* THE EFFECTS 0E VICARIous THERAPYEEEE
lNTERVlEWS onI BEHAVIDR ‘ :::
MODIFICATION III GROUPS

 

‘ Dissertation for the Degree of Ph D. .. ‘ "
MTCHIGAN STATE UNIVERSITY ‘
THOMAS FREDERICK CURRAN

‘ 1974-

 

LIBRARY {E
Michigan State E
University (I:

i

 
  

  

 

T1113 is tp certify that the
thesis entitled
THE EFFECTS OF VIGARIOUS THERAPY
PRETRAINING AND ROLE INDUCTION INTERVIEWS
ON BEHAVIOR MODIFICATION IN GROUPS E

presented by

Thomas Frederick Curran

has been accepted towards fulfillment
of the requirements for

Ph D _degreein Socigl Science

rm 1 [L/Iéfilmm

Major professor
Date W

0—7639

 

  

7“ I‘M-r
“I“

   

Y amTJIuG or "5" ‘E
“MD & SD”?
5M"? WRHNC.

'- "AC’Y BINDERS
In I 1

annual

      
     
   

NIINIIIIINI ROW

.“ 'Tflaam
{3’24

\I "G " /”U‘l

"5 K‘ r - U J 1..
I ‘ ‘3 O .

v , .

 

 

 

ABSTRACT

THE EFFECTS OF VICARIOUS THERAPY
PRETRAINING AND ROLE INDUCTION INTERVIEWS
ON BEHAVIOR MODIFICATION IN GROUPS

By

Thomas Frederick Curran

The present research investigated the effects of Vicarious
Therapy Pretraining (VTP) and Role Induction Interviews (RII) on client
manifest anxiety, motivation to change and positive therapeutic
expectations. Clients were randomly selected from the intakes at
Ingham Medical Center Community Mental Health Center during the month
of October, 1973. Clients who had been in psychotherapy previously
or those whose primary diagnosis was alcohol or drug dependency were
excluded from the research, resulting in a total of 21 subjects, who
were constituted into three groups. Group A received a pre- and
post-test battery in conjunction with VTP/RII. prior to beginning
therapy. Group B received only the pre- and post-test battery prior
to therapy and Group C received VTP/RII and the post-test battery prior
to therapy. All groups utilized the same therapy technique (Lawrence &
Sundel, 1971) and the same therapist.

VTP/RII conditions consisted of exposing clients to a

thirty minute video-tape of a behavior modification group in progress.

:33 Thomas Frederick Curran
0085
Lo

(1' The video-tape was role played by five volunteers using a script
provided by the researcher and simulated a segment of a typical
behavior modification group following the Lawrence and Sundel (1971)
model. The clients were then given an opportunity to react to the
video-tape and ask questions. This was followed by a modified
version of the Orne (1968) Role Induction Interview which suggested
appropriate client behavior in the group and outlined some of the
group procedures and their importance.

The first aspect of the study was concerned with the
effects of VTP/RII on client manifest anxiety, motivation to change
and positive therapeutic expectations. As predicted, groups exposed
to VTP/RII exhibited significantly lower anxiety, as indicated by the
Taylor Manifest Anxiety Scale (1953). Groups exposed to VTP/RII
also showed significantly greater motivation to change, as indicated
by the Miskimins Self-Goal-Other Discrepancy Scale (1967) and
significantly higher levels of positive therapeutic expectations, as
indicated by the Fischer-Turner Attitudes Toward Seeking Professional
Psychological Help Scale (1970).

The second part of the study was concerned with the impact of
VTR/RII on client and therapist evaluations of success in therapy.
Both client and therapist evaluations were found to be significantly
higher for those groups exposed to VTP/RII. Similarly, objective
outcome measurements disclosed that the VTP/RII groups rated signif-
icantly higher than did non-VTP/RII groups, with the exception of

the results of the Lawrence scales (parts 1-3) which did not yield

Thomas Frederick Curran

significance, although they did demonstrate a trend in the predicted
direction.

The final section of the study is devoted to the analysis
of manifest anxiety, motivation to change and positive therapeutic
expectations as predictors of successful outcome. Consistent with
previous studies, the present research suggests that these three
variables are accurate predictors of therapeutic success.

Refinements in design and instrumentation are suggested
and implications of the research findings for clinical practice and

further study are discussed.

THE EFFECTS OF VICARIOUS THERAPY
PRETRAINING AND ROLE INDUCTION INTERVIEWS

ON BEHAVIOR MODIFICATION IN GROUPS

By

Thomas Frederick Curran

A DISSERTATION

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

DOCTOR OF PHILOSOPHY

College of Social Science

197“

to my father

ii

ACKNOWLEDGMENTS

There are many people I want to thank for their help with
the dissertation. First, I wish to thank the members of my dissertation
committees Professors, Charles Hughes, Vic Whiteman, Tom Ruhala, Andy
Barclay and Stanley Brandes. Thanks are also due to Lucille Barber,
Clay Shorkey and Harry Lawrence for their assistance in the preparation
of the dissertation. Next I wish to thank Mary Alice Collins, who
conducted the groups for the research and without whose support and
assistance the project would never have been possible. Finally,
I wish to thank my wife, Betty, for tolerating my long hours away
from home and for tolerating me during the periods when it seemed
that the task would never be completed. I also wish to recognize her
assistance in typing the many drafts of the dissertation and perparing

the final version for publication.

iii

TABLE OF CONTENTS

LIST’OF TABLES . . . . . . . . . . . . . . . . .
LIST OF FIGURES . . . . . . . . o . . . . . . . .
CHAPTER

I. INTRODUCTION . . . o . . . . . . . . . 0

Historical Perspective . . . . .
Current Status of the Problem .
Summary and Prospective . . . .
Nature of the Problem . . . . .

Client Variables . . . . .

Therapist Variables . . . .
Research in Group Psychotherapy

II. REVIEW OF THE RELEVANT LITERATURE . . .
Statement of Problem . . . . . . . . .

III. DESIGN AND METHODOLOGY . . . . . . . . o
Video-Tape Pretraining and Role

Induction Interviewing . . . .

InStmnenmtion 0.00.0.0...
Treatment Conditions . . .

Iv. RESUI‘T‘S I O I O O O O O O O I O O O O I

Analysis of Variance for Effects
of Vicarious Therapy Pre-training/
Role Induction Interviews . . . . .
Analysis of Variance for Subjective
Therapist Ratings of Improvement As
Affected by Vicarious Therapy Pre-
Training/Role Induction Interviews .
Analysis of Variance for Objective
Outcome Measures as Affected by
VTP/RII O O O I O O O I I O O I I O
Correlational Data Evaluating the
Relationship of Post-Test Measures
to Outcome Measures . . . . . . . .

iv

Page
vi

viii

H

lI2
1+7
52

52

58

6O

mSCIJSSION I I I I I I I I I I I I I I

The Impact of VTP/RII on Manifest
Anxiety, Motivation to Change and
Positive EXpectations . . . . . .

The Affects of VTP/RII on Subjective
Evaluations of Therapeutic
Improvement 0 o o o o o o o o a o

The Affects of VTP/RII on Objective
Measures of Therapeutic Outcome .

Correlational Data Evaluating the
Relationship of Post-Test Measures
toou-tcomeooeooooooooo

General Discussion of Results . . .

Implications for Further Research .

BIBLIOW I I I I I I I I I I I I I I I I I

APPENDIX
A.

B.

UNPUBLISHED INSTRUMENTATION . . . . o .

mRRmJATIO NAL DATA I I I I I I I I I I

C. MEAN SCORES REPORTED BY GROUP . . . . .

D. VTP/RIIPROCEDUREB

GROUP PROCEDURES AND GROUP PROCESS . .

Page

67

67

7O
72

74

75
76

93
102

108
112

117

LIST OF TABLES

Table Page

1. Analysis of Variance of Manifest Anxiety as
AffeCted by VTP/RII e o o o o o I o o o o o o o o o e o 53

2. Analysis of Variance of Manifest Anxiety as
Affected by VTP/RII on Pre- & Post-Test
measures 0 e o o o o o o o o o o o e o o o o o e o o o 5“

3. Analysis of Variance of Positive Therapeutic
Expectations as Affected by VTP/RII . . . . . . . . . . 55

h. Analysis of Variance of Positive Therapeutic
Expectations as Affected by VTP/RII on
Pre- & Post-Test Measures . . . . . . . . . . . . . . . 55

5. Analysis of Variance for Motivation to
Change (Part I) as Affected by VTP/RII . . . . . . . . 56

6. Analysis of Variance of Motivation to Change
as Affected by VTP/RII on Pre- and Post-Test
Measures 0 o o o o e o o o o o o o e o o o o o o o o o 57

7. Analysis of Variance of Motivation to Change
(Part II) as Affected by VTP/RII . . . . . . . . . . . 57

8. Analysis of Variance of Motivation to Change
as AffeCted by VTP/RII o o o o e o e e e o o o o o o e 58

9. Analysis of Variance of Subjective Therapist
Rating of Improvement as Affected by VTP/RII . . . . o 59

10. Analysis of Variance of Subjective Client
Evaluation of Improvement as Affected by
m/RIIIIIIIIIIIIIIIIIIIIIIIIII 61

11. Analysis of Variance of Number of Areas of
Interpersonal Relationship Improvement
as Subjectively Evaluated by Clients
and Affected by VTP/RII o o o o o e o o o o o o o o o o 62

vi

Table

12.

13.

11+.

B-l.

B-2.

B-S.

C‘l .

C’Z.

Analysis of Variance of Objective
Outcome Measures as Affected by
VTP/RII o o o o o o o o o o o o

Correlational Data Evaluating the
Relationship of Post-Test Data
to Outcome Data 0 o o e e e o e

Correlational Data Evaluating the
Relationship of Post-Test Data
to Subjective Outcome Data . .

Correlation Data for Intergroup
Pro-Test Measures . . . . . . .

Correlational Data for Intergroup
Post-Test Measures . . . . . .

Correlational Data for Pre- and

Post-Test Measures Vithin Groups

Correlational Data for Instruments
within GrouPS o e o o o e o I o o

Correlational Data for Outcome

Instruments Within Groups . . . .
Pre- & Post-Test Scores . . . . . .

Outcome Scores . . . . . . . . . .

vii

Page

62

65

102

103

104

105

107
108

109

LIST OF FIGURES

Figure Page

1. Results of Cartwright & Lerner's 1963
ResearCh I I I I I I I I I I I I I I I I I I I I I I I 27

viii

CHAPTER I

INTRODUCTION

Interest in the investigation of counseling and psychotherapy
has both a history and an evolution. It is unfortunate, however, that
this common and long standing concern in the constructive change of
behavior and personality has divided rather than unified the interested
parties. As Rogers (1963) points out:

. . . our differences as therapists do not lie simply in
attaching different labels to the same phenomenon. The
differences run deeper. An experience which is seen by

one therapist as healing. growth-promoting, helpful, is

seen by another as none of these things. And the experience
which to the second therapist is seen as possessing these
qualities is not so perceived by the first. We differ at
the most basic level of our personal experience.

Some people may feel that though we differ regarding specific
incidents, . . . nevertheless in our goals and in our general
directions there is much agreement and unity. I think not.
To me it seems that therapists are equally divergent in these
realms (p. 7).
The significance of this state of affairs can best be understood by
examining the evolution and content of the research representative

of the field of psychotherapy.

Historical Perspective
The era prior to the experimental investigation of psychotherapy
can best be characterized as one of "academic tribalism". The various

schools of psychotherapy which existed were largely organized around

loosely organized theoretical formulations based on biased and
unsystematic observations which could not be controlled, and thus
repeated, in any reliable manner. Consequently, adherence to any

of these theoretical views was based on faith, conviction and

personal satisfaction, and loyalties were maintained and perpetuated
by identification with a particular set of esoteric rituals (Bandura &
Walters, 1963). Blocher (1967) seems to have captured the essence

of this historical process when he states:

Much of the history of change in counseling and psychotherapeutic
theory and practice contains elements which closely parallel
those which tend to dominate the evolution of religious
movements and political ideologies. In both cases a movement
tends to be originated by a messianic figure, characterized

by a kind of elan vital, who translated a deeply moving

personal experience into universalistic terms. This leader
quickly attracts a group of worshipful disciples who immedi-
ately begin to generalize the precepts promul ted by the

master into the most widely applicable terms po 4).

 

With little more than faith and the sheer force of opinion
to back untested propositions and doctrinaire assertions, it is
not surprising that these so-called coteries or schools existed as
factions, often times diametrically opposed to one another in
terms of their aims, methods and goals (Arbuckle, 1967; Bandura &
Walters, 1963; Rogers, 1963). However, with such a faith in the
efficacy of their respective techniques, and its resulting hOpe,
failures in practice engendered only a minimum of what Festinger (1957)
has termed "cognitive dissonance".

Both Phillips (1956) and Blocher (1967) have shown how a number
of convenient expressions arose to buttress and thus justify these

already well developed and deeply held personal convictions; i.e.. "the

client is unmotivated", "he lacks ego-strength", "he doesn't have
enough working-through anxiety", etc. "The convenience of this type
of thinking . . . for counselors who readily lose a third to a half
of their clients prematurely, is of course, obvious" (Blocher, 1967, p. h).
In any case, the net effect of these newly coined rationalizations
was effectively to screen out any negative feedback by automatically
attributing untoward consequences to defects in the client (Ellis, 1962).
When coupled with the enormous resistance to extinction generated by
relatively few "successes" delivered on an aperiodic schedule, these
factors served only to reduce any dissonance which may have resulted from
failures in practice, thus eliminating any reason for change or
modification in techniques.
Finally, dissonance between "schools" was further avoided by
limiting contacts between members of the dissonant factions. Even
when they did interact, the violent polemics which resulted often
generated more heat than light. According to Hoskisson (1965):
. . . they . . . get together to wrangle and defame each
other and have a wonderful time, . . . much of specialized
scientific publication seems to consist of mutual condemnation
of each other's work (p. 29).
With the introduction of the methods of science into this
formerly sacrosanct domain, it was hoped that a common core of
empirical knowledge would replace the theories based on tenacity, faith
and intuition (Campbell & Stanley, 1963). This laudable, but peremptory,

waive of optimism soon faded, however, when the predicted rapproach-

ment somehow never materialized.

Current Status of the Problem

 

In a summary of the overall impact of the past 25 years
of research in psychotherapy, Shlien (1966) pointed out that,
"Continued subscription to an existing school of psychotherapy is
based upon personal conviction, investment, and observation rather
than upon general evidence" (p. 125). In a similar vein, Eysenck's1
figures fail to support the hypothesis that existing forms of psycho—
therapy facilitate recovery from neurotic disorders (p. 323). His
more recent reviews (Eysenck, 1955, 1960, 1961, 1965), as well as
those of others (Bailey, 1956; Bandura, 1963; Luborsky, 1969;
Levitt, 1957: Strupp & Bergin, 1969), have led to essentially the same
conclusions.2

The factors contributing to this current state of affairs are
many and varied. As the discussion has disclosed, for a number of
years this predicament was due to the lack of empirical research.
However, as a number of authors have pointed out, the more recent

causes stem from the fact that the existing empirical evidence is

 

1For an explanation of these findings in terms of the
therapist variables see Truax and Carkhuff (1967). For an explanation
in terms of pre-treatment individual differences in clients see
Blocher (1967) and Sprinthall (1967). For a general critique of the
validity of Eysenck's interpretations see Kiesler (1966).

2Cross (l96h) surveyed the literature since Eysenck's 1952
review and found nine studies which used control groups. However, he
felt they were so deficient in other respects that the findings
still could not be interpreted unambiguously. More recent reviews
(Dittman, 1966; Patterson, 1966) have led to essentia11y the same
conclusions.

derived from such poorly organized and controlled research that the
findings could be used to support almost anything, and thus nothing
(Blocher, 1967; Edwards & Cronbach, 1952; Kiesler, 1966; Paul, 1967;
Sprinthall, 1967; Strupp a. Bergin, 1969, 1971).

In Spite of this, researchers and practitioners alike have
not tried to maintain a respectful tentativeness commensurate with
their real ignorance of the problem. Rather, there is a tendency
among partisans of each of the various positions to apply one standard
of adequacy to this inherently poor research when it supports their
theoretical position and an entirely different standard to the same
type of research when it is contrary to their position (Hunt, 1956).

As Goldstein, et a1. (1966, 1971) have pointed out, it is
not uncommon for clinically-minded researchers to disqualify and reject
unfavorable results by pointing to methodological and control problems,
while at the same time citing favorably indentical studies which
support the position they advocate. More specifically, Bandura and
Walters (1963) have shown how psychoanalysts frequently reject
negative findings when the research is based on a translation of psycho-
analytic theory into learning terms, citing the inadequacy of translation,
or misunderstanding of theoretical positions. Yet, they embrace
positive findings with such enthusiasm that the purely psychic dividends
which result unite to compel and further seduce their continued belief
and increased entrenchment in psychoanalytic theory. As a result of
this sort of reSponse to research by many clinicians, the era of

academic tribalism is still with us, and shows little evidence of waning

in the near future.

Schools of psychotherapy still exist with little more
reliable, empirical foundations than before (Berger & McGaugh, 1965;
London, 1964; Luborsky et al., 1971; Rogers, 1963). New schools
continue to emerge (Berne, 1965, Ellis, 1962, Eysenck, 1959, 1960,
1965; Salter, 1961; Stamphl, 1967; Wolpe, 1958) as factions radically
Opposed to traditional psychotherapy. Freshly minted ideas and
glimmerings of understanding become so quickly encapsulated into the
dogma of a "school" or coterie that they are seldom subjected to the
scrutiny and "natural selection" of experimentation (Blocher, 1967;
Berger & McGaugh, 1965; Dittman, 1966). In fact, every effort is often
made to protect and guard what each deems desirable, should it be
"mistakenly confused" with the facts of research, for ". . . non-
confirmation of a cherished hypothesis is acutely painful" (Campbell &
Stanley, 1963, p. 3).

Similarly, as before, these new schools maintain their
autonomy, and thus avoid any potential cognitive dissonance, simply
by building new jargons, creating new journals in which to publish
(Behavior Research and Therapy, Voices, etc.) and generally divorcing
themselves from the rest of the field. Successes by one school are
either impugned as palliative, attributed to factors the critic's
school deems irrelevant, or blatantly disreputed (Rogers, 1963;
Strupp, 1962; Strupp & Bergin, 1971; Wolpe, 1963; Wolpe & Lasarus, 1966).
Finally, as before,

Extremists on all sides have not hesitated in their expenditure

of polemic words and ink to discredit each other, even
though well-controlled comparative studies are nonexistent

(Paul, 1966, p. l).

 

Although the collapse of the field into shapeless solipsism
and feckless relativism, which is the death of science, is not
imminent or pressing, this joint-catharsis—against-a-common—foe
makes for little more than personal harmony and satisfaction
within each faction. While such procedures effectively protect the
members of each coterie from the experience of cognitive dissonance,
they contribute little in the way of constructive, cumulative knowledge
(Campbell & Stanley, 1963). It is true that these precociously
inspired theories often replace one another. However, since this
displacement is typically n93 the result of well controlled, comparative
research, the product rarely augments existing knowledge or serves as
a sequel to what has gone before (Blocher, 1967). In short, it adds
to the history of psychotherapy, but not to its evolution.

The overall effect of this condition is clearly demon-
strated in Colby's (1973) analysis of the current predicament in
psychotherapy--"Chaos prevails" (p. 397). Similarly, Rogers' (1963)
statement graphically portrays the net results of this state of
affairs--"The field of psychotherapy is a mess" (p. 10). Finally,
London (1964) has conceded that:

A detailed examination of the surfeit of schools and theories,
of practices and practitioners that compete with each other
conceptually and economically, shows vagaries which, taken

all at once, make unclear what it is that psychotherapists
do, or to whom, or why (p. 5).

Summary and Prospective

 

As indicated above, a good portion of this "mess" is due

to the fact that most existing schools of psychotherapy are based as

much, if not more, on faith and dogma as on comparatively derived
research findings. By tranSposing flimsy hypotheses into truths

and then selecting research to bolster already developed personal
convictions, these schools become implacable and categorically
indestructable; i.e. immune to dissonant empirical findings (Goldstien,
1969; Matarazzo, 1965). As a consequence, evolution in psycho-
therapeutic theory takes the form of ". . . a fadish discard of old

wisdom in favor of inferior novelties" (Campbell & Stanley, 1963, p. 2).

Nature of the Problem

If, however, psychotherapy is ever to mature beyond the
level of ". . . an undefined technique, applied to unSpecified
problems, with an unpredictable outcome" (Raimy, 1960, p. 93).
then experimenters must abandon research models which perpetuate
distinctions between existing schools and adopt those models which
seek to define techniques, circumscribe limits of applicability
and demonstrate efficacy, within limited contexts (Gendlin, 1967;
Gilbert, 1952; Bednar, 1970; Gruen, 1973; Kiesler, 1966; Lewis, 1973;
Sanford, 1953; Strupp & Bergin, 1969).

In Spite of the formidable obstacles created by methodological
and control problems and in the face of admonitions to the contrary
(Hyman & Berger, 1965; Kiesler, 1966; Strupp, 1962; Strupp & Bergin, 1969)
a number of investigators feel that there is an adequate paradigm
for research in psychotherapy which follows the above prescription
(Blocker, 1967; Edwards & Cronbach, 1962; Frank, 1959; Paul, 1967;

Sprinthall, 1967). Such a design would consider simultaneously the

following: (a) client variables, (b) therapist variables, (c) technique
variables, (d) outcome variables. The magnitude of such an undertaking
is obvious, and much of the remainder of this chapter addresses itself
to the obstacles inherent in such an enterprise, and to the potential

solutions to the problems that they present.

Client Variables
In terms of research methodology, client variables can be
reduced to the dual problem of sample selection and treatment focus.
Borrowing his strategy from the research on the effects of drugs,
Frank (1959) has suggested a promising approach to this problem, which
involves the selection and description of clients in terms of what
he calls "target behaviors". In other words, clients who are going
to be used as subjects for research are selected on the basis of
common or similar distressing behaviors. The description or operational
definition of this common presenting problem then becomes the dependent
variable in the research design. Furthermore, with this approach,
the goal of treatment then becomes change in a Specific direction.
The efficacy of this approach has been successfully demonstrated by
Paul (1966) in his attempts to reduce interpersonal-performance anxiety
in college freshmen.
According to Paul (1966), therapy should:
. . . compare specific techniques in the treatment of an
emotional problem that is delimited enough to allow rigorous
experimental methodology, but significant enough to allow

generalization from the findings and to have implications for
further study in the broader field of counseling and psycho-

therapy (p. 9).

10

If one views the most important test of the effectiveness
of a particular therapeutic treatment as involving (a) change in the
client's distressing behaviors as well as (b) change in these behaviors
outside of the treatment setting, then these two criteria, in conjunction
with client self-reports, go a long way toward achieving this goal. This
observation relates itself to the problems of research in psychotherapy
in some interesting and challenging ways.

First and foremost is the fact that the founders of nearly
all existing forms of psychotherapy derived their theoretical formulations
and based their techniques on observations of radically different
types of clients (Kiesler, 1966). Secondly, the evidence which does
exist, while not entirely satisfactory, in terms of either scope or
consistency, suggests that in fact, psychotherapy, as traditionally
conceived, is a process which has restricted applicability for only
selected sUbgoups of the pOpulation (Blocher, 1967). Considered
together, these two factors seem to suggest that perhaps different
foams of treatment are needed for differing combinations of
personality type and presenting problem (target behaviors).

There is a growing body of evidence which suggests that
therapists do in fact behave Quite differently with different types
of clients (Dittman, 1966; Matarazzo, 1965; Strupp,l962,197l).
However, the relationship between this and outcome is unclear. In
one study (Truax & Carkhuff, 1965) it was found that "therapist
transparency" was positively related to self-exploration in both
hospitalized neurotics and delinquent adolescents. However, whereas

self-exploration was positively related to client improvement among

11

the neurotic group it was inversely related to positive personality
change in the delinquent pOpulation. Such results suggest that, indeed,
there is a significant relationship between client types and problems,
and further that therapy techniques have a differential impact.

on divergent p0pulations, a fact that has until recently been

largely ignored by clinical researchers.

Therapist Variables

To a great extent the situation observed with regard to
client variables holds true for therapist variables and in certain
situations the impact of the latter is even more pronounced than
that of the fermer. There are at least three ways in which the
therapist variable can be treated. The first approach, which exists
predominantly in fantasy, involves using each therapist as his own
control. The advocates of this approach (Paul, 1966, 1967) conclude
that by having each therapist administer each of the treatments, one
can hold the personal-social attributes of the therapist constant
across groups, reducing the placebo effects which may masquerade
as treatment effects.

Not only is this goal impossible to achieve, but the strategy
on which it is based is internally inconsistent. Having therapists
objectively indicate their degree of commitment to certain techniques,
as Paul (1966) has done, excludes by definition an equal commitment to
alternative approaches; the therapist's personality has already
entered into his choice and commitment. Once this is done, finding

". . . therapists who are open—minded enough to learn to use contra—

12

dictory methods without exhibiting attitudes that would greatly
affect their approach" (Paul, 1966, p. 6) becomes an axiomatic
impossibility.
Even if we were to grant the potential plausibility of
this approach, it does nothing to circumvent the original problem,
but rather creates an insoluable dilemma. That is, if one uses this
approach (Paul, 1966) and fails to achieve its supposed goal, then
one is maximizing the differential influence of the placebo effects
in the direction of the techniques preferred by the therapist originally.
If one, in fact, succeeded in finding such "open—minded" therapists
they would most assuredly not be representative of other therapists of
the same or similar orientation. As Arbuckle (1967) has so aptly
pointed out "Differences in counselors automatically become differences
in counseling" (p. 22%).
Perhaps the clearest statement regarding the inseparable
nature of therapist and therapy variables has been offered by
Frank (1959) who states:
It is obvious that the therapist and therapy variables
cannot be completely separated. It is unlikely that a therapist
can conduct different types of treatment with precisely
equal skill or that his attitudes towards them will be
identical. Therefore, differences in results obtained by
two forms of therapy conducted by the same therapist may
be due to therapist rather than treatment variables, especially
since the faith of a therapist in a form of treatment may
account for much of its efficacy. (p. 7).
In our psychotherapy study the psychiatrists disliked minimal
treatment. They gave it reluctantly and felt that they were
shortchanging the patients. The patients remained just as
long in this type of treatment as in the other two, suggesting

that they were not as lacking in confidence in it as the
doctors. (p. 17) .

13

An alternative, and even more absurd, approach is to
attempt to get counselors effectively to role play confidence in
techniques they regularly do not use or in which they do no believe
(Snyder, 1963). This method, if effective, simply adds any placebo
effects back in again, in haphazardous and uncontrollable amounts,
mitigating the entire purpose of this circuitous approach. If
ineffective, the researcher has, once again, introduced placebo
effects, this time systematically and in such a way as to maximize
the differential impact of the treatments being examined. The primary
problems here, as above, is that one never really knows when and if
he has or hasn't failed. In addition, in view of Rogers' (1963)
and Frank's (1959) observations, it becomes difficult to imagine
a Client-Centered therapist, for example, doing Rational Emotive
Therapy or trying to roleplay confidence in such an approach. This
is to say nothing of the inequity created by attempting to train
seasoned veterans of Client-Centered therapy to do Rational Emotive
Therapy in a week or less (Strupp, 1967, 1968).

Finally, both of these strategies lend an air of artificiality
to the research treatments which is not present in the clinical
treatment setting in which these techniques are usually administered.
This latter fact serves only to reduce the external validity or
generality of the findings even further. Clearly, then, both of these
approaches commit the error of misplace precision.

A partial solution to this problem can be achieved by

assuming, as Arbuckle (1967) does, that certain therapists choose

1Q

certain techniques because they are certain kinds of people ~~

i.e. that the therapist's personality and his treatment techniques
are integrally and inseparable linked. Then, by securing therapists
who are committed to techniques which one wishes to compare, and
having each administer the techniques they respectively deem
effective; and comparing what they do (by means of video or audio
tape); one is in a much better position to assess treatment
conditions as they are most often administered with little or no
loss of scientific rigor. Unfortunately, this approach incurs
problems due to the greater variability of the treatments administered
by different therapists (Paul, 1966, 1967), and consequently, is

not the answer to the problem of therapist variables.

A compromise approach is available, however, one which
captures the desirable characteristics of those reviewed above
without incurring the liabilities attending their utilization.

One has simply to examine the impact of a therapy variable that

does not significantly effect the theoretical or technical orientation
of the therapist(s) in question. By utilizing the same therapists

in both conditions, (one in which the variable in question is present
and another in which it is absent) the experimenter can successfully
control for the relationship between therapist personality and
technique, so that the results can safely be attributed to the
presence or absence of the dependent variable. This method allows
for large scale replication, without the necessity of using

hundreds of subjects in the initial study; it circumvents the

absurdity of having each therapist role play confidence in methods

1",:

no

N
V:

F I
«4"

AN!

15

in which he has little or no faith and at the same time retains the
desirable factors of having each therapist act as his own control.
Additionally, it serves to eliminate the ethical question of
offering services perceived to be inferior, to a client population.

Another distinct advantage of this approach is that one may
check on whether or not the assumptions of this model are met,
an advantage not found in the previously discussed strategies. In
addition to comparing what therapists say they do with what they
actually do, by means of tape recordings, objective assessment of
the therapist's personal-social characteristics can be made and
similarities and differences noted. When client variables are
sorted in the manner described earlier, the data on therapist
personal-social characteristics can be compared with the data on
client personal-social characteristics, since, in many cases,
assessment can be made by many of the same measurement instruments.
This is especially true of such personal-social characteristics
as personality type, socio-economic status, age, sex, etc.

This does not mean, however, that outcome results are
simply a measure of therapist personal commitment. One can be
strongly committed to walking to the moon, even though the efficacy
of this technique (walking) can be proven virtually useless. The
compromise approach attempts to hold personal commitment as a
constant, then, by using uniform.outcome criteria for all treatment
and control groups, the results can be interpreted as commitment to

either effective or ineffective treatment, whichever the case may be.

16

It should be remembered that Paul's (1966) conclusions,
strictly speaking, are relevant only to insight oriented therapists
practicing systematic desensitization, and at last count, there
doesn't seem to be an over-abundance of these individuals in the
field. This of course, assumes that Paul's (1966) initial distinction
between therapist personal-social characteristics and treatment
techniques is accepted, and since most of the research (Arbuckle, 1967;
Frank, 1959; Strupp, 1962,1969) seems to be supportive of this stance,
it seems a reasonable distinction to employ in the present research.

The approach offered above, however, allows us to conclude
that a therapist's personal commitment is either too powerful
or relatively impotent, in modifying therapy behavior, whatever the
results support. In concluding this section on input variables then,
discussion has shown that selecting, describing and classifying both
clients and therapists on the basis of pretreatment individual differences
makes for better controlled, more easily interpretable and thus more
legitimately generalizable research, provided that such classification
can be done with the instruments that are presently available for
such measurement. Lacking such instrumentation, the next best
alternative is to use random selection with respect to client
populations and to use therapists as their own controls, when-
ever the research design allows the utilization of such an alterna-
tive. The importance of clearly defining the variables within these
two broad domains has been exhorted by Garfield and Afflick (1961)
who maintain that the time to begin outcome studies is prior to

intake. Similarly, Strupp (1962) has noted the potential value

17

of this area when he states; "research might make an important

contribution by refining the selection of particular patients

for particular therapists and for particular therapeutic methods" (p. 471).
In this manner, we may begin to bury the myths which,

according to Kiesler (1966), have retarded progress in both the

research and practice of counseling and psychotherapys namely the

assumption that clients, therapists, and treatments are homogeneous

entities. In so doing, research will simultaneously give birth to

the area of "individual differences" within the fields of counseling

and psychotherapy; an area which gave to psychology, generally, some

of its earliest and most important discoveries (Sprinthall, 1967).

Research in Group Psychotherapy

 

The above discussion has noted a number of research problems
and cautions, all of which are equally true for research in group
psychotherapy, albeit with some additions imposed by the nature of
the field. Recent reviews of research in group psychotherapy
(Bednar & Lawlis, 1971; Goldstien et al., 1966; Gundloch, 1967;
Yalom, 1970) have c1ear1y indicated the need for improvements in
the quality of the research being done. Keisler (1966) noted that
research in individual psychotherapy has been disorganized and
methodologically unsophisticated, but an even worse state of affairs
has existed in the group psychotherapy area. One of the main
reasons for this is that the many conceptual and methodological
problems inherent in group psychotherapy research have been insuffi-

ciently delineated. Recent reviews of the literature (MacLennan &

18

Levy, 1971; Lubin, Lubin, & Sargent, 1972; Lubin & Lubin, 1973)

show an increase in the volume of production from 327 articles in
1970 to 500 in 1972. and proportionately the number of articles which
can safely be called research, has risen from only 25 in 1969 to

over 80 in 1972. It is clear, however, that the preponderance of
articles still are those which might be called theoretical or case
study papers. The same criticism holds true here as in the earlier
analysis of the individual psychotherapy literature; it simply has
not made any significant contributions to the cumulative body of
knowledge upon which practice is based.

A proper evaluation of group psychotherapy must begin by
determining those advantages and disadvantages which distinguish it
from individual psychotherapy. If the greater number of participants
in group psychotherapy leads only to a greater complexity of dyadic
therapeutic processes, then extensive research into group psycho-
therapy is likely to be far more expensive in terms of time, resources,
and personnel than would the aquisition of an equivalent amount of
information gathered in the field of individual psychotherapy
research.

Truax (1966) measured the levels of accurate empathy, non-
possesive warmth and genuineness expressed by group therapists, and
found that members of groups in which levels of these therapeutic
conditions were high showed greater personality and behavior change
than members of groups in which levels of these therapeutic contitions
were low. This was so even for group members who were not themselves

the recipients of the warm, empathic and genuine remarks made by

19

the therapist. Thus, rating the therapeutic conditions character-
istic of the group proved to be a better predictor of individual
change than rating of the magnitude of these conditions offered to
individual group members. Lieberman (1970) reported similar findings;
a group therapist who systematically prompted and reinforced cohesive
statements was able to significantly increase the amount of cohesion
in his group over that of a control group. Further, the frequency
of therapist reinforcements for cohesion in the group as a whole
was more predictive of early improvement than was the frequency
of reinforcements received by particular group members. Lieberman
(1970) suggests that the level of cohesion within the group is
more significant in producing change for a member than is the amount
of reinforcement directed to any individual members.

Both of the above studies support the notion that there
are group variables which significantly influence individual
outcomes in group psychotherapy. Group psychotherapy does not seem
to be merely a more complex version of individual psychotherapy,
but rather, to be a seperate entity differing in some extremely
significant ways. The task of the researcher then. is carefully to
Specify that which he may borrow from the individual psychotherapy
literature, and clearly seperate it from that which may be used
exclusively in the analysis of dyadic relationships.

For research purposes, group psychotherapy, like individual
psychotherapy, can be conceptualized as a complex array of client
variables, therapist variables, situational variables, and outcome

variables, The methodological issues associated with these

variables have been described by a number of researchers (Bednar, 1970;
Bednar & Lawlis, 1971: Bergin & Strupp, 1970; Kiesler, 1966, 1971;
Meltzoff & Kornriech, 1970; Pattison, 1965). Briefly, they can be
summarized as follows.

1) Uniformity myths (Kiesler, 1966, 1971). There is clearly a
need for increased specificity in group psychotherapy research.
Researchers need to stop evaluating the effects of something called
"group psychotherapy" on somebody called "patients", "out—patients"
or "schizophrenics". Group psychotherapy is not a homogeneous
treatment condition; group psychotherapists differ from one another
in a multitude of ways, and so do psychotherapy patients. As
Bednar and Lawlis (1971) have pointed out, different kinds of group
psychotherapy have differential effects on different kinds of patients.
It is clear that we are not going to learn a great deal about group
psychotherapy until we begin to specify relevant patient characteristics,
therapist characteristics and treatment differences.

2) Evaluating Outcome (Paul, 1967; Strupp a. Bergin, 1969).
Outcome criteria as used in different studies differ to a degree
that makes comparison impossible and consequently significantly
reduce the utility of such research. Furthermore, typical outcome
criteria, such as therapist rating of improvement, self report
questionnaires, attendance records and symptom checklists are not
good estimators of the change in individual patients, which
constitutes the goals of psychotherapy research (Gruen, 1973)-
Checklists, therapist rating, attendance and discharge rates all

sample behavioral domains which are poorly related to one another

(Strupp & Bergin, 1969) and which are quite different from the
domain of behaviors involved in the process of group psychotherapy.
As such, these criteria are not capable of clarifying the relationship
between therapeutic process and outcome and thus of showing us how
to increase the power of our intervention procedures.

3) Inadequacy of present theories (Lewis & McCants, 1973).
As is the case in individual psychotherapy, theories of group
psychotherapy do not lead us to useful research paradigms. Present
theories do not offer the precise definitions of relevant patient
therapist, and treatment variables required for meaningful research
in group psychotherapy. An adequate theory would generate propositions
delineating these variables as well as suggesting the form of their
interactions. Such a theory would also direct researchers to
appropriate process and outcome dimensions. (Dozier Thornton,
personal communication, Jan. 1974).

In response to the methodological problems outlined above
and the paucity of information concerning the interactions among
significant variables in psychotherapy, researchers have allied
themselves with one of two basic camps (each encompassing a number
of off-shoots that will be considered later). Some researchers
have suggested undertaking large-scale multivariate studies, in
which therapist, patient, treatment and environmental variables
are all present in adequate numbers to allow for precise inter-
actional analysis. Statistical analysis is given the burden of
sorting out the crucial interrelationships (Goldstien et al., 1966;

Kiesler, 1966, 1971). Unfortunately, the usefulness of this approach

22

depends upon selecting for analysis those variables which have impact
on individual change. It is precisely the identification of these
variables which neither our theoretical models, outcome and process
research, nor case study literature has in fact accomplished.
Statistical analysis cannot delineate meaningful relationships
among irrelevant or poorly defined variables. Inadequate categories
are no more likely to provide fruitful research results in large-
scale studies than in small ones. At present the large scale
multivariate approach is impractical and requires a degree of
scientific understanding about group psychotherapy which we simply
do not have.

The other camp, seemingly, more aware that we have a low
level of knowledge about psychotherapy in groups advocates a greater
reliance upon naturalistic observation and experimental case
studies (Strupp & Bergin, 1970; Meehl, 1964; Verplanck, 1970).

These procedures are designed to identify variables relevant to
individual change in the clinical setting and to record in detail
the process of intervention and change which leads to individual
growth.

Naturalistic observation refers to observation of the
target phenomenon as it occurs naturally rather than abstracted
from its usual environment in a laboratory setting. The execution
of meaningful research in group psychotherapy requires observation
in the clinical setting. These observations must be precise and
replicable if they are to offer more powerful information than the

clinical case study approach has provided. Kiesler et al., (1967)

23

found that the therapist's evaluation of intratherapeutic events
correlated negatively with evaluation both by patients and trained
observers, which may account for the fact that our rich case study
literature has had such a low yield with respect to identifying

the vital variables in the psychotherapy process. Unfortunately,

a precise, replicable, and reliable method for observing interpersonal
interchange systems is yet to be developed. Bales' system (Bales, 1950)
is innappropriate as its content based emphasis does not allow
utilization in an essentially dyadic interchange network. Promising
advances are being made by Lewishon (Lewishon, 1969) at the University
of Oregon, but as yet his system remains inadequately developed to
meet the challenges posed.

Given that the observational system, prerequisite for the
proper utilization of the case study approach, has yet to be developed;
and that the definitional and theoretical system, prerequisite to
the large-scale multivariate approach, is nonexistent, it is readily
understood why there is such a relative paucity of "good" research
in group psychotherapy. By and large, researchers have attempted
to follow Strupp and Bergin's (Strupp & Bergin, 1969) suggestions
for coordinated research in psychotherapy. The resultant product,
while far from the coordination that Strupp and Bergin have called
for, has at least contributed significantly to our knowledge of
what methods of design and analysis tend n23 to be useful in group
psychotherapy, which at least puts the group researcher on equal
footing with the individual psychotherapy researcher. There is

very little "hard" evidence of what works in either area, but there

24

is a wealth of information regarding those methods of analysis that
have not proven fruitful, and perhaps this is sufficient to provide
a glimpse of the light at the end of the tunnel-~or at least an

indication as to which directions might be most profitable.

CHAPTER II

REVIEW OF THE REVELANT LITERATURE

Frank (1969) has identified what he believes to be the
common factors which account for the success of psychotherapy. He
believes that:

. . . It is probable that at least three processes are
involved in the production of attitude change, which may vary

independently. The first is the production of change; the
second, its duration; and the third its generalizability

(1969. p. 123).
Continuing along the same lines he makes the isolation of relevant
factors even clearer;

. . . the most effective ingredients in psychotherapy lie

in those aSpects of the therapeutic relationship which

raise the patients morale and inSpire him with courage to

try new ways of coping with the stresses that beset him

(Frank, 1969, p. 126).
At the risk of seeming overly simplistic, with respect to the previous
chapter, it seems that the factors which contribute most significantly
to the patient's inspiration and morale are: 1) Anxiety (Bergin &
Jasper, 1969; Distler, 1964; Gallagher, 1954; Gottschalk, 1967;
Katz, 1958; Kirtner & Cartwright, 1958; Hamburg et al., 1967;
Luborsky, 1963); 2) Expectations (Brady et al., 1970; Conrad, 1960;
Goldstein & Shipman, 1961; Lipkin, 1954; Uhlenhuth & Duncan, 1968); and
3) Motivation (Cartwright & Lerner, 1963; Conrad, 1962; Schroeder, 1960;

Strupp et al., 1963). All of these factors have been shown to be

25

26

significantly related to therapeutic outcome by the above authors, and
yet very little has been done by way of relating the combination of all
three to the outcome of psychotherapy.

Distler (1964), in a study conducted with hospitalized
patients at the Camarillo State Hospital in California, concluded
initially that manifest anxiety (rated by the Taylor, 1953 and
Bareson, 1953 scales) was not significantly effective in predicting
the length of hospitalization or the outcome of psychotherapy.

When the sample was broken down according to sex however, both
predictors were found to be significant, although in opposite
directions for men and women, suggesting a sex differential related
to perceived sex-appropriate models of behavior.

Katz (1958) raised the question of whether and how anxiety
was related to the premature termination rate of 30 to 65%, nationwide,
and concluded, for the outpatient population which he studied,
that there seemed to be some discrepancy between the variables
accounting for the subsequent improvement of the client and the
variables which seemed to be related to the patients' continuation
in therapy. This raises an intriguing question; if Katz's (1958)
results are valid, they seem to suggest that we are dealing with
two types of anxiety, one which seems to be related positively to
the liklihood of improvement and another, underlying or "durational
anxiety" which seems to be positively related to the patients'
continuation in therapy, but negatively related to the liklihood of
improvement. The first, "working anxiety" comes perilously close

in definitional terms, to the "need to change" or motivation which

27

will be discussed later. The latter, "durational anxiety" comes much
closer to a useful Operational definition of anxiety. It seems to be
closely related to the individual's willingness or unwillingness
to expose his faults or what he believes to be his "deepest and
darkest secrets", and consequently accounts for the divergence or
differential impact on the therapy process of the two types of
anxiety. Gallagher (1954), utilizing the Rorshach and MMPI scales,
and client centered psychotherapy techniques, concluded that:

. . . unless the client is motivated by some overt anxiety

to change his perceptions and unless he is able to give

of his perceptions freely with the counselor, then client-

centered methods of counseling will produce a minimum of

change (p. 413).
These results are supported by Cartwright and Lerner's (1963) study
which suggest again a differential impact of anxiety. Schematically

the resulting relationship between the variables is presented below:

Lengthlimprovement Need to change Empathy
Short mpmved 000000000000000000 high 0000000000000000000 high
1011 improved 000000000000000000 high 0000000000000000000 10"
Short unimproved 0.0000000000000000 10W 0.0000000000000000. 10W
10H unimproved 000000000000000000 10W 0.00000090000000000 high

Figure I

Results of Cartwright & Lerner's 1963 Research

Although the instrumentation used by Cartwright and Lerner
was not capable of differentiating between working anxiety and
durational anxiety their results suggest that it is this differential
which accounts for the differences in terms of length of therapy and

improvement. Studies by Truax (1965,1967) have indicated that a high

28

level of empathy is effective in producing positive results in

short term therapy, which would account for the differences between
the short/improved and long/improved pOpulations. However, the
differences between the short/improved and long/unimproved populations
cannot be adequately accounted for by the empathy level of the
therapist and the researchers conclude that it may be due to the
antithetical nature of working anxiety and durational anxiety--i.e. one
tends not to exist in the presence of the other, or at least present
instrumentation is not capable of determining the relative levels of
each if they can or do exist simultaneously. If this is in fact

the case, the question relevant to the researcher is how to bring
"working anxiety" up to productive levels while at the same time,
reducing "duration anxiety" to a level at which it does not impede

the process of psychotherapy.

A somewhat similar situation exists with regard to motivational
levels or the "need to change". Several authors (Cartwright & Lerner,
1963: Conrad, 1962; Schroeder, 1960; Strupp et al., 1963) have
concluded that there exists a strong positive relationship between the
individual's need to change and the actual probability that he
will change. Intuitively, this seems a perfectly logical conclusion,
and in fact some of the research (Schroeder, 1960) seems to be more
intuitive than it is empirical; however, the question is more
relevantly how can motivation be modified in such a way as to increase
the probability of success in psychotherapy, rather than is there a
relationship between motivation and change? Cartwright and Lerner (1963)

suggest that there is a clear relationship between the therapist's

29

understanding, experience, etc. and the outcome of therapy, regardless
of motivation. cartwright and Cartwright (1958) also arrive at the
same conclusion, leading to the suggestion that the therapist's
ability to clarify what the therapy relationship is all about and
his ability to assist in setting and attaining therapy goals combine
to increase the probability of successful psychotherapy by simultaneously
increasing the client's motivation to change and his acceptance of
the possibility of change. If this is an accurate perception of
the process, it is reasonable to assume, then, that endeavors to
clarify the client's perception of what psychotherapy is and how
it works should increase his positive expectations, while at the
same thme increasing his motivation to change.

Authors addressing themselves to the relationship of a
client's and therapist's expectations (Brady et al., 1960; Conrad, 1960;
Goldstein J. Shipman, 1961; Lipkin,1954) have uniformly concluded that
positive expectations are highly correlated with positive outcome.
Tien-TehéLin (1973) suggests that the quality of the counseling
relationship is largely a function of the counselor's self confidence
and consequently the positive expectations for improvement which he
projects, while Clemes and D'Andrea (1965) conclude that the patient's
anxiety is a function of expectations and the degree of initial
interview ambiguity. In analyzing the data on the 85 subjects in
their study, they suggest that if initial interview ambiguity can be
reduced, then positive expectations will be increased. The data also

clearly indicates that positive expectations are highly correlated

30

with positive outcome, leading to the conclusion that a reduction in
initial interview ambiguity will be met by more positive outcomes.

Brady et al., (1960) have discovered a similar positive
relationship between expectation of improvement and actual improvement
with a hOSpitalized population, suggesting that this relationship is
not isolated to certain client populations but is in fact found in
all investigated cross sections of the population.

Goldstein and Shipman (1961) found correlations of .405
and .530 respectively with regard to expectations and perceived
symptom reduction and symptom intensity, replicating the results
of an earlier study (Goldstein, 1960) concerned with the effects of
expectation on an undergraduate population at a university counseling
center. Finally, Overall and Aronson (1963) have found that lower
class clients tend to have expectations of psychotherapy which are
closely allied to their expectations of the medical profession in
general. Overall and Aronson conclude that perhaps a good deal of
the ineffectuality of psychotherapy with lower class clients can be
accounted for by observing the discrepancies between their expectations
and the actual process which typifies psychotherapy.

By way of summation then, it is noted that there is a
considerable amount of evidence pointing to the relationship of
positive psychotherapy outcome and the client's initial degree of
anxiety or ambiguity, motivation or need to change and his degree
of positive expectations with regard to psychotherapy. It should also
be noted that this general trend has been present without regard to

the specific client population being considered, nor was the trend

31

significantly affected by varying settings or theoretical orientations,
suggesting that it is generalizable and not dependent upon idiosyncratic
situational determinants.

The above discussion suggests that the process of psychotherapy
may be significantly enhanced by attempting to direct the client's
anxiety, promote his motivation and clarify his expectations. Yet
a review of the literature discloses only five articles (Martin &
Shewmaker, 1962; Hohn-Sardic et al., 1964; Truax et al., 1970;

Pierce et al., 1970; and Warren & Rice, 1973) which have been written
on the effects of planned preparation for psychotherapy, and of that
number, only two (Martin and Shewmaker, 1962; Truax et al., 1970)
have been directly relevant to group psychotherapy. All have been
plagued by methodological problems, resulting in a gaping hole in the
body of knowledge relevant to improving the effectiveness of the
process of psychotherapy in general and group psychotherapy in
particular.

Martin and Shewmaker (1962) review the effects of written
instructions in group psychotherapy remarking that:

One of the first tasks of a prospective patient is to obtain
a minimum comprehension of what he can expect of psychotherapy
and what will be expected of him. One of the initial problems
confronting the therapist, accordingly, is to acquaint the
person with the therapeutic procedure (1962. p. 24).
They attempt to achieve this introduction to the therapeutic procedure
by distributing a two page synopsis of group psychotherapy to the
participants in their groups. Unfortunately, at this point their
study severely suffers, at least from a methodological point of

view. Their utilization of one "relatively unbiased" therapist and

32

one group as the subjects hardly lends to the credence or replicability
of the study and the utility of the project is further handicapped by
their use of informal observation and clinical notes to assess the
impact and effectiveness of the written instructions.

After a similar fashion, Orne and Wender (1968) present
an intuitively sound but empirically untested case for the use of
"anticipatory socialization" in psychotherapy. The authors state
that:

There is a strong positive relationship between a patient's

perception of psychotherapy and its ultimate success. Some

patients who appear to lack motivation for treatment may

be capable of profiting from psychotherapy if they are

taught what to expect--if they understand the "rules of

the game" (1968, p. 1202).
While there is a fair amount of clinical evidence to support their
statement (Frank et al., 1957. 1964; Hoehn-Saric et al., 1964) the
authors, in this case, provide little more than additional buttressing
to the already overly abundant case study literature, while providing
little in terms of verification for their claims.

Fortunately, this sort of intuitive hypothesizing does not
characterize all of the literature relating to psychotherapy
pretraining, and the following examples, while suffering from
methodological problems of their own, show a trend in the right direction.

Sloane et al., (1970) utilized a methodologically sound
design to evaluate the impact of preparation and expectation of
improvement on the outcome of psychotherapy, by using a design that
called for the random assignment of 36 psychoneurotic outpatients

to four groups, each of which received a different indoctrination by

33

the research psychiatrist. Group A was assigned to a psychotherapist
without further explanation. Group B was told firmly that they should
feel and function better after four months of psychotherapy and then they
were assigned to a therapist. Group C had the process of psychotherapy
explained to them by means of Orne's anticipatory socialization
interview and were then assigned a therapist. Group D had the process
of psychotherapy explained to them and in addition were firmly told
that they should be feeling and functioning better within four months.
Sloane (1970) reports that at the end of treatment the patients who
received an explanation of psychotherapy improved slightly but
significantly (p (.05) more than those who did not receive it. The
simple suggestion that the patient would improve within four months
appears to have had no effect on outcome, leading Sloane to suggest
that it is the anticipatory socialization interview alone, that was
responsible for the outcome differentials. At this point, however,
Sloane's study begins to suffer from methodological problems, the
first of which is the fact that his psychotherapists consisted of

nine psychiatric residents with a minimal amount of psychiatric
training and experience. Goldstein (1967) has emphasized the
importance of therapist differences as they relate to outcome, and a
design which utilized nine different therapists and makes no attempt
to control for the differences in their techniques, experience,
personality or approaches to therapy is clearly in violations of his
precautions. At the same time, there is the question of the

therapeutic competence of residents and if the results obtained by an

34

inexperienced group of therapists, using uncontrolled techniques, can
be generalized so as to be useful to the experienced clinician.
Karon's (1971) research would tend to suggest that the experience
differential between experienced and inexperienced therapists alone
is sufficient to cause outcome discrepancies of a magnitude that may
invalidate any study in which they are not contolled for. Furthermore,
Sloane has failed to use any sort of reliable outcome measures,
relying instead on his own clinical judgements in the initial and

in a final interview to determine the relative success or failure of
therapy. Sloane also asked the residents and the patients to rate
their improvement in therapy, a procedure which as was pointed out
earlier, is something less than purely scientific. When these
criticisms are combined with the fact that almost 50% of the subjects
in his study had been in psychotherapy before, and that no attempt
was made to either screen them out of the study or to distribute them
evenly among groups, Sloane's claims of improvement with anticipatory
socialization must be viewed with a certain degree of incredulity.

An earlier study (Nash et al., 1965) while not completely
eliminating the criticisms leveled against Sloane, has attempted to
deal with the problems of therapist differences and to combine the
analysis of these differences with the systematic preparation of
patients to yield a seemingly much more reliable set of conclusions.
Nash has attempted to control for therapist differences by rating
each group of clients seen by each therapist separately as well as
combining them for overall outcome evaluation. This procedure

disclosed significant differences in the way the therapists presented

35

themselves to their clients, in the ratings that they received from
their clients, and in the scores that they were given by a group of
naive raters listening to tape recordings of all of the therapy
sessions. These differences were also reflected in the outcome
scores of both experimental and control groups; the clients of the
experienced and highest rating therapist scoring significantly
higher than the clients of the lowest rated therapist in either
condition. The results from the client groups of the other two
therapists showed no definitive trends, leading the researchers to
conclude that perhaps the therapists' experience, and capability of
sustaining relationships, is of greater importance in the determination
of outcome than the presence or absence of the role induction interviews.
The analysis of the combined factors (therapist, patient attractiveness/
unattractiveness, and presence or absence of role induction) however,
indicates that each can, to a degree, compensate for one or both
of the other variables, the results indicating that the probable
prognosis of positive outcome declines relative to the rated decline
of the other three factors.

An earlier study by the same research team (Hoehn-Saric et al..
1964) supports the same conclusions, although this study lacks the
sophistication of the later attempts. The 1964 study again uses
psychiatric residents as therapists, lacks controls for therapist
techniques and relies on the clinical evaluations of the researchers
for outcome criteria; detracting further from the credibility of the
study, however, are the facts that all clients dropping out of

therapy prior to the fifth session were excluded from the data,

36

and that clients serving as controls and those who received the role
induction interviews were placed in the same groups, leading to
suggestions that the experimental subjects may well have influenced
the control subjects, consequently contaminating the results.

Perhaps the best study in the area of therapy pre-training
is one done by Truax et al., (1966) who employed a sample size of
eighty and a 2x2x2 factorial design. Truax employed eight groups
of ten clients each, four of the groups being hospitalized mental
patients and four institutionalized juvenile delinquents. The
researchers utilized both alternate therapist-present, therapist-
absent sessions and vicarious therapy pre-training in the factorial
design and obtained pre-and post-measures by means of five Q-sort
measures relating to self- and ideal-self-concept measures and self
and ideal-adjustment scores. The results clearly support the hypothesis
that there will be a lack of differential changes in the vicarious
therapy pro-training, non-vicarious therapy pre-training and
alternate-regular sessions in the two different populations. The
hypothesis regarding the use of vicarious therapy pre-training
received less than overwhelming support; although patients receiving
VTP showed improvement on all five of the self concept measures from
pre- to post-therapy, and patients not receiving VTP showed deterioration
on four of the five measures and a minimal gain on the self adjustment
measure, none of the ideal-expert and ideal-adjustment scores were
statistically significant. This leads the authors to conclude that:

. . . if any concrete benefit did accrue it is probably in
the form of potential in that the patient's goals toward

37

which they are seeking to change appear to be, after therapy,

more in keeping with societal expectations as a result of this

treatment (Truax et al., 1966, p. 31).

It is noteworthy that the results of this investigation

are at variance with those presented in the earlier studies. It may
be suggested that the use of more objective measures of pre-and
post-therapy change account for the loss of significant differences
between the VTP and NVTP groups, but it is equally possible to
suggest that the lack of significance is due to the confounding
effects of the factorial design and to find some support in the fact
that four of the interactions in the design were not interpretable.
A suggestion which supports the earlier observation that while the
factorial design has a good many advantages, most researchers concur
that, at this point in time, investigation into the effective
ingredients of psychotherapy does not have the requisite specificity

for its most profitable implementation.

Statement of Problem

 

The problem to be examined in the present research, then,
is one of much conjecture and, as yet, little empirical verification,
namely: "What are the effects of attempts to modify client's
therapeutic expectations, motivation to change, and levels of manifest
anxiety?" The review of the literature would suggest that this is an
amiable enterprise, yet, at the same time, one which has received
little in the way of empirical investigation. Considerable attention
has been given to establishing client expectations, motivation and

anxiety as accurate predictors of such factors as length of treatment,

38

probability of success and reSponse to treatment; however, of the
eight articles devoted to systematic preparation of clients for
treatment, none address themselves to the issue of what impact,
if any, this preparation has on the predictors of therapeutic
success. The present research is devoted to analyzing systematic
client preparation as it affects the predictors of outcome as
well as the outcome itself. Consideration will be given to the
impact of client preparation, via vicarious therapy pretraining
(VTP) and role induction interviews (RII), on the pre-therapy
client manifestations of positive therapeutic expectations,
motivation to change and manifest anxiety. Beyond this, attention
will be given to the effects of VTP/RII on subjective outcome
criteria as reported by both clients and therapist, as well as

to objective outcome criteria. In order to examine these issues,
nine hypotheses have been formulated; each addresses itself to a
Specific aSpect of the research and the composite, to the general
question of the impact of VTP/RII on the clients and the outcome
of group psychotherapy. Specifically, these hypotheses are as

follows:

1) Those clients exposed to vicarious therapy pretraining (VTP)
and a role induction interview (RII) will exhibit a significantly
lower level of manifest anxiety than those not so exposed and
pre- and post-test measures will show a Significant within

group reduction of manifest anxiety when exposed to VTP/RII.

2) Those clients exposed to VTP/RII will exhibit a significantly higher

39

level of positive therapeutic expectations than those not so exposed,
and will Show a significant within group increase when exposed to
VTP/RII.

3) Those clients exposed to VTP/RII will exhibit a Significantly
higher motivation to change than those not so exposed, and will

Show a significant within group increase in motivation to change when
exposed to VTP/RII.

4) Those clients exposed to VTP/R11 will be rated significantly higher
on a subjective scale of therapeutic improvement than will clients not
so exposed.

5) Those clients exposed to VTP/RII will rate the experience as
Significantly more helpful than will those clients not exposed to
VTP/RII.

6) Those clients receiving VTP/R11 will score Significantly higher on
objective measures of therapeutic improvement, than will clients not
receiving VTP/RII.

7) Client manifest anxiety, as measured by the Taylor (1953) Manifest
Anxiety Scale, will be negatively correlated with objective and subjective
outcome measures.

8) Client pre-therapy motivation as measured by the Miskimins (1967)
Self-Goal-Other Discrepancy Scale will be positively correlated with
objective and subjective outcome measures.

9) Client positive therapeutic expectations, as measured on the Fischer-
Turner (1970) Attitudes Toward Seeking Professional Psychological Help
Scale, will be positively correlated with objective and Subjective

outcome measures.

CHAPTER III

DESIGN AND METHODOLOGY

SubjectS(N=21) for the study were randomly selected from
the applications for treatment at the Ingham Medical Center Community
Mental Health Center during the month of October, 1973. Each
applicant was given a number from the table of random numbers,
an identification which would eventually determine the treatment
condition that the client would be assigned to. Those applicants
who had previous experience in psychotherapy were excluded from the
study, as were applicants with a primary diagnosis or presenting
problem of alcohol or drug dependency. The first category was
eliminated in an attempt to maximize the validity of the study and
the latter category because the therapy techniques to be employed
(Lawrence and Sundel, 1971) tend not to be particularly effective
with addictive client groups. After excluding these groups (17 S's)
and those who declined to participate in the research (2 S's) the
initial sample of forty subjects was reduced to the final total of
twenty one.

The sample consisted of fourteen women and seven men, a
sex ratio which is representative of the clientele served at the
clinic. The mean age of the sample was 28 years, the average

yearly income $9,111 and mean number of years of education 13.1.

40

41

Eight of the subjects were married, Six were divorced, four separated
and three had never been married. Five of the subjects reported
their primary problem as a marrital one, five as self concept
or feelings of inadequacy, four as depression and three reported
parent and child problems. Although no accurate data has been gathered
on the distribution of client problems for the entire clinic, the
distribution reported above appears representative of the range
of problems dealt with in the outpatient unit and is congruent with
Overall and Aronson‘s (1963) estimates of problem distributions
in outpatient populations seen in community treatment agencies.

After selection, the subjects were randomly assigned to
one of three treatment conditions. Group A received the pre- and
post-test battery and the outcome battery; the video-tape VTP and a
modified version of Orne's (1968) role induction interview (RII).
Group B received the pre- and post-test battery and the outcome battery
without receiving VTP/RII and group 0 received VTP/R11 without
the pro-test battery, although they did receive the post-test and
outcome batteries.

Each group was assigned to the same therapist, who used
the techniques of group behavior modification described by Lawrence
and Sundel (1971) with all of the groups. Each session was audio-
recorded and reviewed by the researcher to ascertain the uniformity
with which the techniques were applied. .This review disclosed no
Significant differences in the way each group was run or in the
content of the sessions, although there were discernable differences

in the amount of participant interaction and in the manner in which

42

participants interacted with each other and with the therapist.
Although no formal analysis was done of the process of the groups,
the review of the tapes suggested that the groups receiving VTP/R11
interacted more freely, and began implementing the system sooner
(mean -2.3 sessions) than did the group that did not receive VTP/RII
(mean c3.4 sessions).

The review of the tapes also disclosed that although the
design had called for maintaining the therapist's naiveté regarding
which groups had received VTP/R11, by the third session both experimental
groups had mentioned the utility of the procedure and as a consequence
the possibility of conducting a blind study was eliminated.

By utilizing the same therapist and the same therapy
techniques for all groups the design has effectively controlled for
therapist differences and for the differential impact of theoretical
and technical differences, an approach which seemed the most
parsimonious solution to some of the research problems discussed
in Chapter I.

Video-Tape Pretraining and
Role Induction Interviewing

 

 

At an initial interview each subject was seen individually
and instructed that they had the option of participating in group
psychotherapy or of being seen in individual psychotherapy. If
they initially chose to be seen in individual therapy as opposed to
group, customary intake information was gathered, they were given an

appointment with a staff therapist and the initial session was closed.

43

If they chose to participate in group therapy it was explained
that they would be participating in a research project, that all
material collected would be kept strictly confidential and that
their identity would be disguised in the preparation and presentation
of the research findings. Further, the baselining procedure to be
used in the group was explained and they were instructed that the
group would be meeting for six sessions, that its primary emphasis would
be on modifying problematic behaviors and that it would be extremely
important for them to attend all of the group sessions. If they
were assigned to the control group they were advised of the time
and date of the first group session, reminded of the importance of
the baselining procedure and given a set of the pre-test instruments
and instructed to fill them out completely and return them to the
secretary before leaving the clinic. If they were to be assigned to
the experimental groups they were told that an important part of the
group was to participate in one additional individual session in
which they would view a video-tape of a group in progress and would be
told more about how the group worked and what they might expect. The
subjects were then given an appointment for the VTP/RII session and
depending on whether they were in experimental group B or C were
given the pre-test instruments and instructed to fill them out and
return them to the secretary as they left the clinic.

The VTP/RII sessions consisted of a half hour video-
tape of a role played group session. It was led by a therapist who
had a considerable amount of skill and experience using the technique

of behavior modification in groups and the "clients" were volunteers

from a local crisis center who had expertise in role playing. The
entire tape was adlibbed from a general direction script, written by
the researcher (Appendix C), so as to give it the necessary focus
and direction and at the same time contribute the quality of spontaneity.
The script called for role playing the final phases of a teaching
component ( a common element of all six sessions), a brief question
period, review of the baseline material from the previous week, and
focusing on one "client's" report and evaluation of the changes
elicited during the previous week. Other "members" were instructed
to provide feedback and suggestions in accord with the handout
"guidelines to giving and receiving feedback, criticisms and positive
evaluations" an integral part of the programs structure. The "client"
presenting the report was asked to make it generally positive and to
respond as genuinely as possible to the feedback from the therapist and
other group members; following this a behavioral assignment was
negotiated for the next week and the video-tape faded out, suggesting
that the process would be repeated for each of the remaining group
members.

Viewing the tape was followed by a short question period,
and then a modified version of Orne's (1968) role induction interview
(RII) which suggested the appropriate client role in a group of
this nature, and further suggested the efficacy of this approach to
problem solving and that research (Lawrence E Sundel, 1971) had
disclosed that when clients participated appropriately ( as in the

VTP) that they benefitted much more from the group and therapy. The

45

client was then asked if he had any further questions or comments and,
if not, was advised of the time of the first group session, reminded of
the importance of baselining the problem behavior and excused.

All treatment conditions (A,B,&C) were given the post-
VTP battery just prior to the first session, in most cases this was two
weeks from the date that they had taken the pre-VTP battery, although
in some cases it was almost a month. The difficulties inherent in
clinical research and selecting subjects are reSponsible for this time
delay; however, all those who were initially assigned to groups appeared
at least for the first two therapy sessions and consequently no subjects
were lost from the study during this period. Furthermore, the time
between pre- and post-testing, ranging from two to four weeks appears
to have been sufficient, in terms of test repetition validity,
without having been so long as to lose subjects due to frustration or

lack of interest.

Instrumentation

 

For both the pre-VTP and post-VTP test batteries a series
of three instruments were used to determine fluctuations in the client
levels of anxiety, motivation and positive expectation. All instruments
were chosen because they combined the qualities of relative brevity
necessary in clinical research, where clients react negatively to
what seems to them an inordinate amount of pointless testing (Gallagher,
1971), and have demonstrated research validity. The updated version
of the short form Taylor Manifest Anxiety Scale (Taylor, 1953) was used

as an indicator of client anxiety in both the pre- and post-test

conditions in all groups. Likewise, the Miskimins Self-Goal-Other
Discrepancy Scale (Miskimins, 1967) and the Fischer-Turner Attitudes
Toward Seeking Professional Psychological Help Scale (Fischer &
Turner, 1970) were used for the measurement of motivation and positive
therapeutic expectations respectively.

Internal reliability of the Fischer-Turner (1970) instrument
has been established at .86 and test—retest reliability at .89 and
.82 for two and four week intervals respectively (Fischer & Turner,
1970). Likewise the internal consistency of the Miskimins' (1967)
instrument has been established as Significant at the .001 level and
test-retest reliability as also Significant at .001 for all factors
(Miskimins, 1967). The broad usage of the Taylor (1953) instrument
has yielded internal reliability figures ranging from .83 to .97
and test-retest reliability ranges from .91 to .99 (Distler et al., 1964)
So it is not possible to give exact readings on reliability, however,
the Significance of all readings in the given ranges appear to be
more than adequate to establish its utility for the present research.

Outcome measures were secured via the Collins-Curran Scale
of Rational Attitudes (Appendix A) and a series of behaviorally
oriented measures used by Lawrence and Sundel in their research on
group behavior modification (Lawrence & Sundel, 1971) and by a Likert
scaling of therapist progress evaluation. Outcome measures were
administered to all treatment conditions following the close of the
sixth and final session. Their selection was based on a combination
of the factors discussed in Chapter I, their suitability as measures

for the particular treatment modality used and their relative

47

brevity, for the reasons discussed above. By combining attitudinal,
behavioral and subjective evaluations it was hoped that analysis might
disclose potential differences in terms of impact; differences which,
if present, would shed light on the usefulness as well as the specific

implications of the techniques used.

Treatment Conditions

Each group utilized the same therapist and the same treatment
method and modalities, the only differences being presence or absence
of VTP/RII. The therapist was an experienced clinician with ten years
of previous experience, who describes her primary treatment orientation
as behavior modification and her preferred method of working as social
group work; consequently, She was an ideal selection to lead the groups
and to provide the best available model for the implementation of this
particular therapy technique.

The model for behavior modification in groups (Lawrence &
Sundel, 1971) used in the research, called for Six therapy sessions each
covering a selected area of problematic behavior, a cognitive component
relevant to the amelioration or solution of the problem and the develop—
ment of a behavioral assignment to be implemented and evaluated in the
following week. Chronologically the sessions covered: 1) Problem
Specification, a topic relating primarily to the importance of clearly
understanding the nature, boundaries and behavioral indices of the
perceived problem. Participants were encouraged to select 93; problematic
behavior on which to work and were cautioned that ”grandiose" problems,

such as'Ffinding a meaning in life"tend to be life—long concerns

48

and to expect an answer to a problem such as this, in six weeks, is not
realistic. 2) Reinforcement; the nature and impact of reinforcement,
in both its positive and negative forms was explored. Consideration
was given to the amount of "unthinking" reinforcement one uses and

it was suggested that interpersonal problems frequently stem from the
fact that one is reinforcing or being reinforced for a particular
behavior without realizing it. It was suggested that close attention
to reinforcement often leads to such a discovery and consequently

to the solution of the problem. 3) Extinction; the relationship of
extinction to the nature and change of human behavior was explained
and the utility of extinction was related to the content of the previous
week's session. Discussion was directed to how one might use the
concept of extinction, in conjunction with reinforcement, to modify
one's own or another's problematic behavior. It was pointed out that
this is not artifical manipulation of one's self or of another, but
rather, negotiation to achieve change that would result in more
satisfactory behavior. 4) Trying out new behaviors; it was suggested
that, given the extinction of a problematic behavior, another behavior
will inevitably take its place, and since human beings tend to

behave in relatively set patterns, trying out new behaviors will be
necessary to avoid adopting a behavior that may prove to be as
troublesome as the old problematic behavior. This was followed by a
discussion of the "mythical" fears that tend to act as reinforcers to
perpetuate problem behavior and the observation was made that when one
actively confronts these "mythical fears" that one tends to be much

more in control of one's life and as a consequence to feel freer to

49

change other behaviors. 5) Antecedent-Behavior-Consequence; the
observation was made that all human behavior takes place in an

A-B-C progressional system and that by isolating the relationship

of antecedants to behavior and observing the consequences, one can
effectively determine if modifying a particular behavior is desirable
and if so, how the modification may be brought to fruition. Discussion
was directed to how this might be useful in interpersonal, parent/child,
work and school relationships. 6) Making requestS--giving and receiving
positive feedback; the final session was devoted to an exploration of
participants' reactions to giving and receiving positive feedback and
to the analysis of the ways in which they typically made requests.
Almost uniformly clients found that it was difficult for them to

accept positive feedback and that when they gave negative feedback it
was usually done in anger. Conversely, negative feedback was frequently
received angrily and positive feedback given grudgingly or in a
manipulative manner. Discussion centered on alternative methods of
expression, in light of previous sessions and possible change
strategies, Should change be deemed appropriate. The remaindercxfthe
final session was devoted to the evaluation of progress toward
modifying the specific behavior identified in the first session and

to administering the outcome test battery.

Each session typically called for a thirty minute cognitive
presentation on the appropriate area, followed by a Short question
period and then the "working" period which lasted approximately
two hours. Each client volunteered to report on the behavioral

assignment from the previous week and to "work" on applying what had

50

been learned this week to enhance what progress had already been made°
Following this, each client negotiated a behavioral assignment for the
next week, a process involving both the therapist and the other group
members. This process was repeated until all participants had an

opportunity to "wor and to formulate a new or expanded behavioral
assignment.

This particular treatment format was selected because;

1) its utility and efficacy has been demonstrated (Lawrence & Sundel,
1971); 2) experienced and expert therapists were readily available;
3) it appeared that modifications of clients' levels of anxiety,
motivation, and positive expectation would be particularly impactful
in this format; 4) the format is congruent with the researcher's
treatment bias and consequently questions of ethics, therapist and/or
experimenter bias and replicability were not an issue.

Although clinical research is at best a difficult undertaking,
as discussed in Chapter II, it was given priority in the present
research because of its greater potential for impact on clinical
practice and because of the paucity of literature that is directly
relevant to the practitioner. The present research incorporates a
design which, while falling short of the ideals presented by Strupp &
Bergin (1969), represents the best available compromise between the
realities of clinical research and the goals of "straight" empirical
research. Highly sophisticated statistical analysis is not employed

because the "state of the art" does not allow sufficient Specification

of operational definition of variables (Bordin, 1965). The theoretical

basis for multivariate or factorial analysis of clinical practice
being as yet undiscovered, or at least unpublished, it was felt that
the best possible compromise could be reached by tightly controlling
variables such as therapist personality, technique, theoretical
orientation and relying on a relatively Simple design (Arbuckle, 1967)
so as to make analysis as straightforward, and consequently, as

uncontaminated, as possible.

CHAPTER IV

RESULTS

The results are organized into four sections. The first
reports the results of the analysis of variance which examines the
impact of VTP/R11 on the client's anxiety, motivation and positive
therapeutic expectations. The second section is devoted to the analysis
of variance which examines subjective evaluation of therapeutic impact
as it is affected by the presence or absence of VTP/RII; results are
reported both for client evaluation and therapist evaluation. The
third section reports the results of the analysis of variance
which examines the affect of VTP/RII on objective measures of
therapeutic outcome and the final section is devoted to correlational
data relating to anxiety, motivation and expectation levels and
objective measures of outcome.

Analysis of Variance for Effects of
Vicarious Therapy Pre—Training/fii
Role Induction Interviews

Tables 1 through 9 summarize the results of the analysis of
variance utilized to examine the impact of VTP/R11 on the levels of
client manifest anxiety, motivation to change and positive therapeutic
expectations, respectively. Table 1 summarizes the results of the
analysis of variance evaluating the impact of VTP/R11 on the manifest

anxiety exhibited by clients before and after exposure to VTP/RII

52

53

and indicates that there are Significant differences between groups
following this exposure. Table 2 summarizes the analysis of variance
relating to the within group impact of VTP/RII and indicates that,

although, the results were not Significant, they were in the predicted

 

 

 

 

 

 

 

 

direction.
Table 1
Analysis of Variance of Manifest
Anxiety as Affected by VTP/RII
Referent in Time Comparison Groups Groups
Pre- or Post-Test Groups Receiving Receiving df F
Analysis VTP/RII Pre-Test
Pre-Test A and B A yes A yes 1,12 0.0127
B no B yes
Post-Test A and B A yes A yes 1.12 8.5392*
B no B yes
Post-Test A and C A yes A yes 1.12 0.0028
G yes C no
Post—Test B and C B no B yes 1.12 7.1710*
0 yes C no

 

'*<.05

54

Table 2

Analysis of Variance of Manifest
Anxiety as Affected by VTP/RII
on Pre- & Post-Test Measures

 

 

 

 

 

Group Comparison df F
A Pre- & Post-Test 1,12 3.2048
B Pre- & Post-Test 1,12 0,9433

 

* <'.05

As predicted from hypothesis 1 the results indicate that the
presence of VTP/RII produces a significant differentiation between
these groups and those not receiving VTP/RII. Further analysis,
presented in Table 2, indicates that this anxiety reduction is also
present within groups subjected to pre- and post-testing, although
in this case the results were not significant.

Table 3 represents the results of analysis of variance for
fluctuations of client positive expectations of therapeutic outcome
and Table 4 the within group fluctuations of groups exposed
differentially to VTP/RII or not so exposed.

Again the results indicate a Significant impact on client
positive expectations, which tends to substantiate hypothesis 2
which suggested that VTP/RII would significantly increase client

positive expectations of therapeutic outcome.

55

Table 3

Analysis of Variance of Positive
Therapeutic Expectations as
Affected—by VTP/RII

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Referent in Time Comparison Groups Groups
Pre- or Post-Test Groups Receiving Receiving df F
Analysis VTP/RII Pre-Test
Pre-Test A and B A yes A yes 1,12 0.0623
B no B yes
Post-Test A and B A yes A yes 1,12 10.1866**
B no B yes
Post-Test A and C A yes A yes 1,12 2.3023
G yes C no
Post-Test B and C B no B yes 1.12 8.1724*
0 yes C no '
* <:.05
** *(.01
Table 4
Analysis of Variance of Positive
Thera eutic Expectations as
Agfected 5y VTP7RII
on PreJPost-TeSt—
Measures
Group Comparison df F
A Pre- & Post-Test 1.12 9.4986**
B Pre- & Post-Test 1,12 1.7015

56

Likewise the results represented in Tables 5 through 8
provide substantive validation for hypothesis 3 which suggested that
exposure to VTP/R11 would have the tendency to Significantly increase

clients' motivation to change.

Table 5

Analysis of Variance for Motivation to
Change (Part IIIas Affected'

 

 

 

 

 

 

 

 

 

by VTP/ARII
Referent in Time Comparison Groups Groups
Pre- or Post-Test Groups Receiving Receiving df F
Analysis VTP/RII Pre-Test
Pro-Test A and B A yes A yes 1,12 1.1931
B no B yes
Post-Test A and B A yes A yes 1.12 10.6353**
B no B yes
Post-Test A and C A yes A yes 1,12 0.4569
0 yes C no
Post-Test B and C B no B yes 1,12 8.5188*
0 yes C no
* < .025
** < .01

57

Table 6

Analysis of Variance of Motivation
to Change as Affected by VTPZRII
of Pre- and Post-Test Measures

 

 

 

 

 

 

 

Group Comparison df F
A Pre- & Post-Test 1,12 6.6507**
B Pre- & Post-Test 1,12 2.7647
* < .05
** < .025
Table 7

Analysis of Variance of Motivation to Change
(Part II) as Affected by VTP/RII

 

 

 

 

 

 

 

 

Referent in Time Comparison Groups Groups
Pre- or Post-Test Groups Receiving Receiving df F
Analysis VTP/RII Pre-Test
Pre-Test A and B A yes A yes 1,12 0.0236
B no B yes
Post-Test A and B A yes A yes 1,12 7.2202**
B no B yes
Post-Test A and C A yes A yes 1,12 0.0032
G yes C no
Post-Test B and C B no B yes 1,12 8.3863**
C yes C no
‘* (.05

**'<.025

58

Table 8

gggléség 2E Variance of Motivation

 

 

 

 

 

Group Comparison df F
A Pre- & Post-Test 1,12 7.8070**
B Pre- & Post-Test 1,12 1.3690
* <:.05
** (.025

Analysis of Variance for Subjective Therapist
Ratings of Improvement as Affected by
Vicarious Therapy Pre-Training/i
Role Induction Interviews

Table 9 summarizes the results of analysis of variance for
subjective therapist ratings of improvement. The results confirm,
for most factors, that clients exposed to VTP/RII were rated
significantly higher, on a subjective scale of client functioning
at the termination of the group, than were clients not exposed to
VTP/R11. These findings are largely, though not wholly, consistent

with the prediction of hypothesis 4.

Analysis of Variance of Subjective

59

Table 9

 

Therapist Rating of Improvement

As Affected by VTP7RII

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Area of Comparison Groups
Functioning Groups Receiving df F
VTP/RII
Social Functioning A and B A yes 1,5 6.0586*
B no
Social Functioning B and C B no 1.5 4.1202
nges
Social Functioning A and C A yes 1,8 0.9414
nges
Family Functioning A and B A yes 1,5 9.8247**
B no
Family Functioning B and C B no 1,5 7.079l**
nges
Family Functioning A and C A yes 1.8 0.1594
nges
Primary Relationships A and B A yes 1,5 3.7240
B no
Primary Relationships B and C B no 1,5 4.473l*
nges
Primary Relationships A and C A yes 1,8 0.4677
nges
Primary Goal Attainment A and B A yes 1,5 7.8358**
B no
Primary Goal Attainment B and C B no 1.5 8.4375**
G yes
Primary Goal Attainment A and C A yes 1,8 1.2936
@168
Vocational Functioning A and B A yes 1,5 6.0586*

B no

60

Table 9 Continued

 

 

 

 

 

Area of Comparison Groups
Functioning Groups Receiving df F
VTP/RII
Vocational Functioning B and C B no 1.5 7.8536**
C yes
Vocational Functioning A and C A yes 1,8 0.5366
G yes
* (1.10
*4!- < .05

Tables 10 and 11 summarize the results of analysis of
variance for subjective client evaluation of goal achievement and of
improved functioning in interpersonal relationships. The results confirm
that there are significant differences between the VTP/RII and non-VTP/RII
groups, in most categories, with respect both to their perceived
attainment of therapy goals and their improved functioning in inter-
personal situations. Again, the results are consistent with the trends
predicted by hypothesis 5.

Analysis of Variance for Objective

Outcome Measures as Affected
bygVTPZRII

 

 

 

Table 12 summarizes the results of analysis of variance for
the objective outcome measures as affected by VTP/RII. As predicted
by hypothesis 6, those groups receiving VTP/RII scored significantly
higher on the Collins—Curran Scale. The outcome measures on the
Lawrence scales (parts 1-3) were not Significant, but did demonstrate
a trend in the predicted direction. The failure to meet the criteria
of significance with the Lawrence scales will be explored in more

depth in Chapter 5.

61

Table 10

Analysis of Variance of Subjective

 

Client Evaluation of Improvement

 

as Affected by VTP7RII

 

 

 

 

 

 

 

 

 

 

 

 

Area of Comparison Groups
Evaluation Groups Receiving df F
VTP/RII
Primary Goal Attainment A and B A yes 1,5 8.9146**
B no
Primary Goal Attainment B and c B no 1, 5 6.0900*
G yes
Primary Goal Attainment A and C A yes 1,8 0.0440
C yes
Secondary Goal Attainment A and B A yes 1,5 7.3499**
B no
Secondary Goal Attainment B and C B no 1.5 5.9393*
C yes
Secondary Goal Attainment A and C A yes 1,8 1.0682
G yes
Tertiary Goal Attainment A and B A yes 1,5 3.4033
B no
Tertiary Goal Attainment B and C B no 1,5 12.0000**
C yes
Tertiary Goal Attainment A and C A yes 1,8 0.1794
G yes

_~

* < .10
** < .05

62

Table 11

Analysis of Variance of Number of Areas of
Interpersonal Relationship Improvement
as Subjectively Evaluated by Clients
and Affected by VTP/RII

 

 

 

 

 

 

 

 

Comparison Groups
Groups Receiving df F
VTP/RII
A and B A yes 1,5 8.6072**
B no
B and c B no 1,5 7.5263H
C yes
A and C A yes 1.8 0.5677
C yes
* <f.lO
** (.05
Table 12

Analysis of Variance of Objective
Outcome Measures as Affected

 

 

 

 

 

 

by VTP/RII
Comparison Groups
Instrument Groups Receiving df F
VTP/R11
Collins-Curran Scale A and B A yes 1.5 5.7228*
B no
Collins-Curran Scale B and C B no 1.5 7.8800**

G yes

__

63

Table 12 Continued

 

 

 

 

 

 

 

 

 

 

 

 

 

Comparison Groups
Instrument Groups Receiving df F
VTP/RII
Collins-Curran Scale and C A yes 1,8 0.0671
pres
Lawrence Scales Part 1 and B A yes 1,5 0.9772
B no
Lawrence Scales Part 1 and C B no 1,5 1.0909
G yes
Lawrence Scales Part 1 and C A yes 1,8 0.3571
nges
Lawrence Scales Part 2 and B A yes 1,5 0.4794
B no
Lawrence Scales Part 2 and C B no 1.5 0.2264
nges
Lawrence Scales Part 2 and C A yes 1,8 0.0033
nges
Lawrence Scales Part 3 and B A yes 1.5 1.6326
B no
Lawrence Scales Part 3 and C B no 1,5 0.4444
mes
Lawrence Scales Part 3 and C A yes 1,8 0.2413
0 yes
* <f.10

”(.05

Correlational Data Evaluating The Relationship
of Post—Test Measures
to Outcome Measures

 

 

 

Tables 13 and 14 summarize the results of correlations
for post-test data and outcome data. The results confirm that
manifest anxiety is negatively related to outcome and that positive
therapeutic expectations and motivation to change are positively

related to therapeutic outcome, as predicted by hypotheses 7 through 9.

Table 13

Correlational Data Evaluating the
Relationship of Post-Test
Data to Outcome Data

 

 

 

 

 

 

 

 

Post-test Outcome Post-test/Outcome

Instrument Instrument Correlation
Taylor Collins-Curran -0.4536
Taylor Lawrence Part 1 -0.4464
Taylor Lawrence Part 2 -0.4856
Taylor Lawrence Part 3 -0.l786
Fischer-Turner Collins-Curran 0.7207**
Fischer-Turner Lawrence Part 1 0.6619**
Fischer-Turner Lawrence Part 2 0.6120*
Fischer-Turner Lawrence Part 3 0.0261
Miskimins Part 1 Collins-Curran 0.53ll*

Miskimins Part 1 Lawrence Part 1 0.3992

65

Table 13 Continued

 

 

 

 

 

 

 

 

 

 

 

Post-test Outcome Post-test/Outcome
Instrument Instrument Correlation
Miskimins Part 1 Lawrence Part 2 0.5767*
Miskimins Part 1 Lawrence Part 3 0.3511
Miskimins Part 2 Collins-Curran 0.3758
Miskimins Part 2 Lawrence Part 1 0.4045
Miskimins Part 2 Lawrence Part 2 0.5182*
Miskimins Part 2 Lawrence Part 3 0.1825
* (.05
** <I.01
Table 14
Correlational Iata Evaluating the Relationship
of Post—Test Data to Supjective
Outcome Data
Post-test Scale on Post-test/
Instrument Outcome Measure Outcome
Correlation
Taylor Social Functioning -0.7386**
Taylor Family Functioning -0.6765**
Taylor Primary Relationship -0.6640**
Taylor Primary Goal Attainment -0.7586**
Taylor Vocational Functioning -0.4239

 

Fischer-Turner Social Functioning 0.4621

66

Table 14 Continued

 

 

 

 

 

 

(.01

Post-test Scale on Post-test/
Instrument Outcome Measure Outcome
Correlation
Fischer-Turner Family Functioning 0.3272
Fischer-Turner Primary Relationship 0.4392
Fischer-Turner Primary Goal Attainment 0.6902**
Fischer—Turner Vocational Functioning 0.3016
Miskimins Part Social Functioning 0.8950**
Miskimins Part Family Functioning 0.7621**
Miskimins Part Primary Relationship 0.8620**
Miskimins Part Primary Goal Attainment 0.6202*
Miskimins Part Vocational Functioning 0.1632
Miskimins Part Social Functioning 0.7496**
Miskimins Part Family Functioning 0.4899*
Miskimins Part Primary Relationship 0.6283*
Miskimins Part Primary Goal Attainment 0.6566**
Miskimins Part Vocational Functioning 0.1632
‘* (.05

cmmms

DISCUSSION

The results for the most part support the hypotheses
presented in Chapter 3. Analysis indicates that VTP/R11 is an
affective agent for reducing manifest anxiety and increasing
motivation to change and positive therapeutic expectations. The
results also indicate that VTP/RII significantly increases the
positive impact of psychotherapy as measured both by objective and
subjective instruments. Furthermore, the results disclosed the
predicted positive correlation between positive indicators of
motivation and expectation and positively evaluated therapeutic outcome.
Beyond this, the same holds true for manifest anxiety although in the
opposite direction; manifest anxiety being negatively correlated with
outcome.

The Impact of VTP/RII on Manifest Anxiety

Motivation to Change and
Positive Expectations

 

 

The results strongly support hypothesis 1, clearly indicating
that groups exposed to VTP/RII exhibit significantly lower levels of
manifest anxiety than do groups not exposed to VTP/RII. As reviewed in
Chapter 2, the research literature (Bergin & Jasper, 1969; Distler, 1964;
Gallagher, 1954; Gottschalk, 1967; Katz, 1958; Kirtner & Cartwright, 1958;

Hamburg et al., 1967; Luborsky, 1963) is abundant with studies

67

68

demonstrating the impact of pre-therapy and during therapy manifest
anxiety on eventual therapeutic outcome; in addition, a number of
studies demonstrate the predictive validity of pre-therapy manifest
anxiety. However, to this date, the literature has not given much
attention to the viability of modifying the client exhibited levels
of anxiety or to determining what impact such modification might have
on the eventual outcome of psychotherapy. The present research
demonstrates that manifest anxiety is amenable to modification, and
beyond this, that such modification can be achieved with relatively
little difficulty by utilizing VTP/RII methods. The implications of
this research are quite clear, it suggests that utilization of
VTP/RII in the contemporary clinic can provide a feasible and effective
response to such common frustrations as pre-mature client terminations,
policy directives to serve the greatest number of people in the least
amount of time, and ethical directives to provide the highest quality
of service available. The research suggests that implementation of
VTP/RII programs, modified to fit the theoretical and technical
orientations of a variety of therapists, can increase the efficacy
of therapy, facilitate its process, and significantly increase the
probability of positive therapeutic outcome by making the process
easier for the client to conceptualize, while at the same time
decreasing the probability that he will become a victim of premature
termination.

Similarly the present research supports hypothesis 2,

indicating a Significant increase in the level of positive therapeutic

69

expectations. Salesmen and others engaged in daily interpersonal

exchanges have long known that a person tends to respond affirmatively

only if he holds not only positive attitudes toward them, but also

expects their product to perform as well as they suggest it will.
Management research (Cole, 1973) indicates that brand loyalty and

repeat buying is more significantly affected by the congruency of

the consumers' expectations and perceived product performance than

it is by actual quantifiable performance of the product. Likewise,

the psychotherapy research literature (Brady et al., 1970; Conrad,

1960; Goldstein a Shipman, 1961; Lipkin, 1954) recognizes the impact

of positive therapeutic expectations and Frank (1969) suggests that

it is perhaps, the most reliable predictor of therapeutic success

currently available. The present research addresses itself to the

paucity of information available on techniques for modifying the

expectations of psychotherapy held by the client. The Significance

of the results and the relative ease with which VTP/RII is administered

suggest that it is a technique, which if applied to clinical practice

generally, could have the effect of not only increasing the efficiency

of clinical practice but also increasing client satisfaction with

the system. Such increases would be reflected in more efficient

delivery of services, shorter waiting periods between initial

contact with the clinic and provision of services, and shorter
Peatiods of treatment for most clients, consequently, allowing
understaffed clinics to serve more people, more efficiently and with

a hisher degree of client satisfaction.

70

The results also indicate a significant increase in client
motivation to change as a result of exposure to VTP/R11. Again the
research literature (Cartwright a Lerner, 1963; Conrad, 1962;
Schoeder, 1960; Siegal a. Fink, 1962; Strupp et al., 1963) has
suggested that motivation to change is an intrinsic ingredient in
successful psychotherapy and although it has not addressed itself
directly to the issue of increasing motivation, there is an implicit
suggestion that doing so would improve the prognosis for any given
client. In as much as the results have clearly Shown that exposure
to VTP/RII increases motivation to change, it is suggested that its
utilization may result in further streamlining of the therapeutic
process and at the same time increase the probability of successful
achievement of therapeutic goals.

The discussion, thus far, has illustrated the positive
therapeutic impact of VTP/RII and has suggested that its implementation
in the therapeutic community would result in increased efficiency,
impact, client satisfactions and probability of successful outcome.
Further, it has been seen that VTP/RII, as predicted, significantly
reduces client pro-therapy manifest anxiety, while increasing both
positive therapeutic expectations and client motivation to change.
What remains to be discussed is the empirical impact of VTP/RII on

subjective and objective measures of therapeutic improvement.

The Affects of VTP/RII on
Subjective Evaluations of
Therapeutic Improvement
As predicted by hypothesis 3, those subjects receiving

VTP/R11 were rated significantly higher, on subjective therapist

evaluation scales, than were those subjects not exposed to VTP/R11.
These findings are consistent with the research discussed in the
previous section, which suggested that client pre-therapy motivation
to change, positive therapeutic expectations and manifest anxiety,
all comprise effective predictors of therapeutic success. Coupled
with the fact that the results demonstrate the relative ease with
which these variables can be modified, it becomes possible to
conclude that VTP/RII is an effective and parsimonious method for
increasing the liklihood of positive therapeutic outcome, at least
as subjectively evaluated by the therapist.

The same situation holds true for client subjective
reports of therapeutic success, the results indicating that clients
who were exposed to VTP/RII reported significantly greater success
in achieving the primary, secondary and tertiary behavioral goals
which they had set for themselves at the onset of therapy. Contrary
to predictions by Paul (1966), client and therapist evaluations in
this case are not in conflict, probably, at least in part, due to the
fact that clients and therapists were rating the same things and that
each has an adequate understanding of the criteria of improvement.
The primary source of conflict between therapist and client evaluations,
as discussed by Paul (1966) was found to be the lack of clarity
regarding what was being rated. Obviously, if the client and the
therapist are not rating the same thing, or if they entered therapy
With differing expectations or goals, their ratings of success will

inevitable be diSparate. On the other hand, as the results of the

72

present research suggest, such disparities are not the inevitable
product of client/therapist ratings, but apparently are due more to
miscommunication and misunderstandings relating to the criteria

of improvement utilized in the ratingS.

Additional subjective results indicate that when clients
evaluated the number of interpersonal relationship areas in which they
felt they had improved, those clients receiving VTP/RII domonstrated a
significantly greater number and magnitude of areas of improvement.
The consistency of the results is somewhat surprising given the
cautions of Chapter 1 relating to the use of subjective evaluation
instruments, but does Speak quite highly of the techniques (both
therapy and evaluation) used in the present research. Perhaps it is
the relative concreteness of the behavior modification format, as
Opposed to other modalities of therapy that is, at least in part,
responsible for this consistency, or perhaps it is the instrumentation
that was used. Whichever, it is heartening to note the consistency
of the results and possible to suggest that it is not the unreliability
of subjective measurement that is reSponSible for the problems
observed in Chapter 1, but rather that is may be the 1aCk of Specificity,
both with regard to therapeutic techniques and evaluative instruments.

The Affects of Wynn on

Objective Measures of
Therapeutic Outcome

 

The results of the analysis of variance for objective
outcome measures indicate that VTP/R11 impact is strongest on the

COIlins—Curran scale and that although the results are in the

73

predicted direction on the three Lawrence scales, they fall Short

of significance. In part the failure of the Lawrence scales to
produce Significant discriminations may be due to the relative
brevity of the scales and the fact that the extreme high score of
four and the extreme low score of zero, leaves very little room for
meaningful discriminations. The lack of discriminatory ability on
these scales is consistent with much of the experience of Lawrence
(1974), who reports that in studies using much larger samples and
employing the same therapy techniques, but without VTP/R11, the scales
used in the present research also failed to discriminate between

high and low outcome groups. Lawrence has dealt with this problem

by designing different scales, which discriminate much more clearly.
However, Since it is impossible to re-examine the subjects of the
present research, it is possible only to observe that VTP/RII had
Significant effect on the reduction of anxiety and increase of
positive therapeutic expectation and motivation to change and infer from
the studies cited in Chapters 1 a 2 and from the objective data
gathered on the Collins-Curran scale that VTP/RII has a positive
impact on outcome, although further research is obviously required to
make empirically strong claims for the magnitude of its power. The
specificity of the design and as a consequence, the ease with which it
may be replicated, however, makes such replication and expansion
relatively simple. As is the case with all original research in an
area that is as yet underdeveloped, further study and replication was
taken as a given, and in fact, the present research was designed with

I‘eplication in mind.

74

Correlational Data Evaluating the
Relationship of Post-Test
Measures to Outcome

Fortunately, although the analysis of variance for
objective outcome measures did not yield the desired level of
significance, this is somewhat compensated for by the correlational
data reviewed in.Tables 13 and 14 of Chapter 4. The results clearly
indicate that, as predicted from hypothesis 7 manifest anxiety is
negatively correlated, both to subjective and objective outcome
criteria. Again, particularly high correlations are found on the
Collins-Curran scale and on the therapist evaluation scale, although
the Lawrence scales, with the exception of Lawrence part 3, display
correlations at a level similar to that found with the other
instruments,

Likewise, and as predicted from hypotheses 8 and 9, the
data disclose Significant positive correlations for motivation to
change and positive therapeutic expectations on both objective and
subjective outcome criteria. Interestingly, correlations for vocational
functioning are significantly lower than for the other areas of
:Eunctioning suggesting, for the p0pu1ation studied at least, that
functioning in the work or school areas is less responsive to the
effects of psychotherapy or perhaps that this area is less reflective
of changes in interpersonal functioning.

For all other areas and measures, however, the correlations

are high enough to allow the observation that modification of manifest

anxiety, positive therapeutic expectations and motivation to change

constitute a viable method for improving the efficacy of behavior

modification in groups.

General Discussion of Results

While falling Short of the desired levels of significance
in some areas, the present research does provide substantive evidence
of the positive impact engendered by the utilization of VTP/R11. The
results have conclusively shown that VTP/RII is a viable method for
modifying the levels of three important variables that have been
uniformly identified in the psychotherapy literature as reliable
predictors of therapeutic outcome. Likewise it has been shown that
the administration of VTP/RII can be effective in improving the
subjective evaluations of both therapists and clients. In as much
as Katz (1958) has suggested that the premature therapy dropout rate
of 30-65%, reported nationwide, is primarily reflective of the fact
that clients frequently don't understand the process of therapy,
or what is expected of them, it is clear that VTP/R11 may be effectively
employed to reduce this premature termination rate. Moreover, as
VTP/RII has been shown to be an effective catalytic agent in the
process of therapy, it is suggested that implementation of this, or
similar programs, in the existing community mental health programs can
effectively streamline their operation by Shortening the length of the
"initiatory period" during which the client and therapist are struggling
to define the therapy relationship and by clearly and concisely
communicating to clients what they may realistically expect from

therapy and what may realistically be expected of them.

76

The trends in mental health are clearly toward shorter
term, brief and crisis oriented therapy. This being the case, it is
incumbant upon the professional (Mann, 1973) to successfully bridge
the ethical gap between providing the highest quality of services
and providing them in the briefest possible period of time. In
keeping with this objective, the VTP/RII program has been developed
to minimize the time required to begin the "work" of therapy, while
at the same time not jeOpardizing the therapeutic factors involved
in the develOpment of the therapy relationship. The results of the
present research clearly indicate that, while some methodological
and/or measurement modifications are in order, VTP/RII represents
a parsimonious approach to, and an efficacious solution of, the
problem of decreasing client manifest anxiety, maximizing positive
expectations and motivation within the confines of the clinical
setting, while at the same time increasing goal attainment and
client satisfaction.

Implications for
Further Research

 

 

It has been observed, throughout much of the discussion of
results, that as with most pieces of original research, the present
research has certain instrumentation problems that need to be ironed
out before strong empirical statements may be made as to its
Viability as a method of strengthening objective outcome criteria.
While the criticisms of therapist differences, unspecified therapy
techniques and uncertain designs leveled against earlier studies in

Chapter 2 have been dealt with in the design of the present research,

77

some problems remain. Most obvious, is the problem of developing
instrumentation to measure accurately the impact of VTP/RII on
objective outcome criteria. The primary problem here, rests with
the Lawrence scales parts l-3. Although the scales are congruent
with the therapeutic methodology of the program, the results of
this, and other research (Lawrence, l97#) indicate that they are
lacking in discriminatory ability and that suitable modifications,
are necessary before they can begin to supply the substantive data
for verification of the impact of such therapy programs.

Beyond this, it is important to examine the viability of
larger scale studies, incorporating larger samples and perhaps
a variety of matched therapists and clinical settings. The argument
was advanced in Chapter 3, that laboratory research frequently has
questionable validity when applied to clinical settings and it was
observed that while clinical research is more readily translated to
clinical practice, it also has significant drawbacks, in terms of
obtaining large numbers of subjects and the problem of experimental
design within the confines of clinical procedure. Further, it was
‘noted in Chapter 3, that while a larger sample size might have been
desirable, the pragmatics of clinical research, without financial
support, made utilization of a larger sample size a fiscal, as well
as physical, impossibility. It is suggested that if and when
Federal research grants once again become available that a large
scale replication of the present research would be most desirable.

Beyond research considerations, however, the present research

has implications in a number of areas. As already reviewed it has

78

great promise for modernizing and streamlining the practice of
psychotherapy, a most desirable objective in this age of accountability.
Possibilities also exist for the implementation of VTP/RII programs,
such as the one examined here, in the fields of education, labor-
management relations and in fact any endeavor that incorporates the
concepts of change and group interaction. As a means of facilitating
the process of group interaction, and minimizing the "measuring up"
period which charaterizes all newly formed groups, VTP/RII offers

the potential of maximizing the impact of many divergent, group

oriented endeavors.

Conclusion

 

In summary, then, VTP/R11 has been shown to be an affective
agent for decreasing client manifest anxiety, while increasing positive
therapeutic expectations and motivation to change. The present
research reports significantly higher client and therapist ratings
of successful outcome, as well as significantly higher objective
criteria ratings of outcome. Further it has been shown that,
consistent with previous research, manifest anxiety, positive
therapeutic expectations and motivation to change are reliable
and congruent discriminators when applied both to prediction of
therapeutic success and to differentiating levels of outcome.

It has been suggested that, with minor changes in
instrumentation, VTP/RII programs may elicit even more significant
results, and that, given the availability of research funds, larger

scale replication is called for.

79

Finally, the scope of VTP/FII was discussed and it was
suggested that the range of such programs is not limited to the
clinical setting but that with minor adaptations, the VTP/RII
program may be used as a facilitator to the process of a wide
variety of group interactional situations, with positive results.

Much remains to be done, and the research presented here
is only a small, but positive step, in the direction of improving
the systems of service delivery that are, everyday, constituting

a greater part of our lives.

BIBLIOGRAPHY

BIBLIOGRAPHY

Abraham, A. "A Model for Exploring Intra- and Interindividual
Process in Groups," International Journal of Group
Psychotherapy, Vol. 23, No. 1, Spring 1973.

Agras, S. "Instructions and Reinforcement in the Modification of
Neurotic Behavior," American Journal of Psychiatry, 1969,
$25. 1435-1439.

Arbuckle, D. S. "Kinds of Counseling: Meaningful or Meaningless,"
Journal of Counseling_Psychology, 196?, IE. 219-229.

Bachrach, H. "Adaptive Regression, Empathy and Psychotherapy:
Theory and Research Study," Psychotherapy: Theory,
Research and Practice, Vol. 5, No. b, Dec. 1968.

Bailey, K. G., & Bailey, R. C. "Self-concept Modification as a
Function of Audio-tape Playback," Psychotherapy:
Theory, Research and Practice, Vol. 10, No. 2. Summer 1973.

 

Bailey, P. B. "The Great Psychiatric Revolution," American Journal

Bales, R. F. Interaction Process Analysis: A Method for the Study
of Small Groups. Cambridge, Mass: Addison-Wesley
Publishing Co. Inc., 1950.

 

Bandura, A. Behavioristic Psychotherapy. New York: Holt, Rinehart &
Winston, 196?:

Bandura, A. "Influence of Model's Reinforcement Contingencies on
the Acquisition of Imitative Responses," Journal of
Social Psychology, 1965, 589-595.

Bandura, A. ”On Empirical Disconfirmations of Equivocal Deductions
with Insufficient Data," Journal of Consulting & Clinical
Psychology, 1968, 3;. 247-249.

Bandura, A. "Psychotherapy as a Learning Process," Psychological

80

Bandura, A. "Social Learning Through Imitation," In M. R. Jones
(Ed.). Nebraska Symposium on Motivation. Lincoln,
Nebraska: University of Nebraska Press, 1962. 211-269.

Bandura, A., & Kupers, J. "Transmission of Patterns of Self-
Reinforcement Through Modeling," Journal of Social
Psychology, 1964, 6 . 1-9.

 

Bandura, A., & Walters, R. H. Social Learnigg_and Personality
DeveImeent. New York: Holt, Rinehart & Winston, 1963.

Battle, C. C",et a1. "Target Complaints as Criteria of Improvement,"
American Journal of Psychotherapy, 1966, g9, 184-192.

Beckett, J. A. "General Systems Theory, Psychiatry and Psychotherapy,"
International Journal of Groungsychotherapy, Vol. 23, No. 3.
Summer 1973.

Bednar, R. L. "Group Psychotherapy Research Variables," International
Journal of Group Psychotherapy, 1970. g9, 146-152.

 

Bednar, R. L., a: Lawlis, G. F. "Ehnpirical Research on Group Psycho-
therapy," In A. Bergin & s. Garfied (Ed.). Handbook of
Psychotherapy and Behavior Change. New York: Wiley. 1971.

Bednar, R. L., & Parke, C. A. "Client Susceptibility to Persuasion
and Counseling Outcome," Journal of Counselinngsychology.
1969, $6, h15-h20.

Berger, 1. L. "Resistances to Learning Process in Group Dynamics
Programs," American Journal of Psyshiatry, 1969, lgé,
850'8570

Bergin, A. E. "Some Implications of Psychotherapy Research for
Therapeutic Practice," Journal of Abnormal Psychology.
1966, 1;, 235-246.

Bergin, A. E. "The Effects of Psychotherapy: Negative Results
Revisited," Joumnal of Counselinngsychology, 1963, IQ,
244-250.

Bergin, A. E., & Strupp, A. R. "New Directions in Psychotherapy
Research," Journal of Adnormal Psychology, 1970. Zé, 13-26.

Berne. E. Transactional Analysis in Psychotherapyo New York:
Grove Press, 1961.

Blocher, D. "What Counseling Can Offer Clients: Implication for
Research on Client Selection," In J. M. Whiteley (Chm).
Invitational Conference on Counseling: Re-evaluation
and Refocus. Washington: Washington University, Sept. 1967.

 

82

Bordin, E. S. "Simplification as a Strategy for Research in
Psychotherapy," Journal of Consulting Psychology,
1965 o 22: 493'503 0

Brady, J. D., et al. "The Relationship of Expectation of Improvement
to Actual Improvement of Hospitalized Psychiatric Patients,"
Journal of Nervous & Mental Disorders, 1960, 130, 41-44.

Breger, L., & McGaugh, J. L. "Critique and Reformulation of
'Learning-Theory' Approaches to Psychotherapy and Neurosis,"
Psychological Bulletin, 1965, 6}, 338-358.

Butler, J. M. "Self-concept Change in Psychotherapy," Counselipg
Center Discussion Papers. Chicago: University of Chicago.
1960, 16, 1-27.

 

Campbell, D. T., & Stanley, J. C. Experimental and Quasi-Experimental
Designs for Research. Chicago: Rand McNally, 1963.

Cartwright, D. 8., 8c Cartwright, R. D. "Faith and Improvement in
Psychotherapy," Journal of CounselingyPsychology. 1958,
2! 174-1770

Cartwright, R. D. "The Effects of Psychotherapy: A Replication and
Extension," Journal of Consulting Psychology, 1961, g5, 367-382.

Cartwright, R. D., 8: Lerner, B. "Empathy: Need to Change and
Improvement with psychotherapy," Journal of Consulting
Psychology, 1963, g2, 138-144.

Clemes S., & D'Andrea, V. J. "Patient's Anxiety as a Function of
Expectation and Degree of Initial Interview Ambiguity,"
Journal of Counseling Psychology, 1965,,g2. 397.

Colby, K. M. "Psychotherapeutic Processes," Annual Review of
Psychology, 1964: 15' 347-370.

Cronbach, L. T., & Meehl, P. E. "Construct Validity in Psychological
Tests," In Psychological Tests in Minnesota Studies in the
Philosophy_of Science. Minneapolis: University of Minnesota
Press, Vol. 1. l96h.

Dana, R. H. "Manifest Anxiety, Intelligence and Psychopathology,"
Journal of Consultinngsychology, 1956, 3;! 38.40,

Davidson, P. 0., & Costello, C. G. N=1: Experimental Studies
of Single Cases. New York: Van Nostrand Reinhold.
1967.

83

Dibner, A. S. "Ambiguity and Anxiety," Journal of Abnormal and
Social Psychology, 1950. g. 165-173.

Dickoff, H., & Lakin, M. "Patients's Views of Group Psychotherapy:
RetrosPections and Interpretations," International
Journal of Groungsyghotherapy, 1963, 1}, 61-73.

 

Distler, L. S., et a1. "Anxiety and Ego Strength as Predictors
of Response to Treatment in Schizophrenic Patients,"
Journal of Consulting Psychology, 1964, gs, 170-177.

Dittman, A. T. "Psychotherapeutic Processes," Annual Review of
Psychology, 1966, l , 51-78.

 

Dollard, J., & Miller, N. E. Personality and Psychotherapy.
New York: McGraw-Hill, 1950.

 

Edwards, A. L., J: Cronbach, L. J. "Experimental Design for
Research in Psychotherapy," Journal of Clinical
Paighotheram. 1952. §. 51-59.

Ellis, A. Reason and Emotion in Psychotherapy. New York:
Lyle Stuart, 1962.

 

Eysenck, H. J. Behavior Therapy and the Neuroses. New York:
Pergamon Press, 1960.

 

Eysenck, H. J. "The Effects of Psychotherapy," In H. J. Eysenck (ed).
Handbook of Abnormal Psychology. New York: Basic Books, 1961,

397-725.

Eysenck, H. J. "The Effects of Psychotherapy," International
Journal of Psychiatry, 1965:.l: 99-144.

Eysenck, H. J. "The Effects of Psychotherapy and Evaluation," Journal
of Consulting Psychology. 1952. lo, 319-32u.

Feifel, H., & Eellis, J. "Patients and Therapists Assess the Same
Psychotherapy," Joumnal of Consulting Psychology. 1963,

_2_z. 310-318.

Festinger, L. A Theory of Cognitive Dissonance. Evanston, Illinois:
Row, Peterson, Inc., 1957.

 

Fischer, E. H., & Turner, J. L. "Orientations To Seeking Professional
Help: DeveIOpment and Research Utility of an Attitude
Scale," Journal of Consulting and Clinical Psychology,

1970. ii. 79-90.

Frank, J. D. "Does Psychotherapy Work?." International Journal
of Psychiatgy, 1967, 3. 153-156.

 

Frank, J. D. Persuasion and Healing. Baltimore: The John Hopkins
Press, 1961.

 

Frank, J. D. Problems of Control in PsychotheraPY. Washington:
American Psychological Association, 1959, 10-26.

Frank, J. D. "The Dynamics of the Psychotherapeutic Relationship,"
Psychiatry, 1959. gs, 17-29.

Frank, J. D., et a1. "Patients' Expectancies and Relearning as a
Factor Determining Improvement in Psychotherapy,"
American Journal of Psychiatry, 1959, 115, 961.

Frank, J. L., et a1. "Why Patients Leave Psychotherapy,"
Archives Neurology and Psychiapgy, 1959. 22. 283.

Friedman, H. J. "Patient Expectancy and Symptom Reduction,"
Archives of General Psychiatry, 1963, 8, 61-67.

Garfield, S. L., & Affleck, D. C. "Therapists' Judgements Concerning
Patients Considered for Psychotherapy," Journal of Consulting
Psychology. 1961. g2. 505-509.

Gendlin, E. T. "Focusing Ability in Psychotherapy, Personality and
Creativity," In J. M. Shlien (ed.). Research in Psychotherapy.
Washington D. C.: American Psychological Assoc.. 1968, 217-2hl.

Gendlin, E. T. "The Social Significance of Research," In C. R. Rogers,
E. T. Gendlin, D. J. Kiesler and C. B. Truax (ed.). 222
Therapeutic Relationship and Its Impact. Madison: University
of Wisconsin Press, 1967, 523-5#2.

Gilbert, W. "Counseling: Therapy and Diagnosis," Annual Review of
Psychology, 1952,'2, 351-380.

Class, C. V., & Stanley, J. C. Statistical Methods in Education and
Psychology. Englewood Cliffs, N. J.: Prentice-Hall. Inc.,
1970.

Goldstein, A. P. "Domains and Dilemmas," International Journal of
Psychiatry, Vol. 7. No. 3. 1969.

 

 

 

Goldstein, A. P. "Participant Expectancies in Psychotherapy,"
Psychiatpy, 1962. g5. 72-79.

Goldstein, A. P. Patient's Expectancies and Non-Specific Therapy as a
Basis for (un)spontaneous Remission," Journal of Clinical
Psychology, 1960. lé. 399-403-

 

85

Goldstein, A. P. "Therapist and Client Expectation of Personality
Change in Psychotherapy," Journal of Counseling Psychology,
Vol. 7, No. 3, 1960.

Goldstein, A. P. Theraplst-Patient Expectancies in Psychotherapy.
New York: Pergamon Press, 1962.

Goldstein, A. P., & Shipman, W. "Patient Expectancies, Symptom
Reduction and Aspects of The Initial Psychotherapeutic
Interview," Journal of Clinical Psyghology, 1961, 1 ,

129-1330

Goldstein, A. P., et al. Psychotherapy and the Psychology of Behavior
Change. New York: John Wiley and Sons, 1966.

Gottschalk, L. A., et a1. Methods of Research in Psychotherspy.
New York: Appleton-Centruy Crofts, 1966.

 

Grosz, R. D. "Effect of Client Expectations on the Counseling
Relationship," Personnel and Guidance Journal, 1968, fig,
797-8000

Gruen, W. "Some Current Issues in Group Psychotherapy Research
Discussion." International Journal of Groungsychotherapy,
V01. 23, N00 3: summer 19730

Guilford, G. P. Psychometric Methods. New York: McGraw-Hill. 1954.

Gundlach, R. H. "Overview of Outcome Studies in Group Psychotherapy,"
International Journal of Group Psychotherapy, 1967, ll,
1964210.

Heine, R. W., & Trosman, H. ”Intial Expectations of the Doctor-
Patient Interaction as a Factor in Continuance in
Psychotherapy," A.M.A. Archives Neurology and Psychiatry,
1960. g}. 279.

Heller, R., & Goldstein, A. P. "Client Dependency and Therapist
Expectancy as Relationship Maintaining Variables in
Psychotherapy," Journal of Consulting Psychology) 1961..g§,
371-3750

Hoehn-Saric, R., et a1. "Systematic Preparation of Patients for
Psychotherapy--I. Effects on Therapy Behavior and Outcome,"
Journal of Psychiatric Research, 196“, g. 267-281.

Hosskisson, J. B. Loneliness. New York: The Citadel Press, 1965.

 

Hunt, W. A. The Clinical Psyphologist. Springfield, Illinois:
Charles C. Thomas, 1956.

 

86

Hyman, R., & Berger, L. "Discussion of H. J. Eysenck's ‘The
Effects of Psychotherapy," International Journal of
Psychiatry, 1965, l, 317-322.

 

Imber, 3. D.. & Nash, E. A. "Social Class and Duration of Psychotherapy,"
Journal of Clinical Psychology, 1955, ll, 1955,

 

Johnson, D. T. "Effects of Interview Stress on Measures of State
and Trait Anxeity," Journal of Abnormal Psychology. 1968,

21: 245’251 0

Kamin, I., & Coughlan, J. "Subjective Experiences of Outpatient
Psychotherapy: A Follow-up Study," American Journal of
Psychotherapy, 1963, l2, 660.

 

 

Kanfer, F. H., & Marston, A. R. "Conditioning of Self-Reinforcement
Responses: An Analogue to Self-Confidence Training,"
Psychological Reports, 1963, l}, 63-70.

 

Kiesler, D. J. "Some Myths of Psychotherapy Research and the Search
for a Paradign," Psyshological Bulletin, 1966, 6 , 110~136.

Krause, M. S. "Clarification at Intake and Motivation for Treatment,"
Journal of Counseling Psychology, 1968, ii, 576-577.

Krause, M. S. "Client's Expectations of the Value of Treatment,"
Mental Hygiene. 1967. 21. 359-365.

Krause, M. S., et a1. "Focussing on the Client's Expectations of
Treatment," Psychological Reports, 1969, g3, 973-97“.

Krumboltz, J. D. "Behavioral Goals of Counseling," Journal of
Counseling Psychology, 1966, l}, 153-159.

Lakin, M., & Lebovits, B. "Bias in Psychotherapists of Different
Orientations," American Journal of Psychotherapy, 1950.
la) 79'860

Lawrence, H. "Behavior Modification in Groups," In press.

Lawrence, H. Personal interview with H. Lawrence. May, 1974.

Lawrence, H. Personal interview with H. Lawrence. October, 1973.

Lawrence. H., & Sundel, M. "Behavior Modification in Adult
Groups," Social Work, Vol. 17, No. 2. March 1972.

 

Lennard, H. L., & Berstein, A. The Anatomy of Psychotherapy.
New York: Columbia University Press, 1960.

87

Levitt, E. E. "The Results of Psychotherapy with Children:
an Evaluation," Journal of Consulting Psychology, 1957,
2.1... 189’1960

Lewis, P., & McGants, J. "Some Current Issues in Group Psychotherapy
Research,” International Journal of Group Psychotherapy,
v01. 23. NO. 3. summer 1973.

Lieberman, R. "A Behavioral Approach to Group Dynamics: I. Rein-
Forcement and Prompting of Cohesiveness in Group Therapy,"
Behavior Therapy, 1970, l, lul-l75.

Lipkin, S. "Clients' Feeling and Attitudes in Relation to the Outcome
of Client-Centered Therapy," Psychological Monographs, 195C,
68. 75.

London, P. The Modes and Morals of Psychotherapy. New York: Holt,
Rinehart 8c Winston, Inc., 1931..

 

Lubin, B., B., et al. "The Group Psychotherapy Literature 1971,"
International Journal of Group Psychotherapy, 1972,‘gg, 492.

Luborsky, L. "Research Cannot Yet Influence Clinical Practice."
International Journal of Psychiatry, Vol. 7, No. 3,
March 1969.

 

Mac Lennan, B. W., & Levy, N. "The Group Psychotherapy Literature
1969," International Journal of Group Psychotherapy, Vol. 20
NO. 14'. 1970' 300.

Mac Lennan, B. W., & Levy, N. "The Group Psychotherapy Literature
1970," International Journal of Group Psychotherapy, Vol. 21.
N0. 4. 1971. 345-

Mandler, G., & Cowen, J. E. "Test Anxiety Questionnaires," Journal
of ConsultingyPsychology5 1958, 22, 228-229.

Martin, H., & Shewmaker, K. "Written Instructions in Group
Psychotherapy," Group Psychotherapy, 1962. l5. 2#.

 

Matarazzo, J. D. "Psychotherapeutic Processes," Annual Review of
Psychology, 1965, l6, 181-22fi.

McGlynn, F. D., Reynolds, E. J., & Linder, L. H. "Systematic
Desensitization with Pre-treatment and Intra-treatment
Therapeutic Instructions," Behavior Research and Therapy,

1971. 2. 57-63-

88

Miller, A. G., & Harvey, O. J. "Effects of Concreteness-
Abstractness and Anxiety on Intellectual and Motor
Performance," Journal of Consulting and Clinical Psychology,
1973 : 919,: [444-451 a

Miskimins, R. The Miskimins Self-Goal—Other Discrspancnycale. Fort
Collins, Colorado: Rmbsi Inc., 1967.

Morris, L. W., et al. "Effects of Therapeutic Modeling Film on
Cognitive and Emotional Components of Anxiety," Behavior
Therapy, 1970, l, 141-175.

Nash, E. H., et a1. "Systematic Preparation of Patients for
Psychotherapy: II. Relation to Characteristics of
Patient, Therapist and Psychotherapeutic Process,"
Journal of Nervous & Mental Disease, 1965, $29! 37C—383.

Orlinsky, D. E., & Howard, K. 1. "Communication Rapport and Patient
Progress," Psychotherapy: Theory, Research and Practice,
Vol. 5, No. 3, Sept. 1968, 131-136.

Orlinsky, D. E., at Howard, K. I. "The Good Therapy Hour: Experimental
Correlates of Patients' and Therapists' Evaluations of
Therapy Sessions," Archives of General Psychiatry, 1967, l6,
621-632.

Orne, M. T., & Wender, P. H. "The Use and Rationale of Anticipatory
Socialization as a Therapeutic Technique," American
Journal of Psychiatry, 1968, lgfl, 1202-1212.

 

Overall, B., & Aronson, A. "Expectations of Psychotherapy in Patients
of Lower Socioeconomic Class," American Journal of
Orthopsychiatry, 1963, j}, #2.

 

Parloff, M. B. "Some Factors Affecting the Quality of Therapeutic
Relationships," Journal of Abnormal Social Psychology. 1956,

fig. 5-

Patterson, C. H. "A Unitary Theory of Motivation and Its Counseling
Implications," Journal of Individual Psychology. 196C,‘29,
17-31.

Patterson, C. H. "Relationship Therapy and/or Behavior Therapy,"
Psychotherapy: Theory,,Research and Practice. Vol. 5.
No. #, December 1968.

Paul, G. L. Behavior Modification Research: Design & Tactics in
Franksy C. M. 'Behavior Therapy: Appraisal and Status.
New York: McGraw-Hill. 1969.

89

Paul, G. L. Insight vs. Desensitization in Psychotherapy. Stanford,
California: Stanford University Press, 1966.

 

Paul, G. L. "Strategy of Outcome Research in Psychotherapy,"
Journal of Consulting Psychology, 1967,‘22, 109.

 

Phillips, E. L. Psychotherapy: A Modern Theory and Practice.
Englewood Cliffs, New Jersey: Prentice-Hall, 1956.

 

Raimy, V. C. (ed.) Training in Clinical Psychology. Englewood
Cliffs, New Jersey: Prentice-Hall, 1950.

 

Rogers, C. R. "Psychotherapy Today or Where Do We Go Grom Here?,"
American Journal of Psychotherapy, 1963, l2, 5-16.

 

Rogers, C. R. "The Essence of Psychotherapy: A Client-Centered
View," Annals of Psychotherapy, 1959, l, 51.57,

 

Rogers, C. R. "The Interpersonal Relationship: The Core of Guidance."
Harvard Educational Review, 1962.‘22. 916-429.

Rosenthal, R. Experimenter Effects in Behavioral Research. New York:
Appleton-Century-Crofts, 1966.

 

Rubinstein, E. P., & Parloff, M. B. (eds.) Research in Psychotherapy
Vol. I. Washington, D. C.: American Psychological
Association. 1959.

Salter, A. Conditioned Reflex Therapy. New York: Capricorn Book, 1961.

 

Sanford, N. "Clinical Methods: Psychotherapy," Annual Review of

Schroeder, P. "Client Acceptance of ReSponsibility and Difficulty
of Therapy," Journal of Consulting Psychology, Vol. 20.
No. 6, 1960, 467-971.

 

Shlien, J. M. "Cross-Theoretical Criteria for the Evaluation of
Psychotherapy," American Journal of Psychotherapy, 1966, l,

125—134,

Shoben, E. L. "Psychotherapy as a Learning Problem," Psychological
Bulletin, 1969, 36, 366-392.

Siegal, G. S. Nonparametric Statistics for the Behavioral Sciences.
New York: McGraw-Hill, 1956.

Eflxxane, R. B.. et al. "Role Preparation and Expectation of Improvement
in Psychotherapy," The Journal of Nervous and Mental
Disease, 1970. m, 18.26.

9O

Snyder, W. U. "Professional Training for Clinical Psychologists,"
Journal of Clinical Psycholggy, 1962, lg, 243-247.

Spielberger, C. D. "Theory and Research on Anxiety," Anxiety and
Behavior, ed. C. D. Spielberger. New York: Academic
Press, 1966.

Sprinthall, N. "Selecting Clients for Counseling: Are Prior Conditions
Limiting or Illusions?," In J. M. Whiteley (Chm.).
Invitational Conference on Counseling: Reevaluation &
Refocus Conference Proceedings Series No. 2. Washington:
Washington University Press, September 1967.

 

 

Stampfl, T. G., & Levis, D. J. "The Essentials of Implosive Therapy:
A Learning Theory Based Psychodynamic Behavioral Therapy,"
Unpublished Manuscript, John Carroll University, 1967.

Stein, A. "The Nature and Significance of Interaction in Group
Psychotherapy," International Journal of Group Psychotherapy,
1970' Q, 152-158.

Stern, M. I., & Bierman, R. "Facilitative Functioning of A-B
Therapist Types," Psyshotherapy: Theory, Research and
Practice, Vol. 10, No. 1, Spring 1973.

 

Strupp, H. H. "A Multidimentional System for Analyzing Psycho-
Therapeutic Techniques," Psyghiatry, 1967, 29, 293-306.

 

Strupp, H. H. "Nature of Psychotherapists' Contribution to the
Treatment Process," Archives of General Psychiatry, 1960,

2' 219-231 0

Strupp, H. H. "Psychotherapy," Annual Review of Psychology. 1962. l}.
445—478.

 

Strupp, H. H. "Therapists' Evaluation of Two Demonstration
Interviews," Psychotherapy: Theory, Research and Practice.
V01. 5' NO. 3' Fall 1968.

Strupp, H. H., & Bergin, A. E. "Some Empirical and Conceptual Bases
For Coordinated Research in Psychotherapy: A Critical
Review of Issues, Trends, & Evidence," International
Journal of Psychiatpy, 1969, 2, 18-90.

Taylor. J. A. "The Taylor Manifest Anxiety Scale and Intellignece,"
Journal of Abnormal and Social Psychology, 1955,I5l, 347,

Thornton, D. Personal interview with D. Thornton. January 1974.

91

Tien-Teh, L. "Counseling Relationship as a Function of Counselor's
Self Confidence," Journal of CounselingyPsychology. 1973,
ED 293'2970

Truax, C. B. "Effective Ingredients in Psychotherapy: An Approach
to Unraveling the Patient-Therapist Interaction," Journal
of Counseling Psychology, 1963, l9. 256-263.

 

Truax, C. B. "The Process of Group Psychotherapy," Psyshological
Monographs, Vol. 75, No. 14, 1961.

 

Truax, C. B. "Therapist Empathy, Genuineness, and Warmth and
Patient Therapeutic Outcome," Journal of Consulting
Psychology, Vol. 30, No. 5. 1966. 395-401.

 

Truax, C. B. "Unraveling the Patient-Therapist Interaction,"
Journal of Counseling Psychotherapy, Vol. 10, No. 3,
1963, 256-263.

Truax, C. B., & Carkhuff, R. R. "Client and Therapist Transparency
in the Psychotherapeutic Encounter," Journal of Counseling
Parcholggy. 1965. L2. 3-9.

Truax, C. B., a Carkhuff, R. R. "Concreteness: A Neglected Variable
in Research in Psychotherapy," Journal of Clinical Psychology.
196“. .29, 261+“267.

Truax, C. B., et a1. "Changes in Self-Concepts During Group
Psychotherapy as a Function of Alternate Sessions and
Vicarious Therapy Pretraining in Institutionalized Mental
Patients and Juvenile Delinquents," Journal of Consulting
and Clinical Psychology. 1967, 33, 440-447.

 

Wallach, M. S., & Strupp, H. H. "Psychotherapists' Clinical
Judgements and Attitudes Towards Patients," Journal of
Consulting Psychology, 1960,I§4, 316.

White, R. W. "Motivation Reconsidered: The Concept of Competence,"
Psychological Review, 1959, éé, 297-333,

Whitehorn, J. C. "Further Studies of the Doctor as a Crucial
Variable in the Outcome of Treatment with Schizophrenic
Patients," American Journal of Psychology, 1960, llz. 215-223.

Wilkins, W. "Expectancy of Therapeutic Gain: An Empirical and
Conceptual Critique," Journal of Consulting and Clinical
Psychology, Vol. 40, No. 1, 1973, 69-77.

 

 

Wolpe, J. "Psychotherapeutic Efficacy and Objective Research,"
International Joumnal of Psychiatpy, Vol. 7, No. 3, March 1969.

92

Wolpe, J. Psychotherapy and Reciprocal Inhibition. Stanford,
California: Stanford University Press, 1958.

Wolpe, J., & Lazarua, A. P. Behavior Therapy_Techniques: A
Guide to the Treatment of Neurosis. New York: Pergamon
Press, 1966.

Wolpe, J., et al. The Conditioninngherapies. New York: Holt,
Rinehart & Winston, 1964.

 

Yalom, I. D., et a1. "Prediction of Improvements in Group Therapy,"
Archives of General Psychiatry, 1967-.lZ' 159-168.

 

Zax, M., a Klein, A. "Measurements of Personality and Behavior
Changes Following Psychotherapy," Psychological Bulletin,

1960. £2. 435-

APPEN DI CBS

APPENDIX A

UNPUBLISHED INSTRUMENTATION

APPENDIX A

UNPUBLISHED INSTRUMENTATION

THERAPIST EVALUATION OF CLIENT IMPROVEMENT

Social Functioning

 

o 16 32 48 64

Family Functioning

 

o 16 32 48 6h
Primary Relationships

 

O 16*, 32 ‘48 64

Attainment of Primary Goal

 

O 16 32 48 64’

Vocational Functioning

 

0 16’ 32 ‘48 64

Key for scoring: Please rate each client somewhere along the above
numerical scales, indicating the approximate numerical rating or
his improvement in each category.

O-l6 Very Much Worse

17-32 Worse

33-48 No Change

49-64 Improved
65-80 Very Much Improved

93

94

OOLLINS-CURRAN SCALE OF
RATIONAL ATTITUDES

1. Please try to put yourself in this situation and on the
checklisk that follows check those reactions that you feel would
be closest to your own. For example, if you feel that you would be
very likely to get out out of the situation, check "Very Likely"
under choice 1. If you feel you would be very unlikely to do so,
check, "Very Unlikely" under response 5. Please note: This
checklist is to be used only to help us evaluate the procedures

of this program, therefore, it is not necessary for you to sign
your name. Since we are, however, planning to evaluate attitude
change during the program it will be helpful if you would put your
social security number or your date of birth (day, month. year) at
the top right-hand corner.

11. You have just been told by someone close to you (husband,
wife, lover, etc.) that they feel that you've outgrown one another
and that the relationship is dead. It's not anything in particular
that you've done, it's just that they're feeling trapped in the
relationship and want to experience other things and other people.
They don't feel that there is anything to discuss and just hope
that you'll understand.

 

1. Very Likely 3. Don't Know 5. Very Unlikely
2. Likely 4. Unlikely
1 2 3 4 5 1. Try to see the humorous side of the situation.

1 2 3 4 5 2. Take some positive, concerted action on the basis
of your present understanding ofthe situation.

1 2 3 4 5 3. Not worry about it. everything will work out fine.

1 2 3 4 5 4. Talk it over with the persons in the situation
to see if you can work it out.

1 2 3 4 5 5. Try to put yourself in the other's shoes.

1 2 3 4 5 6. Become involved in other activities in order to
help keep your mind off the problem.

1 2 3 4 5 7. Draw upon your past experiences from a similar
situation.

1 2 3 4 5 8. Seek some professional help or advice.

H

2345
1 2 3 4 5

H

2345

l 2 3 4 5

1 2 3 4 5

H

2345

H

2345
1231.5

12345
12345
1 2 3 4 5

l 2 3 4 5

9.
10.

11.

12.

13.

14.

15.
16.

17.

18.

19.

20.

95

Get out of the situation.

Get your feelings out by talking to someone.
Make several alternative plans for handling
the situation; after all, you never know what

might work.

Try to get some perspective by talking it over
with a friend.

Re-examine you own thoughts and feelings-- the
problem may be with you.

Express your feelings to some "out front"
person, to get their reaction.

Try some experimenting.

Try to reduce your tension by smoking, drinking,
etc.

Act spontaneously-- do the first thing you think of.
Be prepared to expect the worst.

Read some books dealing with what may be the worst
possibility.

Confront the person with your feelings.

96

EVALUATION BY GROUP MEMBER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(1) Problem Objective

Very Much Worse Slightly No Slightly Very Much
_lorser Worse _Qhangg_ Better Better Better H

‘12) Problem Objective

Very Much Slightly No Slightly 8 *Very Muéh
Horse Worse Worse Change Better Betterl Better

13) Problem Objective

Very Much Slightly No Slightly

,M MEL—MLJM use.

 

 

 

 

 

 

 

  

 

97

LAWRENCE SCALES PART I
Mrs Jones and Jimmy
Part I:

Mrs. Jones is married and is a mother of one child. She is
a friend of yours and she has asked you to help her with a problem
she has with her two year old son, Jimmy. She complains that
Jimmy‘s behavior is becoming intolerable, and she is beginning to
question her own ability as a mother.

Instructions: Listed below are several questions that you might
want answers to in order to help Mrs. Jones decide what would be

the best thing to do about the problems. Please rank these questions
according to how important you think the answers might be in
deciding what to do about the situation. That is, what do you think
the most important question is, the second most important question.
and so on. Please place a "1" beside the most important, a "2"
beside the second most important, and so on.

 

Questions:
How much time does the mother spend away from Jimmy?

Exactly what does Jimmy do to cause his mother to
call his behavior intolerable?

What attitudes do the father and mother have about
child rearing?

What kind of problems are there between the mother
and her husband?

When, where, and how often does Jimmy behave badly?

How was the mother raised as a child?

If you think there are any other questions that would be important
to ask please write them below.

98

LAWRENCE SCALES PART II
Mrs. Jones and Jimmy
Part II:

Mrs. Jones is a housewife. She seldom gets out of the
house these days because her son, Jimmy requires a lost of attention
and Mrs. Jones is unwilling to leave him with a babysitter. Before
Jimmy's grandmother died six months ago, she used to leave Jimmy with
his grandmother occasionally. Mr. Jones works during the day,'but he
is usually at home in the evening. Mr. Jones considers disciplining
Jimmy something that Mrs. Jones is responsible for. Mr. Jones
frequently complains, and yells at Mrs. Jones about Jimmy's behavior
and the noise he makes around the house. An example of what Mr. Jones
might say in an angry tone of voice is, "Why can't you keep that kid
quiet?"

An example of Jimmy's behavior is that he will come into the
kitchen, point to the refrigerator and ask for ice cream or pop. Mrs.
Jones says, "No," and Jimmy lies down on the floor and kicks and screams.
Then Mrs. Jones either gives Jimmy the ice cream or pop, comforts and
distracts him. or spanks him. Jimmy does this three to four times
every day.

Instructions: Please answer the following question by checking the gng
statement that you think best answers the question. Check only one of
the statements for each_question.

 

Question 1 Jimmy's kicking and screaming behavior is probably
caused by:

 

A. The inconsistency with which the mother
behaves toward him.

 

B. The loss of his grandmother.

 

C. The lack of attention he gets from his father.

D. The attention he gets from his mother right
after he kicks and screams.

Question 2 The mother behaves toward Jimmy's kicking and screaming in
the way she does because:

 

A. She is confused about the feelings she has toward
Jimmy.

 

B. Jimmy stops screaming and kicking.

 

C. Her personal insecurity makes her behave inconsis-
tently.

Questiong3

 

D.

99

She is sometimes angry, and sometimes
sympathetic toward Jimmy.

The best thing for Mrs. Jones to do in order for Jimmy
not to kick and scream whenever she refuses his demands

is to:

A.

B.

 

Spank Jimmy each time he does this and explain
to him that children should not behave this way.

To pay absolutely no attention to Jimmy when he
is kicking and screaming.

To set up a schedule where Jimmy can have treats
only at certain times of the day, and explain this
to him every time he asks for treats.

Never to give Jimmy the ice cream or pop after
saying, "No" and to hold him whenever he kicks
and screams to show him he is loved.

Another example of Jimmy's behavior is that he will scream

and yell after being put to bed at night. If left alone he will kick
the wall, throw his toys and cry. On these occasions, Mrs. Jones
usually stays with Jimmy until he falls to sleep. This has been
occurring almost every night for three months now.

Instructions:

 

Question 4

 

Questiong5

Please check the one statement that best answers the
following questions:

Jimmy probably has these tantrums almost every night

because:

 

 

He likes the attention he gets when his mother
stays with him.

He doesn't get enough attention from his father.

He is afraid of being alone, which is normal
for two year olds.

He is insecure about how much his father and
mother love him.

The most likely explanation for Mrs. Jones' behavior of
staying with Jimmy until he falls asleep is:

A.

 

She is worried that he will not be healthy if
he doesn't get enough sleep.

 

C.

D.

100

Mr. Jones gets angry at her when Jimmy is
yelling and screaming.

She is worried about the psychological damage
that may occur if he cries himself to sleep.

She really enjoys this quiet time with Jimmy.

Question 6 The best thing for Mrs. Jones to do in order for Jimmy
to learn to go to sleep without throwing tantrums is to:

 

A.

 

 

Convince Mr. Jones that he should discipline
Jimmy at night.

Sit with Jimmy while he is falling to sleep until
he grows out of this "stage".

Go into Jimmy's bedroom each time he throws a
tantrum, tell him she loves him but wants

him to be quiet and go to sleep now, and then
leave the room immediately.

Pay no attention to Jimmy's screaming and
yelling after he is tucked into bed.

101

LAWRENCE SCALES PART III

Mr. and Mrs. Smith

Mr. and Mrs. Smith have been married for five years and have
no children. They both say that their marriage is "on the rocks,"
and they complain that they are constantly arguing with each other.
They both say that they care for each other, and would like to
"make their marriage work."

Instructions: Listed below are several questions that might be
asked about the Smith's problem in order to find out what would be
the best thing to do about their situation. Please rank these
questions according to how important you think the answers might

be in deciding what to do about the situation. That is, what do

you think the most important question is, the second most important
question, and so on. Please place a "1" beside the most important
question, a "2" beside the second most important question, and so on.

 

Questions:
How compatible are their attitudes toward marriage?

What do they argue about, and what are some examples
of their arguments?

What kind of family life did each of them have as
children?

When, where, and how often do they argue?
Do they have a satisfying sexual relationship?

What happens just before and right after their
arguing?

Why haven't they had any children?

If you think there are any other questions that would be
important to ask, please write them below.

APPENDIX B

(XDRRELATIONAL DATA

APPENDIX B

CORRELATIONAL DATA

Table B-1

Correlational Data for Intergroup
Pre-Test Measures

 

 

 

 

 

 

Instrument Comparison Correlation
Groups
Taylor A and B 0.5933*
Fischer-Turner A and B 0.8498**
Miskimins Part 1 A and B o.6255*
Miskimins Part 2 A and B 0.7933”

 

* (.05
** (.01

102

 

103

Table B-2

Correlational Iata for Intergroup
Post-Test Measures

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Instrument Comparison Groups Correlations
Groups Receiving
VTP/RII
Taylor A and B A-yes: B-no -O.4676
Fischer-Turner A and B A-yes: B-no 0.0556
Miskimins Part 1 A and B A-yes: B-no -0.2075
Miskimins Part 2 A and B A-yes: B-no -O.10l9
Taylor A and C A-yes: C-yes 0.7270**
Fischer-Turner A and C A-yes: C-yes O.6274*
Miskimins Part 1 A and C A-yes: C-yes 0.8022** .
Miskimins Part 2 A and C A-yes: C-yes 0.7803** 2
Taylor B and C B-no: C-yes -0.6112* .
Fischer-Turner B and C B-no: C-yes -O.439l E
Miskimins Part 1 B and C B-no: C-yes -0.2765
Miskimins Part 2 B and C B-no: C-yes -0.1056
* <:.05

**"(.01

104

Table B-3

Correlational Data for Pre-
and Post-Test Measures
Within Groups

 

 

 

 

 

 

 

 

 

 

Instrument Group Correlation
Taylor A (VTP/RII) 0.1689
Fischer-Turner A (VTP/RII) 0.2623
_7 Miskimins Part 1 A (VTP/R11) 0.2030
Miskimins Part 2 A (VTP/R11) 0.0452
Taylor B 0.4078
Fischer-Turner B 0.6297*
Miskimins Part 1 B 0.7019**
Miskimins Part 2 B 0.3081

 

** (.05
** (.01

105

Table B-4

Correlational Data for Instruments
Within Groups

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Comparison Group Correlation

Measures
Taylor I/Fischer-Turner I A 0.7874**
Taylor I/Miskimins Pt. 1 A 0.5254*
Taylor I/Miskimins I Pt. 2 A 0.4012
Fischer-Turner I/Miskimins I Pt. 1 A 0.7448**
Fischer-Turner I/Miskimins I Pt. 2 A 0.8400**
Taylor I/Fischer-Turner I B 0.3003
Taylor I/Miskimins I Pt. 1 B 0.6029*
Taylor I/Miskimins I Pt. 2 B 0.5128*
‘Fischer-Turner I/Miskimins I Pt. 1 B 0.6257*
Fischer-Turner I/Miskimins I Pt. 2 B 0.3940
Taylor II/Fischer-Turner II A 0.3490
Taylor II/Miskimins II Pt. 1 A 0.6829**
Taylor II/Miskimins II Pt. 2 A 0.4409
Fischer-Turner II/Miskimins II Pt. 1 A 0.5241*
Fischer-Turner II/Miskimins II Pt. 2 A 0.5119*
Taylor II/Fischer-Turner II B 0.7194**
Taylor II/Miskimins II Pt. 1 B 0.7133**
Taylor II/Miskimins II Pt. 2 B 0.5178*
Fischer-Turner II/Miskimins II Pt. 1 B 0.6300*
Fischer-Turner II/Miskimins II Pt. 2 B 0.5049*

 

106

Table B-4 Continued

 

 

 

 

 

 

 

Comparison

Measures Group Correlation
Taylor II/Fischer-Turner II 0 0.4815
Taylor II/Miskimins II Pt. 1 0 0.5290*
Taylor II/Miskimins II Pt. 2 0 0.6482*
Fischer-Turner II/Miskimins II Pt. 1 0 0.5071*
Fischer-Turner II/Miskimins II Pt. 2 0 0.4091

 

107

Table B-5

Correlational Data for Outcome
Instruments Within Groups

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Comparison Group Correlation

Instruments
Collins-Curran/Lawrence 1 A 0.346?
Collins-Curran/Lawrence 2 A 0,5234%
Collins-Curran/Lawrence 3 A 0.7126**
Lawrence l/Lawrence 2 A 0.3273
Lawrence 1/Lawrence 3 A 0.8728**
Lawrence Z/Lawrence 3 A 0.6428*
Collins-Curran/Lawrence l B 1.0000**
Collins—Curran/Lawrence 2 B 1.0000H
Collins-Curran/Lawrence 3 B 1.0000“
Collins-Curran/Lawrence 1 0 0.3279
Collins-Curran/Lawrence 2 C 0.544l*
‘Collins-Curran/Lawrence 3 C 0.3279
Lawrence l/Lawrence 2 0 0.9075**
Lawrence l/Lawrence 3 C l.0000**
Lawrence Z/Lawrence 3 C 0.9705**

 

* 4:.05
** < .01

APPENDIX C

MEAN SCORES: REPORTED BY GROUP

APPENDIX C

MEAN SmRES: REPORTED BY GROUP

Table C-l

Pre- & Post-Test Scores

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Pro-Test Post-Test Group Mean
Fischer-Turner A 52.40
Fischer-Turner B 53.10

Fischer-Turner A 59.70
Fischer-Turner B 48.40
Fischer-Turner C 55.00

Taylor A 31.107
Taylor B 30.10
Taylor A 23.40
Taylor B 34.10
Taylor C 22.60

Miskimins Pt. 1 A 41.70;;
Miskimins Pt. 1 B 46.60
Miskimins Pt. 1 A 54.70
» Miskimins Pt. 1 B 35.60
L . Miskimins Pt. 1 c 49.60

108

109

Table C-l Continued

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Pre-Test Post-Test Group Mean
‘Miskimins Pt. 2 A 41.10;—
Miskimins Pt. 2 B 42.10

Miskimins Pt. 2 A 48.00

Miskimins Pt. 2 B 33.30

Miskimins Pt. 2 c 47.20

Table C-2
Outcome Scores
Outcome Measures Group Mean

Lawrence Pt. 1 A 2.40
Lawrence Pt. 1 B 2.00
Lawrence Pt. 1 C 2.75 _
Lawrence Pt. 2 A 2.20
Lawrence Pt. 2 B 1.50
Lawrence Pt. 2 C 2.25
Lawrence Pt. 3 A 2.40
Lawrence Pt. 3 B 3.00
Lawrence Pt. 3 C 1.75
Collins-Curran A 45.40
‘Collins-Curran B 61.50
Collins-Curran C

46.75

 

110

Table C-2 Continued

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Outcome Measure Group Mean
Therapist evaluation of Social Functioning A 68.00
Therapist evaluation of Social Functioning B 49.00
Therapist evaluation of Social Functioning C 67.25
Therapist evaluation of Family Functioning A 72.80
Therapist evaluation of Family Functioning B 32.0071
Therapist evaluation of Family Functioning C 71.50 A
Therapist evaluation of Primary Relationships A 65.40
Therapist evaluation of Primary Relationships B 42.50
Therapist evaluation of Primary Relationships C 56.25
Therapist evaluation of Primary Goal Attainment A 66.66
Therapist evaluation of Primary Goal Attainment B 29.50
Therapist evaluation of Primary Goal Attainment C 61.95
‘Therapist evaluation of Vocational Functioning A 74.80
Therapist evaluation of Vocational Functioning B 23.00
Therapist evaluation of Vocational Functioning C 69.25
Client evaluation of Primary Goal Attainment A 67.00
Client evaluation of Primary Goal Attainment B 45.75
Client evaluation of Primary Goal Attainment C 64.75
Client evaluation of Secondary Goal Attainment A 62.75
Client evaluation of Secondary Goal Attainment B 47.25
Client evaluation of Secondary Goal Attainment C 58.50

 

111

Table C-2 Continued

 

 

 

 

 

 

 

Outcome Measures Group Mean

Client evaluation of Tertiary Goal Attainment A 57.25

Client evaluation of Tertiary Goal Attainment B 48.50
Client evaluation of Tertiary Goal Attainment C 67.50‘*

Client evaluation of Interpersonal Relationships A 8.25

Client evaluation of Interpersonal Relationships B 5.00

evaluation of Interpersonal Relationships C 10.00

Client

 

APPENDIX D

VTP/RII PROCEDURES

APPENDIX D

VTP/RII PROCEDURES

VTP ROLES

Harold (Ed Brown) Father having trouble with a 16 year old
girl. Specifically he finds himself yelling at the girl. and the
girl (Jill) just runs up to her room and locks the door. These
confrontations usually take place over whether the daughter will do
household chores. Treatment goal--daughter will do household chores
and perform reasonable requests made by Harold without his recourse
to shouting.

Sheila (Betty Larsen) Presenting problems. Usually complies
to unreasonable request of her employers without resistance. This leads
to overwork, fatigue, insomnia and somatic complaints. Tentative
treatment goal--to refuse to comply to unreasonable requests of employers
through performance of appropriate assertive behavior.

Ted (Jim Nevels) Presenting Problems. Son frequently
violates parental rules. Client responds by interrogating the son
as to his motives and makes demeaning comments. Tentative treatment
goal--son will obey parental rules without recourse by client to
interrogation and demeaning remarks.

Barbara (Michele Nevels) Presenting Problems. Employers are

112

113

unduly critical of her work and often make requests of her in a
sarcastic manner. Client responds by complying with the requests,
but in a non-productive fashion leading to further complaints by
her employers. Tentative treatment goal--to reduce the frequency of
criticism and sarcasm by her employers concerning her work.

Janice (Jeanine Mitchell) Presenting problems. Son frequently
hits and threatens younger siblings, and when asked to perform chores,
he delays in compliance and makes annoying comments to the client.
Tentative treatment goals--the frequency of hitting and threatening
siblings will be significantly reduced, and son will perform chores

at the time he is asked, without making abusive comments.
VTP SCRIPT OUTLINE

Tape Opens with Jim (therapist) summarizing the teaching
component on making requests. Summarizes three main points, 1. specify
the behavior you are requesting, what, when, where, and how: 2. state the
reason for the request; 3. sometimes, offer an exchange. Jim asks if there
are any questions, or if anyone can give an example of how it might
be useful. The group responds by giving some appropriate examples of
how they might utilize these suggestions in the future.

Jim--"it seems that we understand making requests quite
well. Would everyone hand in their assignments from last week . . ."

The group members respond and Jim chooses Harold to report
first on how he and his daughter are progressing in their relationship.

Harold reports that his daughter didn't do the dishes as she was

114

supposed to, four times last week and that he wound up yelling at her.
On three other occasions, however, she did do the dishes and he didn't
find it necessary to get angry with her. Jim questions Harold about

a specific example of one of the times that she didn't do the dishes
and one of the times that she did.

Harold reports on the various situations, but at this point
he has not made any connection between how he responds and what happens
immediately afterward or the next time that Jill is supposed to
do the dishes. He doesn't feel that he should have to "pat her on
the head" everytime she does something right.

Further questioning brings out the fact that each time she
did the dishes and Harold did not reinforce her, that the next evening
she conveniently forgot to do the dishes and Harold wound up yelling at
her. At this point Harold realizes that if he were to reinforce her
for doing the dishes, that she might comply with his wishes more
willingly and more frequently.

He also wonders if he might be able to use the new information
on making requests to further improve his relationship with his
daughter. Jim asks him to try to formulate a request to his daughter
and he responds with: "Jill, I would like you to do the dishes now,

I want to get some things from the hardware store and you may use the
car when I get back, if the dishes are done." This strikes one of the
group members as a bribe and she asks Jim and Harold if there might
be a better way of approaching this situation. Jim explains that,

in this situation, Harold is offering a negotiation and not a bribe, but

115

it may well be that there would be a more appropriate response and
asks her if she might have a suggestion for Harold. . .

After some more interchange the therapist and the group
provide feedback on Harold's request and begin to help him to
formulate the behavioral assignment for the next week. He will
continue to keep a record of the conflictful situations that arise
between himself and Jill and will place special emphasis on what
happens just before and after each situation. He will also try to
provide more positive reinforcement for Jill's helping around the
house and to make certain that he makes requests rather than making
demands.

Jim then moves to the next client, who will repeat essen-
tially the same process with his problem, but more likely time will

have elapsed and the VTP will be ended.

116

OUTLINE FOR ROLE INDUCTION INTERVIEW

Outline for the role induction interview that follows
the presentation of the pre-training video-tape.

I. Answer any client questions about the tape.

II. A general exposition of behavior-modification groups.

a.

b.

Ce

9.

f.

Stressing the role of behavior in causing feelings
and reactions.

Citing support for the thesis that helping a person
to change his behavior will help the person change
many facets of his life.

Re-stressing the importance of regular attendance

and carrying out behavioral assignments and report-
ing as self-reinforcement as well as contributing

to the group.

Preparation for resistance to change and suggestion that
a person makes an active choice to resist change and
that he doesn't have to resist.

Psychotherapy as a learning process and this
particular group technique as one of the most
effective.

The importance of vicarious learning and contributing
to the solution of others' problems, especially as

it relates to helping the individual get a handle

on changing his own behavior.

III. The induction of a realistic expectation for improvement within

six sessions.

APPENDIX E

GROUP PROCEDURES AND GROUP PROCESS

APPENDIX E

GROUP PROCEDURES AND GROUP PROCESS

Group Procedures

 

I. General Procedure:

The general procedure entails, in step-wise fashion,
the selection of a problem, problem specification, assessment of
controlling conditions, the assessment of resources and conditions
for modification, planning and implementation of modification, and
maintenance. In addition, a follow-up procedure is being planned
which will not involve the group leaders. For the most part, it
will be expected that clients will be at various stages in the
procedure. This is appropriate in that clients pose varying degrees
of difficulty in moving through the steps. It is important that
modification not be implemented prematurely, that is, without a
completed assessment of the target behavior. It is conceivable
that, for some clients, it may not be possible to implement modifi-
cation at all or until the very end of the group sessions. In
such cases we will want to investigate the relevant factors with respect
to the group model. rather than ignoring such situations by implementing
ad hoc modification. Hopefully, such occasions where modification is

late or does not occur will be rare.

117

118

In addition to the general sequential procedural steps
there are several sub-steps that may also occur sequentially. I am
referring to Specification, assessment, and modification probes.
Specification probes are activities designed to explore possible
reference of the stated problem as opposed to activities designed
to collect information on certain referants as when specification
has been completed. Assessment and modification probes are the same
sort of activities: namely, those employed prior to completed assess-
ment or planned modification for purposes of scanning possibilities
or testing hypotheses. The notion of probes is an interesting one
in behavior modification and we hope to obtain feedback from the

group leaders on their use of probes.

II. Mini-Lectures and Demonstrations:

The group model calls for training clients in certain
aspects of behavior management. This is to be accomplished through
the use of mini-lectures, demonstrations, illustrations, and feedback
throughout the group sessions. Illustrations refer to procedures
involving the utilization of client situations as examples of
behavior principles and feedback refers to the process of interpretation
and clarification of these principles as illustrated by client
situations. Illustrations and feedback involve both client and
therapist participation.

The mini-lectures and demonstration activities are planned
and implemented by the group leaders. Listed below are those

mini-lectures and demonstrations that are to be implemented during

119

the 6 sessions. Also indicated are the appropriate sessions for each.

1. Behavior and behavior specification: first session.

2. Antecedents and consequences: second session.

3. Positive reinforcement, punishment and avoidance
behavior: third session.

4. Ways to increase desired behavior while decreasing
undesired behavior (extinction and differantial
reinforcement): fourth session.

The objective is to utilize lecturing and demonstrations so
that clients can learn these basic ways to observe and manage behavior.
The mini-lectures and demonstrations should be short, simple and
to the point. I recommend that you use behavior modification
jargon sparingly, denoting these principles rather than providing
terms for them.

There are several ways of planning a mini-lecture and
demonstration. These are indicated as follows: Lecture then
demonstration: demonstration then lecture: demonstration, lecture
and demonstration: etc. The task of planning mini-lectures and
demonstrations is the responsibility of the group leaders with
consultation being available as desired. The point is to get these
notions across as effectively and as efficiently as possible. The

use of illustrations and feedback is to follow up on these mini-

1ectures and demonstrations as applicable to client situations.

III. Constituent Techniques:
Constituent to the procedure are various techniques to be
employed or initiated by the group leaders, for the purpose of

obtaining information about behavior or for modifying behavior. Some

120

of these techniques are given below:

1.

2.

3.

5.

Behavior re-enactment: A technique to obtain response

 

display of a target behavior for assessment or modifi-
cation (via feedback). This technique involves verbal
interchanges exemplifying a previous behavioral situation
or one similar to a previous situation and may employ
either client-client or client-therapist dyads.
Behavioral skits: A Technique to demonstrate behavioral

 

events for illustrating behavioral principles, appropriate
vs inappropriate behaviors. or appropriate behaviors

(such as in modeling).

Behavior rehearsal: A technique involving instructions

 

to the client to exhibit in the presence of the group

a desired behavior. The purpose of rehearsing a behavior
may be to bring that behavior under discriminative
control. to shape the form of the behavior. to strengthen
an infrequent behavior or all of these.

Corrective feedback and instructions: A technique
combining a discrimination training procedure, using
verbal contrast or designations of one or more behaviors,
and behavior prescriptions. Corrective feedback may
occur alone, (the group may be used in providing
corrective feedback alone) and instructions may be

aimed at in-session responding or extra-session
responding or both.

Instigation: Prescribing certain behaviors the client

 

is to exhibit in his natural environment.

121

Group Process

 

Each of the six group sessions began in the same way, that is,
the group leader presented a mini-lecture on the Specific area of
behavior modification to be considered. The content of these mini-
lectures was ordered in such a way as to build on the content of
the previous session. In addition the group leader designed each
mini-lecture so that it was as closely related to the problems presented
by the group members as possible. A weekly treatment plan was
formulated for each group member, building upon the progress that
had been observed in the previous session and incorporating the
content of the present mini-lecture. The mini-lectures covered a step-
by-step progression, beginning with problem specification, which was
followed by sessions on reinforcement, extinction, trying out new behavior.
the antecedant-behavior-consequence theory of behavior modification
and concluded by the session on making requests.

Following the mini-lecture, which usually lasted about thirty
minutes, participants were encouraged to ask questions or to seek
clarification. Special emphasis was placed on clarifying the
relationship of the mini-lectures content to the target behavior each
of the members was attempting to modify.

After sufficient clarification had been achieved, the therapist
shifted the group focus to the weekly 'work' sessions, in which each
client volunteered to work on clarifying the events of the previous
week and how he might more profitably employ the concepts of behavior
modification. During these work sessions the therapist and.group

members attempted to help the client to further understand the nature

122

of the problematic behavior as well as factors that might be
contributing to its maintainance or blocking its modification.
This process within the group was stressed as a microcosmic
representation of social interactions and group members were encouraged
to use what they had learned in attempting to help the other members
specify their problem behavior and more fully understand the environ-
ment in which it is observed. Each member, in turn, had an opportunity
to work each week and the importance of taking full advantage of
this opportunity was stressed. Again, the review of the tape recordings
disclosed that groups who had been exposed to VTP/RII were far less
hesitant to volunteer to"work'$ a fact seemingly accounted for
by their high levels of motivation toohange and expectation, as well
as their lower anxiety level. In all groups, however, after the
third session it was not necessary for the therapist to coerce
members into taking their turn at working as they began to see the
effectiveness of the process and to become accustomed to giving and
accepting feedback on what were frequently perceived as very personal
problems.

In addition to facilitating learning, the"work sessions"
also appeared to greatly enhance the development of cohesiveness in
the group. By structuring the interactional process, while at the
same time sanctioning more direct and meaningful communication, the
'work.sessions"served as an excellent opportunity for behavioral
rehersal or trying out new behaviors and for facilitating the

feeling of 'groupness' or cohesion at the same time.

123

Subjectively, this technique of group behavior modification
seems to be relatively free of the "techniques-ness" that seems to
characterize many behavioral groups and in fact seems freer of this
malady than many techniques loosely grouped into the sensitivity, growth
or Gestalt categories. Group members interacted freely and for the
most part observed that the structure of the group, far from detracting
from the closeness of the group contributed to its development by
making risks easier to take. Members also observed that by interacting
with other clients along with the therapist they did not feel the
sort of therapist/client division that they had expected and yet,
at the same time, they didn't feel that the group process was left
entirely up to them, with the therapist riding along as a sort of
"fifth wheel". In summation then, client's responses to the group
procedure were generally positive, they liked the structure and
cognitive content of the group but also responded favorably to the
flexibility which allowed, and in fact facilitated the development
of closeness and cohesion. Participants also responded positively
to the VTP/RII procedure, which they felt, contributed greatly to
reducing their fears and correcting the myths they may have held
about groups. In general it was a positive experience for the clients,

a fact which is reflected in the results of Chapter 4.