A COMPARTSQH OF THE RELATWE EFFECTWENESS FF FFFFFFFFF DESEHSTTTZATTDN FFFFFFL FFFFFFF FFF FLFFFF FFFFFFFF FFFFF FFFFFFFFFFFFF LF FFF FFFFFFFFF FF LFFFFFFFFFFFL FFFF FFFF FF FFF‘FFFFFFF FFF FFFFFFFFFFi—i; TFFFF FFF FFF BFFFFF of PF D V MTGHTGFH STATE UNIVERSITY ‘ ADOFLPH DT LORETO" 1969 ' ~' This is to certify that the thesis entitled A COMPARISON OF THE RELATIVE EFFECTIVENESS OF SYSTEMATIC DESENSITIZATION, RATIONAL-EMOTIVE AND CLIENT-CENTERED GROUP PSYCHOTHERAPY IN THE REDUCTION OF INTERPERSONAL ANXIETY IN INTROVERTS AND EXTROVERTS presented bg Adolph O. DiLoreto has been accepted towards fulfillment of the requirements for Ph.D. degree in Education Q FF FF. FF MMp/ior professor Date June 6, 1969 0469 L I B R A R Y Michigan S Fate University 9 4 F WV“! . _,._._.?,,“____ —_I— .v ABSTRACT A COMPARISON OF THE RELATIVE EFFECTIVENESS OF SYSTEMATIC DESENSITIZATION, RATIONAL-EMOTIVE AND CLIENT-CENTERED GROUP PSYCHOTHERAPY IN THE REDUCTION OF INTERPERSONAL i ANXIETY IN INTROVERTS AND EXTROVERTS By Adolph Di Loreto The present study was organized in an attempt to compare the outcome of three distinct forms of counseling with two distinct client personality types in the treat- ‘ment of a specific, homogeneous problem. More succinctly, it was the purpose of this investigation to compare the Eglflfiilé Eiisgfiizggggg of Systematic Desensitization (SD), Rational-Emotive (RT) and Client-Centered (CC) group PSYChOtherapy in the reduction of interpersonal anxiety in introverts and extroverts. A detailed analysis of the client, therapist, and treatment variables served as a basis for the research hYPotheses which were developed and tested in the present StudY. These hypotheses were as follows: 1. With regard to the extroverts, the order 0f effectiveness of these three techniques in reducing interpersonal and "general" anxiety will be as follows (from most to least effeCtive): Client-Centered, Rational-Emotive, and S.Vstematic Desensitization treatment. Ht 1.1.1.“,71I-ull 1" .~:.,-.,1-,F--| ,...1 1-,... [-‘1‘3'1111 -,.,,, -.‘ “.>_H|u_, ,. ll‘vl’u’l I" ’l‘l." .1 ’1 'u"‘l'.l l.'-'I'l"1‘f|t' "-5!" ~- .1\" 1 I'IYI'Y .I-:| T ‘ ’ ‘ \ ‘ ' - - .-. - r", ‘ . ‘ ' . ‘- ~.. . .- . , ‘ I ~ F Fray : ;~‘ - 1 ' u ‘5‘ l ‘ . -' ‘ _ : so. . Adolph Di Loreto 2. With regard to the introverts, the order of effectiveness of these three techniques in reducing interpersonal and "general" anxiety will be as follows (from most to least effective): Systematic Desensitization, Rational-Emotive, and Client-Centered treat- ment. 3. Each of the treatment conditions will produce a significantly greater reduction in inter— personal and "general" anxiety than either of the control conditions. 4. The no-treatment (placebo) control condition will produce a significantly greater reduction in interpersonal and "general" anxiety than the no-contact control condition. Two hundred and seventeen §s from an Introductory Psychology class of approximately 600 volunteered to take the pre-test battery following a detailed explanation of the present research project as a program of help for students with interpersonal anxiety. One hundred and fortY-nine of the two hundred and seventeen students met the selection criteria. Of these, one hundred §s were then randomly assigned, within stratified blocks. to one of ten introvert and ten extrovert groups. EaCh 0f the twenty groups consisted of five gs. The modal com- Position of each group was two male and three female §S- Each of the ten introvert and ten extrovert groups were then randomly assigned to one of the three treatment or two control conditions, and then to one of the counselors Within treatment. The sixty gs in the treatment groups received roughly eleven hours of RT, CC, or SD group counseling Adolph Di Loreto The twenty students in the no-treatment (placebo) control group received approximately eleven hours of attention. Finally, the twenty SS in the no-contact control group met all the selection criteria but were never contacted and thus were unaware of their participation in the study. A two-way analysis of variance (5X2) with Scheffe post hoc comparisons was computed on the outcome and three month follow-up test data. The results of both analyses confirmed Hypotheses 3 and h. All treated §s had a lower post-test and follow-up anxiety level than any of the control §S. In addition, the no-treatment (placebo) controls had a lower post-test and follow—up level of anxiety than the no-contact controls. However, the placebo benefits were limited almost exclusively to introverts. Hypotheses l and 2 were only partially supported. While both CC and RT exhibited significant introvert— extrovert differences in the predicted direction, the SD treatment was equally as effective with both introverts and extroverts, It was hypothesized that the former results were due to the differential effects of HT and CC in eliciting self-exploration in introverts and extroverts, reSpectively. The latter findings were attributed to the detrimental effects of group SD with introverts. A COMPARISON OF THE RELATIVE EFFECTIVENESS OF SYSTEMATIC DESENSITIZATION, RATIONAL-EMOTIVE AND CLIENT-CENTERED GROUP PSYCHOTHERAPY IN THE REDUCTION OF INTERPERSONAL ANXIETY IN INTROVERTS AND EXTROVERTS BY Adolph/Di Loreto A THESIS Submitted to Michigan State University in partial fulfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY College of Education Department of Counseling, Personnel Services and Educational Psychology 1969 ACKNOWLEDGMENTS There were so many people involved, directly and indirectly, in the successful completion of this research project that it is almost impossible to mention them all individually. To those many university officials, secretaries, etc., I wish to eXpress my deepest appre— ciation for their time and the use of their equipment. In addition, Special thanks is extended to the raters in the present study: Paul Mierly, Holly Boyd, Cheryl Osborne, Jim Buigenthal, Fred Murray, and Bob Biener. Also, I would like to thank the therapists who worked with these students: James Barrick, Roger Bauer, James Crowley, Frederick Hill, Donald Jabury, and James Lowe. Furthermore, I would like to thank the members of my guidance committee: Dr. Gregory Miller, Dr. Robert Craig, Dr. Dozier Thornton, and Dr. John Jordon. Without the innumerable hours they spent with me in organization and preparation, this research would have never materialized. Special appreciation is extended to Dr. Miller, my guidance Committee chairman, for his patient, accepting attitude. Finally, I am particularly grateful to Patricia Whgenaar who typed and retyped the manuscript, handled the details of format, and assisted in the many hours of proof- reading. 11 .2 ' 1'...H.'.‘-‘/ .-‘:‘: r _ a . u . . . - ..... a . . ~_.- ,- r». \, ..Au» r<.- .- .m-v.‘ .‘ ~ .‘ .\ . .. a .. '\--—' ..:-_-....— g‘- ... 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',"- ._‘ ... .: . .c a.” {...-p: (crlr‘ I rr.’ hrvrt' :«rx'P: "7H." "t. ' "fl: "'- . . ..- . 1 ~ ‘ r . ._ .. x.... ... :' --. .. ‘.. ,1... .. ‘}rrf\{kr \vnu' r Irnnr I. 7 ‘ - - ..- . . -- .-. - .. . .. x . . -. ' .. .- vn. . tun u- I-I\l\l . I. 1‘ HI. - ; .‘um. ‘ ' '. l t . TABLE OF CONTENTS Page ACmOwIEDGMENTS C C O I C I I I O O i O O I l O C I O 11 LlsT 0F TABI‘ES I I 0 l O I i O I I O I O I I I I O O 0 v LIST OF FIGURES . . . . . . . . . . . . . . . . . . . viii LIST OF APPENDICES. . . . . . . . . . . . . . . . . . xi Chapter I. INTRODUCTION. . . . . . . . . . . . . . 1 Historical PerSpective. . . . . . . . 2 Current Status of the Problem . . . . . 4 Summary and Prospective . . . . . . . . . 8 Nature of the Problem . . . . . . . . . . . 9 Input Variables . . . . . . . . . . 10 Process and Outcome variables . . . . . 27 Follow-up Variables . . . . . . . . . . . 39 Statement of the Problem. . . . . . . . . . 42 Research Hypotheses . . . . . . . . . . . . 42 II. REVIEW OF LITERATURE Comparative Research: Group Treatment. . . 46 Comparative Research: Individual Treatment 48 Case Studies. . . . . . . . . . . . . . 48 Experimental Research . . . . . . . . . . 51 III I METHODO o I c o l c 1 l r t o I o u n a l o o 56 Subjects. . . . . . . . . . . . . . . . . 56 Instrumentation . . . . . . . . . . . . 56 Pre-treatment Battery . . . . . . . . . . 58 In-treatment Battery. . . . . . . . . . 59 Post-treatment Battery. a o I o o a I o o 60 I O O O C O C 3 6o Follow-up Battery . . . iii L ' I I l I I I u U I I l I I I I v n l I ~ I I I I u I I I I I . I I I q - I ‘ I I . l I I I I I o I , I l I . I I I I I I ' I I I v I I u l . I . ' ‘ o I I I I I I 0 “[31 Palm» A I I . I . I v I I I I I ‘ v I o I l -: o I I I I l . , .I r I . '1‘: 3113:' I . o u I I .r—I l I I I a .. :I' \ ~: I | I l‘ I v I I l . l \ a I I u (1 li'illitulfi {L'Hll‘lfln O-flall'll’] 1" 101! Chapter IV. V. VI. Procedure . . . . . . . . . . Treatment Counselors. . . . Treatments. . . . . . . . . Rational-Emotive Treatment. . . . . . . Client—Centered . . . Systematic Desensitization Treatment. . No-Treatment (Placebo) Control. . . . . No-Contact Control Group. . . . . . Experimental Design and Statistical Analysis ANALYSIS OF RESULTS . . . . . . . . . . . . . Input Data. . . . . . . . . . . . . . . . Process Data. . . . . . . . . . . Data on Client variables. . . . . . . . . Data on Therapist variables . . . . . . Outcome Data. . . . . . . . . . . . . Treatment Main Effects. . . . . . . Treatment Within Personality Type Effects Counselor Effects . . . . . . . . . . . Follow-up Data. . . . . . . . . . . Treatment Main Effects. . . . . . . Treatment Within Personality Type Effects Counselor Effects . . . . . . . . . . . . Summary . . . . . . . . . . . . . . . . . . DISCUSSION OF RESULTS . . . . . . . . . . Treatment--Control Hypotheses . . . . . . . Treatment Effects . . . . . . . . . . . . Counselor Effects . . . . . Generalization of Effects and Symptom Substitution. . . . . . . . Implications for Future Research. . . . . . SUMMARY AND CONCLUSIONS . . . . . . . . . . . B IBLI OGRAPHY I I I I I I I I I I I I I I I I I I I I I APPENDICES o a c o I a I c o o o o a I l n o o I o n 1 iv nun; ' ' l o c ‘ . . . , . - . . . . . , . ' I ‘ . . . . . . . ’ I ' ' ‘ ' ' . I I l y y \. ~ ‘ ' ' ‘ ' - - o o v u u . _ x, ' . . . . .. . _ . - . . , _ . _ ' ' I ' ' - - a n . . , , . ' ‘ u v . - . _ . ... _ .' I ,q.. _ ' ' ' ' c - . . ' ‘ ' I - v . . . . .1 .. A .. ._ . . ' ' I . . v 1 - A v, » - v. ‘ '1 J... >‘ as. . . . . , _ J; .. ' ' ‘ ‘ ' ' - ~ - v . . I ' ' ' ' ' ' - n 1 r. i. . . . . V .K_ "'-.‘\ . . . , . . , _ ' _ . ' ' I ~ . . ~ \» ~ . . ' _ . I ' . ; . ' - u . . . , ' . - . i . . . _ . . I I ' I ' ‘ ‘ ' . . . I . ' I - u a ' ' ‘ ' I I LIST OF TABLES Table Page (CHAPTER III) I. General Experimental Design and Procedure . . . 69 2. Experience Level and General Orientation of the Six Participating Counselors. . . . . . . . . 71 3. Specific Theoretical Orientation to Treatment of the Six Participating Counselors . . . . . 73 4. Frequency of Use of Specific Techniques by Each of the Six Participating Therapists . . 75 5. Therapist Self-Ratings of Personal-Social Characteristics on the Edwards Personal Pre- ference Schedule, Myers-Briggs Type Indicator, and Interpersonal Checklist . . . . 77 6. Experimental Design . (CHAPTER IV) 1. Intercorrelations Between the Interpersonal Anxiety Scales (IPAS), S-R Inventory, Inter- personal (S-R ) and General (S-R) Trait Anxiety Inye ntory (TAI), and Stage Anxiety Inventory (SAI) . . . . . . 9O - . . . 93 Analysis of Variance of Pre-test Data . 2. 3. Pre-test Means and Standard Deviations for Each of the Treatment and Control Groups . . . . . 9h N. Amount of Treatment Received by Each of the Treatment Groups and Amount of Attention Given the No-Treatment (Placebo) Control Ss.. 99 _During the 5. Number of Sessions Missed by EachS ' 0 ' I 101 Treatment Period . . . . . - l I. . . I \ l in] ' . . . 1N . -. "I' -. . .. '5' fl ' .. I . . . . - . .‘ . J'T .'. : _-- .L - F- ’ -. . -.._l\- r. . .'- .\ - . . . . —_. i' . J -i .I ' .‘ I a n ‘ :'. -'\ .v. ‘- -- -'- ... 'I 5‘. Table (CHAPTER IV) 6. Additional Treatment Received by Each S Prior to Treatment, During Treatment, and During F 011 0W_up o o I I o I a I h c 7. Percent of Time Spent in Conversation and Silence by Each of the Client-Centered (CC) and Rational-Emotive (RT) Counselors and SubjectS. O I O O I O o I o o I I O 8. Frequency of Use of Specific Techniques by Each of the Client-Centered (CC) and Rational- Emotive (RT) Therapists . . . . . . . . . . . Percent of Time Spent in Conversation and I O o 9. Silence by Each of the CC and RT Counselors and Subjects for Each Three-Interview Time Period. I ‘ I I I O O O t I I t l O l I I 10. Frequency of Use of Specific Techniques by Each of the CC and ET Therapists for Each Three- Interview Time Period . ll. Analysis of Variance of Therapist Variables of Accurate Empathy (AE), Nonpossessive Warmth (NPW), Genuiness (G), Overall Therapeutic Relationship (OTB), Intensity and Intimacy of Interpersonal Contact (IIIC), and Con- creteness (C) . . . . . . Post-test Means and Standard Deviations for Each of the Treatment and Control Groups. 12. C I O | 13. Analysis of Variance of Post-test Data. Pre- and Post-test Means and Standard Deviations lb. for Each of the Extrovert Treatment and Con- trol Groups . . . . . . . . . . . . . . . . . 15. Pre- and Post—test Means and Standard Devia- tions for Each of the Introvert Treatment and Control Groups. . . . . . . . . . . . .. l6. Scheffe Post hoc Comparisons of Post-test Means for Treatment Main Effects. . . . . .. . . . vi Page 102 123 125 129 130 133 134 136 137 138 139 Table (CHAPTER IV) l 1?. Scheffe Post hoc Comparisons of Post-test Means for Treatment X Personality Type Effects I O O Q C O O O C I O l I I O l O D O 18. Analysis of Variance of Follow-up Data. . . . . 19. Pre-, Post-, and Follow-up Test Means and Standard Deviations for Each of the Extrovert t O 0 Treatment and Control Groups. . 20. Pre-, Post-, and Follow-up Test Means and Standard Deviations for Each of the Introvert Treatment and Control Groups. . . . . . . . . I Scheffe Post hoc Comparisons of Follow-up Test 21. Means for Treatment Main Effects. . . . Scheffe Post hoc Comparisons of Follow-up Means 22. for Treatment X Personality Type Effects. . . vii Page 145 159 160 161 163 169 nah-T af-{aL 47r :I-UF‘.[.U'~, ,‘u \r . . . . - . . . . . . - . k l . \ . . . V“ . ' . . ‘r- l: V .. . . V‘ (l A? _. . - . . . . . ‘., . ~ ,- , J. 3' 3 .. ‘ . \ r'A . .3 . .. p, , vr\‘ '5 ‘.- ‘ r‘ .. )' e u _ " . . . . Cr : i . ' '1'" ' LIST OF FIGURES Figure (CHAPTER IV) 1. Weekly changes in mean level of client self- exploration for each of the Client-Centered (CC) and Rational-Emotive (RT) treatment groups (E=Extroverts, I=Introverts) . . . 2. Weekly changes in group mean on the State Anxiety Inventory for each treatment, each counselor and each client personality type (Extrovert = E, Introvert = I). . . . . . . 3. Weekly changes in group mean on Therapist Rating Sheet for each of the Client-Centered (CC), Rational-Emotive (RT) and Systematic Desensitization (SD) treatment groups, only (E= Extrovert, I- -Introvert). . . b. Weekly changes in group mean on the Index of Interpersonal Activity for each treatment, each counselor, and each client personality type (Extrovert = E, Introvert = I)-. . . . 5. Mean reduction in self-reports and behavior ratings of interpersonal anxiety, general anxiety, and defensiveness from pre- to post- treatment . . . . . . . . . . . . 6. Mean reduction in self-reports and behavior ratings of interpersonal anxiety, general anxiety, and defensiveness from pre- to post— treatment with placebo effects removed from each of the treatment conditions, only. . . . 7. Mean pre—post reduction in self-reports and behavior ratings of interpersonal anxiety, general anxiety, and defensiveness for each treatment and client personality type . . . . viii Page 105 108 114 118 142 um lh8 Figure Page (CHAPTER IV) 8. Mean pre-post reduction in self-reports and behavior ratings of interpersonal anxiety, general anxiety, and defensiveness for each treatment and client personality type with placebo effects removed from each of the treatment conditions, only . . . . . . . . . . 150 9. Mean pre-post reduction in self-reports and behavior ratings of interpersonal anxiety, general anxiety, and defensiveness for each treatment and each counselor . . . . . . . . . 152 10. Mean pre-post reduction in self—reports and behavior ratings of interpersonal anxiety, general anxiety, and defensiveness for each treatment and each counselor with average placebo effects removed from each of the treatment conditions, only . . . . . . . . . . ljh 11. Mean pre-post reduction in self reports and behavior of interpersonal anxiety, general anxiety, and defensiveness for each counselor and client personality type. . . . . . . . . . 156 12. Mean pre-post reduction in self-reports and behavior ratings of interpersonal anxiety, general anxiety, and defensiveness for each counselor and client personality type with average placebo effects removed from each of the treatment conditions, only . . . . . . . . 158 13. Mean reduction in self-reports and behavior ratings of interpersonal anxiety, general anxiety and defensiveness from pre- to follow- up testing . . . . . . . . . . . . . . . . . 165 14. Mean reduction in self-reports and behavior ratings of interpersonal anxiety, general anXiety, and defensiveness from pre- to follow- up testing with placebo effects removed from 167 each of the treatment conditions, only . . . . 15‘ Mean Pre- follow-up reduction in self-reportst and behavior ratings of interpersonal anxie y, general anxiety, and defensiveness for each 171 treatment and client personality type. . . . . ix Figure Page (CHAPTER IV) 16. Mean pre- follow—up reduction in self-reports and behavior ratings of interpersonal anxiety, general anxiety, and defensiveness for each treatment and client personality type with placebo effects removed from each of the treatment conditions, only . . . . . . . . 174 17. Mean pre- follow-up reduction in self-reports and behavior ratings of interpersonal anxiety, general anxiety, and defensiveness for each treatment and each counselor . . . . . . . . . 176 18. Mean pre— follow-up reduction in self-reports and behavior ratings of interpersonal anxiety, general anxiety, and defensiveness for each counselor and each treatment with average placebo effects removed from each of the treat- ment conditions, only. . . . . . . . . . . . . 178 19. Mean pre- follow-up reduction in self-reports and behavior ratings of interpersonal anxiety, general anxiety, and defensiveness for each counselor and client personality type. . . . . 179 20. Mean pre- follow-up reduction in self-reports and behavior ratings of interpersonal anxiety, general anxiety, and defensiveness for each counselor and client personality type with average placebo effects removed from each of the treatment conditions, only . . . . . . . . 181 ... . . V . n . e. \ _ . . l .. . . , .; . . r . . . . ._ . , , I s. . H . .. z . . _ . _ .. . . . « ~ . .. . . ., . r . . . ..u _ . . . . r.\_ . . . . x .. .. . , . . . . . P . u , . J . . . . .. .. . . w. . a . I , . . . .. . . .ulz u. r ./ l. .. . .. . ... I . . . .. J . _ . . .1 i . . . , .1 .. . . . . . . . , . u _ : . o . ‘ . . . . . . . . . . . .. w . t ., . .. . .. .. . . . A . , . .. l .. .. a , . , _ . .. . . . . L n . . . .. o . . . ... . i . I . . x v LIST OF APPENDICES Appendix A. B. Behavior Checklist of Interpersonal Anxiety . Pre-test, Post-test, and Follow-up Test Data Sheets. 0 O C O I l C 0 C O 0 I I 0 O I O Interpersonal Anxiety Scales (Form A & B) . . Index of Interpersonal Activity . . . . Therapist Rating Sheet. . . . . . . Therapist Personal Data Sheet and Therapist Orientation Sheet . . . . . . . . . Explanation of Interpersonal Anxiety and Rationale of Treatment Approaches Given to the v o o O o 0 Treatment Groups. . . . . . . . Profiles of Therapist's Scores on the Edwards Personal Preference Schedule, Myers-Briggs Type Indicator, and Interpersonal Checklist . Manual Employed in Classifying Each Therapist's In-treatment Verbal Behavior. . . . . Reminders Sent to Each of the Treatment Group Members Just Prior to Each Weekly Session . xi 0 Page 219 221 225 241 243 245 251 280 287 308 ( .. . "' u . . . . . . . . . . u ' - . ”.... . . . . . r '-‘ . I ' I - u - -.I- I \p . . .— - ll- . . . . . .x) .e ._:-. . .. ' ... ..-. .. . - r. .' ... . . -' - ' ... . . .-:- (3' ' . .\r - ' CHAPTER I INTRODUCTION Interest in the investigation of counseling and psychotherapy has both a history and evolution. It is unfortunate, however, that this common and long standing concern in the constructive change of behavior and personality has fractionated rather than unified the interested parties. As Rogers (1963) has pointed out: . . our differences as therapists do not lie simply in attaching different labels to the " same phenomenon. The difference runs deeper. An experience which is seen by one therapist as healing, growth—promoting, helpful, is seen by another as none of these things. And the experience which to the second therapist is seen as possessing these qualities is not so perceived by the first. We differ at the most basic level of our personal experience. Some people may feel that though we differ regarding specific incidents, . . , neverthe- less in our goals and in our general directions there is much agreement and unity. I think not. To me it seems that therapists are equally divergent in these realms (p. 7 The reasons for this current state of affairs can best be grasped by a more intense look at the evolution or Psychotherapy research. tril en: the: obse repe Iz'Oflnoe-v-mm 9’95 E —: . 2 Historical Perspective The era prior to the experimental investigation of psychotherapy can best be characterized as "academic tribalism." The various schools of psychotherapy which existed consisted of more or less loosely organized theoretical formulations based on biased and unsystematic observations which could not be controlled, and thus repeated, in any reliable manner. Consequently, adherence to any of these theoretical views was based on faith, con- viction and personal satisfaction, and loyalties were maintained and perpetuated by identification with a particular set of esoteric rituals (Bandura & Walters, 1963). Blocher (1967) seems to have captured the essence of this evolutionary process when he states: Much of the history of change in counseling and psychotherapeutic theory and practice contains elements which closely parallel those which tend to dominate the evolution of religious movements and political ideologies. In both cases a move- ment tends to be originated by a messianic figure, characterized by a kind of elan vital, who trans- lates a deeply moving personal experience into universalistic terms. This leader quickly attracts a group of worshipful disciples who immediately begin to generalize the precepts promulgated by the master into the most widely applicable terms (p. 4). With little more than faith and the sheer force of opinion to back their untested propositions and doctrinaire it is not surprising that these so-called assertions, coteries or "schools" existed as factions, oftentimes diametrically opposed to one another in terms of their aims, methods and goals (Arbuckle, 1967; Bandura & Walters, 1963: . 1 . .... . _ . i .. z _ _ . k i . L E:::I_________________________________________________________________________________________________I' 3 Rogers, 1963). However, with such a faith in the efficacy of their respective techniques, and its resulting hope, failures in practice engendered only a minimum of what Festinger (1957) has termed "cognitive dissonance." Both Phillips (1956) and Blocher (1967) have shown how a number of convenient expressions arose to buttress and thus justify these already well developed and deeply held personal convictions; i.e., "the client is unmotivated,"'he lacks ego—strength," "he doesn't have enough working-anxiety," etc. "The convenience of this type of thinking . . . for counselors who readily lose a third to a half of their clients prematurely, is, of course, obvious" (Blocher, 1967, p. 14). In any case, the net effect of these newly coined rationalizations was to effectively screen out any negative feedback by automatically attributing untoward consequences to defects in the client (Ellis, 1962). When coupled with the enormous resistance to extinction generated by relatively few "successes" delivered on an aperiodic schedule, these factors served only to reduce any dissonance which may have resulted from failures in practice, thus eliminating any reason for change or modification in techniques, Finally, dissonance between "schools" was further avoided by limited contacts between members of the dissonant factions. Even when they did interact, the violent polemics which resulted oftentimes generated more heat than light. According to Hoskisson (1965): L1, . . they . . get together and wrangle and defame each other and have a wonderful time, . . . much of specialized scientific publication seems to consist in mutual condemnation of each other's work (p. 29). With the introduction of the methods of science into this formerly sacrosanct domain, it was hoped that a common core of empirical knowledge would replace the theories based on tenacity, faith and intuition (Campbell & Stanley, 1963). This laudable, but peremptory, waive of optimism soon evanesced, however, when the predicted rapprochement somehow never really materialized. Current Status of the Problem In a summary of the overall impact of the past 25 years of research in counseling and psychotherapy, Shlien (1966) has pointed out that, "Continued subscription [to an existing school of psychotherapy] is based upon personal conviction, investment, and observation rather than upon general evidence" (p. 125). In a similar vein, Eysenck’s (1952)1 first review of the outcome literature concluded with, "The figures fail to support the hypothesis that [existing forms of] psychotherapy facilitates recovery from neurotic disorders" (p. 323). His more recent reviews (Eysenck, 1955, 1960, 1961, 1965), as well as 1For an explanation of these findings in terms of the therapist variable, see Traux and Carkhuff (1967). For an explanation in terms of pre-treatment individual differ- ences in clients see Blocher (1967) and Sprinthall (1967), For a general critique of the validity of Eysenck's inter- pretations see Kiesler (1966). "’ f: 1:" c.- 9 _=5-I 5 those of others (Bailey, 1956; Bandura, 1963; Levitt, 1957), have led to essentially the same conclusions.1 The factors contributing to this current state of affairs are many and varied. As we have seen, for a number of years this predicament was due to a lack of empirical research. However, as a number of authors have pointed out, the more recent causes stem from the fact that the existing empirical evidence is derived from such poorly organized and controlled research that the findings could be used to support almost anything, and thus, nothing (Blocher, 1967; Edwards & Cronbach, 1952; Kiesler, 1966; Paul, 1967; Sprinthall, 1967). In spite of this, researchers and practitioners alike have n23 tried to maintain a respectful tentative- ness commensurate with their real ignorance of the problem. Rather, there is a tendency among partisans of each of the various positions to apply one standard of adequacy to this inherently poor research when it supports their theo- retical position and an entirely different standard to the same type research when it is contrary to their position (Hunt, 1956). 1Cross (1964) surveyed the literature since Eysenck's 1952 review and found nine studies which used control groups. However, he felt they were so deficient h1other respects that the findings still could not be interpreted unambiguously. More recent reviews (Dittman, 1966; Patterson, 1966) have led to essentially the same conclusions. IIIIIIIIIIIIIIIIIIIEII::________________________________________________________________::==____7j 6 As Goldstein, et a1. (1966) have pointed out, it is not uncommon for clinically-minded researchers to disqualify and reject unfavorable results by pointing to methodological and control problems while at the same time citing favorably identical studies which support the More specifically, Bandura & position they advocate. walters (1963) have shown how psychoanalysts frequently reject negative findings when the research is based on a translation of psychoanalytic theory into learning terms on the basis of inadequacy of translation. Yet they embrace positive findings with such enthusiasm that the purely psychic dividends which result unite to compel and further seduce their continued belief and increased entrench— ment in psychoanalytic theory. The result? The era of "academic tribalism" is still with us. Schools of psychotherapy still exist with little more reliable, empirical foundations than before (Breger & McGaugh, 1965; London, 1964; Rogers, 1963). New schools continue to emerge here and there (Berne, 1961; Ellis, 1962; Eysenck, 1959, 1960, 1965; Salter, 1961; Stamphl, 1967; Wolpe, 1958) again as factions radically opposed to the traditional ways of psychotherapy. Freshly-minted ideas and glimmerings of understanding beecme so quickly encapsulated into the dogma of a "school" or coterie that they are seldom subjected to the scrutiny and "natural selection" of experimentation (Blocher, 1967; Breger & IIIIIIIIIIIIIIIIIIIIIIII:—______________“""""““““—_"_" 7 McGaugh, 1965; Dittmann, 1966). In fact, every effort is often made to protect and guard what each deems desir— able, should it be "mistakenly confused" with the facts of research, for ". . . nonconfirmation of a cherished hypothesis is acutely painful" (Campbell & Stanley, 1963; p. 3). ' Similarly, as before, these new schools maintain their autonomy, and thus avoid any potential cognitive dissonance, simply by building new jargons, creating new journals in which to publish their esoteric jargons (Behavior Research and Therapy, Voices, etc.) and generally divorcing themselves from the rest of the field. Successes by one school are either impugned as palliative, attri- buted to factors the critic's school deems relevant or blatantly disreputed (Rogers, 1963; Strupp, 1962; Wolpe, ’ 1963: Wolpe & Lazarus, 1966). Finally, as before, “Extremists on . . . [all] sides have not hesitated {in their expenditure of polemic words and ink] to discredit each other, even though well—controlled comparative studies are nonexistent" (Paul, 1966, p. 1). Although collapse into a shapeless solipsism and feckless relativism, which are the death of science, is not eminent or pressing, this joint-catharsis-against-a- c0mmon—foe makes for little more than personal harmony and satisfaction within each faction; it contributes little in the way of constructive, cumulative knowledge (Campbell —7——*' 8 & Stanley, 1963). It is true that these precociously inspired theories often replace one another from time to time, however, since this displacement is typically g2: the result of well controlled, comparative research, the product rarely augments existing knowledge or serves as a sequel to what has gone before (Blocher, 1967). In short, it adds to the history of psychotherapy, but not to its evolution. The overall effect of this condition is forceably demonstrated in Colby's (1964) analysis of the current predicament in psychotherapy——"Chaos prevails" (p. 347). Similarly, Rogers' (1963) statement graphically portrays the net results of this current state of affairs--"The field of psychotherapy is a mess" (p. 8). Goldstein, §§_§l. (1966) feel that a, ". . . skein of confusion . . . represents our current level of understanding of the field of psychotherapy" (p. 10). Finally, London (1964) has conceded that: A detailed examination of the surfeit of schools and theories, of practices and practi- tioners that compete with each other conceptually and economically, shows vagaries which, taken all at once, make unclear what it is that psycho- therapists do, or to whom, or why (p. v). Summary and Prospective As indicated above, a good portion of this "mess" is due to the fact that most existing schools of psycho- therapy are based as much, if not more, on faith and dogma 7". —7—'*’ 9 as on comparatively derived research findings. By worshiping their flimsy hypothesis into truths and then selecting research to bolster their already well developed personal convictions, these schools become implacable and categorically indestructable; e.g., immune to dissonant empirical findings (Matarazzo, 1965). Evolution, if it can be called that, takes the form of, ". . . a fadish discard of old wisdom in favor of inferior novelties" (Campbell & Stanley, 1963, p. 2). The foregoing analysis, although admittedly one- sided, is not intended to belie the importance of the immense problems and complexities which impede research in psychotherapy or allow, at best, for the most tenuous of controls (Rubinstein & Parloff, 1959; Shlien, 1968; Strupp & Luborski, 1962). Indeed, much of the defection from experimentation to essay writing may be based on this ; very fact. As intimated above, a substantial portion of ‘ this "mass" can also be attributed to very real and formidable methodological and control problems (Frank, 1959: Paul, 1967) as well as to the lack of a universal model for research in counseling and psychotherapy (Kiesler, 1966; Paul, 1966). flature of the Problgm If, however, counseling and psychotherapy are ever to mature beyond the level of ". . . an undefined technique IIIIIIIIIIIIIEIII7_________________________________—__________"”’* 10 applied to unspecified problems with an unpredictable outcome" (Raimy, 1950, p. 93), then experimenters must abandon research models which perpetuate distinctions between existing schools and adopt those which seek to i define their techniques, circumscribe its limits of applicability and demonstrate its efficacy in these delimited contexts (Gendlin, 1967; Gilbert, 1952; Kiesler, 1966; Sanford, 1953). In spite of the formidable obstacles created by methodological and control problems, and in the face of admonitions to the contrary (Hyman and Berger, 1965; Kiesler, 1966; Strupp, 1962), a number of investigators feel that there is an adequate paradigm for research in counseling and psychotherapy which follows the above pre- scription (Blocher, 1967; Edwards & Cronbach, 1952; Frank, 1959; Paul, 196?; Sprinthall, 1967). Such a design would consider simultaneously the following: (a) input vari- ables, (b) process variables, (0) outcome variables and finally, (d) follow-up variables. Let us consider each of these areas separately. Input variables Here we are concerned with the ingredients which 80 into or make up the treatment process; that is, client variables and therapist variables. With regard to the former we are concerned with the client's presenting pro his men Hit] lit} lOI'l 11 problem or distressing behaviors as well as the more stable personal-social characteristics which constitute his life style. In addition, the physical—social environ- ment or the client's life space completes this triad. With regard to the therapist, we are concerned primarily with the techniques he uses in treatment as well as the i more stable personal-social characteristics which constitute his life style or personality. Client Variables In terms of research methodology, client variables can be reduced to the dual problem of sample selection and treatment focus. Borrowing his strategy from research on the effects of drugs, Frank (1959) has suggested a most promising approach to this problem. It involves the selection and description of clients in terms of what he calls "target behaviors." In other words, clients who are going to be used as §S for research are selected on the basis of common or similar distressing behaviors. The description or operational definition of this common pre- senting problem then becomes the dependent variable in the research design. Furthermore, with this approach, the goal of treatment then becomes behavior change in a Specified direction. The efficacy of this approach has been successfully demonstrated by Paul (1966) in his attempts to reduce interpersonal-performance anxiety in c01198e freshmen. — r 12 Interpersonal Anxiety As A Target Behavior for Research Focus According to Paul (1966), therapy research should: . . . compare specific techniques in the treatment of an emotional problem that is delimited enough to allow rigorous experimental methodology, but significant enough to allow generalization from the findings and to have implications for further study in the broader field of counseling and psychotherapy (p. 9). It is the present author's belief that interpersonal anxiety is Just such a problem. Anxiety, generally, is found as a central explanatory concept in almost all contemporary theories of personality, and is regarded as a principal causative agent for such ‘ diverse behavioral consequences as insomnia, immoral and sinful acts, instances of creative self-expression, debilitating psychological and psychosomatic symptoms, and idiosyncratic mannerisms of endless variety (Spielberger, 1966). It has been observed to have untoward consequences on motor behavior and coordination (Luria, 1932; Malmo, 1966), cognitive effectiveness (Saltz & DiLoreto, 1965; Spielberger, 1966), and physiological functioning (Grinker, 1966; Malmo and Shagass, 1949). Even more important, anxiety reduction is a cogent aspect of most, if not all, eX1sting theories of maladjustment and is seen as a salient therapeutic goal by most practitioners. Interpersonal anxiety or anxiety which results from simple, routine interactions with other individuals IIIIIIIIIIIIIIIIIIIIT______________________——————————————————————————————————————————————" 13 is particularly debilitating since it can disrupt normal, but required, daily routines, make otherwise healthy individuals unhappy and dissatisfied with themselves, and generally create discomforts which are unfortunate and otherwise avoidable. Consequently, the area of anxiety generally, and interpersonal anxiety in particular, seems fertile ground for research from both a theoretical and practical point of view. In terms of a target focus for research, small interacting treatment groups provide a prototype stress situation for eliciting interpersonal anxiety and thus can be used as an objective criteria for assessing change in this target behavior from pre— to post-treatment by ! means of behavioral ratings. The importance of this type I of criteria has been exhorted by StruPP (1962) who states ‘H . . if psychotherapy is effective, the benefits must be somehow demonstrable in the person's behavior" (p. 457). In addition, since interpersonal anxiety undoubtedly restricts interpersonal activity, a periodic sample of interpersonal contacts can also serve as an external cri- teria for assessing both progress during the course of treatment, and outcome. The importance of using behavioral criteria external to the treatment setting has been noted by a number of researchers (Luborsky & Strupp, 1962; Paul, 1967; Zax and Klien, 1960). If one views the most important test of the effectiveness of a particular therapeutic treatment as 14 involving (a) change in the client's distressing behaviors as well as (b) change in these behaviors outside of the treatment setting, then these two criteria, in conjunction with client self-reports, go a long way toward achieving this goal. Even with selection on a homogeneous class of target behaviors, however, there is likely to be wide variation in the relatively stable personal-social characteristics of the client (Paul, 1967). However, if in addition to matching on target behaviors, clients are further selected, described and classified on the basis of these relatively stable life style characteristics, then pre-treatment variability among clients can be reduced even further. The importance of this type of research for purposes of assessing treatment effects unambiguously has been noted by many investigators (Blocher, 1967; Kiesler, 1966; Levinson, 1962; Paul, 1967; Sprinthall, 1967; Underwood, 1957). However, research of this nature is conspicuous by its absence. Personality type, although an admittedly illusive and somewhat arbitrary choice in terms of the available empirical evidence on personal-social characteristics, looms as a salient prognostic construct in the minds of many experienced researchers and clinicians (Blocher, 1967; Gelder & Wolff, 1967; Kiesler, 1966; Lang, et a1., 1965; Lazarus, 1963; Sargent, 1961: Sprinthall, 1967). As IIIIIIIIIIIII::f________________________________________________________________'_——_'_—"’ 15 luborsky (1962) has noted, "Of all the influences which are thought to determine the change a patient can make through treatment, the patient's personality is most often thought to be predominant" (p. 123). There are at least two reasons for this belief. First and foremost is the very real fact that the founders of nearly all existing forms of psychotherapy derived their theoretical formulations and based their techniques on observations of radically different types of clients (Kiesler, 1966). Secondly, the evidence which does exist, while not entirely satisfactory in terms of either scope or consistency, suggests that in fact coun- seling and psychotherapy, as traditionally conceived, are processes which have restricted applicability for only selected subgroups of the population (Blocher, 1967). Considered together, these two factors seem to suggest that perhaps different forms of treatment are needed for differing combinations of personality type and presenting problem (target behaviors). There is a growing body of extant evidence which suggests that therapists do in fact behave quite differ- ently with different types of clients (Dittmann, 1966; Matarazzo, 1965; Strupp, 1962). However, the relationship between this and outcome is unclear. In one study (Traux & Carkhuff, 1965), it was found that "therapist trans- Parency" was positively related to self—exploration in IIIIIIIIIIIIIIIIIIEZZ::44______________________________________________________——_*7W 16 both hospitalized neurotics and delinquent adolescents. However, whereas self-exploration was positively related to client improvement among the neurotic group it was inversely related to positive personality change in the delinquent population. Introversion-Extroversion As A Personal- Social Characteristic for Research Focus It is this author's belief that the dimension of introversion-extroversion has many attributes which warrant further interest and investigation. For one, a number of investigators have identified these two continuous, bipolar qualities as accounting for the majority of vari- ance on nearly all self—report personality questionnaires (Cattell, 1966; Eysenck, 1960; Guilford, 1959). Thus, we have here a major dimension of personality which is rela- tively easy to assess, has high empirical validity and is relatively independent of any 922, idiosyncratic operational definition. Personality attributes with such high construct validity are a rarity in this field and command further inquiry on that basis alone. Secondly, introverts and extroverts have been found to differ on a number of qualities which may be predictive of differential treatment outcome. Extrapolating from Pavlov's (1957) findings, Eysenck (1961) and Wolpe (1958, 1966) hypothesized that individuals differ with regard to (a) conditionability — 7 17 (the speed and firmness with which conditioned responses are built-up or learned) and (b) autonomic activity (which affects the strength and intensity of a response once acquired). Eysenck (1961) further maintains that these qualities are related to the excitatory and inhibi— tory potential of an individual's central nervous system and that the latter two factors can serve as a basis for classifying individuals along one of two dimensions: normal-neuroticism, or introversion—extroversion. ( Mowrer's (1966) concept of socialization further 6 elaborates the relationship between nervous system func- tioning and the development of introvert—extrovert types. Since socialization is seen as dependent on conditioning, individuals with strong excitatory and weak inhibitory potential would be expected to form strong and stable conditioned responses, which extinguish slowly, and thus be strongly socialized. Those in whom the inhibitory potential is strong and excitatory potential weak would be expected to form weak and unstable conditioned responses, which extinguish easily, and thus be weakly socialized. According to Eysenck (1961), "The former group would thus tend to develop introverted behavior traits . . . while the latter group would tend to develop extroverted behavior tmite" (p. 27). If this analysis is correct, it would seem that a form of treatment based on counterconditioning would be 18 more appropriate for introverts and one based in extinction more appropriate for extroverts. Wolpin & Raines (1966) and Singer (1968) have suggested that introverts may have better visual imagery than extroverts as they live in fantasy more and thus 'have more practice with visual imagery. Since he is cut off from his relationships with others (Hoskisson, 1965) his imaginary or fantasy life may, ostensibly at least, constitute reality for him. As Franks (1961) has implied, the introvert is a "thinking," "planning," or "ideational" type whereas the extrovert is a "doing" or "acting" type. Wolpin & Raines (1966) and Eysenck & Rachman (1965) have also noted that introverts are more dependent, suggestible and conforming. In fact, Wolpin & Raines (1966) have found that, ". . . scores on the E scale [of the Maudsley Personality Inventory] may predict more generally willingness to comply or conform" (p. 35). In addition, Eysenck & Rachman (1965) and Eysenck (1967) have suggested that introverts may prefer a more mechanical and impersonal form of treatment. Consistent with Franks' (1961) description pre- sented above, Eysenck & Rachman (1965) has characterized the extrovert as, ". . . sociable . . . needs to have people to talk to and does not like reading or studying by himself -. . he prefers to keep moving and doing things" (p. 19), He is "outgoing," "talkative" and "carefree" (p. 16). H: fun-.2121 <1i(1\ hue: nit-“UH! [HI IN] 3“” "1"1'11'3 D“"" 'J|l3\'o\l Isa an} alcf l4[«~l-}-(r.'.‘ alum an! i.-ul“0u hum! (ANSI) car-Hf: [Inc (331‘!) ownin' ‘- H"!"“' {magma-f Innoiv (3"3'I 5"QI’ 701:: o‘iru-vntiu? “In". bud-991437”; mull fats ’zrnm vagina-2‘. u! a-vll vorI-l Do oiruynx-neu ”Ml-b hr“) ::f 5r! GHHL ,1_:=~g;::r::l lanai-7 .41.“; an! l’ttE.".f urn/1v our-II '. "11’! ,‘rn-zl'fI-tn .) .‘Anuin 11“er :'(‘1’:'.'-!}L‘f:.: :.’.Z I'Inli :rn , .‘z; :3! 7'3. (f’ffnruf'v, , “In“! /.'.'<'r.:~.‘: ('IR.’.‘.‘.-R'J‘ :!.' ,5.’>.‘.'. f Pm! ’ Piaf, -/.'::~‘: '1. . ." "I? I.‘.‘ lam" :I': f.‘ 2':':'.-'- "L::::z.'.‘:~.’;bi" ‘7', " a;.'.":.::~-. 'g' “,d::.'.":.'."..“" a .3 .-:n rv.':2":.' :3? l u . I 7 g _ His-:12- 111 ,.::_..- , <7 19 Experimental studies of introversion—extroversion (Eysenck & Rachman, 1965) indicate that extroverts, as compared to introverts, have a higher IQ-vocabulary ratio and higher sociability. Furthermore, unlike the intro— vert, the extrovert is cut off from himself and his feelings (Hoskisson, 1965) since, as Fenichel (1941) has pointed out, acting or doing often serves to circumvent awareness of one's feelings or motives. All of these considerations, when taken together, suggest a form of treatment for introverts which is based on a counter-conditioning model, is somewhat impersonal and mechanical in nature and makes maximum use of the introvert's suggestibility, dependency and conformity as well as his excellent visual imagery. By the same token, the aforementioned also suggests a form of treatment for the extroverts which is based on an extinction model, is predominantly verbal in nature and requires involvement in an intimate and very personal group interaction which emphasizes looking at and focusing on one's "inner self" (e.g., thoughts, feelings, and fantasies). In concluding this section on client variables, then, it appears that the selection, description and class- ification of clients on the basis of pro-treatment indi- vidual differences provides a more adequate definition of the § sample, thus assuring greater replication of the sample across studies and insuring a clearer focus for the assessment of outcome. In addition, utilization .. ‘v ‘1' , J. 20 of a homogeneous problem area, within personality type, allows for more efficient assignment of §S and thus greater equivalence of treatment and control groups, since §s are classified along two dimensions simultane— ously. A11 in all, it appears that the radical reduction in client pre—treatment variability permitted by these two operational distinctions will undoubtedly lead to more easily interpretable findings, more readily repli- cable results, and will put us in a much better position to explain "inconsistent" or "contradictory" findings across studies. Therapist Variables Here we are interested in the therapist's approach (both his philosophical orientation to treatment and his therapeutic techniques) as well as the more stable personal- social characteristics which constitute his life style or personality. There are at least three ways in which the thera- pist variable (the effects of his personality vs. the affects of his approach) can be treated. The first approach, which exists predominantly in fantasy, involves using each therapist as his own control. The advocates of this approach (Paul, 1966, 1967) aver that by having each therapist administer each of the treatments, one can hold the personal-social attributes of the therapist constant 21 across groups, reducing placebo effects which may mas- querade as treatment. Not only is this goal impossible to achieve, but the strategy on which it is based is internally incon- sistent. Having therapists objectively indicate their degree of commitment to certain techniques, as Paul (1966) has done, excludes by definition an equal commitment to alternative approaches; the therapist's personality has already entered into his choice and commitment. Once this is done, findings, ". . . therapists who are open-minded enough to learn to use contradictory methods without exhibiting attitudes that would greatly affect their approach" (Paul, 1966, p. 6) becomes an axiomatic impossi- bility. Even if we were to grant the potential plausibility of this approach, it does nothing to circumvent the original problem, but rather creates a truly insoluable dilemma. That is, if one uses this approach and fails to achieve its supposed goal, then one is maximizing the differential influence of placebo effects in the direction of the techniques preferred by the therapist originally. If one, in fact, succeeded in finding such "open-minded" therapists they would most assuredly not be representative of other therapists of the same ilk. As Arbuckle (1967) has so aptly pointed out, "Differences in counselors automatically become differences in counseling" (P. 224). 22 Perhaps the clearest statement regarding the inseparable nature of therapist and therapy variables has been offered by Frank (1959) who states: It is obvious that the therapist and therapy variables cannot be completely sepa- rated. It is unlikely that a therapist can conduct different types of treatment with precisely equal skill or that his attitudes towards them will be identical. Therefore, differences in results obtained by two forms of therapy conducted by the same therapist may be due to therapist rather than treat- ment variables, especially since the faith of a therapist in a form of treatment may account for much of its efficacy (7). In our psychotherapy study the psychiatrists disliked minimal treatment. They gave it reluctantly and felt that they were short— changing the patients. The patients remained just as long in this type of treatment as in the other two, suggesting that they were not as lacking in confidence in it as the doctors (p. 17). An alternative, and even more absurd, approach is to attempt to get counselors to effectively role play con- fidence in techniques they regularly do not use or in which they do not believe (Snyder, 1962). This method, if effective, simply adds any placebo effects back in again, in haphazard and uncontrollable amounts, mitigating the entire purpose of this circuitous approach. If ineffective, one has once again introduced placebo effects systematically. The real problem here, as above, is that one never really knows when and if he has or hasn't failed. In addition, in view of Rogers' (1963) and Frank's (1959) observations, it becomes difficult to imagine a Client—Centered therapist, for I'lllllllllll::::: . 23 example, doing Rational Therapy or trying to role play confidence in such an approach, or vice versa! This is to say nothing of the inequity created by attempting to train three- to five-year veterans of Client-Centered therapy to do Rational Therapy in a week or less (Strupp, 1967, 1968). Finally, both of these strategies lend an air of artificiality to the research treatments which is not present in the clinical treatment settings in which these techniques are predominantly administered. This latter fact serves only to reduce the external validity or generality of the findings even further. Clearly, then, both of these approaches commit the error of misplaced precision. A partial solution to this problem can be achieved by assuming, as Arbuckle (1967) does, that certain thera— pists choose certain techniques because they are certain kinds of people; i.e., that the therapist's personality and his treatment techniques are integrally and inseparably linked. Then, by securing therapists who are committed to techniques which one wishes to compare, having each administer the techniques they respectively deem effective, and comparing what they say they do with what they actually do (by means of audio or video tape), one is in a much better position to assess treatment conditions as they are most often administered with little or no loss in scientific I'lllllllll"::::: . 24 rigor. Unlike some would have us believe (Paul, 1966, 1967), there is no reason to assume that this approach produces any greater variability in the administration of the treatments than the aforementioned strategies. With this approach, the more therapists repre— senting any one treatment, the more the results can be attributed to the effects of the treatment approach per se and not to any one therapist or his unique personal-social make up. This can be achieved either by replication within and across studies or, in larger facilities, one can begin to sample therapists within "school" or treatment approach just as one samples IQ, introversion, anxiety, etc., from a more general population. Viewed in this vein, the absurdity of using each therapist as his own control becomes even clearer since it would be tantamount to having each S serve as both introvert and extrovert or both high and low anxious, etc., within the same study. Another distinct advantage of this approach is that one can check on whether or not the assumptions of this model are met, a notable disadvantage of the previously discussed strategies. In addition to comparing what thera- pists say they do with what they actually do by means of tape recordings, objective assessment of the therapist's Personalesocial characteristics can be made and similari- ties and differences noted. When client variables are Spelled out in the manner described earlier, the date on thai tech thir cons crit 1116f] clusj ”it! these I; go Dist its, left , are 14 25 therapist personal-social characteristics can be compared with the data on client personal-social characteristics, since in many cases, assessment can be made by many of the same measuring devices. This is especially true of such personal-social characteristics as personality type, IQ, socio-economic status, age, sex, etc. To the remaining dilatories, this does not mean that our outcome results are simply a measure of therapist personal commitment. One can be strongly committed to walking to the moon, even though the efficacy of this technique (walking) can be proven virtually useless. This third approach attempts to hold personal commitment as constant as possible. Then, by using uniform outcome criteria for all treatment and control groups, the results can be interpreted as commitment to either effective or ineffective treatment, whatever the case may be. It should be remembered that Paul's (1966) con- clusions, strictly speaking, are relevant only to insight oriented therapists practicing systematic desensitization, and at last count, there doesn't seem to be too many of these individuals around. This, of course, assumes that we accept Paul's (1966) initial distinction between thera- PiSt personal-social characteristics and treatment techni- ques. If we discard this initial provision, then we are left with the conclusion that personal-social attributes are largely irrelevant to the issue of treatment techniques. 26 The approach offered above, however, allows us to con- clude that our personal commitment is either too effective or ineffective counseling, whatever the results support. In concluding this section on input variables, then, we have seen that selecting, describing and classifying both clients and therapists on the basis of pre-treatment individual differences makes for better controlled, more easily interpretable and thus more legitimately general- izable research. The importance of clearly defining the variables within these two broad domains has been exhorted by Garfield & Affleck (1961) who maintain that the time to begin outcome studies is prior to intake. Similarly, Strupp (1962) has noted the potential value of this area when he states, "Research might make an important contri- bution by refining the selection of particular patients for particular therapists and for particular therapeutic methods" (p. 471). In this manner, we may begin to bury the myths which, according to Kiesler (1966), have retarded progress in both the research and practice of counseling and psycho- therapy: namely, the assumption that clients, therapists, and treatments are homogeneous entities. In so doing, we will simultaneously give birth to the area of "individual differences" within the fields of counseling and psycho- therapy, an area which gave to psychology, generally, some of its earliest and most important discoveries (Sprinthall, 1967) . inte fame do I 86003 The 1 self. of St eere follc the k Imove 0f tr mt] the about tit th (EObbs News the ef: 301al: 2? Process and Outcome variables Process research, or the study of client-therapist interactions, owes its existence, reputation and current fame to two historical events. The first of these has to do with the traditional role ascribed to insight and the second with the so-called criterion problem. The Insight Model Until relatively recently, it was felt that client self-exploration leading to insight was thg modus operandi of successful treatment (Coons, 1957). Successful outcomes were believed to follow correct insight as surely as night followed day. Thus, the "natural" research focus was on the kinds of client-therapist interactions leading to "movement," "improvement," or "insight" during the course of treatment. Positive outcomes and generalization to "real life" settings could be expected to follow inevitably and thus need not be focused on directly. However, recent reviews of this area have clearly demonstrated that not only is this not the gnly way successful treatment comes about (Blocher, 1967; Matarazzo, 1965; Sprinthall, 1967) but that this entire model may, in fact, be in error (Hobbs, 1962; Paul, 1966; Szasz, 1961). In view of the above, it seems clear that treating process, rather than outcome, as product and assessing the effectiveness of one or more treatment regimes by so-called process research is precarious business, to say IIIIIIIIIIIIIIIIIIIIIZ7______________________________________________——*‘__-_'" 28 the least. With the uninevitability of success following insight it becomes immediately apparent that studies of the process of psychotherapy depend, for their validity, on the assumption that counseling and psychotherapy work (Frank, 1967; Greenhouse, 1964). However, in view of Eysenok's (1952, 1961, 1965) and Shlien's (1966) con- clusions, the tenability of this assumption seems in grave doubt. If, as we have noted earlier, counseling and i psychotherapy, as traditionally practiced, do work, they ‘ most certainly have restricted applicability for only a highly select subgroup of clients (Blocher, 1967; Sprinthall, 1967). The problems of process research are even further exacerbated by the fact that the very nature of the research focus (e.g., client-therapist interaction) precludes the use of adequate control groups. Certainly, the use of a no-treatment control group does little or nothing to improve the design of process research. Similarly, the use of a placebo control provides for only the barest minimum beyond which the findings are uninterpretable. Utilizing a comparative approach, where a number of treatments are administered, and thus a number of different types of client-therapist interactions are compared, does circumvent this problem somewhat. However, even with this approach, the absence of a control group makes it difficult to deter- mine any cause-effect relationships. Finally, without at ——— 1 29 least outcome, if not both pre- and post—test measures, the results are of dubious value since we are, in effect, assuming at least a uniform and more often a positive outcome. In this regard, Goldstein, et al. (1966) have offered very timely advice: Research efforts should be directed toward the study of outcome(s) of psychotherapy. . . . Only after we have been able to demon- strate that we can consistently produce a particular change in behavior as a result of a particular manipulation does it seem advis— able to expend effort in studying the “process" involved in the manipulation. We suggest that research be done on the changing of behavior . p. 10 . Similarly, Edgar (1966) has made what seems an empirically reasonable demand when he states that, "Good’ counseling must be judged in relation to 'good' outcomes" (p. 1029). The Criterion Problem Secondly, and certainly not unrelated to the above, is the fact that interest in process variables has been a product of defection from interest in outcome. This "flight into process" (p. 127) as Zubin (1964) has termed it, was due largely to the so-called criterion problem. The problem of deciding on what criteria to employ in evaluating outcomes owes much of its existence, and is mute testimony to the fact, that schools of psychotherapy Still exist. In fact, the so-called criterion problem has 30 virtually no operational definition outside the realm of "school" distinctions.l It is interesting to note that although there are at least as many potential areas of focus in process as in outcome research, and thus as many, if not more, potential "criterion problems,“ process research has never been strapped with this problem. This, it is believed, is due to the fact that process research was initiated and is currently being conducted by predominantly one "school" of psychotherapy: namely, the Client—Centered group, and since their beliefs about the nature of the therapeutic process are relatively homogeneous, at least more so than between schools, the "criterion problem" never openly appeared in this area. But it is most assuredly there, and thus, cannot be used as either an excuse for avoiding outcome research or a criticism of it. Furthermore, as both Frank (1959) and Paul (1966, 196?, 1967a) have demonstrated, the selection, description and classification of clients on the basis of relatively homogeneous pre-treatment variables, as described earlier, goes a long way in circumventing this problem. By lAlthough Strupp (1963) would have us believe that this problem is due solely to our lack of a theory of "normal" behavior, it seems he is saying the same thing since each “school" has an implicit or explicit theory of normal behavior and they are often in severe conflict with one another as Rogers (1963) has indicated. IIIIIIIIIIIIEIII7_________________________________________________________————fi___—’—i 31 selecting clients on common target behaviors, for example, we can begin to separate the criteria of successful treatment from school affiliation and in so doing construct a model for research which is more sensi— tive to client individual differences and less sensitive to the theoretical predelections of individual therapists. With this approach, we are in a much better position to assess the effects of counseling and psychotherapy in light of the only laudable criteria, whether or not the client gets better (Battle, et al., 1966; Betz, 1962; Hoppock, 1953; Rickard, 1965). This approach does not require the abandonment of process research, but rather involves a recasting of both into a unified model. Instead of treating the client-therapist interaction as the goal or focus of research, process variables could be incorporated into outcome research in such a manner so as to aid in the assessment and understanding of how change occurs, during the course of treatment, in the preselected behaviors one is attempting to modify. This approach calls for the fusion of outcome and process variables within a single model and involves measuring, (a) sequential outcomes as the client moves toward the ultimate goal of reduction in target behaviors and, (b) the kinds of client-therapist interactions which actually occur during each treatment session (Strupp, 1968). .- . .a In it ., 5.. - .IIH l. i a. ...—l. ?‘\..r . 1:1.rrg-I a P . If. IIIIII:T___________________________________—_______—_______________*44447" 32 By employing process data to assess how far along the client has come on his way toward or away from a predefined or expected goal, one is in a much better position to offer plausable explanations rather than wild speculations regarding the outcome results (Gelfand & Hartmann, 1968; Reyna, 1964). As Bandura (1968) has ' \ pointed out, "By confining analyses solely to outcomes, investigators could readily affirm all sorts of causal conditions with immunity"(p. 247). Finally, the sequential measurement of change in preselected target behaviors, both within and outside of the treatment setting, by either self-report or behavioral observation, will not only allow us to observe how behavioral change proceeds but will undoubtedly make future directional predictions more pro- bable and research more controllable, as well. Bandura (1968) has captured the essential features of this paradigm when he states: In summary, one might reiterate the basic requirement that any study designed to eluci— date change processes should include adequately measured outcomes that are systematically linked to their presumed controlling variables. When causal linkages are loose and ill-defined, ; spirited disputes flourish but little headway is made in delineating the conditions con- trolling behavioral changes and the mechanisms through which the effects are produced. (p. 249) cen1 one com have 51m West In te r” o: r1min 33 The Comparative APPEQEEE In addition to the aforementioned, there is a third, and related, problem which has hampered the evaluation of counseling and psychotherapy. This problem centers around the use of a research model which compares one treated group with one untreated or (no contact) control group. It seems of little or no value, in terms of adding to our general fund of knowledge concerning the efficacy of counseling and psychotherapy, to employ a simple treatment no-treatment model (Edwards & Cronbach, 1952; Paul, 1967). To demonstrate the effectiveness of a particular treatment by comparing it with no treatment at all, at least in psychotherapy research, is in effect stacking the cards in one‘s own favor (Bergin, 1963; Blocher, 1967; Kiesler, 1966). All forms of intervention from faith healing to aspirin to psychoanalysis will undoubtedly produce some desirable effects, as will simply the passage of time (Eysenck, 1952). As the above implies, and as a number of researchers have noted (Blocher, 1967; Kiesler, 1966: Paul, 1967), the simple treatment no-treatment model asks a meaningless question, e.g., "Does psychotherapy work?" Furthermore, in terms of research methodology, this paradigm provides for only the barest minimum beyond which the research findings become uninterpretable (Campbell & Stanley, 1963; 34 Goldstein, §£_al., 1966; Underwood, 1957). Finally, since all forms of intervention undoubtedly "work," this model, like the simple process model discussed earlier, serves only to perpetuate "school" distinctions by maxi- mizing the occurrence of "positive" outcomes. Research which purports to demonstrate the efficacy of a particular therapeutic approach must be based on a multivariate comparative model which either (a) compares the outcomes of different techniques with the same problem, and/or (b) compares different problems with the same techniques, again on the basis of outcome and follow-up. Although an attention-placebo group may serve as an alternative treatment (Paul, 1967), consider- ably more information is gained by employing two or more "traditional" treatment approaches, in addition to a placebo and no-contact control group. The comparative approach allows for (a) a test of the relative effectiveness of each of the treatment tech- niques, (b) aids in pinpointing which approach(es) works best with which problem(s) and which type(s) of client, and (0) provides for the elimination of the maximum number of rival, yet plausible, explanations of the obtained results, which of course, is the goal of empirical research (Campbell & Stanley, 1963). With regard to this latter asset, the comparative approach is potentially without equal, Moreover, it also has the potential of minimizing .. ......H 3...... K ‘. 35 or even ultimately eliminating the "schools" approach, replacing it with a systematic eclectic approach founded on a common core of empirical knowledge derived from the commonalities and uniquenesses of each of the various competing approaches now in existence. Grummon (1965) has captured the importance of this approach when he states that: If we are going to rest our case about the effectiveness of counseling on whether or not it promotes this or that desirable behavior, we must also consider whether some other pro— cedure might not produce the result more economically and to an even greater degree (p. 63). We need much more of this kind of information before we can make intelligent value judgements about the usefulness of par- ticular kinds of counseling (p. 64). This is especially important in an area such as counseling and psychotherapy where all approaches to treat- ment implicitly or explicitly claim to be effective with all problems. As London (1964) has pointed out: Now if this plentitude of treatments involved much variety of techniques to apply to different persons under different circumstances by different Specialists, there would be no embarrassment of therapeutic riches here, just as there is not within the many specialties of medicine or law or engineering. But this is not the case, . . . . One hardly goes to a psychoanalyst to be cured of anxiety and a nondirective therapist to be treated for homosexuality, as he might to a cardiologist for one condition and a radiologist for another. Nor does the same doctor use Freudian therapy for psychogenic ulcers and Rogerian treatment for functional headaches, as a physician might use medigine for one ailment and surgery for another p. 0 . 011 Sys Com tre atii all the H01; full IIIIIIII:_________________________________________________________________________V "v" 36 Client-Centered, Rational-Emotive, and Systematic Densitization Therapy as Comparative Approaches for Research Focus The decision to utilize these three particular treatment approaches was based on a number of consider- ations. First and foremost among these is the fact that all three of these treatment approaches have dealt with the problem of interpersonal anxiety theoretically (Bandura & Walters, 1963; Ellis, 1962; Grummon, 1965; Rogers, 1955; Wolpe, 1958), and each claims to have treated it success— fully with the techniques they respectively advocate (Bartlett, 1949; Dymond, 1954; Ellis, 1962; Grummon, 1965; Grummon & John, 1954; Lazarus, 1960, 1963; Lazarus & Rachman. 1957: Rogers, 1954; Traux & Carkhuff, 1967; Wolpe, 1958; Wolpe, Salter & Reyna, 1964). Secondly, there is reason to believe that these three treatment approaches may be differentially effective with the dependent variable of interpersonal anxiety. For 3 example, Desensitization has been found to be quite effective with similar target behaviors (Lang, et a1., 1965: Lazarus, 1963, 1966; Paul, 1966, 1967a). Similarly, if Ellis's (1957. 1962) observations are correct, Rational-Emotive treatment may be superior to the more classical insight approaches such as Psychoanalytic and Client-Centered therapy, Although these approaches have never been compared in a single study, these preliminary observations suggest a tentative 37 order of effectiveness as follows: Systematic Desensi- tization, Rational—Emotive and Client-Centered treatment. Furthermore, the characteristics of introverts and extroverts, presented earlier, may well make them differentially receptive to these three different forms of treatment, thus producing different outcomes. For example, if we have legitimately characterized the intro— vert as one who would profit most from a form of treatment based on counter—conditioning and one which makes maximum use of his suggestibility, dependency, conformity and excellent visual imagery, then Desensitization is probably the most appropriate and Client—Centered the least appro- priate form of treatment for him. Similarly, if we have legitimately characterized the extrovert as one who would profit most from a form of treatment which is based on extinction, but which is predominantly verbal in nature and requires involvement in an intimate and personal group interaction which emphasizes self-exploration, then Client-Centered treatment seems the most appropriate and Desensitization the least appropriate form of treatment for him. Finally, these three approaches represent radically different forms of treatment in terms of technique, treat- ment model, and level of organization addressed during treatment (affective, behavioral, cognitive). By maximizing 38 the treatment differences, in this manner, we may be in a much better position to control and check on the ongoing in-treatment procedures and thus make more definitive cause-effect conclusions, while capturing the essential features of most contemporary systems of psychotherapy currently in existence. In summary, then, it is this author's view that, although "schools" were the inevitable consequence of theories based on tenacity, faith and intuition, they have continued to exist largely because the bulk of con- temporary research is of a process and treatment no-treatment nature and thus addresses itself to meaningless questions. Not only do these approaches yield very little useful information, but they tend to maintain and perpetuate school distinctions by allowing therapists to transfer their loyalities and affections from a set of highly eso- teric rituals to a highly selective body of "empirical findings" without ever once taking a closer look at their underlying personal convictions (Hunt, 1956) or whether these commitments are justified in terms of either the available evidence or competing approaches. It is this pseudo-scientific base which makes these schools currently so implacable and unyielding. In order to overcome this predicament, it is believed that research in counseling and psychotherapy must move in two directions. First, we must move from “Him 39 research which emphasizes process to research which emphasizes outcome, but includes relevant process measures of client-therapist interactions as well as measures of sequential changes in the target behaviors under study, so as to aid in our understanding of why we got the results we did. Secondly, movement must occur from outcome studies which emphasize the use of a treatment no—treatment model to studies which emphasize research based on a multi- variate comparative model. With the inclusion of both process and outcome measures, in conjunction with assessment on relevant input variables, we can begin to ask the more appropriate question, "What form of treatment, administered by whom, is most effective for this particular client with that specific problem and under what set of circumstances?" (Blocher, 1967: Paul,l967). Not until we begin to employ research designs which address themselves to this question will we be able to circumscribe the limits of applicability of various techniques and demonstrate their efficacy in these delimited contexts, or put another way, to rid ourselves of the myths of which Kiesler (1966) speaks. Follow—up Variables The need for follow—up data on clients receiving counseling and psychotherapy is of the utmost importance. In an area where placebo effects confound with and frequently --Msinv_ 40 masquerade as treatment, only the passage of time will reveal whether clients have truely changed or are simply placating their therapists by reSponding in a socially desirable manner. Although this problem is less severe when objective behavioral criteria are employed, there are always immediate, short-term benefits which accrue from treatment but which never really become incorporated into the client's permanent behavioral repetoire. The other side of this issue is equally as important; namely, that what is learned or acquired as a consequence of treatment takes time to become effectively assimilated and implemented into action. The period immediately following treatment is undoubtedly the most crucial in terms of which behaviors will be discarded and which incorporated into the client's way of life. Thus, without at least a brief follow-up period, treatment approaches may well get branded as either effective or ineffective on the basis of spruious information alone. This is to say nothing of the importance of checking on such currently controversial phenomenon as spontaneous remission, symptom substitution, or complete recitivism. As Sargent (1960) has pointed out, however, '5 . . the importance of follow-up is equaled only by the magnitude of the methodological problems it presents" (p. 101). The most important of these problems is the very practical difficulty of sample maintenance and 1-i41m: Jlnlr .I.||| l. .... . . . II . :- .. .. lWHJaHIl. dv111.fiu.udn-.HIH l...|| ll|.|1 . . .9 . . u... ...-...n. 1... My... - 41 attrition (Paul, 1967). Since the rate of dropout seems to be directly related to the amount of time between post-testing and follow—up, and since dropout rates tend to be differential, selectively biasing the follow-up findings, tactical decisions favor the use of a short-term follow-up since it improves the probability of total sample assessment. As Paul (1966, 1967a) has shown, when an ade- quate design with proper controls is evaluated by means of the same criteria, a six week follow-up is as good as a two-year one. Follow-up studies also suffer from, ". . . the uncontrollable nature of client experiences during the post-treatment period" (Paul, 1967, p. 333). This predi- cament may be eased somewhat by keeping the follow-up period brief and checking on such blatantly confounding factors as §s receiving additional treatment. Without some knowledge of whether or not §s receive additional post-treatment, cause-effect statements may be invalidly drawn. Thus, the need for follow-up studies is obvious. The practical problems which surround such an effort, however, favor the use of short-term follow-ups which employ identical criterion measures and make every effort to secure data on crucial client behaviors during this post-treatment period. - . I .1}! .... 1.3”, ....I..l.11....11n|..n.il.:4 .IdeJfH. 21-. .- s In.” ”.41! u. 42 Statement of the Problem In view of the preceding considerations, the present study was organized in an attempt to compare the outcome of three distinct forms of counseling with two distinct personality types in the treatment of a specific, homogeneous problem. More succinctly, it is the purpose of this study to compare the relative effectiveness of Systematic Desensitization, Rational—Emotive, and Client- Centered group psychotherapy in the reduction of inter- personal anxiety in introverts and extroverts. Research Hypotheses A review of the published literature revealed no studies dealing directly with the relationship between relative treatment outcome and personality type in clients with a specific, homogeneous problem. Consequently, the case studies and research presented earlier, which dealt independently with these variables, served as the basis for the research hypotheses which were developed and tested in this study. These hypotheses are as follows: 1. With regard to the extroverts, the order of effectiveness of these three techniques in reducing interpersonal anxiety will be as follows (from most to least effective): Client-Centered, Rational-Emotive, and Systematic Desensitization treatment. 2. With regard to the extroverts, the order of effectiveness of these three techniques in reducing "general anxiety" will be as follows (from most to least effective): Client- Centered, Rational—Emotive, and Systematic Desensitization treatment. 43 With regard to the introverts, the order of effectiveness of these three techniques in reducing interpersonal anxiety will be as follows (from most to least effective): Systematic Desensitization, Rational-Emotive, and Client-Centered treatment. With regard to the introverts, the order of effectiveness of these three techniques in reducing "general anxiety" will be as follows (from most to least effective): Systematic Desensitization, Rational-Emotive, and Client— Centered treatment. Each of the treatment conditions will produce a significantly greater reduction in inter— personal anxiety than either of the control conditions. Each of the treatment conditions will produce a significantly greater reduction in "general anxiety" than either of the control conditions. The no-treatment (placebo) control condition will produce a significantly greater reduction in interpersonal anxiety than the no-contact control condition. The no-treatment (placebo) control condition will produce a significantly greater reduction in "general anxiety“ than the no-contact control condition. book We); 111 Dr ““001 them I We < lore, CHAPTER II REVIEW OF LITERATURE In 1956, Corsini & Putzey located 174? articles, books and monographs dealing with the subject of group treatment. Their bibliography covered the fifty-year period from 1905 to 1955. In 1966, Lubin & Lubin located 1986 items dealing with the area of group treatment. Their bibliography covered the nine-year period from 1956 t0 1964. In spite of the fact that there has been an increase in the quantity of publications, with the number of items in the past decade exceeding that of the entire Previous half century, the number of publications which could be classified as research has not increased propor- tionally. Corsini & Putzey (1956) found only five items Which could be classified as research, all of which appeared in print between 1950 and 1955, Only one of these was an outcome study, none employed a control group and none of them was comparative in nature or attempted to gather any type of follow-up data on the clients under study. Further- more, in no instance was any meaningful pre—treatment data 44 45 regarding the S sample provided. Finally, other than the fact that they received "group counseling," "group therapy," etc., neither the treatment regime nor what actually transpired during the course of treatment was spelled out with any clarity. Although Lubin & Lubin (1966) located eleven items which could be classified as research, again only two studies used a control group, only one of them was comparative in nature and none gave any meaningful infor- mation regarding either client pre-treatment individual differences or type of treatment received. However, six of these were outcome studies (four with no control groups) which did obtain follow-up data anywhere from six months to two years after treatment. If these data are characteristic of any trends, there seems to be little evidence to suggest that researgh studies in group counseling and psychotherapy are improving in either quality or quantity. As Matarazzo (1965) has recently noted, "Research in group psychotherapy continues to be notable by its paucity" (p. 214). Research in the area of individual treatment seems to fare little better. In an attempt to evaluate the effectiveness of psychotherapy, Eysenck (1952) searched in vain for research which had included a control group in its design. He found no studies which included a COHtTOl group in his 1952 survey. Similarly, CTOSS'S (1964) 46 review of the outcome literature from 1953 to 1963 revealed only nine outcome studies which used a control group. However, he felt the designs were so weak in other respects that the findings still could not be inter— preted unambiguously. Finally, a brief perusal of the Annual Review of Psychology through 1967 reveals that the quantity of outcome studies with control groups has increased by only five since Cross's review. Although at first blush this may look like the quality of outcome research is improving, a closer exam- ination reveals that only one of these outcome studies (Paul, 1966, 1967a) reports adequate information on input, outcome, and follow-up variables in the context of a com- parative design. Comparative studies are a rarity and good comparative studies are even rarer. As we have seen, there is only one extant comparative outcome study of group treatment which employed a comparable control group. Furthermore, there are only a half dozen comparative out- come studies of individual treatment in existence. They will also be reviewed here in spite of the fact that they are only indirectly related to group treatment and are, by and large, of poor quality. Comparative Research: Group Treatment In an attempt to compare the relative effectiveness of client interaction vs. client insight, Coons (1957) randomly assigned sixty-six hospitalized patients to one Of three groups: one in which client interaction was 4? fostered, one in which client insight was fostered, and a no-treatment control group. Each treatment had three groups of seven members, leaving twenty-four control §s. Each group met for three, one—hour sessions per week for fifteen months. Two therapists administered the separate treatments. The dependent variable in this study was "adjust- ment" as measured by the Rorschach and "intellectual efficiency" as measured by the W-B Intelligence Scale. An "experienced Rorschach examiner" was given a pair of protocols for each g and asked to determine "which one represented the better level of adjustment." When the E's choice was the post-therapy protocol, the patient was considered improved. If E could not choose or if he chose the pre-treatment protocol, the patient was considered unimproved. As a reliability check, another Rorschach g was given twenty randomly selected pairs and instructed in a similar manner. His selections correspond with those of the first g in nineteen out of twenty pairs. 0n the W-B I, an F—ratio was computed on the mean changes for Verbal, Performance and Full Scale IQ from pre- to post- testing. In terms of both "better adjustment" and "increased intellectual efficiency" the interaction group proved far Superior to both insight and control groups, the latter two showing no significant differences. 48 There are a number of problems with this study, not the least of which is the author's passing reference to § attrition due to hospital discharge. Although §s were replaced, which helps somewhat, no data on patient turnover was provided. Similarly, no follow-up data were included either and no attempt was made to spell out the nature of the treatment received. However, the fact that pre- and post-test data were secured in the context of a controlled, comparative study vitiates these shortcomings somewhat, especially since this is the only comparative study on group treatment extant. Comparative Resgarch: Individual Treatment Case Studies Ellis (1957) attempted to compare the relative effectiveness of psychoanalysis (OP), psychoanalytically oriented psychotherapy (PCP), and rational therapy (RT) by examining his private case files to secure cases in which pp administered each of these techniques. He was able to secure seventy-eight "matched pairs" (diagnosis, sex, age, etc.) of clients who had received the latter two treatments and sixteen cases which he had treated by OP (total N=l72) . By rating clients as (a) "little or no progress," (b) "some distinct improvement," or (c) "considerable improvement," on the basis of case notes, he found the 49 following: for OP, fifty percent little improved, thirty—seven percent distinctly improved, and thirteen percent much improved. For POP, thirty-seven percent little improved, forty-five percent distinctly improved, and eighteen percent considerably improved. For RT, ten percent little improved, forty-six percent distinctly improved, and forty—four percent much improved. Chi-square analysis of the data indicated that RT was the most effec- tive and OP the least effective, with POP more effective than OP but less effective than RT. In terms of the paradigm presented in Chapter I, Ellis's "research" falls far short of an outcome study designed to evaluate the relative effectiveness of various forms of treatment. Most serious in this regard is the lack of a control group which makes it virtually impossible to distinguish client improvement Kipp treatment from client improvement because of treatment. The manner in which he selected gs only complicates this matter even further. A lack of follow-up, a failure to check on what actually transpired during treatment, and the fact that he administered all treatments himself further detracts from the quality of this study. Finally, he failed to report such crucial data as mean number of interviews and the criteria on which he based his improvement scale. 50 In a similar study, where the cases of practi- tioners of various schools were compared (Wolpe, et al., 1964), the following results were obtained. Percentage Psychoanalytic Therapy of Recoveries Knight , 1941 63.2 Brody, 1962 60.0 Behavior Therapy Wolpe, 1958 89.5 Lazarus, 1963 78.0 Although the differences here are impressive and overwhelmingly in favor of Behavior Therapy, it should be noted that these findings are subject to every criticism leveled against the data presented by Ellis (1957) above, and thus are far from conclusive proof of anything. A slightly more sophisticated, but nonetheless still non-experimental, study was reported by Lazarus (1966) in which he attempted to assay the relative merits of Behavioral Rehearsal, Advice Giving, and Non-Directive Therapy in the management of interpersonal fears. Although he designed the study and put forth the criteria of improvement prior to seeing any of the §s, the study never- theless represents a report of seventy-five case studies of interpersonally anxious patients. The author treated each § individually for four, thirtY-minute sessions and administered each treatment fro tre 861 out seq cli Alt] 01‘): Ref] Adv) Bah; Ref] were hen the e‘ M0; estm 51 himself on a "random" basis as clients sought treatment from him. Only those clients who admitted to no previous treatment were used. The criterion of success was client self—report of increasingly more effective behavior, outside of treatment, in the interpersonal area. Con— sequently, the criteria undoubtedly varied somewhat from client to client. In any case, the treatment they received, as well as the criterion of success, was poorly reported. Although this may begin to sound redundant, the same criticisms offered above are relevant here, as well. In any case, the following results were obtained. Outcome of Treatment Evidence of Learning % Reflection & Clarification 25 8 32 Advice Giving 25 ll 44 Behavioral Rehearsal 25 23 92 Of the thirty-one §S who did not benefit from either Reflection and Clarification or Advice Giving, twenty-seven were then treated by Behavioral Rehearsal. Of these, twenty-two, or eighty-one percent, "improved," bringing the overall level of effectiveness of Behavioral Rehearsal to 86.5 percent. Experimental Research Shlien (1957), Shlien (1964) and Shlien, Dreikurs & Mosak (1962) report on a study where changes in self- esteem (self—ideal correlation) of clinic outpatients was —: 7 52 investigated by means of the Q-sort technique. In this, the pioneer factorial study in the field of psychotherapy, the authors were interested in the differential influence of (a) Adlerian vs. Rogerian treatment and (b) time- limited vs. time-unlimited treatment on self—esteem. Although gs were unaware they were getting different kinds of treatment, a portion of them were told they would be (time-) limited to twenty interviews because of long waiting lists. The remainder were allowed to terminate at will and did so in a mean number of interviews of thirty- seven. Different therapists administered the respective treatments according to their own predilections and no attempt was made to check on whether in fact two different treatments were really administered. Two matched control groups (own-control & "normal" control) and three treatment groups (two time-limited, one time-unlimited) were then compared at a number of points during treatment as well as one year after termination. The results showed (a) no differences in time- limited vs. time-unlimited treatment, (b) no differences between Adlerian vs. Rogerian treatment, (c) significant differences between treatment and control §S, and (d) significant changes as early as the seventh interview in §s who ultimately improved. Although this study is unique in its factorial design and use of pre- and post-test measures with control goo sho mat) the con rep bes1 0110! fro! stud cede sues preh fitte free} Bose] (plat from these admin 88m {lean l08h —: 7 53 groups and follow-up data, it does have some blatant shortcomings. The most obvious of these is the use of matched rather ppgp randomly assigned gs. In addition, the use of gs from a different population ("normal" controls) seems inevitably to produce differential regression rates. Even the own-control group is not the best since they waited sixty days and were tested at least once more than the other control gs. In spite of the fact that these criticisms detract from the quality of the overall research design, this study stands as a seminal document in terms of what pre- ceded it. Following the trend set by Shlien and his collea- gues, Paul (1966, 1967a) has reported an even more com- prehensive and well-controlled comparative study. He attempted to treat the problem of speech anxiety in college freshmen by classical insight methods (neo-Freudian and Rogerian), systematic desensitization, and simple attention (placebo). He was able to secure ninety-six volunteers from an initial population of 710 students and assigned these §s at random to five different therapists who each administered all three treatments in five therapeutic sessions. The criterion of success was statistical signi- ficance on a number of self-report questionnaires, physio- logical measures, and behavioral ratings of each § while the wee iorf tree rice not exec pote Firs ness IIIIIIIlIIIII—————————————————————————————————————————————————————————————'——’ 54 they were actually giving a speech. Measures in all three of these areas were secured pre-, post-, at six weeks after treatment, and two years after treatment. The results unequivocally supported the super— iority of desensitization over both insight and placebo treatments. Although the latter two treatments were signi- ficantly superior to the no—treatment controls, they did not differ from each other. In spite of the obviously careful planning and execution of this study, a number of points regarding potential interpretative difficulties need mentioning. First, there is some question regarding the true random- ness of assignment of SS since, according to Paul (1966): Any § whose expectations of treatment were much different from the one assigned, and who furthermore did not appear to accept the ration- ale, was reassigned to another treatment. This was necessary for only two §s (p. 29). Secondly, the unit of analysis in this study was change in score from pre— to post-treatment. The use of change scores is questionable since they are notoriously unreliable (Harris, 1963). Finally, no attempt was made to check on the nature or quality of the insight treatment as it was administered (Strupp, 1967). Consequently, his conclusions must be restricted to therapists who say they are insight oriented, and not to insight-oriented therapy E££_§§. It should be remembered, however, that in spite ... . ' I . ' . 4 .- . _' \ .. . , . . . h I . . ~ ' ' ' ll _ -. L1,, . ._ l . .~ .. .- . , ~ I . - .' ... ~ I ' . ‘ . ‘ . I I n. . t. ' . . . i . ' - I . v . IIIIIIIlIIZI""""""""""""""""""""‘——————————————————————————v’ 55 of its shortcomings, Paul's study represents the best designed, most comprehensive comparative study to date. The brevity of this chapter, coupled with the fact that nearly as much space is devoted to criticism as to presentation of findings, is mute testimony to the ) fact that comparative research, especially in the area of group counseling and psychotherapy, is direly needed. CHAPTER III METHOD Subjects The gs for this study were one hundred (fifty- eight female and forty-two male) college freshmen and sophomores (mean and median ages of 18.8 and 19.3 years, respectively) from Michigan State University who volun- teered to participate in this project because of high self-reported interpersonal anxiety and a desire for treatment. This sample was obtained from a larger popu- lation of six hundred students who were enrolled in one section of Introductory Psychology at MSU in the fall of 1967. W119 The main battery of scales administered to this sample was designed to assess (a) client personality type (Myers-Briggs Type Indicator,1 Myers, 1962), (b) the target behaviors of interpersonal anxiety (Interpersonal Anxiety 1Although the entire test was administered, only the introvert-extrovert subscale was employed. 56 Scales, au Subsection Interperso Activity, . anxiety" (1. Subsection Spielberge: cellaneous the degree exploratio; Traux & Car thempflSt r tCarkhuff’ during trea Gorshuch, 1 Alt Study Was s Situations a °Perational aforement 10! rating scale 57 Scales, author; S-R Inventory of Anxiousness, Interpersonal Subsection,l Endler, et a1., 1962; Behavior Checklist of Interpersonal Anxiety, author; Index of Interpersonal Activity, author), and (c) the broader area of "general anxiety" (S-R Inventory of Anxiousness, Fear of the Unknown Subsection,2 Endler, et al., 1962; Trait Anxiety Inventory, Spielberger & Gorsuch, 1966). Finally a number of mis— cellaneous scales were employed in an attempt to gauge the degree of client defensiveness (Edwards Social Desir— ability Scale, Edwards, 1957), the depth of client self- exploration (Sgsic Scale of Depth of Self-Exploration, Traux & Carkhuff, 1967), the quality of the client- therapist relationship (Relationship Questionnaire, Traux & Carkhuff, 1967), and the course of anxiety reduction during treatment (State Anxiety Inventory, Spielberger & Gorshuch, 1966; Therapist Rating Sheet, Neuman, 1968). Although a salient criteria for inclusion in this study was S verbal report of discomfort in interpersonal situations and an expressed desire for treatment, the operational definition of these constructs was based on the aforementioned psychometrically scored questionnaires, rating scales, and checklists. For the crucial dependent lIncluded here were the following items: "Job Interview," "Competitive Contest," "Going for Counseling," "Speech Before a Large Group," and "Meeting a New Date." 2Included here were the following items: "Final Course Examination," "Alone in the Woods at Night," "Sail Boat," and "Crawling on a Mountain Ledge," variable 0 behavioral within and Thc treatment : (IPAS, for: (Interpersc the Tim 11ml < (ESD), and addition, h were secure 0f Interper the first 1; APhenolic: B) schedules, , by each S, 58 variable of interpersonal anxiety, both self-report and behavioral criteria were employed as well as measures within and outside of the treatment setting. Pre-treatment Battery The battery of scales administered prior to treatment included: the Interpersonal Anxiety Scalesl (IPAS, forms A & B), the S-R Inveppory of Anxiousness (Interpersonal, S-RI, and Fear of the Unknown, S-Bg), the Trait Anxiety Inventory (TAI), the State Anxiety Inventory (SAI), the Edwards Social Desirability Scale (BSD), and the Myers—Briggs Type Indicator (MBTI). In addition, behavioral ratings of interpersonal anxiety were secured on each S by means of the Behavior Checklist of Interpersonal Anxiety (see Appendix A) at the time of the first treatment session. Finally, a Data Sheet (see Appendix B) requesting demographic information, time schedules, and motivation for treatment was also completed by each S. lTwo forms of this one hundred item questionnaire, half of the items keyed "true" and half "false," were developed and independently validated by the author in a pilot study employing twenty Ss (see Appendix C). The Pearson product moment correlations were as follows: IPAS, forms A & B, r=.891; IPAS (combined score for form A & B) and S-RI, r=.683; IPAS (combined) and S-RG, r=.4ll; IPAS (combined) and ratings on a five-point scale of anxiousness, r=.619; S-R and ratings on the same five-point scale, r=.584, S-RG and ratings on the same five-point scale, I‘=-1’r75. Thus, the IPAS seem to have good alternate form reliability and are more valid when interpreted as a measure of interpersonal anxiety rather than "general anxiety." Th ment sessi completed Index of I: §during t! each weekl; completed 1 treatment 5 assess week View of the therapist ( 0f interper outside the \ . lTh We Criter determines . Emmy on flash § Was a EHLETPQISom teria. Back We tr Wt daiatmef leek-1y meet} .13in .inclde an 59 In-treatment Battery The battery of scales administered at each treat- ment session included: the Sgate Anxiety Inventory (SAI), completed by each S immediately before each session, the Index of Interpersonal Activity1 (IIA), completed by each S during the course of each week and returned prior to each weekly session, and the Therapist Rating Sheet2 (TBS), completed by each counselor immediately following each treatment session. These instruments were employed to assess weekly changes in anxiety level from the point of view of the client (SAI) and from the point of view of the therapist (TBS), as well as weekly changes in the amount of interpersonal activity (IIA) on the part of each S outside the treatment setting. lThis instrument, developed by the author, lists five criteria, the combined presence or absence of which determines the nature and extent of each Ss interpersonal activity outside of the treatment setting (see Appendix D). Each S was asked to keep a daily record of the frequency of interpersonal contacts which conformed to these five cri— teria. Each S submitted their log weekly as they attended the treatment sessions and was given a new one to be filled out daily, in the same manner, and returned at the next weekly meeting. The total score, derived by pooling the daily incidents of interpersonal contacts, thus served as an objective indicant of weekly changes in interpersonal activity outside of the treatment setting. 2This instrument, developed by Neuman (1968), is a five-point scale ranging from low (1) to high (5) anxious- ness (see Appendix E). Each therapist was asked to judge the degree of anxiety displayed by each S and circle the number (1 through 5) which best described each S's anxiety level during that session. Each therapist rated each S for each of the nine sessions. The total score, derived by pooling the weekly scores across Ss, served as an indication 0f weekly changes in anxiety level as viewed by the therapist, " .. _‘ . -‘_._ _. " " ‘4..-;L‘In‘y‘_'_.‘:'_éa.-.I.a.... .. T1 the comple treatment Sheet (see informatio either pri form A of ‘ 1stered at M (RQ) Th1 (thirteen 1 ‘38 identic exceptions: at this tin each § data period. One class, cons Was 81Ven a me“1113 of . the proJGet 6O Post-treatment Battery The battery of scales administered subsequent to the completion of treatment was identical to the pre- treatment battery with the following exceptions: the Data Sheet (see Appendix B) was revised to obtain from each S information regarding any additional treatment received either prior to or during the project. In addition, only form A of the IPAS was used and the MBTI was not readmin- istered at this time. Finally, the BelatignShippguestion- naire (RQ) was added as part of the post-test battery. Follow-up Battery The battery of scales administered three months (thirteen weeks) following the completion of treatment was identical to the pre-treatment battery with two exceptions: only form B of the IPAS was readministered at this time and the Data Sheet was revised to secure from each S data on crucial behaviors during the post-treatment period. EEQEEQEEE One large section of an Introductory Psychology class, consisting of approximately six hundred students, was given an orientation lecture regarding the nature and purpose of the project at the time of their first class meeting of the term. Every effort was exerted to portray the project as "a program of help for students with interperso time, the Mo realiz‘ so becz problei evident it is 1 out or a numb: include with ti Ia: limitec' "test a anxiety examine that he which 1 enabled enough teach t tests, deal wi blems u taking I'm sur you 0011 ination Th1 iIlclude Social Who bee 61 interpersonal anxiety" and not as research. At that time, the program was explained to them as follows: More and more the university has come to realize that students who fail in college do so because of personal and social, not academic problems. In fact, there is a growing body of evidence which suggests that in many instances it is the more intelligent student who flunks out or drops out before graduation. Consequently, a number of universities around the country, MSU included, have begun to develop programs to deal with these personal and social problems. Last year, when this program began, it was limited to students who were what we might call "test anxious." That is, they experienced so much anxiety either preparing for or taking course examinations that they were failing. We found that helping them learn to control their anxiety, which is a personal not an academic problem, enabled nearly all of them to improve their grades enough to return this fall. Again, we did not teach them how to study better or how to take tests, but rather we tried to teach them how to deal with their anxiety and other personal pro- blems which prevented them from studying and taking tests more effectively. All of you here, I'm sure, have felt on a number of occasions that you could have done much better on a course exam- ination had you been less anxious. This year the program has been extended to include students who eXperience what we might call social or interpersonal anxiety. That is, students who become fearful or anxious when they have to meet new people, express themselves in a group, such as a class like this, or at a dorm meeting, or students who find themselves so anxious at a party they can't pick up a dish or glass because their hands tremble: or students who are afraid to shake hands with someone they've just met because their hands are all sweaty. If you find you can't eat before your speech class or before going to a party or meeting a new date because your stomach is so upset, or if you find your neck or face turning red when you have to speak up in a group or your heart beating so fast and your breathing so irregular you can hardly speak, then you are the kind of person who can profit from this project. If you experience any of these social fears or interpersonal anxieties, then I think we can help you, if you are interested. The ur and is If you will 1: hour e small lor, 1‘ They w you wi weeks. If obliga‘ meetim probabi case, ‘ schedui you an You wil fair tr and mor Th: Th Wished to 1 fill out a Optional do fittery. A I‘urther ela 62 Let me tell you a bit more about the program. The university has hired a number of counselors and is paying them each $200.00 to work with you. If you choose to participate in this project, you will be required to meet with a counselor for one hour each week for ten weeks. You will work in a small group; you, four other students and a counse— lor, for as I indicated, ten, one-hour meetings. They will be spread out over the entire term so you will have one, one-hour meeting a week for ten weeks. If you are interested, however, you will be obligated to commit yourself to ten, one-hour meetings during this fall term. The meetings will probably be held in the early evening, but in any case, they will be arranged to fit your fall schedule. 29 not volunteer for this program unless you are willing to come to all ten meetings, since you will not derive full benefit nor will this be fair to those who are investing their time, effort, and money in working with you. Thank you for your cooperation. The students were then informed that those who wished to volunteer for the project would be required to fill out a number of questionnaires. They were given two optional dates when they could complete this pre-test battery. At the time of pre-testing, the program was further elaborated as follows: Some of you have inquired as to whether or not this is simply a research project, or what. As I tried to indicate in class, the main purpose of this program is to help students with interpersonal anxiety. We are asking you to fill out a number of questionnaires, it is true, so as to be able to evaluate the effectiveness of the overall program, and you may or may not want to call this research. However, the main purpose is not research, but to help you deal more effectively with your inter- personal problems. We know the techniques we are going to employ work, since they have been proven effective on other students just like yourself both here and at other universities. learne the go not to situat you ca help y with m or exp sence these' that yr ing ca. Ju: one hor ten we: four 01 Paid t< mention all stu lities, and som later 1 Pin vOlunte ' yoursel ' seVen , V N ' -‘ going t miss an benefif investi help yd allay bet ou ’ ' ' have be indicat‘ n°t1fie< first In, Thai Two took the PM score a 15 c litent y_n 111$ : 7 63 The idea is simply this, since you have learned to be anxious in the presence of others, the goal of this program is to help you learn not to be anxious in social or interpersonal situations. Just as you learn to be anxious you can unlearn it as well. We are going to help you learn not to be too anxious when faced with meeting new people, speaking up in a group or expressing what you really feel in the pre- sence of others. Since you often have to do these things as a student, the net result is that you will be able to do them while remain- ing calm and relaxed. Just to reiterate briefly, you will meet for one hour per week, probably in the evening, for ten weeks. You will meet in a small group with four other students and a counselor who is being paid to work with you. Before you begin filling out the question- naires you have just received, I want to just mention that we will try our best to accommodate all students who request help. However, our faci- lities, staff, and finances are somewhat limited and some of you may have to wait until a little later in the term to be assigned to a group. Finally, as I stated in class, if you do volunteer for this program, you are committing yourself to ten sessions. Not nine or eight or seven, but ten. SQ £93 volunteer if you are not going to attend all ten sessions. You must not miss any meetings, since you will not derive full benefit, nor will this be fair to those who are investing their time and considerable money to help you or to those students who were turned away because of limited facilities. You will now fill out the questionnaires which have been passed out to you. You will be assigned to a group on the basis of the free time you have indicated on your class schedule. You will be notified by phone of the time and place of your first meeting. Thank you for coming today. Two hundred and seventeen students volunteered and took the pre-test battery. Those who obtained a preference score 2:15 on the MBTI (ninety-seven introverts and seventy—nine extroverts) and a raw score of 2:50 on the IPAS (eisi then rand: of ten int Each of ti modal com; female §s. groups wer treatment counselors 0n tected by first meet were selec Phone. Al. seSsion. ' At V .- ratedonti ‘ I I . A (see Appenr Nth”. li: restations has “Cords mirror. 1 1 meeting tog they had nC 64 IPAS (eighty-nine introverts and sixty extroverts) were then randomly assigned, within stratified blocks, to one of ten introvert and ten extrovert groups (total N=lOO). Each of the twenty groups consisted of five Ss. The modal composition of each group was two male and three female Ss. Each of the ten introvert and ten extrovert groups were then randomly assigned to one of the three treatment or two control groups and then to one of the counselors within treatments. Once this was completed, each student was con- tacted by phone and notified of the time and place of the first meeting. None of the students who volunteered and were selected, refused to participate when contacted by phone. All students who were selected attended the first session. At the time of the first session, each S was rated on the Behavior Checklist of Interpersonal Anxiety (see Appendix A). This instrument, developed by the author, lists approximately three dozen observable mani- festations of anxiety, the presence or absence of which was recorded by two trained raters from behind a one-way mirror.1 It was felt that since these students were meeting together for the first time as a group and since they had not seen the counselor they were to work with 1There was no evidence to indicate that any of the §s were aware of the raters presence either at the time of the pre-, post- or follow—up evaluations. prior to constitut interpers‘ 0: were trail detection by means < so that ea responses, the same g Person, em thirty-sec in a clock this manna seconds ev. half hour , it pooling iions acl‘o: indicant 01 inter.1~ate] Aft MIPS (N4 the same 81 post‘testin extrWerts Provided ,1 65 prior to this time, that the first interview would constitute a prototype stress situation for eliciting interpersonal anxiety. One advanced graduate student and one secretary were trained together for approximately ten hours in the detection and recording of behaviors indicative of anxiety by means of both live and video-tape recorded interviews, so that each rater had a common definition of desired responses. During the first interview, each rater observed the same S for ten, thirty-second intervals. A third person, employing a stopwatch, signaled the end of each thirty-second interval at which time the raters moved, in a clockwise fashion, to the next S in the group. In this manner, each S in the group was rated for thirty seconds every two and one half minutes for the first half hour of the first session. The total score, derived by pooling the total incidence of behavioral manifesta— tions across raters, thus served as an objective behavioral indicant of interpersonal anxiety. The pre-treatment inter—rater reliability, thus computed, was .825. After the ninth, and final treatment session, the groups (N=80) were reorganized so that no two Ss were in the same group or had the same counselor at the time of post-testing as they did during treatment (introverts and extroverts were not mixed). It was felt that this maneuver Provided all the necessary ingredients of a new prototype stress si (new coun the pre-t: E the ninth they woulc or post-tr "active g1 to evaluat last nine were being eVilluating Since neit WDS wer treailment . 81x SXtrovl DU; each § Was "What kind: was your N You feel at Would you c it Yourself The apprmlllli’te each gr 011p 66 stress situation for eliciting interpersonal anxiety (new counselor, new group), comparable in nature to the pre-treatment stress-condition. Each S was informed of this pending maneuver at the ninth and final treatment session. They were told they would be notified by phone of the time of the final or post-test interview and that it would consist of an “active group discussion" in which they would be asked to evaluate the program they had participated in for the last nine weeks. They were also told that the groups were being reorganized so that they would feel freer in evaluating the other Se in their group and their counselor, since neither would be present at this time. Two make-up groups were scheduled for those Ss who missed the post- treatment evaluation sessions. One group consisted of six extroverts and the other of four introverts. During the post-treatment evaluation sessions, each S was asked to respond to the following questions: "What kinds of things did you do in your group?": "What was your reaction to the other group members?"; "How did you feel about the counselor who worked with you?"; "How would you change the program now that you have gone through it yourself?". The post-treatment evaluation interviews lasted approximately one hour each. The modal composition of each group at post—testing was two male and three female gs. Rati during th and in th reliabili‘ Tl treatment phone and were still agreed to it was nec those §s in interviews the remain IntXlal comp I"exhale and On that no :5," they Were c El861m, int: of the larg mm?! was 6? Ss. Ratings were secured from behind a one-way mirror during these active group discussions by the same raters and in the same manner described earlier. The inter-rater reliability at post-testing was .889.1 Three months (thirteen weeks) after the post- treatment evaluation interviews, each S was contacted by phone and asked to return for one last meeting. All Ss were still in attendance at MSU at this time and all agreed to return for this follow-up evaluation. However, it was necessary to schedule three make-up groups for those Ss who missed the regularly scheduled follow-up interviews. One group consisted of five introverts and the remaining two groups of four extroverts each. The modal composition of each group at follow-up was three female and two male Ss. Once again the groups (N=80) were reorganized so that no two Ss were in the same group at follow-up as they were either during treatment or at post-testing. Once again, introverts and extroverts were not mixed. Because Of the large number of Ss involved, this second reorgani- zation was possible with the exception of seven Ss. It was felt that these newly constituted groups provided a \“ 1With the exception of the Relationghip Questign- 9&225. which was mailed to each S the day of their las _ d at the tenth or treatment session and returned complete eek post-test session, all post-testing took place o?el¥owing after the last treatment interview, immediately 0 the post-treatment evaluation interviews. reasonabl stress-co A asked eacl "Now that meeting, 1 "Has it hc ences do 1 feel or ac II raters we: the Behavi in order 1: avoid a Sp author had team in th The new m 1‘18. were 1 and Video.. “”1 of th. for this In Winner dew Ta} the Dl‘ocedI fig In this reasonable facsimile of both the pre- and post-treatment stress-conditions for eliciting interpersonal anxiety. At this follow-up evaluation, three new counselors asked each § in the newly constituted groups the following: "Now that some time has passed since your last group meeting, how do you feel about what you did in your group?"; "Was it helpful, or not?"; "What, if any, specific differ- ences do you notice in yourself or in the way you think, feel or act?" In order to avoid any "halo" effects, two new raters were employed in securing the follow-up ratings on the Behavior Checklist of Interpersonal Anxiety. However, in order to profit from their learning experience, and thus avoid a Spurious reduction in inter-rater reliability, the author had the first two raters train the second rating team in the detection and recording of appropriate behaviors. The new raters, two advanced graduate students in counsel- ing, were also trained for ten hours by means of both live and video-tape recordings so as to provide a common defini- tion of the desired responses. The inter—rater reliability for this new rating team, secured and computed in the manner described earlier, was .831. Table 1 presents a summary of the treatments and the procedures employed in assigning and evaluating the §s in this study. INSVOBORN Us Sula HUD Elfifi'fll‘ NIh.I.°II I N 335 coauz ooHIz Hanan hamlz Have? owlz zflco achucoo mucmvcmuu< Eooummaao aosanoo no: .m HIIIII’hOuEmv>H—H ACOHmmmm 3'03 lulumwm .m some at 3:33 .9532: :5.“ .3 .5 3 :H a: wmcomgmmf woman ecu 2:» .3 mmummmnmmwww .h .auuaxc< uncomhoa x oWMMMMdWoWlmme .uonHEoun mm: uses ocozm an Omfiuduom whou:o>:H Inc»:H ho umHonono u a < a uwv epoch» manusu 05H» :05» who: mm .N Nawaxc< munvw .m omlz nhuuflh to: L0a>d£om co mwzapwm .m .:0Hu:ouua Scan: am nachucov Hahucoo an hundxc< ho mhzoc “oncomaav ocuEuwok» .uszudohu cannaz keynoaqu omflfi Aonmoaamv ascenponhoocH N0H>Huo< Hm:omnum m mamumsa .0: Lou: :oammmm whoaouczoo on» mmuanmuuuou: .5 3:03 we unuaxoozu InvucH go ancH .h lax0han< .: coummaomau ago: oco .: uo 0:0 on can» can ludoaanoz .a hoa>anom museum Hahpcoo ozu vHaom :o nnzaumm .w unaaznoaunmsm hamnonuozo no acosumohu m on» uuaaananunon owlz manucoauaaom .m lama o>auoEm go one on .mxooan Hmaoom uvhuzuu .w manhona 0 do Iaacofiumm he named: vmcwdmms Iozohnm flmmmmmmmwmmm macaw Haaaanwnauun acoaumum zanocap can» we: whovco>cu .mzavmoulohn u>avoafl :33. 3.5.8 .m :38 8.53m .m ..E a .m .m 9.9% comm .m no ESE: flaps .m .3 083 12338. .m museum on .mxoOHn can «Eda Hmmmmmmmm Huoucm>cH summons .»:05 ooaauuuhum sang“: mmozmsoaxccH mum .z mucousuw .N omlz Ivcuaao we and coauwcaaaxm .m the: Amm< Ehomv unsung» unucnso “csLHm II mnucnnoaxc< accumoun moaaom haoaxc< nm~< nanomv .hpoaxcn cohoucuo houno>cu mvw .m u amounu>cH mum .m .s: H .m .m .auoaxew HmzomuoahovcH on» uoHaom huoaxc< Hucoahoahovca lucoaao .N HmcomhoanuucH co om can» M oncom HauomnomhoucH .m cud: aucuuaun Am EhomV A< Ehomv uo coapmcaaaxm .m say u use scams Lou mac: owl: noddom huoaxn< uuamom auodxc< conumudoucouou IaucH umae mmuaum uoonw cyan .N uo Edumonn a coupon HaeouhonhoucH .m unconaoquounH .m oaomsounzn uo .apoax:< Hmconhon Iago»: on» :0 ma uoononn an» unconon uncannon unoucH «o unuaxouno ma M oocwnauona EdanhQ uo ac :odpazuanxo ouuu $28 33 .H $26 fine A ..E H .m .a 3323 no nwcgam A, a :3: am 32:. .a 532235 .a gain 4 ...—31w A annuaam Acouunun nuoav acounnom :oannom unsouo anouuam mcuaoo: aucoauauha aslsoaaom ahuuuum unuEvuonslunom unusuuohs unusuaoha unham on causewanu< acosuwuuuuonm anuao unhum unavoooum van nuance Havcoaahonxm Hah0:00I1.~ mqnC_C_‘ Lib—LL _R_C:Bb£§-_ R_rb_B_c_-_ C_C_R_'B_r_b_ m&_*__ _C_C____fli_B_r ___~£_&R_b b_B__'_R_C_rc_ r_R_'&__Cc____ _C_c___&'_r_B__-_ fl._'R_C_cr_-_ Bb R or C Note: Therapists are coded by "school" as on Table 2. In marke although in the t tend to ‘ i.e., d1: positive perfomar straight: forcement T six there different three dis Since onl they I‘epr (London, have thre here, F: Dist also questionm EdWards, 3 % Brewed E Distg in t terlstics‘ on these r 76 In marked contrast are the RT and B counselors, who although similar, are nonetheless still somewhat different in the techniques they stress. Whereas the RT counselors tend to employ learning theory based treatment techniques, i.e., direct confrontation, information and advice giving, positive attitude, and homework assignments involving the performance of feared acts, the B counselors tend to favor straightforward learning principles, i.e., modeling, rein- forcement, conditioning-counterconditioning, etc. Thus, with regard to treatment approaches, we have six therapists representing three "schools," who have two different specific treatment orientations and who employ three distinctly different kinds of treatment techniques. Since only techniques are relevant here, in the sense that they represent what the therapist "does" to the client (London, 1964), we may consider that, operationally, we have three distinct approaches to treatment represented here. Finally, prior to working with any §S, each thera- pist also completed a battery of self-report personality questionnaires (Edwards Personal Preference Schedule, Edwards, 1959; Myers-Briggs Type Indicator, Myers, 1962; Interpersonal Checklist, Leary, 1956). This procedure Provided a normative description of the sample of thera- Pists in terms of relatively stable personal-social charac- teristics. Table 5 presents the scores of each therapist on these various scales. . . . s . . . . . u _ . . . . , Hmum mmuz mmlm an2 Hal; smuz Halm Halz mzlm HHIZ HMIm Hzlm mmlz 00¢: 55:» o>oa Eon unddxoono HanonhonhmusH mca>aoohun unumuou unamosw wndmusn weaxcanu weamcom Aonoum coconuuonnu LoamuuvzH maze nmwuhmlmhomz OCH MNN P5” AmMHuuv masomzom wonoaouwpm Hmzowhom wchwscu mm ma mm am no No mm mm am Nm Nm oo mo we mm mm mm as ow no em «m mm mm ms Ha ma w: mm am am e: 00 ea m: so am on mw 00 No Fm IL 2K0 who hon non .monoom omen» ho :oauduzwnohnwh cannahm u how I xaucwnn< com H 0600 umugdhofih aunuaxoono HHCOnhonhu»cH and .hOuaoaucH oaze mMMdhml acquaouonm Hsconnam mohmzum 0:» co mufiumahouumnsno Hmuuoml Hmnomnom Mo mmcfiummludum unfinmhozbll.m uqm<9 more sim geneous « at least here. 01 differeni (deferenc endurance all there the four sensing c Although 0f the ot on at lea (dominanc T the B or dominance °n the EP hate and HT and B and aggre and think °f the 10; ranked un, the EPPS ; 78 Quite unexpectedly, all six therapists seem to be more similar than different, indicating a fairly homo- geneous distribution of personal-social characteristics, at least in terms of the operational distinctions offered here. On the EPPS, all therapists are more alike than different on seven of the fifteen "need" subscales (deference. order, autonomy, intraception, abasement, endurance, and heterosexual). Similarly, on the MBTI, all therapists are more similar than different on two of the four subscales, preferring the intuitive mode to the sensing one and the perceiving mode to the judging one. Although the ICL reveals more heterogeneity than either of the other two scales, there is still a marked similarity on at least two of the four interpersonal modes of responding (dominance and submission). The RT counselors scored differently than either the B or CC counselors by ranking high on achievement and dominance and low on affiliation, succorance, and nuturance on the EPPS, and by scoring highest on the dominance and hate and lowest on the submission modes of the ICL. The RT and B counselors ranked about the same on the exhibition and aggression scales of the EPPS, the introvert-extrovert and thinking modes of the MBTI, and the love and hate modes of the ICL. The only areas in which the RT and CC counselors ranked uniquely similar were the need for change subscale of the EPPS and the submission subscale of the ICL. of the c and aggr and nutu feeling of the I scoring from eit] change 31 Succoram as well a should be character to be qua cOlmselor l social oh among the Would Sug demonsI 1 the Seller Orderly, reliance to be 80111 79 The CC counselors scored differently than either of the other two groups by ranking low on the exhibition and aggression, and high on the affiliation, succorance, and nuturance subscales of the EPPS, the extrovert and feeling modes of the MBTI, and the love and hate scales of the ICL. The CC and B counselors ranked similarly by scoring low on the achievement scale of the EPPS, only. Finally, the B counselors can be distinguished from either of the other groups by ranking low on the change subscale and about "average" on the affiliation, succorance, dominance and nuturance scales of the EPPS, as well as low on the submission mode of the ICL. It should be noted that while differences in personal-social characteristics between the CC and other counselors tend to be qualitative, differences between the RT and B counselors tend to be only quantitative. Thus, in terms of relatively stable personal- social characteristics, there tends to be more similarity among the six counselors than their "school" affiliations would suggest. By and large they tend to be more auto- nomous, intraceptive, and heterosexually motivated than the general adult population and less enduring, deferent, orderly, and self-abasing. This is consistent with their reliance on intuitive and perceiving modes and their tendency to be somewhat dominant in interpersonal situations. Th M ment ori into two counselo the othe: garious, addition need otht Ships ch: marked 01 character 11“Mend: on themse 311i on e l miles of introVert Stood the 1mel‘ptl‘s also the has c011st sessmns 80 The differences which do appear tend to follow somewhat the differences noted earlier in Specific treat- ment orientation in that the six therapists tend to fall into two qualitatively distinct groups with the CC counselors in one group and the B and RT counselors in the other. The former group seems best described as gre- garious, non—aggressive, and extremely extroverted. In addition, they not only like to be needed by others but need others themselves and prefer interpersonal relation- ships characterized by strong feelings and emotions. In marked contrast is the latter group which can best be characterized as exhibitionistic, aggressive, and markedly independent and non-conforming. They tend to rely more on themselves than others and prefer to relate interperson- ally on a thinking, logical, or factual level. Treatments The Se in this study were treated concurrently in groups of five. Each of the six therapists treated one introvert and one extrovert group. Each therapist under- stood that the goal of treatment was to be a reduction in interpersonal anxiety. Since not only the efficacy, but also the efficiency, of the various therapeutic approaches was considered crucial, treatment was limited to nine sessions of approximately one to one and a half hours each Makedup sessions were not possible. Two therapists were used as behave a The only presenti groups n therapis aranked endorsed the firs1 informal Spent ex} offered, were base pist (see were offe Hrationa Appendix the first began at construct \ l notioe a . Hoops th 81 used as representative of each approach and were told to behave as they normally would with clients of this nature. The only information given to each therapist was that the presenting problem was interpersonal anxiety and that the groups were scheduled to meet for nine sessions.l Each therapist was also given a copy of the IPAS and S-RI with a ranked listing of the frequency with which each S endorsed a statement in the direction of "high anxiety." The opening two and one-half minutes of all of the first interviews was spent in formal introduction and informal “getting acquainted." The next five minutes were spent explaining interpersonal anxiety. The explanations offered, partially prepared prior to the first interview, were based on the theoretical orientation of each thera- pist (see Appendix G); thus, three distinct explanations were offered. The next five minutes were spent presenting a rational for the course of treatment to be employed (see Appendix G). Finally, the actual treatment portion of the first interview, lasting approximately fifty minutes, began at this point and ended with an explanation of the construction and use of the Index of Interpersonal Activity.2 1By the second interview, the therapists began to notice a drastic difference in the introvert and extrovert groups they were treating. Although this difference was acknowledged, the specific nature of the difference was not revealed to them at this time. 2In the case of Ss who missed subsequent sessions, the information for the IIA was secured by phone the same day as their regularly scheduled treatment session and a new form was immediately mailed to the S to be returned at the next meeting. In this manner, a one hundred percent return of the data was assured. procedur Appendix to who foreeful.‘ neladapt: current 1 his emotj based on he can ck .. . 1, , eMOtional ' ’ T i more rati V t I aPhroaoh, irrationa ' V ' - motion 0 -... . ', . and repla treathent W the Men ”8513611 I. w . V. 7 mateor; ,,' -‘ . ,-: -.-' _ ”morn lo amilogles I 82 Rational-Emotive Treatment This treatment consisted of implementing the procedures put forth by Ellis (1962) and outlined in Appendix G. With this approach, the therapist attempts to reduce interpersonal anxiety by (a) directly, and often forcefully, confronting the client with his irrational and maladaptive philosophies of life,1 (b) showing him how his current perceptions and evaluations, and more importantly his emotional reactions to interpersonal situations, are based on these irrational ideas and (c) teaching him that he can change his perceptions, evaluations, and thus his emotional reactions to interpersonal situations by adopting more rational philosophies of living. According to this approach, any sustained negative emotion is based on an irrational idea and without this idea or philosophy the emotion could not endure over time. Thus, its removal and replacement with a more rational idea is the goal of treatment. With group treatment, every effort is made to get the clients to challenge each other's irrational ideas as well. Finally, weekly "homework" assignments where clients are given tasks to perform which either successively approx- imate or actually duplicate the fear stimulus are an integral Part of this treatment approach. lThese irrational ideas, as well as their rational analOgies, are presented in Ch. 3 of Ellis's (1962) book. procedur tGarvel in Appenl to who to exper: the feel: threaten: He does 1 feelings1 current a 01m feelj ea°h elie members 0 um‘airelin T pr°°edure Ahum}; ‘ rwhee in' muscle I‘ej Stimulus ; to thirty he v18uni: desensiti: 83 Client-Centered Treatment This treatment consisted of implementing the procedures put forth by Rogers (1959), Sullivan (Perry & Garvel, 1953), and Traux & Carkhuff (1967) and outlined in Appendix G. With this approach, the therapist attempts to reduce interpersonal anxiety by encouraging the client to experience, in a psychologically safe relationship, the feeling or feelings which have hitherto been too threatening to experience freely (Rogers, 1963, p. 8). He does his "encouraging" by reflecting and clarifying the feelings, thoughts, etc. "behind" or implied in the client's current actions and verbalizations and by disclosing his own feelings in such situations. With group treatment, each client is encouraged to disclose his feelings to other members of the group as well and to work with each other in unraveling the thoughts, feelings, etc. of each group member. Systematic Desensitization Treatment This treatment consisted of implementing the procedures put forth by Wolpe (1958) and outlined in Appendix G. With this approach, the therapist attempts to reduce interpersonal anxiety by training the client in deep muscle relaxation and then presenting verbally a series of stimulus scenes which the client is to visualize for fifteen to thirty seconds while remaining relaxed. The scenes to be visualized by the client are constructed prior to the desensitization proper and consist of a graded series of situatic ducing. in a con little 0 most an: employed anxiety 1 if the h properly ( 0f desen: Since a ( must be 5 Presentn last, and that beha Secured. approxma him)“ a: rouShlvr cational , am the effort We: tech 0116] 84 situations which range from least to most anxiety pro— ducing. The object is to present the hierarchy of scenes in a controlled fashion so that the client experiences little or no anxiety as he moves up the hierarchy to the most anxiety producing or target behavior. Relaxation is employed since it is physiologically antagonistic to anxiety and thus automatically inhibits anxiety responses, if the hierarchy is properly constructed and the client properly relaxed. Group treatment, although quite similar in terms of desensitization proper, requires a slight modification since a common hierarchy is employed and the therapist must be sure that all members are and remain relaxed before presenting the scenes to be visualized. No-Treatment (Placebo) Control The twenty Ss in this group attended the first, last, and follow—up sessions along with the other Ss so that behavior ratings of interpersonal anxiety could be secured. During the first group meeting, the author spent approximately fifteen minutes with each S exploring the history and current status of their problem. In addition, roughly fifty minutes were spent discussing their edu- cational plans, major areas of academic interest and feelings about the change from high school to university life. Every effort was made to foster and maintain strong rapport with each client. that fin this and ever, ev was fort on an in informed and were (m in the mu .' . .. , so we “01 l each of 1 The topic t0 univer “Darlene learning A With each 01“ mid-te Pending p the autho to the 00: content 0: a "study”. 85 The remainder of the time was spent explaining that financial limitations made it necessary to start this and three other groups at the end of the term. How- ever, every effort was made to insure each S that relief was forthcoming and that we would help as much as possible, on an informal basis, during the interim. Each S was informed of the university's concern for their welfare and were told that they would receive a questionnaire (State Anxiety Inventory and Index of Interpersonal Activity) in the mail each week which they should fill out and return so we would know how they were doing. Two weeks later, the author arranged to meet with each of the four groups separately for a two-hour luncheon. The topic of conversation was limited to their reactions to university life and any academic problems they might be experiencing. Any explanations offered were given from a learning theory frame of reference. Approximately two weeks later, the author again met with each group, this time for about four hours, the week of mid—terms. The focus of the group meeting was their pending psychology mid-term examination. At this time the author answered any questions the group had pertaining to the content of the course and pending examination. The content of this session was, thus, predominantly that of a "study-skills" group. two-how of disco academi< underste to maini other 31 evaluati control attentic selectio were una the pre. DOSt-tes‘ under th The answ‘ t° eithe: E33 18 mph: a“Myers treatmem 86 . Two weeks later, the author again arranged a twoehour luncheon for each of the four groups. The topic of discussion at this time was again centered around academic and educational matters. At all times concern, understanding, and tolerance were eXpressed in an attempt to maintain good rapport. Finally, each of these four groups met with the other groups for both the post-treatment and follow-up evaluations. Altogether, the no-treatment (placebo) control groups received approximately eleven hours of attention each. No-Contact Control Group The twenty §s assigned to this group met all the selection criteria, but were never contacted and thus were unaware of their participation in the study. Although the pre-treatment battery was taken with the other gs, the post-test and follow-up batteries were secured by mail under the guise of a "random sampling" for test validation. The answer sheets were coded so that §s were not required to either sign or address them. Experimental Design and Statistical Analysis The basic experimental design for this study, which is graphically presented in Table 6, emerged as a three way analysis of variance (5x2x2) with counselors nested Within treatments. Since the gs met and interacted as a group for \t” 8? pho>oppxm pno>0hpsH so so oo mo so mo No Ho Hoppsoo Hoppsoo Aonoomamv soapmsflpfiwcomom o>wpoEm monopcoo poopsooloz pcoEpmopBloz oapmfiopmzm IHMQOHpmm upcowao odme apflamsomaom mpsoEpmogB psoflao .Qwfimom ampsoefithxMIl.m mqmnm amm oopsom u Has m mum m «o mamaHucHposm mH.mH SoNN mmoN. mum: wmom magm 3:.m: woomfl m3oOH z.@m Fifi-mm - c . o . IHGCOHPNE . . . . . w me mm oH 3 ms mm 3H 2 ss H mo a 3 mm mm a N am om o m.mm oo.om :.ooH mo.HH m.ms mo.mm m.ssH sm.HH m.mo om.OH o.Ho a :m.mH o.mm mm.s m.m: mo.m :.mm mm.wm m.mmH m . . . . . . . . m . . . . . . . . o a 0 mm mm Hm o omH mm OH o as o: OH 0 Ho H o m a so mm o m Hm om m m Hm om so 0 :mH sm.o o.m: sm.Hm w.HsH OH.HH m.Ho so.oH o.oo m :OHpmN oH.:H o.mm m:.HH o.ms mo.: o.mm m. . . . . uHoncmmmo ms.oH o.mm . . . . m .o: m.ooH om m o om ms sm :.mom MH.mH e.gs sm.mH o.ms H as HH o as om m o Hm Hm ms 0 mmH sH.HH 3.3: om.om 3.3sH Hm.aH s.Ho sm.mH s.mo m H:.@ :.mm m.m . . . . . . ms.OH o.sm mm.m m.mm mm.m m.mm mm.ms m.mmH mm a o.mm m:.om m.me mm.mH o.os sm.mH m.ms H mm o oo sm o smH ms.m s.ms HH.MN m.ssH ms.sH o.mo mm.HH m.mo m emsmocmo .OH m.Hm o:.m .H. . . . . . : sm.o :.mm sm.o “.3m mm.m m.mm mm.mm m.mmH mm.mH s.mm ms.mm s.som oo.oH s.ms mm.HH m.ms H pcmHHo s m ooH sm s m.ms so.mm m.HsH ms.HH o.mo mm.HH m.Ho m mm H mm a so .Ilnlrlrllnln my! M mm M am a mm N mm s mm m Hem: .wum .>cm uses an o u u 11:. m m m Has Hmnm m masH < moQ osmocmpm cam mums: umouoohmll.m mqm<9 _ .._.__..._. -.--...L-—._' - . _ - . : .-_..:__ _._- oontrao‘ here. are sig to scor behavio vers. behavio former ducing °°mPlaij halize" behallo: This W01 here is aninety alterna1 are pm they are W c011011131 than int VIEWS ' fact the (13:3 ' hr], 95 contradictory, two possible explanations seem relevant here. One might hypothesize that since the extroverts are significantly more defensive, they would be expected to score lower on self-report questionnaires but not on behavior ratings secured by impartial, objective obser- vers. Similarly, introvert-extrovert differences in behavior ratings could be explained by reference to the former group's tendency to "internalize" anxiety, pro- ducing increased psychophysiological changes and cognitive complaints, and the latter group's tendency to "exter- nalize" anxiety, producing increased motoric and behavioral changes (Buss, 1962, 1966; Hamilton, 1959). This would lead to the conclusion that what is reflected here is a difference in defensiveness and mggg of anxiety expression, but not anxiety level pg; S2, An alternative hypothesis would be that since extroverts are probably more animated to begin with, simply because they are extroverts, one would eXpect higher scores on behavior ratings for this group. This would lead to the conclusion that extroverts are, indeed, less anxious than introverts, as these self-report measures suggest. There is some evidence to support both of these views. The latter hypothesis seems consistent with the fact that the introverts scored significantly higher (t=3.u7, P :E.OOl) on the Neurotism Scale of the Maudsley claimer questio In spit are hea for the measure the for. the obt: data To: some er Personal Tienste: be Pres: effects intensu intro“, Were ext effects 313nm as31811111: \ by the j 13 Was 96 Personality Inventory (Eysenck, 1962).1 However, advo- cates of the former thesis could rebut with the dis- claimer that this is simply another self-report questionnaire subject to the extrovert's defensiveness. In spite of the intuitive appeal for the "extroverts are healthier" hypothesis, this view fails to account for the fact that the extroverts did score higher on measures of defensiveness. By the same token, however, the former, more "dynamic" hypothesis, while explaining the obtained results well, certainly goes far beyond the data for its explanation and in so doing, contradicts some extant evidence regarding extroversion and inter- personal anxiety (Eysenck, 1960, Eysenck & Rachman, 1965, Wienstein, 1968). Perhaps the results of this study, to be presented later, will shed further light on this issue. Finally, a lack of significant personality main effects on the MBTI indicates no difference in the intensity of introversion and extroversion, e.g., the introverts were no more introverted than the extroverts were extroverted. Similarly, none of the treatment main effects or the treatment by personality interactions were significant at pro-testing either, indicating random assignment within the limits of chance expectations. E 1This scale was administered to the entire class by the instructor at the time of the first class meeting but was not used as part of the regular test battery. these 1 0n the who re; exhibit of anxi labeled high de behavic cative suggest high se introve Marsh The I‘ev cI‘iterj dictory Lorr, S Weinste Social here, 97 In conclusion, then, actuarial interpretation of these pre-test data indicate two distinct types of client. 0n the one hand, there is the group labeled introverts who report high anxiety and low defensiveness but do not exhibit a large number of overt behavioral manifestations of anxiety. On the other hand, there is the group labeled extroverts who report moderate levels of anxiety, high defensiveness, and exhibit a large number of overt behavioral manifestations usually thought to be indi- cative of anxiety. This is a rather interesting finding in that it suggests that researchers who select Ss on the basis of high self-reported anxiety are selecting predominantly introverts Whereas those who select Ss who report only moderate levels of anxiety are selecting extroverts. The reverse holds true of Se selected on behavioral criteria. Perhaps this is one reason for the contra- dictory findings in this area (Frank; 1961; Levitt, 1967; Lorr, §§_§l,, 1958; Spielberger, 1966; Sprinthall, 1967; Weinstein, 1968). Since the (input) data on therapist personal- social characteristics was presented in detail in the previous chapter, it will not be elaborated on again here. with a< pist ' 5 With re target setting observe duringI to the: behavic changes therapi receive all011nt Centre] (rougm number fairly if not come re Which II —_w 98 Process Data The data reported in this section is concerned with accounting for as much of the client's and thera- pist's behavior during the treatment period as possible. With regard to client variables, data on changes in target behaviors both within and outside of the treatment setting, level of self-exploration, and self-report observations on crucial client behaviors prior to, during, and following treatment are reported. With regard to therapist variables, data on in-treatment therapist behavior, level of therapeutic conditions offered, and changes in client target behaviors, as viewed by the therapist, are also reported. Data on Client Variables Table A presents the total amount of treatment received by Ss in each of the treatment groups and the amount of attention given the no-treatment (placebo) control Ss. Although the range is fairly substantial (roughly 1 hour), especially in view of the limited number of contact hours, the differences appear to be fairly evenly distributed, at least across treatments, if not counselors. When viewed in relation to the out- come results to be presented later. however, any biasing which may have resulted seems to favor the treatment rC$+§CC rCrsQCGrnsy UCTEDNQHHIOZ 039 vaxwfiU COHDCQDDQ EONWH \nfl U®>H®O®m DCTEuQQLHLU .HO DQSOEHWII. Q MTHQGDH .HO 9613054. UCHG mQNOhU DQTEDMOHB OCHP rHO 99 .moaoadEo odd» @0 meoEmom pooalom Use popcsoo wasp map Qwsoagp mwmd pcsoEm map mcHQHanpoU an mmsfloaoooa o .m sopdmgo CH oopmoflpsfl mm oopmeflpmo egos onHp omoge* .opssfis unease: map on wsHosdoa soap was mo pQSoEm on» an osswflm mflgp MQHmHQfipHSE 0p wasp mo noon om sow ooaflsvoa oEHp so amp map Eons oomeHpmo who: moeflp omega "opoz :oo.HH :oo_HH :sm.HH :mm.HH :oo.HH :wm.oa :qo.mH :ww.mH mpho>oapCH =oo.HH :oo.HH :o:_mH :HH_HH :o:.HH :mm.HH :om.HH :m:.HH mpao>oapxm * * a m o m o o maze psoHHo Hospsoo AoooomHmv psospmosa psospmoae osospmose psospmoaaloz o>Hoosmems0Hpmm QOHpmNHpHmsomoo oesooQoOIpsoHHo mama osospmoae .mm Hospsoo Aopoomamv psoEpmoaBn mo psdoe< one masosw psospmoae map mo comm an o 02 who co>Ho QOHoeooo< o>Hooom psoepmoae mo pQ:oEoach m\H m\H m to o m H\H H\H H\s H\H H\s H\m H\m H\m o > hogs p m n m o o mama Hososou psoHHo Honoomamv pcmsumoae onEpmomB , psmEpmoaB psmEpsoaB oz o>HooeMIHwQOHpmm coapmNHuHmsomoQ oesopsoOIpcoHHo mama ucoEpmopB .UOHaom pCoEpmoaB map mafiasm.m 30mm an commas mQOHmmom mo hon83211.m mgm<9 TABLE 6. ire; Client .ype Exzrovert In:rove:‘t \ Eur-overt: Litroverts \ \ ERPOVEPI S .h ...l “a, - Verts IIIIIIIIIIIIIIIIIIIIIIIIIIII:I________________________________‘ ”i=3”~_~w‘_‘77 102 TABLE 6.——Additional Treatment Received by Each S Prior to Treatment, During Treatment, and During Follow-up. Treatment Type CC SD RT NTC NCC Client C C B b R r Type . Prior to Treatment Extroverts l/la 1/2b 1/3ab 1/5a 1/10 1/12 Introverts 1/8a 1/5 1/ha 1/1 1/3a a¢ss hhfi' During Treatment b a b a Extroverts 1/3 l/1 l/“ 1/1 1/2 1/1a 1/ub Introverts 1/6 1/3b 1/2 1/1 l/lab l/h During Follow—up Extroverts 1/3 1/3b 1/2 Introverts . 1/2 1/1 2/1 1/1 Note: The numbers in each cell represent the number of §§ followed by the number of sessions missed. For example l/l means one group member missed one session. a . Extra interviews were sought for educational—vocational rather than personal—social reasons. b . Indicates the same S sought treatment in two of the three above periods. of the interv (see i concer; treatm. cases ‘ verts) 10 perc treatme vocatic cases w to and Althoug Views w departu cOunsel of the ‘ 1ntem‘ regular importa] I SamDle 1 interv 1‘ 103 Prior to treatment, twelve gs or roughly 10 percent of the sample reported receiving a total of 69 treatment interviews of which 24 were for educational-vocational (see items marked with an a) and #5 for personal-social concerns. Although the distribution of extra, pre- treatment interviews was far from uniform, in only two cases (ecunselor C's extroverts and counselor R's intro- verts) was the deviation severe. During treatment, thirteen gs or again approximately 10 percent of the sample reported receiving 33 additional treatment interviews, five of which were educational- vocational and 28 personal—social in nature. In only four cases was extra treatment received by the same § both prior to and during treatment (see items marked with a b). Although the distribution of extra in—treatment inter- views was by no means uniform, again only two radical departures appeared (counselor C‘s introverts and counselor r's extroverts). Fortunately, however, ten of the thirteen gs who received additional in-treatment interviews were the same gs who missed one or more of the regularly scheduled treatment sessions, vitiating the importance of these extra interviews somewhat. Finally, eight gs or again about 10 percent of the sample reported receiving thirteen additional treatment interviews during the follow-up period, all of which were for person was additional both treatment with an b). No interviews both period. Because nature of the a tactical decisi the entire samp factor could no eXplanation of noted, however, Med with the those §s who so hm during and §3 from ETOHps is eSPSCially t treatment (1111‘ in Figure intrapersonal C session and f0: verts and SXtrc four, f1‘7‘5-minu near the middle recorded intem 104 were for personal-social reasons. In only one instance was additional treatment received by the same g during both treatment and follow—up periods (see items marked with an b). No §s reported receiving extra treatment interviews both prior to and following the treatment period. Because of the sporadic and uncontrollable nature of the additional treatment received, and since tactical decisions favor maintenance and assessment of the entire sample (Campbell & Stanley, 1963), this factor could not be completely ruled out as a potential explanation of the treatment outcomes. It should be noted, however, that when the data in Table 6 are com- pared with the outcome results in the next section, those §s who sought and received additional counseling both during and following treatment were, by and large, gs from groups which showed the least improvement. This is especially true of those §s who received additional treatment during the follow-up period. Figure 1 presents the mean level of client intrapersonal or self-exploration for each treatment session and for each of the CC and RT counselor's intro- verts and extroverts. This data was obtained by taking four, five-minute samples, one near the beginning, two near the middle, and one near the end, of each tape recorded interview for counselor's C, c, R, and r. w \n Ievel or Bolt—echlcz-ation ch 4:- ‘1 Counselor C Client-Cents 1231+ sss: SJ 011‘— cquloz'axtd. On 6-- mvel or t“ 7 ' 'Cmmselor R J uRational-Emoti 123w: SES§ Figure 1 se1f~explorat: Rational-Emot: Introverts) . 105 l o-—-oE 2 ‘ -——oI G o 0 o H .H *3: t3 3 5' 8 H H s an «5 q: H H ‘1’ a) U1 (0 5 h % 0 0 fl H E g 6 55’ .3 Counselor C 7 Counselor 0 Client-Centered Client—Centered 123h56789 123M56789 SESSION SESSION luv 1 q- 2 q a 0 o '3 '3 3 “ m 3 H H g ‘\ E” a? 1* . (I l \ fl (:1 \ 1“ fl 8 5 Y \ ,R m m \ l \ 0 O b-md \ [—1 -. \ H 6 g 6 ‘ g \\ 3 up \ ) '3 x-.. \ / 7 "Counselor R \ III 7 Counselor r d-Rational-Emotive b’ Rational-Emotive 123M56789 123h56789 SESSION SESSION Figure l.--Weekly changes in mean level of client self-exploration for each of the Client-Centered (CC) and Rational-Emotive (RT) treatment groups (E=Extroverts, I: Introverts). Two undergradue the manual pre: and working inc‘ tape segnents. mean scores to: and rounding t< an objective 1: for each group rater reliabili .813. Since : on a comparablw of comparison 1 the level threw 196?) feel rep: exploration wh: Before various treatmt it should be nv factors seem t data. At roug‘ M him the depth of s interview (fou her of scores if the overall was 21.3 (raw equal this sec for the second we was 3.32. (5.99). divid half-number ( 106 Two undergraduate psychology majors, equipped only with the manual presented by Traux & Carkhuff (1967, pp. l9h—208), and working independently of one another, rated each of the tape segments. The total score, derived by pooling the mean scores for each tape across raters, dividing by two, and rounding to the nearest half-number, thus served as an objective indicant of the level of client self-exploration for each group and each treatment session.1 The inter- rater reliability, computed on the raw observations, was .813. Since it was impossible to secure similar data on a comparable control group, the most convenient unit of comparison was the frequency of scores above and below the level three, which the authors (Traux & Carkhuff, 1967) feel represents the minimum level of client self- exploration which is therapeutic. Before examining more closely the impact of the various treatments on the level of client self—exploration, it should be noted that at least three common situational factors seem to have influenced all the remaining process data. At roughly the time of the third interview and 1Mean score in this case represents the sum of the depth of self-exploration scores for one tape recorded interview (four, five-minute samples) divided by the num- ber of scores summed to equal that total. In other words, if the overall score obtained by one rater for one tape was 21.3 (raw observation) and eight ratings summed to equal this score, the mean would be 2.67. If the mean for the second rater for the same four, five-minute sam- ple Was 3.32, the total score would be the combined mean (5-99), divided by two (2.99), and rounded to the nearest half-number (3.00). - during the wee] paring for and and consistent more a functim treatment effe< Simple 1 CC interviews 1 with introvert: scribed level, introverts and were beyond th: there tends to (within treatm appears to be t (within treatmv That is RT counselor R factory, if oni CC counselor C verts achieved “interaction, " to changes in : counselors c a] interview by 1] extroverted §_s reveals a mark achieving the 106 during the week of the sixth interview, each g was pre- paring for and taking course examinations. Thus, radical and consistent changes at these points were probably more a function of situational factors rather than treatment effects. Simple observation reveals that nearly all the CC interviews with extroverted §s and all the RT interviews with introverted §s were well beyond the minimum pre- scribed level, while only half of the CC interviews with introverts and half of the RT interviews with extroverts were beyond this minimal level. In addition, while there tends to be a marked similarity across counselors (within treatment) for the former two groups, there appears to be a marked dissimilarity between counselors (within treatment) for the latter two groups. That is, whereas CC counselor c's introverts and RT counselor R's extroverts seem to have achieved satis— factory, if only intermediate, levels of self-exploration, CC counselor C's introverts and RT counselor r's extro- verts achieved only “average" levels, at best. This “interaction,“ as we shall see later, was probably due to changes in in-treatment behavior on the part of counselors c and R. As indicated above, however, an interview by interview comparison of both CC counselor’s extroverted §s and both RT counselor’s introverted gs reveals a marked similarity, with all four groups of gs achieving the greatest amount and depth of self—exploration, Those p. with hierarchy of client intn these periods ( exceed the thrw a possible exp: Figure 2 the mean change of therapy for control §s. TI sented earlier interviews are As predi have produced 1 with extroverts approaches resu reduction with allforms of t: inreducing an: specific, ancil tact, interview and relief. Th 0f whether the t0 post-test ing A closer effects reveals 107 Those portions of the SD interviews concerned with hierarchy construction were also rated as to level of client intrapersonal exploration. At no time during these periods did the depth of client self—exploration exceed the three level, thus ruling out this factor as a possible explanation of the SD outcome results. Figure 2 presents a graphic representation of the mean changes in anxiety level throughout the course of therapy for both treatment and no—treatment (placebo) control gs. The same interpretative restrictions pre— sented earlier regarding the third, sixth, and post-test interviews are relevant here also. As predicted, the CC treatment approach seems to have produced the greatest amount of anxiety reduction with extroverted §s while the SD and RT treatment approaches resulted in the greatest amount of anxiety reduction with introverted §s. Similarly, as predicted, all forms of treatment appear to have been more effective in reducing anxiety than simple attention or the non- specific, ancillary benefits derived from personal con- tact, interviewing, and expectation of future treatment and relief. These conclusions seem to hold regardless of whether the unit of analysis is mean change from pre- to post-testing or simply the ultimate post—test mean. A closer examination of the individual counselor effects reveals a marked similarity between the various i :i w Counsel " Client- “'Jff p123 D4 Counse lo . _ Desensit s—t—H— @123 N ”Figure 2.... {2&1 fer eac "Mitt type ANXIETY LEVEL ANXIETY LEVEL .———o E I——--—o I 108 60 - 60 ' 581 58 ~ 56 -- 56 T 5” " 51H— 52 ' 52-- 50 ‘ 50" MB " '48 + M6 fl- “6-" up - nua— h2‘ n2_. “0 '* 140+ 38 -- 38—— 36-- Counselor C 36—- Counselor 0 ~ Client—Centered Client-Centered 3h -r 34 _ i t i i i i t i i i—ri 44—: i 1 i i i t i #44 @1234567896,;) E123h56789§ SESSION o. SESSION o. 60 58 56 514 52 50 A8 116 Ni 112 110‘ 38 36 Counselor B \\ x’36 -— Counselor b ‘, 3h Desensitization '/ 3“ “T Desensitization "III'1I " iii—inJrif'fifi' l 2 3 A 6 8 B m l. 2 3 A 5 6 E SESSION 7 9 § E SESSION 7 9 § m kflflflgéiure 2.--Weekly changes in group mean on the State Anxiety Paschality type (Extrovert E, Introvert for each treatment, each counselor, and each client I) '3-- Counsel w _ Ration: i p12 L ANXIETY LEVEL ANXIETY LEVEL DU‘ILTIU'IUTWON (DONEONOOO Counsel Rationa L. . g l 2 m or R l-Emotive £456 SESSION No Treatment (Placebo) Control I I use SESSION I l 7 Figure 2.——Continued t d POST’— POSTJ- 109 60-— 58—t 56__ 5N1- 52 —-4_ 50*- u8—t 46‘t Hunt 42i~ 407' 384‘ 36" 34" 60 v 58 " 56—r /. Counselor r Rational—Emotive l Li! D: CL: | I 1 1 1 2 insets SESSION No Treatment l 38 I (Placebo) Control 36 t 34» LIILII|1., 'gl ausél/eg'svj “ SESSION 3 aforement pre-post were 1+1 & counselor post than sane scor and 27 & Wi verts rec equaling (to e 39) As predic seen to h verts (p0 CC counse Dre-post 1”'8 extra 2) and CC been pre- reduction c(introl 8 Were ha & M8. and Finally. aftirly eXtI‘OVert It ———_—w 110 aforementioned counselors. The post-test means and mean pre-post change scores for the CC counselor‘s extroverts were 41 & 39, and 13 & 11, respectively. For the SD counselor's introverts the post-test means and mean pre- post changes were 36 & 35, and 18 & 18, respectively. The same scores for the RT counselor's introverts were 39 & 38, and 27 & 15, respectively. With regard to the remaining groups, the extro— verts receiving SD improved far beyond expectation, equaling the CC extroverts in both post-test mean scores (#0 & 39) and mean pre-post anxiety reduction (12 & 10). As predicted, both the CC introverts and the RT extroverts seem to have improved least, with RT counselor R's extro— verts (post—test mean, 42; mean pre-post change, 7) and CC counselor c's introverts (post-test mean, 45; mean pre-post change, 10) improving somewhat, and RT counselor r's extroverts (post—test mean, 46; mean pre-post change, 2) and CC counselor C's introverts (post-test mean, 5U; mean pre—post change, 2) showing even less anxiety reduction than the comparable no-treatment (placebo) control groups (post-test means and mean pre-post changes were #8 & 55, and u & u for the introverted SS, and U4 & 48, and 4 & u for the extroverted Ss, respectively). Finally, it appears that the placebo treatment exhibited a fairly uniform influence on both the introverted and extroverted no-treatment (placebo) control gs, It is interesting to note that these latter "interaction" effects follow very closely the data reported That is, introvert mediate, anxiety r or counse lor's ext §s explor four grou These fin Carkhuff . Traux & C. T Seem to b. of anxiet; and at de. reduction mediate 1. Treater 1, or the So. 8011a1 con'l treatment F: between 1] deEI‘Ee of Whereas w: _._i—‘fl 111 reported earlier on level of client self-exploration. That is, counselor R's extroverts and counselor c's introverts engaged in more and deeper, if only inter— mediate, levels of self-exploration and showed more anxiety reduction than either counselor r's extroverts or counselor C's introverts. Similarly, both CC counse- lor's extroverted SS and both RT counselor's introverted §s explored the most and at the deepest levels and all four groups improved the most, SD treatments not included. These findings are consistent with the data reported by Carkhuff & Berenson (1967), Rogers, 23 al.(l967), and Traux & Carkhuff (1967). Thus, level of client self-exploration does seem to be a predictor variable as far as process measures of anxiety reduction are concerned. SS who explore more and at deeper levels show greater amounts of anxiety reduction than those who eXplore little or at only inter- mediate levels. Those §s who explore the least show no greater improvement than those receiving simple attention or the so—called non-specific benefits derived from per- sonal contact, interviewing, and eXpectation of future treatment and relief. Finally, there appears to be a relationship between in-treatment self-reported anxiety level and degree of client self-eXploration during treatment. Whereas with the CC treatment approach the deepest levels of 011! with it the op} The gr: occur i anxiety as we 1 greate: while 1 amount a more that ii deeper low 161 verts e Self-e1 self-rt therapj except: °°unsej this fj of thi; t°treg lation mileu : "DSych, 112 of client self-exploration tended to occur in conjunction with low levels of client self—reported anxiety, just the opposite seems to hold with the RT treatment approach. The greatest levels of client self-exploration seemed to occur in the context of high levels of self-reported anxiety. This is not the complete story, however, since as we have seen, the CC treatment approach produced the greatest amount of anxiety reduction with extroverts while the RT treatment approach produced the greatest amount of anxiety reduction with introverted gs. Thus, a more accurate statement of this relationship would be that the CC extroverts engaged in more frequent and deeper levels of self-exploration in conjunction with low levels of self-reported anxiety whereas the RT intro- verts engaged in more frequent and deeper levels of self-exploration in conjunction with high levels of self-reported anxiety. As we shall see when examining therapist in-treatment behavior, the two apparent exceptions to this rule, counselor c's introverts and counselor R's extroverts, actually further substantiate this finding. Although it is impossible to specify the direction of this cause-effect relationship, or whether it is due to treatment, therapist or client variables, some specu- lation seems relevant here. Namely, that the therapeutic mileu suggested by Rogers' notion of therapy as a "Psychologically safe" relationship and Ellis's notion of the one, a weekly treatm these §'s se (Figur during each g counse view 0: the th §'s ah ences . Seem t. 2-0: my means, went a; interp. (post.- i 2.3) Change: effect; 113 of therapy as a probing, challenging, and confronting one, are consistent with these findings. Figure 3 presents each therapist's rating of weekly changes in mean anxiety level for each of the treatment groups, only. The most outstanding feature of these data is the somewhat unexpected agreement between §'s self-reports (Figure 2) and therapist's ratings (Figure 3) regarding the course of anxiety reduction during treatment. A session by session examination of each graph reveals n9 marked discrepancies between the counselor's view of the §'s anxiety level and the §'s view of his own anxiety level. In fact, in most cases, the therapists were even able to detect changes in the §'s anxiety level which were due to situational influ— ences other than the treatment (3rd and 6th interviews). Once again, observation of these process data seem to suggest that the CC (post—test means, 2.0 & 2.0: mean pre-post changes, 2.0 & 1.7) and SD (post-test means, 2.0 & 1.7; mean pre—post changes, 2.0 & 1.3) treat- ment approaches were the most effective in reducing interpersonal anxiety with extroverted gs, while the RT (post-test means, 1.6 & l.7; mean pre—post changes,2.4 & 2.3) and SD (post-test means, 1.7 & 1.6: mean pre-post ChaHSBS, 2.8 & 1.9) treatment approaches appeared mest effective in reducing interpersonal anxiety with intro- verted 88. As in Figure 2. the differential effectiveness __ Clieh Couns ~~ Dese . _ Coun ANXIETY LEVEL ANXIETY LEVEL Client—Centered Counselor C I SESSION I l I I I I I I I l | 1 2 3 M 5 6 7 CD_,_ \0 _I_ 51 LI“‘ 3 _i 2 __ __ Desensitization Counselor B 1 eve—H : ii—i H l 2 3 4 5 6 7 8 9 SESSION _L Client—Centered Counselor 0 I t I t I I t—%—~% l 2 3 4 5 6 7 8 9 SESSION Desensitization Counselor b i | i l I I T I l 2 13 4 5 6 7 8 9 SESSION ' ist Figure 3.—-Weekly changes in group mean on Therap Rating Sheet for each of the Client-Centered (CC), Rationglu Emotive (RT) and Systematic Desensitization (SD) treatmen groups, only (E = Extrovert, I = Introvert). ._ Rational-I Counselor 1 . rH—I—I— 1231: sss. 115 Figure 3.—-Continued Rational—Emotive ‘ ~. Counselor R IIriliiJ_J TrlIIII-‘I 1231156789 SESSION 5 4-- 0‘ Ch! \ ’A\‘ 3_- Y ‘\ I‘\ 2-- ‘0‘ __ Rational-Emotive " Counselor r l _ i ‘ i i i I I et—% 1 2 3 LI 5 6 7 8 9 SESSION of SD with in‘ dicted direct: especially in differences wi A 010: effects reveal reported earli (post-test mes more than CC c 3.5; mean pre. extroverts (pc 1-3) improved (post-test Ines larlv. as befc counselors and n011-81Iisteni; , Thus, reaming tree Seneral Conser OVer bOth the is isnored. I SD treatment 1 PI‘Oducing the extroverted §s appear equally amount of an)“ 116 of SD with introverts and extroverts, while in the pre- dicted direction, was small and probably not significant, especially in view of the large introvert-extrovert differences with the CC and RT approaches. A closer examination of the individual counselor effects reveals a similar type of "interaction" as reported earlier. That is, CC counselor c's introverts (post-test mean, 2.7: mean pre-post change, 1.3) improved more than CC counselor C's introverts (post-team mean, 3.5; mean pre-post change, 0.6) and RT counselor R's extroverts (post-test mean, 2.7; mean pre-post change, 1.3) improved more than RT counselor r's extroverts (post-test mean, 3.2; mean pre-post change, 0.3). Simi- larly, as before, the "interaction" between the SD counselors and S personality type appears minimal, if non-existent. Thus, from both the point of view of those receiving treatment and those administering it, the general consensus seems to favor the SD treatment approach over both the CC and RT approaches when S personality type is ignored. When S personality is considered, the CC and SD treatment regimes seem to be equally as effective in producing the greatest amount of anxiety reduction in extroverted SS while the RT and SD treatment approaches appear equally as effective in producing the greatest amount of anxiety reduction in introverted Ss. Final: Figure 3 were: extroverted S: and at deeper logically safv whereas the iv problems more Probing, conf: 6.8. with RT “ Figurv ber of interpv setting for ea control gs, { earlier remaiy generally qua< the result of the beginning s°Phomores (3, Versity life I of the 8amPle in interperso] anatural pro Secondly, in z and Sixth int interperSOnal period. This 117 Finally, as before, the data presented in Figure 3 appears to again support the hypothesis that extroverted Ss explore their interpersonal problems more and at deeper levels in a non-anxiety producing, "psycho- logically safe" environment, e.g. with CC treatment, whereas the introverted Ss seem to explore their personal problems more and at a deeper level in the context of a probing, confronting, and rather anxiety inducing atmosphere, e.g. with RT treatment. Figure u presents weekly changes in the mean num- ber of interpersonal contacts outside of the treatment setting for each of the treatment and no-treatment (placebo) control SS. The three interpretative restrictions imposed earlier remain relevant here as well. Furthermore, the generally quadradic shape of these graphs may have been the result of two additional factors. First, this was the beginning of a new school year for the returning sophomores (30% of the sample) and the beginning of uni- versity life pg; §E for the new, incoming freshmen (70% of the sample). Consequently, the initially sharp rise in interpersonal activity by these Ss probably reflects a natural process of "familiarization" among students. Secondly, in addition to slight drops around the third and sixth interviews, there is a marked decline in interpersonal contacts near the end of the treatment Period. This probably reflects the more or less natural FREQUENCY o 9 Counsel: Desensil 8 7 > 6 3 g 5 m '4 i‘ 3 2 l I 2 3 Figure ll. personal Activi personality typ 118 d O O 9 Counselor c 9 Counselor c 8 Cllent-Centered Client-Centered 8 7 7 56 :6 2 z s5 35 at, 0' [LI I.” s s“ 3 3 2 2 ' I '23‘I56789t 1234567895 SESSION 8 SESSION 8' l0 IO 9 Counselor 8 9 Counselor b 8 Desensitization 8 Desensitization 7 7 :6 56 5 5 E D 3 5 d 0 ml} ml; 1.: a: h. Ll. 3 3 2 2 ' l l 2 3 h 5 6 7 8 9 SESSION POST 12345678932 0 SESSION ‘L Figure M.——Weekly changes in group mean on the Index of Inter— p8rsonal Activity for each treatment, each counselor, and each client personality type (Extrovert = E, Introvert = I). r—IE >--.c I Counselor Rational-E No Treatmer (Placebo) C 17 119 Figure 4.——Continued E ...—g I ~__-—O e V i t O rm E r. 01. la en 8 0 mi u+o O a CR TII+II+I1I “ l i _ i _ N 98 76 5D. 32 l MQZMDGmmm e V .1 t O Rm E r. 011 la en S 0 n1 U+o 0a CR _hL b _ . L’— _N 1 T—J u 4 q — -— 0987654321 1 Nozmbammm l 2 3 4 5 6 7 8 9 SESSION Emom 1 2 3 4 5 6 7 8 9 SESSION No Treatment (Placebo) Control 098 76 54321 1 MOZMDammm \ \ \s \ A O r v t n t 0 nno /, e V m\1 x to A mm , PC v Tania \ on A, N I FLI. . _ _ _ a F. .~ + _ .uJ‘ _|II 0987654321 1 MOZWDGMMfl l 2 3 Li 5 6 7 8 9 SESSION Emom l 2 3 4 5 6 7 8 9 SESSION curtailment restrictions examinations, post-test int Howev general influ specific effe ment approach simple attent had little or personal acti 2.0 & 2.2; 111 cc counselor (post-test mes counselor c's in inter-parse: test mean, 3.( this appears 1 regarding the and anxiety rI ment. Finall: change outside and RT oounse doubled the f (post-test me HA) while 120 curtailment in interpersonal activity imposed by the restrictions inherent in preparing for and taking final examinations, which occurred during the week of the post-test interviews. However, in addition to the aforementioned general influences, there appear to be some differential, Specific effects due to the impact of the various treat- ment approaches. With regard to the introverted Ss, simple attention and expectation of relief seems to have had little or no effect on the frequency of client inter- personal activity outside of treatment (post-test means, 2.0 & 2.2; mean pre-post changes 0.1 & 0.2). Similarly, CC counselor C‘s introverts did not improve either (poet-test mean 2.2; mean pre-post change, 0.0), while counselor c's introverts showed some noticeable increase in interpersonal activity as treatment progressed (post- test mean, 3.0; mean pre-post change 1.1). Once again, this appears to be consistent with the previous findings regarding the differential depth of self—exploration and anxiety reduction for these two groups during treat- ment. Finally, the most substantial gains in behavior change outside of treatment were obtained by the SD and RT counselor's introverted SS. The former groups doubled the frequency of their interpersonal activity (post-test means, 4.0 & 4.3; mean pre-post changes, 2.5 & 2.4) while the latter groups tripled theirs (post-test means, 5.1 & the time of Whil indicate that were about e anxiety with target behavi RT treatment increase in 1 be due to the the RT therap socially, or they were an discussions. from the RT t quickly imple than those re that follow-u obtained to 5 With seem to be an treatments or Apparently, socially, in discomfort 1 extroverts ' 121 means, 5.1 & 5.2; mean pre-post changes, 3.2 & 3.6) by the time of post—testing. While previous self-report measures seemed to indicate that both the SD and RT treatment approaches were about equally as effective in reducing interpersonal anxiety with introverted Ss, in terms of changes in target behaviors outside of the treatment setting the RT treatment approach appears to have produced a greater increase in interpersonal activity. Part of this may be due to the fact that weekly home work assignments by the RT therapists "forced" these S3 to interact more socially, or at least report such interactions, since they were an integral part of the in-treatment, weekly discussions. In any event, the benefits which accrued from the RT treatment approach did appear to be more quickly implemented into activity outside of treatment than those resulting from SD. It is unfortunate, however, that followeup data on this variable could not be obtained to see if this pattern maintained itself. With regard to the extroverts, there does not seem to be any consistent differences among the various treatments or between the treatment and control groups. Apparently, extroverts continue to remain quite active socially, in spite of their self—reported anxiety and discomfort in social situations. It seems that the extroverts' strong need for people and social activity, — generally (Ey overrides the source; namel Table conversation counselors a in obtaining objective, 1 rater bias, category (co ately, by me runs through was perform ratings, yiel series, for t employed in e as those used and Table 8. Obsem counselors tI RT counselor Furthermore, the part of increased sp 4 122 generally (Eysenck, 1960; Eysenck & Rachman, 1965), overrides the anxiety generated by this same stimulus source; namely, other people. Data on Therapist variables Table 7 presents the percent of time spent in conversation and silence by each of the CC and RT counselors and clients. Since the operations required in obtaining these gross time intervals were fairly objective, involving a minimum of judgement, and thus rater bias, these data were secured by the author. Each category (counselor, client, silence) was timed separ- ately, by means of a stop watch, requiring three separate runs through the sampled segments. This entire procedure was performed twice, with a two-week interval between ratings, yielding a correlation of .946, across cate- gories, for the two separate ratings. The tape samples employed in estimating these frequencies were the same as those used to secure the data presented in Figure 1 and Table 8. Observation of these data reveals that both CC counselors tended to be less active verbally than either RT counselor, regardless of client personality type. Furthermore, whereas this less active verbal stance on the part of the CC counselors tended to result in both increased speech activity and fewer silences on the part of the extro1 activity and §s. Converse stance yields the extrovert activity and §S- TABLE 7.--Pe Silence by E Emotive (RT) Client Type Extroverts W C Introverts C E Note: In 0rd speech greate counse rounde A Cl: effects revez about as act tarts, couns 4/ 123 of the extroverted gs, it resulted in less Speech activity and more silence on the part of the introverted gs. Conversely, the RT counselors more active verbal stance yielded less speech activity and more silence from the extroverted gs, but seemed to elicit more speech activity and a minimum of silence from the introverted §S. TABLE 7.--Percent of Time Spent In Conversation and Silence by Each of the Client-Centered (CC) and Rational- Emotive (RT) Counselors and Subjects. 011 t Client-Centered Rational—Emotive en Speaker Type C c R r Counselor 26 25 35 44 Extroverts Client 59 58 “2 25 Silence 14 16 23 29 Counselor 34 40 46 48 Introverts Client 3? 42 45 ”6 Silence 28 18 10 05 Note: In order to avoid inclusion of natural pauses in speech, silences were defined as an interval of greater than five seconds during which neither counselor nor client spoke. Each tabled value was rounded to the nearest percent. A closer examination of the individual counselor effects reveals that whereas counselors C & r remained about as active verbally with both introverts and extro- verts, counselors c & R changed their verbal activity counselors C respectively (Figure 1). symptoms and interpersona In 0 ciation for 1 which compri: counselor cat responses an occurrence. specific tee] for each _S_ p from the sam Presented in rated those “Slants of exPloration 124 level somewhat, counselor c becoming more active with his introverted SS and counselor R less active with his extroverted §S. These changes in therapist behavior produced proportional changes in the amount of client speech behavior and silence, resulting in an increase in the former and a decrease in the latter. These differ- ences in counselor c's & R's Speech activity level may partially account for their increased effectiveness over counselors C & r with introverted and extroverted §S, respectively, in terms of client level of self-exploration (Figure 1), reduction in process measures of target symptoms and complaints (Figures 2 & 3), and increased interpersonal activity outside of treatment (Figure u). In order to gain a better qualitative appre— ciation for the kinds of counselor speech behaviors which comprised these gross frequency groupings, the counselor category was further divided into more specific responses and categorized by type and frequency of occurrence. Table 8 presents the frequency of use of specific techniques by each of the CC and RT therapists for each § personality type. This data was obtained from the same tape segments employed in securing the data presented in Figure 1 and Table 7. After each rater had rated those portions of the tape samples containing segments of the client‘s Speech for level of self- exploration (see Figure l), the same raters, still TlBLE 8.-Prequency Reflection and Clar Reflection and Clar Reflection and Clar Reflection and Clar TOT ALS: Westioning of Peel Questioning of Thi Questioning of‘ Cont Questioning of Beha TOTALS: Interpretation of F Interpretation of T Interpretation of C Interpretation of B TOTALS: Direct Conhontatiol Direct Confrontatior Direct Confrontatiox Direct Confrontatior TOTALS Suggestion: Information and MW Redirecting Questior Self—disclosure: free Association: Reinforcement (Appm Home Work Assignmenl Tnclassii‘iable : “ TOTRLS: W Note: This Table i: to rate all t 'This figure v The numbers here rep “Sglven. For exar entry would be 9, or .~ ”Includes, in Lfitt‘apy, e.g., greei '«I'iis category probal avoid this classifi< ‘1 5: ed. .a ifi 125 TABLE 8.—-Frequency of Use of Specific Techniques by Each of the Client-Centered (CC) and Rational-Emotive (RT) Therapists. Per cent of Use of Techniques by Counselor Technique C c R r [7‘1 H [Ti H [11 H [11 H Reflection and Clarification of Feelings: Reflection and Clarification of Thinking: Reflection and Clarification of Content: Reflection and Clarification of Behavior: TOTALS: .1: o J‘: .L' J?! W o H m |N|4Ln NLAJNKD JJHianJH HU’l ON HU’I O Questioning of Feelings: Questioning of Thinking: Questioning of Content: Questioning of Behavior: TOTALS: lF‘OI4 I—' F‘O 5—: l\.) Interpretation of Feelings: Interpretation of Thinking: Interpretation of Content: Interpretation of Behavior: TOTALS: 2L4o<3u Direct Confrontation with Feelings: Direct Confrontation with Thinking Direct Confrontation with Content: Direct Confrontation with Behavior: TOTALS R)H H Ml lkJF‘C>o HIOIVLU U1k’O\fl\O u)Ol4Lu mL3c>c>m U, E H HI MLQC)H¢2 «unscra.: OJu)O.:63 H H U IM(DE;O,D.JO : wkoc>oi4 U4c>oraun mh4k40<3 umuuow pkOOO H| |H<30xorouumxn udorousm oJH<3ch- UJOCDu |k‘0 H HCDPJOFA W P" m p—I zqm.4(hC2PJP‘a>c Efluyr:a)0LocnuJF “A n.) mlmwxoocoxli—Jm H 3’4 l—-‘ \0 Note: This Table is not identical to Table A, Chapter 3, since it was impossible to rate all of the items listed in the latter table from audio tapes only. *This figure was not included in the frequency count presented above. The numbers here represent simply the number of times a homework assignment was given. For example, if a homework assignment was given each session, the entry would be 9, or 1 entry for each of the 9 sessions. **Includes, in addition, activities not clearly relevant to the tasks of therapy, e.g., greetings, small talk, endings, etc. The very small entries in this category probably reflect the fact that both raters were instructed to avoid this classification unless therapist‘s statements could not be otherwise classified. working inde] those portim ments of the counselor's : to the manuai reliability, .781. The de average of ea Simpi differences between tree most on refl redirecting The RT thera] confrontatio: work assigmm interpretatit quency. A cl CC and RT cow therapists t client‘s fee addressed th behavior. lNei of therapist client level 126 working independently of one another, went back and rated those portions of the same tape samples containing seg- ments of the therapist's speech, categorizing each counselor’s statement by content and frequency according to the manual presented in Appendix 1.1 The inter-rater reliability, computed on the raw frequency count, was .781. The data presented in Table 8 represents a pooled average of each rater's score for each content category. Simple observation reveals that within treatment differences among therapists were substantially less than between treatment differences. The CC counselors relied most on reflection and clarification, suggestion, redirecting questions back to the group, and self—disclosure. The RT therapists, on the other hand, relied on direct confrontation, information and advice giving, and home work assignments. All counselors employed questioning, interpretation, and reinforcement with about equal fre- quency. A closer look at the points of emphasis of the CC and RT counselors reveals that the former group of therapists tended to address their techniques to the client‘s feelings or feeling states while the latter group addressed their techniques to the client's thinking and behavior. 1Neither rater was informed of this second rating of therapist verbal behavior until the first rating of client level of self-exploration was completed. 8: r tended t verted and e approach or personality change in th e becoming m introverts i: rather than more passive counselor r, states. Thus similarly an: verted _S_s, rl § sample was be the meal behavior on ' direction of counseling s expected of counseling 8 eXpected of In v and 8, the 6 Somewhat mo: here is that 4 127 An examination of the individual counselor effects reveals, once again, that while counselors C & r tended to behave almost identically with both intro- verted and extroverted §s, counselors c & R changed their approach or counseling style somewhat depending on the personality type of the group members. The direction of change in their counseling style resulted in counselor c becoming more active, directive, and leading with his introverts than counselor C, emphasizing cognitive rather than feeling states, whereas counselor R became more passive and non-directive with his extroverts than counselor r, emphasizing feeling rather than cognitive states. Thus, while both CC and RT counselors behaved similarly and as predicted with extroverted and intro- verted gs, respectively, their behavior with the remaining § sample was quite variable. This variability appears to be the result of a change in in-treatment counselor behavior on the part of therapist c & B, only. The direction of this change was to make therapist c's counseling style with introverted gs more like that expected of an RT counselor, and to make therapist R's counseling style with extroverted §s more like that eXpeoted of a CC counselor. In view of the information gained from Tables 7 and 8, the data presented in Figures 1 through 4 becomes somewhat more understandable. What seems to be suggested here is that the CC treatment approach produced the more, as tr particular from silenc irrelevant, to statemen of interper cations. F probing, ex reported pr commonly vi progressive treatment so In c role in init of §s self-e interviews v sented in Te techniques 1 their freque time period: Obs the initial by therapis 4 128 greatest amount of verbal activity with extroverted §s while the RT treatment approach produced the greatest amount of verbal activity with introverted gs. Further- more, as treatment progressed, the content of these particular §'s increased Speech activity seemed to move from silences and statements characterized as personally irrelevant, e.g., not related to the presenting problem, to statements characterized by acceptance of the problem of interpersonal anxiety and exploration of its impli- cations. Finally, as these §s became more active and probing, exploring their anxiety at a greater depth, they reported progressively less symptoms and complaints commonly viewed as indicative of anxiety, and engaged in progressively more interpersonal activity outside of the treatment setting. In order to better understand the therapist's role in initiating, or failing to initiate, this process of gs self-eXploration, the nine CC and RT treatment interviews were grouped into thirds with the data pre- sented in Table 7 and the totals of each of the treatment techniques presented in Table 8 recalculated in terms of their frequency of occurrence in each of these three time periods. This data is presented in Tables 9 and 10. Observation of these process data reveals that the initial treatment sessions were occupied predominantly by therapist speech activity. 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H.232 H1259: Hdm m.Om Ham was H.oo 3:98 H.82 H.182 H.OH.:.H.2 H.259: H am m.om H as onus H 8 a :95 H.002 u 8: muootm on? .HuHHmcozum x unusumuha you undo: amoulunom ho ncomdhdnaou 00: unoa uuuonoMII.sH Ham 9 :00 since, wit starting p Wit interperso within per other word differenti Similarly, effects we That is, n (placebo) verts or e 0n SD treatme Contact co be interpr of their F in terms c SimPlc att In “Me of th were 318111 1113- only interpersC Fig 146 since, with the exception of the S-RG, differential starting position effects make these comparisons invalid. With regard to the various self-report measures of interpersonal and general anxiety, none of the treatment within personality type effects were significant. In other words, neither the CC, SD, or RT treatments were differentially effective with introverts or extroverts. Similarly, none of the treatment within personality type effects were significant for either of the control groups. That is, neither the no-contact control nor the no-treatment (placebo) control was differentially effective with intro— verts or extroverts, either. On the other hand, introverts treated by the HT and SD treatments were significantly different from the no- contact control introverts. However, these findings should be interpreted with considerable caution, at least in terms of their practical implications, since the same benefits, in terms of anxiety reduction, accrued from giving gs simple attention, only. In terms of changes in behavior ratings of anxiety, none of the treatment within S personality type effects were significant at the .05 level. Finally, in terms of the IIA, only the RT introverts showed significantly greater interpersonal activity outside of the treatment setting. Figure 7 presents a graphic representation of the mean pre-post reduction in self—reports and behavior ratings of interpe: ness for a: values wer- the post-t- the summed Cle viewing ha- reports of the same p times as 111' reports th observatio in the pre Obs that the c in reducti (placebo) their near still only self‘repor general an none of th direction Int IIlately for: 147 of interpersonal anxiety, general anxiety, and defensive- ness for each treatment and S personality type. These values were computed by subtracting the summed average of the post-test means across instruments and counselors from the summed average of the pre-test means. Clearly, the impact of simple attention and inter- viewing had no greater effect on extroverted S's self- reports of anxiety than simply the passage of time. However, the same placebo conditions resulted in approximately four times as much anxiety reduction in introverted Ss' self— reports than no treatment at all. Once again, while these observations were not statistically significant, they were in the predicted direction. Observation of the treatment differences reveals that the CC and SD approaches were three times as effective in reduction anxiety in extroverts as either the no—treatment (placebo) control or no-contact control groups. Similarly, their nearest competitor, the RT treatment approach, was still only half as effective in reducing extroverts' self-reports and behavior ratings of interpersonal and general anxiety as either the CC or SD treatments. While none of these findings were statistically significant, the direction of the differences are certainly encouraging. Introverted Ss, on the other hand, showed approxi- mately four times as much anxiety reduction when treated by means of HT and SD as compared to the no-treatment 148 CH5 EEHHOH. HsHOOHEEEHH HO HHEHH NYE” mssm-msm Hmumcow .0 quoncm HmcowaoaLoOCH mo mMCHu an» HHHHmcomLoa acmHHo ma h0H>mnon ucm museums cam uzmfibmopo homo you mmwco>Hmcmeo use .zoonzm IaHmm :H :oHuozomL umoansa Emmi-I.> ohzmHm mOZHHHmzmth [INJI Irfiw- >Bmea< Hsnon and museums I HN- IIHI llmd- Ilo fimHI IIH INHI nIN LT .-m IO- II: Iml I'm [0 new n . mozHH¢mmm mmmzm>Hmzmhmq cum unoEummau now Imem :H :OHHosomH pmoal ..HHco o sou mmocm>umnmuwu use .msoHancou acosuwopu on» me .Huwasm can cecal-.m oastm u mm- I mm- NHmez< admmzmo apmez< AdzomMmmmPEE monomer secs-mm mvmw only. The data prese It into Hypot would be c‘ verts, was However, a and 8) wez encouragir follow ver Sir My two c each apprc be cOmpute to Perform “'91“, some °bServatic each Couns Fig mean pre‘l ratings of defensiver 151 only. These values were derived in the same manner as the data presented in Figure 7. It appears, then, that the eXpectations incorporated into Hypotheses l and 2, that these various treatments would be differentially effective with introverts and extro- verts, was not supported by the evidence herein presented. However, as noted, all of the differences (see Figures 7 and 8) were in the predicted direction. What is even more encouraging is the fact that all of these observations follow very closely the process data reported earlier. Counselor Effects Since therapists were treated as a random variable, only two counselors were employed as representative of each approach, and no overall analysis of variance could be computed for the counselor effects, it was not possible to perform any statistical comparisons on this data. How- ever, some meaningful information can be gleaned from observation of the pre—post changes in S anxiety level for each counselor. Figure 9 presents a graphic representation of the mean pre-post reduction in self—reports and behavior ratings of interpersonal anxiety, general anxiety, and defensiveness for each treatment and counselor. These values were computed by subtracting the summed average of 152 Hwnocmm woZHEHm2mme .poaom2300 some was go mmnfipmg a0fi>mncn ucm mphOdmalwa El H< ucmsummpp acme gem mmeo>flmccmmw use «zumfixcm .m mhsmflm mm :H coauozomn pmomlwAQ sweat: MoEcg muomhqw o Hakeemm «zuoflxcm HmEOmthme moZHBm spas goacmcsoo Sumo paw ucchmcap gone now wwcco>fimcmmop ucm .mpcfixcw CH mo mmsflpmg goa>mnmn Ucm mugoachlgaow CH :Ofiposccg mednme cocZII.0H ohzwflm N O O QHIHOO 0.9 HO mmmzmSHmszmm MHmUUa/E gmzmo WEE”? gommEmEH NOILDflGEH lSOd-HEd NVEW In two CC an treatment the pre-p counselor graphic rt self-repo: ness for I values we: the pre-te The the counse reported e treated by n0 treatme Whi between Cc ° PTOdueed Verts as 0 Condition anxiety I‘e verted §s, between 00 R prOdUCed extI‘OVert S 155 In an attempt to more clearly understand why the two CC and two RT counselors showed rather large, within- treatment differences while counselors B and b did not, the pre-post difference scores were plotted for each counselor and s personality type. Figure 11 presents a graphic representation of the mean pre-post reduction in self-reports and behavior ratings of anxiety and defensive- ness for each counselor and s personality type. These values were computed by subtracting the summed average of the pre-test means. The data presented in Figure 11 follows very closely the counselor within § personality type process data reported earlier. That is, introverts and extroverts treated by counselors C, c, R, and r, as well as those given no treatment at all, showed marked differences. While there were virtually no observable differences between counselors C and c with extroverted gs, counselor 0 produced about twice as much anxiety reduction in intro- verts as counselor C. Similarly, the n0~00nta0t control condition resulted in approximately four times as much anxiety reduction in extroverted gs as opposed to intro- verted gs. Conversely, while there were no differences between counselors R and r with introverted §s, counselor R produced roughly twice as much anxiety reduction in extroverts as counselor r. GENERAL ANXIETY xu—rznrzuaouu. auxxmy _ g'aau Your" roan '— 1‘=(d)w - - 35(4)le — You)” —- r‘aum ——- x'r _ . s': .— I'! " — s‘u — I‘n — - 3'1 ~ 1's — — r'm ._ 1‘s- —- a 3‘: _ I‘a - - 3'3 ... \i~}-— «n a I'm -—. :l'aan \ I'oaa _ i'oon -‘ “(dun - - 35(5): \ I'Mdm . - Tau)“ \ I'd _ ‘ 3'4 \ I'u - - 3‘! \ I": - _ l'q \ I'a — a 3': ,\ I'a _ ‘ 3'3 \ I‘o . -_ 3'3 \ \F': GENERAL ANXIETY INTERFERSONAL ANXIETY I‘cou " 3'oou I‘ODN ‘- a‘oon *— ra(d)qu - -— — —- — 8‘°(d)au R I‘M-{H.N '—‘ — — s‘o(d)J.N _- I‘J —- — —- - — — — - — - — — 3'1 ~— {'8 ———————————— 3'! '____-__——__‘___ I‘a — - - --------- H‘Q *——*———————-—-—-—-——-— I‘a ——————— — _____ 3:3 _________________________ I'a —— ----- 3'0 __________________________ I‘o " '- - 2'0 ‘h——‘“—___“""_______'___- ,__,.__.__. : : 5 r a; “ ° “-‘ 5.’ t “r’ t 3 ’9 I‘aau -- 3'33u L— I‘oan - z‘oon _— I'a(d)1u ' — —_' 3‘a(d):u ‘ I'o(a).m - - - ~ -- "I'O(J)J.N _— I'd —- - — - —— —— - - — -— ~ — —- — a“! _— I'N "'——"‘“_“—""‘ 3'8 \ I'q ——-___..________ s‘q ------—--—------- I'E "' “ ' ' — — “““ "'— '''' 3‘8 *- I‘O ""‘""“" 3‘3 -——-—————————————————--- : .-__" a _________________________. " ° '7 f. g x 3 if E'lr‘ MOI-1.00038 LSOJ'IHJ NVEIW 156 BEHAVIOR RATINGS DEFENSIVENESS Figure 11.-Mean pre-post reduction in sslf reports and behavior ratings of interpersonal anxiety, general anxiety, and defensiveness for each counselor and client personality type. No extrovert of the SE of signif self-repc the behav that pred Ir impact of interacti tion of f each of t mean pre. ratings C defensive with aye: ment 00nd Same mam Te Mme; X treatme level! if 157 None of the no—treatment (placebo) control introvert— extrovert differences were substantial. Similarly, none of the SD counselors introvert-extrovert differences were of significant magnitude, either. Once again, while the self-report questionnaires were in the predicted direction, the behavior ratings were in the opposite direction to that predicted. In order to gain a better appreciation for the true impact of the various counselor within S personality type interactions, the effects of simple attention and expecta- tion of future treatment and relief were subtracted from each of the treatment conditions. Figure 12 presents the mean pre-post reduction in self-reports and behavior ratings of interpersonal anxiety, general anxiety, and defensiveness for each counselor and S personality type with average placebo effects removed from each of the treat- ment conditions, only. These values were derived in the same manner as the data presented in Figure 11. Follow-u Data Table 18 presents an analysis of variance of the follow-up data using the mean for each group as the unit of analysis. As can be seen, all but the Edwards Social QE§irability Scale (ESD) showed treatment and personality .05 X treatment effects which were significant beyond the level, indicating that the differences noted at post—testing I'm .. a'm ‘- I'DDN- -- S'DON _- I"! _ , _ >1 3 ‘l s E 1.! . . K i 3'u *- 4 . E I‘o .‘ E n E'Q _‘ 0 1‘2! ' - 3‘! _. 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Finally, whereas the CC and RT treatments were about four times more effective in reducing anxiety as the no-contact control condition, the SD treatment approach was roughly six times more effective as simply the passage of time. The fact that these follow-up data are identical to the post-test data reported earlier indicates that the results obtained at post—testing were maintained during the three- month follow—up period. Once again, it should be made clear that while all these observations were in the predicted direction, and thus encouraging, only the treatment—control comparisons were significant. In order to gain a better appreciation for the true impact of the various treatments administered, the effects of simple attention and eXpectation of future treatment and relief were subtracted from each of the treatment conditions. Figure 14 presents the mean reduction in self—reports and behavior ratings of interpersonal anxiety, general anxiety, and defensiveness from pre- to follow—up testing with placebo effects removed from each of the treatment conditions, only. These data were derived in the same manner as the data presented in Figure 13. O O mUZHHé A 9053 NH. r4952 NB munch/3 mogsHmfim WMAEmSHWH4vHRPR~ .HEHD/HBNL sHSfidLD‘WHEWHBL/HHH 167 psoEpmoap ogpomm o o \. load some mmosofimmmmswgosooa coma.‘ i Oth|%Hmm ‘ EHHOZMIQEOHHE § mammamoazfiao E .aflso .meOfioHoCOO onoooHQ Sufi: mcflpmop QSISOHHoe Op Hmsomaoahopsfl mo mwcflpme AOfl>m£oQ new mph some/So 90328-02 I ZOHENHEmEmE D - r..- wml HNII Il 'Qm... ' jml ma- - 7 .. .a- 3. I on .- ... :mu 3. ... S- Ilwau m- I NH- ”...” 0....“ In ' NH... o- I w- u... 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That is, neither the CC, SD, nor RT treat- ments were differentially effective with introverts or extroverts. Similarly, none of the treatment within per- sonality type effects were significant for either of the control groups. In other words, neither the no-contact control nor the no-treatment (placebo) control was differ- entially effective with introverts or extroverts, either. Once again, however, introverts treated by the ET and SD approaches were significantly different from the no-contact control introverts. However, as noted pre- viously, the practical implications of these findings should be interpreted judiciously, since the same benefits, in terms of anxiety reduction, were evidenced from giving §s simple attention, only. swam 0.3." mfima ms: «4: :.:ma :.m: mm: :6: use»: was so: .13 «.9 :.sm mém :.mn N.m: man 230: Hmlm m m5: H.002 ”.002 H.0nmvfiz fl~uamvfiz H.Dm N.OM NEH! Hie: H.00 nnzuno H.002 H.002 H.0nnCHZ Mucus—oh: N.m:.u. H«Am Hint Huhfl H.UU nQIOLc nuowhta 005.... 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H firm was: H . uo mASOIG H602 M18: Torch: ".1259: Hdm mdm Ham was H38 mesons H.002 ”.18: horse: m.o€§z H on m omil|\ .3930 con uwom uhuonamllNN ans! npuooem on? 3322.3» x newscasts .8.“ was»: 9.1633. .«o “:03 and int within ‘ .05 lev mean pr ratings defensi' These VI of the 1 selors 1 I attentiI at foll( than $11 Superim condth-l< noted a1 1'JhI‘ee—m l the thre noted at “01 and the RT 1 more eff anxiety 170 Finally, in terms of changes in behavior ratings and introversion-extroversion, none of the treatment within S personality type effects were significant at the .05 level. Figure 15 presents a graphic representation of the mean pre- follow-up reduction in self—reports and behavior ratings of interpersonal anxiety, general anxiety, and defensiveness for each treatment and § personality type. These values were computed by subtracting the summed average of the follow—up test means across instruments and coun- selors from the summed average of the pre—test means. As noted at post-testing, the impact of simple attention and interviewing once again had no greater effect at follow-up on extroverted S's self-reports of anxiety than simply the passage of time. Similarly, the four-fold superiority in anxiety reduction of these same placebo conditions with introverts over simply the passage of time, noted at post-testing, was maintained at the time of the three—month follow—up. Extroverted §S treated by CC and SD also maintained the three-fold superiority in anxiety reduction at follow-up noted at post—testing over the no-treatment (placebo) 00n— trol and no-contact control extroverts. In addition, While the RT treatment approach was once again about one-third more effective in reducing interpersonal and general anxiety as either of the controls, it was only half as 171 IOHEMDEEIBOHEOEEH no: He; moggmm .mnzp hudamcomnvm unmade and ".20.: .huoaxcu Ashoeuw .huodxnm Hmcomhoahoucu no nmcfiuwn noH>anon cad munoaohIMHom :a scauosuon a: amok» some ho.» mmwco>unccucu new IonHou Iona :mwzllfid cuswam NOIJIDnCIEH cm'WI'IM ”(Nd W rag. gommmewflfi effectf treatme times a RT or E introve criteri In addi one-thj as the on the trol in aPproao (placeb as the these d HT intr than th the no- eXtl‘ove verts a not sta predict Cess anI 172 effective, on the same criteria, as either the CC or SD treatments. Introverted Ss again showed approximately four times as much anxiety reduction when treated by means of RT or SD as compared to the no—treatment (placebo) control introverts, and ten times as much improvement, on the same criteria, as those introverts given no treatment at all. In addition, the CC treatment approach was once again only one-third as effective in reducing anxiety in introverts as the RT or SD treatments, and one-third more effective, on the same criteria, as the no—treatment (placebo) con— trol introverts. Finally, while the introverts treated by the CC approach were twice as extroverted as the no-treatment (placebo) control introverts and four times as extroverted as the no-contact control introverts at follow-up,none of these differences were significant. However, the SD and RT introverts were approximately five times more extroverted than the CC introverts, ten times more extroverted than the no-contact control introverts, and twenty times more extroverted than the no-treatment (placebo) control intro— verts at follow-up. Once again, while most of these observations were not statistically significant, they were in the direction predicted by the original hypotheses and confirm the pro- cess and outcome data reported earlier. true 1: type re tation each of the mea behavic and def type wi conditi as the type ef Within reSults trsated emPloye ahalysi was not this da gleaned § anXIe 173 In order to gain a better appreciation for the true impact of the various treatment within S personality type results, the effects of simple attention and expec- tation of future treatment and relief were subtracted from each of the treatment conditions, only. Figure 16 presents the mean pre- follow-up reduction in self-reports and behavior ratings of interpersonal anxiety, general anxiety, and defensiveness for each treatment and S personality type with placebo effects removed from each of the treatment conditions. These values were computed in the same manner as the data presented in Figure 15. All of these follow-up, treatment within S personality type effects are identical to the post—test, treatment within S personality type effects, indicating that the results obtained after treatment were maintained over the three-month period following the termination of treatment. Counselor Effects As indicated previously, since therapists were treated as a random variable, only two counselors were employed as representative of each approach, and no overall analysis could be computed for the counselor effects, it was not possible to perform any statistical comparisons on this data. However, some meaningful information can be gleaned from observation of the pre- follow-up changes in S anxiety level for each counselor. 171+ . :.nn ] .IJ .rNHl nVOHI .fi a] .r ml 4: an m 1'. 1r NI omwu.mm a a; M: 7. a a; as v 0 [IE N HOHmflM>OKHkHEHOHmmu>O¢HZH .aazo.m:o«»fie:oo acmaumwnu am» we none Eopm mzmumu cum . umfixcw awhwcw o>oEch muommmo oncomfia nu“: mam» muafluzomaua pcoafio ucm pcmspmmAu nomw Lou mwwcm>a . maumfixcm flmcomhmapmucd «o mwcfiumh hoa>anun ucm muaoamhlwamm CH :oapodump anisoaaou |mha cwozul ma musmflm I aw- n z- 1'9”: n m: rmH» 1' Nu IQ! I 3 I 7.. I a T. pd II 0 1w| .rH 1m» .vN '0 1T m n J 32:32 «Egg mmEEmzflmH—H hag 3E8 bug EOEEEH NOIIDDGEH (In-MONO! 'EIH NVEN mean p: rating: defensi values the fol ality t differe SD cour counsel all sel Counsel effecti than 00 roughly complai Counsel the two the cur cOntrol Figure Control ments. 175 Figure 17 presents a graphic representation of the mean pre- follow—up reduction in self-reports and behavior ratings of interpersonal anxiety, general anxiety, and defensiveness for each treatment and counselor. These values were computed by subtracting the summed average of the follow-up test means across instruments and S person— ality type from the summed average of the pre-test means. As noted at post-testing, virtually no observable differences were evidenced at follow-up between the two SD counselors. However, once again, both CC and both RT counselors showed substantial and reliable differences on all self-reports and behavior ratings of anxiety. That is, counselor c was once again approximately 30 percent more effective in reducing interpersonal and general anxiety than counselor C. Similarly, counselor R was once again roughly 30 percent more effective in reducing cognitive complaints and behavioral manifestations of anxiety than counselor r. Finally, as at post-testing, the differences between the two no—contact control groups were quite large, while the differences between the two no-treatment (placebo) controls were conspicious by their absence. However, as Figure 17 indicates, the differences in the no—contact control groups once again were not reliable across instru— ments. 176 .zpoaxnm amcomhoanwuca mo mmcfipmu pea 858$" mogdmmm mmmzmpHszmn .QOHmmcdoo some new pawEuMmap scam aom mmmcw>fimcowmc new .auoaxcm Hmpwnow >mgon and wpaoamaluamm :H coaposoop azazoaaou [can cmmz||.>H opswaa EH09? gmzww E 303% MOILOflCIEH dfl‘MOI‘IQI “EEK NW“ impact attentf were s1 Figure self-re genera] counsel of the in the why the within- not, th each 00 a graph reducti Persona each 00 °°mpute teSt me; the pre‘ identica 18. int: 0’ 0. H. Showed I 177 In order to gain a better appreciation for the true impact of the various counselors, the effects of simple attention and expectation of future treatment and relief ‘ were subtracted from each of the treatment conditions, only. Figure 18 presents the mean pre— follow—up reduction in self-reports and behavior ratings of interpersonal anxiety, general anxiety, and defensiveness for each treatment and counselor with average placebo effects removed from each of the treatment conditions. These values were computed in the same manner as the data reported in Figure 17. Once again, in an attempt to more clearly understand why the two CC and two RT counselors showed substantial, within-treatment differences while counselors B and b did not, the pre- follow—up difference scores were plotted for each counselor and S personality type. Figure 19 presents a graphic representation of the mean pre- follow-up reduction in self—reports and behavior ratings of inter- personal anxiety, general anxiety, and defensiveness for each counselor and S personality type. These values were computed by subtracting the summed average of the follow-up test means across instruments from the summed average of the pre-test means. The follow-up data presented in Figure 19 is nearly identical to the outcome results reported earlier. That is, introverted and extroverted Ss treated by counselors C. c, R, and r, as well as those given no treatment at all, showed marked differences. .hfico .mCOHpHucoo pcoEummnu on» no some song .Uw>oan muowhuo oncomaa owwao>m Spas aoaom:500 Sumo ecu acmepmwhu some now wwwco>awsmuoo one .mpmaxcw Hmhccmm zuofixcw Hacomaoaaoucfi uo mwcwown Aoa>m2on one munoaoh Imaom :H coaposoon gauzeaaom Iona cmmzla.wa maswam mqua¢mmm mmmzm>Hmzmmmn MHMHNZ< Hoqqom Inch 2 filA, l‘_, 222 PRE-TEST PERSONAL DATA SHEET Name Sex M F AGE College Major Student Number Local Address Local Phone No. Academic Standing: Freshman Sophomore Junior Senior Please indicate below the times which you are free (i.e., the times when you g9 not have classes or other meetings scheduled). Please underline below the description which best depicts your interest in the project Just discussed with you: Extremely interested Want to know more Extremely disinterested REMEMBER: If you wish to participate in this project, you will be required to attend all ten of the counseling sessions. 223 POST-TEST PERSONAL DATA SHEET NAME AGE SEX F M CURRENT ACADEMIC STANDING (IN TERMS OF THE NUMBER OF TERMS YOU HAVE ATTENDED COLLEGE): FRESHMAN SOPHOMORE JUNIOR SENIOR Other than your weekly groups, have you had any other counseling or therapy since the beginning of this term: YES NO If yes, briefly explain: Approximately how many sessions did you have Have you ever had counseling or therapy for personally or vocational problems prior to the beginning of this semes- ter: YES NO If yes, briefly explain: Approximately how many sessions dmiyou have If you have filled out your name and age on this sheet do not bother to put your name, etc. on the top of each 3? 553 separate answer sheets. Just be sure that you have filled out this sheet completely. Campus Address Phone NO. Home Address Phone No. City State Zip Code _"__ 22).: FOLLOW-UP TEST PERSONAL DATA SHEET NAME AGE SEX F M CURRENT ACADEMIC STANDING (IN TERMS OF THE NUMBER OF TERMS YOU HAVE ATTENDED COLLEGE): FRESHMAN SOPHOMORE JUNIOR SENIOR other than your weekly groups, have you had any other counseling or therapy since the beginning of this term: YES NO If yes, briefly eXplain: Approximately how many sessions did you have Have you ever had counseling or therapy for personally or vocational problems prior to the beginning of this semes- ter: YES NO If yes, briefly explain: Approximately how many sessions did you have If you have filled out your name and age on this sheet 99 n2; bother to put your name, etc. on the top of each of the separate answer sheets. Just be sure that you have filled out this sheet completely. Campus Address Phone No. Home Address Phone No. City State Zip Code APPENDIX C INTERPERSONAL ANXIETY SCALES (FORM A & B) 225 226 INTERPERSONAL ANXIETY SCALES (A) DIRECTIONS This inventory consists of a series of numbered statements. Read each statement carefully and decide whether it is true as applied to you or false as applied to you. You are to mark your answer true or false on the answer sheet provided with this booklet. Look at the example below. 1 T-— F=== 2 T=== F—- 3 T=== F— If a numbered statement is TRUE or MOSTLY TRUE, as applied to you, then blacken in between the lines in the column headed T (see 1 above). If a numbered state- ment is FALSE or NOT USUALLY TRUE, as applied to you, blacken in between the lines in the column headed F (see 2 above). If you have never done what the question asks or been involved in the situation which the statement describes, then answer it according to how you think you would act if you actually were in that situation. It is important to keep in mind that there are no right or wrong answers to the questions in this book— let. They are simply true as applied to you or false as applied to you. IMPORTANT: Remember, do not answer these questions with the intention of portraying yourself in the most favorable light possible or in terms of the person you would like to be. Please answer all questions in terms of how you actually behave in the various situations described. We assure you that all information will be treated with the strictest of confidence, so please be truthful. Do not leave any blank spaces. In marking your answers on the answer sheet, check periodically to be sure that the number of the statement you are working on agrees with the number on the answer sheet. Please do not mark in this booklet. NOW OPEN THE BOOKLET AND BEGIN 10. ll. 12. 13. 11:. 15. 16. 17. 227 You hardly ever feel a pain or tenseness in the muscles in the back of your neck. You find it difficult overcoming the feeling that you are inferior to others in many respects. (T) You get angry or disgusted with yourself when you are unable to speak up in a group or voice your opinion. (T) It is not hard for you to ask for help from your friends, even though you cannot return the favor. (F) You feel timid and unsure of yourself in the presence of other people you regard as your superiors. (T) You go out of your way to avoid meeting someone you dislike. It is easy for you to act naturally wherever you are. (F) You are comfortable and at ease while being intro- duced to a person for the first time. (F) You feel equally at ease when both men and women are present. (F) When people become bossy or domineering with you, you tend to "slow down" or do the opposite of every- thing they tell you to do. You have little difficulty telling nosey people to mind their own business. F) You enjoy applying for a job in person. (F) You are not likely to give up your plans even when there is a good deal of opposition by your peers. (F) You feel at ease in all the groups you attend. (F) You give the real reason when you do not want to do something or go somewhere rather than think up a good sounding excuse. (F The thought of making a speech to a group does not frighten you. ~) When a parent, teacher or boss treats you unfairly, you are likely to directly confront them with their unfairness. (F) 18. 19. 20. 21. 22. 23. 24. 25. 26. 27o 28. 29. 30. 31. 32. 33. 228 Because you find it difficult to say "no," people take advantage of you. (T) It is difficult for you to calmly search your mind for the right words to express your thoughts when someone in a group asks you a question unexpectedly. (T) You have little or no stomach trouble (indigestion, gas pains, upset stomach, etc.). (F) You usually say what you feel like saying at the moment. (F) You find it hard to sit still in a small group of unfamiliar people. (T) You feel that it is important to be liked by all your friends. (T) You are relaxed and at ease when you have to intro— duce people to each other. (F) It is easy for you to take the lead in enlivening a dull social affair. (F) When you get anxious in a social situation, the skin on your neck, chest or arms is likely to break out into a rash or spots of red. (T) If you don't get what you want you fight for it. (F) You become anxious and uneasy if it looks like you are going to be late for an appointment. (T) There are only a few friends with whom you can relax and have a good time. (T) You do not feel self-conscious in the presence of important people. When you resent the actions of another person, you promptly tell them so. (F) A person should be fair to a disagreeable or obnoxious person in the presence of others. (T It is easy for you to talk with people as soon as you meet them. (F) 44———————----——————————————————————————————_TZIZZIIIIIIIIII========5 34. 35. 36. 37. 38. 39. 40. 1+1. 42. 43. 4L». 45. 46. 47. 48. 49. 229 If someone you know has been spreading untrue or bad stories about you, you see them immediately and have a talk with them about it. (F) You do not perspire easily even when anxious or upset. (F) If you hold an opinion that is radically different from that expressed by an instructor, you are likely to tell him about it either during or after the class. (F) In a group, you usually think about what you're going to say over and over before you finally say it. ) You attempt new games at social affairs even when you haven‘t played them before. (F) In a group or at a social gathering your mouth, tongue or 11 s are likely to get dry if you become anxious. (T You are willing to take a chance alone in a situation where the outcome is doubtful. F) You feel relaxed and comfortable while speaking before a group. ) You would feel uneasy or self-conscious if you had to volunteer an idea to start a discussion among a group of people. You would like to tell certain of your friends a thing or two, but probably won't. T) You are no more nervous than most others. (F) It is not right to humiliate a person publically even if they deserve it. T) When you are attracted to a person whom you have not(F) met, you make an active attempt to get acquainted. You like to entertain guests. (F) Before speaking, you get a lump 1%)your throat which may interfer with your speech. You avoid arguing over a price with a clerk or salesman. ( ) 230 50. You do not have difficulty making new friends. (F) 51. When someone is not "playing fair," you surely let them know about it. F) 52. You are able to put a disagreeable person "in his place" by direct rather than devious or round—about means. (F) 53. It is easy for you to stand up for your rights when you are in the minority. (F) 54. You look forward to an opportunity to speak in a group. F) 55. You avoid social contacts for fear of doing or saying the wrong thing and hurting another's feelings. (T) 56. You are troubled by nausea and/or vomiting when you know it's your turn to get up before a class and give a talk. (T) 57. You find it uncomfortable and anxiety producing to meet new people and make new acquaintances. T) 58. You are always loyal to your friends. (T) 59. After being introduced to someone for the first time, you usually stick to conventional topics of dis— cussion (school, weather, job, etc.). (T) 60. Sometimes your interpersonal relations are so tense and anxiety producing that your sleep is disturbed that evening. (T 61. You would have no difficulty saying "no" to a sales- man who was trying to sell you something you did not really want. F 62. When things go wrong for you, you feel you are more to blame than anyone else. (T 63. When a clerk in a store waits on others who should come after you, you call his attention to the fact. (F) 64. You are able to tell a roommate that he has done something which upsets you, right there and then when it happens. (F) 65. Your mood is easily influenced by the people around you. (T) 44F_____———————————————________________________:::]IIIIIII=E======:5 66. 67. 68. 69. 70. 71. 72. 73. 749 75. 76. 77. 78. 79. 80. 81' 82. 231 You frequently have to fight against showing that you are bashful. (T) You feel tense and uneasy when you first enter a social gathering. (T) You are restless and uneasy in the presence of unfamiliar people. T) You are able to do things without regard for what others might think or say. F) You seem to be about as capable and smart as most others around you. (F) When you are in a group, you accept the leadership of someone else in deciding what the group is going to do. T) You do not become tense and anxious when you have to voice a dissenting opinion. (F) You feel that it is your friends' duty to sympathize with you and to cheer you up when you are depressed. (T) You have stayed away from another person because you feared loosing your temper and doing or saying some— thing that you might regret afterwards. T) Even though you can conceal it, you feel anxious in new social situations. ) Your hands tremble when you try to handle food, refreshments, etc., at a social gathering. (T) It is im ortant to you to be liked by those around you. (T You find yourself upset rather than helped by per- sonal criticism. (T) You would feel uneasy telling a superior that he had done a bad job on something. (T) trouble When in a group of people you rarely have thinking of the right thing to talk about. (F) You find it very hard to "get tough" with people who are rude and annoying. You feel socially secure. (F) 83. 84. 85. 86. 87. 88. 89. 90. 91. 92. 93. 94. 95. 96. 97. 98. 232 Your thoughts often race ahead faster than you can speak them. Your muscles (neck, legs, arms, etc.) get strained and tense when you are in a group of people you have just met. (T) It is not unusual for you to express strong approval or disapproval of the actions of others. ) You feel your friends should encourage, not criticize, you. (T) You are very open about revealing your "true self" to friends and acquaintances. Life is a strain for you much of the time. (T) You do not try to cover up your poor opinion of a person so that he won't know how you feel about him. (F) You wish you could be as at ease in social situations as others seem to be. ) Your stomach gets tight, fluttery, upset, etc. when you are T? a group of people you don't know very well. You do not worry too long over unpleasant or humili- ating personal experiences. (F) You usually "lay your cards on the table" rather than "beat around the bush" when you disagree with someone. (F) You are likely to stutter or otherwise indicate your anxiety in your voice when you get upset, anxious or excited in the presence of others. (T) You do not feel self-conscious because of your personal appearance. (F) You speak out in a group to oppose those who you feel sure are wrong. ) It is not very difficult for you to express strong feelings of love or affection toward another. (F) You doubt whether people you talk to are really interested in what you say. T) 233 99. When riding on a train, bus, etc. , you engage fellow travelers in conversation. (F) 100. Criticism usually upsets or disturbs you greatly. (T) 234 INTERPERSONAL ANXIETY SCALES (B) DIRECTIONS This inventory consists of a series of numbered statements. Read each statement carefully and decide whether it is true as applied to you or false as applied to you. You are to mark your answers true or false on the answer sheet provided with this booklet. Look at the example below. 1 T— F=== 2 lI‘=== F— 3 T=== F— If a numbered statement is TRUE or MOSTLY TRUE, as applied to you, then blacken in between the lines in the column headed T (see 1 above). If a numbered statement is FALSE or NOT USUALLY TRUE, as applied to you, blacken in between the lines in the column headed F (see 2 above). If you have never done what the question asks or been involved in the situation which the statement describes, then answer it according to how you think you would act if you actually were in that situation. It is important to keep in mind that there are no right or wrong answers to the questions in this booklet. They are simply true as applied to you or false as applied to you. IMPORTANT: Remember, do not answer these questions with the intention of portraying yourself in the most favorable light possible or in terms of the person you would like to be. Please answer all questions in terms of how you actually behave in the various situations described. We assure you that all information will be treated with the strictest of confidence, so please be truthful. Do not leave any blank spaces. In marking your answers on the answer sheet, check periodically to be sure that the number of the statement you are working on agrees with the number on the answer sheet. Please do not mark in this booklet. NOW OPEN THE BOOKLET AND GO AHEAD \l 10 ll. 12. 13. l4, 15. 235 When you think you recognize someone you see in a public place, you ask them whether you have met them before. (F) You take the lead in putting life into a dull party. You seek to avoid trouble with people whenever possible. You feel like telling nosey people to mind their own business, but you seldom do. (T) You can express yourself more easily in speech than in writing. (F) You have little or no trouble with your muscles twitching or jumping. (F) It does not make you feel uneasy walking into a group of people late or when you know that everyone's eyes will be upon you. It is not difficult for you to turn down unreasonable requests made by a close friend. ) You feel uneasy or uncomfortable when you are alone with important people. You prefer to pass by school friends, or people you know but have not seen for a long time, unless they speak to you first. (T) It is not difficult for you to raise your hand in class and disagree with what another person has said. When you are bossed around or unfairly treated by others you are more likely to do the opposite of what they request rather then tell them to their face how you feel. T) It is not difficult for you to openly express strong feelings of affection toward another. (F) You are a self-confident person. (F) When you meet people for the first time or begin to speak in an unfamiliar group, your heart starts pounding faster and faster and your breathing may be uneven. (F) 16. 17. 18. 19. 20. 21. 22. 23. 24. 25 26. 27 s 28 29. 30. 31. 32. 236 You have many ways of hiding your anxiety and uneasyness in social situations, even though they may not always be as effective as you would like. (T) Your thoughts become confused and jumbled when you have to speak up unexpectedly in a group. (T) You expect your friends to always treat you kindly. (T) You are able to say what you really feel and believe in a group. (F) You feel relaxed and at ease while getting acquainted with people. (F) When upset, embarrassed or anxious, you break out in a sweat which annoys you greatly. When a rude or unpleasant person hurts your feelings, you let them know how they make you feel inside. (F) You rarely cross the street in order not to meet someone you see. (F) When you have a real grievance with a close friend, you are able to handle it directly with them. (F) Although you talk fluently with a friend, you are at a loss for words in a group. (T) You find it difficult to ask a friend to return some- thing (book, money, etc.) he has borrowed and forgotten about, even though it may make you angry. (T) You do not become tense and anxious at the prospect of approaching an employer in seeking a raise. (F) You feel at ease and have little difficulty helping others have a good time at social gatherings. (F) You like to be a host or hostess for parties at a club. (F) You may be able to hide your anxiety from others but you can usually feel it yourself. (T) Although it may anger you, you find it difficult to fight for what you believe is right. (T) It is necessary to be friendly to those you meet for the first time. (T) 34. 35. 36 37. 38. 39 o 40. 41. 42. 43. 44. 45. 46 [4’70 48. 49. 50. 237 You would not go out of your way to avoid speaking in a group, if this were possible. (F) When the actions of a friend or roommate irritate you, you are likely to confront them with it right then and there. (F) You are likely to talk back to a policeman or other person in authority over you if you feel unjustly treated by him. You find it easy to start a conversation with a stranger. F) There is a lack of real affection g; closeness in your interpersonal relations. (T) Your feelings are easily hurt. (T) When you have to meet new people or speak in groups, the muscles in the back of your neck tighten up on you. (T) You do not feel obligated to do things for your close friends. ) You are able to show some temper in order to get what is coming to you. You are fearful and tense all the while you are speaking before a group of people. (T) You avoid arguing over a grade with an instructor. (T) You limit your friendships mostly to members of your own sex. In your interpersonal relations you function under a great deal of tension. You like to say what you think about things. (F) If someone steps ahead of you in line, he is likely to hear from you about it. F You are able to "talk back“ to people who often irritate you. (F The thought of speaking up in a group of people does not upset you or make you anxious. (F) You like to form new friendships. (F) 238 51. When you find that something you have bought is defective, you complain or demand an exchange or refund. (F) 52. If you were thrown together by chance with a stranger, you would be relaxed and at ease. ) 53. You are not bothered by acid stomach. (F) 54. You are likely not to speak to people until they T speak to you. 55. You certainly feel useless a good deal of the time. (T) 56. You feel disgusted with yourself after trying to address a group of people. 57. Usually, you simply forgive your friends when they hurt your feelings rather than mention it and create even more difficulty. 58. When you are served stale or inferior food in a restaurant, you immediately complain about it to someone in charge. (F) 59. After being introduced to someone for the first time, you just can't seem to think of things to say or make good conversation. (T) 60. You are no more nervous than most others. (F) 61. You feel depressed by your inability to handle various situations. (T) 62. What others think of you does not bother you. (F) 63. You stand up for your rights in a group when you are in the minority. (F) 64. You like your friends to show a great deal of affection toward you. (T) 65. When a person does not "play fair," you hesitate to say anything about it to them. 66. You would rather apply for a job by going through a personal interview rather than by writing a letter. (F) 67. You often think about the anxiety you feel inside when you have to meet new people. T) 68. 69. 7o. 71. 72. 73. 74. 75. 76. 77. 78. ‘79. 80. 81. 82. 83. 84. 85. 239 You seldom express your anger directly toward the person who has upset you. (T) You have no fears about going into a room by your- self where other people have already gathered and are talking. (F) You are relaxed and at ease when you have to discuss or defend your ideas or opinions with others in a group. Friends should always encourage you when you have met with failure. (T It is not difficult for you to oritize people who are in a position of authority. (F) Meeting people makes you anxious. (T) When someone says silly or ignorant things about something which you know about, you try to set them straight. (F) Few of your friends know the "real you." (T) It is easier for you to annoy or otherwise create minor problems for an unreasonable boss rather than confront him with his unreasonableness. (T) You worry about the image you present socially. (T) You rarely find it necessary to cough or clear your throat before speaking. (F) Criticism of scolding does not hurt your feelings very much. F) It does not make you nervous or uneasy to have to wait for others. You seldom tell your friends what you really think of them. T) You feel uncomfortable meeting people at social affairs. You feel inclined to tremble when you are afraid. (T) You are certainly lacking in self—confidence. (T) You like to let people know where you stand on things. (F) Ii 86. 87a 88. 89. 90. 91. 92. 93. 94. 95. 96. 97. 98. 99. 100. 240 You have no fear of facing an audience. (F) You find it awfully difficult to stand up for what you think is right. (T) You have difficulty thinking clearly when you get worried or excited. (T) When you are in an unfamiliar group, your posture feels strained or unnatural. (T) You are hesitant to shake hands with people you first meet because your palms are moist and clamy. You strongly defend your own opinions as a rule. (F) You feel that you can say what you believe even when you know it may hurt another's feelings. You are not overly sensitive to the comments of others. (F) You are not a nervous person. (F) People often disappoint you. (T) You find yourself worrying a good deal about your social relations. ) If you were a guest at an important dinner, you would do without something rather than ask to have it passed to you. T If you came late to a meeting you would rather stand or leave than take a front seat. ) In school, it is not difficult for you to give an oral report before a class. You take disappointments so keenly that you can't seem to put them out of your mind. T) APPENDIX D INDEX OF INTERPERSONAL ACTIVITY 241 242 INDEX OF INTERPERSONAL ACTIVITY Indicate in the boxes below the number of "dates“ you have had in the last week, e.g., since your last group meeting. Use the following criteria as a definition of the term "date". (I) It may be with a member of either sex. (2) 23 not include regular or routine activities such as those involving parents, relatives, roommates, or members of your weekly group. (3) You must be the one to have asked them for the "date". Do not include activities where someone asked you to do something or go some- where. (4) The destination of this "date" must be to a place or activity outside of your dorm (Union, McDonalds, show, shopping, etc.) and other than to the library for a "study date", only. (5) You may include situations in which all of the above criteria were met, but the other person refused or was unable to attend. Keep tract of the number of times each day your activities conform to the above criteria and record them in the boxes below. It is important that you record these activities on a daily, not a weekly, basis. MON TUES WED THURS FRI SAT SUN L d Please han this form where it will be easily notice each day sEch as on your bulletin board or near your telephone. APPENDIX E THERAPIST RATING SHEET ' 243 244 THERAPIST RATINGS OF CLIENT'S ANXIETY Please rate SS on degree of behavioral and intra-psychic anxiety, fidgeting, tenseness, stammering, shaking, etc.). Therapist: Date Subjects: Date SD 1 CC 1 RT 1 Groups: SD CC 2 RT 2 (l) (2) (3) (4) (5) Anxiety- Anxiety— Anxiety— Anxiety— Anxiety- Level Level Level Level Level 1 2 3 4 5 l 2 3 4 5 l 2 3 4 5 l 2 3 4 5 l 2 3 4 5 12345 12345 12345 12345 12345 12345 12345 12345 12345 12345 1 2 3 4 5 1 2 3 4 5 l 2 3 4 5 l 2 3 4 5 l 2 3 4 5 1 2 3 4 5 l 2 3 4 5 l 2 3 4 5 l 2 3 4 5 l 2 3 4 5 (6) (7) (8) (9) (10) ”12321 “3:31; “323:1 ”£352; “"122; 12345 12345 12345 12345 12345 1 2 3 4 5 l 2 3 4 5 l 2 3 4 5 l 2 3 4 5 l 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 l 2 3 4 5 l 2 3 4 5 1 2 3 4 5 l 2 3 4 5 l 2 3 4 5 1 2 3 4 5 l 2 3 4 5 l 2 3 4 5 l 2 3 4 5 l 2 3 4 5 1 2 3 4 5 l 2 3 4 5 APPENDIX F THERAPIST PERSONAL DATA SHEET AND THERAPIST ORIENTATION SHEET 245 fi 246 THERAPIST ORIENTATION SHEET Gordan L. Paul University of Illinois The following pages contain a number of areas in which psychotherapists have been found to differ. Please indicate your position with regard to each area by placing a checkmark on the scale accompanying each area. For example: 1. Activity-frequency: If you feel that with most clients you are usually active (talkative), or usually passive, you would place the checkmark as follows: 5 , i r ) I 1 3 Active X : : : : Passive/Active_:_:_:_zlPassive If you feel you are more often active than passive, or more often passive than active, you would check as follows: Active : X : z : Passive/Active__:__:__:gg:__Passive If you feel you are about equally active and passive with most clients, or active with as many clients as passive, you would check the middle space: Active : :X: : Passive 10. ll. 12. 13. l4. 15. 247 Activity-frequency: Active__:__:__:_ : Passive (talkat ive) Ton-talkative) Activity-type: Directive__:__:__:__:__Non-directive Activity-structure: Informal__:__:__:__:_yFormal Relationship-tenor: Personal :__:__:__:__Impersonal (involvedT— (detached) Relationship-structure: Unstructured__:__:__:__:__Structured Relationship-atmosphere: Permissive : : : : Non-permissive Relationship-therapist actions: Planned__:__:__:__:__Spontaneous Relationship- client dynamics: Non-conceptualized__ __ __ :__:__Conceptualized Goals-source: Therapist__:__:__:__:__Client Goals—formalization Planned__:__:__:__:__Unplanned (formalized) (unformalized) Therapist Comfort and Security: Always Secure__:__:__:__: Never Secure (Comfortable) -TUncomfortable) Client Comfort and Security: Never Secure :__:__:__:__Always Secure (uncomfortablET (comfortable) Client Personal Growth: Non Inherent__:__:__:__:__Inherent Therapeutic Gains- self understanding (cognitive insight) Important__:__:__:__:__Unimportant Therapeutic Gains-emotional understanding (affective awareness) Unimportant__:__:__:__:__Important . ...,- “-1 248 16. Therapeutic Gains-"symptom" reduction: Important__:__:__:__:__Unimportant 1?. Therapeutic Gains—self disclosure: Unimportant__:__:__:__:__Important l8. Therapeutic Gains- social adjustment: Important__:__: __:__:__Unimportant 19. Therapeutic Gains- confidence in effecting change: Confident__:__: __:__:__Unconfident 20. Learning Process in Therapy: Verbal-conceptual__;__:__:__:__Non-verbal- affective 21. Therapeutically Significant Topics: Historical : : : : Current 22. Therapeutically Significant Topics: :1 Client-centered : : : : Theory-centered ‘1 23. Therapeutically Significant Topics: Ego functions : : : : Super-ego, Id 24. Theory of Motivation: Unconscious : : : : Conscious 25. Curative Aspects of Therapist: 26. Curative Aspects of Therapist: Relationship : : Techniques The following items refer to the use of specific techniques in psychotherapy. Please check to indicate whether you use each technique: Almost always, Usually, About half the time, Only occasionally, Never. Use of Techniques Almost 50/50 Never Always 2?. Reflection and Clarification of Feelings: __ __=__ __fi__ 28. Reflection and Clarification of Content: __:__ __=__fi__ 29. Reflection and Clarification of Thinking: __ _. __-__ __ 7 1 249 30. Reflection and Clarification of Behavior: : : : : 31. Questioning of Feelings: __:__:__:__:__ 32. Questioning of Thinking: __: _______ 33. Questioning of Content: _________ 34. Questioning of Behavior: __:__:__:__:__ 35. Interpretation of Feelings: __:__:__:__:__ , 36. Interpretation of Thinking: __:__:__:__:__ 3?. Interpretation of Content: __:__:__:__:__ 38. Interpretation of Behavior: : : : : 39. Direct Confrontation of Feelings: __:__:__:__:__ 40. Direct Confrontation of Thinking: __:__:__:__:__ 41. Direct Confrontation of Content: __:__:__:__:__ 42. Direct Confrontation of Behavior: __:__:__:__:__ 43. Suggestion (not hypnosis): __:__:__:__:__ 44. Reassurance: __:__:__:__:__ 45. Information & Advice Giving: __:__:__:__:__ 46. Redirecting Questions Back to Client or Group: __:__:__:__:__ 47. Attentive Listening: __:_:__:__:_ 4'8. Self-disclosure: __:__:_:__:_ 49. Modeling Techniques: __.__:__:__:__ 50. Positive Attitude—confidence: __:__:__:__:__ 51. Warmth and Understanding: __:__:__ __:__ 52. Reinforcement (Approval— Disapproval): __:__:__:__ __ 53. Conditioning, Counter- . . Conditioning: ._=__ __:_. __ 54. 55. 56. Free Association: : : : : Homework Assignments: : : : : Other (Please Specify): : : : : THERAPIST PERSONAL DATA SHEET Indicate, in order of preference, the three or four authors who have been most influential in shaping your present approach to psychotherapy. 1. 2. 3. Indicate the "school" or "schools" of psychotherapy to which you feel most identified and related in terms of your therapy approach. ) I : 1. 2. Indicate the number of years of therapy experience you have gained to the present time. Indicate the number of years experience with the "techniques" of the school(s) identified in question B above: Have you obtained personal analysis and/or psycho- therapy? (If yes): 1. Number of sessions: 2. Type (individual, group, both). Indicate the number of sessions for each if youranswer is both: 3. Type of therapy (psychoanalysis, client- centered, Rational-Emotive, Behavioral, etc.) APPENDIX G EXPLANATION OF INTERPERSONAL ANXIETY AND RATIONALE OF TREATMENT APPROACHES GIVEN TO THE TREATMENT GROUPS 251 252 Included here are an explanation of inter- personal anxiety and the treatment rationale as well as a brief outline of the procedures followed by each of the CC, RT, and SD therapists. The explanations of interpersonal anxiety and the treatment rationales were not read directly to the §S. It was felt that this would detract from the personal quality of the treatment. Instead, each counselor familiarized himself with the following material and attempted to present the same ideas in his own words and using his own examples whenever poss- ible. However, since the explanations and rationales which follow were prepared in conjunction with the individual therapists, their presentations followed very closely the descriptions included in the following pages. 253 SYSTEMATIC DESENSITIZATION TREATMENT Explanation of Interpersonal Anxiety "Each of you is here today because you have indicated that you have a common problem-~interpersonal anxiety. This emotional reaction that you experience and call anxiety is the result of your previous experiences with people. In other words, you learn to react to people with anxiousness, and too often, this reaction can easily become habitual so that, before long, you always begin to feel anxious and tense when in the presence of others. However, the fact that interpersonal anxiety is learned means that it can be unlearned. There are a number of ways you can learn to associate tension and anxiety with people or situations involving other people. One of the most frequent ways this happens is by being disappointed or hurt by others. Frequently, this involves doing something and then being "shocked," so to speak, by another person's reaction to you. This may happen many times in the course of your lifetime, and before long, you begin to fear others and what they might say or do to you. Since it's impossible to completely avoid people or be sure of their reaction to you, you are left with no alternative except fear, tension, and anxiety. I'm sure that each of you can think of a number of instances where this has happened. 254 In any event, through the repetition of such experiences, you begin to associate this fear and tension with other people and situations involving other people. One of the things we know about anxiety is that it tends to spread and generalize so that while initially you may fear only certain people and certain situations, this fear spreads to people in general and social situations in general. This is why you frequently can't understand the interpersonal anxiety you eXperience p93; it may be inappropriate to the present situation and people. Before long, you may even try and anticipate this fear and anxiety long before it ever happens and begin to avoid people and activities involving people. When this happens, your anxiety only gets worse. It's a lot like the person who falls off a horse. The longer he waits to get back on, the harder it is for him. Similarly, the more you avoid people and interpersonal situations, the more anxious you get. The key to overcoming this, as we will see in a minute, is to gradually and indirectly introduce yourself back into social situations in a controlled fashion. However, before I begin an explanation of the treatment or the unlearning process, are there any questions on how interpersonal anxiety is learned?“ —: i 255 Treatment Rationale "As long as you can recall or visualize how you've felt in these situations, it is possible to work with your reactions of tension and anxiety right here in this room by having you imagine yourself actually in these situations as vividly as possible. The specific technique we will be using is one called desensitization. This technique utilizes two main procedures--relaxation and counter-conditioning--to reduce your anxiety. The relaxation procedure is based upon years of work which started in the 1930's by Dr. Jacobsen. He developed a method of inducing relaxation which can be learned very quickly, and which will allow you to become more deeply relaxed than ever before. The real advantage of relaxation is that the muscle systems in your body cannot be both tense and ‘ relaxed at the same time. Therefore, once you have learned the relaxation technique, it can be used to counter anxiety, tenseness, and the feelings like those you experience in interpersonal situations. Relaxation alone can be used to reduce anxiety and tension. Often, however, relaxation is inconvenient to use, and really doesn't permanently overcome anxiety all by itself. Therefore, we combine the relaxation technique with the psychological principal of counter- conditioning to actually desensitize you to interpersonal situations such that the anxiety no longer occurs. 256 The way in which we will do this is to first determine the situations in which you become progressively more anxious and build a hierarchy from least to most anxious situations with regard to interpersonal relation- ships, e.g., relationships involving other people. Then I will teach you the technique of progressive relaxation. You will see how this operates very shortly when we actually start training. After you are more relaxed than ever before, we will then start the counter-conditioning. This will be done by having you repeatedly imagine the specific interpersonal situations from the anxiety hier- archy while under relaxation. By having you visualize, very briefly, the interpersonal situations which normally arouse anxiety, while you are deeply relaxed, those situations gradually become desensitized, such that they no longer make you anxious. We will start with those interpersonal situations which bother you the least, and gradually work up to those which bother you the most. Since each visualization will lower your anxiety to the next item, a full-fledged anxiety reaction never occurs. We've used these procedures on many different types of problems, including students with interpersonal anxiety, with excellent results. Most of these pro- cedures will become clearer after we get into them. Do you have any questions about the treatment approach before we continue?" IIIIIIIIII:—___________________________________________________________________—____4i" 257 ; Procedure This approach consisted of a slightly modified and formalized version of the SD treatment advanced by Lazarus & Rachman (1957), Wolpe (1958), and Wolpe & Lazarus (1966) and adapted for group use by Lazarus (1961) and Paul (1966a). While the five fundamental aspects involved in the application of SD were maintained (Paul, 1966), two major innovations were introduced. For one, since gs were desensitized in groups of five, a hierarchy common to all five group members was employed. Secondly, in an attempt to further standardize the administration of the SD treatment across counselors, a tape recording of the relaxation portion of the SD treatment was employed. The tape is identical to the one utilized by Weinstein (1968). Prior to meeting with any gs, both SD counselors were given a list consisting of each test item from the various self—report questionnaires of interpersonal anxiety which all five group members endorsed in the direction of "high anxiousness.“ A separate listing was prepared for each group. In this manner, the item pool from which the ultimate hierarchies were finally constructed contained ggly situations common to all group members. During the first hour approximately ten minutes were Spent exploring the history and current status of the Ss' problem. The next ten minutes were spent eXplaining 258 how interpersonal anxiety is learned, and presenting the rationale underlying the SD treatment. The next ten minutes of the first hour, and the first thirty minutes of the second treatment session, were spent constructing a thematic hierarchy made up of situations related to interpersonal anxiety. Separate hierarchies were con- structed for each group. As indicated above, each group member, including the therapist, received a copy of each test item from the various self-report questionnaires which all five group members endorsed in the direction of "high anxious- ness." Working together, each S and counselor further embellished and added items until all of them were satis- fied as to the completeness of the list. Each group member was then instructed to arrange the various situa- tions described by each item in order of their anxiety eliciting potential, beginning with those that arouse very slight, controllable amounts of anxiety, and working up to those that cause extreme anxiety. In this manner, a thematic, anxiety hierarchy ranging along the stimulus generalization gradient of interpersonal situations was formed. The following are the actual hierarchies employed in the present study: 259 (Hierarchy for Coungelor B's Introverts) Imagine that: 1. ll. 12. 13. 14. 15. 16. 17. 18. You are greeting someone you know slightly and they don't acknowledge. You are greeting someone by mistake. You are ordering food in a restaurant. You are talking with someone who knows more about the subject than you do. You are bumping into someone and they don't forgive you. You are asking a friend to return something they have forgotten about. You are late for a small class and are coming in the front door. You are late for a large class and are coming in the front door, You are asking a question in a small class. You are asking a question in a medium-sized class. You are asking a question in a large class. You are being asked a specific question in a small class. You are being asked a specific question in a medium-sized class. You are being asked a specific question in a large class. You are asking for a refund on bad merchandise. You are asking someone for a date to a football game. You are asking someone for a date to a concert. You are asking someone for a date to a movie. 19. 20. 21. 22. 23. 24. fiHierarghyifor Counselor B's Extroverts) Imagine that: l. 2. __— 260 You are asking a classmate to have a coke with you after class. You are asking for a dance at a mixer. You're bringing your girlfriend or boyfriend home to meet your parents. Your girlfirend or boyfriend is taking you home to meet their parents for the first time. You are dropping a tray full of food at dinner in the cafeteria and everyone looks. You're tripping and falling as you walk into your introductory psychology class. You are at a large party. You are giving a speech before a group of people. You're interviewing for an important job. You're asking a friend to return something they've forgotten about. Someone nosey is prying into your affairs. You are talking with someone whose name you can't remember. While talking loudly about someone you notice them standing nearby. You're waiting for someone to keep an appoint- ment with you. You're late for an appointment. Lu. 261 *1. You're getting out your books to begin studying. 2. You're trying to study before a test and see you can't cover everything. 3. You're trying to figure out a problem and can't. 4. You have six hours left to study before a test. 5. You have five hours left to study before a test. 6. You have two hours left to study before a test. 7. You have one hour left to study before a test. 8. You are walking into the test room and sitting down. 9. You're glancing through the test and don't recognize some of the material. 10. You are meeting your girlfriend's or boyfriend's parents for the first time. 11. You're trying to be nice to an obnoxious person in the presence of others. 12. You are meeting someone you're trying to avoid for fear of losing your temper. 13. A close friend is asking you to do something unreasonable and you are turning them down. 14. You are being criticized. *Due to excessive anxiety over pending mid-term examinations, both SS and counselor decided to work on a test anxiety hierarchy for two sessions (nine items). 262 {Hierarchy for Counselor b's Introverts) Imagine that: l. 2. 10. ll. 12. 13. 14. 15. 16. 17. You are sitting in a doctor's waiting room before a physical examination. You are walking into a psycholo ex eriment with three other subjects. 8y p You have an appointment to meet a professor for lunch. You are discussing low grades with your parents. You are eXpecting an argument between your roommate and you. You are asking your parents for later hours. You are going to talk to your professor about the test he has given. You are telling your roommates about their 1 irritating habits. ‘ You are going to be late for an important appointment. You are the host at a party. You are going into an interview for an important position in a company. You are going to meet a new date. You are going to meet someone that has insulted you before your friends. You are asking a professor a question in class about something you do not understand. You are getting up to give a speech before a 1 large group. . You are trying to carry on a conversation with a total stranger. \ You are going to be meeting your steady's parents for the first time in a few minutes. 263 gHierarchy for Counselor b's Extroverts) Imagine that: l. 10. 11. 12. 13. 14. 15. 16. 17. 18. You are walking into a psychology experiment with three other subjects. You are at a party and notice that a large crowd has gathered. You are asking your parents for later hours. You are meeting someone for the first time. You are discussing low grades with your parents. You are going to be meeting your steady's parents for the first time in a few minutes. You are meeting the movie star you admire most. You are telling your roommates about their irritating habits. You have an appointment to meet a professor i for lunch. You are asking a professor a question in class about something you do not understand. You are the host at a party. You are going to meet someone that has insulted i you before your friends. i You are eXpecting an argument between your roommate and you. 1 \ As you walk into the cafeteria for dinner you drop your full tray. You are going into an interview for an important { position in a company. 1 You are going to be late for an important appointment. You are getting up to give a Speech before a large group. You are about to tell your parents about your sudden marriage plans. 264 During the final thirty minutes of both the first and second sessions, each § received training in progressive relaxation by means of an audio tape recording (approximate length, 28 minutes). This procedure con- sisted of an accelerated form of Jacobsen's (1938) original routine and involved alternately tensing and relaxing gross-muscle groups, learning to focus attention on these muscles, while moving progressively through the body extremities and trunk region until a state of deep muscle relaxation was achieved. The sequence in the tape recording followed very closely the one's outlined by Paul (1966). During the two relaxation training periods each § was instructed to make a "mental note" of any one or two exercises (neck, legs, back, face, etc.) which were particularly relaxing and also note at which point, if any, relaxation training ceased to be beneficial, e.g., relaxing. The former information was utilized during the desensitization proper to help get a S relaxed again after he had signaled anxiety associated with a hierarchy item. The latter information was used during the desensi- tization proper to progressively reduce the time Spent in muscle relaxation. By noting at WhiCh POint no further relaxation ensued, and by communicating this to the therapist by means of the familiar index-finger signal, the therapist could stop the relaxation training tape when ._i__.“_._.l.4_i.__kli_#.A.4_ug i M.- . . 5.. 265 all members signaled complete relaxation. In this manner, the time required to achieve deep levels of muscle relaxation was shorter with each treatment hour, leaving more time each session for the desensitization proper. The third through ninth sessions were conducted as follows. The first five minutes were spent in either a general discussion or question and answer period. Since no verbal communication was allowed during the desensitization proper, it was felt that this brief time period was required for verbal interchanges among SS and between §S and counselor. Thus, it was not limited exclusively to treatment related material, and on occasion, was dispensed with altogether when §S had nothing to dis- ' cuss. Those portions of the seven treatment interviews concerned with the desensitization proper were conducted in the manner described by Paul (1966). During the last few minutes of each session following the successful completion of an item, the SS were aroused and reactions to images, etc. were discussed. Each counselor was instructed to maintain a warm, interested, and helpful attitude as in any therapeutic relationship. 266 BATIONAL-EMOTIVE TREATMENT Explanation of Interpersonal Anxiety "Each of you is here today because you have indicated that you have a common problem—-interpersonal anxiety. This emotional reaction that you experience and call anxiety is the result of your previous exper- iences with other people. In other words, you lgggn to react to people with anxiousness, and too often, this reaction can easily become habitual so that, before long, you always begin to feel anxious and tense when in the presence of others. However, the fact that interpersonal anxiety is learned means that it can be unlearned. The way you learn to experience emotions such as tension and anxiety around other people or in situations involving other people is fairly well understood, and part of what I want to do here today is explain this process to you. There are many ways in which emotions can be classified. For example, you can classify them as posi- tive or negative depending on whether they make you feel good or bad. You can also classify emotions as transient or enduring depending on how long they last. We are more interested here in negative emotions since they are the ones that cause you trouble, e.g., make you feel bad. ;* - 267 In addition, we are further interested in enduring emotions since they are the one's which make you feel bad over and over again, e.g., they endure over time. Interpersonal anxiety is just such an enduring, negative emotion. It frequently makes you feel bad and occurs almost everytime you have to deal with people or situ- ations involving people. Thus, interpersonal anxiety, or anxiety which results from Simple, routine inter- actions with other people, is particularly debilitating since it can disrupt normal, but required daily routines, make otherwise healthy individuals unhappy and dissatis- fied with themselves, and generally create discomforts which are unfortunate and otherwise avoidable. How are enduring negative emotions such as interpersonal anxiety learned? Well, it may not be immediately apparent, but all enduring emotions are caused by our thinking. Any emotion which is not transient, that is, which endures over time is maintained by our thoughts. For example, if you are upset by a car accident, your upset, whatever it may be, will disappear soon after you leave, e.g., when the external event, the accident, is gone. In short, it is transient. Enduring, negative emotions such as anger, depression, anxiety, etc. d3 n93 go away when the thing you are angry, depressed, or anxious about is gone. The reason they don't go away is because you continue to think about it, e.g., you continue —: \ 268 5 to tell yourself something about it. For example, if a friend or roommate says something negative about you, you may be angry, depressed, or anxious for weeks on end. It doesn't go away when they are gone because you continue to think about it, over and over for weeks on end. You continue to tell yourself something, usually something silly or irrational about the interchange between you and your friend which maintains your angry, depressed, or anxious state. Let's look at this latter sequence more closely. fit this point, the diagram below was put on the black- board.) A. Your friend or roommate tells you something they dislike about you. B. C. You get upset, e.g., angry, depressed, or anxious. Something happens to you at point A, and you get upset at point C. You erroneously believe that A causes C, when in fact B, or what you tell yourself about A, is what causes you to get upset at C. And as long as you continue to believe B, you will get upset over and over and stay upset. The kinds of things you tell yourself at B are, of course, learned. Usually, they are silly, irrational beliefs you've learned in the process of growing-up and have never challenged or unlearned. In this case, for 269 example, you might be telling yourself something like [at this point, the following B statements were also put on the blackboard]: B. What others think and/or say about me is more important than what I think about myself. B.‘ I have no right to do what I want if it might hurt someone else's feelings. B." He has no right to say that to me. B."' I need people's approval for what I do. Without these silly, irrational statements you tell your- self at B, the feelings you have at point C could not endure over time. This is the chief difference between the transient negative feelings everyone experiences, but which come and go, and the enduring feelings such as interpersonal anxiety which linger on and on for weeks, months, and sometimes years. Without these statements at B, your negative, upsetting feelings at C would last only a short time, at most. The key to overcoming this upset at C is dis- covering what irrational statements you are telling your- self at B and gradually correcting or replacing them with more rational ones so your upset feelings at C will disappear. However, before going into an explanation of the treatment or the unlearning process, are there any questions on what causes interpersonal anxiety?" 270 Treatment Rationale "The goal of this group will be to help each other uncover, challenge, and correct as many of these irrational statements at point B as possible. We will try and do this in two different ways. First of all, we all have to take the responsibility of confronting both ourselves and other group members. By this I mean that all of you must be willing to share your emotional reactions with the group and help each other really pin— ppinp clearly the actual B sentences which keep these negative emotions alive. This is the only way you can ever hope to overcome them. Secondly, you will have regular homework assignments designed to elicit various feelings. We will discuss your reactions to these assign- ments regularly in the hopes of discovering what state- ments you are telling yourself to maintain your upsetness.* What I am saying, then, is that to overcome these negative emotions which create troublesome interpersonal relationships you must first uncover these irrational statements or beliefs which cause your anxiety and liter- ally replace them with more functional or rational ones. *While initial homework assignments were given at large, later assignments were tailored to each individual §. For example, the first assignment given to all §S was to go into a restaurant, order a cup of coffee, then when the waitress brings it tell her you changed your mind and now want a coke. As an example of a tailored homework assignment, one girl, who was upset by her inability to tell busdrivers to stop when she saw someone running to catch the bus, was told to do just that, even if the bus was crowded. 271 In order to uncover them you must be willing to examine the interpersonal situations in which you feel anxious and discuss them here in the group. Furthermore, you must make active attempts to engage in interpersonal situations, e.g., do the homework assignments,and share these experiences with the group so that all of us can help each other. Do you have any questions about the treatment approach before we continue?" Procedure Following questions relative to the treatment rationale, the RT therapists asked each S if they were presently feeling anxious. Those Ss who indicated the most anxiety and the greatest willingness to begin treat- ment were the focus of the therapists initial therapeutic efforts. In addition, every effort was made before the end of the first session to get as many group members involved, both directly and indirectly, as possible. The first session ended with the aforementioned homework assignment. Each session typically began with a review of the successes and failures relative to the weekly homework assignments. Feelings elicited during attempts to con- duct these assignments were elucidated and related to maladaptive and irrational philosophies of living, and their derivities. At each session, every effort was made .' I i I i l r 272 to get Ss to challenge each other and help other Ss develop more adaptive, rational, and functional E state- ments. Each counselor was instructed to maintain a warm, interested, and helpful attitude, as in any thera- peutic relationship. CLIENT-CENTERED TREATMENT EXplanation of Interpersonal Anxiety "Each of you is here today because you have indicated that you have a common problem--interpersonal anxiety. This emotional reaction that you experience and call anxiety is the result of your previous exper- iences with other people. In other words, you lgggn to react to people with anxiousness, and too often, this reaction can easily become habitual so that, before long, you always begin to feel anxious and tense when in the presence of others. However, the fact that inter- personal anxiety is learned means that it can be unlearned. The way you learn to experience emotions such as tension and anxiety around other people or in situations involving other people is fairly well understood, and part of what I want to do here today is eXplain this pro- cess to you. In order to understand any type of anxiety you have to have some working concepts about how people function. First, we can divide areas of human life into three spheres; thinking, feeling, and behaving. If we compare anxious with non-anxious people we will soon see that in the former group these three areas operate independently of, and often — 7 274 at odds with, one another whereas in the latter group these three areas seem to "flow together," more or less as a whole. In other words, a person who is anxious is one who may think one thing, feel another, and do, e.g., behave, a third way altogether. This is exactly why he's anxious. In many ways, the anxious person is analogous to a machine where all the parts do not fit together very well. As the machine runs, it builds up friction, and the friction in the machine is analogous to anxiety in humans, e.g., it results from all the parts not working together. In the non-anxious person, thoughts, feelings, and behavior "flow together," they form a unit, a whole. In this way, little friction or anxiety results. Let's see if we can't make this more specific. If a non-anxious person is bored, for example, by a peer's conversation (boredom being a feeling or emotion), he will probably start focusing his attention (thinking) on this boredom, trying to figure out why he is bored, and will behave in a bored manner, i.e., leave, tell his friend how boring Sgggg conversation is, or make it more exciting, e.g., behave differently. This is a rather simplified example of what is meant by functioning as a whole person, or as a unit. The anxious person, in this same situation, may :22; bored, continue on with the discussion SS 1: SS were interested (behavior), and simply think to himself how he wished he could leave, or think about how wrong it __- .__.— 275 f is for him to be bored, etc. In any case, the important point is that he is not functioning as a whole unit. At the feeling level he is bored, behaviorally he acts interested, and in terms of thinking he is either wishing the conversation were over or condemning himself or the other person. This disjointed mode of functioning is what causes friction or anxiety. The key to understanding the difference between the wholely functioning, non—anxious person, and the disjointedly functioning, anxious person lies in the ability to listen uncritically, be honest, and accepting. In the example above, uncritical listening allows the non- anxious person to accept his boredom. He doesn't have to feel guilty and thus pretend he is interested or blame himself or his friend for making pig Eggpg. He simply uncritically accepts his feeling of boredom. He is being honest with both himself and his friend by conveying his boredom to his friend, not with the intent of plaming, but with the idea of, "Let's make this unboring!“ Thus, the key to reducing or getting rid of interpersonal anxiety is to get all the parts, e.g., behavior, thinking, and feeling, functioning as a unit, or a whole. The way to do this is to uncritically listen to the feelings others elicit in you, accept them as valid £93 123, communicate your feelings honestly and with the desire of wanting to work together to do something about 276 it. If you are unable to listen uncritically, accept your feelings, and/or communicate them honestly, you are simply going to "split" yourself apart, thinking one thing, feeling another, and doing something altogether different. Once you begin to do this, the only conse— quence is friction or anxiety. Although I do not want to spend too much time discussing how people get "Split apart" so that thinking, feeling, and behaving no longer function as a unit, I do want to say that you lpggp this, probably as a child growing up. You learn to feel guilty when bored or blame yourself or others. You learn to pretend you're interested when you're not, etc. But you can unlearn it and can unlearn it by learning to be a non—critical listener, accepting, and honest in your interpersonal relationships. As indicated above, the key to overcoming this anxiety is to listen uncritically, be accepting of your feelings, and communicate them honestly. This is not easy to do, but it is what we will spend the next nine weeks trying to do. However, before going into an explanation of the treatment or unlearning process, are there any questions on what causes interpersonal anxiety?" Treatment Rationale "The goal of this group will be to develop uncritical listening skills and secondly to try and create 2?? an atmosphere in here which lends itself to acceptance of feelings and honest communication among the members of this group. I feel that the atmosphere of honesty and acceptance is E2 important I just can't stress it enough. I want all of us to feel that we can say whatever we're feeling, and if we "make mistakes," as we inevitably will, that we can maintain enough of a willingness and openness to go back and look at things and try and sort out what happened in that “mistake." The way we can begin is to try and respond to each other, not in terms of the content of what's said, but in terms of the feelings the speaker elicits in us. For example, if I say something, and some feeling inside of you says, "No that's not right?", tell me about it. Try and describe that feeling. That feeling tells me how you experience me and that's the way I can learn and change. I can say, "Yes, that's right, I didn't really mean that, now why did I say that. Did I just want to impress you, was that my way of saying I like you, or what?" This may seem relatively simple to you, but as you will see when you try it, it's not. We have been taught for so long to pay attention to content, or more importantly, to disregard feelings, that many times we may have trouble deciding even what feelings a person elicits in us. But this is how you learn to listen 2'78 uncritically, you focus on what, in fact, is coming across to you, not on classifying it as good or bad, right or wrong, etc. This holds even for feelings of anger. If they are there, then trying to decide if they are important, bad, etc. makes no sense. They're just there. Learning to honestly communicate, of course, goes hand in hand with sensitive listening. In fact, the more I think about it, the more I think one flows from the other. If you can listen uncritically, with the intent of trying to figure out what feelings people elicit in you, you're going to be less blaming and less condemning of yourself and others. If you are less blaming and less condemning, people are going to feel freer and more at ease in communicating with you about their feelings. Well, where does that leave us? What we have to do to start with is watch ourselves so we pay attention to the feelings we have when others talk, and communicate these feelings so others know how we experience them. Do you have any questions about the treatment approach before we continue?" Procedure Following questions relative to the treatment rationale, the CC counselors asked each S if they were presently feeling anxious. Those Ss who indicated the 279 most anxiety and the greatest willingness to begin treat- ment were the focus of the therapists initial therapeutic efforts. In addition, every effort was made before the end of the first session to get as many group members involved, both directly and indirectly, as possible. Little or no structure was imposed on the content of each group interview. Ss brought up and dealt with material that was current and pressing. Feelings about group members were stressed, while reactions to friends, relatives, etc. though not excluded, were given secondary consideration. Each therapist was instructed to maintain a warm, interested, and helpful attitude, as in any thera- peutic relationship. APPENDIX H PROFILES OF THERAPIST'S SCORES ON THE 1 ‘ EDWARDS PERSONAL PREFERENCE SCHEDULE, MYERS-BRIGGS LEE INDICATOR, AND INTERPERSONAL CHECKLIST 280 __:—F 281 Edwards Personal Preference Schedule NAME Ccfinselor .....B sax Male nous um, Adult a" 5.... l“ 10 _08_ 15 _21._ 13 20 11 17 05 12 09 1o 22 15 13" ......m. '16 18 ll 75 95 39 92 58 _69_ on 26 18 10 89 69 87 Pan-mil. uh do! ord uh cut an In! nu. dun aha nu! dig and ho! a" Pam-um- 99 99 95 95 90 9° 80 3° 75 75 7O 70 60 60 50 5° 40 40 30 30 25 25 20 20 )0 10 S 5 I 'l ach do! ord uh our 1:" in! we do!» aha nur :Ilg end In! any NAME Counselor b sex Male Nmms usso Adult .... s“... 13 07 _10' _17__19S 15 26 09 15 08 12 15 09 21 16 £ Pornnrllc 32 04 20 87 88 58 99 42 57 12 26 62 07 87 76 _70_ Pore-"Ill: och dd and uh nut a" In! we dom tube run dig and In! 1:99 Percentil- 99 99 95 95 9° 90 .. :3 75 7O 70 60 60 50 50 £0 40 30 30 25 7’ no 20 10 10 5 5 Edwards Personal Preference Schedule NAME Counselor C Pare-Milo a¢h do! aid uh our NOIMS USED 1 5 0 3 5 7 0 1 Adult 15 99 Forum“. 99 NAME Counselor c ......m 1" 10 _02,_¥?,i8_ Percamile 46 18 00 47 84 Pcrcenlile a(l\ dcl ord uh aul ‘79 99 1. — __ 283 Edwards Personal Preference Schedule MIME): Male Moms ussp Adult n.5,," 19 08 03 16 _20_ 11 21 09 21 02 10 20 OS 20 17 1‘4“ ......... iiifi 92 2" 95 '10 89 00 15 91 01 85 82 97 Forum”. och def ovd uh our :1" In! In: den aha nur rJIg cud Im can Put-M". ” 99 95 95 90 90 3° to 75 75 70 70 ‘° so 50 5° 40 40 30 30 25 25 20 20 l0 l0 5 5 I l och dof and uh an! all m we don obu nut dig and he! a" NAM! Counselor r 5“ Male Mm“. USED Adult R.,, 5“,, 23 06 04 20 _2_3_ 10 2O 08 19 03 08 20 07 21 18 14 Pun-mil. 98 02 01 97 98 18 92 33 80 01 M 91 O3 87 87 _9_7_ Plvcum'lo och do! old uh out afl In! wc darn aha mu chu and In! a" Pure-Mlle 99 99 95 95 90 90 no so 75 7’ yo 70 so so 50 50 40 40 10 :o ,5 15 ,0 20 284 GRAPHIC REPRESENTATION OF THERAPIST SELF—RATINGS ON THE MYERS—BRIGGS TYPE INDICATOR 65 100 100 25 25 0 0 29 25 Counselor 0 Counselor b 65 25 65 % 100 100 P I 100 l 25 0 Counselor C 25 Counselor B 65 L_ 100 100 25 25 Counselor r 100 100 25 \/ \ 3 . l Ind I I 0| 5 v I I INA: /\ I S T I N F A, A, A 7i .. IQ. ll- 7 lnml L llQfl 2 Ill I IL ;\ 1\ lg 0 Counselor R 65 25 100 GRAPHIC REPRESENTATION OF THERAPIST SELF— RATINGS NTHE INTERPERSONAL CHECK LI Mama. gem“, _ l9 _#% . \fgph‘ WK, 2. Riva a“ " , :: Q . 6;. ix“ ' pt} 5‘ 0 0376 Q R I 4'. U .- :: 0. :: °" .. ‘96 .- 7? c h .. 09 I, \b w b I 3 B ' ‘ n C W ' - 0 w . L ‘f —’ m " d C 0: .2 ’ 4’ 2 S I “ ' 'Al;ll:: :::’L::‘IA ' :vl'v #111] ' :I:::Illl:l:ll|llé - 3 m -_ L .. w _ > C) V‘ / -~ 0 To : ‘9 -- 1~ A - 4 _ 2’ r w 0 " a Q/ '2 '7 \ 0 <1 . -- U r ' l . X . H/ . K - vwc I a? . WQ #7 I / v Q. ' ~ ‘0 4&8? . OL"\ " Eff¢c|nfi FIGURE 1 INTERPERSONAL CHECK LIST ILLUSTRATING THE CLASSIFICATION OF INTERPERSONAL BEHAVIORS INTO l6 VARIABLE CATEGORIES MANAGES OTHERS DOMINAYING “o uxzs RESPONSIOI- 4:: 1 LITV , \“I it , 4 J0 ..1\ coon Luau q: 60., i. 1 o: s a so} .55 “of“ ronccrul. "8’!” 4:10, It. SQ. 37/6 4 qc‘ 3: L S‘- u 5’ '2' z 0 at: g 25.- t‘ z: ‘3 n ‘0! a ‘2‘ tum: I“. q K Ito...“ >>>- K o_ :4 u: ” g>l kcdb-D ”j 2 :.Ju ,_ ‘0‘ ‘>‘ 5‘ ’°° * .. o zu° 9:- E 5 z k 2 " av: ‘ :3", x E E zua .- on... I 8:: 5 n.3— u.° E . “0‘“ at ‘t P 10 “ t“ c APPENDIX I MANUAL EMPLOYED IN CLASSIFYING EACH THERAPIST'S IN-TREATMENT VERBAL BEHAVIOR 287 ...-.. __’ " MANUAL FOR CLASSIFYING THERAPIST'S BEHAVIOR The categories and examples listed in this manual are intended to exemplify the various types of therapeutic activity engaged in by counselors of differing theoretical orientations. They are intended to represent meaningful abstractions from the various modes of therapeutic inter— ventions and are predicated upon the commonly recognized differences in technique among counselors of different "schools“. The major categories and subcategories herein represented are intended to be objective, non-evaluative, and mutually exclusive. With extensive training and practice, even naive raters can achieve a reasonably high inter-rater relia- bility with this scale, as was evidenced in the present study. The two raters employed here were given roughly five hours of explanation and ten hours of live practice on actual audio tapes of real counseling sessions. By the end of their training they achieved an inter—rater reliability of .831. 289 I. REFLECTION AND CLARIFICATION Included in this category are counselor state- ments which reflect the feelings, thoughts, and/or behaviors "behind" or implied in the S's current actions and verbalizations. For example: Cl: "I just couldn't take her nagging anymore so I, I just grabbed my coat and slammed the door as I left." Th: "You must have felt terribly angry at her." Cl: "I could have killed the bitch." Th: "She must have hurt you very deeply." Both of these therapist statements would be classified as "reflection of feelings." In both cases the counselor is clearly referring to the S's feelings, i.e., anger and hurt. In particular, he is referring to those feelings which he believes lurk behind or are implied in the S's verbally related behavior. In many instances the tape samples you will be rating will not be as clearly recognizable as the above sequence. For example, the therapist, in this same instance, may have said, "I'll bet you were feeling pretty angry?" or "I wonder if you were feeling hurt again?" At first blush this may seem like a question (which would be classified under heading II below). However, it seems obvious that the counselor believes the feeling he is reflecting is or was present and is simply asking a rhetorical question in order to make the § aware of its presence. 290 The following is another example of reflection. In this case, the counselor is reflecting the S's thoughts rather than his feelings. Cl: "I just sat there feeling more and more depressed as the evening went on." Th: "I can't help but wonder if you weren't just sitting there thinking about what you thought would happen if you would have gotten-up and began moving around more socially." Here, again, the therapist is reflecting, e.g., stating what he feels is "behind" or implied in the Ss statement, but his focus, in this case, is the S's thought processes. Statements of this nature would be classified as "reflection of thinking." In addition, the counselor may use reflection in relation to the S's behavior as opposed to his thoughts or feelings as above. For example: C1: "It seemed like the only alternative I had was to tell him to shut-up. Well . . . , I could have left . . . , I guess?" Th: "It does seem like those are the only ways you have, right now at least, of stopping arguments from getting out of hand." Counselor statements of this type are classified as "reflection of behavior." Thus, the basic criteria for the inclusion of counselor statements under the heading of "reflection" are: (a) a minimum of interpretation, and (b) reflection of what the therapist feels is "behind" or implied in the S's statement. Notice that, unlike interpretation, IIIIIIIIT_________________________________________—_________—________—I 291 the therapist accepts the S's formulation without intro- ducing a new frame of reference and simply reflects what he feels is "behind" it. Even if the counselor’s reflections are simply a preamble to a more focused _question or interpretation, if it meets the above criteria, it will be classified as reflection. Clarification is taken to mean a restatement of the content of the Ss verbalizations, including simply repeating words or phrases, for purposes of clarification. Summaries which are essentially non-interpretative will also be classified as clarification. "Reflection of con~ "clarification of content" will be considered As with tent" and identical for the purposes of this study. reflection, clarification may include questions when they are essentially rhetorical in nature, e.g., for purposes of clarification rather than information seeking or gathering, as well as clarifications which serve as a precursor to other kinds of statements. The following are examples of clarification. Cl: "I can't do that, I just can't!" Th: "Can't?" Cl: "I get upset when he does that." Th: "You mean when your boyfriend sits down and tries to tell you how he feels, that upsets you?" —————-————-~— 292 C1: "Uh (sigh). Everytime I think about that it turns me off." Th: "Then just thinkipg about not being a good sex partner turns you off, as you say." As with reflection, clarification may refer to either thoughts, feelings (motives), or behavior. The three samples above are examples of clarification of behavior, feelings, and thoughts, respectively. II. QUESTIONING Here we are interested in counselor statements which are essentially exploratory in nature. Questions which are information seeking or geared at information gathering are classified here. For example: Cl: "I put everything I have into every class I take." Th: "What happens if, or when, you begin noticing that you're not doing as well in a class as you would like to?" It seems clear in this example that the counselor is seeking information. Thus, this response would be class- ified as "questioning." Since the therapist is referring more to the S's behavior than his thoughts or feelings, this response is further classified as "questioning of behavior." Cl: "I just get upset when I'm around him." Th: "What do you mean, upset? Do you get angry, depressed, disgusted, or what?" 293 The example above is also considered a question. However, the content of the counselor's statement class- ifies this response as "questioning of feelings." In addition to exploratory probings such as these, counselor statements which requisition examples, elabor- ations, case history information, etc., from the client are also classified as "questioning." For example: Cl: "I don't ever get mad. Outwardly mad." Th: "Can you think of a specific instance when you were angry and kept it inside?" Cl: "We had more fun before we got to know each other." Th: "Can you tell me more about that?" Cl: "I feel bad when I buy things for myself." Th: "How did your father react when you brought something new home?" Each of the above samples reflect the requisitioning of examples, elaborations, and case history material, respectively. Furthermore, while the second example represents "questioning of behavior," the first and third example represent "questioning of feelings.“ I Thus, the basic criteria for inclusion in this category is information gathering. This may be done by direct probing ("Why?", "What do you do on the weekends?", "Why did you do that?", "How would you like to be able to 294 handle that?") or by asking for examples, elaborations, etc. Even if these questions serve only to lay the groundwork for an interpretation, etc., they will be classified here if they meet the above criteria. Questions which are obviously rhetorical in nature are classified under heading I. Finally, "questioning of content" will be reserved for those therapist responses which meet all of the above criteria, but do not clearly refer to either the S's thoughts, feelings, or behaviors. III. INTERPRETATION Here we are concerned with counselor statements which are essentially analytic in nature. Such state~ ments include defining the S's problem, establishing connections, analyzing defenses, etc. It differs from "reflection and clarification" in that, with interpre- tation, the therapist goes beyond the S's formulations and introduces a new frame of reference for analyzing defenses, establishing connections, etc. For example (establishing connections): Cl: "It does seem like the men I pick out are more helpless and dependent." Th: "It seems like this is the same kind of relationship you had with your father, also. He was always the helpless and dependent one and you were also the one who rescued him." 295 In many, but not all, interpretations there is great emphasis placed on time periods in the S's life other than the present, i.e., childhood, adolescence, etc. The example above, since it refers to the S's activity, is classified as "interpretation of behavior." Below is another example of "interpretation of behavior," but in this case, the counselor is analyzing the S's defenses. Cl: "I always feel terrible when I meet people for the first time. It's like I'm going to get shot-down or rejected." Th: "And your way of preventing this from happening is either running away from the relationship or continually doing things for people over and over so they won't reject you." Again, statements in the form of a (rhetorical) question may be disguised interpretations. C1: "I just feel like there's nothing I can do to please her." Th: "You've had that feeling before, haven't you? Remember what you said about your parents?" Once again, it seems clear that the counselor is not seeking information, but imparting it, albeit somewhat indirectly. In this case, the statement is classified as an "interpretation of feeling." By "interpretation of content" is meant an interpretation on either the thinking, feeling, or activity level which is based solely on what the S has just said. No attempt is made to pull together past and present knowledge. For example: \ 296 C1: "Boy I sure don't like getting up this early in the morning to come here." Th: "You mean you're mad at me for making you come this early to group." This example is classified as "interpretation of content" (feeling) since a new frame of reference is offered, feeling is the focus of the therapist statement, and the entire statement is contemporary, e.g., based solely on the S's last verbalization. The important points to remember in classifying interpretations are (a) they impose a new frame of reference on the S, (b) they are analytic, and (0) they usually involve reference to elements in the S's past. In addition they can refer to either thinking, feeling, or behaving and should be classified as such. IV. DIRECT CONFRONTATION: Here are classified counselor statements which challenge, oppose, or otherwise forcefully point out to the S the inconsistencies in his thinking, feeling, and/or behavior. For example: Cl: "I'm upset because I know he doesn't even care for me." Th. "No you're not, you're upset because you believe his not caring for you is important to your existence. Here the therapist is opposing the S's point of view and pointing out what he believes to be the cause of her problem. Although he does present a new frame of 297 reference, as in "interpretation," the forcefulness of his presentation, as well as his exclusive reliance on contemporary, and mostly intra-psychic, events dis— tinguishes "confrontation" from "interpretation." Confrontation involves very active, emotive encounters. Since the therapist in the above example is confronting the S with her beliefs, this would be classified as "direct confrontation with thinking. Cl: "That really hurt my feelings." Th: "How can he hurt your feelings? What you mean is that you took what he said and hurt your own feelings with it." Here the counselor is showing the S how she blames others but in effect is the one who is ultimately hurting her- self. Direct, personalized explanations of this nature are classified as "confrontation with feeling." C1: "Whenever I do what I want they just start yelling and screaming at me." Th: "What you're doing now is the same as the blaming you were doing before. You want to do what you want, but not be responsible for your actions." In this case the therapist is pointing out inconsistencies in the S's behavior. Thus, this sample would be classified as "confrontation with behavior" as would be the examples below. Cl: (S speaking and acting like a "little girl.") Th: 'T'm sure that half the reason why people don't want to be around you is because you act like a damn 9—year old Spoiled brat. 298 C1: "He's just as unreliable as he is reliable." Th: "Yea, and that's just the way you want it so you can blame all your anxieties on pig unreliability." Thus, much of the technique of direct confronta— tion involves a forced reorientation or reevaluation by the therapist. He accomplishes this by challenging, opposing, or otherwise pointing out to the S his loosely organized explanations and forcefully offers alternative explanations of the S's problem. By "confrontation with content" is meant a challenge or pointing-out of inconsistencies or discre- pancies in the S's prior comment, only, with no reference to other people, times, or places. For example: Cl: "I don't . . . , no that doesn't bother me." Th: "Oh, bullshit! You're shaking and all upset and can't even talk straight, now why is it so hard for you to admit that?" V. SUGGESTION By suggestion is meant counselor behaviors which either seek to indirectly get the S to think, feel, or behave in a given way or present a number of alternatives which the S must choose from. The S is always left the final say in matters of suggestion. For example: Cl: "I'm not really sure how he feels about me." Th: "Well, you could always try asking him." 299 C1: "She ' s beaut iful.’ " Th: "Why don't you try asking her for a date." Cl: "I don't really know what to do. I do need the money." Th: "Well, if it were me, I probably wouldn't take it because I think you're right, there's too many strings attached. While all three of the above are examples of indirect suggestion, only the first two would be thusly classified. The last example, although suggestive in nature would be classified under heading VIII (self- disclosure) below since the counselor is explicitly using himself as a reference. The following are examples of suggesting alternatives. Cl: "I'd like to visit them but I don't know what to do about school." Th: "Well, it seems like you have at least three alternatives. You can take an incomplete and make up the exam later, just forget about it and hope your other test scores will carry you through, or talk to the instructor and see if he can help you." C1: "I enjoy sex, but I want more than that." Th: "Couldn't you discuss this with him to see if this relationship has more to offer or start dating other guys who can offer you more than just sex.“ While "suggestion" is usually easy to discern, it can be confused with "self-disclosure" or "questioning." 300 In the former case, the therapist uses himself, not just his opinion, as a frame of reference. In the latter case, the therapist is seeking information quite directly, not trying to impart it, indirectly. VI. INFORMATION AND ADVICE GIVING Counselor statements which involve structuring the therapeutic situation (describing the functions and tasks of therapy), discussions about theory, etc. are all classified here as well as direct suggestions for activity within and outside of treatment. Statements of this nature imply "the therapist as expert." He gives information and advice, states opinions, and answers I direct questions. These communications are primarily objective. When they are EEEE to convey reassurance (warmth) or rejection (disapproval) they will be classified under heading X below (reinforcement). For example: Cl: "My boyfriend doesn't like that." Th: "I don't want to hear about what he wants, what do you want." The following is also an example of counselor statements which structure the counseling relationship and is thus classified as "information and advice giving." C1: "I don't think it helps much to talk about them?" Th: "No, neither do I.’' 301 In addition, counselor statements which are intended to explain an idea, concept, or theory are classified here, also. For example: Cl: "I fight it with everything I have but can't seem to get anywhere." Th: “I believe that, because, well I just don't think people change by trying to disect-out those parts of themselves they dislike. You have to accept what you despise about yourself, not try to cut it out like the bad part of an apple." These statements are usually relatively easy to identify since they typically make reference to people in general. For example: Cl: "I just can't believe that people are that selfish." Th: "It seems to me that most or perhaps . . yes, all people do things for selfish reasons, I think. But I do feel that if you know yourself well, then when you act in accord with this true self your selfishness is also benevolent." Although many references such as "you" and "your" are made, they seem to refer to people in general, e.g., not to this S exclusively, and are thus classified as conceptual explanations. Finally, the most direct form of information and advice giving is exemplified below. C1: "Do you think I should drop out of school?" Th: "No!" Here the therapist simply responds directly (not with suggestion or by redirecting the question back to the individual or group) to a question by the Ss. 302 VII. REDIRECTING QUESTIONS Here the therapist avoids a committed response by redirecting questions back to their source, e.g., either the individual or the group. Cl: "Do you think I should have sexual relations with him?" Th: "I think you already know the answer to that question." C1: "I wonder if I should even try to explain my feelings to her?" Th: "Only you can decide that for yourself, Bob." Cl: "Should I even tell my parents?" Th: "What do you think?" Cl: "I wonder if I shouldn't just drop out and transfer to a junior college?" Th: "Let's see what the rest of the group thinks about that." Cl: "I would like to try it (pause). What do you think?" Th: "I wonder, how does the rest of the group feel about that." The examples above cover nearly all the variations of "redirecting questions." Remember, the counselor simply puts the responsibility for a specific answer either back on the individual or the group. VIII. SELF-DISCLOSURE Counselor statements classified here involve the therapist either revealing his feelings about the lm or his feelings about a person, place, or thing the CD is presently reacting to. The following are examples of the latter. Cl: "We just don't communicate. He never seems to understand me." Th: "I know what you mean. Whenever I don't feel heard or understood by someone, I can't help but feel very isolated and alone." Cl: "Many times I never really understand my anger." Th: "Something I recently learned may be of help to you. I find that when I'm angry the only way I ever understand it is by blowing up. Then, later when I look at it, somehow I just know whether it was appropriate or justified or whatever. I know what I con- tributed to it and what's not mine." Cl: "They just can't seem to understand that church and I are just incompatible. I can't explain it, but that's the way it is." Th: "I know exactly what you mean. I always feel kind of out of place in church, like I walked into the ladies restroom or something." Self—disclosure may serve to reveal the thera- pists feelings or reactions to the client per Sp, as well. For example: C1: Th: Cl: Th: Cl: Th: 304 "He says he doesn't trust me." "I wouldn't either. I think what you do is so far removed from your inner feelings that I just wouldn't trust you with what I think is the important parts of me." "Yes, but . . . " "Now just shut-up, god damit, and listen to me for a change . . . , o.k." ——_—_‘ (S acting and speaking like a "little girl".) "Boy that irritates the hell out of me when you act like a little girl. I can't help but feel others must react to you in the same way also." IX. FREE ASSOCIATION Here are classified those counselor statements which require the S to verbalize the first thing that comes to mind upon the presentation of a cue by the therapist. Th: Th: "I'm going to say a word and when I do I want you to tell me the first thing that comes to mind. Don't hold anything back. Just say what 'pops' into your mind." "What does that make you think of when you say that word. What's the first thing that comes into your mind." 305 X. REINFORCEMENT Here we are interested in counselor statements which convey approval or disapproval, warmth or rejection, etc. If the reinforcing aspects of a counselor's state- ments are incidental to the communication itself, then they should be classified under the appropriate heading above. However, if the therapist seems to be trying to encourage or discourage certain thoughts, feelings, or behaviors, then the response will be classified as "reinforcement." For example: C1: "I think about what you say I don't accep it blindly on faith, its not like . . . " Th: "Beautiful." Cl: . . . not Th: "That's great, I don't want you to. C1: "I do seem to understand things much better when I focus on what's going on inside of me rather than on what other people are doing to me." I Th: "Ah, that's great. Wow, do you know that some people never learn that all their life. Beautiful!" Cl: "I know that most of the time it's as much a problem in me communicating as it is in their listening. It's like . . . (long pause)." Th: "Oh, Christ, don't stop now. Go ahead, go ahead." Cl: "Well, it's like if I was really clear about what I wanted to say then I could probably get by her barriers as well as mine." 306 Cl: "It AE his fault. He started it." Th: "No, no, no, shit no!" Cl: "What do you mean, no?" Th: "It's not even important whose fault it was. Until you stop blaming him and see your role in it you're never going to get anywhere." While the first therapist statement is classified as "reinforcement" (disapproval), his second statement would be classified as "direct confrontation with behavior" since he is actively challenging and pointing out to the S what he believes is important. It is not classified as "information and advice giving," even though direct suggestion and structuring are involved, because of the active, emotive nature of the encounter. The following are also examples of "reinforcement" via disapproval. Cl: "I really think I could do better at another university." Th: "I think you're like a bar of Ivory soap. 99 and 44/lOO's percent gas and hot air." Cl: "Sometimes I wonder why that always happens to me." Th: "Uh (sigh)." C1: "Hal" I Th: "Uh, just uh. That's a bado, a no-no, you know?" The examples above should help clarify some of the difficulties inherent in classifying a statement as fi__________fl 307 "reinforcement." The central criteria should rest on whether or not you think the therapist's intent is solely to encourage or discourage. If this is the case, then the response will be classified here. XI. UNCLASSIFIABLE Here are classified activities not clearly relevant to the task of therapy, e.g., greetings, small talk, endings, etc. Other than that, this category will not be used unless therapist statements absolutely cannot be otherwise classified. APPENDIX J REMINDERS SENT TO EACH OF THE TREATMENT GROUP MEMBERS JUST PRIOR TO EACH WEEKLY SESSION 308 309 ATTENTION Good day . Who says you never get any mail. This very personal and individualized letter is being addressed to you, that's right, to you, as a reminder of your coming group meeting on . Isn't it nice to be thought of. Have a good day now, and don't forget about your group. ATTENTION Hello there you great big healthy student. This is your friendly phantom writer, again, calling to remind you of, guess what? Right, you have a group meeting on Now go out there and give the world hell, and we'll see you soon at the next group meeting. ATTENTION Did you know that live spelled backwards is evil. See how helpful we are, and we'll be even more helpful if you come to your next group meeting on . Come on, live a little. This is your phantom writer signing-off for now with a reminder from that wise old philosopher the Dean of Students (?) who says, "Whatdaya mean your tired, get out a dat bed and study or else you won't learn nuttin." See ya at the group meeting. 310 ATTENTION Do you have those post-midterm blues? Does it feel like your get-up-and-go has got-up-and-gone? Do you feel like the whole world is against you, just now when your security blanket has a gaping hole in it? Is that what's troubling you poopsy? ‘ Well, don't fret, your group meeting is coming up on , and we'll see that you get an extra dose of good ole TLC. ATTENTION Would you believe that we're going to have beer and pretzles at the next group meeting! Would you believe cookies and milk!! Would you believe we're going to have a next group meeting!!! Don't get all excited, we are, on . See you there. ATTENTION Isn't it great to be 'healthy', 'socially adjusted', ' 'emotionally stable', 'balanced', 'poised', 'confident , 'adequate', 'secure', 'with-it', 'real', and 'groovy'. Yes sir, you're sure looking good, and you'll feel even better if you come to the next group meeting on . 311 ATTENTION Just think, the last installment on that beautiful, new personality of yours will be due on . After that, it will be all yours, baby, for good and for ever. Well, see ya at the next group meeting. P.S. The best of luck on your final exams. 11 1 I ERSWY 1 III 3 129 ...:\.1v