THE EFFECT OF THERAPIST-PATIENT CONFLICT SIMILARITY UPON. THERAPISTS‘ PROGNOSTIC EVALUATIONS AND OTHER CLINICAL JUDGMENTS OF THEIR PATIENTS Thesis for the Degree of Ph. D. MICHIGAN STATE UNIVERSITY PHILLIP I. SNETT 1972 I...» z LIBRARY Michigan State 0‘ 221‘ I UmvetSity This is to certify that the thesis entitled THE EFFECT OF THERAPIST—PATIENT CONFLICT SIMILARITY UPON THERAPISTS' PRCGNOSTIC EVALUATIONS AND OTHER CLINICAL ‘JUEGEENTS OF THEIR PATIENTS presented by Phillip I. Snett has been accepted towards fulfillment of the requirements for _Ph._D_.._degree in My Mario: professor Date /’r/39/’é_ /’ 0-7639 HOAG & 800K BINDERY INC. ,. LIBRARY BINDERS grungy]. mama; sh “cw The purpose c Ii'gIIen Ice of there :21? ' . .IeT s prognost .“M . p ‘ UN)“ “gated were tht' Ts liking of his Pt! 11:; :Ierapy with h: ratings given to Pts -':': conflict simila‘ ES 2‘ ~ ’ Mlined I It Was hvoot] - I u .0 ..' EIOgnosis r Jimenss ~ would b ‘3; H, sue t 3 ar e pe .‘L J “‘9 decl‘ee t 4 0 w :59 hlc ABSTRACT THE EFFECT OF THERAPIST-PATIENT CONFLICT SIMILARITY UPON THERAPISTS' PROGNOSTIC EVALUATIONS AND OTHER CLINICAL JUDGMENTS OF THEIR PATIENTS BY Phillip I. Snett The purpose of this study was to examine the effect cn'influence of therapist-patient (T—Pt) conflict similarity umxlthe T's prognostic evaluations of his Pts. Also :hwestigated were the effects of perceived Pt motivation, INS liking of his Pts, and the degree of T's interest in (hung therapy with his Pts upon the therapy prognosis ratings given to Pts. Further, the relationship between TFPt conflict similarity and each of these three variables was examined“ It was hypothesized that, for any given T, the timrapy prognosis ratings given to Pts following initial appointments would be positively related to the degree to Ifluch the Pts are perceived as being motivated for therapy, Hithe degree to which the T likes his Pts, and to the degree to which the T is interested in doing therapy with his Pts. It was further hypothesized that, for any given T'the degree of conflict similarity between the T and hlS .r‘ | 5"" T :: amid be negati' 2:13; given to th- :15 Pts, to the (1891‘ fieragy with his Pts ;::;ncsis ratings gi a::::in::r.ents . szziywere used in t are given the Black 331,1 structions . “e had 01‘ doin The RP prot ..;sed by Blum (196 I593 a T “d each 63 c as had bean 5, the Phillip I. Snett Pts would be negatively related to the therapy motivation ratings given to the Pts, to the degree to which the T likes his Pts, to the degree to which the T is interested in doing therapy with his Pts, and, most importantly, to the therapy prognosis ratings given to his Pts following initial appointments. Five male Ts were used in the study. For each T, the first eight consecutive Pts who met the criteria of the study were used in the data collection. Both the Ts and Pts were given the Blacky Pictures (BP) according to the stan- dard instructions. Immediately after finishing the initial interview, the T rated his Pt with regards to his therapy prognosis for the Pt, the degree of motivation he perceived in the Pt, the ciegree of liking he had for the Pt, and the amount of inter- est he had for doing therapy with the Pt. The BP protocols were scored according to a system «devised by Blum (1962). The degree of conflict similarity kxetween a T and each of his Pts was determined by computing product-moment correlations between the T's scores and the scores of each of his Pts. As had been predicted, for the total group of five it's, the therapy prognosis ratings given by Ts were positively related to the degree to which the Pts were perceived as being motivated for therapy (p < .01) , the isgree to which t! testis the T wa: ;1 3'9 w W 9 m w} r1- *3 C) T"- fi R. F)- m .3 m (L) ('7‘ C” (k (b 3.4 Appendi: cients between i the rank of eac? Prognosis as we Of his Pts. Ta between the ran and Therapy Pro Relationshi Coeffic 69 Test of the Hypotheses Hypothesis 1: For any given therapist, the therapy prognosis ratings given to patients following initial appointments will be negatively related to the degree of conflict similarity between the therapist and his patients. Appendix F shows the conflict similarity coeffi- cients between each therapist and his patients as well as the rank of each coefficient. Appendix H shows the Therapy Prognosis as well as other ratings that each T gave to each of his Pts. Table 4 shows the degree of relationship between the ranks Of T-Pt Conflict Similarity Coefficients and Therapy Prognosis Ratings. TABLE 4 Relationships Between Therapist-Patient Conflict Similarity Coefficient Ranks and Ranks of Therapists' Therapy Prognosis Ratings of Their Patients Spearman Rank Correlation Test Of Therapist Coefficient Total Significance I .357 II -.287 III -.452 n.s. IV —.O72 V .443 As Ta] combined prob supported by consistent tr predicted re: and Therapy 1 TI: ‘1 5 (f) 9 "3 "'3 3* m 'U Q 0 m a) 'U H "5 L.) N n H. (+ ‘31 Tab' 70 As Table 4 shows, the statistical test of the combined probabilities indicated that Hypothesis 1 was not supported by the data; i.e., there was no significantly consistent trend for the group of Ts with regards to the predicted relationship between T-Pt Conflict Similarity and Therapy Prognosis ratings. Hypothesis 2A: For any given therapist, the therapy motivation ratings given to patients following initial appointments will be negatively related to the degree of conflict similarity between the therapist and his patients. Table 5 shows the degree of relationship between the ranks of T-Pt Conflict Similarity Coefficients and Therapy Motivation ratings. TABLE 5 Relationships Between Therapist-Patient Conflict Similarity Coefficient Ranks and Ranks of Therapists' Therapy Motivation Ratings of Their Patients __v_-: L Spearman Rank Correlation Test of Therapist Coefficient Total Significance I .460 II -.319 III -.446 n.s. IV -.110 v -0051 As ca the combined did not find significantly regards to tr Similarity ar It sir from the res1 demonstrate a T3' 71 As can be seen in Table 5, the statistical test of the combined probabilities indicated that this hypothesis did not find support in the data. That is, there was no significantly consistent trend for the group of Ts with regards to the predicted relationship between T-Pt Conflict Similarity and Therapy Motivation ratings. It should be noted that T I appeared to be different from the rest of the T group in that he is the only T to demonstrate a positive relationship of any degree. Hypothesis ZB: For any given therapist, the therapy prognosis ratings given to patients following initial appointments will be positively related to the degree to which the patients are perceived as being motivated for therapy. Table 6 shows the degree of relationship between the ranks of Ts' Therapy Prognosis and Therapy Motivation ratings. As can be seen in Table 6, the test of the combined probabilities indicated that the hypothesis was clearly supported (p‘<.Ol) for the T group. That is, for the entire group of Ts there was a significant trend for the variables of therapy prognosis and therapy motivation to be positively related. Relat ionsh Rat Tnerapist H H H/ III IV In: (' " (“NJ "rj ‘ n rut—es; 72 TABLE 6 Relationships Between Ranks of Therapists' Therapy Prognosis Ratings and Ranks of Their Therapy Motivation Ratings of Their Patients Spearman Rank Correlation Test of Therapist Coefficient Total Significance I .897** II .950** III .740* p< .01 IV .447 V .769* *p< .05. **p< .01. Concerning the individual Ts, four of the five Ts demonstrated a significant relationship. Although T IV's degree of association did not reach significance, the variables were related only to a lesser degree for him. Hypothesis 3A: For any given therapist, the degree to which he likes his patients following initial appointments will be negatively related to the degree of con- flict similarity between the therapist and his patients. Table 7 shows the degree of relationship between ranks of T-Pt Conflict Similarity Coefficients and Patient Likability ratings. Relations? Coefi Therapist II III IV 73 TABLE 7 Relationships Between Therapist-Patient Conflict Similarity Coefficient Ranks and Ranks of Therapists' Patient Likability Ratings of Their Patients Spearman Rank Correlation Test of Therapist Coefficient Total Significance I .277 II -.294 III -.l47 n.s. IV -.294 V .109 As can be seen in Table 7, the statistical test of the combined probabilities indicated that this hypothesis did not find support in the data. That is, there was no significantly consistent trend for the group of Ts with regards to the predicted relationship between T-Pt conflict similarity and patient liking. Hypothesis 33: For any given therapist, the therapy prognosis ratings given to patients following initial appointments will be positively related to the degree to which the therapist likes his patients. Table 8 shows the degree of relationship between ranks of T's Therapy Prognosis and Patient Likability ratings. Relationshi. Rati- E’nerapist b . Rege S‘Owed a Si 9n: land T II } 74 TABLE 8 Relationships Between Ranks of Therapists’ Therapy Prognosis Ratings and Ranks of Their Patient Likability Ratings of Their Patients Spearman Rank Correlation Test of Therapist Coefficient Total Significance I .629+ II .625+ III .650* p< .05 IV .664* V .857** *p< .05. **p< .Ol. +.1o >p > .05. As can be seen in Table 8, the test of the combined probabilities indicated that the hypothesis was supported (p<:.05) for the T group. That is, for the entire group of Ts there was a significant tendency for the variables of therapy prognosis and patient liking to be positively related. Regarding the individual Ts, Ts III, IV and V showed a significant relationship between the two variables. T I and T II had trends (.10 >p:>.05) in the expected direction. ‘L \ KS (‘3 K 1* :34 Q "S <+ '.‘S H‘ m (3 '(1 u "'1 D 0 D . 4, *3 (‘30. Q, R\ s) ‘3 '(1 m ('~ A Tabl: tie ranks o f Therapy Inte REIatio Co \\ therapist \ I II III Iv V .u' ~‘. simported CAD . u Slstent 3.x “dicted 75 Hypothesis 4A: For any given therapist, the degree to which the therapist is interested in doing therapy with his patients is negatively related to the degree of conflict similarity between the therapist and his patient. Table 9 shows the degree of relationship between the ranks of T-Pt Conflict Similarity Coefficients and Therapy Interest ratings. TABLE 9 Relationships Between Therapist-Patient Conflict Similarity Coefficient Ranks and Ranks of Therapists' Therapy Interest Ratings of Their Patients Spearman Rank Correlation Test of Therapist Coefficient Total Significance I .400 II .100 III -.l47 n.s. IV .450 V -.038 As Table 9 shows, the statistical test of the com- bined probabilities indicated that this hypothesis was not supported by the data. That is, there was no significantly consistent trend for the group of Ts with regards to the predicted relationship between T-Pt conflict similarity and therapy i nte r significant t Tabl ratings Relation merapist II III *1 P< .05. b(.ol. 76 therapy interest. Also, there were no individually significant trends for any of the Ts. Hypothesis 4B: For any given therapist, the therapy prognosis ratings given to patients following initial appointments will be positively related to the degree to which the therapist is interested in doing therapy with his patients. Table 10 shows the degree of relationship between the ranks of T's Therapy Prognosis and Therapy Interest ratings. TABLE 10 Relationships Between Ranks of Therapists' Therapy Prognosis Ratings and Ranks of Their Therapy Interest Ratings of Their Patients Spearman Rank Correlation Test of Therapist Coefficient Total Significance I .851** II .642* III . 749* p < .05 IV -.063 V .448 *p< .05. **p< .01. As Ta} probabilities by the data (1 there was a s. Prognosis rat be positively Regar‘ strated a 519: Also notewort‘ different frOZ essentially n while the 0th 77 As Table 10 shows, the test of the combined probabilities indicated that this hypothesis was supported by the data (p<:.05). That is, for the entire group of Ts there was a significant trend for the variables of Therapy Prognosis ratings and interest in doing therapy with Pts to be positively related. Regarding the individual Ts, Ts I, II and III demon- strated a significant relationship between the two variables. Also noteworthy is the fact that T IV appears to be clearly different from the rest of the group in that he demonstrated essentially no relationship regarding the two variables while the other Ts all showed positive relationships. Post Hoc Tests of the Hypotheses Involving ConfliCt Similarity Tests Utilizing Response Defensiveness Similarity (RDS) Coefficients As can be seen in the Scoring Manual (Appendix A), 13 of the 30 test factors are designated as reflecting defensive styles of responding to the Blacky Pictures. Sixteen of the factors, on the other hand, appear to be direct projective expressions of various types of psycho- sexual conflict.1 1Factor VII-A, "Father as Preferred Identification Object/'appears to be a psychodynamically healthy type of responding, as the Ts and gs are males. It is therefore not considered here as being a conflict factor. In ord T-Pt similarit only the score rationale unde the suspicion respondents t< 10(s'ical sound items might b “direct Confl IEflect'mg Cc T5 (and 30pm conflict fac1 res"POHSes th. Itw avoidance. V mus, Could 78 In order to conduct a series of post hoc analyses, T—Pt similarity coefficients were first re-computed using only the scores on the 13 "defensive" factors. The rationale underlying the decision to do this involved the suspicion that Ts, as well as other more sophisticated respondents to the BP, might be consciously avoiding patho- logical sounding alternatives. Although the unstructured items might be partially "measuring" Ts' conflicts, the "direct conflict expression" factors might not be accurately reflecting conflict strength because of item—avoidance. The Ts (and soPhisticated Pts) might be avoiding the direct conflict factors by choosing the more innocuous sounding responses that load into the defensive factors. It was further reasoned that defensiveness in response, which was the result of conflict expression avoidance, was an indirect expression of the conflict and, thus, could be considered an alternative measure of conflict. It was reasoned that it might, in fact, be a more sensitive measure because these factors would "trap" conflict eXpression. Appendix G shows the Response Defensiveness Similarity (RDS) Coefficients between each T and his Pts. Also listed are the ranks of these similarity coefficients. U: K 1 k '3 “1.1 X‘ 3"“ Q C) t+ ('0: F) H (D m m (I) 'H U "5 *3 0) w the ranks ‘ ratings . Relatic Therapist II III 79 Hypothesis 1: For any given therapist, the therapy prognosis ratings given to patients following initial appointments will be negatively related to the degree of conflict similarity between the therapist and his patients (as indicated by response defensiveness similarity). Table 11 shows the degree of relationship between the ranks of T-Pt RDS Coefficients and Therapy Prognosis ratings. TABLE 11 Relationships Between Therapist-Patient Response Defensiveness Similarity Coefficient Ranks and Ranks of Therapists' Therapy Prognosis Ratings of Their Patients Spearman Rank Correlation Test of Therapist Coefficient Total Significance I .714+ II -.132 III -.500 n.s. IV .723”r V .430 +J0>p>.0& As can be seen in Table 11, the statistical test of the combined probabilities indicated that this hypothesis again was not supported by the data. That is, there was no significantly consistent trend for the group of Ts with regards to t Conflict Sin imilarity, Howe (.10 > p > , 05 predicted, V relationshi] GriGinal COi Inat is, f0. tended to b k to] P21 EPI th re Ta Ne r“NU-rs ratings A “:1 e (20%: 345‘ . ~3an Wat Pics L a Si s 3s." «t n IKEQ, 80 regards to the predicted relationship between T-Pt Conflict Similarity, as indicated by response defensiveness similarity, and Therapy Prognosis ratings. However, for Ts I and IV there was now a trend (.10>>p=>.05), in the opposite direction to what was predicted, whereas neither of these two Ts evidenced relationships that even approached significance when the original coefficients of conflict similarity were used. That is, for Ts I and IV Therapy Prognosis ratings now tended to be positively related to T-Pt Response Defensive- ness Similarity (.10:>p >.05). Hypothesis 24: For any given therapist, the therapy motivation ratings given to patients following initial appointments will be negatively related to the degree of conflict similarity between the therapist and his patients (as indicated by response defensiveness similarity). Table 12 shows the degree of relationship between the ranks of T—Pt RDS Coefficients and Therapy Motivation ratings. As can be seen in Table 12, the statistical test of the combined probabilities indicated that this hypothesis again was not supported by the data. That is, there was not a significantly consistent trend for the group of Ts with regards to the predicted relationship between Conflict Similarity and Therapy Motivation ratings. Relationshi Simila Tl: fi. 4! fierapist II III MU m ’U L4, 8' 81 TABLE 12 Relationships Between Therapist-Patient Response Defensiveness Similarity Coefficient Ranks and Ranks of Therapists' Therapy Motivation Ratings of Their Patients Spearman Rank Correlation Test of Therapist Coefficient Total Significance I .740* II -.209 III -.511 n.s. IV .442 V -.026 *p< .05. Regarding the individual Ts, T I now showed a sig- nificant relationship (p<<.05), in the Opposite direction, whereas no significant relationship between the two vari- ables was found in the original analysis. For T I there was now a positive relationship between RDS and Therapy Motivation ratings. Hypothesis 3A: For any given therapist, the degree to which he likes his patients following initial appointments will be negatively related to the degree of con- flict similarity between the therapist and his patients (as indicated by response defensiveness similarity). Tablc the ranks of ratings . Relations Simi \ \ flmrapist \ I II III 82 Table 13 shows the degree of relationship between the ranks of T-Pt RDS Coefficients and Patient Likability ratings. TABLE 13 Relationships Between Therapist—Patient Response Defensiveness Similarity Coefficient Ranks and Ranks of Therapists' Patient Likability Ratings of Their Patients Spearman Rank Correlation Test of Therapist Coefficient Total Significance I -.331 II .540 III .806* n.s. IV -.209 V .082 *p< .05. As Table 13 shows, this hypothesis again was not supported by the data, for the T group, utilizing the RDS Coefficients. 0f further interest was the fact that there was now a significant relationship, in the opposite direction, (p<=.05) for T III, whereas he originally did not evidence a significant relationship between the two variables. That is, for T III there was now a positive relationship between RDS and Patient Liking. Hupoti For a; thera; patie confl patie' simil Table ranks of T-pt REIationsh. Coef: III IV 83 Hypothesis 4A: For any given therapist, the degree to which the therapist is interested in doing therapy with his patients is negatively related to the degree of conflict similarity between the therapist and his patients (as indicated by response defensiveness similarity). Table 14 shows the degree of relationship between ranks of T-Pt RDS Coefficients and Therapy Interest ratings. TABLE 14 Relationships Between Therapist-Patient Response Defensiveness Coefficient Ranks and Ranks of Therapists' Therapy Interest Ratings of Their Patients Spearman Rank Correlation Test of Therapist Coefficient Total Significance I .751* II .150 III -.331 n.s. IV .100 V .140 *p< .05 As Table 14 shows, the statistical test of the combined probabilities indicated that this hypothesis again was not supported by the data. That is, there was not a significantly consistent trend for the group of Ts with regards to the predicted relationship between T-Pt RDS and Therapy Interest. Howe relationship '1‘ I original between the T I now shoe Therapy Inte Tests Utiliz As t CCEfficientg in Certain i it was f€lt second ream expreSSiOn" alfiCant fix factors and icant trend: ”field no fi: ind 68d ' the 84 However, for T I there was now a significant relationship (p<<.05), in the opposite direction, whereas T I originally did not show a significant relationship between the two variables when the data were first analyzed. T I now shows a positive relationship between RDS and Therapy Interest. Tests Utilizing Direct Conflict Similarity (DCS) Coefficients As the post hoc analyses of the data using RDS Coefficients yielded various changes in significance levels in certain instances,with regards to individual therapists, it was felt that the possibility clearly existed that a second reanalysis, this time utilizing "direct conflict expression" item factors only, might uncover further sig- nificant findings. It was reasoned that both the defensive factors and conflict factors could separately yield signif- icant trends yet cancel out each other's "pull" and, thus yield no findings when combined into one index. This was, indeed, the case as indicated by the original set of analyses. Using the direct conflict expression items only, a third index of T-Pt similarity was computed. Appendix I shows the T-Pt Direct Conflict Similarity (DCS) Coefficients. Also listed are the ranks of these Coefficients. ‘_-— Table the ranks of '1 ratings _ II III IV 85 Hypothesis 1: For any given therapist, the therapy prognosis ratings given to patients following initial appointments will be negatively related to the degree of conflict similarity between the therapist and his patients (as indicated by direct conflict similarity). Table 15 shows the degree of relationship between the ranks of T-Pt DCS Coefficients and Therapy Prognosis ratings. TABLE 15 Relationships Between Therapist-Patient Direct Conflict Similarity Coefficient Ranks and Ranks by Therapists' Therapy Prognosis Ratings of Their Patients Spearman Rank Correlation Test of Therapist Coefficient Total Significance I .179 II -.527 III -.l90 n.s° IV -.612 V -.437 As Table 15 shows, the statistical test of the combined probabilities indicated that this hypothesis was not supported by the data for the third time. That is, there was no significantly consistent trend for the group of Ts with regards to the predicted relationship between DCS and Therapy Prognosis. 0f i: different fr« slight non-s. flict Simila: ofthe Ts sh: fact that T for RDS and '. C1id not demo: PIOCJnosis. Euro: *\ FOP C Patir app34 therc Table Id’lKS of T‘Pt rating As Ta obabil ies “spotheSI wa his t a 319 is with L regar. 86 Of interest is the fact that T I appeared to be different from the rest of the group in that he showed a slight non-significant positive relationship between Con- flict Similarity and Therapy Prognosis ratings whereas the of the Ts show negative associations. Also, despite the fact that T I had earlier shown a tendency (.10>>p>'.05) for RDS and Therapy Prognosis to be positively related, he did not demonstrate a relationship between DSC and Therapy Prognosis. Hypothesis 2A: For any given therapist, the therapy motivation ratings given to patients following initial appointments will be negatively related to the degree of conflict similarity between the therapist and his patients (as indicated by direct conflict similarity). Table 16 shows the degree of relationship between ranks of T-Pt DCS Coefficients and Therapy Motivation ratings. As Table 16 indicates, the test of the combined probabilities revealed that, for the third time, this hypothesis was not supported by the data. That is, there was not a significantly consistent trend for the group of Ts with regards to the predicted relationship between T-Pt DCS and Therapy Motivation ratings. 87 TABLE 16 Relationships Between Therapist-Patient Direct Conflict Similarity Coefficient Ranks and Ranks of Therapists' Therapy Motivation Ratings of Their Patients Spearman Rank Correlation Test of Therapist Coefficient Total Significance I .244 II -.589 _1 III -0192 nos. ‘ IV -.210 V -.742* *p< .05. Other interesting findings emerged, however. For T V there was now a significant relationship (p<<.05) in the expected direction (negative) between the two variables whereas in the two previous tests of this hypothesis no significant trends emerged for T V. Also, T I appeared to be different from the rest of the group in that this T is the only T to yield a positive, though not significant,relationship of any magnitude between DCS and Therapy Motivation ratings. 88 Hypothesis 3A: For any given therapist, the degree to which he likes his patients following initial appointments will be negatively related to the degree of con- flict similarity between the therapist and his patients (as indicated by direct conflict similarity). Table 17 shows the degree of relationship between the ranks of T-Pt DCS Coefficients and Patient Likability ratings. TABLE 1 7 Relationships Between Therapist-Patient Direct Conflict Similarity Coefficient Ranks and Ranks of Therapists' Patient Likability Ratings of Their Patients Spearman Rank Correlation Test of Therapist Coefficient Total Significance I .203 II -.491 III -.651’r p < .05 IV -.580 V -.456 +.1o >p > .05. As Table 17 shows, the test of the combined prob- abilities indicated that this hypothesis was supported by the data. In contrast to the two previous tests of this hypothesis where no relationship was found, it appeared now ‘IEE. 89 that there was a significantly consistent trend (p‘<.05) for the group of Ts with regards to the predicted relation- ship between DCS and liking of Pts. For the group of Ts degree of liking of Pts was negatively related to the degree of T-Pt DCS. There are other interesting findings regarding the individual Ts. For T III there was now a trend toward a negative relationship (.10:>p:>.05) between DCS and liking of patients, whereas T III showed a positive relationship (p<:.05) between RDS and liking of Pts. Also T I is clearly set apart from the other Ts in that T I is the only one showing a positive (though not significant) relationship of any magnitude between DCS and Pt Likability. Hypothesis 4A: For any given therapist, the degree to which the therapist is interested in doing therapy with his patients is negatively related to the degree of conflict similarity between the therapist and his patients (as indicated by direct conflict similarity). Table 18 shows the degree of relationship between the ranks of T-Pt DCS Coefficients and Therapy Interest ratings. 90 TABLE 18 Relationships Between Therapist-Patient Direct Conflict Similarity Coefficient Ranks and Ranks of Therapists' Therapy Interest Ratings of Their Patients Spearman Rank Correlation Test of Therapists Coefficient Total Significance I .227 II -.150 III -.552 n.s. IV .214 V -.181 As Table 18 shows, the test of the combined prob- abilities indicated that this hypothesis was not supported, for the third time, by the data. There again was not a significantly consistent trend for the group of Ts with regards to the predicted relationship between DCS and Therapy Interest. CHAPTER V DISCUSSION This study attempted to explore some of the variables entering into the T's prognostic evaluations of his Pts at the time of the initial or intake interview. Attention was focused solely on the T's subjective or clinical judgments with no attempt made to validate his prognostic judgments with any outside criteria. The main hypothesis tested was that a T's therapy prognosis ratings of his Pts were negatively related to the degree to which the T was conflictually similar to his Pts (Hypothesis 1). That is, the more similar the T was to his Pt: with regards to conflict, the more likely he would be to give the Pt a poorer prognosis for improvement in therapy. It was further predicted that the T's prognostic evaluations of his Pts would be positively related to the dagree of motivation for therapy that he perceived in his Pts (Hypothesis 2A), but that his perceptions of therapy motivation would, themselves, be negatively related to the degree of conflict similarity between the T and his Pts (HYpothesis 2B) . 91 92 Also thought to have a positive association with therapy prognosis ratings was the degree of liking that the T had for his Pts (Hypothesis 3A), but that the degree of liking that a T had for his Pts would be negatively related to the degree of conflict similarity between the T and his Pts (Hypothesis BB). | Finally, it was predicted that therapy prognosis ratings would be positively associated with the degree ' ." of interest that the T had in doing therapy with his Pts E (Hypothesis 4A), but that the degree of interest in doing therapy would, itself, be negatively related to the degree of conflict similarity between the T and his Pts (Hypothesis 4B). As had been predicted, for the total group of the five Ts, the therapy prognosis ratings given by Ts to their Pts were positively related to the degree to which Pts were perceived as being motivated for therapy (p<:.01), the degree to which the T liked his Pts (p<:.05), and the degree to which the T was interested in doing therapy with his Pts (p‘<.05). However, none of the negative relationships pre- dicted to exist between T-Pt conflict similarity and therapy prognosis ratings, perceived Pt therapy motivation, liking of Pts, and interest in doing therapy with Pts was supported by the data when the original measure of conflict and con- flict similarity was used. 93 Post hoc tests of the conflict similarity hypotheses, in which defensive similarity and (direct) conflict similar- ity were analyzed separately, yielded some interesting as well as statistically significant results. When Response Defensive Similarity (RDS) Coeffi- cients were used, there again were no significantly m. consistent trends, for the T group, with regards to the predicted negative relationships between conflict similarity ' V J and therapy prognosis ratings, perceived Pt therapy motiva- tion, liking of Pts, and interest in doing therapy with Pts. But, some Ts now showed significant relationships or trends, in the direction Opposite to what was predicted, in certain instances. That is, some Ts gave or tended to give better therapy prognosis ratings to Pts they saw as being better motivated, liked Pts more, and were more interested in doing therapy with Pts who were defensively similar to them. When Direct Conflict Similarity (DCS) Coefficients were used to again test the conflict similarity hypotheses, a significantly consistent trend (p<=.05) regarding the predicted relationship between liking of Pts and conflict similarity was found. That is, for the total group of Ts conflict similarity was negatively related to the amount of liking of Pts. 5!— J’jr 94 Hypotheses Not Involving T-Pt Conflict Similarity The results of the present study that indicate that therapy prognosis ratings given to Pts are positively related to perceived Pt therapy motivation (Hypothesis 2B), liking of Pts (Hypothesis 3B), and interest in doing therapy with Pts (Hypothesis 4B), are similar to those of Garfield and Affleck (1961), Strupp (1958a, 1958b), Strupp and Wallach (1965) and Wallach and Strupp (1960). The present data suggest only that a positive relationship exists between therapy prognosis and perceived Pt therapy motivation, liking of Pts and interest in doing therapy with Pts. The data themselves do not suggest any cause and effect relationships. Nonetheless, an important question, indeed, is whether Pts are perceived as having a better therapy prog- nosis because, for example, they are perceived as being more motivated for therapy or, on the other hand, they are per- ceived as being more motivated for therapy because they are perceived as having a better therapy prognosis. Further, does the T like certain Pts more because he perceives a better therapy prognosis in these Pts or does he perceive a better therapy prognosis in these Pts because he likes the Pts? Finally, is the T more interested in doing therapy with certain Pts because they are perceived as having a 95 better therapy prognosis or is the Opposite direction Of causation true? The present author's observation is that Pts are given better therapy prognosis assessments because they are perceived as being better motivated for therapy rather than the reverse being true. Obviously, this Observation is highly subjective. However, Strupp and Williams (1960) obtained evidence that supports this writer's contention. They concluded, from their findings, that the Pt's motiva- tion for therapy was the single most important factor affecting their Ts' various evaluations Of their Pts. On the other hand, Strupp and Williams (1960) felt that Ts' liking of Pts may be the result of perceiving them as good Pts. The present writer takes issue with this interpretation. It is felt that the liking of a Pt, par- ticularly after an initial interview, is not simply the result of perceiving the Pt as being a good Pt or as having a good therapy prognosis. The relationship between liking Of Pts and therapy prognosis is, indeed, more complex than that. As had already been indicated (and will be discussed in more detail later), it was found in the post hoc analyses that Pt Likability and Conflict Similarity are, across Ts, negatively related. That is, Ts tend to like Pts better when the Pts are conflictually dissimilar to them. Or, Ts progressively more dislike Pts who are progressively 96 conflictually similar to them. Quite possibly, Pts who are conflictually similar to Ts are more threatening to the Ts and are, therefore, liked less. Thus, although the Pts therapy prognosis may be a factor entering into the T's liking of the Pt, the degree of conflict similarity to the Pt also is an important vari- able affecting the T's liking of his Pts at the point Of the initial interview. The T's interest in doing therapy with Pts would seem to be, at least in part, the result of perceiving a good therapy prognosis in Pts. Of course, other factors might come into play such as the degree Of interest that the Pt's psychopathology might hold for the T. The type of problem the Pt has might interest the T in the Pt despite the fact that the T might also consider the Pt as having a poor therapy prognosis. However, logic would seemingly dictate that it is more likely that a T is more interested in doing therapy with a Pt because he perceives a good therapy prognosis in the Pt rather than attributing a better therapy prognosis to the Pt because he happens to be inter- ested in doing therapy with the Pt. Hypothesis ZB, which dealt with the relationship between therapy prognosis ratings Ts give their Pts and the amount of therapy motivation they perceive in their Pts was the most strongly confirmed hypothesis (p<=.Ol). As Table 6 shows, four Of the five Ts individually demonstrated a 97 significant relationship between these variables. The other T, T IV, showed a weaker trend in the expected direction. It is possible that T IV's theoretical orientation is reSponsible for this weaker association between therapy prognosis and therapy motivation. As Table 1 shows, T IV described himself as a behavioral therapist. Perhaps for this T the symptomatic behavior of the Pt becomes the most important consideration in assessing the Pt's therapy prognosis and, thus, other variables such as the Pt's therapy motivation might have less Of an influence upon his perception of therapy prognosis, at least in comparison with the other Ts. T IV, however, does consider the Pt's motivation but, again, not as strongly as the other Ts in this study. Hypothesis BB, which was concerned with the rela- tionship between therapy prognosis ratings and the T's liking of Pts, was also supported for the group of Ts (p<:.05). Although Ts' I and II degrees of relationship between therapy prognosis and Pt liking did not reach statistical significance, the degree Of relationship for these Ts was only slightly less than that seen for the other three Ts. Hypothesis 4B, the one which dealt with the rela- tionship between therapy prognosis ratings given to Pts and the level of interest that the T has for doing therapy with 98 his Pts, was supported for the group of Ts (p‘<.05). Significant relationships were found individually for T I, T II, and T III. Although T V's degree of association between therapy prognosis and therapy interest was not statistically significant, his degree of association between the two variables was not much weaker than Ts I, II and III. _mq T IV, on the other hand, was clearly different from the other Ts in that there essentially was no relationship ' . e at all between therapy prognosis and therapy interest seen E] for this T (see Table 10). Perhaps T IV's theoretical orientation as a behavioral therapist and his likely interest in symptomatic behavior is causing the lack Of association between therapy interest and Pts' therapy prognosis. That is, this T's therapy interest in the Pt may focus almost entirely on the nature of the Pt's symptoms--on the suitability of the symptoms for behavior therapy--rather than on the Pt's prognosis as determined by the same general considerations that the other Ts use in their assessments of prognosis. Hypotheses Ipvolving T-Pt Conflict Similarity Contrary to what had been predicted, four of the seven hypotheses did not find support in the original analysis of the data. These were the hypotheses which dealt with the predicted negative relationships between 99 T-Pt conflict similarity and perceived Pt therapy prognosis (Hypothesis 1), perceived Pt therapy motivation (Hypothesis 2A), amount of liking for Pts (Hypothesis 3A), and interest in doing therapy with Pts (Hypothesis 4A). In addition to no significantly consistent trends being uncovered for the T group with regards to any of these predicted relationships, l~m1 none Of the 20 individual tests (five Ts X 4 hypotheses) indicated a significant relationship between conflict ' ;'* similarity and any of the other variables. ii There were several possible explanations for this complete lack of findings, regarding the effect of T-Pt conflict similarity, which will be Offered and discussed. This will be done in the order of increasing plausibility as an explanation for the original lack of findings. 1. The T group is very atypical, unusual, or biased in such a way that otherwise usual phenomena are not Operating. This explanation does not appear to have much merit and, therefore, can be quickly discarded. Aside from the fact that a small number of Ts (N==5) was used in the study, this sample appears to be an adequate representation Of many groups of functioning Ts, at least when compared with many mental health clinics. The one deficiency is the lack of a psychiatrist. Otherwise, there are essentially three levels 100 Of experience and some variety in theoretical approaches represented (see Table l). 2. The Blacky Test, which was used as the instrument to tap conflict, is an invalid measure. This argument appears to have little weight in ‘,-F view of Sappenfield's (1965) findings. He concluded, after comprehensively reviewing Blacky Test literature, that ". . . in general . . . there appears to be far more evidence for the Blacky's validity than for its lack of validity [p. 420]." 3. The Scoring Manual (Blum, 1962) is either invalid or faulty in some way and, thus, the indices Of conflict and T-Pt conflict similarity are, them- selves, faulty. This explanation is considered as having some merit as a possible explanation for the lack of results in the hypotheses dealing with T-Pt conflict similarity. The method by which the scoring manual was constructed was described in an earlier chapter. Blum (1962) suggested that he had demonstrated construct validity of the scoring fac- tors by his approach Of relating Blacky Picture scores to a wide variety Of dependent variables such as other test scores, biographical data of the gs, etc. 101 Although the factors which emerged, via the pooling Of that data, appeared to have construct or internal valid- ity, no attempt was made then to further validate scores on the various factors against any outside criteria. Thus, there is a lingering question as to the validity of the factor scores although some evidence for the validity of the factors does exist. Clearly, if the factor scores are not entirely valid, the conflict similarity hypotheses may not have been adequately tested. The further possibility that the lack of findings was due to unreliabil- ity Of the scoring has been eliminated by the high reliabil- ity that had been demonstrated in the present study. 4. There is something unusual about the Pt population that might be operating in such a way that these Pts don't affect the Ts the way Pts usually do. Although this Pt population was not statistically compared to the general population or to any other out- patient mental health clinic population, an inspection of Table 2 seems to indicate that there is nothing very unusual about these individuals, at least with regards to such fac- tors as age, education, amount of previous therapy and marital status. However, one interesting possibility does emerge as a factor that might have some influence on the T-Pt Conflict Similarity scores and, thus, the lack of results. As Table 2 102 shows, some Pts were seen individually for the initial appointment while others were seen along with their wife and/or child(ren). It is possible that the presence of other individuals during the interview could have had enough Of a "diluting" effect, with regards to the rela- tionship being established between the T and the Pt, that lmJ there was not enough of a relationship basis created for conflict similarity "clash" to occur. I u Had the number of Pts for each T been sufficiently Hi large enough, separate analyses would have been done to test out this theory. Perhaps T-Pt conflict similarity is a critical factor in a one-to-One interaction but not when other people are present in the interview situation. It is possible that the predicted effects could have been Operat- ing in the individual interviews but not in the others and, thus, these effects could have been "washed out." 5. The hypothesized relationships do not, in fact, exist. The evidence presented in Chapter II to substantiate these hypotheses appeared to be quite sound. (Any attempt to comprehensively restate the arguments leading to the formulations of these hypotheses would involve, in fact, a restatement of much of the same content). However, the present evidence, or lack of evidence, to be more precise, suggests that these relationships do not, indeed, exist. 103 6. The Conflict Similarity Coefficients may have been faulty not because of any intrinsic lack of valid— ity but because the Ts and sophisticated Pts may have avoided pathological sounding responses that loaded into certain conflict factors in the scoring manual. Sophistication on the parts of the Ts and certain Pts may have, in part, accounted for the lack of findings for the hypotheses concerned with T-Pt conflict similarity. That is, the Ts may have avoided many important re3ponses, particularly in the multiple choice items and, consequently, their conflict scores may have been weakened measures. It is reasonable to assume that Ts would attempt, at least some Of the time, to choose innocuous sounding responses. Thus, although the T's conflicts may have been partially measured by the unstructured items (such as the spontaneous stories), avoidance was possible on the multiple choice items. This problem is magnified by the fact that a story to a cartoon, no matter what the length or how pathological sounding it may be, contributes no more weight to a factor score than a single multiple choice item. It was possible to test out this possibility, at least indirectly. If the Ts were attempting to avoid--if they were being "defensive"--then, possibly, an examination of the defensive factors might prove fruitful. As will be seen later, this, indeed, was the case. 104 Since the defensive factors were analyzed separately and, in fact, yielded some significant findings, a third set of analyses was performed on the conflict similarity hypoth- eses utilizing similarity indices that were based on the conflict items only. Further results, which will be discussed shortly, were Obtained. 7. T and Pt conflict behavior was not appropriately measured by the original Conflict Similarity Coefficients because, in fact, this original measure (Total Conflict Similarity Coefficient) was a com- bined measure of conflict similarity and defensive similarity. As the further findings Of this study, which are to be discussed shortly, seem to prove, this possibility has the most merit as the explanation for the original lack Of findings for the hypotheses concerned with T-Pt conflict similarity. Differential reSponses on the parts Of some Ts to conflict similarity and defensive similarity appeared to have "washed out" the relationships Of either one to the other variables. 105 Post hoc Tests Of the Hypotheses Involving T-Pt ConfliCt Similarity Utilizing Alternative Measures of? Conflict Similarity As was described in an earlier chapter, 13 of the 30 factors delineated in the Scoring Manual (Appendix A) were designated by Blum (1962) as reflecting defensive -_J styles of responding to the BP. Each of the 11 BP cartoons has at least one defensive factor that can be scored, if . ' . l scoring on that factor is indicated. The scoring scheme, E; then, is presumably able to trap the defensive derivatives Of psychosexual conflict as well as the more direct pro- jective expressions of the various conflicts. Assuming that a defensive response on a particular cartoon was related psychodynamically to the conflict that the particular card was presumably representing, it was felt that T-Pt Conflict Similarity Coefficients based only on these defensive factors could be considered an indirect measure Of conflict similarity. Further, it was reasoned, this revised measure might be more sensitive because it might indirectly measure conflict that might not be other- wise measured due to item avoidance. Coefficients based on these defensive factors were designated as the T-Pt Response Defensive Similarity (RDS) Coefficients. Coefficients based on 16 of the remaining 1? factors were designated T-Pt Direct Conflict Similarity (DCS) 106 Coefficients as these factors were the ones that appeared to reflect direct projective expressions of conflicts. As the following results show, conflict similarity and defensive similarity appear to be two separate entities rather than being alternative measure of conflict similarity. l. Hypothesis 1 predicted a negative relationship between therapy prognosis ratings given to Pts and the degree of T-Pt conflict similarity. This hypothesis was not supported for the group of Ts when the TCS Coefficients were used in the original analysis or when the data were reanalyzed utilizing either the RDS or DCS Coefficients. However, as Table 19 shows, some interesting find- ings emerged for some Ts when the RDS and DCS Coefficients were used. Whereas, for T I, no relationship between therapy prognosis and conflict similarity emerged when either the TCS or DCS Coefficients were used, there was a trend (.102>p2>.05) toward a positive relationship for T I between RDS and Therapy Prognosis ratings given to Pts. That is T I showed a tendency to give better prognosis ratings to Pts who were defensively similar to him while conflict similar- ity to Pts had little bearing on his Therapy Prognosis ratings. 107 TABLE 19 Summary Of the Relationships Between the Various T-Pt Similarity Coefficients and the Various Therapist Ratings Of Patients Therapist I II III IV V Total Conflict Similarity R_an_ke= Therapy prognosis ranks .357 -.287 -.452 -.072 .443 Therapy motivation ranks .460 -.319 -.446 -.110 .051 ' I " Patient likability ranks .277 -.294 -.l47 -.294 .109 LJ Therapy interest ranks .400 .100 -.147 .450 .038 f Response Defensiveness Similarity Ranks: Therapy prognosis ranks .714+ -.l32 -.500 .723+ .430 Therapy motivation ranks .740* -.209 -.511 .442 .026 Patient likability ranks -.331 .540 .806* -.209 .082 Therapy interest ranks .751* .150 -.331 .100 .140 Direct Conflict Similarity seeks: Therapy prognosis ranks .179 -.527 -.l90 -.612 .437 Therapy motivation ranks .244 -.589 -.l92 -.210 .742* Patient likability ranks .203 -.491 -.651+ -.580 .456 Therapy interest ranks .227 -.150 -.552 .214 .181 Therapy prognosis ranks- therapy motivation ranks .897** .950** .740* .447 .769* Therapy prognosis ranks- patient likability ranks .629+ .605I .650* .664* .857** Therapy prognosis ranks- therapy interest ranks .851** .642* .749* -.063 .448 *p< .05. **p< .01. +.10 >p > .05. 108 The data in Table 1 offer no eXplanation as to why T I shows a tendency to be positively responsive to Pts' defensiveness while, at the same time, apparently unaffected by their conflict similarity to him, with regards to the Therapy Prognosis ratings he gives Pts. Perhaps, for T I, defensiveness of Pts to their conflicts (when similar to |__1 his own) is non-threatening and, perhaps, even comfortable. It is clear that T I responds more comfortably to the mutual defensiveness than to the similarity in the conflicts themselves. As was the case with T I, T IV showed a trend (.10 >p2>.05) toward a positive relationship between RDS and Therapy Prognosis rating whereas TCS and DCS were not related to Prognosis ratings. That is, T IV showed the tendency to give better Prognosis ratings to Pts who are defensively similar to him while conflict similarity to Pts had little bearing on his Therapy Prognosis ratings. T IV's theoretical orientation or behavior therapy is a possible explanation for this occurrence. Speculatively, this approach might reflect a preference or relative comfort in dealing with symptomatology (defensive derivatives of underlying conflicts) rather than underlying conflicts which accounts for his tendency to positively respond to the Pts' defensive similarity to himself. In other words, T IV might be "at home" with Pt defensiveness just as he is comfortable with Pt symptomatology, although 109 the direction of causality between theoretical orientation and our findings might Operate in either direction and is, of course, tentative in any event. 2. Hypothesis 2A predicted that T-Pt conflict similarity would be negatively related to the T's per- J ‘.P' u.- ception of the Pt's level of therapy motivation. This hypothesis did not receive support for the entire group Of Ts whether the data were analyzed using the bi TCS, RDS or DCS Coefficients. That is, no statistically significant trends across the Ts were uncovered with regards to the hypothesized relationship between Conflict Similarity and Therapy Motivation ratings when any of the three alter- native measures were used. However, in two instances, for individual Ts, there were interesting findings that emerged when the RDS and DCS Coefficients of Similarity were used (see Table 19). T I showed a positive relationship (p<<.05) between RDS and Therapy Motivation ratings given to Pts whereas DCS and Motivation ratings appeared to be unrelated. That is, T I appears to react positively to defensive similarity to Pts, with regards to the therapy motivation he perceives in the Pts, whereas the degree of conflict similarity with Pts has little bearing on the amount of motivation he sees in his Pts. Perhaps, as explained earlier, for T I, Pts who defend against their conflicts in a manner similar to his 110 own are non-threatening and, perhaps, even comfortable. It is clear that T I responds more comfortably to the mutual defensiveness than to the similarity in the conflicts themselves. T V showed a negative relationship (p‘<.05), as had been predicted, between DCS and Therapy Motivation ratings I“‘ Of Pts while RDS was unrelated to these ratings. That is, while T V appears unaffected by defensive similarity to ' ._u Pts, with regards to his motivational ratings Of them, be h; is certainly negatively influenced in these perceptions by the degree Of conflictual similarity to his Pts. Perhaps conflict similarity is threatening to him, at least to the extent that it affects (negatively) his perceptions of Pt therapy motivation. 3. Hypothesis 3A predicted that the amount of liking that a T had for his Pts would be negatively related to the degree of conflict similarity between the T and his Pts . Whereas, for the entire group Of Ts, there was no statistically consistent trend for defensive similarity to be negatively related to Pt liking, it was found that there, indeed, was a significant trend for the group Of Ts with regards to the predicted negative relationship between con- flict similarity and liking Of Pts. That is, for the T group as a whole, there was a significant tendency (p‘<.05) 111 for Ts to like less Pts who are conflictually similar to them. In other words, Ts do not like Pts whose conflicts are similar to their own. Regarding the individual Ts, T III showed a positive relationship (p<:.05) between defensive similarity and Pt likability while at the same time, showed a tendency _ I (.102>p2>.05) for conflict similarity and liking of Pts to be negatively related. That is, T III clearly liked Pts ‘ .f who were defensively similar to him but tended to dislike I] Pts who were conflictually similar to him. As Table 1 shows, T III is the least experienced T. Perhaps because of his lack of clinical experience, T III is much more comfortable with Pts' defensive behavior (when similar to his own) and made uncomfortable by their conflictual behavior (when similar to his own). 4. Hypothesis 4A predicted that T-Pt conflict similarity would negatively influence the degree of interest that the T had for doing therapy with his Pts. This hypothesis did not receive support, for the group of Ts, when any of the three coefficients of sim- ilarity was used in the data analysis. Therefore, there appeared to be no significantly consistent trend for the T group with regards to the hypothesized negative relation- ship between T-Pt conflict similarity and interest in doing therapy with Pts. 112 Concerning the individual Ts, T I showed a positive relationship (p<=.05) between defensive similarity to Pts and degree Of interest in doing therapy with Pts, while conflict similarity to Pts was unrelated to his therapy interest in them. That is, T I appears to be interested in doing therapy with Pts who are defensively similar to him while the degree of conflict similarity to Pts does not affect his interest in them. A speculation for this is that ' L T I might have some awareness of his defensiveness and gets L; interested in defensively similar Pts because they might provide an Opportunity for him to "learn" about himself. It thus appears that the TCS Coefficient Of T-Pt similarity was an inappropriate measure Of conflict simi— larity because it is, in actuality, a mixture of both defensive and conflict components. The net result Of the utilization of the TCS Coefficient was that the separate effects of conflict similarity and defensive similarity were combined. Since, as it was later seen, RDS and DCS had Opposite effects on some Ts' judgments, the effects of each was cancelled out by the other when the TCS index was used. The DCS appeared to be, in fact, a more accurate and empirically sounder measure of conflict similarity since it was composed entirely Of factors indicating direct expres- sion of conflicts. Indeed, the hypothesis regarding conflict similarity and Pt liking was confirmed when this more accurate measure 113 of conflict was used. In addition, with regards to the therapy motivation hypothesis, the predicted negative effect Of conflict similarity was found to be true for one T when the DCS Coefficient was used. It appears, from the post hoc analyses of the data, that some Ts appear to react differently to defensive sim- ilarity to Pts and conflict similarity to Pts. There is an instance in which defensive similarity has a positive influ- ence while conflict similarity negatively influences the T. There are also several instances, for individual Ts, in which defensive similarity is influencing a judgment while conflict similarity is not, or vice versa. Apparently, for some Ts, conflict similarity can Operate as a negative influence on the T's judgments of therapy motivation and liking of Pts while defensive sim- ilarity has a positive influence on the various judgments Of some Ts. This would suggest that, for some Ts, conflict similarity creates a threatening or uncomfortable situation for the T and thus negatively affects these judgments. 0n the other hand, certain Ts appear to be quite comfortable with defensive similarity to their Pts and, thus, are favorably influenced in these judgments. The T who seemed to react most differently to conflict and defensive similarity was T III, this occurring with regard to the liking of Pts. As will be recalled, T III is the most inexperienced. 114 The question arises whether limited experience is a factor associated with the differential responding to defensive and conflict similarity. It is, of course, possible that T III's inexperience is totally unrelated and, instead, personality factors in this one T account for the differential responding. Another rather intriguing result Of the post hoc analyses was the variability that was seen among the Ts across the hypotheses with regards to either the magnitude or direction of the relationships between variables. There are several instances, in the tests Of the hypotheses, in which the range Of the Ts' individual correlations is quite wide. Of course, the fluctuations seen could be accounted for solely on the basis of randomness of Observation. However, there is another interesting possibility. The present sample Of Ts, as was commented earlier, is rather heterogeneous with regards to experience and theo- retical orientation. The question arises as to whether the variability in findings may be due to, in part, the varia- bility in the sample of Ts. If this speculation has substance, then we have one possible explanation for the contradictory nature of the past similarity research that was reviewed earlier by this writer. That is, what was found in each of these studies (i.e., T-Pt similarity facilitates, interferes with, has a curvilinear relationship 115 with, or has no relationship with therapy process and/or outcome) may be, at least in part, a function of the kind Of T sample that was used. Possibly, homogeneity in eXpe- rience level, theoretical orientation and/or other factors may account for certain findings or lack of findings. Also, some studies may get results while others do not due to the type of conflict that is focused upon. Future research should focus on the conditions in which conflict similarity is a factor in a therapeutic relationship rather than simply whether it is or is not an influence on process and/or outcome. The preceding discussions of the findings of this study and of the methodological problems suggest a possible refinement Of the present study so that a more powerful retest of the hypotheses could be done. The new study, to begin with, would want to answer whether or not the Pt is being seen alone or seen along with others is an important consideration. That is, is there indeed a "diluting" effect on the T-Pt relationship when others are present which may, in part, have contributed to only partial support for the hypotheses in this study? The new study would allow for the two conditions of interviewing to occur in sufficiently large numbers so as to test for this possibility. Secondly, a large enough number of Ts would be used to allow for the tests of the condition of therapy experience 116 to possibly show its effect on the interactions between T-Pt conflict similarity and the judgments under consideration here. Thirdly, the DCS Coefficients would be the index of conflict similarity that would be used although it is clearly useful to also investigate defensive similarity. Finally, the Scoring Manual would be modified in that the unstructured items would be more heavily weighted in importance. This would partly compensate for the problem Of test SOphistication. The findings of this study have an implication for the training of new Ts. Since the liking of a Pt is a particularly important consideration for a young T in his consideration Of his relationship with the Pt, and since liking Of Pts appears to be more negatively related to conflict similarity for the inexperienced T in this study as compared with the more experienced Ts that were used, there is an implication to this. That is, effective training Of new Ts should heavily emphasize the necessity Of a T getting to know himself and his unresolved conflicts, either via intensive supervision of therapy or via the T's own personal psychotherapy, or, preferably, both. CHAPTER VI SUMMARY ..1 As early as 1910, Freud (1953) recognized that a I“ psychotherapist's own personality and attitudes affect the course of psychotherapy and that a therapist's unresolved ' neurotic problems can adversely affect the process of E} therapy. Despite this early warning, little therapy research done prior to 1950 focused on the important variable of the T. Since 1950, however, a large quantity of research has investigated personality or personal variables of the T or has dealt with a variety of factors involved in the T-Pt interaction. Despite this vast quantity of research, little had been done with regards to investigating the area of T conflict as it relates to the process Of assessing Pt prog- nosis for improvement with therapy. The purpose of this study was to examine the effect or influence of T-Pt conflict similarity upon the T's prog- nostic evaluations of his Pts. Also investigated were the effects Of perceived patient motivation, T's liking Of his Pts, and degree of T's interest in doing therapy with his Pts upon the therapy prognosis ratings given to Pts. 117 118 Further, the relationship between T-Pt conflict similarity and each Of these three variables was examined. A review of the literature having relevance to the present study indicated that there was some evidence sug- gesting a relationship between a T's attitudes towards a Pt and the therapy prognosis that he gives the Pt. Studies interested in the effect of T-Pt similarity or complementar- ity on the therapeutic relationship are mixed in their conclusions. Several studies found no relationship between the degree of T-Pt similarity and therapy outcome and/or process. Several other studies suggested that a curvilinear relation- ship exists between T-Pt similarity and therapy outcome and/ or process, with a medium amount Of similarity being most associated with favorable therapy outcome. A third group of studies presented evidence to suggest that T-Pt similar- ity is a positive factor with regards to therapy process and/or outcome. Finally, the fourth and largest group of studies suggested that certain kinds of T-Pt similarity adversely affects therapy process and/or outcome or that a complementary relationship between the personality factors Of T and Pt is most desirable. It was hypothesized that, for any given T, the therapy prognosis ratings given to Pts following initial appointments will be positively related to the degree to which the Pts are perceived as being motivated for therapy LL .. , 119 (Hypothesis 2B), to the degree to which the T likes his Pt (Hypothesis 3B), and to the degree to which the T is inter- ested in doing therapy with his Pts (Hypothesis 4B). It was further hypothesized that, for any given T, the degree of conflict similarity between the T and his Pts will be nega- tively related to the therapy motivation ratings given to the Pts (Hypothesis 2A), to the degree to which the T likes his Pts (Hypothesis 3A), to the degree to which the T is interested in doing therapy with his Pts (Hypothesis 4A), and, most importantly, to the therapy prognosis ratings given to his Pts following initial appointments (Hypothesis 1). The gs were five male Ts. For each T, the first eight consecutive Pts who met the criteria of the study were used in the data collection. Prior to any Pt contact, each T was given the Blacky Pictures (BP) according to the stan- dard instructions (Blum, 1950). The Pts were also adminis- tered the BP prior to their first appointments with their Ts. Immediately after finishing the initial interview, the T rated his Pt with regards to his therapy prognosis for the Pt, the degree of motivation he perceived in the Pt, the degree of liking he had for the Pt, and the amount of inter- est he had for doing therapy with the Pt. The BP protocols were scored according to a system devised by Blum (1962). This method yielded scores on 30 factors. The indices of conflict were the scores Obtained 120 on the factors. The degree of conflict similarity between a T and each Of his Pts was determined by computing product- moment correlation (Walker and Lev, 1953) between the T's scores and the scores of each of his Pts. TO test the four hypotheses involving conflict similarity, a rank correlation coefficient (Siegel, 1956) was computed between the ranks Of T-Pt Conflict Similarity Coefficients and the ranks of the rating in question. Each T was considered an independent test Of hypothesis in ques- tion. The Kolmogorov-Smirnov One Sample Test (Siegal, 1956) was used to test the significance Of the five Ts, under each hypothesis. The scoring of the BP protocols proved to be quite reliable with an r==.94 being Obtained between Judges A and B. Also, these two judges agreed 84.22 percent with regards to the subjective items only. The results of the study were that three of the seven hypotheses tested found support in the data while the remaining four were not supported in the original data analysis. As had been predicted for the total group of five Ts, the therapy prognosis ratings given by Ts to their Pts were found to be positively related to the degree to which the Pts were perceived as being motivated for therapy (p<<.01), the degree to which the T liked his Pts (p<<.05), and the degree to which the T was interested in doing therapy with his Pts (p<<.05). 121 Contrary to what had been predicted, four of the seven hypotheses originally did not find support in the data. These were the ones which predicted a negative relationship between T-Pt conflict similarity and perceived Pt therapy prognosis, perceived Pt motivation for therapy, amount Of liking for Pts, and the amount of interest in doing therapy with Pts. Several alternative explanations for the original lack Of support were presented and discussed. It was con- cluded that the most likely reason for the original lack of support was that conflict was not appropriately measured by the original method and, in fact, the original Conflict Similarity Coefficient was a combined measure of conflict similarity and defensive similarity. When post hoc analyses Of the data were done with conflict similarity and defensive similarity being consid- ered separately, the hypothesis which predicted a negative relationship between conflict similarity and liking of Pts was confirmed for the T group. Also, when Ts were looked at individually, there were several instances in which defensive similarity was positively associated with various T judgments and/or conflict similarity was negatively asso- ciated with these judgments. The various findings were discussed with particular attention being focused on the differential responding of Ts to T-Pt conflict similarity and T-Pt defensive similarity. 122 A more powerful study to further test the conflict similarity hypotheses was proposed. The details of the new study were based on the methodological problems encountered in the present study as well as the results Of this study. Finally, some consideration was given to the application of the present results to the training of Ts as well as a proposed explanation for the highly variable results gotten in previous similarity research. APPENDICES Ls \Cm APPENDIX A SCORING MANUAL CARTOON I Factor I-A. Oral Craving THEME: (l) B is too Old to be nursing. (2) B is too large. INQUIRY: 3 b 4 a 5 b 6 a RELATED COMMENTS: (1) Food (2) Water (3) Hunger (4) Containers (5) etc. (6) "Bone" is not scored in this category. PLEASE NOTE: 0 Related comments are not scored on Cartoon I. 0 One point is given for each cartoon having related comments, but only one point can be assigned to any one cartoon even if it has two or more comments. 123 124 Factor I-B. Oral RejectiOn THEME: (l) M rejecting or strongly disinterested. -disgusted -tired -petered out -reluctant to feed B -wants to get away -all played out (More than "not paying attention" or "only doing duty.") INQUIRY: mtnpuOka OOOOU‘ 125 Factor I-C. Sugar Coating, (Defensive Style of Responding) THEME: (l) M contented or enjoying herself while feeding B. 5 -M quite happy. -M very cooperative. INQUIRY: 1 a 2 a 6 a PREFERENCES: LIKE . LIKE BEST :>' score one p01nt for each 126 CARTOON II Factor II-A. Playfulness (Defensive Style of Responding) THEME: (including item 1 of inquiry) (l) B playing with collar. -acting tough 1 -playing E -pretending to fight collar u_J -pretending collar is enemy or beast (2) B exercising body, sharpening teeth, expending energy INQUIRY: 3 c ' 4 a PREFERENCES: LIKE score one Oint for each LIKE BEST P 127 Factor II-B. Supply Seeking THEME: (including item 1 of inquiry) (l) B feels deserted by M. -B is angered by M's desertion. -M has gone Off and B wants her. -M died and left him. -B has a left-out and lonely feeling. INQUIRY: 2 3 4 5 6 U'DIU'WO RELATED COMMENT: (l) Stealing food or bone PLEASE NOTE: 0 One point per cartoon 0 Do not score on Cartoon I Factor II-C. 128 Resentment Over Oral Deprivation THEMES: (including item 1 of inquiry) (1) (2) (3) Feeding reference implying deprivation. B is mean; uncontrollable rage. Violence or physical struggle involving M. -B has just killed M. -B fought with M. -He wrenched the collar from her neck. -Someone else took M away by force. NOTE: Score one point for each theme INQUIRY: 3 b PREFERENCE: Worst 129 CARTOON III Factor III—A. Exploitation THEME: (l) INQUIRY: PREFERENCE: B doesn't want to dirty own place, smart to go elsewhere. -B has sense enough not to relieve himself outside his own house. He has learned better. -B's pretty wise not messing up ground around his own house. Smart dog. -B being a clever dog has chosen a spot far removed from his own kennel to relieve himself. -B is a very clean dog but has selfish habit Of leaving his stool near his parents' doghouses. d c d M will scold B (not bark at him or punish physically) P will scold B (not bark at him or punish physically) LIKE 130 Factor III-B. Choosing Obvious Neutral Responses (Defensive Style Of Responding) INQUIRY: l c 2 b 3 c 4 a 4 c 5 Nothing 6 P will say nothing or will let M handle the situation. 131 Factor III-C. Attempted Denial of Anal Preoccupation (Defensive Style of Responding) -B buried a bone between one Of the huts the day before and now he can't seem to remember exactly where. -Here B is digging to bury the collar. —Here he is digging, using up energy and attracting M. we -B seems to be kicking up some dirt. This is to release some energy he's stored up. J THEME: (1) Complete omission or denial of anal reference. FA 3 m1 'h INQUIRY: 1 d 3 a 5 M will bark (not scold). RELATED COMMENTS: Later reference to Cartoon III, defecation or the anal region. -B looks on with certain misgivings for he has a faint suSpicion that he will also get it in the end (Cartoon VI). -B has just taken his morning's morning in front Of his parents' houses again. He knows he shouldn't have and P is out to get him and beat hell out of him (Cartoon Ix). -Maybe they have something to do with how I defecate, don't know what these fool things are (Cartoon V). -B's conscience is bothering him for his defecating on the floor of his house (Cartoon IX). NOTE: Score one point per cartoon. 132 CARTOON IV Factor IV-A. Undisguised Oedipal Involvement THEMES: (including item 1 of inquiry) INQUIRY: (l) B competitive toward P. -B wants to make love feels hostility toward P. -B wants to be in P's place. a -P is B's rival. i -P is inferior to B. (2) B wants to love M. -B wants to make love to M. -B has a mother complex. . -Oedipus complex. =’ ~ -B loves M. J -B desires incest. L 3 a 4 c 5 P will punish B physically (e.g., beat him... spank him...bite him...kick him...). 7 (Answer to question "why?" in conjunction with choice of alternative "b.") Sexual aspects of B's relationship to M. -Then P would be able to Observe the up-to-date approved methods of lovemaking. -Incest. -B would be having the fun and I'm all for B. -M and son neck. RELATED COMMENTS: (1) (2) Connotations of oedipal involvement on other cartoons. -B is very much in love with his M and stays near her all the time. -By shaking M's collar which represents M, B is attempting to forestall a mother complex. -B was very disappointed because M had not shown her love for him. -He wants to come between his M and P. Sexual love reference involving B and M on other cartoons. -M seems to be in ecstacy while mothering B. Yet it is natural. However the drawing is unnecessarily suggestive. (3) 133 -B is using his sex urges for the first time, he is trying to get the relationship of his body to hers. -He probably wants M for other reasons than food. -Much more of this (discovering sex) and M had better watch out. NOTE: One point per cartoon including comments (1) and (2). B competitive towards P (on spontaneous story for Cartoon X). -B thinks he can do almost anything P does. -B figures he'll be as big or better than P. -B figures he got the best of P there. -B wants to be greater than P. 134 Factor IV-B. Disguised Oedipal Involvement (Defensive Style of Responding) THEME: (including item 1 of inquiry) (l) B wants attention (not affection). -B is no longer parents' only interest. -B wants attention. -B is spoiled. NOTE: Attention themes must be devoid of oedipal connotation to be scored. 3 b 4 d 5 Nothing 7 (Answer to question "why?" in conjunction with choice of alternative "a.") Father-son relationship is healthy. -It would show B and P are getting along so well. -Because father and son should be very close companions. -Two males are more common. -He shows too much attachment to M. INQUIRY: (Answer to question "why?" in conjunction with choice of alternative "b.") -B and M belong together more naturally. -It would be more natural because B is a boy and M is a girl. -It would seem more logical for the pup to be with his M. -Maternal love is considered stronger than paternal love. -It's the most usual picture. PREFERENCE: LIKE Factor V-A. THEME: (1) INQUIRY: :bN mm 135 CARTOON V Fear Of Punishment for Masturbation B is afraid of being discovered. -One eye peeks out to watch for parents. -B is watching to see if anybody is looking at him. b Yes, implication of yes, possibly. -B does fear something might happen to him. (In answer to question "What?" provided first part of item is answered "Yes.") B is afraid Of being discovered. M will scold, warn or stop him. P will scold, warn or stop him. Factor V-B. THEME: (l) INQUIRY: 1 3 4 136 Concern Over Sexual Maturation B is growing up and thinking about girls. -B discovered something new about himself and the sensations are pleasant, undoubtedly will develop into a healthy sexed dog and start noticing females in a different light. —B is maturing into an older dog and realizes certain organs of his body Operate to arouse a pleasant sensation when he sees a female dog. -This is the first stage from there through other stages to a family of his own. c T (In answer to question "What?" provided first part Of item is answered "Yes.") B doesn't know what he's afraid of. 5 M will explain, advise. 6 P will explain, advise or praise B. Factor V-C. THEMES: INQUIRY: (l) (2) 137 Denial of Masturbation Guilt (Defensive Style of Responding) Denial of B's concern. -B is washing himself just as all dogs do. There is nothing funny or no sex involved. -B chasing after fleas come across his genitals and is licking them. The taste is probably salty and B likes salt; he has no other view in mind and is merely reacting as all dogs do to salt solutions on their bodies. -This behavior is not intrinsically immoral. -B sees nothing wrong in it. B chasing fleas, cleaning himself. -B is looking for fleas, trying to get rid Of fleas by licking them. -Shows he's been brought up well by family, taught to keep himself clean. NOTE: Do not score here if "cleaning" and sexual reference are mixed together in the same story. l a 2 a 3 B is not thinking of anyone here 5 Nothing 6 Nothing Factor VI-A. 138 CARTOON VI Overwhelming Castration Conflict THEMES: (l) B is wondering if he's next; doesn't know he's next. -He is a little worried about his meeting the same fate, and also feels sorry for T. _ -B wonders when it will happen to him. wfi‘f (2) INQUIRY: 1 3 3 4 4 5 6 PREFERENCE: -B is somewhat disgusted but more afraid and worried, for his turn is next. B feels sorry for T. -B is very sad because T is going to have her _+k tail cut off. 3 ' -He thinks, "Poor Tippy." k‘ -He knows that it is being done for her beauty and can't do anything about it but he is sympathizing with her. Yes (Why?): B would rather have his own tail N U'U cut Off than go through the suspense Of wondering if it will happen to him. O (Why?): B is too frightened to have it cut Off right away -NO, because he's afraid to get his tail cut Off. -NO, because B doesn't know if it would hurt or not. -NO, he will be afraid Of the pain seen in T. -No, because he does not want to be afraid. WORST 139 Factor VI-B. Minimizing Castration Anxiety THEMES: INQUIRY: (Defensive Style of Responding) (l) B is hanging around and watching curiously. -B saw T in a strange situation and stood around to see the results. -In general, he will be a curious bystander. -B seems naively interested in this procedure; a smarter dog would not be in the vicinity. (2) B minimizes the whole situation. -As T is blindfolded, B watches T lose her tail with apparently no emotion. -T's going to get hurt but B is not at all worried; he doesn't even care. (3) T afraid, puzzled, upset. -B is not apprehensive because nothing has yet happened, but T is because she is blindfolded. -Poor T is terrified and will surely let out a howl when he loses his tail. -T is nervous since this never happened to her before. -T is scared. O (Why?): B is not concerned about his own tail. -No, he doesn't expect it himself. -I don't think he thinks anything about his tail. -NO, I don't think he is worried. —Doesn't concern him, not Old enough to think about it. ““35 1L.“ 140 CARTOON VII Factor VII-A. Father As Preferred Identification Object THEMES: (l) B is imitating P. -B has at last found someone to boss around. He is trying to act like his father. -B is pretending he's a papa dog and telling some smaller dog man to man stuff. -B is feeling fatherly toward the toy dog, playing house. (2) B is jealous Of the toy, dislikes it. -The vicious feeling that he is seeing a new aspirant for attention in his neighborhood makes him mad. -B looks angry at the toy, as if he dislikes it. -B thinks this dog is going to join his family, he doesn't want any more dogs in the family and he is going to growl at the dog and hit it to scare it away. INQUIRY: ("M and P" not scored on any Of these items) 1 2 3 4 5 6 O'U'U’U'U'U PREFERENCE: LIKE 141 Factor VII-B. Mother As Preferred Identification Object THEME: INQUIRY: (1) UlubWNH B is imitating M. -B is doing the same thing to the toy dog as his mother does to him. -Here B is playing like M and pretending that the toy dog is himself. ("M and P" not scored on any of these items) M M M M M 142 Factor VII-C. Evasion of Identification Issue THEME: (l) INQUIRY: mmwai—a (Defensive Style of Responding) B is playing, pretending. -B is playing with the toy dog, it looks as though he's having fun. -B again is playing in the land of make-believe. Here he thinks he is company commander giving orders to his men. 0-60-3888 Factor VIII- THEME: (l) INQUIRY: 1 2 3 4 6 143 CARTOON VIII A. Overt Hostility Toward Sibling and Mother B has hostile feelings -B doesn't like T because she's a "parent dog"; he'll get even. -B hates T now. -He gets madder and madder as he watches the proceedings. ZOWOQI RELATED COMMENT: Cartoon IV, Item 4a (B suspects M and P are planning an addition to the family.) 144 Factor VIII-B. Reaction-Formation to Sibling Rivalry THEMES: (1) (2) INQUIRY: 1 2 3 5 6 PREFERENCES: (Defensive Style of Responding) Emphasis on B's happiness. -B looks like he is happy. In a minute he will probably join them so he can get into the picture too. -T is being rewarded for some commendable act; B is looking on with admiration. -He is proud of his family. They have short- comings but so what? He wishes he had a camera so that he could record this tender scene for posterity. Denial or minimizing Of B's concern. —SO they're trying to make me jealous, eh? Well, I don't give a damn and they can't make me jealous anyway. -B is now becoming more used to the idea of not being the center of attraction and doesn't get angry so easily. -B is not disturbed but simply wondering why T is getting so much attention. -B is watching with apparently little or no feeling while M and P caress T. is not angry at anyone. LIKE BEST score one p01 0 ea 145 Factor VIII—C. Rejection In Favor of Sibling THEME: (I) INQUIRY: 1 2 4 5 PREFERENCE: Strong feelings of rejection. -B seems to be the black sheep Of the family. He is very unhappy at being left out of things. -B will either break up completely and start weeping and then get mad or he'll become a delinquent dog. —B probably thinks he is not loved by anyone and is contemplating running away at this moment. -B is hurt, angry, and has a feeling of betrayal. -He feels left out and unwanted, nobody cares about him and they don't even see him. OU‘U’Q: WORST 146 CARTOON IX Factor IX-A. Partial Denial of Guilt THEME: INQUIRY: (Defensive Style of Responding) (l) B in relation to the hereafter or God; B's own death. -B shakes and shudders as he thinks of his horrible past as he can see an angel condemning him to Hell. God have mercy on B. -B's afraid that his affair with T will keep him from a dog's heaven. -If he kills himself he will certainly go to a bad place--Hell! -B has just discovered religion and has come to wonder and worry about death. 2 c 4 c 5 c 6 (l) B will be morose, sad, sulky. -B will cry and give up hope. -B will feel very badly. -He'll worry a lot but not do much. -B will go off and sulk. -He'll run to his M and cry on her shoulder. (2) B might die. —He'11 crawl in a hole and die. -B might kill himself. "'7 147 Factor IX-B. Guilt-Ridden Hostility Toward Sibling THEME: (l) Hostility toward T. -I would say that B had murdered T. -He thought it over and decided to kill T. -He has been extremely cruel to T and now his conscience bothers him. -B just stole T's food and was congratulating himself on his exploits. INQUIRY: l Hostility toward T. -He might have bitten T. -He beat T up. —B has murdered T. -B did something to be blamed on T. a T a a B will wait for the worst; exPect punishment. -B will sit back and let himself be blamed for his crime. -He'll pay for his wrong. -He'll go home and face the music. -He'll take it like a man. 7 a 0‘01wa 148 Factor IX-C. Qualification of Pervasive Guilt (Defensive Style of Responding) THEME: (l) Guilt will be long-lasting; depressed, despondent. —He comes to the conclusion that he is a very worthless character compared to other dogs. -He feels very low. -Here B is beaten and dejected. He feels that no one loves him and he might as well leave. -He can't sleep. It keeps coming back to torment him. He did something he shouldn't of and now he keeps thinking of it. INQUIRY: 2 b 5 b 7 b PREFERENCE: WORST RELATED COMMENTS: Reference to Cartoon IX or conscience. -He wants to be the envy of all the other dogs, also compensate for his wrongdoing. -The trouble with his conscience is over now and he has forgotten it. -B feels guilty that he's not barking or in some way warning T. -Nevertheless B is a neat, well-mannered dog and is putting dirt around it. He is ashamed of what he did. NOTE: One point per cartoon Factor X-A. THEME: (l) INQUIRY: 1 2 4 5 PREFERENCES: 149 CARTOON X Overtlnyositive Percgption of Self and Father (Defensive Style of Responding) P esteemed positively. -B has always admired the gracefulness of his father. He dreams he will grow up to be as fine a dog as P and maybe a little better. -B is dreaming that he is grown up and a famous hunting dog, strong, proud, and smart. Perhaps his father was once a dog like this or he just wants to be this of his own volition. -B dreams that someday he will be a great hunter that his father is. avorably WOJW'U LIKE :> so re one int for each LIKE BEST 0 9° Factor X-B. THEME: (l) INQUIRY: 2 3 5 6 150 Negative Perception of Self and Father B is indulging in wish-fulfilling fantasy. -B dreams he is a super dog, very handsome, strong, and perfect form. -By golly, I'm going to be the best bird dog possible. -Here he is a knight in shining armor, all- powerful. -He's dreaming of what he'd like to be when he grows up. Not as good. c c a RELATED COMMENTS: Any reference on Cartoon XI back to Cartoon X. Factor XI-A. THEME: INQUIRY: (l) 1 2 3 4 5 151 CARTOON XI Mother-Surrogate As Love Object Dream figure is M or resembles M. M M b b Comparable -M is pretty close to the dream figure. -M compares fairly well. -They're similar. —Okay. -M is not as beautiful but just lovable in a different way. rm xiii-‘1 , Factor XI-B. THEME: (l) INQUIRY: PREFERENCE: 152 Heterosexual Fantasy, (Defensive Style of Responding) B thinks the dream figure is unattainable. -He feels that she is perfection and he has little chance of attaining her. -In real life he knows he can never marry anything as nice as this dog. -He likes her very much, hopes she likes him, is afraid she doesn't. The dream figure doesn't remind B of anyone. c c Is no similarity between M and the dream figure. -Not very alike. -No similarity between them. -Not at all. -Out of the question. NO. (answer to question "Why?"): B doesn't like effiminate boys. -No, he's no sissy. -No, he's not really a fairy. -To be like her wouldn't be masculine. LIKE BEST Factor XI—C. THEME: INQUIRY: (l) 1 2 3 4 6 6 153 Narcissism The dream figure is B or resembles B. Himself Himself a a Yes (answer to question "Why?"): Because the dream figure is a superior kind of dog. —Yes, he could show up everyone else. -In some ways perhaps because she is gentle and sympathetic. -Yes, because it's good-looking. APPENDIX B PATIENT THERAPY PROGNOSIS RATING FORM Using the scale provided below, please rate your patient with regards to the degree to which you consider his prognosis for improvement in therapy as being favorable or unfavorable. It does not matter whether or not you plan upon seeing your patient in therapy. Rules for Ratipg 1. You are to use your own personal criteria of what decides a favorable or unfavorable therapy prognosis. 2. Rate your patient immediately after seeing him for the first time. 3. Circle the number on the scale which you think is appropriate. THERAPY PROGNOSIS RATING SCALE -lO/-9/—8/—7/-6/—5/-4/-3/-2/-1/ +1/+2/+3/+4/+5/+6/+7/+8/+9/+l0 Unfavorable Favorable Patient's Name Therapist's Name Date of Rating 154 APPENDIX C PATIENT'S MOTIVATION FOR THERAPY In my Opinion, this patient's motivation for therapy is: l extremely weak--so weak that he might very well have been "forced" to come to the clinic. 2 :> weaker than most people I have interviewed. 3 4 about average as compared with other peOple I have interviewed. 5 :> stronger than most people I have interviewed. 6 7 extremely strong. 155 ~m... " _ APPENDIX D THERAPIST'S INTEREST IN DOING THERAPY I have: T f u 1 no interest whatsoever in doing therapy with this A} patient. EV 2 less interest in doing therapy with this patient than with most peOple I have interviewed. 3 4 an average amount of interest in doing therapy with this patient. 5 more interest in doing therapy with this patient than with most peOple I have interviewed. 6 7 seldom been as interested in doing therapy with a patient as I am with this patient. 156 APPENDIX E PATIENT LIKABILITY SCALE In my Opinion, this patient is: 1 so unlikable that I feel I would be ineffective as J a therapist with him. 2 more difficult for me to like than most of my patients. 3 more difficult for me to like than some of my patients. 4 about average in likability as compared to the rest of my patients. 5 more likable than some of my patients. 6 more likable than most of my patients. 7 one of the most likable patients I ever interviewed. 157 APPENDIX F THERAPIST-PATIENT CONFLICT SIMILARITY COEFFICIENTS Therapist II III IV Patient ra Rank r Rank r Rank r Rank r Rank A .165 6 .459 5 .052 8 .422 2 .233 6 B .399 2 .617 l .300 6 .139 7 .796 1 C .219 5 .347 6 .335 4 .274 5 .391 4 D .148 7 .004 8 .332 5 .339 4 .231 7 E .716 l .569 2 .069 7 .184 6 .060 8 F .072 8 .338 7 .400 2 .394 3 .310 5 G .297 4 .478 4 .383 3 .648 l .521 3 H .354 3 .483 3 .506 l -.003 8 .669 2 aPearson Product-Moment Correlation. 158 THERAPIST-PATIENT RESPONSE DEFENSIVENESS APPENDIX G SIMILARITY COEFFICIENTS Therapist II III IV ra Rank r Rank r Rank r Rank r Rank .386 6 .310 5 -.246 8 .259 5 .090 7 .069 8 .590 l .159 5 .193 6 .832 1 .586 4 .373 4 .194 4 .527 2 .356 5 .325 7 .162 7 .030 6 .107 8 .247 6 .700 2 .433 3 .002 7 .335 3 .050 8 .612 3 .139 8 .605 l .312 4 .653 3 .388 5 .274 6 .384 3 .672 l .757 2 .874 l .524 2 .470 2 .116 7 °633 4 aPearson Product-Moment Correlation. 159 .‘s, 160 .mcflumu mfimocmoum >mmuone @ .mcaumu ammumnu How coflum>fluoa m.ucmflummo .mcHuMH ucwflumm onu sues mmmuonu mcwoo cw umououcH n .maHume suHHHnmxHH HemHumem e+ e m m m- m m m e- N v e H+ m m m m+ m m m m e+ m e e m- m e e m+ e e m m+ v m e m+ e m m 0 4+ m e m m- m m m m- m m m 4+ m e m m- m m e a m+ e e m m+ m e m m+ e m m m- m m a 5+ m m m m H+ m m m m- m m N H+ m m m m+ e m e m- m m m a e+ m e m H- e e e m+ e e e m+ e e m m+ a e e o m+ m e e m- m m N e- v m m m+ m e m m- H H m m m+ m m m a- H e N ~+ e e m ~+ e e e e- m m e a me 28 H9 am m8 :9 HB an m& SB HB am me 28 H8 Am ©m9.o£fi QHB mam ucwwumm > >H HHH HH H umfimmumna mBZmHfifim mHmmB m0 WUZHeflm AflUHZHAU .mBmHmdmmmB m xHOmemd APPENDIX I THERAPIST-PATIENT DIRECT CONFLICT SIMILARITY COEFFICIENTS Therapist II III IV Patient r Rank r Rank r Rank r Rank r Rank A .183 4 .445 5 .347 5 .438 2 .011 7 B .559 2 .479 3 .425 3 .396 3 .532 1.5 C .118 5.5 .303 6 .403 4 -.082 6.5 .221 8 D .075 7 .054 8 .293 7 .305 4 .533 1.5 E .582 l .548 2 .140 8 -.122 8 .255 4 F -.267 8 .000 7 .453 2 -.082 6.5 .125 5.5 G .276 3 .470 4 .504 1 .537 l .513 3 H .117 5.5 .733 l .308 6 .110 5 .127 5.5 161 APPENDIX J THERAPIST DATA FORM NAME: AGE: DEGREES HELD: PROFESSIONAL AFFILIATION (PLEASE CIRCLE ONE): CLINICAL PSYCHOLOGY PSYCHIATRIC SOCIAL WORK PSYCHIATRY NUMBER OF YEARS FUNCTIONING AS A PROFESSIONAL: APPROXIMATE NUMBER OF PATIENTS INTERVIEWED: APPROXIMATE NUMBER OF THERAPY HOURS DONE: MAIN THEORETICAL ORIENTATION: 162 APPENDIX K PATIENT DATA SHEET NAME: AGE: MARITAL STATUS: (CIRCLE ONE) SINGLE MARRIED SEPARATED DIVORCED EDUCATION: (CIRCLE ONE) 1 2 3 4 5 6 7 8 9 10 ll 12 l 2 3 4 Grade School Jr. High High School College OCCUPATION: Have you had previous counseling or psychotherapy? 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