J mull1mmlillllnllllnlfllllml “, L

3 1293 00682 4043

LIBRARY
Michigan State
University

 

 

 

 

This is to certify that the

dissertation entitled
CLIENT SEX AND DEGREE OF DEPENDENCY:
RELATION TO PSYCHOTHERAPISTS'
JUDGER’IENI‘S OF CLIENT IMLADJUSTIHENT

presented by

Randall Lee Wolthuis

has been accepted towards fulfillment
of the requirements for

Ph.D. degreein Counseling Psychology

 

Major professor

./ (7
// . /
k.//
Date 2/2 5/ 57

MS U a": an Affirmative Action/Equal Opportunity Institution 0-12771

 

 

MSU

LIBRARIES
-—

 

 

 

r

RETURNING MATERIALS:
Place in book drop to
remove this checkout from
your record. FINES will
be charged if book is
returned after the date
stamped below.

 

 

‘ lJUN lg n.

 

 

 

qqy5267

CLIENT SEX AND DEGREE OF DEPENDENCY: RELATION TO
PSYCHOTHERAPISTS' JUDGEMENTS OF CLIENT MALADJUSTMENT

BY
Randall Lee Wolthuis

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

DOCTOR OF PHILOSOPHY

School of Health Education, Counseling
Psychology and Human Performance

1987

ABSTRACT

CLIENT SEX AND DEGREE OF DEPENDENCY: RELATION TO
PSYCHOTHERAPISTS' JUDGEMENTS OF CLIENT MALADJUSTMENT

BY
Randall Lee Wolthuis

The purpose of the current study was to investigate the
effect of client sex and client behavior (dependent vs.
independent) in therapy on the assessments of
psychotherapists. Since dependent behavior is more
congruent with the traditional female stereotype and
independent behavior with the traditional male stereotype,
it was expected that clients whose behavior deviated from
the expected stereotype would be more harshly judged than
their opposite-sex counterparts.

Two-hundred-thirty-one psychologists and clinical social
workers (59% rate of return) responded to a written vignette
in which a client was described. The client was described
as either male or female. The client's behavior in therapy
was presented as either dependent or independent. Subjects
were asked to respond to a 20-item questionnaire created by
the experimenter. Items required subjects to make

assessments of clients' vulnerability to various symptoms of

 

maladjustment. The questionnaire also asked subjects to
provide demographic data on themselves.

Results indicated that, as expected, psychotherapists
did view the dependent male as more vulnerable to
maladjustment than the dependent female. The independent
female, however, was not rated as more vulnerable to
maladjustment than the independent male. Psychotherapists
rated the dependent male and independent male as
significantly different from each other in terms of
vulnerability to maladjustment but not the dependent female
and independent female. In addition, more experienced and
older psychotherapists gave higher maladjustment
vulnerability scores than did lesser experienced and younger
psychotherapists.

Results imply that some sex role stereotyping may
continue to exist among psychotherapists. The dimension of
client dependence/independence may be a more salient factor
in psychotherapists' assessments when evaluating a male as
opposed to a female. Reasons for the finding of no
difference between psychotherapists' scores for the
independent female and independent male are discussed both
in terms of the design of the study and cultural factors.

It may be that societal changes in recent years have diluted
the bias against independence for females. It may also be

that the severity of the stereotype violation is a factor in
psychotherapists' assessments of clients. Further research

is necessary to clarify these issues.

 

adm- mum-cm ’7'}; ,

._ .nr-c up so 6-".
0" CV en '
.o oh- 3".
~. “4.14,. 09”..
acmwcsvcm ' .
Onr‘ 1"} m
”N
ouch!"
'l‘h era a: e several people who deem! fit;
cl .0
a:‘-... wiledqement for them help end euppor: I u u
o 1. v
commute-n members, Dre. Rochelle Bebeck. MUH- Decree: “
" " '1 I '1‘
John L‘Uwell for their eeeieunce and enooureg‘eet. I d
' : "C AA
.{étl‘fiJl to Dr . Lawrence Deer end Dr. Gerry Pitt-O 1.

their valuable assistance with the eutleticel fulfill“. !

res-pr. .31 y His). to acknowledge Dr. Richard Johfllfflo D! V~'. f:
c:.a.:z.erson. 13le was always I'ell.10 to I.“ I, . ~I'w' ‘ :1
questions. in process my cggcgggle}? end no be I, M“. {3' ‘ l
Fur this, l an ear] grateful. ‘ ‘.l“_
I am thankful to ny perente. Ralph ml ‘31!” .3We- y 0‘ .4.
uhOSe mu turance and encouragement were 0 «can: I“ ' A
learning in my early yeace. 1 e100 wish.» M.” U. ‘.
William Van Barden,‘ a colleague, friend. OM “filth 5
Bill helped me get through a difficult the "I” ~ “t 51‘. ]

yeer. lle node I. feel «leaned end Md. MI I.

. -a. \f.

help, I found renewed my.
1 we uh. be e1. m

   

  
   

3“; I
: "
swat N?

1

‘: '3-:v*€t- )3 W '

ACKNOWLEDGEMENTS

There are several people who deserve special
acknowledgement for their help and support. I thank my
committee members, Drs. Rochelle Habeck, Linda Forrest and
John Powell for their assistance and encouragement. I am
grateful to Dr. Lawrence Baer and Dr. Harry Piersma for
their valuable assistance with the statistical analyses. I
especially wish to acknowledge Dr. Richard Johnson, my
chairperson. Dick was always available to hear my
questions, to process my concerns, and to be my advocate.
For this, I am very grateful.

I am thankful to my parents, Ralph and Marilyn Wolthuis,
whose nurturance and encouragement were a catalyst for
learning in my early years. I also wish to acknowledge Dr.
William Van Eerden, a colleague, friend, and therapist.

Bill helped me get through a difficult time during the past
year. He made me feel welcomed and accepted. With his
help, I found renewed energy.

I would like to also express appreciation to my
children, Ryan and Kimberly, who always seemed to understand
when their father was "too busy.’I Watching them mature and

enjoying their growth prevented me from becoming too

consumed with myself and my task. They provided me with joy
and happiness which eased my burden considerably.

A special acknowledgement is due my wife, Linda. This
is where words do not do justice to the feelings felt.
Linda's quiet strength and stability, her ready willingness
to sacrifice, her love and companionship, and her optimistic
approach to life are all valued and cherished beyond words.
I am happy and priviledged to be her life's companion.

Finally, I wish to humbly thank my Creator, the One who
has seen fit to provide me with the personal strength and
stamina I have needed, but also the supportive people so
important and valued during the past year. His faithfulness
to me during my life becomes clearer and clearer to me as
life goes on.

"Saving, helping, keeping, loving,
He is with me to the end."

iv

 

TABLE OF CONTENTS
page
LIST OF TABLES O O O I O I O l O O O C I O I D I I O 0 vii

LIST OF FIGURES I c e o I O o o o e o o e O o o o O I ix

CHAPTER

I INTRODUCTION . . . . . . . . . . . . . . . . 1
II REVIEW OF THE LITERATURE . . . . . . . . . . 7
Sex Role Stereotyping . . . . . . . . . . . 8
Non—psychotherapists . . . . . . . . . 8
Psychotherapists . . . . . . . . 12

Stereotype Deviations and Mental Health
Judgements . . . . . . . . . . . . . . . 18
Non-psychotherapists . . . . . . . . . 18
Psychotherapists . . . . . . . . . . . 22
Dependence and Independence . . . . . . . . 27
Role of Women . . . . . . . . 27

Masculine and Feminine Identity

Formation . . . . . . . . . . . . . . 28
Empirical Studies . . . . . 30
Psychotherapy and Dependence/Independence . 33
III METHOD . . . . . . . . . . . . . . . . . . . 37
Subjects . . . . . . . . . . . . . . . . . . 37
Procedure . . . . . . . . . . . . . . . . . 37
Cover letter . . . . . . . . . . . . . 38
Client Vignettes . . . . . . . . . . . 39
Instruction Sheet . . . . . . . . . . . 40
Questionnaire . . . . . . . . . . . . . 40
Post Cards . . . . . . . . . . . . . . 43
Hypotheses . . . . . . . . 43

Statistical Analyses . . .
Iv RESULTS 0 I I O O O I I C I O O I D O I O I 49
Description of Subjects . . . . . . . . . . 49

Questionnaire Inter-item Consistency
Ratings of Client Dependency . . . . . . . . 52

l
I
I
0
0'
N

 

CHAPTER
Main Hypotheses . . . . . . . . . . . . . . 58
other Hypotheses I I I I I I I I I I I I I I 61
Summary of Findings . . . . . . . . . . . . 67

V DISCUSSION 0 e e e I e o o e a e o o o o a o 69

Review of Findings . . . . . . . . . . . . 73
Limitations of the Study. . . . . . . . . . 83
Implications for Research . . . . . . . 84

Implications for Clinical Training and
Practice I I I I I I I I I I I I I I I I I 87

APPENDICES
Appendix A - Cover Letter . . . . . . . 89
Appendix B1 - Dependent Client Vignette . . . . . 90
Appendix 32 - Independent Client Vignette . . . . 92
Appendix C - Instruction Sheet 0 e e e e e o e e 94
Appendix D - Maladjustment Assessment
Questionnaire . . . . . . . . . . 96
Appendix E - Post Cards . . . . . . . . . . . . 101
BIBLIOGRAPHY

 

Table

10

11

12

13

LIST OF TABLES

Psychotherapists' Profession . . . . . . . .
Psychotherapists' Sex . . . . . . . . . . .
Psychotherapists' Theoretical Orientation .
Psychotherapists' Primary Clients . . . . .

Psychotherapists' Activity in
Psychotherapy . . . . . . . . . . . . . . .

Psychotherapists' Age . . . . . . . . . . .
Psychotherapists' Years of Experience . . .

Psychotherapists' Average Hours of
Therapy Per Week . . . . . . . . . . . . . .

Mann-Whitney g Test for Degree of Dependence
in Dependent and Independent Vignette
Situations I I O I I I I I C I I I I I I I O

Mann-Whitney g Test for Maladjustment
Vulnerability Scores in Dependent Male

and Dependent Female Vignette

Situations . . . . . . . . . . . . . . . . .

Mann-Whitney g Test for Maladjustment
Vulnerability Scores in Independent Male and
Independent Female Vignette Situations . . .

Mann-Whitney 9 Test for Maladjustment
Vulnerability Scores in Dependent Male and
Independent Male Vignette Situations . . . .

Mann-Whitney 9 Test for Maladjustment
Vulnerability Scores in Dependent Female
and Independent Female Vignette

Situations . . . . . . . . . . . . . . . . .

53
54
55

56

58

58

61

61

62

 

Table

14

15

16

17

18

19

Mann-Whitney 2 Test for Maladjustment
Vulnerability Scores of Male and Female
Psychotherapists . . . . . . . . . . . . .

Mann—Whitney 9 Test for Maladjustment
Vulnerability Scores of Social Workers
and Psychologists . . . . . . . . . . . .

Mann-Whitney g Test for Maladjustment
Vulnerability Scores by Psychotherapist
Activity in Conducting Psychotherapy . . .

Kruskal-Wallis One Way Analysis of
Variance by Ranks Test for Maladjustment
Vulnerability Scores by Psychotherapist
Theoretical Orientation . . . . . . . . .

Kruskal-Wallis One Way Analysis of
Variance by Ranks Test for Maladjustment
Vulnerability Scores by Psychotherapist
Primary Clients . . . . . . . . . . . . .

Spearman Rank Correlation Coefficient (5s)
for Maladjustment Vulnerability Scores

by Psychotherapist Age, Years of
Experience and Hours per Week of
Psychotherapy . . . . . . . . . . . . . .

viii

62

63

63

65

66

66

Figure

LIST OF FIGURES

Mean Ranks of Maladjustment Vulnerability
Scores for Dependent Male, Dependent
Female, Independent Male and Independent
Female . . . . . . . . . . .

ix

59

 

CHAPTER I

INTRODUCTION

During the 1970's there occurred an explosion of
research which investigated the effects of a person's sex on
the opinions, judgements and assessments of
psychotherapists. This research was precipitated in no
small part by the now classic study by Broverman, Broverman,
Clarkston, Rosenkrantz and Vogel (1970) which revealed what
has since been described as a "double standard of mental
health." That is, males and females were described by
psychotherapists as healthy when their behavior complied
with commonly held sex role stereotypes. Furthermore, males
were viewed as more healthy than females since
psychotherapists' concept of health for a sex-unspecified
adult did not differ significantly from the concept of
health for a man but gig differ significantly from the
concept of health for a woman. At about the same time
authors such as Chesler (1972) charged that therapists
define mental health in terms of sex role stereotypes.
Furthermore, Chesler asserted that therapists impose their

stereotypes on their clients in the name of good therapy,

thereby not promoting mental health but inhibiting it.

These charges, along with the Broverman et a1. (1970)
findings ignited a flurry of research which investigated the
effect of a client's sex on psychotherapists. This research
was fueled further by the Womens Movement which was gaining
momentum during the 1970's.

Despite activism and legislation designed to diminish
sex discrimination and increase public awareness about
commonly held beliefs about men and women, recent studies
have found remarkable stability in the sex role stereotypes
of the general public (Ruble, 1983; Werner & LaRussa, 1985).
For example, respondents of both sexes continued to view men
as more forceful and independent than women. Since
psychotherapists are human beings, they are products of
their culture and are prone to be influenced in both overt
and subtle ways by that culture. Several studies have
revealed that psychotherapists also have stereotypic beliefs
about men and women and invoke them when making mental
health judgements (Maslin & Davis, 1975; Swenson & Ragucci,
1984). Furthermore, there is evidence that persons behaving
in a manner not congruent with traditional sex role
stereotypes are assessed as more maladjusted than persons
whose behavior complies with traditional sex role
stereotypes (Coie, Pennington & Buckley, 1974; Miller,
1974).

Since females have been traditionally stereotyped as
dependent while men have been stereotyped as independent,
one would expect researchers to have focused on the effect
of a person's sex and degree of dependence on the judgements
of practicing psychotherapists. It is interesting to note,
however, that there is very little empirical research which
has had as its focus the clinical judgements of therapists
confronted with male and female clients exhibiting dependent
or independent behavior. There exists a need for this
research. Research investigating sex bias in psychotherapy
has declined markedly since 1980. The gains made by the
Womens Movement along with the decline in research may have
lulled psychotherapists and researchers alike into believing
that sex role stereotyping is not as much a factor in
psychotherapy as it once was. This is unfortunate. Since
there are many client behaviors within the process of
psychotherapy which may invoke sex role stereotypes, the
research possibilities remain abundant.

Past research involving sex role stereotyping has relied
heavily on clinical analogue methodology in which subjects
in the study are presented with case material, usually in
written form. The investigator is then free to vary the
client's sex, behavior, or other pertinent variables within
the text of the written vignette. It has been suggested
that analogues which describe clearly a client's behavior in

certain situation may be more powerful in eliciting sex

‘

biased responding than analogues which merely describe a
client's traits (Whitely, 1979). Most studies investigating
the effect of sex role-deviant behavior on therapists'
judgements of mental health have used analogues in which the
behaviors of interest occur outside of the psychotherapy
relationship. Therapists' judgements as determined by a
client's behavior within therapy have been examined in only
a small number of studies. Furthermore, in no study has the
effect of client sex and degree of client dependence
(independence versus dependence) on therapists' judgements
been examined. The present research was proposed to
investigate this.

Human relationships intimately involve both dependence
and independence. It is a given that life inevitably is
characterized by attachments to and separations from people.
Young children bond with their parents or caretakers but
later in life separate from them. Adults form relationships
with other adults and life's circumstances (e.g. moving
away, death, divorce) dictate that the relationship must
end. The process of psychotherapy also requires that a
person form an attachment to another person, in this case a
therapist, only to inevitably detach and disengage from this
same person when treatment is finished. Traditional sex
role stereotypes hold that for men being able to separate
from a relationship and be independent is valued and a sign

of mental health whereas for women bonding and attaching to

‘

others is valued and a sign of mental health (Gilligan,
1982).

It might be expected that if therapists hold sex role
stereotypes of mental health, they may invoke those
stereotypes when confronted with client behavior in the
therapy relationship which is either dependent or
independent. The purpose of the present research is to
investigate the effects of client sex and degree of
dependence on therapists' judgements of the client's
vulnerability to maladjustment. It is expected that the
client's sex and degree of dependence will interact in such
a way that therapists will view the male behaving in a
dependent manner as more vulnerable to maladjustment than a
female behaving the same way. Similarly, it is expected
that a female behaving in an independent manner will be
viewed by therapists as more vulnerable to maladjustment
than a male behaving in like manner.

In Chapter II the pertinent literature on sex role
stereotyping is reviewed. Studies will be presented in
which psychotherapists' and non-psychotherapists' mental
health standards for both males and females were examined.
In addition, studies involving sex role-deviant behavior and
its effect on the mental health judgements of
psychotherapists are also presented. Since the behavioral
dimension of dependence and independence is strongly sex

role linked, a review of pertinent theoretical and empirical

‘

literature on this dimension is also presented. In Chapter
III the methodology of the present study is presented. The
data are reviewed and the statistical analyses are presented
in Chapter IV. A discussion of the results and their

implication is presented in Chapter V.

CHAPTER II

REVIEW OF THE LITERATURE

Psychotherapists are presumably trained to view each
client as a unique individual with his or her own unique
attributes and possessing his or her own unique strengths
and weaknesses. People viewed in this manner are less
likely to be categorized and described by virtue of their
membership in a group. If, however, a psychotherapist
responds to a client on the basis of a client's attribute
and commonly held beliefs about others who share that same
attribute, a problem exists. The client loses his or her
individuality and effective treatment is compromised.

This study concerns itself particularly with the sex of
the client. Since there appears to be pervasive and rather
enduring stereotypes of the male and female, it would not be
surprising to find psychotherapists sharing in those
stereotypes. To the extent that this occurs, the danger
exists whereby a client is viewed or treated in a particular
way by virtue of his or her sex. Succummbing to the
traditional stereotype obscures the vision of the therapist

who sees only a "female," for example, and fails to see the

many other significant traits of the client as well as the
client's unique life situation.

Pertinent research involving sex role stereotyping is
presented. Since the behavioral dimension of dependence and
independence is strongly associated with sex role
stereotypes, a review of this relevant empirical and

theoretical literature will also be presented.

Sex Role Stereotyping

Non-psychotherapists

 

Sherriffs and McKee (1957) employed a sample of college
students at the University of California at Berkeley and
found very sharp and distinct stereotypes of males and
females. Fifty men and 50 women were given two cards each
with 200 adjectives on them. Subjects were asked to check
those adjectives which they thought were in general true of
men (or women). The results revealed a clear difference in
the perception of males and females along several traits.
For example, men were viewed by subjects of both sexes as
significantly more frank, thorough, logical, independent,
and aggressive than women. Women were viewed as
significantly more pleasant, social, warm, sentimental, and
sensitive than men. Sheriffs and McKee summarized their
findings by noting that the stereotype of men as described

by subjects of both sexes seemed to encompass three notions:

‘

a straightforward and uninhibited social style, rational
competence and ability with a tendency toward being active,
and a bold effectiveness in dealing with the environment.
Furthermore, it should be noted that in a later study (McKee
& Sheriffs, 1959), it was found that men were concerned that
women not be aggressive, independent, dominant, or forceful.
About ten years later, Rosenkrantz, Vogel, Bee,
Broverman and Broverman (1968) reported sex role stereotypes
very similar to those reported by Sheriffs and McKee (1957).
Seventy-four men and 80 women, all college undergraduates,
were given what has since become known as the Sex Role
Stereotype Questionnaire (SRSQ). It contained 122 items
each of which described an attitude, behavior or personality
trait which was believed to differentiate men and women.
The items were arranged in bipolar form along a seven—point
continuum. Subjects were to rate an adult male, an adult
female and themselves along the continuum for each item. It
was found that men were viewed in relation to women as
having more competence and lacking warmth and
expressiveness. Women were seen as being warmer and more
expressive but lacking competence in comparison to men.
Traits in the "competence" cluster included "ambitious",
”independent", "objective", and ”active“. Broverman, ngel,
Broverman, Clarkston and Rosenkrantz (1972) found that these
same stereotypes occurred independent of the age, sex,

educational level, religion and marital status of the

10

respondents. After extensive administration of the SRSQ to
hundreds of subjects who varied on the traits mentioned
above, they concluded that sex role stereotypes were very
distinct and very pervasive.

More recent research seems to indicate that these
stereotypes continue to flourish. Ruble (1983) administered
the Personal Attributes Questionnaire (PAQ) to 128
undergraduates from a midwestern university. The PAQ
consisted of 54 items from the SRSQ which had been shown,
through previous research, to differentiate the typical man
from the typical woman as described by subjects in previous
studies. Thirty-two males and 32 females were asked to rate
along a six—point continuum how typical it would be for a
man (or woman) to possess each trait. Independent-group t
tests were performed with a confidence level of at least 2
(.01 required to indicate a significant difference. Results
showed that sex role stereotypes remained very strong for
that sample of undergraduates. Significant differences
between the typical man and typical woman were found for 53
of the 54 comparisons. For 51 of the comparisons,
differences were significant at the p (.001 level of
confidence. The typical male was found to be, for example,
more independent, aggressive, outspoken, and active than the
typical female. The typical female, on the other hand, was
found to be more in need of approval, more emotional, and

more aware of others' feelings than the typical male.

 

11

Werner and LaRussa (1985) replicated the Sheriffs and
McKee (1957) study in an attempt to determine if there were
differences in the content of sex role stereotypes over
time. This was an interesting study since the sample
consisted of 50 male and 50 female undergraduates at the
University of California at Berkeley, the same site where
Sherriffs and McKee selected their sample. The same
procedure was followed. Subjects were asked to check from a
list of 200 adjectives those which were true in general for
a man (or woman). Sixty-two percent of the adjectives
significantly ascribed to men versus women in 1957 continued
to be a part of the male stereotype. Seventy-seven percent
of the adjectives ascribed to women in 1957 remained part of
the female stereotype. Again, males continued to be viewed
as more frank, independent, dominant, and determined than
women. Women were viewed as more gentle, sensitive,
sociable, and trusting than men. These results are of
particular significance since they were obtained at a campus
known for the progressiveness and activism of its students.

In summary, there is a considerable amount of evidence
which suggests that sex role stereotypes continue to exist
among non-psychotherapists. Several studies have been
presented which demonstrate that men and women continue to
be perceived by both males and females as fundamentally
different from each other on many behavioral attributes.

Although activism, advocacy, and legislation have

12

encouraged, and in some cases required, that men and women
be viewed and treated equally, there remains a very strong
and pervasive stereotype for both a man and a woman. Males
and females continue to be viewed as very different from
each other.

Psychotherapists

Since psychotherapists are products of their culture, it
might be expected that they too share the stereotypes that
are apparently so prevalent among non-psychotherapists.
Indeed, several studies have shown that psychotherapists do
have strong beliefs about not only what men and women are
like, but also about what attributes describe a healthy man
and a healthy woman.

The most widely cited study on this question was
conducted by Broverman et al. (1970). Their subjects
consisted of 79 practicing psychotherapists, including
psychiatrists, psychologists, and social workers. More than
half held doctorate degrees and their ages ranged from 23 to
55 years. All subjects were given the SRSQ developed by
Rosenkrantz et a1. (1968). The subjects were asked to use
the 122 bipolar items to describe either a healthy female, a
healthy male, or a healthy adult (sex-unspecified). Healthy
women were found to differ significantly from healthy men by
being, for example, more submissive, less independent, less
adventurous, and more emotional. Furthermore, it was found

that the concept of health for the sex-unspecified adult did

‘

13

not differ significantly from the concept of the healthy man
but was significantly different from the concept of the
healthy woman. This finding has come to be known as the
"double standard of mental health": healthy women were
viewed as less healthy than healthy men. In addition,
masculine traits were found to be more socially desirable
than feminine traits on a significant number of items.
Broverman and her colleagues concluded that clinicians
viewed a client as healthy if he or she was fulfilling the
expectations of one's sex role. Since men and women
apparently have different sex roles, there would logically
be different standards of health for the two sexes.

The Broverman et a1. (1970) research precipitated
Phyllis Chesler's classic Women and Madness (1972) in which
she charged that psychotherapists reinforce the double
standard of mental health by believing that normality for
the female amounts to embracing the female sex role. Since
accepting the female sex role requires a woman to believe
that women are inferior to men, psychotherapy which subtly
urges women to adopt the traditional sex role confines women
to an oppressed position. Thus, women who are normal are
less healthy than and inferior to men.

This negative view of women in relationship to men was
further illustrated in more research. Fabrikant (1974)
asked psychotherapists to describe male and female sex

roles. Although the View of women differed somewhat from

14

previous research, the traditional view of women was
retained. Women were seen as significantly more exploiting
and fragile than men by both male and female
psychotherapists. In addition, female psychotherapists
viewed women as more subordinate than males. Eighty-three
percent of male characteristics were viewed as positive by
male psychotherapists, 86% by female psychotherapists.
However, only 31% of all female traits were viewed as
positive by male psychotherapists and 33% by female
psychotherapists.

Swenson and Ragucci (1984) investigated the sex role
stereotypes of psychotherapists using a slightly different
method. Using the concept of androgyny proposed by Bem
(1977), Swenson and Ragucci defined the androgynous
individual as one who scored above the median on both
stereotypic masculine and feminine characteristics. The
undifferentiated person was defined as one who scored below
the median on both stereotypic masculine and feminine
characteristics. The purpose of the study was to determine
the mental health standards of practicing psychotherapists
when given an androgynous alternative. Twenty-one male and
21 female psychotherapists were given the Bem Sex Role
Inventory. Each participant was asked to rate a mentally
healthy person (sex-unspecified), a healthy man, and a
healthy woman along a seven-point continuum for each

characteristic. The Bem Sex Inventory is composed of 60

15

items, 20 items each which describe attributes traditionally
masculine or feminine, and 20 items which describe neutral
attributes (Bem, 1974). The order of presentation was
counterbalanced. It was found that the mentally healthy
person, man, and woman were categorized in significantly
different ways. Almost 43% of the participants described
the mentally healthy person (sex-unspecified) as masculine
while nearly 62% of the subjects described the healthy man
as androgynous. The mentally healthy female was classified
as undifferentiated by 52% of the subjects. Swenson and
Ragucci noted that this may be evidence for a new and more
destructive double standard of mental health: that is, a
combination of masculine and feminine traits is acceptable
for both sexes but they should be strong for males and weak
for females. Furthermore, male and female 'ratees" were
viewed as significantly different in the expected direction
with regard to traditionally masculine and feminine
characteristics.

O'Malley and Richardson (1985) also found evidence that
males and females were still described in stereotypic ways
by psychotherapists. They presented 249 psychotherapists
(psychologists, counselors and social workers) with the
SRSQ. Like the Broverman et a1. (1970) study, participants
were told to imagine they were about to meet an adult male
(or female, or person, sex-unspecified). Only the 38

stereotypic items which had been shown in previous research

‘

16

(Rosenkrantz et al. 1968) to differentiate men and women
were analyzed. It was found that although the
sex-unspecified person was perceived as having both
masculine and feminine characteristics, the male and female
were still perceived differently and in the traditionally
stereotypic manner. Psychotherapists who were given healthy
female instructions scored female-valued items significantly
higher than male-valued items. Similarly, psychotherapists
given healthy male instruction scored male-valued items
significantly higher than female-valued items. O'Malley and
Richardson concluded that psychotherapists continued to hold
different concepts of men and women and that their standards
paralleled societal sex role stereotypes.

At least two other studies revealed similar sex role
stereotyping, but only on the part of male subjects. Both
employed counselors-in-training as subjects. Maslin and
Davis (1975) presented 22 doctoral and 68 masters degree
candidates at Temple University with the SRSQ. Again, only
the 38 items defined as stereotypic were scored and
analyzed. It was found that there was a significant
difference between the scores of males rating the healthy
female and the scores of females rating the same. The male
subjects rated the healthy female in more of the
traditionally and stereotypically feminine direction whereas

female subjects did not.

17

Harris and Lucas (1976) used the same methodology with
social work students at the University of Minnesota. Male
subjects viewed the healthy male and healthy female as
significantly different with the healthy female being placed
in the traditional feminine direction. In addition, male
subjects rated the healthy woman in a significantly
different manner than did female subjects. Male subjects
again viewed the healthy female as possessing more of the
traditional feminine traits than did female subjects.

In summary, several studies have been presented which
support the belief that psychotherapists do possess sex role
stereotypes of males and females. There is overwhelming
evidence that psychotherapists continue to view men and
women in traditionally stereotypic ways. Indeed, Whitely
(1979) reviewed 12 studies investigating the existence of
such stereotyping among mental health professionals and
found some evidence for sex role stereotyping in 11 of the
studies. Similarly, Sherman's (1980) extensive review shows
evidence for sex role stereotyping by psychotherapists in 14
of 15 studies done in North America. It appears that a
person is judged to be healthy when and if he or she
possesses attributes and characteristics which conform to
the traditional sex role stereotypes so pervasive in this

society.

l8

Findings such as these have led to the accusation that
psychotherapists, in defining normality as conformity to
traditional sex roles, subtly encourage women to be normal
by being inferior to men and by being, for example, less
active, less independent, and less dominant (Chesler, 1972).
A further belief was that deviations from traditional sex
role stereotypes play an important role in therapists'
assessments of the relative normality of clients seeking
psychotherapy. This question is addressed in the next

sections.
Stereotype Deviations and Mental Health Judgements

If there exist different sex role standards of health
for men and women, it follows that attributes and behavior
which violate traditional sex role stereotypes will be
viewed as evidence of maladjustment. Indeed, there is
evidence that both non-psychotherapists and psychotherapists
view a person as maladjusted if his or her attributes or
behavior deviate from the stereotypic norm.
Non-psychotherapists

Zeldow (1976) asked 50 male and 50 female undergraduate
students to read and evaluate statements that were
attributed to psychiatric patients but were not symptomatic
of emotional disturbance. The statements were drawn from

the Masculinity-Femininity and Lie scales of the Minnesota

‘

19

Multiphasic Personality Inventory. On half of the
questionnaires the statements were attributed to male
patients and on the other half to female patients. Subjects
were asked to assess each statement for the degree of
emotional maladjustment, using a seven-point scale that
ranged from "none" to "severe“. Results indicated that when
a female patient expressed an attitude conventionally
thought to be masculine, whe was evaluated as significantly
more disturbed by a male judge than if she had described
herself in terms of the traditional feminine stereotype. No
similar bias against women was found when the judge was
female.

Costrich, Feinsteen, Kidder, Maracek and Pascale (1975)
presented 128 undergraduates with an audio recording of a
discussion between a student and a counselor concerning a
low term paper grade. In one tape the student was angry and
critical of the professor who gave the grade (the aggressive
treatment condition). In the other, the student was
disappointed and apologetic, emphasizing his or her own
feelings of inadequacy (the passive treatment condition).
Each subject listened to only one version of the tape and
rated the person on a number of items. It was found that
the aggressive woman and the passive man were both seen as
in need of therapy more than their stereotyped counterparts.
Thus, behavior which deviated from the stereotype appeared
to have resulted in a more harsh judgement by the subjects

in this sample.

‘

20

Coie, Pennington and Buckley (1974) were interested not
only in the particular behavior which was judged to violate
sex role stereotypes, but also the situational context in
which it occurred. They presented 288 male and 288 female
undergraduate students with a written vignette which
described either a male or female student. Three different
kinds of situational stressors that were used in the
vignettes included rejection from a potential career choice
(medical school rejection), interpersonal rejection
(rejection by a fiance), and competency pressure (an oral
examination). Four behavioral reactions to these situations
were described: aggression, social withdrawal, somatic
complaints, and cognitive dissociation. Subjects were asked
to respond to nine questions along a seven-point continuum.
In the oral examination condition, less psychological
disorder was attributed to males than to females for the
identical behavior, indicating that subjects of both sexes
were perhaps more willing to be sympathetic with males who
were reacting to career-related stress. In the inter-
personal rejection condition, hospitalization was seen as
significantly more appropriate for the male than the female.
These results supported the hypothesis that psychotherapists
would assess the female experiencing career-related stress
and the male experiencing interpersonal stress as more
maladjusted than the male experiencing career-related stress

and the female experiencing interpersonal stress. Subjects

‘

21

were presumably responding to the expectation that males, by
virtue of being male, were accustomed to dealing with career
stress and that females, by virtue of being female, were
accustomed to dealing with interperSonal stress.
Furthermore, it was also found that females were evaluated
as more disordered than males when demonstrating aggressive
behavior. Similarly, greater disorder was attributed to
males than to females when exhibiting somatic complaints.
The authors concluded that some stressful situations may
have greater salience for members of one sex than those of
the opposite sex because of the role-relatedness of the
situation. Sex roles may not only alter the meaning of the
behavior exhibited, but they also may interact with the
context in which the behavior occurs to alter its meaning.
Since the traditional stereotypes of the sexes hold that
males self—disclose less than females, it would be expected
that they would be judged differently depending on whether
their self—disclosing conformed to or deviated from the
expected stereotype. Derlega and Chaikin (1976) presented
64 male and 64 female undergraduate students with a written
vignette in which the sex of the person and the amount of
self-disclosure was varied. It was found that subjects of
both sexes rated a male stimulus person as being better
adjusted psychologically when he failed to disclose than
when he did disclose information about a personal problem.

The female stimulus person, on the other hand, was viewed as

22

better adjusted when she disclosed than when she did not.
These results are consistent with the expected stereotypes
of men and women on the dimension of self-disclosure.
Psychotherapists

There is evidence that psychotherapists also are prone
to assess a person as maladjusted if his or her behavior
deviates from the expected sex role stereotype. Thomas and
Stewart (1971) hypothesized that counselors would perceive
female clients having traditionally feminine career goals
differently in comparison to female clients having
traditionally masculine career goals. Sixty—two volunteer
high school counselors in St. Paul, Minnesota served as
subjects for the study. All subjects were exposed to an
audiotape in which a high school female gave personal
information about herself, her family, her school and her
career goals. The occupations of engineer and home
economist were selected both because they hold extreme
positions on the masculine-feminine continuum and because
all of the girls on the audiotape had math and science
interests and abilities. It was found that both male and
female counselors rated conforming career goals as more
appropriate than deviant career goals. Furthermore, both
male and female counselors rated female clients with deviant
career goals to be more in need of counseling than those

with conforming career goals.

23

Abramowitz, Abramowitz, Jackson and Gomes (1973) exposed
71 counselors to a written vignette in which a person was
described. The vignette presented the person as an
intelligent individual but having a history of problems with
parents and underachievement. The vignette varied the sex
of the person as well as the political orientation, liberal
or conservative. The subjects then rated the person on
psychological adjustment. It was found that the liberal
female client was rated as significantly more maladjusted
than her liberal male counterpart. This was true for
subjects with conservative political orientations only.

This is similar to the findings of another study (Abramowitz
et al., 1975) in which a female aspiring to go to medical
school was rated as more maladjusted by traditional
counselors than by untraditional counselors. Traditional
counselors were more harsh in their judgements of the
medical school-aspiring female presumably because her career
decision deviated from the expected stereotype.

In clinical analogue studies, researchers attempt to tap
the sex role stereotypes of subjects with vignettes usually
in written form. Subjects are usually presented with case
material in which the investigator is free to manipulate
variables of interest such as the sex of the stimulus
person, his or her behavior, or other pertinent variables.
Although the analogue has been criticized by some for its

lack of external validity (Stricker & Safrahan, 1983), it

24

remains an important and viable research tool. It is
necessary in sex bias research in order to determine whether
a given evaluation is either valid, representing the actual
traits of the client, or prejudicial, representing the
irrelevant trait of the sex of the client (Smith, 1980). In
naturalistic studies, it is impossible to determine if a
psychotherapist's judgement of a client is due to the
relevant or irrelevant characteristics of a client.

Analogue studies allow for an easier determination of the
effect of irrelevant client attributes on the judgements of
psychotherapists.

In his review of the literature, Whitely (1979)
suggested that analogue material which clearly described sex
role-deviant behavior seems to elicit more adverse
judgements than material which merely describes traits.

With non-psychotherapist subjects, for example, Derlega and
Chaikin (1976) found a much stronger effect using a specific
behavior (self-disclosure) than did other investigators
(e.g. Chasen, 1975; Gomes and Abramowitz, 1976) who used
traits. In such cases as these, behavioral descriptions
seem to add authenticity and realism to the experimental
situation. Several studies which describe both conforming
and deviant sex role behaviors have produced significant
results when using psychotherapists or psychotherapist-

trainees as subjects.

25

Miller (1974) presented 67 psychotherapists with a
written vignette in which a person was behaving in a passive
manner. It was found that the stimulus person in the
vignette was rated as better adjusted when the vignette was
labelled as female than when it was labelled as male.
Furthermore, more therapists chose passivity as the focus of
therapy when the vignette was described as male than when it
was described as female.

Feinblatt and Gold (1976) gave clinical and school
psychology graduate students written vignettes in which the
behavior of children was described. The sex of the child
was varied as was the behavior of the child which was
described as either passive and emotional, or defiant and
aggressive. It was found that the child exhibiting behavior
traditionally deemed inappropriate to his or her sex was
viewed as more disturbed and significantly less likely to
have a successful future than the child exhibiting
stereotype-congruent behavior.

Tribich (1977) presented 80 psychotherapists and 80 lay
people with three written vignettes, one in which the
stimulus person was behaving in a way more stereotypic of
males, one in which the stimulus person was behaving in a
way more stereotypic of females, and one in which the
behavior was sex-independent. Of significance was the
finding that the male stimulus person who responded to a

crisis with crying and other traditionally “feminine"

26

reactions was rated as more disturbed than a female stimulus
person who reacted in the same manner. In addition, the
male stimulus person who reacted with crying was rated as
more disturbed than either a man or woman who reacted with
anger or other stereotypically "masculine" behaviors.

In summary, there exists a large body of research which
suggests that non—psychotherapists and psychotherapists
alike are apt to judge a person as more maladjusted if his
or her behavior deviates from behavior traditionally
associated with the stereotypic notions of male and female.
The effect of the sex of the stimulus person may be a
complex one since it has been shown to interact with subject
characteristics such as the sex of the subject (Zeldow,
1976) and the political orientation of the subject
(Abramowitz et al., 1973). It may also interact with the
situational context in which the behavior occurred (Coie et
al., 1974). This is consistent with the observations of
others who believe that the effect of a person's sex on
clinical judgement is most likely a complex one (Murray,
1983; Zeldow, 1978). Despite the apparent complexity, it
appears that violations of sex role norms lead to adverse
mental health judgements. The clinical analogue is a viable
and necessary tool for investigating sex bias. It may be
that written analogues which present people exhibiting
specific behavior are more likely to tap the sex role
stereotypes of the subjects than are analogues which merely

describe traits.

27

Dependence and Independence

Traditional sex role stereotypes clearly place males and
females at distinctly different places along the continuum
of dependence/independence. Males have been viewed as more
independent than females, females as more dependent than
males. In order to gain a perspective on why this is the
case, it makes sense to briefly describe the traditional
role of women. Also discussed will be the views of
theorists who have discussed the differences between male
and female identity formation. Finally, the empirical
literature will be examined to see if research has indeed
demonstrated whether healthy women and healthy men are
viewed differently on this dimension.

Role of Women

 

An examination of how males and females are perceived to
differ with regards to dependence and independence might
appropriately begin with a brief discussion of the
traditional role of women. In essence, the woman's role
traditionally has been complementary to the roles of other
people (Kirsch, 1974). That is, the role of women is to
assist others in the expression of their roles.

Keller (1974) states that the role of women has been
viewed as having three central themes: maternal, wifely,
and erotic functions with primary emphasis on the maternal

and wifely functions. Keller nicely summarizes the primary

28

aspects of the female role:

1. A concentration on marriage, home and children as
the primary focus of feminine concern.

2. A reliance on a male provider for sustenance and
status. This important component of the wife role
is symbolized by the woman taking her husband's name
and sharing her husband's income.

3. An expectation that women will emphasize nurturance
and life-preserving activities, both literally as in
the creation of life, and symbolically in taking
care of, healing, and ministering to the helpless,
the unfortunate, the ill. Preeminent qualities of
character stressed for women include sympathy, care,
love, and compassion, seemingly best realized in the
roles of mother, teacher, and nurse.

4. An injunction that women live through and for others
rather than for the self. Ideally, a woman is
enjoined to lead a vicarious existence - feeling
pride or dismay about her husband's achievements and
failures or about her childrens' competitive
standing.

5. A stress on beauty, personal adornment, and
eroticism, which, though a general feature of the
female role, is most marked for the glamour girl.

6. A ban on the expression of direct assertion,
aggression, and power strivings except in areas
clearly marked as a woman's domain - as in the
defense of hearth and home (Keller, 1974, pp.417-
418).

It appears then that the traditional role of women requires
that a woman be others-oriented as well as dependent on her
husband rather than herself for her own support and sense of
well-being.

Masculine and Feminine Identity Formation

 

This orientation toward others is also emphasized in
Chodorow's (1978) discussion of male and female development
as it relates to identity formation. She contends that all
children are initially dependent on, in most cases, a female

mother or caretaker. This results in all children, both

29

girls and boys, forming a strong attachment to her. During
separation and individuation (ages one through three), young
girls experience themselves as like their mothers and fuse
the experience of attachment with the process of identity
formation. In contrast, young boys view themselves as
different from their mother or caretaker and separate their
mother from themselves as individuation develops.
Consequently, Chodorow believes that the feminine
personality is defined in relation to and in connection with
others. The masculine personality, on the other hand, is
defined by separation and independence from others.

Chodorow concludes that female gender identity is threatened
by separation and independence whereas male gender identity
is threatened by intimacy and dependence.

After extensive interviews with many males and females,
Gilligan (1982) made similar conclusions. She found that
for women their identity was based on intimacy and was
defined in the context of a relationship to or with someone.
For men, their identity was based on being independent. In
studying the self-descriptions of males and females,
Gilligan found that males were likely to describe themselves
as "intelligent”, ”logical”, and even "cocky". These
descriptions suggest a sense of one's separateness and
independence from others. In contrast, women were prone to
describe themselves as ”giving to” or ”helping out” which

suggests a sense of one's attachment to others.

30

In summary, the traditional role of women has been
presented as promoting functions in the service of others,
most notably a husband or children. The traditional role
also requires that a woman depend on her husband and not
herself for her own sense of suppport, strength, and sense
of well-being. Furthermore, it has been suggested that the
feminine personality is defined in relationship to and in
connection with other people whereas the masculine
personality is defined by independence from others
(Chodorow, 1978). This is confirmed vividly in the
self-descriptions of both males and females (Gilligan,
1982). Since dependence implies an attachment to others and
independence a separation from others, it follows that
healthy males and females may be viewed differently on the
dimension of independence and dependence. Available
empirical studies which have addressed this are presented
next.

Empirical Studies

 

It has been shown in several studies that males and
females are perceived differently on the
dependence/independence continuum. Rosenkrantz et a1.
(1968) found that subjects valued independence in men more
so than in women. In addition, subjects considered having a
strong need for security to be more valued in women than in
men. In the Broverman et al. study (1970), healthy males

were viewed as significantly more independent than healthy

31

females by the sample of practicing psychotherapists.
Similarly, Harris and Lucas (1976) found that
psychotherapist-trainees viewed the healthy male as
significantly more independent than the healthy female.

More recent research employing non-psychotherapists as
subjects reveals similar findings. Ruble (1983) found that
undergraduate students viewed the attribute of independence
as significantly more typical of men than women. It was
also found that the need for security was seen as
significantly more typical for women than for men. In a
replication of Sherriff and McKee's (1957) study, Werner and
LaRussa (1985) found that subjects of both sexes were more
likely to describe a hypothetical male as independent than a
female. In addition, a female was more likely to be
described as submissive than was a male.

Given these findings, it might be expected that females
viewed as independent would be judged as more maladjusted
than males viewed as independent. Similarly, it would be
expected that males viewed as dependent would be judged as
more maladjusted than females seen as dependent. A review
of the available literature reveals only one study (Pringle,
1973) in which this was investigated. In this study,
subjects were not more likely to judge the dependent male
and the independent female as more maladjusted than their
stereotyped opposite-sex counterparts. It should be noted,

however, that the subjects of this study were high school

32

counselors, not psychotherapists, who volunteered and who
were judging the behavior of high school students.

This decline in research is unfortunate. Whitely (1979)
suggested that vignettes which merely describe client traits
may not be as potent or salient in eliciting adverse mental
health judgements than are vignettes which describe a
client's behavior. Such a description adds authenticity to
the vignette. If this is true, there is more that can be
learned about the effect of client sex and behavior on the
assessments of psychotherapists. Furthermore, the decline
in research is particularly unfortunate because very few
investigators have examined the effects of a client's
behavior and sex on psychotherapists' judgements within the
therapist-client relationship. Most researchers who have
studied the effects of sex role-deviant behavior on the
clinical judgements of psychotherapists have used analogues
which have described a client's behavior which is irrelevant
to the therapist-client relationship. Since there are many
client behaviors within psychotherapy which may still invoke
the stereotypes of psychotherapists, the research
possibilities remain abundant.

In summary, it has been suggested by several researchers
that healthy or typical males are perceived as more
independent than healthy or typical females who are viewed
as more submissive and as having a stronger need for

security. A review of the literature reveals only one study

33

which examined whether a dependent male or an independent
female were judged to be more maladjusted than their
stereotypic opposite-sex counterparts. No study has had as
its focus psychotherapists' evaluations of clients on the
basis of client behavior (dependent versus independent)
within the context of the therapy relationship. Research
involving sex role stereotyping has declined and possible
reasons for that decline were presented. Finally, it was
suggested that since there are many client behaviors within
psychotherapy that may invoke the stereotypes of

psychotherapists, many research possibilities still exist.

Psychotherapy and Dependence/Independence

The process of psychotherapy involves both attachment
and separation, dependence and independence. In distress, a
client is dependent on a therapist for help and forms an
alliance with the therapist. Termination of therapy is an
experience of independence and separation for the client and

for the therapist. James Mann, in his classic Time-Limited

 

Psychotherapy (1974), advocates limiting certain clients'

 

treatment to 12 sessions so as to keep clients focused on
the inevitability of ending treatment and separating from
the therapist. He contends that the human condition is

characterized by a denial of separation and advocates the

time-limiting of therapy in order to raise the client's

34

awareness that separation is inevitable.

Traditional sex role stereotypes hold that males are
expected to have little problem with separations from
significant people in their lives while women are expected
to have difficulty with such separations. Since psycho-
therapy termination is a separation experience, it follows
that males and females might be expected to have more
problem with separating and being independent from the
therapist than would males. Furthermore, if sex role
stereotypes affect the mental health judgements of
therapists and if sex role-deviant behavior leads to adverse
mental health judgements, it might be predicted that
therapists may judge a male demonstrating "dependent" or
"clinging" behavior in the therapy situation as more
maladjusted than his female counterpart. Similarly, a
female demonstrating "independent" or ”separating“ behavior
may be viewed as more maladjusted than her male countepart.
Since no study has had this as its focus, the current
research is designed to investigate this.

Since the emergence of the Diagnostic and Statistics

 

Manual of Mental Disorders (DSM-III) published by the

 

American Psychiatric Association in 1980, psychotherapists
have become increasingly active in assessing in a client
those pervasive features which characterize the client's
relatively stable and enduring personality pattern. This is

commonly done on Axis II of the DSM-III's multi-axial

35

format. Axis I is reserved for the client's current symptom
picture. Millon (1981) defines personality as "a complex
pattern of deeply embedded psychological characteristics
that are largely unconscious, cannot be eradicated easily,
and express themselves in almost every facet of functioning"
(p. 8). Axis 11 gives the psychotherapist an opportunity to
assess the degree to which a client's personality is
integrated. It assesses the personality style or disorder
of a client and reflects the therapist's assessment of the
client's overall vulnerability to maladjustment. Hence,
most psychotherapists now view a client's current symptom
pattern (as reflected on Axis 1) within the context of
whatever assessment can be made of the client's overall
personality style (as reflected on Axis II).

If the feminine personality is defined by attachments to
and dependence on other people and the masculine personality
is defined by independence and separation from others,
dependency will be viewed as incongruent with the masculine
personality and independence with the feminine personality.
It might be expected, then, that psychotherapists will view
a male demonstrating dependent behavior as more vulnerable
to maladjustment than a similar female. Similarly, a female
behaving in an independent manner may be viewed as more

vulnerable to maladjustment than her male counterpart.

36

In general, research exploring sex role stereotyping and
the mental health judgements of psychotherapists has been
explored. Males and females appear to be viewed differently
with respect to many attributes, including dependence and
independence. Despite the need to investigate the effect of
client sex and client behavior within the therapist-client
relationship, research on the sex role stereotyping of
psychotherapists has declined in recent years. The process
of psychotherapy requires a client to attach to and be
dependent on a psychotherapist at the beginning of therapy
and be independent from the therapist at the end of therapy.
If the healthy masculine personality is congruent with
independence and separation from others and the healthy
feminine personality is congruent with dependence and
attachments to others, and if psychotherapists view men and
women differently on the dimension of dependence/
independence, it might be expected that clients whose
behavior deviates from the expected stereotype will be
judged as more vulnerable to maladjustment than clients of
the opposite sex for whom the same behavior is stereotype-

conforming. The current study examines these relationships.

CHAPTER III

METHOD

Subjects

Psychotherapists asked to participate in the study were
selected from membership lists of the Michigan Psychological
Association and the National Association of Social Workers.
Only those persons who listed clinical practice as main
activity were selected. Every eighth social worker and
every fourth psychologist on their respective lists were
selected. This yielded a total of 392 psychotherapists, 196
social workers and 196 psychologists. Of the 196 social
workers, 78 were males and 118 were females. Of the 196
psychologists, 110 were males and 86 were females.

Procedure

 

Each psychotherapist was mailed a packet of materials
including a cover letter, a client and treatment vignette,
an instruction sheet, a questionnaire, and a stamped and
addressed envelope for easy return of the questionnaire.
Identical materials were sent to all subjects, with the
exception that the sex and degree of dependency of the

hypothetical client was varied. Subjects were randomly

37

38

assigned to one of four treatment conditions: dependent
male, dependent female, independent male, independent
female. All client information was created by the
experimenter and did not represent any actual client. A
follow-up post card was mailed one week after the intital
mailing and again two weeks after the initial mailing in
order to increase compliance. The post cards were composed
of a few sentences which conveyed appreciation for filling
out the questionnaire if it had already been done. The post
cards also emphasized the importance of the research and
gently encouraged compliance.

Cover Letter

 

The cover letter was constructed on Michigan State
University stationery using the letterhead of the School of
Health Education, Counseling Psychology and Human
Performance. Its primary purpose was to engage the
psychotherapists in completing the task. Since the primary
purpose of the research was to determine whether
psychotherapists invoke sex role stereotypes in their
clinical judgements, the true purpose of the research could
not be revealed in order to avoid social desirability of
responding. The cover letter informed subjects that the
true nature of the study was not able to be revealed at the
time when they received the materials, but promised them a
full and complete explanation of both the nature and results

of the study as soon as the results were available. The

39

cover letter also described the procedure for carrying out
the exercise and gave a reliable estimate of completion
time. It mentioned the voluntary nature of the exercise and
assured confidentiality of responding. The cover letter
appears as Appendix A.

Client Vignettes

 

The client vignettes were designed by the experimenter
to be credible and realistic. The vignettes described the
client as either male or female and as either dependent or
independent. The dependent vignette described a client who
was demonstrating behavior which is commonly thought of as
dependent. After improvement, the client was described as
clinging to and resisting separation from the therapist.
The independent vignette described a client who valued
relying on his or her own resources and, after improving,
initiated separation from the therapist. In order to ensure
that the vignettes validly and accurately portrayed
dependence and independence, five experienced
psychotherapists were given the independent vignette and
five other psychotherapists were given the dependent
vignette. They were asked to read the description and then
answer along a seven-point continuum the degree to which
they viewed the client in question as dependent or
independent. A score of one represented "very independent"
while a score of seven represented ”very dependent”. The

mean of psychotherapists' scores on the dependent vignette

40

was 6.6 with a standard deviation of .55. The mean of the
scores of psychotherapists who received the independent
vignette was 2.8 with a standard deviation of .84. The
difference between the means for the dependent and
independent vignette on degree of dependence was 3.8, a
difference of at least 4.5 standard deviations. Therefore,
there is evidence which suggests that for these psycho-
therapists, the vignettes did indeed differentiate the
dependent from the independent client on degree of
dependence. The dependent and independent vignettes appear
as Appendix 81 and 82, respectively.

Instruction Sheet

 

The instruction sheet encouraged the psychotherapist to
use his or her expertise and clinical intuition in assessing
the extent to which he or she believed the client in
question was vulnerable to maladjustment. In short, it
encouraged an assessment of the client's general
vulnerability to maladjustment, not an assessment of the
client's current level of maladjustment. The instruction
sheet appears as Appendix C.

Maladjustment Assessment Questionnaire

 

The development of the questionnaire was an arduous and
time-consuming task. The goal of this development was to
produce a reliable and valid questionnaire, one which
contained items related to psychological maladjustment which

were sufficiently correlated with each other so as to derive

41

a total score for all of the items combined. Construct
validity was demonstrated by agreement of five experienced
psychotherapists that all items were indicators of or
correlated with psychological maladjustment. In addition,
most items contained symptoms taken directly from the
DSM-III.

There were a total of four pilot studies done. The
experimenter relied on verbal feedback from psychotherapists
who participated in the pilot studies. This feedback helped
to make improvements and refinements in the questionnaire.
Items which used terminology such as ”severe" or "very low"
were eliminated since therapists were likely to respond to
the item on the basis of the descriptive terms ”severe” or
"very low”. Other items were eliminated for other reasons.
For example, an item which stated "This client is vulnerable
to having problems at his or her place of employment" was
eliminated because pilot scores revealed a large
variability, suggesting that psychotherapists varied greatly
in their willingness to project this type of maladjustment
onto the client. Furthermore, the number of items was
sharply reduced on the recommendation of several respond-
ents, some of whom had done research using a similar format.
The first three pilot studies used 30 to 35 items with each
item requiring a response along a five-point Likert scale.
It was felt that such a large number of items, some of which

were worded in the negative direction, produced fatigue in

42

respondents who found their attention to the task waning
significantly as they neared the end of the questionnaire.
The fourth pilot study used 20 items with each item
requiring a response along a seven-point Likert scale. No
less than twenty different psychotherapists were employed in
each pilot study. The intercorrelation of items, as
measured by coefficient alpha (Anastasi, 1976) calculated on
each pilot study ranged from .75 to .96 with the final
questionnaire generating the latter reliability. Hence,
there is very strong support for using this dependent
measure and combining scores from items into a final score.
The final questionnaire contained 20 items all of which
asked the subject to, along a seven-point Likert scale,
either agree or disagree with a statement concerning their
perception of the client's vulnerability to maladjustment.
Items were worded in both the affirmative and negative so as
to eliminate any response set in a subject. From each item
a maladjustment score was able to be found, ranging from one
to seven. The sum of all items represented the final score.
The second part of the questionnaire asked the subjects
to give information about themselves which included their
sex, age, profession, theoretical orientation, years of
experience, whether they were currently conducting therapy,
hours of therapy per week, and their primary client popula-
tion, adults or children or both. Also included in the

second part of the questionnaire was the question which

43

asked the subjects to rate the client on the degree of
dependency. This was embedded in the second part of the
questionnaire so as not to alert the subjects to the true
nature of the study. The questionnaire appears as Appendix
D.

Post Cards

 

All subjects were mailed a post card both one week and
two weeks after the initial mailing. All subjects were
mailed both cards since there was no way of determining the
identity of respondents from non-respondents. The post
cards thanked respondents for their compliance and
urged non-respondents to consider the importance of the
task. The wording of the post cards is presented as
Appendix E.

Hypotheses

 

Two main hypotheses were tested. Hypotheses I stated
that psychotherapists would view the dependent male as more
vulnerable to maladjustment that the dependent female.
Similarly, hypotheses 11 stated that psychotherapists would
view the independent female as more vulnerable to
maladjustment that the independent male. Since dependency
is commonly considered to be more pathological than
independence, it was anticipated that psychotherapists would
view the dependent client as more vulnerable to
maladjustment than the independent client. To that end,

hypothesis III stated that the dependent male would be

44

viewed as more vulnerable to maladjustment that the
independent male. In like manner, hypothesis IV stated that
the dependent female would be viewed as more vulnerable to
maladjustment than the independent female. The null
hypotheses of no relationship between each demographic
variable and psychotherapists' ratings of maladjustment
vulnerability were also tested. All hypotheses were tested
against a .05 level of significance.

Statistical Analyses

 

The interitem consistency of the questionnaire was
analyzed by calculating coefficient alpha (Anastasi, 1976)
based on the responses of all subjects.

The balance of the data analysis was conducted using
nonparametric statistical techniques. There were several
reasons for this choice. First, the level of measurement
achieved in this research was, strictly speaking, ordinal.
Parametric statistics require at least an interval scale of
measurement whereas nonparametric statistics can be applied
to data based on nominal and ordinal scales. Second, the
assumptions underlying parametric statistics are by no means
guaranteed in this research. Of particular significance is
the assumption that the variances of comparison groups are
equal. Inspection of raw data revealed a wide range of
variability among comparison groups. For example, there was
much variability in the distribution scores from the

subjects given the independent vignette but comparatively

45

little variability in the distribution of scores from the
subjects given the dependent vignette. Since assuming equal
variances and applying parametric statistics under these
conditions would jeopardize the validity of the findings,
nonparametric statistics seemed a logical choice. Further-
more, when cell sizes are unequal (as in the current study),
the researcher runs an even greater risk of jeopardizing the
validity of the final inference (Hays, 1981). Third, the
nonparametric statistical tests used in this study are the
most powerful nonparametric tests and compare very favorably
to the most powerful parametric tests (Siegel, 1956). Since
the samples in the current study were large, the
nonparametric tests represented an attractive alternative to
parametric tests. Power was maximized and the researcher
was free from the restrictive assumptions and requirements
of parametric statistics.

Three nonparametric statistical tests were employed in
this study. The Mann-Whitney g_test is used to test whether
two independent groups have been drawn from the same
population. Thus, the main hypotheses were tested using the
Mann-Whitney g test. It was also used to test the
significance of demographic variables which had two levels
(such as therapist sex, for example). When using the
Mann-Whitney g_test, the researcher first assigns all scores
a rank from the lowest to the highest. That is, the lowest

score receives a rank of one, the next lowest a rank of two

46

and so on. The value of g’is equal to the number of times
in the ranking a score in one comparison group precedes a
score in the other comparison group. With large numbers of

scores, g_is computed using the following formula:

n1(n1+l)

 

9=n1“2+ ‘Rl

Here, n1 and n2 refer to the number of scores in the
respective comparison groups. R1 is the sum of the ranks
assigned to the group whose sample size is n1. The sampling
distribution of Q approaches normality as n1 and n2 increase

in size. The mean of this distribution is given as follows:

r'1 n2

The standard deviation of the sampling distribution of g is

given as follows:

n2 (n1+n2+1)

:3
l-J

 

0"U =
12

47

Thus, one determines the significance of an observed value

of g_by using the following formula:

2-”?-

 

“'9.

The second nonparametric statistic used in this study
was the Kruskal-Wallis One-Way Analysis of Variance by Ranks
test. It is used to test whether more than two independent
samples were drawn from different populations. Thus, one
way in which it was used in this study was to test whether
therapists from different theoretical orientations differed
in their assessment of maladjustment vulnerability. In the
Kruskal—Wallis test, scores are ranked and the sum of the
ranks in each group is found. The Kruskal-Wallis test
determines whether these sums of ranks are so disparate that

they are not likely to come from samples which were all

drawn from the same population. The formula employed is as

 

follows:
k 2
12 R.
H = E —l— -3(N+1)
N +(N+l) j=l nj

where §_is the statistic used in this test,

k is the number of samples,

nj is the number of scores in the jth group,

48

N is the total number of scores in all groups combined,

Rj is the sum of the ranks in the jth group.

When all groups are drawn from the same population, H is
distributed approximately as chi square with k-l degrees of
freedom.

The final nonparametric test used in the current study
was the Spearman Rank Correlation Coefficient (£5)‘ It
measures the association between two variables and requires
that both variables are measured in at least an ordinal
scale so that scores may be ranked in two ordered series.
Thus, this statistical test was used to determine the degree
of association between maladjustment vulnerability scores
and variables such as therapist age, years of experience and
hours of therapy per week. The significance of an obtained

5s can be then tested using the following formula:

 

where N is the total number of subjects. The value defined
in the above formula is distributed as Student's t with N-2

degrees of freedom.

CHAPTER IV

RESULTS

Description of Subjects

 

A total of 392 questionnaires were mailed to prospective
subjects. Six questionnaires did not reach their intended
destination and were returned. A total of 242 (62.7%)
responses to the task were received. From these, 231
(58.9%) usable questionnaires were produced. Eleven
responses were not usable for a variety of reasons. One
person elected not to participate because of taking another
vocation. One person stated she had no time. One person
felt she had insufficient information to risk making a
judgement about the client in question. Three people
expressed disagreement with the underlying assumption that
inferences about a client's personality could be drawn on
the basis of the given information. Five potential subjects
either incompletely or incorrectly filled out the
questionnaire. Their responses were not used in the data
analysis.

Of all 231 subjects whose responses were used, 125 were
social workers and 106 were psychologists (see Table 1).

There were 123 male psychotherapists and 108 female

49

50

Table l

Psychotherapists' Profession

 

 

 

 

 

 

 

Profession Number Percent
Psychology 125 54.1
Social Work 106 45.9
Total 231 100.0
Table 2
Psychotherapists' Sex
Sex Number Percent
Male 123 53.2
Female 108 46.8
Total 231 100.0

 

51

Table 3

Psychotherapists' Theoretical Orientation

 

 

Theoretical Orientation Number Percent
Analytic 40 17.3
Neoanalytic 19 8.2
Transactional Analysis 3 1.3
Gestalt l .4
Rogerian l .4
Cognitive-Behavioral 19 8.2
Behavioral 7 3.1
Eclectic 123 53.3
Other 18 7.8

 

Total 231 100.0

52

psychotherapists (see Table 2). A majority of the subjects
(53.3%) described themselves as eclectic in their
theoretical orientation (see Table 3). Adults were the
primary clients of 170 subjects (see Table 4). Most
subjects (83.6%) were active in the practice of
psychotherapy (see Table 5). The average age of subjects
was 46.4 years (see Table 6). Subjects had an average of
13.5 years of psychotherapy experience (see Table 7). The
average number of hours per week spent conducting
psychotherapy was 17.5 hours (see Table 8). Of the 231
subjects whose questionnaires were used, 57 each responded
to the dependent male and the dependent female, 54 responded
to the independent male and 63 responded to the independent
female.

Questionnaire inter-item consistency

 

Analysis of the inter-item consistency of the
questionnaire based on the subjects' responses produced an r
of .932. This is indicative of an instrument which is
highly reliable and which is composed of items which are
sufficiently correlated with each other to derive a
composite score from the sum of all items.

Ratings of Client Dependency

 

Subjects' ratings of both the independent and dependent
client on degree of dependency were analyzed using the
Mann-Whitney Q_test. As expected, it was found that

subjects did view the client in the dependent vignette as

53

Table 4

Psychotherapists' Primary Clients

 

 

 

 

Primary Client Number Percent

Adults 170 73.6

Children 46 19.9

Both 15 6.5

Total 231 100.0
Table 5

Psychotherapists' Activity in Psychotherapy

 

 

Activity Number Percent
Active 193 83.6
Inactive 38 16.4

 

Total 231 100.0

 

54

Table 6

Psychotherapists' Age

 

 

 

Males Females All
Age Number Percent Number Percent Number Percent
21-30 5 4.1 7 6.5 12 5.2
31-40 61 49.5 40 37.0 101 43.7
41-50 33 26.9 29 26.9 62 26.8
51-60 21 17.1 20 18.5 41 17.8
61-70 2 1.6 10 9.2 12 5.2
71+ 1 .8 2 1.9 3 1.3
Total 123 100.0 108 100.0 231 100.0

 

55

Table 7

Psychotherapists' Years of Experience

 

Years of

psycho-

therapy Males Females All
experience Number Percent Number Percent Number Percent

 

1-5 11 8.9 21 19.4 23 9.9
6-10 45 36.6 37 34.3 82 35.5
11-15 33 26.8 17 15.7 50 21.7
16-20 14 11.4 20 18.6 34 14.7
21-25 8 6.5 4 3.7 12 5.2
26-30 5 4.1 4 3.7 9 3.8
31+ 7 5.7 5 4.6 12 5.2

Total 123 100.0 108 100.0 231 100.0

56

Table 8

Psychotherapists' Average Hours of Therapy Per Week

 

 

Average

hours per Males Females All
week Number Percent Number Percent Number Percent
0-5 21 17.1 23 21.3 44 19.0
6-10 14 11.4 16 14.8 30 13.0
11-15 13 10.6 11 10.2 24 10.4
16-20 26 21.1 24 22.2 50 21.7
21-25 15 12.2 16 14.8 31 13.4
26-30 15 12.2 7 6.5 22 9.5
31+ 19 15.4 11 10.2 30 13.0

Total 123 100.0 108 100.0 231 100.0

57

significantly more dependent than the client in the
independent vignette, z'= 10.45, p_= .0001 (see Table 9).
There was no difference in the ratings of the dependent male
and the dependent female on degree of dependency, g = .192,
p = .848. Similarly, there was no difference in the ratings
of the independent male and the independent female on degree
of dependency, g'= -.461, p = .645.

Main Hypotheses

 

Since ranking is essential to the application of the
nonparametric statistical techniques used in this study, it
is beneficial to present the mean rank of each of the four
comparison groups. A perspective is gained by examining
these mean ranks in relationship to each other. The mean
ranks for the dependent male, independent male, dependent
female and independent female on the measure of
vulnerability to maladjustment are 150.13, 87.18, 122.88,
and 103.60, respectively (see Figure l).

Hypothesis I stated that psychotherapists would view the
dependent male as more vulnerable to maladjustment than the
dependent female. A one-tailed Mann-Whitney U test on the
data supported this hypothesis, 2.: 2.34, p = .009 (see
Table 10). Subjects did view the dependent male as signifi-
cantly more vulnerable to maladjustment than the dependent
female.

Hypothesis 11 stated that psychotherapists would view

the independent female as more vulnerable to maladjustment

58

Table 9

Mann-Whitney U Test for Degree of Dependence in
Dependent and Independent
Vignette Situations

 

 

Vignette Number Mean Rank 5 p

Dependent 114 161.33

Independent 11? 71.83

Dependent vs. 231 10.45 .0001*
Independent -

 

* one-tailed

Table 10

Mann-Whitney U Test for Maladjustment Vulnerability

Scores in Dependent Male and Dependent Female
Vignette Situations

 

 

Vignette Number Mean Rank 5 .p
Dependent Male 57 64.73
Dependent Female 57 50.27
Dependent Male vs. 114 2.34 .009*

Dependent Female

 

* one-tailed

59

l40-l -Dependent

Mean 110-l
Rank I

100‘| 'g”’,a”’aa’¢aav
|
90-] -Independent

 

80-l
I
70-)
l
60-I
I
I o 0
Male Female
Client
Figure 1

Mean Ranks of Maladjustment Vulnerability Scores for
Dependent Male, Dependent Female, Independent Male and
Independent Female

60

than the independent male. This hypothesis was not sup-
ported using the same test, 5 = -l.26, p.= .103 (see Table
11). Responses of subjects revealed no significant
difference in maladjustment vulnerability ascribed to the
independent male and the independent female.

Other Hypotheses

 

Hypothesis III stated that psychotherapists would view
the dependent male as more vulnerable to maladjustment than
the independent male. The data supports this hypothesis, 5
= 4.90, p_= .0001 (see Table 12). Subjects viewed the
dependent male as significantly more vulnerable to
maladjustment than the independent male.

Hypothesis IV stated that psychotherapists would view
the dependent female as more vulnerable to maladjustment
than the independent female. This hypothesis was not
supported by the data, §_= 1.62, p_= .052 (see Table 13).
Responses of subjects revealed no significant difference in
maladjustment vulnerability ascribed to the dependent female
and independent female.

The null hypothesis of no difference between the levels
of each demographic variable was tested using two-tailed
non-parametric tests. No differences were found in
psychotherapists' maladjustment vulnerability ratings due to
therapists' sex, 3 = .424, p = .671 (see Table 14).
Similarly, no differences were found due to therapists'

profession, z = -.185, p = .853 (see Table 15). There were

61

Table 11

Mann-Whitney U Test for Maladjustment Vulnerability
Scores in Independent Male and Independent Female

Vignette Situations

 

Vignette

 

Independent Male
Independent Female

Independent Male vs.
Independent Female

 

* one-tailed

Number Mean Rank 3. ‘p
54 54.72
63 62.67
117 -1.26 .103*
Table 12

Mann-Whitney U Test for Maladjustment Vulnerability
Scores in Dependent Male and Independent Male

Vignette Situations

 

Vignette

 

Dependent Male
Independent Male

Dependent Male vs.
Independent Male

Number Mean Rank 3’ p
57 70.57
54 40.62

111 4.90 .0001*

 

* one-tailed

62

Table 13

Mann-Whitney U Test for Maladjustment Vulnerability
Scores in Dependent Female and Independent Female
Vignette Situations

 

 

Vignette Number Mean Rank 3_ p
Dependent Female 57 65.93

Independent Female 63 55.60

Dependent Female vs. 120 1.62 .052*

Independent Female

 

* one-tailed

Table 14

Mann-Whitney U Test for Maladjustment Vulnerability
Scores of Male and Female Psychotherapists

 

 

Psychotherapist

Sex Number Mean Rank 5 p
Male 123 117.75

Female 108 114.01

Male vs. Female 231 .421 .671*

 

* two-tailed

63

Table 15

Mann-Whitney U Test for Maladjustment Vulnerability
Scores of Social Workers and Psychologists

 

 

Profession Number Mean Rank 3. p

Social Work 106 116.88

Psychology 125 115.25

Social Work vs. 231 -.182 .853*
Psychology

 

* two-tailed

Table 16

Mann-Whitney U Test for Maladjustment Vulnerability
Scores by Psychotherapist Activity in
Conducting Psychotherapy

 

 

Psychotherapist

Activity Number Mean Rank 5 p

Active 193 116.41

Inactive 38 110.89

Active vs. 231 .467 .640*
Inactive

 

* two-tailed

64

no differences in vulnerability to maladjustment scores
between psychotherapists who were active in conducting
psychotherapy and those who were not, 5 = .467, p_= .640
(see Table 16). These null hypotheses were tested using the
Mann-Whitney 9 test.

The Kruskal-Wallis One-Way Analysis of Variance by Ranks
test was used to test the null hypothesis of no relationship
between psychotherapists' vulnerability to maladjustment
ratings and psychotherapists' theoretical orientation. No
effect was found between theoretical orientation and
maladjustment vulnerability ratings,:[2 (7, N_= 231) = 9.40,
p = .310 (see Table 17). Similarly, the same test was used
to test the null hypothesis of no relationship between
maladjustment vulnerability scores and psychotherapists who
differed in their primary clients. No difference was found
in psychotherapists' ratings between psychotherapists who
worked with predominantly adults, children or both,3C2 (2, N
= 231) = 1.03, p = .598 (see Table 18).

The Spearman Rank Correlation Coefficient was calculated
to determine the degree of association between
psychotherapists' maladjustment vulnerability scores and the
variables of psychotherapist age, years of experience and
hours conducting therapy per week. The calculated
coefficient, Es’ was then tested for significance against
the null hypothesis of no relationship between maladjustment

vulnerability scores and each variable. A summary of the

65

Table 17

Kruskal-Wallis One Way Analysis of Variance by Ranks
Test for Maladjustment Vulnerability Scores by
Psychotherapist Theoretical Orientation

 

 

Theoretical 2
Orientation Number Mean Rank :[' ‘p

Analytic 40 131.32

Neoanalytic 19 124.89

Transactional
Analysis 3 124.67

Gestalt 1 115.0

Rogerian 1 5.0

Cognitive-Behavioral 19 93.79

Behavioral 7 88.61

Eclectic 123 114.94

Other 18 122.11

Total 231 9.40 .310

 

66

Table 18

Kruskal-Wallis One Way Analysis of Variance by Ranks Test
for Maladjustment Vulnerability Scores by
Psychotherapist Primary Clients

 

 

 

Primary Clients Number Mean Rank 3L2 p
Adults 170 113.46
Children 46 121.53
Both Adults and 15 127.80
Children
Total 231 1.03 .598
Table 19

Spearman Rank Correlation Coefficient (Es) for Maladjustment
Vulnerability Scores by Psychotherapist Age, Years of
Experience and Hours per Week of Psychotherapy

 

 

Variable Number Es 2
Age 231 .181 .003
Years Experience 231 .246 .001
Hours per Week of 231 .102 .061

Psychotherapy

 

67

tests is presented in Table 19. The null hypothesis was
rejected for psychotherapist age and years of experience.
Psychotherapists' ratings of maladjustment vulnerability
were positively and significantly associated with psycho-
therapist age (Es = .181, p_= .003) and psychotherapist
years of experience (_r_'s = .246, p_= .001). The null
hypothesis was retained with respect to the average number
of hours of therapy per week. No association was found
between psychotherapists' ratings of maladjustment
vulnerability and the average number of hours per week spent
conducting psychotherapy (Es = .102, p = .061).

Summary of Findings

 

Consistent with the expectation that psychotherapists
would invoke sex role stereotypes when assessing
vulnerability to maladjustment in a client, psychotherapists
did view the dependent male as more vulnerable to
maladjustment than the dependent female. Contrary to
expectations, they did not view the independent female as
more vulnerable to maladjustment than the independent male.
While the dependent male was viewed as more vulnerable to
maladjustment than the independent male, the dependent
female was not viewed as more vulnerable to maladjustment
than the independent female (although results in the
direction of the hypothesis nearly reached significance, p_=
.052). Psychotherapist sex, profession, theoretical

orientation, activity, primary clients and hours of therapy

68

per week were not related to maladjustment vulnerability
scores while psychotherapist age and years of experience
were related. Specifically, older therapists and therapists

with more years of experience gave higher scores.

CHAPTER V

DISCUSSION

During the 1970's there was a tremendous research
emphasis on the sex role stereotyping of clients by
psychotherapists. The Womens Movement and the landmark
research by Broverman et a1. (1970) precipitated a
controversial but healthy movement toward the examination of
the feelings, attitudes and preconceived beliefs of the
psychotherapist. This was long overdue. It raised the
awareness of psychotherapists to their own belief systems
and sensitized the mental health community to paying more

attention to the therapist in the therapist-client dyad.

 

Such an awareness went beyond the traditional psycho-
analytical concept of countertransference. The classic
viewpoint of countertransference proposed by Freud
(1910/1959) restricts countertransference to the unconscious
reactions of the psychotherapist to the transference mani-
festations of the client. That is, the psychotherapist's
feelings and attitudes toward a client were thought to be
precipitated by the client's behavior and conduct within the
psychotherapy relationship. It was then the
psychotherapist's job to identify and dispel such reactions

to the client.
69

70

Such a conceptualization of countertransference seems
unacceptably restrictive. It implies that the feelings,
attitudes, and beliefs of a psychotherapist toward a client
are due to the client's unique pathology and presentation in
the therapy relationship. To some extent it relieves the
psychotherapist of the responsibility for owning his or her
feelings toward a client since these feelings are considered
to be more revealing of the client than the psychotherapist.
Fortunately, the concept of countertransference has evolved
significantly in recent years. Epstein and Feiner (1979),
for example, described countertransference as "all of the
feelings and attitudes of the therapist toward the patient"
(p. 12).

This totalistic notion of countertransference is more
appealing because it embraces a more permissive attitude
toward the feelings and attitudes of the psychotherapist.
Such feelings and attitudes are not considered to be
precipitated solely by the client. They also emanate from
the psychotherapist who is viewed as a unique individual, a
person whose thoughts, feelings, and beliefs were shaped
through many life experiences. This definition of
countertransference accepts the psychotherapist for what he
or she is: a human being.

Since psychotherapists are human, they are products of
their culture. Existing research on sex role stereotyping

strongly suggests that our culture has had and still has

71

clear ideas of what attributes and behavior constitute
normality for a man and a woman. Long before psycho-
therapists decide on their career, their culture leaves
lasting impressions of what constitutes normality and what
does not. During their formative years, children and
adolescents are exposed to and adopt many of their
cultures's beliefs about males and females. This comes
about in both overt and subtle ways through many different
influences - religious institutions, the words and conduct
of parents, the mass media, teachers, textbooks. Beliefs
about what males and females ought to be like and how they
are thought to be fundamentally different from each other
are internalized quickly by children. Such beliefs are
rigid and not easily modifiable.

To say that psychotherapists are always objective and
neutral in their clinical judgements is to deny their
humanity. It would indeed be surprising to find that
psychotherapists are immune to the influences of their
culture. Since our culture has adopted the belief that men
and women are fundamentally different from each other on
many different attributes, it would be expected that
psychotherapists would share in such a belief. Much
research in the 1970's has provided support for this claim.

Unfortunately, research involving the sex role
stereotyping of psychotherapists has declined dramatically

in the 1980's. This decline was premature since there have

72

been few studies which have addressed the sex role
stereotypes of psychotherapists faced with a client's actual
behavior in therapy. Every psychotherapy committment
involves both a dependence on and later an independence from
a psychotherapist. Since dependence and attachments toward
people are viewed as being congruent with the stereotypic
feminine personality while independence and separations from
people are viewed as being congruent with the stereotypic
masculine personality, it could be expected that the
clinical judgements of psychotherapists would be influenced
by client behavior, depending on whether or not such
behavior conformed to or deviated from the behavior expected
given the client's sex. The current study was designed to
address this. It is hoped that this research will encourage
further examination of the most neglected individual in the
therapeutic dyad - the psychotherapist.

In the balance of this chapter, the findings of the
current research are reviewed and examined in more detail.
Limitations of the study are briefly presented and implica-
tions of the findings for further research and for clinical

training and practice are discussed.

73

Review of Findings

Hypothesis I stated that psychotherapists would view the
dependent male client as more vulnerable to maladjustment
than the dependent female. The findings support this
hypothesis. Psychotherapists in the current study did view
the dependent male as more vulnerable to maladjustment than
the dependent female. This finding is in agreement with the
findings of other research (Thomas & Stewart, 1971; Miller,
1974; Tribich, 1977) which supported the general hypothesis
that psychotherapists are more likely to assess a person as
maladjusted if his or her behavior or attributes deviate
from the expected sex role stereotype. The positive support
for hypothesis I suggests that psychotherapists were more
harsh in their judgement of the male client that the female
client, presumably because the dependent behavior attributed
to the client was viewed as more incongruent with the male
stereotype than the female stereotype. If this explanation
accounts for the finding, it can be said that stereotyping
by psychotherapists continues. That is, psychotherapists
may indeed continue to view the healthy or typical female as
being more dependent than the healthy or typical male simply
because she is female. It also suggests that the strong
prohibition against males behaving in a dependent manner
continues to exist for this sample of psychotherapists.

Hypothesis II was analogous to hypothesis 1. If it was

74

expected that psychotherapists would view the dependent male
as more vulnerable to maladjustment than the dependent
female because of the incongruence of dependence with
“maleness”, it could also be expected that psychotherapists
would View the independent female as being more vulnerable
to maladjustment than the independent male because of the
incongruence of independence with "femaleness". This was
hypothesis II. Contrary to expectation, the findings did
not support this hypotheses. There are several possible
explanations for this. Perhaps psychotherapists no longer
view independence as incompatible with the female
stereotype. Indeed, during the past 15 years much has
occurred to erode the traditional prohibition against
independence for women. The Womens Movement raised the
public's awareness to the unequal way in which males and
females were viewed. It actively encouraged women to
demonstrate their independence and strength. The
institution of affirmative action policies opened the door
wider for women to be placed in occupations and training
programs where their self-sufficiency and ability to rely on
their own resources were demonstrated. In addition, the
independence of women is modeled everywhere today in the
person of the working woman. Although an inequity still
exists in the way men and women are viewed and treated at
the workplace, women are rising to top levels at their

places of employment, assuming more and more responsibility.

75

It is conceivable that psychotherapists, influenced by these
dramatic changes, now view independence as more permissible
for the female than it once was. Considering hypotheses I
and 11 together, the findings suggest that it may be more
permissible for a female to be independent than it is for a
male to be dependent. This makes sense when one considers
that there was no corresponding social movement which
encouraged dependent behavior in males to be viewed as
acceptable. Instead, the focus was entirely on encouraging
independence in females to be viewed as acceptable.

This changing role of women may be one reason why
psychotherapists did not view the independent female as more
vulnerable to maladjustment than the independent male.
Stated differently, independence, separating from others and
using one's own resources may be more congruent with the
feminine personality than it once was. If this is so, a
female's independent behavior may not represent as much of a
deviation from the behavior expected as it once did.
Therefore, less vulnerability to maladjustment would be
attributed to her. Inspection of the data reveals another
possible reason why psychotherapists failed to attribute
more maladjustment vulnerability to the independent female
than to the independent male. This reason will be discussed
after the findings of hypotheses III and IV are briefly
presented.

It was anticipated that psychotherapists would assess

76

the dependent client as more vulnerable to maladjustment
than the independent client and that this would hold true
for both male and female clients. Hypothesis III was
supported by the findings. That is, the dependent male was
viewed as more vulnerable to maladjustment than the
independent male. Hypothesis IV was not supported by the
findings. The dependent female was not viewed as more
vulnerable to maladjustment than the independent female. It
should be noted, however, that the statisical test employed
to test hypotheses IV resulted in p.= .051, very close to
the .05 level of significance necessary to give support to
the hypothesis. Taken together, these findings suggest that
when psychotherapists make a determination of client malad-
justment on the basis of degree of dependency, client
dependence or independence may be more salient in that
determination if the client is male than if the client is
female. It could be that for psychotherapists the
stereotype for females is less polarized on the dimension of
dependence/independence than it once was while for males the
stereotype remains sharply polarized. When making a
judgement on the vulnerability of a client to maladjustment,
psychotherapists may attend more to the male whose behavior
violates the traditional stereotype than to the female whose
behavior violates the traditional stereotype.

Let us now return to hypothesis II which unexpectedly

showed that psychotherapists did not view the independent

77

female as more vulnerable to maladjustment than the
independent male. It was mentioned that another possible
reason exists for this finding. Inspection of raw data
revealed much variability in both the maladjustment scores
and the degree of dependence scores of psychotherapists who
received the independent vignette. In contrast,
comparatively little variability was noted in the
maladjustment vulnerability scores and degree of dependence
scores of psychotherapists who received the dependent
vignette. Even though psychotherapists in general viewed
the independent client as significantly different from the
dependent client on the dependence/independence dimension
(see Table 9), it seems that many psychotherapists viewed
the independent client as dependent. This was not
anticipated. Possible reasons for this are now discussed.

It was anticipated that psychotherapists would attend to
the client's dependent or independent behavior with the
therapist as described in the vignette and use that
information in order to make a judgement of the client's
vulnerability to maladjustment. It was expected that this
would be the most salient stimulus in the vignette.
However, it could be that some psychotherapists made their
judgements on the basis of the nature of the client's
presenting problem. Since the vignette described the client
as having some trouble coping with the loss of an

opposite-sex friend, this may have suggested "dependence",

78

even in the independent vignette situation. It is possible
that some psychotherapists attended more to this than was
expected.

There is another reason why psychotherapists may have
viewed the client in the independent vignette as dependent.
Psychotherapists may have simply read too much into the
vignette, attemping to see what was not there. Although the
independent vignette represented the experimenter's best
attempt at presenting a client who valued independence and
relying on his or her own resources, some psychotherapists
may have tried to project dependence onto the independent
client. It was interesting to note that four subjects, all
of whom received the independent female vignette, made
comments near the question which asked them to rate the
client on the degree of dependency. A11 suggested, in
essence, that although at first glance the client appeared
independent, she was in reality dependent. Two of these
four described her as "counterphobic", a term denoting the
deliberate seeking out of anxiety producing situations
(Cameron, 1963). For these psychotherapists, the female
client in the independent vignette was actually dependent
because she was running toward the very thing she feared,
namely independence. It may not be coincidental that no
such unsolicited comments were made by psychotherapists
receiving the independent male vignette.

Since some psychotherapists apparently did view the

79

client in the independent vignette as dependent, it was
possible that the maladjustment vulnerability scores for the
independent males could have been increased relative to the
malajustment vulnerability scores for the independent
females since, as hypothesis I suggested, dependent males
were more harshly judged than dependent females. Thus, the
hypothesized differences between the independent male and
the independent female may have been obscured due to the
fact that the scores of psychotherapists who viewed the
independent client as dependent may have been more inflated
for the male than the female client. This inflation may
have offset the expected effect of the stereotype.

It was appropriate, then, to try to determine if only
those psychotherapists who viewed the independent client as
independent differed in the maladjustment vulnerability
ascribed to the independent male and the independent female.
Of the 54 psychotherapists responding to the independent
male vignette, 37 rated the client as independent (a score
of one to three on the scale assessing degree of depend-
ency). Of the 63 psychotherapists responding to the
independent female vignette, 40 rated the client as
independent. A one-tailed Mann-Whitney 9 test was performed
on these scores. Again, a .05 level of significance was
required in order to support they hypothesis that the
independent female would be viewed as more vulnerable to

maladjustment than the independent male. Results did not

80

support the hypothesis (5 = 1.40, p = .081). When only the
scores of psychotherapists who viewed the independent client
as independent were used, no difference was found in
maladjustment vulnerability ascribed to the independent male
and the independent female.

The purpose behind the independent vignette was to
present client independence in a way that psychotherapists
would respond to that independence as a stimulus. The
validity of the findings are in jeopardy if psychotherapists
responded to other factors. One such factor - the
possibility that the independent client was instead viewed
as dependent - was discussed. There is evidence that the
scores of psychotherapists who viewed the independent client
as dependent appear not to have biased the original
findings. It is possible that psychotherapists responded to
other vignette stimuli. One possible stimulus may have been
the manner in which the client initiated psychotherapy
termination. This seems unlikely, however, since the client
was described as being able to be dependent, in a healthy
manner, on the therapist (as all clients must), and, after
improving, initiating separation. The manner in which the
client requested termination of psychotherapy was not
considered by the experimenter or his consultants to be
evidence in any way for maladjustment. Indeed, clients
often leave therapy in this manner and do so appropriately.

Even if psychotherapists viewed the client's way of

81

separating from the therapist as aberant, it would be
expected that they would view the female as more vulnerable
to maladjustment than the male since separating is more
congruent with the stereotypic masculine personality.

In summary, it is unlikely that psychotherapists
attended to the manner in which the client initiated the
termination of therapy. Furthermore, the scores of
psychotherapists who viewed the independent client as
dependent appear not to have biased the original finding.
Taken together, this discussion is evidence for the validity
of the original finding. It may be that psychotherapists
are more willing to view independence as congruent with the
feminine personality. Perhaps this aspect of the stereotype
has changed.

These findings can be discussed in terms of Gilligan's
(1982) developmental theory. She discusses deve10pmental
perspectives of each sex and suggests that as they merge
into adulthood, members of each sex see the limitations of
their developmental path and consider more seriously the
developmental path of the opposite sex. The current
findings suggest that psychotherapists may allow this
"crossing-over" for women but not for men.

Regarding psychotherapists' demographic characteristics,
the sample of psychotherapists who responded to the study
was, in comparisons to other samples, very experienced.

With an average age of 46.4 years of age and an average of

82

13.5 years of clinical experience, this was a fairly
seasoned group. The findings suggest that the
psychotherapists were very homogeneous in their manner of
responding to the task. There were no differences in
vulnerability to maladjustment scores due to psychotherapist
sex, profession, or theoretical orientation. Similarly,
psychotherapists who were currently active conducting
psychotherapy did not differ from inactive psychotherapists
in the way they assessed the clients. No difference was
found in the response of psychotherapists on the basis of
their primary client or the number of hours of therapy
conducted per week. There was a significant effect for both
age of the psychotherapist and years of experience.
Specifically, older and more experienced psychotherapists
rated the client as more vulnerable to maladjustment than
younger and less experienced psychotherapists. This trend
has been observed in other studies (Murray & Abramson,
1983). One possible explanation is that as therapists get
older and acquire more experience, they are not as
idealistic and become a bit more pessimistic in their
assessments. It should be noted that since age and years of
experience are highly correlated with each other, they may
not represent two distinct factors. It is probable that
years of experience was more salient than age in terms of
psychotherapists' assessments. Psychotherapist age, then,

was significantly related to psychotherapists assessments by

83

virtue of the fact that psychotherapists with more years of
experience are likely to be older than psychotherapists with
fewer years of experience.

Although there was a statistically significant
relationship between psychotherapists' vulnerability to
maladjustment scores and both age and years of experience of
the psychotherapist, inspection of the actual correlation
coefficients reveals very weak relationships (Es = .181 and
r = .246, respectively). It is likely, therefore, that the
clinical judgements of psychotherapists had less to do with
the age and years of experience of the psychotherapists than
with other factors, presumably psychotherapists' sex role

stereotypes as invoked by the stimuli in the vignette, the

sex and behavior of the client.

Limitations of the Study

The findings of this study are to be considered in the
light of the limitations of the study. There are several
limitations which are noteworthy. First, the questionnaire
used in the research was an unproved instrument. However,
it is thought to possess good validity and reliability.
Second, the validity of the findings is affected by the rate
of psychotherapist compliance. Nearly 60% of
psychotherapists responded with usable questionnaires.

While this is considered a good response rate, it is

84

possible that respondents differed from non-respondents in
some way. To the extent that this is true, the findings of
the study are more tenuous. However, since psychotherapists
who did respond were very homogeneous in their responses, it
is anticipated that non-respondents did not differ from
respondents in a way affecting the final findings. Third,
to the extent that the findings are generalizable, such
generalization can only apply to Michigan psychotherapists
who are members of the clinical divisions of the National
Association of Social Workers and the Michigan Psychological
Association. Fourth, there is a possibility that the
independent vignette may not have represented independence
to a degree which was salient enough to elicit stereotypic

responding.

Implications for Research

The findings of the present study imply that the
apparent decrease of interest in investigating sex role
stereotyping during the past several years was premature.
There is evidence that stereotyping continues. It behooves
researchers, therefore, to pay more attention to it.
Although the current study suggested that psychotherapists
assessed the dependent male more negatively than the
dependent female, further research is needed in order to

determine if psychotherapists' clinical decisions and

85

behavior are affected by these assessments.

There is much variability in the degree to which people
are tolerant of attachments to and affiliations with other
people (including psychotherapists). On one extreme end of
the continuum is a certain clinginess, a desire for intense
closeness and union. On the other end of the continuum is
intentional avoidance, a desire to be as removed from and
uninvolved with people as possible. While the two vignettes
in this study did not represent these extremes, the
independent vignette was further removed from its extreme
than was the dependent vignette from its extreme. Perhaps
further research could determine if a client's more overt
desire to be detached from and uninvolved with a
psychotherapist would be more powerful in invoking sex role
stereotyping on the part of psychotherapists. The female
may be judged as more vulnerable to maladjustment than the
male when her behavior more blatantly violates the
traditional stereotype.

The advantage of clinical analogue methodology lies in
its ability to control extraneous client variables which
also may affect the clinical judgements of psychotherapists.
There are so many client variables in actual therapy
settings that to say a particular clinical judgement was
made on the basis of the client's sex would be difficult to
defend. Although the clinical analogue study has been

criticized for its lack of external validity, it is felt

86

that it remains a viable research tool and, as such, should
not be abandoned.

The present study was conducted with the assumption that
psychotherapists have been influenced by their culture.
Because of that influence, it was assumed that they are
prone to view males and females differently in regards to
attributes and behavior such as dependence/independence
which are traditionally sex role linked. While it is
assumed that all psychotherapists are influenced by their
culture in this global manner, it is also true that
psychotherapists all have different life histories. Our
experiences in childhood and adulthood are all different.
Therefore, it seems vital to pay attention not only to the
influences of our culture, but also to the unique life
experiences of psychotherapists. The more general notion of
countertransference mentioned earlier accepts the uniqueness
of each psychotherapist. It would be well for researchers
to consider the countertransference paradigm recommended by
Davidson (1983). She states that the notion of sex bias is
"incapable of moving beyond the surface structure of overt
social attitudes to the less accessible level of covert deep
structures inherent in the reciprocal exchange between
patient and therapist” (p. 179). In contrast, Davidson
feels that countertransference takes into account the
therapist's own personal history and personal dynamics.

Such an approach would attempt to relate sex role

87

stereotyping on the part of a psychotherapist to the
therapist's own personal history and life experiences as

well as to his or her culture.

Implications for Clinical Training and Practice

Since the present study suggests that psychotherapists
are likely to be more harsh in their assessments of a male
who is behaving in a dependent manner, psychotherapists will
need to evaluate their own biases. This study concerned
itself only with clinical assessment. However, it seems
logical to assume that the assessments psychotherapists make
about clients intimately affect their conduct and decision
making with clients. Psychotherapists could respond
clinically to a ”dependent" male in many different ways
depending on the uniqueness of each psychotherapist. Some
of these responses could be untherapeutic and
counterproductive. For example, a psychotherapist, alarmed
by such a client, may feel the client is incapable of
assuming responsibility for himself or herself and may make
recommendations (such as hospitalization, for example) which
may further undermine the client's self esteem. Another
psychotherapist may simply abhor the client's behavior
because it violates his or her own notion of "maleness" and
consequently, may terminate therapy prematurely. The

possible reactions are endless. The obvious implication is

88

that psychotherapists in clinical practice need to know
themselves. They need to be open to examining how they are
impacted on an affective and cognitive level by clients. A
willingness to examine those feelings and thoughts in the
light of their own biases is a necessary trait in effective
psychotherapists.

Since sex role stereotyping is rooted in one's
experience with society as well as one's unique past
history, it is important for clinical supervisors and
graduate programs to challenge psychotherapist-trainees to
examine their beliefs about men and women. It seems that
too many graduate psychology programs emphasize knowledge
acquisition at the expense of healthy introspection and
self-examination. Graduate programs designed to train
future psychotherapists would do well to pay more attention
to the unique beliefs that students have about men and
women. Students should be challenged to examine both the
origins of such beliefs and how these beliefs could be
expected to affect their work with clients. This kind of
emphasis during a student's training not only benefits
clients but it also shapes psychotherapists who view self-

examination as absolutely essential to the helping process.

APPENDICES

89

Appendix A

Cover Letter

MICHIGAN STATE UNIVERSITY

 

COLLEGE OF EDUCATION 0 SCHOOL Of HEALTH EDUCATION. EAST W0 0 MEGAN 0 “I.”
COUNSELING PSYCHOLOGY AND HUMAN WANG 0
SU ERICKSON MALI.

June 7, 1986

We would very much appreciate your help with a study we are conducting
involving client assessment. The true nature of the study cannot be
revealed at this time but deals generally with variables affecting client
vulnerability to maladjustment. In order to do this. we are dependent

on psychotherapists like yourself answering a very brief questionnaire.

Enclosed is a brief description of a client and the client's treatment.
Please read the description and the instructions to the questionnaire.
Using your clinical expertise and intuition, please answer all questions
and return the questionnaire in the stamped envelope provided.

Please be assured that your responses will be confidential as there is

no way of identifying you from your responses. A full explanation of the
nature and results of this study will be mailed to each person receiving
the questionnaire as soon as those results are available.

This is an important project for us and we anticipate that what we learn
will help therapists and clients alike. Your participation is voluntary
and you may withdraw your participation at any point. Of course. a very
high rate of compliance is vital with studies of this nature. This
exercise will take only 10 to 15 minutes of your time. He hope you can
give your most serious attention to this brief exercise.

Thank you in advance for your cooperation with this very important research.

Sincerely.

Richard Johnson. Ph.D.
Professor
School of Health Education, Counseling Psychology and Human Performance

Randall Wolthuis. Ph.D. cand.
School of Health Education, Counseling Psychology and Human Performance

M5 U is - Min-alive Anise/Equal Wis-u, [unit-cm

90

Appendix Bl

Dependent Vignette

Carol is a 20-year-old undergraduate student who was
referred to counseling by a classmate. One month prior to
Carol's seeking help, her boyfriend whom she had been seeing
regularly for a few months told her he wanted to break up
with her. At the intake interview, Carol complained of
severe depression with a lack of energy and initiative. She
appeared anxious and visibly distraught. She acknowledged
difficulty getting to sleep and a recent inability to
concentrate. She appeared depressed and tired. Carol
stated that she had missed several classes recently.

A course of psychotherapy was recommended to Carol by her
therapist and that therapy focused on Carol's adjustment to
the loss of her boyfriend. Carol agreed with the plan of
treatment but felt she needed to be seen in therapy more
than once per week as her therapist had suggested. She felt
that once a week sessions would not be enough and said to
her therapist, "I think I need to talk to you alot right
now."

Carol's approach to therapy can best be described as eager.
She seemed to enjoy her time with her therapist. She talked
about how good it felt to, in her words, "lean on someone
who cares". Carol was able to talk about her feelings she
had about losing her boyfriend as well as feelings about a
rejecting and critical parent. After 12 weekly
psychotherapy sessions Carol began to show improvement. Her
energy level increased and her sleep patterns returned to
normal. She was attending classes again. During the course
of therapy, Carol often expressed her appreciation of her
therapist, noting at times, "I don't know what I would have
done if you were not here to lean on.”

After approximately five months of therapy Carol and her
therapist reviewed the treatment goals. Carol's therapist
felt that Carol was ready to and treatment and although
Carol agreed that the original treatment goals had been
reached, she talked about her hesitance to stop therapy.
She said she was afraid to, in her words, ”go it alone".
Carol and her therapist discussed this and her therapist
asked Carol how she felt continued therapy would benefit
her. Carol replied, “I'm not sure...I just don't think I'm
ready to stop yet.” Carol and her therapist were able to
discuss further Carol's apprehension and together they

91

agreed on a therapy termination date. As that date
approached, Carol made a few phone calls to her therapist,
at times requesting special appointments. She acknowledged
an increase in anxiety. One week before therapy was to end,
Carol said, "I don't think I'm ready to stop coming here. I
just don't think I can cope well enough right now. You have
helped me so much. It seems like you are the only one who
seems to know how to help me.” She asked for therapy to
continue.

92

Appendix 82

Independent Vignette

Carl is a 20—year-old undergraduate who was referred to
counseling by a classmate. One month prior to Carl's
seeking help, his girlfriend whom he had been seeing
regularly for a few months told him she wanted to break up
with him. At the intake interview, Carl complained of
severe depression with a lack of energy and initiative. He
appeared anxious and visibly distraught. He acknowledged
difficulty getting to sleep and a recent inability to
concentrate. He appeared depressed and tired. He also
stated that he had missed several classes recently.

A course of psychotherapy was recommended to Carl by his
therapist and that therapy focused on Carl's adjustment to
the loss of his girlfriend. Carl agreed with the plan of
treatment which included weekly therapy appointments. He
acknowledged that seeking help was difficult for him and
noted, "I've always solved my own problems.“ He wondered if
weekly therapy sessions were therapy. He expressed regret
about not being able to help himself but admitted, "I can't
go on like this anymore."

At first, Carl was tentative in his therapy sessions. He
acknowledged that he was accustomed to, in his words,
"working out my own problems by myself". He was able,
however, to form a working relationship with his therapist.
He talked about the feelings he had about losing his
girlfriend as well as feelings about a rejecting and
critical parent. After 12 weekly psychotherapy sessions
Carl began to feel better. His energy level increased and
he was again sleeping normally. He was attending classes
again. Almost as soon as he began to feel better, Carl
began to talk about ending therapy. He said he felt he had
benefitted greatly from the counseling and had weighed
carefully the option of continuing therapy. However, Carl
said he felt better and saw no need to continue in
treatment. Carl's therapist noted that Carl had arrived a
bit late for the last two appointments and had less to say
in his therapy sessions.

Although Carl's therapist would ideally have liked Carl to
continue in therapy a bit longer, extending therapy was not
viewed as absolutely necessary. Carl's resolve to end
therapy was strong and his therapist, sensing that resolve,
agreed to end treatment. Carl expressed appreciation to his

93

therapist for the help he received. He also said he was
glad to be ending therapy, stating that he was anxious to,
in his words, ”prove to myself that I can get along by

myself."

94

Appendix C

Instruction Sheet

Most psychotherapists view a client's behavior as having its
origin from two sources:
1. A client's maladjustment or impaired functioning may
be a reaction to certain stressors or current
events. An Adjustment Disorder diagnosis on Axis I
or the DSM-III would be an example.

2. The client's maladjustment or impaired functioning
may be indicative of and arising from the client's
basic level of personality adjustment which, for our
purposes here, shall refer to the client's basic
character structure or personality style (analogous
to Axis II of the DSM-III). This is the extent to
which the personality is integrated, a measure of
the client's general vulnerability to having
problems coping at any time in life, not just in
crisis. A client's basic level of adjustment is
reflected in her or her ability to adapt to change,
relate to others, control impulses and be relatively
free from debilitating symptoms. This basic level
of personality adjustments is not generally thought
to vary within adult clients over time.

 

It is possible for some therapists to view a client's
maladjustment as well as a client's behavior in therapy as
purely a reaction to a clearly identifiable stressor or
stressors. If this were true, a therapist would not
necessarily view the client as particularly vulnerable to
future problems, assuming the current problems are resolved.
However, some therapists may view a client's maladjustment
and behavior in therapy to arise not only from the client's
recent stress but also from deficits in the client's basic
character structure/personality style. If this were true,
one would possibly view the client as much more likely to be
vulnerable to future maladjustment.

We have found that therapists are able to make reliable and
consistent judgements and inferences about a client's
general vulnerability to maladjustment and impaired
functioning. You have just read about this client and have
formed impressions. We understand that only a limited
amount of information is available to you in this client and
therapy description. However, based on your perception of
this client's general vulnerability to symptoms and impaired

95

functioning, please answer the following questions using all
client information given to you as well as your own clinical
intuition. The questions are not asking for your perception
of the client's current clinical condition. Instead, we are
asking you to determine the extent to which you think this
client is vulnerable 13 general to maladjustment. For
example, question #2 is not asking if you think this client
is depressed p91. It is asking if you think the client is
in general vulnerable to depression.

96

Appendix D

Maladjustment Assessment Questionnaire

 

 

Please answer all questions by circling one of the following
responses:

SA Strongly Agree

MA Moderately Agree
SLA Slightly Agree

N Neutral

SLD Slightly Disagree
MD Moderately Disagree
SD Strongly Disagree

This client is likely to experience psychological
problems and impairment in functioning later in life.

SA MA SLA N SLD MD SD
This client is likely to be vulnerable to depression.
SA MA SLA N SLD MD SD

This client is not vulnerable to problems which would
require treatment again later in life.

SA MA SLA N SLD MD SD

This client is vulnerable to periods of low energy
levels.

SA MA SLA N SLD MD SD
This client is vulnerable to having suicidal thoughts.
SA MA SLA N SLD MD SD

This client is not vulnerable to feelings of
inadequacy.

SA MA SLA N SLD MD SD

This client is likely to experience impaired
relationships with others.

SA MA SLA N SLD MD SD

This client is not likely to be vulnerable to feelings
of hopelessness.

SA MA SLA N SLD MD SD

10.

11.

12.

13.

14.

15.

16.

17.

18.

97

SA Strongly Agree

MA Moderately Agree
SLA Slightly Agree

N Neutral

SLD Slightly Disagree
MD Moderately Disagree
SD Strongly Disagree

This client is vulnerable to experiencing feelings of
alienation and loneliness.

SA MA SLA N SLD MD SD

This client will not likely be in need of some form of
psychotherapy again later in life.

SA MA SLA N SLD MD SD

This client is likely to have a tendency toward being
pessimistic about the future.

SA MA SLA N SLD MD SD

This client is not vulnerable to experiencing periods
of nervousness and tensions.

SA MA SLA N SLD MD SD

This client is vulnerable to feelings of despair.
SA MA SLA N SLD MD SD

This client is vulnerable to experiencing anxiety.
SA MA SLA N SLD MD SD

This client is not likely to be vulnerable to feelings
of helplessness.

SA MA SLA N SLD MD SD

This client is likely to cope with stress
satisfactorily.

SA MA SLA N SLD MD SD
This client is likely to cope with change adequately.
SA MA SLA N SLD MD SD

This client is vulnerable to experiencing mood swings
and affective lability.

SA MA SLA N SLD MD SD

19.

20.

98

SA Strongly Agree

MA Moderately Agree
SLA Slightly Agree

N Neutral

SLD Slightly Disagree
MD Moderately Disagree
SD Strongly Disagree

This client is likely to worry excessively
SA MA SLA N SLD MD SD

This client is likely to have experienced psychological
problems and maladjustment in the past.

SA MA SLA N SLD MD SD

(please turn to next page)

99

The following information about yourself is needed in order
to compare your responses to therapists similar to you.
Please provide the following information and place the
questionnaire in the envelope provided.

1. Your profession (check one):
__Social Work
__Psychiatry
__Psychology
__Other, please specify:

 

2. Number of years of counseling and/or psychotherapy
experience (please round off to nearest year):

 

3. Your sex:
__Male
__Female

4. Your age:

5. Your theoretical orientation (please check only one):
__Mainly Analytic
__Mainly Neoanalytic
___Mainly Transactional Analysis
__Mainly Gestalt
__Mainly Rogerian
__Mainly Behavioral
__Mainly Cognitive Behavioral
__Eclectic
__Other, please specify:

 

6. Are you currently conducting therapy?
__Yes
__No

7. Looking at only the personality trait of dependency, on
the following continuum please rate the degree to which
you view this particular client as dependent. We
realize that more information about this client would
make such a determination easier. However, please give
your best inference:

Very dependent 7 6 5 4 3 2 1 Very independent
8. Do you work primarily with adults or children?

.__Adults
_QChildren

100

9. Please provide the average number of hours per week you
spend conducting therapy:

 

Thank you very much for your help! Please place the
questionnaire in the envelope and mail it at your earliest

convenience.

101

Appendix E

Post Cards

Dear Colleague,

Just a reminder! If you have already mailed your
completed Maladjustment Assessment Questionnaire which we
sent to you recently, thank you very much. Be assured, your
responses will be very useful.

If you have not found time yet, at your earliest
convenience, please fill out the questionnaire and mail it
to us. This is very important to us and your response will
be very useful. Thank you in advance!

Sincerely,

Dear Colleague,

Just another friendly reminder. We have no way of
knowing if you have filled out and mailed the Maladjustment
Assessment Questionnaire we recently sent to you. If you
have, great! We really appreciate your concern for what we
are doing.

If you have not, we urge you to do so. We are very
dependent on your responses which will be useful to both our
clients and therapists. Please respond as soon as possible.
Thanks again in advance.

Sincerely,

BIBLIOGRAPHY

Bibliography

 

Abramowitz, S., Abramowitz, C., Jackson, C., & Gomes, B.
(1973). The politics of clinical judgement: What non-
liberal examiners infer about women who do not stifle
themselves. Journal of Consulting and Clinical
Psychology, 21(3), 385-391.

 

 

Abramowitz, S. 1., Weitz, L. J., Schwartz, J. M., Amira, S.,
Gomes, 8., & Abramowitz, C. V. (1975). Comparative
counselor inferences toward women with medical school
aspirations. Journal of College Student Personnel, 19,
128-130.

 

American Psychiatric Association (1980). Diagnostic and
Statistical Manual of Mental Disorders (DSM-III.
Washington, D.C.: American Psychiatric Association.

 

 

Anastasi, A. (1976). Principles of psychological testing.
New York: MacMillan.

 

Bem, S. L. (1977). On the utility of alternative procedures
for assessing psychological androgyny. Journal of
Consulting and Clinical Psychology, 25, 196-205.

 

 

Broverman, I. K., Broverman, D. M., Clarkson, F. E.,
Rosenkrantz, P. S., & Vogel, S. R. (1970). Sex-role
stereotypes and clinical judgements of mental health.
Journal of Consulting and Clinical Psychology, 35, 1-7.

 

Broverman, 1., Vogel,S., Broverman, D., Clarkson, F., &
Rosenkrantz, S. (1972). Sex-role stereotypes: A current
appraisal. Journal of Social Issues, 28, 59-78.

 

Cameron, N. (963). Personality development and
psychopathology. Boston: Houghton Mifflin.

 

 

Chasen, B. (1975). Diagnostic sex-role bias and its relation
to authoritarianism, sex-role attitudes and sex of the
school psychologist. Sex Roles, 1(4), 355-368.

 

Chesler, P. (1972). Women and madness. New York: Doubleday.

 

102

103

Chodorow, N. (1978). The reproduction of mothering.
Berkeley: University of California Press.

 

Coie, J. D., Pennington, B. F., & Buckley, H. H. (1974).
Effects of situational stress and sex roles on the
attribution of psychological disorder. Journal of
Consulting and Clinical Psychology, 32, 559-568.

 

 

Costrich, N., Feinstein, J., Kidder, J., Maracek, J., &
Pascale, L. (1975). When stereotypes hurt: three studies
of penalties for sex-role reversals. Journal of
Egperimental Social Psychology, 11, 520-530.

 

 

Davidson, C. (1983). Making a conceptual leap from sex bias
to countertransference: a closer look at the
patient-therapist dyad. In J. Murray & P. Abramson
(Eds.), Bias in psychotherapy (pp. 168-191). New York:
Praeger.

 

Derlega, V. J., & Chaikin, A. L. (1976). Norms affecting
self-disclosure in men and women. Journal of Consulting
and Clinical Psychology, 31, 376-380.

 

 

Epstein, L., & Feiner, A. H. (1979). Countertransference.
New York: Aronson.

 

Fabrikant, B. (1974). The psychotherapist and the female
patient: perceptions, misconceptions and change. In V.
Franks & V. Burtle (Eds.), Women in Therapy (pp. 83-112).
New York: Brunner/Mazel.

 

Feinblatt, J., & Gold, A. (1976). Sex roles and the
psychiatric referral process. Sex Roles, 2(2), 109-122.

 

Freud, S. (1959). (The future prospects of psychoanalytic
therapy) (J. Strachey, Ed. and Trans.). New York: Norton,
1959. (Original work published 1910).

 

Gilligan, C. (1982). In a different voice. Cambridge:
Harvard University Press.

 

Gomes, B., & Abramowitz, S. (1976). Sex-related patient and
therapist effects on clinical judgment. Sex Roles, 3(1),
1-13 e

 

Hays, W. (1981). Statistics (3rd ed.). New York: CBS College
Publishing.

 

Harris, L., & Lucas, M. (1976). Sex-role stereotyping.
Social Work, 21(5), 390-395.

 

104

Keller, S. (1974). The female role: constants and change.
In V. Franks & V. Burtle (Eds.), Women in Therapy. New
York: Brunner/Mazel.

 

Kirsch, B. (1974). Consciousness-raising groups as therapy
for women. In V. Franks & V. Burtle (Eds.), Women in
Therapy (pp. 326-356). New York: Brunner/Mazel.

Mann, J. (1973). Time-limited psychotherapy. Cambridge:
Harvard University Press.

Maslin, A., & Davis, J. L. (1975). Sex-role stereotyping as
a factor in mental health standards among counselors in
training. Journal of Counseling Psyphology, 22, 87-91.

 

McKee J., & Sherriffs, A. (1959). Men's and women's beliefs,

ideals, and self-concepts. American Journal of Sociology,
_6-_4_’ 356-3630

 

Miller, D. (1974). The influence of the patient's sex on
clinical judgment. Smith College Studies in Social Work,

 

Millon, T. (1981). Disorders of Personality. New York: Wiley
& Sons.

Murray, J. (1983). Sex bias in psychotherapy: a historical
perspective. In J. Murray & P. Abramson (Eds.), Bias in
Psychotherapy, (pp. 3-39). New York: Praeger.

 

Murray J., & Abramson, P. (1983). An investigation of the
effects of client gender and attractiveness on
psychotherapists' judgements. In J. Murray & P. Abramson
(Eds.), Bias in Pyschotherapy, (pp. 129-168). New York:
Praeger.

 

O'Malley, K., & Richardson, 8. (1985). Sex bias in
counseling: Have things changed? Journal of Counseling
and Development, 65, 294-299.

 

 

Pringle, M. B. (1973). The responses of counselors to
behavior associated with independence and achievement in
male and female clients. Dissertation Abstracts
International, 32, 1627A. (University Microfilms No.
73-24,659)

 

 

Rosenkrantz, P., VOgel, 8., Bee, H., Broverman, 1., &
Broverman, D. M. (1968). Sex-role stereotypes and
self-concepts in college students. Journal of Consulting
and Clinical Psychology, gg, 287-295.

 

 

105

Ruble, T. (1983). Sex stereotypes: Issues of change in the
1970's. Sex Roles, 9(3), 397-402.

 

Sherman, J. (1980). Therapist attitudes and sex-role
stereotyping. In A. Brodsky & R. Hare-Mustin (Eds.),
Women and psychotherapy: An assessment of research and
practice (PP. 35-63). New York: Guilford Press

Sherriffs, A., & McKee, J. (1957). Qualitative aspects of
beliefs about men and women. Journal of Personality, 25,
451-464.

 

Siegel, S. (1956). Nonparametric statistics for the
behavioral sciences. New York: McGraw-Hill.

 

 

Stricker, G., & Shafran, R. (1983). Gender and
psychotherapy: A review of the empirical literature. In
J. Murray & P. Abramson (Eds.), Bias in Psychotherapy
(pp. 192-215). New York: Praeger.

 

Swenson, E., & Ragucci, R. (1984). Effects of sex-role
stereotypes and androgynous alternatives on mental health
judgments of psychotherapists. Psychological Reports,

Thomas, A., & Stewart, N. (1971). Counselor response to
female clients with deviate and conforming career goals.
Journal of Counseling Psychology, 18(4), 352-357.

 

Tribich, D. A. (1977). The influence of sex-role stereotypes
and sex-role self-concept on judgments of mental health.
(Doctoral dissertation, Rutgers University, 1977).
Dissertation Abstracts Interntional, 32, 5384.

Werner, P., a La Russa, G. (1985). Persistence and change in
sex-role stereotypes. Sex Roles, 12(9/10), 1089-1100.

 

Whitely, B. (1979). Effects of nonpathological sex role
stereotypes on student evaluations of psychiatric
patients. Journal of Consulting and Clinical Psychology,
11, 304.

Zeldow, P. (1978). Sex differences in psychiatric evaluation
and treatment: An empirical review. Archives of General
Psychiatry, 35, 89-93.

 

"IIIII'IIIIIIIIIIIII