. Ir, Iii . iflufi‘wfiowu‘; Imuu IIITIHI'II-I _ L IIIIIL'II‘"; ' III I II'fzI'Ifl—W . m T.- III III IIII I ‘IIl‘Q IQI‘I’I IIIIII-III'IQQQh I II IIIII QQQQQ] ”M I IIIIIIII II :IImII‘I IIII ml: QIIQTI. IAIIIQIQJ III “IQ-IQ“ I'II "HQHQQQQQ “.1” \QRII'V I Q .QQQ' QQQQQ Q'I I‘IQi 'IIIQ’ Q I I}. NI”! QQ “III: QQ IIII . I l n IIIIIthL 'an Q Q ‘M .n Q l IIQII . "QLQQ IQI'IQI'I IIIIII Q QIIII A‘IQQ‘ QIQQQQIIQ| II 'IIIQQIIIE “I" QQ (I. , III Q' III ‘Q QHQ IMMI. 'QI" IHQI .L 'I'IIE' ~ ““4de QQQQIQw. l IN ijE; QOIII 'QQI'I I II“ "QQQQQ‘QQQ QMIQ‘ Q QQIQIUQ Q Q Q ‘ iJl' II 'r'II'h‘I'IQI Q-Q" I III. Qh‘ IEI'IIQI‘QI .QQQIQQ' I lull."QQuch “Iiiii Q5“ JUQHQQQMHUQ IL«.IQ;"QQQ QQII‘Q Q‘QQ'I' Q uplQQQQ L'u- 5" Q-QQQ QQQQM ”I". -"Q”‘Q“'“r.rf hm ‘3 0"" IHW J m 'QI‘QQQHI Q5153“ QWQ'QQQQQQQQQ . I'II ‘Q;‘ ‘ 5 ‘ H Q 'QQQQ'Q QQ ""QQQ‘QwL QM. ' Q . {Q'Q'q .fQQQQ I Q'Q'Q'Q " w w -. n» ." ""1 .L 'Q‘” ~ [I I IQJQQJQII' 'ImIII IIII 6Q | Q “MUMQQIQII ”IN ”I Q I Q {INQIQ Q QIII|Q§11 I ‘ [HQ IINI. H, Q I QQIL'IQII ' Q I Q I H "‘ QQ'I' 1mm“ "5% Hr QI‘Q‘QQ'QQ)" 'I'IIQIIQ'IQIQQ‘Q‘Q” """ «Ni-1.] 50.3” A": QQL' QQQQ': "" .. ,I “.IIQ Q I'Qm u I ‘Q QHIIIWH'Q" “*QQJI Qm "QQIQQQQ QQQUQQ Q‘Q‘QQQIII' II I'MQQJIIL QQQ' QQLQQQ ~. QQQQT: ’5 I JLQ Q1 HLIQ 5 I IIIII'IIQQII QQQIQ'QIQ I I QQQQQQII IQ'I-II II"Q IMQIII HHQIQIQ II‘I‘I-II I Q IQ . _ MI QMQQI QQ'QQB‘Qlf"; . '* Q ~I‘J . 11“,! with“ zhféfw ‘QQF 5o} II:QQ- «It |_. IIIQuImII I QQIQ' IIIQW ‘h ‘— 3 I " QQIQ' . M" ".Q eQQQI. .l JQQII I I 4 KIIg’II -. m:j5I1III~§LI¥!II L Q”; ' fI'Q ' III I “‘33; Q III; Q. IQ II‘“ 1|lI III . . I- 'u': Q11- Ma"- Q‘Q‘LQQQ'Q’ "QQQIQ: tn Ifm TILL 53': IQQ/I‘IQ-I‘am,“ QQLQII Q51. (g ~1'Q1QQQE‘QQQQI: r IIIL’II X; 3:75;“? ch S} .Q I" if] I I lIIHIE %‘ " ("Q {I 'Qn I I I I I I "Q . I. Q . I 5'31. 'Q‘-';.:Q .LQ'Q.‘ '% Q’J’f‘wlc. I Q" QQQQQ ' "Q; .Q QQ. IQI'uQ5 Tfiig 2351;555an *QUQ'QQ‘fiQQ 9Q. 5:: - 'JLHQI Q I'QL-QQ‘MQQQI' Q ”w I I M 'IQI 'I1_'|.'. IIN' h. my 4 1'7: [1 I! .7 (‘15 v ‘1 ”($15“ "$5 "at!” J ' :3": P .4I_I.IL:Q 5Q“: I ': 50-51 . II-N'Q'I'I. I. I I5L:EVI III/g HQ \. QQ'" (Q'fi 9;: .1. “'I a; 7. 1 ; I..I‘IIIIIIv; .~ It. . . ._ . II I 1- , III I ‘5‘ . L II1L' . QQ'Q A :57'fi-‘ZQvtnflshlfifi _ w ' . '; y . ‘ .., . LI ..J':1Ju...‘1w.-‘ - v - ." LIV, II 4 1.. . I ”I .’ '4' 19,. ‘I'Ql' .. I“ ’5 - v‘ "7 "L' ‘ ‘ Q Q‘Q“ 51f! I" Q‘ 5"” G")! ‘Q'Q’-" AQ 1. «his? . II. _ 2.5; .1, 1 . I. ‘ ' 'Q 'lQioI. II’L [71‘ " IIW QQUIIII WI“ L 5.354.552;th ‘ LII ‘ r ‘ :u 7' 5' '5'” PSI , I'II I by! I'I ,I; I‘ ‘ '1'thng 3“" "7"” Q5145?” QQIQIQQ . #:3351393 ITIleQ'JQJI (QQ‘LQ;S'l}'-I- "'Q.,Q,.’I'v’~v’ 1% '.‘.“I v 1' ~ 'L ~ ‘ "4 ‘. I '1 "Q I '31:). L I . L’II‘I'IQ'I "4 Q I - " _ L I . ' ' ' :3!“ 15”!“ 'IQQII'; :IQHI-‘Q’Mi' VIE-5 1"{QQW‘I1'5Q1'Q :9??? 4-- - I I , I 7 . n \ I I , .1 ‘ ’ I 5‘ .Q' .l L v "I v .7' V ' H" . .1. "I ' Il"'lrf;. \"Q. “Q Q ' 00:” Q‘ IQ'I'RQIII Q ‘1 'l 1.5111513; I555" 5' -‘o“"‘ :‘u- .I‘ ‘ IQL‘ , ”I .I.-. :‘5 ‘5 Di 'I‘JH'QII'QIH :Q:QII:' ' ”4",“ c. Q AQ.‘}JII'I.I"1|$IQI‘UQI MQI II LIQI’I ‘Q‘Q'v’ln II, a- I’I_'I' 'II_ J: TCIIII. In." 55:53.51.” -..II-_’~L " Q QIQ I I. I) ”Q :r: « . “ ....'--.- " "'1‘ W75": I-.'1,Q’Q‘;3n~'- QQQ' WNW” l ' L“:..'nQiQ' Q L " . HIM. ' *"Q Q Q LJQ u'lg'mt. wing": «W K'QQQN'Q' Q'Q‘QIQ'Q' , I. Q .I . ‘55 TI“ ' ..II “,1 '5ILI' I'm .‘ 'A‘ZEQII-Q‘I‘ II I HJ'IIIII IILII "IIIIIIII-I-IIIDL TI III‘JQI:I‘% III II ’ITI'.‘ QIQ I‘QIIIII III II [III 0" 5 I Milt," Q WM . ' ‘ ‘f_ Mu.ch nu QQQQQ h" .'*."LrQ ‘1 1 I . II . QT . I," . _ . .III. r" I» . . If ' , u] u v Q 5%“ J ”in: L‘s-.4 .HQ)! LL; 2:0: i't""'5 ”SUN-1'12 Hhhka‘d t-‘fiflflufl l-‘JUngfin ' "H E 3‘ ' ‘3 This is to certify that the thesis entitled Effects of Black Therapist Attitudes on Diagnostic, Treatment Recommendation, and Prognostic Estimates presented by Decolius H. Johnson has been accepted towards fulfillment of the requirements for Ph . D degree in Education My W/ ’ l Major p ofessor Date 11-26-79 0-7639 OVERDUE FINES ARE 25¢ PER DAY PER ITEM Return to book drop to remove this checkout from your record. G) 1980 DECOLIUS H. JOHNSON ALL RIGHTS RESERVED EFFECTS OF BLACK THERAPIST ATTITUDES ON DIAGNOSTIC, TREATMENT RECOMMENDATION, AND PROGNOSTIC ESTIMATES BY Decolius H. Johnson A DISSERTATION Submitted to Michigan State University in partial fulfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY Department of Counseling, Personnel Services, and Educational Psychology 1979 ABSTRACT EFFECTS OF BLACK THERAPIST ATTITUDES ON DIAGNOSTIC, TREATMENT RECOMMENDATION, AND PROGNOSTIC ESTIMATES BY Decolius H. Johnson This study was conducted to test the effect of selected black therapist attributes and selected black client attrib- utes upon the clinical judgments of black therapists. Ninety-six black social workers (48 males, 48 females) represented the sample for this study. Black social workers were typed as black-consciousness therapists or traditional black therapists according to their score on the Black Attitude Instrument (BAI). The BAI is a self-report instrument designed to measure attitudes held toward blacks and toward being black. A high score on the instrument indicated positive attitudes, and a low score indicated negative attitudes. Each black social worker responded to a randomly deter- mined case description of a black client (aggressive black male client, aggressive black female client, control black male client, or control black female client). Each black social worker reported his/her clinical impression of a black client by completing an evaluation sheet pertaining to diagnosis, diagnostic labeling, treatment recommendation, prognosis, liking for client, and sex-role apprOpriateness of the client's behavior. Fifteen hypotheses were formulated to test whether sig— nificant relationships existed between black therapists' type and sex, black clients' type and sex, and black therapists' clinical judgments. Outcome measures used to test these relationships were diagnosis, diagnostic labeling, treatment recommendation, prognosis, liking for client, and sex-role appropriateness. Multivariate and univariate analysis of variance was the statistical procedure used to analyze the data. The alpha level of .05 was set for rejecting the null hypotheses. Four- teen hypotheses failed to be supported at the .05 level of significance; one hypothesis was supported on one of the six outcome variables. The conclusions from this study are as follows: (1) Classification of black clients tended not to be influenced by black therapist type (black-consciousness and traditional). Positive and negative attitudes held by black therapists toward other blacks and toward being black did not significantly affect their clinical judgment of black clients. (2) Black clients exhibiting aggressive behavior were perceived as being as mentally healthy as black clients exhibiting nonaggressive behavior. The presence of aggres— sive behavior in black clients did not appear to affect the clinical judgments of black therapists. (3) Black male and female therapists did not signifi— cantly differ in their clinical judgments of black clients on the outcome measures of diagnosis, diagnostic labeling, treatment recommendation, prognosis, and liking for the cli- ent. Black female therapists did rate the black client's behavior as more appropriate for his/her sex than did black male therapists. (4) The sex of the black clients did not appear to affect the classification they received from black therapists. (5) Classification of black clients for treatment tended not to be influenced by any interaction between black thera- pist type, black therapist sex, black client type, and black, client sex. ACKNOWLEDGMENTS I would like to thank Ms. Consuella Reed, M.S.W., for sharing her professional knowledge relative to the role of black social workers in the mental health profession. My family deserves special recognition and great praise for being patient and tolerant during this experience. Finally, I extend my deepest feelings of appreciation to an old man, Adolphus Johnson, who dared to believe in the possibility of all things. ii TABLE OF CONTENTS LIST OF TABLES . . . . . . . . . . CHAPTER I. II. III. INTRODUCTION OF THE STUDY . Operational Definitions . Importance of the Study . Statement of the Problem Hypotheses . . . . . . . Limitations . . . . . . . Assumptions . . . . . . . Overview . . . . . . . . REVIEW OF RELATED LITERATURE Classification in Psychotherapy Influence of Black Therapist/Black Client Variables on Classification . Summary . . . . . . . . . METHODOLOGY . . . . . . . . Population . . . . . . . Sample . . . . . . . . . Procedures . . . . . . . Instrumentation . . . . . Design of the Study . . . iii Page vi 10 10 14 24 27 27 28 29 31 36 IV. V. Hypotheses . . . . . . . . . . . . . . . . . Data Analysis . . . . . . . . . . . . . . . . Summary . . . . . . . . . . . . . . . . . . . ANALYSIS OF THE DATA . . . . . . . . . . . . . Introduction . . . . . . . . . . . . . . . . Presentation of Data . . . . . . . . . . . . Hypotheses to Examine Main Effects of Thera- pist Type/Sex and Client Type/Sex . . . . . Hypotheses to Examine Two-Way Interactions Among Therapist Type/Sex and Client Type/ sex 0 O O O O O O O I O O O O O O O O O C O Hypotheses to Examine Three-Way Interactions Among Therapist Type/Sex and Client Type/ sex 0 I I O O I O O O O O I O O O O I O O O Hypothesis to Examine Four-Way Interaction Between Therapist Type/Sex and Client Type/sex O O O O O O O O O O O I O O O O O sumary O O O O O I O O O O O O O O O O O O 0 SUMMARY, DISCUSSION, IMPLICATIONS, AND SUGGES- TIONS FOR FUTURE RESEARCH . . . . . . . . . . Summary . . . . . . . . . . . . . . . . . . . Discussion . . . . . . . . . . . . . . . . . Implications . . . . . . . . . . . . . . . . Suggestions for Future Research . . . . . . . Limitations of the Study . . . . . . . . . . APPENDICES A. B. C. DEMOGRAPHIC DATA . . . . . . . . . . . . . . . BLACK ATTITUDE INSTRUMENT: PRETEST AND REVISED CASE DESCRIPTIONS O O O O O O O O O O O O O O 0 iv 37 40 41 42 42 43 43 48 54 58 59 62 62 65 68 69 70 73 77 83 D. EVALUATION SHEET (QUESTIONNAIRE) E. LETTERS OF INTRODUCTION . . . . REFERENCES.............. TABLE 1. 10. 11. 12. 13. LIST OF TABLES Reliability Coefficients for Diagnosis, Prog- nosis, Liking for Client, and Sex-Role Appro- priateness Variables . . . . . . . . . . . . . . Multivariate and Univariate Analysis Results for Hypothesis 1 Across Six Outcome Variables . . . Multivariate and Univariate Analysis Results for Hypothesis 2 Across Six Outcome Variables . . . Cell Means for Male and Female Black Therapists' Responses on Dependent Variable of Sex-Role Appropriateness . . . . . . . . . . . . . . Multivariate Hypothesis 3 Multivariate Hypothesis 4 Multivariate Hypothesis 5 Multivariate Hypothesis 6 Multivariate Hypothesis 7 Multivariate Hypothesis 8 Multivariate Hypothesis 9 Multivariate and Univariate Analysis Results Across Six Outcome Variables . and Univariate Analysis Results Across Six Outcome Variables . and Univariate Analysis Results Across Six Outcome Variables . and Univariate Analysis Results Across Six Outcome Variables . and Univariate Analysis Results Across Six Outcome Variables . and Univariate Analysis Results Across Six Outcome Variables . and Univariate Analysis Results Across Six Outcome Variables . and Univariate Analysis Results Hypothesis lO Across Six Outcome Variables . Multivariate and Univariate Analysis Results Hypothesis ll Across Six Outcome Variables . vi PAGE 35 44 45 46 47 48 49 50 51 52 53 54 55 14. 15. l6. 17. 18. 19. Multivariate and Univariate Analysis Results Hypothesis 12 Across Six Outcome Variables . Multivariate and Univariate Analysis Results Hypothesis l3 Across Six Outcome Variables . Multivariate and Univariate Analysis Results Hypothesis l4 Across Six Outcome Variables . Multivariate and Univariate Analysis Results Hypothesis 15 Across Six Outcome Variables . Multivariate and Univariate Analysis Results Effects of Selected Black Therapist and Black for Client Characteristics on Clinical Impressions of Black Therapists . . . . . . . . . . . . Mean Rating Scores for Black-Consciousness Versus Black Traditional Male Therapists on Selected Items Pertaining to Diagnosis, Treat- ment Recommendation, and Prognosis for Aggres- sive Black Females . . . . . . . . . . . . . vii 56 57 58 59 60 67 CHAPTER I INTRODUCTION OF THE STUDY Blacks have received increased attention in psycho- therapy literature over the past 20 years. The major focus of this literature is on the psychological differences and similarities of black clients as compared with white clients, and the white therapist/black client relationship. Research- ers have attempted to provide illumination to such issues as the white therapiSt's effectiveness with black clients and the nature of the therapeutic relationship within the white therapist/black client dyad. Little attention, however, has been given to investigating the relationship that exists between the black therapist and the black client. The emergence of black therapists in the mental health profession is a recent phenomenon (Bayton, Austin, & Burke, 1965; Wispe, Ankard, Hoffman, Ash, Hicks, & Porter, 1969). The number of blacks in the mental health profession has increased dramatically since 1960. This increase in black mental health professionals may be seen as a response to the declining role of the "preacher" as the traditional mental health caretaker in the black community (Ring & Schein, 1970). It may also reflect a response to the black commu- nity's increased acceptance of counselors, psychologists, psychiatrists, and social workers as legitimate providers of psychological services (F. Jones, 1972). Brieland's (1969) research indicated that a growing number of blacks are deliberately seeking the services of black therapists. During the past decade, black therapists have increased their efforts to address issues relevant to the welfare of the black client population. Their involvement is manifested through such organizations as the American Association of Black Psychologists and the National Association of Black Social Workers. These organizations focus on issues unique to the black therapist and black client populations. In order for black therapists to provide services which enhance the welfare of the black client population, an investigation of the relationship that exists between the black therapist and black client is crucial. This study will investigate the influence of the black therapist's attitudes and sex on diagnosis, diagnostic label- ing, treatment recommendation, prognosis, liking for client, and sex-role appropriateness of a black client's behavior. Operational Definitions Operational definitions used in this study are listed below. Aggressive-assertive black client. A black client whose case description reflects aggressive- assertive behavioral characteristics. Black-consciousness therapist. A black therapist who holds positive attitudes towards blacks on being black as indicated by his/her score on the Black Attitude Instrument (+l/2 standard deviation from the mean). Black therapist. A person of African descent who is in the helping profession of social work. Black traditional therapist. A black therapist who holds negative attitudes toward blacks on being black as indicated by his/her score on the Black Attitude Instrument (-l/2 standard deviation from the mean). Case description. A case history of a black client containing—information relative to identification data, the presenting problem, family history, educa— tional data, interpersonal relationships, and symp- tom picture reflecting predominantly aggressive- assertive behavioral characteristics. Classification. Diagnosis, diagnostic labeling, treatment recommendation, prognosis, liking for the client, and sex-role appropriateness ratings of a client. Control black client. A black client whose case description’is void of aggressive-assertive behav- ioral characteristics. Diagnostic labeling. Categorization of a black client's BEhavior according to Diagnostic and Statistical Manual of Mental Disorders, Second Edition (DSM—II). Diagnosis. Descriptive statements of the maladjust- ment and severity of maladjustment of a black client's behavior. Prognosis. Predictive outcome of a black client, With and without treatment intervention. Liking for client. Positive attraction for a black client. Sex-role appropriateness. A black client's behavior perceived as normal for his/her sex. Treatment recommendation. Prescription to deal with a Black client's behavior. Importance of the Study If black mental health professionals are to meet the challenge of an increased demand for their services within the black community, their attitudes and perceptions of black clients must be evaluated. Attitudes and perceptions of the therapist are basic treatment tools in the therapeutic encounter. The therapist's attitudes and perceptions help determine the meaning and clinical significance of such behavior as aggression and assertion and thus have implica- tions for the quality of psychological services rendered. The therapist may have negative attitudes toward the black client which influence his/her clinical judgment in such a manner that classification of the black client's dynamics is biased. Pasteur (1971) reported findings on the attitudes held by black counselors toward disadvantaged black male youths. He found that black counselors whose origin was "lower class" held more negative attitudes toward disadvan- taged black youths than did black counselors whose origin was "middle class." The black therapist's attitudes toward black clients may be shaped by the kind of training received. B. Jones et a1. (1970) suggested that clinical training pro- grams tend to psychologically "whiten" the racial identity of black therapists by ignoring the fact of race. This ten- dency, along with the absence of black supervisors as role models, is believed to foster a training climate that is not conducive to promoting strong identification with the prob- lems of black people. The implication is that black thera- pists, as a consequence of their training, may deny their racial identity and distance themselves from black clients. In so doing, the therapist's clinical judgment may be compromised and the black client may be inappropriately classified and treated. This study stresses the importance of having black therapists examine their attitudes toward black clients and being black in the classification phase of the therapeutic encounter. Also of importance may be the need to change existing classification criteria in mental health agencies to reflect relevant diagnostic, prognostic, and treatment recommendation estimates for black clients. Such classifica- tion “structure" may evolve from continued research of the black therapist and black client and then be adepted for use by black professionals concerned with this relationship. Ultimately, the uniqueness of the black client may require a therapeutic approach that addresses the specific needs of the black client. Problems which may hinder the black therapist/black client relationship have been identified. Further explora- tion of these problems is required if black mental health professionals are to respond effectively to the psychological needs of the black client pOpulation. Statement of the Problem Calnek (1970) postulated two distinctive types of black therapists. First, traditional black therapists are those therapists who prefer black clients who exhibit passive, nonassertive behavioral patterns. They perceive this behav- ioral pattern as an appr0priate and desirable response to frustrations encountered in one's daily life. Attitudes held by these therapists reflect the influence of racism in that passive behavioral patterns are seen as an appropriate sur- vival mechanism while aggressive behavioral patterns are viewed as inapprOpriate and maladaptive. Second, black- consciousness therapists are those therapists who prefer assertive and aggressive black clients. These therapists see aggressive behavior as symptomatic of mental health and as an appropriate response to racism and other frustrations encountered in daily living. Assuming that Calnek's assumptions regarding black therapist types are correct, then, what would be the effect on the classification process relative to the black client? This study will investigate whether black therapists (tradi- tional vs. black-consciousness) will render different classi- fications to a black client exhibiting aggressive-assertive behavioral characteristics as the primary symptom picture. The sex of the therapists and clients will be investigated to determine its influence on the classification of a black client. Hypotheses Hypotheses pertaining to the effects of black therapist type and sex and black client type and sex on the classifica- tion of black clients are as follows: H1: Black-consciousness therapists will give a more favorable classification to black clients than black traditional therapists. Black female therapists will give a more favorable classification to black clients than black male therapists. There will be no significant difference between the classification given aggressive black clients and nonaggressive (control) black clients. Black male clients will receive a more favorable classification than black female clients. There will be a significant interaction between black therapist type and black thera- pist sex in determining the classification given to black clients. There will be a significant interaction between black therapist type and black client type in determining the classification given to black clients. There will be a significant interaction between black therapist type and black client sex in determining the classification given to black clients. There will be a significant interaction between black therapist sex and black client type in determining the classification given to black clients. There will be a significant interaction between black therapist sex and black client sex in determining the classification given to black clients. There will be a significant interaction between black client type and black client sex in determining the classification given by black therapists. There will be a significant interaction between black therapist type, black thera- pist sex, and black client type in determin- ing the classification given to black clients. There will be a significant interaction between black therapist type, black therapist sex, and black client sex in determining the classification given to black clients. Black female therapists will give a more favorable classification to black clients than black male therapists. There will be no significant difference between the classification given aggressive black clients and nonaggressive (control) black clients. Black male clients will receive a more favorable classification than black female clients. There will be a significant interaction between black therapist type and black thera- pist sex in determining the classification given to black clients. There will be a significant interaction between black therapist type and black client type in determining the classification given to black clients. There will be a significant interaction between black therapist type and black client sex in determining the classification given to black clients. There will be a significant interaction between black therapist sex and black client type in determining the classification given to black clients. There will be a significant interaction between black therapist sex and black client sex in determining the classification given to black clients. There will be a significant interaction between black client type and black client sex in determining the classification given by black therapists. There will be a significant interaction between black therapist type, black thera- pist sex, and black client type in determin- ing the classification given to black clients. There will be a significant interaction between black therapist type, black therapist sex, and black client sex in determining the classification given to black clients. H13: There will be a significant interaction between black therapist type, black client type, and black client sex in determining the classification given to black clients. H14: There will be a significant interaction between black therapist sex, black client type, and black client sex in determining the classification given to black clients. 15: There will be a significant interaction between black therapist type, black therapist sex, black client type, and black client sex in determining the classification given to black clients. Limitations This study is limited in scope. The study is designed to focus on black social workers as representative of black psychotherapists within the helping professions. Real clients were not used in this study. The contrived nature of the stimuli (case histories) to which the subjects were exposed may have restricted their ability to respond as though they were dealing with real clients. There was no control over the conditions under which the subjects participated in the study. Thus, there was no way of knowing what external stimuli may have been influencing the subjects' behavior while participating in the study. Assumptions Basic to this study is the assumption that a therapist's attitude is a major treatment tool in the classification process and thus has a major influence on the course and outcome of psychotherapy. It is further assumed that a therapist's attitude toward blacks being black will influence the meaning attached to what is observed in the behavior of a black client. Finally, it is assumed that behavior is motivated by one's attitude and that behavior can be predicted. Overview Research studies and related literature pertinent to black therapist/black client variables and classification are viewed in Chapter II. The methodology of the study, including sample pOpulation, procedures, instrumentation, hypotheses, design, and statistical analysis, is presented in Chapter III. The results of the study are analyzed in Chapter IV. Finally, a summary of the study, discussion of the findings, and implications for future research are presented in Chapter V. CHAPTER II REVIEW OF RELATED LITERATURE The review of related literature covers major issues and problems associated with the following: (1) classification in psychotherapy as it relates to the effective treatment of the client, and (2) the influence of black therapist and black client variables on classification in psychotherapy. Classification in Psychotherapy Effective treatment begins with an accurate classifica- tion of the client during therapy. Its purpose is to commu- nicate what has gone wrong with the client, an appropriate treatment method, and the probable effectiveness of a treat- ment method in alleviating the problem. The use of traditional classification models such as the second edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-II) as a part of the treatment process has generated much controversy in psychotherapy. Therapists who adhere to the traditional medical model hold that an analysis of maladjustments based on symptoms and signs of the client is essential to the delivery of effective treatment. The ability to accurately label and/or make a statement about the psychOpathology of a client is viewed as a useful tool in the treatment process (Woodruff, Goodwin, & Guze, 1974). Critics 10 11 of the traditional classification model hold that classifica- tion practices based on the medical model concept of mental disorder are inappropriate and unnecessary for understanding and treating emotional and behavioral problems (Bandura, 1969). Therapists who adhere to a Rogerian orientation hold that the classification process itself may be a hindrance to the therapeutic process and thus is not needed to effectively treat clients. A major problem encountered when using the traditional classification model relates to the validity and reliability of the model. The existence of a wide variety of symptoms related to more than one diagnostic category and the lack of therapist consistency in applying similar weights to the same symptoms when diagnosing the same client on different occa- sions raise serious questions about the usefulness of the DSM-II classification model in psychotherapy. Much criticism of the DSM—II relates to how it is cur- rently used in psychotherapy. Attempts to classify clients are often designed to meet the therapist's need to label what he/she observes while the needs of the client are overlooked. Many therapists operate in an environment which requires that a DSM—II label be given a client. Therapists often assign a classification to a client that is not appropriate, and some therapists believe that classification is a relatively simple process requiring little skill. The consequence of such belief is often the neglect of the client's needs. Many critics indicate that classification categories 12 carry negative connotations and subject the client to harmful stigmatization. The result is that the client is penalized in therapy and in society. Szasz (1961, 1971b) considered classification as just another means by which man is dehuman- ized and subjected to unpleasant consequences. Being classi- fied as mentally ill thus becomes one of the ways society imposes its demands on selected segments of the population. One is classified as mentally ill when engaging in behaviors considered socially deviant by the therapist. Szasz (1971a) cited the use of classification practices to justify differ- ential status and treatment accorded blacks in society as an illustration of the derogatory purposes for which classifica- tion systems are employed: "In the United States, where social customs and policy dictated that the Negro race be systematically subjugated, psychiatry and psychoanalysis lent their specialized jargons of justification to this policy" (p. 469). Using blacks as a metaphor, Szasz provided a con- vincing argument that all clients who are subjected to clas- sification practices are essentially being cast in the role of "nigger." Merriouns' (1974) and Pasamanick's (1963b) historical analyses of the relationship between blacks and psychotherapy clearly demonstrated society's influence in determining who will be classified as "sick" or "normal" and, thus, who will be included or excluded from the ingroup of society. The recent reclassification of homosexuality from a mental disorder category to a nonmental disorder category lends support to Szasz's (1961) claim that the outgroup 13 becomes converted into members of the ingroup where they can then be afforded favorable treatment. While admitting the shortcomings of the DSM-II classifi- cation model, supporters of the medical-model approach argue that not enough is known about behavioral disorder to permit a clear choice between a classification system based on the medical-model concept and a system based on another approach such as that advocated by behavioral therapists (Nathan, 1967). Misuse and abuse of any classification system is a serious problem that should not be allowed to detract from the DSM-II classification model itself and the purposes for which it was designed. Pasamanick (1963a) stated that "all scientific endeavor leading to the testing of hypothesis of etiology, treatment and prevention of disorder rests on the classification of disorders" (p. 398). Zigler and Phillips (1961a) argued that while existing classification models are open to criticism, a system of classification is necessary and useful to the Operation of a predictive psychology. The problems associated with the use of traditional classification models (such as DSM-II) in psychotherapy are numerous. These problems relate to whether or not the tradi- tional classification model has value in psychotherapy. It does not seem likely that these problems will be resolved in the near future. There is general agreement that a system of classification is necessary if behavioral and emotional dis- orders are to be treated effectively in psychotherapy. 14 Influence of Black Therapist/Black Client Variables on Classification While the role of the client in the classification process has long been a topic of investigation, the thera- pist's contribution to that process has not gone unnoticed. Lowinger and Dobie (1964, 1968), Strupp (1958), Wallach and Strupp (1960), and Whitehorn and Betz (1960) have demon- strated relationships between personal qualities of the therapist and diagnostic and prognostic estimates of clients for treatment. Strupp (1960), in investigating the influence of the therapist's personality on the therapeutic process, stated: . . . the therapist's choice of words in diagnos- ing and describing the patient's emotional dynamics may reflect a subtle (moral) value judgment about the patient. A diagnostic label assigned to a patient may carry with it a trace of disapproval which may have a pervasive influence on succeeding therapeutic interactions; such terms as "psycho- pathic," "paranoid," "character disorder" may be more revealing of the therapist's attitude than of the patient to whom they are assigned. (p. 302) Zigler and Phillips (1961b) suggested that the therapist may be responding to criteria external to the domain of the traditional classification model when diagnosing a client. Thorne (1953) took the position that an experienced therapist may classify clients by using "intuition" or by operating on "the feel of the case." Investigations involving blacks as clients and/or thera- pists have been undertaken in an attempt to determine the influence of client-therapist variables on the classification process. 15 Hollingshead and Redlich (1958) reported that diagnosis and therapist expectations for a client are related signifi- cantly to the client's position in the class structure of society. Clients who were black and lower class were more likely to receive unfavorable diagnostic and prognostic estimates from white male therapists than clients who were white and upper class. Brill and Storrow (1960) reported similar findings while attempting to control for the economic factor associated with seeking treatment. They found no sig- nificant relationship between social class, training, and experience of the therapists assigned and classification practices. Race and sex of the therapists were not reported in this study. Kleiner, Tuckman, and Lavell (1960) compared data on high-status whites and low-status nonwhites. Their intent was to investigate the pattern of mental disorders associated with a prevalence of extreme aggressive behavior or extreme withdrawal behavior (paranoid schizophrenia and process and reactive schizophrenia) were more prevalent among low-status nonwhites than high-status whites. The investi- gators attributed the concentration of schizophrenia in the low-status group to environmental frustrations incurred in society as a consequence of their racial membership. Thus, a therapist's diagnosis was interpreted as accurately reflecting a prevalence of disorders among nonwhites. No information was given about the therapists who made the diagnoses (e.g., sex, race, experience). Lane (1968) investigated the effects of sex and race on 16 the rating of schizophrenics (process and reactive). Process-reactive ratings of schizophrenics were used as an indicator of prognosis and, thus, determined the kind of treatment made available to patients. Lane compared the records of 200 adult schizophrenics (50 Negro males, 50 Negro females, 50 white males, 50 white females) from admission files of the Cleveland Public Hospital. The subjects were mainly lower class. The therapists were white males. Lane found that black males were rated as process more than black females. Lane concluded from her findings that "being Negro increases one's chances of being rated process but being Negro and male almost assures it" (p. 17). Yamamoto, James, Bloombaum, and Hatten (1967) investi- gated race as a factor in patient selection by surveying the treatment course of 594 patients admitted to an outpatient clinic. The racial groups involved in the study were white (sex not reported). The findings revealed that duration in therapy (six sessions or more) was related to race and sex of the patients, with b1acks--and especially black males-- having the shortest duration. In addition, they found a positive correlation between social distance and ethnocen- tricity of the therapists and duration in therapy of black patients. In other words, high-prejudiced white therapists (§.= 9) saw male and female black patients for a fewer number of sessions than did low-prejudiced white therapists (N = 6). The findings suggest that therapist attitude may be an important factor in the therapeutic relationship when the 17 therapist is white and the patient is black. The therapist's attitude may result in the patient being rejected for treat- ment, or it may result in the patient receiving less than adequate treatment. The disparity in the number of patients comprising each racial group (only five Orientals were in the patient sample) should be taken into account when considering the results of this study. In addition, the study did not control for the possible influence of "work schedule flexibility" on the length of stay in treatment of black males. In an outpatient clinic, black males may have had less available time away from their jobs to devote to therapy sessions. This may have resulted in early termination or drOpping out of therapy on the part of black males. Despite methodological problems that weaken the conclusions that Yamamoto et a1. arrived at, the study does generate questions regarding the role that therapist attitude may play in the therapeutic relationship when both therapist and client are black. In an attempt to determine if a therapist's clinical judgments are influenced by his social values such that black clients receive less favorable classifications than white clients, Schwartz and Abramowitz (1975) systematically varied the sex and race attributes of a patient in an analogue situation. Therapists (N = 102, white, predominantly male) were then asked to give their clinical impressions and treat- ment recommendations. The therapists were given the Tradi- tional Beliefs Scale and divided into two groups (high 18 scorers, therapists with more traditional beliefs; and low scorers, therapists with less traditional beliefs). The findings failed to show that the resultant therapist bias was consistently against patients identified as black or female. Some interesting findings of this study were that (l) the black-designated patient's chance for recovery was rated more favorably than the white-designated patient; (2) less traditional therapists attributed greater maladjustment to patients identified as male than did more traditional therapists; (3) therapists, regardless of values, recommended "insight-oriented" therapy more for white males than black males; and (4) the patient was viewed as more attractive when identified as black rather than white by therapists used in the study. The results indicated that social values held by therapists were significantly related to their classification practices. Gross and Associates (1969) studied treatment decisions made in a psychiatric emergency room. Diagnosis and disposi- tion (treatment recommendations or referral) were related to patient sex and race. They concluded that as the sociocul- tural distance between therapist and client widened, diagno- sis became less accurate, and referral and recommendation became more ambiguous. The therapists used in this study were nurses and psychiatric interns (race and sex not reported). Muller, Chafetz, and Blane (1967) also investi- gated treatment decisions made in a hospital setting and reported similar findings. While the results of these 19 studies suggest that treatment decisions are based on factors external to patient psychopathology, caution should be taken in attempting to generalize these findings beyond an emer- gency treatment setting. Simon, Fleiss, and Gurland (1973) compared symptoms and diagnoses in a racially mixed group of 192 hospitalized patients. Each patient was diagnosed twice by different therapists (race and sex not reported). The first diagnosis was made by a project staff member using a structured inter- view approach. The second diagnosis was made by a hospital staff member using a variety of interview techniques. The results showed that when diagnosed by hospital staff thera- pists, race and diagnosis were significantly related. Black patients were diagnosed schizophrenic as opposed to affective illness (depression) more than white patients. When diag- nosed by project therapists, however, no association between race and diagnosis was found. Dorfman and Kleiner (1962) arrived at a similar conclusion as Simon et al. (1973) regard- ing project therapist diagnosis showing no association between race and diagnosis. Dorfman and Kleiner (1962) looked at the effects of therapist race (three white and two black psychi- atrists; sex not reported) on treatment diagnosis and recom- mendation of black and white first-admission patients (sex not reported). They concluded that therapist race was irre- levant to the classification process. Methodological con- siderations such as sample size and use of parametric statistics raise some question as to how effectively the 20 hypothesis under consideration was tested. Therapist and client variables such as attitudes, values, sex, and race have been shown to exert influence on the therapeutic process and, specifically, the classification of clients for treatment. While the research literature is not conclusive as to the degree of influence these variables have on the classification process, the literature suggests that diagnosis, treatment recommendations, and prognosis may not be based on the client's pathological manifestations alone, but on selected therapist attributes. While few studies focused exclusively on the black therapist/black client dyad, these studies do raise questions about the probable influence of the above variables on the classifica- tion process when both therapist and client are black. Solomon and Patch (1974) identified a major problem encountered when a traditional classification model such as DSM-II is used with clients who are representative of a sub- culture. They indicated that a distinction has to be made between pathological symptoms and subcultural norms reflected in a client's behavior in order for classification to be effective. The black therapist's familiarity with black cul- ture places him/her in a position to better evaluate the meaning of the black client's behavior in the context of his/her environment. Carkhuff and Pierce (1967) reported that race and social class of both therapists (two white and two black females) and clients (hospitalized schizophrenic females, both black 21 and white) had a significant effect on the depth of self- exploration in an initial interview. Clients shared more information about themselves with the therapist when race and social class were similar. Banks (1972) compared the effects of black and white counselors (four black and four white males) on black and white clients (N = 32) who were middle and lower class. Banks concluded that racial similar- ity enhanced the therapeutic process (initial interview), but that there was no significant effect associated with social class. The differences in findings reported by Banks and by Carkhuff and Pierce (1967) relative to the influence of social class on the therapeutic process may be due to the manner in which each Operationally defined "social class." Thus, within the black therapist/black client dyad, the com- monality of race and mutual experience of racism may enhance the classification process, by minimizing anxiety related to self-disclosure and misunderstandings resulting from differ- ences in language usage (F. Jones, 1972; Merriouns, 1974). While these factors lend support to the therapeutic relation- ship between the black therapist and black client, other factors which may exist in that relationship may adversely affect the black therapist/black client relationship. Over- identification and denial on the part of the black therapist may be critical factors affecting the black therapist/black client relationship (Grier, 1967; Vontress, 1971). The black therapist's attitude toward himself and the client may have been so influenced by the negative effects of the black 22 experience (self-hatred) that his effectiveness with black clients is hindered. Derbyshire (1967) suggested that the black therapist's attitudes may be influenced by accultura— tion (assimilation). The black therapist may have assimilated values related to behavior deemed appropriate and normal by the larger white society. Pasteur (1971) reported findings on the type of attitudes black counselors held toward dis- advantaged black male youths. Pasteur found that black coun- selors whose origin was "lower class" held more negative attitudes toward disadvantaged black youths than black coun- selors whose origin was "middle class." Such attitudes may lead the black therapist to make diagnostic and treatment recommendations not indicated by the symptoms of the black client. There has been some speculation that problems arising in the black therapist/black client relationship may be related to the kind of training the black therapist has received. B. Jones et a1. (1970) suggested that clinical training programs tend to psychologically "whiten" the racial identity of black therapists by ignoring the factor of race. This tendency, along with the absence of black supervisors as role models, is believed to foster a training climate that is not conducive to promoting strong identification with the problems of black people. The implication of this line of inquiry is that black therapists, as a consequence of their training, may deny their racial identity and distance them- selves from black clients. In so doing, therapeutic 23 effectiveness is jeOpardized. The literature suggests that black therapists can be typed according to attitudes held towards other blacks who exhibit certain behavioral characteristics. In addition, differential reactions to these characteristics are viewed as sex-linked. Calnek (1970) postulated two distinctive types of black therapists. First, traditional black therapists are those therapists who prefer black clients who exhibit passive, non- assertive behavioral patterns. They perceive this behavioral pattern as an appropriate and desirable response to frustra- tions encountered in one's daily life. Attitudes held by these therapists reflect the influence of racism in that passive behavioral patterns are seen as an appropriate sur— vival mechanism while aggressive behavioral patterns are viewed as inapprOpriate and maladaptive. Second, black- consciousness therapists are those therapists who prefer assertive and aggressive black clients. These therapists see aggressive behavior as symptomatic of good mental health and as an appropriate response to racism and other frustrations encountered in daily living. Passive, nonassertive behavior is seen as inappropriate and maladaptive. The relationship between black males and black females has its own implications for the black therapist/black client relationship. Bayton, Austin, and Burke (1965); Bryson, Bardo, and Johnson (1975); and Calnek (1970) indicated that the historical evolution of the black female's role in 24 American society resulted in her assuming a dominant asser- tive position. Assertive and aggressive behavioral traits were fostered in black females while prohibited in black males. The role of the black male in relation to the expres- sion of aggressive and assertive behavior was also influenced by the negative consequences imposed on black males by the white society for possessing such characteristics (Grier & Cobbs, 1968; Karon, 1975). Thus, black female therapists may view aggressive or assertive behavior in black male clients and label it as maladaptive. Black male therapists may also perceive the expression of aggressive behavior in black male clients as a dangerous act which should be inhibited and thus label it maladaptive. Summary The use of classification models in psychotherapy has generated much controversy involving the reliability and validity of classification model DSM-II in psychotherapy, the value of any classification model in the therapeutic process, and the value of a traditional classification model in the treatment of clients representative of a subculture. While misuse and abuse of any classification model represent a serious threat to the effective practice of psychotherapy, it is generally recognized that a system of classification is essential to the operation of a predictive psychology. Therapist variables such as attitudes and values, sex, 25 and race have been shown to influence the therapeutic process and, specifically, the classification of clients for treat- ment. Thus, diagnosis, treatment recommendations, and prog- nosis may not be based on the client's patholOgical manifes- tations alone, but on selected therapist attributes. While few studies have focused exclusively on the black therapist and black client, these studies do raise questions about the probable influence of therapist and client variables on the classification process when both therapist and client are black. A major problem encountered when a traditional classifi- cation model such as DSM-II is used with black clients is that a distinction has to be made between pathological symp- toms and subcultural norms reflected in the client's behavior. The black therapist's familiarity with black culture may place him in a more favorable position to evaluate the cli- ent's behavior within the context of his environment. Pos— sible adverse effects on the classification process may occur through over-identification, denial, and assimilation on the part of the black therapist. These factors may influence the black therapist's atti- tude toward black clients to such a degree that the black therapist will make diagnostic, prognostic, and treatment recommendations not indicated by the symptoms of the black client. The literature suggests that black therapists can be typed according to attitudes held toward other blacks who exhibit certain behavioral characteristics. In addition, a 26 differential reaction to these behavioral characteristics is viewed as sex-linked. Calnek (1970) postulated two types of black therapists: (1) traditional black therapists are those who hold a negative attitude toward blacks and prefer blacks who are passive and nonassertive; and (2) black-consciousness therapists are those who have positive attitudes toward blacks and who prefer blacks who are aggressive and assertive. The relevancy of Calnek's postulation to the black therapist/ black client relationship and the classification process has not been demonstrated by research. Research and literature which focus exclusively on the black therapist/black client relationship are meager. The available literature suggests that the presence or absence of selected problems within the black therapist/black client dyad may occur as a consequence of attitudes held by the black therapist toward the black client. CHAPTER III METHODOLOGY This study was designed to determine the effects of black therapist type and sex and black client type and sex on the classification of black clients for treatment. The participants in this study included black social workers with varying years of experience, theoretical orien- tation, and educational background. The research instruments used were the Black Attitude Instrument (BAI), developed for the purpose of the study, and a modified version of a questionnaire developed by Wal- lach (1959) for assessing therapists' clinical impressions of clients. The BAI provided a method of identifying par- ticipants for the study. The modified questionnaire provided a method for assessment and evaluation of participant response. Population Black social workers were selected as the pOpulation of interest because this group represents the largest group of black professionals, excluding ministers, with the longest history of involvement in the delivery of mental health services to black people. 27 28 Sample The primary sample consisted of 222 black social workers who attended the 1977 National Association of Black Social Workers Convention and black social workers from southwestern Michigan. Of these subjects, 57 percent were female and 43 percent were male. The distribution of these subjects accord- ing to age, educational level, and geographic location is presented in Appendix A. Of the 96 black social workers who comprised the final sample for this study, 50 percent were male and 50 percent were female. Of the sample, 52 percent were 25-34 years old, and 44 percent were 35 years or older. Regarding educational level, 72 percent of the sample had M.S.W. degrees or higher. There were 46 percent of the sample from the midwestern sec- tion of the United States. The age, educational level, and geographic distributions of the final sample are presented in Appendix A. Other demographic data of the 96 subjects for this study included theoretical orientation and years of experience work- ing with clients. Of the sample, 50 percent indicated a preference for a social psychological theoretical orientation when working with clients, and 20 percent indicated a prefer- ence for psychodynamic theoretical orientation. There were 77 percent of the sample who had 3 or more years of experi- ence working with clients, and 9 percent who had less than 2 years of experience working with clients. The distribution of the final sample by years of work experience and 29 theoretical orientation is presented in Appendix A. Procedures The BAI (see Appendix B), an instrument designed to measure attitudes of blacks pertaining to blacks, was admin- istered to 222 black black social workers. The 130 partici- pants who scored l/2 standard deviation from the mean on the BAI and who had indicated a willingness to participate in the study were treated as potential subjects. Each potential sub- ject was mailed one randomly determined case description of a hypothetical black client. The case description contained information about the client's family background, interper- sonal relationships, academic background, and presenting problem. Aggressive-assertive behavioral characteristics were prominent in the symptom picture. Four versions of the client profile were effected by interchanging male/female attributes and by omitting aggressive-assertive behavioral characteristics from the symptom picture. The resulting con- figurations were as follows: black male client, exhibiting aggressive-assertive behavior; black female client, exhibit- ing aggressive-assertive behavior; black male client, exhib- iting no aggressive-assertive behavior; and black female client, exhibiting no aggressive-assertive behavior. The latter two configurations were included in this study as a control measure. The case descriptions are presented in Appendix C. In utilizing case descriptions of clients as experimental 3O stimuli rather than actual clients in this study, it was assumed that enough similarity existed between being exposed to a case description and an actual client to make it rele- vant for the participants. The participants were asked to give clinical impressions of a hypothetical client by responding to a 20-item question- naire (Evaluation Sheet). The Evaluation Sheet contained items pertaining to diagnosis, diagnostic labeling, treatment recommendations, prognosis, liking for the client, and sex- role appr0priateness (see Appendix D). Subjects were asked to return the completed Evaluation Sheet in a stamped, self-addressed envelope. The letters of introduction are presented in Appendix E. Within a 90-day waiting period, 104 participants responded; the response rate was 80 percent. Eight respon- dents were dropped from the study to ensure equal cell sizes and equal number of respondents by sex. The method used to determine deletion was to delete those participants who had omitted responding to items on the Evaluation Sheet, and by randomly deleting a respondent. The final composition of the sample used in the study was assumed to be representative of the population from which it originated. 31 Instrumentation Black Attitude Instrument Purpose. The BAI is a 45-item, self-report psychologi- cal inventory that measures attitudes toward black peOple and toward being black. The instrument was designed specifically to be used with a black pOpulation. Unique cultural charac- teristics reflected through response styles, belief systems, and attitudes make it imperative that psychological instru- ments used on representations of the black population be based on black cultural norms. Given the diversity within the black p0pulation, the task of developing instruments to adequately assess psycho- logical functioning and dysfunctioning among blacks would necessarily be complex and would entail a great deal of effort. Black professionals have begun to undertake the task of developing new models to assess psychological functioning within the black society (Hall, Freedle, & Cross, 1972; Williams, 1976). It seems reasonable to assert that if black therapists are to deal effectively with problems of mental health among blacks, the black population should be the source from which criteria are developed to assess psychological functioning. Development. The BAI is an objectively scored test designed to give a comprehensive coverage of attitudes held by blacks toward blacks and toward being black. The 45 items comprising the instrument consist of statements made most frequently by blacks in reference to other blacks or in 32 reference to themselves. The 45 items are reflections of six attitudinal themes that relate in a psychologically mean- ingful way to how blacks feel toward other blacks and toward themselves: (1) sense of trust, (2) sense of belonging, (3) sense of security, (4) sense of affiliation, (5) sense of control or autonomy, and (6) sex-role relationship. Seven independent raters agreed that responses to the 45 items were indicative of a positive/negative attitude toward blacks or toward being black and represented at least one of the six attitude themes (71 percent agreement accept- able for inclusion as representing one of six themes). The independent raters were composed of two black female social workers, one black male university instructor, two black male therapists (counseling), one black female education adminis- trator, and one black female homemaker/factory worker. The BAI is presented in Appendix B. Scoring. The instrument was scored by totaling the responses to each 5-point Likert scale item. Mean response score and standard deviations were established. High scores (scores above the mean) indicated positive attitudes toward blacks and toward being black. Low scores (scores below the mean) indicated negative attitudes toward blacks and toward being black. The mean score was 150.6, and the standard deviation was 19.0 (N'= 222). Pretest. The instrument was pretested on 108 black col- lege students (graduate and undergraduate) attending Western Michigan University. The pretest instrument consisted of 52 33 items (see Appendix B). Reliability coefficient for the pre- tested instrument was .65. Black social worker population. The revised instrument was tested on 222 black social workers for this study. Black social workers were categorized as traditional or black- consciousness therapists. Participants who scored high on the revised instrument (1/2 standard deviation above the mean) were classified as black-consciousness therapists. Those par- ticipants who scored 1/2 standard deviation below the mean were classified as traditional therapists. Participants who scored around the mean were not included in the final phase of the study. Construct validity. Seven independent raters indicated that the items were good measures of six attitude themes, and that responses to their items indicated positive or negative attitudes toward blacks and toward being black. Thus, the instrument is assumed to have adequate construct validity. Reliability. Reliability coefficient for the 45-item instrument was .81. Items were deleted, revised, and added to the instrument based on their demonstrated or assumed ability to elicit differential responses. There were 22 items left unchanged. Usefulness. The usefulness of the BAI is in its ability to discriminate selected patterns in attitudes that are related to response styles and psychological functioning of blacks within the black population. Black professionals must determine for themselves the applicability of this instrument 34 to specific problems confronted in psychotherapy or other helping relationships with black clients. There are several important points to consider in using this instrument: 1. The test is based within a general framework of black psychology. 2. Psychometric properties, while adequate, have been explored on a limited number of black population samples and under few diverse conditions. 3. The instrument has been subjected to limited research; thus, findings involving the BAI are restricted. Evaluation Sheet (Questionnaire) The Evaluation Sheet consisted of 20 items taken pri- marily from a questionnaire devised by Wallach (1959) for the purpose of assessing therapists' clinical impressions of cli- ents. Items were added and modified to conform to the pur- poses of this study. Items 1-7 pertained to diagnosis. Item 8 pertained to treatment recommendation. Items 9, 10, and 12 pertained to prognosis. Items 11, 15, and 16 (sex-role appropriateness) and Items l4, l7, and 20 (liking for the client) were included to assess their influence of therapist judgment. A S-point Likert scale was used for all items except Items 13, 18, and 19. Item 13 pertained to therapist use of diagnostic labeling. The categorical responses were placed on a 7-point scale of psychological deviation. Items 18 and 19 were included to get demographic information per- taining to length of experience as a therapist and theoretie cal orientation. These two items, being demographic in nature, were retained as categorical responses. 35 Items were modified to reflect the sex of the client in the case description where needed. The Evaluation Sheet was assumed to have reasonable content validity (see Appendix D). Content analysis. The data were collected and analyzed to determine the reliability of items with respect to each variable of interest. Each participant's score on the indi- vidual items comprising each variable was used to determine reliability for each variable. Reliability coefficients are reported in Table 1. Reliability scores for treatment recom- mendation and labeling were not computed because these vari- ables consisted of one item each. Table 1 Reliability Coefficients for Diagnosis, Prognosis, Liking for Client, and Sex-Role ApprOpriateness Variables Variable Item Numbers Reliability Diagnosis 1, 2, 3, 4, 5, 6, 7 .74 Prognosis 9, 10, 12 .76 Liking client 14, 17, 20 .31 Sex-role ll, 15, 16 .23 N = 93. Missing cases = 3. Diagnosis and prognosis variables seemed reasonably reliable (.74 and .76, respectively). The variables of Liking for client and sex-role appropriateness had low reli- ability scores (.31 and .23, respectively). The items 36 comprising these variables did not appear to form clusters, as was anticipated. Examination of the item analysis of the scale regarding liking for the client indicated that Item 16 was depressing the scale and, thus, was a weak item. Parti- cipants may have interpreted Item 16 as either referring to the client's symptom picture and problem type or to the cli- ent's personality and life style. Item 11 appeared to be the weakest item in the Sex-role appropriateness scale. Parti- cipants may have responded to this item in terms of behavior they perceived as appropriate for black males and females in general as opposed to behavior they perceived as appropriate for black male and female clients. Participants' responses to items comprising the liking and sex-role appropriateness scale indicated that they did not perceive the scale items as a measure of the same variables. The instrument yielded six scores, namely, diagnosis outcome, treatment recommenda— tions, prognosis outcome, diagnostic labeling, sex-role appropriateness, and liking for the Client. Outcome measures produced by the dependent variables, Liking for client and sex-role appropriateness, should be evaluated with caution because of the low reliability of those dependent variables. Design of the Study The four independent variables expected to produce the experimental effect were: therapist type with two levels, namely, traditional and black-consciousness; therapist sex; client type with two levels, namely, aggressive and control; 37 and client sex. The dependent variables were the six scores from the modified questionnaire (Evaluation Sheet), namely, diagnosis, diagnostic labeling, treatment recommendation, prognosis, liking for client, and sex-role appropriateness. The ques- tionnaire was used to gather data on therapists' clinical impressions of clients. The design of the study is shown in Figure l. Hypotheses Hypotheses pertaining to the effects of black therapist type and sex and black client type and sex on the classifica- tion of black clients for treatment are presented below. The hypotheses examine the effects of the four independent vari- ables across six outcome variables related to classification. These outcome variables are diagnosis, diagnostic labeling, prognosis, treatment recommendation, liking for client, and client sex-role appropriateness. The research hypotheses tested are as follows: H1: Black-consciousness therapists will give a more favorable classification to black cli- ents than black traditional therapists. H2: Black female therapists will give a more favorable classification to black clients than black male therapists. H3: There will be no significant difference between classifications given to aggressive black clients and nonaggressive (control) black clients. H4: Black male clients will receive a more favorable classification than black female clients. Therapist Type Black- consciousness Male Female Traditional Male Female N = 96. Code: M1 M2 M3 M4 M5 M6 m1 38 Aggressive Client Controlled Client Male Female Male Female M1 M2 M3 M1 M2 M3 M1 - M6 M1 - M6 M4 M5 M6 M4 M5 M6 16 Diagnosis. Diagnostic labeling. Treatment recommendation. Prognosis. Liking for client. Sex-role appropriateness. Respondents per cell. Figure 1. Design of study. 10‘ 11’ 12' 13‘ 14’ 39 There will be a significant interaction between black therapist type and sex in classifying black clients. There will be a significant interaction between black therapist type and black client type in determining how black clients will be classified. There will be a significant interaction between black therapist type and black client sex in determining classification given to black clients. There will be a significant interaction between black therapist sex and black client type in determining classification given to black clients. There will be a significant interaction between black therapist sex and black client sex in determining classification given to black clients. There will be a significant interaction between black client type and sex in determining how they will be classified by black therapists. There will be a significant interaction between black therapist type, black thera- pist sex, and black client type in deter- mining classification given to black clients. There will be a significant interaction between black therapist type, black thera- pist sex, and black client sex in deter- mining classification given to black clients. There will be a significant interaction between black therapist type, black client type, and black client sex in determining classification given to black clients. There will be a significant interaction between black therapist sex, black client type, and black client sex in determining classification given to black clients. 40 H15: There will be a significant interaction between black therapist type, black thera- pist sex, black client type, and black client sex in determining classification given to black clients. Data Analysis The design and sample meet the assumptions for analysis of variance as indicated by Glass and Stanley (1970): (1) randomization--participants were randomly assigned; (2) inde- pendence--independence between and within cells and units within cells; (3) normality--population is normally distrib- uted; and (4) equality of variance--analysis of variance is robust when cell sizes are equal. Hypotheses 1 through 15 were tested in a multivariate four-way analysis of variance. The dependent variables were the six variables pertaining to diagnosis, diagnostic label- ing, prognosis, treatment recommendation, liking for client, and client sex-role appropriateness. An alpha level of .05 was established for the rejection of each null hypothesis. The alternate hypotheses were accepted when a statistical level of significance was reached. In the event that a null hypothesis was rejected, univariate data and mean scores were analyzed to determine on which of the dependent variables were the differences, and the size of the difference, between the groups. The univariates were explored at an alpha level of .00833. This alpha level for the univariate analysis was determined by distributing the alpha level evenly across the 41 six dependent variables. Summary This study was designed to examine the effects of black therapist type and sex and black client type and sex on the classification of black clients for treatment. The popula- tion, sample, procedures, instrumentation, design, hypotheses, and data analysis used were described in the present chapter. An analysis of the results is presented in Chapter IV. CHAPTER IV ANALYSIS OF THE DATA Introduction This study was designed to investigate whether black traditional therapists versus black-consciousness therapists would render differential classifications to black clients exhibiting aggressive-assertive behavioral characteriStics as the primary symptom picture. The sex of the therapists and clients was investigated to determine its effect on classifi- cation. The following classification variables were mea— sured: (1) diagnosis, (2) diagnostic labeling, (3) prognosis, (4) treatment recommendation, (5) liking for client, and (6) sex-role apprOpriateness. The sample for this study consisted of 96 black social workers. Fifteen hypotheses were formulated in order to determine whether significant relationships existed between black therapist types, black client types, and the classifi- cation practices of black therapists. A four-way multivariate analysis of variance was util- ized to analyze the data. Differences were judged as sig- nificant when they reached or exceeded the .05 level of confidence. Where a multivariate test reached the .05 level of significance, univariate analyses were performed to 42 43 determine on which variable the differences were appearing. Presentation of Data Each hypothesis is restated. The hypotheses are pre- sented and discussed according to the manner in which the data were analyzed, namely, findings pertaining to the main effects of the four independent variables, findings pertain- ing to two-way interaction among the four independent vari- ables, findings pertaining to three-way interaction among the four independent variables, and findings pertaining to four- way interaction among the four independent variables. The .05 level of confidence was established for rejecting the nullthypotheses. Hypotheses to Examine Main Effects of Therapist Type/Sex and Client Type/Sex Hypothesis 1 HO: Black-consciousness therapists and black traditional therapists will not differ in their classification of black clients. H : Black-consciousness therapists will give a more favorable classification to black cli- ents than black traditional therapists. This hypothesis was formulated to compare the clinical judgments of black therapists identified as black-consciousness therapists with those identified as black traditional thera- pists. The purpose of this hypothesis was to address the issue of possible clinical bias associated with black thera- pist attitudes toward blacks and toward being black. Multivariate analysis of variance results for the main 44 effects of black therapist type indicated no statistically significant difference (3 = 1.50, p <:.191). Thus, the null hypothesis was not rejected. Multivariate and univariate results are shown in Table 2. Table 2 Multivariate and Univariate Analysis Results for Hypothesis 1 Across Six Outcome Variables E P. Hypothesis 1 1.4954 .1914 Diagnosis .2319 .6315 Labeling 2.2325 .1391 Treatment recommendation .8290 .3653 Prognosis .6607 .4188 Liking for client .5542 .4588 Sex-role appropriateness .5207 .4727 Hypothesis 2 H : Black male and female therapists will not differ in their classification of black clients. H : Black female therapists will give a more favorable classification to black clients than black male therapists. This hypothesis was formulated to compare the clinical judgments of male and female black therapists. The purpose of this hypothesis was to address the issue of possible clinical bias associated with a differential impact of the black experience on black males and black females. Multivariate analysis of variance indicated a significant 45 difference between the clinical judgments of black male therapists and black female therapists (N = 2.41, pi< .035). Multivariate and univariate results are shown in Table 3. Table 3 Multivariate and Univariate Analysis Results for Hypothesis 2 Across Six Outcome Variables E P. Hypothesis 2 2.4077 .0351* Diagnosis .0756 .7841 Labeling .0941 .3446 Treatment recommendation .2073 .6502 Prognosis .3095 .5796 Liking for client 1.4752 .2281 Sex-role appropriateness 9.2852 .0032** *2 < .05. **p_ < .008. Univariate analysis was used to examine the contribution of each of the dependent variables to the overall treatment effect. The alpha level used to explore univariates was .05, equally distributed across each of the six dependent measures. This was done in order to control for overall error rate. Thus, the alpha level for analyzing univariates was .008. Univariate analysis indicated that the sex-role appropriate- ness score contributed significantly to the overall treatment effect (N = 9.2852, 2 < .0032). Univariate analysis of Hypothesis 2 (Table 3) indicated that the sex-role appropriateness outcome variable accounted 46 for the difference in clinical impressions given by black male and black female therapists. Black female therapists rated the black client's behavior as more appropriate for his/her sex than did black male therapists. Table 4 shows the cell means of black male and female therapists' responses on the outcome variable of sex-role appropriateness for Hypothesis 2. Results from the sex-role appropriateness variable should be analyzed with caution due to the low reli- ability generated by that scale (refer to Table 1). Table 4 Cell Means for Male and Female Black Therapists' Responses on Dependent Variable of Sex-Role ApprOpriateness Source N Cell Means Male 48 Y = 1.802 Female 48 §'= 3.554 Hypothesis 3 H : There will be no difference between the classifications given aggressive black clients and nonaggressive (control) black clients. H : Aggressive black clients will receive a different classification than nonaggressive (control) black clients. This hypothesis was formulated to compare the ratings given aggressive black clients with the ratings given control black clients. The purpose of this hypothesis was to 47 determine if the presence or absence of aggressive behavior in a black client's symptoms had any impact on black thera- pist ratings. Multivariate analysis of variance indicated no signifi- cant difference between the classification given aggressive black clients and nonaggressive (control) black clients (N = 1.65, p < .145). The null hypothesis was not rejected. Multivariate and univariate results are shown in Table 5. Table 5 Multivariate and Univariate Analysis Results for Hypothesis 3 Across Six Outcome Variables E. P. Hypothesis 3 1.6509 .1450 Diagnosis 2.2551 .1372 Labeling 3.1181 .0813 Treatment recommendation .2073 .6502 Prognosis .1783 .6740 Liking for client .4490 .5048 Sex-role appropriateness .2502 .6183 Hypothesis 4 HO: There will be no difference between the classifications given black male clients and black female clients. H : Black male clients will receive a more favorable classification than black female clients. The purpose of this hypothesis was to determine if the sex of the black client had an influence on the clinical 48 judgments of black therapists. Multivariate analysis of variance indicated that black male clients were not rated significantly different from black female clients (N = .33, p94 .918). The null hypothe- sis was not rejected. Multivariate and univariate results are shown in Table 6. Table 6 Multivariate and Univariate Analysis Results for Hypothesis 4 Across Six Outcome Variables E B Hypothesis 4 .3315 .9184 Diagnosis 1.4940 .2252 Labeling .0185 .8923 Treatment recommendation .4663 .4967 Prognosis .4712 .4945 Liking for client .0167 .8975 Sex-role appropriateness .0491 .8253 Hypotheses to Examine Two-Way Interactions Among Therapist Type/Sex and Client Type/Sex Hypothesis 5 HO: There will be no interaction between black therapist type and sex in classifying black clients. H : There will be a significant interaction between black therapist type and sex in classifying black clients. This hypothesis was developed to determine if an inter- action between black therapist type and sex would have an impact on the ratings given to black clients. 49 Multivariate analysis of variance indicated no differ- ence in ratings due to an interaction between black therapist type and sex (N = .46, p < .833). The null hypothesis was not rejected. Multivariate and univariate results are shown in Table 7. Table 7 Multivariate and Univariate Analysis Results for Hypothesis 5 Across Six Outcome Variables .1: 2 Hypothesis 5 .4638 .8330 Diagnosis .3767 .5412 Labeling .0185 .8923 Treatment recommendation .0518 .8206 Prognosis .0260 .8724 Liking for client .2198 .6405 Sex-role appropriateness .6392 .4264 Hypothesis 6 H : There will be no interaction between black therapist type and black client type in determining the classification given to black clients. H : There will be a significant interaction between black therapist type and black client type in determining the classifi- cation given to black clients. This hypothesis was formulated to test for possible interaction effects between black-consciousness therapists and black traditional therapists, and aggressive black cli- ents and nonaggressive black clients on the classifications 50 given to black clients. Multivariate analysis of variance indicated that no difference was found in the classification of black clients that could be attributed to an interaction between black therapist type and black client type (N = .62, p < .716). The null hypothesis was not rejected. Multivariate and uni— variate results are shown in Table 8. Table 8 Multivariate and Univariate Analysis Results for Hypothesis 6 Across Six Outcome Variables 2: 2 Hypothesis 6 .6169 .7162 Diagnosis .5565 .4579 Labeling 1.4945 .2252 Treatment recommendation .4463 .4967 Prognosis .5535 .4591 Liking for client .2198 .6405 Sex-role appropriateness .0193 .8899 Hyppthesis 7 H : There will be no interaction between black therapist type and black client sex in deter- mining the classification given to black clients. H : There will be a significant interaction between black therapist type and black client sex in determining the classification given to black clients. This hypothesis was formulated to test for possible interaction effects between black-consciousness therapists 51 and black traditional therapists, and black male clients and black female clients on the classifications given to black clients. Multivariate analysis of variance indicated no differ- ence in ratings given to black clients that could be attrib- uted to an interaction between therapist type and client sex (3 = .94, p <'.47l). Multivariate and univariate results are shown in Table 9. Table 9 Multivariate and Univariate Analysis Results for Hypothesis 7 Across Six Outcome Variables r p. Hypothesis 7 .9414 .4708 Diagnosis .1149 .7356 Labeling 1.4945 .2252 Treatment recommendation .2073 .6502 Prognosis .3041 .5829 Liking for client 1.0248 .3145 Sex-role apprOpriateness 1.0275 .3138 Hypothesis 8 H : There will be no interaction between black therapist sex and black client type in determining the classification given to black clients. H : There will be a significant interaction between black therapist sex and black client type in determining the classifi- cation given to black clients. This hypothesis was formulated to evaluate possible 52 differences in classification that may be influenced by an interaction between black male and female therapists, and aggressive and nonaggressive (control) black clients. Multivariate analysis of variance indicated that aggres- sive and nonaggressive black clients did not differ in the ratings they received from black male and female therapists (N = .89, p'< .509). The null hypothesis was not rejected. Multivariate and univariate results are shown in Table 10. Table 10 Multivariate and Univariate Analysis Results for Hypothesis 8 Across Six Outcome Variables 1:: 2 Hypothesis 8 .8866 .5092 Diagnosis 1.8467 .1780 Labeling .1661 .6848 Treatment recommendation .0518 .8206 Prognosis .0094 .9231 Liking for client .8854 .3496 Sex-role appropriateness .1918 .6627 Hypothesis 9 H : There will be no interaction between black therapist sex and black client sex in deter- mining the classification given to black clients. H : There will be a significant interaction between black therapist sex and black client sex in determining the classification given to black clients. This hypothesis was formulated to test for possible 53 differences in ratings given to black male and female clients by black male and female therapists. Multivariate analysis of variance indicated no differ- ence in ratings between black male and female clients (N = 1.24, p < .298). The null hypothesis was not rejected. Multivariate and univariate results are shown in Table 11. Table 11 Multivariate and Univariate Analysis Results for Hypothesis 9 Across Six Outcome Variables .F_ B Hypothesis 9 1.2360 .2977 Diagnosis 3.1139 .0815 Labeling 2.2325 .1391 Treatment recommendation .2073 .6502 Prognosis .2382 .6269 Liking for client .1623 .6882 Sex-role appropriateness 1.7068 .1952 Hypothesis 10 H : There will be no interaction between black clients' type and sex in determining how they will be classified by black therapists. H : There will be a significant interaction between black clients' type and sex in deter- mining how they will be classified by black therapists. This hypothesis was formulated to determine whether aggressive black male and female clients and nonaggressive black male and female clients would receive different classi- fication ratings from black therapists. 54 Multivariate analysis of variance indicated no signifi- cant difference in ratings given to aggressive black male and female clients and nonaggressive black male and female clients (N = 1.95, p < .084). The null hypothesis was not rejected. Multivariate and univariate results are shown in Table 12. Table 12 Multivariate and Univariate Analysis Results for Hypothesis 10 Across Six Outcome Variables .P; 2 Hypothesis 10 1.9487 .0839 Diagnosis .0730 .7878 Labeling .4613 .4990 Treatment recommendation .2073 .6502 Prognosis .3102 .5791 Liking for client 3.5659 .0627 Sex-role appropriateness 7.1868 .0090 Hypotheses to Examine Three-Way Interactions Among Therapist Type/Sex and Client Type/Sex Hypothesis 11 Ho: There will be no interaction between black therapist type, black therapist sex, and black client type in determining the clas- sification given to black clients. H : There will be a significant interaction between black therapist type, black therapist sex, and black client type in determining the classification given to black clients. This hypothesis was formulated to determine whether 55 differences between ratings given to aggressive versus non- aggressive (control) black clients occur as a result of an interaction between black therapist type and sex. Multivariate analysis of variance indicated no signif- icant difference in ratings given to black clients by black- consciousness and black traditional male and female thera- pists (N = .78, p <1.588). The null hypothesis was not rejected. Multivariate and univariate results are shown in Table 13. Table 13 Multivariate and Univariate Analysis Results for Hypothesis ll Across Six Outcome Variables E E Hypothesis 11 .7803 .5880 Diagnosis 1.3223 .2537 Labeling .1661 .6848 Treatment recommendation .2073 .6502 Prognosis .2365 .6281 Liking for client .5522 .4597 Sex-role appropriateness 1.5155 .2220 Hypothesis 12 H : There will be no interaction between black therapist type, black therapist sex, and black client sex in determining the classi- fication given to black clients. H : There will be a significant interaction between black therapist type, black therapist sex, and black client sex in determining the classification given to black clients. 56 This hypothesis was formulated to determine if differ- ences between ratings given to male versus female black clients occur as a result of an interaction between black therapist type and sex. Multivariate analysis of variance indicated no differ- ence in ratings given to male and female black clients (N_= 1.90, p1< .093). The null hypothesis was not rejected. Multivariate and univariate results are shown in Table 14. Table 14 Multivariate and Univariate Analysis Results for Hypothesis 12 Across Six Outcome Variables .r: p. Hypothesis 12 1.8951 .0927 Diagnosis 1.6827 .1983 Labeling 4.1513 .4500 Treatment recommendation 1.2953 .2585 Prognosis 1.4443 .2330 Liking for client .5398 .4647 Sex-role appropriateness .0054 .9417 Hypothesis 13 H : There will be no interaction between black therapist type, black client type, and black client sex in determining the classification given to black clients. H : There will be a significant interaction between black therapist type, black client type, and black client sex in determining the classification given to black clients. This hypothesis was formulated to determine whether 57 differences in classification ratings given by black tradi- tional versus black-consciousness therapists occur as a result of an interaction between black client type and sex. Multivariate analysis of variance indicated no signifi- cant difference between ratings given to aggressive and non- aggressive black male and female clients (N = 1.46, p <..203). The null hypothesis was not rejected. Multivariate and uni- variate results are shown in Table 15. Table 15 Multivariate and Univariate Analysis Results for Hypothesis l3 Across Six Outcome Variables F. .2 Hypothesis 13 1.4631 .2025 Diagnosis .7755 .3812 Labeling 2.2325 .1391 Treatment recommendation .0518 .8206 Prognosis .0252 .8742 Liking for client 4.9472 .0290 Sex-role appropriateness .1911 .6632 Hypothesis 14 H : There will be no interaction between black therapist sex, black client type, and black client sex in determining the classification given to black clients. H : There will be a significant interaction between black therapist sex, black client type, and black client sex in determining the classification given to black clients. This hypothesis was formulated to determine whether 58 differences in classification ratings given by black male versus female therapists occur as a result of an interaction between black client type and sex. Multivariate analysis of variance indicated no differ- ence between ratings given to aggressive and nonaggressive black male and female clients (N = .71, p < .640). The null hypothesis was not rejected. Multivariate and univariate results are shown in Table 16. Table 16 Multivariate and Univariate Analysis Results for Hypothesis 14 Across Six Outcome Variables E 2 Hypothesis 14 .7131 .6402 Diagnosis .6620 .4183 Labeling .9041 .3446 Treatment recommendation .0518 .8206 Prognosis .0841 .7726 Liking for client .0743 .7859 Sex-role apprOpriateness .5186 .4736 Hypothesis to Examine Four-Way Interaction Between Therapist Type/Sex and Client Type/Sex Hypothesis 15 Ho: There will be no interaction between black therapist type, black therapist sex, black client type, and black client sex in deter- mining the classification given to black clients. 59 H : There will be a significant interaction between black therapist type, black thera- pist sex, black client type, and black client sex in determining the classifica— tion given to black clients. This hypothesis was formulated to determine whether differences in classification ratings occur as a result of interaction between black therapist type, black therapist sex, black client type, and black client sex. Multivariate analysis of variance indicated no differ- ence in ratings (N = 1.27, p *wou1d "put the fear of God in us." W. D. and her brothers arui sis- ter got along well because they were taught to always "stick up for each other" and never fight amongst themselves. W. D.'s 21-year-old brother is married and living away from home. Her 18-year-old brother is living at home; he plans 90 to enter college in the fall. W. D.'s lS-year—old sister is living at home. W. D. has a good academic record: high school grade point average (GPA), 3.75 (A-); university GPA up to her senior year, 3.55 (B+); overall I.Q., 125. She is the first member of her family to go to college. Half of her education is paid for by academic scholarships and minority grants; her parents provide the other half. W. D. works at part-time jobs to pay for clothing and to have spending money. APPENDIX D EVALUATION SHEET (QUESTIONNAIRE) INSTRUCTIONS: You are requested to read the case description carefully and form clinical impressions of the client. Answer the ques- tions that are on the Evaluation Sheet. Please answer all the questions, even if you feel that additional information is needed to respond to some of the questions. It is impor- tant that you respond to the questions without assistance from others. When you have completed the task, please return the informa- tion in the enclosed stamped, self-addressed envelope pro- vided. Thank you. 91 l) 2) 3) 4) 5) 6) Subject 92 EVALUATION SHEET Responses to Ma1e(Female) Case Description Considering the entire range of mental disorders, how would you characterize the degree of disturbance in this client? a) b) C) d) e) How much a) b) C) How much problem? a) b) C) Not disturbed Mildly disturbed Moderately disturbed Seriously disturbed Extremely disturbed ego strength does this client seem to have? d) Considerable e) A great deal Very little Some A moderate amount insight does this client have into his(her) d) Considerable e) A great deal Very little Some A moderate amount How appropriate is this client's anxiety level? a) b) C) d) e) Very appropriate Somewhat apprOpriate Moderately inappropriate Considerably inappropriate Extremely inappropriate How would you rate this client's overall emotional maturity? a) b) C) Very poor d) Good Poor e) Excellent Fair characterize this client's social adjustment? a) Very poor d) Good b) Poor e) Excellent C) Fair 7) 8) 9) 10) 11) 12) 93 How much environmental stress does this client have to deal with? a) Very little d) Considerable b) Relatively little e) A great deal c) A moderate amount What kind of treatment would you recommend for this client? a) No treatment b) One-shot interview c) Short-term therapy d) Long-term therapy e) In-patient hospitalization If you were working with this client, how long would you expect treatment to last? a) Less than 1 month d) From 1 to 2 years b) Less than 3 months e) Longer than 2 years c) 3 months to 1 year How would you expect this client to get along with treatment? a) Very poor d) Good b) Poor e) Excellent c) Fair a) Very inappropriate b) Somewhat inappropriate c) Average d) Moderately appropriate e) Extremely appropriate How would you expect this client to get along without treatment? a) Very poor d) Good b) Poor e) Excellent c) Fair l3) 14) 94 Check the diagnostic label you think best describes the patient: Brain disorder Acute brain disorder (any type) Chronic brain disorder (any type) Psychotic disorders Involutional reaction Manic-depressive reaction Psychotic depression SchiZOphrenic reaction (any type) Paranoid reaction Psychophysiologic autonomic or visceral disorder (any type) Psychoneurotic disorders Anxiety reaction Conversion reaction Depressive reaction Obsessive compulsive reaction Phobic reaction Psychoneurotic reaction Personality disorders Compulsive personality Cyclothymic personality (affective personality) Paranoid personality Passive-aggressive personality Schizoid personality Sociopathic personality disturbance (any type) Transient situational personality disorder (any type) Mental deficiency (any type) No maladjustment or mental disorder If you were requested to treat this client, how would you feel about it? a) b) C) d) e) Adverse Interest lacking Neutral Moderately interested Extremely interested 95 15) Is this client's behavior typical of male(female) clients seen by you in treatment? a) Not at all d) Considerably b) Somewhat e) Extremely c) Average 16) How masculine(feminine) do you think this client is? a) Not at all d) Considerably b) Somewhat e) Extremely c) Average 17) How would you characterize your personal reaction to a) Strongly negative d) Somewhat positive b) Somewhat negative e) Strongly positive c) Neutral 18) Years of experience you have working with clients: a) Less than 1 year d) From 3 to 5 years b) From 1 to 2 years e) More than 5 years c) From 2 to 3 years 19) What theoretical orientation do you use when working with clients? a) Psychodynamic b) Social psychological c) Existential d) Psychophysiological e) Other (specify) 20) How would you rate your willingness to accept this client for treatm nt? a) Very willing d) Somewhat unwilling b) Somewhat willing e) Very unwilling c) Neutral 96 N.v o.v m.m m.¢ m.¢ o.¢ ~.v ~.v m.v m.v h.m m.v m.m m.m m.m m.v Aaa o.m m.m o.m m.v m.v >.m m.m m.v m.v o.m o.m h.v m.m m.¢ m.m m.m Ama m.m m.m m.m m.~ m.m m.m ~.m N.m m.~ m.m ~.m m.~ >.~ m.m h.m m.~ ANA m.m ~.v m.m m.m >.N m.m >.N m.m m.m m.~ m.~ ~.m v.m m.m m.m o.m AHH o.w m.m m.m m.m o.v m.v o.m o.v m.¢ m.m m.m m.v ~.w m.e m.¢ w.m Aoa m.H m.m m.~ m.m h.m o.m m.m o.~ m.~ m.~ m.~ m.~ o.m m.H m.N m.~ Am m.m N.m h.~ ~.m o.m m.~ m.m n.m o.m o.m N.m o.m m.m m.~ o.~ ~.m Am o.a >.m m.a N.e o.v ~.m >.m w.m ~.v m.v m.m m.v m.v N.v m.m h.m A» m.m o.m m.m m.m N.m h.m ~.m h.m m.m m.m h.~ m.m N.m >.m o.v n.m Am m.m h.m o.m o.m m.m h.m 5.H m.m o.m o.v m.~ ~.m m.m m.m o.v m.m Am n.a ~.~ m.m m.m m.m m.~ m.m m.m m.a o.~ ~.~ ¢.m m.~ m.m o.~ m.m Aw m.m m.a n.~ m.m w.H m.m m.a >.H m.~ m.m N.~ o.~ o.~ m.m m.~ m.m Am m.m o.m o.v o.m m.m o.v m.m h.m >.m o.v m.m m.m m.m m.m m.v m.m AN o.~ >.H m.H m.~ ~.N m.H m.m m.m n.a m.H o.m o.N m.H m.a m.H m.m AH m z m S h 2 m 2 m 2 m 2 h S m 2 meuH mucmflau mucmfiau mucmflao mucmfiau mucoflao mucofiao mucmfiao mucmwau Houucoo T>Hmmoumm< Honucoo m>flmmmumm¢ Honucoo T>Hmmmumm¢ Houucoo m>wmmmumm¢ Gm u we moamsom :8 u me most: 2% u E moatsom Gm u me most: mumflmmnone xomHm HMCOAUHUTHB mumwmmuona mmmcmsowomcoolxooam uofi>o£mm ucmflau mo mmwcmbowumoummd oaomlxmm oco .bcoflau How mCHxHA .CoHumocmEEoomm ucwEummuB .mflmocmonm .mCHHTQMA owumocmmea .mflmocmMHn unmanneuo> ucoocmmma me o» madcamuuwm mEmuH mom mwuoom mafiuom com: HQ magma 97 .ucoflao pwouu ou mmmcmcflaafiz .cofluomou HMCOmHmm .mcaasommE\TCHCHEmm .ucmflao How u0w>mnon HMOHQSB .ucmflao ummuu op oufimoo .Hmnma UHumocmmwa .ucoEumeu usonuw3 cowuocsm .mmmcmumflnmoummm maoulxmm .ucmEummnu nbw3 cowuocsm .ucmEumoHu mo sumcmq .cofiuoocoeaoomu ucmEummHB .mmmuum Hmucoecoufi>cm .ucmaumsmom Hafioom .muwusume HmcoHuOEm .mumwxco mumemoummfl om .unmflmcH 5H .cuocwnum 0mm ma .Toconusumflo mo moumwo OHNMV‘I!) I-lr-Ir-iI-lr-ir-t I-INMV'LHOFQO‘ EmuHm .Amdoum THmeu comm cw o ocm mama comm cw ov mm H THmEmm pcmwao Hobos .mm H mamsom umflmmuonu Hobos .muoz m.m m.H o.~ m.H m.m m.H m.H m.~ m.~ o.m m.m m.a m.m o.~ m.m m.a Aom o.v N.v m.m m.m o.v o.v h.m m.m m.e h.m >.m N.v m.¢ h.m ~.a w.m Aha n.m m.m m.m ~.m n.m m.m m.m m.m m.v m.m o.m h.m ~.m m.m >.m m.m Ama m.m h.a o.m m.m m.m v.m m.H m.m m.m m.~ m.H o.m N.N m.m >.m m.a AmH m 2 m 2 m 2 m 2 m S h E m 2 m 2 EOUH mucmflao mucmflao mucmaao mucoflau mucoflao mucowau mucmflau mucmfiao Houucou 0>Hmmmuoo¢ Houucoo T>Hmmoumm< Honucoo T>Hmmmumm4 Houucou m>wmmoumm¢ 1am u mo mosasom lam u me most: Iam numb moamsom 1am n me most: mumaotumae xotam Hmcoauaooua mumflmonmca mmmCmsowomc00Ixomam Aoooaaucooc Ho manta APPENDIX E LETTERS OF INTRODUCTION II. DeColius Johnson Doctoral Candidate Counseling & Personnel Ser. Michigan State University Your participation is needed to evaluate this experi- mental instrument related to black belief systems. If you are willing to participate in a doctoral research study on black therapists, please fill in your name and address. The research study will take place at a later date. Time involvement is approximately 1/2 hour. Thank you for your c00peration. Name: Address: Age: 18-24 25-34 35-44 45+ Sex: M F Date: Education level: Profession: Geographic location: North East South West Midwest 98 99 (Subject's name) (Subject's address) Date, 1977 Dear : Thank you for indicating your willingness to participate in this research project during your attendance at the Black Social Workers Convention in New Orleans (April, 1977). A sample of black therapists throughout the country are par- ticipating in this research. The purpose of the research is to compile data on clinical judgments of black therapists relative to their evaluation of black clients for treatment. The entire task requires about 1/2 hour to complete. Confidentiality will continue to be respected. Results of the research will be made available to participants at a later date. Sincere thanks and appreciation for your participation and support. Kindly, DeColius Johnson REFERENCES REFERENCES Bandura, A. Principles of behavior modification. New York: Holt, Rinehart & Winston, 1969. Banks, W. M. The differential effects of race and social class in helping. Journal of Clinical Psychology, 1972, 28, 90-92. Bayton, J. A., Austin, L. J., & Burke, K. R. Negro percep- tion of Negro and white personality traits. Journal of Personality and Social Psychology, 1965, pp. 250-253. Brieland, D. Black identity and the helping person. Children, 1969, l§(5), 171-176. Brill, N. 0., & Storrow, H. A. Social class and psychiatric treatment. Archives of General Psychiatry, 1960, 3, 340-344. Bryson, S., Bardo, H., & Johnson, C. Black female counselor and the black male client. Journal of Non-White Con- cerns, 1975, 2(3), 53-58. Calnek, M. Racial factors in the countertransference of the black therapist and the black client. American Journal of Orthopsychiatry, 1970, 49(1), 39-46. Carkhuff, R. R., & Pierce, R. Differential effects of thera- pist race and social class upon patient depth of self- exploration in the initial clinical interview. Journal of Consulting Psychology, 1967, §i(6), 632-634. Derbyshire, R. L. United States Negro identity conflict. Sociology and Social Research, 1967, §l, 63-77. Dorfman, E., & Kleiner, L. J. Race of the examiner and patient in psychiatric diagnosis and recommendations. Journal of Consulting Psychology, 1962, 2§(4), 393. Glass, G. V., & Stanley, S. C. Statistical methods in educa- tion andgpsychology. Englewood Cliffs, N.J.: Prentice- Hall, 1970. Grier, W. H. When the therapist is Negro: Some effects on the treatment process. American Journal of Psychiatry, 1967, 123, 1587-1591. 100 101 Grier, W. H., & Cobbs, P. M. Black rage. New York: Basic Books, 1968. Gross, H. S., & Associates. The effect of race and sex on the variation of diagnosis and disposition in a psychi- atric emergency room. Journal of Nervous and Mental Disease, 1969, l4§(6), 638-642. Hall, W. S., Freedle, R., & Cross, Jr., W. E. Stages in the development of a black identity. Iowa City: American College Testing Program, Research and Development Divi- sion, 1972. Hollingshead, A. B., & Redlich, F. C. Social class'and mental illness: A community study. New York: John Wiley & Sons, 1958. Jones, B., et al. The problems of black psychiatric resi- dents in white training institutions. American Journal of Psychiatry, 1970, 127, 798-802. Jones, F. The black psychologist as consultant and thera- pist. In R. L. Jones (Ed.), Black psychology. New York: Harper & Row, 1972. Karon, B. P. Black scars. New York: Springer, 1975. Kleiner, R. J., Tuckman, J., & Lavell, M. Mental disorder and status based on race. Psychiatry, 1960, 23, 271-274. Lane, E. A. The influence of sex and race on process- . reactive ratings of schizophrenics. Journal of Psychol- ogy, 1968, pg, 15-20. Lowinger, P., & Dobie, S. An evaluation of the role of the psychiatrist's personality in the interview. In J. H. Masserman (Ed.), Science andypsychoanalysis (Vol. 7). New York: Grune & Stratton, 1964. Lowinger, P. & Dobie, S. The attitudes of the psychiatrist about his patient. Comprehensive Psychiatry, 1968, 2(6), 627-632. Merriouns, H. S. Black therapist-black patient; black therapist-white patient: An exploratory stu_y. Unpub- lished doctoral dissertation, University of California at San Francisco, 1974. Muller, J. J., Chafetz, M. E., & Blane, H. T. Acute psychi- atric services in the general hospital: III. Statis- tical survey. American Journal of Psychiatry, 1967, 131: 46-57. 102 Nathan, P. E. Cues, decisions, and diagnosis: A system- analytic approach to the diagnosis of psychopathology. New York: Academic Press, 1967. Pasamanick, B. On the neglect of diagnosis. American Jour- nal of Orthopsychiatry, 1963, fig, 397-398. (a) Pasamanick, B. Some misconceptions concerning differences in the racial prevalence of mental disease. American Journal of Orthopsychiatry, 1963, 3;, 72-86. (h) Pasteur, A. B. The social class origins of black counselors and their attitudes towards disadvantaged youth. Unpub- lished doctoral dissertation, Northwestern University, 1971. Ring, S. I., & Schein, L. Attitudes toward mental illness and the use of caretakers in a black community. Amer- ican Journal of Orthospychiatry, 1970, 59(4), 710-716. Schwartz, J. M., & Abramowitz, S. I. Value-related effects on psychiatric judgment. Archives of General Psychi- Simon, R. J., Fleiss, J. L., & Gurland, B. J. Depression and schizophrenia in hospitalized black and white mental patients. Archives of General Psychiatry, 1973, 28, 509-512. Solomon, P., & Patch, V. D. (Eds.). Handbook of psychiatry (3rd ed.). Los Altos, Calif.:- Lange Medical Publica- tions, 1974. Strupp, H. H. The performance of psychiatrists and psychol- ogists in a therapeutic interview. Journal of Clinical Psychology, 1958, A2! 219—226. Strupp, H. H. Psychotherapists in action. New York: Grune & Stratton, 1960. Szasz, T. S. The use of naming and the origin of the myth of mental illness. American Psychologist, 1961, 19, 59-65. Szasz, T. S. The Negro in psychiatry. American Journal of Psychotherapy: 1971, 2;, 469-471. (a) Szasz, T. S. The sane slave. American Journal of Psycho- therapy, 1971, gs, 228-239. (b) Thorne, F. C. Back to fundamentals. Journal of Clinical Psychology, 1953, 9, 89-91. 103 Vontress, C. E. Racial differences: Impediments to rapport. Journal of Counseling Psychology, 1971, ig, 7-13. Wallach, J. S., & Strupp, H. H. Psychotherapists' clinical judgments and attitudes towards patients. Journal of Consulting Psychology, 1960, 24(4), 316-323. Wallach, M. 8. Certain relationships between psychothera- pists' attitudes and their perceptions of patients. Unpublished doctoral dissertation, University of North Carolina, 1959. Whitehorn, J. C., & Betz, B. J. Further studies of the doc- tor as a crucial variable in the outcome of treatment with schizophrenic patients. American Journal of Con- sulting Psychology, 1960, ill, 215-223. Williams, R. L. Themes of black awareness. St. Louis, Mo.: Institute of Black Studies, 1976. Wispe, L., Ankard, J., Hoffman, M., Ash, P., Hicks, L. H., & Porter, J. The Negro psychologist in America. Amer- ican Psychologist, 1969, 21, 142-150. Woodruff, Jr., R. A., Goodwin, D. W., & Guze, S. B. Psychi- atric diagnosis. New York: Oxford University Press, 1974. Yamamoto, J., James, Q. C., Bloombaum, M., & Hatten, J. Racial factors in patient selection. American Journal of Psychiatry, 1967, 124, 630-636. Zigler, E., & Phillips, L. Psychiatric diagnosis: A critique. Journal of Abnormal and Social Psychology, 1961, §§(3), 607-618. (a) Zigler, E., & Phillips, L. Psychiatric diagnosis and symp- tomatology. Journal of Abnormal and Social Psychology, 1961, 63(1), 69—75. (h) HICHIGnN STATE UNIV. LIBRARIES ll)WINWNW“)I”)WIVIHIWNINWWI 31293100643224