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AN OBSERVATIONAL ANALYSIS OF DEMOGRAPHIC CHARACTERISTICS,
PERSONALITY PROFILES, AND PERCEIVED PROBLEM-SOLVING

SKILLS OF ADOLESCENTS IN THERAPEUTIC FOSTER CARE

BY

Charlene Crickon Kushler

A DISSERTATION

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

DOCTOR OF PHILOSOPHY

Department of Counseling Psychology, Educational
Psychology, and Special Education

1991

ABSTRACT

AN OBSERVATIONAL ANALYSIS OF DEMOGRAPHIC CHARACTERISTICS,
PERSONALITY PROFILES, AND PERCEIVED PROBLEM-SOLVING
SKILLS OF ADOLESCENTS IN THERAPEUTIC FOSTER CARE

BY

Charlene Crickon Kushler

An observational analysis was performed on 41
adolescents placed in therapeutic foster care, a
relatively’ new 'treatment setting. Data. were obtained
using the Millon Adolescent Personality Inventory, the
Personal Change Questionnaire, and a demographic survey.

Frequency data examined revealed that the majority of
adolescents in therapeutic foster care were Caucasian
females who were temporary wards of the court or state.
More than 40% of the adolescents had a history of
psychiatric or residential treatment and had been in more
than one previous foster care placement. The length of
placement in therapeutic foster care averaged close to
1 year.

Research questions focused on the personality
profiles and perceived problem-solving skills of the

adolescents in that setting, as well as the relationship

Charlene Crickon Kushler

of those variables to the length of time in treatment.
The results indicated the predominance of certain
personality styles among the adolescents placed in
therapeutic foster care. In particular, the adolescent
females most frequently evidenced a Passive-Aggressive
personality style. The second most prominent styles were
equally divided among the Avoidant, Histrionic, and
Compulsive personality styles. The male adolescents’ most
common personality styles were Passive-Aggressive and
Antisocial. A significant positive correlation was found
between the Compulsive personality style and length of
time in treatment.

No correlation was found between the adolescents’
perceived problem-solving skills and length of time in
treatment. There was a significant correlation between
therapist rating of client functioning and time in
treatment. Furthermore, a significant positive relation-
ship existed between perceived problem-solving skills and
age. Additional significant positive correlations were
found between the Narcissistic and Histrionic personali-
ties and certain perceived problem-solving skills. A
significant negative correlation was found between the
Avoidant personality and all four of the problem-solving

scales.

Charlene Crickon Kushler

A discussion and interpretation of these findings
were presented. Implications of these results include the
possibility of using personality testing for screening
candidates for this treatment modality and the potential
desirability of introducing a problem-solving skills
training component to therapeutic foster care. Directions

for further research were offered.

In loving dedication to my husband, Martin Gregory,

and our daughter, Jessica Nicole.

ACKNOWLEDGMENTS

In hindsight, I feel like my doctorate has been a
lifetime in the making. I wish it were possible to
acknowledge all of the people along the way who had an
impact on my life.

This dissertation has been the product of the
support, encouragement, and guidance of some very special
people. I would like to begin expressing my gratitude by
thanking the faculty who served as my committee: Dr. Bill
Hinds, Dr. John Schneider, Dr. Dick Johnson, and Dr. James
Snoddy. Without their patience and guidance, this
research endeavor would not have been possible. In
particular, I would like to thank Dr. Bill Hinds, my
committee chair, for his continuous encouragement,
support, and direction in developing the study and shaping
the dissertation. His faith in my work provided an anchor
for me throughout the process.

In addition, I feel indebted to Dr. Linda Forrest,
who gave me emotional support in persevering in the
program and inspired me with a new framework for looking
at life.

I would like to offer a special thanks to Dr. Joel

Kelley, who not only provided me with a research

vi

instrument but also gave me emotional support in
weathering the dissertation process, as well as Dr. Bonnie
Fons, who graciously shared her knowledge and time.

A special recognition needs to be given to Alice
Kalush, Sue Cooley, Douglas Miller, and Richard Brown, who
lent their professional expertise to this project.

Any acknowledgment would not be complete without
expressing heartfelt thanks to my parents, Virginia and
Charles Crickon, for providing me with the love of reading
and the value of education that brought me this far. It
would also like to express my gratitude to my mother and
Kym for providing my daughter with mother-substitutes
during the many hours I was wrapped up in this
dissertation process, and to Judy, Anne, and those
relatives and friends who offered support and
encouragement along the way.

Finally, and most importantly, I would like to
express my deepest love and appreciation to my husband,
Marty, and our daughter, Jessie, who experienced many
sacrifices so that I could pursue this doctorate. To
Marty: Thank you for sharing my life--the emotional
upheavals, the arduous tasks, and all the effort, none of
which could ever culminate in a finding more significant
than you. To Jessie: I hope this effort in some way has
a positive influence on your life, the way you have given

meaning to mine.

vii

TABLE OF CONTENTS

LIST OF TABLES . . . . . . . . . . .

LIST OF GRAPHS . . . . . . . . . . .

Chapter
I. INTRODUCTION TO THE STUDY . .

Background . . . .
Need . . . . . . . .
Purpose . . . . . . .
Research Questions .
Theory . . . . . . . . .
Summary and Overview . .

II. REVIEW OF RELATED LITERATURE

Review of the Literature on
education . . . . . . . .
General Skills Training .
Specific Skills Training

Review of the Literature on
Solving . . . . . . . . .
Personal Paradigm Shift .

Review of the Literature on
Foster Care . . . . . . .

Summary . . . . . . . . . .

III. METHODOLOGY . . . . . . . . .

Sample . . . . . . . . . .
Population . . . . . . .
Sample-Selection Criteria
Description of the Sample

Procedures . . . . . . . .

Instrumentation . . . . . .

The Millon Adolescent Person

Inventory . . . . . . .

viii

Therapeutic

< o o o o o

0 Po. 0 o o o o

Page
xi

xii

UitOmmUIH H

17
20
23

26
38

43
47

49

49
49
50
51
52
54

54

The Personal Change Questionnaire
Survey . .
Design . . .
Data Analysis
Summary . . .

IV. DATA ANALYSIS . . . . . . . . . . . . . .

Results . . . . . . . . . . . . . . . .
Descriptive Survey Results . . . . .
Results Regarding Personality Profile

of Adolescents in Therapeutic
Foster Care . . . . . . . . . . . .
Results Regarding Awareness of
Elements Necessary for Problem
Solving . . . . . . . . . . . .
Results Regarding Possibility of a
Correlation Between Personality
Profiles and Length of Time in
Therapeutic Foster Care . . . . .
Results Regarding Possibility of a
Correlation Between Length of Time
in Therapeutic Foster Care and
Awareness of Problem-Solving
Elements . . . . . . . . . . .
Results Regarding the Possibility of
a Correlation Between Personality
Profiles and Awareness of Problem-

Solving Elements . . . . . . . . .
summary 0 O O O O O O O O O O O O O 0
Descriptive Data . . . . . . . . .

Personality Profile . . . . .
Perceived Problem-Solving Skills
Correlation of Time in Therapeutic
Foster Care With Personality
Profiles . . . . . . . . . . . . .
Correlation of Time in Therapeutic
Foster Care With Perceived Problem-
Solving Abilities . . . . . . . . .
Correlation of Personality Profiles
With Perceived Problem-Solving
Abilities . . . . . . . . . . . . .

V. SUMMARY AND CONCLUSIONS . . . . . . . . .
Review of the Study . . . . . . . . . .

Conclusions Regarding Demographic
Variables . . . . . . . . . . . . . .

ix

Page
67
73
74
75
76
77
78
78
79

104

111

111

113
114
114
115
115

116

116

116
118
118
119

Page

Conclusions Regarding Personality

Prefile O O O O O O O O O O O O O O O 120
Conclusions Regarding Self-Rating of
Problem-Solving Skills . . . . . . . 127

Conclusions Regarding the Relationship

Between Length of Time in Thera-

peutic Foster Care and Personality . . 129
Conclusions Regarding the Relationship

Between Length of Time in Therapeutic

Foster Care and Perceived Problem-

Solving Abilities . . . . . . . . . . 133
Conclusions Regarding the Relationship

Between Personality and Perceived

Problem-Solving Abilities . . . . . . . 135
Implications of the Results for Theory

and for Therapeutic Foster Care

Programs . . . . . . . . . . . . . . . 137

Implications for Future Research . . . . 140

Exploratory Research . . . . . . . . . 140

Longitudinal Research . . . . . . . . . 140

Outcome Research . . . . . . . . . . . 141

Limitations of Observational Studies. . 142

APPENDICES

A. THE MILLON ADOLESCENT PERSONALITY

INVENTORY O O O O O O O O O O O O O O O O 1 4 4

B. THE PERSONAL CHANGE QUESTIONNAIRE . . . . . 147

C. THE SURVEY . . . . . . . . . . . . . . . . 152

REFERENCES . . . . . . . . . . . . . . . . . . . . 153

Table

LIST OF TABLES

Perceived Problem-Solving Abilities .

Correlations of Length of Time in Thera-

peutic Foster Care With MAPI Scales .

Correlation of Length of Time in Thera-
peutic Foster Care With the Personal

Change Questionnaire . . . . .

Correlation of Age of Adolescent With the

Personal Change Questionnaire .

xi

0

Page

109

111

112

113

Graph

1.

lo.

11.

12.

13.

14.

Comparison of
Scale . .

Comparison of
Scale . .

Comparison of
Scale . .

Comparison of

Comparison of
Scale . .

Comparison of
Scale . .

Comparison of
Scale . .

Comparison of
Scale . .

Comparison of
Scale . .

Comparison of

LIST OF GRAPHS

Results

Results

Results

Results

Results

Results

Results

Results

Results

Results

Esteem Scale . . .

Comparison of Results
scale 0 O O O I 0

Comparison of Results
Acceptance Scale .

Comparison of Results
Scale . . . . . .

Comparison of Results
ance Scale . . . .

xii

on the Introversion

on the Inhibited

on the Cooperative

on the Sociable Scale

on the Confident

on the Forceful

on the Respectful

on the Sensitive

on the Self-Concept

on the Personal

on the Body Comfort

on the Sexual

on the Peer Security

on the Social Toler-

Page

81

83

84

86

88

90

91

93

95

96

97

98

100

101

15.

16.

17.

18.

19.

20.

Comparison of Results
Scale . . . . . .

Comparison of Results
Confidence Scale .

Comparison of Results
Control Scale . .

Comparison of Results
formity Scale . .

Comparison of Results
Achievement Scale

Comparison of Results
Consistency Scale

xiii

on the Family Rapport

on the Academic

on the Impulse

on the Social Con-

on the Scholastic

on the Attendance

Page

102

103

105

106

107

108

CHAPTER I

INTRODUCTION TO THE STUDY

This chapter begins with a brief historical overview
of the evolution of therapeutic foster care, culminating
with the legislation that has defined the focus of this
type of treatment program. Following this explanation is
a description of the need as well as its purpose. Because
this is an observational analysis rather than an
experimental design, the focus for this study is provided
through five research questions that attempt to define and
describe the therapeutic foster care population.
Additionally, a brief overview is provided of the three
major theories underlying this study: psychoeducation,
problem. solving, and ‘therapeutic foster care as a
treatment modality. Finally, a summary concludes this

chapter.

W
From their inception and throughout their history,
foster care placements have fluctuated between a custodial
and a treatment orientation. The concept of foster care
dates back to the Elizabethan Poor Law of 1601, when the

colonies stipulated the' local care of the needy.

Specifically, the law allowed for the apprenticeship of
needy children to promote training aimed at being self-
supporting in adulthood.

This benevolent intention was translated
pragmatically into the "binding out" or indenturing of
orphaned, neglected, or destitute children, a practice
that originated in England (Cox & Cox, 1985). In addition
to indenturing, some communities also used vendue, which
was the auctioning off of children to individuals who
claimed they would care for the children for the lowest
price (Cox & Cox, 1985). Thus, initially, this arrange—
ment was of a custodial nature, with the children provid-
ing a source of labor to the families in whose homes they
were placed.

Although the binding out of children provided support
for the majority of children in need, by the mid- to late
eighteenth century, large cities had begun to maintain
almshouses, a precursor to institutionalization of
dependent children. Because the conditions in these
houses were often deplorable, resulting in a mortality
rate in the 1800s of 80% to 90%, philanthropic and
religious groups began sponsoring private orphanage
asylums (Cox & Cox, 1985). By the 18305, these private
childcare institutions had replaced the indenture system.

In the years prior to the Civil War, a new type of

childcare institution began to emerged. These facilities

were called reformatories and were created for the
placement of juvenile offenders. Rehabilitation rather
than custodial care was emphasized. This laid the
foundation for the treatment orientation of present-day
childcare institutions. The plan at that time was to
release the children after one or two years of treatment
to be apprenticed to rural families. State Boards of
Charity emerged at that time to supervise these childcare
arrangements (Cox & Cox, 1985) . However, this treatment
orientation was short-lived. Following the Civil War, an
immense number of children were orphaned and displaced,
resulting in a shift once again to merely custodial care.

However, the social reform movement of the 19005
precipitated a change from relief to prevention. Charles
Loring Brace founded the Children’s Aid Society, which
advocated the use of foster homes, promoted the "science"
of child placement, and emphasized attention to the needs
of the child (Cox & Cox, 1985). As part of the reform
movement, legislation was passed that outlawed the
placement of children in almshouses. Private charity
organizations flourished, and denominational foster care
homes emerged. In 1909, President Theodore Roosevelt
convened the first White House Conference on Children,
which encouraged the shift from institutions to foster

home placements. By 1920, the Child Welfare League of

America had been formed to supervise the standards of
childcare.

Although the Social Security Act of 1935 established
child welfare services, federal money was not available
until 1947. The government actually did not grant any
significant funding for foster care until 1961. This was
immediately followed in 1962 by a change in the definition
of child welfare services to include prevention and
rehabilitation. However, this shift to a treatment
orientation was short-lived. In 1967, the emphasis
reverted to tangible, custodial services rather than
counseling. The literature offers no explanation for this
change in orientation (Cox & Cox, 1985).

Foster care as a treatment tool resurfaced in 1971

with the publication of Foster Care of Children: Nurture
a ea t, published by the U.S. Department of Health,

Education, and Welfare. In 1975, the Child Welfare League
of America continued this orientation in its Standards for

0 Se ' es. Under "Objective and Purpose," it
stated:

The ultimate objectives of foster family services
should be the promotion of healthy personality
development of the child, and the amelioration of
problems that are personally or socially
destructive. . . . Foster family care should provide,
for the child whose own parents cannot do so,
experiences and conditions that promote normal
maturation (care), prevent further injury to the
child (protection), and correct specific problems
that interfere with healthy personality development
(treatment).

This clear statement of the treatment intent of
foster care was followed in 1975 by the creation of Title
XX, which authorized the following (Cox & Cox, 1985):

a. community-based prevention and rehabilitation
services:

b. prevention and reduction of inappropriate insti-
tutional care;

c. referral to institutional care when appropriate.

Elements (a) and (b) of Title XX form the foundation
for the emergence of therapeutic foster care, a community-
based prevention/rehabilitation program aimed at minimiz-
ing inappropriate institutional care. Beginning in the
late 19705, therapeutic foster' care 'treatment. programs

started to appear in the literature.

Need

The :most recent. national statistics indicate ‘that
approximately 396,000 children are in foster care homes
(Cox & Cox, 1985). The proportion of adolescents within
this population has doubled in the past few years from 24%
to 49% (Timberlake & Verdieck, 1987).

Timberlake and Verdieck (1987) offered explanations
for the phenomenon of a higher representation of adoles-
cents in foster care:

1. A larger number of children enter foster care at

an early age and remain through adolescence.

2. A decrease in external family supports and
social-control influences make out-of-home placements
necessary for this age group.

3. An increased willingness appears to exist for
parents to turn "problem" adolescents over to social
service agencies.

4. Delinquent adolescents are being diverted into
the child care system.

This last point is part of a more basic trend of
deinstitutionalization that has emerged in the mental
health field in recent years. Within the past decade, the
mandate to locate the least restrictive setting has
resulted in a diversion of adolescents from correctional
and psychiatric facilities into newly created therapeutic
foster homes (Hawkins, Meadowcraft, Trout, & Imster,
1985). These diverted adolescents are prime candidates for
a treatment-oriented foster care program.

The therapeutic foster care programs that began to
emerge in the late 19705 revolve specifically around a
treatment component for foster care. The literature makes
reference to a 75% to 82% success rate, which is neither
defined nor quantified (Webb, 1988).

Specific delineation of the characteristics of this
population or definitive criteria for appropriate
referrals to these programs have been lacking in the

literature. Host descriptive statements merely note that

these children have "behavioral or emotional problems."
The question then becomes which children constitute
appropriate referrals to therapeutic foster care, i.e.,
who is supposedly being successfully served by these
programs? Profiles of this population are lacking.
Identifying who is being served by therapeutic foster
care programs would provide a foundation for later
research into the efficacy of this treatment strategy and
would ensure the appropriateness of referrals based on the
evaluation of who benefits from this form of intervention.
Quality assurance rests on the ability to evaluate program
effectiveness. However, quality assurance cannot be
ascertained when the population is ill-defined, leaving
the targeted behaviors for change not clearly enumerated.
Evaluation of a particular program’s effectiveness and
justification for the choice and high expense of
therapeutic foster care as a treatment option necessitate
specificity of the characteristics of those children
benefiting from this modality. The literature regarding
therapeutic foster care describes each programs'
functioning without performing an analysis of the
population itself. An observational analysis of
adolescents currently in therapeutic foster care could
reveal some distinguishing patterns and could
differentially identify factors that correlate with

successful treatment and subsequent placement.

ose

The primary purpose of this study was to ascertain
certain characteristics of the adolescents served by
therapeutic foster' care jprograms. To accomplish this
task, selected therapeutic foster care programs were
examined with the intention of identifying characteristics
of the adolescents in placements. This examination
included assessing the personality profile of the children
as well as examining the effect of treatment by measuring
their performance on a personal change questionnaire.
Finally, attempts were made to identify factors that

correlated with length of stay in placement.

Resear ue 1on5

1. Is there a personality profile of adolescents in
therapeutic foster care?

2. Are adolescents in therapeutic foster care aware
of elements necessary for personal change or problem
solving?

3. What is the correlation between personality pro-
files and length of time in therapeutic foster care?

4. What is the correlation between length of time in
therapeutic foster care and awareness of personal change

or problem-solving elements?

5. What is the correlation between personality pro-
files and awareness of personal change or problem-solving

elements?

Theory

This section contains an overview of the three major
theories that underlie this study: psychoeducation,
problem solving, and therapeutic foster care. The section
begins with a macroscopic theoretical perspective by
outlining the broad field of psychoeducation. This
discourse narrows to discuss a specific psychoeducational
intervention model, the problem-solving approach, which
can be applied in various treatment settings. Finally,
the theory behind therapeutic foster care is explored to
help in understanding the treatment program selected for
this study.

Psychoeducation entered the mental health scene 35
years ago, emerging from the theoretical coupling of the
fields of education and psychology (Sanford, 1955).
Withstanding the tests of time and professional scrutiny,
psychoeducation has gained legitimacy as an assessment and
intervention strategy (Authier, Gustafson, Guerney, &
Kasdorf, 1975; Goss, 1964; Guerney, Guerney & Stollak,
1971/1972: Larson, 1984: Masher & Sprinthall, 1971:

Miller, 1969).

10

The crux of this new model has been to provide a
teaching format for the delivery of human services. In
particular, the practitioner and client focus on the
development of personal and interpersonal skills and
attitudes that the client could apply to resolve present
and future psychological problems (Guerney et al., 1970).

Inherent in the psychoeducational approach are three
basic assumptions (Larson, 1984):

l. The practitioner is a teacher of the client.
Therefore, therapeutic intervention is seen as a learning
process (Guerney et al., 1970, 1972).

2. The client’s problems are viewed as a skill
deficit or lack of competency that can be overcome with
training.

3. The client is viewed as an active, self-
responsible, and self-directing person, even in the
treatment setting.

Within the context of this new psychoeducational
model, one of the areas of research has been the
facilitation of competency in personal problem solving and
decision making (Parker, 1987). The major advantage in
learning a problem-solving process in treatment is that
the principles can be readily transferred from one
situation or content area to another (Hepworth & Larsen,
1990). A client's acquisition of these skills would not

only remedy the immediate problem but would also serve a

11

preventive function by enhancing the client’s future
coping capacity.

Problem-solving theory revolves around three core
terms that need to be operationalized at this point:
"problem," "problem-solving" behavior, and "solution."

The term "problem" refers to a specific situation or
set of related situations to which a person must respond
in order to function effectively in his/her environment.
Accordingly, a situation would be deemed problematic if no
effective response alternative was immediately available
to the individual confronted with the situation (Davis,
1966: Lazarus & Folkman, 1984; Skinner, 1953). Included
in this definition are all those situations that, due to
novelty, complexity, ambiguity, or conflicting stimulus
demands, fail to (elicit "automatic" effective actions,
thus requiring problem-solving behavior.

"Problem solving" is defined as a behavioral process,
whether overt or cognitive in nature, which (a) makes
available a variety of potentially effective response
alternatives for dealing with the problematic situation
and (b) increases the probability of selecting the most
effective response from among these various alternatives
(D'Zurilla & Goldfried, 1971). Thus, this definition
includes both the generation of alternative responses as

well as decision-making or choice behavior.

12

Finally, a "solution" or effective response refers to
the response or pattern of responses that alters the
situation so that it is no longer problematic to the
individual and at the same time maximizes other positive
consequences and minimizes other negative ones (D'Zurilla
& Goldfried, 1971).

Using this "problem--problem solving--solution" para-
digm, individuals could be perceived as differing in their
ability to problem-solve. This differential functioning
could be viewed as existing on a continuum. On one end
are those individuals deemed to be effective in their
decision-making capacity. Socrates observed that
competent individuals are "those who manage well the
circumstances which they encounter daily, and who possess
a judgment which is accurate in meeting occasions as they
arise and rarely miss the expedient course of action."
Juxtapositioned to these individuals are those who appear
unable to appropriately resolve certain situational
problems in their lives and who, accordingly, bear the
labels of "abnormal," "deviant," or "emotionally
disturbed." These are frequently the labels worn by the
adolescents placed in the therapeutic foster care treat-
ment programs examined in this study.

Theoretically, the core of these therapeutic foster
care treatment programs is the use of specially selected

and trained foster parents, who act as paraprofessionals

13

and implement treatment programs designed by agency staff
for adolescents or children within the family’s context
(Hawkins et al., 1985). The main component of this
strategy is the "professional" parent who functions as the
main "agent of treatment" rather than merely as a
custodial caregiver. Other specific features, according
to Hawkins et al. (1985), include:

1. Supervisory staff, who provide a range of
services to the foster parents and to the adolescents and
their families.

2. A recruitment and training program to obtain
highly qualified foster parents.

3. An emphasis on professionalism of the parenting
role as indicated by a salary for the foster parent
commensurate with that of a beginning child care worker,
rather than merely being provided room and board reim-
bursement.

4. A high degree of accountability of the
supervisory staff, the foster parents, and the adoles-
cents.

5. Extensive foster parent support services,
including 24-hour on-call emergency services; liaison
services with the school, courts, and other community
agencies: respite care: and intensive supervision (often
weekly rather than the monthly or quarterly supervision

provided to regular foster care families).

14

6. An individualized point system to motivate the
adolescent's behavior in the foster home and to direct
treatment goals.

7. Foster parent and adolescent evaluations to
provide feedback.

8. Treatment services to the adolescent's biological
family.

The theoretical advantages of this treatment model
have been well-documented (Hawkins et al., 1985; Hazel,
1982; Lanier & Coffey, 1981: Larson, Allison, & Johnson,
1978: Rubenstein, Armentrout, Levin, & Harold, 1978). A
brief summary is as follows:

First, the disruption to the adolescent’s life is
minimized in that opportunity to engage in normal
activities is facilitated by a family setting.

Second, a greater proportion of the cost of the
placement is invested directly into the treatment of the
child rather than into buildings, maintenance staff,
equipment, or other typical residential expenses.

Third, because an actual facility does not need to be
maintained, there is less pressure either to retain
adolescents after treatment goals have been achieved or to
accept inappropriate referrals.

Fourth, treatment is highly individualized because of

the placement of only one or two children per home.

15

Fifth, the behaviors targeted for change are highly
relevant to the tasks of daily living because of the
context of that treatment. Thus, these new behaviors are
more likely to transfer to the adolescent's own home due
to the similarity of settings.

Sixth, positive incidental learning occurs as a:
result of exposure to a relatively healthy family.

Finally, a broad range of adolescent clients can be
served by this program model due to the individualized
treatment and separate placement opportunities.

Thus, theoretically speaking, therapeutic foster care
programs provide the opportunity to target the problem-
solving skills of the adolescents in care and alter their
"deviant" labeling. One of the goals of this study was to
investigate whether those problem-solving skills were

affected by the therapeutic foster care programs examined.

Summary and ngryiew

This chapter contained an overview of the evolution
of the therapeutic foster care programs that provides the
treatment context for this study. Additionally, the need
and purpose of this study were described, along with five
research questions designed to define and describe the
therapeutic foster care population being examined. The

chapter ended with a brief presentation of the three

16

theories underlying this study: psychoeducation, problem
solving, and therapeutic foster care.

In Chapter II, the relevant literature is reviewed
for the following three areas: psychoeducational theory,
problem-solving theory, and therapeutic foster care. The
research procedures and design are presented in Chapter
III, along with a discussion of the construction and
validity of the Millon Adolescent Personality Inventory
and the Personal Change Questionnaire. The analysis of
the results is described in Chapter IV, while conclusions
and recommendations for future research are presented in

Chapter V.

CHAPTER I I

REVIEW OF RELATED LITERATURE

This chapter contains a literature review of the
three major theories used in this study. Moving from the
macroscopic to the microscopic perspective, the chapter
begins with a review of the literature on
psychoeducational theory. This is followed by a
literature review on a type of psychoeducational model,
problem-solving theory (which includes the theory behind
the Personal Paradigm Shift, a specific problem-solving
approach contributing to this study). Finally, the
chapter ends by focusing on a literature review of
therapeutic foster care, a specific treatment concept in

which problem-solving theory can be applied.

v' h te t s educ '

The historical development of the psychoeducational
approach can be traced through the cumulative beliefs of
various theorists and researchers over the past century.
As far back as Watson (1916), researchers believed that
human attitudes, interests, values and behavior could be

extremely malleable with proper environmental

17

18

manipulation. In accordance with this philosophy,
psychoeducation views much of human behavior as the result
of learning and experience rather than instinct or genetic
predisposition.

Later, Skinner (1938, 1953) provided direction for
learning-oriented therapists when he developed the concept
of operant conditioning. Skinner strengthened the basis
for the psychoeducational approach with his focus on
targeting specific teaching objectives regarding behaviors
and by developing specific teaching programs for
accomplishing those goals. Using this learning-based
approach, Wblpe (1958) targeted his interventions toward
the "psychologically distressed." An almost simultaneous
factor at this time for the evolving psychoeducational
approach was Albee’s (1959) warning to the profession that
a need-supply gap was imminent. Through his writings, he
urged a shift from the traditional counseling model, in
order to have the supply of counseling services meet the
projected demand that he anticipated.

This push for a new model was occurring as decades of
research had allegedly failed to provide strong,
convincing proof that traditional therapy was effective
and.‘efficient (Eysenck, 1952: Levitt, 1957, 1963).
Psychoeducation was one of the nontraditional approaches
that gained strength with these disputed research
findings.

19

At this same time, the emergence of the importance of
prevention rather than remediation resulted in a shift to
a more instructional model of intervention. This shift
entailed a change in emphasis with goals and interventive
style. Rogers (1951) ushered in a portion of this shift
with his focused attention on goals and responsibility,
with an emphasis on client determination. Specific
impetus for the cognitive-emotional-behaviora1 style that
characterizes psychoeducation was contributed by Ellis
(1963), who stressed teaching cognitive-emotional skills
to people for their use in facilitating their own personal
and interpersonal goals.

Following these initial historical roots, the
psychoeducational approach began to gain its own identity
when theorists like Patterson and Carkhuff (1969) urged
psychological practitioners to consider educational
training as a therapeutic modality. Patterson and
Carkhuff stated that perhaps therapy was not necessary.
Instead they supported direct training or education of
individuals in the "conditions of good human relations--
not only normal people and children but the emotionally
disturbed as well" (p. ix). As part of this emergence of
its own identity, psychoeducation was defined and
differentiated from traditional therapy by theorists like

Authier, Gustafson, Guerney and Kasdorf (1975).

20

Traditional therapy was perceived as following an illness
model: "abnormality--diagnosis--prescription--therapy--
cure" (Authier et al., 1975). The psychoeducational model
has a pattern of "client dissatisfaction--goa1 setting--
skill teaching--satisfaction or goal achievement." The
client is perceived as a pupil who is taught not only
symbolic and cognitive processes of change but also
instruction in overt behavior.

Within the psychoeducational approach are two types
of programs: one that focuses on general skills training
and the other that emphasizes specific skills“ The
following provides examples in the literature of the two

models.

k' s 'n'n

General skills training programs stress counseling
skills, communicationt skills, interpersonal skills,
and relationship skills. Carkhuff (1971) and Ivey (1971)
developed two of the most popular general skills training
programs.

Carkhuff’s program has been used to teach the
interpersonal skills of empathy, respect, concreteness,
genuineness, self-disclosures, confrontation, and
immediacy to various groups of psychiatric inpatients
(Pierce & Drasgow, 1969: Vitalo, 1971), to parents of

emotionally disturbed children (Carkhuff & Bierman, 1970),

21

to college students (Berenson, Carkhuff & Myrus, 1966), to
Head Start teachers (Bierman, Carkhuff & Santilli, 1969),
to groups consisting of teachers and parents of different
races (Carkhuff & Banks, 1969), and others.

Ivey's (1971) program emphasizes less global
communication skills, such as attending behaviors, open-
invitation-to-talk, paraphrasing, minimal-encouragement-
to-talk, and reflection-of-feeling. Ivey's program has
also been used with various populations, including
psychiatric inpatients (Donk, 1971; Ivey, 1973; Orlando,
1974) and. psychiatric outpatients (Galassi, Galassi, &
Litz, 1974: Gormally, Hill, Otis & Rainey, 1975).

Both Ivey's and Carkhuff’s programs involve teaching
a variety of communication skills by explicit instruction
and feedback in graded practice. The therapist's role is,
thus, conceptualized as that of a teacher who uses
behavioral shaping with emphasis on verbal reinforcement.
Additionally, role playing in dyads or triads is
frequently used, along with audio and/or video feedback.

In addition to the Carkhuff and Ivey programs, other
models have been developed to teach general skills
competency. These include the Step Group Therapy model,
the Conj ugal Relationship Enhancement Program, and the
Parent Effectiveness Training Program, which are briefly

described in the following paragraphs.

22

The Step Group Therapy program by Authier and Fix
(1977) is a blend of group therapy with behavior therapy
using the psychoeducational format. The program consists
of teaching nine communication skills in a series of three
steps. Patients are promoted from one group to the next
by demonstrating competency in that particular set of
skills emphasized at each step. The program uses written
definitions of skills, model tapes, didactic instruction,
and a counselor who acts as a teacher, using the above
modalities along with successive approximation
reinforcements to encourage the development of skills.

The Conjugal Relationship Enhancement Program (Ely,
Guerney, & Stover, 1973) explicitly teaches the
communication skills inherent in the roles of "speaker"
and "listener" in marriage counseling situations. This
model has been adapted and used by Collins (1971) and
Rappaport (1971). Another marital counseling psychoeduca-
tional program by Weiss, Hops and Patterson (1973) teaches
the more specific skills of contracting and negotiating in
relationships.

Gordon’s (1973) Parent Effectiveness Training teaches
both basic communications skills and specific parenting
skills. A similar parenting program has been developed by

Patterson and Gullian (1968).

23

MW

Specific skills training programs are numerous and
address diverse populations. Probably the most widely
known is the Structured Learning Therapy developed by
Goldstein (1973). This program is unique in that it was
specifically designed to fill the void mentioned earlier
between public demand for psychological services and the
number of psychological practitioners available to meet
the need. Furthermore, the program was intentionally
designed to address the lifestyles, need, and
environmental realities of the lower socioeconomic class
because traditional methods of treatment have not always
been adequate or appropriate for this population.

Structured Learning Therapy focuses on the use of
modeling, role playing, and social reinforcement to
enhance patient autonomy, assertiveness, internal
controls, role-taking abilities, sense of mastery in
social interactions, accuracy of affective perception and
communication, tolerance for frustration and ambiguity,
and other useful behaviors in which the person may be
deficient. Structured Learning Therapy has been
successfully used with various psychiatric populations
(Gutride, Goldstein, & Hunter, 1973, to increase social
behavior of psychiatric inpatients: Goldstein et al.,
1973, to teach independence to outpatient and inpatient

populations).

24

Gutride, Goldstein, and Hunter (1974) contributed one
of the more recent additions to the Structured Learning
Therapy, i.e., the development of a transfer of training
phase. This phase directly teaches trainees skills that
will help them cope with stress when they return to their
home environments. Thus, the teaching of coping skills
has become an important adjunct to the psychoeducational
model.

In addition to the Structured Learning Therapy
program, other specific skills training models have been
directed toward various populations. These can be briefly
enumerated to reflect the breadth of applicability of this
type of program, based on research in the literature: job
hunting (Hunt & Azrin, 1973); interpersonal communication
skills (Rathus, 1973); developmental tasks of children and
adolescents (Gum, Tamminen, & Smaby, 1973; MacMullen,
1973): sexual satisfaction (Masters & Johnson, 1970);
irrational thoughts (Ellis, 1961, 1963): controlling
problem behavior, problem solving, and decision making
(Krumboltz & Thoresen, 1969; Mahoney, 1974); coping with
frustration (Giebink, Stover, & Fahl, 1968): handling
aggressive impulses (Gittelman, 1965); alleviating
depression (Lewinsohn, Weinstein, & Shaw, 1969: Idbert &
Lewinsohn, 1973): learning constructive marital conflict

resolution (Bach & Wyden, 1969): "healthy talk" by

25

schizophrenics (Meichenbaum, 1969): and. problem-solving
skills training programs (D'Zurilla & Goldfried, 1971).

In addition to this breadth of usage and most
relevant for the purposes of this study, the
psychoeducational approach has been repeatedly used to
alter the learning behavior of disturbed/delinquent
children and adolescents (Beck & McDonnell, 1982: Brown,
1980: Brown & Quay, 1978: Glick & Goldstein, 1987:
Konstantareas & Homatidis, 1984). Two research examples
of using the psychoeducational model with delinquents are
Minuchin, Chamberlain, and Graubard (1967) and Carpenter
and Sugrue (1984).

Minuchin et al. (1967) used a psychoeducatonal
approach with disturbed/delinquent children by training
them to focus attention, to organize and obtain
information through communication, and to search for
solutions to conflicts when interacting with teachers.
Improvements were significant in attention, style of
communication, and cognition.

Carpenter' and Sugrue (1984) used the
psychoeducational model with a heterogeneous delinquent
treatment program. They combined affective education and
social skills training in an outpatient setting. They
found that delinquents with immature personalities or
neurotic features appeared to benefit more from this

approach than those with characterological disorders.

26

In summary, as can be noted from the above
references, the literature is replete with studies
attempting to identify what characteristics or populations
are most amenable to the psychoeducational approach. The
research results have indicated that the psychoeducational
model has been used successfully in diverse contexts with
various populations, including emotionally disturbed or
delinquent adolescents. One of the specific skills
training approaches within the field of psychoeducation is

problem solving.

v' o ' u o

The clinical application of problem-solving training
had its beginnings in the late 19605 and early 19705 as
part of the trend toward clinical interventions that
focused on the facilitation of social competence.
Developmentally speaking, D'Zurilla and Goldfried (1971)
provided the theoretical underpinnings of problem-solving
theory. Their research, which spanned more than 15 years,
resulted in the following two beliefs:

1. The first belief is that ineffective coping with
problematic situations, along with its personal and social
consequences, may‘ be the necessary and sufficient
condition for an emotional or behavioral disorder

requiring psychological treatment.

27

2. The second belief is that problem solving may be
most efficiently developed by training individuals in
general procedures or skills.

These two findings have relevance for the adolescents
in this study. Since the therapeutic foster care
adolescents have been identified as having emotional/
behavioral disorders requiring treatment, they fit within
the first belief system of D’Zurilla and Goldfried.
Accordingly, the possibility of being able to remedy their
deficient problem solving through skills training could
provide a direction for future experimental research into
the adolescent population and therapeutic foster care.

In line with the theoretical conceptualizations of
D’Zurilla and Goldfried (1971), problem solving can be
viewed as a cognitive-affective-behavioral process,
culminating in the discovery of a solution to a problem.
D'Zurilla and Goldfried proposed a prescriptive or
normative model of social problem solving that focused on
how individuals should solve problems in order to maximize
their effectiveness (as opposed to a descriptive model
that merely describes how individuals typically solve
problems).

The D’Zurilla and Goldfried model was based on a
melding of relevant problem-solving theory and research
literature from the fields of experimental psychology,

education and industry. The final D'Zurilla model

28

consisted of the following five components: problem
orientation, problem definition and formulation,
generation of alternative solutions, decision making, and
solution. implementation and 'verification. Individually,
each component serves a definite purpose or function in
the problem-solving process. Combined, the five
components are expected to maximize the probability of
ascertaining the most effective solution when
appropriately applied to a particular problem.

Following the lead of D'Zurilla and Goldfried (1971),
Spivack, Platt, and. Shure (1976) provided support for
exploring the problem-solving capability of clients. In
their research, they compared a group of "deviant"
individuals with a group of "normal" individuals. Their
results indicated that the deviant group demonstrated
inferior skills in problem solving compared to the normal
group with respect to three major areas:

1. The deviant group generated fewer possible
solutions to hypothetical problem situations.

2. The deviant group suggested solutions that were
often antisocial in nature.

3. The deviant group had very inaccurate expecta-
tions about probable consequences of alternative solu-

tions.

29

Furthermore, Spivak et al.'s (1976) results indicated
that promising results could be obtained when deviant
subjects received systematic training in problem solving.
Substantial research can be found in the literature on the
use of problem-solving skills training with adolescents,
as can be noted by the references in the following
paragraphs.

Kazdin, Esveldt-Dawson, French, & Unis (1987) focused
on problem-solving skills training by comparing three
conditions: cognitive-behavioral problem-solving skills
training to nondirective relationship therapy and a
control condition for antisocial children. Fifty-six
children between the ages of 7 and 13 were randomly
assigned to one of four therapists and the three
conditions. The children were hospitalized in a
psychiatric facility during the period of treatment and
discharged thereafter. The problem-solving training
condition led to significantly less externalizing and
aggressive behaviors and fewer behavioral problems at home
and at school and more prosocial behaviors than the other
two conditions. These effects were evident immediately
after treatment and at a 1-year follow—up.

Tisdelle and St. Lawrence (1988) examined the
effectiveness of social problem-solving skills training
with conduct-disordered in-patient adolescents. Training

criteria were socially validated with nonhospitalized

30

adolescents. Three baseline assessment sessions were
conducted before the intervention, and further assessments
were administered after each training session. Only when
the subjects attained the skill level exhibited by the
normal adolescents in the comparison group did the
training progress to the next phase. Five problem-solving
component skills were taught to the adolescents: problem
identification, goal definition, generation of alterna-
tives, comparison of consequences, and selection of the
best alternative. Verbal problem solving improved,
generalized to unfamiliar problem situations, and was
maintained at a l-month follow-up assessment.

Christoff et a1. (1985) evaluated the effectiveness
of a problem-solving training program for adolescents.
The subjects were four adolescents ranging in age from 12
to 14 years who were referred to the training program
because they were socially withdrawn and lacking in social
skills. The results showed a significant increase in both
problem-solving skills and specific social interaction
skills. All improvements were maintained at a 5-month
follow-up assessment.

Sarason and Sarason (1981) used this approach to
enhance problem-solving cognitions and effective coping
behavior in problematic situations relevant to

adolescents. The successful results were maintained at a

31

1-year follow-up. In addition, objective measures within
the school setting were also apparent, including lower
rates of tardiness, fewer absences, and fewer referrals to
school personnel for problem behavior.

Other problem-solving skills training programs have
been developed and evaluated with successful results.
Some programs have had the benefit of replicated research.
Jacobson (1977) fine-tuned his research using a treatment
and control group by adding a nonspecific therapy group
(Jacobson, 1978). The following summary of his 1977 and
1978 research highlights his findings.

Jacobson (1977) developed a behavior marital therapy
program using problem-solving skills training. The
program was initially evaluated in an outcome study
involving 10 distressed marital couples, who were randomly
assigned to either a treatment group (involving 10
sessions) or a waiting-list control group. The results
indicated that the couples in treatment improved
significantly more than the waiting-list control group on
both problem-solving behavior and marital adjustment
measures. At a l-year follow-up, the treatment gains were
maintained. In addition, frequency of problematic
behaviors in the home was significantly affected by the
specific problem-solving treatment procedures.

Jacobson (1978) conducted a second study to replicate

the above findings, allowing for the addition of a

32

nonspecific therapy group to control for nonspecific
factors such as attention and expectation of benefit. The
nonspecific group included discussions of the relationship
problems but contained no specific problem-solving skills
training. The results confirmed the findings of the first
study. In addition, the results showed that the problem-
solving treatment group demonstrated significantly more
improvement than the nonspecific treatment group on
measures of problem-solving behavior and marital
adjustments. These gains were maintained at a 6-month
follow-up assessment.

Robin (1979, 1980) also fine-tuned his initial
research. The problem-solving program he designed for
parent-adolescent dyads experiencing conflict has been
evaluated in three clinical outcome studies: one by Robin,
Kent, O’Leary, Foster, and Prinz (1977), one by Robin
(1981), and one by Foster, Prinz, and O'Leary (1983).

In the first study, Robin et a1. (1977) randomly
assigned 22 mother-adolescent dyads to a problem-solving
training group or a waiting-list control group. The
results demonstrated dramatic improvement in problem-
solving behavior in the problem-solving group relative to
the control group at the post-treatment assessment.
However, no definitive evidence of improvement in conflict

resolution behavior was noted at home.

33

In the second study, Foster et a1. (1983) randomly
assigned 28 families to a waiting-list control group, a
problem-solving group with generalization programming, or
a problem-solving group without generalization training.
The results indicated that both treatment groups improved
significantly more than the control group on several
measures of parent-adolescent conflict and communication
behavior at home. These results were generally maintained
at a 6- to 8-week follow-up assessment. The lack of
significant differences between the two treatment groups
was attributed to enhancements in the problem-solving
training, such as inclusion of fathers in the program
instead of mothers and adolescents only, an emphasis
during training on the families' real problems instead of
hypothetical ones, and the addition of two sessions.

In the third study (Robin, 1981), problem solving was
compared to a less structured "best alternative treatment"
in an attempt to control for nonspecific factors such as
expectations of benefit. The alternative treatment was
short-term. family' therapy' conducted in an eclectic or
family systems approach. Thirty-three families were
randomly assigned to the two treatment groups or to a
waiting-list control group. The results showed that both
treatments produced significant improvement in conflict
resolution and communication behavior at home. Only the

problem-solving group demonstrated significant improvement

34

in problem-solving communication. These treatment effects
were maintained at a 10-week follow-up. Furthermore, the
parents in the problem-solving group rated their
experience more favorably than did the family therapy
group with regard to improvement in their relationship
with their adolescents, improvement in their adolescents'
behavior at home, improvement in problem-solving
discussions at home, and the extent to which the program
fulfilled their expectations.

Research has also been done on the use of the
problem-solving model for reducing stress and enhancing
ineffective coping skills. Two studies regarding coping
were by Moon and Eisler (1983) and Dixon, Heppner,
Petersen, and Ronning (1979).

Moon and Eisler (1983) compared the problem-solving
group to a stress-inoculation and a social-skills training
group when examining anger control issues. The results
showed that stress inoculation significantly decreased
anger-provoking cognitions but did not increase
appropriate assertiveness. However, both the problem-
solving training group and the social skills training
group significantly reduced anger-provoking cognitions and
increased assertive or socially appropriate behaviors.

Dixon et a1. (1979) also used problem-solving skills

training to enhance the generation of alternatives and

35

choice behavior with undergraduate college students. The
subjects were randomly assigned to the problem-solving
group, a pretest-posttest control group and a posttest-
only control group. The problem-solving group showed
significantly better problem-solving skills; the
difference resulted primarily from less impulsivity in
problem-solving situations.

Heppner, Hibel, Neal, Weinstein, and Rabinowitz
(1982) also later studied the effects of the problem-
solving model with college students with problem-solving
deficits. Subjects were randomly assigned to the problem-
solving group or a delayed-treatment control group.
Following training, the subjects in the problem-solving
group, compared to the control group, reported fewer
problems on the problem checklist, more problem-solving
confidence, a greater tendency to approach rather than
avoid problems, and a more favorable self-assessment of
their problem-solving skills. These gains were maintained
at a l-year follow-up evaluation. Similar results were
obtained in research by Parnes and Noller (1973) conducted
over a 2-year period with college freshmen.

Problem solving has also been used in the treatment
of depression. Nezu (1986) randomly assigned 26
clinically depressed subjects to one of three conditions:
problem-solving therapy, problem-focused therapy, or a

waiting-list control group. Statistical analyses and

36

clinical analyses indicated substantial reductions in
depression in the problem-solving group. These results
were maintained over a 6-month follow-up period. In
addition, the improvement in depression was significantly
greater in the problem-solving group than in the other two
groups. This superiority was maintained at a 6-month
follow-up evaluation. Furthermore, the results indicated
that the problem-solving group increased significantly
more than the other two groups in self-appraisal of
problem-solving effectiveness and also in locus of control
orientations from external to internal. Again, these
improvements were also maintained at the 6-month follow-
up assessment.

Hussi‘an and Lawrence (1981) also used problem-
solving skills training in the treatment of depression
with geriatric patients in a nursing home. The problem-
solving group showed significant improvement relative to
the waiting-list control group and the social
reinforcement training group. This superiority was
present at a 2-week follow-up, although the differences
were no longer significant at the 3-month follow-up
assessment.

Other researchers have also examined the use of
problem-solving training with psychiatric patients

(Bedell, Archer, & Marlowe, 1980: Coche, Cooper, &

37

Petermann, 1984: Coche & Flick, 1975; Edelstein, Couture,
Cray, Dickens, & Lusebrink, 1980: Hansen, St. Lawrence, &
Christoff, 1985: Siegel & Spivack, 1976a, 1976b).

The problem-solving therapy approach also has been
used successfully with weight-control problems (Black &
Scherba, 1983: Black & Threlfall, 1986: Straw & Terre,
1983), alcoholism (Chaney, O’Leary, & Marlatt, 1978;
Intagliatia, 1978), vocational indecision (Mendonca &
Siess, 1976), academic underachievement (Richards & Perri,
1978), agoraphobia (Jannoun, Munby, Catalan, & Gelder,
1980), and with community problems (Briscoe, Hoffman &
Bailey, 1975).

Given the wealth of research on problem solving
following the original findings of D'Zurilla and Goldfried
(1971), this dissertation study included a specific
problem-solving model, the Personal Paradigm Shift, when
examining the adolescent population in therapeutic foster
care. The Personal Paradigm Shift was developed by Hinds
(1983) at Michigan State University with the intention of
educating the client in therapy in a manner that would
promote learning of the process of personal change. The
paradigm approaches change as a problem-solving process
with four phases that closely follow the final components
of the D'Zurilla model: awareness of the problem, decision

making as a process, selection of oppositional

38

alternatives to targeted behaviors, and the planning and

implementation of necessary actions.

so a1 ad' S i

Since the Personal Paradigm Shift forms the
foundation for one of the instruments used in this study
(i.e., the Personal Change Questionnaire), an explanation
of the paradigm stages is deemed appropriate at this
point (Hinds, 1983).

Stage 1--Awareness. This stage consists of seven
steps aimed at creating self-understanding. The essence
of this stage is that the individual confronts and
examines the critical relationships between internal and
external variables that contribute to the maintenance of
personal problems.

Step 1: instructs the individual to describe a
personal problem which he/she wants to resolve.

Step 2: asks the individual to set initial goals
related to the problem chosen. (These goals are
operationalized as behavioral objectives, aimed at
assisting the individual in looking toward the future
with optimism regarding possible resolution.)

Step 3: asks the individual to identify the
antecedent events to the problem.

Step 4: has the individual identify the internal
reactions, i.e. beliefs, feelings, mental images, and
physiological reactions, that occur within the
individual that accompany the antecedent events.

Step 5: focuses on helping the individual see the
sequential chain of behavioral actions that are taken
by that individual when the problem situation occurs.

39
Step 6: has the individual identify the consequences
that follow the actions addressed in Step 5.
Step 7: asks the individual to describe what beliefs
or needs must be abandoned before behavior can be
changed and the problem resolved. (This final step is

a unique feature that is not found in other behavior
change or problem-solving models.)

W This stage is aimed at
having the individual use the information gained in the

previous stage to examine his/her decision-making process.
Decision making is seen as consisting of three steps:
Step 1: constructing a balance sheet of perceived
rewards and punishments entailed in solving the
problem versus not changing.
Step 2: making a cognitive and emotional commitment
to change versus accepting the current situation as
satisfactory.
Step 3: confronting the resistance to change and
identifying the fears associated with changing and
resolving the problem.

--0 s' 'o ' s. This stage
attempts to help the individual develop a new set of
internal reactions to foster a sense of self-control. The
four steps in this stage are aimed at generating new
beliefs, feelings, physiological reactions, and mental
images to counter those identified in the Awareness Stage.
The individual is asked to record the stressful conditions
of the problem situation as part of the first step and
then to think of new healthy internal reactions to oppose

the existing ones as part of the second step. The third

40

step has the individual think about new actions to replace
old problematic behaviors. The final step has the
individual identify the new consequences that will follow

the new actions.

a -- n . The final stage
consists of ten steps aimed at reducing the individual’s
fear and increasing his/her motivation for change. This
stage targets the individual's feelings of helplessness,
hopelessness, and loss of control.

Step 1: asks the individual to identify the initial
goal he/she needs to achieve to maintain motivation.
This goal must be realistic, specific, countable, and
in behavioral terms.

Step 2: focuses on recognizing and creating support
systems for instituting change.

Step 3: uses the concepts of observational learning
and modeling in having the individual seek
information and identify others who have achieved
their goals and, thus, resolved their problems.

Step 4: has the individual identify what appropriate
reward he/she will provide him/herself following the
accomplishment of the initial goal change. The
individual must be able to use this positive
reinforcement as a continued source of motivation
throughout this process.

Step 5: is unique to this model in that the
individual is taught to organize a plan of attack for
working on the personal problem. The individual is
asked to clearly delineate the appropriate order of
behaviors he/she will need to perform to achieve the
desired behavior change and resolve the problem.

Step 6: teaches the individual the meaning of
feedback and how to develop a specific feedback
system to maintain motivation.

41

Step 7: helps the individual develop a time frame for

accomplishing goals and resolving problems.

Step 8: assists the individual in developing back-up

plans in the event that he/she encounters failure in

first trying to resolve the problem.

Step 9: addresses the issue of fear of success, i.e.,

the individual's unconscious attempt to undermine

personal change and return to self-defeating
behavior.

Step 10: has the individual keep a daily or weekly

log to record the specific gains made in achieving

behavior change and resolving problems. This written

record is intended to provide the individual with a

support system to maintain motivation toward problem

resolution.

With the Personal Paradigm Shift, as with other
psychoeducational problem-solving models, the ultimate
goal is to teach the individual the process of personal
change and to have the individual see him/herself as an
active agent making behavioral choices that either
facilitate or impede problem resolution.

TwO research studies have been performed using the
Personal Paradigm Shift. One study was by Jeney (1985),
and the other by Parker (1987).

In his dissertation, Jeney (1985) used the Personal
Paradigm Shift to assess the pain perceptions, health
behavior, and psychological disturbance of 51 chronic-pain
patients. A multivariate analysis of variance on the
subjects as a group was performed on the pain data and

found to be nonsignificant for both the pretest-posttest

comparison and the pretest follow-up comparison. The

42

author contended that the reasons for lack of significance
included the small sample size, inappropriate dependent
measures, the improvement evidenced in both groups, the
brevity of the treatment period, and the subjects'
rejection of the rehabilitation model.

However, Parker (1987) in his dissertation used the
Personal Paradigm Shift in assessing the stress, health
behavior, and academic achievement of college students who
had been identified as academic underachievers. Again the
group, not the individual, was the unit of analysis
regarding gain scores obtained from pretest-posttest and
pretest follow-up comparisons. A two-way analysis of
variance performed on the pretest follow-up comparison of
quarterly grade point averages found a significant
difference for those who had used the Personal Paradigm
Shift. Parker stated that the absence of significance in
other aspects of the design might have been attributable
to the brief treatment period, the inappropriate dependent
measures, the size of the treatment group, the evidence of
improvement in both groups, and the developmental and
personality factors that characterized the subjects
involved in the study.

In summary, the literature on problem-solving theory,
including the research on the Personal Paradigm Shift,

supported the use of problem-solving skills training with

43

various populations for application not only at a remedial

level but also for prevention and/or enhancement.

;- —. .7 - ,'te -tur- ., - -,:--- .- e gee

Because therapeutic foster care is a relatively new
phenomenon, the literature, both descriptive and
evaluative, is scant. Webb ( 1988) commented that, in
1983, 32 private agencies administered specialized
therapeutic foster care programs in Michigan alone. Most
of these programs had been developed since 1978. Webb
indicated that evaluations have tended to be anecdotal,
without research supporting the efficacy of therapeutic
foster care as a treatment modality. In fact, she was
able to find only one comparative study (Rubenstein,
Armentrout, Levin, & Harold, 1978). In summation of her
analysis of the literature on therapeutic foster care,
Webb asserted the need for further evaluations to
determine whether therapeutic foster care as a treatment
modality can effectively influence a odearly defined
population.

In their comparative study, Rubenstein et a1. (1978)
discussed the Parent-Therapist Program in Ontario, Canada.
This program was designed for emotionally disturbed
latency-age children (ages 6 to 12) as an alternative to
institutionalization. An experimental design was used to

evaluate the program. Twenty-seven children were admitted

44

into the Parent-Therapist Program, and 45 children were
placed in residential treatment centers. The average
length of time in placement was 18.7 months. The
researchers used the Quay-Peterson Behavior Problem
Checklist to ascertain the degree of behavioral
disturbance. A three-way analysis of variance revealed
that both groups showed improvement not related to the
treatment modality to which they were assigned. However,
the authors contended that the Parent-Therapist Program
had a per diem rate of $24.05 to $30.16, compared to a
residential treatment rate of $47.43 to $63.77. The
authors, therefore, noted that therapeutic foster homes
are more cost-effective than residential treatment.

Three articles focused on the subsequent placement of
children after discharge from therapeutic foster care as
providing a positive assessment of the treatment modality
(Bauer & Heinke, 1976: Hawkins, Meadowcraft, Trout, &
Luster, 1985; Larson, Allison, & Johnson, 1978). Bauer
and Heinke reviewed the therapeutic foster care program
developed at the Fond du Lac Office of the Wisconsin
Department of Health and Social Services. In its 8 years
of operation, the program had placed 175 children, ranging
in age from 2-1/2 to 17 years. No behavioral or
psychological criteria for referral were indicated. Of
the 42 children discharged, 29% returned to live with

their birth parents, 23% were placed in adoption, 12%

45

entered independent living situations, 22% were placed in
group homes or other treatment homes, and 7% entered
institutions. From these outcome measures, the authors
determined that "most of the youngsters who have
participated in the program have made significant gains."
Larson et a1. (1978) article discussed the Alberta
Parent Counselors program in Canada. Eighty-seven
children between the ages of 8 and 16 were placed in
therapeutic foster homes. More than 50% had committed
delinquencies; half were a grade or more behind in school.
All demonstrated conduct problems, such as aggressiveness,
withdrawal, social anxiety, depression, hyperactivity, or
disobedience. The average placement was 8.7 months. The
evaluation design was descriptive and process-oriented,
relying on systematic recording of the project experience.
For evaluation purposes, assessments of the children
involved four diagnostic instruments, interviews, school
reports and behavioral indicators. The only statistical
finding reported was that 70% of the 50 children
discharged from the program were placed in permanent
situations in the community. Thirty percent were still in
need of specialized institutional care. As with the
Rubenstein et a1. articles, the authors indicated that the
$23 per day cost "compared favorably" with institutional
care costs during that year, making the program cost-

effective.

46

Hawkins et a1. (1985) discussed the PRYDE model of
therapeutic foster care. This program placed children
ranging in age from 4 to 18 years in therapeutic foster
care due to aggressive, attention-getting, hyperactive, or
unethical behavior. The program's results were measured
from three perspectives: (a) discharge rates: 82% of the
16 children were discharged to less restrictive, less
structured settings: (b) recidivism: of 28 children
discharged, only 1 had reentered the child welfare or
juvenile court system 6 months after discharge; and (c)
self-report: satisfaction questionnaires completed by the
youths in the program revealed that 85% of their
statements were "very positive about their foster
parents."

Hazel (1982) reviewed the Kent Family Placement
Project. Adolescents ranged in age from 14 to 18 years
and consisted of three groups: delinquent boys, girls
with unacceptable or dangerous behavior (though not
necessarily illegal), and casualties of the system (i.e.,
children who were being stored in institutions). The
author indicated that an independent study (not further
defined) of 25 placements, as well as the Project's own
evaluation (not further clarified) of 156 boys and girls
placed in the program, revealed that three-fourths of them

"improved during placement. " This "improvement" was not

47

specifically defined, nor was any information provided
regarding the design or measurement instruments used.

Lanier and Coffey (1981) discussed the specifics of
the therapeutic foster care program developed at the
Smokey Mountain Area Mental Health Center» Ln this
article they merely described the services offered and did
not indicate the number or criteria of children served.
Furthermore, no statistical or evaluative outcome data
were noted. The authors did comment that their approach
was cost-effective, although no supportive documentation
was provided.

In summary, only one comparative study on the
efficacy of therapeutic foster care appeared in the
literature (Rubenstein et al., 1978) . Furthermore, in
that study no significant difference in improvement was
found between children in therapeutic foster care and
those placed in residential facilities. However, the
authors did contend that therapeutic foster care was more
cost-effective than residential treatment, a finding
reiterated by Larson et a1. (1978) and Lanier and Coffey

(1981).

may

Psychoeducation, which has emerged from the coupling
of the fields of psychology and education, does not follow

the traditional medical model but instead has a format of

48

intervention beginning with client dissatisfaction, moving
to the setting of goals and the instruction of specific
skills, and culminating in particular goal achievement. A
specific skills training program within the field of
psychoeducation is problem solving, which has been used
successfully with various psychiatric populations,
including emotionally disturbed and delinquent
adolescents. Problem-solving theory contends that
ineffective coping with problem-solving situations, along
with accompanying personal and social consequences, may be
the necessary and sufficient condition for the development
of an emotional or behavioral disorder requiring
psychological treatment. An additional contention is that
specific skills training in problem solving may be
necessary. One such specific training program is the
Personal Paradigm Shift, used in this study. A treatment
setting in which an examination of the problem-solving
skills of the population is lacking is therapeutic foster
care, where adolescents are placed with specially trained
foster parents who function as change agents. Although the
literature is substantial regarding descriptions of
therapeutic foster care programs, few data exist on
identifying the specific population being served by this
treatment modality. Filling a portion of this data gap by
identifying some of the characteristics of this population

was the focus of this study.

CHAPTER III

METHODOLOGY

This chapter contains a discussion of the therapeutic
foster care population, the sample-selection criteria, and
the representative sample that was examined in this study.
Additionally, procedures and instrumentation used in this
study are explained. The section on the Millon Adolescent
Personality Inventory (MAPI) includes a description of the
instrument, its construction, scoring, reliability and
validity, as well as a review of the research on this
instrument. The discussion of the Personal Change
Questionnaire contains a description of the instrument,
including information regarding its reliability and
validity. Additionally, a brief overview is given of the
survey developed for this study. A presentation of the
data analysis and design of the study, followed by a

summary, concludes Chapter III.

Sa e

Popularion

Child and Family Services is a private, nonprofit

organization with a central office in Okemos, Michigan.

49

50

Fourteen statewide branches accept foster care referrals
from various private and public agencies throughout
Michigan. Ten of those branches have therapeutic foster
care programs, with a total population of approximately
250 children placed in therapeutic foster care at any give
time. Nine of those ten branches agreed to participate in
this study, representing' approximately’ 220 children in

therapeutic foster homes.

Sample-Selegrion Crireria

The criteria for selecting the adolescents for this
study were as follows:

1. The adolescent must be between the ages of 13 and
18 years.

2. The adolescent must be placed within the
therapeutic foster care program at the agency (as opposed
to being in regular foster care).

3. The adolescent must have at least an average IQ
and/or be able to read at a sixth-grade level or better in
order to complete the instruments used in this study.

From the pool of adolescents meeting those criteria,
a sample of 100 adolescents was randomly selected. A
return rate of 94% from the adolescents' therapists was
obtained for the demographic information on these

adolescents. However, a final voluntary subject

51

population on the MAPI and Personal Change Questionnaire

consisted of 41 adolescents.

Description of the Sample

Descriptively speaking, of the 94 adolescents
initially surveyed in therapeutic foster care for this
study, the following results were obtained. With regard
to race, 86 were CaucasiansAnglo, 5 were Hispanic, 1 was
Native American, and 2 were biracial. Forty-nine were
male and 44 were female: one adolescent’s gender was not
noted on the survey. With regard to state or court ward-
ship, 62 adolescents were temporary wards, 14 were perma-
nent wards (meaning parental rights had been terminated),
and 18 were missing data on the survey for this variable.
Concerning family status, 51 were biological offspring, 5
were adopted, and 38 were missing data on the survey for
this variable. The mean age was 15.65 years. The mean
length of time in therapeutic foster care was 17.7 months,
and the mean length of time in regular foster care pro-
grams was 4.2 months. The mean number of previous foster
care placements was 1.6. The mean score by the therapists
of the adolescents’ overall functioning on a scale of 0
(poor) to 7 (very well) was 4.5.

A statistical comparison was run between the 41 (n =
41, Group B) adolescents who agreed to participate and the

59 (r = 59, Group A) who did not complete their

52

instruments. A total of eight different demographic and
descriptive variables (i.e., age, gender, race, whether or
not the adolescent was a ward of the court or state,
length of time the adolescent had been in therapeutic
foster care, number of previous foster care placements,
whether the adolescent had ever been institutionalized,
and the therapist’s rating--on an 8-point scale--of how
well the adolescent dealt with problems) were examined.
The analysis revealed that, except for gender, there were
no significant differences between the two groups. A
further statistical analysis indicated that gender had no
significant correlation with any of the variables of
interest in this study (i.e., the adolescent’s self-rating
of problem-solving ability, the therapist’s rating of the
adolescent’s problem-solving ability, the length of time
in therapeutic foster care, or any of the four components
of‘ the Personal Change. Questionnaire). This suggests
that, for the purposes of this study, the final sample was
representative of the original sample, with no noticeable
biasing.

Complete descriptive data on the study sample are

presented in the Results section.

Procedures
For each adolescent, the branch agency received one

descriptive survey for the therapist to complete, as well

53

as one MAPI and one Personal Change Questionnaire for the
adolescent to complete. The adolescents were given the
following written instructions:

You were selected to be a part of a study of
teenagers in special foster care programs. Your
participation is completely voluntary. You can stop
being in this study any time you want. The study
consists of two questionnaires that will take you
approximately one hour to complete. You won’t be
putting your name on these forms and no one will know
which answers were yours. Your therapist will be
available to answer any questions you might have.
Are you willing to be a part of this study by
completing these forms?

Upon receiving a verbal consent, the adolescent was
then provided with the two instruments (the MAPI and the
Personal Change Questionnaire), both of which contain
instructions for completion.

With consultation from the branch agencies, an
additional statement was developed to give to the
adolescent as an explanation for the study:

We are asking you to complete these forms to help us
find out how adolescents in foster care programs like
yours feel and think. Once we know that, we may be
able to be more helpful. You will notice that one of
the forms asks you to pick a behavior of yours that
has created problems for you, like talking back to
teachers, not talking about your feelings, not
getting your chores done, or not completing your
homework. Once you have picked the problem, just
answer the questions on the form. Maybe the behavior
you pick is one that you are working on as a goal in
your foster home, with your caseworker or counselor,
or at school. There is no right or wrong answer to
these questions. Just answer as honestly as you can.
If you need help in deciding on a problem or goal,
you can ask your foster parents, caseworker, or
counselor for help. Thank you for helping us by
answering these questions.

 

54

The reference to the Personal Change Questionnaire
specifically in this statement was due to the resistance
expressed by the therapists to administer this instrument
to the adolescents because of its stance of self-
responsibility regarding behavior. Some therapists
strongly verbalized that the adolescents were victims and
not responsible for the problems for which they were
receiving treatment. The statement allowed the
adolescents to select a behavior that they perceived as
creating problems for them. This will be discussed
further with reference to the results in the Discussion

section.

Wish

e ' o o esce t
P s ' vento

The MAPI consists of 150 true-false items designed to
measure objectively certain personality dimensions,
expressed concerns, and behavioral correlates in
adolescents between the ages of 13 and 18 years. (See
Appendix A.) The scores on the profiles are adjusted for
prevalence data on each of the 20 scales, using normative
scores.

The eight personality variables are derived from
Millon’s (1969, 1981) theory of personality, which
consists of a 2 x 4 matrix (passive/active x detached/

dependent/independent/ambivalent).

55

The first dimension pertains to the pattern of coping
behavior employed by the adolescent to maximize rewards
and minimize pain. An active pattern means that the
adolescent appears aroused and attentive, arranging and
manipulating life events to obtain gratification and avoid
discomfort. A passive pattern results in an apathetic,
restrained, yielding, or resigned demeanor that suggests
the adolescent is content to allow events to take their
own course without personal attempts at regulation or
control.

The second dimension revolves around the primary
source from which the adolescent attempts to gain comfort
and satisfaction (positive reinforcement) or to avoid
emotional pain and distress (negative reinforcement). The
detached type experiences few rewards or satisfactions in
life, either from self or others. The dependent type
measures personal satisfactions or discomforts by how
others react. The independent type relies on personal
values and desires, with little regard to the concerns and
wishes of others. Finally, the ambivalent type feels
conflicted over whether to follow others or be guided by
personal desires and needs.

The eight resulting personality styles are as

follows:

56

Scale 1: Introversive (31 items): Passive-Detached:
is quiet, unemotional, indifferent about involvement
with others.

Scale 2: Inhibited (41 items): Active-Detached: is
withdrawn, mistrustful, lonely, fearful of rejection.

Scale 3: Cooperative (35 items): Passive-Dependent:
seeks relationships in which others provide support,
lacks initiative or autonomy, is clinging.

Scale 4: Sociable (29 items): Active-Dependent:
intensely needs attention and approval, is
dramatically emotional, superficial, capricious,
manipulative.

Scale 5: Confident (42 items): Passive-Independent:
is self-assured, has high self-esteem, is self-
centered, exploitive, takes others for granted.

Scale 6: Forceful (37 items): Active-Independent:
intensely' needs jpower' and. control, is suspicious,
hostile, angry.

Scale 7: Respectful (29 items): Passive-Ambivalent:
is serious-minded, rule-conscious, subservient with
underlying anger and opposition, fearful of
disapproval.

Scale 8: Sensitive (46 items): Active-Ambivalent: is
pessimistic, emotionally labile, explosively angry
alternating with apologetic.

The following eight scales on the MAPI are considered

"expressed. concerns," which focus upon the affect and

cognitions that adolescents may experience about issues

that tend to concern this age group at one time or another

during this developmental stage. The intensity with which

the adolescents experience these issues is reflected in

the score elevations of each scale.

Scale A: Self-Concept (36 items): clarity of
identity--who one is and what one will become.

57

Scale B: Personal Esteem (36 items): level of
satisfaction experienced by the adolescent when
comparing self against an ideal.

Scale C: Body Comfort (21 items): comfort with body
maturation and adolescent developmental changes.

Scale D: Sexual Acceptance (28 items): satisfaction
with sexuality and development of heterosexual
relationships.

Scale E: Peer Security (23 items): degree of
acceptance and sense of belonging with peers.

Scale F: Social Tolerance (26 items): interpersonal
sensitivity and respect for others.

Scale G: Family Rapport (25 items): degree of
comfort within the family system.

Scale H: Academic Confidence (30 items): attitudes
toward academic achievement.

The MAPI also contains four behavioral correlates.
These have been assessed through empirically derived
scales rather than self-report. High scores on these
scales suggest the respondents answered similarly to
adolescents with poor impulse control, difficulty
conforming to rules and norms, poor academic achievement,
or school truancy. The scales are labeled as follows:

Scale SS: Impulse Control (35 items).

Scale TT: Societal Conformity (39 items).

Scale UU: Scholastic Achievement (41 items).

Scale WW: Attendance Consistency (36 items)

Sggrrgg_rn§_u521. When constructing the MAPI, Millon
(1982) believed that his personality inventory measured

traits, concerns, and behaviors that were neither normally

58

distributed nor of equal prevalence in normal and clinical
populations. Accordingly, Millon maintained that
transforming the raw scores into standard scores was
inappropriate. Accordingly, when scoring the MAPI, raw
scores are transformed into base rate scores. This
conversion was determined by personality trait prevalence
data obtained in external validation studies on 430
individuals.

Two arbitrary numbers were selected to designate the
two base rate cutting lines. A base rate score of 75
indicated the "presence" of the personality trait,
concern, or behavior. Adolescents scoring above 74 are
said to possess, to a clinically significant degree, the
trait, concern, or behavior assessed. Similarly, a base
rate score of 85 indicated the "predominance" of the
personality, trait, or behavior. Adolescents scoring
above 84 on a scale are considered to display that trait,
concern, or behavior as a dominant element of their
clinical picture. A base rate score of 50 was selected to
represent the median for all adolescents who participated
in the test-construction studies.

Within the MAPI instrument are items to assess
reliability and validity of responses. Three factors

contribute to nonusable responses:

59

1. Tendencies of the adolescent to "deny" emotional
problems, trying to appear healthier than would be
objectively determined.

2. Tendencies of the adolescent to "complain"
excessively, trying to appear more disturbed than is
objectively justified.

3. Tendencies of the adolescent to respond
"randomly," i.e., not answering, either by accident or
intentionally, in a manner reflecting comprehension and
relevance.

For the reliability index, items were included to
focus directly on the adolescent’s belief that his/her
responses represent an enduring set of feelings and that
he/she took the testing situation seriously. Three items
that comprise the reliability index (Scale 21) have been
shown to be very successful in identifying those
adolescents for whom test-taking attitudes or lack of
conviction reflected in their responses resulted in scores
with little enduring meaning. A score of 2 is recorded as
unreliable, 0 equals reliability, and 1 is questionably
reliable.

The validity index (Scale 22) targets problems
arising from noncomprehension or random responding. These
problems seem to occur, according to the manual, when the
adolescents are too disoriented to focus or maintain

interest in the inventory or are purposely avoiding

60

committing themselves due to their perception of
consequences associated with the test” .Accordingly,
implausible but nonbizarre items were included that had a
frequency response of less than .01 among normal or
clinical populations. Seventy-five percent of all
adolescents who fail to complete the MAPI carefully or
relevantly are detected by the three items in this index,
which is highly sensitive to careless, confused, or random
responding. Again, scores of 2 indicate unreliability, 0
suggests reliability, and 1 indicates questionable

reliability.

uat o e ’abi i a d vali 't . To develop a
diagnostic instrument capable of efficiently assessing
adolescents on a number of significant personality and
behavioral characteristics, the MAPI was constructed with
attention directed to reliability as well as internal
structure and external validation.

Empirical evaluation of the MAPI consists of (a)
reliability estimates for test-retest stability and
internal consistency, (b) scale intercorrelations, (c)
external correlations with other personality instruments,
and (d) results of factor analyses.

The reliability and validity of the MAPI instrument
have been carefully investigated by other researchers,

using a variety of established empirical procedures,

61

including test-retest and internal consistency indicators
of reliability and convergent validity with other
diagnostic inventories. The procedures used and results
obtained are described in detail in Millon, Green &

Meagher (1982).

Researgn on rne MAPI. Because the MAPI is a

relatively new instrument, little research was available
for review. Only one study to date has appeared in the
literature regarding the use of the MAPI as a validating
instrument (Levine, Green, & Millon, 1986). To establish
external-criterion validation, 181 adolescent subjects
completed the MAPI and the Separation-Individuation Test
of Adolescence (SITA), which is based on Mahler’s theory
of early childhood separationsindividuation processes. An
examination of the results by Levine et a1. supported the
establishment of external validity for the MAPI.

Other research has been conducted on the MAPI and
presented at various conferences, printed in unpublished
reports at psychiatric institutions, and written as
dissertation findings. In her dissertation, Fons (1987)
used the MAPI to compare 30 adolescents in a psychiatric
inpatient unit to two groups of 30 high school students
(one group of high school students having scored in the
abnormal range on the MAPI pretest and one group having

scored in the normal range). Fons found a greater degree

62

of test-retest stability in the personality scales of the
MAPI than in the Expressed Concern scales. She was also
able to demonstrate that scores on the Inhibited and
Sensitive scales decreased with treatment, that the
Sociable and Confident scales scores increased with
treatment, that the Expressed Concern scales decreased
with treatment, and that the untreated groups evidenced no
significant differences on pre-posttest scores.

Five presentations examined the MAPI at the Millon
conference in Miami, Florida, in March 1986 (Fons, 1987).
The following is a summary of those articles:

Zupkus (1986) discussed her research in the use of
the MAPI to differentiate among normal, emotionally
disturbed, and delinquent adolescents. With 60 subjects
in each group, membership was predicted with 60.5%
accuracy among all three groups and with 76.1% accuracy
between the normal and pathological groups. Additionally,
Zupkus found that Forceful and Sensitive personality
styles were more frequent among maladjusted adolescents
than among normals.

Watchman (1986) presented research data that used the
MAPI to differentiate between depressed and nondepressed
adolescents. His results indicated that high scorers on
the Introversive, Cooperative, and Respectful scales used

denial as a coping mechanism and changed very little when

63

depressed; high. scorers. on 'the Forceful and Sensitive
scales became more aggressive when depressed: and high
scorers on the Inhibited, Sensitive, and Cooperative
scales became highly intropunitive. The findings suggested
that personality style as measured by the MAPI is a
salient factor in determining an adolescent’s response to
coping with depression.

Tracy (1986) reported results from research using the
MAPI with 230 adolescent inpatients and outpatients. He
warned that the MAPI’s weakness tends to rest in the area
of diagnosis of the more severe Axis I pathology,
including psychosis and major depression.

Pantle and Wassink (1986) also employed the MAPI with
inpatient adolescents selected from the crisis treatment
unit of a psychiatric hospital. They found no significant
difference using the MAPI between the groups who had
threatened suicide and those who had demonstrated no
suicidal behavior before admission. However, the MAPI did
differentiate between those who had attempted suicide and
those who had not, with the group attempting suicide
having significantly higher scores on Inhibited and
Sensitive and significantly lower scores on Sociable and
Confident.

Using the MAPI, Pantle and Houskamp (1986) assessed
differences among adolescents with a history of sexual

abuse. Three groups of adolescents, matched by age,

64

gender, and diagnosis, were equally divided among those
having experienced documented severe sexual abuse,
moderate sexual abuse, and no sexual abuse. Their results
indicated that MAPI profiles on adolescents who had
experienced sexual abuse differed from the profiles of
adolescents who had not been sexually abused. The
Inhibited, Personal Esteem, Peer Security, and Social
Tolerance scales were significantly higher in the two
sexually abused groups, whereas the Sociable and Confident
scales were significantly lower. Furthermore, as the
severity of the sexual abuse increased, so did the scores
on the Peer Security and Social Tolerance scales, whereas
scores on the Sociable and Confident scales declined.
Pantle and Houskamp interpreted those findings to mean
that severely abused adolescents perceived themselves as
less confident and outgoing and as having greater
difficulty with peer relationships and tolerance for
others.

The MAPI also has been used in two unpublished
reports researched at Pinerest Christian Hospital in Grand
Rapids, Michigan, in 1988. Using the MAPI, VanZytveld
(1988) assessed 56 adolescents characterized by
differential levels of suicide proneness. The three
groups being compared were those who had threatened

suicide, those who had attempted suicide, and those who

65

had no history of suicidal behavior. Significant
differences were found among the groups. Specifically,
those who had threatened suicide scored highest on the
Inhibited and Sensitive scales and lowest on the Sociable
and Confident scales. Additionally, on the Expressed
Concern scales, the threateners scored highest on having
issues regarding Self-Concept, Personal Esteem, Body
Comfort, Sexual Acceptance, Peer Security, and Social
Tolerance. Those who had attempted suicide showed
significantly less distress on the MAPI relative to those
who had threatened suicide. VanZytveld suggested that the
difference might have been due to the attempters seeing
themselves as having made a choice and, thus, having
achieved some type of resolution. On the other hand, the
threateners could be seen as being in the midst of
indecision and, thus, of distress that is reflected in the
MAPI scales.

The other research study conducted at Pinerest. was
performed by Houskamp (1988) and used the MAPI to assess
differences between a sexual-abuse group and a control
group with no history of sexual abuse. Significant
differences were found on the Inhibited, Sociable,
Confident, Personal Esteem, Peer Security, and Social
Tolerance scales. As noted in other research cited

herein, scores on the scales correlate with the severity

66

of the abuse, indicating a possible relationship between
severity of sexual abuse and its effects.

In a paper presented at the Society of Personality
Assessment in New Orleans, Louisiana, in March 1988,
Trenerry, Pantle, and Ziebelman (1989) compared the MAPI
with the Rorschach in assessing 63 adolescents admitted to
an inpatient crisis unit. They found a significant
correlation between the Depression index and the
Inhibited, Cooperative, Sociable, Confident, and Forceful
Personality scales. Furthermore, they found a
constellation of MAPI Personality scales that demonstrated
predictive value regarding suicidal behavior.

Pantle (1989) described a comparison of the MAPI with
the Rorschach and the Multiscore Depression Inventory in a
paper presented at the Society for Personality Assessment
in New York in April 1989. Pantle performed the
comparison to assess mood disorders of adolescents
hospitalized for depression at the Pinerest Christian
Hospital in Grand Rapids, Michigan. Pantle reported that
an elevation in the Forceful scale may be indicative of
"masked depression" that presents as disruptive behavior.
In line with Millon’s theories, Pantle’s research further
suggests that passive-aggressive and avoidant types are
susceptible to depressive disorders, whereas histrionic,

narcissistic, and antisocial personality styles tend to be

67

intolerant of negative affect and often take a "flight
into health" shortly after being admitted for treatment.
In summary, published research on the MAPI is sparse.
However, research findings presented at conferences and
summarized in dissertations and unpublished reports
have supported its use in assessing various adolescent
populations. In particular, the MAPI has been found to
have assessment value in terms of depression, suicidal
proneness, and sexual abuse. These findings would suggest
the appropriateness of using the MAPI with the adolescent

population in this study.

The Personal Change Questionnaire

The Personal Change Questionnaire consists of 38
questions. (See Appendix B.) Respondents are asked to
answer on a scale from 0 (very poor) to 7 (very well).
The first 37 questions relate to the process of problem
solving and are based on the four stages of the Personal
Paradigm Shift: (a) awareness; (b) decision making, (c)
oppositional alternatives, and (d) treatment planning and
action. The final question (#38) asks the respondents to
rate themselves on their own problem-solving ability. (A
corresponding question regarding the respondent’s problem-
solving ability is asked of the therapist on the Survey

instrument used in this study.)

68

W- The Personal Change

Questionnaire’s four stages correspond to identical stages
in the Personal Paradigm Shift. Each stage in the
Personal Paradigm Shift consists of detailed steps
designed to educate the respondent about the relationships
between external behaviors and internal experiences, such
as thoughts, feelings, and bodily reactions. Because the
Personal Change Questionnaire is based directly on the
Personal Paradigm Shift, the items on the questionnaire
correlate with the individual steps of the Personal
Paradigm Shift. The following is a description of the
stages as they relate to the items on the Personal Change
Questionnaire:

Stage One: Awareness (Items 1-10). The first stage
is designed to guide respondents through a self-analysis
of their present behaviors to discover the personal
dynamics of the present problem. The focus is on
identifying the problem and its antecedent or concurrent
thoughts and feelings. The intention is that respondents
become aware of and examine relationships between internal
and external variables that create and maintain their
personal problems.

stage Two: Decision-Making (Items 11-17). The
second stage is based on awareness gained in Stage One.
The focus is on determining how the information from Stage

One influences their decisions about making changes. The

69

problem-solving process at this stage consists of three
steps: constructing a balance sheet of thoughts and
feelings surrounding personal changes, making a commitment
to change, and confronting the barrier of fear about
changing.

Stage Three: Oppositional Alternatives (Items 18-
26) . The third stage aims at helping the respondents
replace old internal reactions with new thoughts,
feelings, and behaviors. In addition, this stage attempts
to foster a sense of self-control over internal reactions
and subsequent behaviors.

Stage Four: Treatment Planning and Action (Items 27-
37). This final stage provides realistic steps for
developing and carrying out plans to bring about desired
changes and solving the problem identified in Stage One.
The problem-solving process in this stage consists of goal
setting, finding appropriate role models and support
groups, and creating specific methods of record-keeping

and self-evaluation.

t va ' 't . The Personal Change
Questionnaire is new and, at the time of this study, was
being researched in terms of its reliability, content
validity, and construct validity (Kelley, in process).
Kelley (1989) noted that the reliability of the Personal

Change Questionnaire could be evaluated in terms of

70

Cronbach’s alpha. The content validity relied on the use
of expert judges regarding the items on the questionnaire.
To assess construct validity, Kelley stated that the
clients were to be given a self-rating and a therapist’s
rating, which were subjected to a correlational analysis.

Kelley’s (1991) preliminary results suggested that
the Personal Change Questionnaire did demonstrate good
reliability in terms of its internal consistency. Kelley
found the Personal Awareness scale to have a Cronbach’s
alpha of .83, the Decision-Making scale to have a .81
score, the Oppositional Alternatives scale to have a .92
score, and the Planning and Action scale to have a
Cronbach’s alpha of .92, thus indicating good internal
consistency for each of the four scales in the instrument.

In addition, in terms of construct validity, Kelley
found that the clients’ self-ratings and the therapists’
ratings of problem-solving ability were in fact positively
correlated (r = .44, p = .001) , thus demonstrating the
validity of that aspect of the Personal Change
Questionnaire.

Because the original Personal Change Questionnaire
targeted adult clients, minor alterations were made for
this study in vocabulary and with regard to examples used,
in order to enhance readability and comprehension of the

items by an adolescent population. Two methodological

71

safeguards were incorporated to ensure that the resulting
instrument could be appropriately completed by this target
population. First, the instrument was pilot-tested with a
sample of 10 adolescents (5 male and 5 female) randomly
selected by the staff of St. Vincent Home for Children in
Lansing, Michigan. This group was selected because of
their similarity to the target population of this study.
Adolescents from the St. Vincent Home frequently move into
therapeutic foster care programs. The adolescents in the
pilot test were all able to successfully read and complete
the test instrument.

As a second check, a panel of professionals who work
with this population was selected to review the instrument
and make suggestions regarding wording and comprehension.
The only suggestion received from the panel was that the
word "counseling" be substituted for "therapy." This
change was made in the instrument provided to the
adolescents in this dissertation study.

Although comprehensive reliability and validity
testing of the Personal Change Questionnaire was well
beyond the scope of this study, certain methodological
procedures were employed to address these issues. In
particular, the four Personal Change Questionnaire stages
were examined using a combination of rational and
empirical criteria, including (a) logical fit of each item

with its scale, (b) significant correlation of each item

72

with its scale, (c) overall scale internal consistency
(using Cronbach’s alpha), (d) no substantive improvement
in scale internal consistency if the item were removed,
and (e) items correlated highest with their own scale.

The scales for the four stages satisfactorily met all
of the first four criteria. However, a total of 6 of the
37 items did correlate slightly (although not
significantly) higher with another scale than with their
own. The content of those six items was reexamined in
terms of their logical fit with their original and
competing scales. For the purposes of this study, it was
determined that the original scale placement was
satisfactory.

The reliability of each of the four scales, in terms
of internal consistency, was found to be similar to the
previously cited results obtained by Kelley. The Personal
Awareness scale demonstrated a Cronbach’s alpha of .80,
the Decision-Making scale was .78, the Oppositional
Alternatives scale was .84, and the Planning and Action
scale was .91, thus indicating that each of the four
scales demonstrated good internal consistency.

Finally, there was one opportunity for directly
examining the issue of validity in this study. Item 38 of
the Personal Change Questionnaire assesses the

adolescents’ perceptions of their overall problem-solving

73

ability. Similarly, the survey completed by the
adolescents’ therapists for this study included an item
measuring the therapists’ assessment of the adolescents’
problem-solving ability. The results showed that the
correlation of the two different measures was
statistically significant (r = .40, p ==.01), indicating
at least that degree of external criterion validity for
the Personal Change Questionnaire. Once again, this
result is very similar to the previously cited results
obtained by Kelley.

On the basis of the prior research with the Personal
Change Questionnaire, together with the pilot-testing and
expert review conducted of preliminary procedures, it
appears that the instrument used was reliable, valid, and
appropriate for the target population examined in this

study.

$11M!

The final instrument used in this study was the
survey to ascertain certain demographics of the population
in therapeutic foster care. (See Appendix C.) The
instrument was given to the adolescent’s therapist to
complete and return.

The questions on the survey included age, gender,
race, family status (biological or adopted, temporary or

permanent ward), length of time in therapeutic foster care

74

programs, length of time in regular foster care programs,
number of previous foster care placements, and history of
residential placement or psychiatric hospitalizations.
The final question asked the therapist to rate the
adolescent on his/her problem-solving ability at the
current time, using a scale of 0 (very poor) to 7 (very
well).

This instrument was mailed to the therapist assigned
to each of the adolescents selected for inclusion in this
study. It was successfully completed and returned for all

of the subjects included in the final study results.

51 n

The design of this study consisted of an
observational analysis of the population in therapeutic
foster care using the demographic information on the
survey, the personality profiles suggested by the MAPI,
and the examination of problem-solving abilities indicated
by the Personal Change Questionnaire. Because this study
involved observational analyses rather than an
experimental or quasi-experimental design to measure the
effects of an experimental treatment, most typical
concerns regarding threats to validity were not pertinent.
Nevertheless, one factor of concern in the design was the
relative newness of the MAPI and the Personal Change

Questionnaire. Both instruments have been developed only

75

recently and, therefore, have not been extensively
researched regarding reliability and validity. Caution,
accordingly, was exercised in terms of interpreting the

results.

Wis

The analysis of the therapists’ survey featured basic
descriptive statistics, including the frequencies, means,
and standard deviations of the various variables. Cross-
tabulations were made to develop frequency tables and
descriptive graphs.

The primary research instruments, i.e., the MAPI and
the Personal Change: Questionnaire, ‘were first. analyzed
using similar descriptive statistics. (Results for the
MAPI were structured according to the protocols suggested
by the developers of that instrument.) Gender differences
on the Personal Change Questionnaire were examined using
two-tailed t-tests and on the MAPI, using the Pearson chi-
square statistic. Differences between the study sample of
adolescents and the national normative data were examined
using the Pearson chi-square test for goodness of fit. In
each case, a significance level of .10 was selected due to
the small sample sizes available and the exploratory
nature of this study.

In addition, a variety of correlational analyses were

conducted among and between variables in the two

76

instruments, and between these instruments and the
descriptive and demographic variables obtained from the
therapists’ survey. Finally, Pearson correlations were
used to examine the relationship between time in
therapeutic foster care and results on the MAPI and the
Personal Change Questionnaire.

All analyses were conducted using the Statistical

Package for the Social Sciences (SPSS) computer software.

Summary

A sample of adolescents in therapeutic foster care
was observed relative to a demographic survey, the Millon
Adolescent Personality Inventory, and the Personal Change
Questionnaire. The MAPI was designed to assess the
overall make-up of an adolescent’s personality, including
coping styles, expressed concerns, and behavioral
patterns. The Personal Change Questionnaire analyzes
problem-solving abilities in terms of personal awareness,
decision-making skills, knowledge of oppositional
alternatives, and planning and implementation behaviors.
The research questions were examined through means,

frequencies, cross-tabulations, and Pearson correlations.

CHAPTER IV

DATA ANALYSIS

In Chapter IV, the results of the study are
presented. Initially, the results of the descriptive
survey are provided in order to identify the therapeutic
foster care adolescent population studied. Thereafter,
the results on each of the five research questions are
presented. Specifically, the following contents are

included:

W: the results of the MAPI in an

attempt to ascertain if there is a personality
profile of adolescents in therapeutic foster care.

Reseereh Questien z: the results of the Personal
Change Questionnaire in an attempt to determine if
adolescents in therapeutic foster care are aware of
elements necessary for personal change or problem
solving.

Beseerch Queer; on 3 : the correlation between the
results on the MAPI and the length of time in
therapeutic foster care.

5 h e ' : the results on correlational
data regarding the relationship between the length of
time in therapeutic foster care and the results on
the Personal Change Questionnaire.

s u 'o : the correlation between the
results on the MAPI and the results on the Personal
Change Questionnaire.

This presentation of information is followed at the

end of the chapter by a summary of the results on the

77

78

descriptive survey, as well as all five research ques-

tions.

Resulrs

sc ' tiv u e es 1 s

The results of the descriptive survey cover the 41
adolescent subjects in therapeutic foster care who
completed all of the instruments involved in this study.

Sixteen of these adolescents were male; 24 were
female. The data on one survey were incomplete with
regard to gender. Ninety-five percent of the sample was
Caucasian-Anglo, and 5% was Hispanic. Twenty-nine percent
of the adolescents were temporary wards of the court or
state, six were permanent wards, and data were incomplete
on the remaining six. Thirty-seven percent of the
adolescents had a history of psychiatric hospitalization
or residential treatment. The mean age was 15.8 years.
The mean length of time in the therapeutic foster care
program was 16.9 months, and the mean length of time in
regular foster care placements prior to admission into
therapeutic foster care was 8 months. The number of
previous foster care placements before entering
therapeutic foster care was 1.6.

The data on 5 of these 41 adolescents were omitted in
the analyses when the results on the MAPI indicated that
their profiles were invalid. This removal of five

subjects was not considered to have posed a threat to the

79

data analysis (as discussed earlier, in the Methods
section).

es e ' on t
of' d sc 5

Therepeutie Foster Qere

The possibility of a personality profile of
adolescents in therapeutic foster care was assessed via
the MAPI. In examining the results of the MAPI, all 20
scales were used. When constructing the MAPI, Millon
prepared national normative data, for both males and
females, for each of the first eight scales. The summary
scores from these normative data were obtained for use in
this study via a personal telephone conversation with
Millon’s offices (Kevin Anderson, National Computer
Systems Professional Assessment Services, October 1,
1990). In terms of these first eight scales, the results
of this study were compared to the national normative
sample, as well as undergoing an analysis by gender. The
remaining 12 scales do not have any normative data
available. Accordingly, a comparison was made only
between the males and females within this study.

Per the scoring instructions of the developers of the
MAPI instrument, the data have been divided into the
percentage of adolescents who scored at 75 or above,
indicating the "presence" of that trait, and those who

scored at 85 or above, indicating the "predominance" of

80

that trait. In addition, a total score combining the
presence and predominance scores has been provided for
both the male and female populations. These data are
presented in Graphs 1 through 20.

For the first scale, Introversive, the normative
female population scored at 9.6% for presence, whereas the
therapeutic foster care females scored at 4.5% (see Graph
1). For predominance, the normative sample scored 7.4%,
whereas the females in therapeutic foster care scored
9.1%. Thus, the total combined score reflects a similar
percentage for the normative sample (17%) as for the
subjects in this study (13.6). For the male population,
the results on this scale were even closer. In terms of
the presence of that trait, the normative and therapeutic
foster care males scored identically (7.7%). For
predominance, the scores were almost identical (norm
group: 8.5%; study group: 7.7%). This resulted in a total
combined score of 16.2% for the normative group and 15.4%
for the therapeutic foster care males. Together, these
results suggest little difference between the study
population and the national normative group on this
variable, for either males or females. When a comparison
is made between males and females on being Introversive,
the females have a similar total score to the males in the

normative and study samples

81

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82

For the second scale, Inhibited, the females in the
normative sample scored similarly (11.3%) to the females
in therapeutic foster care (9.1%) for the presence of the
trait (see Graph 2). However, the females in this study
scored higher (22.7%) than the normative population (9.9%)
on the predominance of this trait. Thus, the total
combined score for the females in therapeutic foster care
(31.8%) was greater than the total score for the normative
population (21.2%). Interestingly, this was also the case
for the male subjects. The normative population scored
similarly on presence (9.8% vs. 7.7%) and higher on
predominance (12.1% vs. 0%), resulting in a higher total
score for the normative male population (21.9%) when
compared to the males in this study (7.7%). Although
males and females in the normative population were
relatively similar on their scores on being Inhibited
(21.9% and 21.2%, respectively), the females in this study
scored significantly higher (31.8%) than the therapeutic
foster care males (7.7%).

For the third scale, Cooperative, the females in the
normative population scored similarly (17.6%) to the
therapeutic foster care females (18.2%) on the presence of

that trait (see Graph 3). However, on the predominance of

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85

the characteristic, the normative population scored 13.8%,
whereas the female subjects in this study scored 4.5%.
Accordingly, the total combined score for the normative
female population was somewhat higher at 31.4% than for
the females in therapeutic foster care (22.7%). With
regard to the males, the normative population scored
higher than the therapeutic foster care males on both the
presence and predominance of the characteristic (15.4% vs.
7.7% and 11.3% vs. 7.7%, respectively). Thus, similar to
the female comparison, the total combined score was
somewhat higher for the normative male population at 26.7%
than for the therapeutic foster care males at 15.4%. When
the genders were compared, the females scored higher than
the males on this trait for both the normative population
and therapeutic foster care subjects.

For the fourth scale, Sociable, the female normative
population scored less (10.2%) than the females in
therapeutic foster care (22.7%) on presence, although on
predominance the normative population scored slightly
higher at 15.2% than the females in therapeutic foster
care at 9.1% (see Graph 4). The combined total placed the
therapeutic female population with a similar score on this
trait (31.8%) to the normative population (25.4%). The
same trend occurred with the males. The therapeutic

foster care males scored higher than the normative males

86

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87

on the presence of the trait (23.1% vs. 15%) but similarly
on the predominance of the trait (7.7% vs. 9%,
respectively). Nevertheless, as with the females, the
combined total score resulted in the therapeutic foster
care males scoring fairly similarly at 30.8% to the
normative males at 24.7%. When the sexes were compared on
the total score for this trait, there was almost no
difference for either the normative or the therapeutic
foster care populations.

For the fifth scale, Confident, the therapeutic
foster care females scored similarly to the normative
female: population (9.1% 'vs. 12%, respectively) on the
presence and predominance (9.1% vs. 7.4%) of the trait
(see Graph 5). Thus, for the total combined score, the
normative female population was very similar to the
therapeutic foster care females (19.4% vs. 18.2%,
respectively). With the males, the normative population
scored about the same as the therapeutic foster care
subjects on presence (8.9% vs. 7.7%) and slightly higher
on predominance (14.2% vs. 737%). Accordingly, the
normative male population had a slightly higher total
combined score (23.1%) than the therapeutic foster care
male subjects (15.4%). In comparing the genders, the

females in therapeutic foster care scored higher than the

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89

males in therapeutic foster care on this trait, whereas
the reverse was true with the normative population.

For the sixth scale, Forceful, the females in
therapeutic foster care scored slightly higher than the
normative females on presence (9.1% vs. 5%), predominance
(13.6% vs. 8.8%), and therefore on the total combined
score (22.7% vs. 13.8%, respectively) (see Graph 6). That
was also true of the therapeutic foster care males. The
males in this study scored higher than the normative males
on the presence of this trait (30.8% vs. 10.6%). The
differences were smaller for predominance (15.4% vs.
12.1%), although the trend was still present. For the
total combined score, the therapeutic foster care males
scored significantly higher for this trait (46.2%) than
the normative population (22.7%). In terms of gender
differences, the males scored higher than the females for
both the therapeutic foster care and normative
populations.

For' the .seventh scale, Respectful, the female
therapeutic foster care subjects scored slightly higher on
presence (18.2% vs. 11.3%), similarly on predominance
(13.6% vs. 12.4%), and slightly higher on the total
combined score (31.8% vs. 23.7%) (see Graph 7). However,

for the males, the therapeutic foster care subjects scored

90

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92

very similarly to the normative population on presence of
the trait (7.7% vs. 6.9%) and on the predominance of the
characteristic (7.7% vs. 9.3%). Accordingly, the
therapeutic foster care males scored almost the same as
the normative males on the total combined score (15.4% vs.
16.2%, respectively). The females in both the normative
and therapeutic foster care populations scored higher than
the males on this characteristic. The difference was
significant in the therapeutic foster care group.

For the eighth scale, Sensitive, the therapeutic
foster care females scored slightly lower (9.1%) than the
normative females (12.3%) on presence of the trait but
higher on the predominance of the characteristic (27.3%
vs. 11%, respectively) (see Graph 8). Accordingly, the
therapeutic foster care females scored higher on the total
combined score than the normative females (36.4% vs.
23.3%). For the males, the therapeutic foster care
population scored higher than the normative population on
the presence of the trait (30.8% vs. 8.5%) and the
predominance of the trait (15.4% vs. 8.9%). They were
significantly higher on the total combined score (46.2%
vs. 17.4%) . Interestingly, the therapeutic foster care
males scored higher than the therapeutic foster care
females on this trait, but the reverse was true of the

normative population.

93

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94

For the remaining 12 scales of the MAPI, normative
data were not available. Accordingly, a comparison was
made between males and females in therapeutic foster care
on presence, predominance, and total combined scores.

For the Self-Concept scale, the females were similar
to the males on the presence of the issue (9.1% vs. 7.7%),
slightly higher on the predominance (22.7% vs. 0%) and
significantly higher on the total combined scores (31.8%
vs. 7.7%) (see Graph 9).

On the Personal Esteem scale, males scored higher
than females on the presence of the issue (23.1% vs.
13.6%) but similarly on the predominance (23.1% vs.
27.3%). On the total combined score, the males scored
similarly to the females (46.2% vs. 40.9%) (see Graph 10).

On Body Comfort, males scored almost identically to
females on both the presence of the issue (23.1% vs.
22.7%) and the predominance (7.7% vs. 9.1%). Therefore,
they were nearly the same on the total combined score
(31.8% vs. 30.1%) (see Graph 11).

In terms of Sexual Acceptance, the males outscored
the females on presence of the issue (18.2% vs. 0%), were
similar on predominance of the issue (18.2% vs. 15.4%),
and were higher on the total combined score (36.4% vs.

15.4%) (see Graph 12).

95

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With reference to Peer Security, the males scored
similarly to the females on the presence of the issue
(23.1% vs. 18.2%). However, the females scored higher on
the predominance of the issue (22.7% vs. 0%).
Nevertheless, for"the ‘total combined score, the 'males
outscored the females (40.9% vs. 23.1%) (see Graph 13).

On Social Tolerance, the females scored higher than
the males (18.2% vs. 0%) on the presence of the issue, but
the males outscored the females on the predominance of the
issue (15.4% vs. 4.5%). For the total combined score, the
females scored slightly higher than the males (22.7% vs.
15.4%) (see Graph 14).

With reference to Family Rapport, the males outscored
the females on the presence of the issue (23.1% vs. 13.6%)
and on the predominance (46.2% vs. 22.7%), and were
significantly higher on the total combined score (69.3%
vs. 36.3%) (see Graph 15).

In terms of Academic Confidence, the males scored
similarly to the females on the presence of the issue
(7.7% vs. 9.1%) but higher on the predominance of the
issue (15.4% vs. 4.5%) and, accordingly, on the total
combined score (23.1% vs. 13.6%) (see Graph 16).

Relative to Impulse Control, the males were similar
to the females on the presence of the issue (7.7% vs.

4.5%), were higher on the predominance (15.4% vs. 4.5%)

100

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104

and were higher on the total combined score (23.1% vs. 9%)
(see Graph 17).

With regard to Social Conformity, the males also
outscored the females on presence (38.5% vs. 18.2%) and
predominance (7.7% vs. 0%). Consequently, the males were
significantly higher on the total combined score (46.2%
vs. 18.2%) (see Graph 18).

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outscored the females on the presence of the issue (23.1%
vs. 9.1%), but both genders scored 0% on the predominance
of the issue. Accordingly, the males scored higher than
the females on the total combined score (23.1% vs. 9.1%)
(see Graph 19).

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females scored significantly higher than the males. The
males scored. 0% for jpresence, predominance, and total
combined score. The females scored 13.6% on presence and
predominance, with a total combined score of 27.2% (see
Graph 20).

MW

er Elements Neeeesary fer
Wins

On a scale of 0 to 7, adolescents in therapeutic
foster care on an average rated themselves on problem-

solving abilities as shown in Table 1.

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109

Table l

Perceived Problem-Solving Abilities

 

 

 

 

Males Females
Scale Signifi-
Mean SD Mean SD cance*

Personal Awareness 5.12 1.50 5.21 1.15 N.S.
Decision Making 5.19 1.52 5.02 1.69 N.S.
Oppositional

Alternatives 5.50 1.45 5.57 1.22 N.S.
Planning and

Action 4.98 1.51 5.24 1.83 N.S.

 

*Two-tailed r-test, p < .10; N.S. = not significant.

No significant differences were found between males
and females in this study on their scores for any of the
four problem-solving scales. In terms of differences
between the scales themselves, there was one clearly
significant finding. For the total sample (males and
females combined), the mean score on the Oppositional
Alternatives scale was significantly higher (p < .05) than
the scores on each of the other three scales. This basic
trend persisted for both males and females, although with
the smaller sample size only a few of the within-sex
comparisons reached statistical significance. For males,
the Oppositional Alternatives score was significantly

higher than the Personal Awareness score (9 < .11”. For

110

females, the Oppositional Alternatives score was
significantly higher than that observed on both the
Personal Awareness scale (9 < .05) and the Planning and
Action scale (9 < .10).

Direct interpretation of the scores obtained on the
Personal Change Questionnaire is difficult due to the lack
of normative data and the fact that the scale points on
the questionnaire are not individually defined. Because
the Personal Change Questionnaire uses a type of global
visual analog scale, ranging from 0 to 7 with only two
end-point descriptors (0 is "Don’t know" and 7 is "Know
very well"), a score of 5 or 6 would suggest that the
adolescents in therapeutic foster care generally perceived
themselves as having a moderate level of knowledge and
awareness. The statistical comparisons discussed
previously would further suggest that adolescents in
therapeutic foster care perceived themselves as most
knowledgeable in identifying alternative courses of action
and the accompanying consequences (i.e., the Oppositional

Alternatives scale content).

111

su 5 Re d' 05 '

e Correlarion Between Perseeality
Profiles and Length of Time in
W

The third research question, examining the
relationship of time in therapeutic foster care with the
MAPI scores, was analyzed by performing Pearson
Correlations with scale scores. Of the 20 MAPI scales,

only 4 demonstrated significant or near significant

correlations. These are outlined in Table 2.

Table 2

Correlations of Length of Time in Therapeutic
Foster Care With MAPI Scales

 

 

 

Variable Pearson Correlation Significance
Respectful r = .29 p = .045
Impulse Control r = -.25 p = .075
Peer Security r = .21 p = .111
Sensitive r = -.20 p = .125
Qerrelation Between Length of Time
WM
Awereness of Prohlem-Solying Elements

In terms of the fourth research question, none of the
four Personal Change Questionnaire sections of Personal
Awareness, Decision Making, Oppositional Alternatives, or
Planning and Action were significantly correlated with

length of time in therapeutic foster care. However, the

112

individual Personal Change Questionnaire item measuring
the adolescent’s self-rating of overall functioning
(PCQ#38) was positively and nearly significantly related
to length of time in therapeutic foster care (see Table

3).

Table 3

Correlation of Length of Time in Therapeutic Foster
Care With the Personal Change Questionnaire

 

 

Pearson
Variable Correlation Significance
Personal Awareness r = -.040 p = .405
Decision Making r = -.032 p = .427
Oppositional Alternatives r = -.152 p = .188
Planning and Action r = -.057 p = .370
PCQ #38 r = .210 p_ = .111

 

Further analysis revealed that each of the four
Personal Change Questionnaire sections was significantly

correlated with the age of the adolescent (see Table 4).

113

Table 4

Correlation of Age of Adolescent With the
Personal Change Questionnaire

 

 

Pearson
Variable Correlation Significance
Personal Awareness r = .31 p = .034
Decision Making r = .41 p = .007
Oppositional Alternatives r = .34 p = .024
Planning and Action r = .35 p = .019

 

Results Regarding the Possibiliry of
e Correlation Between Personality
Profiles and Awarenese ef Problem-
§olvigg Elements

With reference to the fifth research question
regarding a possible correlation between the Personal
Change Questionnaire and the MAPI, the following relation-
ships were discovered through data analysis:

The Personal Awareness Scale was negatively
correlated with the Inhibited style (r = -.34, p = .023)
and with Self-Concept (r = -.31, p = .035). There was
almost a significant negative correlation between Personal
Awareness and Scholastic Achievement (r = -.27, p = .056).
A significant positive relationship was found between
Personal Awareness and the Confident style (r = .29, p =
.046).

The Decision-Making Scale was negatively correlated

with the Inhibited style (r = -.34, p = .020). A

114

significant positive correlation was found between the
Decision-Making Scale and the Sociable style (r = .33, p =
.026) as well as the Confident style (r = .39, p = .009).

The Oppositional Alternative Scale correlated
negatively with the Inhibited style (r = -.35, p = .019)
and with Self-Concept (r = -.33, p = .024). There was
almost a significant positive correlation between
Oppositional Alternatives and the Confident style (r =
.27, p = .053).

The Planning and Action scale correlated negatively
with the Inhibited style (r = -.28, p_ = .048) and almost
significantly negatively with Scholastic Achievement (r =

-.28, p = .053).

umma
Descriptive factors as well as five research
questions were investigated in this study. A summary of

the results is provided in the following paragraphs.

es ' 've ata

A summary of the descriptive data on the 36
adolescents in the final sample is as follows: Twenty-two
adolescents were female, 13 were male, and gender on 1 was
missing. Thirty-five were Caucasian-Anglo, and 1 was
Hispanic. Twenty-six were temporary wards, 4 were

permanent wards, and data on 6 were missing. More than

115

40% had a history of psychiatric hospitalization or
residential placement. The adolescents averaged 1.5
previous foster care placements, where they had spent a
mean length of time of 5 months. The adolescents averaged
1 year in therapeutic foster care. The mean age of the
adolescents in therapeutic foster care was approximately

15-1/2 years.

Personality Profile

The initial research question explored the possible
existence of a personality profile of adolescents in
therapeutic foster care. As pertained to the first eight
scales of the MAPI, females in therapeutic foster care
most frequently had a Sensitive style, whereas the males
most frequently had a Sensitive or Forceful style. With
reference to the remaining 12 scales of the MAPI, the
issues of most concern to females in therapeutic foster
care were Personal Esteem and Peer Security, whereas for

the males the issue was Family Rapport.

Perceiyed Problem-Solving Skills

The second research question examined the awareness
of elements necessary for problem solving. The results
indicated that the adolescents in therapeutic foster care
rated themselves between 4.98 and 5.57 on a 0 to 7 scale.
This level of response would suggest a perceived moderate

level of knowledge and awareness.

116

Qorrelarion of Time ih Therapeutie
Eosrer Cere flirh Pereonality Profiles

The third question explored the relationship of time
in therapeutic foster care with personality profiles. A.
significant positive relationship was found with the
Respectful style. A significant negative relationship was
indicated relative to the issue of Impulse Control.
gorrelatieh of Time in Thereheurie
Eesrer Care With Perceiveg
Erohlem-Solvihg hhilities

The fourth research question examined the
relationship between length of time in therapeutic foster
care and perceived problem-solving abilities. No
relationship was found between the four elements of
problem solving and length of time in therapeutic foster
care. However, a significant positive relationship was
found between age and each of the four elements of problem

solving.

Qorrelarioh of Persohality Profiles With
Perceived Prohlem-Solving hhilities

The final research question explored any relationship
between personality profiles and perceived problem-solving
abilities. The Inhibited style was significantly negative
in its correlation with all four elements of the problem-
solving process. Significant negative correlations were
found between various personality profiles and subscales

of the problem-solving process: between Personal

117

Awareness and Self-Concept, and between Oppositional
Alternatives and Self-Concept. Significant positive
correlations were found between various personality
profiles and subscales of the problem-solving process:
between Personal Awareness and the Confident style,
between Decision Making and the Sociable style, and
between Decision Making and the Confident style.

The results of this study are summarized and analyzed
in more detail in Chapter V. A discussion of the implica-
tions of these results in terms of future research,

theory, and program application is also provided.

CHAPTER V

SUMMARY AND CONCLUSIONS

This chapter contains an overall review of the study,
followed by conclusions and interpretations of the data.
The implications of the findings for theory development

and future research are also included.

Review of the Study

An observational analysis was conducted of 41
adolescents in therapeutic foster care. Research
questions were aimed at ascertaining the characteristics
of 'these: adolescents, in ‘terms of ‘various descriptive
variables, personality profiles, and perceived problem-
solving abilities. In addition, personality profiles and
perceived problem-solving abilities were examined relative
to length of time in the treatment setting. Millon’s
formulation of personality development provided the
theoretical underpinnings used in the determination of
personality profiles. The examination of the adolescents’
awareness of the problem-solving process was based on the

research of Hinds and other psychoeducational theorists.

118

119

The findings revealed certain personality profiles
for adolescents in therapeutic foster care that occurred
more frequently than in the normal population. For the
females in therapeutic foster care, the Sensitive
personality style prevailed. For the males, the Sensitive
and Forceful personality styles were most common. A
significant positive relationship was found between length
of time in therapeutic foster care and the Respectful
personality style.

No relationship was found between length of time in
therapeutic foster care and perceived problem-solving
abilities, although a positive relationship was found
between length of time in treatment and both the
adolescents’ and the therapists’ ratings of the

adolescents’ functioning.

Cohelusions Regarding thegrahhie Veriahles

The frequency of data within the various variables
examined revealed that the majority of adolescents in
therapeutic foster care were Caucasian females who were
temporary wards of the court or state. More than one-
third of the adolescents had a history of psychiatric or
residential treatment and had been in more than one
previous foster care placement before entering therapeutic
foster care. The data suggested no predominant pattern in

terms of prior placements in that adolescents entered

120

therapeutic foster care after both more restrictive and
less restrictive placements elsewhere. The average number
of months spent in regular foster care before placement in
therapeutic foster care was 8 months. This time period
might be indicative of the length of time needed to
determine that treatment rather than a custodial placement
was necessary for the adolescent. The length of placement
in therapeutic foster care averaged close to 1-1/2 years.
Data regarding the subsequent placements of
adolescents leaving therapeutic foster care (either
successfully or prematurely) could be quite informative
relative to how therapeutic foster care serves adolescents
in the continuum of mental health care. Unfortunately,
follow-up data on the adolescents who left the therapeutic
foster care program in this study were sought but could

not be obtained.

Conclusions Regarging Persohelity Profile

In response to the question regarding the personality
profile of adolescents in therapeutic foster care, the
results of the first eight scales of the MAPI can be
used to ascertain frequent or common descriptors.

With reference to females, the largest percentage of
responses (36.4%) reflected a Sensitive style. This
finding was higher than the presence and predominance of

this profile in the normal population (23.3%). This scale

121

measures self-dissatisfaction and emotional/behavioral
unpredictability. High scorers tend to be discontented
and pessimistic, with a low tolerance level for
frustration. A central issue with this type is their
struggle between acting out and curtailing resentments.
This style corresponds with the Passive-Aggressive
personality of the DSM III-R.

This finding was closely followed by three equally
predominant profiles (31.8% each): Inhibited, Sociable,
and Respectful. These results were more pronounced than
those of the normal population, where the predominance of
these profiles was less (21.2%, 25.4%, and 23.7%,
respectively).

The Inhibited scale measures social discomfort and
withdrawal. High scorers tend to be shy and socially ill-
at-ease. They desire closeness but have learned to
maintain a distance and not trust others. They often feel
lonely, but fear of rejection keeps them from revealing
their feelings. This style corresponds with the Avoidant
personality of the DSM III-R.

The Sociable style is characterized by outgoing,
charming, and impulsive behavior. High scorers are
talkative, emotionally expressive, and frequently
dramatic. They tend to have strong but brief

relationships with others and become bored in long-term

122

commitments. This style corresponds with the Histrionic
personality of the DSM III-R.

The Respectful scale measures responsible,
conforming, cooperative behavior. High scorers are
usually serious-minded, orderly, efficient, rule-conscious
individuals who keep their emotions in check and try to
lead a predictable existence. According to Millon (1981),
this personality type experiences strong anger and
resentment, which makes them ambivalent regarding being
interpersonally dependent or independent. To control
these rebellious and oppositional feelings, they become
overly conforming and overtly submissive. This style
corresponds with the Compulsive personality of the DSM
III-R. Length of time in therapeutic foster care was
significantly positively correlated with this variable.

For the males, two scales, Forceful and Sensitive,
equally predominated the results at 46.2% each, reflecting
the presence of two fairly distinct subgroups among males
in therapeutic foster care. These findings suggest a
considerably stronger tendency toward these profiles than
in the normal population (22.7% and 17.4%, respectively).

The Forceful scale measures domination, fearless
assertiveness, and tough-mindedness. High scorers are
often strong-willed, blunt, unkind, impatient, and

frequently question the abilities of others. This style

123

corresponds with the Anti-Social personality of the DSM
III-R.

As described previously, the Sensitive scale measures
self-dissatisfaction and emotional and behavioral
unpredictability. High scorers tend to be discontented
and pessimistic. This style parallels the Passive-
Aggressive personality of the DSM III-R.

After these two scales, the next most frequent
profile for the males (30.8%) was the Sociable style.
This finding was slightly higher than the presence and
predominance of this profile in the normal population
(24.7%). As indicated previously, the Sociable scale
reflects a charming, outgoing, and impulsive individual,
with brief but intense relationships, paralleling the
style of the Histrionic of the DSM III-R.

When reviewing these personality styles, the common
denominators among the female adolescent therapeutic
foster care population appeared to be impulsivity, anger,
and lack of social competence. Impulsivity also appeared
to be a common factor in the personality styles that
composed the majority of male referrals for therapeutic
foster care placements. As noted in Chapter II,
psychoeducational problem-solving skills training programs
have proven to be effective in improving social
competence, decreasing aggression, and increasing internal

controls (by teaching tolerance for frustration and

124

ambiguity). Accordingly, a case could be made to
seriously consider using a psychoeducational problem-
solving approach with this population, based on their
personality styles.

In terms of the remaining 12 scales of the MAPI,
which address Expressed Concerns, the adolescents in
therapeutic foster care appeared to have the following
issues:

For the females, 40.9% were assessed as having
Personal Esteem and Peer Security issues. The Personal
Esteem scale score indicated dissatisfaction when
comparing self against an ideal. The Peer Security scale
score suggested a lack of a sense of acceptance by peers.
These scores suggest a lack of a sense of social
competence and possibly the experiencing of negative
labeling effects from being in an out-of-home placement.

The females in therapeutic foster care also scored
high on the scales evaluating their Sexual Acceptance
(36.4%), Family Rapport (36.3%), Self-Concept (31.8%), and
Body Comfort (31.8%). These results suggest a lack of
satisfaction in the development of heterosexual
relationships, discomfort within the family system, lack
of clarity regarding who she is and what she will become,
and a discomfort with body maturation and changes

accompanying adolescent development. Perhaps further

125

research into additional identifying information regarding
this population could expand an understanding of these
concerns. For example, if a high proportion of female
adolescents in therapeutic foster care have been sexually
abused, a high score on Sexual Acceptance, Self-Concept,
Body Comfort, and Family Rapport could be easily
explained. Because research has already been done using
the MAPI with sexual abuse victims, correlational patterns
could be compared with this population.

The remaining scale scores reflected the following
hierarchy of issues: Attendance Consistency (27.2%),
Social Tolerance (22.7%), Social Conformity (18.2%),
Academic: Confidence (13.6%), Scholastic .Achievement
(9.1%), and Impulse Control (9.0%). Of particular
interest in these findings is the low level at which the
female adolescents perceived their impulse control to be a
problem. This was at odds with the profiles reflected in
the MAPI Personality Scales, suggesting a lack of personal
awareness among these female adolescents. This finding is
discussed later in this chapter relative to the Personal
Change Questionnaire, in which the adolescents rated
themselves on Personal Awareness.

For the males, the most frequent issue (69.3%) was
Family Rapport, which gauges the degree of discomfort the
adolescent experiences within the family system. A high

score here was not surprising for the males or females in

126

this study, given the nature of the population sampled and
the necessity for placement outside the home.

The next two most common issues (46.2% each) were
Social Conformity and Personal Esteem. As noted
previously, the Personal Esteem scale ascertains the level
of dissatisfaction experienced by the adolescent when
comparing self against an ideal. An out-of-home placement
and labeling effects may once again have played a role in
this finding. The Social Conformity scale score reflected
a lack of compliance to societal rules and regulations.
This finding paralleled the presence of antisocial
impulsive behaviors found in the MAPI personality
profiles, suggesting accurate personal awareness by the
male adolescents in this regard.

The fourth most frequent issue was Body Comfort
(30.1%). As described earlier, this scale score suggests
discomfort with body maturation and the changes that
accompany adolescent development. Again, further
exploration of additional identifying factors such as
sexual abuse might explain this finding.

The eight remaining scales reflected the following
hierarchy of issues: Peer Security, Academic Confidence,
Scholastic Achievement, and Impulse Control each with a
score of 23.1%; Sexual Acceptance and Social Tolerance

with a score of 15.4% each: a Self-Concept score of 7.7%:

127

and an Attendance Consistency score of 0%. As noted with
the females, the Peer Security issue for the males might
be related to labeling effects and being in an out-of-home
placement. However, what is of interest, in that it
differs from the findings with the female population, is
that the males appeared to have a moderate awareness that
their impulsivity was a problem. This difference might
have ramifications in terms of interventions with each
population.

In summary, the findings on the Personality and
Expressed Concern scales regarding both the female and'
male adolescents in therapeutic foster care reflected
issues regarding impulsivity, aggressiveness, and lack of
social competence. Because research on psychoeducational
problem-solving skills training programs has demonstrated
effective intervention with these issues, the desirability
of attempting to use the problem-solving approach with

this population in this setting warrants consideration.

ob - v' ' s

The conclusions that can be drawn on the self-rating
of the problem-solving abilities of the adolescents in
therapeutic foster care are limited. The lack of
normative data precludes the ability to assess the
therapeutic foster care sample scales relative to other

populations.

128

However, comments can be made among the subscales and
between the sexes. In terms of both the males and
females, the adolescents in therapeutic foster care rated
themselves highest on their ability to identify
Oppositional Alternatives when in a problem situation.
This self-perception tends to be at variance with the
research by Spivack et a1. (1976), who found that
"deviant" individuals generated fewer possible solutions
than the normal population and frequently suggested
solutions that were antisocial in nature.

Of particular interest relative to the male
adolescents was the finding that they rated themselves
lowest on Planning and Action, indicating perceived
difficulty in implementing and maintaining their choices.
This self-perception is congruent with the male
adolescents’ personal awareness of their impulsivity,
discussed earlier in this chapter.

Unlike the males, the females rated themselves lowest
on Decision Making, indicating a perceived difficulty in
identifying what reinforces their behavior and in making a
behavioral commitment. The impulsivity and unpredicta-
bility that characterize the Passive-Aggressive person-
ality style (the most prevalent personality style among
this female adolescent population) might be related to

their perceived inability to make a behavioral commitment.

129

On the other hand, their perception of not being able to
identify what reinforced their behavior was congruent with
the lack of personal awareness noted earlier in this
chapter and might reflect the high percentage of
Histrionic personality styles in this population, as
discussed earlier in this chapter. Because Personal
Awareness is the focus of one of the stages in the
Personal Paradigm Shift, this finding might indicate a
possible need for problem-solving skills training on this

issue.

Conclusions Regarding the Relationship Between
Length of Time in Therapeutic Foster
Qere and Personality

The results of this study indicate that some
relationships exist between certain traits reflected in
the MAPI personality profiles and length of time in
therapeutic foster care. For example, the significant
positive relationship between the Respectful style and
length of time in therapeutic foster care raises an
interesting question. Do adolescents with a Compulsive
personality stay longer in therapeutic foster care because
their responsible, conforming, cooperative, rule-conscious
behavior does not precipitate expulsion to other
placements (with other styles being weeded out over time),
or do adolescents with various styles develop more of a

Compulsive personality style over time in therapeutic

130

foster care? Theoretically speaking, Millon would state
that personality patterns are enduring over time and would
not be easily changed except by intensive intervention.
Unfortunately, because a correlation does not indicate
causality, this question cannot be answered in the current
study. However, this question could be examined using a
different experimental design .that tracks adolescents over
time and, thus, assesses whether personality profiles and
behavioral patterns remain stable.

Juxtapositioned to the previous finding is the
discovery that a significant negative relationship existed
between lack of Impulse Control and length of time in
therapeutic foster care. Thus, adolescents who are in
therapeutic foster care the shortest period of time have
greater problems with impulse control. A logical
explanation would be that impulse control is being
acquired over time in therapeutic foster care, a
possibility that warrants attention and further research.

Two other relationships reached near-significance
levels. Concerns regarding Peer Security positively
correlated with length of time in therapeutic foster care.
The interpretation of this finding is that adolescents
feel less of a sense of belonging and acceptance in

relation to peers the longer they remain in therapeutic

131

foster care. Various explanations of this finding are
possible. Adolescents in therapeutic foster care may feel
increasingly different from their peers, possibly due to a
labeling effect that is either self-imposed or socially
prescribed, the longer they remain placed out of their
family homes. On the other hand, adolescents who have
issues about feeling different from their peers may
require longer treatment. Another possible explanation is
that the longer adolescents remain in therapeutic foster
care, the greater their ability to identify accurately
their differences from their peers that warranted their
out-of-home placement. Because causality cannot be
ascertained in this study, further research would be
warranted. In any event, as noted previously in this
chapter, social competence can be improved using a
psychoeducational problem-solving approach, which warrants
consideration with this treatment population.

Finally, a near-significant negative relationship was
noted between the Passive-Aggressive personality and
length of time in therapeutic foster care. As discussed
with reference to Impulse Control, this finding suggests
that those adolescents who seem self-dissatisfied and
unpredictable effectively and behaviorally do not remain

long in therapeutic foster care. Various explanations

132

seem feasible. One possible explanation for this finding
is that foster parents and/or staff are not engaged by
the discontented, pessimistic, and moody attitude of these
adolescents and choose to consider other placement
arrangements rather than experience the erratic
interpersonal style of these adolescents (a social
competency issue). A second explanation is that the
impulsive style of this personality results in a premature
termination of treatment and a replacement in another
setting. As noted previously in this chapter, both
impulsivity and social competence have been successfully
influenced by the psychoeducational problem-solving
approach. However, an issue related to this finding about
the short treatment stay of this personality style is that
the Passive-Aggressive personality style characterizes the
largest. percentage of adolescents in the therapeutic
foster care population, thus suggesting the likelihood of
a high turnover rate and a high percentage of unsuccessful
placements for a large portion of the referrals.

In terms of implications, the above-noted
correlations between certain characteristics on the MAPI
and length of time in therapeutic foster care are
intriguing, but they suggest the need for further research

to ascertain causal factors with regard to these four

133

relationships. Given the significant positive and
negative correlations of these traits, it could
conceivably be possible, with further analysis, to use the
MAPI instrument as a screening tool for therapeutic foster
care admissions to facilitate selection of the best-suited

candidates for treatment.

0 lusions e t e ela t

Lengrh or Time in Therapeurie Posrer gare
and Perceived Problem-Solving Ahilities

No significant correlations were found between length
of time in therapeutic foster care and the four scales of
the Personal Change Questionnaire. If the Personal Change
Questionnaire is a measurement of perceived problem-
solving ability, this suggests the possibility that
adolescents are not improving in problem-solving skills
during their tenure in therapeutic foster care. (This
might be related to the stated view of some of the
therapists noted in Chapter III that the adolescents in
therapeutic foster care were victims and not responsible
for their behavior.) If that is the case, this finding
would suggest the need to strengthen the focus of the
program in terms of building problem-solving capabilities.
However, due to the design of this study, that need cannot
be definitively established. One other possible
explanation for these results is that adolescents who do

improve in problem-solving skills leave treatment and,

134

thus, do not establish a long tenure in the program.
Further study would be necessary to help clarify this
issue.

One interesting finding regarding the Personal Change
Questionnaire was that Item 38, measuring the adolescents’
self-rating of overall functioning, was nearly
significantly correlated with length of time in
therapeutic foster care. Thus, adolescents who had the
longest placements in therapeutic foster care tended to
rate themselves as having higher levels of functioning.
This relationship is strengthened by the fact that
therapists’ ratings of adolescents’ problem-solving
ability were strongly positively correlated with length of
time in treatment.

Although these findings are encouraging and would be
consistent with the aim of therapeutic foster care
programs, causality cannot be determined by these
correlations. Two competing explanations arise: Do
longer stays in therapeutic foster care produce better
functioning, or are adolescents with better functioning
able to remain longer in the program? A longitudinal
study design would be required in order for conclusions to
be drawn on this issue.

One final interesting observation in this area of the

study was that each of the four scales of the Personal

135

Change Questionnaire was significantly positively
correlated with age. This finding, together with the lack
of any relationship to time in treatment, suggests that
problem-solving ability, as measured by the Personal
Change Questionnaire, might be much more influenced by
simple developmental growth than by participation in
therapeutic foster care. Although the design of this
study once again precludes a definitive answer on this
issue, these results would tend to lend further weight to
the recommendation for increased emphasis on problem-
solving skills in therapeutic foster care. (A more
radical interpretation would be that therapeutic foster
care cannot influence problem—solving ability and that,
therefore, foster care should assume a more custodial
function while natural maturational processes increase

problem-solving ability over time.)

Conclusiohs Regarding the Relationship Between
Persohelity and Perceived Problem-

The following positive relationships were found
between personality and the adolescents’ perception of
their problem-solving abilities:

The Confident style, which parallels the Narcissistic
personality of the DSM-III R, had significant or near

significant positive correlations with three of the four

elements in the problem-solving process. There was no

136

correlation between the Narcissistic personality and the
Planning and Action scale. Without further research, it
is difficult to determine whether these high self-ratings
regarding problem-solving were merely an expression of the
high confidence of the Narcissistic personality. If that
is the case, it is of interest that this confidence did
not extend itself to Planning and Action. This result may
be related to the adolescents’ level of personal awareness
of a problem with impulsivity that was noted earlier in
this chapter.

A significant positive relationship was found between
the Decision-Making scale and the Sociable style or
Histrionic personality. Clinically speaking, this finding
is quite congruent with the dynamics of this personality.
According to Millon, Histrionic personalities result from
a specific parenting style that irregularly positively
reinforces parentally valued behaviors. As a result, the
Histrionic learns to focus attention on rewards and the
behaviors on which they are contingent. The Decision-
Making scale explores reinforcements of behavior, an area
where Histrionics can, accordingly, rate themselves quite
high.

In terms of significant negative correlations, the
following relationships were found:

The Inhibited style or Avoidant personality was

negatively correlated with Personal Awareness, Decision

137

Making, Oppositional Alternatives, and Planning and
Action. This finding appears congruent with the issues of
the Avoidant personality style, which is characterized by
social discomfort and withdrawal and would, thus,
logically have a self-perception of being deficient in
terms of problem-solving abilities.

Self-Concept 'was also significantly negatively
correlated with Personal Awareness and Oppositional
Alternatives. This suggests that those adolescents who
lack clarity about who they are and what they will become
also perceive difficulty in their problem-solving skills.

Finally, a nearly significant negative correlation
was discovered between Scholastic Achievement and the two
scales of Personal Awareness and Planning and Action.
Thus, these adolescents whose academic performance does
not match their academic potential perceive themselves as
seriously lacking in certain aspects of problem-solving
behavior. Further research would be necessary to decipher
whether this perceived difficulty in problem solving is a

cause or effect of their academic problems.

lmplicatiehs or rhe Resulrs for Theory and
for Therapeutic Poster Cere Progrehs

The theoretical foundation for the personality
profiles found in this study rests with the work of

Millon. The basis of his theory is that personality

138

patterns are deeply embedded, largely unconscious, and not
easily eradicated. These intrinsic and pervasive traits
emerge from a complex matrix of biological dispositions
and experiential learnings. The existence of certain
personality profiles found in the adolescents in
therapeutic foster care at a level not found in the
normative population confirms the distinctiveness of these
adolescents in treatment from the general population.

Theoretically speaking, the important question is:
Can these enduring personality patterns be positively
influenced by the therapeutic foster care setting? If so,
what length of time in placement would be necessary for
this influence to occur? If not, this type of personality
profile assessment might be a useful screening tool to
identify adolescents with personality styles not well-
suited to being able to remain in therapeutic foster care
placements and, thus, not being able to benefit from the
setting. Rather than expose these adolescents to another
disruption or failure in their lives, attention could be
focused on seeking other treatment alternatives.
Obviously, further research, using a longitudinal
experimental design, is required before any conclusions
can be drawn regarding the feasibility or advisability or
such a screening process.

The implications of the findings of this study

regarding problem-solving skills are unclear. Although it

139

is evident that adolescents in therapeutic foster care
possess certain patterns in their responses, the meaning
of those findings is difficult to ascertain due to the
newness of the instrument and the lack of comparative data
from other populations.

This study sheds little light on the question of
whether therapeutic foster care had any effect on the
adolescents’ problem-solving skills. On one hand, the
positive correlation of length of time in treatment with
the adolescents’ self-rating of problem-solving ability is
encouraging. (That relationship is made more noteworthy
by the fact that therapists’ ratings of the adolescents‘
problem-solving ability tend to validate the adolescents‘
self-ratings.) On the other hand, length of time in
treatment was not correlated with any of the four Personal
Change Questionnaire scales. This latter finding could
suggest the need for a problem-solving skills training
component to be added to therapeutic foster care.

Another aspect of interest is the finding that older
adolescents in therapeutic foster care had better problem-
solving abilities. Such information may help distinguish
what age should be targeted for psychoeducational
interventions regarding the problem-solving process.

Further research seems warranted in this regard as well.

140

Implicetions for Future Reseerch

Further research on this population, and on the
instruments used, could follow various paths. These are

discussed in the following paragraphs.

Erplorarory Research

A study similar to the current research, but with an
expanded focus and larger population, could further
explore the interrelationships of personality profiles,
problem-solving skills, and behavior. For example, a
study correlating the adolescents’ perceived problem-
solving skills with behavioral indicators could be
designed, in order to explore whether the adolescents’
self-ratings of their skills are a function of distorted
perceptions due to personality styles or are based on

reality factors.

it 'na e ea ch

An experimentally designed study, using a larger
sample, that tracks the adolescents in therapeutic foster
care (and an appropriate comparison group) over time could
reveal causality factors regarding change patterns. In
particular, the issue of whether therapeutic foster care
can influence. dysfunctional personality characteristics
and/or problem-solving abilities could be more adequately

examined.

141

From a more theoretical standpoint, additional
research on the Personal Change Questionnaire is also
needed to develop a better understanding of how
adolescents’ problem-solving skills change over time. One
specific finding from this study that needs to be examined
in more detail is the relationship of age to the problem-

solving process.

Optcome Research

Because an experimental design could not be used with
this study, conclusions could not be drawn about the
findings regarding causality. A longitudinal study, using
a larger sample, that compares adolescents with certain
personality profiles in therapeutic foster care to
adolescents in other settings (such as regular foster care
and residential placements) could accomplish two important
purposes. First, it could assess whether and to what
extent each of these treatment modalities is able to
produce beneficial effects on dysfunctional personality
profiles over time: and, second, it could help indicate
which setting is more beneficial for adolescents with
different personality patterns. This would help establish
whether this type of personality profile screening could
be a useful tool for determining a treatment modality for

particular adolescents.

142

A similar approach to outcome research would also be
helpful regarding the Personal Change Questionnaire. In
addition to the basic task of developing a better
understanding of what effect therapeutic intervention can
have on the problem-solving skills of this population,
such research could also be used to devise ways to better
target interventions directed at the development of those

skills.

Limitations of Observatienel Studies
As discussed in the first chapter of this study, the

findings contained herein are preliminary in nature.
Because an experimental design with random assignment was
not possible, causality with regard to the findings cannot
be determined. However, as the focus of this study was
primarily to identify and explore the population in
therapeutic foster care, the results have been
informative.

Some of the limitations of this study include the
small sample size, the self-selection necessary in
voluntary research, the newness of both instruments
(particularly the Personal Change Questionnaire), and the
absence of available normative data on many of the scales
of both the MAPI and the Personal Change Questionnaire.
It is hoped, however, that an accumulation of data on this

population can begin with the findings of this study,

143

thereby laying the groundwork for future research into

this treatment modality.

APPENDICES

APPENDIX A

THE MILLON ADOLESCENT PERSONALITY INVENTORY

144

 

 

 

 

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MIllon Adolescent PersonalIty Inventory - MAPI(C) - can
by Theodore Millon. Catherine J. Green. Robert B. Meagher. Jr. ! Clinical
, Interpretive .
, Report
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right side at the page. Do not till in the special code

 

sections beiow. Your counselor will complete these. "I ACTIVITIES
4. The toIIowing pages contain a list 01 statements that “m" c'"
young people use to describe themsatves. They are Arts Cratts
printed here to help you in describing your teelings DramatIcs
and attitudes. Try to be as honest and serious as you Entertain-as

can in marking the statements since the results will
be used to help your counselor learn about you and
help you pIen your tuture.

5. Do not be concerned that a tew ot the
statements will seem unusual to you:

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important person.

6 Q (DI get a lot of .aatislaction in my
school work

7 ® ®l enioy thinking about sex.

I I sort of leaI sad when I see
someone who's lonely.

O G Q I'm sure oi my laelings about
most things.

10 G ®l always try to do what is
proper.

II G (Di em a quiet end cooperative
person

12 ®® I'm pretty sure I linow who I am
and what I want in late.

13 ®®l lael guilty when I have to
lie to a hand.

M 6) 6| get so touchy that I can't
tell: about certain things.

15 ®®l try hard to do well at almost
everything I do.

Id ® ®I become very excited or upset
once a wool: or more.

17 GQWhen i get angry. I usually
cool down andle

laelings pass

I. G) (D I'm quite sure that I am sexually
attractive.

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145

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38 G G) I like to arrange things down to
the last date

36 G) G) In this world. you either push
or get shoved.

37 G) Q My social lilo is very satislying
to me.

3. ®® I don't think I have as much
Interest in sea as others
my age.

39 @G) When someone hurts me. I try
to lorget It.

40 G) (D I enjoy getting one ol the highest
grades on a test.

41 Q Q My parents are very kind to me,

42 ® ® I have a strong desire to win any
game I play with others.

so ® (D I think I have a good build.

as CD CD I have almost no close ties with
others my age.

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is good.
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an ut

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tor people who are always
worried about things.

‘2 Q G I seem to have a problem getting
along with other teenagers.

03 G) G) Thinking about sex coniuses me
much oi the time.

04 ® ® I would much rather lollow
someone than be the leader.

as G) 0 To get ahead In this world I'm

willing to push people who get
in my way.

so 6 0 I am pleased with the way my
body has developed.

61 G) G) I can see more sides ol a problem
better than others can.

00 Q 0 I would rather be almost anyplace
but home.

0! G G Becoming involved In other

people's problems is a waste
OI time.

70 G Q I guess I‘m a compiainer who
aspects the worst to happen.

TI 9 @l otten do things tor no reason
other than it might be tun.

72 Q Q It is not unusual to lael lonely
and unwanted.

73 Q Q l teal pretty aimless and don' t
know where l' m going.

14 @Q I do my best to stop anyone lrom
trying to boss me.

75®®Itlsaasomaonayawmlottan
start to yawn. too.

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nogood.
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people than avoid telling them
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at ®®rmprettylmmetureabeutaesual
matters.

02®®rdretherlustlaarounddolna
nothingthanwerhergoto

II®®Letsolhidssaemtohaveitln
terms.

u®®lmengthamoatimportentthlngs
aparaonoenhovaareastreng
willandthadrivatogotahead.

 

[Dosaoaasoaaoaaaaoaoooooo 194284

 

Ob®® At no time In my Ilia have
I had any hair on my head or
my body.

ss®® l onehoet so stoned Iaitherirom
alcohol.“ or drugsl that I don‘ t
know what I'm mdoing.

07 G (D 'unishment never stoppedme
omdolng r I wanted.
fl®®lveryoitenthinklam not
wanted by others In a group.

fl®®0thars my age seam to have
things together better than I do.

OO®®Paopia can lniluanoa me quite
easily.

.1 @G) I otten iaal so angry that I want
to throw and break things.

s2®®lllhe ithordtoundaratand why
people cry at a sad movie.

03 G G l oitan say things that I regret
having said.

94 G) G I guess I depend too much on
others to be helpiul to ms.

05 Q Q I’m not answering these
questions honestly at all.

06 G (D I have a pretty hot temper.

s7 G) G) I iaal ten but oi things
socla I.ly

D. G) (D I like to be the one In authority
to take charge oi things.

99 ® CD I‘ve just about given up as tar
as school is concerned.

100 6CD l Ilka it st home.

let G) G) I don't IIIIIIII thet other
teenagers are not interested
in my irlandshlp.

102 G e I think teenagers are expected
to know too much about
sex.

103 ®® I am very pleased with all
the things I have done up
to new.

to4 G G) Others my age never seem to
call me to get together
with them.

I
los®®lllitstotelletherseeeutthe

things I have done well.

100®®lemgledthetieelinge eiIoIIt
sax have become a part oi my

liia new.

101®®lgatvary htanadwhen
I think oi IIg ell alone
in the world.

los®®lryouesltsamtoeescrlee
myasli I wouldn‘t know what
to say.

iO!®®ldon’tdependmuchonothar
pacplaioririandship.

tto®®l mot lrrll rhese leech oi
myseli in liia.

CS Trans-“tit” Maxi-1.318 1510312

 

146

111®® II I read these questions a month
mno.w I'm sure I would
change most oi my answers

nz®® Tosaesomaonesuiiering doesn't
bot.harme

11:66) I'm Ieelous olthe special
att antion that the other
children in the iamily get.

114 @G azsnpaopla are better looking

Its G) C?) All my Ilia I have to 'blow up-
every now and than.

110 ® G) A quiet hobby is more iun ior
me than a part y

117®® I get upset when I see a very
sick person

118 ® ® I get upset when things I don‘t
expect happen to me.

119®® I worry about my looks.

120 G) Q I'm among the more popular
kids It school

121 CD CD There are always a number oi
reasons why most problems
can't be solved.

122 GG I do my best to get along
with others by being pleasant
and agreeable

123 G) a Sex is disgusting

124 (D (D I have «own across the Atlehtic
30 times last year.

125 ®® it is good to have a regular way
oi doing things so as to avoid
mistakes.

126 (D (D My iemilyn. is .elways yelling
and light

12'! G) G) I would like to continue In

school and college as long
as I can.

12. @(D I seem to lit in right away with
any group oi new kids I most.

129 G) Q There's nothing I like more

than tting in a car and
acorn ng oil.

13006) l'vadone most things In my
Iweiiavery wel.l

131®®Lonalykldsuauallydasarva

132®®lilwanttovdosomathing. liust
ittwlthout thmkingoiwhat
might happen.

tsa®®sellrtlsolwhstlheveoorlehes
bsanappracistsdbyothsrs.

134®®Ihaven't baanpaying much
attantrontothaquastieneon
thasapagse.

138®®lmaksnastyremarkstopsoplo
lithaydaservait.

180®®Ieitenieeleslirmllestlng
ereIlIIIl.sortorieetIIIllte.

IatGDQ I‘m ashamed oi my body.
lu®® NobodyM seems to care about
his atho

130 Q G I think rrh better looking than
most oi the kids I know.

14039 I'm very mature ior my I”
andmknow what I want to do
inl

141 ®® I like being In a crowd Inst to
be with lots oi people.

142 Q G In many ways I iaal very
superior to most people.

143 Q G) Most other teenagers don't
seem to like me.

m G) G) Most people an be trusted to
be kind and thoughtiul.

14b ®® I lilts to run a lot.
lee G) (D I don't really care what I'll
do in Ilia.

147 G G I oiten iaal that others do not
want to be iriendly to me.

I48 (D (D It is very diiiicult ior ms to
stop ieelings irom coming out.

149 ® ® I worry a great deal about
sexual matters.

150 G) (D I can control my iaalrngs
easily.

 

 

FOR PROCESSING
RETURN TO

NATIONAL
COMPUTER
SYSTEMS

P.O. BOX 1294
MINNEAPOLIS.
MINNESOTA 55440

 

 

APPENDIX B

THE PERSONAL CHANGE QUESTIONNAIRE

147

PERSONAL CHANGE QUESTIONNAIRE

mm: For each statement, circle a number on how well you
know yourself on a scale of 0 to 7, with 0 meaning that you "don’t
know" and 7 meaning that you know "very well.” Statements refer to
your' own behaviors, thoughts, feelings, goals, etc. The word
"goals" refers to plans for changing your old behaviors.

Don’t Know Know Hell

I. I know what my main problem
is. Example: I get into
fights at school. 0 l 2 3 4 5 6 7

2. I know specific goals or ways
that will help me solve this
problem. Example: I could
handle my anger by talking,
not hitting. O l 2 3 4 5 6 7

3. I know the situation in which
my problem takes place.
Example: I know I get angry
when someone teases me. 0 l 2 3 4 5 6 7

4. I know what I feel when this
problem happens. Example:
I get embarrassed when people
tease me. 0 l 2 3 4 5 6 7

5. I know what I am thinking in
this problem situation.
Example: I wonder if some-
thing is wrong with me. 0 l 2 3 4 5 6 7

6. I know what actions I take when
these thoughts and feelings
happen in the problem situation.
Example: I stop hanging around
with kids who tease me. 0 l 2 3 4 5 6 7

7. I know the consequences of my
actions in this problem situa-
tion. Example: I know I’ll
get grounded if I fight. 0 l 2 3 4 5 6 7

8. I know if I am proud or ashamed
of myself in this problem situa-
tion. Example: I usually put
myself down for letting other
kids’ words bother me. 0 l 2 3 4 5 6 7

10.

ll.

l2.

13.

l4.

l5.

16.

17.

148

I know what I will lose if I
give up my current behavior in
the problem situation: Example:
I lose the feeling of being
strong that I get when I fight.

I know what need of mine is
being met by my current behav-
iors in the problem situation.
Example: I like the attention
I get when I fight.

I know what punishments I will
get when I change my actions in
the problem situation. Example:
It would feel like a punishment
to lose some of the attention I
get from fighting.

I know the rewards I will get
when I change my actions in the
problem situation: Example:

If I stop fighting, I will be
given extra social outings at
home.

I know the punishments I will

get if I don’t change my actions.
Example: I will lose friends if
I keep fighting.

I know what rewards I will get
if I don’t change my actions.
Example: If I keep fighting, I
will be suspended and won’t have
to attend school for a week.

I know how much I am trying to
change my actions. Example: I
am willing to miss some free time
to attend therapy sessions.

I know the fears I will have if

I don’t change my actions.
Example: I may have to leave this
placement and go somewhere worse.

I know how to avoid my fears.
Example: I can act like it
doesn’t bother me that I may have
to leave. '

18.

19.

20.

21.

22.

23.

24.

25.

26.

27.

149

I know I can bring about new
feelings in the problem situation.
Example: I know I can feel good
about myself no matter what other
people say.

I know I can bring about new
thoughts in the problem situation.
Example: I can think about making
friends instead of fighting when

I go outside.

I know I can bring about new ways

of seeing things in the problem
situation. Example: I can see

myself being popular and having
un.

I know my body could feel differ-
ent in the problem situation.
Example: I could feel less tense
at school.

I know I can have new opinions
about myself in the problem
situation. Example: I can think
of my anger as a balloon filled
with air that I can control let-
ting out.

I know I can learn new behaviors
to solve my problems. Example:
I could walk away when someone
teases me.

I know the consequences of my
new behaviors. Example: Walk-
ing away from a fight could keep
me from getting grounded.

I know I can see myself in a new
way. Example: I can feel strong
being in control of myself.

I know what needs will be met by
my new behavior. Example: I’ll
be able to have more friends if
I don’t fight with people.

I know where to start to make
changes. Example: I know what
I need to do first to stop fighting.

28.

29.

30.

31.

32.

33.

34.

35.

36.

150

I know I can find someone to be
helpful in making this change.

Example: The staff would help

me change.

I know I can get information for
making changes. Example: My

caseworker can tell me some good
ideas for controlling my temper.

I know I can find a role model.
Example: I know someone else who
learned to control their temper.

I know I can give myself rewards
for making changes. Example:

When I learn to control my temper,
I’ll buy myself a new radio.

I know I can make a plan for making
these changes. Example: I can
plan out my free time at school so
I am too busy to be hanging around
outside where I could end up
fighting.

I know I can give myself feedback
on my progress. Example: I can
keep track of my fights to see
how I’m doing.

I know it will take time to change.
Example: If I work hard, I could
probably learn to control my tem-
per by my birthday.

I know that I can make a backup

plan if I fail to reach my goal.
Example: If I lose my temper, I
could decide to exercise a half
hour each night so I won’t feel

tense at school the next day.

I know I can make a plan to avoid
ruining my success. Example: Each
week I could look over how I have
done in controlling my temper to
see if I have followed my plan.

151

37. I know I can keep a diary or chart
to follow my change. Example: I
can make a chart that includes how

many fights I have gotten into

that week. 0 l 2 3 4 5 6 7

Please give a score on how well you feel you are dealing with your
problems: (Circle one.)

Poorly Very Hell
0 l 2 3 4 5 6 7

APPENDIX C

THE SURVEY

152

THE SURVEY

To: Intensive Foster Care Program
Branch Agency:

From: Charlene Crickon Kushler
Date: December ll, l989

The following adolescent has been selected for the study being
conducted on Intensive Foster Care:

 

Please complete the following information on this adolescent:

 

 

Age: Race: Caucasian

Black ______
Sex: M or F Hispanic

Indian
Family Status: (please circle) Oriental
Biological or Adopted Biracial
Temporary or Permanent Ward Other
Length of time in Intensive Foster Care Programs: months
Length of time in regular foster care programs: months

Number of previous foster care placements:
History of residential placement or psychiatric hospitalization:
yes or no

For the purpose of evaluating this adolescent for this study, please
rate this adolescent on how well he/she is dealing with his/her
problem at this time from your perspective, using the scale of 0 to
7 below.

Poorly Very Hell
0 l 2 3 4 5 6 7

This survey needs to be returned by December 20, l989, to:

Charlene Crickon Kushler
c/o Central Office

Child and Family Services
2l57 University Park Drive
P.O. Box 348

Okemos, Michigan 48805

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