ABSTRACT
JOB EFFECTIVENESS AND PERSONAL ATTRIBUTES
OF MENTAL HEALTH PARAPROFESSIONALS
By

Donna Jean Small

Many residential treatment authorities have depicted
mental health paraprofessionals (MHPs), who have direct con-
tact with patients throughout their working hours, as crucial
to successful treatment. However, little research attention
has been given to MHPs' effectiveness or personal character-
istics. This study concerned MHPs' effectiveness, as
perceived by their professional supervisors (psychiatrists,
psychologists, and social workers), patients, peers, and
self-reports. It also explored the linkages of effectiveness
indicators with dimensions of interpersonal behavior which
have previously been found salient to interpersonal relation-
ships in general, and to helping relationships in particular.
Included among these interpersonal variables were measures
of: acceptance-rejection of others (ARO), acceptance-
rejection of self (SAR), self-disclosure, TAT pathogenesis,
number of personal problems acknowledged, like-disliked
ratings, and an "I'm OK, You're OK" questionnaire.

This study focused on A3 MHPs, mostly BA degree holders
and averaging 2“ years of age, employed in residential

treatment units for adolescents in a prominent private

Donna Jean Small
facility. Seven additional MHPs on these units who de—
clined to contribute to some phase(s) of the study averaged
less favorable scores than the participants on 17 of 18
different ratings by others. Each MHP's effectiveness was
rated by the professional unit supervisor, by four of the
"most improved" patients in that unit, by several (mean = 5)
unit co-workers, and by self. All four sources (supervisors,
patients, peers, and self) made ABC and SAR ratings of each
MHP. Self-disclosure ratings were provided by peers and
self. Pathogenesis scores were derived from judges' ratings,
using an empirical scoring system, of Thematic Apperception
Test stories written by MHPs. Mooney Problem Check List
responses served as a measure of acknowledged personal
problems.

Analyses of seventeen work effectiveness items yielded
two distinct four-item clusters which were named Knowledge
and Skills (KS) and Role Commitment (BC). In the data from
supervisors, co-workers, and self, KS and RC scores corre-
lated only moderately, but they correlated highly (.90) for
patients. Across sources there was much consensus about
the KS and RC effectiveness ratings, although this was
stronger for the KS than RC cluster -—perhaps because the
KS items had clearer behavioral referents.

Multiple regression analyses and other intercorrelations
between all effectiveness indicators and personality

measures demonstrated that effectiveness related importantly

Donna Jean Small
with ARO and SAR, but only when ARO and SAR were not self-
reported. Personality self-reports failed to predict
effectiveness, except in the dubious case of self-rated
effectiveness. Although moderately intercorrelated, peer-
rated SAR and job longevity vied to best predict KS
effectiveness as perceived by both peers and supervisors.
Together, longevity and peer-rated SAR predicted over 56%
of the variance in KS effectiveness by either source. The
situation was foggier for RC effectiveness. Supervisors'
RC ratings were best predicted by supervisors' ARO, followed
by supervisors' Liking. Peers' RC effectiveness was best
predicted by peers' Liking, patients' SAR, and peers' ARO.
Over 50% of the variance in RC effectiveness was wholly
predictable from personality measures, as job longevity did
not contribute to predicting Role Commitment. Self-disclo-
sure ratings by peers did not appreciably add to the
multiple regression prediction of effectiveness. TAT
pathogenesis scores, scores on the "I'm OK, You're OK"
questionnaire, and number of personal problems failed to
correlate significantly with any measure of job effective-
ness. However, a qualitative analysis of written additions
to Mooney Problem Check List responses suggested that more
effective MHPs were more likely than others to claim
acceptance of responsibility for personal problems which

they were actively trying to resolve.

Donna Jean Small

Patients showed a unique and curious tendency to
favorably rate MHPs who scored as more pathogenic on the
TAT and who acknowledged more personal problems. Patients
were also unable to differentiate between the KS and RC
components of MHPs' effectiveness. These response patterns
differed sharply from those of the MHPs and supervisors.
On the reasonable assumption that MHPs and supervisors
were less maladjusted than the patients, it appears that
both groups tended to value persons more like themselves.
If confirmed by new studies, this observation would limit
confidence in patients' perceptions, contingent upon their
degree of disability.

In summary, this study identified two distinctive
facets of the effectiveness of mental health paraprofes-
sionals--knowledge and skills versus role commitment--and
confirmed the expectation that measures of ARO and SAR
would link positively with job effectiveness. Several

issues deserving further study were also noted.

JOB EFFECTIVENESS AND PERSONAL ATTRIBUTES

OF MENTAL HEALTH PARAPROFESSIONALS

By

Donna Jean Small

A DISSERTATION
Submitted to
Michigan State University
in partial fulfillment of the requirements
for the degree of
DOCTOR OF PHILOSOPHY

Department of Psychology

1976

ACKNOWLEDGMENTS

I give my thanks:
- to John Hurley, for his huge amount of help, support,
and patience, and for the hard time he gave me when I
needed it;
- to Gene, for his encouragement and for periodic release
from other responsibilities;
- to Brian, Dan, and Jon, for what they were willing to
do without;
- to Joe Cotton, for the time he provided and the interest
he showed;
- to Helen Benedict, for her helpful suggestions and
understanding support;
- to Art Seagull and Bert Karon, for their approval;
- to the workers and raters at The Oaks who participated
in the study;
- to The Oaks' administration, for their cooperation and

support.

11

TABLE OF CONTENTS

List of Tables . . . . . .
List of Figures . . . .

List of Appendices
Introduction . . . . . . .
Review of the Literature
Method . . . . . . .

Results . . . . . . . .
Discussion . . . . . . . . . .
Summary and Conclusions
References . . . . . . .

Appendices

iii

Page

iv

vi

39
66
81
83
87

Table

10.

11.

LIST OF TABLES

Page
MHW Rating Sheet. . . . . . . . . . . . . . .28
Means and Standard Deviations of Variables. .37

Product-Moment Correlations of Test-Retest
Ratings of NH? Effectiveness by Therapists. .HO

Image Analysis Results for Individual MHW
Rating Sheet Items. . . . . . . . . . . . . .A5

Product-Moment Correlations of Various
Effectiveness Scores. . . . . . . . . . . . .u6

Product-Moment Correlations of Effectiveness
Ratings with Personality Descriptions of
MHPS o o o o o o o o o o o o o o o o O o o 050

Product-Moment Intercorrelations of Person-
ality Variables and Effectiveness Scores, for
Ratings by Therapists . . . . . . . . . . . .52

Product-Moment Intercorrelations of Person—
ality Variables and Effectiveness Scores, for
Ratings by Patients . . . . . . . . . . . .53

Product-Moment Intercorrelations of Person-
ality Variables and Effectiveness Scores,
for MHP-Peer Ratings 0 o o o o o o o o o o 05“

Product-Moment Intercorrelations of Person-
ality Variables and Effectiveness Scores,
for MHP-Self Ratings . . . . . . . . . . . .55

Product-Moment Correlations of Length of
Employment with Effectiveness Scores. . . . .62

Summary of Multiple Correlation Coefficients

for Predicting Effectiveness Indicators With

All Statistically Significant Predictors

Ranked in Importance Downward From Top of

Each Column . . . . . . . . . . . .63
iv

LIST OF FIGURES

Figure Page

1. Typal Analyses of Individual Items on the
MHW Rating Sheet (general impression,
#16, included). . . . . . . . . . . . . A2

2. Typal Analyses of Individual Items on the
MHN Rating Sheet (general impression,
#16, omitted) . . . . . . . . . . . . . 43

3. Structure of Linkages Between Job Effectiveness
and Personality Attributes. . . . . . . . . 56

LIST OF APPENDICES

Appendix Page
A. Self-Disclosure Measure. . . . . . . . . . . 87
B. "0K" Questionnaire . . . . . . . . . . . . . 89

C. Letter of Introduction and Background Sheet
for MHPs . . . ... . . . . . . . . . . . . . 98

D. Mean Effectiveness and Semantic Differential
Scores of Subjects and Non-Subjects. . . . . 99

E. Effectiveness Scores of Individual MHPs. . .100

F. Semantic Differential Scores of Individual
MHPs . . . . . . . . . . . . . . . . . . . .101

G. Personality Variable Scores of Individual
MHPs . . . . . . . . . . . . . . . . . . .102

H. Intercorrelations Among MHw Rating Sheet .
Items, for Therapist Ratings . . . . . . .103

I. Intercorrelations AmOng MHW Rating Sheet
Items, for Patient Ratings . . . . . .10“

J. Intercorrelations Among MHW Rating Sheet
Items, for Peer Ratings. . . . . . . . .105

K. Intercorrelations Among MHW Rating Sheet
Items, for Self Ratings. . . . . . . . . .106

L. Frequency of Ratings for MHW Rating Sheet
Items. . . . . . . . . . . . . .107

M. Product—Moment Correlations of Effectiveness
Scores with OK Questionnaire and PathOgenesis
Scores . . . . . . . . . . . . . . . . . . .108

N. Product-Moment Correlations of Effectiveness
Scores with MHP's Mooney Scores. . . . . . .109

vi

vii

Product-Moment Correlations of OK Questionnaire,
Self-Disclosure, and Pathogenesis Scores. . . . .llO

Personality Variables as Predictors of Effective-
ness of MHPs, Listed in Order of Their Strength

as Predictors .111

INTRODUCTION

In a residential treatment program, the Mental Health
Paraprofessional (MHP), the worker who is with the patients
in their daily activities, plays a major role. In addition
to providing physical care and supervision, the MHP becomes
actively involved in developing and carrying out treatment
recommendations. The relationship between the MHP and the
patient is an important therapeutic tool. Within the treat-
ment setting, some MHPs are considered by their co-workers,
their patients, and their professional supervisors, to have
a beneficial effect, a few are seen as having a negative
effect, and most are seen somewhere in the middle of this
continuum. What factors contribute to these differences
in perception? Some research has been done, though very
little, in dealing with the specific question of relating
personality variables to job effectiveness of MHPs in
residential treatment. Research relating to other types
of mental health paraprofessionals may also apply.

There is a growing volume of research that indicates
the importance of the variables, acceptance of self,
acceptance of others, and self-disclosure, as important
in helping relationships. These variables have been

examined in parent-child relationships, psychotherapy

l

2

relationships, and T-group outcomes. They have not been
used specifically to study the effectiveness of MHPs; they
are used in this study because of their broad applicability
in other helping relationships.

The purpose of this study is to develop theoretical
information about the kinds of behavior that is helpful
to MHPs, by examining variables that have been found to be
important to other helping persons. The variables, accep-
tance of self, acceptance of others, and self-disclosure,
are studied in relation to perceived Job effectiveness of
MHPs. A measure of pathogenesis, another variable that
has been found to be usefully studied in a variety of
relationships, will also be used. Another variable, the
reporting of personal problems, is included because it
has been described as important in the performance of MHPs.
Hopefully, in addition to theoretical information, the
results will be useful in selecting potential MHPs, and in
providing some guidelines in the training of MHPs, by
pointing out some areas of personality and interpersonal

behavior that may be useful to develop.

REVIEW OF THE LITERATURE

Role of the Mental Health Paraprofessional

The role of the MHP (often called "Mental Health
Worker," "Child Care Worker," or "Counselor") in residential
treatment varies much from institution to institution. For
example, in some, the MHP is the primary therapist for the
patient, while in others, his function is primarily as a
supervisor of daily activities. Therefore, generalizations
are difficult to make. However, over the last several years,
there has been a growing realization that MHPs hold a very
important position (some say the most important position)
in the treatment of the child. (Diggles, 1970; Maier, 1971;
Portnoy, Biller, and Davids, 1972; Schwartz, 1968;
Trieschman, Whittaker, and Brendtro, 1969; and Whittaker
and Trieschman, 1972).

This represents a shift since Lourie and Schulman
(1952) described two different viewpoints regarding the
function of the residential staff. The first involved a
situation where the living group was seen as an adjunctive
therapeutic aid, rather than a central part of treatment,
i.e.,the residential staff was seen as secondary to the
individual therapist, and its function was to provide an
environment that was benevolent. However, staff members

were not to deal directly with the children's problems.
3

A
The second viewpoint placed emphasis on the concept of
group milieu treatment, using the residential staff to
directly handle the children's conflicts and distortions
therapeutically, as they appeared in daily living. Most
residential treatment centers were of the first type in the
1950's (Lourie and Schulman, 1952).

This emphasis has shifted, and many experts in residen-
tial treatment have pointed out the importance of the
milieu, and of MHPs as therapeutic agents. MHPs are with
the patients for long periods of time, and have an opportu-
nity to provide therapeutic help in the context of a rela—
tionship with them.

For example, Trieschman, Whittaker, and Brendtro (1969),
believe that the major difficulty in children who need
residential treatment is in their development of appropriate
relationships with adults; they have become unresponsive to
social reinforcers, and have rejected adult role models.

The Job of the MHP is to establish a relationship with the
child; by "establishing a relationship," the authors mean
that the MHPs increase the child's communication with him,
increase the child's responsiveness to social reinforcers
provided by him, and increase the child's tendency to model
his behavior. These aspects of the relationship facilitate,
respectively, the child's ability to utilize insight
learning, reward and punishment learning, and identification-

imitation learning.

5

Holmes (1971) emphasizes the importance of the relation-
ship between worker and patient, stating that the effective
psychiatric nurse deals with the patient on a person-to-
person level, expressing herself authentically. The skills
required are, she says, "that she be able to (a) help the
patient accept and appreciate his own inner experiences,
which means that she has to be able to tolerate sharing in
some of these experiences, and (b) meet the patient in real
encounter" (p.99).

KonOpka, Kamps, and Wallinga (1961), in writing about a
group home setting that evolved into an intensive treatment
program, related that the staff became more involved in the
treatment program, both with the children and with each
other. This led to strong counter-transference feelings
and acute anxiety reactions in some staff members; those
who were unwilling or unable to cope with this left, but
the more effective workers stayed and dealt with the rela-
tionships as they developed. Open communication and mutual
respect were stressed, as was criticism given and received
in the spirit of improving the total treatment program.

The need for emotional involvement between MHPs and
children is also stressed by Maier, Hilgeman, Shugart, and
Loomis (1955). They state that the worker must feel free
to use himself in emotional interaction with the children,
and that this involvement is related to self-examination
and concern for one's own attitudes, feelings, responses,

and problems. They have found that over one-half of the

6
MHPs discuss their own personal problems with their super-
visors, and that they sometimes enter psychotherapy them-
selves. Their intense relationships with the children and
the climate of the psychiatric setting makes it necessary
for them to face their own conflicts as they arise in their
work.

At the Orthogenic School, the MHPs are the therapists
for the children; they are supervised by mental health
professionals, but the children do not have any other thera-
pist than the MHPs who are with them on the residence.

Much emphasis is put on the MHP's relationships with the
children and on his own personal development. It is believed
that an important part of becoming a MHP is "to recognize in
ourselves those existential experiences that match theirs...
To become a Child-Care Worker means first and foremost to
become oneself because only then can one become a self to
others" (Bettelheim, 1966, p.705). A major task Of the
supervisor is to help the MHP develop deeper insights into
himself, trusting that these insights will benefit both the
worker and the children with whom he works. Effective MHPs
are seen as young adults who themselves are experiencing a

need for emotional and intellectual growth.

"It is his own need for achieving integration, his
conviction that through his experiences at the school
he will achieve it, that permits the worker to dedicate
himself to the children under his care, to create that
emotional closeness and unique empathy with the child
that will set going again the process of deve10pment
that broke down in the child's early years"

(Bettelheim and Wright, 1955, p. 707).

7

The Orthogenic School was intensively studied by an
anthropologist for over a year, using direct observation
of children and MHPs, case records, informal conversations,
and a record of daily life at the school (Henry, 1957).
Henry concluded that MHPs, as well as the children in their
care, are seeking self—understanding, and that this is a
main incentive for their work.

"No counselor who does not wish to create a new Self,

who is unprepared to solve her own emotional problems,

and no one who is unable to take the sick child as a

focus for her own development, finds it possible to

endure at the School.
In this respect, he pointed out some parallels between the
children's and the staff's development: three years is the
average length of stay for the children, and three years is
also the approximate length of time it takes for MHPs to
achieve a "feeling of relative assurance in task performance";
also, six or seven years is the maximum length of stay for
the children, and this is also the maximum length of employ-
ment for MHPs, in general.'

Thus, these narrative accounts of the role of the MHP
have stressed the importance of the worker's relationship
with the child. Aspects of this relationship include open
communication on a person—to-person basis, the sharing of
experiences on a feeling level, and the worker serving as a
role model. The ongoing personal development and self

exploration of the worker is seen as important in his work

with the child.

Research on MHPs

 

There is a marked paucity of research in the area of
MHP effectiveness. One of the few studies that has been
done establishes MHPs as effective role models. Portnoy
(1973) asked children in residential treatment to perform a
task after watching models perform the same task. Some
models were presented as people who would be Child Care
Workers at the institution, some as people who would be
therapists, and some as visitors (neutral figures). They
found that the Child Care Worker figures were more effective
models than the neutral figures, the therapist figures were
also more effective models than the neutral figures, and,
the Child Care Worker figures were more effective models
than the therapist figures, when the two were directly
compared. Portnoy concluded that "the Child Care Worker,
by the nature of his role, is an extremely influential
figure for children in residential treatment" (p._19),

In a study of job effectiveness of MHPs at The Oaks
in 1973, Sturman found few correlations between scores on
the 16 PF and ratings of job effectiveness. Out of 128
possible correlations, only four were significant at the
.05 level. Ratings for Individual Counseling Skills were
slightly related to a tendency to be affected by feelings,
rather than emotionally stable. Ratings for Group Counsel-
ing Skills were related to assertiveness and to being imagi—
native and non—conforming; Group Counseling Skills were also

slightly related to a tendency to be reserved rather than

9
outgoing. There were no significant correlations between
the 16 PF and the job rating categories of General Employ-
ability, Ability to Function on a Team, Milieu Counseling
Skills, Administrative Skills, Personal Growth, or the
Total Rating. It appears that the 16 PF has limited appli-
cation for the purpose of studying MHP effectiveness. The
results that indicate a positive relationship between job
effectiveness and tendencies to be emotionally unstable and
reserved were thought to be due to the fact that MHPs could
be more effective if they had had some experience with what
the patients were going through.

Davids, Laffey, and Cardin (1969) obtained some related
findings in their study of MHPs at Bradley Hospital in Rhode
Island. They found that workers who obtained the highest
ratings from their supervisors in job effectiveness, rated
themselves higher on alienation traits and lower on affili-
ation traits. The authors conclude that these results

"might indicate insight or lack of defensiveness

on the workers' part... or, it might be that a

certain degree of personal and social maladjustment,

as indicated in these self-ratings, is desireable
for working well with emotionally disturbed children"

(p. 76).

In sum, research has supported the notion of MHPs as
effective role models. Further, effective MHPs tend to
describe themselves as slightly emotionally unstable,
reserved, and alienated, as well as aggressive, imaginative,
and non-conforming. These results are fairly consistent
with narrative accounts of the role of the MHP. Both empha-

size his/her function as a role model. The findings on

10
alienation traits and emotional instability seem consistent
with descriptions of the effective MHP as a person in touch
with his/her own problems and in search of his/her own

answers .

Research on Interpersonal Behavior

 

Because there has been so little research done specifi-
cally on MHPs, studies relating more generally to inter-
personal behavior and to other kinds of helping persons were
examined. Since MHPs are also helping persons in the inter-
personal realm, it is reasonable to expect that some variables
that have been found to be important to other kinds of re-
lationships, especially helping relationships, will also be
important to MHPs.

Evidence from several diverse areas of study, including
psychotherapy, child development, encounter groups, and
psychiatric patients, indicates that there are two important
factors of interpersonal behavior that show up repeatedly.
These factors have been given different labels by different
researchers, but basically they refer to self-acceptance-
rejection (SAR) and acceptance-rejection of others (ARO)
(J.R. Hurley, 1976c). These dimensions have been found to
be independent of each other, and can be represented by two
orthogonal axes that separate all interpersonal behavior into
four quadrants that correspond to the positions, I am OK,
you are OK; I am OK, you are not OK; I am not OK, you are
OK; and I am not OK, you are not OK. These positions have

been popularized in Harris' (1967) best-selling book.

ll

J.R. Hurley (1976b) has cited research that supports
these dimensions in the diverse areas of general personality
descriptions, behavior in group settings, family relation-
ships, and psychopathology and psychotherapy. Both of these
dimensions are important to mental health and well-being
(J.R. Hurley, 1976b); in fact, the product of SAR and ARO
has been used as a measure of social competence (Hurley and
Force, 1971). The dimensions SAR and ARO have proved useful
for research in many areas.

For example, Bierman (1969), who refers to these dimen-
sions as acceptance-rejection and active-passive, reports
on studies of the psychotherapy relationship. It has been
demonstrated that therapist positive regard (corresponding
with ARO) is positively related to client outcome. Thera-
pist activeness (corresponding with SAR) has many effects
on the client. For example, therapist activeness has been
shown to be positively correlated with client activeness.
This is true for both quantitative measures of activeness
(frequency and length of utterances), and for qualitative
aspects of activeness, in terms of deepening self explora-
tion and insight. Therapists who take an active part in
structuring the interview by letting the client know what
to expect, following up client leads, and probing specific
areas, rather than passively accepting anything the client
brings up, being amibguous, and providing few clues to
guide the client, tend to make clients feel less anxious

and more satisfied with the therapy relationship. Therapists

12
who are active in the quantitative sense (talking more
frequently and longer) also tend to be active in the quali-
tative sense (provide some structure in the interview);
therapists also tend to have a fairly constant level of
activity, across various clients. Therapist passiveness
tends to lead to more broken appointments, complaints
about the therapy relationship, and premature termination.
Active therapists tend to have better client attendance,
more desireable process behavior in clients, and more favor-
able outcomes. This relationship breaks down if the active-
ness goes to controlling, dominating behavior that permits
little freedom of response in the client; this interaction
of the two dimensions, self-acceptance and other-rejection,
does not produce positive results. Confrontation leads to
increased client self-exploration only if it is done in the
context of empathy and positive regard.

Bierman (1969) points out that attending-empathic-
understanding behavior appears to be related to the positive
aspects of both dimensions, acceptance and activity.
Accurate empathy of the therapist has been shown to facili—
tate productive process behavior on the part of the client,
as well as improved life functioning at termination.
Therapist genuineness or transparency produces greater
transparency or self-exploration in the client; this is
thought to be facilitated because the therapist removes
ambiguity and provides a model for the client. When thera—

pists are low on the dimensions of acceptance and activity,

13

clients have been found to get worse.

Bierman also reports some findings from the field
of child development, and concludes that

"conditions of active engagement in the context of

positive regard and accurate empathic understanding

are Optimal for personal development and well-being.

The consistency of effects of therapist—offered con-

ditions with the effects of parent- and teacher-offered

conditions lends support to the generality of the two-

dimensional model" (p.3U8).

Support for the generality of this model also comes in
a report of several empirical studies of maternal behavior;
Shaefer (1959) demonstrated that many existing concepts of
maternal behavior could be ordered within a two dimensional
space. Only molar social and emotional interactions were'
used, since the important factor in personality develOpment
is the total pattern of a child's experience, rather than
specific practices. He developed a circumplex order of
maternal behavior; this is a circular order than can be
portrayed by a two dimensional diagram with two aXes, both
of which correlate highly With other variables within the
matrix, but which have zero or low correlations with each
other. The axes in this study were labeled love-hostility
(corresponding to ARO) and autonomy-control (corresponding
to SAR).

Similar dimensions were also obtained by Lorr, Bishop,
and McNair (1965), who used currently observable inter-
personal behavior to classify non-psychotic psychiatric

patients. Across three samples of 525 patients, they

derived four types that correspond well with the four

14
positions under discussion. Their types were: (I) inhibited,
submissive, and abasive, with low ratings in dominance,
competitiveness, and hostility (corresponds with self—
rejection); (II) agreeableness, nurturance, affection,
sociability, with low ratings on hostility, mistrust, and
detachment (corresponds with other-acceptance); (III) hos-
tility, mistrust, detachment, with low ratings in agreeable-
ness, nurturance, love, and sociability (corresponds with
other-rejection); (IV) exhibitionistic, dominant, competi-
tive, hostile, with low ratings on inhibition, submissive-
ness, and abasiveness (corresponds with self—acceptance).

Adams (1964) emphasized the interpersonal behavior
aspect of mental illness, pointing out that all interper-
sonal behavior can be meaningfully categorized within the
frame of reference of two axes. "The Dominance-Submission
axis defines the degree of acceptance or rejection of self,
while the Affection-Hostility axis defines the degree of
acceptance or rejection of the other" (p. 195)- The four
quadrants correspond to the four traditional temperaments,
sanguine, choleric, melancholic, and phlegmatic. These
dimensions have recurred in factor-analytic studies of the
MMPI, and they have also been used in interpreting the
Rorschach and Thematic Apperception Test.

"It is clear that the same fundamental patterns have

been repeatedly observed by many contemporary and
historical writers, even though the words used may

seem very different. These similarities and conver-
gences would not have been so consistently noted unless

there were certain universal features in all human
conduct" (p. 196).

15

Thus, evidence has come from many researchers, indi-
cating the importance of two aspects of interpersonal beha-
vior. One of these aspects reflects the feelings and
attitudes that a person has about himself, and the concepts
used to describe this aspect include activity versus
passivity, autonomy versus control, dominance versus submis-
sion, and "I am OK," versus "I am not OK." All of these
concepts reflect the degree of acceptance or rejection a
person has about himself.

The other aspect that has shown up repeatedly reflects
the feelings and attitudes that a person has about others,
and the concepts used to describe this aspect include
acceptance versus rejection, love or affection versus hos-
tility, "you are OK" versus "you are not OK," and agree-
ableness, nurturance, and sociability versus mistrust and
detachment. All of these concepts reflect the degree of
acceptance or rejection a person has about others.

Both of these aspects, acceptance of self (SAR) and
acceptance of others (ARO), are involved in the attending,
empathic, understanding behavior that has been found to be
helpful in psychotherapists.

A variable that is closely related to the concepts of
SAR and ARO is self-disclosure. J.R. Hurley (1976c), in
addition to pointing out the usefulness of the concepts of
SAR and ARO in studying encounter groups, also points out

that self-disclosure of the trainer was found to be a major

facilitator of T-group participant gains in three

16
independent, dissimilar studies. In other studies, self-
disclosure of group members was found to be related to
positive regard from other group members, and to ratings of
self- and other-acceptance.

Hurley and Force (1971) found positive changes of
participants in T-groups to be highly correlated with self-
disclosing and feedback—seeking behavior of trainers. This
was an extension of Culbert's (1968) earlier finding that
trainers who were more self-disclosing had the effect of
temporarily accelerating the participants' self-awareness
in the early phase of a T—group. In the Hurley and Force
study, ratings of trainers were found to be quite consistent
over time and in different T-groups. The product-moment
correlation between the participants' ratings of the effect-
iveness of their trainers and a change score obtained six
months post-lab was .98. The most important variable related
to trainer effectiveness was self-disclosure ratings by
others, not by self-report.‘ Feedback-seeking behavior of the
trainer was a second important variable.

The validity of self-disclosure, as measured by self-
report instruments, is questionable. Hurley and Hurley
(1969) obtained positive correlations between the Jourard
Self-Disclosure Questionaire scores (obtained by self-
report) and a peer-rated measure of self-concealment in a
study of 50 students in a graduate course on groups. They
also obtained negative, though not significant, correlations

between this self-report measure and three peer-rated

17
measures of self-disclosure. All peer—ratings of self-
disclosure and self-concealment tended to support the
validity of each other.

Self-disclosure has been shown to be effective in pro-
ducing desired changes. In a study of effectiveness of
interviewer behavior, Powell (1968) compared three forms
of interviewer intervention: (1) approval-supportive;

(2) reflection-restatement; (3) open disclosure, or "state-
ments designed to match the subject's self-reference with

a statement from the experimenter about his own thoughts,
feelings, or experiences about the pertinent tOpic." Results
indicated that negative self—reference statements increased
when reinforced by a reflection-restatement or by open disclo-
sure, but positive-self-reference statements increased only
when reinforced by open disclosure. The reason that appro-
val-supportive responses were ineffective was felt to be
that, especially in this experimental situation, this kind

of blanket support could be seen as a lack of interest or
understanding. The researcher concludes that "self—disclo-
sure encourages self-disclosure in a face-to-face

interview ... Open disclosure seems well designed to convey
the experimenter's interest, acceptance, and understanding."

Truax and Carkhuff (1965) report other studies that
indicate successful therapy outcomes are related to more
self-exploration and transparency on the part of the
patient, and that patient transparency is related to thera-

pist transparency. They describe two functions of therapist

18
transparency: (1) to serve as a model for patients to
imitate; (2) to remove ambiguity in the situation and
therefore lessen anxiety and fears in the therapy encounter;
this would be expected to make patient transparency more
likely.

In summary, then, it can be said that interpersonal
behavior has been usefully studied in terms of the concepts
of SAR and ARO; these dimensions are stable and independent,
and the presence of both in a relationship is conducive to
mental health and growth. Helping persons with high scores
on both dimensions have been found to be more effective than
those with lower scores. Self-disclosure is related to high
scores on both of these dimensions, and is facilitative of

positive change.

Research on Pathogenesis

 

Another variable that has been found to be important
to mental health and to the helping professions is patho-
genesis (Melnick and Hurley, 1969; Meyer and Karon, 1967;
Mitchell, 1968, 1969; and Vandenbos and Karon, 1971). This
is a measure of the extent to which the dominant person in
a relationship takes the needs of the dependent person into
account. To obtain this measure, Thematic Apperception Test
stories are scored by an objective set of criteria (Meyer
and Karon, 1967). A high (pathogenic) score indicates that
the person, when in the dominant position of a dominant-

dependent relationship, does not consider the needs of the

19
other person when the needs are in conflict. In fact, he
may unconsciously use the dependent person for the satis-
faction of his own needs. 0n the other hand, a low (benign)
score indicates that the person, when in the dominant posi-
tion, does take the needs of the dependent person into
account.

The pathogenesis score was initially used to differ—
entiate mothers of schizophrenics from mothers of normals,
and it did so very effectively. It also has successfully
differentiated mothers of severely disturbed schizophrenics
from mothers of less disturbed schiZOphrenics; mothers and
fathers of schizophrenics, delinquents, and normals; child-
abusive mothers from non-abusive mothers; and effective
therapists from less effective therapists. In this last
study, Vandenbos and Karon (1971) found that schizophrenic
patients of benign therapists, more than the schizophrenic
patients of pathogenic therapists, were functioning at
higher levels after six months of treatment, as measured
by intellectual tests, clinical status interviews, and
length of hospitalization.

Relating these findings to studies on interpersonal
behavior, it seems that the pathogenesis score would be
negatively correlated with measures of ARO, since both

measures reflect behavior toward other people.-

20
Statement of the Problem

In an attempt to study some factors involved in job‘
effectiveness of MHPs, a variety of variables were examined.
These variables had their origination in other areas of
human relationships, because there has been such a small
amount of research done with MHPs.

In the study of interpersonal behavior, SAR has been
found to be an important variable for helping persons. In
the study of MHPs, positive correlations between job effec-
tiveness, and aggressiveness and imagination seem to be
similar to the SAR measure. Therefore, because SAR is
important to other helping persons, and because the cOncept
of self-acceptance seems consistent with the concepts of
aggressiveness and imagination, it seemed reasonable to
assume that the investigation of this variable in relation
to job effectiveness of MHPs would be fruitful.

The variable, ARO, also found to be important to
helping persons, has not been studied in MHPs. It was
included here, along with SAR, as the other dimension that
has shown up repeatedly in studies of interpersonal behavior.
The importance of acceptance of others seems often to be
taken for granted in the field of residential treatment;
this may explain the lack of research that has specifically
included this variable.

Self-disclosure, related to high scores on both SAR
and ARO, has also been shown to be important in the helping

professions. This seems to be related to the importance,

21
discussed in narrative accounts, of the self-involvement
and personal development of the effective MHP; Open commun-
ication and sharing of feelings have been stressed in these
accounts. Thus, it seemed likely that effective workers
would tend to score higher on measures of self-disclosure
than less effective workers. Since self—ratings have been
found to have little correlation with ratings by others,
both types of ratings were used here.

The concept of pathogenesis has not been studied in
MHPs, although it has been shown to be an important variable
in other kinds of relationships. Since the concept of
pathogenesis involves a relationship between a dominant
person and a dependent person, the relationship between the
MHP and patient parallels this; i.e., the MHP is responsible
for "caring for" the patient. This measure was included
in the study for this reason, as well as for the reason
that the concept of pathogenesis has successfully differen-
tiated subjects in different kinds of relationships in other
studies. Theoretically, it seemed that the pathogenesis
score would be negatively correlated with ARO, since the
ARO score reflects the degree of acceptance of others, and
the pathogenesis score reflects the degree of not consider-
ing the needs and feelings of others.

Because the ideas of personal growth and active exami-

nation of one's own feelings and problems are stressed in
narrative accounts of the role of the MHP, a measure of the

extent to which problems are reported was included in this

22
study. It was expected that more effective workers would
report more personal problems.
A scale for degree of liking was included, in order to
ascertain if something as simple as liking would differen-

tiate as well as other, more complicated measures.

Design

Effectiveness of MHPs at a residential treatment center
was rated by the workers' supervisors, by their patients,
by their co-workers, and by themselves. These different
types of raters were used in order to determine whether
effectiveness is viewed similarly or dissimilarly by the
different rater groups. Because of differences in role, as
well as in age, training, and experience, the various rater
types could be expected to view effectiveness differently.
On the other hand, the pattern of functioning in residential
treatment could possibly reduce these differences between
rater types. This is because the MHPs of each residence are
trained by, and tend to model their behavior and perceptions
on, the therapist of that residence. Also, the patients,
after being in treatment for a period of time, begin to
model their behavior and perceptions on the MHPs and therapist.
Therefore, it may be that the various types of raters report
on effectiveness of MHPs in similar ways.

All four types of raters also gave ratings of SAR and
ARO, for the same reasons.

Self-disclosure was rated by self and by co-workers.

Ratings by self and by others were both included because of

23
previous findings that indicated little or no correlations
between the two. Co-workers were selected to do the ratings
by others because it was felt that they were in the best
position, as co-workers, to evaluate the degree of MHP
self-disclosure.

Each MHP also completed a self-report measure of SAR
and ARO, a pathogenesis measure, and a report of personal
problems.

The effectiveness measure was then correlated with all
the other measures, as tests of the hypotheses.

The following hypotheses were examined:

Hypothesis 1. Effectiveness of MHPs is positively correlated

 

with SAR.

Hypothesis 2. Effectiveness of MHPs is positively correlated

 

with ARO.
Hypothesis 3. Effectiveness of MHPs is positively correlated
with self-disclosure.

Hypothesis A. Effectiveness of MHPs is negatively correlated

 

with pathogenesis.

Hypothesis 5. Effectiveness of MHPs is positively correlated

 

with the number of personal problems reported.

Because the variables under examination may well be
interrelated with each other, the correlations with effec-
tiveness alone could be incomplete. Therefore, as a
secondary addition, a multiple regression analysis was done
after the other analyses, to ascertain the independent con—

tribution of variables to the effectiveness rating.

METHOD

Setting

The Oaks is a residential treatment center of the
Brown Schools, located in Austin, Texas. It is licensed
as a private psychiatric hospital and treats emotionally
disturbed children and adolescents who are believed to have
a chance to return to the community after treatment.
Diagnostic categories of the patients include severe adjust-
ment reaction, behavior disorder, personality disorder,
neurosis, and psychosis.

There are ten residences, each with a capacity of
twelve patients; at the time of this study, there were
three residence units for adolescent girls (approximate
ages 13 to 17), four for adolescent boys, one coed residence
for adolescents, one coed group of younger children (ages
9 to 13), and one group of boys, age 10 to 14. There is
also an Intensive Care Unit on campus with six beds; this
is used for patients of the other units who need a closed
setting and more intensive treatment in a time of crisis
during the course of treatment, for a period of up to three
months.

Each residence group has a therapist (social worker,
psychologist, or psychiatrist) who is responsible for pro-
viding treatment and acting as administrator for that

2“

25
residence. The treatment team for each residence includes
the therapist, the chief MHP, five to eleven other MHPs,
and a teacher representative. This team meets weekly to
discuss the twelve patients and develop plans for their
treatment. The duties of the residence therapist include
individual therapy with each of the twelve patients, family
therapy, group meetings on the residence, hiring and
training MHPs, generally establishing and maintaining the
group milieu, and coordinating the individual treatment
program for each patient. The MHPs work 8-hour shifts on
the residence, and their function is to provide supervision
for the patients, develop relationships with them, record
their daily progress on the residence, participate in the
development of the treatment plan for each individual, and
carry out treatment recommendations in the context of

their relationship with the patients.

Subjects

An attempt was made to include as subjects all MHPs
at The Oaks who had been employed for at least one month
on one of the adolescent residences. Only the adolescent
residences were used, in order to eliminate possible
complications due to different types of treatment with
different age groups.

Each subject received payment of six dollars, approx-
imating their regular hourly wages for the two-to-three

hour time period that was required.

26

Of the 50 MHPs who fit the criteria for inclusion as
subjects, A3 completed the data—gathering procedure. Of
the seven that did not, two reported they were too busy to
come in for three hours, two had terminated employment and
could not be reached, two were unwilling to be included,
and one could not be reached after failing to arrive at a
scheduled time. Most of the MHPs are college-age young
peOple. Of the 50 that were eligible for this study, four
were older women; three of these women did not participate.

Among the A3 subjects, there were 18 females and 25
males. The mean age was 23.7, and the age range was 20 to
38 (excluding the one 38-year-old woman, the age range was
20 to 28). There were 3A single, 6 married, 1 separated,
and 2 divorced MHPs. Thirty-nine had no children, two had
one child, one had two children, and one had three children.
All but one had some college education, and 2A had bachelor's
degrees; the mean number of years of education was 15.3,
and the range was 10 to 18. Seventeen of the subjects were
currently enrolled in college. Their major fields of study
included Psychology (16 subjects), Sociology (5), Education
(A); also, there was one subject in each of the fields of
Political Science, Communication, Criminology, History,
Nursing, Anthropology, and Fine Arts (not all subjects
listed a major field of study). The mean length of time
at The Oaks was one year, three months, with a range from

zero years, two months, to four years, zero months.

27

Instruments

 

The Mental Health Worker Rating Sheet (MHW Rating

 

Sheet, Table l) is a new form, develOped for the purpose
of this study. Several sources of ideas and information
were used in the development of this scale.

The rating sheet that had long been in use at The Oaks
included ten qualities, each of which was rated on a four-
point scale from excellent to poor. These qualities were
skill, initiative, loyalty to organization, ability to get
along with others, dependability, health, personal habits
and conduct, honesty, attendance, and supervisory ability.
The rating sheet was used for MHPs, as well as for all other
employees at The Oaks, and therefore did not well represent
the specific skills of the MHP. A later rating sheet was
develOped at The Oaks for this purpose, including ratings in
the seven categories of general employment requirements,
ability to function within the organizational structure,
milieu therapy and child care skills, administrative
abilities, individual counseling skills, group counseling
skills, and personal initiative and growth potential. This
was an improvement, but the rating sheet included detailed
descriptions of each of these categories, and required the
rater to read four pages of such descriptions in order to
make the rating.

Therefore, rating scales in use elsewhere were sought.
Davids, 23; a1; (1969) used a rating scale that included

five factors: ability to get along well with others, skills

MHW

Res

1.

WORK

10.
ll.
12.
13.

1A.
15.
16.

Table l

MENTAL HEALTH WORKER RATING SHEET

Rater

 

 

idence Date

 

 

Dependability, attendance

poor

below average

average

above average

very good

outstanding

 

 

Handling daily routines: meals, cleanup,
physical needs

 

Relationship with USO, administration

 

Relationship with other MHWs

 

ING WITH RESIDENTS:

Likeability to the residents

 

Ability to maintain control and set
limits

 

Ability to understand psychological
processes

 

Desire to help

 

Individual counseling skills

 

Group counseling skills

 

Activities planning and participation

 

Desire to learn new skills and insights

 

Interest in changing and growing
personally

 

Takes initiative

 

Supports team decisions

 

General impression of this worker

 

 

 

 

 

 

 

28

 

29
and abilities, parental functions, frustration tolerance,
and potential for growth. Schwartz (1968) described
several functions and skills necessary for effective func-
tioning of MHPs, although he did not incorporate them into
a rating scale.

From these various sources, from long discussions with
administrators and other therapists at The Oaks, and from
personal experience, I integrated the various ideas into
the MHW Rating Sheet that is used in this study. It includes
16 items, each of which is checked in one of six categories
from 'poor' to 'outstanding'.

The MHW Rating Sheets were given with the following '
instructions:

Please rate each MHW in each area of job functioning.

Do not omit any ratings; if you are unsure, make your

best guess. Feel free to write in additional comments

at the bottom or on the back of the sheet.

The Semantic Differential Scales provide a measure of

 

SAR and ARO, as described by J.R. Hurley (1976a), who also
established the construct validity of this instrument.

In this study, each worker was rated by his supervisor,
by four of his patients, by his co-workers, and by himself
on a 10-point continuum for each of nine scales. Scales for
self-acceptance were: shows feelings - hides feelings,
expressive - guarded, active - passive, and independent -
dependent. Scales for other-acceptance were: warm - cool,
helps others - harms others, involved - detached, and
accepts others - rejects others. An additional scale of

like - dislike was also included.

30
The scales were administered on nine pages, with a
different scale on each page. Every MHP on each residence
was listed at the side of the page; each worker was rated
on the first scale, then on the second scale, etc. The
SAR and ARO scales were alternated. The instructions were:

Please "X" in the space on each of these scales best
representing your personal impression of how each
person on your team has behaved recently, including
yourself. If you use the full range as much as pos-
sible, the ratings will be more informative. Please
avoid omissions. This first scale is somewhat
different from all others in that it asks how much
you like each group member, rather than requesting

a rating of that person's behavior.

 

The Self-Disclosure Measure (S.J. Hurley, 1967)

 

describes various behaviors from "overtly self-concealing"
to "self-disclosing," along an eight-point continuum (see
Appendix A). This measure has been found to correlate with
other peer-rated measures of self-disclosure, whether
administered at the same time, after five weeks, or after
nine weeks (Hurley & Hurley, 1969). Thus, both consensual
validity and predictive validity have been demonstrated.

Scores on this measure have been found to be signi—
ficantly correlated with effectiveness of T—group trainers
(Hurley & Force, 1971); it should be pointed out, however,
that the measure is not a pure reflection of the concept of
self-disclosure, but includes evaluative overtones that may
be related to many aspects of personality or behavior, such
as rigidity, inhibition, defensiveness, and concern for
others' feelings.

Each worker in this study was placed somewhere along

31
the eight—point continuum by each of his co-workers
and by himself.

The "OK" Questionnaire was used as a secondary measure

 

of SAR and ARO. Since it is a self-report measure, it
would have value in the selection process of MHPs, if it
proved successful in differentiating workers on the basis
of effectiveness.

This measure is an improved form of that used by Allen
(1973), who used it as a measure of interpersonal position;
i.e., he placed subjects into four groups, depending on
their relative feeling of their own "OK-ness" and the
"OK-ness" of others. Results in his study generally
supported the hypothesis relating interpersonal position
and adjustment. Subjects in the "I am OK, you are OK"
group received the highest adjustment scores; subjects in
the "I am not OK, you are not OK" group received the lowest
adjustment scores; subjects in the "I am OK, you are not
OK" and the "I am not OK, you are OK" groups received
intermediate adjustment scores.

One advantage of the "OK" Questionnaire is that it
takes into account the fact that people have differing
feelings about the degree of OK-ness of themselves and of
others, depending on the situation they are in and on the
trait being considered. On this questionnaire, the subject
rates himself and others on a six-point scale from "very
negative" to "very positive" for three different traits in

each of 20 situations (see Appendix B). A score for

32
"OK Self" and "OK Other" is derived as a sum of the self
ratings in all the items.

The Mooney Problem Check List, Adult form, was used
as a measure of the extent to which MHWs reported having
problems in the areas of health, economic security, self-
improvement, personality, home and family, courtship, sex,
religion, and occupation. This test is a list of 288
problems in the various areas, and subjects are asked to
underline those problems which are troubling to them,
and to circle those which are most troubling. The score
for each area is the sum of problems underlined, plus the
sum of the problems circled (thus, those problems most
troubling are counted twice).

The subjects also were asked to reply in narrative
form to the following:

1. Use the space below to indicate any additional

problems that you may have. 2. Write a brief

summary of what you consider to be your chief problems.

3. Would you like to talk to someone about some of

your problems?

The Thematic Apperception Test was used as a measure of
pathogenesis. Ten cards were selected for inclusion on the
basis of their differentiating more pathogenic from benign
themes in previous studies; these cards were 1, 3GF, 3BM,
A, 8 GF, 90F, 11, 12M, 15, and 19. The test was group
administered in written form and each story was judged for
pathogenesis by two raters independently (see Meyer and

Karon, 1967, for a description of the rating procedure).

Both raters were female; one, age 2A, had completed a

33
bachelor's degree in Social Science and was beginning
a graduate program in Special Education. The other, age
23, was an undergraduate student in Drama.
Written instructions were given to the subjects as

follows:

This is a test of imagination. Look at the ten
pictures and the ten sheets of paper; notice that
each card has a code number/letter on the back,
matching the codes on the sheets of paper. Your task
will be to make up as dramatic a story as you can for
each picture. Tell what has led up to the event shown
in the picture, describe what is happening at the
moment, including what the characters are feeling and
thinking, and then give the outcome. Write your
thoughts as they come to your mind. Do not take more
than about 5 minutes for each picture.

Remember, use a separate sheet for each story, ,
so that the code on the back of the picture matches the
code on the sheet of paper. To make corrections, draw
a single line through the corrected words. Be sure to
include:

What happened before the picture?
What is happening in the picture?
What are the characters thinking and feeling?
How does it end?
Do not write your name on the pages.

Procedure

 

Data from therapists. The eight therapists who worked
with adolescent groups were asked to list the MHPs who had
worked on their residence for at least one month. Then they
were asked to name the four patients on the residence who
were "farthest along in treatment, in the sense that they
have progressed well, have learned about themselves and
about relating to others, and are generally closer to

discharge."

3A

The therapists then completed a MHW Rating Sheet and
the Semantic Differential Scales for each MHP on their
residence. To determine the reliability of the MHW Rating
Sheet, the therapists repeated their ratings after a
six-week interval.

On two of the residences, the therapist worked part
time, and was assisted by a Mental Health Associate, a
Bachelor's level worker with several years of experience
at The Oaks. Since, on these residences, the Mental Health
Associates were more closely involved with supervising the
MHWs, and since one of these therapists was the experimenter,
the Mental Health Associate's ratings were used, rather
than the therapist's ratings. To determine the patients
farthest along in treatment on these two residences, the
therapist and Mental Health Associate made a joint
decision.

Of the therapists who completed the rating Scales,
there were six MSWs and two Mental Health Associates.
There were five males and three females, and the age range
was 23 to 35 (mean 29.5). Four were married and four were
single; five had no children, two had one child, and one
had two children. The length of their clinical experience
ranged from 8 months to 7 1/2 years (mean 5 years, 7
months), and the length of their employment at The Oaks
ranged from 8 months to 5 years (mean 3 years, 5 months).

Data from patients. The four patients selected as

 

being farthest along in treatment completed a MHW Rating

35
Sheet and the Semantic Differential Scales for each MHP
on their residence. This data was collected in small
groups. Of the 32 patients initially selected as farthest
along in treatment, 28 completed the rating scales. Of the
others, two ran away and were discharged, and two refused
to participate at their scheduled times; another time
could not be arranged before discharge. Another patient
was selected by the therapist as a substitute for one of
these patients, but because of patient and staff turnover,
it was felt that it would be better not to substitute a
patient who knew the MHPs less well on the other residences.
Therefore, there were 29 patients who completed the rating’
scales; one of the residences (contributing seven MHPs
to the sample) had three patients instead of four who
completed the scales, and one residence (contributing
three MHPs to the sample) had two patients instead of four
who completed the scales.

Diagnostic categories Of these patients were: schizo-
phrenia, latent type (2 patients), anxiety neurosis (l),
hysterical neurosis (1), depressive neurosis (3), cyclo-
thymic personality (1), schizoid personality (1), obsessive-
compulsive personality (3), passive—aggressive personality
(3), inadequate personality (1), borderline personality (1),
other personality disorder (3), behavior disorder (1), adjust-
ment reaction of adolescence (3), overanxious reaction of
adolescence (2), unsocialized aggressive reaction of

adolescence (2), other reaction of adolescence (l).

36

Data from MHPs. Each MHP, in groups of one to six,

 

was given a packet including, in order:

(1) A letter of introduction and background information
sheet (see Appendix C)

(2) MHW Rating Sheets (with instructions to rate himself, as
well as his co-workers)

(3) Semantic Differential Scales (with instructions to rate
himself, as well as his co-workers)

(A) Self-Disclosure Measure (with instructions to rate
himself, as well as his co—workers)

(5) The "OK" Questionnaire (a self-report instrument)

(6) Mooney Problem Check List (a self-report instrument)

(7) Thematic Apperception Test

Scores

Means and standard deviations of effectiveness scores
and other variables for the A3 subjects are presented in
Table 2. It is interesting to note that self-ratings are
higher than ratings by the other raters in all cases. Peer-
ratings of SAR and ARO are lower than the SAR and ARO
ratings by other raters.

Mean effectiveness and semantic differential scores for
therapist—, patient-, and peer-ratings of the seven MHPs who
did not complete the data-gathering process are presented
in Appendix D, along with the means of the MHPs who did
complete the data-gathering process. Of interest is the
fact that, in 17 comparisons out of 18, the subjects

received higher scores and more favorable scores than did

 

 

 

 

 

 

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38
the HHPs who did not complete the data-gathering process.
Effectiveness scores, semantic differential scores,
and personality variable scores of each MHP are presented

in Appendices E, F, and G, respectively.

RESULTS

Effectiveness Scores

 

Reliability. The test-retest reliability of the

 

therapists' ratings, after a six-week interval, was
determined by product-moment correlation coefficients.
The correlations for the eight residences are presented in
Table 3. In this table and in others that follow, decimal
points are omitted. Residence F. involved a change of
therapist, so that a different person rated the MHPs on
retest; this therapist began working during the week of
the initial testing, so he had known the MHPs for six
weeks at the time of the second ratings.

The number of MHPs that were rated by therapists is
different from the number included in the remainder of
the study, because 7 of the 50 MHPs that were rated by
therapists did not complete the data-gathering procedure.

The lowest correlation is .30, and 20 of the 2A
correlations range from .65 to .82. There tended to be less
stability for the Role Commitment scores and more stability
for the Knowledge and Skills scores, than for the total
effectiveness scores.

The initial therapist ratings were used for correlations
with the other instruments. This was done because the

initial rating was completed nearer to the time of the other

39

Table 3

Product-Moment Correlations of Test-Retest Ratings

of MHP Effectiveness by Therapists

 

 

Reliability
Residence p** Total RC KS
A 6 53 68 82
B 7 65 39 75
C 6 81 67 81
D 6 6A 38 69
E 7 65 71 72
F* 7 67 78 77
G A 71 30 A7
H 7 72 8O 79

 

*Test and retest ratings were given by two different
raters on this residence.

**n=50

AO

Al

data-gathering.

Treatment of effectiveness scores. In order to deter-
mine how to treat the MHW Rating Sheet data, an elementary
linkage analysis (McQuitty, 1957) was done, using the 16
individual MHW Rating Sheet items for therapist-ratings,
for patient-ratings, for MHP—ratings (excluding self—
ratings), and for MHP self-ratings. This method yields typal
structures in which all members of a given type correlate
more highly with at least one other member of that type,
than with non-members. These typal structures are presented
in Figure 1.

Because item 16, "general impression," assumed a
central clustering position in all the typal analyses
except the patient-ratings, the typal analyses were repeated,
with item 16 omitted (see Figure 2, p.u3 ). With the
"general impression" item omitted, an additional type emerged
for the therapist-, MHP-, and self-ratings, and the types
became more distinct. The patient types showed almost no
change with the omission of item 16.

There were two decisions to be made, with regard to
the treatment of the effectiveness scores:

1. The therapist-, MHP-, and patient-ratings could be
combined, or they could be treated separately. Because the
typal structures were dissimilar in the various groups, it
was decided to treat them separately.

2. The 16 items in the rating sheet could be treated

separately, they could be combined into a single effectiveness

Figure l

Typal Analyses of Individual Items on the MHW Rating Sheet
(General Impression, #16, Included)

Therapist-Ratings

 

 

 

 

_________ l l\.-' l5 j ...
"0‘*9_’7—’\l6-Vl2:|33 I
x 6/ , 2 ’f'“ ‘L
~__-- A4 4:5
3
Patient—Ratiggs l
................................. iéuunuuiia
5. i5 'l-sa . 9*: 2 2 2.";- if:
34" us"? *—,,I"_'4
3*‘4 5" #9.”;
ll 6‘
2
Peer—Ratings
,’4:7‘\\ 3 ll ............
r-‘\/‘/ \\\\\—"__¢\ {'3:|5° 39'
'4—" (\6—2I '6 —)x : IO)
7‘ " -' """" t2}
,4 2 ............................
5
Self Ratings
ll
/6\ ? ? 2K ...8. ...... ié”
’ “‘x R :. ——k .2
‘. )7.:t+s<——|9fi ' -.,f— , s
\9 +I‘ K ......
“~19: 4 '5 ...................... jg»,
Type I Type II
Note. """" = RC items (8. desire to help; 12. desire to

learn new skills and insights; 13. interest in changing
and growing personally; 15. supports team decisions)

------- - KS items (6. ability to maintain control
and set limits; 7. ability to understand psychological pro-

cesses; 9. individual counseling skills; 10. group coun-
seling skills)

42

Figure 2

Typal Analyses of Individual Items on the MHW Rating Sheet
(General Impression, #16, Omitted)

Therapist-Ratings

 

2 .--'é':- 3 ,

 

 

 

. . / l
\x / t, _ ,’ l(I) :t I
IBe—IZé—l4x—6V" “<7—"9 4:5
. t t “-
l-5: ll
Patient-Ratings I
...t
l2 8';
5'53" y {j
I. ‘L . '3 .7-4'.”_”'_'\
3:24 ----- :t .
597KBQRN6/
\\,/
ll “2
Peer Ratings
3 2 ’I” ' “‘\\
___"_-_i’,/ t, ‘\\
‘~Z:_->_§i-‘=_'9) {Bethe-4+5 Yak—am
...-T... + ...... ¢E \/
8" '2
Self Ratings I
ease-z x’e \ t
....|.§.o.. ‘§:z_\l/ ITI :95...
2 t 5
........ 3
Type I Type II Type III
Note. ------- = RC items (8. desire to help; 12. desire to

 

learn new skills and insights; 13. interest in changing and
growing personally; 15. supports team decisions)

------- = KS items (6. ability to maintain control
and set limits; 7. ability to understand psychological pro-
cesses; 9. individual counseling skills; 10. group coun-
seling skills)

43

uu

score, or they could be divided into a number of groups or
clusters of similar items. For help in making this decision,
image analysis was also available, in addition to the
elementary linkage analysis. Image analysis, similar to
factor analysis, was computed with a program designed to

give the simplest structure, selecting from all the struc-
tures obtained, using different possible numbers of factors
(Veldman, 197“). Image analysis results are presented in
Table 4. Both image analysis and elementary linkage analysis
produced only moderate consistencies between the groups of
raters, for two clusters of items. The two clusters that
emerged were:

(a) Role Commitment (RC): items 8 - desire to help, 12 -
desire to learn new skills and insights, 13 - interest in
changing and growing personally, and 15 - supports team
decisions.

(b) Knowledge and Skills (KS): items 6 - ability to main-
tain control and set limits, 7 - ability to understand
psychological processes, 9 - individual counseling skills,
and 10 - group counseling skills.

Because these clusters were only fairly consistent, it
was decided to use the total combined score, in addition to
the two clusters, in the correlations with the other data.
Correlations between groups of raters on the total effective-
ness scores and on the two cluster scores are given in Table
5. Self-ratings of MHPs are presented separately from

ratings by peers. Thus, each MHP received four sets of

Table 4

Image Analysis Results for Individual MHW Rating Sheet Items

Therapist Ratings

 

Factor
Factor
Factor
Factor
Factor
Factor
Factor

MHP Ratings

\lmU‘l-C‘UONH

Role Commitment; items 12, 8, 16, 15, 11, 13
Knowledge and Skills; items 9, 7, 10, 6
Dependability; item 1

Sociability; item 5, u

Initiative; item lu

Administrative; item 3

Psychological knowledge; item 7

 

Factor

Factor
Factor
Factor
Factor

1.

UTEUUN

Knowledgeable involvement; items 9, 10, lu, 6,
7, 3, 11, 16, 8

Team functioning; items 15,
Likeability to patients;
Dependability; item 1
Daily routines; item 2

13, 12, u

item 5

Patient Ratings

 

Factor

Factor
Factor
Factor
Factor

1.

mtwm

Knowledgeable involvement; items 12, 7, 9, 1U,
8, 10, 13, 6, 11, 2

Staff relationships; items 4, 3

Likeability; items 5, l6

Dependability; item 1

Supportive of team; item 1“

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46

147
scores: one by the therapist on his residence (his
supervisor); one reflecting a composite score of 2, 3, or
4 patients on his residence; one reflecting a composite
score of 2, u, S, or 6 of his co-workers (the "MHP-peer"
rating); and one self-rating (the "MHP-self" column). The
therapist scores and the MHP-self scores are given by a
single rater for each MHP, whereas the patient scores and
the MHP-peer scores are derived by pooling data from more
than one rater.

Within all rater types except patients, there is a
clear distinction between RC and KS clusters. That is, the
correlations between these two clusters are much lower than
the correlations of either with the total effectiveness
score.

Between rater types, there is greater across—perceiver
consensus about the KS cluster than about the RC cluster;
this is true in every comparison between rater type groups.
This finding indicates that different raters are in agree-
ment with each other about the knowledge and skills of
MHPs (their ability to maintain control and set limits,
their ability to understand psychological processes, their
individual counseling skills, and their group counseling
skills),to a much greater extent than they are in agreement
with each other about the role commitment of MHPs (their
desire to help, their desire to learn new skills and
insights, their interest in changing and growing personally,

and their support of team decisions). This is probably

us

because the knowledge and skills of MHPs are comparatively
easily and directly observable kinds of behavior to all
raters, while the components of role commitment of MHPs are

less directly observable kinds of feelings, attitudes, and

 

motivations, which require a greater degree of interpretation

 

of observable behavior. This is consistent with the higher
reliability scores for the KS cluster than for the RC
cluster.

There is a considerable difference between the self-
ratings of RC and the self-ratings of KS; in all cases, the
self-rated KS scores correlated much more highly with the
scores by other raters, than did the self—rated RC scores.-

Intercorrelations among MHW Rating Sheet items, for
therapist-, patient-, peer-, and self-ratings, are presented
in Appendices R, I, J, and K. Frequency of ratings for
individual MHW Rating Sheet items, for each rater class, are

presented in Appendix L.

Pathogenesis Scores

 

The product-moment correlation coefficient for inter-
rater reliability of the TAT pathogenesis scores was .78.
A combined score of both raters was used for the correlations
with the other data; the corrected reliability for the com-
bined score, using the Spearman-Brown formula, was .88.

The mean pathogenesis score in this study cannot be
meaningfully related to mean scores in other studies, since

the TAT cards used here were different.

“9

Self-Disclosure Scores

 

The correlation of self—ratings of self-disclosure

with team member ratings of self-disclosure was .05.

Hypotheses

 

Hypothesis 1: Effectiveness of MHPs is positively

 

correlated with SAR (self acceptance-rejection).

When using the Semantic Differential Scale as a measure
of SAR, Hypothesis 1 is confirmed (see Table 6). Of “8
correlations between effectiveness scores and SAR scores,
36 reached statistical significance. Only self-ratings
and/or patient—ratings did not reach significance.

When using the "OK" Questionnaire as a measure of SAR,
Hypothesis 1 is not confirmed. The problem may well be
within this measure, however, as no scores derived from
it correlated significantly with any of the effectiveness
scores (see Appendix M).

Hypothesis 2: Effectiveness of MHPs is positively

 

correlated with ARO (acceptance-rejection of others).

When using the Semantic Differential Scale as a
measure of ARO, Hypothesis 2 is confirmed (see Table 6). Of
H8 correlations between effectiveness scores and ARO scores,
33 reached statistical significance. All of those that did
not reach significance involve self-ratings and/or patient-
ratings.

When using the "OK" Questionnaire as a measure of ARO,

Hypothesis 2 is not confirmed. The scores derived from this

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51
measure did not correlate significantly with any of the
effectiveness scores (see Appendix M).

Hypothesis 3: Effectiveness of MHPs is positively
correlated with self-disclosure.

Results are presented in Table 6. When team member
ratings of self—disclosure are used, Hypothesis 3 is con-
firmed; all correlations between effectiveness scores and
MHW ratings of self-disclosure reach statistical signifi-
cance.

When self-ratings of self-disclosure are used, there
are no statistically significant correlations.

Hypothesis u: Effectiveness of MHPs is negatively
correlated with pathogenesis.

Results are presented in Appendix M. Hypothesis u
is not confirmed; none of the correlations reached
statistical significance.

Hypothesis 5: Effectiveness of MHPs is positively
correlated with the number of personal problems reported.

Results are presented in Appendix N. Hypothesis 5 is
not confirmed. There was only one correlation that reached
statistical significance, and this is no more than would

be expected by chance.

Relationships among Variables

 

Intercorrelations among the personality variables and
effectiveness scores for each kind of rater are presented
in Tables 7-10. McQuitty typal analyses of these inter-

correlations are presented in Figure 3 (p. 56). In this

Table 7
Product-Moment Intercorrelations of Personality Variables
and Effectiveness Scores, for Ratings by Therapists

SAR ARO Like SD Total RC KS Path OK OK

Eff Self Other
SAR 00 6M 77 52 65 5M 50 -05 00 ~04
ARO 6M 65 68 66 6H an -11 -14 -08
Like 77 65 57 59 56 “5 08 -ll -07
SD 52 68 57 59 NH 55 -15 —02 08
Total Eff 65 66 59 59 88 88 -18 —08 -08
RC 5U 6U 56 UN 88 62 -12 -O9 -16
KS 50 uu AS 55 88 62 -18 —07 -OH
Path -05 —11 08 -15 -18 -12 -18 -O2 -21
OK Self 00 -14 -11 -O2 -O2 -O8 -O9 -02 62

OK Other -OH -08 -O7 O8 —08 -16 -ou —21 62

52

Table 8
Product-Moment Intercorrelations of Personality Variables

and Effectiveness Scores, for Ratings by Patients

Total OK OK
SAR ARO Like SD Eff RC KS Path Self Other

SAR oo 76 50 25 75 7O 73 -O6 00 -O7
ARO 76 83 31 8a 7a 79 1a -05 00
Like 50 83 12 65 56 61 28 —2o -23
SD 25 31 12 38 35 3h -15 -02 08
Total Eff 75 84 65 38 9M 96 11 -1M -10
RC 70 7a 56 35 9a 90 05 -2o -15
KS 73 79 61 3M 96 9O O9 -13 -05
Path —ns 1M 28 -15 11 05 09 -02 -21
OK Self oo -05 -02 -02 —1u -2o -13 -02 62

OK Other -07 OO -23 O8 -l0 -15 -05 -21 62

53

Table 9
Product-Moment Intercorrelations Of Personality Variables

and Effectiveness Scores, for MHP-Peer-Ratings

Total OK OK

SAR ARO Like SD Eff RC KS Path Self Other
SAR 75 68 71 75 60 71 -16 08 11
ARO 75 81 79 75 75 6O -21 01 14
Like 68 81 77 75 76 56 —26 -O2 06
SD 71 79 77 65 58 52 -15 -O2 08
Total Eff 75 75 75 65 86 93 -05 -O5 02
RC 60 75 76 58 86 68 -16 -O6 08
KS 71 6O 56 52 93 68 O2 -06 —O3 3
Path -16 -21 -26 -15 -05 -16 02 -02 -21
OK Self O8 01 -O2 -O2 -05 -O6 —O6 -O2 62
OK Other 11 1a 06 08 02 08 -O3 —21 62

5M

Table 10
Product-Moment Intercorrelations of Personality Variables

and Effectiveness Scores, for MHP-Self-Ratings

Total OK OK
SAR ARO Like SD Eff RC KS Path Self Other

SAR 52 27 “3 69 51 66 0“ 37 17
ARO 52 MM 18 M5 M9 3M 07 27 17
Like 27 MM 17 32 22 33 05 19 06
SD M3 18 17 22 10 2O 11 3o 35
Total Eff 69 M5 32 22 82 87 -11 21 1M
RC 51 M9 22 lo 82 5M -11 1M 18
KS 66 3M 33 2O 87 5M -18 17 07
Path OM O7 O5 11 -11 -ll -18 -O2 -21
OK Self 37 27 19 3O 21 1M 17 -O2 62
OK Other 17 17 O6 35 1M 18 07 —21 62

55

Figure 3

Structure of Linkages between Job Effectiveness
and Personality Attributes

Therapist—Ratings

54 56
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56

57
figure, heavy bonds show typal linkages. McQuitty's typal
structure has been supplemented by depicting all other
statistically significant correlations in lighter bonds.
Correlations between variables are given, and arrows point
toward the variable which contributed more to the total
covariance of the intercorrelational matrix.

The three effectiveness scores are linked with each
other for all four kinds of raters. The patient-ratings
and MHP self-ratings link SAR, ARO, and like scores with the
effectiveness scores. Therapist-ratings of ARO and MHP
peer-ratings Of SAR are linked with effectiveness scores.
For therapist-ratings, SAR and like scores form a second
type, and for MHP peer-ratings, ARO and like scores form a
second type. Thus, for therapists, acceptance of others
is linked with effectiveness, while acceptance of self is
linked with liking. For MHP peers, acceptance of others
is linked with liking.

For all kinds Of raters, the OK self and OK other
scores formed a separate type. The pathogenesis score
was linked to the OK other score for therapist and MHP
self-ratings; for patient- and MHP peer-ratings, the patho-
genesis score was linked to liking. An interesting contrast
is evidenced in the correlation between pathogenesis and
liking which is positive for patient-ratings but negative
for MHP peer—ratings; that is, patients tend to like
workers with high pathogenesis scores, while MHP peers tend

to like workers with low pathogenesis scores.

58
From all the typal analyses presented (Figures 1, 2,
and 3), it appears that patients have a consistently more
simple view of the world. Their ratings produce fewer and
less complicated types than do the ratings of the other

kinds of raters.

Qualitative Aspects of Reported Problems

 

In considering the lack Of statistically significant
findings with the Mooney Problem Check List scores, several
possible reasons present themselves.

The number of problems reported might, but does not
necessarily reflect the number of problems a person has.

It may be more related to a response set, or threshold,
beyond which a person checks an item as being a problem.

More importantly, the number of problems checked does
not give any idea Of the attitude Of the subject about the
problems. Narrative accounts of the role of MHPs have
stressed the importance of the MHP to be actively involved
in finding himself, and in finding his own answers to his
own problems. An item checked as a problem on the Mooney
Problem Check List might indicate an area that the worker
is struggling with, or it might be a passive complaint.

In an effort to look beyond the numerical scores in
problem areas, I made an attempt to determine whether
qualitative differences could be found, on the basis Of the
narrative responses at the end of the checklist. This was

a page with three requests for a narrative response:

59
"1. Use the space below to indicate any additional problems

that you may have. 2. Write a brief summary of what you
consider to be your chief problem. 3. Would you like to
talk to someone about some of your problems?"

To make this qualitative comparison, I developed a
high effective group and a low effective group of eleven
MHPs each. These groups were formed on the basis of having
a high or low total effectiveness score by all three rater
types (therapist, MHP, and patient, excluding self-ratings).
There is no overlap of rating scores between the high and
low groups.

The written responses Of the high- and low-effective'
groups were examined on the basis of the amount of respon-
sibility that was taken for the problems listed. There
were differences between subjects in attitudes about pro-
blems, particularly in terms of whether the problems were
owned (as opposed to being blamed on other people or
environmental factors), and whether the person was doing
something about the problem. Brief condensations of these
attitudes are listed here, with the number of subjects from
the high and low groups that fit each category. (These
statements were not made by the subjects, but represent
an impression of their attitudes about their problems,

based on a qualitative judgment Of their narrative responses.)

6O

Attitude Effectiveness
High Low

 

I have a few problems, but nothing

serious. 0 2
My only problems are money and going
back to school. 0 l

I have problems, but it's because of

money and/or it's someone else's

fault. I l
I have problems which I accept as mine,

but have a hopeless feeling about

them, and therefore can do nothing. 1 2
I have problems which I accept as mine

(No mention of doing anything, but

seems to have resistance to it) 0 l
I have problems which I accept as mine.

(No mention of doing anything, but no

resistance) 2 2
I have problems which I accept as mine,

and I know I need to make my own

decision. 0 l
I have problems which I accept as mine,

and I am talking to someone about

them. 3 l
I have problems which I accept as mine,
and I am working on them. 3 O

I have problems which I accept as mine,
I am working on them, and making
progress. 1 O
In sum, there are more workers who say they have pro-
blems that they accept as their own, and who are actively
involved in doing something about them, in the high

effective group than in the low effective group.

Length of Employment

 

After the high and low groups were developed, a compar-
ison of background information of the two groups revealed
a clear difference between them in length of employment.
All eleven workers in the low-effective group were employed
for less than one year, but only two in the high-effective
group were employed for less than one year. The mean

length of employment was 23 months for the high—effective

 

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61
group, and 6 months for the low-effective group. Thus,
the more effective workers tend to be those who have been
employed longer.

Correlations between length of employment and effective-
ness scores are given in Table 11. Eight of the 12 correla-
tions are statistically significant. For every kind of
rater, the correlation between length of employment and KS
is higher than the correlation between length of employment

and RC.

Multiple Regression Analysis

 

In order to clarify the independent contribution of each
personality variable as a predictor of effectiveness, a
multiple regression analysis was done after the other corre—
lation coefficients were obtained (Kim, 1975). This
analysis used the 'default Options' and limited the predic-
tors to the first nine extracted. Since length of employ-
ment at The Oaks differentiated between the high and low
effective groups, this variable was included in the analysis.
A summary of the multiple regression correlations is given
in Table 12, with all predictors shown until the next would
not add significantly (p<.05) to the regression equation.

As the table indicates, 18 of the predictors are SAR
scores (2 contribute negatively), 12 are ARO scores (3
contribute negatively), 6 are like scores (3 contribute
negatively), M are self-disclosure scores (all M contribute
negatively), l is a Mooney Problem Check List total score,

and 6 are length of employment scores (1 contributes

Table 11
Product-Moment Correlations of Length of Employment

with Effectiveness Scores

3
Therapist-ratings:
Total eff M5**
RC 23
KS 65**
Patient-ratings:
Total eff M6**
RC 39**
KS 50**
Peer—ratings:
Total eff MO**
RC 19
KS 51**
Self-ratings:
Total eff 11
RC 02
KS 38*

*p < .05
**p < .01

62

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63

6M
negatively).

SAR ratings are generally the best predictors of
effectiveness scores, especially for peer— and patient-
ratings Of SAR. Self—ratings of SAR are good predictors
Of self-rated effectiveness only, and secondarily of thera-
pist-rated role commitment. Therapist—ratings of SAR,
surprisingly, do not add significantly to the predictability
of effectiveness by any kind of rater, including therapists.

After SAR ratings, ARO ratings are the next best
predictor, but only for role commitment and total effective—
ness (except patient-ratings of ARO, which also predict
patient-ratings of knowledge and skills). This occurs within
rater types; across rater types, therapist—ratings of ARO
also predict patient-ratings of role commitment and total
effectiveness. Self-ratings of ARO correlate negatively
with therapist-ratings of role commitment, and peer—ratings
of ARO correlate negatively with self-ratings of role
commitment.

Length Of employment was a good predictor of knowledge
and skills, whether rated by therapist, peer, or patient,
but not by self.

Liking by peers is a good predictor of peer- and self-
rated role commitment, and of peer-rated total effective-
ness. Liking by therapist predicts therapist-rated role
commitment, and, more distantly, peer-rated role commitment;
liking by therapist correlates negatively with patient-
rated total effectiveness. Liking by self is not a good

predictor; liking by patients predicts peer-rated role

65
commitment, but negatively and secondarily.

Peer-rated self-disclosure scores do not add signifi-
cantly to other predictors of effectiveness. Self-rated
self-disclosure scores are moderate negative predictors
of therapist-rated role commitment, knowledge and skills,
and total effectiveness.

The OK Questionnaire scores, the Mooney Problem Check
List scores, and the pathogenesis score, are not good

predictors of effectiveness.

DISCUSSION

Effectiveness

 

Effectiveness scores, derived from the MHW Rating Sheet,
are reliable (Table 3) and consensually valid (Table 5).
Since the RC and KS clusters correlate less with each other
than with total effectiveness, these clusters seems to repre-
sent distinctive facets Of effectiveness. Over half of the
variance Of each cluster is independent of the other, except
for ratings by patients. The consensual support for the KS
cluster exceed that Of the RC cluster; the KS cluster is
also more related to length of employment than is the RC

cluster.

ffectiveness and Acceptance of Self and of Others

Results strongly support the importance Of SAR and ARO
in job effectiveness of MHPs. Workers who are perceived
as effective in role commitment (RC), knowledge and skills
(KS), and total effectiveness, are also perceived as
accepting of themselves and accepting of others. This
correlation holds, in general, for ratings by supervisors,
patients, peers, and self-ratings. Correlations tend to be
higher between effectiveness and self- and other-acceptance
scores within the same rater class; i.e., therapists'

ratings of effectiveness generally correlate more highly

66

67
with therapists' ratings of acceptance than do acceptance
ratings by MHPs (peers or self) or patients. However,
the correlations across rater classes are also largely
positive and frequently attained statistical significance.
Multiple regression analyses also highlight the predicta-
ability of effectiveness scores from measures of SAR and
ARO.

These results further support the importance of the
SAR and ARO dimensions in helping relationships. MHPs in
residential treatment can now be added to the list of
populations for whom these dimensions have been found
relevant. Encompassing the areas of behavior in group
settings, family relationships, psychopathology, psycho-
therapy, maternal behavior, and now, workers in residential
treatment, the dimensions SAR and ARO appear indeed to have
broad applicability.

With respect to research on MHPs, acceptance of self
seems to reflect the assertative, imaginative, non-conform-
ing qualities that Sturman (1973) found to be related to
group counseling skills, and both acceptance of self and
of others seem to reflect the mutual respect discussed by
Konopka pp. gl.(l96l).

The three classes of raters show interesting variations
in linkages between effectiveness scores and the acceptance
scores. Correlation coefficients between effectiveness
and acceptance scores indicate that therapist-ratings of

self-acceptance tend to relate more strongly with the KS

68
cluster, while therapist—ratings of other-acceptance link
more with RC and total effectiveness. The multiple
regression analyses underscore the potency of therapist's
ARO ratings to predict RC and total effectiveness, but
therapist's SAR scores do not add significantly to the
predictability Of the KS cluster, or Of any other effective-
ness score. This means that although therapist ratings of
SAR correlate with KS, these SAR ratings do not make an
independent contribution, apart from their correlation
with other predictors, to the KS score.

Patient's SAR ratings correlate more strongly with
therapist- and self—ratings of effectiveness, while patient-
ratings of other-acceptance correlate more strongly with
patient- and peer-ratings of effectiveness. Multiple
regression analysis indicates that patient-ratings of ARO
are good predictors Of patient-rated effectiveness, but
do not add significantly to the predictability formula
for peer-rated effectiveness. On the other hand, patient—
ratings Of SAR are good predictors of both therapist- and
patient-rated effectiveness.

Peer— and self-ratings of SAR correlate more strongly
with effectiveness ratings, especially the total effective-
ness and the KS cluster, than do peer- and self-ratings of
ARO. These correlations carry independent predictive value,
as indicated in the multiple regression analysis.

Self-ratings of effectiveness are best predicted by

self-rated SAR, while patient-ratings of effectiveness are

69
best predicted by ARO. The therapist- and peer-rated
KS cluster is best predicted by SAR, while the therapist-
and peer-rated RC cluster is best predicted by ARO.

The KS effectiveness score tends to be more related to
self-acceptance, while the RC score relates more to other-
acceptance. This indicates that good working knowledge
and skills go along with self-acceptance in MHPs, while a
strong role commitment goes along with other-acceptance.

MHP self-ratings are generally weak predictors of
effectiveness, and no notable correlations obtain between
patients' ratings of effectiveness and MHP self—ratings on
personality variables. This means that patient-perceived‘
effectiveness has little to do with MHP self-rating on
SAR or ARO, and that patients' SAR and ARO ratings of MHPs
have little to do with MHP self-reported effectiveness.

In contrast, nearly MO percent (8 Of the 21) of the
correlations between MHP peer-ratings and patient—ratings
were statistically significant.

Correlations between peer-rating of RC and patient's
ratings of both SAR and ARO are trivial (-.08 and .OM),
whereas the peer-rated KS correlates significantly (.33
and .35) with patient's ratings of both self- and other-

acceptance.

Self—Disclosure

 

Another major finding Of thisstudy is the consistent
correlation between peer-rated self-disclosure and effec-

tiveness scores. The near-zero correlation (.05) between

7O
self-disclosure as rated by self versus co-workers is
consistent with findings reported by Hurley and Hurley (1967).
Co—worker's ratings of self—disclosure correlate signifi-
cantly with every effectiveness score by all raters, unlike
the consistently trivial correlations of effectiveness with
self-rated self-disclosure.

Correlations of self-disclosure scores with other
variables are presented in Appendix 0. MHPs'ratings of
self-disclosure are significantly correlated with SAR and
ARO scores Of therapists, MHPs, and self-ratings, and with
patient-rated ARO. Self-ratings of self-disclosure,
however, only correlate significantly with self-rating of
SAR, and self- and other—acceptance as measured by the "OK"
Questionnaire.

Self-disclosure, as found by multiple regression
analysis,does not add significantly to other variables in
the prediction of effectiveness scores. This means that
the self-disclosure scores are largely subsumed by other
variables and make little independent contribution to
the predictability of effectiveness. Thus, it seems likely
that self-disclosure is, at least in large part, a combina-
tion of the qualities of self- and other-acceptance in a
person. An MHP who is accepting of self and of others would,
likely, be an effective worker he or she would also, likely,
be self-disclosing. But the self—disclosing qualities are
not independent of the acceptance qualities, and so add no

new information on the predictability of effectiveness.

71

Only when self-disclosure is rated by others, not by
the self, does the present study support the importance of
self-disclosure in helping relationships. This clarifies
prior findings that established self—disclosure as an
important factor in T-group trainer effectiveness (Culbert,
1968; J.R. Hurley, 1976c), in interviewer behavior (Powell,
1968), and in psychotherapy relationships (Truax & Carkhuff,
1965).

Self-disclosure, as studied here, seems to be consis-
tent with the emphasis, in narrative accounts of the role
of the MHP, on open communication (Konopka et al., 1961),
authentic self-expression on a person-to-person level
(Holmes, 1971), and a lack of defensiveness (Davids et al.,

1969).

Length Of Employment

 

Length of employment is significantly correlated with
KS and total effectiveness,_but not with RC, except for
patient-ratings. In addition, multiple regression analysis
shows that length Of employment is a strong predictor of
KS, but not of RC. These findings indicate that the skills
represented by the KS cluster are largely learned by training
and experience, while the RC cluster represents character—
istics less related to the kinds of training and experience
emphasized at The Oaks. This is consistent with my impres-
sions, from experience at The Oaks, that the RC items of the
MHW Rating Sheet (desire to help, desire to learn new skills

and insights, interest in changing and growing personally,

72
and supports team decisions) are good ggply predictors
of workers who will choose to remain longer at The Oaks.
In contrast, the KS items (ability to maintain control and
set limits, ability to understand psychological processes,
individual counseling skills, and group counseling skills)
tend to increase as length of employment increases. The
reason for this is that MHPs at The Oaks receive very little
pre-job training. They are mostly college students who have
little or no formal training in mental health care delivery.
After an interview with the therapist, a new MHP works two
or three shifts with an experienced MHP who prdvides
further explanations and serves as a role model, and then
the new MHP works shifts as any other worker. As he or she

works longer, the knowledge and skills increase.

"OK" Questionnaire

 

There are not statistically significant correlations
between effectiveness scores and "OK" Questionnaire scores
for self-acceptance or other-acceptance. (See Appendix 0
for correlations of "OK" Questionnaire scores with other
variables.) Thus, this instrument is not useful in the
selection of potential MHPs. This instrument's self-
report character may contribute to these negative results,
but cannot completely explain the lack of positive findings,
in view of the many statistically significant correlations

for self-report scores on SAR and ARO.

73
This discrepancy is probably due to other facets of
the questionnaire's make-up, in that the semantic differen-

tial scales ask for a comparison of all team members with

 

each other, with the instruction to "use the full range as
much as possible," while the "OK" Questionnaire involves pp

comparison between self and others. Also, it's instructions

 

give no emphasis to using the full range. Therefore, the
"OK" Questionnaire appears highly susceptible to response
sets.

In addition, the semantic differential scales ask for
general impressions Of recent behavior, while the "OK"
Questionnaire asks for responses to specific situations
with regard to specific traits. Subjects presumably re-
sponded to the "OK" Questionnaire in the context of their
general feelings about that specific situation; i.e., their
answers would mean, "compared to the way I usually feel,
in this situation I felt ." The semantic differential
scales, in contrast, invite responses more consistent with

the individual's typical self-perception.

Pathogenesis and Reported Problems

 

This TAT index likewise failed to correlate signifi-
cantly with effectiveness scores or with gpy other variable
in this study (see Appendix 0). Since the pathogenesis
score yielded no statistically Significant results, it
Shows little practical utility in differentiating MHPs

on the basis of effectiveness. Similar results obtained in

74
another recent study. Amberg (1976), studying fathers
who were inmates in Jackson State Penitentiary, and relying
on projective measures, found no variables, including the
pathogenesis measure, which reliably discriminated between
abusive fathers and two control groups. However, Evans
(1976), in a study of mothers receiving Aid to Dependent
Children welfare funds, found many large differences between
child-abusers and a control group using Objective and TAT
measures, and marginal (p <.O6, two-tailed test) differences
using the pathogenesis score.

In spite of the lack of statistically significant
results there are some tendencies in the data that indicate
interesting perceptual differences between the patients and
the other raters. Correlations of pathogenesis with thera—~
pists' and MHPS' ratings of ARO are in the expected negative
direction (-.11 and -.21, respectively); however, pathogene-

sis correlates ppsitively with patient's ratings of ARO

 

(.lM). This indicates a tendency for therapists and MHPs

to rate workers with high pathogenesis scores as unaccepting
of others, but a perplexing trend for patients to rate high
pathogenic workers as accepting of others. Furthermore,
pathogenesis' highest correlation is a <.28 with patients'
liking, barely short Of statistical significance (2; $.29;
p_<.05). Thus, patients tend to like MHPs who, according

to their pathogenesis scores, do not consider patient needs
and feelings. Conversely, the MHPs tend to like their co-

workers who score low on pathogenesis (p= —.26). This

75
pattern is consistent with the correlations of effectiveness
scores with pathogenesis (Appendix M). The patients' ratings
Of effectiveness tend to correlate positively with patho-
genesis scores, while the therapist-, peer-, and self-
ratings of effectiveness tend to correlate negatively with
pathogenesis scores, although none of these correlations
attain statistical significance. Patients seem to view
workers with high pathogenesis scores more favorably than
do the therapists or peers of the MHPs.

The differing orientations of patients from MHPs and
therapists also show up in the correlations of effectiveness
with the reporting Of problems on the Mooney Problem Check.
List (see data in Appendix N). Virtually only positive
(26 of 27) correlations obtain between Mooney scores and
patient's effectiveness ratings. In contrast, the corres-
ponding correlations between Mooney scores and effectiveness

ratings by therapists and MHP's peers are predominantly

 

negative (35 of 5M). Patients, unlike either the therapists
or MHPs, link the reporting of problems with effectiveness,
even though none of the effectiveness scores correlate
significantly with Mooney scores.

A connection between these Mooney patterns and the
pathogenesis results seems likely, in that patients, more
than therapists and peers, tend to like, and view as more
effective, those workers who score higher on pathogenesis
and personal problems. Thus, even though no individual

correlations attain statistical significance, there appears

76
to be a broad and consistent tendency for patients to more
favorably regard those workers who report more personal
problems (Mooney) and who seem to be less considerate of
the feelings of dependent persons (pathogenesis).

This pattern is reminiscent of Sturman's (1973)
finding that MHPs with good individual counseling skills
tended to be emotionally unstable. Davids et all. (1969)
also found that a certain degree of personal and social
maladjustment may be desirable in working with emotionally
disturbed children.

Assuming that patients see themselves as having pro-
blems, and that they have backgrounds with parents and other
adult figures likely to have higher than average pathogene-
sis scores (a reasonable assumption, since pathogenesis has
previously been found[ Mitchell, 1971] to be successful
in differentiating parents of the emotionally disturbed
from parents Of normals), it seems that patients show some
tendency to view more favorably those workers who are more
like themselves, or who have some characteristics similar

to other Significant adults in their lives.

Qualitative Aspects of Reported Problems

 

It is intriguing to note, from the qualitative aspects
Of the narrative responses to the Mooney Problem Check List,
that more effective workers take more responsibility for
their problems. This finding closely parallels the

emphasis in the literature on personal involvement (Konopka

77
et al., 1961), emotional interaction with patients related
to self-examination and working on one's own problems
(Maier, et al., 1955), and the personal development of the
IHP through insights into himself (Bettelheim, 1966;
Bettelheim & Wright, 1955). This seems to be quite a pro—

mising area to pursue in further research.

Predicting Effectiveness of MHPs

 

Personality variables as predictors of rated effective-
ness of MHPs are listed in Appendix P, according to the
size of their correlation with effectiveness scores. The
multiple regression analysis results in Table 12 shed even.
more light on the strength Of personality variables as
predictors of effectiveness. Several implications can be
drawn from these data:
(1) In general, correlations between effectiveness scores
and personality variables are highest within rater tppes.
(2) Across rater types, therapist-ratings of ARO are better
predictors of RC than are SAR ratings, while peer-,
therapist-, and patient-ratings of SAR are better predictors
of KS and total effectiveness. Self-ratings are quite
inconsistent, and are not good predictors.
(3) For therapist-ratings of effectiveness, SAR is a better
predictor than ARO. The only exceptions are that the
therapist-rating of ARO is a better predictor of therapist-
rated RC and total effectiveness than is the therapist-

rating of SAR. For patient—ratings of effectiveness, ARO

78
is more important than SAR. For peer-ratings of effective-
ness, both SAR and ARO are important.
(M) There is a tendency for ratings Of SAR to be better pre-
dictors of the KS cluster and ratings of ARO to be better
predictors of the RC cluster.
(5) The "Liked" score correlates with effectiveness within
all rater groups. Across rater groups, therapist liking is
important to all groups, peer liking is important only to
peers and therapist, and patient liking is important only
to patients. Taken as an independent variable, apart from
its correlation with other variables, liking is a good
predictor Of effectiveness only with peer-ratings of liking
for peer-rated RC and total effectiveness.
(6) The OK Questionnaire, the Mooney Problem Check List
scores, and the pathogenesis score are inadequate predictors
of ratings Of effectiveness.

In summary, the best predictor of role commitment is
therapist-rated ARO, followed by patient- and peer-rated
ARO. The best predictors of knowledge and skills are peer-
and patient—rated SAR, although number of months employed
predicts KS about equally well. Peer-ratings of self—
disclosure correlate well with effectiveness, and would be
useful in the absence Of SAR and ARO ratings. Therapist
"liking" also correlates well with RC effectiveness.

In a hiring situation, ratings by previous supervisors
and/or peers and/or patients of the applicant might be quite

helpful in Obtaining information about SAR and ARO, although

79
it might be difficult to devise a suitable context for these
ratings because they were made here in the context of
similar rating Of co-workers. Ratings by other of self—
disclosure might also be helpful. The present data indicates
that therapist-ratings are most valid, followed closely by
peer-ratings, and trailed more distantly by patient-ratings.
In the absence Of these, or in addition to them, the char—
acteristics, SAR, ARO, self-disclosure, and liking, could
be kept in mind during an interview process.
The qualitative focus on the Mooney Problem Check List,

indicating that workers rated as effective tend to take
more responsibility for their own problems, offers further
suggestions, especially if the initial impression presented
here is substantiated by further research. The feelings
and attitudes of potential MHPs could be elicited by written
responses or by interview.

With regard to MHPs already hired, it would be beneficial
to keep in mind the variables of SAR and ARO when developing

training programs.

Suggestions for Further Research

 

l. Attempt to further validate the MHP effectiveness
rating by using a behavioral measure Of the MHP in some
kind of actual interaction with the patient(s). For
example, the MHP could be Observed in a group meeting, and
his effectiveness directly rated by Observers.

2. Do a longitudinal study, getting personality data

80
at the onset Of employment, and periodically thereafter,
collecting both personality and effectiveness data. In this
way, better information could be obtained on the predicta-
bility of initial personality measures for future job
effectiveness. Also, information could be Obtained on the
stability over time of both the personality variable scores
and effectiveness measures.

3. Further investigate the qualitative aspects Of
responsiblity taken for personal problems, as presently
reflected in the written addition to items on the Mooney
Problem Check List.

M. Although previous studies found that the broad
interpersonal dimensions Of SAR and ARO are relatively
independent, there was a considerable overlap between the
measures of them used in this study. Thus, these SAR and
ARO measures intercorrelated .6M for therapists, .76
among patients, .75 among co-workers, and .51 among self—
ratings. The overlap between these measures could probably
be markedly reduced by further development of these measures.

5. Also deserving further investigation was the clear
tendency for patients, unlike either the therapists or MHPs,
to rate more favorably the MHPs who showed greater evidence

of emotional problems in interpersonal behaviors.

SUMMARY AND CONCLUSIONS

The effectiveness of Mental Health Paraprofessionals
(MHPs) in a residential treatment center was rated by their
supervisors, patients, co-worker peers, and by self. These
effectiveness ratings yield two moderately independent
components, a Knowledge and Skills (KS) element and a Role
Commitment (RC) element. Both of these, plus the total
effectiveness score, were examined for linkages to several
selected personality variables and for consistency across -
rater classes.

MHPs rated as being effective were also rated as being
accepting Of themselves (SAR) and accepting of others (ARO).
SAR tends to link with the KS component of effectiveness,
while ARO tends to link with the RC component.

Self-disclosure is correlated with effectiveness only
when measured by others, not by self. Self-rated self-
disclosure does not correlate with peer-rated self-disclo-
sure.

This study strongly supports the generality of the
concepts, SAR, ARO, and self-disclosure, extending their
applicability to the MHP population.

Therapist-ratings generally carried more predictive
value, followed by peer-ratings, and then by patient-ratings.

Self-ratings were generally not useful in differentiating
81

82
MHPs on the basis of effectiveness as rated by others.

The KS component of effectiveness improves with the.
training and experience attained during length of employ—
ment, but the RC component shows no such relationship. In
a longitudinal study, this RC component may emerge as an
early predictor of effectiveness.

Patients, more than other raters, tended to see more
favorably those MHPs who were not considerate of the feelings
of dependent persons, and who reported more personal pro-
blems. Scores for pathogenesis and for the number of per-
sonal problems reported did not differentiate workers on the
basis of effectiveness as rated by others.

A promising area for further research is presented;
this involves focusing on the amount of responsibility a

person assumes for his own problems.

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Schwartz, W. The practice Of child care in residential
treatment. Presented at the Bellefaire Centennial
Symposium, Cleveland, Ohio, May 2“, 1968.

 

Sturman, M. E. Personality factors which determine job
success of mental health workers. The Oaks

Magazine, 1973, g, 3-M.

 

Trieschman, A. E., Whittaker, J. K., & Brendtro, L. K.
The Other 23 Hours. Chicago: Aldine Publishing
Company, 1969.

 

Truax, C. B., & Carkhuff, R. R. Client and therapist
transparency in the psychotherapeutic encounter.
Journal pf Counseling Psychology, 1965, 12, 3—9.

 

Vandenbos, G. R., & Karon, B. P. Pathogenesis: a new
therapist personality dimension related to therapeutic
effectiveness. Journal pf Personality Assessment,
1971, 35, 252-260.

 

Veldman, D. J. Simple structure and the number of factors
problem. Multivariate Behavioral Research, 197“, 2,
no. 2.

 

Whittaker, J. K., & Trieschman, A. E. Children Away from
Home. Chicago: Aldine-Atherton, 1972.

 

APPENDICES

Appendix A

Self—Disclosure Measure

Overtly Self-Concealing:

 

1. lakes an obvious effort to project some desired self-
image. Seems to continually express opinions, rationalize,
or make defensive statements which are often predictable.
Personality structure seems very rigid. Person seems not
to hear or accepts ideas or feelings of others.

2. The effort to project a desired self-image is less
obvious than type 1. Rigidity of thinking is partially
concealed by a pleasant facade. Seems to hear and accept
Opinions of others momentarily, but quickly re—establishes
a new defensive position with other rationalizations.

Covertly Self-Concealing:

 

3. Seems quiet and withdrawn from group interaction and
uses passivity as a defense against involvement with others.
Resists efforts to elicit social participation. Hostility
or indifference is often conveyed by non-verbal expressions
of boredom, sulkiness or anger.

A. Seems quiet and withdrawn from group interaction and
uses passivity as a defense against the exposure of anxiety
and fear. Conveys by expression or other non-verbal
behavior an attitude Of wanting to communicate with others
but of not knowing how or of being afraid to try.

Involved Conventional:

 

5. Plays the role of a conventionally friendly person but
rarely reveals self. May be outgoing and congenial but

is limited by conformity to a social code restricting con—
versation largely to ideas and safe tOpics rather than
feelings Of intimate topics. Seems more inhibited than de-
fensive in emotional expression.

6. Often participates in group interaction and seems gen-
uinely involved and concerned for others' feelings and
problems but rarely reveals own personal feelings. The
person who frequently plays helper but hardly ever plays
helpee epitomizes this type.

87

88

Self-Disclosing:

 

7. Seems in good contact with own feelings and reveals
them from time to time. Seems genuinely motivated toward
self-honesty which can be shared with others, but sometimes
appears uncomfortable with this goal. Expresses more about
self than reactions to others.

8. Is actively involved in sharing thoughts and feelings
about self and others in group interactions. Although
not always transparent the person seems to be highly
motivated toward being self-disclosing and seldom appears
uncomfortable with this goal.

Rate each of your team members, including yourself,
by assigning a number to each name below:

 

 

 

 

 

 

Appendix B

THE "OK" QUESTIONNAIRE - INSTRUCTIONS
This is a measure of "existential position," an impor-
tant concept in the theory Of "transactional Analysis"

(e.g., Eric Berne, Games People Play; Harris, I'm 9K,

 

You're 9K). To answer accurately, you will need to under-
stand the concept Of existential position and think about
how it applies to you.

All Of us have some general feelings and attitudes
about how "good," "worthwhile," and "OK" we are (or how
"bad," "worthless," and "not-OK" we are). We also have some
general feelings about how good, worthwhile, and OK (or bad,
worthless, and not-OK) other people are. There are four
existential positions, based on the combination of our
feelings about ourselves ("I") and our feelings about other
people ("Other"):

I'm OK - Others are OK: "We're all winners."

I'm fine, good, worthwhile, and "OK," and so are other
people. I like myself and other people.

I'm OK - Others are not-OK: "I'm better than others."

I'm fine, good, worthwhile, and "OK," but other people are
not so hot. I like myself but not other people.

I'm not-OK - Others are OK: "Others are better than I am."

 

Other people are fine, good, worthwhile, and "OK," but I'm
not so hot. I like other people but not myself.

I'm not OK - Others are not OK: "We're all losers."

I'm not much good, and neither is anybody else. I don't
like myself or other people.

89

90
If each of us could "fit" into one position, this
questionnaire would be simple: you'd just indicate which
position fits you best. However, most of us change posi-

tions, depending on two things: the situation we are in,

 

and the trait we have in mind.

The situation: You may feel OK in some situations (or
with some peOple) and not others. For example, you may
feel OK when you are with friends and not-OK when you are
with strangers. Similarly, you may like other people when
you are at a party ("Others are OK") and dislike other
people in the classroom ("Others are not-OK").

 

The trait: In any particular situation, you may feel
OK in some ways and not-OK in others. For example, on a
date you may feel "I'm OK-intelligent" and "I'm not—OK-shy."
Similarly, you could feel that your date is attractive
("Others are OK-good-looking") but not too bright (Others
are not-OK-dumb).

 

A final complication is that "OK-ness" can be a matter
of degree; instead of feeling OK-rich vs. not-OK-poor, you
may feel very rich, somewhat rich, somewhat poor, or flat
broke. Where you place yourself (or someone else) on this
scale Of OK-ness will depend on the situation you are in
and the trait you have in mind.

This questionnaire takes all of these complications into
account. You will be asked to indicate your existential
position for 3 traits in 20 different situations. For each
position, you will also be asked to rate the degree to
which you feel OK (or not-OK) and the degree to which you
feel the other people are OK (or not-OK).

Instructions:

 

These instructions may sound complicated. You may want

to refer to the examples on the following page as you read
them.

91

Each item is based on one situation, and your answers
will probably be most accurate if you think of some person-
ally meaningful situation rather than answering in general
terms. For each item, try to recall a specific situation
that you have been in. The first concrete situation that
comes to mind will be fine. The situation may be recent
or past, frequent to infrequent, or whatever, as long as it
is one you can remember specifically. Make a brief note
(a word or phrase) of that specific situation in the space
marked "Situation: ". With that specific situation in
mind, think of the existential position you were in at that
time.

To rate degree of OK-ness, use 6-point scales (6 = very
positive, 1 = very negative). For example, if the situation
were "On a date" and you were rating the trait of attrac-
tiveness, you might choose the "I'm OK - Others are OK"
position and rate yourself very attractive (6) and your date
slightly attractive (A), or vice versa. For the "I'm not-
OK - Others are OK" position, you might rate yourself
slightly unattractive (3) and your date moderately attrac-.
tive (5).

Take a look at the following examples.

very negative (very not-OK)
moderately negative (moderately
not-OK)

slightly negative (slightly not-OK)
slightly positive (slightly OK)
moderately positive (moderately OK)
very positive (very OK)

Rating Scales:

NH

O\U1 EU)

A. On a date. Situation: with Bill last Friday

 

Traits "I" "Other"
a) attractive vs. unattractive _5_ _3_
b) interesting vs. dull _1_ _5_
c) sincere vs. insincere _6_ 5

These answers mean that the person rated herself moderately
OK-attractive, very not-OK dull, and very OK-sincere. She
rated her date slightly not-OK—unattractive, slightly OK-
interesting, and moderately OK-sincere.

 

92

 

With my parents. Situation: over last vacation
Traits 2;: "Other"
a) friendly vs. unfriendly _2_ _3_
b) adjusted vs. maladjusted _6_ _5_
c) openminded vs. closedminded _3_ _2_

GO over this one until you understand it.

Final Notes:

 

1.

There are no "correct" answers. Each item was chosen
so that someone could be in any one of the four positions
for any trait in that kind of situation.

Please answer all items; if you can't think of a specific
situation, or you are not sure of your positions in a
particular situation, make your best guess.

For some items, a definite other person may not be
involved (e.g., "when I get up in the morning"). For
these items, base your answers on how you felt about
other people in general when you were in that situation.

 

Keep the above rating scales in front of you as a
reminder while you complete the following questionnaire.

THE "OK" QUESTIONNAIRE

Borrowing something from someone. Situation:

 

(Note: Answer according to how you felt in that
situation.)

Traits "I" "Other"
a) friendly vs. unfriendly

b) honest vs. dishonest

c) sincere vs. insincere

Talking to a teacher. Situation:

 

Traits "1" "Other"
a) openminded vs. closedminded
b) concerned vs. apathetic

c) intelligent vs. unintelligent

With peOple I don't know. Situation:

 

Traits "I" "Other"
a) outgoing vs. shy
b) interesting vs. dull

c) attractive vs. unattractive

When someone doesn't like me. Situation:

 

Traits "1" "Other"
a) Openminded vs. closedminded
b) concerned vs. apathetic

c) kind vs. cruel

93

9M

5. In high school. Situation:

 

(Note: "Other" may mean "people in generalTr herei)
Traits :1: "Other"

a) friendly vs. unfriendly

b) adjusted vs. maladjusted

c) attractive vs. unattractive

6. In a competitive situation. Situation:

 

Traits "I" "Other"
a) openminded vs. closedminded
b) honest vs. dishonest

c) intelligent vs. unintelligent

7. Asking someone for help. Situation:

 

Traits "I" "Other"
a) friendly vs. unfriendly
b) concerned vs. apathetic

c) sincere vs. insincere

8. In an unfamiliar situation. Situation:

 

Traits "I" "Other"
a) friendly vs. unfriendly
b) adjusted vs. maladjusted

c) openminded vs. closedminded

95

9. After an argument. Situation:

 

Traits "1" "Other"
a) Openminded vs. closedminded
b) kind vs. cruel

c) sincere vs. insincere

10. When I was a young child. Situation:

 

Traits "I" "Other"
a) friendly vs. unfriendly
b) kind vs. cruel
c) outgoing vs. shy
Note: You are halfway done. If you are getting tired of
this, try daydreaming for a few minutes before you continue.

You are asked to rate a lot of situations because a smaller
number might give a biased picture.

11. In the classroom. Situation:

 

Traits "I" "Other"
a) Openminded vs. closedminded
b) concerned vs. apathetic

c) interesting vs. dull

12. When I get up in the morning. Situation:

(Note: "Other" = ”peOple in general" or the person(§)
you were in bed with.)

 

Traits "I" "Other"
a) kind vs. cruel
b) outgoing vs. shy

c) attractive vs. unattractive

13.

l“.

15.

16.

96

In a discussion of politics. Situation:

Traits "I"
a) openminded vs. closedminded
b) concerned vs. apathetic

c) intelligent vs. unintelligent

Being interviewed for a job. Situation:

Traits "I"
a) interesting vs. dull
b) attractive vs. unattractive

c) intelligent vs. unintelligent

Giving advice to someone. Situation:

 

"Other"

 

"Other"

 

Traits "I"
a) concerned vs. apathetic
b) honest vs. dishonest

c) sincere vs. insincere

With people in authority. Situation:

"Other"

 

Traits "I"
a) adjusted vs. maladjusted
b) openminded vs. closedminded

c) intelligent vs. unintelligent

"Other"

97

17. When I am all alone. Situation:
(Note: "Other" = "peOple in general")

 

Traits "I" "Other"
a) adjusted vs. maladjusted
b) concerned vs. apathetic

c) honest vs. dishonest

18. At work. Situation:

 

Traits "I" "Other"
a) friendly vs. unfriendly
b) interesting vs. dull

c) intelligent vs. unintelligent

l9. Lying in bed at night. Situation:

 

Traits "1" "Other"
a) adjusted vs. maladjusted
b) honest vs. dishonest

c) sincere vs. insincere

20. Studying for an exam. Situation:

 

(Note: "Other" = classmates and/or teacher)
Traits 1;: "Other"

a) adjusted vs. maladjusted

b) honest vs. dishonest

c) intelligent vs. unintelligent

How accurate were your answers? very__ fair1y__ slight1y__
not at all__

Appendix C
Letter of Introduction and Background Sheets for MHPs

Dear MHW,

Thank you for taking part in this research. Your
participation will not only help me personally in completing
requirements for a PH.D. in Clinical Psychology from
Michigan State University; also, it will hopefully be
beneficial to The Oaks and to other residential treatment
centers in future hiring and training of Mental Health
Workers.

All of the information you give will be completely
confidential; it will not affect your job, you will not be
identified personally in the final results, and it will
not be included in your personnel file. In fact, no one
at The Oaks will have access to the information other than
myself.

Please begin by completing the background information,
below; then complete the other materials in the order they
are presented. Again, I want to thank you for your parti-
cipation.

Donna Jabury

BACKGROUND INFORMATION

Name Age Sex.

Marital Status . Number of Children

 

Education completed

 

Are you presently enrolled in college? Major

 

Length of time at The Oaks

 

Length of time on current residence at The Oaks

 

98

Appendix D
Mean Effectiveness and Semantic Differential Scores of
Subjects and of MHPs Who Did Not Complete

Data-Gathering Process

Subjects Non-subjects
(Q = 43) (a = 7)
Therapist-ratings:
Total eff 72.7 65.3
RC 19.4 18.1
SAR 23.5 20-7
ARO 27.6 26.6
Like 7.1 5-3
Patient-Ratings:
Total eff 72.4 67.5
RC 19.4 17.1
KS 18.1 16.7
ARO 28.1 27.5
Like 7.1 6.7
Peer-ratings:
Total eff 72.0 63.3
RC 19.0 16.4
KS - 17. 14.6
SAR 22.7 19.0
ARO 26.6 24.6
Like 7.1 6.3

99

Appendix E
Effectiveness Scores of Individual MHPs

Therapist Patient MHP-Peer MHP-Self

 

 

 

 

MHP Total RC KS Total RC KS Total RC KS Total RC KS

 

880 220 210 807 206 202 916 232 232 850 200 240
650 170 150 610 180 131 62M 202 168 800 200 200
800 200 200 786 188 201 839 230 22M 840 220 220
620 160 140 689 186 15M 802 20M 198 820 240 180
5M0 1M0 140 7M7 198 18M 820 214 206 700 170 180
520 150 110 661 184 158 7M6 210 188 780 240 190
700 2M0 110 5M7 151 121 663 188 148 780 200 190
760 240 150 656 185 155 707 197 159 650 190 180
810 230 190 729 205 192 758 201 187 750 200 180
10 680 200 150 713 185 181 752 183 188 860 230 210
11 820 210 240 650 168 181 897 229 236 830 220 220
12 800 200 220 609 188 165 815 207 212 910 230 230
13 820 230 150 611 16M 121 710 195 157 650 180 150
14 M80 150 100 655 179 166 368 100 92 490 130 120
15 730 180 190 626 170 158 716 180 182 _790 220 210
16 800 210 210 870 224 223 768 208 202 630 170 180
17 830 200 210 900 231 238 710 178 172 890 240 220
18 730 190 180 854 23M 22o 65M 160 162 760 220 170
19 660 170 160 735 191 191 62M 176 148 700 220 170
20 870 230 200 890 231 219 79M 191 209 810 220 190
21 790 190 180 759 202 183 ' 775 198 183 800 200 200
22 890 210 220 916 234 227 856 191 240 860 190 230
23 600 160 130 6M0 177 136 654 193 128 680 190 120
2M 590 180 120 72M 208 177 6M1 196 133 680 230 120
25 630 160 150 747 191 186 58M 164 136 580 180 120
26 630 140 160 885 ‘224 226 731 171 196 780 -200 190
27 540 130 140 713 181 191 587 163 144 680 200 150
28 8M0 200 220 810 217 206 762 199 190 650 140 180
29 820 210 230 8M3 226 226 720 166 218 890 240 240
30 900 230 210 818 213 216 850 204 218 730 170 190
31 860 240 180 621 163 151 746 202 182 850 230 200
32 700 190 170 551 1M9 111 796 212 188 810 210 210
33 670 210 150 572 177 139 700 210 152 700 190 180
34 400 100 90 M21 118 101 M88 1M2 116 620 190 130
35 860 240 200 688 209 172 6M8 19M 152 920 240 200
36 690 170 200 830 210 210 745 190 205 610 150 160
37 700 190 140 675 190 175 590 140 140 740 200 180
38 510 160 90 650 175 170 615 180 140 680 190 150
39 840 230 210 715 194 179 636 167 149 720 200 170
Mo 580 160 130 685 186 175 . 705 184 185 500 140 120
41 900 230 240 864 221 224 830 207 218 830 230 210
M2 910 2M0 240 833 215 211 718 193 188 770 200 190
M3 850 230 210 825 210 219 753 201 193 890 240 220

\ooouoxmn-wmw

Note: Scores given are mean scores, times ten; possible range for Total

Effefitiveness is 160 to 960; possible range for RC and KS 18 40
to 2 0.

 

100

Appendix F

Semantic Differential Scores of Individual MHPs

 

 

 

 

 

Therapist Patient MHP-Peer MHP-Self

MHP SAR ARO Li SAR ARO Li SAR ARO Li SAR ARO Li

1 320 350 80 225 303 65 302 340 86 330 330 90
2 220 300 70 158 223 60 226 284 76 240 330 90

3 310 330 80 215 325 73 298 346 88 210 300 90

4 270 330 70 148 263 70 266 272 78 260 320 90

5 190 260 60 203 273 60 240 310 76 260 290. 70

6 230 270 70 160 205 60 222 260 72 280 320 70

7 230 270 90 170 227 70 215 262 69 320 300 90

8 280 330 80 204 237 74 249 305 84 250 280 70

9 290 320 90 227 280 77 229 280 79 220 270 60
lo 160 300 60 187 254 67 197 247 67 270 310 90
11 240 230 90 180 264 74 279 270 84 260 290 90
12 210 270 80 134 214 57 265 275 74 260 300 90
13 330 300 90 214 260 77 250 265 70 190 220 70
14 170 200 40 173 273 83 110 150 18 140 190 50
15 240 210 60 320 288 63 248 254 72 330 270 90
16 280 270 90 265 318 78 194 266 76 200 230 80
17 290 320 90 280 358 88 270 306 78 280 300 70
18 160 300 70 245 340 88 164 208 64 280 320 80
19 220 250 60 230 313 73 248 256 62 200 290 80
20 310 340 90 298 358 88 215 288 78 290 330 .50
21 230 320 80 258 335 83 218. 285 80 230 290 70
22 310 280 70 313 350 88 298 230 65 310 260 80
23 230 290 90 218 275 68 218 273 73 250 310 90
24 200 280 80 253 335 78 190 243 75 210 300 70
25 230 270 70 245 308 88 155 230 63 140 210 70
26 210 230 60 335 345 88 265 288 83 270 300 90
27 210 230 50 210 205 55 178 210 55 240 270 80
28 270 310 80 290 285 63 273 300 75 220 260 80
29 310 290 90 343 308 78 235 213 65 350 330 90
30 310 310 90 308 358 90 268 298 76 270 250 80
31 330 330 80 235 230 45 258 284 76 290 210 50
32 250 270 70 198 203 45 236 272 72 250 280 90
33 120 220 50 148 165 53 120 230 76 220 260 90
34 70 100 30 133 175 58 152 176 46 200 290 80
35 200 280 60 253 195_ 30 208 228 68 260 270 90
36 220 190 70 280 350 90 170 260 45 220 290 70
37 310 230 70 265 315 70 200 225 65 250 230 70
38 150 240 60 225 260 60 185 245 60 260 290 70
39 220 300 60 245 295 78 225 288 78 270 340 80
40 80 230 30 220 263 65 188 278 65 210 300 90
41 220 320 80 300 323 85 298 335 83 320 340 80
42 250 310 70 288 318 80 260 278 73 260 280 80
M3 210 290 50 283 328 88 280 315 78 240 340 90

Note: Scores given are mean scores, times ten; possible range for SAR

and ARO is O to 360; possible range for Like is 0 to 90.

101

Appendix 0
Personality Variable Scores of Individual MHPs

Self Disc 0K Quest Mooney Problem Check List

 

 

 

moon.» CDUIU'IUJWWUWONLM'NI 3:

#
MHP Pe Se Sel 0th He ES SI Py HF Ct Sx R1 0c Path mo
1 78 70 286 264 4 o 10 7 0 7 2 o 0 55 2

2 64 70 306 272 1 4 6 12 6 0 3 o o 33

3 76 70 298 291 2 4 1 4 1 o o 1 . o 75 1

4 64 70 272 276 7 6 18 14 11 2 1 4 o 67

5 58 80 285 291 10 11 20 17 9 3 2 0 6‘ 58 1
6 60 70 260 271 4 4 2 3 6 1 8 0 o 58

7 57 70 300 255 0 2 3 3 o 0 2 0 0 100

8 69 50 247 209 9 6 16 20 7 7 1 6 2 44

9 65 70 227 211 3 3 11 17 2 5 2 3 0 33
10 52 70 248 240 4 18 326 37 12 5 7 0 5 80 1
11 75 70 281 253 0 3 7 17 0 3 11 0 3 72 4
12 69 70 204 243 10 10 15 41 7 11 1 2 2 46 1
13 52 70 228 228 75 2 3 17 1 1 1 l 2 53 4
14 32 60 256 239 1 1 9 8 o 0 0 1 o 71‘

15 6o 80 294 271 M 2 10 10 11 1 0 o 2 12 14
16 64 70 245 285 1 0 8 13 2 3 3 o 1 :22 42
17 7o 70 303 273 9 12 29 32 6 4 4 4 4 18 9
18 62 70 294 260 1 8 7 15 2 2 1 0 1 82 23
19 64 60 252 268 11 10 11 28 3 6 o 1 2 50 30
20 73 70 249 227 9 8 27 38 5 7 7 10 2 81 13
21 65 60 239 275 2 7 24 19 o 5 1 o 6 9 14
22 43 80 266 230 5 6 5 0 2 2 0 0 5 73 25
23 7o 80 278 264 3 7 10 34 11 9 3 1 2 87 9
24 48 70 258 269 3 10 12 23 13 2 0 3 5 45 6
25 53 50 201 203 12 8 13 28 4 6 3 1 12 92 6
26 73 70 251 215 3 4 5 12 o 3 4 0 1 69 21
27 55 80 271 268 4 14 25 37 15 9 l 8 9 50 10
28 63 80 273 260 0 7 3 5 2 0 0 o o 50 42
29 50 80 281 241 3 15 19 15 16 7 2 o 6 78 48
30 74 80 273 280 3 10 11 25 0 6 1 2 3 72 19
31 64 70 293 292 5 3 4 12 o 1 3 1 6 .30 12
32 64 70 286 243 3 4 4 1 1 0 0 o 1 27 16
33 38 60 258 239 6 12 8 12 5 3 3 3 1 .55 4
34 26 80 308 299 7 9 10 1 5 4 3 0 2 54 3
35 64 60 270 258 6 8 16 16 5 5 2 2 o 46 3
36 45 60 279 254 4 7 17 8 1 M 0 1 6 91 18
37 55 60 298 294 1 2 10 5 1 2 0 0 1 69 M
38 45 70 291 283 8 9 26 23 9 18 3 0 6 62 9
39 65 60 305 288 7 2 9 4 4 o o 0 0 3o 42
40 50 60 242 234 2 5 22 21 8 4 6 3 8 44 5
41 75 80 241 291 8 13 23 31 14 5 7 6 4 69 42
42 60 50 252 243 5 13 21 23 13 6 2 l 1 33 14
43 l 4 2 10 7 0 1 1 1 46 9

7O 60 288 266

102

 

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105

 

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os so ss so so ss so .so ao os so oa oo aa ao ss
mm OM mm OM 0N >3 mm MN mm :0 HM MM Nm H: NN OH
om MN MM M2 MN :N mm MN mm m: MM H: Hm HM HM M
o: om Nm Mm ss HM MN MN om om Hm mm HN M: m: m
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106

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CH 0M M: MH HN HM M: sH M HM MN M : MN MM M o M M H o M M o H
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107

Appendix M

Product-Moment Correlations Of Effectiveness Scores

with OK Questionnaire and Pathogenesis Scores

OK Questionaire

 

 

Effectiveness
Scores SAR ARO Pathogenesis
Therapist:
Total ~08 ~08 ~18
RC ~09 ~16 ~12
KS ~07 ~04 ~18
Patient:
Total ~14 ~10 11
RC ~20 ~15 05
KS ~13 ~05 O9
MHP-Peer:
Total ~05 02 ~05
RC ~06 08 ~16
KS ~06 ~03 02
MHP—Self:
Total 21 14 ~11
RC 14 18 ~11
KS 17 07 ~18

108

 

 

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MHI Mo MOI sOI MHI Mo sOI MOI MOI Hmpoe
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109

Appendix 0

Product-Moment Correlations of OK Questionnaire,
Self-Disclosure, and Pathogenesis Scores with Other Variables

OK Self-
Questionaire Disclosure

 

 

Variables Self Other MHP Self Path

 

Therapist Ratings:

 

Semantic Diff ~ SAR 00 ~04 52** 12 ~05
Semantic Diff - ARO —1M -08 68** -04 -11 ,
Semantic Diff ~ Like ~11 ~07 57** 20 ~08 ;
Patient Ratings:
Semantic Diff ~ SAR 00 ~07 25 11 ~04
Semantic Diff ~ ARO ~05 00 31* ~02 14~
Semantic Diff ~ Like ~20 ~23 12 ~12 28
MHP-Peer Ratings:
Semantic Diff ~ SAR 08 ll 71** 28 ~16
Semantic Diff ~ ARO 01 14 79** 04 ~21
Semantic Diff ~ Like ~02 06 77** 08 ~26
Self Disclosure ~02 08 100 05 ~15
MHP-Self Ratings:
Semantic Diff ~ SAR 37* 17 37* 43** O4
Semantic Diff - ARO 27 17 37* 18 O7
Semantic Diff ~ Like 19 06 20 17 05
Self Disclosure 30* 35* 05 100 11
OK Questionnaire: Self 100 62** ~02 30* ~02
OK Questionnaire: Other 62** 100 08 35* ~21
Mooney:
Health ~32* ~10 ~02 ~16 ~02
Economic Security ~17 ~02 ~17 15 16
Self-Improvement ~21 ~02 ~04 ~06 ~06
Personality ~50** ~18 24 01 06
Home & Family ~07 07 ~11 20 ~04
Courtship ~28 ~10 02 02 12
Sex ~15 ~09 18 O9 18
Religion ~29 ~20 19 ~02 02
Occupation ~27 ~12 ~27 00 13
Pathogenesis ~02 ~21 ~15 11 100

*p < .05, two-tailed test
**2 < .01, two-tailed test

110

Appendix P
Personality Variables as Predictors of Effectiveness of MHPs,

Listed in Order of Their Correlations with Effectiveness

For Therapist-Ratings of Effectiveness

Therapist SAR and ARO

Peer SAR

Therapist Like (better predictor of RC than of KS)

Peer Self-Disclosure (better predictor of KS than of RC)
Patient SAR

Peer ARO and Like

Patient ARO (for KS and Total Eff only)

Self SAR

GDNOUTJZ'UONH

For Patient-Ratings Of Effectiveness

Patient ARO

Patient SAR

Patient Like
Therapist ARO

Peer Self-Disclosure
Therapist SAR

Peer SAR and ARO
Therapist Like

CDNONU'IJZ‘UUI'UH

For Peer-Ratings of Effectiveness

Peer SAR (better predictor of KS than of RC)

Peer ARO and Like (better predictor of RC than of KS)
Peer Self-Disclosure

Therapist ARO

Therapist Like

Therapist and Self SAR

Self ARO and Like

Patient SAR and ARO (predicts KS only)

(IDNIQUTJZ’LAJNI-J
o o o a o o a o

111