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LIB R A R Y
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This is to certify that the

thesis entitled

A COMPARISON OF THE TRADITIONAL FILIAL THERAPY PROGRAM

TO AN INTEGRATED FILIAL-IPR PROGRAM

presented by

Chris G. Dematatis

has been accepted towards fulfillment
of the requirements for

 

 

Ph.D. degree in Education

at

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ii

 

OVERDUE FINES:

25¢ per day per item

RETURNING LIBRARY MATERIALS:
Place in book return to runove
charge from c1rcu1at1on records

A COMPARISON OF THE TRADITIONAL FILIAL THERAPY PROGRAM

TO AN INTEGRATED FILIAL-IPR PROGRAM

By

Chris G. Dematatis

A DISSERTATION

Submitted to
Michigan State University
in partial fulfillment of the requirements

for the degree of

DOCTOR OF PHILOSOPHY

Department of Counseling, Personnel Services,

and Educational Psychology

1981

6-1/5‘73?

ABSTRACT

A COMPARISON OF THE TRADITIONAL FILIAL THERAPY PROGRAM
TO AN INTEGRATED FILIAL-IPR PROGRAM

33'

Chris G. Dematatis

The purpose of this study was to design and evaluate modifications
in a particular method of intervention into the parent-child relation-
ship known as Filial Therapy. In Filial Therapy parents are taught
methods of client-centered play therapy so that they may function as
psychotherapeutic agents to their own children. It was hypothesized
that the introduction of important elements from Kagan's Interpersonal
Process Recall (IPR) training model would enable a crucial dimension
of the parent-child relationship, the parents' own emotional conflicts,
to be therapeutically addressed in a more systematic and reliable manner.

The two components of Kagan's model which were integrated into the
traditional Filial program are affect simulation and videotape recall.
In affect simulation parents were shown filmed vignettes of a variety
of interpersonal scenes. The goal was to familiarize parents with
their own emotional responses to stressful interpersonal situations.

As parents become familiar with the concept of interpersonal fears

and started to become familiar with their own, the videotape recall
component of the IPR model was introduced. The goal here was to
systematically familiarize parents with the specific interpersonal fears

which they encountered in their interactions with their children, the

manifestation of those fears in behavior, and the impact of that behavior
on their children. In the recall process, parents confront their own
fears when they are ready rather than when the clinician thinks that
they are ready, as is the case in the traditional Filial Therapy program.

The experimental design of this study was a pretest/posttest control
‘group design, with the traditional Filial Therapy model serving as the
control group to the integrated Filial-IPR model. The sample for this
study consisted of 32 volunteer parents of children with emotional or
behavioral problems. Parents were members of the military who were
referred by their Family Practice and Pediatric physicians at Dewitt
Army HosPital at Ft. Belvoir, Virginia. Subjects were randomly assigned
to one of the two treatment methods and to one of the two leaders. There
were four groups, two treatment and two control, with eight members in
each group. The leaders were the eXperimenter and a school psychologist
experienced with play therapy and parent training groups. The groups
met for two hours each session for a total of sixteen weeks.

In order to compare the effectiveness of each of the programs the
following dependent variables were studied: (a) parental acceptance,
(b) affect sensitivity, (c) play therapy skills, and (d) child adjustment.
The specific measures used to assess these variables were the Porter
Parental Acceptance Scale, the Affect Sensitivity Scale, the Filial
Problem List, the Parent Check List, and videotape ratings of communica-
tion of acceptance, allowing self direction, and involvement.

Seven specific research hypotheses were formulated to test for

differences between each method. Each research hypothesis related to

each of the dependent measures. Each of the hypotheses predicted no
differences in gain scores, pre to post, between the two different
measures. Each hypothesis was tested for differences with two different
ANCOVA computer analyses. The ANCOVA was employed to adjust for initial
pretest differences between groups by using the pretest scores as the
covariate. One analysis examined method x leader x interaction effects.
The second, more powerful analysis combined leaders and analyzed only
differences between methods. Significance was set at the .05 level.

The results of the analyses showed significant differences on only
one of the dependent measures, the parent play therapy skill communica-
tion of acceptance. This difference was in favor of the IPR method
and was supported by both ANCOVA analyses. Significant differences
were not found on any of the other major hypotheses.

A secondary analysis was independently carried out on each training
method. Two hypotheses were stated, one for each method, predicting
pre to post positive raw score differences on each measure for each
method. Each hypothesis was tested for pre to post raw score differences
using the parametric matched pairs t-test and the nonparametric Wilcoxon
signed-ranks test. Hypotheses were stated directionally in favor of
pre to post improvement on each measure. Significance testing was
carried out at the .05 level. The results indicated that both methods

achieved significant pre to post gains on most of the variables considered.

To my wife Anne-—
For her love, encouragement, and

invaluable contributions to this study

ii

ACKNOWLEDGEMENTS

I am indebted to a number of peOple for their help in the
completion of this project. I wish to thank all of the peeple in the
Clinical Psychology Training Section at Saint Elizabeths Hospital for
their financial and emotional support of this study, and for the
excellent clinical training they have made available to me. Particular
thanks go to Dr. Elliot Blum, who has taught me much about therapy and
supervision. I also wish to thank Dr. Phil Scrofani for his time and
ideas in the inception and early development of this study.

My thanks also to those peOple at Dewitt Army Hospital, Ft. Belvoir,
Virginia, who facilitated the implementation of this project. Particular
thanks go to Dr. Lester York, whose example and knowledge taught me
much about the administration and implementation of a large research
project..

I wish to thank Cathie Love for her help in preparing the manuscript.

For their support on and off my committeeI would like to express
my appreciation to Dr. Albert Aniskiewicz, Dr. Douglas Miller, and
Dr. Sam Plyler.- My thanks to each of these peOple extends especially
to the roles they have played in my development as a therapeutic person.

Finally, I would like to thank my committee chairman,

Dr. Norman Kagan, for his support, guidance, and very useful feedback

throughout this study.

iii

TABLE OF CONTENTS

LI S T OF TABLES O O I O O O O O O O O O O O O O O O O 0

LIST OF APPENDICES O O O O O O O O O O O O O O O 0

Chapter

1.

2.

3.

PURPOSE 0 O O O O O O O O O O O O O O O O 0

Need for the Study . . . . . .
Statement of the Problem . . . .
Definition of Terms . . . . . . . . . . .
Delimitations of the Study . . . . . . . .
Assumptions of the Study . . . . . . . . .
General Hypotheses . . . . . . . . . . .
Theoretical Considerations . . . . . . . .
Filial Therapy . . . . . . .
Interpersonal Process Recall (IPR).
Summary and Overview .

REVIEW OF THE LITERATURE . . . . . . .

The Parent—Child Relationship . . . . .

Use of Parents as Agents for Change
Psychodynamic Approaches
Behavioral Approaches .
ClientrCentered Approaches

Summary and Discussion . . . . . . . .

'IPR Research Outcomes . . .

Summary and Discussion . . . . . . . . . .

METHODS . . . . . . . . . . . . . . . . . .

Participants . . . . . . . . . . . . . .
The Settings . . . .
Play Therapy Group Leaders .
Data Collection . . . . . .
Instrumentation .
Affective Sensitivity Scale .
Porter Parental Acceptance Scale
Child Adjustment . . . . .
Filial Problem List . . . . .
Parent Check List . . . . . . . .
Videotape Rating Scale . . . . . . .
Selection and Training of Raters
The Design .

iv

Page
vi

. viii

18
21
21
23
24
29
31
38

39

39
4O
41
41
42
42
43
45
45
46
46
47
48

Chapter Page

Hypotheses . . . . . . . . . . . . . . . . . . . . . . 48
Independent Variables . . . . . . . . . . . . . . . . 50
Filial Program. . . . . . . . . . . . . . . . . . . 50
Role of the Group Leaders . . . . . . . . . . . . 50
Training Methods . . . . . . . . . . . . . . . . . 51
Didactic Methods . . . . . . . . . . . . . . . . 51
Dynamic Methods . . . . . . . . . . . . . . . . . 51
Reinforcement Method . . . . . . . . . . . . . . 52
Generalization Method . . . . . . . . . . . . . . 53
Necessary Attitudes of Filial Leaders . . . . . . . 53
Play Therapy Skills . . . . . . . . . . . . . . . 53
Stages of Filial Therapy Group Process . . . . . . 55
Phase I-—Parent Training . . . . . . . . . . . . 55
Phase II-—At-Home Sessions . . . . . . . . . . . 56
Integrated Filial Therapy-IPR Program . . . . . . . . 58
Statistical Analysis . . . . . . . . . . . . . . . . . 59
Summary . . . . . . . . . . . . . . . . . . . . . . . 6O
4. ANALYSIS OF THE RESULTS . . . . . . . . . . . . . . . . 63
Preliminary Analysis . . . . . . . . . . . . . . . . . 63
Primary Analysis . . . . . . . . . . . . . . . . . . . 64
Inter-Rater Reliability . . . . . . . . . . . . . . 80
Summary of Primary Analysis . . . . . . . . . . . . 80
Secondary Analysis . . . . . . . . . . . . . . . . . 82
Summary of Secondary Analysis . . . . . . . . . . . 89
5. SUMMARY, RESULTS AND DISCUSSION . . . . . . . . . . . . 91
Summary . . . . . . . . . . . . . . . . . . . . . . . 91
Results . . . . . . . . . . . . . . . . . . . . . . . 96
'Discussion . . . . . . . . . . . . . . . . . . . . . . 98
Participants' Subjective Comments Regarding the
Program . . . . . . . . . . . . . . . lll
Limitations and Suggestions for Future Research . . . 112
APPENDICES . . . . . . . . . . . . . . . . . . . . . . . . . . . ll6

BIBLIOGRAPHY . . . . . . . . . . . . . . . . . . . . . . . . . . 146

LIST OF TABLES

Table Page
4.1 Pearson-Product—Moment Correlations of Mother—Father
Scores on Each Measure . . . . . . . . . . . . . . . . . . 64
4.2 PPAS Means, Standard Deviations, and Mean Change Scores . 66
, 4.3 ANCOVA of PPAS Scores (Leaders x Methods) . . . . . . . . 66
4.4 ANCOVA of PPAS Scores (Methods Only) . . . . . . . . . . . 67
4.5 ASS Means, Standard Deviations, and Mean Change Scores . . 68
4.6 ANCOVA of ASS Scores (Leaders x Methods) . . . . . . . . . 68
4.7 ANCOVA of ABS Scores (Methods Only) . . . . . . . . . . . . 69
4.8 FPL Means, Standard Deviations, and Mean Change Scores .4. 70
4.9 ANCOVA of FPL Scores (Leaders x Methods) . . . . . . . . . 71
' 4.10‘ ANCOVA of FPL Scores (Methods Only) . . . . . . . . . . . 71
4.11 PCL Means, Standard Deviations, and Mean Change Scores . . 72
4.12 ANCOVA of PCL Scores (Leaders x Methods) . . . . . . . . . 73
4.13 ANCOVA of PCL Scores (Methods Only) . . . . . . . . . . . 73

4.14 Communication of Acceptance: Means, Standard Deviations,
and Mean Change Scores . . . . . . . . . . . . . . . . . . 75

4.15 ANCOVA of Communication of Acceptance Scores (Leaders x
Methods) . . . . . . . . . . . . . . . . . . . . . . . . . 75

4.16 ANCOVA of Communication of Acceptance Scores (Methods

Only) . . . . . . . . . . . . . . . . . . . . . . . . . . 76
4.17 Allowing Self Direction: Means, Standard Deviations,

and Mean Change Scores . . . . . . . . . . . . . . . . . . 77
4.18 ANCOVA of ASD Scores (Leaders x Methods) . . . . . . . . . _77
4.19 ANCOVA of ASD Scores (Methods Only) . . . . . . . . . . . 78

4.20 Involvement: Means, Standard Deviations, and Mean
Change Scores . . .'. . . . . . . . . . . . . . . . . . . 79

vi

Table
4.21
4.22

4.23
.4.24
4.25
4.26

4.27

ANCOVA of Involvement Scores (Leaders x Methods) . . . .

ANCOVA of Involvement Scores (Methods Only) . . . . . .

Inter-Rater Reliability

Coefficients for Videotape

Ratings of Parent Play Therapy Skills . . . . . . . . .

Analysis of Pre to Post
Filial Method Using the

Analysis of Pre to Post
Filial Method Using the

‘Analysis of Pre to Post

Filial-IPR Method Using

Analysis of Pre to Post
Filial-IPR Method Using

Differences for the Traditional
Matched Pairs T-Test . . . . . .

Differences for the Traditional
Wilcoxon Signed-Ranks Test . . .

Differences for the Integrated

Differences for the Integrated

the Wilcoxon Signed-Ranks Test .4

vii

Page
79

8O

81

84

85

87

88

LIST OF APPENDICES
APPENDIX Page
A. Porter Parental Acceptance Scale . . . . . . . . . . . . . 116
B. Filial Problem List . . . . . . . . . . . . . . . . . . . 125
C. Check List for Parents . . . . . . . . . . . . . . . . . . 131
D. Videotape Rating Scales . . . . . . . . . . . . . . . . . 134

E. The Affective Sensitivity Scale . . . . . . . . . . . . . 136

F. Letter to Parents . . . . . . . . . . . . . . . . . . . . 138
G. Parent Consent Form . . . . . . . . . . . . . . . . . . . 139
H. Playroom Guidelines for Parents . . . . . . . . . . . . . 140

I. Toys for the Playroom . . . . . . . . . . . . . . . . . . 144

J. Comments on Parent Play Therapy Program . . . . . . . . . 145

viii

CHAPTER 1

PURPOSE

The purpose of this study is to evaluate the effectiveness of
modifying a particular method of intervention into the parent-child
relationship. This method employs the basic structure of an existing
strategy for intervening in the parent-child relationship, called
Filial Therapy, and integrates crucial components from another
methodology, Interpersonel Process Recall (IPR), which uses videotape
and stimulus film techniques. The effectiveness of this integrated
Filial Therapy-Interpersonal Process Recall model will be assessed by
comparing it to the traditional Filial Therapy program without IPR

methodology.

Need for the Study

 

Since the 1960s, several writers (Hobbs, 1963; Albee, 1968;
Guerney, 1969; Miller, 1969) have stated that the conventional "medical"
model is not meeting society's needs for preventive and remedial services.
It is becoming increasingly clear that there is a need for greater
and more efficient utilization of manpower and wider dissemination of
available information in order to meet society's mental health needs.
Therefore, an important area of investigation is the possibility of
training para-professional parents, teachers, police, etc. to deliver
effective psychological services through the use of educational programs
and para—professional training (Kagan, 1973; Archer, 1971; B. Guerney,

L. Guerney, Stollack, 1971).

2

One important area of application of this idea is the education
of parents to be psychotherapeutic agents to their own children.
Several writers on personality development, including Rogers (1951),
Sullivan (1953), and Erickson (1968) have stressed the importance of
the parent-child relationship to the personality development of the
child. These writers have discussed the central role that an unhealthy
parent-child relationship plays in the creation of emotional problems
in children. Once such problems become relatively fixed, even massive
expenditures of professional time may fail to be of use (Guerney, B.,
1954). Consequently, a logical place to focus either remedial or
preventive interventions in the battle against emotional disturbance
is the parent-child relationship.

Starting in 1909, when Freud described the case of "little Hans,"
but eSpecially since 1950, there have been a growing number of efforts
to use parents in the treatment of their own children. One of the most
promising efforts to emerge in this direction is Filial Therapy (see
Chapter 2, Review of Literature). This approach trains parents to
function as psychotherapeutic agents, while the professional functions
in the role of therapist educator. Developed by Bernard Guerney (1964),
this was the first systematic effort to so train parents. In Filial
Therapy, parents are taught to do client-centered play therapy with
their own children in order to alleviate present concerns and conflicts
as well as to develop parenting skills for future use. The efficacy
of Filial Therapy in dealing with the problems of emotionally disturbed

children has been established in three research studies (B. Guerney,

3
et al., 1971; Oxman, 1971; Sywulak, 1978). However, while the Filial

Therapy program has been proven to be both an effective therapeutic
intervention which aims to improve the parent-child relationship and
an effective para-professional program which provides more efficient
use of professional time, it is only a beginning. Questions still

remain about the best ways to help parents improve the mental health

of their children.

Statement of the Problem

 

As Kagan (1973) points out, "the most basic issue confronting mental
health today is reliability, not validity." (p. 44) The question is no
longer is psychotherapy works, but which patient, therapist, and
technique variables are important in influencing client growth. Accord-
ing to Strupp and Bergin (1969) new and more effective techniques need
to be deve10ped and evaluated.

The problem addressed by this study is whether elements of two
different training models can be effectively combined so that a crucial
dimension of the parent-child relationship, the parents' emotional
conflicts, are therapeutically addressed in a more systematic and
reliable manner. The primary structure of this new intervention is
derived from the Filial Therapy program (B. Guerney, 1964). Integrated
into this structure are crucial components of the Interpersonal Process
Recall (IPR) model, develOped by Norman Kagan and colleagues (1963).
While a more detailed description and rationale for both interventions
will be offered later in this chapter (see Definitions and Theoretical
Considerations), the rationale for the addition of IPR to the traditional

Filial Therapy model is presented here.

The goal of Filial Therapy is to help parents acquire basic play
therapy skills such as active listening, communication of acceptance
and understanding, limit setting, and allowing the child to be self-
directed. Another goal is the elimination of certain parental behaviors
which are inconsistent with the principles of non-directive play therapy
and which prove to reinforce maladaptive behavior and emotional conflict
in the child. The current model attempts to achieve these goals through
a number of strategies, including modeling, didactic presentations,
social reinforcement, and the use of observational feedback.

A premise of the Filial model is that most childhood problems are
a consequence of an unsatisfactory parent-child relationship (B. Guerney,
1964). Since difficulties in the parent-child relationship likely
'result from emotional conflicts within the parent, sufficient attention
must be paid to the emotional conflicts experienced by parents in
their relationships with their children. In this regard, B. Guerney
(1964) writes: "It is emphasized to the parent that the specific
techniques will be meaningless, or worse, if they are applied only
mechanically and not as a reflection of a genuine attempt at empathy."
(p. 307) How does Filial Therapy help the parent whose own conflicts
severely hamper his/her ability to be genuinely empathic? B. Guerney
proceeds by saying: ”A parent's very difficulty in learning to play
such a role may be a valuable source of material for examination and
eventual insight. . . .It is anticipated that this will be a catalytic
force for group therapy of parents that will be of significant value."
(p. 308) Specifically addressing how parental problems are dealt with,

Andronico, Fidler, B. Guerney, and L. Guerney (1967) write: "The

5

therapist uses his clinical judgment to determine when to make
appropriate shifts from didactic to dynamic elements." (p. 12) This
exclusive reliance on leader skill and sensitivity entails some risks.
The leader may miss areas of conflict; he or she may threaten parents
by addressing these issues prematurely. The leader's own areas of
emotional conflict may make it difficult for him/her to empathically
respond to the parents, just as the parent's conflicts make it difficult
for them to reapond to their children. So, while the Filial Therapy
model does address areas of emotional conflict for parents, it appears
that these areas of emotional conflict are addressed in an unsystematic
and unreliable manner, one which is highly dependent on leader skill.

Modification of the traditional Filial Therapy program will entail
' the integration of two components of a training model, Interpersonal
Process Recall (IPR), developed by Norman Kagan and colleagues (1967)
at Michigan State University. Kagan's model has been used to train
para—professionals as well as professionals in the mental health field.
This model shares with Filial Therapy the goal of more efficient use
of professionals' time and knowledge in meeting society's preventive
mental health needs. It is also built upon similar theoretical
foundations (see Theoretical Considerations).

The two components of Kagan's model which were integrated into the
traditional Filial Therapy program were videotape recall, the heart
of the IPR training model, and affect simulation (see Definitions, this
chapter). It was hypothesized that the addition of these two components
would improve the Filial program by: (a) gradually introducing parents
to their own emotional responses to stressful, but general, interpersonal

situations through affect simulation films; (b) systematically familiar-

6
izing parents with the Specific interpersonal fears and conflicts which
they encountered in their interactions with their children, the mani-
festation of those conflicts in behavior,.and their impact on their
children; and (c) providing parents additional practice in non-directive,
facilitative interaction by practicing the inquirer role (see
Definitions of Terms, this chapter).

In summary, the purpose of this study was to evaluate the effective-
ness of a modified Filial Therapy program which integrated elements of
Kagan's IPR training model. This modified Filial Therapy program had
as its control the traditional Filial Therapy program designed by
B. Guerney (1964) and currently offered by L. Guerney at the Pennsylvania
State University. It was hypothesized that the introduction of
components of Kagan's IPR model would accelerate and heighten skill
development of the parents as play therapists. It was also hypothesized
that greater gains in parental acceptance and child adjustment would

occur in the integrated model (see General Hypotheses, this chapter).

Definitions of Terms

 

Specific terms used in this study are defined as follows:

Filial Therapy: Filial Therapy is a method of treating emotionally

 

and behaviorally disturbed children between the ages of three and ten.
Deve10ped by B. Guerney and colleagues (1964), this approach employs
parents as psychotherapeutic agents with their own children. The
professional functions as a therapist-educator to the parents. Filial
Therapy is a highly structured training treatment program in which

parents learn client—centered play therapy techniques with their own

7
children in order to alleviate present concerns as well as to provide
parenting skills for future use. A more detailed description of the
Filial Therapy program occurs in Chapter 3.

Interpersonal Process Recall (IPR): IPR is a method of training
professional and para-professional counselors, therapists, and medical
educators, and is used to accelerate the process of psychotherapy. IPR
develops skills in interviewing techniques, affective sensitivity,
and self study through videotape recall. Although parts of the model
are devoted to teaching Specific skills, the core activities allow
trainees to determine for themselves what is important in their self
study. A permissive, supportive atmosphere is created in IPR.which
encourages self-exploration and provides an affective and cognitive
base for skill development and personal growth.

There are three basic parts in a complete IPR course:

1. Basic communication skills are developed through demonstration,

 

practice, and discussion. The basic skills taught are exploratory,
active listening, affective, and honest labelling responses.
2. The trainee is acquainted with his/her own responses to

stressful situations through affect simulation films.

 

3. Videotaped recall is the major component of IPR. In this

 

section, trainees are videotaped as they relate to another in a help—

ing situation. They then sit down with a trained facilitator, called

the inquirer (all trainees learn to perform this role), and review

the videotape. The trainee is encouraged to re—experience and explore
all of his/her thoughts, feelings, reactions, images, strategies, and,
fantasies which occurred in the interaction as he/she reviews the

videotape. The facilitator does not stop the tape to offer criticism

8
or praise. Rather, he/she helps in the process of self discovery
through theuse of nonthreatening exploratory leads when the trainee
has stepped the tapes at points which are important to him/her. IPR
can be easily modified but is usually offered asna 30-hour course.
It can be offered in ten three-hour sessions occurring once a week,

expanded, or compressed into a weekend.

Delimitations of the Study_

 

The following factors delimit the generalization of the results
of this study:

1. The subjects used in this study were all members of the
military or military dependents referred to this study by their Family
Practice and Pediatric physicians at Dewitt Army HOSpital, Ft. Belvoir,
'Virginia. Their ages ranged from 24 to 45 years.

2. Parents referred to this study had children with a variety of
emotional and behavioral problems. No families were accepted to the
study whose children showed signs of autism or childhood schizophrenia.
None of the children of families accepted for the study evidenced
overt signs of organicity.

3. Parents accepted to the study were volunteers, and were
presumably motivated to help their children.

4. Both traditional Filial Therapy and integrated Filial—IPR
groups ran for a period of 16 weeks. In the past, traditional Filial
Therapy groups have run for 20 to 24 weeks.

5. Group leaders both attended a five—day training program in

Filial Therapy. Neither leader had experience leading Filial Therapy

groups prior to the study. Both leaders were trained in IPR methodology.
One leader was the experimenter who was trained in a 30 hour IPR course.
The other leader was given ten hours of IPR training by the experimenter.
Neither leader had prior experience with the IPR model in a therapeutic
situation.

6. The study did not examine whether the treatment or control
groups had differential effects on individuals with different personality

and socio-economic characteristics.

Assumptions of the Study

 

The following assumptions were made for the present study:

1. that most childhood problems are a consequence of unsatisfactory
parent-child relationships; 4
- 2. that both parents and children are capable of cognitive,
emotional and behavioral growth and learning and can be helped to change
in positive directions;

3. that changes in child adjustment can be reliably and validly
measured by problem check lists;

4. that changes in parental acceptance, affective sensitivity,
and demonstrated play therapy skills can be reliable and validly
measured, and that these qualities are reflective of parental ability
to function as psychotherapeutic agents with their own children; and

5. that acquisition of therapeutic skills will generalize into
everyday parenting skills.

General Hypotheses

 

General hypotheses for this study are stated here. Specific

research hypotheses are stated in Chapters 3 and 4.

10

1. Parents who are trained in the integrated Filial-IPR method
will show greater gains in a measure of parental acceptance than
parents trained in the traditional Filial Therapy method.

2. Parents who are trained in the integrated Filial-IPR method
will show greater gains on a measure of affective sensitivity than
parents trained in the traditional Filial Therapy method.

3. Parents who are trained in the integrated Filial-IPR method
will show greater gains in videotape measures of the play therapy
skills of acceptance of feelings, allowing self direction, and involve-
ment than parents trained in the traditional Filial Therapy method.

4. Children of parents who are trained in the integrated Filial-
IPR.method will show greater gains on two measures of child adjustment
.than parents of children trained in the traditional Filial Therapy
method.

Evaluation will be in the form of objective paper and pencil
tests and ratings of videotapes of actual parent—child play therapy
sessions. Parental acceptance, according to Porter (1954), is "one
of the essential elements underlying the whole structure of the parent-
child relationship." (p. 177) Affective sensitivity provides a measure
of the parents' understanding of the childfs feelings; Ratings of
the videotaped sessions will provide measures of the parents' play
therapy skills. Finally, changes in child adjustment should reflect
changes in the parent-child relationship as well as the self-concept

of the child.

11
Theoretical Considerations

In this section there will be a discussion of the theoretical
underpinnings of both the Filial Therapy and Interpersonal Process
Recall model. It will be demonstrated that each model shares the
assumption that behavior and personality are influenced by self concept
and phenomenological field of the observer. This section will begin
with a discussion of the question of combining elements and techniques
from different methods in order to create a new method.

Arnold Lazarus (1976) has develOped a therapeutic approach called
multimodal therapy. He assumes that peOple experience a range of
difficulties across the range of modalities of human experience. These
include the behavioral, affective, cognitive, sensate, and imagery
modalities. This approach assumes that therapeutic change will result
only if the therapist can assess the modality or modalities where the
problems exist and provide the intervention best suited to that modality.
The goal is to find the method that works best on a specific problem.
The multimodal approach supplies a rationale for applying this
"technical ecclecticism."

Different writers, including Kagan, et a1. (1967), B. Guerney
(1964), and Eckstien and Wallerstien (1958) point out that difficulties
in learning to be therapeutic also arise. It follows that these
difficulties may occur across the same modalities described by Lazarus.
The same technical ecclecticism is in order for the task of discovering
the most effective methods of training persons to function therapeutically.

Parents learn to facilitate the growth of self confidence,.self

direction, and self responsibility in their children through mastery

12
of the Filial methods. The use of IPR components allows parents to
gain mastery of Filial methods by experiencing the same learning

processes.

Filial Thergpy

 

The theoretical model upon which Filial Therapy is based is client-
centered play therapy and is derived from Roger's (1951) client-centered
therapy. This theory assumes an inherent capacity in each individual
for growth and self direction. The client-centered approach postulates
that this capacity for growth will be released when certain definable
qualities in the therapeutic relationship,such as genuineness, empathy,
and unconditional positive regard, are experienced by the client.

Axline (1947) applies the eight basic principles of Rogerian client-
'centered therapy to play therapy with children as follows:

1. The therapist must develOp a warm, friendly relationship with
the child, in which good rapport is established as soon as possible.

2. The therapist accepts the child exactly as he is.

3. The therapist establishes a feeling of permissiveness in the
relationship so that the child feels free to eXpress his feelings
completely.

4. The therapist is alert to recognize the feelings the child
is expressing and reflects those feelings back to him in such a manner
that he gains insights into his behavior.

5. The therapist maintains a deep respect for the child's ability
to solve his own problems if given an opportunity to do so. The

responsibility to make choices and to institute change is the child's.

13

6. The child leads the way; the therapist follows.

7. The therapist does not attempt to hurry the therapy along.
It is a gradual process and is recognized as such by the therapist.

8. The therapist establishes only those limitations that are
necessary to anchor the therapy to the world of reality and to make
the child aware of his responsibility in the relationship. (pp. 73-74)

Filial Therapy is an intervention designed to improve the parent-
child relationship by teaching apprOpriate parenting skills. The
primary goal of Filial Therapy is to overcome the child's emotional
and behavioral problems by educating the parents to serve as the
psychotherapeutic agent. B. Guerney (1964), the originator of Filial
Therapy, summarizes the theory behind personality change underlying
'the model:

The manner in which the child's play sessions are to be

conducted is intended first to break the child's per-

ception or miSperception of the parents' feelings,

attitudes, or behavior toward him. Second, they are

intended to allow the child to communicate thoughts,

needs, and feelings to his parents which he has pre-

viously kept from them, and often from his own awareness.

(This communication is mainly through the medium of play.)

The children's sessions with their parents are thus meant

to lift repressions and resolve anxiety-producing

internalized conflicts. Third, they are intended to bring

the child--via incorporation of newly perceived attitudes

on the part of his parents--a greater feeling of self

respect, self worth, and confidence. (p. 306)
The goal is accomplished by teaching the parents the principles and
skills of client-centered play therapy as outlined by Axline above.
The secondary goal is to generalize these skills to everyday parent-

child relationships outside the formalized play therapy sessions

conducted at home. The focus is not upon the past, or the parents'

l4
role in creating his child's problems, but upon the present and future.
The importance of skill deveIOpment for preventive as well as thera-
peutic purposes is stressed.

The advantages of using the parent rather than a professional
therapist to treat the child are many. An important advantage is that
the parent has an on-going and important relationship with the child,
while the building of a therapist-child relationship often takes
considerable time. Quoting B. Guerney (1964), "Every bit of success
that the parent achieves in successfully filling the prescribed role
should have an effect many times more powerful than that of a therapist
doing the same thing." (p. 308) Given the interactional nature of
parent-child difficulties, any changes in the parents' contributing
'behavior should contribute to improving the on—going situation.

Another advantage is that the parent's involvement heightens the
parent's motivation to be helped, and to be of help. This should
reduce the resistance to treatment so common when the child is seen‘
by a professional. Finally, this approach offers parents the opportunity
to learn interpersonal skills which cannot only help the child work
through his current problems, but also be generalized to consolidate
their gains as well as be generalized to other members of the family,
including the Spouse. This can serve to reduce those tensions in the
whole family situation which may be playing a part in sustaining
symptomatic behavior in the child.

While the theory of personality change underlying the play therapy

sessions is primarily derived from Rogers (1951), the method used to

lS
teach these skills are based upon behavioral theory as well as student-
centered methods. Training is accomplished through didactic presenta—
tion, modeling of play therapy skills, exercises, social reinforcement
for mastery of the required principles and skills, and generalization
(see Chapter 3, Filial Program). In addition, Filial leaders model
client-centered skills when helping parents to explore their own areas

of emotional conflict in relation to their children.

Interpersonal Process Recall (IPR)

 

The theoretical framework underlying the IPR model is also based
primarily upon Rogerian personality theory. IPR assumes that behavior
and personality are influenced by self concept and the phenomenological
field of the perceiver. This idea relates to both the affect simulation
“films and the recall process. Kagan (1967) identified a number of
interpersonal fears which limit the ability of persons to become closely
and intimately involved, or which limit the ability to allow for
increasing differentiation in a relationship. Briefly stated, these
fears include giving and receiving affection, and eXpressing and
receiving hostility. The affect simulation films and the videotape
recall components of the IPR model both aim to help trainees to experience
and begin to accept these fears. By accepting these fears they are
accepting a part of themselves which may have been previously denied.
This self acceptance can lead to greater self confidence and stronger
self concept. It can allow them to take more interpersonal risks and

learn new interpersonal behavior.

l6

Trainees are first eXposed to these fears when they view the
affect simulation films. This first exposure allows the trainees to
begin to eXperience these fears in the less risky experiencing of
filmed actors. The ensuing group discussion allows parents to share
their fears and learn that others have similar interpersonal fears.
The second step in learning to recognize and accept interpersonal fears
occurs in the videotape recall. Seeing oneself interact with another
person on videotape is a powerful form of feedback. In this setting
one can discover one's interpersonal fears, see their manifestation
in behavior, and see the impact on the person interacted with.

The other source of learning occurring in the videotape recall
component of IPR occurs in learning to function as an inquirer. It
is the inquirer's job to help the person going through videotape recall
in their efforts to explore their thoughts and feelings during their
interaction. To do so, the inquirer must pay close attention to the
verbal and non—verbal communication taking place. The inquirer role
requires skills of non-judgmental, non-interpretive, and non-directive
interaction with the purpose of allowing others to gain insight and
experience self discovery. This leads to a sense of self responsibility

for one's own learning and behavior change.

Summary and Overview

 

This chapter described the need for and purpose of this study which
is to design and evaluate modifications of the traditional Filial Therapy
program designed by B. Guerney (1964). The primary modification of the

traditional program involves integration of major components of Kagan's

17
(1967) Interpersonal Process Recall method of training. In addition,
terms were defined and limitations, assumptions, and general hypotheses
were stated. The theoretical framewoflusunderlying each model were
described and a rationale for combining elements of the two models
was provided.

In Chapter 2, a three-part review of the literature examines
research on parent-child relationships, the history of the use of parents
as change agents for their children, and research outcomes of previous
Filial Therapy and IPR research studies. Chapter 3 will contain a
discussion of pOpulation characteristics, experimental design, dependent
measures, and formal experimental hypotheses. A detailed description
of each treatment method is also provided. Chapter 4 contains a
presentation of the analysis of the data; and Chapter 5 contains the
results, conclusions, and implications of the study, as well as limita-

tions in the design and recommendations for future research.

CHAPTER 2

REVIEW OF THE LITERATURE

This chapter consists of three sections. The first section
presents research findings related to the parent-child relationship.
The second section is a review of the research findings in various
efforts to use parents as agents of change, including research outcomes
for Filial Therapy. The final section presents research outcomes for

Interpersonal Process Recall (IPR).

The Parent-Child Relationship

 

A number of studies have examined the relationship between parental
attitudes and behavior and effective psychological and social function-
ing in children. The review of this section is not exhaustive of the
literature, but does summarize the trend of the literature in this area.
Several consistent findings emerge from these studies.

Baldwin (1949) examined the dimensions of warmth, democracy, and
indulgence as they occur in the home environment and related them to
nursery school behavior. The factor of democracy emerged as the most
significant factor in accounting for variability in the behavior of
the children. Children from democratic homes were more active and
socially outgoing, favored in their peer groups, and rated high on tasks
requiring curiosity, originality, and constructiveness. It was also
found that indulgent parents fostered physical apprehension and a lack.

of skill in gross motor activities.

18

19

A study by Becker, Peterson, Hellmer, Shoemaker, and Quay (1959)
examined the relationship between parental behavior and personality
factors, and behavior disorders in children. In families with children
found to be shy, sensitive, or without self confidence a factor analysis
showed a relationship with ratings of the fathers' behavior. In those
families with conduct disordered children, both parents were prone to
give harsh vent to emotions and tended to be arbitrary.

A second study by Becker, Peterson, Luria, Shoemaker, and Hellmer
(1962) examined factors which they believed to be crucial in the
develOpment of children. Parents of 71 kindergarteners were examined
on 64 to 71 scales. Among the findings: (1) there was a strong
relationship between degree of parental hostility and physical punish-
‘ment and aggressive behaviors in children; (2) where the father is
hostile, punitive, and strict, the children Show more personality
problems.

In a study by Baumrind (1967) the relationship between parental
child rearing practices and competencies in children was examined.

In the group of children described as self reliant, assertive, self
controlled, buoyant, and affiliative, the parents were found to be
consistent, loving, and secure in the way they handled their children.
They were also likely to provide reasons for making demands, communicate
more clearly than other parents, and expect mature behavior from their
children.

In the group of children who were rated to be more insecure and

fearful, less affiliative with peers, less content, and more likely to

20
become hostile or regressive under stress, the parents were found to
be less nurturant, and less involved with their children. They did
exert firm control but tended to offer little support or affection.
In addition, they did not use reason when giving orders. The third
group of children was described as lacking in self control and self
reliance. Their parents were characterized as not well organized,
self effacing, and lacking confidence in their ability to influence
their children. They expected less from their children than other
parents and babied their children more.

COOpersmith (1967) studied the relationship between varying levels
of self esteem in adolescents and child rearing practices as determined
by interviews with mothers. The subjects were drawn from a School
'population and were measured on subjective and behavioral indices. It
was found that high self esteem children experienced nearly total
acceptance by their parents, clearly defined and enforced limits, and
reSpect for differences that exist within those limits.

In a study by Miller (1971) the relationship between self esteem
and the quality of communication was studied. Data was collected from
three different inventories. Miller found that the general self image
and social self image of the child was significantly related to the
degree of empathy, genuineness, and positive regard of the mother towards
the child. When there were high levels of these qualities present,
the child's self esteem was high.

A number of consistent findings emerge from this review of research

on the parent-child relationship. In general, parents of children who

21
were rated high in self esteem, self confidence, affiliativeness,
popularity, and self reliance were found to be democratic, empathic,
loving, consistent, involved, and able to set firm limits. Parents
of children rated to be conduct disordered, withdrawn, and fearful
tend to come from homes which are indulgent, arbitrary, angry, and
inconsistent. It is apparent that those qualities of the parent-child
relationship which are associated with positive mental health in
children are the same as those relationship variables and skills taught
in the Filial Therapy program. The next section will review the
research literature on efforts to use parents as psychotherapeutic

agents of change with their children.

Use of Parents as Agents for Change
The literature on the use of parents as psychotherpeutic agents
with their own children divides into three areas: psychodynamic,
behavioral, and client-centered therapies. This section of the
literature review will be divided along similar lines, with research
findings on the Filial Therapy method discussed under client-centered

approaches.

Psychodynamic Approaches
Freud (1959) described the first reported case where a parent
functioned as therapist for his child. The father of "little Hans"
was enlisted in the treatment of his five year old son's phobia.
Ruben (1945) concluded that the outcome was possible because the father

had been analyzed and concluded that the use of this method is rare

22
because it requires the parent to consciously accept and use the
analysts' interventions.

Jacobs (1949) described the treatment of a three year old child
through involving the mother. The mother-child relationship was
described as improved after five months of therapy because the mother
was able to establish a strong positive relationship with the therapist.

Ruben and Thomas (1947) worked with individual mothers to resolve
early deveIOpmental complications by providing information and advice
to mothers on how to handle specific situations. Instruction ranged
from simply changing a situation, to having mothers interpret the child's
unconscious conflicts in order to bring about a change in the child's
personality. Ruben and Thomas worked with over 100 cases and concluded
ethat mothers could make appropriate analytic interpretations.

Elkish (1953) included mothers into the therapists' treatment of
children. He assumed that the mother would want to imitate the therapist
in an unconditional acceptance of the child. Furman (1969) concluded
that for parents to be considered for participation in therapy for
their child, they should be free from personal psychodynamics which
might negatively influence the child. He suggested that mothers who
may not benefit from inclusion in the therapy or a guidance approach
are mothers who have primarily the same defenses as their child.

In summary, while many analysts claim that parents have been usefully
included in the therapy of their children, the literature shows no
systematic or empirical research supporting that claim. Most reports

are of individual case studies which provide little reliable evidence‘

23

upon which to judge their effectiveness. The variety of approaches
seem tailored to the specific problems of a particular parent or child
and are not based upon a set of general skills which can be taught to
a variety of parents to treat a range of childhood problems. Each of
these methods is taught in the context of a specific case, so does not
provide a more efficient use of professional time. In fact, Ruben and
Thomas (1947) question whether their successful cases were not simply

concurrent therapy of the mother and child.

Behavioral Approaches

 

Wahler at al. (1965) conducted one of the first well controlled
experimental studies examining parental variables contributing to the
maintenance and alteration of deviant child behavior. He treated three
.children ranging in age from three to six. Mothers were trained to use
contingency management procedures, including punishment. Each child
demonstrated behavior change. Wahler (1969) later trained a mother
to eliminate her five year old child's stubborn and destructive behavior.
A number of other writers trained parents to modify a variety of
behaviors including tantrums (Hawkins, Peterson, Schweid, and Bijou,
1966), excessive scratching (Allen and Harris, 1966), self care and
social interaction skills (Mira, 1970), enuresis (Shah, 1969), and
fire setting behavior (Holland, 1969). In all of these cases, as well
as in most cases in the literature, the authors are reporting individual
cases of treatment for fairly specific problems.

In one of the few cases where more than a single set of parents '
were trained, Wahler (1969) trained five pairs of parents to modify

inapprOpriate behavior of their four to six year old children. He found

24
that the withdrawal of attention had no effect or increased oppositional
behavior for these children. When an isolation procedure was employed,
undesirable behavior was reduced.

In a review of the behavioral literature related to use of parents
as change agents, Frangia, Reisinger, and Ora (1977) note that the
majority of studies do not eXplicitly state their parent training
procedures. In addressing the question of how well techniques described
in the literature generalize out of the clinic, these same authors
indicate that the literature provides no evidence that this occurs.

They also note that most studies relate to modification of a particular
response or response pattern and that "the data to support generaliza-
tion of techniques across classes of behavior are limited and the
available findings are difficult to interpret." (Frangia, Reisinger,
and Ora, 1977, p. 109)-

In conclusion, the literature indicates that existing efforts to
train parents to function as behavioral change agents to their children
have been effective but limited to specific techniques applied to
Specific problem behaviors. The literature fails to show that,an
effective method of teaching parents a range of behavioral techniques

which cover a range of problems, has yet been developed.

Client—Centered Approaches

 

While a number of studies, including Dorfman (1958), Moustakas
and Schlacock (1955), and Axline (l964),establish the utility of client-
centered play therapy procedures when practiced by a professional,

few studies have been carried out on the use of parents as change agents.

25
In fact, the only studies to use parents in a client-centered inter-
vention are those pertaining to Filial Therapy.

The first systematic investigation of the Filial Therapy model
was conducted by L. Stover and B. Guerney in 1967 in order to explore
the workability and practicality of training parents of emotionally
disturbed children in the therapeutic role. The question at hand was
whether parents of emotionally disturbed children could learn the
skills necessary to resolve some of the interpersonal and emotional
problems which they may well have had a role in creating.

Stover and B. Guerney (1967) employed two experimental and two
control groups to investigate this question. Groups contained six to
eight mothers and were formed by random assignment. They were drawn
Ifrom a pOpulation of mothers applying for psychological services at
the Psychological Clinic of Rutgers University. The study included
10 girls and 18 boys who had been previously diagnosed as emotionally
maladjusted as a result of parent interviews and psychological testing.
The experimental group met at the clinic for ten one and one-half hour
training sessions while the control group received no training during
the course of the study. The researchers reported that findings
indicated Filial Therapy training did move parents toward the goal of
providing the necessary climate.

A second, more comprehensive study by B. Guerney and Stover (1971)
attempted to further investigate the efficacy of the Filial Therapy
method. In this study, conducted at the Psychological Clinic of Rutgers

University and the Huntington Psychiatric Clinic, 51 of 71 mothers were

26

recommended for participation. Only parents evidencing mental retarda-
tion, psychosis, or suicidal or homicidal impulSes were screened out.
The authors report that only mothers were included for research and
practical reasons. Children were screened only for suSpected organicity
and if problems seemed transient or insignificant. The children
included 13 girls and 58 boys between the ages of 4 and 10 years.

A weakness of the study was its lack of a control group. A
one-group pretest/posttest design was used. Criteria for selection
into the groups was the existence of a "serious" emotional difficulty.
Therefore, problems were usually of longer standing duration and
results unlikely to be exclusively accounted for by maturation. Analysis
of videotape ratings indicated that mothers could be trained to acquire
the play therapy skills of communication of acceptance, allowing self
direction, and involvement. Tape ratings also indicated that as a result
of their playroom experiences, children worked out aggressive feelings,
decreased in affective displays, and dealt more realistically with
their mothers in terms of conversation and sharing. Two measures filled
out by clinicians indicated that children had improved significantly.
Finally, children showed significant improvement on a variety of parent
report inventories measuring symptomatology and psycho-social adjustment.

‘Oxman in 1971 attempted to compare the parents and children used
in the 1971 Stover and B. Guerney study (above) to a control group.
The control group consisted of 77 mother-child pairs recruited by
providing free babysitting in exchange for participation in the study.

Experimental and control groups were matched with respect to geography,

27
age of parents and children, socio-economic status, and size of
family. Oxman compared the groups over a lZ-month period and found
significantly greater improvement in the experimental group over the
control group in terms of the two variables she studied. These were
child symptomatology and maternal dissatisfaction. The major weakness
of her study is that the families, while matched on a number of
variables, are not matched on child adjustment. Oxman may have compared
two different papulations.

Horner (1974) provided additional evidence that Filial Therapy
may be an effective treatment intervention. Horner administered the
Problem Check List (Leventhal and Stollack, 1965) to parents of 60
children prior to and at the completion of 6 months of Filial Therapy
-treatment. The mean number of problems checked by parents was
significantly reduced from pretest levels from 22.02 to 13.88 (p = .0001).
Again, there were no controls employed in this study.

A follow-up study by L. Guerney (1976) provided information about
the lasting effects of the Filial Therapy program. A brief follow-up
questionnaire was collected on 42 of a possible 51 former participants
in the Filial program. The questionnaire was filled out from between
one and three years after the termination of treatment. Results
indicated that:

1. Only 3 of the 42 children who had participated in the program
were receiving professional help at the follow-up.

2. Out of the 42 parents responding, 32 reported the child as

having continued improvement since termination; 4 reported the_child'

ll

28
as remaining the same; 4 reported the child's adjustment as deteriorating;
and 1 reported their child as ”worse than ever."

3. Sixty-four percent of the parents attributed their child's
improved functioning to their ability to better relate to the child,
in conjunction with their child having become older.

4. Parents generally responded with an overall positive evalua-
tion of the Filial Therapy program. The results of this study suggest
that the Filial Therapy program is generally effective, and that gains
are maintained from one to three years.

Finally, Sywulak (1978) conducted the best controlled study of
Filial Therapy to date. In this study, subjects served as their own

controls during a four month waiting period which was followed by four

”months of participation in the Filial Therapy program. This was a

major improvement over the Oxman study because it was possible to
control for possible differences between families who seek professional
help from those who do not. Fathers were included in a pOpulation of
13 married couples and 6 single mothers. They represented a total of
19 emotionally disturbed children. These parents were recruited from
families interested in participating in the Filial Therapy program as
offered by the Individual and Family Consultation Center of the
Pennsylvania State University.

The effectiveness of the Filial Therapy approach was assessed by
studying the variables of parental acceptance and child adjustment.
Parental acceptance was measured by the Porter Parental Acceptance

Scale (Porter, 1954), and child adjustment was measured by having

29
parents complete the Filial Problem List, the Parent Check List and
the Parent Rating Scale. Parents completed these pencil and paper
measures at four different points in time: (a) at intake, prior to
the four month control period; (b) following the four month control
period, just prior to the beginning of training; (c) after two months
of treatment; and (d) after four months of treatment.

Results of this study indicate that the Filial Therapy program is
significantly effective at improving both parental acceptance and child
adjustment. An examination of the data at different points in time
showed that parental acceptance achieved marked improvement by the
second month. There was also some evidence of positive changes in
child adjustment after two months. Those changes continued throughout
the four months of treatment.

Overall, the Filial Therapy research conducted so far validates
Filial Therapy as a method of training parents to function in a thera-
peutic relationship with their own children. Research findings
indicate that children resolve emotional conflicts and improve in their
emotional and behavioral adjustments. The literature also indicates
that parents show significant gains in play therapy skills and acceptance
of their children. While these results are very promising, research
investigating the efficacy of the current Filial Therapy model needs
to be replicated, utilizing diverse pOpulations and better use of

control groups.

Summary and Discussion

 

A review of the various methods of training parents to function

as psychotherapeutic agents for change with their children reveals

30
several advantages of the Filial Therapy method over other methods.
The research literature on psychodynamic approaches offers little
reliable evidence to support the effectiveness of methods used. In
addition, virtually all methods are tailored to Specific cases and do
not provide a general set of skills which can be used across a variety
of problems. Because these methods are all tailored to specific cases,
there is no evidence that these approaches offer a solution to the
problem of more efficient use of professional time through the use of
para-professionals. While the literature on behavioral methods does
offer evidence that these methods are effective, these methods are
limited in similar ways to the psychodynamic approaches. They tend
to be limited to single cases, with parents taught specific techniques
'to deal with Specific, usually behavioral,problems. The behavioral
literature fails to show a method which deals with a range of problems,
and which can be taught to a group of parents. The Filial Therapy
approach has demonstrated its effectiveness in several research studies,
and has the advantage of being able to treat a variety of problems,
of teaching skills that are generalizable for later use in a variety
of situations, and of providing a more efficient use of professional
time because it is best taught to groups of parents. Also, because
it focuses on the parents' relationship with the child, and because
it is taught to parents in groups, it seems particularly well suited
for the integration of IPR technology. A review of the literature

on IPR research outcomes is presented in the next section.

31
IPR Research Outcomes

The research literature on IPR is quite extensive. IPR as a
training method has been used in counselor education and supervision,
the training of para-professionals, in both general and teacher
education, and quite extensively at many medical schools to train
medical students and residents in interviewing skills. In addition,
the IPR method has been used to study client growth in therapy and
to accelerate the process of psychotherapy. This review of the IPR
literature will be focused on those areas of IPR research relating
most directly to the training of parents for the role of psycho-
therapeutic agents to their own children. These areas will be IPR
and psychotherapy, IPR and counselor education, and IPR and para-
-professional training. IPR research in the area of medical education
and general education has been reviewed in detail elsewhere (Novick,
1978) .

The earliest studies examining the use of Interpersonal Process
Recall in psychotherapy were case studies of individual psychotherapy
clients. While these early studies lack the controls and generaliz-
ability of larger controlled experimental research, they were crucial
in the development of the IPR model. In a study (Kagan, Krathwohl,
and Miller, 1963), separate client recalls were found to accelerate
client growth of a female client whose individual counseling sessions
of five months had yielded little growth. Therapist and client were
video recorded, and a recall session of both counselor and client was
conducted by a trained inquirer. During recall, the client was able '
to discuss previously blocked areas, and the counseling process

accelerated significantly.

32

In another case study (Woody, Kagan, Krathwohl, and Farquahar,
1965), hypnosis was used to facilitate the recall process. Videotapes
of recall sessions were studied by eight clinicians and indicated
hypnosis helped the client increase his involvement in the recall
procedure and improved his relationship with his therapist.

Resnikoff, Kagan, and Schauble (1970) Studied a more severely
disturbed 18 year old high school senior. Videotaped recall was
introduced after the twelfth session of counseling. Two groups of
judges who were unaware of the IPR intervention rated tapes of sessions
nine through twelve on five variables: (a) ability to gain insight,

(b) level of defensiveness, (c) ability to experience feelings, (d)
ability to relate to the therapist, and (e) overall therapeutic
relationships. Following the IPR session, ratings of both groups of
judges increased over all five variables. This case suggested that
progress in therapy may be accelerated by introducing videotape recall,
even when a good relationship exists.

In a larger experimental study Schauble (1970) studied the reSponses
of 12 counseling center clients to therapy using video recall of the
clients' responses to the affect simulation films, and then their recall
of actual therapy sessions. Schauble's study, based on a small total
n, showed significant between—group differences in favor of the IPR
group on three of the five dependent measures. It was concluded that
the IPR method had accelerated client growth in therapy.

Van Noord (1973) replicated Schauble's study with some modifications.
He retained the n of 12 students but increased the number of therapists

from 2 to 12, used a MANCOVA and ANCOVA analysis, and changed 1

33

dependent variable. He observed no significant differences between
groups on the MANCOVA, nor on separate ANCOVAS of individual measures.
He did report that subjective client comments found IPR methods helpful
in self exploration and exploration of the therapeutic relationship.

Both Schauble and Van Noord reported that a frequent therapist
criticism had to do with the imposition of structure in the IPR
treatment group. The rigid sequential use of techniques was seen as
a hindrance because it did not take into account the specific needs of
each client. Both researchers recommended more flexibility in the use
of IPR techniques, and that the impact of IPR be studied over a longer
period of time.

Tomory (1979) conducted a study evaluating the effectiVeness of
'the IPR model in psychotherapy which attempted to improve on the earlier
studies in ways suggested by their authors. IPR stimulus film techniquesand
videotape recall were used in conjunction with dyadic therapy and
compared with traditional dyadic methods without IPR. The sample was
50 clients at a university counseling center. The therapists were
three interns and two regular staff therapists. Clients were seen from
4 to 15 sessions. Each therapist saw 10 clients, 5 treatment and 5
control. Therapists were allowed to select the IPR techniques which
they believed best suited their clients' needs. IPR techniques had
to be used in at least five of the first ten sessions. The dependent
measures included self-report questionnaires and inventories, therapist
questionnaires, and tape ratings of in-therapy client verbal behaviors.
The statistical analyses indicated no significant differences between.
treatment groups on any of the six measures. Both methods indicated

statistically significant pre to post movements on some measures.

34

A major area of IPR research has been in the area of counselor
education. Goldberg (1967) compared supervision using IPR to
traditional audiotape counseling supervision. In this study all
trainees interviewed their clients for 30 minutes for 6 weekly sessions.
The group receiving traditional supervision received one hour of
‘individual supervision aimed at understanding the therapeutic relation-
ship by listening to the audiotape. The first 2 sessions of IPR
supervision included a 15 minute client recall observed by the counselor
and a 45 minute counselor recall. During the next two supervisory
sessions, the trainees conducted recalls for each other. During
the final 2 supervisory sessions, mutual recall was conducted for 60
minutes by the supervisor. The dependent measures were the Counselor
-Verbal Response Scale (hereafter referred to as the CVRS) and the
Wisconsin Relationship Orientation Survey (hereafter referred to as
WROS). The study showed that the trainees using IPR methods showed
greater gains on the CVRS than the traditionally trained trainees.

Spivak (1970) compared the IPR method to a traditional classroom
training approach. He found significant differences (p ( .05) favor-
ing the IPR method on the understanding, specific, and exploratory
subscales of the CVRS in the coached client situation, and on all
the CVRS scales when role playing clients were used. He found no
significant differences for Carkhuff's accurate empathy scale or for
the Affective Sensitivity Scale (hereafter referred to as the ASS).

Using prison counselors as trainees, Grzegorek (1971) compared

two types of training with different emphases. One method was called

35
cognitive-intellectual and encouraged trainees to develop more effective
ways of dealing with inmates. The IPR method, called experimental-
accepting, encouraged trainees to become more aware of their own
reactions in interpersonal situations. IPR stimulus vignettes and
recall were employed. He found no significant differences in affective
sensitivity as measured by the ASS. The trainees using the IPR method
did make significantly greater gains in empathic understanding and on
the understanding, specific, and exploratory scales of the CVRS.

Kingdon (1975) compared IPR supervisory techniques with traditional
supervisory techniques. Counselors were masters level counseling
students, and clients were volunteer undergraduate psychology students.
Supervisors were doctoral students in counseling. The IPR treatment
consisted of three videotaped counseling sessions followed by client
recall and counselor recall sessions, with a mutual recall session
following the third session. The control group consisted of three
audiotaped sessions each followed by an hour of traditional supervision.
No significant results were found on counselors' empathy level, client
satisfaction, supervisor ratings, or clients' self reported inhibitions.
IPR supervision did demonstrate a significant change in the clients'
level of self eXploration over time.

That area of previous IPR research with perhaps the most obvious
relevance to this study has to do with para-professional training.
Scharf (1971) examined the training of undergraduates to function as
para-professional counselors. She compared an intensified IPR course

with an intensive community skills program. Each program lasted 5 day5v

36
and totalled 40 hours. The community skills program was based upon
Carkhuff's work with empathy training, discrimination training, role
playing, group discussion, and client interviewing. The IPR model
consisted of a discussion of facilitative conditions, tape rating,
affective skills training, role playing, and the IPR process. Scharf
examined the effects of training on six dependent variables as a post-
test and eight weeks later as a follow-up. The results were inconclusive.
Scharf concluded that an intensified course format (40 hours in 1 week)
was not an effective way to teach, using either model.

A study by Dendy (1971) involved training undergraduate resident
assistants as para-professional counselors. His treatment group con-
sisted of 22 resident assistants who were trained over a period of
six months rather than in one week, as in the Scharf study. Training
occurred in two four-week phases and totalled thirty-eight hours.

He compared this treatment to a similar group receiving the same train-
ing but without affect simulation films. He also compared it with the
empathy training groups used by Scharf (above), and a group of eight
professional counselors at the Michigan State University Counseling
Center. Dendy used the same dependent variables that Scharf used.

These included the Affective Sensitivity Scale (Form C), audiotapes

of client interviews rated on the Carkhuff Empathic Understanding in
Interpersonal Process-Revised (CE-II), and the Counselor Verbal Response
Scale. Subjects were tested before and after each phase of treatment.
Dendy found significant improvement in interviewing skills in both

phases of treatment, significant growth in affective sensitivity, and

37
no loss of skills during the three-month period between training phases.
Before the IPR training, there were large differences between pro—
fessionals and para-professionals, in favor of the professionals. It
was found after training that there were no significant differences
between these groups on different measures of helping skills.

Archer (1971) studied the same undergraduates trained in Dendy's
(1971) study to see if they could be used to train other undergraduates
in interpersonal skills. He also examined whether methods originally
develOped for use in a therapeutic setting could be used by para-
professionals in a growth-oriented setting, and how a structured train-
ing model using videotape recall, affect simulation, and tape rating
would compare with an unstructured encounter-developmental group approach.
The structured IPR approach also utilized exercises from Carkhuff's
(1965) work. Also, control groups were utilized. The criterion measures
used were: the ASS (Form C), a measure of affective sensitivity;
the Personal Orientation Inventory, a measure of self actualization;
the Wisconsin Relationship Orientation Survey (WROS), and the Barret
Lennard Relationship Inventory, measures of insight and depth in peer
relationships.

Results indicated that the structured IPR training model could be
used successfully to train undergraduates to teach interpersonal
skills to other students. The students trained in the IPR groups
were found to have significantly greater interpersonal skills than
those in the no treatment and encounter—develOpmental groups. Separate
one-way ANCOVAs on each measure indicated no significant differences

on all of the measures except the depth of peer relationship measure,

38
the Wisconsin Relationship Orientation Inventory. Archer concluded
that undergraduate para-professionals using the IPR training model
could train other undergraduates to have more effective interpersonal
skills. He also concluded that counselor training methods could be

adapted to a growth-oriented setting.

Summgpy and Discussion

A review of the literature indicates that IPR has proved to be
an effective method of teaching helping skills and heightening affect
sensitivity over a range of settings and pOpulations. Research find—
ings indicate that the IPR method has been effective in training
counselors, accelerating client growth in therapy, in training para—
professional counselors, and in the training of medical students and
residents in interviewing skills. To date, there has been no direct
research utilizing IPR methodology in the training of parents as
effective therapeutic agents to their own children. However, because
of the previous success of IPR in training of para-professionals as
well as professionals, there is reason to believe that IPR methods can
successfully be taught to parents in order to more effectively and

reliably facilitate their acquisition of play therapy skills.

CHAPTER 3

METHODS

This chapter contains a detailed description of the participants,
settings, group leaders, data collection, instrumentation, design,

hypotheses, treatments, and data analyses used in this study.

Participants

All subjects were referrals from Dewitt Army HOSpital at Ft. Belvoir,
Virginia. Parents of children who were identified by their Family
Practice and Pediatric physicians as having emotional problems were
referred to the researcher for assignment to a Filial Therapy group.
All subjects volunteered to be in the study.

Parents were informed that participation in the program, called
the Parent Play Therapy Program, would require regular attendance at
a two-hour weekly meeting for sixteen weeks, and that for the last
eight weeks they would be required to conduct weekly play therapy
sessions at home with their child or children. In addition, they were
informed that they would be required to purchase a kit of toys for $50.00.

There were 32 parents, including 12 couples and 8 parents attend-
ing without spouses. Parents were volunteers, and presumably motivated
to help their children resolve their emotional conflicts and to improve
their relationships with their children. Individual subjects or couples
‘were randomly assigned to treatment and control groups. Parents were.

asked their permission to be part of a research evaluatibn of the

39

4O
Filial Therapy program and were assured that their rights as subjects
would be protected.

Children accepted as candidates for participation in the Filial
Therapy program ranged in age from three to ten years and were
experiencing emotional and behavioral difficulties, according to
parental reports.

In previous studies of Filial Therapy some researchers (B. Guerney
and Stover, 1971) attempted to screen out children with problems of
organicity. In another study, by Sywulak (1978), there was no attempt
to screen out such children. In the Sywulak study children identified
with such problems (there were four) had adjustment scores which were
consistently lower and showed less change throughout the study than
those of other children. In this study no attempt was made to screen
these children out. There was no overt evidence of organicity and no

parents reported that their children had been so diagnosed.

The Settings

 

There.were two settings for this eXperiment. The parent training
groups met for two hours once each week at the Family Practice Clinic
at Dewitt Army HOSpital. The clinic had a practice and an observation
room with a one-way mirror between them to allow for observation and
videotaping. The practice room was converted to a play therapy room
prior to each meeting. Adjoining both these rooms was a conference
room where parents could meet comfortably when not observing practice
play therapy sessions. There was also a babysitting room with a babyj

sitter paid by the parents. This was used by children who were in for

41

practice play sessions, as well as by parents whose regular babysitting
arrangements temporarily broke down.

The setting for most parent-child play sessions was in the family
home. Important factors to be considered in the parents' selection of
a room at home are specified later in this chapter under Stages of

Filial Therapy Group Process, Phase II: At-Home Sessions.

Plgy Therapy Group Leaders

 

Play therapy group leaders were the researcher and a female leader
selected on the basis of her experience leading parent education groups
and practicing play therapy as a school psychologist in a public
school setting. Both attended a five-day conference on Filial Therapy
offered by the originators of Filial Therapy, Bernard and Louise Guerney,
at the Pennsylvania State University. The researcher also has
experience leading training groups of various kinds, and received 30
hours of training in the Interpersonal Process Recall (IPR) model.

The other leader was given ten hours training in IPR by the eXperimenter.

Data Collection

 

The testing consisted of the following pencil and paper measures:
the Affective Sensitivity Scale (Form E, 1980), the Porter Parental
Acceptance Scale, the Filial Problem List, the Parent Check List, and
the Videotape Rating Scale. These measures are described in the next
section and found in Appendices A through E. All of the measures
except the ASS were given to the parents to complete at home before
the first session and were turned in at the first session. They were,

administered again during the last week of training. The ASS was

42
administered during the first and last sessions of each group. Finally,
an open-ended sentence completion form (Appendix J), similar to that
used by Sywulak (1978), was given during the final meeting in order to
obtain participant's subjective reactions to the program.

In addition, as a process measure parents were videotaped in their
first and last in-clinic training sessions. These tapes were rated on
Stover's (1971) three dimensions: communications of acceptance,
allowing self direction, and involvement. Taping occurred through a
one-way mirror so that the videotape equipment was not visible to the
children in the playroom.

Instrumentation

 

' The following instruments were selected as measures of the dependent
variables being studied. Criteria involved in the choice of these
measures included adequate reliability and validity. It is believed
that these instruments measured the dependent variables, and that these,
in turn, reflected important outcomes and process dimensions of the

parent-child relationship.

Affective Sensitivity Scale

The Affective Sensitivity Scale (ASS) is an instrument designed to
measure an individual's ability to detect and describe the immediate
affective state of another. Developed initially by Kagan, et a1. (1970
on), the scale is now in its fifth revision. The ASS consists of
multiple choice items which the subject completes after viewing filmed
vignettes of actual encounters in a variety of settings, including

medical and psychotherapy interviews, and school, work and family settings.

43

The first scale, Form A, contained 86 items on 41 scenes involving
11 different clients and counselors. The test-retest reliability was
between .70 and .80. A correlation between pre and post training
ratings of counseling effectiveness of .49 was obtained. The second
scale, Form B, consisted of 89 items. The test-retest reliability was
between .58 and .75. Concurrent validity studies showed that a low
positive relationship existed between scores and judgments of counselor
effectiveness. A study by Danish and Kagan (1971) showed that the ASS
reflects personal growth in interpersonal sensitivity.

More recent versions of the ASS have attempted to improve the
scale by introducing other settings than just counseling and psycho—
therapy, by improving the technical quality of sound and picture clarity,
and by introducing more current situations where clothing was more
contemporary.

In this study, the 1980 version of Form B was used for evaluation
and consisted of 55 items and takes approximately 75 minutes to complete.
Because of the newness of Form E, reliability and validity data have
not yet been published but is eXpected to be as high as in earlier

versions.

Porter Parental Acceptance Scale
In order to assess a general attitude of acceptance on the part of

parents involved in this study, the Porter Parental Acceptance Scale

 

(Porter, 1954) was used. This scale is based on an Operational
definition of the construct of parental acceptance which consists of

four dimensions or subscales. By Porter's (1954) definition, an

44
accepting parent is one who: (a) regards the child as a person who
has feelings, and respects the child's right and need to express those
feelings; (b) values the unique make-up of the child and fosters that
uniqueness within the limits of healthy personal and social adjustment;
(c) recognizes the child's need to differentiate and separate himself/
'herself from his/her parent and allows the child to become an autonomous
individual; and (d) has unconditional love for the child (i.e., loves
the child regardless of how well or how poorly the child behaves). .In
contrast, Porter defines a non—accepting parent as one who is rejecting,
over—protective, or indulgent.

The form of the items selected by Porter was one which described
situations where children express overt behaviors or verbalizations.
Each item is repeated twice in the questionnaire, first, to see how
the parent fgglg in the situation, and secondly, to see what the parent
‘dggs in the situation. This last ten—item section was eliminated from
this administration of the instrument. The responses to each item
(whether measuring the parents' general way of feeling or the parents'
general course of action) were written so as to build a continuum from
low to high acceptance, and the items were weighted from one to five.

Using the Spearman—Brown Prophecy formula, a split—half reliability
coefficient of .87 was obtained on the Porter Parental Acceptance Scale.
An attempt at checking the validity of the scale was accomplished by
establishing criteria against which to evaluate the items and by asking
five judges to rate the items. Porter (1954) reports that there was

no instance in which at least three out of five judges did not agree.

45
Furthermore, the greatest degree of disagreement was by a distance of
only two scale points, and this disagreement occurred in only 18.67

percent of the responses.

Child Adjpstment
In order to best assess child adjustment within the time constraints
of this study, two separate child adjustment measures were used. These

included the Filial Problem List and the Parent Check List.

 

Filial Problem List. The Filial Problem List was adapted by Horner

 

(1974) from the Problem List (Leventhal and Stollack, 1965) via a factor
analytic study of the original measure. The original list of 237
children's problems were derived from a survey of the literature.

:Instructions for completion of the measure involved underlining
those problems which apply to the child of concern and then rating the
severity of the problem on a three point scale. A rating of "1"
indicates that the item is true of the child, but not really a problem,
a rating of "2" indicates that the item is true of the child and is a
mild problem, and the rating of "3" indicates that the item is true of
the child and is a serious problem. (For the purposes of this study,
a rating of "1" was scored as "O," a rating of "2" was scored as "l,"
and a rating of "3" was scored as "2.")

Although no reliability checks have been done on the Filial Problem
List to date, the original Problem List obtained a test-retest Pearson-
Product-Moment Correlation of .85, representing the reliability of I
parents' responses after an average l7-week interval. (B. Guerney and

Stover, 1971)

46

Parent Check List. The Parent Check List was develOped at the

 

Wichita Guidance Center by Brewer (1958). It contains short descriptions
of children's behavior, subclassified by factor analysis into five
problem areas: problems of learning and achievement (ten items);

active behavior (ten items); passive behavior (ten items); disturbed
.feelings (ten items); and physiological tension (ten items). Eleven
items were not scored on any factor but were included in the total

score because they were discriminating in the original selection process.
The total score istfimrnumber of YES responses with a maximum maladjust-
ment score of 55. The minimum score of 0 reflects highest level of
adjustment. A Split-half reliability correlation of .92 was obtained

on 50 cases in which odd and even numbered items were correlated. In
addition, evidence of construct validity has been shown for the Wichita
Parent Check List in that hypothesized results were obtained in research

(B. Guerney and Stover, 1971).

Videotape Rating Scale

 

It was believed that by rating videotapes of each parent conduct-
ing actual play therapy sessions in the clinic playroom, direct measures
of each parent's skill level in play therapy techniques could be
obtained. Videotapes of each parent's first and last in-clinic practice
sessions were collected. The rating scales used in this study were
developed by Stover, et a1. (1971) and provided measures of communication'
of acceptance, allowing self direction, and involvement. Each variable
was rated on a continuous five point scale from very low levels of

each skill to the highest levels. Each tape was rated for five three—

47
minute segments and a total score for each variable was determined
by adding the five individual ratings together. Pre and post video-
tapes of each parent were mixed together and presented to raters in
a double-blind fashion to assure a non-biased score. Neither the
raters nor the experimenter knew which tapes were pre training and
which were post training. None of the tapes were rated until the
completion of all sessions. Reliability correlations for coding these
scales ranged from .73 to .99. The Pearson-Product-Moment correlation
on the original measure was .85 and the scales were found to be
extremely sensitive measures of the behaviors in question in the.

original study. (See Appendix D for directions and actual scales.)

Selection and Training of Raters

The two raters for the videotape rating scales of parent play
therapy skills were chosen from a pOpulation of clinical psychology
graduate students who were familiar with the principles of non-directive
play therapy. One rater was near the completion of her doctoral
program and the other was near the completion ofher masters program.
Both were paid for their work as raters. Interrater reliability was
determined by an analysis of variance (Ebel, 1951). Both inter—judge
and intra-judge correlations are reported in Chapter 4.

Both raters completed 15 hours of training prior to beginning
actual ratings of pre and post tapes. Parents were rated on five point
scales along the three dimensions of communication of acceptance,

allowing self direction, and parental involvement. (See Instrumentation

Section, this chapter.) Training consisted of having judges rate

48
non-experimental videotapes of actual play therapy sessions until
percentage of agreement levels reached at least the 80 to 90 percent
range. This experimenter trained the raters, explaining the criteria
for ratings at different points on each scale, and helped identify
subtle shades of behavior as belonging to one point on the continuum

6r another.

The Design

In this study, observations were made on all of the dependent
variables except the tape ratings at the following times: (a) as a
pretest prior to the beginning of the groups, and (b) as a posttest at
the completion of the groups. Tapes of clinic play sessions were
collected at each parent's first in-clinic training sessions and at
their last in-clinic training session. The treatment group was the
Filial Therapy program with integrated IPR components. The control
group consisted of traditional Filial Therapy. Parents were randomly
assigned to treatments and leaders so that there were four groups of
eight parents each. Each leader led one treatment group and one control
group. The design of this study may be diagrammed following Campbell

and Stanley's (1963) notation, below:

 

1-7 xT O1—7

(four months)

0

Hypotheses

 

While earlier research studies indicate that both Filial Therapy

and Interpersonal Process Recall (IPR) are effective intervention

49

strategies, there was not sufficient evidence to predict directionality

in the testing of the research hypotheses of this study. The following

hypotheses were considered to be the primary hypotheses of the study

and were tested in order to assess the relative effectiveness of these

two methods of training parents to function as play therapists to their

'own children.

H1:

Parents trained in an integrated Filial-IPR program will show no
difference in gains, pre to post, in parental acceptance than
those parents trained in the traditional Filial program, as
measured by the Porter Parental Acceptance Scale (alpha at .05).

Parents trained in an integrated Filial-IPR program will show no

_differences in gains in parents' ability to detect and describe

the affective state of another, over parents trained in the
traditional Filial Therapy program, as measured by the Affective
Sensitivity Scale (alpha at .05).

Children of parents trained in the Filial-IPR method will show no
greater improvements in child adjustment, pre to post, as measured
by the Filial Problem List, than children of parents trained by
the Filial Therapy model (alpha at .05).

Children of parents trained in the integrated Filial—IPR method
will show no greater improvements in child adjustment, pre to post,
as measured by the Parent Check List, than children of parents

trained by the traditional Filial Therapy program (alpha at .05).

50

H : Videotape ratings of parents' play therapy sessions will not
Show greater gains, pre to post, in the play therapy skill of
communication of acceptance, from one training method to another
(alpha at .05).

H : Videotape ratings of parents' play sessions will show no differences
in gains, pre to post, in the play therapy skill of allowing self
direction, from one method of training to another (alpha at .05).

H : Videotape ratings of parents' play therapy sessions will not Show
greater gains, pre to post, in the play therapy skill of parental

involvement, from one method of training to the next (alpha at .05).

The analytical procedures used to test these hypotheses are dis—

cussed later in this chapter.

Indgpendent Variables

 

Filial Progpam

 

Role of the Group Leaders

 

The primary role of the leader in the Filial Therapy groups was
that of parent educator or trainer. His/her task was to teach the
parents play therapy skills. Filial Therapy leaders provided the parents
with the rationale for play therapy and helped them acquire these skills.
Additionally, Filial leaders were sensitive to parents' feelings and
difficulties in dealing with their children, and offered acceptance and
support for those feelings at the same time they helped parents to explore
them. The Filial Therapy leader's goal was to train the parents in skills
and problem-solving techniques which they could then use to both solve

and prevent problems in their relationships with their children.

51

TrainingTMethods

 

Filial Therapy training techniques employed by each therapist in
training parents were classified as follows: didactic, dynamic,
reinforcement, and generalization.

Didactic Methods. Didactic techniques included short lectures,

 

modeling, demonstrations, role playing and exercises. These techniques
were employed in order to teach the concepts behind client-centered

play therapy, including acceptance, empathy, child leadership, genuine-
ness, structuring, and limit setting. The same techniques were employed
in teaching the skills which Operationalized these concepts. In addition,
Filial therapists frequently refer to a list of adult behaviors which

are unacceptable in the play sessions. (See section on Play Therapy
Skills.)

Dynamic Methods. Dynamic methods included a recognition of the

 

importance of parents' feelings about their children and the Filial
training. Although the didactic function is considered essential in
teaching the necessary skills, it was impossible to teach parents
different ways of interacting with their children without running

into emotional and life problems which have so far affected the parent-
child interaction.

A conflict of old and new ideas, attitudes, and behaviors is
often experienced. This requires close attention and sensitivity
on the part of the leaders to subtle cues from parents indicat-
ing that they are experiencing conflict. Support must be
provided for parents in their struggle to change. Since

parents will often disguise a feeling of personal anxiety in

the context of an intellectual question, leaders make a habit

of reflecting any feeling messages that they detect along with
the substantive response. -

(L. Guerney, pre-publication manuscript)

52

In this regard, it was important for the Filial therapist to
understand the interplay between didactic and dynamic elements, and
to be able to decide which method to employ at different moments
during the parent groups. This issue was addressed by Andronico,
Fidler, B. Guerney, and L. Guerney (1967) where they wrote:

The group sessions are seen as a blending of these dynamic

and didactic elements. The parents are told that it is

expected, in the course of their learning how to conduct

play periods with their children, that they will also

explore their own feelings. The therapist uses his clinical

judgment to determine when to make the apprOpriate shifts

from didactic to dynamic elements. One of the times when

concentration on the parents' feelings occurs is when it

becomes obvious that a particular parent is unable to

either understand or follow through behaviorally with a

concept because of his own emotional problems. . . . Once

the emotional problem is worked through, the process may

return to a didactic one of discussing play periods. (pp. 13—14)

The therapist may decide that a particular parents' emotional
problems are too great to focus on during the meeting and either agree
to meet with the parent outside of the group or refer the parent to
individual psychotherapy.

Reinforcement Method. Mastery of the principles and skills of
client-centered play therapy was facilitated by the use of social
reinforcement. Leaders praised individual efforts towards skill
mastery. They also praised the group as a whole for regular attendance,
mutual support, helpfulness, etc. By reinforcing individuals who
praised and supported other group members, leaders facilitated a
supportive atmosphere. Leaders communicated the expectation that each
parent could master the different aSpects of the play therapy, and
difficulties were seen as temporary. When they did occur, leaders

‘proceeded to reinforce small steps which gradually approximated the

desired goal.

53

Generalization Method. Generalization of Filial Therapy skills to

 

the outside world was often addressed specifically in Filial Therapy
groups. Generalization to the outside was intentionally not addressed
in the first stages unless initiated by parents. Parents themselves
usually began considering ways in which they could apply these skills
outside of the play seSsions. This was reinforced. In the final

stage of Filial Therapy, the shift of focus to "real life" is addressed
deliberately. Specific assignments are made and time is allotted to
discuss how it went. Focusing on dynamic issues is important here

because generalization often raised many emotional issues for parents.

Necessapy Attitudes of Filial Leaders

B. Guerney, L. Guerney, and Stover (1972) have addressed the
importance of the attitudes of the Filial Therapy group leaders which
most facilitate successful outcomes:

The therapist--who in this context could really be called
a therapeutic educator-~should behave in such a way that
the parent perceives him as one who (a) understands the
parent's difficulties, his problems, his needs, and his
emotions; (b) solicits and reSpects the parent's view—
points and Opinions even as he may try to persuade him
to adOpt or experiment with behaviors based on differing
vieWpoints; (c) does not blame the parent or hold him

to account for any deficiencies of his child in their
past relationship; and (d) sees the parent as a vital,
indispensable helpmate in trying to improve the well
being of his child. (p. 275)

Plgy Therapy Skills

Play therapy skills include empathic understanding and responding,
allowing self direction, limit setting, and structuring. Parents
structured each play session by informing the child that the playroom

has a relatively permissive atmOSphere with a minimum of limits which

54
were mentioned to the child at the point of transgression of those
limits. These limits included physical aggression towards the parent,
activities which create a danger to the child, activities which would
result in expensive damage to the play area, and the reality limit of
time. Rooms used for play therapy were arranged specifically for the
sessions to provide as free an environment as possible. There was
usually very little furniture, and expensive or breakable items were
removed. Toys were chosen for the playroom on the basis that they
allowed for various eXpressions, including fantasy, competition, mastery,
and aggression.

Parents allowed self direction by permitting the child to do or
say whatever he or she wanted, with the exception of the above limits.
Parents communicated understanding and acceptance primarily through
the skill of reflective listening. In addition, a warm and permissive
atmosphere was maintained by prohibiting parents from criticizing,
praising, encouraging, reassuring, questioning, leading, directing,
advising, teaching, moralizing, or punishing. Sywulak (1978) comments
on the results of effective play therapy:

. . .In utilizing the play therapy techniques in an apprOpriate

manner, the parents achieve several purposes of primary

significance in the creation of a situation in which the child
could become aware of the feelings he had now allowed himself

to recognize. In the presence of an accepting parent, the

child has the Opportunity to eXpress these feelings through

play and to come to a better understanding of how to cOpe with

these feelings. In addition, the play sessions enable the child

to build a feeling of trust and confidence in the parent which,
in turn, enables the child to communicate more honestly and

fully with the parent. Further, play sessions enable the child

to build confidence in himself, thereby allowing the child to see
himself as a more worthwhile and likable person which, in.turn,

is eXpected to result in healthy emotional and behavioral
adjustment. (p. 44)

55

Spgges of Filial Therapy Group Process

Filial Therapy groups typically proceed through three stages:
training, home sessions, and generalization. The first two of these
are considered in detail below. The final stage, generalization,
usually occurs after four or five months. In this stage, parents
begin initiating discussions about outside issues and applications of
the principles learned earlier. Leaders reinforce and encourage this
shift in Filial groups which continue beyond four or five months. This
research project did not attempt an extensive generalization stage due
to limitations in time.

Phase I--Parent Training. This stage of training lasted the first

 

eight weeks of the program. The four primary goals Of this phase were:
(a) to get the parents at ease with the leaders; (b) to provide the
parents with a solid rationale and understanding of the Filial Therapy
approach; (c) to teach the parents the skills of client-centered play
therapy; and (d) to initiate the children into the play therapy
experience, These gOals were accomplished by following the structured
format below.

Session I: This session was devoted to explaining the nature of
the Filial Therapy process and the parents' role with their children.
Parents were asked to explain their reasons for participating in Filial
Therapy. The leaders attempted to set the parents at ease by listening
empathically to parental concerns and trying to relate mastery of play
therapy skills to the parents' concerns about their children. At this
session, parents also watched a videotaped play session as demonstrated
by the leaders in order to orient them to their task and hOpefully allay

anxiety about the task.

56

Questions and discussions followed the demonstration. This gave
the leaders a chance to reinforce significant aspects of the rationale
for play therapy, and to begin initial instruction in the skills
necessary to conduct play therapy sessions.

Sessions II: During this session, parents again Observed the
leaders demonstrating play therapy skills, this time with one of their
own children during a 15 minute play session. This was observed by all
the parents and then discussed. Emphasis was not on the child's behavior
but on the role of the leader as a play therapist. Parents then used
the remainder of the session to practice the skills of reflective
listening, structuring, and limit setting in preparation for their own
first practice sessions in the following weeks.

'Sessions III-VIII: During these remaining sessions of the Train-
ing Phase, two to three parents per week began conducting 15 minute
in-lab play sessions, and then discussed them as a group. Again, the
emphasis here was upon parent behavior and play therapy skills and not
on the child's behaviOr or problems. By Session VIII, each parent had
had two sessions, had begun eliminating certain negative behaviors,
and began mastery of more constructive skills.

Phase II--At-Home Sessions. During the second phase of the Filial

 

Therapy program, the groups shifted their focus from play sessions
conducted at the clinic to play sessions conducted in the home. Except
for the ninth session, parents also continued to bring children to the

clinic to keep improving their play therapy skills.

57

Session IX: No play sessions were conducted so that the leaders
could focus fully on establishment of the play sessions at home.
Parents were asked to consider which room of their home would be most
suitable for the play periods, what time and what day would be most
satisfactory for both parent and child, which additional limits would
be necessary to prevent unnecessary damage to the home, and how to
structure play sessions so as to incorporate them smoothly into the
functioning of the household. At the end of the meeting, parents
purchased a $50 toy kit.

Session X and Remaining Sessions: At-home Sessions were begun.
The parents continued to take turns bringing their children to the clinic
for play sessions. Group meetings usually began with two play sessions
conducted by the parents. These helped maintain and improve the
parents' skill level, although discussions began to focus on the mean-
ing of the child's behavior as well as that of the parent. At this
point, the meaning of the child's behavior as well as the parents'
emotional reactions were given high priority, since by this time the
children were usually using the sessions in a more expressive and
meaningful manner. This gave rise to issues which required exploration
of parental feelings. The leaders' ability to shift between dynamic
and didactic methods was important here, as well as their ability to
relate the importance of the play therapy skills to the emerging
emotional issues of both parent and child. A sizable portion of each
meeting was used to discuss the at-home sessions of each of the parents.

In many cases, as parents further mastered the skills, emotional issues

58
began to resolve and parents began talking about broader application
of the skills and concepts of play therapy. With sufficient time,

the group would have tackled these issues in the generalization phase.

Integrated Filial Therapy-IPR Prgggam

The integrated Filial-IPR program was structured in much the same
way as the previously described Filial Therapy program, with the
following changes.

1. In Sessions VII and VIII, in addition to doing a single practice
session, parents were shown the affect stimulus vignettes from the IPR
model. This introduced them to the notion Of interpersonal fears
arising in stressful interpersonal situations and helped them begin to
familiarize themselves with their own emotional reactions to specific
situations. The stimulus vignettes were introduced at this point
because parents were just beginning to discuss their play session
reactions to their children. The leaders began focusing on the at-home
sessions during week eight and continued this discussion the following
week. This allowed time for the additional training activities
introduced during week nine.

2. In Session IX, parents began by seeing the IPR film on the
inquirer's role (Mason Media, Inc., 1965). After viewing the film,
they broke into groups of three and role played helping interactions
and then practiced the role of inquirer with each other. The members
of each triad were videotaped as they took turns playing the role of
helper, helpee, and inquirer. This session attempted to build upon the

previous sessions which introduced the notions of interpersonal fear

59
and risks. It also began to acquaint the parents with the recall
process as a powerful form of feedback. Finally, in learning to
serve as inquirers to each other, parents received additional practice
in non-directive helping skills. Parents concluded preparations to
begin their at-home sessions the next week.

3. In all the play sessions conducted at the clinic setting
thereafter, parents alternated in playing the role of inquirer as the
demonstrating parents reviewed their demonstration sessions on videotape.
This was done in the large group where group leaders, as well as other
parents, were free to respond as inquirer. The group leaders also gave
feedback to parents on their performance as inquirers when this was
required.

In summary, the learning of the role of inquirer, as well as the
practice of actual interpersonal process recall, began in the eighth
session and continued for the life of the group. This introduced into
the integrated model the hypothesized benefits of the uniquely
structured use of videotape feedback and self discovery, and allowed
parents to play an integral part in this process. This, of course,
provided parents with an additional opportunity to practice non-directive,
empathic responding and to further integrate this mode into their

interpersonal style.

Statistical Analysis

 

The statistical analysis used to test for significant differences
between groups was an analysis of covariance, using the pretest scores

as covariates. Analysis of secondary hypotheses was accomplished using

60
the Wilcoxon signed-ranks test as a nonparametric measure, and the

matched pairs t-test as a parametric measure.

Summary

The sample for this study consisted of 32 volunteer parents con-
cerned about their children's emotional and behavioral problems.

There were 12 married couples and 8 parents without spouses in attendance.
Parents were referred by their Family Practice and Pediatric physicians
when seeking help from them. Children with very severe emotional
problems and overt signs of organicity were not accepted into the study.
Group leaders were this researcher and a female schoOl psychologist

with experience leading parent education groups and practicing play
therapy.

The experimental design used was a pretest—posttest control group
design. Individuals and couples were randomly assigned to one of four
groups of eight. Two of these groups were treatment groups and two
were control groups. Each leader led one treatment group and one
control group. The treatment group was the Filial Therapy program
with integrated IPR components. The control group was a traditional
Filial program without IPR components. All groups met one evening
per week for two hours over a period of sixteen weeks. All parents
began at-home play therapy sessions after eight weeks.

The measures used to assess the dependent variables of parental
acceptance, affective sensitivity, play therapy skills, and child
adjustment were the following: the Porter Parental Acceptance Scale,
the Affective Sensitivity Scale, the Filial Problem List, the Parent

Check List, and videotape ratings of the play therapy skills of

61
communication of acceptance, allowing self direction, and involvement.
Ratings on these last three were made in double blind fashion by two
independent judges on videotapes from the parents' first and last
in-clinic practice sessions. Data from the other measures was
collected at the first and last meetings of each group. Subjective
parent comments were alSo obtained.

The specific methods, skills, necessary roles, and attitudes of
the leaders, and the structure and schedules of both the treatment and
control groups were described in considerable detail.

All research hypotheses were stated nondirectionally. The .05
level of significance was used in all cases. The statistical analysis
used to test for differences between groups was the analysis of
covariance. The pretest scores were used as covariates. Analysis of
secondary hypotheses concerned with pre to post gains for each method
were analyzed nonparametrically with the Wilcoxon signed-ranks test

and parametrically with the matched pairs t-test.

CHAPTER 4

ANALYSIS OF THE RESULTS

In this chapter each of the primary hypotheses outlined in
Chapter 3 will be separately evaluated by an analysis of the experimental
data. The primary analysis will test for differences in gains between
the two methods. Two different ANCOVAs will be used in this analysis,
with pretest scores used as the covariates. This will control for
initial differences between groups on each measure.

A secondary analysis of the data will examine pre to post raw score
differences for each method on each measure (in order to examine whether
parents trained in each method show improvement pre to post training).
For this purpose both a matched pairs t—test and the Wilcoxon signed-
ranks test have been used.

Preceding both of these analyses will be a preliminary analysis
of the relatedness of data from mother-father pairs who were reporting
about the same child. This analysis was necessary in order to determine
whether the scores of these pairs were independent and to be treated
separately in the primary and secondary analyses.

In addition, inter-rater reliability findings for those measures

based upon videotape ratings of parent play therapy skills are reported.

Preliminagy Analysis

 

A Pearson-Product-Moment Correlation Analysis was used to compare
data collected separately from mother-father pairs who were reporting

about the same child. Correlation coefficients were calculated for

63

64
mother-father pairs on each measure. Two fathers had to drop out
near the end of the study, thus reducing the n from 12 to 10 for the
posttest. Table 4.1 lists the results of this correlation analysis
for both pretests and posttests. Correlations between mother-father
pairs were low and non-significant on both pre and posttests for all
measures, indicating that data collected on these pairs was independent.

This finding influences determination of the n size for the following

 

 

analyses.
Table 4.1
Pearson-Product-Moment Correlations
of Mother-Father Scores on Each Measure
Measure Pre (n = 12) Post (n = 10)

Porter Parental Acceptance Scale .49 .40
Affective Sensitivity Scale -.22 .43
Filial Problem List , .24 .23
Parent Check List .24 .39
Videotape Rating-—Communication of

Acceptance .22 .45
Videotape Rating—-Allowing Self Direction .01 .15
Videotape Rating--Involvement —.29 .47

 

NOTE: For p = .05, r must equal .532.

Primary Analysis
Each of the seven primary hypotheses relates to differences in gain

scores between each method. Each hypothesis relates to a different

65
dependent variable. The initial ANCOVA results examine both therapist
and treatment main effects. While the hypotheses are only concerned
with treatment effects, the leader and interaction data are included
to examine differences between leaders and to examine the possibility
of experimenter bias (the experimenter, Leader I, led two of the four
groups, one of each method). Results of a second more powerful ANCOVA
which combined leaders are also included.

For clarity, each hypothesis is restated. The hypotheses are
stated nondirectionally. Significant testing was carried out at the
.05 level for each of the runs. Summary ANCOVA tables are presented,
as well as tables of raw score pre and posttest means and standard

deviations.

Hypothesis One (H1): Parents trained in an integrated Filial-IPR program

 

will Show no differences in gains, pre to post, in parental acceptance,
as measured by the Porter Parental Acceptance Scale (alpha at .05).
The PPAS was mailed to parents prior to the first group meeting.

They were asked to complete it without conferring with a spouse or
partner and to bring it to the first group meeting. As a posttest,

each parent was given the PPAS at the next to last meeting and asked to
complete it prior to the last group meeting. Table 4.2 lists the means
and standard deviations for each method, pre to post training, as well
as mean change scores. Table 4.3 is an ANCOVA table with leader, method,
and interaction results. Table 4.4 presents ANCOVA results for a com—

bined leader, method only analysis.

Tabl

66

e 4.2

PPAS Means, Standard Deviations, and Mean Change Scores

 

 

Mean
Pretest Posttest Change

Treatment Group M SD M SD Score
Leader I ~Filial 96.85 18.44 101.66 22.34 4.81
Leader II-Filial 105.55 7.73 113.42 10.43 7.87
Leader I -Filial-IPR 105.75 10.66 114.00 16.61 8.25
Leader II-Filial-IPR 100.62 19.82 108.62 10.87 8.00

 

NOTE: Leader I is the experimenter in this and the following tables.

ANCOVA of PPAS Scores

Tabl

e 4.3

(Leaders x Method)

 

 

Source df F P
Leaders 1 0.548 0.527
Methods 1 0.483 0.500
Interaction 1 0.179 0.190
Covariate1 1 0.129 0.001*
Error 23

 

lMeasures initial pretest differences between groups.

*P = .001

67
Table 4.4

ANCOVA of PPAS Scores
(Method Only)

 

 

 

Source df F P
Method 1 0.349 0.566
Covariate 1 0.141 0.001*
Error 25

Results: There are no significant treatment effects for either ANCOVA

analysis; therefore, the null hypothesis is not rejected.

 

Hypothesis Two (H2): Parents trained in an integrated Filial-IPR program
will show no differences in gains, pre to post, in the parents' ability
to detect and describe the affective state of another over parents trained
in the traditional Filial Therapy program (alpha at .05).

This hypothesis was tested using Form E of the Affective Sensitivity
Scale (ASS) originally developed by Kagan and Schneider (1970). This
multiple choice scale was administered to each person during the first
and last group meeting of each program. Table 4.5 lists the means,
standard deviations, and mean change scores of each group's raw scores,
pre and post training. Table 4.5 is the ANCOVA table for the leader x
method x interaction analysis, and Table 4.7 provides results of a

combined leader, method only analysis.

68

Table 4.5

ASS Means, Standard Deviations, and Mean Change Scores

 

 

 

 

 

Mean
Pretest Posttest Change
Treatment Group M SD M SD Score
'Leader I -Filial 31.43 6.40 32.50 6.44 1.07
Leader II-Filial 29.66 6.00 34.57 6.05 4.91
Leader I ~Filial-IPR 31.25 4.86 36.14 4.94 4.89
Leader II-Filial-IPR 29.12 4.38 31.00 5.34 1.88
NOTE: Leader I was the experimenter.
Table 4.6
ANCOVA of ASS Scores
(Leaders x Methods)
Source df F P
Leaders 1 0.496 0.820
Methods 1 0.306 0.591
Interaction 1 0.368 0.064
Covariate 1 0.125 0.002*
Error 23

 

*P < .01

69
Table 4.7

ANCOVA of ASS Scores
(Method Only)

 

Source df I F P

 

 

Method 1 0.179 0.678
Covariate 1 0.130 0.001*
Error 25

*P = .001

Results: There are no significant treatment effects for either ANCOVA
analysis; therefore, the null hypothesis is not rejected. It should be
noted that the P value of the interaction effect approaches the .05
level of significance. A less significant but similar result occurred
in the testing of Hypothesis 1. In both cases, Leader I achieved
numerically greater gain Scores for the Filial-IPR method. The implica-
tions of these leader differences will be considered with results on

other measures and discussed in Chapter 5.

Hypothesis Three (H3): Children of parents trained in the integrated

 

Filial-IPR method will show no differences in improvement in child
. adjustment, pre to post, than children of parents trained by the
traditional Filial Therapy model, as measured by the Filial Problem List
(alpha at .05).

Parents were pretested and posttested with the Filial Problem List
in the same manner as with the Porter Parental Acceptance Scale. They

were asked to turn it in at the first group meeting, and again at the

70
last group meeting. The higher the raw score on the FPL, the greater
the magnitude of the child's maladjustment. An improvement on this
measure is indicated by a lower score on the posttest than the pretest.
Table 4.8 lists the means and standard deviations for each method, pre
and post training, as well as the mean change scores. Tables 4.9 and

4.10 describe the same analyses used to test the previous two hypotheses.

Table 4.8

FPL Means, Standard Deviations, and Mean Change Scores

 

 

Mean
Pretest Posttest Change

Treatment Group M SD M SD Score
Leader I —Fi1ial 98.85 59.73 87.83 62.98 -11.02*
Leader II—Filial 50.55 34.31 39.71 29.90 -10.84
Leader I -Filial-IPR 84.00 62.47 54.57 48.42 -29.43
Leader II-Filial-IPR 54.50 25.58 44.25 21.80 -1o.25

 

*A negative value on this measure indicates a pOsitive change. A lower

posttest score indicates a reduction in perceived problems.

71
Table 4.9

ANCOVA of FPL Scores
(Leaders x Methods)

 

 

 

 

 

Source df ' F P
. Leaders 1 0.272 0.612
Methods 1 0.625 0.557
Interaction 1 0.811 0.619
Covariate 1 0.521 0.0
Error 23
Table 4.10
ANCOVA of FPL Scores
(Methods Only)

Source . df F P
Method 1 0.509 0.511
Covariate 1 0.678 0.0
Error 25

 

Results: There are no significant treatment effects for either ANCOVA

analysis; therefore, the null hypothesis is not rejected. Table 4.8

indicates that Leader 1 again appears to achieve greater gain scores

for the Filial-IPR method than Leader II though Table 4.9 indicates

that the differences between leaders is not significant.

72
Hypothesis Four (H4): Children of parents trained in the integrated
Filial-IPR method will show no differences in gains in child adjustment,
pre to post, as measured by the Parent Check List (PCL), than children
of parents trained in the traditional Filial method (alpha at .05).
The Parent Check List pre and posttest data was gathered in the

Same manner as the ASS and FPL. Parents completed the forms just prior
to the first and last group meetings. As with the FPL, higher scores
indicate higher levels of emotional and behavioral problems. Table 4.11
lists raw score means, standard deviations, and mean change scores, pre
and post training. Table 4.12 presents ANCOVA results for a combined
Table 4.13 presents ANCOVA

leader, method, and interaction analysis.

results for a method only analysis.

Table 4.11

PCL Means, Standard Deviations and Mean Change Scores

 

 

Mean
Pretest Posttest Change
Treatment Group M SD M SD Score
Leader I -Filia1 27.28 9.82 23.28 10.10 -3.45*
Leader II-Filial 16.66 11.98 12.42 12.48 -4.24
Leader I -Fi1ia1-IPR 24.00 12.21 15.71 10.19 —8.29
Leader II-Filial-IPR 18.87 9.76 9.87 5.76 -9.00

 

*A negative mean change score indicates a reduction in perceived problems;

hence, is a positive change.

73
Table 4.12

ANCOVA of PCL Scores
(Leaders x Methods)

 

 

 

 

 

Source df F P
Leaders 1 0.252 0.122
Methods 1 0.342 0.074
Interaction 1 0.401 0.948
Covariate 1 0.437 0.0
Error 23

Table 4.13
ANCOVA of PCL Scores
(Methods Only)

Source df F P
Method 1 0.322 0.081
Covariate 1 0.558 0.0
Error 25

 

Results: There are no significant treatment effects for either ANCOVA

analysis; therefore, the null hypothesis is not rejected. It should be

noted that the probability level in both analyses approaches significance.

Differences, though not significant, favor the IPR method of treatment;

 

Hypothesis Five (H5): Videotape ratings of parents' play therapy

sessions will not show differences in gains in the play therapy skill of

74
communication of acceptance, pre to post, from one training method to
another (alpha at .05).

This hypothesis, and the two following it, was evaluated by video-
tape ratings of parents' play therapy skills. The skill evaluated in
this hypothesis is communication of acceptance. The videotape ratings
‘were made on each parent's first and last in-clinic practice sessions
(procedure described in Chapter 3) and as a process measure provide
direct evidence of the parent's skill levels in play therapy techniques.

On the Communication of Acceptance scale ratings were determined
by rating both the highest and lowest levels of skill observed in each
three minute segment, and then averaging the scores. Ratings were made
on a continuous five point scale, with the highest score, five, reflect-
ing the lowest levels of this skill and a score of one reflecting the
highest levels of skills. Ratings were made on five three minute
segments, and a total score was obtained by adding the average scores
for each three minute segment. The total n is three less than with
previous measures because technical problems with the videotape equip-
ment made data collection impossible in a few cases. Pre and post
videotapes were presented in a double blind fashion to assure a non-
biased score. None of the tapes were rated until the completion of
all groups. Inter-rater reliability coefficients and a discussion of
the statistical procedure used to determine them will be found later
in this chapter.

Table 4.14 lists pre and post training means and standard deviations

for each group, as well as mean change scores. Mean scores are determined

75
by adding together the total score of each rater. The ANCOVA analyses
found in Tables 4.15 and 4.16 are based upon these total scores.
Table 4.15 is the ANCOVA table for the leader x method x interaction
analysis and Table 4.16 is the ANCOVA table for the methods only

analysis.

Table 4.14

Communication of Acceptance:
Means, Standard Deviations, and Mean Change Scores

 

 

Mean
Pretest Posttest Change

Treatment Group M SD M SD Score
Leader I -Filial 20.25 3.32 19.83 3.69 -0.42*
Leader II-Filial 25.56 7.34 21.08 5.33 —2.48
Leader I ~Filial-IPR 20.50 6.31 16.33 3.12 —4.17
Leader II—Filial-IPR 19.75 3.79 16.85 2.32 -2.90

 

*A.negative mean change score reflects an improvement in play therapy skills.

Table 4.15

ANCOVA of Communication of Acceptance Scores
(Leaders x Methods)

 

 

Source df F P
Leaders 1 0.280 0.607
Methods 1 0.568 0.026%
Interaction 1 0.517 0.980
Covariate . 1 0.105 0.318
Error 20

 

*P <, .05

76
Table 4.16

ANCOVA of Communication of Acceptance Scores
(Methods Only)

 

 

 

Source df F P
Methods 1 0.605 0.021*
Covariate 1 0.127 0.271
Error 22
*P < .05

Results: Significant treatment effects were found in both ANCOVAs, in
each case favoring the integrated Filial-IPR method. Therefore, the null
hypothesis is rejected. Again, Table 4.14 suggests that Leader I achieved

somewhat greater gain scores than Leader II.

 

Hypothesis Six (H6): Videotape ratings of parents' play therapy sessions
will show no differences in gains, pre to post, in the play therapy skill
of allowing self direction, from one method of training to another

(alpha at .05).

This hypothesis was evaluated in the same manner as the preceding
hypothesis. Table 4.17 lists means and standard deviations for each
group, pre to post training, and mean change scores. Tables 4.18 and
4.19 present ANCOVA results for a leaders x methods and a methods only

analysis.

Means, Standard Deviations, and Mean Change Scores

77
Table 4.17

Allowing Self Direction:

 

 

Mean
Pretest Posttest Change

Treatment Group M SD M SD Score
Leader I -Filial 21.16 6.43 14.00 4.05 ~7.l6*
Leader II-Filial 21.37 8.68 18.83 7.57 —2.54
Leader I -Filial-IPR 18.57 4.57 17.00 3.79 -l.57

 

*A negative mean change score reflects improved play therapy skill.

Table 4.18

ANCOVA of ASD Scores
(Leaders x Methods)

 

 

Source df F P
Leaders 1 0.185 0.186
Methods 1 0.416 0.532
Interaction 1 0.122 0.280
Covariate 1 0.210 0.159
Error 20

 

78
Table 4.19

ANCOVA of ASD Scores
(Methods Only)

 

 

Source - df F P
Methods 1 V 0.422 0.529
Covariate 1 0.223 0.145
Error 22

 

Results: There are no significant treatment effects for either ANCOVA

analysis; therefore, the null hypothesis is not rejected.

Hypothesis Seven (H7): Videotape ratings of parents' play therapy

 

sessions will show no differences in gains, pre to post training, in
the play therapy skill of involvement, from one method of training to
the next (alpha at .05).

This hypothesis was evaluated in the same manner as the previous
hypothesis. Ratings were made on the same videotapes and performed
by the same raters. Table 4.20 lists means and standard deviations
for each group's, pre and post training, and mean change scores.
Tables 4.21 and 4.22 present ANCOVA results for a leaders x methods,

and a methods only analysis.

Means, Standard Deviations, and

79
Table 4.20

Involvement:

Mean Change Scores

 

 

Mean
Pretest Posttest Change
Treatment Group M SD M SD Scores
'Leader I -Filial 16.16 5.92 19.16 4.49 2.50
Leader II-Filial 20.62 4.95 14.50 5.28 -5.12*
Leader I -Filia1-IPR 12.85 3.57 17.33 6.18 4.48
Leader II-Filial-IPR 16.50 5.31 14.42 4.72 -2.08

 

*A negative mean change score reflects improved play therapy skills.

Table 4.21

ANCOVA of Involvement Scores
(Leaders x Methods)

 

 

Source df F P
Leaders 1 0.862 0.008*
Methods 1 0.346 0.569
Interaction 1 0.276 0.611
Covariate 1 0.945 0.006*
Error 20

 

*P ( .01

80
Table 4.22

ANCOVA of Involvement Scores
(Methods Only)

 

 

Source df F P
Methods . 7 1 0.345 0.848
Covariate 1 0.418 0.0502
Error 22

 

Results: There are no significant treatment effects for either ANCOVA
analysis; therefore, the null hypothesis is not rejected. It should be
noted that in the leaders x methods ANCOVA, significant differences

between leaders were found.

Inter-Rater Reliability

 

The inter-rater reliabilities in this study were calculated
according to Ebelh Formula (Ebel, 1951) which employs a two-way analysis
of variance technique. The reliabilities obtained were based upon the
total score for each parent on each dimension, as determined by each
rater. This formula employs reliability coefficients for each rater,
pre to post, on each measure, as well as between raters at each point
in time. Inter-rater reliability coefficients are reported in Table
4.23 below. Coefficients are reported separately on the pretest and
posttest for each scale. These coefficients were sufficiently reliable

for the final statistical analyses.

81
Table 4.23

Inter-Rater Reliability Coefficients
for Videotape Ratings of Parent Play Therapy Skills

 

 

Skill Pretest Posttest
Reflection of Feelings .92 .97
Allowing Self Direction .86 .96
Involvement .95 .93

 

Summary of Primary Analysis

 

The primary analysis consisted of two different ANCOVAs for each
of the seven hypotheses. Both ANCOVAs were concerned with differences
in gain scores, pre to post, between each method. One of the ANCOVAS
examined leader effects as well as treatment effects and their interaction.
The other ANCOVA combined groups by method and examined differences
between methods. This offered a more powerful test of differences
between methods. In the case of each hypotheses, both ANCOVA analyses
were in close agreement.

0f the seven different outcome measures examined, only one measure,
the play therapy skill communication of acceptance, was found to be
affected more by one method than the other. In this case, the
integrated Filial-IPR method achieved significantly greater gains in
this skill than the traditional Filial Therapy program. On one of the
measures of child adjustment, the Parent Check List, significant differences
were approached (P B .073 and .081) but not attained using a two-

tailed test. Differences here also favored the IPR method of training.

82
Significant leader differences (.008) were found on the play therapy
skill of involvement. These differences were independent of method,
however, and do not concern our primary hypotheses.

On the hypothesis concerning affective sensitivity, the inter-
action effect between leader and method scores approached significance
(.064) with Leader I favoring the Filial-IPR method and Leader II
favoring the Filial only method. As the data has emerged, differences
between group leaders became apparent. Leader I, the experimenter,
achieved greater gain scores for the Filial-IPR method than with the
Filial only method and achieved greater gain scores for the Filial-IPR
method than Leader II. These differences are not considered in the
primary or secondary hypotheses, however, and will be discusSed in

Chapter 5.

Secondary Analysis

 

While the primary hypotheses of this study were concerned with
differences between the two training methods, additional informal
hypotheses.were formulated which predicted that parents in each train-
ing method would show pre to post improvement on each of the dependent
measures considered in the primary analysis. In other words, this
secondary analysis set aside the question of which method was more
effective and examined whether each method was effective in its own
right. It is believed that such an analysis was needed since the previous
research on Filial Therapy and para-professional applications of IPR
technology was not extensive. Additional evidence of the efficacy of
each method should contribute to our confidence in them, as well as

an understanding of the conditions under which they are most effective.

83

It is important to note that no non-treatment control groups
or attention only placebo control groups were used to compare the
results of training with no training. Results should be considered
with this in mind since parent improvement may be the result of
maturation or history. However, Sywulak's (1978) research on Filial
Therapy found that when subjects served as their own controls over a
four month period, there was no significant pre to post gain, while
there was significant improvement before and after treatment. This
would suggeSt that the factors of history and maturation have exerted
a negligible effect on this study.

The analysis of pre to post differences employed both a parametric
and nonparametric analysis. This was thought advisable due to the
small n's. The parametric statistic was the matched pairs t-test and
the nonparametric statistic was the Wilcoxon signed-ranks test. The
results of the analyses for the Filial Therapy groups are listed in
Tables 4.24 and 4.25 and the results of the integrated Filial-IPR
analyses are listed in Tables 4.26 and 4.27. For simplicity and
because the hypotheses are informal, all of the instruments used to
measure each method will be considered under the single hypothesis

stated for each method.

Hypothesis Eight (H8): Parents trained under the traditional Filial

 

Therapy model will show a significant pre to post training increase
on each of the seven dependent measures.
This hypothesis was evaluated using the Porter, FPL, PCL, ASS

and videotape ratings of communication of acceptance, allowing self

84

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86
direction, and involvement. Table 4.24 lists the results of the
matched pairs t-test analysis and Table 4.25 lists the results of the
Wilcoxon signed-ranks test. All p values are for a one-tailed test

with alpha at .05.

Results: This hypothesis was fully supported by the data on the Porter
Parental Acceptance Scale, the Parent Check List, and the videotape
ratings of allowing self direction. There is partial support for the
hypothesis on the Filial Problem List and videotape ratings of
communication of acceptance. The hypothesis received no support on the
Affective Sensitivity Scale and the videotape rating of involvement.

In the two cases where the hypothesis received partial support the
parametric analysis indicated significant gains while the nonparametric

analysis did not.

Hypothesis Nine (H9): Parents trained in the integrated Filial-IPR

 

model will Show a significant pre to post training increase on each of
the seven dependent measures.

This hypothesis was evaluated using the Porter, FPL, PCL, A88
and videotape ratings of communication of acceptance, allowing self
direction, and involvement. Table 4.26 lists the results of the para-
metric matched pairs t-test and Table 4.27 lists the results of the
nonparametric Wilcoxon signed-ranks test. All p values are for a one-

tailed test with alpha at .05.

Results: This hypothesis was fully supported for the Porter Parental
Acceptance Scale and the Filial Problem List. The hypothesis is partially

supported on the Parent Check List, the Affective Sensitivity Scale, and

87

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88

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89
videotape ratings of communication of acceptance and allowing self
direction. The hypothesis received no support on the videotape rating
of involvement. In the four cases where the hypothesis is partially
supported, the nonparametric analysis indicates significant gains while
the parametric analysis does not. This is in contrast to the data
examined in Hypothesis Eight, where the parametric analysis shows

partial support.

Summary of Secondary Analysis
Each of the methods was analyzed independently for pre to post
training gains on each of the seven measures used in the primary analysis.
Because of the small n both a parametric and nonparametric statistic
were used. The parametric statistic was the matched pairs tetest and
the nonparametric statistic was the Wilcoxon signed-ranks test. Hypotheses
were stated directionally with one-tailed tests used and alpha at .05.
Including those measures for which one but not both of the
statistical analyses show significant increase, the traditional Filial
program has a positive impact on five of the seven dependent measures.
These include measures of parental acceptance, child adjustment, and
the play therapy skills of communication of acceptance and allowing
self direction. Parental acceptance, child adjustment (as measured by
the Parent Check List), and the skill of allowing self direction were
shown to increase in both statistical analyses. There was no significant
evidence that affective sensitivity and parental involvement were

improved with this method.

90

With the integrated Filial-IPR method, improvement was shown
on Six of the seven dependent measures. Parental acceptance and child
adjustment (as measured by the Filial Problem List) were shown to
increase significantly when analyzed both parametrically and non-
parametrically. Child adjustment (as measured by the Parent Check
List), affective sensitivity, parental allowance of self direction,
and communication of acceptance were shown to increase significantly
when analyzed nonparametrically. No significant improvement in tape
ratings of parental involvement was shown by either method of analysis.

In summary, there is evidence that both methods of training proved

effective.

CHAPTER 5 .

SUMMARY, RESULTS AND DISCUSSION

§2EEEEX
Several writers (including Hobbs, 1964; Albee, 1968; and Miller, G.,

1969) have identified the importance of training para-professional
counselors, parents, teachers, police, etc. to deliver effective psycho-
logical serVices. This has been in reSponse to the failure of the
conventional medical model to meet society's needs for preventive and
remedial mental health services and the need for more efficient use of
professional time. As the crucial impact of the parent-child relation-
ship on the etiology of emotional problems in children has become better
understood, that relationship has been seen as a logical place to focus
remedial and preventive interventions. One para-professional program
designed to train parents to function as psychotherapeutic agents

is Filial Therapy (B. Guerney, 1964). In Filial Therapy parents are
taught to do client—centered play therapy with their own children in
order to alleviate present concerns and conflicts as well as to develOp
effective parenting skills for prevention of future problems.

A review of the Filial Therapy research suggests that Filial Therapy
is an effective method of intervention in the alleviation of children's
emotional problems. However, the need for additional controlled studies
of the Filial Therapy model, as well as the need to find new ways to

improve the parent-child relationship, have resulted in the current

91

92

study. Since difficulties in the parent-child relationship likely
result from emotional conflicts within the parent, sufficient attention
must be paid to these conflicts, the traditional Filial Therapy program

relies on the clinicalyjudgment of the therapist teaching the parents

 

in determining when and how to focus on the parents' emotional conflicts.
The risk is that the therapist will mis-time his interventions or fail to
see areas of emotional conflict in parents.

The purpose of this study was to design and evaluate modifications
in the traditional Filial Therapy program so that a crucial dimension
of the parent-child relationship, the parents' emotional conflicts, are
therapeutically addressed in a more systematic and reliable manner. To
this end, two important elements of Kagan's Interpersonal Process Recall
(IPR) training model have been integrated into the traditional Filial
Therapy program. Kagan's IPR has been used to train para-professionals
as well as professionals in the mental health field. In this regard,
IPR shares with Filial Therapy the goal of a more efficient use of the
professional's time. In addition, Filial Therapy and IPR are built
upon similar theoretical foundations.

The two components of Kagan's model which were integrated into the
traditional Filial program are affect simulation and videotape recall.
In affect simulation parents were shown filmed vignettes of a variety
of interpersonal scenes. The goal was to familiarize parents with their
own emotional reSponses to stressful but general interpersonal situations.
As parents became familiar with the concept of interpersonal fears and

started to become familiar with their own, the videotape recall component

93
of the IPR model was introduced. The goal here was to systematically
familiarize parents with the Specific interpersonal fears which they
encountered in their interactions with their children, the manifesta-
tion of those fears in behavior, and the impact Of that behavior on
their children. In the recall process, parents confront their own
fears when they are ready rather than when the clinician thinks that
they are ready. In addition, parents were taught to perform the inquirer
role with each other during the recall sessions in order to provide them
with additional practice in non-directive, facilitative interaction.

The experimental design of this study was a pretest/posttest control
group design, with the traditional Filial Therapy model serving as the
control group to the integrated Filial-IPR model. This study is seen
as a partial response to the need to design and evaluate more effective
methods of training parents as para-professionals, as well as a reSponse
to the need to further replicate the promising but limited research in
Filial Therapy. The sample for this study consisted of 32 volunteer
parents of children with emotional or behavioral problems. Parents
were members of the military who were referred by their Family Practice
and Pediatric physicians at Dewitt Army Hospital at Ft. Belvoir, Virginia.

In this study there were 18 females and 14 males, including 12
married couples. A total of 20 households were represented. Subjects
were randomly assigned, either as couples or individuals (when the spouse
was not participating), to one of the two treatment methods and to one
of the two leaders. There were four groups, two treatment and two
control, with eight members in each group. Each leader conducted one '

control and one eXperimental group. The leaders were the experimenter

94
and a school psychologist experienced with play therapy and parent
training groups. The groups met for two hours each session for a
total of sixteen weeks. The structure of both experimental and control
groups is outlined in detail in Chapter 3. The introduction of the
IPR components began during the seventh week in the experimental groups.
At this point, parents were gaining mastery of basic play therapy skills
and beginning to focus on their own emotional responses to their children.

In order to compare the effectiveness of each of the programs the
following dependent variables were studied: (a) parental acceptance,
(b) affect sensitivity, (c) play therapy skills, and (d) child adjustment.
The specific measures used to assess these variables were the Porter
Parental Acceptance Scale (PPAS), the Affect Sensitivity Scale (ASS),
the Filial Problem List (FPL), the Parent Check List (PCL), and video—
tape ratings of communication of acceptance, allowing self direction,
and involvement. The PPAS, the A58, the FPL, and the PCL were completed
by parents prior to the first group meeting and prior to the last group
meeting. Videotape ratings were made in the first and last in-lab
practice play sessions conducted by each parent.

The primary interest of the study was to compare these two methods
of training. Seven specific research hypotheses were formulated to test
for differences between each method. Each research hypothesis related
to each of the dependent measures. Each of the hypotheses predicted
no differences in gain scores, pre to post, between the two different
measures. Each hypothesis was tested for differences with two different

ANCOVA computer analyses. The ANCOVA was employed to adjust for initial

95

pretest differences between groups by using the pretest scores as the
covariate. One analysis examined method x leader x interaction effects.
The second, more powerful analysis combined leaders and analyzed only
differences between methods. Significance testing was carried out at
the .05 level. The results of the analyses showed significant differences
on only one of the dependent measures, the parent play therapy skill
communication of acceptance. This difference was in favor of the IPR
method and was supported by both ANCOVA analyses. On a measure of
child adjustment, the Parent Check List, differences favoring the IPR
method approached significant levels (.081 and .073) on both ANCOVAS.
In the leader x method x interaction ANCOVA of the ASS, the interaction
effect approached significance (.064) but was not reached. Significant
' differences were not found on any of the other major hypotheses.

A secondary analysis was independently carried out on each train-
ing method. Two hypotheses were stated, one for each method, predict—
ing pre to post positive raw score differences on each measure for each
method. Each hypothesis was tested for pre to post raw scores using
the parametric matched pairs t-test and the nonparametric Wilcoxon
signed-ranks test. Hypotheses were stated directionally in favor of pre
to post improvement on each measure. Significance testing was carried
out at the .05 level. The results indicated that for the integrated
Filial-IPR method, significant positive pre to post differences were
found in both parametric and nonparametric analyses of parental acceptance
and child adjustment as measured by the FPL. In addition, significant

positive differences were found on the PCL, ASS, and videotape ratings

96
of communication of acceptance and allowing self direction when the
nonparametric Wilcoxon was used. The P g .05 was approached but not
achieved on each of the remaining measures when the data was analyzed
parametrically.

The results indicated that for the traditional Filial Therapy
groups, significant, positive pre to post differences were found in both
analyses in parental acceptance, child adjustment as measured by the
PCL, and the play therapy skill allowing self direction. In addition,
significant and positive pre to post differences were found on the FPL
and on videotape ratings of communication of acceptance when the para—
metric matched pairs t-test statistic was used. These differences

were not supported in the nonparametric analysis.

Results

These results lead to several conclusions from the study. The
following conclusions relate to the primary analysis:

1. Parents trained in an integrated Filial-IPR training model
did not show greater gains in parental acceptance than parents trained
by the traditional Filial Therapy model. According to Porter (1954),
"Parental acceptance is one of the essential elements underlying the
whole structure of the parent-child relationship." (p. 180)

2. Children of parents trained in an integrated Filial—IPR train-
ing model did not Show significantly greater gains in child adjustment
than children of parents trained by the traditional Filial Therapy
model, though near significant differences (P = .074, 2-tailed test)

favoring the integrated Filial—IPR method were achieved on one of the

97

measures of child adjustment. Changes in child adjustment should
reflect changes in the parent-child relationship as well as changes
in the self concept of the child.

3. Parents trained in integrated Filial—IPR groups did not show
greater gains in affective sensitivity, an indicator of the parents'
ability to identify their child's feelings, than parents trained in
traditional Filial groups.

4. Parents trained in integrated Filial-IPR groups did achieve
significantly greater gains in one of the three play therapy skills
measured (communication of acceptance) than parents trained in the
traditional Filial groups. Differences were not found on the skills
of allowing self direction and involvement.

The following conclusions relate to the secondary analysis carried
out:

1. Parents trained in the integrated Filial—IPR groups did show
significant pre to post gains in parental acceptance, and their
children demonstrated improved child adjustment. There is evidence
that parents also achieved meaningful gains in affective sensitivity
and the play therapy skills of communication of acceptance and allowing
self direction.

2. Parents trained in the traditional Filial groups also showed
significant gains in parental acceptance and the play therapy skill
allowing self direction. Their children also showed improved child
adjustment. There is some evidence that parents showed improvement in

the play therapy skill communication of acceptance.

98

Discussion

 

The primary focus of this study was whether or not an integrated
Filial-IPR program was more effective than the traditional Filial
Therapy model in influencing the dependent variables of parental
acceptance, affect sensitivity, child adjustment, and selected play
therapy skills. A secondary focus of the study was whether each
method was effective in its own right at influencing positive change
on each of the same variables. With regard to the primary focus,
significant differences favoring the integrated Filial-IPR groups were
found on only one of the seven measures used, the play therapy skill
communication of acceptance. Differences favoring the integrated
Filial-IPR groups approached significance on one of the two measures
of child adjustment, the Parent Check List (PCL). With regard to the
secondary analysis, both methods showed significant pre to post gains
on most of the measures, on either both, or one of, the two analyses
employed.

It is important to note that the pre to post control group research
design was not as valid as it would have been if a no treatment
placebo attention control had been used. Either of these would have
helped control for the effects of history, maturation, and test/retesting,
particularly in the case of the secondary analysis. However, Sywulak's
(1978) study, in which subjects served as their own controls for four
months prior to four months of Filial Therapy, indicated that there
were no significant gains over the four month control period on any

of her four measures, including the PPAS, the FPL, and the PCL- There

99

were significant gains on these measure pre to post training. There-
fore, while a no treatment or attention placebo control group would
have improved the experimental design of this study, previous related
research suggests that the threats to internal validity from history,
maturation, and test/retesting would have been negligible. We can
conclude, therefore, that while the integrated Filial—IPR groups were
more effective than the traditional Filial groups at significantly
influencing only one of the dependent variables, both methods were
effective at positively influencing the parent-child relationship.

As indicated in Chapter 4, potentially significant differences
between the group leaders became apparent as the data emerged. While
there were no statistically significant interaction effects discovered
in the leader x method x interaction ANCOVAs, significant interaction
effects were approached on the PPAS (.190) and ASS (.065). In addition,
Leader I, the experimenter, achieved greater gain scores for the
integrated Filial-IPR method on five of the seven measures. Leader
II achieved no differences in gain scores between methods on three of
the measures. She achieved differences in gain scores favoring the
integrated Filial-IPR method on two measures and differences favoring
the Filial only method on the remaining two measures.

These differences were further analyzed to see if differences
favoring the integrated model were statistically significant for Leader
1. Because of the small n involved, the Mann Whitney U Test was chosen.
The total n was not sufficiently large to conduct a multivariate analysis.
Testing revealed that these differences were not statistically significant.

However, these differences are impressive and need to be considered.

100

One possible explanation for Leader 1, the experimenter, con-
sistently achieving results favoring the integrated model while Leader
II did not is experimenter bias. The experimenter did not experience
this to be the case. Another possible explanatiOn for these leader
differences has to do with relative amounts of experience with the
IPR methodology. The experimenter completed a 30 hour IPR course
taught by Dr. Kagan at Michigan State University. In addition, be
carefully read the IPR manual and trained the other group leader
for approximately ten hours prior to the introduction of IPR components
into the parent groups. Thus, he had 40 hours of experience with IPR.
The other group leader's only exposure to IPR was the ten hours of
training and a careful reading of the IPR manual. It may well be that
leaders need to have more hours of experience with the IPR model before
they can use it with the confidence and skill necessary to effect
significant treatment differences. Tomory (1978) suggests that leaders
have a full year of experience with IPR techniques before beginning
research sessions. Although one advantage of the IPR model is that it
can be taught to clinicians in a relatively short time, clinicians
may need a great deal of practice before they have fully integrated
the techniques into their working styles.

The same relative inexperience of the leaders with the Filial
Therapy method may have also been a factor. Both group leaders attended
an intensive five day workshop offered by the originators of Filial
Therapy. In addition, both leaders had considerable experience using

play therapy techniques in their clinical work. Leader 11 also had

101

conducted several Systematic Training for Effective Parenting groups.
However, neither leader had run long-term Filial Therapy groups prior
to this research study. While the pre to post training gains were
positive for each method, they may have been stronger if the group
leaders had had more experience with the Filial model.

Another factor which should be mentioned in discussing possible
bias on the part of either of the group leaders is their personal
relationship.' The leaders had a close personal relationship and became
engaged to be married before the completion of the groups. A number
of possible factors related to the relationship could have been
operating to bias the performance of the leaders, including: pro-
fessional competitiveness, anxiety about performance, and desire to
please or impress, coercion, and even a wish to sabotage. Personal
discussions through the course of the experiment did indicate that
there were feelings of competitiveness and anxiety about performance.
However, both leaders felt that these factors were minimal and were
outweighed by feelings of supportiveness and the increased opportunity
to discuss difficulties and insure that the groups were following the
same structure. Nonetheless, future research should include systematic
procedures for controlling leader bias.

The description and rationale for Filial Therapy presented in
Chapter 1 contained the concept that the goal of Filial Therapy was to
teach parents play therapy skills so that they, rather than an outside
professional, may be central in the amelioration of their children's

behavioral and emotional problems. Among the basic Filial Therapy skills

102

are empathic understanding, allowing self direction, and limit setting.
Under the umbrella of the skill of empathic understanding are the
dependent variables of parental acceptance, affective sensitivity,
communication of acceptance, and involvement.

Parental acceptance is communicated primarily through the skills
of reflective listening and involvement and through the relative
lack of limits, controls, or directions. Parental acceptance, as
measured by the Porter Parental Acceptance Scale (PPAS), was not
affected differentially by the two methods of training. However, the
PPAS is a paper and pencil outcome measure. The play therapy skill,
communication of acceptance, as measured by ratings of videotapes of
actual parental behavior, is an in vivo process measure, and because
it is a more direct measure may be more valid. What is important here
is that the attitude of parental acceptance be communicated to the
child. If the child fails to feel accepted by the parent even though
the parent may internally feel more accepting of the child, it does
the child no good. Differences between methods favoring the integrated
Filial-IPR approach were found on the skill of communication of
acceptance. It may be that attitudes of parental acceptance were
equally affected by both methods and that only the communication of
parental acceptance was favorably affected by the Filial-IPR groups.
Support for this conclusion must be tempered by the fact that significant
gains on the play therapy skill communication of acceptance are found
on only one of the two (parametric and nonparametric) analyses for each
method. Thus, there is evidence of significant improvement on this

skill for each method but the evidence is not conclusive.

103

The dependent variable, affective sensitivity, is also a component
of empathy. Affective sensitivity, as measured by the ASS, is the
ability to identify what it is that another person is feeling. It
does not address whether that understanding is communicated. The
primary analysis indicated no differences in gains on this measure
between methods. The secondary analysis showed no significant gains
pre to post for either method when results were analyzed parametrically.
Significant gains were shown for the IPR groups but not for the
traditional Filial groups when the results were analyzed nonparametrically.
The expected increases in affective sensitivity did not occur for the
traditional Filial Therapy groups while evidence is mixed regarding
such increases for the integrated Filial-IPR groups. Some of the
factors which could account for this include: (a) a possible ceiling
effect of the instrument for those parents scoring in the upper ranges
of the scale at pretest; (b) questions about the validity of the newest
form of the scale; and (c) resistance to taking the posttest during
the last session. Many parents at the last session had a great deal
of feeling about terminating the groups and last minute concerns about
dealing with their children. They were resentful of giving up more
than an hour when they had so many concerns. Finally, (d) the impact
of seeing the same filmed vignettes a second time may have been mild
compared to the real life situations encountered with their children
and therefore parents may not have been motivated to respond to the

testing in a thoughtful way.

104

Parental acceptance is also communicated through the skills
of allowing self direction and involvement. In allowing self direction,
the parent shows willingness to follow the child's lead without
limiting, controlling, criticizing, teaching, praising, or moralizing.
This enables the child to build confidence in himself as he explores
‘new ways of being. Parental involvement has to do with being fully
observant and aware of the child's feelings and behavior. An uninvolved
parent is not as likely to notice what a child is thinking and feeling
and will be unable to communicate acceptance to the child about important
feelings, ideas, and behavior. Differences between methods were not
found on either of these variables. With the skill of allowing self
direction, traditional Filial groups showed significant pre to post
gains when analyzed both parametrically and nonparametrically while
integrated Filial-IPR groups showed significant pre to post gains when
analyzed nonparametrically. The parametric analysis here did approach
significance (p‘( .20). The leader x method x interaction ANCOVA for
the skill of involvement failed to show differences betweer methods
but did show significant (p = .008) differences between leaders.
While involvement scores improved for one leader, they declined for
the other leader in both groups. This finding is curious since scores
for that leader's groups showed improvement on all other dependent
measures. This finding might be eXplained by a lack of leader involve—
ment during the posttest tape collecting phase of the group or a lack
of attention or emphasis to that particular skill while emphasizing

others.

105

A factor which may have influenced all of the process measures
of play therapy skills is the tendency of Filial groups to reach a
plateau (Sywulak, 1978). When the groups run for such a long period
of time they enter periods of flagging interest and enthusiasm. Post-
test videotapes collected during one of these periods would perhaps
show an atypically low level of skills. The specific skill of involve-
ment would seem eSpecially likely to be so affected. Another factor
which would influence pre to post training results was technical
problems with the videotape equipment. This occurred more in the early
stages of the groups before the leaders were fully familiar with the
equipment but it did occur near the and also. In a few cases, second
rather than first sessions were used as the pretest. In other cases,
next to last sessions were used at the posttest. Since the groups
might meet two to four times before a parent does another in-lab session,
a great deal of vicarious learning may have taken place from watching
other parents' practice sessions. In fact, all participants observed
the leaders do two demonstration sessions before first being taped. Such
learning may have given an inaccurate indication of the parents'
pretraining skill level. Ideally, videotapes of some sort of intake
session prior to the first group would be collected as the pretest
measure of play therapy skill levels. When posttest tapes were next
to the last practice sessions for a parent, measurement was taken on a
shorter training period. Technical problems necessitated these modifica—

tions in six cases equally distributed over methods.

106

The outcome variable in this study was child adjustment. It was
believed that improvements in the parent-child relationship and the
working through of emotional conflicts in the presence of parental
acceptance will result in improvement in behavior, greater mastery of
difficult feelings and greater self confidence. The two instruments
measuring this variable were the Parent Check List and the Filial Problem
List. Significant differences between methods were not found on either
method but differences favoring the IPR method were approached (p ( .08
and .09) on the PCL. Consequently, there is a good possibility that
the introduction of IPR components into the traditional Filial Therapy
program does result in greater improvement in child adjustment than the
traditional Filial method alone. This conclusion must be tempered
with the fact that significance was approached on only one of the two
measures of child adjustment. Another caution derives from the fact
that both measures of child adjustment were completed by parents on
their own children. Consequently, they are subject to parental biases
to see problems as worse than they are or to deny the severity of existing
problems. With the FPL, the Filial-IPR groups demonstrated significant
pre to post gains when analyzed both parametrically and nonparametrically.
The Filial—only groups showed significant gains only when analyzed
parametrically (significant gains approached, p < .13, when analyzed
nonparametrically). The reverse occurred with the PCL. Filial-only
groups showed significant pre to post gains when analyzed both ways,
while the Filial-IPR groups only showed significant pre to post gains
with the nonparametric statistic. (Here again though the parametric

statistic showed gains approaching significance, p < .10.) There is

107

evidence then that both methods positively influence child adjustment,
but results are equivocal for each method depending on the statistic
used to analyze the results. In her study, Sywulak (1978) established
that the greatest gains in parental acquisition of play therapy skills
occurred during the first two months of parent training, while the
greatest improvement in child adjustment occurred during the second
two months of training. This is logical since at-home sessions did
not begin until after the eighth week. Sywulak pointed out that Filial
Therapy groups typically run for six months or more. It may be that
the full effects of the parent groups on child adjustment may require
more time to fully manifest itself.

Although significant differences favoring the integrated Filial-
IPR method were found on one of the seven dependent variables and
significant differences favoring the integrated Filial-IPR groups were
approached on another variable, the full impact of the introduction
of IPR methodology on the traditional Filial Therapy model is difficult
to assess. There are several factors which could account for this.

One area where the impact of IPR may have been considerable was
on the play therapy skill of limit setting. While many parents have
difficulty expressing warmth and acceptance, many other parents have
their hardest time saying no to their children even when it is important
to the child's physical or emotional safety. Many of these parents
are eventually able to eXpress their fear that their child will feel
rejected while others are afraid of their children's anger. The

importance of the stimulus vignettes and the recall process in eventually

108

recognizing and gaining control over these fears was great for several

of the parents. However, there were no workable measures of this skill
which could be used in this study. Indeed, the Filial program is
designed to reduce the need for limit setting to a minimum. Trans-
gressions of limits during play sessions usually occur infrequently

and often in the at—home sessions. This makes the direct measurement

of limit setting skills very difficult, if not impossible. The closest
we can come to assessing this skill is in its impact on child adjustment.

As mentioned above, changes in child adjustment tend to occur
later in the Filial Therapy program. Subjective comments from parents
at the end of the 16 weeks indicated that they were just beginning
to see changes in their children's behavior and feelings. Other parents
said that they thought the program should last from a few to several
weeks longer. While previous research does not indicate that parents‘
play therapy skills continue to increase significantly after four
months, it may be that attitudes of parental acceptance and affective
sensitivity would also continue to show increases over longer periods
of time. If so, the positive but somewhat mixed results of this
analysis might be stronger.

A related factor which may account for the failure to find more
differences between methods has to do with structural differences
between the traditional and integrated Filial groups. Each group met
for two hours a week for sixteen weeks. However, at the seventh week“
IPR groups viewed stimulus films and discussed them for at least one
hour. During the eighth and ninth weeks parents saw additional stimulus

vignettes and a film on the inquirer role. In addition, parents spent

109

time practicing the inquirer role as they role played helping situations
and conducted recalls with each other for the first time. While the

IPR groups were getting IPR training, the traditional Filial groups
were able to do more in-lab practice sessions and devote more time to
emotional concerns of parents, as well as spend more time discussing

the initial'at-home sessions which began during week nine. This may
have put the IPR groups "behind" the traditional Filial groups, and

it may be that the IPR groups would need more than the remaining nine
sessions after IPR introduction in order to integrate the new learnings
and possibly "go ahead of" the non-IPR groups.

In addition, the timing for introducing IPR methods may have been
poor.° Although parents were just beginning to express their own
emotional reactions to the sessions, they were also preparing to start
their at-home sessions. Some parents expressed resentment at having
to shift focus away from play sessions. This may have created an initial
negative set towards IPR which may have persisted for a while. However,
subjective comments from most participants tended to be very favorable
about IPR with many parents requesting that it begin earlier.

In order to insure as much equality of conditions as possible for
both treatment groups, group leaders attempted to follow the same strict
schedule in introducing the IPR methodology. Both leaders reported
feeling constrained by the schedule and that more flexibility in
introducing and using the methodology would have allowed smoother and'
better timed introduction of the techniques. This finding is consistent
with those of Schauble (1970), Van Noord (1973), and Tomory (1979), all

of whom examined the use of IPR techniques in individual psychotherapy.

110

In discussing the impact of IPR techniques it is important to
mention that in subjective comments from the group members exposed to
IPR techniques, there was a range of reactions. Some parents seemed
to benefit from IPR techniques a great deal. Some identified IPR
techniques, particularly the recall sessions, as the most valuable
part of their group experience. Some parents seemed to benefit a great
deal from the film on interpersonal fears followed by stimulus vignettes.
Many parents requested that IPR be introduced earlier into the course
and be used more frequently. Only two parents exposed to the IPR
methods expressed directly negative criticism of the methods. It
may be that certain types of parents benefit more from IPR techniques
than others. Informal observations by both group leaders suggested
that parents of higher socio-economic status took to the model most
eagerly, and that mothers did more than fathers.

More than one parent expressed dissatisfaction with learning the
inquirer role. There was some feeling that the probing, nonreflective
nature of the inquirer role was in conflict with the role of play
therapist, which is non-probing and more reflecting of feelings. It
was recommended that the leader function as inquirer during recall
sessions so that parents could stay focused on the play therapy role.

Finally, the results of this study need to be considered in view
of the specific population. The fathers were all members of the armed
forces and their families were military dependents. As a number of
parents pointed out and as became apparent in the group meetings,

there is a strong caste system by rank in the military. This system

111

is formalized and in some ways reflects class factors of education

and income. This appeared to be a problem particularly for the men,

with the largest barrier between enlisted men and commissioned officers.
As one Lieutenant Colonel put it, "I don't want some E-S to see that I
have problems handling my kids. What if I have to give him orders

some day?"' At times this caste system seemed to result in some difficult
group dynamics. Usually the leaders' skill was able to resolve some

of these problems but the effect may have been to inhibit self scrutiny
for some parents. This may have particularly affected IPR groups where

the focus was more clearly on the parents' own emotional conflicts.

Participants' Subjective Comments Regardinggthe Program

Written feedback from the parents provided much useful qualitative
information about the program. Parents reported that the groups in
general helped them to: (I) understand and accept how their children
feel; (2) understand better their own feelings; (3) be firm in setting
limits; (4) learn to enjoy Spending time with their children again;

(5) appreciate and respect their children more; (6) let their children
be their own persons; (7) improve their relationships with their children;
and (8) feel more capable as a parent.

Parents identified the following elements of the groups as most
helpful: (1) doing the play sessions; (2) discussing them; (3) getting
feedback from the group leaders and other parents; and (4) seeing that
other parents are frustrated as well. Several parents in the integrated

Filial-IPR groups reported that the recall sessions were most helpful.

112
Those aspects of the groups which parents found most helpful in
real life situations were: (1) reflective listening; (2) allowing the
child to make some of his own choices and live with the consequences;
and (3) being able to set reasonable limits.

Feedback on each of the leaders was very positive. Comments

'showed appreciation of the leaders' "support, caring, understanding,‘

"acceptance," "non-judgmental attitudes," "useful and perceptive feed-

' and "competence

back," "willingness to accept feelings and empathy,‘
in dealing with children."

A great number of parents said they thought the program would be
improved if it lasted longer. Other suggestions for improvement
included more in-lab practice sessions and families from a broader
variety of backgrounds. Three persons indicated that they felt some
discomfort being grouped with families with different military rank.

A few persons in the Filial only groups indicated that they would have
liked the benefit of seeing themselves on the videotapes collected as
pretests and posttests.

Specific comments collected from parents in the Filial-IPR groups
recommended: (1) elimination of the inquirer role for parents; (2)

beginning recall sessions earlier; and (3) more recall sessions each

week.

Limitations and Suggestions for Future Research
1. A major limitation of the study was that it was only conducted
for four months. It is recommended that in future research the sessions

be carried on for six months or longer which is customary in Filial

113
Therapy. This would have allowed more time to measure the impact of
each method on child adjustment, parental acceptance, and affect
sensitivity. This particularly would have afforded parents more time
to benefit from stimulus vignettes and recall sessions and incorporate
learnings from them into their play sessions.

2. To‘gauge the full effect of IPR methodology on Filial Therapy,
it is recommended that leaders using IPR techniques have more experience
with them. Ideally, leaders should have the experience of learning~
from and teaching IPR techniques at least once before participating
in a research project measuring the impact of IPR. The same recommenda-
tion holds in terms of leader experience with Filial Therapy.

3. It is recommended that future research on these methods employ
several group leaders. With fewer leaders, interaction effects between
leaders could obscure differences between methods. The use of several
leaders will help control for differences in training and bias about
outcome. It is recommended that the experimenter in future studies
not be a group leader.

4. The small n of 27 means that relatively large differences
between methods must be found in order to establish significant treatment
differences. With a too small n size, it is more likely also that
chance factors can influence results so that you won't know if findings
are due to treatment or error. It also makes it impossible to assess
for differential effects upon specific personality types. IPR techniques
may work best with people who already have some facility in exploring

their own feelings. Or it may work best with or have the greatest impact

114

on people who-have difficulty expressing their feelings. It is
recommended that future research include a larger n and that the
differential effects on different personality types be examined.

5. It is recommended that in future research group leaders be
allowed some flexibility in determining when to introduce and use IPR
'techniques into the Filial groups.

6. Future research should examine the effects of introducing IPR
methods earlier or later in the course of the sessions. Some parents
requested that it start earlier, so as not to overlap with the begin-
ning of the at-home sessions, and/or find more time to experience
recalls.

7. Some of the difficulty assessing the full impact of IPR methods
may be related to the social structure of the military population. It
is recommended that the impact of IPR techniques on Filial Therapy be
studied on non—military families as well, and that future research on
a military pOpulation divide groups on the basis of rank or other
socio-economic indicators to determine if both traditional Filial and
integrated Filial-IPR groups benefit differentially from each method.

8. Another limitation of this study was the failure to directly
measure the skill of limit setting or to indirectly measure it by
other outcome measures than child adjustment. This failure may
particularly affect measurement of the impact of IPR techniques since
they seem valuable at helping parents discover and learn to deal with.

their fears of saying no to their children. For many parents, this is

llS
their most difficult area. It is recommended that some means of
measuring the impact of IPR on this skill be devised and included in

future research in this area.

APPENDICES

APPENDIX A.

PORTER PARENTAL ACCEPTANCE SCALE

APPENDIX A.
PORTER PARENTAL ACCEPTANCE SCALE
Father

Date Rater Mother (specify)
Other

 

 

 

We are trying to learn more about parent-child relationships. To
do this we need the cooperation and assistance of many parents. You can
help us a great deal by filling out the attached questionnaire as frankly
land as carefully as possible. Sincere and frank answers are requested
so that valid data can be secured.

You will note that the questionnaire does not call for any mark of
identification. Thus, your answers, as well as the many others, will be
absolutely anonymous. Furthermore, all of the responses will be treated
confidentially and will be used only for purposes of scientific research.

Please answer all questions. If you cannot give the exact answer
to a question, answer the best you can.

 

 

GENERAL INFORMATION
1. Sex: Male Female 2. Year of birth

3. Year of marriage

 

4. Living with spouse at present time: Yes No

5. Married more than once: Yes No

 

 

6. If married more than once, was previous marriage ended because of:

 

Death Divorce Other (please state)
7. Draw a circle around the number of years of schooling you have completed:

1 2 3 4 5 6 7 8 l 2 3 4 l 2 3 4 l 2 3 4
Grade School High School College Post-Graduate

8. Religious Affiliation:
Protestant Jewish None

Catholic Other (please state)

 

116

117
9. Was your childhood and adolescence, for the most part, spent in:
open country or village under 1,000
_____a town of 1,000 to 5,000
_____a city of 5,000 to 10,000
_____;a city of 10,000 to 50,000
_____a city of 50,000 to 100,000
_____e.city of 100,000 to 250,000
______a city of 250,000 or over
10. Present family income (annually):
______under $4,000
______$4,000 to $7,000
______$7,000 to $10,000
______$10,000 to $13,000
______$13,000 to $16,000
______$l6,000 to $25,000
______$25,000 or over

11. Husband's occupation (be Specific, such as Dairy Farmer, Drug Store
Clerk; College Professor, Auto Mechanic, etc.)

 

12. Wife's occupation:

 

13. Ages of children (to nearest birthday):

Ages of boys: ; ; ; ;

 

Ages of girls: ; ; ; ;

 

While responding to the following questions, please think of the one
child you are most concerned about.

Age of this child

Grade in school

BE SURE AND REFER ONLY TO THIS CHILD WHILE ANSWERING THE QUESTIONS.

118

Listed below are several statements describing things which children
do and say. Following each statement are five reSponses which suggest
ways of feeling or courses of action.

Read each statement carefully and then place a circle around the
letter in front of the ong_response which most nearly describes the feel-
ing you usually have or the course of action you most generally take when
your child says or does these things.

It is possible that you may find a few statements which describe a
type of behavior which you have not yet experienced with your child. In
such cases, mark the response which most nearly describes how you think
you would feel or what you think you would do.

Be sure that you answer every statement and mark only one reSponse
for each statement.

1. When my child is shouting and dancing with excitement at a time when
I want peace and quiet, it:

a. makes me feel annoyed; -

b. makes me want to know more about what excites him;

c. makes me feel like punishing him;

d. makes me feel that I will be glad when he is past this stage;
eu makes me feel like telling him to stop.

2. When my child misbehaves while others in the group he is with are
behaving well, I:

a. see to it that he behaves as the others;

b. tell him it is important to behave well when he is in a group;

c. let him alone if he is not disturbing the others too much;

d. ask him to tell me what he would like to do;

e. help him find some activity that he can enjoy and at the same
time not disturb the group.

3. When my child is unable to do something which I think is important
for him, it:

a. makes me want to help him find success in the things he can do;
b. makes me feel disappointed in him;

c. makes me wish he could do it;

d. makes me realize that he cannot do everything;

e. makes me want to know more about the things he can do.

4. When my child seems to be more fond of someone else (teacher, friend,
relative) than me, it:

a. makes me realize that he is growing up;

b. pleases me to see his interest widening to other peOple;

c. makes me feel resentful;

d. makes me feel that he does not appreciate what I have done for him;
e. makes me wish he liked me more.

119

When my child is faced with two or more choices and has to choose
only one, I:

a.

b.

tell him which choice to make and why;

think it through with him;

point out the advantages and disadvantages of each, but let
him decide for himself;

tell him that I am sure he can make a wise choice and help him
foresee the consequences;

make the decision for him.

When my child makes decisions without consulting me, I:

a.
b.

C.
d.
e.

punish him for not consulting me;

encourage him to make his own decisions if he can foresee the
consequences;

allow him to make many of his own decisions;

suggest that we talk it over before he makes his decision;
tell him he must consult me first before making a decision.

When my child kicks, hits, or knocks his things about, it:

(DD-00‘5”

makes me feel like telling him to stop;

makes me feel like punishing him;

pleases me that he feels free to express himself;

makes me feel that I will be glad when he is past this stage;
makes me feel annoyed.

When my child is not interested in some of the usual activities of
his age group, it:

CLO 0‘0)

makes me realize that each child is different;

makes me wish he were interested in the same activities;
makes me feel disappointed in him;

makes me want to help him find ways to make the most of his
interests;

makes me want to know more about the activities in which he
is interested.

When my child acts silly and giggly, I:

tell him I know how he feels;

pay no attention to him;

tell him he shouldn't act that way;

make him quit;

tell him it is all right to feel that way, but help him find
other ways of expressing himself.

10.

11.

12.

13.

14.

120

When my child prefers to do things with his friends rather than
with his family, I:

a.
be
C.

d.
e.

encourage him to do things with his friends;

accept this as part of growing up;

plan Special activities so that he will want to be with his
family;

try to minimize his association with his friends;

make him stay with his family.

When my child disagrees with me about something which I think is
important, it:

a.
b.
c.
d.
e.

makes me feel like punishing him;

pleases me that he feels free to express himself;
makes me feel like persuading him that I am right;
makes me realize he has ideas of his own;

makes me feel annoyed.

When my child misbehaves while others in the group he is with are
behaving well it:

makes me realize that he does not always behave as others in
his group;

makes me feel embarrassed;

makes me want to help him find the best ways to express his
feelings;

makes me wish he would behave like the others;

makes me want to know more about his feelings.

When my child is shouting and dancing with excitement at a time
when I want peace and quiet, I:

(DOaOU‘DJ

give him something quiet to do;

tell him that I wish he would st0p;
make him be quiet;

let him tell me about what excites him;
send him somewhere else.

When my child seems to be more fond of someone else (teacher,
friend, relative) than me, I:

a.

try to minimize his association with that person;

let him have such associations when I think he is ready for
them;

do some special things for him to remind him of how nice I am;
point out the weaknesses and faults of that other person;
encourage him to create and maintain such associations.

15.

16.

17.

18.

19.

121

When my child says angry and hateful things about me to my face,

it:

a.
b.
c.
d.
e.

makes me feel annoyed;

makes me feel that I will be glad when he is past this stage;
pleases:me that he feels free to express himself;

makes me feel like punishing him;

makes me feel like telling him not to talk that way to me.

When my child shows a deep interest in something I don't think is
important , it:

makes me realize he has interests of his own;

makes me want to help him find ways to make the most of this
interest;

makes me feel disappointed in him;

makes me want to know more about his interests;

makes me wish he were more interested in the things I think
are important for him.

When my child is unable to do some things as well as others in
his group, I:

(DQOU‘W

tell him he must try to do as well as the others;
encourage him to keep trying;

tell him that no one can do everything well;

call his attention to the things he does well;

help him make the most of the activities which he can do.

When my child wants to do something which I am sure will lead to
disappointment for him, I:

a.
b.
c.
d.
e.

occasionally let him carry such an activity to its conclusion;
don't let him do it;

advise him not to do it;

help him with it in order to ease the disappointment;

point out what is likely to happen.

When my child aCts silly and giggly, it:

(DO-00‘!!!

makes me feel thatinill be glad when he is past this stage;
pleases me that he feels free to express himself;

makes me feel like punishing him;

makes me feel like telling him to st0p;

makes me feel annoyed.

20.

21.

22.

23.

24.

122

When my child is faced with two or more choices and has to choose
only one, it:

a.

b.

c.
d.
e.

makes me feel that I should tell him which choice to make and
why ;

makes me feel that I should point out the advantages and
disadvantages;

makes me hOpe that I have prepared him to choose wisely;
makes me want to encourage him to make his own choice;

makes me want to make the decision for him.

When my child is unable to do something which I think is important

for him, I:

a. tell him he must do better;

b. help him make the most of the things which he can do;

c. ask him to tell me more about the things which he can do;
d. tell him that no one can do everything;

e. encourage him to keep trying.

When my child disagrees with me about something which I think is
important, I:

tell him he should not disagree with me;

make him quit;

listen to his side of the problem and change my mind if I am
wrong;

tell him maybe we can do it his way another time;

explain that I am doing what is best for him.

When my child is unable to do some things as well as others in
his group, it:

mmoo‘m

makes me realize that he cannot be best in everything;

makes me wish he could do as well;

makes me feel embarrassed;

makes me want to help him find success in the things he can do;
makes me want to know more about the things he can do well.

When my child makes decisions without consulting me, it:

makes me hOpe that I have prepared him adequately to make his
decisions;

makes me wish he would consult me;

makes me feel disturbed;

makes me want to restrict his freedom;

pleases me to see that as he grows he needs me less.

25.

26.

27.

28.

29.

123

When my child says angry and hateful things about me to my face, I:

a.

b.
c.
d.
e.

tell him it is all right to feel that way, but help him find
other ways of expressing himself;

tell him I know how he feels;

pay no attention to him;

tell him he shouldn't say such things to me;

make him quit.

When my child kicks, hits, and knocks his things about, I:

make him quit;

tell him it is all right to feel that way, but help him find
other ways of expressing himself;

tell him he should not do such things;

tell him I know how he feels;

pay no attention to him.

When my child prefers to do things with his friends rather than
with his family, it:

makes me wish he would Spend more time with us;

makes me feel resentful;

pleases me to see his interests widening to other peOple;
makes me feel he does not appreciate us;

makes me realize that he is growing up.

When my child wants to do something which I am sure will lead to
disappointment for him, it:

(LOUD)

8.

makes me hOpe that I have prepared him to meet disappointment;
makes me wish he did not have to meet unpleasant experiences;

makes me want to keep him from doing it;

makes me realize that occasionally such an experience will be

good for him;

makes me want to postpone these experiences.

When my child is not interested in some of the usual activities of
his age group, I:

try to help him realize that it is important to be interested
in the same things as others in his group;

call his attention to the activities in which he is interested;
tell him it is all right if he is not interested in the same
things; '
see to it that he does the same things as others in his group;
help him find ways of making the most of his interests.

30.

124

When my child shows a deep interest in something I don't think
is important, I:

a.
b.
c.
d.
e.

let him go ahead with his interests;

ask him to tell me more about this interest;

help him find ways to make the most of this interest;
do everything I Can to discourage his interest in it;
try to interest him in more worthwhile things.

THANK YOU VERY MUCH FOR YOUR COOPERATION.

APPENDIX B.

FILIAL PROBLEM LIST

APPENDIX B.

Date
Name of Rater

Relationship to Child

FILIAL PROBLEM LIST*

("FPL")

Information provided on this list is CONFIDENTIAL.

*The FPL was developed at the Individual and Family Consultation Center,

Pennsylvania State University, 1974, by Peter L. Horner, M.S. Items
were derived in part from Leventhal and Stollack's "Problem List,"

Children's Psychiatric Center, Inc., Eatontown, New Jersey.

125

126
INSTRUCTIONS

The following list describes a wide variety of problems children
often have. Please underline any item which you feel applies to your
child. Then, to the right of each item you underline, indicate how
serious a problem you feel this is by placing a l, 2, or 3 in the
blank provided: ' _

A.1 means -- "This item is true for my child, but it is not
really a problem."

A 2_means -- "This item is true for my child, and it is a mild
problem."

A 3_means -- "This item is true for my child, and it is a severe
problem."

 

EXAMPLES
If you underlined item 20, and you did not think it was
' really a problem, then you would place a'l in the blank
to the right, like this:
20. Bites nails 1
Or if you underlined the same item, but felt it was a
serious problem, then you would place 3.; in the blank to

the right, like this:

20. Bites nails 3

 

 

 

Please do NOT consult with your spouse; each parent should fill out
this form separately. If you have any problems completing this list,
please do not hesitate to call for assistance.

10.
11.
12.
13.
14.
15.
16.

17.

18.

19.

20.

21.

22.

23.

127

Eats too little 24.
Not eating the right food 25.
Wets bed at night 26.
Gets lower grades in 27.
school than should
Does not talk plainly, poor 28.
communication

29.
Shy with other children

30.
Too few friends
Feels inferior to other 31.
children
Picked on by children 32.
Has no self confidence 33.
Nervous, tense

' 34.

Sad, unhappy too often

35.
Cries too easily
Feels helpless 36.
Blames self too much 37.
Gets into trouble 38.
Destroys prOperty of 39.
others

40.
Steals

41.
Lies

42.
Bites nails

43.
Picks nose

44.
Always late, dawdles

45.
Difficulty falling asleep
or sleeping 46.

Troubled restless sleep
Slow in reading
Cannot keep mind on Studies

Does not pay attention to
teacher

Restless in class
Stomach cramps, aches

Headaches for no physical
reason

Feels different from other
children

Easily led

Left out by children of
own age

Never chosen as a leader

Is self-conscious about
own body

"Big Shot"

Gets angry too easily
Fear of darkness
Panics when afraid

Too easily discouraged
Breaks promises

Thumb sucking

Bad table manners
Untidy

Has bad dreams

Afraid to speak up in class

47.

48.
49.
50.
51.
52.
53.

54.

55.
56.
57.

58.
59.
60.
61.

62.

63.
64.

65.
66.
67.

68.

Fights too much with
children

Blows his top
Sulks, pouts
Gripes too much
Fear—ridden child
Unusual fears

Does not do chores

Takes advantage of
people

Disobeys parents
Not close to parents
Scratches self a lot

Swears, uses dirty -
language

Unable to keep to a
time schedule

Uses hands in poorly
coordinated way

Restless, can't stay in
one place

Non-athletic.

Does not like to go
to school

Does not spend enough
time in study

Not interested in books
Always wants revenge
Irritable child

Teases excessively

128
69.
70.

71.

72.

73.

74.

75.

76.

77.
78.
79.
80.
81.

82.

86.
87.
88.

89.

90.

Daydreams a lot
Gets too excited

Does not try to correct
bad habits

Too stubborn with parents

Continued demanding of
gifts, new things

Wants too much attention
from parents

Careless in own appearance

Careless with clothes and
belongings

Selfish, won't share
Does not complete work
Poor memory

Unsure of self in school

Has had a number of accidents

Plays too much with younger
children.

Bossy with brothers/sisters

Jealous of brothers/sisters

Preoccupied with own thoughts

Loses temper
IS erratic, unpredictable
No control over emotions

Fights back, talks back to
elders

Too dependent upon mother,
father

129
91. Inconsiderate of parents

92. Bumps into furniture, trips,
etc.

93. Watches TV all the time

94. Trouble adjusting to a new
school

95. Tries to get attention in
class

96. Fights brothers/sisters
97. Gets peOple angry, provokes

98. Loses own possessions
frequently

99. Gets completely out of
control

100. Oversensitive to criticism
from parents

101. Behind other children on
dressing

102. Feels bad about own physical
appearance

103. Elimination problems (e.g.,
diarrhea, constipation, gas,
holds urine, etc.)

104. Dangerous habits (describe)

105. Sex-related problems (e.g.,
"peeps," exposes self, etc.)

106. Physical tension problems (e.g.,
hives, ulcers, colitis, sweats,
nausea, dizziness, etc.)

107. Excessively passive, meek

108. Body movement problems (e.g., clumsy
in using legs, jerky movements, lazy,
apathetic, has no energy, head banging,
paralyzed,moves too slowly, has twitches,
rocks all the time, etc.)

130

In order to give us a more complete picture of your child, please
answer the following questions.

1. If there are any problems with your child which were not included
on the list, please note them here.

2. In your own words, write a brief description of your child's
personality.

3. What do you think the child's best attributes are?

Below are several questions about the list you have just filled out.
Your comments here will help us make the list more useful for other
parents. Thank you for your help.

1. About how long did it take you to complete this list?

2. Do you think this list gives a fairly good "picture" of your child?
If not, why not?

3. Other comments.

Parent's name Child's name

 

 

Child's age

ALL INFORMATION ON THIS LIST IS CONFIDENTIAL.

APPENDIX C.

CHECK LIST FOR PARENTS

Date

APPENDIX C.
CHECK LIST FOR PARENTS*
Father

Rater ~ Mother (specify)
Other

This is a list of things that parents have said about their children.-
You are to read each one and draw a circle around YES if it is true

or mostly true for your child, and draw a circle around NO if it is 325
true or mostly not true for your child. YOU MUST ANSWER EVERY QUESTION.
If more yes than no, answer YES. If more no than yes, answer NO.

EVERY QUESTION MUST BE ANSWERED.

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

No

No
No
No
No
No
No
No
No
No

No

No

No
No

No

1.

2.

10.

11.

12.

13.

14.

15.

16.

My child seldom finishes what he/she begins.

At the slightest upset, my child's coordination becomes
poor.

My child is learning under force at home.

He never seems happy, like other children.

My child does not seem to be learning as he should.

My child cannot conform to tasks in school.

My child says people don't like him.

My child gets over-excited in crowds.

Hitting and pushing other children are usually what he does.
My child cannot keep track of his toys and materials.

My child is a discipline problem, at home and in school.

My child is constantly irritable with the children he
plays with.

My child has nervous habits (like pulling at his clothes,
clearing his throat often, and snuffing his nose).

My child cannot make friends at school.

My child cannot get interested in anything.

My child has the habit of raiding the cupboard for forbidden
food.

 

*Developed at Wichita Guidance Center, Wichita, Kansas

131

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

No
No
No
No

No

No

No

No

No

No
No
No
No
No

No

No
No
No
No

No

No

17.

18.
19.
20.
21.

22.

23.

24.

25.

26.

27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.

38.

39.

132

My child refuses to pick up clothes and toys around the
house.

My child refuses to do things to help around the house.
On the whole, my child is rebellious and resentful.

My child lacks self-confidence.

Often I can see the tension building up in my child.

I can see that my child is becoming more unhappy all the
time.

My child cannot get along with my husband/wife.

My child's behavior is unpredictable; I never know what
he is going to do next.

My child is a very poor reader.

At times, my child seems to hate everybody who comes near
him. '

In most things, my child cannot keep up with other children.
Any change in the things around him disturbs my child.

My child is out of step with the way of life in our home.

At home, my child often refuses to answer when called.

My child is constantly irritable at home.

My child daydreams a great deal.

My child is driving his teacher mad.

He seems to have no regard for our warnings and instructions.
Discipline of any kind only makes him furious.

My child cries easily.

My child can only make passing grades.

Teachers complain that my child never finishes assignments

‘in school.

My child is not ready to do the work that is expected of him.

Yes

Yes
Yes

Yes

Yes
Yes
Yes

Yes
Yes

Yes

Yes
Yes
Yes

Yes

Yes

Yes

No

No
No

No

No
No
No

No
No
No
No
No

No

No

No

No

40.

41.
42.

43.

44.

45.

46.,

47.

48.

49.

50.

51.

52.

5'3.

54.

55.

133

My child becomes discouraged when he has to do something
on his own.

He often reacts with temper tantrums.
The teacher says that my child will not respond in class.

My child's grades are inconsistent; either real high or
real low.

My child has ability, but he won't use it.
My child feels I am picking on him.
Eating is a constant problem with my child.

My child seems driven by either a nervous energy or a
conflict to talk constantly.

My child has to have everything his way and if not, he is
at a complete loss.

You can hold my child's attention only a very Short time.

My child seems to be one of those children that just can't
do anything right.

My child frequently gets into things that he knows he
should not get into.

My child often does things to attract attention even though
he will be punished for doing it.

My child teases and torments the other children.

My child's jumping and moving around all the time worries
me.

They say my child is restless at school.

APPENDIX D.

VIDEOTAPE RATING SCALES

APPENDIX D.

VIDEOTAPE RATING SCALES

A. Communication of Acceptance

Verbal recognition and acceptance of feelings

Verbal recognition and acceptance of behavior only

Social conversation or no conversation

Slight or moderate verbal criticism stated or strongly implied

Verbal criticism: argumentative, "preaching,"

feelings or behavior, abusive language

open rejecting

B. Allowing the Child Self—Direction

1.

2.

Shows willingness to follow child's lead
Child has Option for lead-taking

Takes lead without giving child an Option
Directs or instructs child to do something

Persuades, cajoles, demands, pushes, interrupts, interferes
in child's activity, insists on new activity

C. Involvement

1.

Fully observant of child's behavior, adult gives no indication
of being aware of the child's behavior

High level of attention

Marginal attention: The adult is involved in his own independent
activity to a degree that interferes somewhat with attention to
child.

Partially withdrawn or preoccupied

Completely preoccupied, or self-involved, or shut off.

134

135
SCORING

A rating is made for every three-minute interval on a score sheet
as illustrated in Figure 1 below.

Scoring is retrOSpective for each three-minute interval for all
categories. Thus, in each case the coder enters a score which he thinks
'may qualify as highest or lowest for the three-minute interval as it
occurs, and changes as necessary during the remainder of the three-
minute interval. To obtain a total score for Communication of Acceptance,
highest and lowest scores are averaged. The lowest score only is entered

for the subscales Allowing Child Self-Direction and Involvement.

 

 

 

 

 

 

 

 

 

 

 

 

COMMUNICATION Score Highest Level 1 l 2 ' Score

OF ACCEPTANCE Score Lowest Level 2 3 2 fi/; : :15

ALLOWING SELF- Score Lowest Level 3 2 5 a 10

DIRECTION only

INVOLVEMENT Score Lowest Level ' 5 3 5 a 13
only .

The Videotape Rating Scale Scoring Sheet

Figure 1.

APPENDIX E.

THE APFECTIVE SENSITIVITY SCALE

 

APPENDIX E.
THE AFFECTIVE SENSITIVITY SCALE

Forms D & E

Instructions

 

You will be viewing short scenes of actual encounters between two
or more individuals. You are to identify what feelings the peOple have
about their concerns or toward the person they are working with.

Although in any one scene the persons may exhibit a variety of
feelings, for the purpose of this instrument you are to concentrate
on identifying their last feelings in the scene.

After you view each scene ask yourself:

If the peOple involved were to view this same
scene, and if they were completely Open and
honest with themselves (i.e., if they could
identify their real feelings) how would they
describe their feelings?

After you decide which response comes closest to what the people are

feeling, whether about their concerns or the other person they are with,
fill in the space provided on your answer sheet.

136

137

Sample Items

 

Scene 1-1 FORMER TEACHER-4TH GRADE STUDENT
SETTING: INFORMAL ENCOUNTER, DISCUSSING AN EARLIER INTERVIEW

Opening statement (teacher): "When we talk, we normally touch
each other."

Closing statement (teacher): "You said something that really made
‘ me feel good, and I wanted to hug."

Time: 50 seconds
ITEM 1. WHAT IS THE STUDENT FEELING AT THAT POINT?
a. I'm sorta uncomfortable and uptight. I'm embarrassed.
b. I'm feeling comfortable now.
c. I'm not feeling much of anything.
ITEM 2. WHAT IS THE STUDENT FEELING ABOUT THE TEACHER AT THAT POINT?
a. I'm afraid. I don't want to be touched right now.
b. I feel good about you. I'd like to hug you, too.
c. I'm really scared. What are you going to do next?
Scene 1-2 FORMER TEACHER - 4TH GRADE STUDENT
SETTING: INFORMAL ENCOUNTER, DISCUSSING AN EARLIER INTERVIEW

Opening statement (teacher): "Did you feel it was different?"

Closing statement (teacher): "We didn't sit on pillows this time,
did we?"

Betsy (student): "No."
Time: 25 seconds
ITEM 3. WHAT IS THE STUDENT FEELING AT THIS POINT?
I'm a little happier now, but not much.

I wish we had brought some pillows. I would have liked that.
c. I'm really uncomfortable, but I'm scared to show it.

0“”

ITEM 4. WHAT IS THE STUDENT FEELING ABOUT THE TEACHER AT THIS POINT?

I'm still not really relaxed. I still don't trust you.
I'm relieved. She didn't change the subject.
c. I feel safe now. We like each other.

0‘03

APPENDIX F.

LETTER TO PARENTS

APPENDIX F.

LETTER TO PARENTS

March 31, 1980

'Dear

AS you know, you have been selected to participate in the Parent
Play Therapy Program. As I explained to you, you will also be
participating in a research project. We are trying to discover the
most effective ways to teach parents play therapy skills.

We need your help in this endeavor. Would you please complete
the enclosed forms and bring them with you to the first group meeting
next week? On the forms which ask you about your children, fill out
the forms for the child whose behavior or problems are of the greatest
concern to you. If both parents are participating in the program, be
sure that both parents fill the form out for the same child, even if
you intend to spend weekly play therapy time with more than one child.
When both parents are participating, be sure to complete the forms
independently. Do not discuss the answers with your partner until
after you have turned your forms in.

In addition, please read and sign the Parent Consent form. If
you have questions or concerns regarding the form, please contact me
individually or raise them in the first meeting.

I will contact you again this week to notify you of the day, time,
and place of your regular group meeting. Thank you for your coOperation.

(Sincerely,

Chris G. Dematatis

Program Director

Parent Play Therapy Program

517-7171 or 664-6047 (days)

765-1950 (evenings)
Enclosures

138

APPENDIX G.

PARENT CONSENT FORM

APPENDIX C.
PARENT PLAY THERAPY PROGRAM
Parent Consent

l. I understand that participating in the Parent Play Therapy Program

at the Dewitt Army Hospital at Ft. Belvoir, my child and I will also be
participating in a research project. Data obtained from questionnaires
or educational or training sessions will be employed for evaluation and
'research purposes.

2. I also understand that audio or video taping of the sessions in
which I participate will be played for the purposes of research data
collection. ‘

3. No names or descriptions of families or individuals will be made in
reporting results of the research in a manner that would permit a
reader to identify anyone concerned.

4. Participants have the Opportunity to assist training of a few other
professionals by allowing the investigator to use the data and tapes
for this purpose. Presentation to a larger group will require a signed
consent for this Specific purpose.

5. The Parent Play Therapy Program has been outlined in detail for me
along with a description of the benefits to be expected from the program
and any alternative procedures that may be more advantageous for the
participant. Furthermore, I understand that I am free to withdraw my
consent and to discontinue participation at any time.

6. I understand that there will be a cost of approximately $50.00 for
materials for this program, that this cost must be paid by me and is
not reimbursable from federal funds, and that I am responsible for
obtaining the materials directly from the supplier.

7. Any questions I may have had concerning this project have been
answered satisfactorily. I agree to full participation in the Parent
Play Therapy Program and authorize the project to use research data
and tapes for such purposes.

 

 

Date Signature of Mother

 

 

Date Signature of Father

Participating Children

 

 

139

APPENDIX H.

PLAYROOM GUIDELINES FOR PARENTS

APPENDIX H.

PLAYROOM GUIDELINES FOR PARENTS

Introductorngessagg

, this is a very special room. You can do almost anything
you want to do in this room. If you cannot do something, I will tell you.

 

Departing Messagg

 

Give two time warnings as to the session's end. One time warning is
to be given at five minutes before the end of the play time and the
last warning is to be given at one minute before the end.

Examples: "Johnny, we have (five, one) minute(s) more to play today."

At the end of the play time, firmly, but pleasantly say: "Our
time is up for today. We have to leave now."

Resistance: If the child is reluctant to leave the room, reflect
his feelings and restate that the session is ending. Use your
body and voice to stress your message and insistence:

1. Stand straight up from your kneeling position on his level.

2. Take him gently by the shoulder and guide the child in the
direction of the door.

3. Go directly to the door and Open it.

4. Change the tone of your voice from acceptance to a firm and
clear intention.

Remember first to reflect the child's feelings before attempting
to enforce his leaving.

Limits

Definition

 

A limit is a rule or guideline for behavior which is defined and enforced
by imposing consequences or results if the limit is broken.

Rationale

Children need help to define their boundaries and to feel safe and yet
able to explore their environment and to try out more adult behaviors.

140

141
Children learn that what happens to them is a direct consequence of
their behavior. They can begin to take responsibility for their actions
by the prOper use of limits and consequences.
Guidelines to consider before makigg a limit
1. Is this limit necessary for the safety of the child?
2. Is this limit necessary for the safety of others?
3. Is this limit necesSary for the protection of valuable prOperty?
4. IS this limit enforceable?
Reasons for settinggas few limits as possible

1. Children cannot be expected to remember a great number of rules.

2. If few bounds are imposed, the child can explore the situation as
much as possible and he can lead the way.

3. Since consistency is important (you want to be viewed as a person
who does what he says), the fewer the limits imposed, the more
likely it is that the limits will be enforced every time they are
broken.

Steps in setting limits

1. Determine if a limit is necessary. Limits in the playroom are:

a. Nothing should be thrown at the mirrors, camera, or windows.
b. No crayons On the blackboard.

c. No sharp objects or kicking should be directed to the bop bag.

d. The room should not be left during the session except for one
trip to the bathroom.

a. M§§§_destruction of the toys is not allowed.
Leaving the room for a bathroom trip:

a. Reflect the need.

b. State the limit.

c. Structure the leaving.

142
Example: "Johnny, you want to go to the bathroom." (reflection)

"You can only leave this special room when you want to go to
the bathroom. We can leave now." (stating the limits as to
when leaving is allowed)

Upon re-entry into the room, reintroduce the child to the
situation: "We are now in the special room again.“

The bathroom trip can be avoided mainly by structurigg the situation
before the session begins by simply asking the child if he needs to go
to the bathroom.

 

2. State the limit to the child.
a. Be brief and clear.

b. Phrase the limit in a forceful but pleasant tone. Change your
voice from the acceptance level to one of authority.

c. In this order, catch the child's attention; reflect his desire
to do the prohibited action; than state the limit.

Example: "Billy, you want to hit the mirror with the dart. Remember,
I told you if there was something you couldn't do, I would
tell you? One of the things you cannot do in this room is
shoot darts at the mirror."

d. Next, give the child an alternative structure to allow him to
Open up again and redirect his own play.

Example: "One of the things you cannot do is shoot the dart at the
mirror, but you can shoot it almost anywhere else in the room."

This statement provides a limit and a Structure without restricting
play too much and allowing the child to make his choice as to where
to shoot the darts.

e. If the child persists in asking why, reflect his question,
and then answer him with a simple reason.

Example: "You want to know why you cannot shoot the mirror. Because
it might break. If the mirror breaks, it will cost too much
money to be replaced."

3. Warning.

If the child breaks the limit you have just set (the second time this-
occurs in the session), remind him of the first warning and redestablish

143

the limit and state what will happen if the limit is broken again. A
warning is given so that the child knows beforehand what will happen
if he breaks the limit and can decide for himself whether he will risk
the consequences.

Example: "Johnny, remember I told you that you could not shoot the
darts at the mirror? If you shoot the darts at the mirror
again today, we will have to end the play time for today."

4. Enforcement of consequences

Restate the rule and follow through with the consequence you warned him
about. Use a firm but pleasant tone. Perhaps stand up immediately or
guide him to the door to help him clearly distinguish your insistence
that he now leave because he has broken a limit.

Example: "Johnny, remember I told you if you shot the mirror again,
you would have to leave the play room for today? Since you
choose to shoot the mirror, we have to leave today right now."

A child will begin to learn that he is responsible for what happens to

him when he makes a choice to break a limit when he has been warned

previOusly and knows what the result will be.

For each subsequent session, start at the warning stage and progress to
enforcement of consequences if necessary. For only the first time, do
you state the limits. After each limit is Stated when it comes up, go
to the warning stage.

 

APPENDIX I.

TOYS FOR THE PLAYROOM

APPENDIX I.

TOYS FOR THE PLAYROOM
Inflated plastic bop bag (at least four feet high)
Dart gun with darts
Rubber knife
Non-hardening modeling clay
Plastic cowboys, Indians, soldiers
Family of puppets
Doll family (mother, father, brother, sister, baby)
Baby bottle
Bowl for water
Crayons, paints
House box for doll furniture and family
Cups and saucers
Drawing paper

Tinker toys or similar construction toys

14:.

APPENDIX J.

COMMENTS ON PARENT PLAY THERAPY PROGRAM

‘4

‘Q

APPENDIX J.

COMMENTS ON PARENT PLAY THERAPY PROGRAM

Please complete the sentences below with a brief comment.

10.

ll.

12.

The course helped me to
I think I got the most from the
It would have been more helpful if

One thing I learned from the play sessions that I think is useful
in real life is

I would like to have had more

The best thing about the leader was

It would have been better if the leader had

I felt that my child regarded the play sessions as

The course would be improved if

If a friend or neighbor asked me about the class, I would

Insofar as change in my relationship with my child goes, I would
say that it has

Additional comments please. Use back side if necessary.

145

BIBLIOGRAPHY

BIBLIOGRAPHY

 

Albee, G. W. Conceptual models and manpower requirements in psychology.
American Psychologist, 1968, 23, 317-320.

Allen, K. E. and Harris, F. R. Elimination of a child's excessive
scratching by training the mother in reinforcement procedures.
Behavior Research and Therepy, 1966, 4, 79-84.

Andronico, M. P., Fidler, J., Guerney, Jr., B. G., and Guerney, L. F.
The combination of didactic and dynamic elements in filial therapy.
International Journal of Group Psychotherapy, 1967, 10-17.

Archer, Jr., J. Undergraduates as Para:professional Leaders of Inter-
personal Training Groups Using an Integrated IPR (Interpersonal
Process Recall) Videotape Feedback/Affect Simulation Training
MOdel. Unpublished doctoral dissertation, Michigan State
University, 1971.

, Fiester, T., Kagan, N., Rate, L., Spierling, T., and
Van Noord, R. New method for education, treatment and research in

human interaction. Journal of CounselinggPeychology, 1972, 19,
275-281.

 

Axline, V. M. Play Therapy. Boston: Houghton-Mifflin, 1947 and 1969
(3rd ed.)

 

. Therapeutic play techniques: play therapy procedures
and results. American Journal of Orthopsyehiatry, 1955, 25,

 

Baldwin, A. L. The effect of home environment on nursery school behavior.
Child Development, 1949, 20, 49-61.

, Kalhorn, J., and Freese, F. H. Patterns of parental
behavior. Psycholoiical Monograph, 1945, 58, (whole no. 268).

 

 

Baumrind, D. Child care practices anteceding three patterns of pre-
school behavior. Genetic Psyehology Monographs, 1967, 75, 43-86.

 

Becker, W. C., Peterson, D. R., Hellmer, L. A., Shoemaker, D. J., and
Quay, H. C. Factors in parental behavior and personality as

related to problem behavior in children. Journal of Consulting
Psychology, 1959, 23, 107-118.

 

146

147

Becker, W. C., Peterson, D. R., Luria, 2., Shoemaker, D. J., and
Hellmer, L. A. Relations of factors derived from parent inter-
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