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thesis entitled
Lessening Pathogeneéis:_
Preventive Interventions
presented by

Brenda Lynn Mayne

has been accepted towards fulfillment
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Date 7/14/1990

 

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LESSENING PATHOGENESIS: PREVENTIVE INTERVENTIONS

BY

Brenda Lynn Mayne

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

MASTER OF ARTS

Department of Psychology

1990

m- 0789/

ABSTRACT
LESSENING PATHOGENESIS: PREVENTIVE INTERVENTIONS

BY

Brenda Lynn Mayne

This study tested the effect of two interventions on
subjects' levels of pathogenesis. Pathogenesis was defined
as the degree to which one uses others to satisfy one's own
needs. Previous studies have shown that, measured by TAT
stories, pathogenesis scores differentiate parents of
disturbed children from parents of normals, and successful
therapists from unsuccessful therapists. Both treatment
conditions were found to decrease pathogenesis. The
cognitive-behavioral class, based on P.E.T. (Gordon, 1988),
increased the number of benign stories told; the more
dynamic course, based on Kaufman's theories of shame and
power (Kaufman, 1985, Kaufman & Raphael, 1983), decreased

the number of pathogenic stories given.

DEDICATED TO
MY FATHER, DON JAMES MAYNE.

(1929-1989)

ACKNOWLEDGEMENTS

I would like to thank and acknowledge the support and
theoretical contributions of my committee members, Bert
Karon and Gersh Kaufman, and the statistical and editorial
help of Ray Frankman. Paul Eyke donated countless hours for
the scoring of TAT stories, and Richard Myer assisted in the
administration of the TAT. I would also like to thank my
father for his encouragement in my return to graduate
school, and my mother for her unfailing financial and moral

support.

iv

TABLE OF CONTENTS

List of Tables
Introduction
Method
Subjects
Procedure
Scoring
Results
Discussion

Summary and Conclusions

Appendix A: Scoring Criteria for
Pathogenesis

Appendix 8: Description and Content of
Cognitive-Behavioral Parenting Class

Appendix C: Course Description and Syllabus
for Psychology of Health and Self-Esteem

Appendix D: Consent Form

Appendix E: Demographic Information by
Treatment Condition

Appendix F: Correlations of Treatment and
Demographic Variables by Levels of
Pathogenesis and Change

References

vi.

«the.» ha

oo

16

19

20

25

30

42

44

45

46

LIST OF TABLES

Table 1: Within group comparisons of pre- and
post-treatment pathogenesis scores.

Table 2: Between group comparisons of pathogenesis
scores.

Table 3: Scheffe comparison of mean change scores
between groups.

Table 4: Within group comparison of mean benign
stories given pre- and post-treatment.

Table 5: Within group comparison of mean pathogenic
stories given pre— and post-treatment.

Table 6: Between group comparison of pre-treatment
pathogenesis scores.

Table 7: Scheffe comparison of pathogenesis scores
before treatment.

Table 8: Between groups comparison of pathogenesis
scores after treatment.

Table 9: Scheffe comparison of pathogenesis scores
after treatment.

Table 10: Significant correlations relating

pathogenesis and demographics.

vi

10

10

ll

11

13

13

14

14

15

INTRODUCTION

This study examined the effects of two interventions on
subjects' levels of pathogenesis. Pathogenesis was defined
as the degree to which one unconsciously uses dependents to
satisfy one's own needs, despite a conflict between one's
own needs and those of the dependents (Meyer & Karon, 1967).
Measured by TAT stories (Meyer & Karon, 1967; see Appendix A
for scoring criteria), pathogenesis has been found to
distinguish psychologically destructive people from those
who are psychologically nurturant. Pathogenesis scores have
been found to differentiate mothers of schizophrenics from
mothers of normals (Meyer & Karon, 1967; Mitchell, 1968),
child-abusive mothers from non-abusive mothers (Melnick &
Hurley, 1969), and parents of schizophrenics and delinquents
from those of normals (Mitchell, 1971). VandenBos and Karon
(1971) found pathogenesis scores of therapists to be
inversely related to client improvement.

Research in pathogenesis has focused primarily on its
role in the etiology of psychopathology. However, research
is needed to determine the possibility of intervening in
this destructive interpersonal style. The dynamic theory on

which pathogenesis is based suggests that attempts to lessen

pathogenesis must address the unconscious needs being met by
the person's approach to dependent relationships.
Theoretically, the pathogenic person is unaware of his/her
destructive style (Karon, 1963) and the pathogenic person
has no motivation to change his/her style of interaction
because the unconscious needs being met. Borofsky,
VandenBos, and Karon (1970) found the effects of
psychoanalytic psychotherapy on pathogenesis varied
depending on whether the therapy focused on the client's
dependent relationships and whether the client consciously
elected to become more benign or pathogenic towards those
dependents. Although the conscious choice implied by this
research suggests that cognitive interventions might be
helpful, measures of conscious motivation and action are not
correlated with measures of pathogenesis (Melnick & Hurley,
1969: VandenBos & Karon, 1971), indicating that cognitive or
behavioral interventions alone would be insufficient.
Therefore, it was hypothesized that successful intervention
must address both unconscious needs and dependent
relationships.

This study examined the effects of two interventions on
pathogenesis ratings: a cognitive-behavioral intervention
based on Gordon's (1988) Parent Effectiveness Training: and
an undergraduate course which utilized theories of shame and
the dynamics of power (Kaufman, 1983: Kaufman and Raphael,

1985) to teach students to become more aware of their

unconscious needs and desires (see Appendices B and C for
course descriptions and content). It was hypothesized that
participation in the cognitive-behavioral class would not
affect pathogenesis scores because it does not address
unconscious motivations. The second course was expected to
lessen students' overall ratings of pathogenesis by teaching
them to consciously recognize their needs, to separate their
needs from those of others in their lives, and to recognize
when those needs conflict. Due to the lack of research
suggesting otherwise, age, gender, race, and SES of the
students were not expected to affect the results.

Because pathogenesis is defined within the context of
dependent relationships, it is plausible that experience in
caring for dependents might affect ratings; it was
hypothesized that the presence of dependent relationships
would lessen initial levels of pathogenesis and increase
change scores. Additionally, due to the age of population
(mean age = 22.4 years) used in this study, consideration
was given to whether developmental issues surrounding the
subjects' separation from dependent relationships with their
parents might increase pathogenesis scores. Because
pathogenesis measures one's rejection of others' needs, it
was hypothesized that subjects separating from parental
relationships would demonstrate higher levels of

pathogenesis.

METHOD

Misfits

Volunteer subjects were recruited from the two
treatment conditions. 22 students from "Parenting Skills"
offered by Lansing Community College participated during the
Winter, Spring, and Summer, 1989 terms. 23 students
enrolled in "Psychology of Health and Self-Esteem" at
Michigan State University, volunteered during the 1989
Winter and Spring terms. 27 control subjects were recruited
from introductory psychology courses offering extra-credit
for research participation at Michigan State University.

The subjects were told that the study was part of on-going

research examining psychology classes at the University and

Community College.

There were five demographic differences between the
subjects in the cognitive-behavioral course and those in the
dynamic intervention and control group.

1. Subjects in the cognitive-behavioral group were older
(mean age of cognitive-behavioral subjects = 28, of both
other groups = 20).

2. Cognitive-behavioral subjects were more likely to have
children (17 of the cognitive-behavioral subjects had
children, as opposed to only 4 of the other subjects).

3. Subjects in the cognitive-behavioral treatment had

separated from their parents longer than had subjects in

the dynamic course and in the control group (this was
confounded with age).

4. Subjects in the cognitive-behavioral class were less
financially advantaged (the average cognitive-behavioral
subject lived in a household earning less than $25,000;
the average subject in the other two groups reported a
family income of $25,000 - 50,000.)

5. Finally, six of the subjects in the cognitive-behavioral
class had been referred to the class (though not to the
study) by either the courts or Protective Services

because of parenting difficulties.

(See Appendix E for a complete breakdown of demographic data
by treatment condition.)
229299219

Subjects were recruited during the first class meetings.
They were given the following information by the
experimenter:

"I am a graduate student in the clinical

psychology program at Michigan State University.

I am conducting research on the psychology classes

offered by the University and Lansing Community

College. For this research project, I need twenty

students who would be willing to participate this

week and at the end of the semester. This will

take approximately one hour each time and involve

writing stories in response to pictures. The
identities of all participants will remain
confidential and the results of individual testing
will be anonymous.‘ Your course instructor will
not know of your participation or test results.

At the completion of this project you will receive

a summary of the findings."

Before beginning data collection, subjects signed
consent forms outlining their rights as volunteer
subjects (see Appendix D for a sample consent form).
Subjects were administered the TAT twice: once during
the first week of class and then again ten weeks later,
at the end of each course. The administration of the
TAT utilized Tomkins' (1947) group format with slides
of the cards projected on a screen. The subjects were
instructed to write their stories down, using non-
erasable ink and drawing single lines through any
errors. Fifteen cards were presented in the following
order: 18M, 2, 38M, 4, 5, 78M, 8BM, 9GP, 9BM, lZBG,
12M, 13MF, 19, 20, 16. Subjects were given the
following instructions:

"I am going to show you a set of 15 pictures,
one at a time. I want you to write me a story
telling me what is going on in the picture, what

the characters might be feeling and thinking, what

led up to it, and what the outcome might be. In
other words tell me a good story." (Instructions

for the TAT are adapted from Karon, 1981.)

Subjects were given five minutes to write each
story with a one minute pause (during which the slide
screen was blank) between each story.

Additionally, during the first administration, each
subject completed a brief questionnaire regarding age,
race, sex, amount of education, religion, SES, number
of dependents, and, as a crude measure of independence,
the number of years they had been either self-
supporting or living apart from their family of origin.
W

Two undergraduate research assistants scored the
randomized TAT stories according to the Karon system
for scoring pathogenesis (Meyer & Karon, 1967) (see
Appendix A for scoring criteria). Scoring for
pathogenesis involves three categories of responses:
pathogenic, benign, and neutral. An individual's
pathogenesis score is determined by dividing the number
of pathogenic stories by the total number of benign and
pathogenic stories (P/P+B). Interscorer reliability as

measured by a product-moment correlation was 0.92.

RESULTS

Pathogenesis scores, pre- and post-treatment, were
averaged across raters and computed for each subject.
Table 1 presents the results of t-tests used to compare
pretreatment pathogenesis scores with post-treatment
scores within each group. Significant decreases were
found between the pre- and post-treatment scores for
both treatment groups. Comparisions of the amount of
change across groups, revealed that, whereas the
dynamic treatment resulted in significantly more change
than occured in the control group, the change evidenced
by the cognitive group was not significantly higher
than that of the controls, nor significantly lower than
the dynamic group (Tables 2 and 3).

The manner in which the two treatment groups
decreased pathogenesis scores was different. The
cognitive group showed a significant increase in the
number of benign stories, but did not decrease the
number of pathogenic stories (Tables 4 and 5). The
dynamic group did not increase benign stories, but

significantly decreased pathogenic stories after

 

 

Pre "TX Mean

(Standard Deviation)
Post-Tx Mean
(Standard Deviation)
N

t

2.08*

4.00**

 

*R< .05, two-tailed, **p<

.01, two-tailed

Table 2: e w o s o e s's c

figgrsfii

----------------------:n.a-ly-s-i-s- -o-f- Va-r.i-a.r:c-e -----------------------
Degrees of Sun of Mean F

Source Freedom Squares Squares Ratio

Between Groups 2 .0253 .0127 3.6908*

Within Groups 69 .2368 .0034

Total 71 .2621

 

*p< .05, two-tailed

 

 

Table 3:
srsunai
Dynamic Cognitive Control
Group Group Group
Mean
Change
Dynamic -.0513
Cognitive -.0355
Control -.0070 *

 

(*) Denotes pairs of groups significantly different at the .05

level.

10

Table 4:

 

e s 'v
- - t
Cognitive Dynamic Control
Group Group Group
Pre-Tx Mean 3.5909 5.8261 6.0556
(Standard Deviation) (1.151) (1.690) (1.601)
Post-TX Mean 4.8409 5.7391 6.0926
(Standard Deviation) (1.621) (1.214) (1.507)
N 22 23 27
t -4.06** .22 -.15

 

*n< .05, two-tailed, **p< .01, two-tailed

Table 5: flithin_sr9un_s9aearis9n_91_msen_nethegenis_§tgries_

- o -

 

Pre-Tx Mean
(Standard Deviation)
Post-Tx Mean
(Standard Deviation)
N

t

Cognitive

(1.862)

6.5227

(1.349)
22

-.95

(1.690)

5.3043

(1.204)
23

2.95**

Control

6.0741
(1.080)
5.9815
(1.148)
27

.64

 

*p< .05, two-tailed, **p< .01, two-tailed

treatment (Tables 4 and 5). The control group showed
no significant changes in the types of stories told.
When compared to the other groups, the cognitive
group demonstrated significantly higher levels of
pathogenesis both pre- and post-treatment (Tables 6-9).
As indicated in the Methods section, the cognitive
group differed demographically from the other groups.
The cognitive group was older, more likely to have
children, had separated longer from their parents,
reported lower incomes, and included 6 court-referred
students. With the exception of income level, all of
these factors were correlated with higher levels of
pathogenesis before and after treatment (Table 10).
Removal of the data from court-referred subjects did
not affect the results. It should be noted that the
cognitive group self-selected the parenting class, and
identified themselves as needing help in parenting:
this is a confounding variable which, due to sampling,
cannot be removed from the demographic variables of
age, having children, or separation from parents. Also
confounded with the treatment and demographic
differences of this group was the strong trend
positively relating change scores to the presence of
dependents in the home (r=.1959, p<.10, two-tailed).
Correlations of other demographic variables with

pathogenesis scores, pre- or post-treatment, did not

12

Table 6: 3‘ .“r 0 0-9 one: f or 0‘ 9 '- ‘otuf! 9: 100‘!‘

EQQI§§&

“mum“-------—------An-a-l-y-s-i-s- -o-f- Va-r-i.a-n.c.e -----------------------
Degrees of Sum of Mean F

Source Freedom Squares Squares Ratio

Between Groups 2 .2299 .1149 27.507**

Within Groups 69 .2883 .0042

Total 71 .5182

 

**p< .01, two-tailed

 

Table 7: e son t e s o es b
SIQQIEEDEI
Control Dynamic Cognitive
Group Group Group
Mean
Control .5067
Dynamic .5313
Cognitive .6386 * *

 

(*) Denotes pairs of groups significantly different at the .05

level.

13

T613188: 3‘ 1;! ° 9.9 .119. 'l '. 9'. I°£;Q‘-_ : ° ’ o. ‘-

Analysis of Variance

Degrees of Sum of Mean F
Source Freedom Squares Squares Ratio
Between Groups 2 .1984 .0992 25.565**
Within Groups 69 .2678 .0039
Total 71 .4662

 

**p§ .01, two-tailed

 

Table 9: t e co
treatmenti
Dynamic Control Cognitive
Group Group Group
Mean
Dynamic .4800
Control .4996
Cognitive .6032 * *

 

(*) Denotes pairs of groups significantly different at the .05

level.

14

Table 10: s e a at e e
demegranhissl

 

Correlation Coefficients

Pre-Treatment Post-Treatment
Pathogenesis Pathogenesis
Age .5287** .4315**
Years Separated
From Parents .4883** .3921**
Number of
Children .6384** .5026**
Court Referred .5731** .4285**

 

**p< .01, two-tailed

15

reach significance level. Appendix F lists all

correlations.

DISCUSSION

This study sought to find ways in which
pathogenesis could be lessened by examining a
cognitive-behavioral parent training course and a
dynamically based self-esteem course. Despite higher
initial levels of pathogenesis in the cognitive-
behavioral group and contrary to expectations, subjects
in both coursesdemonstrated significant change. The
two groups achieved the change using very different
interventions: this was evidenced not only by the very
different focuses of the courses, but very strikingly
by the changes in the TAT stories told by the two
groups. The cognitive-behavioral group increased in
the number of benign stories: their course strongly
emphasized the value and importance of respecting
others' needs, and devoted considerable time to
teaching conflict resolution skills. In discussing
their experiences, subjects in the cognitive-behavioral
class made frequent reference to this aspect of their
course. For example, one subject, court referred to

the class because of his history of using harsh

16

physical discipline, said, "It teaches you that kids
are people, not just kids. And even though it's
sometimes hard to see, I really do think it works
better. The kids learn that what they want is
important."

The dynamic intervention, as predicted, also
lessened pathogenesis ratings, but did so by decreasing
the number of pathogenic stories told. This
intervention devoted considerable time to teaching
subjects to recognize their own needs. The effects of
early childhood experiences and unconscious processes
were explored in depth through multiple means during
the course. Rather than stressing consideration of the
needs of others, this course emphasized subjects'
ability to take care of themselves. It might be
assumed that the course lowered pathogenesis ratings by
helping the subjects become more conscious of their own
needs, thereby reducing pressure to unconsciously use
others. Other research (Chang, 1988) on this
intervention has demonstrated that it increases
subjects' awareness of their own affect and cognitive
processes, as well as the impact of their thoughts and
feelings on their behavior.

The control group, as predicted, did not

demonstrate any significant changes in levels of

17

pathogenesis. This finding provides preliminary
support for the reliability of pathogenesis over time.

A nonsignificant trend in the data suggests that
relationships with dependent children increases the
change achieved by these interventions: however, the
cognitive-behavioral group was formed expressly for the
purpose of changing parent-child relations and it was
the change evidenced by this group which underlies this
trend. These subjects' motivation and access to
situations permitting the practice of newly acquired
skills may account for this change.

It was hypothesized that the process of separating,
of leaving one's family of origin, would increase one's
disregard for the needs of others, and that subjects
temporally closest to this process would score more
highly on pathogenesis indices. This was not borne out
by the data. The measure of separation was very crude
and may have obfuscated results: however, the negative
correlation between age and pathogenesis also suggests
that developmental separation issues are not linked to

the usage of others to satisfy one's needs.

18

SUMMARY AND CONCLUSIONS

This study provides the first evidence that
pathogenesis might be affected by interventions which
are time- and cost-effective. The principles taught by
both of the interventions are commonly found in
psychotherapy and psychoeducational classes. The
differences in the ways in which pathogenesis was
lessened indicates that pathogenesis is not a unitary
personality variable: additional research would be
helpful in determining the multiple components of this
interpersonal style. This research confirms clinical
experience that potential for increasing interpersonal
competence is not related to demographic variables, and
suggests that preventative strategies need not be
limited to specific populations. However, the outcome
measure used in this study did not include behavioral
measures, confirmation from other sources (such as
dependents), or delayed follow-up. Additional research
is needed to determine if changes in pathogenesis
ratings are felt by dependents to a significant degree

and if changes are maintained for any length of time.

19

APPENDICES

APPENDIX A

SCORING CRITERIA FOR PATHOGENESIS

Criteria for scoring follow from two points:
First, if the story contains an interaction between a
dominant and a dependent person, both with somewhat
conflicting needs, the interaction is examined for some
consideration by the dominant person of the dependent's
needs. If the dominant person fails to take the
dependent's needs into account the story is scored as
pathogenic. If the dominant person does consider the
dependent's needs, it is scored benign.

If the story lacks a dependent interaction it is
examined for themes that include such interactions
although there is only one person in the story, and
intrapsychic themes. Stories containing themes of
loneliness, despondency, and helplessness are all
scored as pathogenic. Stories that illustrate themes
of potency, helpfulness, and success or escape stories
that emphasize personal growth are scored as benign.
Stories that cannot be scored as pathogenic or benign
are scored neutral. Pathogenesis scores are computed
using the formula: P/(P+B), where P is the number of
stories judged pathogenic and B is the number of

stories judged benign. (Meyer & Karon, 1967).

20

Meyer and Karon (1967) presented the following as

examples of pathogenic, neutral, and benign themes:

We:

1. Murder

2. Boss driving workers hard.

3. Parents make boy study or practice when he does not
want study.

4. Mother supposedly kind, but not meeting expressed
needs of child.

5. Mother showing particularity for one child over
another.

6. Any kind of talking to as a form of punishment.

7. Mother warning child about things that can harm
him/her while growing up.

8. Mother telling child he/she has not worked to full
ability.

9. Going to cemetery to scare people.

10. Husband gives wife news that he is leaving town (or
her).

11. Spying on girlfriend.

12. Being stood-up.

13. Monster ready to attack child or smaller animal.

14. Happy old witch and pretty young woman.

15. Man telling wife something to hurt her, e.g., took

secretary to dinner.

21

16.

17.

18.

19.

20.

21.

22.

23.

24.

25.

26.

27.

28.

29.

30.

31.

Mother reading to child from Bible to teach her a
lesson.

Woman and evil conscience: woman with devil behind
her.

Mother feels what she has said to daughter has done
little good.

Husband interrupts something wife is interested in.
Nasty remarks to a subordinated, making him/her
unhappy.

King or leader leading nation to ruin.

Mother does not like something about child (looks,
attitude, dress, etc.) even though child likes it.
Refusal of marriage bid: one is interested, one is
not.

Mother checking up on child.

Destructive witch themes.

Family ruled or dominated by another.

Husband or father jealous or forbidding.

Woman harming child by punishment.

Suicide attempt to frighten someone.

Man pulling out of extra-marital affair and woman
does not want to.

Losing interest in playing the violin. The child
playing the violin against his will is assumed to

imply coercion even if parents are not mentioned.

22

W

1. No interaction between two people, though somewhat
conflicting needs.

2. One person enjoying him/herself.

3. No people or living things.

4. Two people, but no indication of interaction.

5. Conflict with person's own needs, not other
person's.

6. Thinking about a mother who was kind.

7. Wanting to join a dead person.

W

1. Parents force child to do something, the child is
unhappy, the parents change.

2. Teacher consoling a problem child or helping a
gifted child.

3. Guides leading animals across difficult area.

4. Reunion of two people, both people pleased.

5. Person springing pleasant surprise on another.

6. Parent interrupts punishment of child by another
parent.

7. Stopping children from activity in which they would
be likely to get hurt.

8. Woman trying to console man in trouble.

9. Father and daughter consoling each other after
death of mother.

10. Helping people at a disaster.

23

11.

12.

13.

14.

15.

16.

17.

18.

19.

Son or daughter interested in advice or stories
from parents.

Woman working hard for benefit of children.
Mother thinking about children and is happy.
Accepted presentation of love or evidence of
mutual love.

Mother admiring work of children or making
something they like.

Man heeds woman's wish not to leave.

Any attempt to help or console with no ulterior
motive.

Prevention of disaster (suicide, murder, etc.).

Mother enlightening child about sex.

24

APPENDIX B

DESCRIPTION AND CONTENT OF COGNITIVE-BEHAVIORAL

PARENTING SKILLS CLASS

The cognitive-behavioral class was based on Parent
Effectiveness Training (Gordon, 1988), a widely used
program for training parents. The class was offered by
Lansing Community College. It met twice a week for two
hour sessions over a ten week term. Enrollment was
limited to 15. Though primarily didactic, the course
incorporated demonstrations of the skills taught,
practice sessions, and daily homework assignments.
Students were assigned 2.3.1. In Action (Gordon, 1988)
and kept daily journals detailing their homework
experiences. No tests or papers were required.

Parent Effectiveness Training (P.E.T.) teaches two
fundamental principles: first, recognizing that parents
and children have their own needs and problems, and
second, that there are specific skills (primarily
communication skills) which can assist family members
in fulfilling their own needs. The course taught these
concepts in three overlapping segments. The first
three weeks were devoted to learning to recognize
children's needs and how to help children solve their

own difficulties. The second three weeks focused on

25

helping the parents to recognize their own needs and to
accept the responsibility of meeting them. Finally,
the last four weeks of the course attempted to train
parents in a style of conflict resolution that included
input and compromise from both parents and children.
The first segment, teaching parents to recognize
the needs of their children, focused on problem
ownership and listening skills. In P.E.T. Gordon
(1988) divides behavior into three categories:
behavior which causes the child problems, behavior
which causes problems for the parent, and non-
problematic behavior. He goes on to postulate that
parents falsely assume that they are responsible for
solving all of the problems besetting their children.
In doing so they not only encourage dependency and
prevent their children from learning problem-solving
skills, but they take on the impossible task of being
completely responsible for someone else. Armed with
poor communication skills, such parents are described
as neither understanding their children's problems nor
providing support. P.E.T. describes the following 12
communication styles as "roadblocks to effective
communication":
1. Ordering, Directing, Demanding
2. Warning, Threatening

3. Moralizing, Preaching

26

4. Advising, Giving Solutions

5. Lecturing, Teaching, Giving Facts
6. Judging, Blaming, Criticizing

7. Praising, Buttering Up

8. Name Calling, Ridiculing

9. Interpreting, Analyzing

10. Reassuring, Sympathizing

11. Probing, Questioning, Interrogating

12. Withdrawing, Diverting, Distracting

Parents are taught that these types of
communication are often useful and effective, but that
they are inappropriate when first trying to understand
someone else's problems. Rather parents are taught
basic listening skills including passive listening,
acknowledgement of the information received, some
opening questions, and active listening skills. This
component of P.E.T. stresses respect for children as
separate people whose perceptions and feelings are
valuable. Because these skills are often new and
awkward for parents, the first three weeks of the
course focus on them exclusively. The skills are
practiced in and out of class, and common problems are
discussed. Those routinely covered are: respecting
children's desires not to disclose, accepting

children's negative feelings as valid, and recognizing

27

that once aired, many problems do not require parental
problem solving. Some basic recognition of the
parents' needs and agendas is taught at this stage, but
the primary focus is on listening to one's children.

The second segment of the course focused on
teaching parents to meet their own needs. The primary
skill taught in this segment is that of making "I
statements." Parents are first taught to own their
problems with children's behaviors, and then to
recognize the underlying emotions and cognitions. A
three part form response is used: "I feel emotion,
when you Wager. because 928mm
effggt_gn_thg_pargnt." Because parents often express
only anger, time is spent recognizing the emotions that
anger covers: fear, embarrassment, hurt, and
disappointment. P.E.T. stresses that the importance of
"I statements" is the ownership of the problem by the
parent - not manipulation or guilt-induction. Although
many children do change their behavior in response to
parental "I statements", the course emphasizes that
such behavior only occurs in when the parent genuinely
listens to the children's messages. "I statements" are
not viewed as a means of conflict resolution.

As the parents become more adept at stating their
needs in the form of "I statements", they are

encouraged to express praise in the same format. The

28

ownership of feelings and genuineness of the message is
stressed.

The last third of the course focuses on conflict
resolution. While recognizing that children need
guidelines and limits, P.E.T. argues that parents do
not need to use power to enforce them. Punishment and
coercion are discourage in favor of "no-lose problem
solving." Problem-solving is described as a logical
extension of active listening and problem ownership,
wherein parents and children discuss compromises,
goals, rules, and behavior consequences together.
Consideration for each other's needs and real-world

consequences are emphasized.

29

APPENDIX C

COURSE DESCRIPTION AND SYLLABUS FOR PSYCHOLOGY OF

HEALTH AND SELF-ESTEEM

This description and syllabus was prepared by
Gershen Kaufman, Ph.D., for Psychology of Health and
Self-Esteem, offered through the Department of

Psychology, Michigan State University.

This course attempts to develop psychological
health through explorations of affect as the critical
mediator of stress and self-esteem. The course begins
with the exploration of powerlessness-affect-stress
cycles. The development of personal identity and
interpersonal competence is begun by translating
psychological principles into effective tools for daily
living.

1.9191119!

The most important skills needed to live life are
often given the least attention. This course attempts
to answer several questions for the individual,
including: How does one create an inner sense of
competence and effective power in the world? How are
direction and purpose discovered? Are there ways to

learn to feel secure in an environment of accelerating

30

uncertainty and powerlessness? How are satisfying and
supportive relationships with peers, parents, and
partners built? Problems in daily living arise when
individuals have not learned to effectively accomplish
these essential developmental tasks. This course
offers an educational experience in developing these
necessary psychological skills by exploring the sources
of power and shame as foundations for competence.
Through living consciously from a position of personal
power, it is believed that one can learn to build a
competent self.
II. Objectives

The specific objectives of this course include
reduction of stress, enhancement of self-esteem,
development of personal identity, effective management
of affect, and development of interpersonal competence.
Additionally, students are taught a series of
experiential tools which aid in building a competent
self. These practical tools are translations of
psychological principles in to action.
III. EQIEQE

The course combines weekly lectures with smaller
section meetings to facilitate group discussion. The
first class meeting of each week is conducted as a
lecture with all sections (approximately 100 students)

meeting together. The second class meeting each week

31

is conducted as an individual section meeting (20—30

students). Regular and consistent attendance is

required.
IV- We
Kaufman, G. (1985). ° we a 'n .

Cambridge: Schenkman.

Kaufman, G. and Raphael, L. (1983). Dynamics of

Essen—811W- Cambridge:
Schenkman.
V. ' e ss nme s
1. e io a rs

A two-page reaction paper is due each week. These
papers must reflect the student's personal experience
with the tools presented that week and demonstrate
her/his knowledge of the theory and specific concepts
presented in the assigned readings.

2. Term_Eaesr

An eight-ten page integrative term paper is
required at the end of the course. The term paper must
demonstrate the student's mastery of course concepts by
relating the various psychological principles to their
respective tools as well as relating the principles and
tools to the larger process of psychological health and
self-esteem. Additionally, the paper must include
discussion of the student's experience applying course
concepts to her/his personal life in both experiential

and conceptual terms. Finally, the paper should

32

include an evaluation of the effectiveness of the tools
and principles as experienced by the student.
VI- Grading

This is a 3-credit, pass/no grade course. In order
to receive a passing grade, students must complete all
weekly reaction papers, the term paper, and participate
in class meetings. Students are responsible for all
material presented and all work assigned when they are
absent.
VII. fizedeage Assisgengs

Graduate assistants conduct the individual section
meetings and grade all assigned work. Assistants for
this course are graduate students in clinical

psychology.

33

COURSE OUTLINE

Qlase_neetings Unite Beedinge
Week 1 & 2 I. w s - ow r
ct- t 5 Ch. 1
Power
Powerlessness
Affect
Stress
Week 3 8 4 II- Shame_and_§elf: Shame
Esteem Ch. 1-5

Week 5 & 6

Week 7 & 8

Week 9 & 10

III.

IV.

Dynamics of Shame
Shame Profile
Self-Concept
Addiction

Ideneity: The Pewe;
Selfls_Belatien: Ch. 2
Ship wign the

gel:

Inner Voices

Guilt and Self-Care
Inner Child
Self-Affirming Identity

Dimensions of Power

Consciousness; Ch. 3

Iogls fog Releasing
Affect

Owning
Detachment
Self-Observation

Imagery

Inter sona Bowe;
Campaignse Ch. 4-5

Developmental Perspective
Relationship Principles
Relationship Process
Power and Shame

34

TOOLS AND TOPICS FOR ASSIGNMENTS
Week One: Paper should cover:

I. Tools: Discuss your personal experiences
working with the following tools; give
specific examples along with your honest
reactions and also describe any difficulties
or discoveries encountered:

1. Happiness List: Make a list of five
events every day which leave you feeling
happy, a smile on your face.

2. Adequacy List: Make a list of five events
every day which leave you feeling proud of
yourself.

II. Theory: Answer the following study questions
based on ngamics of Bowen, Ch. 1:

1. How do the happiness and adequacy tools
relate to the four central concepts of
responsibility, choice, living
consciously, and power?

2. How does power relate to powerlessness?

Week Two: Paper should cover:

I. Tools: Discuss your personal experiences
working with the following tools: give
specific examples along with your honest
reactions and also describe any difficulties

or discoveries encountered:

35

II.

1. Describe a current situation of
powerlessness.

2. Identify your affective reactions during
it.

3. Identify two choices for coping different—
ly with that situation that could enable
you to take back power.

Theory: Answer the following study questions

based on ngemies e; Pgweg, Ch. 1:

1. What is the meaning of the concept of
power as described in the text?

2. How does the need for power develop?

Week Three: Paper should cover:

I.

Tools: Discuss your personal experiences
working with the following tools: give
specific examples along with your honest
reactions and also describe any difficulties
or discoveries encountered:

Describe an old shame scene from childhood.
It can be of any intensity or variety
(embarrassment, shyness, guilt, self-
consciousness, discouragement, inferiority).
It can be from any setting (family, school,
peer group). Describe your reactions before

and after that scene.

36

2. Discuss how that old shame scene continues
to affect you today, either positively or
negatively.

II. Theory: Answer the following study questions

from Sneme, Ch. 1-3.

1. What is the significance of shame and how
does shame develop?

2. How does shame influence the development

of personality and identity?

Week Four: Paper should cover:

I.

II.

Tools: Discuss your personal experiences
working with the following tools: give
specific examples along with your honest
reactions and also describe any difficulties
or discoveries encountered:

1. Apply the Shame Profile to your own
personality. Discuss the particular
affects, needs, drives, and purposes
which, for you, have become fused with
shame.

2. Discuss the role of shame in your own
life, how shame has affected you.

Theory: Answer the following study questions

based on fineme, Ch. 4, 5, and Epilogue:

1. What are the consequences and significance

of shame internalization?

37

2. What are essential aspects of the healing

or therapy process in regard to shame?
Week Five: Paper should cover:

I. Tools: Discuss your personal experiences
working with the following tools; give
specific examples along with your honest
reactions and also describe any difficulties
or discoveries encountered:

1. Observe, accurately name, and describe
your inner voices and your characteristic
negative identity scripts (self-blame,
self-contempt, comparison-making).

2. Attempt to replace negative voices/scripts
with a new self-affirming voice/script and
discuss your observations.

II. Theory: Answer the following study questions
based on Dynamics 9f Beyer, Ch. 2:

1. How does the self's relationship with the
self originate and what is necessary for
changing it to a satisfying one?

2. What is the significance of defining
"identity" as the "self's relationship
with the self"?

Week Six: Paper should cover:
I. Tools: Discuss your personal experiences

working with the following tools: give

38

II.

specific examples along with your honest

reactions and also describe any difficulties

or discoveries encountered:

1. Experiment with inner child imagery or
reparenting imagery and discuss your
observations of the experience.

2. Work with the inner child tool through
verbal or behavioral methods and discuss
your observations.

Theory: Answer the following study questions

based on Dynenics of finger, Ch. 2:

1. What is the meaning of significance of the
inner child concept?

2. How does the inner child concept relate to

the concept of identity?

Week Seven: Paper should cover:

I.

Tools: Discuss your personal experiences

working with the following tools: give

specific examples along with your honest

reactions and also describe any difficulties

or discoveries encountered:

1. Practice the consultation with self tool
daily and discuss your observations.

2. Discuss which affects, needs, and bodily
states you are readily aware of, and which

are hardest for you to recognize.

39

II. Theory: Answer the following study questions

based on W. Ch. 3:
1. Why is a "language of the self" necessary

and useful?
2. How is the process of "differentiating and
then owning" inner events related to

"living consciously"?

Week Eight: Paper should cover:

I.

Tools: Discuss your personal experiences
working with the following tools: give
specific examples along with your honest
reactions and also describe any difficulties
or discoveries encountered:

1. Discuss three different, enngen; relation-
ships (friend, family, romantic) along the
following dimensions:

a. Determine what you are
needing, expecting, or looking for in
each of these relationships by
observing your recurring relationship
scenes.

b. Objectively observe each of the three
individuals to determine how well your
expectations match reality in each

relationship.

40

II.

Theory: Answer the following study questions

based on Dyneniee_efi_£exe1, Ch. 4 and 5:

1. What is the relationship between "staying
defended" and "vulnerability"?

2. What is the relationship among power,

shame, and intimacy?

Week Nine: Paper should cover:

I.

II.

Tools: Describe in depth your experience
applying concepts from this course in your
personal life. Discuss and evaluate your
experience with the tools and concepts from and

experiential as well as conceptual perspective.

Theory: Demonstrate your mastery of course
concepts by relating the various principles to
their respective tools and the larger process
of psychological health. Discuss the dynamics
of the five central dimensions of psychological
health: stress, self-esteem, personal
identity, releasing affect, and interpersonal

competence.

41

APPENDIX D

SUBJECT CONSENT FORM

1.

I have freely consented to take part in a
scientific study being conducted by: Brenda L.
Mayne, Graduate Student under the supervision of:
Dr. Bertram P. Karon, Professor of Psychology.

The study has been explained to me and I understand
the explanation that has been given and what my
participation will involve.

I have freely consented to write stories about
slides viewed during this experiment.

I understand that the experiment will last
approximately 60 minutes and that my answers will
be identified by a number rather than by my name
and will be treated in strict confidence.

I understand that I am free to discontinue my
participation in the study at any time without
penalty.

I understand that the results of the study will be
treated in strict confidence and that I will remain
anonymous. Within these restrictions, the results
of the study will be made available to my at my
request.

I understand that my participation in this study

does not guarantee any beneficial results to me.

42

8. I understand that, at my request, I can receive
additional explanation of the study after my
participation is complete.

9. I understand that in the unlikely event of physical
injury resulting from research procedures, Michigan
State University, its agents, and employees will
assume that responsibility as required by law.
Emergency medical treatment for injuries or illness
is available where ijury or illness occurred in the
course of the experiment. I have been advised that
I should look toward my own health insurance

program for payment of said medical expenses.

Signed:

 

Date:

 

TITLE OF RESEARCH PROJECT: Lessening Pathogeneisis:
Eneventive Innervengions.

43

APPENDIX E

DEMOGRAPHIC INFORMATION BY TREATMENT CONDITION

Cognitive-
32112212131
Sex: Men 10
Women 12
Marital Status:
Single 15
Married 3
Separated/Divorced 4
Race: African-American 3
Caucasion 18
Native American 0
Asian 1
Other 0
Religion: Catholic 4
Protestant 13
Jewish 2
Muslim 2
Other 1
Income: Working Class 15
Middle Class 6
Upper Class 1
Mean Age 27.9
Mean Years of Education 13.9
Mean Years Independent .
of Parents 6.7
Years Caring for
Dependents for Subjects
Having Children (number 2.4

of subjects in parentheses)

(17)

220.6111;

H N
ONH

orahamtx

H
NOHQu

\ll-‘UI

Contggi

11
16

u
H1401

N

OHOHG

g.»
woumm

10

19.8

14.2

APPENDIX F

CORRELATIONS OF TREATMENT AND DEMOGRAPHIC VARIABLES BY
PATHOGENESIS AND CHANGE

(p values are reported in parantheses.)

LEVELS OF

Change
Score

.5081

Pathogenesis Pathogenesis
Initial Final
Treatment -.6789 -.3978
(.000) (.001)
Semester of Data .1226 .1197
Collection (.305) (.321)
Sex -.1652 -.1190
(.166) (.319)
Marital Status .1599 .1667
(.127) (.162)
Race .0550 .0562
(.646) (.639)
Religion .1002 .0465
(.397) (.698)
Age .1416 .1486
(.205) (.201)
Years of Education -.0115 .0831
(.924) (.488)
Years of Caring .4883 .3973
for Dependents (.000) (.001)
Years Independent .0987 -.1052
of Parents (.435) (.337)
Income -.1472 -.1317
(.224) (.367)
Court Referral .5295 .3691
(.000) (-001)

45

(.000)

.1032
(.388)

.0897
(.453)

-.1427

(.177)

-.0045

(.970)

-.1123

(.206)

-.0504

(.634)

-.0504

(.323)

.1959
(.099)

-.1256

(.310)

.1681
(.164)

-.3066

(.009)

REFERENCES

Borofsky, G.L., Vandenbos, G. R., and Karon, B. P.
(1970. June) - MMW
1i 1 . !' ! Jli E
neyehoaneiyeie IIQQEEQDE- Paper presented at the

meeting of the Society for psychotherapy research,

Chicago.
Chang, S. S. (1988). Ine neasuzenenn e: eneme and its
e tionsh' to o rs t ' s.

Unpublished doctoral disseration, Michigan State
University, East Lansing, MI.

Gordon, T. (1988). ELELIL_in_ee§ien. New York:
Bantam Books.

Hollingshead, A. B., & Redlich, F. C. (1958). §oeiai
elee§_eng_ nennal illness. New York: Wiley.

Kaufman, G. (1985). finen_: The poge;_e§_ee;i_g.
Cambridge: Schenkman.

Kaufman, G. & Raphael, L. (1983). Ine_gyneniee_ef

neyezg Buiiging e eompetent eeif. Cambridge:
Schenkman.

46

Karon, B. P. (1963). Study of the mother-child
relationship in a case of paranoid schizophrenia.
AEQILQQD_EQQIDQI_QI_ EEYQDQLDQIQEY:_127 522’533-

Karon, B. P. (1963). The resolution of acute
schizophrenic reactions: A contribution to the
development of nonclassical psychotherapeutic
techniques. £§Y§DQLD§I§DY.- _ 1, 27-43.

Karon, B. P. (1981). The Thematic Apperception Test
(TAT). In A. I. Rabin, Ed., Assessment with
ngjecnive neennignes; A eeneiee ingzeguction (pp.
85 - 120). Springer: New York.

Melnick, B. & Hurley, J. R. (1969). Distinctive
personality attributes of child abusing mothers.

ur o sult n i i a s olo ,__;, 746-
749.

Meyer, R. G., & Karon, B. P. (1967). The
schizophrenic mother concept and the TAT.
Psyghiet;x,_§9, 173-179.

Mitchell, K. M. (1968). An analysis of the

schizophrenic mother concept by means of the

Thematic Apperception Test. EQUID§1__ 9f

, 3, 6, 571-574.

Mitchell, K. M. (1969a). Concept of "pathogenesis" in

parents of schizophrenic and normal children.

ourn orm Esychoiegy, 4, 4, 423-424.

47

Mitchell, K. M. (1969b). Social class and the

schizophrenic mother concept. Reyeneiegieei
Bengz§§,_zfi, 463-469.

Mitchell, K. M. (1971). Ine QODQQDE gfi "pethogenesis"
ensue. 9arente_9f_sshiz9nnrenisl_delinguentl_and
nggnni childnen. Unpublished manuscript,
University of Georgia, Department of Psychology,

Athens, GA.

Meyer, R. (1964). A s o sch' o hreno en'
nether. eoneepg Dy neans 9f fine TAT. Unpublished

master's thesis, Michigan State University, East

Lansing, MI.

Murray. H- A. (1943). Ibematis_aenerseetign_Test
nnnnel. Cambridge, MA: Harvard University Press.

Nicoles, N. (1970). Tne zeiationsnin between geggee
9f_maternal_ 2atb99enisitx_and_sexeritx_gf_egez
impairment_in_ ssbizephrenis_9ffserins-

Unpublished doctoral dissertation, University of
Michigan, Ann Arbor, MI.

Rapaport, D. (1952). Projective techniques and the
theory of techniques. Journal of Egojective
Thinking, 16, 269-275.

VandenBos, G. R., & Karon, B. P. (1971).
Pathogenesis: A new therapist personality

dimension related to therapeutic effectiveness.

genznei e: Bensonaiity Assessneng, 35, 252-260.

48

Tomkins, S. S., (1947). The Thenegic Apperception
Teen; New York: Grune and Stratton.

49

"I7'1?iii'iitlflitl'liiflii