependency rating maturity rating mean self-exploration rating therapist's status mean rating of therapist's warmth Tennessee Self Concept Number of Deviant Signs Score pre-therapy TSCS NDS post—therapy TSCS NDS difference between pre and post—therapy NDS scores female male experienced inexperienced not available 49 50 APPENDIX D RAW DATA FOR THE COUNSELING CENTER CLIENT SUBJECTS TSCS IDS S M-C SD Age Sex . Df I Dp M Ex T W Pre Post D 1 3 20 P 2 5 4 3 6.38 I 3.38 40 3 37 2 5 21 M 2 3 3 5.50 E 3.44 40 38 2 3 5 21 F 1 3 3 4 5.38 I 3.44 17 15 2 4 5 21 P - 1 - - 5.31 E 3.38 - - - 5 6 20 F 4 2 2 1 3.71 E 2.81 46 6 40 6 6 20 F 3 3 2 3 5.69 I 3.31 - - - 7 6 19 F 4 2 3 2 4.50 I 3.81 18 30 -12 8 7 28 F 4 3 3 4 4.88 I 3.94 27 14 13 9 7 25 P 4 2 2 3 6.19 E 3.15 - - - 10 8 19 F 3 4 3 4 5.19 I 3.71 - - - 11 8 21 P l 4 3 4 6.38 I 3.81 9 10 -1 12 8 18 F 2 4 4 3 5.19 E 3.50 42 29 13 13 9 22 M - 5 3 5 5.44 I 3.62 29 10 19 14 9 18 P 3 3 3 3 5.31 E 3.06 14 17 -3 M 6.6 20. 5.36 3.45 28.2 17.2 11.0 SD 1.10 .35 16.2 Range 3-9 15 16 19 F 4 3 3 3 4.81 I 2.88 17 7 10 16 16 22 P 4 2 3 2 5.75 E 3.81 28 13 15 17 16 20 M 2 4 4 2 5 50 E 3.62 33 27 6 18 17 20 F 2 4 3 2 3.12 I 3.56 - - - 19 17 19 F 2 3 3 2 4.88 I 2.44 - - - 20 17 20 F - 2 - - 6.19 E 3.50 - - - 21 18 18 M - 2 - - 2.38 I 2.38 - - - 22 20 20 F - l - - 5.50 E 4.06 - - - 23 23 22 F 2 4 2 4 5.62 E 3.25 5 3 2 24 23 19 F 4 2 2 2 4 19 E 3.71 - - - 25 23 21 M 3 2 4 2 4.62 E 3.56 11 5 26 23 18 F 2 3 3 l 6.06 E 3.62 10 9 1 M 19.1 19. 4.90 3.34 17.3 10.8 6.5 SD .69 .66 4.79 Range 16-23 STATE UNIV 1293030 RSITY LIBRARIE 01"le