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a K»,

  

This is to certify that the

thesis entitled

THE EFFECTIVENESS OF VALUE EDUCATION IN CHANGING VALUES
AND SELF-REGARD IN ADULT PSYCHIATRIC INPATIENTS

presented by
Thomas J. Elzinga

has been accepted towards fulfillment
of the requirements for

Ph.D. degreein Counseling, Personnel

, Services, and
Educational Psychology

 

 

(lb—m E. “ma—9Q):

Major professor

Date July 14, 1980

 

0-7639

     
  

OVERDUE FINES:

. 25¢ per day per item

., A“ _

1 {ii}. ' RETURNING LIBRARY MATERIALS:

AVE-"5;.- J,” - Place in book return to remove
1' “\\"”<t,f. . 3- charge from circulation records

    
     
 

 

\

 
 

 
 

15.6

 

 

 

 

 

THE EFFECTIVENESS OF VALUE EDUCATION
IN CHANGING VALUES AND SELF-REGARD
IN ADULT PSYCHIATRIC INPATIENTS

By

Thomas J. Elzinga

A DISSERTATION

Submitted to
Michigan State University
in partial fulfillment of the requirements
for the degree of

DOCTOR OF PHILOSOPHY

Department of Counseling, Personnel Services,
and Educational Psychology

1980

 

ABSTRACT
THE EFFECTIVENESS 0F VALUE EDUCATION
IN CHANGING VALUES AND SELF-REGARD
IN ADULT PSYCHIATRIC INPATIENTS
By

Thomas J. Elzinga

The present study was designed to assess the effectiveness of
value education in modifying the importance of selected values and
increasing self-regard with adult psychiatric inpatients. Four values,

freedom, self—respect, responsible, and self-controlled, were found to

 

exhibit significant increases in ranked importance on Rokeach's Value
§U§V§y_from the time of admission to discharge for a sample of 58
patients in a pilot study.

A second phase of this study consisted of experimental efforts
to modify the importance of the four values using another sample of
l20 incoming patients representing balanced numbers of males and females
and psychotic and nonpsychotic admitting diagnoses. Four experimental
value education exercises (treatments) were designed, each aimed at one
of the four "target" values, i.e., targets for change. Each treatment
provided the subject with three types of information: (1) a table
showing high, average, and low ”scores" for a target value obtained by
former patients, (2) descriptive characteristics of patients who place
high importance on the value and patients who place low importance on
it, and (3) the experimenter's conclusions about the significance of

the value when it is ranked high or low. A fifth, control treatment,

 

Thomas J. Elzinga

was designed which simply presented a series of statements suggesting
that values, generally, were important to examine.

Each subject first rank-ordered his values on the Value Survey
and was then administered his randomly assigned treatment. The
Value Survey was administered immediately following treatment and two
weeks later. At two weeks, scales purporting to measure similar con—
structs as the target values (indirect measures) were also adminis-
tered. At three weeks, four measures of self-regard were administered.
It was predicted that after intervention each experimental group would
(l) place greater importance on its respective target value, (2) show
less variance in the ranked importance of its target value, (3) place
more importance on indirect measures of its target value, and
(4) exhibit higher self-regard than control subjects.

Omnibus F tests were first used to identify treatment effects
and interactions of treatment with sex and diagnosis. Repeated
measures ANOVAs were used to assess effects on each target value's
ranking and each target value's variance (Levene's test). MANOVAS
were used to assess effects on each set of indirect measures of target
values and the set of self-regard measures. All significant treatment
effects and Simple main effects for sex and diagnostic groups were
followed by post hoc tests of the directional effects predicted.

Analysis of treatment effects on target value rankings indicated
that patients receiving value education aimed at responsible obtained
a significantly higher mean rank on responsible over time than patients
in two contrast groups. Psychotic patients receiving the responsible

exercise obtained a significantly higher mean rank on responsible two

 

Thomas J. Elzinga

to three weeks after treatment than psychotic patients receiving the
four comparison exercises. None of the remaining treatments showed
significant effects on their respective target values.

Analysis of treatment effects on target value variances revealed
significantly less spread of self-respect ranks immediately after
treatment for females receiving the self-respect exercises than
females receiving the responsible exercise. Males receiving the
responsible exercise revealed a significant decrease across time in
the spread of responsible ranks when compared to males receiving the
freedom exercise. Contrary to prediction, experimental interventions
generally increased the spread to target value rankings, while the
control group consistently revealed the least Spread in each target
value's rankings.

Only one of nine indirect measures of target value importance
was effected by value education. Females receiving the freedom
exercise placed significantly less importance on acceptance of
authority than females receiving all other treatments when observed
two weeks after intervention. No association between any value

education exercise and increased self-regard was found.

 

DEDICATION

To Bev, my wife, and my sons, Tom and Dave,
who have cheerfully accepted the extra burdens placed
on them and supported me with love and unending

patience.

 

 

ACKNOWLEDGMENTS

I wish to express my warm thanks to the members of my committee
who have always given generously of themselves. Each one has been an
exceptional model of a psychologist and educator. Their influences
will be felt throughout my professional career.

Don Hamachek, my advisor and committee chairman, has always pro-
vided any needed support or advice throughout my program of study.

He has broadened my interests and awareness by encouraging scholarship
in many directions. His warm regard has inspired greater personal
confidence within me. I am deeply grateful for these gifts and
privileged to share his friendship.

Andy Porter, a remarkable teacher, invested much time and
interest in this project. I have enjoyed and appreciated many
stimulating discussions, his disciplined thinking, and warm support.

I will always be grateful for the research skills he has given me--
a foundation on which to build.

Joe Byers has stimulated my thinking many times with his highly
creative and integrative capacities so abundant in his own thoughts.
I appreciate his interest and service on my committee.

I wish to thank Ellen Strommen for serving on my committee. Her
breadth of knowledge and careful reviews of this project have resulted

in many excellent suggestions and have been sincerely appreciated.

 

I would also like to thank Suwatana Sookpokakit and Al Hammer of
the MSU Office of Research Consultation for their assistance in
computer programming and analysis of data.

I have appreciated the cooperation of the administration, staff,
and patients of Pine Rest Christian Hospital who have participated in
this study. In particular, I wish to express gratitude to Judy
Malicki who served as a research assistant and to Kathy Buteyn and

Harriet Kuipers who typed the initial drafts of the dissertation.

 

TABLE OF CONTENTS

 

Page
LIST OF TABLES . . . . . . . . . . . . . . . . vii
LIST OF APPENDICES . . . . . . . . . . . . . . x
Chapter
I. INTRODUCTION . . . . . . . . . . . . . . 1
Values and the Social Sciences . . . . . 2
Early Deterrents to the Study of Values . . . . 3
Scope of Value Inquiry. . . . . . . . 6
The Need for This Study . . . . . . . . . lO
Purpose . . . . . . . . . . . . l2
Research Hypotheses . . . . . . . . . . . l2
Theory and Methodology . . . . . . . . . . 13
Overview . . . . . . . . . . . 14
II. THEORETICAL BACKGROUND . . . . . . . . . . T6
The Concept of a Value . . . . . . . . l6
The Concept of Values Systems . . . . . 25
The Function of Values and Value Systems . . . . 30
Self— -Conception . . . . . . . . 34
Cognitive Change . . ' . . 45
Summary of the Major Theoretical Assumptions
Underlying the Present Study . . . . . . 56
III. EMPIRICAL BACKGROUND PROVIDED BY THE PILOT STUDY . . 59
Purpose of the Pilot Study . 59
Primary Constructs and Assumptions Underlying the
Pilot Study . . . . . . . . . 60
Specific Objectives . . . . . . . . . . . 66
Procedures . . . . . . . . . . . . . 69
Pilot Study Results . . . . . . . 76
Conclusions About Each Target Value . . . . . 89
Summary of the Pilot Study . . . . . . . 98
IV. EXPERIMENTAL DESIGN AND METHODOLOGY . . . . . . lOl
Subjects . . . . . . . . . . . . . . lOl
Measures . . . . . . . . . . . . . . l02

Chapter Page

 

Description of Treatments . . . . . . . ll3
Observations of Dependent Variables . . . . . 120
Hypotheses . . . . . . . . . . . . . . 121
Data Matrix . . . . . . . . . . . . lZl
Methods of Analysis . . . . . . . . . . . 122
Summary . . . . . . . . . . . . . 125
V. ANALYSIS OF RESULTS . . . . . . . . . . . 127
Analysis of the Effects of Value Education on
Target Value Ranking . . 127
.Analysis of the Effects of Value Education on the
Variance of Target Value Rankings . . . l34
Analysis of the Effects of Value Education
Indirect Measures of the Target Values . . . . l39
Analysis of the Effects of Value Education on
Measure of Self— -Regard . . . . . l43
Discussion of Results . . . . . . . . . . l46
Summary of Results . . . . . . . . . . . l53
VI. SUMMARY AND CONCLUSIONS . . . . . . . . . . l57
Summary . . . . . . . . . . . . . . . 157
Conclusions . . . . . . . . l6O
Implications for Psychotherapy . . . . . . . l64
Implications for Future Research . . . . . . l76
REFERENCES . . . . . . . . . . . . . . . . . l84
APPENDICES . . . . . . . . . . . . . . . . . l9l

Vi

Table
3.1

LIST OF TABLES

Mean Ranks of Selected Terminal and Instrumental
Values on Admission and Discharge for 58 Adult
Inpatients . . .

Percentage of Male and Female Patients with Rank
Increases at Discharge on Five Values . . .

Significant Intercorrelations of Target Values and
18 Terminal Values on Admission (Pre) and Discharge
(Post) . . . . . . . . . . . .

Significant Intercorrelations of Target Values and
18 Instrumental Values on Admission (Pre) and
Discharge (Post) . . . . . . . .

Significant Intercorrelations of Target Values
Ranks and MMPI Scores on Admission (Pre) and
Discharge (Post) . . . . .

Mean Target Value Rankings on Admission and
Discharge for Non-psychotic and Psychotic Patients.

Significant Intercorrelations of Target Values
and MACC Behavioral Adjustment Scores at Admission
(Pre) and Discharge (Post) . . . .

Correlation of Length of Hospitalization and
Target Value Rankings Obtained on Admission and on
Discharge . . . . . . . . . . .

Mean Target Value Rankings on Admission and
Dishcarge for Patients in Aftercare and Patients
Not in Aftercare . . . . . . . . . .

Mean Target Value Rankings on Admission and
Discharge for Patients Rated "Improved" and
"Unimproved"o on Follow— —Up .

Correlation of Likelihood of Future Hospitalization
with Target Value Rankings Obtained on Admission
and Discharge . . . . . . . . . . .

Page

77

78

8O

81

82

83

85

86

86

87

89

 

Table

5.T3

P-l

P-2

Mean Rankings of Freedom by Diagnosis and Treatment
Groups . . . . . .

Effects of Value Education on Rankings of Self-
Respect . .

Mean Rankings of Responsible for Each Treatment
Group .

Mean Rankings on Responsible at Times I and II by
Treatment and Diagnostic Groups . . .

Mean Ranks on Self-Controlled for Males and Females
in Each Treatment Group . . . . . .

Mean Deviation Scores on Freedom Across Time by
Treatment and Diagnosis . . . . . . .

Mean Deviation Scores on Self— Respect by. Treatment
and Diagnosis . .

Mean Deviation Scores on Self-Respect Across Time
for Males and Females in Each Treatment Group

Mean Deviation Scores on Responsible Across Time
for Males and Females in Each Treatment Group

Mean Deviation Scores on Self-Controlled for Each
Treatment Group . . . . . . . . .

Mean Scores on Indirect Measures of Freedom of Sex
and Treatment Group . . . . . . . . . .

Mean Scores for Indirect Measures of Self— -Respect
Responsible, and Self— Controlled by Treatment
Group

Mean Scores for Experimental and Control Subjects
on Self— -Acceptance and Self- Satisfaction by
Diagnosis .

F Ratios for Sources of Variance in the Repeated
Measures Anovas of Target Value Ranks . . .

F Ratios for Sources of Variance in the Repeated

Measures Anovas of Target Value Deviation Scores
(Levine's Test) . . . . . . .

viii

Page

T29

T30

T3T

T33

T34

T36

T37

T38

T39

T40

T42

T44

T45

247

248

 

Table

P-3

P-4

P-5

P-7

P—8

P-9

P-TO

F Ratios for Sources of Variance in the
Multivariate Anova of the Three Indirect Measures
of Freedom .

F Ratios for Sources of Variance in the Univariate
Anovas of the Three Indirect Measures of Freedom

F Ratios for Sources of Variance in the
Multivariate Anova of the Pair of Indirect
Measures of Self-Respect

 

F Ratios for Sources of Variance in the Univariate
Anovas of the Two Indirect Measures of
Self-Respect

 

F Ratios for Sources of Variance in the Multivariate
Anova of the Pair of Indirect Measures of
Responsible . . . .

 

F Ratios for Sources of Variance in the Univariate
Anovas of the Two Indirect Measures of Responsible .

 

F Ratios for Sources of Variance in the Multi-
variate Anova of the Pair of Indirect Measures
of Self-Controlled . . . . . . .

F Ratios for Source of Variance in the Univariate
Anovas of the Two Indirect Measures of Self-
Controlled ,

 

F Ratios for Sources of Variance in the Multivariate
and Univariate Anovas of the Set of Four Self-Regard
Measures . . . . .

ix

Page

249

249

250

250

25T

25T

252

252

253

 

Appendices
A.
B.
C.

C323

LIST OF APPENDICES

The Rokeach Value Survey
Survey of Interpersonal Values
Personal Value Scales

Value Profile Scales and Social Responsibility
Scale

Self-Esteem Scale
Index of Adjustment and Values

Scale to Measure Internal Versus External
Control .

Part 1: Pretreatment Value Survey .
Treatment 1 -- Freedom Exercise .
Treatment 2 -- Self-Respect Exercise
Treatment 3 -- Responsible Exercise
Treatment 4 -- Self-Controlled Exercise

Treatment 5 - Non-Targeted Exercise

Final Page of Part II for All Subjects
Part III: Value Survey at Time I

F Ratios for All Sources of Variance in All
Tests Performed (Table P-l through P-11) .

Page
T92
197
201

204
209
211

216
219
223
227
231
235
239
24T
243

246

 

CHAPTER I

INTRODUCTION

A heightened interest in values is being prompted by the special
needs of society developing in recent decades. More than ever, con-
temporary society manifests accelerating technological growth, diverse
educational and occupational opportunities, an enormous array of
products and services, concerns about environment, resources and
population, changing family structures and life styles. These are
some of the many factors involved in a movement from absolutism to
relativism in culture (Smith, 1963) that arouse value conflicts within
traditiona1,rwflatively stable value systems serving individuals,
groups, and society.

While each generation has always challenged and modified the
value systems of its predecessors, the process has been sufficiently
gradual and limited in scope to provide continuity across generations.
It is not change pepdse that has led to value crises in contemporary

society. It is the rapid rate of Change that is implicated.

 

Accelerating change contributes to a geometric expansion in the

range of choices and can render any given value system obsolete before
it acquires an enduring stability (Buhler, 1962). Frequent and
repeated disillusionment with the guiding principles in individuals'

lives will likely have far-reaching effects on their social and

 

emotional development and functioning. Some degree of change in an
individual's value system likely reflects growth and increasing
maturity. Other changes may reflect a desperate search for a

stable identity and meaning in a world where diversity in choices
generates anxiety and rapidly fluctuating values alienate individuals
from themselves and others. The institutions of society and the
behavioral sciences, in particular, are now confronted with a myriad
of questions concerning the nature of values and their relevance in

addressing the practical problems of society and human lives.

Values and the Social Sciences

 

The concept of human values has not yet found its established
place among the important constructs within the social-behavioral
sciences. Although values provide a favorite topic of discussion in
many disciplines, systematic inquiry into the nature of values utiliz-
ing empirical methods has been scant. No unifying or dominant ”value
theory" exists for social-behavioral scientists (Smith, 1963), nor
has any major theory of personality accorded values an integral role
in human development and behavior. Among social scientists exploring
group phenomena, some traditional interest has existed in understand—
ing values as characteristics of cultural groups or political and
ideological systems. Behavioral scientists with interests directed
at the psychology of the individual and intrapsychic processes have

almost entirely avoided the topic of values held by individuals. The

 

role or significance of values in cognition, and personality generally,

is a direction in which inquiry has only begun.

Relatively recent developments, however, suggest that the issue
of values is growing in importance in some areas of applied psychology.
Educators recognize a broadening conception of educational needs. The
concept of "affective education" includes such specialized educational
objectives as ”value clarification" (Raths, Harmin, & Simon, 1966).
The work of Kohlberg (1964) in the Piagetian tradition has revitalized
interest in moral development lying dormant since the early studies-
of Hartshorne and May (1928). Rokeach (1973) has steadfastly worked
over several decades to formulate and provide empirical validation of
one of the most comprehensive "value theories" to date. Others have
addressed questions about the significance of values in mental health
and psychotherapy (Buhler, 1962; Lowe, 1969). Smith (1961) suggests
the concept of "mental health" conceals a pure value problem. From
various areas, questions about values have been slowly coming into
focus. The recent trend toward cognitive perspectives throughout
psychology (Mahoney, 1977) promises to provide even greater impetus

to the study of values.

Early Deterrents to the Study of Values

 

Rapid social change has inevitably generated new needs and worked
to challenge and dissolve value systems of the past giving rise to the
contemporary concern over values in society and social science. In
contrast to these contemporary forces, there are numerous factors
which, until 30 years ago, deterred behavioral scientists from inquiry

into values and still act as deterrents today (Smith, 1963).

 

Science in its "pure" sense has traditionally concerned itself
with facts and methods in which values have no place. Value concerns
have been assigned to the domains of philosophy, ethics, and religion.
Efforts to have a value-free scientific methpd have created an indif—
ference and a tendency to dismiss values as potential scientific

subject matter (Dukes, 1955).

 

The notion of values as a relevant construct in psychology pre-
sents difficult conceptual and definitional problems that have also
worked against its inclusion in theory and research. Values tran—
scend specific situations and are expressed in highly abstract terms.
Constructs such as needs, attitudes, or traits reflect lower-order
abstractions more readily defined, measured, and linked to motives
and observable behavioral events. As theory building proceeds out
of empirical research those explanatory constructs most proximal or
easily related to observable events are likely to receive proportion-
ately greater attention in research. The broadly inclusive and
abstract character of values as a construct may have discouraged
research efforts while awaiting further theoretical development of
other lower-order constructs.

Not all theorists have accorded values a status conceptually
distinct from other constructs, but prefer to equate values with such
constructs as needs, social norms, interests, attitudes, and traits.
The ease by which values can be reduced or equated with existing
constructs may be a function of their abstract character as well as

the common motivational bases shared by these various constructs.

 

Nhen values have been given a distinct place among constructs,
they have generally been viewed as highly stable or fixed as in the
tradition of trait psychology. Such variables typically are regarded
as extraneous or "nuisance" variables with less appeal as variables
of interest in dynamic formulations of personality or experimental
approaches concerned with manipulation of independent variables and
change in dependent variables.

In addition to the conceptual barriers to research, values do
not readily lend themselves to measurement. Their broad character-
istics and the difficulty linking them to specific events demon—
strating their relevance and strength may again be one factor. It
has been observed that attitude studies outnumber value studies about
six to one (Rokeach, 1973). Attitudes are conceptualized and
measured as lying along a continuum with negative and positive poles.
Values do not lend themselves to measurement following such a model,
since a given value is typically conceived of only lying in a
positive direction and having relevance primarily in a hierarchical
relationship to other values and less on some singular measure of the
strength of a particular value. Scaling techniques developed by
Guttman and Likert have been credited with promoting attitude
research. Comparable techniques for value measurement have not been
readily available until Thurstone's (1954) approach to the subjective
metric and value measurement. While the absence of adequate research
tools has certainly discouraged value research, their development has
in turn been hampered by the theoretical and conceptual difficulties

associated with values.

 

 

In summary, deterrents to value inquiry first of all stem from
a philosophy of science which traditionally has denied any role of
values in determining its own methods and objectives coupled with a
phobic avoidance of values as scientific subject matter. Secondly,
conceptual, theoretical, and methodological concerns have presented
an interrelated set of obstacles impeding efforts to systematically

explore values.

Scope of Value Inquiry

 

Since questions about values may arise wherever human concerns
exist, the scope of value inquiry is exceedingly broad, involving
almost any context or discipline. The level of questions may range
from values held by individuals to the values of institutions, ideo-
logical systems, cultural groups or nations. Empirical inquiry may
proceed along a multitude of lines in building value theory and
integrating it with the constructs in current social and psychological
theories. Within psychological theory alone, the acquisition, organi-
zation, and function of values and value systems within the indi-
vidual's cognitive system raise a host of questions. The relation-
ship of values to affective and behavioral components of human
functioning and the conditions and consequences of value change
provide numerous avenues of study. Anthropology, sociology,
political science, and other disciplines each provide domains of

special concern.

 

Applied Psychology

The functions of values as both products and processes in
cognition and their special significance in relationship to self-
conceptions represent major areas in psychology where existing
theories need to be expanded and integrated with value theory.
Since values are closely linked with cognitions involving the
appraisal of self, others, or objects and events relevant to the
self, itis likely that the dynamic motivational features of values
will take on greater importance in conceptions of personality, emo-
tional, and social development and functioning as research progresses
(Smith, 1963).

As the significance of values, the processes by which they are
learned, and their functions become clearer, value theory will have
practical implications for parents, educators, counselors, and others
interested in behavioral guidance and change. Parents have tradi-
tionally assumed the responsibility of directly transmitting their
values to their children and allowed only those social institutions
sharing similar values to assist in the process. Generally, indi-
viduals or institutions less directly identified with parental
authority are reluctant to say they are teaching or differentially
promoting selected values. The term "value clarification" and its
methods suggest a neutral position on the part of the educator in
which no preference is offered for one value over another.

A similar posture has been taken by many counselors and
psychotherapists whether assisting an individual in making specific

life decisions or in treating him for any of the array of

 

psychopathological disorders or personal adjustment problems.
Psychotherapists in their professional role usually come from the
mental health tradition with the corresponding disease model most
apparent in psychoanalysis. Again, the scientific tradition deterred
medical practice as well as research from any direct concern with
values. Psychotherapists oriented to the learning tradition, and
equally respectful toward "pure" science, have also functioned as if

value considerations are not relevant in their applied work.

Values Within the Psychotherapeutic
Setting

While the scientific tradition has deterred practitioners from
facing the problem of values in their work, counselors and therapists
are increasingly acknowledging values as an important variable in
therapy. However, those therapists willing to face the problem of
values remain in a dilemma. Existing value theory is skeletal, with
a limited data base, and rather isolated from prevailing theories of
personality, psychopathology, and psychotherapy. Almost all studies
of values and therapy have been of a descriptive or correlational
nature (see reviews by Ehrlich & Wiener, 1961; and Kessel & McBrearty,
1967). In the psychotherapeutic setting, value concerns and issues
may be directed at any of three major areas where values can be found.
These areas include (1) value orientations associated with various
theoretical systems, (2) therapists' values, and (3) patients' values.

In psychotherapy, the broadest concerns with values may involve
questions about the value orientations implicit in competing theories

of personality and psychotherapy. What differences and similarities

 

exist in terms of values regarded as relevant and important for
healthy functioning (Smith, 1969)? What are the implications of
different value orientations for the objectives and methods of
psychotherapy? How are varying, perhaps incompatible, value systems
integrated in an "eclectic" approach to psychotherapy?

At the level of individual psychotherapists, questions arise
concerning the interrelationship of the therapists' personal value
systems and the system they subscribe to in their professional and
theoretical orientation. To what extent are selected values communi-
cated or promoted and by what direct or indirect means? To what
extent does a therapist practice and recognize various levels of
neutrality or nonneutrality? Are particular values implicated more
readily than others in the issue of neutrality? Is value change
regarded as an objective or by-product of therapy when it occurs?

15 the responsibility for such change seen as lying with the therapist
or patient? These are some of the many issues likely confronting
therapists who seek to understand the relationship of their own

values and behavior both as individuals and practitioners.

Questions directed at patients' values are likely to reflect
theoretical concerns about the nature of values and psychopathology
and applied concerns about the significance of particular values in
the treatment of individuals within the patient population. Questions
may be directed at differences between the value systems of patients
in comparison to normal individuals. Do differences in the value
systems of these groups reflect important values associated with

effective social and psychological functioning? As entering

 

TO

Characteristics, do the values systems of individual patients have
diagnostic significance in assessing the patients? Do they provide
prognostic information and implications for planning the design and
methods of treatment? To what extent do changes in values occur as
a function of treatment? What are the interaction characteristics
of patient and therapist values within the therapeutic process? Are
some value changes prerequisite for improvement in other criterion
areas of functioning? Should direct efforts be taken as part of
therapy to bring about changes in such values? What methods are
effective in inducing value Changes? What psychological mechanisms
are involved in value change and related changes within the person-

ality system?

The Need for This Study

 

It is at the level of patient's values that this study is
selectively directed. The many questions raised above continue to
await answers based on empirical study. The present study is offered
as an empirical approach directed at a few key questions. Can
”psychologically important" values be identified? Assuming that
some values, more than others, may have significant intrapsychic
implications, it may be within the psychiatric population that dys-
functional value systems can be identified and associated with dys-
function in personality and behavior. Can such identified values be
directly modified by educational interventions? Will indirect
changes be observed in lower-order and higher-order cognitions as

predicted by value theory? Value theory at present generally

 

11

suggests that other values and attitudes related to a particular
value undergo change as a function of the more central value change
(Rokeach, 1973). In addition, value theory postulates the primary
function of values to be the maintenance and enhancement of self-
regard. On that basis, modification of psychologically important
values should ultimately change self-regard. Presumably, changes in
psychologically important values and enhancement of self-conception
and selféesteem early in the course of contemporary psychiatric
treatment will facilitate such treatment, which is often aimed at
enhancing self-conception. By directly centering on those cognitions
or beliefs crucial to effective psychological functioining, both the
speed and potency of psychotherapy may increase.

Research in the psychotherapeutic setting will have implications
for understanding the role of values in all individuals to the extent
that the same processes and their psychological significance hold
true for all populations of individuals. The benefits of research
on patients' values will have immediate benefits in generating new
insight and modifications in existing methods of therapy and counsel-
ing as well as promising new methods uniquely focused on value change.
In addition, the psychological significance and substantive relevance
of particular values for effective human behavior is likely to become
Clearer and serve as a basis for evaluating the value systems impli-
cit in various theoretical orientations and therapeutic strategies.
Therapists too may profit from having a clear point of reference to

evaluate those values guiding their lives and professional practices.

 

 

12

Purpose

The primary purpose of this study was to assess the effective-

 

ness of value education directed at four empirically selected target

values, freedom, self-respect, responsible, and self-controlled.

 

 

Four value education exercises which differ in terms of the target
value examined and a non-targeted (control) exercise were used. The
targeted value education exercises were evaluated in terms of their
effectiveness in (1) increasing the ranked importance of the target
value relative to other values within the individual's value system,
(2) establishing a consistent level at which the target value was
ranked across the group of individuals receiving the same exercise,
(3) increasing the importance of value constructs presumed to be
closely related or synonymous with the ranked target value, and
(4) enhancing selected dimensions of self-regard.

The identification of the four target values was a prerequisite
for this study. That objective was accomplished in a pilot study

which is presented in detail in Chapter III.

Research Hypotheses

 

There were four major hypotheses under investigation in this

study which are stated as follows:

Hypothesis 1:

 

Patients who receive value education aimed at
examining the importance of a particular target
value will rank that value higher within their
value systems than patients receiving other
value education exercises.

 

T3

Hypothesis 2:

 

Patients who receive value education aimed at a
particular target value will, as a group, exhibit
less variability in the level of ranking that
value than patients receiving other exercises.

Hypothesis 3:

 

Patients receiving value education aimed at a
particular target value place more importance on
value constructs closely related to the target
value than patients receiving other exercises.

Hypothesis 4:

 

Patients receiving value education aimed at a

psychologically significant target value will

exhibit higher self-regard than patients

receiving a non-targeted control exercise.

Theory and Methodology
The work of Milton Rokeach over the past several decades has

yielded a fairly comprehensive value theory which is integrated with
both a theory of cognitive change and a humanistic perspective of
personality development (Rokeach, 1973). Based on these formulations,

Rokeach's methodological contributions include an instrument for

measuring values, the Value Survey (1967), and a model for value

 

education. Rokeach and others have contributed to a growing body of
empirical studies for over a decade using his theory and methods.

The present study was based on Rokeach's theoretical framework
and used both his instrument and an adaptation of his value education
model. The present study is different from much of the earlier work
in the Rokeach tradition in several respects. First, it was directed

at a psychiatric population. Second, it used additional methods of

 

T4

measuring the changes in target values. Third, it directly con-

sidered the effects of value change on self-regard.

Overview

In the present chapter, a sketch of the contemporary position
and importance of value theory within social science has been pre-
sented. In Chapter II, a more detailed presentation of Rokeach's
formulations is undertaken within a broader theoretical discussion
of major constructs and issues related to values, value systems,
self-conception and cognitive change. Chapter III is a detailed
description of the pilot study which provided the empirical back-
ground for the experimental value education exercises under investi-
gation in this study. The pilot study primarily served to identify
psychologically important target values for the patient population
and map the relationship of the target values to other patient
characteristics. In Chapter IV, the design and methodology of the
experimental value education phase of this study is presented. The
specific dependent variables are identified and the instruments used
as outcome measures are described. The basic value education pro-
cedure and methods of data collection and analysis are described.
The analysis of results is presented in Chapter V by examining, in
turn, the effects of value education on (1) target value rankings,
(2) variance in target value rankings, (3) indirect measures of
target values, and (4) measures of self-regard. In Chapter VI, a
summary of this study is presented with conclusions about the effec-

tiveness of value education and directions for further research.

 

T5

The unsatisfactory state of value theory and many directions for
research that may ultimately lead to further integration of value
theory and self-concept theory will begin to be apparent in the

theoretical discussion to follow.

 

CHAPTER II

THEORETICAL BACKGROUND

Within this chapter, the major formulations of Rokeach are pre-
sented and discussed in a broader theoretical context to examine
issues and constructs Closely related to his theory though, at times,
not fully articulated within it. The discussions in this chapter
fall into three major areas: values, self-conception, and cognitive

change.

The Concept of a Value

 

The definition of a value formulated by Rokeach (1973) provides
the foundation of the present study. Before examining his definition,
some of the major issues of diversity related to the concept of value
will be discussed in order to set some philosophical boundaries
around the concept of value and clarify some basic value terms.

First, approaches to classifying values will be identified. Second,
the issue of whether values are subjective or objective will be
examined as the central one underlying most diversity surrounding
the concept. Finally, Rokeach's definition of a value will be dis-

cussed.

16

 

T7

Classifying Values

 

Rescher (1969) has outlined six major dimensions on which values
can be classified. These dimensions provide a starting point with
some heuristic convenience for identifying some of the conceptual

issues underlying any definition of the construct value.

1. Values may be classified by their subscribership, i.e., who

 

holds the value. A particular value may be held by an individual or
by some specified group of individuals. However, when considering a
value held by some group it is implied that a substantial number of
individuals within the group subscribe to the value.

2. Values may be classified by the objects at issue. The
objects may be things, individuals, groups, or societies, which
specify the domain where the value, conception of some desirable
characteristic, is applicable.

3. Values may be classified by the benefits realized by the
value. The needs, wants, desires, interests, or other motivational
forces provide categories of benefits that may be realized by certain
values. For example, a social benefit may be realized by a value
such as courtesy.

4. Values may be Classified in terms of the purposes at issue.
Classification involves describing the mechanism by which the benefit
underlying the value is realized. An object, activity, or event may
be regarded as having "X value" or I'value for X purposes” where X
denotes some functional characteristic that ultimately leads to the

realization of some benefit. This line of classification may be

 

 

 

 

T8

viewed as evaluation of specific objects and events or assignment of

 

"value" to specific things. Much confusion arises out of the two
usages of "value", i.e., an object having yelpe_and a person having
a value.

5. Values may be classified in terms of the relationship

between the subscriber and the beneficiary. This essentially leads

 

to two broad classes of values, self-oriented and other-oriented
values. "Other-oriented values may range in applicability from very
select groups to mankind generally.

6. Values may be classified in terms of the relationship of a

 

value to other values. Some values may reflect ends in themselves,

 

i.e., realization of the value has intrinsic merit, reflects a goal,
or terminal state of affairs. Other values may be viewed as sub-
ordinate in the sense of mainly facilitating the realization of the
end or terminal values. These values are the means values or

instrumental values which have more immediate relevance in guiding

 

activities on a daily basis.

These dimensions may be considered in terms of their parallel
features and the sorts of complex classification systems that may be
developed by crossing various dimensions with one another. It should
be noted that the conceptual dimensions above yield largely categori-
cal classifications. Rescher (1969) notes that quantitative dimen-
sions can be introduced which consider such things as the hierarchy
of importance of values within categories of classification.

Temporal expectations related to the immediacy of receiving benefits

 

19

related to certain values may be quantifiable. In addition, a
special and highly narrow type of quantitative classification system
is apparent when objects or activities are scaled in terms of
exchange value via monetary units. Many of the concepts of value

and value theory stemming from the field of economics are applicable
in the social sciences' struggle with the concept of value. Concepts
such as supply and demand, cost-benefit analysis, exchange value,
indifference curve analysis, and preference ordering of goods may be
suggested by the discussions throughout this chapter.

Values as Subjective or Objective
Phenomena

 

Perhaps the most central issue, historically, related to
defining the construct value has been a question of whether values
are subjective or objective. This problem has been discussed in
detail by Frondizi (1971) who phrases the question as follows: "Are
things valuable because we desire them (subjective), or do we desire
them because they are valuable (objective)?" The extreme subjec-
tivist position has been expressed by Dodd (1951), "Let a value be
defined as a desideratum, i.e., anything desired or chosen by some-
one sometime." The extreme objectivist views a value as existing
independently of any subject and as a type of object in itself.
"Values are absolutes, existing in the mind of God as eternal ideas,
as independent validities . . ." (Adler, 1956). At both extremes,
the value is located outside of the individual whose behavior may be
under study (Barton, 1962). In one case, an object is a value in

itself if it elicits interest from the subject. In the other case,

 

20

a value itself is a type of object, with intrinsic merit, in the
form of an idea to be discovered and subscribed to by the subject.

Frondizi (1971) attempts to solve the subjective-objective
problem by positing a tension between subject and object that varies
in predominance along a hierarchical continuum of values. At the
lowest levels, where objects are the sources of immediate pleasurable
or unpleasant experiences, the subjective predominates with each
individual crediting some value to the object as a function of his
experience. At the highest point, involving ethical values, the
objective predominates. A value such as justice has a kind of
objectivity that is compelling apart from the subject's experience
or desires.

Baier (1973) has attempted to resolve the problem in a somewhat
different manner by distinguishing between two kinds of yglpe

assertions. He defines value imputations as assertions that someone

 

 

holds or subscribes to some particular value. An imppted value is

 

viewed as a fact demonstrated by some measure of the individual's
behavior to promote certain ends. Baier defines value assessments
as assertions that some object or event has some capacity to favor-

ably affect someone's life. An assessed value is the measure of the

 

capacity of something to confer a benefit. Here, we see most
clearly the distinction between (1) yglpe as a qualitative belief
that is subscribed to by a person or imputed to a person by an out-
side observer and (2)-yglpe as a quantity (of varying specificity

and reliability) assigned to some object.

 

21

An assessed value is a product; judgement, or outcome of the

process or activity of evaluating. While closely related, the

 

process of valuing is not synonymous with evaluating. Valuing is
generally used to denote the activities of selection and subscribing
to imputed values as well as assigning some degree of hierarchical
organization and commitment to them. Evaluation uses and applies
imputed values as tools (criteria) to produce (measure) assessed

values for various entities. The terms, value judgement or value

 

conclusion, are synonymous with assessed value in terms of being the

 

same type of cognitive product. Value judgement and value conclusion
are merely broader terms that come into use when the evaluation
process becomes more complex. Consider the cognitive processes
involved in arriving at a sipgle_assessed value (e.g., good or bad,
right or wrong, has value or has no value) for a highly complex
issue (Coombs, 1971). A complex issue would involve multiple facts
about multifaceted objects and events to be assessed in terms of
multiple criteria (imputed values) of varying strength relative to
one another. In contrast, determining the assessed value for a
single feature of an object using a highly reliable standard is a
simple matter. In fact, this simple case is only an act of measure-
ment and becomes a case of evaluation or value judgement only if

the standard's scaling is also correlated with a dimension of desir-
ability or preferability. This additional dimension is based on
some imputed vahng i.e., a variable criterion or conception from

one individual to the next.

 

22

The distinction between "desire“ and a "conception of the
desirability” parallels the subjective-objective issue. Most social
scientists hold to the "conception of desirability” as a key part of
defining imputed values. This is a more or less objective stance in
which a value is a concept or abstraction, and, therefore, is objec-
tive in the sense that it may or may not be recognized or selected
and subscribed to. Social scientists vary more in terms of what is
meant by "desirability" in arriving at definitions of value. In
most cases, desirability is considered in a social context, wherein
the benefits involved consider jointly the good of the individual
and others. Desire may be in conflict with what is desirable for
either an individual‘s or other's welfare. Conceptions of what is
personally desirable may include satisfaction of individual desires
and goals when they ultimately benefit a person and do not interfere
with legitimate demands from others. The legitimate demands people
place on one another give rise to social values and define the moral

parameters of value (Baier, 1973).

Definition of a Value

 

Most attempts to define a value among social scientists fall
between the extremes of subjectivism and objectivism with a predomi-
nant emphasis on objective formulations. Some representative defini-
tions which have clearly influenced the most recent definition
offered by Rokeach should be noted. Morris (1956) identified three
kinds of values: (1) "Operative" values reflecting what people

actually choose, (2) ”Conceived" values reflecting what individuals

 

23

conceive as desirable or preferable, and (3) "Object" values reflect-
ing what is preferable whether or not it is preferred or conceived as
preferable. Morris' "conceived value" is similar to Kluckhohn's
(1952) definition of a value as "a conception, explicit or implicit,
distinctive of an individual or Characteristic of a group, of the
desirable which influences the selection from available modes,

means and ends of action." Williams (1968) has defined values as
criteria or standards used in making evaluations or judgements.

Rokeach provides the following definition of a value. "A yglge_
is an enduring belief that a specific mode of conduct or end-state
of existence is personally or socially preferable to an opposite or
converse mode . . ." (Rokeach, 1973, p. 5).

In defining a value as "enduring" Rokeach emphasizes the rela-
tive stability of values. He points out that values are acquired in
an absolute manner, i.e., an end-state or mode of conduct is either
preferable or it is not. Any instability or possibility for a
change lies in the integration and various hierarchical structures
of values that are possible in the value system as a whole. The
absoluteness of the belief is further implied in Rokeach's use of
the phrase "preferable to an opposite or converse mode . . ." which
considers each value label in contrast to its antonym or negation
of the belief. To this extent, Rokeach assumes that all men possess
the same values (to different degrees) and, furthermore, implies
that values cannot be abandoned once subscribed to. In an earlier

definition, Rokeach (1968) used the phrase "preferable to alternative

 

 

24

modes . . . or end-states . . ." which was less specific and defined
a value in relationship to other values rather than as a single
entity.

The term "belief" clearly denotes a cognition. Rokeach speci-
fies a value as further belonging to the class of beliefs labeled
prescriptive or proscriptive. These beliefs are differentiated from
(1) descriptive or existential beliefs (factual, true or false) and
(2) evaantive beliefs wherein some object is judged good or bad.
Evaluative beliefs are assessed values (or value judgements) as
defined by Baier (1973).

Rokeach uses the term ”preferable” in contrast to "desirable”
which is frequently favored by others. His rationale is that the
term "desirable" is difficult to define and confused with desire,
when upon analysis a value is really a preference for some mode or
end-state over its opposite. However, not all preferences are
values. Only those preferences exhibited when modes of conduct or
end-states are paired with their opposites are values. In dis—
tinguishing between "specific modes of conduct and end-states of
existence," Rokeach maintains the dual classification of values as

primarily either instrumental or terminal. As a secondary classifi-

 

cation, Rokeach uses the phrase "personally or socially preferable.”
It is not immediately clear from this definition whether the
personal-social distinction refers to the domain of applicability
(object) of the value or the beneficiary of the value. Rokeach's
discussion ofiim issue (1973, pp. 7-11) suggests that the beneficiary

of the value may be implied in the distinction. In fact, the value

 

25

systems an individual would impose on himself (one domain) and on
others (other domains) might be substantially different, particularly
when values with a personal focus are involved, i.e., those less

implicated in social organization and morality.

The Concept of Value Systems

 

Rokeach's conception of a value as a singular entity is one in

 

which values are absolute and objective. They are relatively
limited in number and possessed by all individuals. There can be
no consideration of individual differences in terms of saying that
one individual has a particular value while another does not.

It is possible to conceptualize individual differences in the
degree of differentiation and salience of a single value and to
attempt to measure such differences. It is also possible to con-
sider individual differences in the hierarchical organization of
values in relationship to other values within the individual's
system of values. Here, measurement of individual differences
associated with a single value yield a measure of relative importance
always obtained in the context of an individual's other values.

Rokeach defines a value system as "an enduring organization of

 

beliefs concerning preferable modes of conduct or end-states of
existence along a continuum of relative importance" (1973, p. 5).
In his definition of a yglge, the term "enduring" may have been
unnecessary since the definition and underlying assumptions specify

that a value is a fixed belief. In the definition of value system,

 

the term "enduring" is more clearly a relative one, indicating a

 

26

degree of stability in the organization of a system of fixed beliefs
yet allowing for change in that organization.

This definition of value system further specifies two primary

 

types of values, instrumental and terminal. The definition implies
separate systems or continua corresponding to the two sets of values.
Although separate, the two systems are functionally related with
instrumental values theoretically playing a subordinate role to

terminal'values.

Terminal Value System

 

Rokeach estimates the number of personally or socially prefer-
able end-states to be about a dozen and a half. Since his Vglgg
Sgpyey involves the rank ordering of 18 terminal values on one con-
tinuum and 18 instrumental values on a second continuum, he implies
that this set of identified terminal values nearly exhausts the
population of terminal values. The organization of an individual's
terminal value system is viewed as more stable than the instrumental
value system. Terminal values are more fundamental, as well as
abstract, in the sense of being limited to the most basic intra-
personal and interpersonal needs of individuals. The factors affect-
ing the organization of terminal values may also be limited. There
may be a limited number of fundamental value orientations (Kluckhohn
& Strodtbeck, 1961) or core beliefs of an existential or philosophi-
cal nature about man's relationship to himself, nature, or society
that influence the organization of terminal values. In addition,

varying levels of cognitive development, maturity, personal

 

27

integration, and other similar factors may limit the number of

organizational patterns likely to be found.

Instrumental Value System

 

Rokeach estimates the number of instrumental values to be as

high as five to six dozen. Since the second part of his Value Survey

 

involves the rank ordering of 18 instrumental values, only a sample
(about 20 to 35 percent) of the population of instrumental values is
represented in his instrument. Instrumental values are less stable
in organization than terminal values. The range of preferable modes
of conduct is wider than the range of end-states and allows for
greater variability in the paths and priorities used to achieve
those ends. The factors facilitating and inhibiting modes of con-
duct are likely to be of greater number and involve the availability
of specific cultural and personal resources in realizing instru-
mental values.

Rokeach distinguishes between two primary types of instrumental

values, competence values and moral values. Competence values are

 

more personal in focus and reflect an individual's standards of
adequacy and self-actualization. When important competence values
are violated or unrealized, feelings of shame over inadequacy may be
aroused. Moral values are interpersonal in focus and reflect modes
of conduct directly affecting others. Moral values, when violated,
arouse feelings of guilt over doing wrong. Moral values are asso-
ciated with the most intense experience of "oughtness." This experi-

ence is seen as originating within widely shared social demands that

 

28

people place on one another and themselves in order to ensure sur-

vival and other benefits within a social environment. A social norm

 

is easily confused with a moral value because both refer to pre-
scriptive or proscriptive beliefs about required modes of behavior.
However, social norms refer to specific rules of behavior governing
specific situations. Norms may or may not facilitate the realization
of transcending moral values.

Problems Related to the Terminal-
Instrumental Distinction

 

 

The distinction between terminal and instrumental values is
fairly clear in differentiating between two separate systems that are
functionally related. However, the distinction can also be applied
within the systems themselves. As such, the organization of the
terminal value system may have a terminal value functioning as an
instrumental value to another terminal value. Conversely, one
instrumental value may be instrumental in the attainment of another.

Generally, the continuum of instrumental values is considered
to be of lower Ultimate importance than the continuum of terminal
values. However, when the conception of instrumentality enters in
the organization of values on the same continuum, it is not clear
how this functional relationship may effect the relative importance
an individual places on the values. This problem raises questions
about "response set" in ranking values. That is, one individual may
interpret importance in terms of the ultimate value where another
may View importance in terms of temporally more urgent or prerequi-

site value. The idea of urgency is similar to notions of value

 

29

arising out of deficiency or demand with limited supply. Expectations
of attainability of the more ultimate values may enter into one's
interpretation of importance. A strong social or moral orientation
may weight related values more heavily on a scale of importance.
Indeed, "response set" and "functional interrelationships" in value
system organization may be nearly equivalent processes.

Value Systems as Two Subsystems Within the
Organization of the Cognitive System

 

 

Considering the structural aspects of the total belief system,
Rokeach (1973) proposed an organized system composed of 10 inter-
connected subsystems. These subparts differ in the type of cognition
included and in the relative centrality of the cognitions in both the
cognitive and personality systems. The most central or core sub-
system is comprised of cognitions about the self_and represents the
most stable and dynamically important beliefs in cognition and per-
sonality organization. Decreasing on the centrality dimension, self-
conceptions are followed by the terminal and instrumental yglge

systems.

A fourth type of cognitive subsystem is an attitudinal system

 

or the organization of two or more attitudes into an ideological
system. A single attitude is another type of subsystem as it repre-
sents a number of organized beliefs focused on a specific object or
situation. Attitudes and attitudinal systems are cognitively less
central and stem from self-conceptions and values in some respects.
Other cognitive subsystems include cognitions about one's gwg_

behavior, cognitions about significant others' attitudes, values,

 

 

30

or behavior; and cognitions about the behavior of nonsocial objects.
These components of the belief system also occupy a less central

position than values and self-conceptions.

The Function of Values and Value Systems

 

The functional aspect of the cognitive system includes many
interrelated processes such as attending, perceiving, remembering,
reasoning, evaluating, problem-solving, learning, and conceptualiz-
ing. These processes interacting with existing cognitive content and
environmental stimuli yield new cognitive products enabling the
organism to adapt, survive, and modify the cognitive system itself.
Human beings with their advanced conceptual and unique linguistic
abilities can enhance their existence by communicating their concep-
tions with others and formulating conceptions about themselves.
While some degree of conceptualization may serve basic survival
needs in many species, only in humans can needs achieve systematic
representation in cognition as values. These values are employed
as cognitive elements in a variety of ways to ultimately satisfy the

underlying needs (Rokeach, 1973).

Long-Range Function of Values

 

Rokeach indicates that all beliefs, including values, ultimately
serve the single purpose of maintaining and enhancing self-conception.
He uses the term self-conception in the same sense that McDougall
(1926) refers to self—regard as the master sentiment, i.e., a collec-
tion of beliefs about the self-as-an-object with affective connota-

tions of favorability or unfavorability. To this extent, self-regard

 

 

31

may be viewed cognitively as an attitude or attitudinal system in
which the self-as-object is conceptualized and evaluated by the
self-as-subject who in turn experiences the affective connotations
of these cognitions.

Rokeach indicates that the long-range function of values are to
give expression to human needs with maintenance and enhancement of
self-regard being paramount, yet reflecting a rubric under which
more specific needs may be subsumed. Values are viewed as cognitive
transformations and representations of societal needs as well as
individual needs. As expression of needs, Rokeach designates three
main functions of values: (1) adjustment, (2) ego-defensive, and
(3) self-actualization or knowledge. These three functions have been
designated by others (Smith, Bruner, & White, 1956) as functions of
attitudes. By positing values as more central, Rokeach Views these
functions as more directly related to values. The adjustment func-
tion of values is reflected by any value whose content and realiza-
tion ensures safety and security in the physical or social environ-
ment. The second, ego-defensive function of values is evident when
personally or socially unacceptable needs, feelings, or actions are
cognitively transformed by defense mechanisms such as rationalization
and reaction formation into justified motives and actions supported
by accepted values. Helpfulness as an important value for psycho—
therapists provides an acceptable concept for satisfying voyeuristic
desires. The preservation of ethnic purity may permit blatant
activities of discrimination and segregation. The most insensitive

confrontations between people may masquerade as honesty while

 

32

concealing hostile or sadistic impulses. Finally, the self-
actualization function of values is reflected in value content
aimed at wisdom, personal growth integration, competency, greater
knowledge and awareness, and meaningful existence.

Rokeach indicates that an individual's value system may be
organized to emphasize one set of functions more than others. The
specific organization may reflect a level of development in a person.
His level of maturity may be gauged by assessing which functional
orientation is dominant among high-ranking values. Some values may
be low—ranking by either having diminished in functional relevance
(needs which are satisfied) or not yet having acquired importance
(needs discovered after more basic ones are satisfied). This con-
ception of the functions of values parallels Maslow's hierarchical
theory of motivation and needs (Maslow, 1954). Maslow's conceptions
of higher-order B(being)-values and lower-order D(deficiency)-va1ues
deal with terminal values for the most part. Terminal values reflect
the underlying needs as ends in a fairly straight-forward way and are
more likely to indicate an individual's developmental level. Instru-
mental values may take on new organizational and functional patterns
as an individual's maturity level and terminal value system change.

The conception of long-range functions of values embraces most
dynamic theories of motivation and personality. The adjustment and
self-actualization functions clearly have ties with both humanistic
self-theory and cognitive developmental traditions. Kohlberg's
(1964) theory of moral development describes increasingly mature

(more objective and less subjective) levels of moral reasoning which

   

33

at the highest levels reflect fewer adjustment concerns and more
patterns of thought and values characterizing self-actualized indi—
viduals. The ego-defensive functions stem from psychoanalytic theory
and, particularly, the use of values in secondary processes involved
in defending the ego against anxiety.

Psychoanalytic theory has not dealt systematically with values
other than to locate them structurally within the superego and its
subdivisions: conscience and ego-ideal. The conscience reflects an
incorporated system of proscriptive beliefs concerning actions
related to punishment from parents which now produce guilt if com-
mitted, while the ego-ideal represents a system of prescriptive
beliefs about actions (or modes of behavior) previously rewarded by
parents which now internally give rise to feelings of pride or shame
(Hall and Lindzey, 1970). However, as psychoanalytic ego psychology
has evolved with a more autonomous conception of ego during the past
century, the ego-ideal as a construct has been distinguished from
the super-ego and has increasingly been attributed to ego functioning
involved in reality testing with flexibility in setting goals for the
self (Erikson, 1959). Parallels may be found in Erikson's (1959)
eight stages of ego development and other developmental theories in
terms of a progression of tasks (needs to be met) leading to one's
identity and increasingly mature psychosocial functioning in terms
of competence and salient values. It may be hypothesized that
failure to resolve any one of the developmental crises may lead to
a particular form of psychopathology and a characteristic value

system organization reflecting the salient needs for that stage of

 

 

34

development as well as any particular values necessary for ego-
defensive purposes. Thus, in psychoanalytic language, we may con-
ceive of values as not only employed in cognitive defense mechanisms
such as rationalization, but also reflecting a given level of ego
development and any underlying ego deficits. We may speculate that
the construct of value as a cognitive derivative of need may be a
unifying construct which ultimately will lead to more parallels among
diverse personality theories formulated more directly in terms of

motivation or need.

Short-Range Function of Values

 

Rokeach views the short-range function of values as standards
to guide ongoing activities and value systems as general plans to
resolve conflicts in decision making when values (needs) are in com-
petition with one another. This short-range View of value functions
is highly cognitive in presenting values as conceptual tools or
criteria that are employed for evaluation purposes in a variety of
Circumstances. People, objects, issues, activities are simply
evaluated or compared in the light of the existing criteria. The
resulting cognitive product may be a judgement, an attitude, or a

conclusion that some action is preferable to another.

Self-Conception

 

The construct self has acquired fairly extensive use in many
personality theories over the last four decades without achieving
any consensus about its definition. It has broadly been considered

to be linguistically synonymous with person (Ossorio & Davis, 1968)

 

35

used in the special instance when an individual as a subject (who is
called "1") identifies that same individual as an object (called
“me”). Self has been more narrowly and systematically defined as a
differentiated part of the phenomenal field within an individual's
personality (Rogers, 1951). Self has been both equated with and
differentiated from the construct_egg. When differentiated, the ego
is regarded as a non-phenomenonal personality construct which
includes the cognitive and perceptual processes among its many func-
tions and ”knows" the phenomenal self as well as other objects within
the phenomenal field (Smith, 1950). Greatest confusion arises in
differentiating between the ego and the construct of a non-phenomenal
self, inferred self, or unconscious self (Sherif, 1968). The notion

of unconscious conceptions, evaluations, and concomitant affective

 

responses existing within an individual toward himself presents many
theoretical problems in the development of self-concept theory
(Wylie, 1968). While Rogers uses the term §e1j_as a noun to desig-
nate a construct that is both a structure as well as a process, Wells
and Marwell (1976) recommend using the term only as a modifier to
signify all reflexive events in which the agent and object of

activity are the same person.

Self-Conception as a Structure

 

The term self-concept (or self-conception as a product of self-

 

conceptualization) in its broadest sense refers to a cognitive system
or structure. This term, like the term self, is subject to contro-

versy, but more manageable by assuming a reasonably adequate shared

 

 

 

36

meaning of the term self. Wylie (1968) uses the term ”generic self-
concept" to cover the spectrum of self-concept definitions. She
suggests a molecular approach in dealing with the construct and
recommends maintaining subdivisions of the generic term. A basic
distinction is maintained between actual and ideal self—concepts.
She further divides the actual self-concept into (1) social self-
concepts and (2) private self-concepts. The ideal self-concept is
also separated into (1) one's own ideal self-concepts and (2) con-
cepts of other's ideals for one. These four subdivisions are further
viewed as multidimensional. The social self-concept includes the
multiple roles that individual assumes in.relationship to others and
his characteristic conceptions of his performance in these roles and
the social effects of his behavior. These conceptions about an
individual may be formulated by others as well as himself. The term
insightfulness is used to reflect the degree of congruence between
an individual's social self-concept and thoseconceptions formulated
by others about the person. The actual private self-concept may
include many dimensions of self-conceptualization operating within
an individual that are not readily accessible to external observers

of his social behavior.

Self-Conception as a Process

 

Self-conception as a cognitive process is also a broad term
which has been typically used to refer to two distinct processes,
self-evaluation and self-affection, according to Wells and Marwell

(1976). They identify three aspects in self-conception:

 

37

(l) cognitive, (2) affective, and (3) behavioral. The cognitive
aspect includes the "psychological content" of the self-attitude.
The affective aspect refers to the "valuation" placed on the content.
The behavioral aspect refers to the behavioral responses elicited by

or toward the self-object.

Self-Evaluation. Wells and Marwell's reference to the "psycho-

 

logical content" of the self-attitude includes that collection of
beliefs about actual self-characteristics as well as beliefs about
desirable self-characteristics. This necessarily implies two pre-
requisite processes to self-evaluation: (1) conceptualization of
the actual self and (2) conceptualization of values implicated in
ideal-self characteristics. These two processes yield the products
or structural content comprising the generic self-concept described
by Wylie (1968). As such, it would include all descriptors an indi-
vidual would use in response to the question "Who am I?" It is clear
that this question can potentially elicit factual content, social
roles, specification of values, aspirations, attitudes, preferences,
existing self-evaluative cognitive products, or any other cognition
that a person uses in differentiating self from other social and
non-social objects. Thus, self-conception does not start with self-
evaluation, but with perception and conceptualization of relatively
enduring characteristics of the self and the acquisition of some
value criteria.

In a sense, self-evaluation is a higher-order cognitive process

which uses products making up the actual self-concept and values to

 

38

maintain and generate new cognitive products (self-judgements) and
their concomitant affective products. Many self-judgements exist as
stable aspects of the actual self-concept and cannot, in principle,
exist independently from their affective concomitants. However,
defense mechanisms such as dissociation may enable functional
separations between cognition and affect within the total personality
system. Other defenses may modify the cognitive-affective relation-

ship as well.

Self—Affection. The affective component of self-conception is

 

typically referred to by the term self-esteem. Most definitions of

 

self-esteem View it as a relatively enduring and global experiential
characteristic of individuals arising from a multitude of specific
self-judgements (Coopersmith, 1967). Self-esteem has been defined
and measured in various ways depending on various assumptions about
the structure of the self-concept and which processes are relevant.
Examination of various conceptions of self-esteem reveals that no
simple one-to-one correspondence between self-evaluation and self-
esteem can be formulated.

The simplest view of self-esteem is one in which it reflects a
measure of overall approval or disapproval toward the self as the
referent object considered as a whole (Rosenberg, 1965). This con-
ception does not consider specific dimensions of self-conception and
views levels of self-esteem as lying along a single continuum of

self-regard with positive and negative poles.

 

39

Self-esteem has been equated with the actual self-concept or
the collection of adjectives used by a person to describe himself.
The positive and negative descriptors in proportion to the total set
of descriptors provides a measure of the affective favorability or
unfavorability of a person toward himself (Gough & Heilbrun, 1965).
This conception of self-esteem may be extended to include some pre-
conceived weighting of the characteristics involved, i.e., some
values aSsociated with the descriptors such that by summing them
some will contribute or detract more than others to the global level
of self-esteem. This View of self-esteem assumes a shared value
system that is held by both the observer and the subject describing
himself.

A refinement of this View of self-esteem which takes individual
differences into account is to define self-esteem as a discrepancy
between actual self-concept and ideal self-concept (Block, 1961).
Measurement of the ideal self-concept would reflect the individual's
value system rather than the observer's. This View assumes that the
actual self-concept, however favorable or unfavorable by an
observer's standards, only generates an affective response as a
function of the ideal self-concept and underlying values of the

individual. The term self-satisfaction has been employed for self-

 

esteem inferred from measures of self and ideal-self discrepancy
(Bills, 1951). It is further assumed that greater congruence between
real and ideal self-concepts is associated with better psychological

adjustment.

 

40

Self-esteem has also been defined in more phenomenal terms in
the sense of more directly measuring the feeling arising from self-

evaluation (Bills, 1954). The term self-acceptance has been used in

 

preference to self-esteem. .Self-acceptance flmflies that two indi—
viduals may have identical actual self-concepts and share the same
ideal self-concepts (and value systems), yet react differently to the
discrepancies that exist or occur. This conception implies psycho-
logical differences among individuals which may either attenuate or
intensify feelings of satisfaction and dissatisfaction. Different
affective reactions to the same self-evaluation process would have
to be attributed to tempermental differences or non-phenomenal
processes such as defense mechanisms that are separate from the
generic self-concept yet modify its dynamic characteristics.
Self-acceptance may be used in another sense to indicate a
characteristic of the self-evaluation process in which an individual
may be very aware of discrepancies between real and ideal self-
concepts, yet hold other cognitions that modify his affective
response. He may View his ideal self-concept as an ideal never-to-
be-achieved and have an "aspired" self-concept (Sherwood, 1962)
which reflects his realistic strivings and sources of dissatisfaction.
In a sense, he is tolerant of and.comfortable with many discrepancies
between real and ideal self-conceptions. Similarly, he may be less
disturbed by discrepancies between social and personal components
within either the actual or ideal self-concepts. Values such as

inner harmony, self-respect and freedom may reflect goals of an

 

individual to manage and dissipate the negative affect aroused by

 

4T

discrepancies within and between intrapersonal and interpersonal
areas of self-conception. This may be accomplished by increasing
one's acceptance of these incongruities or decreasing one's need to
comply with the standards of others. In this context, self-acceptance
may be regarded as a transformation of basic affective responses to
behavior-value conflicts provided the cognitive elements such as
self-actualization values are operative. Thus, self-acceptance
would be a function of higher-order values modifying the affective
response to violations of other values. Self-acceptance would be a
function of a particular type of ideal self-concept, in this case,
rather than originating from temperamental or non-phenomenal person-
ality processes.

It is clear that the organization of the value system is the
foundation for the ideal self-concept as well as for conceptions of
ideal-others that an individual may formulate. The question can be
raised whether or not the construct of an ideal self—concept is a
useful concept in cognitively oriented studies of self—evaluation,
since it involves an indirect application of values to self-
conceptions. It is more parsimonious to view both the ideal self-
concept and self-evaluations (judgements) as cognitive products which
primarily arise from values as standards. A clear description of an
individual's value system may ultimately be used to identify the
salient characteristics or dimensions of the self-concept most likely
to generate greatest satisfaction or dissatisfaction as well as
identifying higher-order cognitions that modify the affective

responses accompanying self-evaluation.

 

 

42

Behavior Mediated bnyelf-Conception. The behavioral aspect of

 

self-conception denotes the behavioral response or predisposition to
the self-as-object in the same manner that behavior is mediated by

an attitude formulated toward any other object. Therefore, a person's
level of self-esteem is regarded as a significant entering character-
istic which must be accounted for in predicting behavior in those
situations where the self is a salient object. Some conceptions of
self—esteem involve predictions about other behaviors mediated by
self-esteem. These formulations consider an individual's tolerance

of stress (Ziller, 1969), confidence and level of aspiration in

given situations (Diggory, 1966), and tolerance and regard toward

others (Berger, 1952) as indicators of self-esteem.

Dynamic Properties of Self-Esteem. Self-esteem has the status

 

of an independent variable with dynamic properties operating within
cognition and personality as well as behavior. Rosenberg (1968) has
suggested that psychological selectivity enters into situations where
ambiguity and the range of options are greatest and especially in
self-evaluation. He suggests that values may be selected by the
person which maintain and enhance his self-esteem. An ideal self-
concept may be formulated which is fairly consistent with the actual
self-concept. Thus, a reciprocal relationship may be posited between
self-concepts and values with self-esteem at the center operating as
both a dependent variable (product of self-evaluation) and an inde-
pendent variable influencing cognitive selection processes. As a

dependent variable, an individual experiences self-esteem as a sense

 

43

of worth based on his evaluation of his competence in performing in
valued areas (e.g., when his demand on himself exceeds his expecta-
tion that he can meet that demand, it results in devaluation of him-
self as an instrumental object). The joint factors of value and
expectancy (self-conception), in this instance, generate self-esteem
(worth) and mediate behavior reflecting a level of aspiration con-
sistent with the self—evaluation.

However, as an independent variable, self-worth may be high in
the face of low aspiration and limited successes in behavior by
altering the criteria of aspiration and worth (values). Also, high
self-esteem and high aspiration may occur in the face of consistent
behavioral failure, if the expectancy (conception of what one can do)
can be maintained consistently high as well. This would require
cognitive selection by ignoring, denying, repressing, or distorting
actual self-conceptions rather than lowering standards. When self-
esteem is maintained through cognitive selection processes effecting
either values or self-conceptions, an individual is likely to psycho-
logically be more defensive.

In 1890, William James presented the equation: self-esteem =
success/pretension (SE = S/P). When self-esteem is viewed as a
dependent variable, the numerator and denominator on the right hand
side "objectively" generate a given level of self-regard, i.e., self-
esteem equals the ratio of accurate self-conceptions to existing
self-values. When self-esteem is viewed as an independent variable

with dynamic properties, it may affect (1) specific mediated success

 

44

in behavior, (2) perceived success and failure, or (3) the magnitude
and organization of self-values.

Wells and Marwell (1976) describe three prevailing models of
self-esteem. (l) The "high self-esteem model" simply predicts
better adjustment associated with higher levels of self-esteem
(SE = S). Self-values would be a fixed variable and, perhaps, one
which defines individual success. (2) The "low self-esteem model”
posits two basic personality types using different defense mechanisms
in dealing with negative information about themselves. The person-
ality types correspond to Byrne's (1961) "repressors" and "sensi-
tizors." Repressors have high self-esteem by distorting self-
conceptions (SE = S + defense mechanisms), while sensitizors demon-
strate low self-esteem and remain open to negative information
(SE = S). The sensitizors, who typically experience more guilt and
shame, may actually be more involved in value system struggles and
the defensive use of values in rationalizing and intellectualizing.
This group's only recourse for enhancing self-esteem is through
increased successes or value system change allowing for comfortable
integration of negative self-conceptions. (3) The "medium self-
esteem model" predicts that maximum adjustment is found in indi-
viduals with moderate levels of self-esteem, while at the extremes
of measured self-esteem psychopathology is likely to be found.
Worchel and McCormick (1963) found that moderate levels of self-
esteem are associated with more tolerance of dissonance and better
problem-solving skills, while extremely high levels may be associated

with narcissism, and extremely low self-esteem with self-rejection.

 

45

Wylie (1974) also reports consistent associations between neuroticism
and low self-esteem.

It may be postulated that as individuals move to the extreme
ends of the self-esteem scale, self-esteem becomes less of a product
and more of a determiner of the self-evaluation processes. At low
self-esteem levels, reality testing may remain intact while mal-
adjustment reflects adaptations to rigid or demanding values and
sensitivities to negative information concerning the self which
yield considerable subjective distress. At extremely high levels,
greater psychopathology, primitive defense mechanisms, impaired
reality testing, and poor social adjustment are likely to be found
in the face of relatively little subjective distress. The role of
values as criteria used in governing behavior and evaluating oneself
may be minimal in extremely disturbed individuals. Values may func-
tion more as archaic introjected beliefs, regressed guidelines for

behavior, or indicators of deficiencies in need satisfaction.

Cognitive Chapge

 

Rokeach (1973) proposes that psychologically significant cogni-
tive Change occurs when an individual becomes aware of contradictions
within his belief system. However, in contrast to many inconsistency
theories, Rokeach does not hold to a simple conception of any two
cognitive elements being in inconsistent relationship to one another.
He proposes that in every instance of psychologically important
cognitive change, the cognitive elements consist of (l) a cognition

about oneself and (2) a cognition (or cognitions) about one's total

 

46

performance in a given situation. In one sense, the two cognitive
elements really involve two types of self-cognitions: (l) a pre-
existing, fairly stable conception about oneself and (2) a current,
more transient and situationally evoked perception of oneself via
one's behavior. Jointly, these cognitions in a given situation have
the potential to arouse a state of satisfaction or dissatisfaction.
When a state of self-dissatisfaction is aroused, cognitive change

may occur and is always directed by one overriding goal: to maintain
and, if possible, enhance self-conceptions.

One's total performance in a given situation may include any
number of relevant cognitions (e.g., cognitions about one's behavior,
a particular attitude, a certain value) involving the TO cognitive
subsystems. These cognitions may or may not be in a consistent rela-
tionship with one another. The course of cognitive Change is such
that any or all of those cognitions which are inconsistent with self-
conceptions will undergo Change. In the process, the cognitions
related to one's performance may be brought into a logically con-
sistent relationship or may become more inconsistent with one another.
A simple example might be depicted as a triad of cognitions involving
a self-conception A, a value B, and an attitude 9 elicited in a
situation. If A, B, and C are all consistent no change would be
expected. If A is consistent with B and C, while B and C are incon-
sistent, no self-dissatisfaction and "psychologically important"
change would be expected. If A is inconsistent with C, but not B,

C will Change in a direction consistent with A regardless of the

degree of consistency between B and C initially or after C changes.

 

47

If B and C are both inconsistent with A, both will change in a direc-
tion consistent with A. At first glance it may seem absurd that a
person may sacrifice internal consistency among beliefs to accommodate
self-conceptions. However, most counselors can attest to the fre—
quency with which their clients express contradictory beliefs,
irrational conclusions, and Clear-cut delusions.

Rokeach views self-dissatisfaction (an affective experience) as
the determinant of change. He distinguishes between self-
dissatisfaction as a situationally determined phenomenon and self-
esteem as a fairly stable characteristic of an individual. Rokeach
also distinguishes between general and specific sources of self-
dissatisfaction. These sources reflect the degree of discrimina-
tions a person is able to make about specific aspects of performance
contradicting self-conceptions and contributing to the state of
self-dissatisfaction. He also refers to a diffuse state of self-
dissatisfaction without defining it. The implication is that self-
dissatisfaction may be aroused by unspecified sources in a situation
and persist without identification and resolution in the underlying
cognitive contradictions. He appears to suggest that this type of
affective state is independent of self-esteem, but a mutual contribu-
tor to an individual's affective state.

Rokeach notes that not all self-dissatisfaction leads to cogni—
tive change and that defense mechanisms may be employed at various
points to avoid the arousal of self-dissatisfaction, suppress the
affect or cognitive contradiction in some way, or even resolve the

contradiction by employing additional cognitions that negate or

 

48

rationalize away contradictions. At present, existing theory is a
long way from integrating ego-defensive cognitive processes with the
theories of cognitive consistency and self-evaluation.
Self-dissatisfaction is most likely to occur when the cognition
of one's performance in a given situation contradicts a stable self-
conception or characteristic ascribed to oneself and valued by that
individual. In most situations, instrumental values are likely to
be most directly related to induced states of dissatisfaction because
they represent the standards used to assess one's competence and
morality (worth as an instrumental object). Terminal values may
ultimately be implicated in instances of self-dissatisfaction because
of their functional relationship to instrumental values, even though
terminal values are less likely to be directly implicated in the day-
to-day situations in which an individual is continuously evaluating
his performance.
Distinguishing Between Processes of

Cognitive Consistency and Enhance-
ment of Self-Esteem

 

 

 

Rokeach's model of inconsistency is not fundamentally different
from Festinger's (1964) most current fimmmflation of dissonance theory.
Festinger viewed the degree of total experienced dissonance as a

function of the importance placed on cognitive elements involved and

 

the proportion of relevant dissonant relations. Since cognitive
elements related to the self are expected to carry greatest impor-
tance or weight, experiences of greatest cognitive dissonance are

likely to involve self-percepts. In a sense, the self i§_the highest

 

49

value, weighting all self-cognitions more importantly than other
cognitions. The empirical studies of cognitive dissonance have been
restricted to cognitive relationships involving a self-percept as

one cognitive element and have consequently restricted the theory

to this domain as well (Smith, 1968). Further extension of the
theory would necessarily require value system concepts as a source
for weighting cognitions not pertaining to self, yet involved in dis-
sonant relationships. M. Brewster Smith (1969) has stated that two
basic processes need to be distinguished: (l) the trend toward
cognitive consistency and (2) the trend to maintain and enhance self-
esteem. These processes are independent, although the second is
likely to take precedence over and alter the former when self-
cognitions are involved (Rosenberg, 1968). That is, self-evaluation
and self-esteem processes are dynamically stronger than strivings
toward cognitive consistency. It may be possible to extend this
further and postulate that all evaluation processes are stronger

than basic consistency strivings with evaluation of self-as-object
being strongest.

The most parsimonious conception would equate affective
experiences of consonance with satisfaction and dissonance with
dissatisfaction. Furthermore, these experiences would be concomi-
tants of all cognitive evaluative processes regardless of object and
relevant values involved. Inconsistencies elicited by evaluation of
non-self objects would generate lower magnitudes of dissonance than
those aroused by self-evaluation. Such a formulation would not

distinguish between the two processes of (1) cognitive consistency

 

50

and (2) maintenance of self-esteem, but rather posit one process
occurring with varying intensity as a function of values and objects
involved.

It may be argued that Rokeach's theory of values and cognitive
change is restricted only to that class of events that involve a
conception of the self-as-an-object and affective responses toward
the self. It excludes cognitive change and learning involving values
that mayoccur independent of self-conceptions from the realm of
psychological importance. As such, his theory suggests that dis-
satisfaction with non-self objects does not lead to cognitive
changes of any psychological importance.

A second weakness in Rokeach's formulations may be found in his
superficial treatment of the constructs of self-conception and self-
esteem. Since self-conception is central to his conception of
Change, its relationship to values needs further articulation.
Rokeach gives no indication of whether he subscribes to the tradi-
tional notion of an ideal self-concept as a structural part of the
self-concept and a component of self-esteem. Since beliefs such as
values and products of evaluation (attitudes) may also be viewed as
possessions of an individual, they also answer the question "Who am
I?" which Rokeach takes to mean self-conception. If self-conceptions
and values are to be viewed as separate categories or systems of
cognition, then Rokeach will ultimately need to narrow his definition
of self-conception and formulate the relationships between values,
self-conceptions, and self-esteem as independent constructs. Certain

values may be more salient contributors to self—esteem than others in

 

51

the sense of being standards with even greater stability and
resistance to change than self-conceptions. Such values would con-
sistently contribute to low self-esteem if the individual's self-
conception falls short. Conversely, some values may be intrinsically
less stable and easily subscribed to because they fit existing self-
conceptions and ultimately generate greater self—esteem.

In Viewing cognitive change, Rokeach has conceived of values as
cognitions that operate as dependent variables when in a conflictual
relationship with self-conceptions. The pre-existing interrelation-
ships of self-conceptions and values as independent variables con-
tributing to self-esteem is not developed. Nor is the dynamic role
of self-esteem as an entering characteristic and independent variable
affecting the change process considered.

Early Value Education Studies
Using the Rokeach Model

 

 

One of the earliest value education experiments by Rokeach was
conducted in 1968 using two subpopulations of Michigan State
University freshmen: those enrolled in James Madison College
(emphasizing social science interests) and those enrolled in Lyman
Briggs College (natural sciences). The basic experiment was essen-
tially two replications on these populations. A total of 366 sub-
jects were involved from 19 classroom units (8 control and 11 experi-
mental).

One week prior to experimental'Nmervention, all subjects were
pretested to measure three attitudes: equal rights for blacks, equal

rights for people generally, and America's presence in Vietnam. The

 

52

following week, immediately prior to the experimental intevention,
the subjects' values were pretested by having them rank order the 18
terminal values which included freedom and eguality. All subjects
were then asked to rank the 18 values as they thought the average
MSU student would.

The basic experimental intervention (which excluded subjects in
control classrooms) proceeded primarily as follows. (1) Subjects
were then shown ”Table 1" which depicted composite rankings for MSU
students on the 18 values. (2) The experimenter pointed out that the
typical student ranked freedom number 1, but ranked eguality number
11. (3) To arouse self-dissatisfaction, the experimenter suggested
that students in general are more interested in freedom for them-
selves than for others. (4) Subjects were asked to indicate their
level of sympathy and involvement with civil rights demonstrations.
(5) To arouse further self-dissatisfaction, subjects were then shown
"Table 2" which indicated that students fell into three groups:

(a) civil rights "participants" who ranked freedom 6 and equality 5,
(b) "sympathizers” who ranked freedom land eguality 11, and (c) "non-
sympathizers" who ranked freedom 2 and equality l7. (6) The experi-
menter interpreted "Table 2” as again indicating that people who are
against civil rights care only about their own freedom. (7) Subjects'
reactions to the treatment were then assessed by having them respond
to items measuring their agreement with the experimenter's interpre-
tation, their level of ego-involvement in the treatment, and general

level of satisfaction with their rankings.

 

53

All subjects were posttested at 3 weeks, 3-5 months, and 15-17
months on their values and attitudes toward equal rights and Vietnam.
In a very unobtrusive manner, all subjects were contacted by the
NAACP 3-5 months after intervention and invited to join the organiza-
tion. At 15-17 months they were again asked to join or renew their
membership.

Rokeach found significant increases in rankings of eguality for
experimental subjects across time on all three posttests of values
and no significant changes for control subjects. He found that
experimental subjects exhibited significant increased favorable
attitude toward equal rights for blacks at 3-5 months and 15-17
months in contrast to control subjects. He also found a signifi-
cantly higher incidence of positive responses to the NAACP solicita-
tions at 3-5 months and 15-17 months.

Rokeach concluded that his data support his conception of value
change generated by self-dissatisfaction and that such change is
enduring. Furthermore, the change in equal-rights attitude at 3-5
months reflects a repercussive character in cognitive change to less
central beliefs which, although delayed, ultimately brings them into
consistency with self-conceptions and relevant values. The
behavioral response to NAACP solicitation coinciding with attitude
Change presumably demonstrated mediating effects of value change to
attitude change and ultimately to behavior change.

The methodology of Rokeach's study and its underlying theoreti-
cal formulations have acquired paradigmatic status (Zenzen & Hammer,

1978) and have been the basis for numerous studies during the past

 

54

decade. Penner (1971) found similar results in a replication of
Rokeach's study and additionally found that white experimental sub-
jects exhibit more eye contact with black laboratory partners three
months after treatment than control subjects. In a replication by
Cochrane and Kelly (1971), similar findings were obtained at 5 to 8
weeks and found to be unrelated to any of 19 personality measures
obtained on the subjects. In another replication, Rokeach and
McLellan (1972) found that similar results were obtained even if
subjects were given only information about others and not about them-
selves. McLellan (1973) found that the experimenter's interpreta-
tions of Tables 1 and 2 in the basic treatment were essential factors
in producing change. Hollen (1972) investigated the value labeled

a world of beauty. He found that significant increases in rank

 

importance could be induced by giving subjects information that
young people and better-educated people place more importance on
this value than the general public. He further demonstrated that
increased rankings on that value led to more favorable ecological
attitudes toward highway beautification and placing bans on non-
returnable containers and cars in cities. In a study aimed at quit-
ting smoking (Conroy, Katkin, & Barnette, 1973), the researchers
gave experimental subjects information showing the "smokers" ranked

broadminded 3rd and self-disciplined 8th, while "quitters" ranked

 

 

self-disciplined lst and broadminded 8th. Experimental subjects

 

 

significantly increased their rankings of self-discipline over a 2

 

to 3 week period following treatment and were able to maintain a

very consistently low level of cigarette consumption over a 16 day

 

55

period. Control subjects exhibited an initial reduction in consump-

tion with steadily increasing consumption over the same period.

Value Education and the Present Stggy

 

Value education, in this study as in the earlier studies, is
broadly defined as a process of giving individuals information about
aspects of their own value-system organization and some implications
of a target value relevant to self-conceptions. This process is
presumed to have the potential to induce self-dissatisfaction and
subsequent cognitive changes in value system organization if the
individual becomes aware of any existing inconsistency between the
value and his self-conception. Indirect or repercussive effects of
value change are expected to occur throughout the cognitive system.

The present study of value change differs from earlier studies
in a number of important ways. First, it is conducted with a
psychiatric inpatient population. Second, it is aimed at identify-
ing and modifying values which are most likely to be implicated in
psychological functioning. Third, it considers the possibility that
some values may have an optimal level of importance in relationship
to other values. Fourth, it considers alternative indirect measures
of value change. These include methods of value measurement based
on multiple items reflecting specific attitudes related to the value.
Finally, it considers the repercussive effects of value change on

self-regard using multiple measures.

 

56

Summary of the Major Theoretical Assumptions
Underlying the Present Study

 

The major theoretical formulations discussed in this chapter
which provide the rationale for the present study are summarized in
the five paragraphs below.

1. While all values, as beliefs held by individuals, have a
functional relationship to self-conceptions, some values are more
likely than others to serve as mediators in maintaining or enhancing
an individual's level of self-regard and effective psychological
functioning. Some instrumental values are likely to have a highly
salient role in ongoing self-evaluations of competence and moral or
social worth. Certain terminal values are likely to have salient
effects on self-evaluation in more indirect ways; either as mediators
of instrumental values or as abstract representations of strivings
in which self-esteem as an end in itself may vary in importance from
one individual to another. Some terminal value systems may reflect
states of maturity in which individuals are less vulnerable (more
accepting) when assaults on self-esteem are experienced.

2. Identification of those values involved in impaired psycho-
logical functioning may be accomplished by the empirical study of the
course of value changes within psychiatric populations. Presumably,
psychotherapeutic treatment in many instances is explicitly aimed
at modifying and enhancing self-conceptions which in turn mediate
value change. Psychotherapy may involve many implicit efforts to

promote the importance of certain values as well.

 

57

3. The direct modification of significant values using value
education techniques is likely to be a useful adjunct to psycho-
therapy. Value education would enable patients to more clearly
articulate sources of psychological conflict at a cognitive level,
revise their belief system, and ultimately enhance their level of
self-regard.

4. The modification of values through value education may be
manifested in many ways. At the most general level, change in a I
value may result in a higher rank placement and salience of that
value within the value system hierarchy. However, certain values
may be psychologically important, yet be excessively salient in rela-
tionship to other values. In such cases, modificathxiof the value
may involve a redefinition or greater differentiation of the sub-
stantive meaning of value and a decrease to some optimal level of
placement within the value hierarchy. A value change may be further
manifested by mediating changes in attitudes related to specific
objects or situations having a functional relationship to the value.
Value change should be reflected by multiple-item and unobtrusive
measures of the value based on specific related attitudes as well
as by changes in rank ordering. (A value change may effect one
related attitUde more favorably than another. This would reflect a
change, not only in importance, but of meaning or domain in which
the value is deployed. To posit an unidirectional change in a value
and 311 related attitudes is highly simplistic and ultimately of

little use in value theory.)

 

58

5. While dissatisfaction generated by a perceived inconsistency
between a value and self—conception is viewed as the mechanism for
psychologically important value change, the reciprocal mechanisms
mediating enhanced self-regard as a function of value change have
not been formulated. It may be argued that delayed repercussive
effects of value change may be found in the attitudinal system of an
individual toward himself as an object, similar in kind, but more
salient than the change process in attitudes toward non-self objects.
Reorganization of important instrumental values at a psychologically
more mature level will lead to new modes of self-appraisal on a day-
to-day basis with an accumulative effect of more specific experiences
of self-satisfaction and fewer instances of dissatisfaction. In
addition, increased clarity and commitment to one's values leads to
greater awareness and a sense of mastery and control over one's life
on a day-to-day basis. Reorganization of important terminal values
at a psychologically more mature level will lead to a Clearer sense
of Ultimate purpose, integration, and identity within an individual.
This would free him from both internal and external demands to con-
form to rigid norms or expectations that may be both unnecessary
sources of self-dissatisfaction and at variance with his strivings
toward realization of greater potentials within himself. The ulti-
mate test of value education will rest on such outcomes and their
behavioral manifestation in more effective personal and social

functioning.

 

CHAPTER III

EMPIRICAL BACKGROUND PROVIDED
BY THE PILOT STUDY

Purppse of the Pilot Study

 

Any effort to design an effective value education procedure
according to Rokeach's model has at least two prerequisites. First,
it is necessary to identify a relevant target value on logical or
empirical grounds. Second, it is necessary to establish a data base
which maps some important relationship(s) between the target value
and other cognitive elements. The pilot study reported in this
chapter was needed to identify the target values and to provide the
empirical basis on which to construct the experimental value educa-
tion exercises (treatments) used in the later phase of this investi-
gation.

The purpose of the pilot study was to identify values that are
psychologically important for a group of adult psychiatric inpatients.
The sets of values considered were the 18 terminal values and the 18

instrumental values measured by the Value Survey (Rokeach, 1967).

 

Those values identified as psychologically important were further
studied in relationship to patients' other values, psychopathology,
behavior patterns, length of hospitalization, and clinical status

one year after hospitalization.

59

60

Primary Constructs and Assumptions
Underlying the Pilot Study

 

 

Psychologically Significant Values

 

Most values are likely to have some degree of general psycho-
logical significance as well as specific significance based on indi-
vidual differences among people. This study operationally defines a

psychologically significant value as one increasing in rank importance

 

across a group of individuals when temporally associated with the
clinical treatment and improved functioning of the group members.

It is assumed that the group initially undersubscribes to the partic-
ular value and that the value is differentially promoted in various
ways within the hospital milieu and treatment program.

This conception of a psychologically important value differs
from an equally viable one based on the concept of deficiency needs
(Maslow, 1954). To the extent that values reflect transformations
of needs, those underlying needs which are unmet or frustrated should
find expression in high ranking values. These values should decrease
in rank importance once those needs are securely met and the indi-
vidual is functioning at a level of greater psychological maturity.
It was assumed that value changes related to deficiency motivation
reflect developmental processes occurring over a relatively long
time span with less involvement in immediate and conscious cognitive
processes. As such, measurable changes in those values were not
expected during the course of short-term intensive inpatient treat-

ment.

61

Values that lend themselves to fairly rapid change are expected
to have characteristics of easy involvement in conscious cognition
processes and immediate relevance to the day-to-day performance of
individuals. Consistent with this expectation, terminal values with
an emphasis on more remote end states may have less relevance than
instrumental values which guide day-to-day behavior. It is expected
that personal terminal values (as desirable end states which an
individual holds primarily for himself) are likely to carry greater
importance in the individual's intrapsychic functioning than terminal
values with an interpersonal focus.

Instrumental values have been classified into two categories
designated as either competence values or moral values. Since an
individual's evaluation of his ongoing performance and sense of worth
will revolve around self-conceptions of his "goodness" (moral values)
and ”greatness" (competence values), instrumental values might
generally be expected to vary in terms of their relative preoccupa-
tion with morality or competence as manifest in feelings of guilt or
inadequacy. To the extent that moral values have characteristics of
"ought" with strong social sanctions, they are likely to be more
stable and resistive to change than competence values. Competence
values are likely to show greater individual differences about pre-
ferred modes of behavior. As standards of adequacy held by a particu-
lar individual, these competence values are likely to carry greatest
psychological significance for each individual.

The classification of a value as terminal or instrumental,

personal, social, moral or competence may have implications concerning

62

its psychological importance. However, the substantive character or
meaning of a specific value for an individual ultimately determines
its cognitive-psychological importance. A given value may vary in
semantic aspects, clarity, and implications within the belief systems
of different individuals. At the same time, it is assumed that any
given value has sufficient universality in meaning and psychological
significance that it can profitably be isolated and studied by group
methods and yet have clear implications for the cognitive and psycho-

logical functioning of individuals.

Target Values

 

The term target value is used to denote a psychologically

 

important value that has been selected as a target for Change via
value education. The criteria for selection of target values in the
pilot study reflect some of the assumptions about psychological sig-
nificance discussed above. Those criteria used in this study are
determined by a twofold objective: to isolate those values with
greatest psychological implications for the greatest number of indi-
viduals within the inpatient group.

The specific empirical and logical criteria for selection were
as follows:

1. A target value would demonstrate a consistent increase in
rankings across a majority of the inpatient group from time of
admission to discharge.

2. A target value would be sufficiently universal to exhibit

relevance for both male and female patients.

63

3. A target value may be either a terminal or instrumental
value, and classified as personal, social, moral, or competence.
However, the face validity of a specific value as reflected by its
content and implications would provide logical support for its
psychological relevance.

4. Two terminal values and two instrumental values would be
the numerical limit of values to be used in the second, experimental
phase of this investigation.

5. Each target value would further exhibit psychological
relevance through a network of empirical and convergent relationships
which reflect an association between the value's level of importance
and a patient's level of psychological functioning.

Mapping Relationships Between Target Values
and Other Patient Characteristics

 

 

In order to establish the psychological significance of a target
value, its relationship to clinically significant constructs also
needed to be demonstrated. These relationships further were required
to converge into a consistent logical network centered around the
target value and amplifying its significance. In addition to pro-
viding a base for interpreting the significance of a target value,
such empirically established relationships Ultimately provided the
subject matter for value education.

Each target value was examined from two perspectives. First,
the ranking of a target value upon admission to the hospital was
considered to be an entering characteristic of the patient. Second,

the ranking of a target value at discharge was considered to be an

64

outcome variable associated with the treatment process. As such
target values were examined in relationship to other entering
characteristics and outcome variables associated with the patient
population.

Each target value isolated in this study was examined in rela—
tionship to a number of variables within five areas designated as
follows:

1. }other terminal and instrumental values,

2. psychopathological characteristics of patients,

3. observed behavior patterns during hospitalization,

4. duration of hospitalization, and

5. the clinical status of patients one year after

hospitalization.

Organization of the Value Systems. Rokeach indicates that the

 

value system as a whole includes many functional relationships both
within and between the terminal and instrumental subsystems. The
distinction between terminal and instrumental is not clearcut. One
or more instrumental values may be instrumental in attaining another
instrumental value or a terminal value. A terminal value can be
instrumental in the attainment of other terminal values. The organi-
zation of the value system in relationship to a target value was
considered important in defining the significance of the target value

within the value system upon entering the hospital and upon leaving.

Values and Psychopathology. Any target value regarded as

 

psychologically important should demonstrate correlations between

65

its level of importance and personality measures reflecting continua
of healthy to disturbed functioning. If the value has sufficient
implications for psychopathology it should manifest a relationship

to clinical diagnoses as well.

Values and Behavior. Rokeach has emphasized the antecedent role

 

of values in mediating behavior. The psychological validity of a
target value should as a minimum be demonstrated by its consistent
association with observable behavior patterns. Ultimately, value
change should be accompanied by behavior change. The pilot study
examined patient behavior patterns in the hospital milieu and their

relationship to target values.

Values and Length of Hospitalization. The duration of

 

hospitalization for a given patient is often multidetermined.
Relevant factors may nuflude such things as the severity of distur-
bance, the capacity to function outside of the hospital, patient
motivation, response to treatment, financial resources, adequacy of
medical insurance, variations among therapists in treatment approach,
and even the availability of alternative placements or programs when
continued hospitalization is contraindicated. The pilot study
examined this variable to determine whether or not patients' values

are correlated with length of stay.

Values and Long-Term Implications on Patient Functioning. Value

 

theory emphasizes the relative stability of values over time.

Rokeach has demonstrated long-term behavioral change in response to

66

value change. The psychological and clinical relevance of values
and value changes should extend beyond the period of hospitalization.
The pilot study addressed this problem with several longitudinal
objectives. These objectives were to examine the long-range impli-
cations of values as entering and outcome variables in predicting
patient status one year after hospitalization. The patient's
involvement in treatment at that time, his progress after leaving
the hospital, and the predicted likelihood of hospitalization in

the future were examined.

Specific Objectives

 

The specific objectives of the pilot study are outlined below
under seven major headings as follows: (1) Identifying psychologi-
cally important values, (2) Isolating target values, (3) Relation—
ship of target values and other values, (4) Relationship of target
values and psychopathology, (5) Relationship of target values and
observed behavior, (6) Relationship of target values and length of
hospitalization, and (7) Relationship of target values and patient
status one-year post-hospitalization.

Identifying Psychologically
Important Values

 

 

Objective 1. The first objective was to identify terminal

 

values exhibiting a significant increase in rank order from time of
admission to discharge. It was predicted that significant increases
would be found among values with a personal rather than a social

emphasis. Among the personal values, those most relevant to

67

self-evaluation, self-satisfaction or self-conception were expected

to exhibit greatest psychological significance.

Objective 2. The second objective was to identify instrumental

 

 

yglges exhibited a significant increase in rank order from time of
admission to discharge. It was predicted that significant increases
would be found among those values with a focus on competence and
personal characteristics associated with the broad concept of self-

actualization.

Isolating Target Values

 

Objective 3. The third objective was to examine the values

 

identified by Objectives 1 and 2 and isolate those values exhibiting
relevance for both males and females. Increased rankings for at
least 50 percent of both groups was the designated criterion for

potential target values.

Objective 4. The fourth objective was to designate two terminal

 

and two instrumental values as target values. This designation was
based on selection of those values presumed to be most salient in
psychological functioning as suggested by face validity and any
greater magnitude or frequencycfi’rank increase for one value in
comparison to others.

Relationship of Target Values
and Other Values

 

 

Objective 5. The fifth objective was to identify all signifi-

 

cant intercorrelations between target values and other values within

68

the terminal value system both at the time of admission and

discharge.

Objective 6. The sixth objective was to identify all signifi-

 

cant intercorrelations between target values and other values within
the instrumental value system both at the time of admission and at
discharge.

RelationShip of Target Values
and Psychopathology

 

 

Objective 7. Significant correlations between the target values

 

and personality characteristics measured by the MMPI both at the time

of admission and discharge were to be identified.

Objective 8. A comparison of target value rankings for non-

 

psychotic and psychotic patients at the time of admission and dis-
charge was made to determine whether differential importance in
values is reflected in patient diagnosis.

Relationship of Target Values
and Observed Behavior

 

 

Objective 9. Significant relationships were to be identified

 

between target value rankings and staff observations of behavior
patterns on admission and discharge. The behavioral variables were
designated as motility (activity level), affect (mood), cooperation,
communication, and total adjustment. (Correlations were based on

only admission or only discharge data.)

69

Relationship of Target Values and
Length of Hospjtalization

 

 

Objective 10. Significant relationships between target value

 

rankings on admission and discharge and duration of hospitalization

were to be identified.

Relationship of Target Values to Patient
Status One-Year after Hospitalization

 

 

Objective 11. Those patients in aftercare and those not in

 

aftercare one year after hospitalization were to be compared to
identify differences in their target value rankings upon admission

and discharge.

Objective 12. Those patients rated by their therapists as

 

either ''improved" or "unimproved" one year following discharge were
to be compared on admission rankings of target values and on dis-

charge rankings.

Objective 13. One year after hospitalization, each therapist

 

was asked to indicate his expectation of the likelihood of each of
his patients requiring future psychiatric hospitalization. The
relationships between these predictions and target value rankings

upon admission and discharge were to be examined.

Procedures

 

Subjects
The subjects for the pilot study were 22 male and 36 female

patients admitted to a private psychiatric hospital in Grand Rapids,

Michigan over a seven week period. Their ages ranged from 18 to 69

70

with a mean of 36.1 years. The entire age range was well represented
through age 54 with only three subjects beyond the age of 55. Thirty-
one percent of the sample resided in the country where the hospital
was located. Another 31 percent came from neighboring counties;

22 percent came from other parts of Michigan; 16 percent of the

sample came from other states and Canada.

The sample reflected relatively high formal education with a
mean grade level of 12.5 years. Education ranged from subjects who
completed grade seven to those with graduate degrees. Nineteen
percent of the subjects did not complete high school; 51 percent
terminated their formal education upon graduation from high school;
17 percent had one to three years of education beyond high school
adn 14 percent held bachelor or graduate degrees.

Sixty-eight percent of the patients were married; 21 percent
were single; and 12 percent were widowed or divorced. Forty percent
of the sample listed their employment status as "housewife." Of the
remaining patients, 29 percent indicated that they had been holding
a specific job for two or more years; 19 percent were employed in a
job which they had held for one year or less. The remaining 12 per-
cent included students and unemployed persons.

The religious affiliations of the patients indicated that 83
percent of the sample were Protestant, 12 percent were Catholic, and
5 percent had no affiliation. Thirty-six percent of the patients
were affiliated with two specific Protestant denominations which
historically founded the hospital and contributed financially to

its operation and development.

71

The patient group represented a variety of diagnostic categories.
Thirty-six percent were diagnosed as exhibiting a neurosis, typically
the depressive type. Fifty-four percent were diagnosed as exhibiting
a psychosis, primarily including various types of manic-depressive
illness or schizophrenia and psychotic depressive reactions. Another
12 percent carried other diagnoses such as one of the personality
disorders. The average length of hospitalization for patients in the
sample was 5.5 weeks with a range from 1.5 weeks to 14 weeks.
Eighty-three percent of the sample were admitted for the first time
to this particular hospital and, for most, it represented their
first psychiatric hospitalization.

The number of patients in the pilot study was about 10 percent
of the patients admitted to the adult intensive treatment program in
any one-year period. The characteristics of this sample are fairly

typical of patients admitted in recent years.

Measures

Value Survey. The Value Survey developed by Rokeach (1967) was

 

selected because of its close relationship to the value theory formu-
lated by Rokeach. The Value Survey is the most comprehensive and
broadly applicable instrument currently available for measuring values
and value systems. It consists of two sets of values: a sample of

18 terminal values and a sample of 18 instrumental values (see
Appendix A). The values were selected on conceptual and empirical
grounds to provide the most representation possible by 18 distinct

values within each of the two value systems.

72

The Value Survey requires that respondents rank the 18 terminal
values from most to least important. Form D of the Value Survey was
used in this study as it facilitates the ranking task by providing
gummed labels on which the values are printed. These labels can be
easily moved from one position to another until the respondent has
vertically arranged all of the values from rectangular boxes numbered
l_on top down to l§_on the bottom. After ranking the terminal values,
the respondent is directed to do the same with the set of 18 instru-
mental values.

Extensive research has been done with the Value Survey by both
Rokeach (1973) and Feather (1975). These investigators provide con-
siderable data related to the validity of the survey as well as norms
associated with various groups differing in sex, age, ethnic back-
ground, religious and political persuasion, and other characteristics.
These investigators report median test-retest reliability coeffi-
cients on the terminal value eyetem_as high as .80 on Form 0 over a
time span of about one month down to .60 after two and one-half years.
The reliability coefficients for eipgle terminal values range from
about .40 to .88 with median values of .63 or higher in 5-week
test-retest studies. Reliability coefficients for the instrumental
value eyetem_range from .70 when tested after five weeks to .51
after two and one-half years. .Sipgle_instrumental values exhibit
test-retest coefficients ranging from .37 to .76 with a median of

.56 after five weeks.

73

Minnesota Multjphasic Personality Inventory. The MMPI was

 

selected because of its extensive research background and widespread
use as a major assessment and diagnostic tool in clinical settings.
The MMPI consists of 566 true-false items which were empirically
determined to differentiate various clinical groups from normal
individuals. The basic MMPI scales included four validity scales
and ten clinical scales. The validity scales are primarily used to
examine response set, although they frequently have clinical implica-
tions. Three validity scales and nine Clinical scales are included
in this pilot study and reflect various personality characteristics
in clinical terms. Among the validity scales, the L Scale measures
tendencies to cover-up minor faults. The F Scale measures deviation
from typical response direction on a number of items and reflects
such things as the severity of disturbance, exaggeration of diffi-
cultires, or lack of cooperation. The K Scale measures defensive-
ness in admitting to psychological difficulties when scores are
highly elevated, while reflecting characteristics of adaptiveness and
ego strength at moderate elevations.

The names of nine clinical scales included in this study indi-
cate some of the clinical groups used in development of the MMPI.
The clinical scales are designated hypochondriasis, depression,
hysteria, psychopathic deviate, paranoia, psychasthenia, schizophrenia,
hypomania, and social introversion. While these terms are diagnostic
(and in some cases archaic), the scales do measure fairly definable

personality characteristics.

74

MACC Behavioral Adjustment Scale. This scale was selected

 

because of its usefulness in providing an accurate assessment of
various aspects of behavioral adjustment in the hospital setting.
The scale consists of ratings in four behavioral adjustment areas

designated: Motility, Affect, Cooperation, and Communication. A

 

Total Adjustment score is also computed from the sum of the last
three areas. The scale has been shown to be a valid measure of
clinical improvement with an inter-rater reliability coefficient of

.89 (Ellsworth, 1957).

Measuring Patient Aftercare Status. Information related to the

 

status of patients one year after the onset of the study was obtained
from each patient's primary therapist by means of a brief survey.
This survey requested information about (1) the patient's involvement
in aftercare, (2) the patient's current functioning compared to time
of discharge, and (3) the therapist's expectation of the patient

requiring future hospitalization.

Program of Data Collection

The following is a description of the step-by-step procedures in
which all testing, surveys, and other aspects of data collection were
completed.

1. All patients were scheduled to complete the Value Survey and

the Minnesota Multiphasic Personality Inventory within five days

 

following admission. These were administered along with any other
written psychOlogical tests ordered for each patient following the

usual clinical procedures.

75

2. Within the first week of each patient's hospitalization,
one of the on-duty nursing staff working closely with the patient

was requested to complete the MACC Behavioral Adjustment Scale.

 

3. Within five days prior to discharge, each patient was

scheduled for a second administration of the Value Survey and the

 

MMPI.
4. At the time of each patient's discharge, one of the on-duty
nursing staff was requested to rate the patient's current behavior

on the MACC Behavioral Adjustment Scale.

 

5. Following each patient's discharge, all necessary demo-
graphic data, discharge diagnosis, and length of hospitalization were
obtained from the medical record which is maintained on each patient.

6. One year following the onset of the pilot study, the primary
therapist for each patient in study was surveyed to determine
(a) whether the patient was being followed on an aftercare basis,

(b) whether the patient has continued to improve since hospitaliza-
tion, and (c) the therapist's expectation of the patient requiring

hospitalization in the future.

Analysis of Data

 

The preliminary analysis of the data in the study was essentially
correlational and utilized common parametric statistical techniques.
Rokeach (1973) has indicated that analyses involving the rank-ordered
values can appropriately use these techniques when small samples are
involved. In addition, the degree of nonindependence when making
comparisons across individuals is minimal (an average intercorrela-

tion of -.O6) when as many as 18 values are involved.

76

The comparison of increases in mean ranks from admission to
discharge for the terminal and instrumental values utilized a
liberal (P = .10) one-tailed t-test for dependent samples. All
relationships between target values and other variables were
identified by computation of the Pearson product-moment correlation
coefficient. All coefficients which are significant at the .07
level (.06 for correlations among values) were retained and examined
in relationship to the target values. Comparison of the various
patient subgroups on target value mean ranks utilized the t-test for
independent samples and a significance level of .07 in a two-tailed
test. The significance level of .07 was chosen (in preference to a
traditional level of .05) to decrease the probability of a Type II
error and ensure that a sufficient data base would be available for
constructing the value education exercises. A significance level of
.06 was used for correlations among values since the ranking procedure
spuriously inflates the coefficients to a slight degree.

Analyses were conducted to examine relationships among data
obtained on admission and discharge separately. This approach was
used to develop separate profiles of the entering patient and out-

going patient.

Pilot Study Results

 

The results of the pilot study are presented below in the same
sequence as the 13 objectives outlined earlier. In a section follow-
ing this presentation of results, the results will be summarized

separately for each identified target value.

77

Psychologically Important Values

Objective 1 was to identify important terminal values for the

 

patient population. Examination of terminal value changes resulted
in the identification of self-respect, freedom and pleasure as
potential target values. These three values exhibited significant

increases in mean ranking from admission to discharge (Table 3.1).

Objective 2 was to identify important instrumental values.

 

Only two of the values, responsible and self-controlled, increased

 

 

in sufficient magnitude to be retained as potential target values

(Table 3.1).

TABLE 3.1.--Mean Ranks of Selected Terminal and Instrumental Values
on Admission and Discharge for 58 Adult Inpatients.

 

 

 

 

 

Mean Rank
Values Admission Discharge Change Significance*
Terminal Values
Self-respect 6.52 5.77 0.75 .07
Freedom 10.01 9.07 0.94 .09
Pleasure 12.77 11.85 0.91 .05
Instrumental Values
Responsible 7.09 5.69 1.39 .03
Self-controlled 9.71 8.20 1.50 .02

 

*
One—tailed t-test on dependent measures.

78

Isolating Target Values

 

Objective 3, following the identification of potential target

 

values, was to establish relevance for both sexes. The minimum
criterion for retaining a value is that 50 percent of both sexes
increase in discharge rankings. Table 3.2 gives the percentage of
patients in each sex group exhibiting increased rankings. Each of
the five values meets this criterion for consideration as a target

value.

TABLE 3.2.--Percentage of Male and Female Patients with Rank
Increases at Discharge on Five Values.

 

 

 

Sex
Potential Target Value Male Female
Self-respect 61.9 50.0
Freedom 61.9 58.3
Pleasure 52.4 52.8
Responsible 63.2 58.8
Self-Controlled 63.2 52.9

 

Objective 4 was to designate as target values two terminal and

 

two instrumental values. Since only two instrumental values met the
first two criteria, no elimination of instrumental values is needed.
However, one of the three terminal values needed to be eliminated.

It was concluded that self-respect should be retained as a terminal

 

79

target value because of its obvious implications for self-evaluation.
Freedom is retained in preference to pleasure because of the greater
number of increases in both sex groups and particularly females.

Relationships Between Target
Values and Other Values

 

 

Objective 5 was to identify significant relationships between

 

each target value and other values within the terminal value system
at the time of admission and at the time of discharge. Table 3.3
gives only those~correlation coefficients significant at the .06 level
or higher between each of the four target values and the 18 terminal

values at admission (pre) and discharge (post).

Objective 6 was to identify the significant relationships

 

between each target value and other values within the instrumental
value system at the beginning of hospitalization and at discharge.
A11 correlation coefficients significant at the .06 level or higher
are presented in Table 3.4.

Relationship of Target Values
and Psychopathology

 

 

Objective 7 was to identify entering and outcome relationships

 

between each target value and MMPI scales using only admission data
and then discharge data. All correlation coefficients significant
at the .07 level or higher are presented in Table 3.5. With the
exception of scales L and K, negative correlations indicate an
association between high ranks and increased psychopathology on any
given MMPI scale. Positive correlations associate high ranks with

less personality dysfunction.

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83

Objective 8 was to further map the relationship between target

 

values and psychopathology In! comparing the mean ranks on admission
and discharge of the two diagnostic groups, non-psychotic and
psychotic. Table 3.6 presents the mean ranks for the two groups on
admission and discharge. Out of eight comparisons made using an

alpha level of .07, only the admission rankings on self-controlled

 

yield a statistically significant difference (P less than .03)

between non-psychotic and psychotic patients on a two-tailed t-test.

TABLE 3.6.--Mean Target Value Rankings on Admission and Discharge
for Non-psychotic and Psychotic Patients.

 

 

 

Diagnosis

Non-Psychotic Psychotic

Target Value Time (ri= 21) (n = 31)
Freedom Pre 10.57 9.42
Post 9.10 9.33
Self-Respect Pre 7.14 6.52
Post 4.81 6.77
Responsible Pre 7.33 7.34
Post 5.75 5.68

Self-Controlled Pre 11.14* 7.55*
Post 9.20 7.60

 

*
Difference significant at P less than .03 on a two-tailed
t-test.

84

Relationship of Target Values
and Observed Behavior

 

Objective 9 was to identify all significant relationships

 

(P = .07) betweeen each target value and staff ratings on the five
scales of the MACC Behavioral Adjustment Scale. The significant
correlations upon entering the hospital and at the time of discharge
are presented in Table 3.7. Negative correlations indicate an
association between high rankings and better adjustment (with the
exception of the Motility Scale where higher ranks are associated
with poorer adjustment). Positive correlations associate high
rankings with poorer adjustment.

Relationship of Target Values and
Length of Hospitalization

 

 

Objective 10 was to identify relationships between target value

 

rankings on admission and discharge and duration of hospitalization.
All correlations are presented in Table 3.8. The significant
negative correlations indicate higher ranks associated with longer
stays and, conversely, an association between low ranks and shorter
stays.

Relationship of Target Values and Patient
Status One Year After Hospitalization

 

 

Objective 11 was to compare admission and discharge rankings

 

for patients in some type of aftercare and those not in care one year
after hospitalization. Table 3.9 presents the mean ranks obtained
for these two groups upon entering and leaving the hospital. Of eight

comparisons made, four resulted in a significant difference at P less

85

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86

TABLE 3.8.—-Corre1ation of Length of Hospitalization and Target
Obtained on Admission and on Discharge.

Value Rankings

 

Time of Value Rankings

 

 

Target Value Admission Discharge
Freedom -.05 .17
Self-Respect -.22* -.21*
Responsible -.Ol -.24*
Self-Controlled -.17 -.15

 

*
Significant at P equal or less

than .05.

TABLE 3.9.--Mean Target Value Rankings on Admission and Discharge
for Patients in Aftercare and Patients Not in Aftercare.

 

Patient Status

 

 

Aftercare No Aftercare P less
Target Value Time (n = 24) (n = 12) than*
Freedom Pre 10.21 11.50
Post 10.42 7.00 .03
Self-Respect Pre 6.50 3.83 .04
Post 5.88 3.83 .05
Responsible Pre 7.54 5.00
Post 5.82 6.25
Self-Controlled Pre 8.41 9.36
Post 7.05 11.33 .01

 

*
Two-tailed t-test.

87

than .05. It is concluded that differences exist between patients
"in aftercare” and "not in aftercare" on discharge rankings of

freedom, self-respect, and self-controlled. In addition, a difference

 

 

on admission rankings of self-respect exists for the two groups.

 

Objective 12 was to identify differences in target value ranking

 

on admission and discharge between patients rated "improved" and
"unimproved” on one-year follow up. The mean ranks on entering and
leaving the hospital for these groups are presented in Table 3.10.
Only one of eight comparisons made suggested a significant difference.
It is concluded that a difference exists between improved and

unimproved patients in their mean rankings of self-respect upon

 

admission to the hospital.

TABLE 3.10.--Mean Target Value Rankings on Admission and Discharge
for Patients Rated "Improved" and “Unimproved“ on

 

 

Follow-Up.
Improved Unimproved

Target Value Time (n = 26) (n = 8)
Freedom Pre 10.61 10.13

Post 9.23 8.64
Self—Respect Pre 4.42* 6.75*

Post 4.85 5.25
Responsible Pre 5.96 6.88

Post 5.24 6.29
Self-Controlled Pre 7.88 9.50

Post 8.72 8.43

 

*
Significantly different at P less than .04.

88

Objective 13 was to examine the relationship of target value

 

rankings and therapists' predictions of the likelihood of patients
requiring hospitalization in the future. Each therapist rated his
patient on a Likert-type survey item. The frequency of ratings for

the 58 patients on the item choices were as follows:

 

 

Item Choice Number of Patients
Very unlikely ................... 3
Fairly unlikely ................. 12
More unlikely than likely ....... 13
More likely than unlikely ....... 19
Fairly likely ................... 6
Very likely 5

The correlation between therapists' predictions (scaled l to 6)
and target value rankings obtained on admission and discharge are
presented in Table 3.11. Four out of the eight correlations are
significant. The conclusions are as follows. Higher entering
ranks on freedom are associated with greater likelihood of future
hospitalization. Both higher entering ranks and higher discharge

ranks on self-respect are associated with decreased expectation of

 

future hospitalization. Finally, higher rankings on self-controlled
at time of discharge are associated with increased expectation of

future hospitalization.

 

 

89

TABLE 3.11.—-Correlation of Likelihood of Future Hospitalization with
Target Value Rankings Obtained on Admission and

 

 

 

Discharge.
Time of Value Rankings
Target Value Admission Discharge
Freedom -.31* .03
Self-Respect .37* .36*
Responsible .08 -.06
Self-Controlled -.O7 -.32*

 

*Significant at P equal or less than .01.

Conclusions About Each Target Value

 

The following discussion is a summary of the findings and con-
clusions related to each of the four target values. Each target value
will be discussed separately from a perspective which arbitrarily
dichotomizes the patients into those ranking a particular target value
high and those ranking it low. Each discussion of a target value will
summarize the findings by primarily characterizing the "high-ranking"
patient. Separate characterizations will be offered for (1) patients
entering with high ranks on the target value and (2) patients ranking

the value high at the end of their hospitalization.

Freedom

High Admission Rankings on Freedom. Patients entering the

 

hospital with relatively high rankings on freedom exhibit a

9O

characteristic organization within their value system. They are
likely to place higher importance on equality and being independent,
logical, and self-controlled. In contrast to patients entering with
lower ranks on freedom, the high-rank patients place less importance
on obtaining happiness, salvation, pleasure, or social recognition,
and more importance on being capable, honest, obedient, and polite.
Patients entering with lower rankings on freedom are likely to pre-
sent a value system organization characterized in a generally
opposite manner. In this dichotomization, a picture emerges of
patients with concerns over freedom, fair play, and control of one-
self rather than by others. In sharp contrast is the patient with
less concern over freedom who seeks happiness through more social
submissiveness and conformity.

Patients entering with high rankings on freedom manifest greater
psychopathology in a number of areas (MMPI scales). They express a
greater number of psychiatric complaints pointing toward more serious
psychological disturbance (F scale). They manifest impulsiveness,
resentment toward authority, and shallowness, dissatisfaction, and a
lack of conformity in their interpersonal relationships (Psychopathic
deviate scale). They are prone to be overly sensitive, easily hurt,
and resentful in response to perceived criticism and quick to project
blame and responsibility on others (Paranoia scale). They manifest
higher levels of anxiety, tension, and fear (Psychasthenia scale),
and exhibit more nonconformity in thought processes and attitudes
(Schizophrenia scale). Conversely, patients entering with lower ranks

on freedom are apt to present a more conventional personality picture

91

with a capacity for closer, less alienated and less frictional
relationships.

Consistent with the pathological characteristics associated with
high entering ranks on freedom, patients diagnosed with more serious
illnesses (psychotics) tend to have higher rankings on freedom than
less disturbed patients (neurotics). High rankings of freedom are
also found among patients observed by staff to be less cooperative,
more resistive, and less likely to initiate and stay with tasks
(MACC). When patients are followed-up one year after entering the
hospital, those who entered with higher ranks on freedom are generally
viewed by their therapists to be among those most likely to require

hospitalization in the future.

High Discharge Rankings of Freedom. Patients exhibiting high
rankings on freedom at the time of discharge reflect a markedly dif-
ferent organization within their value systems than was apparent for
those high ranking patients entering the hospital. Clearly, the high
ranking patients at discharge include some of the patients with
initially high ranks who remained fairly high as well as patients
with initially low ranks who increased their rankings.

Within their value systems, high "freedom" patients on discharge
place importance on having an exciting life and being ambitious,
broadminded, and intellectual. Less importance is placed on salva-
tion as before as well as on true friendship, helpful and loving.

Self-controlled was important along with freedom on admission, but

 

shows an opposite relationship at discharge where it is now important

for patients ranking freedom low.

92

At the time of discharge, there is no apparent distinction
between patients ranking freedom high or low on personality character-
istics, diagnosis, and behavioral adjustment. Those with higher rank-
ings at the end of hospitalization are found to have shorter hospital
stays and are less likely to be involved in care one year after
hospitalization.

The major conclusions drawn about the value freedom are as

follows: ‘

1. The entering rankings have both diagnostic and prognostic
implications with high ranks associated with more severe pathology,
poorer adjustment in the hospital, and a greater likelihood of
returning to the hospital.

2. As an outcome variable, high rankings on freedom have a
generally positive meaning and are associated with an increased
appreciation of values directed at personal fulfillment, although a
decreased emphasis is evident on some values of a moral or social
nature. High discharge rankings may reflect a rapid hospital course
and less need for prolonged aftercare.

3. For a portion of the patient sample entering with low ranks
on freedom, there appears to be positive psychological implications
for increasing their appreciation of this value. For patients
emphasizing freedom on admission, freedom is likely experienced as a
deficiency and perceived as imposed on them by others. For these
patients, their exercise of freedom may lack mature consideration of

others resulting in negative social relationships. For this group, a

93

decrease in freedom's importance or a re-definition of freedom may

be indicated as part of therapy.

Self-Respect

 

High Entering Ranks on Self-Respect. Patients ranking self-

 

respect high upon entering the hospital also place higher importance
on social recognition (respect and admiration from others) and on
being independent or self-sufficient. At the same time they place
less importance on broader social concerns such as having a world of
peace or beauty and national security. Concern with family security
and being forgiving tends to be less for those who place greater

importance on self-respect.

 

Patients entering the hospital who place greater importance on

self-respect express fewer psychiatric complaints and difficulties

 

(F scale), less sensitivity to criticism and less need to blame others.
The high value they place on respect from others does not appear to
leave them particularly vulnerable to criticism or dependent on
approval from others. While approval is desired, their self-approval
comes first.

Incoming patients ranking self-respect high are observed by staff

 

to exhibit better adjustment within the hospital. They exhibit greater
cooperation, initiative, communicate more effectively with others and
readily grasp what is told to them. However, these patients are found
to have a longer stay in the hospital. Based on the characteristics

of these patients, it is suggested that they are particularly compat-

ible with the hospital milieu and motivated in treatment. These

94

factors may reduce any pressures to hasten discharge from the

patient or the staff who likely enjoy working with the patient.
Although entering high-rank patients are likely to be hospital-

ized longer, the long-term implications for them are favorable. They

are less likely to be in aftercare a year after entering the hospital.

They are likely to exhibit continuing improvement after leaving the

hospital and less likely to require hospitalization in the future.

High Discharge Rankings of Self-Respect. Patients ranking self-

 

respect high at discharge presents a picture quite similar to the
entering high-rank patient. They continue to exhibit a concern with
being independent and a de-emphasis of some social values. They are
less concerned about such personal, hedonistic values as pleasure
and a comfortable life. They are less concerned with being clean,
helpful, or obedient. The high-rank patient places greater importance
on obtaining inner harmony, mature love, and wisdom, and on being
courageous and honest. Such patients show a value system organization
emphasizing personal-growth values rather than comfort or security.
In their relationships with others, they strive toward maturity,
honesty, and assertiveness, rather than more conforming efforts to
be helpful or obedient which were likely to be stressed during earlier
developmental years.

At the outcome of hospitalization, high-rank patients continue
to express fewer psychiatric problems and manifest less depression
and ansiety. They are more outgoing and responsive toward others.

This picture of "high self-respect" patients showing less pathology

 

95

is also reflected in their psychiatric diagnosis as less disturbed
(non-psychotic).

The high-rank patient upon discharge continues to reflect a
longer hospital stay, but is not likely to be in care a year after

hospitalization nor expected to require hospitalization again.

Responsible

 

High Admission Rankings of Responsible. Patients ranking

 

responsible high on admission do not exhibit any values which con-

 

sistently are important in conjunction with responsible. High-rank
patients tend to place less importance on being broadminded and for-
giving. In contrast, patients who place less importance on being
responsible are more concerned about being open-minded and willing
to pardon others.

Patients entering with high ranks on responsible are found to

 

exhibit less depression, pessimism, and anxiety. They are likely to
be more organized, realistic and persistent. High incoming ranks on

responsible may have some long-term implications. They tend to be

 

more characteristic of patients who continue to improve after

hospitalization and less likely to remain in aftercare.

High Discharge Rankings of Responsible. Patients with high

rankings on responsible at the end of hospitalization are similar to

 

patients ranking self-respect high. They place greater importance

 

on mature love and social recognition. However, they also place
greater importance on being helpful. They Show less concern for a

world at peace and place less emphasis on being cheerful, clean and

 

96

forgiving. The person ranking responsible high seems to be strongly

 

oriented to others' needs and his relationship with others.

The personality characteristics of high ranking patients at dis-
charge reflect more ego-strength and better self-concepts with fewer
expressions of psychological conflicts. Their mood is more positive
and freer from worry. They are more outgoing and interested in others
and less likely to develop frictional relationships or resentful
attitudes.

High discharge rankings on responsible are associated with longer

 

hospital stays as was true of high self-respect rankings. In general,

 

the conclusions about responsible parallel those relating to self-

 

respect. High rankings on admission and discharge have positive
implications concerning the patients' personality characteristics,

hospital course and outcome.

Self-Controlled

 

High EnteringyRankings of Self-Controlled. Patients entering

 

the hospital with high rankings on self-controlled present a value

 

system similar in some respects to those entering with freedom high.
These patients place importance on being independent and logical as
well as obtaining freedom; at the same time, they place less impor-
tance on happiness and being honest, capable, or ambitious. Nor does
being cheerful, loving and forgiving hold as much importance for

patients ranking high as for patients with lower self-controlled

 

rankings.

97

Patients entering with high ranks on self-controlled exhibit a

 

more constricted, guarded personality picture and are less susceptible
to suggestions. Personality testing indicates they have higher energy
levels and are more restless, impulsive, impatient, and hyperactive
than patients with lower rankings. High-rank patients are more likely
to be diagnosed as more seriously disturbed (psychotics). They are
viewed by staff as being overactive, loud, boisterous, restless and

"on the go." These patients are likely to stay in the hospital longer.

High Self-Controlled Rankings at Discharge. Patients with high

ranks on self-controlled upon discharge generally show a rather dif-

 

ferent picture from patients who ranked freedom high and even from

patients who ranked self-controlled high on admission. The high-rank

 

patient on discharge now places less importance on freedom as self-

controlled becomes more important. He places importance on such

 

values as inner harmony or freedom from inner conflict, salvation,
and being obedient.

The high-rank patient on discharge reflects greater depression,
pessimism, worry, and anxiety. He is more reserved, shy and sensitive
in social situations. He was likely to have been diagnosed as more
seriously disturbed. The high-rank patient even near discharge is
viewed by staff as more uncooperative and resistive. Following dis-
charge, this patient is likely to require aftercare and is expected
to require hospitalization again.

It is concluded that self-controlled, like freedom initially,

 

receives high rankings in those patients who, by virtue of a serious

98

disturbance and great difficulty inhibiting impulses, place importance
on controlling themselves as a form of deficiency motivation. Other

patients, typically stronger, undersubscribe to self-controlled and

 

during the course of hospitalization begin placing more importance
on this value as one which is instrumental to more adaptive and
effective functioning. Conroy (1973) demonstrated that smokers were
only effective in breaking their habit when they gave sufficient
importance to this value.

The negative implications of high ranks at discharge are likely
a function of the deficiency-motivated rankings remaining high or
increasing in contrast to more moderate increases motivated by the
treatment process in low-rank patients at admission. As in the case

of freedom, the psychological meaning of self-controlled may have at

 

least two variations. However, patients increasing in their appre-

ciation of self-controlled as instrumental to self-actualization

 

remain overshadowed by the magnitude of rankings of patients who are

pathologically deficient in realizing the same value.

Summary of the Pilot Study

 

This pilot study was designed to examine 18 terminal values
(preferable end states) and 18 instrumental values (preferable modes
of conduct) selected as potentially significant in the psychological
functioning of 58 adult psychiatric inpatients. Two terminal values,

freedom and self-respect, and two instrumental values, responsible

 

 

and self-controlled, were isolated as psychologically significant.

 

Significant relationships were found between each target value and

patients' other values, personality characteristics, psychopathology,

 

99

behavior in the hospital, length of hospitalization, clinical status
one year after entering the hospital, and likelihood of returning to
the hospital.

It was concluded that patients who ranked self-respect high on

 

admission or discharge revealed less pathology, better hospital
adjustment, and more favorable prognoses than patients ranking it
low. The same conclusions were reached about the clinical picture of

patients who ranked responsible high on admission or discharge.

 

Patients who ranked freedom high on admission exhibited a more
negative clinical picture than those who ranked it low. However, at
the time of discharge high rankings on freedom were associated with
less patient pathology, better hospital adjustment, and a more

favorable prognosis than low rankings. Although self-controlled

 

rankings increased for the sample over the course of hospitalization,
high rankings both on admission and discharge were associated with
an unfavorable clinical picture. The negative patient character-

istics consistently associated with high ranks on self-controlled

 

and with high admission ranks on freedom were interpreted as
reflecting severe deficiencies in realizing these values. These
deficiencies were considered to be related to the inability of
more deeply disturbed patients to feel a sense of freedom and control
over their lives.

The pilot study was regarded as successful in demonstrating
important, consistent, and meaningful relationships between values
and numerous clinical variables. The consistency of findings was

supported by variables that represent diversity in constructs,

TOO

methods of measurement, data sources, and time span. The signifi-
cance of each value was further underscored by its relevance for a
heterogeneous group of patients in terms of sex and psychopathology.
The study offered support for Rokeach's formulation of a value as a
cognitive transformation of a need. It further supported the notion
that a value's "importance" may be determined either by its intrinsic
ideal properties or by a pathological deficiency in realizing the
value.

The pilot study was also regarded successful in its major goal
of meeting the prerequisites for the second phase of research con-
cerned with experimental value education. The relationships identi-
fied in the pilot study provided the subject matter for the value
education exercises administered to another sample of patients
admitted later to the same psychiatric program. The methodology and
results of the experimental value education phase of this study are

presented in the following chapters.

 

CHAPTER IV

EXPERIMENTAL DESIGN AND METHODOLOGY

Subjects

One hundred and twenty adult psychiatric inpatients were used in
the experimental phase of this study. They represented four sub-
populations to control for sex and admitting diagnosis. The sample
included 30 non-psychotic males, 30 psychotic males, 30 non-psychotic
females, and 30 psychotic females. All were incoming patients
admitted to the adult intensive treatment program of Pine Rest
Christian Hospital. The subjects' ages ranged from 17 to 75 with a
mean age of 35. The educational level of the patients ranged from
completion of grade seven to graduate degrees. The sample represents
a relatively well-educated group. Only 16 percent had not completed
high school; 32 percent were high school graduates while another 32
percent had from .5 to 3.5 years of education beyond high school.
Fourteen percent held four-year degrees and 6 percent held graduate
degrees.

Thirty—two percent of the patients were residents of Kent County
in Western Michigan where the hospital is located. Twenty-five per—
cent of the patients resided in neighboring counties and another 25
percent in other parts of Michigan. Fourteen percent of the patients

came from other states and 4 percent came from Canada.

101

 

 

102

The marital statuses of the patients indicated that 57.5 percent
were married; 32.5 percent were single; 7.5 percent were divorced; and
2.5 percent were widowed.

Sixty percent of the subjects held jobs; 20.8 percent were
exclusively homemakers; 8.3 percent were exclusively students; 9.2
percent were unemployed; and 1.7 percent were retired.

The religious affiliations of patients were predominantly
Protestant. Thirty-one percent were affiliated with the Christian
Reformed Church and Reformed Church of America which historically
founded and supported the hospital. Another 42.5 percent of the
patients were affiliated with other Protestant Churches; 12.5 percent
were Catholic; and 14.2 percent reported no religious affiliation at

the time of admission to the hospital.

Measures
The empirical observation of the dependent variables in this
study utilized eight available instruments which are described in

detail below. The instruments and dependent variables are listed

 

 

as follows:

Instrument Dependent Variables

Value Survey Freedom

(Rokeach, 1967) Self-Respect
Responsible
Self-Controlled

Survey of Interpersonal Conformity

Values Independence (SIV)
(Gordon, 1960) Leadership
Personal Values Scales Independence (PVS)

(Scott, 1965) Self-Control

 

103

Instrument

 

Value Profile
(Bales & Couch, 1969)

Social Responsibility Scale
(Berkowitz & Lutterman,
1968)

Self-Esteem Scale
.(Rosenberg, 1965)

Index of Adjustment
and Values
(Bills, 1951)

Internal-External Control

Dependent Variables

 

Acceptance of Authority

Need-Determined Expression
vs. Value-Determined
Restraint

Individualism

Social Responsibility

Self-Esteem

Self-Acceptance
Self-Satisfaction

Locus of Control

Scale
(Rotter, 1966)

Value Survey

 

The Value Survey was used to measure the direct effects of the
treatments on target value rankings immediately following treatment
and repeated two to three weeks later. This instrument is described

in detail in Chapter III on pp. 71-72 and presented in Appendix A.

Survey of Interpersonal Values (SIV)

 

The SIV is a commercially published test which has had fairly
extensive use in research and counseling settings. It is a brief,
self-administered, forced-choice test consisting of 30 sets of three
statements. The respondent must designate one of the three as most
important to him and one as least important. Each statement addresses
some aspect of behavior, interacting with others, or being regarded

and treated by others in some way (see Appendix B).

 

104

The SIV provides scores for six factor-analytically developed

value dimensions or scales named sgpport, conformity, recognition,

 

 

 

independence, benevolence, and leadership. Three of these scales

 

 

were used in this study as indirect measures for three of the target

values. Independence is defined by Gordon (1960) as I'having the

 

right to do whatever one wants to do, being free . . ." and being

associated with a non-sociable personality trait. Independence was

 

used in this study as an indirect measure of the importance of target
value freedom.

The leadership scale was selected as an indirect measure of the

 

target value self-respect. While the author defines leadership as

 

 

being in charge or having authority or power over others, he indi-
cates that the value is associated with personality trait tendencies
of an individual who is "an original thinker, energetic, self-assured
and assertive.“ It was assumed that the value construct measured by

the leadership scale would overlap substantially with target value

 

self-respect.

 

The SIV conformity scale was selected as one indirect measure of

 

the target value responsible. The conformity scale is defined as

 

 

”doing what is socially correct, following regulations closely, doing
what is accepted and proper, being a conformist." The author indi-

cates that the value conformity is associated with personality traits

 

described as careful and responsible. The target value responsible

 

(dependable, reliable) and the value conformity were assumed to be

 

measuring the same construct to some extent.

105

Reliability. The author obtained test-retest reliabilities for

 

the scales over a ten-day interval based on college students. These

were found to be .86 for conformity, .89 for independence, and .88

 

 

for leadership. Reliabilities estimated by the Kuder-Richardson

 

method were found to be .82 for conformity, .86 for independence and

 

 

.83 for leadership.

 

Validity. A number of studies have been summarized by Gordon
(1963) which provide normative data on a variety of groups with dif-
ferent demographic, personality, or ideological characteristics. A
number of studies attest to the validity of the value scales by
revealing significant associations between the scales and a variety
of criteria. For example, department managers in a soap company who

scored high on the conformity scale were rated as less effective in

 

their jobs by plant managers. Engineers who value receiving support
from others were rated lower in performance by their supervisors.
Sales effectiveness as rated by supervisors of retail clerks was

found to be (1) positively correlated with conformity for both sexes,

 

(2) negatively correlated with recognition and leadership for males,

 

 

and (3) negatively correlated with independence for females. Gordon

 

(1963) compared data on 61 male and 60 female neurotic outpatients
with a sample of normal males and females of about the same age and
marital status. He found the patient group to have significantly

lower conformity scores and significantly higher scores on the

 

independence scale. No differences were found on the leadership

 

 

scale.

106

Personal Value Scales (PVS)

 

The complete PVS consists of 12 scales each measuring a differ-
ent personal value (Scott, 1965). An initial 60-item version Was
developed and later expanded to a 240-item version. Two of the 12
scales were used in this study as indirect measures of target values.

The independent scale was selected as an alternative measure for the

 

target value freedom. The self-control scale was selected as an

 

indirect measure of the importance of target value self-controlled.

 

Each scale consists of a series of statements describing
behaviors or personality characteristics associated with the value
being measured. The respondent gives his opinion of each item by
checking one of three response options--"always admire," "depends on
the situation,“ and "always dislike." Half of the items on each
scale are direct-scored and half are reversed-scored. The two scales
are found in Appendix C.

The independence scale consists of 22 items (from both the short

 

and long forms of PVS) and the self-control scale consists of 21

 

items. In order to reduce any transparency of these two measures in
the present study, some minor modifications of the scales were made.

Five of the items of the independence scale were rewritten to

 

eliminate forms of the words freedom and independent. One item of

the self-control scale ("Practicing self-control") was eliminated

 

because of its obvious content. Finally, the items from both scales
were alternated and presented as one inventory (Appendix C) to the

subjects.

107

Reliability. Scott based his reliability measures on college

 

undergraduates. He reports alpha coefficients of .68 on the short

version of the self-control scale and .85 on the long version. The

 

two-week test-retest stability on the short version was .72 and the

correlation between short and long forms was .78. The independence

 

scale yielded alpha coefficients of .55 (short form) and .82 (long
form). The two-week test-retest reliability coefficient for the
short form was .73. The correlation between both forms of the

independence scale was .74.

 

Validity. Scott correlated scores obtained under three sets in
instructions for rating items: (1) according to "rightness" or
"wrongness" of the trait (item), (2) according to whether others
should admire or disapprove of the trait, and (3) whether the trait
is admired or not in oneself. Significant intercorrelations were
obtained. They were interpreted as evidence of concurrent validity.
Another study reported correlations between value scale scores and
separate ratings of distress over transgressions presumed to be
related to the various values. Scott found significantly higher
scores on independence for students in a drama club who were judged

to be nonconformists than students in other comparison groups.

Value Profile (VP)

 

The Value Profile (Bales & Couch, 1969) consists of 143 value
statements which are presented in a Likert format with six response
categories. The response categories are (1) Strongly Disagree,

(2) Disagree, (3) Slightly Disagree, (4) Slightly Agree, (5) Agree,

108

and (6) Strongly Agree. The VP was developed on a predominantly
undergraduate sample of 552 subjects by factor analysis of the items.
The factor analysis yielded four orthogonal factors: 1, Acceptance
of Authority; II, Need-Determined Expression vs. Value-Determined
Restraint; III, Equalitarianism; and IV, Individualism.

Items from three of the VP factors were selected to provide
indirect measure of three target values likely to be implicated.
These target values include freedom (which should be inversely

related to factor 1, Acceptance of Authority); self-respect (related

 

to factor IV); and self-controlled (factor II, Value-Determined

 

Restraint).

For the present study, the three scales were constructed using
the 10 items with the highest factor loadings on their respective
factors. The 10 items included in the "Acceptance of Authority
Scale" had a range of factor loadings from .56 to .76 with a mean of
.69. The range of factor loadings for items on the "Individualism
Scale" was .28 to .49 with a mean of .39. The items on the "Need-
Expression vs. Value-Determined Restraint Scale" had a range of
factor loadings from -.20 to .62 and a mean of .39 (absolute value).
Items with negative factor loadings were reversed-scored on this
scale. Since each of the three scales contained 10 items with six
response categories, each scale provided a range of raw scores from
10 to 60. The 30 items were interspersed among each other and the
eight items of the Social Responsibility Scale described in the next
section. This resulted in a 38-item inventory which was simply

entitled Part V (see Appendix D).

   

109

Social Responsibility Scale (SRS)

 

The SRS is a brief scale designed to assess traditional social
responsibility or a person's orientation toward helping others apart
from any specific gain for himself (Berkowitz & Lutterman, 1968).
The scale presumably measures a personality characteristic rather
than a value pep_se. However, it is clear that at least half of the
scale's items call for an opinion as to the relative desirability or
importance of certain attitudes or behaviors stemming from the con-
cept of social responsibility. As such, the items of this scale are
likely to provide some indirect measure of the value an individual
places on social responsibility as well as measuring the strength of
that personality characteristic. On that basis, the SRS was selected

as an indirect measure of the target value responsible.

 

The SRS consists of eight Likert scale items. Half of the items
are reverse scored. The respondent is required to respond on a 5-
point scale with categories designated as strongly agree, agree,
undecided, disagree, and strongly disagree. In order to use this
scale in the most unobtrusive fashion, two modifications of the scale
were used in this study. First, the 5-point response scale was
changed to a 6-point scale identical to that of the Value Profile
above. Second, the SRS items were hmerspersed with the items of the

VP and administered within the same format (see Appendix 0).

Reliability. The authors administered the SRS to a probability

 

sample of 766 adults throughout the state of Wisconsin. The internal
consistency of the scale was regarded as "very satisfactory," although

no reliability data were reported.

 

TlO

Validity. In support of the conservative and traditional
orientation of the scale, the authors found higher scores with
greater frequency among working class than among middle class
respondents. High scores were more likely to affiliate with the
Republican party. Within both classes high scoring individuals on
the SRS were more likely to make financial contributions to educa—
tional or religious organizations, to be more active in organizations,

and to show greater political interest, knowledge, and participation.

Self-Esteem Scale (Rosenberg, 1965)

 

This scale is one of the best and most efficient measures of
"global self-esteem." It consists of 10 Likert-type items on which
the subject is allowed one of four responses: strongly agree, agree,
disagree, or strongly disagree. The items are fairly homogeneous in
using "self-as-a-whole” as the referent object. The items are
scored on only the agree-disagree dichotomy. The scoring system
combines some items to yield a 7-point Guttmann scale indexing a uni-
dimensional attitude of favorability to unfavorability toward self.
The SES items are found in Appendix E.

The scale has a reported coefficient of reproducibility of .92
and a two-week test-retest reliability of .85. The scale has revealed
high concurrent validity with other measures of self-esteem with cor-
relations ranging from .53 to .83. Correlations with measures of
other self-constructs are consistently lower suggesting some construct
validity for this scale. Evidence for the scale's construct validity

is found in various studies showing theoretically predicted associations

111

with depression, anxiety, interpersonal security, and participation

in activities (Wylie, 1974).

Index of Adjustment and Values
(Bills, 1951)

 

The IAV is one of the better constructed and widely-used self-
report instruments available. It provides two major scores: (1) a
"Self-Acceptance” score and (2) a "Self-Minus-Ideal DisCrepancy”
score from which a "Self-Satisfaction" score is inferred.

The IAV consists of 49 trait adjectives exhibiting adequate test-
retest stability. Subjects respond to each adjective in terms of
three questions. (1) How often are you this sort of person?

(response is on a 5-point scale from "most of the time” to I'seldom).
(2) How do you feel about being this way? (a 5-point scale from "very
much like . . .” to "very much dislike . . .”). (3) How much of the
time would you like this trait to be characteristic of you? (a 5-
point scale from ”seldom" to "most of the time"). The sum of
responses on (2) provide a measure of ”self-acceptance." The sum of
item discrepancies in response to (l) and (3) provide a measure of
congruence between self and ideal-self or "self-satisfaction." (It
should be noted that some investigators use the sum of scores for the
responses to question (1) to provide an additional "self” score).

The IAV is found in Appendix F.

Reliabilities. Wylie (1974) reports split-half reliabilities on

 

self scores ranging from .53 (college students) to .92 (factory

workers) with test-retest coefficients from .90 (6 weeks) to .81

 

112

(6 months) for college students. Self-acceptance score split-half
coefficients are .91 to .93 for nurses with test-retest reliabilities
ranging from .83 (6 weeks) to .70 (6 months) for college students.
Self-minus-ideal discrepancy scores yield split-half coefficients
ranging from .87 to .93 with test-retest reliabilities from .87

(6 weeks) to .61 (6 months) using college students.

Validity. All three self-regard scores reveal significant
moderate correlations with a variety of measures of similar constructs.
These correlations range from .24 to .71 depending on the particular
self-regard instruments and sample sizes involved (Wylie, 1974).

Many studies demonstrate theoretically predicted associations with
different constructs including achievement, affective state, body
satisfaction, and acceptance of others (Wylie, 1974). There is some
evidence for discriminant validity for self-acceptance and self-
satisfaction scores, which correlate from -.67 to as low as -.25.

The self score and the self-satisfaction score correlate .70 to .83,
but are somewhat inflated by the common self score. The discriminant
validity between the self score and self-acceptance score is the most
questionable because their correlations range from .71 to .90.

Scale to Measure Internal Versus
External Control (Rotter, 1966)

 

 

This scale consists of 29 forced-choice items, 6 ”fillers" and
23 pairs consisting of an internal and an external belief statement.
A single score is computed by totaling the number of external beliefs

endorsed (ranging from O to 23). Higher scores indicate increasingly

 

113

more generalized expectation that reinforcement or events in one's
life are controlled by forces external to oneself (see Appendix G).

The scale yielded an internal consistency coefficient of .70
and test-retest reliabilities ranging from .60 and .83 (one month)
to .49 and .61 (two months) for undergraduate males and females,
respectively.

Validity studies show little correlation with social desirability
measures.' Factor analytic studies support the unidimensionality of
the I-E Scale. Numerous studies provide theoretically expected
empirical associations with other constructs demonstrating the con-
struct validity of the scale (Rotter, 1966; Lefcourt, 1966; Hersch &
Schreibe, 1967).

Description of Treatments

 

Five value education exercises were designed for the present
study. Four of these exercises represent experimental treatments
each designed around a different target value. The fifth exercise
represents a control condition which addresses the importance of
values generally, but does not address any specific target value.
The four experimental exercises differed in content, but paralleled
each Daniin the nature and sequence of activities constituting the
treatment. The design of the control exercise also paralleled the
others, although activities specifically involving target value
examination were omitted.

Value education exercises were randomly assigned to incoming

patients. During the first week of hospitalization, each subject was

 

 

114

scheduled for "research testing.” The subject was then individually
administered the designated value education exercise which consisted
of a pretreatment activity requiring the rank ordering of one set of
18 values (Part I) and, then, the actual treatment exercise (Part II).
The sequence of pretreatment and treatment steps are described in

detail below.

Part I: Pretreatment Value Survey

 

gflgyyet. Each subject was given a three-page handout entitled
”Value Survey--Part I." The first page contained some introductory
comments about the research. These comments informed the subject
that the research concerned value systems, thanked the subject for
participating, informed him that he would be scheduled for two more
sessions in about two or three weeks, instructed him that his own
ideas and personal opinions were the ”best" answers and to ask for
help whenever he was unsure about what he was supposed to do (see

Appendix H).

Step 2. The second page of the handout contained the standard
instructions for rank ordering 18 values on form D of the Rokeach

Value Survey.

ggggng. On the third page of the handout, the subject rank
ordered either the 18 terminal values or the 18 instrumental values
depending on which set of values contained the target value to be
examined. Half of the control subjects ranked the terminal values

and half the instrumental values. The subject returned Part I to

 

115

the experimenter Upon completion and was immediately administered

Part II.

 

Part II: Treatments

Part II consisted of a four-page handout entitled ”Comparing
Your Values With Other People'I for experimental subjects and a two-
page handout entitled "Some Conclusions About Values" for control
subjects.. The first two pages (Steps 4 through 7) involved target
value examination and were omitted from the control exercise (see

Appendices I through M).

Step_4. The subject was presented with a table of scores on
which his ranked ”scores“ for seven values from Part I had been trans-
ferred. The table was designed so the subject could compare his
”scores" with those of former patients. For each experimental treat-
ment, the values in the comparison table were different. However,
the table format and criteria for selecting the relevant values were
the same for each table designed. For each table, the seven relevant
values included the target value, two values with the greatest posi-
tive correlations with the target value found in the pilot study, and
four values with the greatest negative correlations found in the pilot
study. The table was designed so that the subject could determine
whether his target value was ranked high, average, or low in compari-
son with former patients. In addition, he could evaluate to what
extent the six associated values within his value system approximated
the "typical patterns” of former patients. In Step 4, the subject was

simply required to study the comparison table.

116

Step 5. After studying the table, the experimental subjects
were required to respond to the question "Which group do you think
you are most like?" The subject circled his response on a scale

ranging from l--"Almost exactly like the HIGH (target value) group'l

 

to ll--"Almost exactly like the LOW (target value) group."

 

This activity was included in the treatment for several reasons:
(1) to strengthen the probability that the subject will study the
comparison table by requiring an active response to it, (2) to force
the subject to formulate a conclusion about himself in relationship
to the target value, and (3) to have a measure of how consistently

that self-perception reflects the table data.

Step_§, On the second page of Part II, the experimental subjects
were presented a second table. This table provided further informa-
tion about the target value. The table was designed in a dichotomous
fashion to Show differences found in the pilot study between "patients
placing greater importance" and “patients placing less_importance" on
the target value.

The second table offered a variety of statements based on
personality tests, observations of hospital staff, length of stay,
therapist's expectations, and, in some cases, observed changes in
target value rankings for patients on leaving the hospital. The
statements in the table could depict positive, negative, or neutral
patient characteristics for either high or low rankings of the target
value. However, based on pilot study results, positive character-

istics were generally associated with high rankings on self-respect

 

 

117

and responsible and with leg rankings on freedom and self-

 

controlled.

 

The purpose of the second table was to provide information with
the potential to arouse self-dissatisfaction with one's ranking of
the target value. It is necessary that the patient identify with
former patients generally and more specifically with either those
patients ranking the value high or those ranking it low. Given this
identification, he becomes aware of characteristics within himself
that may be implicated by his performance in ranking the target value.
At that point, an affective state of self-dissatisfaction (or satis-

faction) may be aroused.

§£§E_Z- Following presentation of the second table, the subject
was instructed "Once again, indicate which group you think you are
most like." The subject again rated himself on the 11-point scale
as in Step 5. This activity was again included to maintain active
participation on the subject's part and to provide a measure of the
impact of the information in the second table on the subject's

identification with either the high or low group.

Step_§. The third page of Part II for experimental subjects
began with a section entitled "Conclusions About Former Patients."
The first page of Part II for control subjects began with a similar
section entitled "Some Conclusions About Values.‘I

For experimental subjects, several general statements were made
about the target value. In each case, the first statement suggested

that the meaning and importance placed on the target value affects

 

7| .|1'Tll[[| |1l

118

what people feel and do. That statement was followed by some sug-
gestions as to why people may rank the value high or low in the light
of the second table. A final suggestion was made that it would be
worthwhile for people to think about what the target value means to
them and how it may affect them.

For control subjects, four statements are offered which address
values generally. The first statement pointed out that values affect
how a perSon views and feels about things. The second, that values
provide a basis for making decisions and determine what a person does
in many situations. The third statement suggested that when people
change, their values also change in some important ways. The fourth
statement suggested that it is worthwhile for people to know what
values are important to them and how they affect their lives (see
Appendix M).

After the subject had read the conclusions presented in Step 8,
the salient portions of the experimental treatments were considered
completed. The remaining steps (9 to 13) essentially consisted of
questions designed to measure the immediate impact and validity of

the treatments for all subjects.

Step_9. Following presentation of the conclusion statements,
both experimental and control subjects were asked to respond to the
question "What do you think?" They circled their responses on a
scale from 1--”I agree completely . . ." to ll--"I disagree com-

pletely .

 

119

This item was included to further assess the validity of the
treatments through the subject's acceptance of the experimenter's
interpretations and, by inference, the data on which the conclusions

were drawn.

Step 10. All subjects were asked the question, "How do you
feel, right now, about the way you have arranged your values?" The
subjects again circled responses on an 11-point scale. This item was
included to give some indication of any dissatisfaction aroused in

treatment groups in contrast to the control group.

Step 11. On the last page of Part II, subjects were told, "We
would now like to find out what you think about this way of learning
about your values." They were first asked to respond on an 11-point
scale to the question, "Did you find it interesting or thought-

provoking."

Step 12. Subjects were then asked to respond similarly to the

question, "Do you feel you learned something about your values?"

Step 13. Finally, the subjects were required to given an indi-
cation of their overall perception of congruence between their
behavior and value system by responding to the question, "00 most of
the things you do match the way you arranged your values?" (Steps
ll-13 are found in Appendix 0.) After responding to these questions,

all subjects were instructed to turn in Part II.

 

120

Observations of Dependent Variables

 

The measures of the dependent variables in this study were
obtained over a period of four weeks in three separate sessions. The
time frame and specified measures obtained in each session were
identical for every subject. The plan of data collection used is

described below.

we;

Immediately following the value education treatment (Part II
above), each subject was administered the complete Value Survey. It
was labeled Part III (see Appendix N). The subject was first asked
to rank order the set of 18 values that he had not yet been exposed
to. Next, he was asked to once again rank order the set of 18 values
that he had rank ordered in Part I (the initial phase of the value

education exercise).

Time II

Two to three weeks after value education, each subject was
scheduled for a second battery of inventories. This battery consisted
of a second administration of the complete Value Survey and the four
instruments providing the various indirect measures of the target

values (Appendices A, B, C, and 0).

Time III
Three to four weeks after value education, each subject was
scheduled for a third battery of inventories consisting of the three

instruments measuring the four self-regard variables (Appendices E,

F, and G).

 

121

Hypotheses

 

The four major research hypotheses under investigation in this

study are stated as follows:

Hypothesis 1:

 

Patients who received targeted value education will
obtain a higher mean rank on their respective target
value measured at Times I and II than patients
receiving other value education exercises.

Hypothesis 2:
Patients who receive targeted value education will
exhibit less variance in their respective target
value ranks at Times I and 11 than patients receiving
other value education exercises.

Hypothesis 3:

 

Patients who receive value education aimed at a
particular target value will obtain higher mean
scores on the set of indirect measures of their
respective target value at Time 11 than patients
receiving other value education exercises.

Hypothesis 4:

 

Patients who receive targeted value education will
obtain higher mean scores on the set of four self-
regard measures at Time III than patients receiving
the non-targeted control exercise.

Data Matrix

 

Thirty incoming patients within each of the four subgroups
defined by sex and diagnosis were randomly assigned to the five treat-
ment conditions. The design is basically a 5 by 2 by 2 factorial
design in which the three factors (treatment, sex, and diagnosis) are
fixed, crossed, and balanced. There are 20 cells with 6 replications

per cell. Since the first two hypotheses involve the repeated

122

observations of target value rankings at Times I and II, the basic
design is extended into a repeated measures design with the time as

a fourth factor.

Methods of Analysis

 

The general strategy of analysis for each hypothesis involved
two stages. The first stage always consisted of an omnibus test of
the null hypotheses of no treatment main effects and no interaction
of treatment with other factors. The second stage, following rejec-
tion of a given null hypothesis, consisted of post hoc analysis of
the data using the Tukey and Sheffe methods (T and S methods) for
pairwise and complex contrasts, respectively. These procedures were
used to test the specific directional hypotheses for treatment main
effects or simple main effects within each level of any factor inter-
acting with treatment. The specific omnibus procedures used in the

first stage of analysis for each hypothesis are described below.

Analysis: Hypothesis 1

 

A three-way (treatment, sex, and diagnosis) repeated measures
ANOVA was used to evaluate the treatment effects on the rankings of
each of the four target values observed immediately following treat-
ment (Time I) and two to three weeks after treatment (Time II).

Each of the four univariate tests focused on the treatment main
effect and examination of all interaction effects of treatments with

the factors sex, diagnosis, and time.

 

 

123

Analysis: Hypothesis 2

 

Levene's test of homogeneity of variances was used to analyze
the effect of the experimental treatments in reducing the spread of
target value rankings within their respective groups at Time I and
Time II. The analysis consisted of four separate three-way repeated
measures ANOVAS on the absolute value of the difference between the
observed target\nflue ranking and its cell mean rank. The four
univariate tests focused on treatment main effects and all interaction

effects of treatments with sex, diagnosis, and time.

Analysis: Hypothesis 3

 

A three-way multivariate analysis of variance test was used to
evaluate treatment effects and interactions on each set of dependent
variables indirectly measuring their respective target value's
importance. The four separate MANOVAS involved nine dependent vari-
ables observed only at Time II; three dependent variables associated
with freedom and two dependent variables for each of the other target

values.

Analysis: Hypothesis 4

 

A single three-way MANOVA was used to analyze the effects of
treatments and interactions of treatments with sex or diagnosis on the
set of four dependent variables measuring self-regard observed three

to four weeks after treatment (Time III).

 

124

Significance Levels

 

Different alpha levels were used for the two stages of the
analysis. For each omnibus test, the level of significance was set
at .10 in order to reduce the probability of making a type II error.
The rationale for this approach is based on two considerations.
First, the F test includes numerous non-directional tests of differ-
ences among the five treatment groups which are not of interest in
this study. Thus, the omnibus test is more conservative than a
planned comparison focusing on the single contrast of interest. On
the other hand, theory in the area of value change is not sufficiently
strong to support the use of planned contrasts. A second considera-
tion involves the limited number of subjects across treatments (cell
n = 6) within each level designated by sex and diagnosis. Glass and
Stanley (1970) recommend setting alpha at .10 or .15 when a small
number of subjects are involved in order to reduce the probability
of a type 11 error.

At the second stage of analysis, specifically examining the
directional research hypotheses, greater protection against a type I
error was employed. A non-directional test at the .10 level of
significance uses a critical value comparable to a directional test
at the .05 level of significance. Since the post hoc hypotheses of
interest were directional, the level of significance should be
interpreted as .05. Even though the T and S methods are employed in
a one-tailed manner, they still provide conservative tests. They
are designed to provide a given level of protection for the collection

of all possible constrasts among treatment groups. However, in the

 

125

present study, a maximum of four pairwise contrasts held potential
interest. Using the S-method, only 11 complex directional tests

between a designated target group and all combinations of 2, 3 and 4

 

of the comparison groups were of interest.

Summary

The sample for this study consisted of 60 male and 60 female
psychiatric inpatients. Thirty non-psychotic patients and 30 psychotic
patients (per admitting diagnosis) were represented within each sex
group. Patients within each of the four subgroups were randomly
assigned to one of five value education exercises. Four experimental
exercises and one control exercise were used. The four experimental
treatments were similar in format and each directed at examining the
importance of a different target value. The control exercise was not
targeted.

Incoming experimental patients were first asked to rank order a
set of 18 values which contained their target value. They were then
given three types of information: (1) an indication of whether their
rank placement of the target value was high or low in comparison to
other patients, (2) statements about some characteristics of patients
who ranked the target value high and those who ranked it low, and
(3) the experimenter's conclusions about the significance of the
target value when ranked high or low. Control subjects received only
information suggesting that values generally were important to under-

standing feelings and behavior.

 

126

Immediately after completing the exercise, each subject was

administered the complete Value Survey(both sets of 18 values). Two

 

weeks later, the subject was administered the Value Survey for a

 

second time and a number of indirect measures of each of the target
values using other instruments measuring the same or a closely related
construct. Three weeks later, the subject was administered three
instruments measuring four dimensions of self-regard.

Four separate three-way repeated measures ANOVAS were used to
test for treatment main effects and simple main effects on each of
the four target values' mean ranks. Levene's test was used in four
three-way repeated measures ANOVAS to test for treatment main effects
and simple main effects in reducing the variance of target value
rankings. Four three-way MANOVAs were used to assess treatment effects
on each set of indirect measures corresponding to a target value. A
single three-way MANOVA was used to assess treatment effects on the
set of four self-regard variables. All significant omnibus tests
were followed with contrasts using the Tukey and Sheffe methods to

test for the directional differences as hypothesized.

CHAPTER V

ANALYSIS OF RESULTS

Chapter V is organized into six sections. The results associated
with the four major hypotheses of this study are presented in the
first four sections. In each section, the hypothesis is generally
examined by analysis of observations related to each target value

taken in the following sequence: freedom, self-respect, responsible,

 

 

 

self-controlled.

 

The effects of value education on target value rankings across
time are examined in the first section. Results of the analysis of
the effects of value education on the variance of target value ranking
are presented in the second section. The analysis of effects of value
education on indirect measures of target values is presented in the
third section. The fourth section is a presentation of results of
the analysis of value education effects on self-regard. The fifth
section is a discussion of the results associated with each hypothesis.
The final section is a summary of the results associated with each
value education exercise.

Analysis of the Effects of Value Education
on Target Value Ranking

 

 

The major experimental hypothesis under consideration in this

section is stated as follows:

127

 

 

128

Hypothesis 1:

 

Patients who receive value education directed at
examining the importance of a target value (freedom,
self-respect, responsible, or self-controlled) will
obtain a higher mean rank across time on the target
value than patients receiving other value education
exerCTses.

A three-way repeated measures analysis of variance was used to
evaluate the treatment effects on the rankings of each of the four
target values. Each of the four statistical tests focused on the
treatment main effect and examination of all interaction effects of
treatments with the factors sex, diagnosis, and time. Following the
methods and rationale of analysis presented in Chapter IV, all ANOVA
findings significant at the .10 level will be presented for each
target value. (F ratios for all sources of variance can be found in
Table P-l, Appendix P.) Each significant omnibus test will be
followed by presentation of the appropriate means and directional
comparison tests of the means using the T and S methods at a signifi-
cance level of .05 (one-tailed).

In addition to the fomal analysis outlined above, some non-
significant trends, either consistent with or contrary to the
hypotheses, will be noted in the presentation of results.

Effects of Value Education on
Rankings of Freedom

 

 

In the three-way repeated measures ANOVA on the ranking of free-
gpm, no significant treatment main effects were found. Out of all
interaction effects involving treatments, only the treatment by

diagnosis interaction was significant (F = 3.495, P = .010,

 

 

 

129

df = 4,100). The mean rankings of freedom for each treatment group
within the two levels of diagnosis are given in Table 5.1. It was
predicted that patients receiving Treatment 1 (freedom) would obtain
higher mean rankings on freedom within each level of diagnosis than

patients in the comparison groups.

TABLE 5.1.--Mean Rankings of Freedom by Diagnosis and Treatment

 

 

 

Groups.
Diagnostic Category

Treatment Group Non-Psychotic Psychotic
1. Freedom 7.92* 9.58*
2. Self-Respect 6.71 11.00

3. Responsible 11.00 9.21

4. Self-Controlled 9.46 7.25

5. Control 9.42 9.33

 

*Not significantly higher than comparison groups.

Comparison of the means for simple main effects among pep;
psychotic patients reveals that Group 1 exceeds Groups 3, 4, and 5.
The mean difference between Group 1 and Groups 3, 4, and 5 is 2.04.
The critical difference for this complex contrast using the Scheffe
method is 3.29 (P = .05, df = 4,100). Pairwise comparison of Group 1
with each of the three groups using the Tukey method reveals that

none of the differences exceed the critical difference of 3.56

 

130

(P

.05, df = 100). Comparison of the means for simple main effects
among psychotic patients reveals that Group 1 exceeds only Group 2 by
a mean rank difference of 1.42 which is not significant using the
Tukey method.

Effects of Value Education on
Rankings of Self-Respect

 

 

No treatment main effects or interaction effects involving

treatments were found in the repeated measure ANOVA of self-respect

 

rankings. The mean rankings on self-respect across time for each

 

treatment group are found in Table 5.2.

TABLE 5.2.--Mean Rankings on Self-Respect at Times I and II for Each
Treatment Group.

 

 

 

 

Mean Rank
Treatment Group Time I Time 11 Change
1. Freedom 6.88 5.42 + 1.46
2. Self-Respect 5.83 6.42 - .59
3. Responsible 8.17 6.54 + 1.63
4. Self-Controlled 7.21 5.21 + 2.00
5. Control 6.37 5.33 + 1.04

 

It is of interest to note that patients in Group 2 (Self—Respect)
obtained the highest mean rank at Time I as predicted. However,

Grom32 was also the only group to exhibit a decrease in rankings from

 

131

Time I to Time II in contrast to consistent increases across the
comparison groups. The target group did not maintain high ranks as
predicted and deviates from the general maturational pattern of
increased ranks observed in the comparison groups.

Effects of Value Education on Ranking
of Responsible

 

 

The repeated measures ANOVA on the rankings of responsible

 

resulted in two significant findings: a treatment main effect
(F = 2.538; P = .044; df = 4,100) and a treatment by diagnosis by
time interaction (F = 2.148; P = .080; df = 4,100). The mean rank-

ings for each treatment group are given in Table 5.3.

TABLE 5.3.--Mean Rankings of Responsible for Each Treatment Group.

 

 

 

Treatment Group Mean Rank
1. Freedom 7.15

2. Self-Respect 8.20*
3. Responsible 6.43*
4. Self-Controlled 8.89*
5. Control 6.33

 

*
Group 3 significantly higher than groups 2 and 4 (T-method,
= 1.76, P = .05, df = 100).

O

 

132

Patients receiving Treatment 3 (responsible) obtained higher
mean rankings than Groups 1, 2, and 4, but did not exceed the control
group. The mean difference between Group 3 and Groups 1, 2, and 4 is
1.65 and does not exceed the critical difference of 2.29 determined
by the Scheffe method (P = .05, df = 4,100). Pairwise comparison
between Group 3 and each of the other treatment groups reveals that
Groups 2 and 4 exceed the critical difference of 1.76 using the T-
method.

The mean rankings of responsible across time for non—psychotic

 

and psychotic patients in each treatment group are presented in
Table 5.4. Comparison of mean ranks and mean difference (change)

scores for simple main effects among non-psychotic groups revealed

 

neither significantly higher rankings at Times I and II, nor a sig-
nificant increase (change) over time. Comparison of mean ranks and
change scores among psychotic patients for simple main effects revealed
that psychotic patients in Group 3 obtained significantly higher rank-
ings at Time II than psychotic patients in the comparison group.

Mean rankings at Time I and mean change scores for Group 3 were not
significantly greater than any one of the comparison groups.

Effects of Value Education on
Rankings of Self-Controlled

 

 

The repeated measures ANOVA did not reveal any significant treat-
ment main effect or interaction effects involving treatment. The

mean ranks on self-controlled for treatment groups and each sex by

 

treatment group are presented in Table 5.5.

 

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134

TABLE 5.5.--Mean Ranks on Self-Controlled for Males and Females in
Each Treatment Group.

 

 

 

 

Mean Rank
Treatment Group Male Female Combined
1. Freedom 8.79 9.17 8.98
2. Self-Respect 9.25 9.29 9.27
3. Responsible 7.28 11.13 9.21
4. Self-Control 10.66 7.38 9.02
5. Control 8.20 9.37 8.54

 

Mean ranks are presented separately for sex groups in Table
5.5 even though the treatment by sex interaction was not significant
(F = 1.933; P = .110, df = 4,100). Within levels of sex, Group 4
males exhibit the lowest mean while only Group 4 females exhibit the
highest mean as predicted.

Analysis of the Effects of Value Education
on the Variance of Target Value Rankings

 

 

The value education exercises were constructed to provide
negative information associated with high rankings, as well as low
rankings, on some of the target values. In addition, the thrust of
the treatments was not designed or expected to suggest that any
particular target value belonged in the number 1 rank order position.
As a consequence, it was predicted that the treatments would reduce

the variance of their respective target value rankings.

 

135

The major experimental hypothesis under consideration is stated
as follows:

Hypothesis 2:

 

Patients who receive value education aimed at examining
a particular target value will exhibit less variance in
their rankings of that target value across time than
patients receiving other value education exercises

when observed immediately and two to three weeks after
intervention.

A three-way repeated measures ANOVAS using Levene's test of
homogeneity of variances was employed for each target value and
followed by post hoc analysis of significant omnibus test findings.
(F ratios for all sources of variance can be found in Table P—Z,
Appendix P.) The results for each target value are presented below.

Effects of Value Education on the
Variance of Freedom Rankings

 

The three-way repeated-measures ANOVA on the absolute deviation
(rank minus cell mean) scores of freedom resulted in only one signifi-
cant finding: a time by treatment by diagnosis interaction (F =
2.194; P = .075; df = 4,100). The mean deviation scores across time
by treatment and diagnostic groups are presented in table 5.6.
Comparison of the means reveals that non-psychotic and psychotic
patients receiving Treatment 1 (freedom) do not exhibit significantly
lower variances at either time or decreased variance in rankings

across time as hypothesized.

 

136

TABLE 5.6.--Mean Deviation Scores on Freedom Across Time by Treatment
and Diagnosis.

 

 

 

Non-Psychotic Psychotic

Treatment

Group Time I Time II Change Time I Time 11 Change
1. Freedom 2.7 3.4 - .7 3.3 3.9 - .6
2. Self-Respect 4.7 3.3 1.4 2.8 2.9 - .1
3. Responsible 3.2 4.1 - .9 3.4 3.6 - .2
4. Self-Control 3.3 3.0 .3 3.0 3.1 - .1
5. Control 1.8 3.0 -l.2 3.8 2.1 1.7

 

Effects of Value Education on the
Variance of Self-Respect Rankings

 

 

The ANOVA of self-respect deviation scores resulted in a sig-
nificant treatment main effect (F = 3.034; P = .021; df = 4,100).

Two significant interaction effects were also found: (1) treatment
by diagnosis (F = 2.331; P = .061; df = 4,100) and (2) time by treat-
ment by sex (F = 3,050; P = .020; df = 4,100).

The mean deviation scores for treatment by diagnostic group and
combined groups are given in Table 5.7. Comparison of the combined
group means (main effect) reveals that patients receiving Treatment
2 exhibited a mean deviation score that was only lower than Group 3
(a non-significant difference). Investigation of simple main effects

among non-psychotic patients reveals that Group 2 obtained a lower

 

mean deviation score than Groups 3 and 4 (non-significant differences).

 

 

137

TABLE 5.7.--Mean Deviation Scores on Self-Respect by Treatment and

 

 

 

Diagnosis.
Treatment Group Non-Psychotic Psychotic Combined
1. Freedom 2.4 2.2 2.3
2. Self-Respect 2.6* 4.0* 3.3*
3. Responsible 2.9 4.2 3.5
4. Self-Control 2.8 3.2 3.0
5. Control 1.6 3.6 2.6

 

*
Group 2 not significantly lower than any comparison group.

Among psychotic patients, Group 2 obtained a lower mean deviation
score than Group 3 which is also not significant.

The mean deviation scores representing the time by treatment by
sex interaction are presented in Table 5.8. Investigation of simple
main effects among males reveals that Group 2 exhibited the greatest
decrease in variance over time (as predicted). However, this change
is not significantly different from any of the comparison groups.
Among females, Group 2 was the only one to exhibit increased variance
across time, and directly opposite to hypothesized results. Group 2
females did obtain the lowest variance at Time I as predicted and

significantly lower than Group 3 females.

 

138

TABLE 5.8.--Mean Deviation Scores on Self-Respect Across Time for
Males and Females in Each Treatment Group.

 

 

 

 

 

Male Female

Treatment

Group Time I Time II Change Time I Time II Change
1. Freedom 2.0 3.6 -l.6 2.4 1.1 1.3
2. Self-Respect 4.0 3.3 .7* 2.3** 3.6 -l.3
3. Responsible 3.8 3.3 .5 4.5** 2.5 2.0
4. Self-Control 2.8 3.0 - .2 3.9 2.1 1.8
5. Control 2.8 3.0 - .2 2.6 1.8 .8

 

*
Not significantly different from comparison groups.

**Significantly different (T-method, C = 2.1, P = .05, df = TDD)

Effects of Value Education on the
Variance of Responsible Rankings

 

 

The ANOVA of deviation scores for responsible resulted in a sig-

 

nificant time by treatment by sex interaction (F = 2.032; P = .096;
df = 4,100). The mean deviation scores across time for males and
females in each treatment group are presented in Table 5.9. Compari-
son of the means for simple main effects among males reveals that
Group 3 exhibits both a significantly lower variance at Time II and a
significant decrease in variance over time when contrasted with

Group 1.

   

139

TABLE 5.9.--Mean Deviation Scores on Responsible Across Time for
Males and Females in Each Treatment Group.

 

 

 

 

 

 

Male Female
Treatment
Group Time I Time II Change Time I Time II Change
1. Freedom 2.6 4.9* -2.3** 3.0 2.7 .3
2. Self-Respect 3.7 3.3 .4 3.8 3.5 .3
3. Responsible 3.3 2.0* 1.3** 3.3 3.5 - .2
4. Self-Control 4.5 2.9 1.6 3.5 3.1 .4
5. Control 1.7 1.9 - .2 3.8 2.5 1.3
*Significant difference (T-method, C = 2.3, P = .05, df = 100)
**Significant difference (T-method, C = 3.1, P = .05, df = 100)

Effects of Value Education on the Variance
of Self-Controlled Rankings

 

 

The ANOVA of deviation scores on rankings of self-controlled

 

resulted in a significant treatment main effect (F = 2.574;

P = .042; df = 4,100). The mean deviation scores for each treatment
group are given in Table 5.10. Inspection of the means reveals that
Group 4 obtained the highest variance among treatment groups, and
directly opposite hypothesized results.

Analysis of the Effects of Value Education
Indirect Measures of the Target Values

 

 

Two to three weeks after the value education interventions, all
subjects were administered four sets of indirect or alternative

measures of the importance of each of the target values. This

 

140

TABLE 5.10.--Mean Deviation Scores on Self-Controlled for Each
Treatment Group.

 

 

 

Treatment Group Mean Deviation Score
1. Freedom 4.4
2. Self-Respect 4.5
3. Responsible 3.8
4. Self-Controlled 4.6
5. Control 3.2

 

involved a total of nine dependent variables; three associated with
freedom and two associated with each of the other three target values.
This involved a total of nine dependent variables; three associated
with freedom and two associated with each of the other three target
values.

The major hypothesis under consideration is stated as follows:

Hypothesis 3:

 

Patients who receive value education directed at
examining a particular target value will place
greater importance on closely related constructs
indirectly measuring that value than subjects
receiving other value education exercises when
observed two to three weeks after intervention.

A three-way multivariate analysis of variance test was used to
evaluate treatment effects and interactions on each of the four sets
of indirect measures corresponding to the target values. (F ratios

for all sources of variance in the multivariate and univariate

 

T41

ANOVAS can be found in Tables P-3 through P-lO, Appendix P.) The
findings for each set of dependent variables are presented in this

section.

Indirect Measures of Freedom

 

The three-way MANOVA on the set of three dependent variables
indirectly measuring the importance of freedom resulted in a signifi-
cant treatment by sex interaction (Multivariate F = 1.569, P = .100,

df = 12,259.575). The univariate F test results for each of the three

dependent variables are as follows: Independence (PVS) (F 1.761,

 

P = .142, df = 4,100); Acceptance of Authority (F = 2,381, P = .056,

 

df = 4,100); Independence (SIV) (F = 1.114, P = .354, df = 4,100).

 

The mean scores for each dependent variable by sex and treatment
group are presented in Table 5.11. Inspection of the mean scores
reveals that among all females, those receiving Treatment 1 obtained
mean scores as predicted on each dependent variable. Post hoc
analysis of simple main effects resulted in significant differences

only for females on acceptance of authority. Group 1 females were

 

significantly lower (more independent of authority) than the four
comparison groups using the S-method (critical difference = 7.38,
P = .05, df = 4,100). Pairwise comparison yielded significant dif-
ferences only between Group 1 and Groups 3 and 4 (T-method, critical

difference = 8.27, P = .05, df = 100).

 

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143

Indirect Measures of Self-Respect,
Responsible, and Self-Controlled

 

 

The three-way MANOVA's on the three remaining sets of indirect
measures resulted in no significant findings. However, the treatment
group means reflect a trend in which the higher means on the dependent
variables are associated with their respective target groups. The
treatment group means for each of the indirect measures are presented
in Table 5.12.

Analysis of the Effects of Value Education
on Measures of SeTf—RegardT

 

 

Three to four weeks after value education, all patients were
administered four conceptually distinct measures of self-regard.
These dependent variables are designated as follows: (1) Self-esteem,
(2) Self—Acceptance, (3) Self-Satisfaction, and (4) Internal versus
External Locus of Control.

The major hypothesis under consideration is stated as follows:

Hypothesis 4:

 

Patients who‘receive value education aimed at examining
a particular target value will obtain higher mean
scores on the four measures of self—regard three to
four weeks after interventRNTthan patients receiving a
non-targeted control value education exercise.
A three-way multivariate ANOVA was used to analyze the effects
of treatments and interactions between treatments and sex or diagnosis
on the four dependent variables measuring self-regard observed three
to four weeks after intervention. (F ratios for all sources of
variance in the MANOVA and univariate ANOVAS can be found in Table

P-ll, Appendix P.)

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145

Results

No significant differences in treatment main effects or inter-
actions with treatment were found among treatment groups for the set
of four measures of self-regard. While not under investigation in
this study a significant diagnosis main effect was observed (Multi-
variate F = 2.906, P = .025, df = 4,97). The significant univariate

F tests were observed on self-acceptance (F = 7.948, P = .005,

 

df = 4,100) and self-satisfaction (F = 2.939, P = .089, df = 4,100).

 

On both variables, psychotic patients in all experimental groups
exhibited more positive self-regard than non-psychotic patients while
the control group exhibited an opposite pattern. Although the treat-
ment by diagnosis interaction was not significant, the pattern of
mean scores for psychotic patients is consistent with the hypothesis.
A distinction between experimental and control subjects is suggested
by this trend. The mean scores for the two groups are presented in

Table 5.13.

TABLE 5.13.--Mean Scores for Experimental and Control Subjects on
Self-Acceptance and Self-Satisfaction by Diagnosis.

 

 

 

 

Variable Diagnosis Experimental Control Combined
Self-Acceptance: .Non-Psychotic 160.69 166.83 161.92
Psychotic 179.10 163.25 175.94
Self-Satisfaction: Non-Psychotic 52.71 46.75 51.52
Psychotic 40.41 52.75 42.88

 

*
Low means indicate higher self-satisfaction (less self minus
ideal discrepancy).

 

146

Discussion of Results

 

The results are discussed below in the same order as presented.
Trends in the data presented above, or even observed in the course of
analysis, are freely discussed. Efforts are made to integrate some
of the findings, relate them to the pilot study, compare treatments
with one another, and to formulate some conclusions about the results
and methods of analysis.

Treatment Effects on Rankings
of Target Values

 

 

The results of this study indicate that the experimental value

education exercise aimed at reponsible was the most generally effec-

 

tive of the four in increasing the rank importance of its target
value. It was especially effective for psychotic patients over time.
Patients receiving the “responsible exercise'l exhibited a rank

increase in the level of importance on responsible within two to three

 

weeks comparable to the level pilot study subjects exhibited upon
discharge from the hospital after an average length of stay of five
weeks. The responsible exercise had a one-directional thrust, i.e.,
favorable characteristics were consistently associated with higher
ranks. Therefore, it could be expected to be more consistent with the

hypothesis than the freedom or self-controlled exercises. It would

 

affect all subjects in a similar manner by maintaining high initial
ranks or raising low ones. The responsible exercise may be expected

to be measurably superior to the self-respect exercise based on two

 

factors: (1) the greater stability and presumed resistance to change

of a terminal value, and (2) the relatively higher entering ranks on

 

147

self-respect which place it near the "ceiling" of the 18 unit con-

 

tinuum. Any other important terminal values occupying higher posi-

tions than self-respect are extremely stable and effectively act as

 

a ceiling as well.

Trends were observed across the other three exercises suggesting
weak treatment effects on their target values. The freedom exercise
resulted in the greatest increase in freedom rankings over time and
the higheSt mean rank at Time II. The freedom exercise had a two-
directional thrust, i.e., negative patient characteristics associated
with high ranks while still emphasizing the importance of freedom.

In contrast to the usual picture, psychotic patients in the freedom
group had lower ranks than non-psychotics. This suggests that such a
two-directional treatment thrust was operating. The information about
freedom promoted an increase in ranks for non-psychotics and a
decrease for psychotic patients.

The self-respect exercise was clearly the most one-directional

 

in favoring higher ranks. It resulted in the highest mean rankings

of self-respect immediately following treatment. However, these

 

immediate effects were not maintained across time (except by non-
psychotic males who typically show lowest entering ranks and greatest
rank increase as a function of hospitalization). Thus, the effects

of the self-respect exercise suggest experimental compliance forcing

 

self-respect rankings upward. Since self-respect is a high ranking

 

 

terminal value generally and surpassed only by a small number of the

most stable and important values held by an individual, major

 

T48

cognitive reorganization would be necessary to maintain increased
rankings over time.

The self-controlled exercise also exhibited a trend suggesting

 

a differential two-directional effect. Females receiving this

exercise obtained the highest mean ranking of self-controlled while

 

males received the lowest mean rankings (in contrast to each other
and across their respective sex groups). This pattern is opposite
the pilot study characteristics of males and females who rank self-

controlled high and low, respectively. The content of the self-

 

controlled exercise presents negative patient characteristics asso-

 

ciated with high ranks while still emphasizing the importance of

self-controlled for improved function. Thus, the pattern of mean

 

rankings for males and females after intervention is consistent with

the dual thrust of this exercise.

Treatment Effects on Target Value
Variance

 

With a few exceptions, the results of this study consistently
yielded results directly opposite those hypothesized for target
value variances. Highest variances on target values as well as
increased variances over time were frequently observed among experi-
mental groups. In contrast, the control group exhibited lowest vari-
ances on three of four target values at Time I and all four target
values at Time 11. Two general conclusions are suggested.
(1) Targeted value education is likely to increase the variance on
the target value as well as other values within the value system.

(2) A non-targeted exercise is not likely to introduce additional

149

variance in rankings of individual values within the system. It is
possible that these findings are an artifact of the rank ordering
technique or individual reactions to interventions involving both
extreme upward and downward shifts in ranks.

Statistical support for the hypothesis of decreased variance
induced by value education was found in highly restricted instances.

The self-respect exercise yielded lowest variance for females at

 

Time I. This finding is likely to be a function of the compliance
effect noted earlier and ceiling effects associated with the nature

of self-respect as a high-ranked terminal value generally, and for

 

female patients in particular (an entering characteristic found in
the pilot study). It was also noted that among all patients, non-

psychotic males receiving the self-respect exercise revealed greatest

 

decrease in variance over time. This was the only subgroup receiving

the self-respect exercise to increase rankings over time. Again, a

 

combination of a treatment effect and time (maturation) effect was
likely to enhance the ceiling effect and reduce variance for this
subgroup.

Statistical support for reduced variance effects of the

responsible exercise was found, but restricted to male patients

 

observed at Time II. Pilot study results revealed a substantial

increase and a high mean discharge ranking of responsible (4.31) for

 

male patients. Again, the reduced variance observed may be a ceiling
effect achieved by the combined effects of treatment, time (matura-

tion), and sex.

 

150

The subjects in the freedom exercise group exhibited the greatest
increase in variance of freedom over time. This group also exhibited
the greatest increase in mean rank over time and highest Time II
rankings of freedom. It is suggested that the two-directional thrust
likely reduced variance on freedom at Time I, while the delayed treat-
ment effect served to increase both rankings and variance at Time 11.
Thus, treatment effects on rankings may have been different at Time I
(two—direCtional) and at Time II (more one-directional) resulting in
a net increase in variance over time. It should also be noted that
freedom is generally ranked in the middle of the 18 unit continuum of
terminal values and has greater variance than values lying toward

either end.

Treatment Effects on Indirect Measures
Statistical support for the effectiveness of the freedom
exercise in increasing the importance of freedom was demonstrated when

jjggyyyp is measured indirectly by the variable acceptance of authority.

 

However, only females receiving the freedom exercise exhibited sig-
nificantly lower scores on this measure. In the pilot study, females
exhibited greater increases in rankings of freedom than males at the
time of discharge. Those results suggested that the value freedom
may have special significance for females. It can be concluded that
the freedom exercise is effective in producing repercussive effects
within the cognitive system of females to significantly alter their
attitudes and perceptions in relationship to authority. These

repercussive effects are further supported by evidence of these

 

151

females placing highest importance on the two other indirect measures,

independence (PVS) and independence (SIV).

 

 

While not significant upon analysis, five of the remaining six
indirect measures exhibited mean scores consistent with predictions.
This pattern of mean scores is clearly above chance when the value
education exercises are viewed as four replications of an experi-
mental procedure. The trends observed suggest that all of the treat-
ments may have repercussive effects in cognition that produce
observable changes in alternative measures of a given target value's
importance two to three weeks after intervention.

Individualism promises to serve as an alternative construct in

 

measuring the importance of self-respect. The measures of social

 

responsibility and conformity gave evidence of being enhanced, for

 

 

males and females, respectively, by the responsible exercise. The

measure self—control resulted in highest means for females receiving

 

the self-controlled exercise.

Treatment Effects on Self-Regard

 

Multivariate analysis of the set of four self-regard variables
yielded no significant treatment effects of interactions with treat-
ment. The conclusion is that self-regard was not enhanced by epy_of
the four experimental value education exercises. The results under-
score the centrality and stability of self-conceptions and their
historical resistance to change by experimental interventions. The
functional links between value change and enhanced self-regard will

likely remain an area of investigation for years to come.

 

152

Before concluding that any studies into the relationships
between value education and enhanced self-regard are not likely to
be productive, there are some aspects of the present analysis of
self-regard that should be noted. Analysis did reveal a diagnosis
main effect with psychotic patients generally revealing greater self;

acceptance and self-satisfaction (less self-ideal-self discrepancy)

 

 

than non-psychotic patients. While that finding was not specifically
relevant for this study, it raises interesting questions about dif-
ferences in self-perception and ego defenses between the two diagnos-
tic groups. It was further observed that the diagnosis effect was
restricted to the experimental groups with the control group reflect-
ing a slight but opposite pattern of scores. Considering only
psychotic patients, all experimental versus control, these data are

consistent with the major hypothesis.. Using self-acceptance as an

 

example, it is of interest to note that a contrast of all experi-
mental versus control psychotic patients yields a t-ratio of 1.80
(significant at the .05 level). This raises the question of whether
or not the method of analysis was sufficiently powerful to assess the
effects of value education on self-regard. Clearly, any analysis
which weights the control group appropriately against all experimental

subjects may give evidence of general effects of targeted value educa-

 

tion versus non-targeted activities. Assessing whether a specific
target value has greater implications for self-regard than another is
a separate and more demanding question from a methodological stand-

point.

153

Summary of Results

 

The results of this study are summarized below by presenting
the findings associated with each of the five treatment groups. For
each group, any specific research hypotheses supported are first
stated. Secondly, several types of trends related to the treatment
group are stated. (1) Since each of the four experimental treatments
are conceptualized as replications of a basic procedure, one type of
trend presented primarily reflects predicted, but non-significant,
findings occurring across the four replications. These trends are
viewed as jointly supportive of the major hypotheses. (2) Trends
are presented that reflect findings that are opposite prediction, yet
consistent across treatments. (3) Trends reflecting differential
characteristics of treatments that were anticipated are also presented.

A11 trends are viewed as identifying areas for further study.

Treatment Group 1 (Freedom)

 

Hypothesis Supported:

 

Female patients receiving value education aimed at
freedom exhibit less acceptance of authority two to
three weeks later than females in four comparison
value education groups.

Trends Observed:

 

1. Group 1 exhibited the greatest increase over time
in rankings of freedom and the highest mean ranking
at Time II among the five groups.

2. Group 1 non-psychotic patients exhibited higher
mean rankings on freedom than three comparison
groups of non-psychotic patients.

3. Contrary to prediction, Group 1 exhibited the
greatest increase in variance of freedom rankings
across time.

 

154

4. Group 1 exhibited the highest mean score on
independence (SIV).

 

5. Group 1 females and non-psychotic males exhibited
the highest mean scores on independence (PVS)
among their respective comparison groups.

 

Treatment Group 2 (Self-Respect)

 

Hypothesis Supported:

 

Female patients receiving value education aimed at

- self-respect exhibit less variability in their
rankings of self-respect when observed immediately
after intervention than females receiving value
education aimed at responsible.

 

 

 

Trends Observed:

 

1. Group 2 exhibited the highest mean self-respect
ranking at Time I with a slight mean decrease by
Time II while all comparison groups exhibited a
consistent, significant increase from Time I to
Time II. (Within Group 2, only the non-psychotic
male tubgroup exhibited an increase in rank over
time.

 

2. Group 2 non-psychotic males exhibited the greatest
decrease in variance of self-respect among all non—
psychotic males.

 

3. Contrary to prediction, Group 2, as a whole,
exhibited the greatest variance on self-respect
rankings at Time II among the five groups.

 

4. Group 2 exhibited the highest mean score on
individualism among all groups. (Group 2 non-
psychotics obtained the highest cell means.)

 

5. Group 2 exhibited the second highest mean on
leadership.

 

Treatment Group 3 (Responsible)

 

Hypotheses Supported:

 

Patients receiving value education aimed at responsible

 

obtain higher mean rankings of responsible when
observed immediately and two to three weeks after

 

 

155

intervention than patients receiving value education
aimed at self-respect or self-control.

 

 

Psychotic patients receiving value education aimed
at responsible obtained higher rankings on responsible

 

 

two to three weeks after intervention than four groups
of psychotic patients receiving other value education
exercises.

Male patients receiving value education aimed at
responsible exhibit less variability in ranking of
responsible when observed two to three weeks after
intervention than male patients receiving value

. education aimed at freedom.

 

 

Trends Observed:

 

1. Group 3 patients exhibited the greatest increase
in rankings of responsible over time among the
five groups.

 

2. Group 3 patients exhibited the highest mean scores
on conformity among the five groups. (Group 3
females obtained the highest cell means.)

 

3. Group 3 males obtained the highest mean score on
social responsibility among all males.

 

Treatment Gropp 4 (Self-Controlled)

 

Trends Observed:

 

1. Group 4 females exhibited the highest mean ranking
of self-controlled among all females.

 

2. Contrary to prediction, Group 4 males exhibited
the lowest mean ranking of self-controlled among
all males.

 

3. Group 4 was the only group to exhibit a decrease
in variance of self-controlled rankings over time,
while exhibiting the highest overall variance
(contrary to prediction).

 

4. Group 4 exhibited the highest mean score on self-
control (indirect) among the five groups.

 

156

Treatment Group 5 (Control)

 

Trends Observed:

 

1. The control group exhibited the lowest variance
on every target value at Time I and Time II with
the exception of self-respect rankings at Time I.

 

2. Within the control group little difference was

observed on self-regard measures between psychotic

and non-psychotic patients. Experimental sub-

jects exhibited significantly higher self-regard

for psychotic than non-psychotic patients.

In summary, statistical support for Hypothesis 1 was provided

by Treatment 3. No support was offered for Hypothesis 2. Treatment
1 provided some support for Hypothesis 3 among females. No support

was offered for Hypothesis 4.

CHAPTER VI

SUMMARY AND CONCLUSIONS

Summary

This study was designed to assess the effectiveness of targeted
value education with adult psychiatric inpatients. It represented an
application of Milton Rokeach's (1973) theoretical and methodological
contributions toward the understanding of human values. The first
phase of this research consisted of a pilot study designed to isolate
psychologically important values. Those values became the target
values for each of the experimental value education exercises under
investigation in the second phase of the study.

The pilot study used a sample of 58 patients who were administered

the MMPI and the Value Survey upon hospital admission and discharge.

 

The Value Survey measures the rank importance of 18 terminal values

 

(preferable end states) and 18 instrumental values (preferable modes
of conduct). Behavioral ratings were obtained from nursing staff on

the MACC-Behavioral Adjustment Scale for each patient at the begin-

 

ning and end of hospitalization. One year after discharge, each
patient's therapist was surveyed to obtain data on the patient's
clinical status and likelihood of future hospitalization.

The pilot study resulted in the isolation of two terminal values,

fpeegom_and self-respeCt, and two instrumental values, responsible

 

and self-controlled. Each of the four values exhibited a significant

 

157

 

158

increase in mean rank importance over the course of hospitalization.
Many significant relationships were found between each target value
and variables including other values, personality characteristics,
diagnostic status, behavior patterns in the hospital, length of
hospital stay, and likelihood of future hospitalization. The find-
ings provided a consistent and interpretable network of relationships
for each target value which amplified its psychological significance
and meaning. The findings also provided ample content for designing
a value education exercise aimed at each target value. In general,

self-respect and responsible revealed consistent favorable clinical

 

 

implications associated with higher rankings both on admission and
discharge. Freedom revealed a differentiated pattern of findings in
which high entering ranks were associated with unfavorable clinical
characteristics, while favorable clinical implications were associated
with low entering ranks, rank increases, and higher outcome ranks.

Self-controlled revealed an association between unfavorable clinical

 

characteristics and high ranks both upon admission and discharge,
while favorable clinical implications were associated with low enter-
ing ranks and low rankings at discharge (even though significant
increases were observed over the course of hospitalization).

In the experimental phase of this study, four experimental value
education exercises were designed in a similar format, but differed
in target value and content. A fifth non-targeted value education
exercise was designed for use with a control group. The sample con-
sisted of 120 incoming adult psychiatric inpatients and represented

four equal subgroups of 30 based on sex and an admitting diagnosis of

 

159

psychotic or non-psychotic. Patients from each subgroup were randomly
assigned to one of the five value education treatments. Subjects
receiving experimental treatments first were required to rank order
that set of 18 values which included their target value, while control
subjects were randomly divided and asked to rank either terminal or
instrumental values. Experimental subjects were then given three
general types of information: (1) an indication whether their rank
placement of the target value was high or low in comparison to former
patients, (2) statements about characteristics of patients who rank
the value high and those who rank it low, and (3) the experimenter's
conclusions about the significance of the value when ranked high or
low. Control subjects received only a series of experimenter's
statements suggesting that values, generally, were important to under-
standing feelings and behavior.,

Four hypotheses were advanced which predicted that targeted
value education would (1) increase the mean rank importance of its
respective target value, (2) reduce variability among subjects in
ranking the target value, (3) enhance the importance of the value on
a highly similar construct when measured by more indirect and
unobtrusive alternative methods, (4) enhance self-regard on a set of
four dimensions. Observations of various dependent variables were
made at three times. Immediately following treatment (Time I), each

subject was administered the complete Value Survey (both sets of 18

 

values). Two to three weeks after treatment (Time 11), each subject

was again administered the Value Survey and a selection of nine

 

indirect measures of target values (a set of three variables

 

T60

measuring the importance of freedom and a pair of variables corre-
sponding to each of the other target values). Three to four weeks
after treatment (Time III), each subject was administered three
instruments measuring four self-regard variables.

Four separate three-way repeated measures ANOVAS were used to
test for treatment main effects and simple main effects on each of
the four target values' mean ranks. Levene's test was used in four
three-way repeated measures ANOVAS to test for treatment main effects
and simple main effects in reducing the variance of target value
rankings. Four three-way MANOVAS were used to assess treatment
effects on each set of indirect measures corresponding to a target
value. A single three-way MANOVA was used to assess treatment effects
on the set of four self-regard variables. All significant omnibus
tests were followed up with contrasts using the Tukey and Sheffe

methods to test for the directional differences as hypothesized.

Conclusions

 

The major conclusions drawn from the experimental phase of this
study are summarized below under four headings corresponding to the

dependent variable considered in each research hypothesis.

Target Value Ranking

 

Among the five treatments, only the value education exercise

directed at responsible yielded statistically significant findings

 

demonstrating its effectiveness in increasing target value rankings.

Two research hypotheses were supported.

 

 

161

1. Value education aimed at responsible was more effective
in increasing the mean rank of responsible at Times I
and II than two of the comparison treatments (self-
respect and self-controlled).

 

 

2. Value education aimed at responsible was most effective
in increasing the mean rank of responsible for psychotic
patients two to three weeks after intervention, when
compared to psychotic patients receiving the four other
treatments.

 

 

The measured superiority of the responsible exercise was

 

discussedin terms of both (1) its unidirectional thrust (in contrast
to the freedom and self-controlled exercises) and (2) its reduced
vulnerability to ceiling effects (in contrast to the self-respect

exercise). The particular effectiveness of the responsible exercise

 

with psychotic patients is likely to be a joint function of their
relatively lower entering ranks and the negative implications asso-
ciated with lower ranks that was presented to them.

The three remaining experimental treatments exhibited trends
suggesting weak treatment effects in the directions predicted. Free:
gom_was ranked highest at Time II for its respective target group and
particularly for non-psychotic members (who enter with lower rankings).

Self-respect was ranked highest at Time I for its target group. Self-

 

controlled was ranked highest for females and lowest for males

 

receiving the self-controlled treatment when contrasted to other

 

females and males. Such outcome ranks are consistent with the dif-
fering entering ranks associated with sex and the two directional

thrust of the self-controlled exercise.

 

 

I ['1'

 
 

162

Variability of Target Value Rankings
In only two restricted instances did value education yield sig-
nificant findings supporting the research hypothesis predicting less
spread in target value rankings within targeted groups.
3. Value education aimed at self-respect was more effective
in reducing variability of self-respect rankings of

females immediately after intervention when compared to
females receiving Treatment 3 (responsible).

 

 

4. Value education aimed at responsible was more effective
than Treatment 1 (freedom) in reducing variability of
responsible rankings for males two to three weeks after
intervention.

 

 

Contrary to prediction, three measures of target value spread
at Time I and all four measures at Time II revealed that variability
in rankings was consistently lowest for the control group. Highest
variances were generally exhibited by the experimental groups on
the various target values. These findings led to two additional
general conclusions.
5. Targeted value education increases the variance of
its respective target value rankings as well as other
values within the system.
6. A non-targeted intervention does not increase the
variance of individual values within the system.
The specific findings in (3) and (4) above reflect exceptions to
the strong trend found contrary to prediction. Those exceptions were

discussed in terms of probable ceiling effects. Self-respect is

 

generally a high ranking entering value particularly for females.

Responsible is a high ranking value for males which becomes even more

 

I..-

 

T63

important during hospitalization (maturation). Therefore, the effect

of the treatments may be to immediately push self-respect near the

 

continuum ceiling for females and to push responsible near the ceiling

 

for males by enhancing the maturation effects occurring over the two

to three week period between intervention and Time II.

Indirect Measures of Target Values

 

Only one of the nine indirect measures exhibited a significant
change two to three weeks after interventions.
7. Value education aimed at freedom was more effective

than the four other exercises in decreasing acceptance
of authority in females at Time II.

 

 

Those females in the freedom target group also obtained highest

mean scores on the other two indirect measures of independence (SIV

 

and PVS). Since females, more than males, exhibit greater matura-
tional increase in freedom's importance during hospitalization,
freedom may have greater psychological importance for them. The
freedom exercise was then more salient for females than males. In
contrast to other females, those receiving the freedom exercise were
likely to examine the concept of freedom earlier and more extensively
during hospitalization resulting in subsequent repercussive cognitive
changes in attitudes toward authority as predicted by value theory.
The Six indirect measures for the remaining three target values
did not exhibit significant Changes. However, three of these
measures yielded highest mean scores consistent with predictions and
two yielded second highest mean scores for their respective target

groups.

T64

Measures of Self-Regard

 

No treatment effects on self-regard measures were found. An
incidental diagnosis main effect was found in which psychotic
patients exhibited greater self-regard than non-psychotic patients

on two independent variables, self-acceptance and self-satisfaction.

 

 

These findings, while paradoxical, are consistent with findings
reported by others indicating pathological enhancement of self-regard
in seriouSly disturbed individuals and more negative self-appraisal
with subjective distress in neurotic individuals (Wylie, 1974;

Worchel & McCormick, 1963).

Implications for Psychotherapy

 

The value education interventions in the experimental phase of
this study represent a minute portion of each patient's experience
during the course of intensive inpatient treatment. A typical
patient's hospitalization includes individual and group psychotherapy
sessions Up to three times a week. The patient is given daily
activity therapy Classes focusing on topics such as assertion train-
ing, human development, marriage, divorce, human sexuality, managing
stress, self understanding, loss and grief, and effective communica-
tion skills. Patients are provided with recreational activities, art
therapy, psychodrama, educational and recreational films, and video-
tape experiences. Chemotherapy, special behavior modification pro-
grams, marital or family therapy, and vocational counseling may be
included in treatment programs if indicated. It is within this con-

text that the experimental value education exercises have been tested.

 

 

165

While the study has been conducted in a field setting, it has
had a strong theoretical focus. Its primary purpose was to determine
whether the educational exercises could induce changes in the rank
ordering of a value that would be earlier and of greater magnitude
than would be expected on the basis of hospital treatment alone.
Presumably, the many therapies following the experimental intervention
may provide additional reinforcing effects once the patient's atten-
tion has been directed toward a particular target value. The
indirect measures provided an additional measure of the value's
importance based on theorized repercussive changes in more specific
cognitions related to the value.

Psychotherapists typically promote values indirectly throughout
the process of therapy. The therapist's specific activities such as
active listening, providing feedback, interpreting, and offering
direct suggestions are centered around a specific patient's experi-
ences and conflicts. The therapist's actions are designed to suggest
a better way (i.e., a valued end-state or mode of conduct) for the
patient to function. The therapeutic process in this instance is an
inductive process in which the patient ultimately arrives at value
generalizations based on a multitude of specific experiences and
insights achieved with the therapist.

The present study suggests that therapy may profitably include a
deductive approach as well. The deductive process clearly involves
direct "teaching" of certain values and their implications early in
therapy. Those values then provide a general framework of goals or

criteria which the patient and therapist use throughout therapy.

166

These criteria provide a basis for evaluating the patient's function-
ing and deducing solutions for specific conflicts facing the patient.
For example, did the patient use a preferable mode of conduct such as
responsible or self-controlled? Will certain behavior lead to greater
realization of a preferable end state such as self-respect or freedom?
The therapeutic process involves clarifying the boundaries of these
values such that the effective social relationships and the satis-
faction of other's needs may be promoted as well.

The most important practical contribution of this investigation
has been the explicit identification of four psychologically important
values. The practicing therapist may profitably View freedom and

self-respect as significant and desirable end-states toward which his

 

patient is striving. Similarly, therapists may view responsible and

 

self-controlled as desirable modes of conduct that may be relevant to

 

the patient's attainment of such end-states. Consequently, these
four values represent important areas of patient assessment and
potential goals for therapy.

Many therapists already engage in considerable informal evalua-
tion of their patients' behavior and attitudes as indirect manifesta-
tions of these values. Each therapist is likely to have some model
of the healthy individual which implicitly dictates the relative
importance of these values in his practice. Therapists promote these
values in therapy to the extent that they are important in their
models and perceived as deficient or unrealized in the patient's

functioning.

 

167

The therapist may improve on the informal assessment of each new

patient by using the Value Survey to determine the relative importance

 

of these key values followed by some exploration of the dynamic factors
contributing to the levels of rank importance observed. Each of the
four target values is considered below in terms of the significant
questions and issues that the therapist should address in assessing

the patient's values and functioning.

Freedom

If the patient ranks freedom high (e.g., 9 to l, as indicated in
the pilot study), certain questions need to be asked. Is the patient's
life situation one in which his activities are dominated by some
social role or the dictates of others? Is this domination a function
of the patient's inability to function self-sufficiently or imposed
on him by a powerful authority figure? Does the patient's behavior
justify restrictions being placed on him? To what extent does the
patient appreciate the realistic limits of personal freedom deter-
mined by the needs of others and society? Is the patient's high
ranking of freedom a reflection of his egalitarian ideology or a
strictly personal concern over his freedom? If freedom is ranked low
(12 to 18), does the patient exercise his freedom and feel free of
unnecessary external restrictions in his life? Or does the patient
have a narrow, underrated concept of freedom and fail to recognize
areas where he may function more independently and use opportunities
which ultimately enhance his life? The answers to such questions will

provide direction and goals in therapy specifically aimed at realizing

 

.fsa...

168

the psychological benefits of freedom while retaining the benefits of
satisfying interpersonal relationships. The experimental study
demonstrated that for female patients, examination of the value 1199?
gem led to a change in attitude toward authority. This change is not
necessarily a rejection of authority, but may reflect increased
capacity to define one's own rights and discriminate legitimate
demands stemming from authority whether its source be individual,
institutional, or societal. Healthy ego functioning involves the
capacity to satisfy organismic needs within the context of external
reality. Clarification and differentiation of a value and determining
its relative importance will promote ego development. An integrated
self, personal competence, and similar constructs in theories of
psychopathology and therapy all involve the use of a value system
both as a tool for defining the self and making decisions in response
to the external world. The value freedom represents one in which a
personal need is conceptualized as a goal or ideal for the self and
also is assigned some priority among other values to allow for
successful social adjustment. Freedom as an abstract conception
becomes a value only in preference to the concept of no freedom.

Reality and other values prevent its absolute realization.

Self-Respect

 

When the therapist turns his attention to assessing the patient's

ranked importance of self-respect, another set of questions needs to

 

be asked based on this investigation. If self-respect is ranked high

 

in importance (4 to 1), does the patient experience a deficiency in

self-esteem or simply recognize the importance of self-respect as

169

psychologically important end-state? The results of this investiga-
tion and others suggest that less disturbed patients (non-psychotic,
neurotic) experience greater dissatisfaction with themselves and are
more self-critical, yet are better candidates for therapy and also

recognize the importance of self-respect. Indeed, when self-respect

 

is a high ranking value, the therapist may be dealing with a patient
who has essentially mastered the survival, security, identity, and
belongingneeds outlined by Maslow (1954) and is now struggling with
self-esteem needs. On the other hand, the more disturbed individuals
(psychotics, borderline personality disorders) have severe deficiencies
in self-identity, self-integration, and trust and security in inter-
personal relationships. For such patients, self-respect or self-
esteem is maintained in primitive psychopathological ways involving
significant distortions of self and others. In a sense, a real con-
cern with self-esteem is deferred until these patients master the task
of establishing a stable self. Consequently, when the therapist

observes a low rank (9-18) on self-respect, the first question con-

 

cerns the development of the self. Does the patient possess a self
as a sufficiently stable object differentiated from other individuals
which can be subjected to internal evaluation and held in esteem? If

self-respect is ranked low, is the patient confusing it with selfish-

 

ness, oriented toward others, or failing to acknowledge the importance
positive self-regard has as a necessary prerequisite for mature func-

tioning?

 

T70

Responsible

 

As an instrumental value, responsible represents a mode of con-

 

duct preferable to not being responsible. Rokeach (1967) further
defined this value as being dependable and reliable which places it

in social context. However, in the hospital milieu therapy responsi-
bility is often promoted in a personal sense. Patients are encouraged
to "own their feelings,” make their own decisions, avoid blaming
others for their difficulties, and relinquish their helpless or
victimized roles. Being responsible may mean asserting oneself in

the face of inappropriate demands or impositions from others. These
two facets of being responsible (socially and personally) have cor-
responding implications for interpersonal and intrapersonal adjustment.

If a patient ranks responsible high (6 to l), he likely possesses

 

a strong sense of social responsibility based on this study's findings.
However, does he feel deficient in his conduct as a socially respon-
sible person? Does he sacrifice self-respect or freedom due to
excessive deference to the desires of others? Does he appreciate the
need to exercise personal responsibility toward himself as an object?

If a patient ranks responsible low (8-18), does the patient under—

 

estimate the benefits of responsible behavior? Does his more
regressed status (as suggested by this study), mean that responsible
behavior seems irrelevant or out of reach for the patient?

The experimental study showed that psychotic patients were able
to place a higher priority on responsible conduct once they were
given information suggesting its benefits. This effect was not

immediate, but most apparent two to three weeks after intervention.

 

171

This delay in changing argues against experimental compliance or sug-
gestibility. Instead, these patients were able to carefully process
the information and reformulate over time either their definition or
Iniority of being responsible. This finding should suggest to the
practicing therapist that a value can be addressed directly in the
early stages of treatment. The patient can be assisted in clarifying
the value's significance and importance and, then, offered credible
information in an educational manner for his consideration. The
patient can freely, over time, reformulate his cognitions in a way

that is internally congruent for him.

Self-Controlled

 

Self-control as a value has little intrinsic benefit. It defies
the pleasure principle and requires that one tolerate stress and con-
trol pressing impulses. It is clearly a means-to-an-end and a prime
example of an instrumental value. The present study clearly demon-
strated that patients most deficient in this mode of conduct place
greater ranked importance on this value, while those with greater
observed self-control rank it low.

If a patient enters therapy ranking self-controlled high (6 to

 

1), the therapist must determine whether the patient has realized the
benefits of self-control or is deficient. In the case of deficiency,
major therapeutic work will be aimed at developing impulse control,
stress tolerance, and a capacity to delay gratification in a patient
who may have severe ego defects or inadequate social orientation. If
the patient enters therapy with relatively low rankings on self-

controlled (11 to 18), the therapist determines whether the patient

 

 

 

172

can benefit from placing higher general importance on self-controlled.
Does the patient only need new directions for exercising his capacity
for self-control? Is the patient excessively self-controlled in some
respects?

A trend was noted in the experimental study for high ranking
patients (males) and low ranking patients (females) to decrease and
increase their ranks respectively after receiving information about
the defiCiency nature of high ranks and the undervaluation implicated
by low ranks. Again, the therapist may explore his patients actual
self-control in the light of the importance placed on self-controlled
and, early in therapy, provide educational information designed to
modify the value and associated behavior. One indirect measure of
self-control as a value showed a trend toward increased importance
for all subjects receiving the self-controlled exercise. This indi-
cates that a value may drop in rank importance, while increasing in
cognitive importance. The therapeutic importance of values as
expressions of the patient's needs as well as ideals is underscored
by such deficiency motivated high ranks. Paradoxically, the patient's
highest ”values" may indicate the direction for therapeutic inter-

vention.

Interrelationship of the Four Values

The four target values provide a preliminary composite picture
of the ingredients of mental health. Based on their observed rankings
in this study, the four values themselves may be placed in a hier-

archical arrangement with self-respect at the top followed by

 

 

T73

freedom, responsible and self-controlled. Since enhancement of the

 

 

 

self-concept and self-esteem reflects the dominant goal in most
therapies, it is appropriate that self-respect as a personal value,
basic need, or criterion for mental health should occupy this para-
mount position. Respect for self dictates and facilitates the attain-
ment of freedom to its fullest expression without imposing on the
freedom of others. Exercise of freedom in this manner allows for
satisfactory interpersonal relationships and social adjustment. It
does not jeopardize respect for self by violating social moral values.
Nor does it allow for loss of self-respect by submission to the
demands or judgements of others. The sufficient self possesses posi-
tive regard for self and the capacity to choose and act freely in

full contact with reality.

The modes of conduct for day-to-day functioning which lead to
and maintain the end states of self-respect and freedom are, at least
partially, embodied in responsible and self-controlled behavior.
Responsibility for self and others requires self-control in order to
competently deal with and master social reality. Internal control
facilities responsible as well as independent choices and actions.
These activities enable an individual to develop and maintain a state
of relative freedom and self-respect and, yet, pursue and promote
social values and the welfare of others. Neglect of one's own welfare
jeopardizes self-respect through shame and inadequacy stemming from
dependence on others. Neglect of others' welfare jeopardizes self-
respect through guilt due to violations of moral values requiring

respect for humanity in addition to self.

 

174

The Therapist's Values

 

Lowe (1969) has distinguished four value orientations among

therapists. (l) Naturalism reflects a concern with need-satisfaction

 

values. (2) Culturalism emphasizes values leading to social adapta-

 

tion. (3) Humanism is concerned with self-actualization values.

(4) Ineism_places importance on values leading to personal integra-
tion and development of a life philosophy. The four values investi-
gated in this study are most consistent with the humanistic orienta-
tion. Furthermore, they are conpatible with western culture's
emphasis on the individual (Buhler, 1962). However, the values
investigated in this study clearly cross all orientations in that
they reflect needs-to-be-satisfied that fall in an intermediate area
of Maslow's path toward self-actualization. They allow for need ful-
fillment within a context of social adaptation governed by certain
modes of conduct. These values do not preclude development beyond
self-actualization to levels of personal integration and commitment

extending beyond the self. For example, a world at peace may have

 

little immediate psychological relevance to a person struggling with
a need to belong or low self-esteem. Yet that same value may become
a passionate goal for an individual who has mastered and transcended
the problems of adjustment and self-esteem encountered in the therapy
setting. I

The successful therapist must be able to examine his patient's
values as an index of that patient's level of development. Thera-
peutic goals are directed by the needs of that level and the develop—

mental tasks of the next level. The model of development is the

 

T75

therapist's professional theoretical orientation and not the salient
values reflecting his personal level of development. Presumably, the
therapist has succeeded to some degree in mastering the tasks facing
his patient and has the skill to facilitate similar development in his
patient. The therapist may subscribe to self-actualization values
without being self-actualized. He may even struggle with developing
his own sense of self-esteem and be able to help his patient do the
same. The therapist who is deficient in empathic skills would likely
fail in trying to help an individual who has a capacity for empathy
and is struggling toward enhancement of self-regard. The therapist
who would attempt to impose either his personal or theoretically
oriented values on a patient without regard for the patient's develop-
mental status might expect to fail. If the patient enters with a

need to deal with those values, the therapist may be able to communi-
cate and promote change. Indeed, successful treatment has frequently
rested on a fairly high pre-existing degree of similarity between
therapist and patient (Ehrlich & Wiener, 1961). At present, the

Value Survey may serve as a tool for investigating such therapist-

 

patient similarities. Empirical work needs to be done in differen-
tiating between therapist's personal and mental health value systems
and observing which are relevant to the process of change as the

patient's values move in the direction of the therapist's values.

 

 

T76

Implications for Future Research

 

Limitations in the Present Study

 

Since each of the four experimental treatments may be viewed as
a replication of the basic value education format, the trends which
appear across these replications suggest two areas of possible weak-
ness in the present study. (1) The interventions may have been too
mild to generate Changes of sufficient magnitude to be detected.
(2) The experimental methodology used in this study was not suffi-

ciently powerful to detect the effects predicted.

Potenoy and Direction of Treatment Effects. The potency of a

 

value education intervention is ultimately defined by the cognitive
and behavioral changes it produces. Setting questions of measurement
aside, it is important to note those factors in the present study
which are likely to mask the potency of the interventions used. First,
the theorized stability of the constructs, values and self-conceptions,
in contrast to other cognitions implies that value change will be
difficult and the magnitude of change small. Second, the target

values used in this study were selected because they exhibited a
maturational history (during hospitalization) of increasing in impor-
tance. Therefore, any intervention designed to facilitate this
maturational course must effect changes in rank of greater magnitude
than comparison groups which are not static, but changing in the same
direction predicted for the target group. Third, the interventions
used in this study were likely to have differential effects on sub-

jects as a function of their entering ranks. In most cases, either

 

‘1 I. III I. 111.11 1
l

 

T77

maintenance or enhancement of the rank importance of the target value
would be encouraged. In some cases, a decrease in rank importance
would be effected by the intervention. Consequently, treatment
potency measured in terms of higher mean ranks is partially dissi-
pated by subjects whose appropriate response to treatment includes a

decrease in the level of target value importance.

Methodological Weaknesses. The trends observed in this study

 

strongly suggest that the methodology employed did not provide suffi-
cient precision and power in testing the null hypotheses. The most
obvious factor likely affecting precision in this study was the use

of only six subjects per cell. A more precise replication of the
present study might use two or three times the number of subjects per
cell. A second factor suggesting insufficient precision concerns the
possibility of greater variability on measures of dependent variables
for the psychiatric population generally in contrast to other popula-
tions. This is suggested by the mean entering rank levels of the
target values falling in the middle of the 18 unit continua. A middle
mean rank for the group may reflect a fairly balanced spread of scores
(variance) or many scores falling in the middle "unstable" region of
the conthnnmi(introducing less reliability for this population).
Another source of variability is suggested by the observed trend
toward increased spread of target value rankings following treatment,
i.e., variance introduced simply by intervention which lowers pre-

cision.

178

The design and analysis used only post-treatment observations.
The question may be raised whether greater precision might have been
obtained by using an analysis of covariance approach based on pre-
treatment rankings of target values or using pre-treatment ranks as
an additional blocking variable. The format for analysis used in this
study employed omnibus tests followed by post hoc methods. It was
noted in Chapter IV that some loss of power could be associated with
this approach in contrast to an analysis using the method of planned
comparisons.

The discussion above provides several general implications for
any future replication of the present study. (1) Increase the sample
size by a factor of two or even three. (2) Use pretreatment observa—
tions of target value rankings in assessing treatment effects.

(3) Consider the method of planned comparisons as a more powerful

analytical approach.

Focusing Inqury on Single Values

 

Since values are limited in number and regarded as highly central
within cognition, empirical studies of values should appropriately
focus on a single value, except when the functional relationship
between two values are under investigation. From such a perspective,
the present study may be analogous to investigating attitudes toward
fast food restaurants and school busing within the context of a single
study.

The substantive and functional characteristics of two different

values may be dramatically different even if they share a common

179

denominator of being "psychologically important" by some operational
criterion. A value may be psychologically important for one popula-
tion and not for another. The same value may be important for dif-
ferent reasons, i.e., intrinsic objective importance versus deficiency
importance. A value may vary in semantic aspects, level of abstrac-
tion, and differentiation of domains of applicability.

While certain dimensions (such as content, importance, commit-
ment, benefits, beneficiaries, or domain of application) may be common
to all values, inquiry centered on a particular value would continue
to require correlational approaches to specify the range of indi-
vidual differences and modal points on those dimensions which
characterize that particular value. For example, the value freedom
may have a highly restricted meaning for one individual with corre-
sponding restrictions and functional properties on other dimensions.
Research centered solely on freedom would map only its substantive
and functional characteristics within the personality system including
those attitudes and behaviors which can be reliably associated with
variations in those Characteristics. Ultimately, a body of data con-
cerning the nature of freedom would be developed which might depict
a variety of conceptions of freedom. More reliable methods of
measuring freedom both as a value and as a "state" achieved at some
level are necessary in order to ultimately investigate issues related
to ideal versus deficiency sources of value. At present, the general
concept of a value may be viewed as a kind of "metaconstruct" whose
ultimate nature may be understood only when the nature of separate

values are understood.

180

The implication of such issues is that a given value has many

 

parameters which need to be thoroughly investigated. The character-
istics of a particular value may dictate its role in cognition and
personality functioning as well as the most effective methods for
inducing change, rather than any general theory of values or cognition
at present. The suggestion is that inquiry should proceed from under-
standing the nature of particular values to the nature of values
generally.

The Development of Alternative
Value Measures

 

 

The Value Survey has demonstrated usefulness in many empirical

 

investigations. However, from the perspective of a given value it
must be regarded as measuring only one dimension of that value, i.e.,
its rank importance relative to those values included in the ranked
set. It is possible to conceive of instruments which are designed

to measure individual differences on a number of dimensions of a
specific value. In addition to some measure of rank importance, a
dimension of concreteness versus abstractness of meaning might be
included which would essentially define the domains where the value
is salient for a given subject. A continuum measuring the degree of
deficiency or realization ofthe value experienced by the subject
would reflect a motivational characteristic of the value. Other
motivational features might include delineation of the type of affec-
tive responses (shame or pride, guilt or worthiness) associated with
a given value and the intensity of feeling associated with violations

and manifestations of the values.

181

The examples above are only a few of many possible dimensions
to consider in measuring values. Those items in existing value scales
which are highly correlated with a certain value's rank may provide
the basis for more reliable measures of the value's importance. A
large pool of items may ultimately provide a basis for a factor
analytic approach in delineating salient dimensions of a given value.

A Microscopic Approach to Under—
standing Value Change

 

 

By simultaneously investigating four target values, the present
study has offered only a macroscopic examination of value change and
repercussive effects. 'This study has not addressed the mechanisms of
cognitive change in any detail. Future research efforts may be more
profitable by taking a more singular approach to value education and
cognitive change as well. Such an approach would focus on a single
target value and perhaps vary the salient content of the value educa-
tion treatment. For example, a study of value education targeted on
freedom might include a comparison of approaches giving positive,
negative, or combined information or approaches giving information
about either low ranking or high ranking individuals. The different
approaches may be crossed with subjects with different entering rank
levels in an effort to determine the most potent aspects of value
education content and their relative impact on subjects with different
entering positions on the value. Such strategies may be more effec-
tive in assessing the effects of interventions with a two-directional

thrust than observations of deviation scores.

182

The Role of Self-Regard in
Value Research

 

 

The integration of existing self theory and value theory has
barely begun. The present study underscores the stability of self-
conception reflected by global measures of self-regard. It is
probably of little value to examine value education effects on global
self-regard until those values which have a significant bearing on
self-esteem have been identified. It may prove to be true that no
single value possesses a measurable relationship of glgbgl_self-
regard. Instead, certain values contribute differentially as a func-
tion of the value's importance and only those self-perceptions
relevant to the value. Self minus ideal-self measures of self-regard
are based on such discrepancies and illustrate the confounding role

of values in self-regard measures. The Value Survey itself could be

 

modified and administered with additional instructions to rank order
the labels according to "time invested” or "success in achieving”
the items. A discrepancy score could be computed and inferred as a
measure of self-regard or self-satisfaction. The discomfort some sub-
jects express while rank ordering "values" probably reflects the
simultaneous awareness and comparison with their actual behavior
patterns. A measure of this discomfort could also be construed as
a measure of self-regard.

Studies in the near future may profitably use measures of self-
esteem as one entering characteristic to be mapped to the measures of
a particular value or as an independent variable that influences a

subject's response to value education. Shrauger (l975) has suggested

 

183

that there is more evidence supporting self-esteem theory than cogni-
tive consistency theory in terms of the subject's affective reaction
to external evaluations. Low self-esteem individuals react more
strongly to either positive or negative evaluative information than
their high self-esteem counterparts. However, when cognitive
processes involved in the interpretation and retention of evaluative
information are examined, research data support the cognitive con-
sistency model. Given the present state of value inquiry, level of
self-esteem may be more useful as an independent variable with dif—
ferential effects on both affective and cognitive responses to value

education interventions rather than as an outcome variable.

 

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184

 

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APPENDICES

191

 

APPENDIX A

THE ROKEACH VALUE SURVEY

192

APPENDIX A

 

 

 

THE ROKEACH VALUE SURVEY
V A LU E S U RV EY
BIRTH DATE SEX: MALE—FEMALE
CITY and STATE OF BIRTH
NAME (FILL IN ONLY IF REQUESTED)

193

194

"18111118110113

On the next page are 18 values listed in alphabetical order. Your task is to arrange
them in order of their importance to YOU, as guiding principles in YOUR life. Each
value is printed on a gummed label which can be easily peeled off and pasted in the
boxes on the left-hand side of the page.

Study the list carefully and pick out the one value which is the most important for
you. Peel it off and paste it in Box 1 on the left.

Then pick out the value which is second most important for you. Peel it of! and
paste it in Box 2. Then do the same for each of the remaining values. The value which
is least important goes in Box 18.

Work slowly and think carefully. If you change your mind, feel free to change your
answers. The labels peel off easily and can be moved from place to place. The end re-
sult should truly show how you really feel.

 

 

 

 

 

 

 

 

 

mVouude

 

‘0

 

O

 

d
d

 

N

 

(O

 

I;

 

UI

 

3

 

Q

 

 

 

oo

 

A COMFORTABLE LIFE
(a prosperous Iiie)

AN EXCITING LIFE
(a stimulating. active life)

A SENSE OF ACCOMPLISHMENT
(lasting contribution)

A WORLD AT PEACE
(tree of war and conflict)

A WORLD OF BEAUTY
(beauty of nature and the arts)

EQUALITY (brotherhood.
equal opportunity ior all)

FAMILY SECURITY
(taking care of loved ones)

FREEDOM
(independence. free choice)

HAPPINESS
(contentedness)

INNER HARMONY
(freedom from inner conflict)

MATURE LOVE
(sexual and spiritual intimacy)

NATIONAL SECURITY
(protection from attack)

PLEASURE
(an enjoyable. leisurely lite)

SALVATION
(saved. eternal liie)

SELF-RESPECT
(sell-esteem)

SOCIAL RECOGNITION
(respect. admiration)

TRUE FRIENDSHIP
(close companionship)

WISDOM
(a mature understanding at life)

WHEN YOU HAVE FINISHED, GO TO THE NEXT PAGE.

 

(DVO‘UI'lkde

mwomnafijoo

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Below is another list of 18 values. Arrange them in order of imporunca, the same as before.

AMBITIOUS
(hard-working, aspiring)

BROADMINDED
(open-minded)

CAPABLE
(competent. effective)

CHEERFUL
(lighthearted. ioyful)

CLEAN
(neat, tidy)

COURAGEOUS
(standing up for your beliefs)

FORGIVING
(willing to pardon others)

HELPFUL (working
for the welfare of others)

HONEST
(sincere. truthful)

IMAGINATIVE
(daring. creative)

INDEPENDENT
(self-reliant. sell-sufficient)

INTELLECTUAL
(intelligent, reflective)

LOGlCAL
(consistent. rational)

LOVING
(affectionate. tender)

OBEDIENT
(dutiful. respectful)

POLITE
(courteous. well-mannered)

RESPONSIBLE
(dependable, reliable)

SELF-CONTROLLED
(restrained. self-disciplined)

 

APPENDIX B

SURVEY OF INTERPERSONAL VALUES

197

 

 

 

 

 

 

 

 

 

 

 

RAW SCORE

 

PERCENTILE

 

NORM GROUP

 

 

 

Nzunv -_-

Date

 

Grmlv or Occupation

 

_. _ Marital Slntuq

School Mr Firm . _ _ _

APPENDIX B

SURVEY OF INTERPERSONAL VALUES

. SURVEY OF INTERPERSONAL VALUES

By LEONARD v. GORDON

DIRECTIONS

In this booklet are statements representing things that people consider to be important to
their way of life. These statements are grouped into sets of three. This is what you are asked to do:

Examine each set. Within each set, find the one statement of the three which represents what
you consider to be most important to you. Blacken the space beside that statement in the column
headed M (for most).

Next. examine the remaining two statements in the set. Decide which one of these statements
represents what you consider to be least important to you. Blacken the space beside that statement
in the column headed L (for least).

For every set you will mark one statement as representing what is most important to you.
one statement as representing what is least important to you. and you will leave one state-
ment unmarked.

Example
M L
To have a hot meal at noon ........................... :2::: —
To get a good night's sleep. . . .
“To get plenty of fresh air .........................
Suppose that you have examined the three statements in the .-».-.:nple. and although all three

of the statements may represent things that are important to you. you feel that “To get plenty

of fresh air" is the most important to you. You would blacken the space in the column headed M
(for most) beside the statement. Notice that this has been done in the example.

You would then examine the remaining two statements to decide which of these represents
something that is least important to you. Suppose that “To have a hot meal at noon" is the
least important to you. You would blacken the space in the column headed L (for least) next to
this statement. Notice that this has been done in the example.

You would leave the remaining statement unmarked.

In some cases it may be difficult to decide which statement to mark. Make the best decision
that you can. This is not a test; there are no right or wrong answets. Be sure to mark only one
M (most) choice and only one L (least) choice in a set. Do not skip any sets. Answer every set.
Turn this booklet over and begin.

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A Subsidiary OI IBM

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198

199

Mark your answers in column A —————e A

 

To be free to do as I choose .....

To have others agree with me ‘ ............

To make friends with the unfortunate . ............

To be in a position Of not having to follow orders _ ............

............

To follow rules and regulations closely ............

............

To have people notice what I do 1...: ......

To hold an important job or office . ............

............

To treat everyone with extreme kindness ............

............

To do what is accepted and proper . . . ............

............

To have people think of me as being important ............

To have complete personal freedom . , ............

............

To know that people are on my side , ............

............

To follow social standards of conduct _. . .. ,, ...... :33.

To have people interested in my well being .. ............

............

To take the lead in making group decisions ‘ ............

............

To be able to do pretty much as I please ‘ ............

............

To be in charge of some important project , _ ............

.............

To work for the good of other people . . . _ . ........... .

------------

To associate with people who are well known . . I ............

............

To attend strictly to the business at hand .. ............

To have a great deal of influence . .. ._ ----------- .

To be known by name to a great many people . _ 33;; 33;:

To do things for other people ;;;;;; ;;;;;;
To work on my own without direction . :;;;;; ;;;;;:

To follow a strict code of conduct ;;:;;; ;;;;;;
To be in a position of authority . . . . 331;; ::::::
To have people around who will encourage me 3:3; 3.3;

 

To be friends with the friendless .. 33;; 333;
To have people do good turns for me , :33: :13:
To be known by people who are. important . ;::::: :::;::

To be the one who is in charge . .. . :::::; ::::::
To conform strictly to the rules. :33; 2,:
To have others show me that they like me . :::;:: ::::;:

To be able to live my life exactly as I wish :::::: :::;::
To do my dun" :::::: :::::.
To have Others treat me with understanding ::;:;: .33:

To be the leader of the group I'm in :::::: :::;;:
To have peOplc admire what I do 33:: 2.2..
To be independent in my work :::::; H.,:

To have people act considerately toward me ;;;;;; 5;;
To have other people work under my Ilil't‘CilOll :::::: -;;:::
To spend my time doing things for others . 33;: 33;;
To be able to lead my own life ;:::::
To contribute a great deal to charity . ~
To have people make favorable remarks about me )“13. ::-:~

Turn the page and go on.

   

 

200

 

Mark your answers in column 3 -——§ 3
. M I.
To be a person of influence .................................................. . 333 333
T0 be treated With kindness ....... 33;; 1:33:
To always maintain the highest moral standards . .. .. . 333 333
M L
To be praised by other people... . _. . 333 333
To be relatively unbound by social conventions . . ,. . 333 333
To work for the good of society ........................................... . 333 333
M l
To have the affection of other people. .............. . ........ . . 333 333
To do things in the approved manner.-,..... . . 333 333
To go around doing favors for other people ..... . . 333 333
M L
To be allowed to do whatever I want to do...... ........... . 333 333
To be regarded as the leader .. .. ......, .... ____________
To do what is socially correct ..... .. 33; _______
M L
To have others approve of what I do . . .. 333 333
To make decisions for the group 333 333
To share my belongings with other peOple .. .. 333 333
M L
To be free to come and go as I want to . .... 333 333
To help the poor and needy. . 333 333
To show respect to my superiors .. _ .. . 333 333
M L
To be given compliments by other people . _. . 333 333
To be in a very responsible position ............... 333 333
To do what is considered conventional ........ . ........ . . 333 333
M L
To be in charge of a group of people...... .. .. ...........
To make all of my own decisions
To receive encouragement from others .. .-... 333
M
To be looked up to by other people ....... . .. 333 3
To be quick in accepting others as friends .. .. . . 333 333
To direct Others in their work . 33:: :33;
M L
To be generous toward other people . ..... ., ,_ 333 333
To be my own boss ..... ........_ .. . 333 333
To have understanding friends .. .. .. . .. . 333 333
M l.
To be selected for a leadership position . .. . _ . 333 333
To be treated as a person of some importance . . . 333 333
To have things pretty much my own way.......... ... 333 333
M L
To have other people interested in me....... .. .. 333 333
To have proper and correct social manners . .. 333 333
To be sympathetic with those who are in trouble .. 333 333
' M L
To be very popular with other people,.........._. .. .. 333 333
To be free from having to obey rules, _. ... , . . 333 333
To be in a position to tell others what to do .. .. 333 333
M L
To always do what is morally right .. .. . ... 33;; :33:
To go out of my way to help others ....................... .. .. 33:; ;::;;;
To have people willing to olfer me a helping hand . .. 333 33;:
M l.
To have people admire me .. . . .. .. . . _ 2::122 ::::::
To always do the approved thing .. . . :;:::: ::::::
To be able to leave things lying around if I wish . .. .. ._ :::::: :::.;:

 

 

 

 

 

 

 

 

 

 

APPENDIX C

PERSONAL VALUE SCALES

201

 

APPENDIX C

PERSONAL VALUE SCALES

9mg

W

 

 

Please read over the following statements. Decide whether it is something you always admire
in other people, or something you always dislike, or something that depends 23_the situation
whether you admire it or not.

Check one space behind each statement for your answer.

 

 

‘ Depends on
Always Admire ' Situation Always Dislike

*1. Showing one's feelings readily.
2. Being different from other people.
*3. Replying to anger with gentleness.

4. Keeping one's opinions to himself when
they differ from the group's.

*5. Letting off steam when one is frustrated.

6. Standing up for what one thinks right,
regardless of what other's think.

. Always being patient with peeple.

8. Acting so as to fit in with other people's
way of doing things.

*9. Letting people know when one is annoyed
with them.

10. Encouraging other peOple to act as they please.
*'11. Not getting upset when things go wrong.

12. Working and living in harmony with other
people.

* 13. Becoming so angry that other people know
about it.

14. Living one's own life, independent of others.
*.15. Keeping one's hostile feelings to himself.

16. Suppressing one's desire to be unique and

different.
*‘l7. Swearing when one is angry.
18. Being a non-conformist.

* 19. Suppressing the urge to speak hastily in anger.

 

(*) indicates self—control items.
Independence items are unmarked.

 

 

202

24.

* 25.

26.

* 27.

28.

*29.

30.

*‘31.

32.

*33.

34.

‘*35.

36.

37.
38.

*39.

40.
*41.

42.

203

Depends on
Always Admire Situation

Never acting so as to violate social
conventions

Letting others see how one really feels.
Going one's own way as he pleases.

Hiding one's feelings of frustration from
other people.

Always checking on whether or not one's inten-
ded actions would be acceptable to other peeple.

Getting upset when things don't go well.

Being outspoken and frank in expressing one's
likes and dislikes.

Keeping one's feelings hidden from others.

Always basing one's behavior on the recognition
that he is dependent.

Expressing one's anger openly and directly
when provoked.

Thinking and acting on one's own without
social restraints.

Suppressing hostility.

Being careful not to eXpress an idea that might
be contrary to what other people believe.

Telling peeple off when they offend one.

Being a person who doesn't care what others
think of his opinions.

Not expressing anger, even when one has a
reason for doing so.

Acting in such a way as to gain the approval
of others.

Depending on others.
Being original.

Never losing one's temper, no matter what the
reason.

Going along with the crowd.
Losing one's temper easily.

Conforming to the requirements of any situation
and doing what is expected of one.

Always Dislike

APPENDIX D

VALUE PROFILE SCALES AND SOCIAL
RESPONSIBILITY SCALE

204

 

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APPENDIX E

SELF-ESTEEM SCALE

209

O

* 3.

* 5

10.

ll.

12.

13.

14.

15.
16.

17.

18.

APPENDIX E

SELF-ESTEEM SCALE

PARI VII

INSTRUCTIONS

 

 

Read each statement below
Behind each statement, mark one of the four spaces
with an "X" to show what you feel about yourself..

 

 

 

Strongly
Agree Agree Disagree

I feel that I'm a person of worth, at
least on an equal plane with others.

I would rather decide things when they come
up than always try to plan ahead.

I feel that I have a number of good qualities.

I have always felt pretty sure my life
would work out the way I wanted it to.

All in all, I am inclined to feel that I
am a failure.

I seem to be the kind of person that has
more bad luck than good luck.

I am able to do things as well as most
other people.

I never have any trouble making up my mind
about important decisions.

I feel I do not have much to be proud of.

I have always felt that I have more will
power than most people have.

I take a positive attitude toward myself.
There's not much use for me to plan ahead be-
cause there's usually something that makes

me change my plans.

0n the whole, I am satisfied with myself.

I nearly always feel pretty sure of myself
even when people disagree with me.

I wish I could have more respect for myself.
I certainly feel useless at times.

I have often had the feeling that it's no use
to try to get anywhere in this life.

At times I think I am no good at all.

——_—-

Strongly
Disagree

 

(*) items included in the self-esteem scale

 

210

 

APPENDIX F

INDEX OF ADJUSTMENT AND VALUES

211

 

 

 

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APPENDIX G

SCALE T0 MEASURE INTERNAL
VERSUS EXTERNAL CONTROL

216

 

1.

10.

ll.

12.

A

APPENDIX G

SCALE TO MEASURE INTERNAL VERSUS EXTERNAL CONTROL

PART VIII

INSTRUCTIONS

 

 

 

Read each pair of statements below.
Decide whether A or B is closest to
your own opinion. Put an "X" in one
of the two spaces to show which one
is closest to what you believe.

 

Children get into trouble because their parents punish them to much.

The trouble with most children nowadays is that their parents are too easy with

Ital?) le? lwlp lmr> Aw I» lep all

them.

Many of the unhappy things in peeple's lives are partly due to bad luck.
People's misfortunes result from the mistakes they make.

One of the major reasons why we have wars is because people don't take enough
interest in politics.
There will always be wars, no matter how hard people try to prevent them.

In the long run people get the respect they deserve in this world.
Unfortunately, an individual's worth often passes unrecognized no matter how
hard he tries.

The idea that teachers are unfair to students is nonsense.
Most students don't realize the extent to which their grades are influenced by
accidental happenings.

Without the right breaks one cannot be an effective leader.
Capable people who fail to become leaders have not taken advantage of their
opportunities.

No matter how hard you try some people just don't like you.
Peeple who can't get others to like them don't understand how to get along
with others.

Heredity plays the major role in determining one's personality.
It is one's experiences in life which determine what they're like.

I have often found that what is going to happen will happen.
Trusting to fate has never turned out as well for me as making a decision to
take a definite course of action.

In the case of the well prepared student there is rarely if ever such a thing
as an unfair test.
Many times exam questions tend to be so unrelated to course work that studying
is really useless.

Becoming a success is a matter of hard work, luck has little or nothing to do
with it.

Getting a good job depends mainly on being in the right place at the right time.

> 03 |3> it” |2> Dall3> |w|>

B—

The average citizen can have an influence in government decisions.
This world is run by the few people in power, and there is not much the little
guy can do about it.

217

13. A When I make plans, I am almost certain that I can make them work.
3 It is not always wise to plan too far ahead because many things turn out
be a matter of good or bad fortune anyhow.
14. A There are certain people who are just no good.
B There is some good in everybody.
15. A In my case getting what I want has little or nothing to do with luck.
B Many times we might just as well decide what to do by flipping a coin.
16. A Who gets to be the boss often depends on who was lucky enough to be in the
right place first.
B Getting people to do the right thing depends upon ability, luck has little
or nothing to do with it.
17. A As far as world affairs are concerned, most of us are the victims of forces
we can neither understand, nor control.
B By taking an active part in political and social affairs the people can con-
trol world events.
18. A Most people don't realize the extent to which their lives are controlled by
accidental happenings.
B There really is no such thing as "luck."
19. A One should always be willing to admit mistakes.
B It is usually best to cover up one's mistakes.
20. A It is hard to know whether or not a person really likes you.
B How many friends you have depends on how nice a person you are.
21. A In the long run the bad things that happen to us are balanced by the good ones.
B Most misfortunes are the result of lack of ability, ignorance, laziness, or all three.
22. A With enough effort we can wipe out political corruption.
B It is difficult for people to have much control over the things politicians
do in office.
23. A Sometimes I can't understand how teachers arrive at the grades they give.
B There is a great connection between how hard I study and the grades I get.
24. A A good leader expects people to decide for themselves what they should do.
B A good leader makes it clear to everybody what their jobs are.
25. A Many times I feel that I have little influence over the things that happen to me.
B It is impossible for me to believe that chance or luck plans an important role in
my life.
26. A People are lonely because they don't try to be friendly.
B There's not much use in trying too hard to please people, if they like you,
they like you .
27. A There is too much emphasis on athletics in high school.
B Team sports are an excellent way to build character.
28. A What happens to me is my own doing.
B Sometimes I feel that I don't have enough control over the direction my life
is taking.
29. A_____Most of the time I can't understand why politicians behave the way they do.

B—

218

In the long run the people are responsible for bad government on a national
as well as on a local level.

APPENDIX H

PART I
PRETREATMENT VALUE SURVEY

219

PART I
PRETREATMENT VALUE SURVEY

VALUE SURVEY

{LEI

This is a scientific study of value systems.
We are conducting this research to better
understand and help the patients who enter
Pine Rest Christian Hospital.

Thank you for participating in this study.

You will have your first session of questions
today. You will be scheduled for two more
sessions in about two or three weeks.

For scientific reasons, you will sometimes be
asked to answer the same questions more than
once. However, we hope that you will find
the sessions interesting and learn more about
yourself.

There are no right or wrong answers in this
study. The best answers are your own ideas
and personal opinions.

Please feel free to ask for help while you
are working at any time you are unsure about
what you are supposed to do.

* * * * 'k t * 'k * * t * * *

You may now turn to page 2. Please read the
instructions carefully and begin working.

220

 

 

221

Page 2.

lllSIlillBilllNS

On the next page are 18 values listed in alphabetical order. Your task is to arrange
them in order oi their importance to YOU, as guiding principles in YOUR life. Each
value is printed on a gummed label which can be easily peeled off and pasted in the
boxes on the left-hand side of the page.

Study the list carefully and pick out the one value which is the most important for
you. Peel it off and paste it in Box 1 on the left.

Then pick out the value which is second most important for you. Feel it off and
paste it in Box 2. Then do the same for each of the remaining values. The value which
is least important goes in Box 18.

Work slowiy and think carefully. If you change your mind, feel free to change your
answers. The labels peel off easily and can be moved from place to place. The and re-
sult should truly show how you really feel.

222

Page 3.

 

oowoourxoom...

00 ‘\I ()~ Ln J>. 00 l\) ... CD ‘(3

 

 

(Labels for the 18 terminal

 

values were presented here
for one-half of the control

 

group and all subjects re-
ceiving Treatments 1 and 2.)

 

 

 

(Labels for the 18 instrumen—
tal values were presented to

 

the remaining control subjects
and all subjects receiving

 

Treatments 3 and 4.)

 

 

 

 

 

 

 

 

 

 

 

WHEN YOU HAVE FINISHED, turn this 1_n_.
(You will be given Part ‘II.)

APPENDIX I

TREATMENT I -- FREEDOM EXERCISE

223

 

 

TREATMENT I -- FREEDOM EXERCISE

PART II.
COMPARING YOUR VALUES WITH OTHER PEOPLE
Your scores for seven of the values which you arranged are

circled below in a way that you will be able to compare
them to the scores of others who have come into Pine Rest.

 

 

 

 

 

 

 

 

 

 

 

 

 

People who place People who place
more importance on . less importance on
FREEDOM Average FREEDOM
Values have these scores: scores: have these scores:
FREEDOM l to 9- 10, ll 12 to 18
When FREEDOM is When FREEDOM is
more important, these less important, these
two values are often two values are often
more important too. less important too.
EQUALITY 1 to 12 13, 14 15 to 18
NATIONAL SECURITY 1 to 15 16, 17 18
When FREEDOM is When FREEDOM is
more important, these less important, these
four values tend to be four values tend to be
less important. more important.
HAPPINESS 18 to 6 5, 4 3 to l
SALVATION 18 to 4 3, 2 l
SOCIAL RECOGNITION 18 to 15 - 14, 13 12 to 1
PLEASURE 18 to 15 l4, 13 12 to 1

 

If your scores tend to fall
on this side of the page,
you may be like people who
place less value on FREEDOM

If your scores tend to fall
on this side of the page,
you may be like peOple who
place more value onEREEDOM

il-I-flril-

 

 

WHICH GROUP DO YOU THINK YOU ARE MOST LIKE?
(Circle one number)

Almost exactly A little bit A little bit Almost exactly
like the HIGH like the HIGH like the LOW like the LOW
FREEDOM group FREEDOM group FREEDOM group FREEDOM group
' I I I
1 2 3 4 5 6 7 8 9 10 11
l t F
Quite a bit I am about Quite a bit
like the HIGH average or like the LOS
FREEDOM group not sure FREEDOM group

 

 

GO ON TO THE NEXT PAGE

224

225

From previous research, we have found some other differences
between patients who place FREEDOM high and those who place FREEDOM
lower in importance at the time of admission to the hospital.

 

 

 

 

Patients placing greater Patients placing less

importance on FREEDOM importance on FREEDOM

This group is more likely to These patients express fewer
indicate more problems on their problems on personality tests.

personality tests.
They indicate that they are
Show more dissatifaction and less anxious or nervous.
resentment toward others.
Nurses see them as more

Are more easily hurt and cooperative and better at starting
quicker to blame others for their and sticking with things.
problems.

These patients are more likely

Are seen by the doctors as to put more importance on EREEDOM
having more serious problems. by the time they leave the hospital.

After leaving the hospital, After being discharged, fewer
they are expected by their of these patients are expected by
therapists as being among those their therapists to require
more likely to return. hospitalization in the future.

 

 

ONCE AGAIN, INDICATE WHICH GROUP YOU THINK YOU ARE MOST LIKE.

 

(Circle one number)

Almost exactly A little bit A little bit Almost exactly
like the HIGH . like the HIGH like the LOW like the Low
FREEDOM group FREEDOM group FREEDOM group FREEDOM grow
1 I Y I
1 2 3 4 5 6 7 8 9 10 11
I l l
Quite a bit I am about Quite a bit
like the HIGH AVERAGE or like the LOW
FREEDOM group not sure FREEDOM group

 

 

GO ON TO THE NEXT PAGE

 

 

226

CONCLUSIONS ABOUT FORMER PATIENTS

We believe the meaning and importance people place
on FREEDOM affects much of what they feel and do.

Some people come into the hospital who place too
much importance on their personal freedom. They
may have greater difficulty getting along with
others in their life. They may feel that others
stand in the way of what they want.

Other people come into the hospital who place too
little importance on their freedom. They may go
along with what others want too often. They may
not put enough importance on what they want.

It is probably worthwhile for people to think
about what FREEDOM means to them. And to look
at how and when they exercize their freedom.

 

 

 

WHAT DO YOU THINK?
' (Circle one number)

I agree completely I completely
with the above I agree I disagree disagree with
conclusions a little a little the conclusions
t r r I
1 2 3 4 5 6 7 8 9 10 11
I I I
I agree I'm not I disagree
quite a bit sure quite a bit

 

 

HOW DO YOU FEEL, RIGHT NOW, ABOUT THE WAY YOU HAVE ARRANGED YOUR VALUES?

(Circle one number)

Extremely A little A little Extremely
SatiSfied satisfied dissatisfied dissatisfied
I I I I
1 2 3 4 5 6 7 8 9 10 II
I I I
Satisfied I'm not Dissatisfied
quite a bit sure quite a bit

 

 

GO ON TO THE NEXT PAGE

APPENDIX J

TREATMENT 2 -- SELF-RESPECT EXERCISE

227

 

APPENDIX J

TREATMENT 2 -- SELF-RESPECT EXERCISE

PART .ll

COMPARING YOUR VALUES WITH OTHER PEOPLE

Your scores for seven of the values which you arranged are
circled below in a way that you will be able to compare
them to the scores of others who have come into Pine Rest.

 

 

People who place
more importance on

 

Average

People who place
less importance on

 

 

 

 

 

 

 

 

 

 

 

 

SELF-RESPECT SELF-RESPECT
Values have these scores: scores: have these scores:
SELF-RESPECT l to 4' 5, 6, 7, 8 9 ‘to 18
'When SELF-RESPECT is When SELF-RESPECT is
more important, these less important, these
two values are often two values are often
more important too. less important too.
SOCIAL RECOGNITION 1 to 12 l3, 14 15 to 18
WISDOM 1 to 6 7, 8 9 to 18
When SELF RESPECT is WhenSELF RESPECT is
more important, these less important, these
four values tend to be four values tend to be
less important. more important.
A WORLD OF BEAUTY 18 to 16 15, 14 13 to 1
NATIONAL SECURITY 18 to 17 16 15 to 1
FAMILY SECURITY 18 to 7 6, 5, 4 3 to 1
A WORLD AT PEACE 18 to 14 13, 12 11 to 1
If your scores tend to fall * If your scores tend to fall
on this side of the page, * on this side of the page,
you may be like people who * you may be like peOple who
place more value on 551-1“ * place less value on SELF'
RESPECT, * RESPECT.
WHICH GROUP DO YOU THINK YOU ARE MOST LIKE? (Circle One number)

 

Almost exactly
like the HIGH
SELF-RESPECT
group

A little bit
like the HIGH
SELF-RESPECT

group group
I I
3 4 5 6 7
I I
Quite a bit I am about
like the HIGH AVERAGE or
SELF-RESPECT not sure

group

60 ON TO THE NEXT PAGE

2283

A little bit
like the LOW
SELF-RESPECT

Almost exactly
like the LOW
SELF—RESPECT
group

8 9 10 11
I

Quite a bit

like the LOW

SELF-RESPECT

group

229

From previous research, we have found some other differences

between patients who place SELF-RESPECT high and those who place
SELF-RESPECT lower in importance at the time of admission.

 

 

Patients placing greater
importance on SELF-RESPECT

Patients placing less
importance on SELF-RESPECT

 

 

These patients express fewer
problems on personality tests.

Nurses see this group as easier
to communicate with and making

a better adjustment to the
hospital.

These patients tend to stay in
the hospital somewhat longer.

More likely to be among those
showing even more improvement
after leaving the hospital.

These patients more often indicate
they are sensitive and easily hurt
by what others say.

This group is seen as less
cooperative by the nurses.

More likely to be in therapy one
year after coming into the
hospital.

Their therapists see them as more
likely to return to the hospital
again some day.

 

 

Almost exactly
like the HIGH
SELF-RESPECT

group

ONCE AGAIN, INDICATE WHICH GROUP YOU THINK YOU ARE MOST LIKE.

I

3

I
Quite a bit
like the HIGH
SELF-RESPECT
group

(Circle one number)

A little bit A little bit Almost exactly
like the HIGH like the LOW like the LOW
SELF—RESPECT SELF-RESPECT SELF-RESPECT
group group group
I
5 6 7 8 9 10 11
I I

I am about Quite a bit

AVERAGE or like the LOW

not sure SELFBRESPECT

group

 

 

GO ON TO THE NEXT PAGE

 

 

230

CONCLUSIONS ABOUT FORMER PATIENTS

We believe the meaning and importance people place on
SELF-RESPECT affects much of what they feel and do.

Some people come into the hospital who place fairly high
importance on SELFBRESPECT. They like to be admired by
others, but feel it is especially important to approve
of themselves. They still seem to get along well with
other people.

Other people come into the hospital who place less
importance on SELFBRESPECT. They seem to have more
difficulties within themselves and with others. They
may have more trouble adjusting to the hospital and
progressing in therapy.

It is probably worthwhile for people to think about
what SELF-RESPECT means to them. And to look at how
it may affect the things they do.

 

 

 

WHAT‘QQ YOU THINK?
(Circle one number)

I agree completely I completely
with the above I agree I disagree disagree with
conclusions 3 little a little the conclusions
I I I I
1 2 3 4 5 6 7 8 9 10 11
I I I
I agree I'm not I disagree
quite a bit sure quite a bit

 

 

HOW DO YOU FEEL, RIGHT NOW, ABOUT THE WAY YOU HAVE ARRANGED YOUR VALUES?

(Circle one number)

Extremely A little A little Extremely.
satISfled satisfied dissatisfied dissatisfied
I I I I
1 2 3 4 5 6 7 8 9 10 11
I I I
Satisfied I'm not Dissatisfied
quite a bit sure quite a bit

 

 

fiQ ON TO THE NEXT PAGE

 

APPENDIX K

TREATMENT 3 -- RESPONSIBLE EXERCISE

231

 

APPENDIX K

TREATMENT 3 -- RESPONSIBLE EXERCISE

PART ;;_

COMPARING YOUR VALUES WITH OTHER

PEOPLE

Your scores for seven of the values which you arranged are

circled below in a way that you will be

able to compare

them to the scores of others who have come into Pine Rest.

 

 

People who place
more importance on

 

People who place
less importance on

 

 

 

 

 

 

 

 

 

 

RESPONSIBLE Average RESPONSIBLE
Values have these scores: scores: have these scores:
RESPONSIBLE l to 6 - 7 . 8 to 18
[When RESPONSIBLE is When RESPONSIBLE is
more important, these less important, these
two values are often two values are often
more important too. less important too.
POLITE l to 11 12, 13 14 to 18
AMBITIOUS 1 to 6 7, 8 9 to 18
When RESPONSIBLE is When RESPONSIBLE is
more important, these less important, these
four values tend to be four values tend to be
less important. more important.
BROADMINDED 18 to 10 9 8 to 1
LOGICAL 18 to 15 14, 13. 12. ll. 10 9 to 1
LOVING" 18 to 5 4. 3 2, 1
FORGIVING 18 to 11 10, 9, 8, 7, 6 _ 5 to 1

 

 

 

If your scores tend to fall * If your scores tend to fall
on this side of the page, * on this side of the page,
you may be like peeple who * you may be like people who
place more value on * place less value on
RESPONSIBLE. * RESPONSIBLE.
WHICH GROUP DO YOU THINK YOU ARE MOST LIKE? (Circle one number)
Almost exactly A little bit A little bit Almost exactly
like the HIGH like the HIGH like the LOW like the LON
RESPONSIBLE RESPONSIBLE RESPONSIBLE RESPONSIBLE
group group group group
I I
1 2 3 4 S 6 7 8 9 10 11

I I

I am about
average or
not sure

Quite a bit
like the HIGH
group

Quite a bit
like the LOW

group

 

GO ON TO THE NEXT PAGE

2232

 

233

From previous research, we have found some other differences
between patients who place RESPONSIBLE high and those who place
RESPONSIBLE lower in importance at the time of admission.

 

 

 

 

Patients placing greater Patients placing less

importance on RESPONSIBLE importance on RESPONSIBLE
These patients tend to be more These patients tend to eXpress more
optomistic and realistic. pessimistic attitudes.
These patients are more organized This group tends to have more complaints
and persistent. of anxiety and nervousness.
They are more likely to show even These individuals tend to feel more
greater improvement continuing depressed.

after they leave the hospital.
More people in this group are likely
to be in therapy one year after coming
into the hOSpital.

 

 

ONCE AGAIN, INDICATE WHICH GROUP YOU THINK YOU ARE MOST LIKE.

(Circle one number)

Almost exactly A little bit A little bit ALmost exactly
like the HIGH like the HIGH like the LOW like the LOW
RESPONSIBLE RESPONSIBLE RESPONSIBLE RESPONSIBLE
group group group group
I I I
1 2 3 4 S 6 7 8 9 10 11
I I I
Quite a bit I am about Quite a bit
like the HIGH average or like the LOW
RESPONSIBLE not sure RESPONSIBLE
group group

 

 

 

 

234

CONCLUSIONS ABOUT FORMER PATIENTS

We believe the meaning and importance people place on
RESPONSIBLE affects much of what they feel and do.

People who come into the hOSpital placing greater
- importance on RESPONSIBLE appear to feel better and
be more realistic.

Some people may place too much importance on being
responsible and find that they may not always be fair
to themselves by neglecting things that could be
important for them.

Some peeple place too little importance on being
responsible and find it difficult to take charge of
their lives.

It is probably worthwhile for people to think about
what RESPONSIBLE means to them and how it may affect
what they do.

 

 

BEE no 3; THINK?

 

(Circle one number)

I agree completely I completely
with the above I agree I disagree disagree with
conclusions a little a little the concluSIons
I I I I
1 2 3 4 5 6 7 8 9 10 11
I I I
I agree I'm not I disagree
quite a bit sure quite a bit

 

 

HOW DO you FEEL, RIGHT NOW, ABOUT THE RAT ‘L'OU RWE ARRANGED YOUR VALUES?

(Circle one number)

Extremely A little A little Extremely
satiSfiEd satisfied diSSUCiSEit’d dissatisfied
I g I I
1 2 3 4 3 6 7 3 9 10 11
I I I
Satisfied I'm not Dissatisfied
quite a bit sure quite a Dlt

 

 

GO ON TO THE NEXT PAGE

APPENDIX L

TREATMENT 4 -- SELF-CONTROLLED EXERCISE

235

 

APPENDIX L

TREATMENT 4 -- SELF-CONTROLLED EXERCISE

PART II

COMPARING YOUR VALUES WITH OTHER PEOPLE

Your scores for seven of the values which you arranged are
circled below in a way that you will be able to compare
them to the scores of others who have come into Pine Rest.

 

 

People who place
more importance on

 

People who place
less importance on

 

 

SELF-CONTROLLED Average SELF-CONTROLLED
Values have these scores: scores: have these scores:
SELF-CONTROLLED l to 6 7, 8, 9, 10 11 to 18

 

When SELF-CONTROLLED is
more important, these
two values are often
more important too.

 

When SELF-CONTROLLED is
less important, these
two values are often
less important too.

LOGICAL l to 9 10, ll, 12, 13, 14 15 to 18

INDEPENDENT 1 to 6 7, 8, 9, 10, 11, 12 13 to 18

 

When SELF-CONTROLLED is
more important, these
four values tend to be
less important.

 

When SELF-CONTROLLED is
less important, these
four values tend to be
more important.

LOVING 18 to 5 4, 3 2, 1
HONEST 18 to 5 4, 3, 2 l
AMBITIOUS 18 to 9 8, 7 6 to 1
CAPABLE 18 to 11 10, 9, 8 7 to 1

 

If your scores tend to fall
on this side of the page,
you may be like peOple who
place more value on SELF-
CONTROLLED.

If your scores tend to fall
on this side of the page,
you may be like people who
place less value on SELF-
CONTROLLED.

iii-I'l-

 

WHICH GROUP DO YOU THINK.YOU ARE MDST LIKE?

(Circle one number)

Almost exactly A little bit .A little bit Almost exactly
like the HIGH like the HIGH like the LOW like the LOW
SELF-CONTROLLED SELF—CONTROLLED SELF-CONTROLLED SELF-CONTROLLED
group group group group
I I I
1 2 3 4 5 6 7 8 9 10 11
' I I I
Quite a bit I am about Quite a bit
like the HIGH average or like the LOW
group not sure group

 

GO ON TO THE NEXT PAGE

236

237

From previous research, we have found some other differences
between patients who place SELF-CONTROLLED high and those who place
SELF-CONTROLLED lower in importance at the time of admission.

 

 

Patients placing greater
importance on SELF-CONTROLLED

Patients placing less
importance on SELF-CONTROLLED

 

 

These patients say they feel more
energetic, restless, and impatient.

More of this group are seen by the

doctors as having more serious problems.

Nurses see more of these patients as
being overactive, "on the go" and
impulsive.

More of these patients have a longer
stay in the hospital.

These patients tend to be more
open to what others say

These patients are more willing to
talk about themselves.

They tend to be more patient.

These patients tend to have a
shorter stay in the hospital.

Many of these patients place more
importance on self-controlled as
they improve in the hospital.

 

 

ONCE AGAIN, INDICATE WHICH GROUP YOU THINK YOU ARE MOST LIKE

(Circle one number)

Almost exactly A little bit A little bit Almost exactly
like the HIGH like the HIGH like the LOW like the LOW
SELF-CONTROLLED SELF-CONTROLLED SELF-CONTROLLED SELF-CONTROLLED
group group group group
I I I I
1 2 3 4 5 6 8 9 10 11
I I I
Quite a bit I am about Quite a bit
like the HIGH AVERAGE or like the LOW
SELF-CONTROLLED not sure SELF-CONTROLLED

group

group

 

 

GO ON TO THE NEXT PAGE

 

 

238

CONCLUSIONS ABOUT FORMER PATIENTS

We believe the meaning and importance peOple place on
SELF-CONTROLLED affects much of what they feel and do.

Some peOple come into the hospital placing great impor-
tance on SELF-CONTROLLED. They are often among those who
also are having the most trouble controlling their actions.
For these people, self-control may be important because it
is so difficult.

Others come into the hospital who place rather low impor-
tance on SELF-CONTROLLED. Many of these people find

that it is worthwhile to place more value on SELF-CONTROLLED
in order to manage their lives better.

It is probably worthwhile for people to think about what
SELF-CONTROLLED means to them. And to look at how it
may affect what they do.

 

 

 

 

AT pg YOU THIN-K?

 

(Circle one number)

I agree completely I completely
with the above I agree I disagree disagree with
conclusions a little a little the conclusions
I I I I
1 2 3 4 S 6 7 8 9 10 I1
I I I
I agree I'm not I disagree
quite a bit sure quite a bit

 

 

HOW DO YOU FEEL, RIGHT N W, ABOUT THE WAY YOU HAVE ARRANGED YOUR VALUES?

(Circle one number)

Extremely A little A little Extremely
satisfied satisfied dissatisfied dissatisfied
I I I I
1 2 3 4 S 6 7 8 9 10 11
I I I
Satisfied I'm not Dissatisfied
quite a bit sure quite a bit

 

 

GO ON TO THE NEXT PAGE

APPENDIX M

TREATMENT 5 -- NON-TARGETED EXERCISE

239

 

 

APPENDIX M

TREATMENT 5 -— NON—TARGETED EXERCTSE

PART-£1
SOME CONCLUSIONS ABOUT VALUES
We believe that a person's values will affect how he views
things and feels about things.

A person's values are his basis for making decisions and
determine what he does in many situations.

We believe that when peOple change, their values change in
some important ways too.

It is worthwhile for people to know what values are important
to them and to understand how these values affect their lives.

 

 

 

WHAT g YOU THINK?

 

 

(Circle one number)

I agree completely I completely

with the above I agree I disagree disagree with
conclusions a little a little the conclusions
I I I I
1 2 3 4 5 6 7 8 9 10 11
I I I
I agree I'm not I disagree
quite a bit sure quite a bit

 

 

HOW DO YOU FEEL, RIGHT NOW, ABOUT THE WAY YOU HAVE ARRANGED YOUR VALUES?

(Circle one number)

Extremely A little A little Extremely
satiSfied satisfied dissatisfied dissatisfied
I I I I
l 2 3 4 5 6 7 8 9 IO 11
I I I
Satisfied I'm not Dissatisfied
quite a bit sure quite a bit

 

 

GO ON TO THE NEXT PAGE

240

 

APPENDIX N

FINAL PAGE OF PART II FOR ALL SUBJECTS

 

”—

241

APPENDIX N

FINAL PAGE OF PART II FOR ALL SUBJECTS

We would now like to find out what you think about this way of
learning about your values.

 

 

DID YOU FIND IT INTERESTING 0R THOUGHT-PROVOKING?

1 2 3 4 5 6 7 8 9 10 11
Extremely A little A little Extremely
interesting and interesting boring boring

though t-provoking

 

 

m YOU FEEL YOU LEARNED SOMETHING ABOUT YOUR VALUES?

1 2 3 4 5 6 7 8 9 10 11
Yes, I Quite A few Not No, I did
learned a bit things much not learn
a lot anything

 

 

DO MOST OF THE THINGS YOU DO MATCH THE WAY YOU ARRANGED YOUR VALUES?

1 2 3 4 5 6 7 8 9 10 11
Everything I do I usually act Quite often Nothing I do fits a;
is consistent with according to my actions do is consistent with
the way I arranged the way I not match the the way I arranged
my values arranged my way I arranged my values

values my values

 

 

THIS IS THE END OF PART II.

WHEN YOU ARE FINISHED, TURN THIS PART IN
. AND YOU WILL BE GIVEN PART III.

 

 

242

APPENDIX 0

PART III
VALUE SURVEY AT TIME I

243

APPENDIX 0

PART III: VALUE SURVEY AT TIME I

PART III

, On this page are 18 more values listed in alphabetical order.
ARRANGE THESE VALUES in order of importance to YOU, as guiding principles in your life.

 

 

 

 

 

 

 

(Labels were presented here
for the set of values the
subject had not ranked ini-
tially.)

 

 

00 ‘4 C> I)! h» 00 h) _u

 

<3

 

CD

 

d
d

 

NJ

 

00

 

I;

 

(h

 

<3"

 

<3

 

 

 

00

 

WHEN YOU HAVE FINISHED, GO TO THE NEXT PAGE.

244

245

Here are the 18 values which you arranged earlier. Please ARRANGE THEM
AGAIN in order of their importance to you RIGHT AI THIS TIME.

 

 

 

00 ‘4 (3‘ Ch ls (x) h) —d

ooVOGKEI-SZOO

 

 

 

 

 

(Labels were presented here

 

for the same set of values
ranked by the subject prior
to treatment.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

When ygg_have finished, turn in this

part. This will complete today's test

session. We will let you know when to

come in for the second session. THANK YOU 3

APPENDIX P

F RATIOS FOR ALL SOURCES OF VARIANCE
IN ALL OMNIBUS TESTS PERFORMED
(TABLE P-T THROUGH P-TT)

246

 

 

 

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247

 

 

 

 

 

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248

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m m m m m m m m «m@ mosoom
UOHHOHUGOUIMHQm OH n—Hwfiommwm HUOWmOMIMHmm EOVOMHW

 

msam> umwsme

 

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oooss soos<s oo mssozs mosomsoz oossooos mos zH oostsss oo moosoom sos moHH<s o I: muo oooss

 

249

TABLE P—3 -— F RATIOS FOR SOURCES OF VARIANCE IN THE MULTIVARIATE
ANOVA OF THE THREE INDIRECT MEASURES OF FREEDOM

 

 

 

Source df F P
TR (Treatment) 12,259.575 1.180 .297
SX (Ser 3,98 .587 .624
DX (Diagnosis) 3,98 6.410 .001
TR by SX 12,259.575 1.568 .100
TR by DX 12,259.575 .851 .597
SX by DX 3,98 .731 .535
TR by SX by DX 12,259.5751 1.489 .128

 

TABLE P-4 —— F RATIOS FOR SOURCES OF VARIANCE IN THE UNIVARIATE
ANOVAS OF THE THREE INDIRECT MEASURES OF FREEDOM

 

Dependent Variables

 

 

 

 

 

 

 

Independence Acceptance Independence
£222_ ' " of Authority ‘LSIXL
Source df* F P F P F P

TR (Treatment) 4 .923 .453 .863 .488 2.011 .098
SX (Sex) 1 1.121 .292 .892 .347 .001 .975
DX (Diagnosis) 1 .266 .607 19.232 .001 .286 .594
TR by SX 4 1.761 .142 2.382 .056 1.114 .354
TR by DX 4 .069 .991 1.371 .246 1.199 .316
SX by DX l .018 .892 .050 .822 2.186 .142
TR by SX by DX 4 1.742 .142 1.071 .375 1.370 .249

 

* df error = 100

250

TABLE P-5 —- F RATIOS FOR SOURCES OF VARIANCE IN THE MULTIVARIATE

 

ANOVA OF THE PAIR OF INDIRECT MEASURES OF SELF—RESPECT

 

 

 

source df F P
TR (Treatment) 8,198 1.592 .129
SX (Sex) 2,99 1.032 .359
DX (Diagnosis) 2,99 2.260 .109
TR by SX 8,198 .487 .864
TR by DX 8,198 .408 .914
SX by DX 2,99 1.291 .279
TR.by SX by DX 8,198 1.562 .137

 

TABLE P—6 -— F RATIOS FOR SOURCES OF VARIANCE IN THE UNIVARIATE
ANOVAS OF THE TWO INDIRECT MEASURES OF SELF-RESPECT

 

 

Dependent Variables

 

 

 

 

Individualism Leadership

Source df* F P F P

TR (Treatment) 4 2.164 .078 .380 .246
SX (Sex) 1 .202 .654 .692 .196
DX (Diagnosis) 1 4.478 .036 .001 .987
TR by SK 4 .341 .849 .611 .655
TR.by DX 4 .286 .886 .497 .737
SX by DX 1 .672 .414 .613 .207
TR by SX by DX 4 1.395 .241 .521 .201

 

* df error = 100

251

TABLE P-7 -- F RATIOS FOR SOURCES OF VARIANCE IN THE MULTIVARIATE

 

ANOVA OF THE PAIR OF INDIRECT MEASURES OF RESPONSIBLE

 

 

 

Source df F P
TR (Treatment) 8,198 .479 .869
SX (Sex) 2,99 1.275 .283
DX (Diagnosis) 2,99 2.770 .067
TR by SX 8,198 1.178 .313
TR by DX 8,198 .605 .772
SX by DX 2,99 3.485 .034
TR byfiSX by EX 8,198 1.066 .388

 

TABLE P-8 -- F RATIOS FOR SOURCES OF VARIANCE IN THE UNIVARIATE
ANOVAS OF THE TWO INDIRECT MEASURES OF RESPONSIBLE

 

 

Dependent Variables

 

 

 

 

 

Social
Responsibility Conformity
Source df* F P F P

TR (Treatment) 4 .532 .712 .443 .777
SX (Sex) 1 2.476 .118 .079 .778
DX (Diagnosis) 1 .002 .964 5.596 .020
TR by SX 4 1.434 .228 .958 .434
TR by DX 4 .834 .506 .407 .803
SX by DX 1 5.467 .021 1.452 .231
TR by SX by DX 4 1.781 .138 .392 .813

 

* df error = 100

 

252

TABLE P-9 -— F RATIOS FOR SOURCES OF VARIANCE IN THE MULTIVARIATE
ANOVA OF THE PAIR OF INDIRECT MEASURES OF SELF—CONTROLLED

 

 

 

Source df F P
TR (Treatment) 8,198 .723 .670
SX (Sex) 2,99 .017 .983
DX (Diagnosis) 2,99 .367 .693
TR by SX 8,198 .987 .446
TR by DX 8,198 .282 .971
SX by DX 2,99 .513 .599
TR by SX by DX 8,198 1.096 .367

 

TABLE P—lO —— F RATIOS FOR SOURCES OF VARIANCE IN THE UNIVARIATE
ANOVAS OF THE TWO INDIRECT MEASURES OF SELF—CONTROLLED

 

Dependent Variables

Value—Determined

 

 

Self-Control Restraint
Source df* F P F P
TR (Treatment) 4 .457 .766 1.160 .333
SX (Sex) 1 .000 1.000 .033 .855
DX (Diagnosis) 1 .011 .916 .741 .391
TR by SK 4 1.126 .348 1.035 .393
TR by DX 4 .126 .972 .378 .823
SX by DX 1 .716 .399 .496 .482
TR by SX by DX 4 .587 .672 1.657 .166

 

* df error = 100

253

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STRTE UNIV. LIBRR

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