THE USE OF MULTIPLE THERAPY
IN GROUP COUNSELING AND
PSYCHOTHERAPY

Thesis for the Degree of Ph. D. ,

MICHIGAN STATE UNIVERSITY
KENNETH GUY NUNNELLY
1968

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ABSTRACT

THE USE OF MULTIPLE THERAPY
IN GROUP COUNSELING
AND PSYCHOTHERAPY

By

Kenneth Guy Nunnelly

The purpose of the study was to evaluate the effectiveness
of multiple therapy, using male and female therapists, in group
therapy with university counseling center clients. It was hypoth-
esized that after therapy clients in a group led by two therapists
would be more improved than clients in groups led by one therapist
on the following outcomes: (1) perceptions of father acceptance;
(2) perceptions of mother acceptance; (3) increase in ego strength;
(4) increase in self-acceptance; and, (5) decrease in social
introvers ion .

In a consideration of the history and theory of multiple
therapy it was pointed out that the therapeutic configuration of
multiple therapy represented a family situation with both parents
present. The resulting therapy was regarded as a process of
personal maturation. It was stated that in the early stages of therapy

conflicts pertaining to clients' problems with one or both parents

Kenneth Guy Nunnelly

would be brought into sharp focus . Once trusting relationships with
the therapists were established clients would be secure in regressing
to deep levels of feeling. They would subsequently be supported in
strengthening their feelings of adequacy in coping with their emotions.
and with environmental problems. As the therapy process continued
clients' individualization and self-acceptance would be helped by
their experiences of the two therapists’ sometimes similar and some-
times contrasting perceptions of them. The terminating phase of
therapy for the clients would be the establishing of healthy relation-
ships to persons outside of the therapy setting.

In a review of experimental studies no research evidence was
found which supported the use of multiple therapists in group therapy.
However, authors of descriptive reports indicated that in their
experiences multiple therapy was an approach that appeared to be
consistently effective with both individual and group clients .

The design of the study was a pretest-posttest design in which
the multiple therapy group was compared with a group led by a male
therapist and a group led by a female therapist on five outcome
variables: (l) perceptions of father acceptance; (2) perceptions of
mother acceptance; (3) ego strength; (4) self-acceptance; and,

(5) social introversion. Scales from three objective instruments were
used as operational statements of the variables. The scales were:
the Father Acceptance and Mother Acceptance scales of the Family

Relations Inventory, the Total Positive scale of the Tennessee Self

Kenneth Guy Nu nnelly

Concept Scale, and the Ego Strength and Social Introversion scales
of the Minnesota Multiphasic Personality Inventory.

The clients were single, male and female undergraduate students
who were selected for participation in the study according to the
following three criteria: (1) there were expressed needs for help in
resolving conflicts with one or both parents; (2) there were feelings
of self-depreciation; and (3) there was dissatisfaction with relation—
ships to peers. Clients were assigned to groups on the basis of their
time availability. Each group met for thirteen sessions, for twenty-
six hours of therapy. There were six clients in each group.

The male therapist was a counseling center intern who was
completing his doctoral degree in Counseling Psychology. The
female therapist had just completed her counseling center internship
and had received her doctoral degree in Clinical Psychology. Both
therapists had similar training experiences, and had worked together
as a multiple therapy team prior to the study.

An analysis of covariance statistic was used to analyze data
obtained before and after therapy. Where results were statistically
significant, pc;s_tho_c comparisons were used to test differences
between adjusted mean scores. On the basis of the results, the

following conclusions were formulated:

1. Clients in the multiple therapy group perceived their fathers
as being more accepting than did clients in the male therapist group,

which partially supported the contention that multiple therapy helped

Kenneth Guy Nunnelly

clients resolve conflicts with one or both parents . No differences
were found on comparisons between the female therapist group and

the multiple therapy group on perceptions of father acceptance.

2 . There was no statistical support provided for hypotheses
that the use of multiple therapists would be more effective than the
use of one therapist in group therapy for increasing clients'
perceptions of mother acceptance, feelings of ego strength, feelings

of self-acceptance, and social adjustment.

3 . There was no indication that one—therapist groups showed
more pretest to posttest improvement than the multiple therapy group
on any of the five variables which were measured. The implication
was that the use of multiple therapists did not prove to be less

effective than the use of one therapist in group therapy.

4. The multiple therapy group did not deteriorate on any of
the measures used to assess therapeutic progress, which contradicted
claims of some practitioners who stated that the use of more than one

therapist would be detrimental to clients' improvement.

The results were discussed and suggestions for revision of
theory and design were made. Following a speculative examination
of the data in which several tentative conclusions were formulated,
it was suggested there was slight but consistent enough evidence in
support of the use of multiple therapists that further investigation

would be warranted.

THE USE OF MULTIPLE THERAPY
IN GROUP COUNSELING AND

PSYCHOTHERAPY

By

Kenneth Guy Nunnelly

A THESIS

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

DOCTOR OF PHILOSOPHY

College of Education
Department of Counseling, Personnel
Services and Educational Psychology

1968

to nona, my very favorite person

ii

AC KNOWLEDGM E NTS

A considerable amount of the labor which led to the development
and completion of the thesis was in collaboration with individuals
whose interest and help made it a most rewarding experience. The
writer would like to acknowledge the contributions of the following

persons:

Dr. William Farquhar, chairman of the doctoral committee, for
his guidance throughout the Ph.D. program and in the writing of the
study.

Dr. Norm Abeles, Dr. Sam Plyler, and Dr. john Suehr, who
provided many perceptive and useful suggestions concerning several
aspects of the study.

Mr. Gerald Gillmore, who was gracious with his time and
patience in programming data for computer analysis .

Dr. Charlene Carter, for her participation in the study as a
uniquely sensitive and competent therapist and colleague.

Dr. Bill Kell, for his excellent supervision and for a friendship
of many dimensions .

Mrs. Nona Nunnelly, for her patient attention to the typing

and duplicating of several drafts of the thesis manuscript.

iii

TABLE OF CONTENTS

LIST or TABLES
CHAPTER I: INTRODUCTION.

Need for the Study .
Definition of Counseling and Psychotherapy.
Definition of Multiple I‘herapy

Purpose of the Study .

Hypotheses

Overview

CHAPTER II: HISTORICAL AND THEORETICAL
CONSIDERATIONS .

A History of Multiple Therapy.

The Client's Experience of Multiple Therapy
Impaired Relationships with Parents
Regression and Ego Development .
Self-Differentiation and Sexuality
Interpersonal Relationships
Termination . .

Summary .

CHAPTER III: REVIEW OF RESEARCH AND DESCRIPTIVE
LITERATURE

Experimental Research .
Descriptive Studies . . . . .
Related Descriptive Reports
Summary .

iv

. viii

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.17
.18
.22
.24
.28
.30
.31

.32

.32
.35
.39
.42

CHAPTER IV: DESIGN OF THE STUDY

Selection and Description of the Sample
Setting and Procedure for Group Therapy
Therapist Training and Experience .
The Instruments Used in the Study .
The Family Relations Inventory (FRI) .
Reliability
Validity . .
The Ego Strength Scale of the MMPI (Es)
Reliability
Validity . .
The Tennessee Self Concept Scale.
Reliability
Validity . . .
The Social Introversion Scale of the MMPI (Si)
Reliability
Validity .
Statistical Hypotheses . .
I. Perceptions of Father Acceptance
II. Perceptions of Mother Acceptance .
III. Development of Ego Strength
IV. Acceptance of Self.
V. Social Introversion
Analysis to be Used .
Summary .

CHAPTER V: ANALYSIS OF RESULTS

Hypothesis 1: Perceptions of Father Acceptance .

Hypothesis II: Perceptions of Mother Acceptance .

Hypothesis 111: Development of Ego Strength .
Hypothesis IV: Self-Acceptance

Hypothesis V: Social Introversion .

Summary .

CHAPTER VI: SUMMARY, CONCLUSIONS, DISCUSSION,

SPECULATIONS, LIMITATIONS,- AND
IMPLICATIONS

Summary.
Conclusions
Discussion of Results

43

43

.45

46
47
48
49
50
51
52
52
54
56
56
57
58
59
6O
61
61
62
62
63
63
66

68

68
7O
71
72
73
74

75

75
77
79

 

 

Perceptions of Parents . . . . . . . . 79
Ego Strength, Self-Acceptance and
Social Adjustment . . . . . . . . . 81
Improvement in One- Therapist Groups . . . 82
Absence of Deterioration . . . . . . . . . 82
Speculations About the Data . . . . . . . . . . 83
The Fantasied Parent-Surrogate . . . . . . 83
Ego Strength . . . . . . . 85
Self-Acceptance and Self-Differentiation . . 86
Social Introversion. . . . . . . . 88
Two Other Indications of Improvement . . . 88
Limitations of the Study . . . . . . . . . . . . 89
Implications for Further Research . . . . . . . . 91
AFinalWord. . . . .. . .. .. .. . . .. 93
BIBLIOGRAPHY . . . . . . . . . . . . . . . . . . . 95
APPENDIX
A. Descriptive Data Pertaining to Client's
Group Membership, Sex, Age, Class
and Attendance . . . . . . . . . . . . . 99
B. A Brief Description of the Groups . . . . . 100
C. Pearsonian Correlations for Pretest and Post—
test Scores for the Father Acceptance, Mother
Acceptance, Ego Strength, Total Positive, and
Social Introversion Scales . . . . . . . . 103
D. Analysis of Variance Data for Pretest and Post-
test Scores for the Father Acceptance, Mother
Acceptance, Ego Strength, Total Positive,
and Social Introversion Scales . . . . . . 104
E. Analysis of Covariance Data for the Father
Acceptance, Mother Acceptance, Ego Strength,
Total Positive, and Social Introversion
Scales . . . . . . . . . . . . . . . . . 106
F. A Sample of Items From the Father Acceptance
Scale of the Family Relations Inventory . . . 109
G. Adjusted Mean Scores for the Subscales of

the Total Positive Scale . . . . . . . . . 110

vi

Individual Scores, Mean Scores and Changes

in Scores from Pretest to Posttest: Father
Acceptance and Mother Acceptance

Scales . . . . . . . . . . . . . . . . . 111

Individual Scores, Mean Scores, and Changes
from Pretest to Posttest on the Ego Strength,

Total Positive and Social Introversion

Scales . . . . . . . . . . . . . . . . . 113

vii

Table 4 .

Table 4 .

Table 5 .

Table 5 .

Table 5 .

Table 5 .

Table 5 .

Table E.

Table E.

LIST OF TABLES

KR 20 Internal Consistency Reliability Estimate
for Students Participating in The Study: N = 20

Pearsonian Correlations Between Pretest Scores
and Posttest Scores for the Father Acceptance
Scale, the Mother Acceptance Scale, the Ego
Strength Scale, the Total P Scale, and the Social
Introversion Scale . . . . . . . . .

Obtained and Adjusted Mean Scores for the
Father Acceptance Scale of the Family Relations
Inventory .

Obtained and Adjusted Mean Scores for the
Mother Acceptance Scale of the Family Relations
Inventory . . . . . . .

Obtained and Adjusted Mean Scores for the Ego
Strength Scale of the Minnesota Multiphasic
Personality Inventory. . . . .

Obtained and Adjusted Mean Scores for the
Total Positive Scale of the Tennessee Self
Concept Scale

Obtained and Adjusted Mean Scores for the
Social Introversion Scale of the Minnesota
Multiphasic Personality Inventory

Analysis of Covariance Data for the Father
Acceptance Scale

Analysis of Covariance Data for the Mother
Acceptance Scale . . .

viii

50

65

69

71

72

73

74

106

107

Table E. 3

Table E.4

Table E. 5

 

Analysis of Covariance Data for the Ego Strength
Scale . . . . . . . . . . . . . . . . . . . . 107

Analysis of Covariance Data for the Total
PositiveScale ................108

Analysis of Covariance Data for the Social
IntroversionScale . . . . . . . . . . . . . . .108

ix

CHAPTER I: INTRODUCTION

There are many techniques which are employed to help clients
achieve therapeutic health. Traditionally therapists have used the
one-to—one relationship.“ which began in the intense, long-term
doctor-patient arrangement of the psychoanalytic approach. When
demands for therapist time increased, and the values of socializa-
tions were made known, the practice of group therapy was established.
Researchers in the fields of counseling and psychotherapy have
investigated process and outcome variables present in the traditional
methods. They varied the length of therapy, they experimented with
different numbers of clients working with one therapist, they changed
the types of client populations, and they used a variety of therapeutic
procedures.

A recent and somewhat unique procedure of therapy has been
to vary the number of therapists who relate to a client or a group of
clients. Seldom has more than one therapist been used, because the
presence of additional therapists has been regarded as non—traditional
and inefficient. There have been indications, however, that the use
of two or more therapists in either individual or group therapy would
make it possible to obtain results which not only included those of

traditional one-therapist approaches , but would enhance them.

1

2

Where two or more therapists are used it is believed that
clients are helped to intensely experience and resolve conflicts
specifically elicited by a particular configuration which is represented
by the therapists' relationship. In the special case of the therapists
being of opposite sexes , the configuration is that of a symbolic
family. In group therapy it is that of a symbolic family with parents
and siblings present. The family-like setting leads clients to
experience, express and resolve conflicts which may be traced to
incomplete, fixated or distorted processes in ”emotional maturation.
When there are male and female therapists present, clients are
given an opportunity to use them as models for sex and role identi-
fication, and for help in establishing healthy interpersonal
relationships .

A related advantage of using two or more therapists is that it
benefits the therapists perhaps as much as it does their clients.
Therapists who work together find that it increases their therapeutic
effectiveness , it helps them in their professional and personal growth,
and it facilitates their personal compatibility.

The relatively new technique of using two or more therapists
has been called "multiple therapy, " or "cotherapy, " the two terms
being somewhat interchangeable. The term multiple therapy is used
in the study to represent the configuration of the relationship of two
therapists to each other and to their clients. It is not to be confused

with the term "multiple counseling, " which has been used to mean

3

counseling with more than one client, nor does it refer to situations
in which role playing is used.

The use of multiple therapists presents an intriguing subject
for research and discussion. Client outcomes unique to the process
need to be examined. The..therapists' relationship needs to be
studied to find what kinds of personal compatabilities and divergency
are required for good therapy. Multiple interactions between persons
and the relationships they establish present a new problem for
students of therapeutic processes. Doubts may be raised about the
advisability of using two therapists where one has usually sufficed,
but the indications are that therapeutic outcomes are augmented by
means of the multiple therapy approach. For that reason multiple
therapy should be studied with the View that it may prove to be of
worth at least to the client's growth, if not to considerations of

efficiency and tradition.

Need for the Study

A study which indicates whether or not multiple therapy has
value equal to or beyond that of traditional therapeutic approaches
would be useful to a wide range of practitioners who work in a
variety of settings. Research would give a preliminary indication
of the worth of the theoretical formulations which claim that multiple
therapy has an effect that other forms of therapy do not, being that

of creating a milieu resembling that of a family.

4

The present study is designed to contribute theoretical and
research knowledge to the subject of the use of multiple therapists
in group counseling and psychotherapy. Hopefully it will be of use
to college counselors and psychotherapists, to practitioners in
individual and group counseling, and to students who would like to

participate in the experience of multiple therapy.

Definition of Counseand Psychotherapy

As used in the study counseling and psychotherapy is defined
as a growth-facilitating process which takes place in the context
of interpersonal relationships between therapists and clients, and
which encompasses the personal and situational concerns which are
expressed by clients. The therapists have been trained in skills
pertaining to both of the disciplines of Counseling Psychology and
Clinical Psychology. The term "therapy" will be used to denote

"counseling and psychotherapy . "

Definition of Multiple Therapy

Multiple therapy is an approach to therapy in which two or
more therapists are simultaneously present with one or more clients.
Therapists are free to interact with clients at whichever levels of
depth and intensity therapist and client personalities permit. The
interactions present in one-therapist situations are also present in
multiple therapy, but in multiple therapy there is the added

dimension of there being several possible therapist-client

5

relationships instead of just one. Therapist-client interactions lose
their dyadic nature and give way to what Kell and Burow describe as
a multiplicity of relationships:

There are at least four dynamically distinct possible relation-
ships when two therapists work with one client, and when a
second client is involved the number of relationships increases
considerably. These relationships are, namely, (1) and (2)
that between the client and each of the therapists separately,
(3) that between the two therapists and (4) the client's inter-
action with the relationship between the two therapists.

These four recapitulate the client's relationship to his parents
in the simplest form, but we add to it two more, which are each
therapist's interaction with the relationships between the client
and the other therapist. It is the addition of interrelationships
between two people when a third or fourth person is present
that we see the opportunity for both conflict generation and
resolution not so available in dyadic therapy.1

The addition of a second therapist, then, multiplies the number
of relationships with which clients and therapists must contend. It
expands the boundaries of conflicts which are perceived and experienced
by clients and therapists in the interview. Mullan and Sangiuliano
have reached similar conclusions in their phenomenological approach

to multiple therapy:

Multiple-therapy is the simultaneous therapeutic approach
by two or more separate and yet related therapists to a
single patient, married couple, a family or patient group.

. . . .Its therapeutic effectiveness is felt not alone by the
patient by also by the therapist. Thus , for the former it
makes available a uniquely charged milieu in which there
is such openness and spontaneity that growth becomes a
necessity. For the latter, supported by a close colleague,

 

.1 Bill L. Kell and Josephine M. Burow. Developmental
Counseling and Therapy (Boston: Houghton Mifflin Co. , to be
published Spring, 1969), 372-373.

6

there is offered an unlimited possibility to search for and
to find new meanings .1

The power of multiple therapy is based on the creation of a
therapeutic milieu in which numerous highly dynamic interactions
take place, to the mutual benefit of clients and therapists. It
approximates the family situation with siblings present. It increases
the number of possible interpersonal relationships and evokes more
conflicts related to developmental problems than does that of one-

therapist approaches .

Purpose of the Study

The purpose of the study is to present a history and theory of
the use of multiple therapists in group therapy, to derive testable
hypotheses from the theory, and to obtain and examine research
data to compare outcomes of clients' experiences of therapy between

one—therapist groups and a multiple therapy group.

Hypotheses
The following general hypotheses were formulated for the
study and will be considered in detail in Chapter IV, Chapter V

and Chapter VI:

 

1Hugh Mullan and Iris Sangiuliano. The Therapist's Contri—
bution to the Treatment Process (Springfield, 111.: Charles C.
Thomas, 1964), 164.

7

I. Clients' experience in a multiple therapy group will be
such that at the end of therapy they will report they perceive their
fathers as being more accepting than will clients in one-therapist

groups .

II. Clients in a multiple therapy group will have more
positive perceptions pertaining to mother acceptance than will

clients in one—therapist groups at the end of therapy.

III. Multiple therapy clients will have more feelings of

adequacy, of ego- strength, than will one-therapist clients.

IV. Self-acceptance, which is composed of clients'
perceptions of themselves as worthy physicial, social, moral,
family and personal beings , will be more positive for multiple

therapy clients than for one-therapist clients .

V. At the time of termination, one-therapist clients will
be less improved in social adjustment than will multiple therapy

clients .

Overview

In Chapter II the history of multiple therapy will be considered,
followed by a theory pertaining to the client's experience of multiple
therapy in a group setting.

A review of research literature and descriptive reports pertaining
to multiple therapy comprises Chapter III.

In Chapter IV, the design and instrumentation involved in the
experimental investigation of research I hypotheses is presented.

Results of the study are reported in Chapter V. The results
are interpreted and discussed in Chapter VI, and suggestions for

further research are made.

CHAPTER II: HISTORICAL AND THEORETICAL CONSIDERATIONS
A History of Multiple Therapy

The use of more than one therapist in the therapy interview
was advocated by Adler and his colleagues in the 1920's, when they
reported having two counselors meet with a parent and child to
Openly discuss problems created by an impasse in the child's thera-
peutic progress .1 They found that this Open consultation facilitated
the child's therapy, that he responded favorably. In 1939, Reeve
formed a "joint interview" team consisting of a female social worker
and a male psychiatrist, and reported that they were successful in
treating several kinds of client problems. There were two major
advantages to this type of interview: therapists' understandings of
the clients were enhanced, and clients tended to respond to the
therapists as parental figures. Reeve acknowledged the increased
complexity of multiple therapy over one-therapist interviews, but
wrote:

It presents a greater flexibility to the patient by giving him

an Opportunity to react to one or the other. Theoretically,

it affords an Opportunity for the patient to love and hate
without having to direct this toward any one person. It

 

1Rudolf Dreikurs, Techniques and Dynamics of Multiple
Psychotherapy, Psychiatric Quarterlgz, 1950, a, 788.

9

10

further affords him an opportunity to react with a minimum
fear of retaliation.1

A few years later, in the middle 1940's, John Warkentin and
Carl Whitaker formed a therapeutic partnership that led to the
expansion of the practice of multiple therapy and gave it professional
respectability. They began their work by seeking in-interview con-
sultation from each other. The availability of a trusted consultant
gave the therapists courage to deal with a wider range of problems,
such as those experienced by marital couples . Warkentin described
his feelings about the advantages of multiple therapy:

Impasse situations during treatment and problems in the

ending of therapy became much less threatening, with the

certainty that there was a consultant available to share

the responsibility. Similarly, group psychotherapy became

a more intense experience for both therapist and patients

because we became less afraid of 'transference-

countertransference jams. '2

Both men entered into practice at the Atlanta Clinic, in Atlanta,
Georgia. They and their colleagues began experimenting with
multiple therapy approaches and in 1949 they published an article in

which they described the results of three years of work. 3 They found

that the treatment of one client by two therapists helped therapists

 

1George H. Reeve. Trends in Therapy: V.A. Methods of Coordi-
nated Treatment. American Journal of Orthopsychiatry, 1939, 9, 747.

ZJohn Warkentin. Partners in Psychotherapy. Voices: The Art
and Science of Psychotherapy, 1967, 3, 10.

3Carl A. Whitaker, John Warkentin, and Nan Johnson. A Philo-
sophical Basis for Brief Psychotherapy. Psychiatric QuarteLly, 1949,
2;: 439-443.

ll

perceive the therapeutic process in depth, it helped them understand
their own emotional functioning, and it increased their capacity for
effective psychotherapy. Principles concerning the therapists'
relationship to the client were formulated from the point Of view that
the therapists' personal attention to the subjective life of the client
helped the client experience forces deep in his personality. If the
therapist was unable to give warmth, and if he needed the client for
his own satisfaction, his relationship to the client might be patho-
logical. The therapist's feelings are therapeutic if they are like
those of a nurturant parent:

The giving of the mature therapist is best described in terms

of the feeling the child should get from the parent. The

mature therapist is consistently parental. This parental

role, as the therapist lives it, includes emotional support,

definition of limitations, the capacity to accept aggression

and the ability to give without needing repayment.1

The following year, 1950, the Atlanta group published a paper
on the use of multiple therapy as a means of resolving therapeutic
impasse, which was defined as a stalemate or deterioration in the
therapeutic relationship.2 A consultant was called in to carry part
Of the responsibility for the client, which freed the therapist and
patient to express feelings of inadequacy in handling the relation-

ship. The Atlanta group continued their innovative approaches to

therapy by using up to ten therapists in the treatment of one client.

11bid., 433.

2Carl A. Whitaker, John Warkentin, and Nan Johnson. The
PSychotherapeutic Impasse. Americanjournal of Orthopsychiatry,
1950, _2_(_), 645.

 

12

They concluded:
In the multiple therapy situation some patients seemed
much more free than in individual therapy to act out their
feelings , both positive and negative. . . . (The client) felt
safer in his dependence on the therapists as a powerful
unit, and less guilty over his sexual or hostile responses. 1
In an article in 1956, practitioners in the Atlanta group
stated that on the basis of their experiences they found multiple
therapy was a more effective form of treatment with all clients
than was individual psychotherapy.2 They noted that in multiple
therapy there was greater freedom for the therapists to be personally
involved than there was in individual therapy. Multiple therapy
also offered specific advantages to the client:
The patient can express more varied and more intense
needs simultaneously. . .The patient can express his
positive and negative transferences, separately and
simultaneously, toward the two therapists. The multiple
therapy situation thus provides a matrix for a group
experience similar to that of a family group, even though
it still remains symbolic. 3
Whitaker and his colleagues described multiple therapy as an

interpersonal matrix in which a client underwent corrective emotional

experiences. The crucial dynamic in therapy was a feeling interchange

 

1Carl A. Whitaker, John Warkentin, and Nan Johnson. A Com-
parison of Individual and Multiple Psychotherapy. Psychiatry, 1951 ,
_1_4. 416.

2Carl A. Whitaker, T. P. Malone, and John Warkentin.
Multiple Therapy and Psychotherapy. In F. Fromm-Reichmann and
J. L. Moreno, Proggass in Psychotherapy (New York: Grune and
Stratton, 1956), 1, 211.

3Ibid.

13

between client and therapists that had as its model the parent-child
relationship and which consisted of insights that were felt rather
than verbalized. It was assumed that clients entered therapy out
of their own expectation that it would be possible for them to grow.
Growth was facilitated by the mobilization of constructive anxiety
which was felt by the client when he simultaneously perceived the
two therapists in different ways: one was perceived realistically,
the other was perceived in the context of a transference projection.1
Other early contributions to the understanding and practice
of multiple therapy were made by Rudolf Dreikurs. 2' 3'4 He found
that the presence of a second clinician made the therapy relation-
ship objective and helped the client develop an accurate under-
standing Of himself. He also found that therapists' frustrations were
minimized because of the support given by a colleague.5 Multiple
therapy was regarded as advantageous for the patient because of the

way it facilitated termination: "The constant inclusion of the second

therapist prevents too dependent a relationship on one therapist and

 

11de., 212-214.

2Rudolf Dreikurs. Techniques and Dynamics of Multiple Psycho-
therapy. Psychiatric Quarterly, 1950, 24, 788-799.

3Rudolf Dreikurs, Bernard H. Schulman, and Harold Mosak.
Patient-therapist Relationship in Multiple Psychotherapy: I. Its Advan-
tages for the Therapist. Psychiatric Quartem, 1952, 2_6_, 219-227.

4Rudolf Dreikurs, Bernard Schulman, and Harold Mosak. Patient-
therapist Relationship in Multiple Psychotherapy: II. Its Advantages
for the Patient. Psychiatric Quarterly, 1952, _2_6, 590-596.

SDreikurs, 1950, 789-795.

14

makes it easier for the patient to carry over his newly found relation-
ship to people other than the therapist. 1

After the popularization of multiple therapy by the Atlanta
group and by Dreikurs there was an increase in the numbers of
practitioners who used the new technique and wrote about it.
Throughout the 1950's multiple therapy was being practiced in
diverse settings with a variety of client populations . Haigh and
Kell advocated its usefulness for training new therapists and pro-
viding opportunities for conducting counseling and psychotherapy
research. 2 Buck and Grygier used a heterosexual cotherapy team
with juvenile delinquents . 3 Cameron and Stewart had two therapists
meet with a group of psychoneurotic patients, and reported that it
was a new and successful form of group therapy.4 Male and female

therapists were used in a parents' group by Grunwald and Casella, 5

 

1Dreikurs, etal., 1952, 224.

2Gerald Haigh and Bill L. Kell. Multiple Therapy as a Method
for Training and Research in Psychotherapy. Journal of Abnormal and
Social Pyohology, 1950, Q, 659-666.

3Alice E. Buck and T. Grygier. A New Attempt in Psycho-
therapy with Juvenile Delinquents. American Journal of Psycho-
therapy, 1952, 6, 711-724.

4John L. Cameron and Ronald A. Y. Stewart. Observations on
Group Psychotherapy with Chronic Psychoneurotic Patients in a
Mental Hospital. The International Journal of Grog) Psychotherapy,
1955, 5, 346-360.

5Hanna Grunwald and Bernard Casella. Group Counseling with
Parents. Child Welfare, 1958, fl, 11-17.

 

15

and in groups of chronic aged patients by Linden.1

Critical response to the practice Of multiple therapy was for
the most part voiced by Slavson, who felt that having more than one
therapist present would create too much anxiety for patients, that
creating a surrogate parent situation would cause acting out of
feelings rather than achievement of insight. 2 Some support was
given to Slavson's point of view in research investigations by
Daniels3 and by Staples,4 both of whom concluded that the use of
multiple therapy with eighth-grade students created oedipal anxiety
that blocked therapeutic progress.

The expansion of multiple therapy into other therapeutic
endeavors continued throughout the 1960's. Multiple therapy

approaches were being used in family therapy, 5 with male

 

1Maurice E. Linden. The Significance of Dual Leadership in
Gerontolic Group Psychotherapy: Studies in Gerontolic Human
Relations, 111. The International Journal of Group Psychotherapy,
1954, 4, 262—273.

2S. R. Slavson. Common Sources of Error and Confusion in
Group Psychotherapy. International Journal of GrougPsychotherapy,
1953' £1 3-28.

3Marvin Daniels. The Influence of the Sex of the Therapist
and of the Co-therapist Technique in Group Psychotherapy with Boys.
(Doctoral Dissertations, New York University). Ann Arbor, Michigan:
University Microfilms, 1958. No. 58-660.

4Ethel Janes Staples, The Influence of the Sex of the Therapist
and of the Co-therapist Technique in Group Psychotherapy with Girls.
Dissertation Abstracts, 1959, L9, 2154.

5James L. Framo. Rationale and Techniques of Intensive Family
Therapy. In I. Boszormenyi—Nagy and J. L. Framo (Ed.), Intensive
Family Therapy. (New York: Harper and Row, 1965) , 143-212 .

16

1 with college students,2 and in an increasing

homos exuals ,
number of group therapy and professional training programs . In
two books, the subject of multiple therapy was covered in depth.
In the first book, by Mullan and Sangiuliano, 3 two chapters were
devoted to a phenomenological understanding of multiple therapy
as it affected the therapists and as it was experienced by their
clients. In the second book, by Kell and Burow,4 there was
included a personal and thought-provoking sharing of experi-
ences and ideas about multiple therapy. The authors considered
such matters as indications for multiple therapy, the nature of
therapists' relationship, the use of fantasy and imagery in multiple
therapy, and its meaning to them and to their clients.

The above were but a sampling of publications and studies
which had made significant contributions to the development of
multiple therapy as a new approach to counseling and psycho—
therapy. It was estimated there were one-hundred twenty-five

available references on the subject, a great many of them having

been written in the last ten years .

 

1Melvin Singer and Ruth Fischer. Group Psychotherapy of
Male Homosexuals by a Male and Female CO-Therapy Team.
International burnal of Group Psychotherapy, 1967, l_7, 44-52.

2Shirley M. Corrigan. Coeducational, Cotherapist Group
Therapy. Journal of the American College Health Association,
1967, l_5, 248-250.

3Mullan and Sangiuliano, 1964.

4Kell and Burow, 1969.

17

The Client's Experience of Multiple Therapy

The effectiveness of multiple therapy is attributed to the
special meaning of the therapists' presence: clients experience
the two therapists as symbolic parents. In the beginning stages
of therapy conflicts which developed in a client's childhood and
adolescence and which pertained to the client's problems with
parents or other familial figures are brought into sharp focus by
the client's relationship to the therapy team and by the therapists'
relationship to each other. Once the client reduces his initial
resistance to change and begins to trust the therapists the
security of the multiple therapy situation helps him temporarily
regress to deep levels of feeling and experiencing that pre-
viously had been unexpressed or uncontrolled . Subsequently,
he begins to strengthen his ego functioning and personality inte-
gration. The client finds that the therapists' relationship to each
other and to him helps him facilitate his self-differentiation and
his acceptance of his sexuality. As concerns with family conflict
and self-esteem are resolved the client will be free to deepen his
relationships to his peers, using the therapists' relationship as a
model for healthy social interaction.

Multiple therapy in a group setting is a process which
facilitates personality change and development. Clients experience
being in a family,they resolve developmental conflicts, they

integrate their self-concepts, they develop a mature acceptance Of

18

themselves, and they establish healthy relationships with others.
In the remainder of the chapter these characteristics of multiple

therapy are considered in depth.

Impaired Relationships with Parents

One of the indications for multiple therapy is that a client
have a life history which is characterized by an impaired relation-
ship with one or both parents . According to Kell and Burow: "The
interest in these cases is to afford the client an opportunity to
interact with two parental surrogates who will recreate the earlier
conflict in such a way as to let the client experience the feelings
which characterized the earlier relationships. "1 The usefulness
of multiple therapy in correcting impaired parent-child relation-
ships is described by Mullan and Sangiuliano:

We hypothesized that one way to reverse the process of

the sick patient-child is through the therapeutic reorien-

tation of the key members (mother and father) of the family.

If the patient is no longer at home, having made some

attempt toward self—determination, or if the family cannot

or will not enter therapy, there is still the possibility for

a kind of reorientation of key family figures. This is

through the patient's selection and use of a symbolic

family, the multiple therapists.2

Correcting impaired relationships with parents is somewhat

dependent on a mature and spontaneous relationship between the

 

11bid., 377-378.

2Hugh Mullan and Iris Sangiuliano. Multiple Psychothera-
peutic Practice: Preliminary Report. American Journal of Psycho-
therapy, 1960, 1_4, 552.

19

two therapists:
The freer interactional state of multiple-therapy is assured
when the mutually concerned therapists become responsible
and express their feelings for one another. It can readily
be seen that this setting offers the patient the opportunity
not only to experience and respond to two different thera-
peutic agents but also as well, to observe and respond to the
dynamic evolving relationship between the two. In this
therapeutic triangle the patient realizes, as he struggles for
identification and belonging, that his therapists are present
not only for him but also for themselves as well. Questions
which come immediately into focus confront the patient with
his separateness, responsibility for self and his basic ego-
centricity .1
The critical difference between multiple therapy and other
approaches to therapy is that multiple therapy forces the client to
respond not only to two therapists but also to their relatedness and
their separateness. 2 At first the client reacts to the multiple
therapy configuration as if it were his family situation, attempting
to act out the same roles in the group that he learned in his home.
If he grew up with parents who were insecure in their relatedness
he may attempt to divide the therapists , to have other clients side
with him or against them, or to manipulate the therapeutic process.
If he was encapsulated in a family where separateness was
regarded with fear and anxiety, he may insist that therapists and

other group clients not disagree with each other, that they be in

complete harmony among themselves , that he not be forced to be

 

1Mullan and Sangiuliano, 1964, 166.

21bid., 186.

20

different or to take responsibility for determining his own behavior
apart from them. The multiple therapists do not respond to these
kinds of demands, and clients must reorient themselves to a new
kind of parental relationship that represents a healthy marriage.
The following are examples of situations where multiple therapy
would be appropriate for helping clients in their reorientation.

(l) A client from a family in which there was an inadequate
parent presents a problem for the therapists because the client may
attempt to divide the therapy team. For example, a male client
who rejected his father and formed a dependent attachment to his
mother may reject the male therapist by refusing to accept any help
from him, by not being receptive to a relationship with him. The
client is likely to want to be closer to the female therapist and to
direct his needs for help exclusively to her. It is possible he may
try to take the place of the male therapist by competing with him
in the group. In the process of therapy the client finds he will not
be allowed to displace the male therapist, that the female therapist
accepts and supports the male therapist's adequacy as a man. The
client is encouraged to break his tie with his mother and to go to a
man who is able to give him a meaningful relationship.

(2) Where there was deprivation with one or both parents
multiple therapy helps clients experience themselves as part of a
whole family. In this case a short-term intense relationship with

one therapist might be appropriate, as long as the other therapist

21

is not unwillingly excluded.

(3) If parents were not secure in their relationship it might
have been possible for the client to enlist one of the parents to
side with him against the other parent and siblings. A female client,
for example, may attempt to attract the male therapist into an
alliance with her against the female therapist and against other
group clients, which is a repetition of a family situation in which
she was father's choice of a companion over that of her mother and
her brothers and sisters . In this case the client experienced a
parental relationship into which she was able to intervene because
the parents were not close to each other. In multiple therapy she
finds she cannot get the male therapist to side with her, that he
maintains his intimacy with the female therapist, the result being
that she must give up her fantasied bond with her father. This
frees her to break away from him, to be the maturing young woman
that she is, and it encourages her to turn to her peers for compan-
ionship.

(4) In some families the tie between parents and between
parents and children was somewhat symbiotic, resembling such an
intertwining of personalities and interweaving of needs that chil-
dren were not able to free themselves without feeling excess guilt,
fears of punishment, or insecurity. The identity of the client was
not his own, nor were his behaviors. He was made to feel that in

order to keep his parents he had to meet their needs unquestioningly,

22

that he was somehow responsible for holding the family together.
Clients who experienced such situations find in multiple therapy
they are not responsible for the therapists maintaining their relation-
ship together. They also discover the therapists can be separate
from each other without there being subsequent deterioration in

their symbolic marriage. More significantly, however, clients
discover their therapists wish them to be free, and they are permitted
to put their lives in order without having to first meet the needs of
parental figures .

Once clients clarify their feelings about the nature of their
relationships to their parents, and they understand their parents'
strengths and weaknesses, they develop healthy acceptance of
their fathers and mothers as human beings. Idealized, distorted
perceptions become reality-based, and there is a settling down of
the agitation and impasse that characterized impaired relationships.
Because of their relationships to the multiple therapists clients
feel they are accepted and cared about in a new, symbolic family.
They feel free from involvement in the entanglements which inhibited

their growth out of childhood .

Regression and Ego Development
In the process of developing a trusting relationship with the
therapists clients loosen their defenses and begin to experience

their needs at deep feeling levels . They become aware of emotions

23

and fantasies that had been repressed, denied, confused or uncon-
trolled since childhood. This is the regression experience, which
Whitaker, Malone and Warkentin described as the "core phase" of
therapy:

This regression appears to be necessary for the development

of a healthy self-esteem and, subsequently, a healthy inte-

gration. The core experience is apparently an essential need

for the satisfaction of infantile deprivations, and is basic to

all therapeutic experiences, even though the illness which

the patient presents may arise out of later experiences. 1

The multiple therapy relationship provides the security
necessary for the client's regression to a child—like emotional state.
In the presence of the two therapists a client feels it is safe to
regress. One of the therapists may regress with him while the other
gives both of them support in working through the regression. 2 For
example, a male client may own his feelings of dependency on
women, and express them by asking the female therapist to comfort
him and perhaps even to hold him as would a mother. She responds
by relating to the client at deep feeling and fantasy levels. The
male therapist supports their being close in their mutual expressions
of feeling and needing. After the client clearly experiences him-
self as a dependent child regression gives way to mature feelings

and behaviors. If the client and the female therapist prolong the

regression, the male therapist intervenes in order that a regressive

 

1Whitaker, et al., 1956, 215.

ZKell and Burow, 1969, 448.

 

24

impasse might not develop . Symbolically it is like a father who
helps his son break away from a symbiotic tie with the mother and
begin coping with life outside of the family. At the same time the
two therapists resume their intimate contact with each other, which
signals to the client they are capable of meeting their needs without
being dependent on him. He will be encouraged to develop his
sense of self apart from them.

The healthy integration following regression is a matter of the
client's learning to understand and handle his feelings and of his
finding ways to cope with his environment which are reality-
oriented. This may be regarded as the strengthening of his ego,
his self-directedness. The stronger his ego, the stronger his sense
of being capable of assuming responsibility for handling his feelings
and behaviors . The development of personal adequacy and stability
indicates a client has made a break from childhood and has begun
to define for himself the direction his life will be taking. He is
capable of handling both his phenomenological and his physical

environments .

Self-Differentiation and Sexuality

A client's growth depends on how well he differentiates him-
self from his family and from other persons close to him. University
students express the need for individuation when they participate in

groups and activities regarded by society as non-conformist, by

25

their frequent insistence they be treated as adults rather than as
immature adolescents, and through their criticisms of established
values , traditions and organizations . Many of the students who
come to counseling centers feel they have no sense of individu-
ality. In multiple therapy the client's individuation occurs by
means of the discovery that his therapists and peers respond to him
and to each other in ways that are sometimes differing and some-
times similar. Kell and Burow write: "We think our different ways
of responding are not only appropriate in helping us, the therapists,
to be differentiated both individually and from each other, but also
that such different responses promote differentiation in a client. "1
The client experiences the two therapists as persons who are
not bound to being alike, who respect the differences they find in
each other, yet who are able to have a mutually fulfilling relation-
ship. The implication is that one can be an individual, but it does
not mean he will be isolated from others. When a client discovers
he is perceived in sometimes contrasting ways by the therapists and
by other group members he no longer can feel and behave as a stereo-
typed child nor can he look to others for a definition Of himself. He
finds he must develop his individuality apart from them. As persons
differentially respond to him, so can he differentially respond to

others. This helps him establish himself as separate from his family

and from other significant persons in his life. Male and female

 

11bid., 432-433.

26

clients understand themselves as men and women, rather than as
children who have little personal integrity Of their own.

A part of the individuation process is the client's acceptance
of his sexuality. The multiple therapy group facilitates acceptance
in two ways. The first is the client's experiencing of the same—
sexed therapist as an adequate and competent individual who is com-
fortable with his sexuality. The second is the development of close
relationships with male and female peers.

It is important that clients respond to their therapists as com-

petent, individualized men and women. Out of it will come their
own adult sex and role identifications. Elizabeth Mintz writes:
"In a group with male and female therapists, both of whom pre-
sumably are clear about their sexual identity and reasonably happy
with it, a patient of either sex has an especially good chance to
introject this sexual self—acceptance. "1 Kell and Burow write that
such identification takes place in the multiple therapy situation,
where a client will identify with the therapist Of the same sex and
should have the encouragement of the other therapist in being ade-
quate in the appropriate sex role. 2

It is possible that a male client, for example, may identify

with the masculine attributes and feelings of the male therapist.

 

1Elizabeth Mintz. Transference in Co-Therapy Groups.
Jpprnal of Consulting Psychology, 1963, a, 36.

2Ken and Burow, 1969, 379.

27

He may look to the therapist for help he did not get from his own
father in learning about being a man. At the same time he will be
encouraged by the therapist to maintain his individuality, his
separateness as a person. The female client may find that she can
learn something from the woman therapist about being feminine.
She may need permission to have sexual feelings, to accept her
needs to be independent and competent as well as dependent, and
to enjoy her relationships with men.

Not only can the same-sexed therapist be helpful to a client
but it is also important that the Opposite-sexed therapist be
supportive in the client's attempts to define and strengthen his
sexual identity. The problem experienced by the client may have
had its beginnings in punitive, confused or rejecting behaviors on
the part of an opposite-sexed parent who was anxious about the
client's developing sexuality. As a result the client may have
repressed or distorted his sexual feelings. For example, a male
client who has fears of becoming homosexual may indicate consid-
erable dissatisfaction with his father's inadequacy and punitive
competitiveness , and complain about his mother's dominance over
him. He is likely to develop fear of the female therapist's power
and he may attempt to frustrate the male therapist's Offers to be
helpful to him. He first needs the female's encouragement to trust
the male therapist, and assurances she cannot prevent him from

asserting his masculinity. The male therapist will encourage him

28

to own his adequacy and to pull out of his developmental impasse
with his mother and his father. He may demonstrate by his own
feelings and behavior with the female therapist that a man can have
relationships with women which are enhancing rather than regressive
and destructive.

The client's individuation leads to his acceptance of his
sexuality. His feelings of value, worth and adequacy become more
pronounced. He is able to perceive himself as a physical and emo-
tional entity apart from and in relationship to the persons around

him. He is comfortable with his humanness .

Interpersonal Relationships

When clients develop confidence in their identity and become
comfortable with their sexuality they are free to establish intimate
and fulfilling relationships with their peers. It is a difficult task
for some. Sullivan wrote that a person assumes certain risks when
he allows someone to become important to him. One's security and
satisfaction is often dependent on others and for these reasons,
according to Sullivan, people are susceptible to the circumstances
which destroy people close to them or which destroy the effective-
ness of their relationships.1 Clients who have begun to reach out

to others may experience the anxiety that risk-taking elicits . It is

 

lHarry Stack Sullivan. Clinical Studies in Psychiatry (New
York: W.W.Norton and CO. , 1956), 106.

29

a theme Often expressed in group therapy, one that seems to have
considerable personal meaning to students . Feelings of alienation
and isolation are expressed by persons who wish to be closer to
each other but who have not felt free to risk establishing intimate
relationships .

It will be important that clients learn from the therapists'
interaction how persons mutually enhance one another, how they
work through their conflicts, how they Openly express their feelings,
how they depend on one another, and how they are able to keep their
separate identities . Clients can learn from each other how to acquire
and maintain meaningful friendships, how to deal with each other in
heterosexual relationships, and how to handle competition in their
educational and occupational pursuits . By means of feedback from
other group members clients discover how others feel about them,
what kinds of impressions they make, whether or not they can be
comfortable being open with their feelings , how they handle feelings
of anger and confusion elicited by experiencing rejection from
others, and what it is like to be accepted and cared for on the
basis of intrinsic worth rather than extrinsic performance.

The outcome of increased adequacy in handling relationships
in the multiple therapy group is a healthy involvement in social life
outside of the group. Clients initiate companionships when they are
lonely, they no longer fear dating, they are capable of being

intimate with others without inappropriate fear of loss and rejection.

3O

Termination

Once clients develop means of satisfying their needs outside
of the therapy group they will have less reason to remain in treat-
ment. They feel they no longer are dependent children, but are
adults who are capable of assuming responsibility for themselves
and who can ask for help when they need it. As termination nears
they may experience some ambivalence about leaving, and some may
even think of new problems for the group to consider, but the thera-
pists are ready to see them go and they do not enter into a new
therapeutic contract. The termination of therapy becomes an act of
self-affirmation in which vacillation between remaining and leaving
gives way to a definitive separation from the symbolic family of the
past and from those in the group who became partners, friends, and
confidants in the struggle that led to their growth and maturation.

Clients then enter into their environment with an increased
clarity about themselves, with a sensitivity to the feelings and needs
of others, and with confidence in their capability of handling the
problems with which they are confronted. Their experience of life
becomes similar to their experience of therapy: multi-dimensional,

changing, challenging, self-fulfilling.

31

Summary

The client's experience in the multiple therapy group is
essentially that of a process of maturation which is facilitated by
the symbolic meaning of the therapists' relationship. It begins with
working through problems that developed from impaired relationships
with one or both parents . The experiences of regression and self-
differentiation help the client own and understand his feelings. He
develops his individuality and makes appropriate sex and role
identifications . The final stage in the process of therapy is the
establishment of mature interpersonal relationships.

In Chapter III, consideration will be given to research
investigation and descriptive reports pertaining to the use of multiple
therapy in groups and to the variables discussed in the preceeding

paragraphs .

CHAPTER III: REVIEW OF RESEARCH

AND DESCRIPTIVE LITERATURE

In a review of research literature concerning the use of
multiple therapists in group counseling and psychotherapy only
two completed experimental studies were found. Private communi-
cations indicated that other experimental studies were underway
but no data had been published. Most of the literature on multiple
therapy was descriptive and theoretical and for the most part
concerned mental patient populations , but there were two reports
which described the use of multiple therapy in groups of college
students . Studies in which theoretical assumptions received
support on the basis of other therapists' experience with multiple

therapy were also considered.

Experimental Research
The two studies in which experimental designs were employed
were doctoral dissertations written by two therapists who used male

and female eighth grade students (from the same school

32

33

population. 1 '2 Daniels investigated the influence of the sex of the
therapist and the multiple therapy technique in group psychotherapy
with boys . In Staples' project groups of girls were used. Since
design, procedures and outcomes were similar only the thesis by
Daniels was considered.

Daniels used four groups of eighth grade boys who had
exhibited problem behavior in school. Subjects were randomly
assigned to a no-treatment control group, a group with a male
therapist, a group with a female therapist, and a group with male
and female cotherapists . His purpose was to demonstrate that
remedial methods would cause positive changes in attitude toward
school, that the two therapist group would lead to more improve-
ment than single therapist groups, and that the female therapist
alone would have less success with behavior problem boys than
would the male therapist alone.

Both therapists were school psychologists . Neither were
specialists in group psychotherapy. The female therapist was 43

years of age, the male therapist was 28. The female therapist had

 

1Marvin Daniels. The Influence of the Sex of the Therapist
and of the Co-therapist Technique in Group Psychotherapy with
Boys. (Doctoral Dissertation, New York University) Ann Arbor,
Michigan: University Microfilms, 1958. No. 58-660.

2Ethel Janes Staples. The Influence of the Sex of the
Therapist and of the Cotherapist Technique in Group Psychotherapy
With Girls. Dissertation Abstracts, 1959, a, 2154.

34
worked in the school for four years; the male therapist had been
there for four months. The theoretical orientation of the two
therapists was primarily Freud and Sullivan.

Subjects were rated on behavior by teachers before and after
therapy. They were pretested and posttested on measures of intel-
lectual functioning, achievement levels, conscious attitudes toward
school, and on ten personality dimensions . Intragroup comparisons
were made by using t-tests on pretest-posttest differences in
scores. Between group comparisons were made by using two-tailed
median tests, since pretest scores were found to have skewed dis-
tributions. Tape recordings were analyzed for qualitative variables.

Regarding the effectiveness of the multiple therapy group, the
results were not significant. The multiple therapy group improved
in discipline and in overall behavior, but it deteriorated in attitudes
toward school, become more anxious, showed a drop in self-
confidence, and tended to be more emotionally disturbed. Neither
the male therapist group nor the female therapist group showed deteri-
oration. An analysis of tape recordings revealed that the multiple
therapy group was tense and non-verbal.

Daniels wrote the following in interpreting his findings:

These boys were drastically affected merely because they

were confronted with a male and female adult in a repli-

cation of the family setting. The situation itself. . .was

too threatening for them to tolerate with equanimity.

Perhaps oedipal overtones in that situation stimulated
and augmented the unconscious castration anxiety which

35

is present, according to Freudian theories, in all boys
at or near puberty.

Daniels' thesis was comprehensive. His theoretical consid-
erations were thorough and he used a number of measuring devices
(behavior ratings , objective tests , projective tests, process
variables). He used an adequate experimental design that controlled
well for internal validity.

There were some problems which might have contributed to
negative findings, however. The first was the relative difference in '
ages of the therapists. If the family constellation was symbolized
in the multiple therapy group, then the "mother" was much older
than the "father" , by fifteen years. A second difficulty was related
to the population used. Eighth grade problem boys were not likely
to be stable behaviorally or emotionally, and they might not have
been appropriate subjects for group therapy.

Daniels was aware of the problems in his study. He suggested
that the investigation be replicated with adult groups rather than

with groups of eighth grade students .

Descriptive Studies
Rabin prefaced his study with the observation that recent
interest in the uses of multiple therapy in group therapy warranted

investigation, and he asked the question: "How does co-therapy

 

1Daniels, 1958, 154.

36

compare to regular, one therapist, group psychotherapy along
dimensions crucial to theory and practice? "1 He designed a study
in which he assessed the attitudes of group therapists about the
differences between two forms of group therapy. A SO-item Co-
Therapy Rating Scale was given to 38 experienced group therapists
who had worked with both types of groups. Descriptive statistics
were used. Rabin found that the therapists preferred multiple therapy
groups for a variety of reasons: there was moderate positive thera-
peutic movement, transference patterns were complete and were
worked through effectively, the self-understanding of the therapist
was enhanced and, multiple therapy offered special advantages in
dealing with oedipal problems by, "providing the reality stimulus for
the transference to paternal and maternal objects. "2 Multiple
therapy also facilitated identification with a healthy person of the
same sex, it provided clients with an opportunity to work through
problems of masculinity, femininity, and heterosexual fears, and

it furnished a context for the understanding of patient resistances . 3
Rabin found that a good relationship between the two therapists was
regarded as the most important criterion in developing a multiple

therapy group, and he concluded:

 

1Herbert M. Rabin. How Does Co-Therapy Compare with
Regular Group Therapy? American Journal of Psychotherapy. 1967 ,
_2_1_ , 244 .

21bid., 252.

31bid., 252-253.

37

It is this investigator's hunch that the relationship has some

basic parallels with a good working partnership or marriage;

it deepens with the successful mastery of personal conflicts

and with the sharing of achievements and pleasures. 1

The study was exploratory, and based on a small sample, but
it indicated there was favorable response to the use of multiple
therapists in groups .

Corrigan published a report of her study of coeducational,
group therapy with college students who were clients at the Univer-
sity of Minnesota Mental Hygiene Clinic. 2 The clinic staff
counseled about one-hundred students in groups over a three-year
period of time, using multiple therapists. She reported that experi-
ence in multiple therapy with groups of college students had been
valuable, that a family- surrogate situation had been created where
problems with parents , siblings and heterosexual inhibitions could
be resolved.

Corrigan mentioned that many students had an aversion to
group therapy, which was attributed to problems in relating to
others, inordinate dependency, embarrassing sexual problems, and
3

a perception of group therapy as not being "real" therapy.

Corrigan felt, however, that this technique of group therapy

 

llbid., 253.

2Shirley M. Corrigan. Coeducational, Cotherapist Group
Therapy. Ernal of the Americgp College Healplp Association, 1967 ,
_1_§, 249.

31bid., 249.

38

was successful:

It is our belief that if the patient stays with the group and
becomes involved, he will, in fact, gain from the process.
There are many aspects which transcend the individual
therapeutic relationship: support in identification, under-
standing from real empathy, warmth without threat (demands),
criticalness without rejection, friendliness without the
necessity of friendship, heterosexual intimacy without
commitment, confessionwwithout group sanctions, community
of problems with heterogeneity of symptoms, concerns with
the resolution of problems in terms of reality, and, finally,
diffuse reinforcement. For some students, a diminution in
the feelings of isolation and a reduction in the feeling of
being different have, in themselves, contributed to initial
improvement. 1

Slipp reported his experiences with an Open, multiple therapy
group of college students which had been meeting for two years .
He found that students used the group therapy experience to achieve
individuation they had not achieved in their families . From obs er—
vations of the group he outlined five types of family situations
which perpetuated symbiotic attachments to children: (1) the child
was a narcissistic extension of the family identity; (2) parents were
dependent on the child to be a companion; (3) parents were inconsis-
tant with permissiveness and with controls; (4) parents were
alienated from one another and tried to force the child into taking

sides; and (5) parents were emotionally withholding.2

 

11bid., 249-250.

2Samuel Slipp and Madge K. Lewis. Separation Problems in
College Students. In J. L. Moreno (Ed.) , International Handbook
of Group Psychotherapy (New York: Philosophical Library, 1966) ,

39

According to Slipp, students attempted to cope with their
problems by placing some sort of distance between themselves and
their parents. It was done by physical separation, isolation and
withdrawal, identifying with the role of helper in the family and
acting out against parental expectations and values . Slipp felt that
group therapy helped students with problems by permitting them to

assert their sexual identity. 1

Related Descriptive Reports

Clients became less defensive when in a multiple therapy
group, according to Grunwald and Casella, because their needs for
accepting parental figures were satisfied. It had the two-fold result
of freeing clients to use their energies to work on constructive per-
sonality change rather than having to look for a set of adequate
parents, and it permitted therapists to be helpful to them. 2

Mintz found the use of male and female multiple therapists
was of special value since it enabled clients to simultaneously
relate to two parental figures where it may have been lacking in

real life. 3 It was also necessary for a client to confront the

therapist of the sex which most threatened him. In addition to the

 

lIbid., 624-625.

2Hanna Grunwald and Bernard Casella. Group Counseling with
Parents. Child Welfare, 1958, Q, 15.

3Elizabeth Mintz. Transference in Co-Therapy Groups. journal
of Consglting Psychology, 1963, AZ, 37 .

4O

transference phenomena, according to Mintz, there was the matter

of a client's sex and role identification being facilitated by multiple
therapy in the group, which was helped by the therapists' acceptance
of their own masculine and feminine roles .1

Demarest and ‘I‘eicher studied transference feelings which
developed in therapy groups with multiple therapists present:

The presence of male and female therapists made it possible

for the patient to structure a family group, which allowed

the acting out of family conflicts and the setting up of
familial constellations in which problems of sibling rivalry,
mother-son, and father- son struggles could be perceived
and worked through.

The authors found that using therapists of different sexes
committed the client to relating to a figure of one sex alone, to a
figure of one sex in the presence of the other, and to both figures
3
together.

In their approach to multiple therapy Mullan and Sangiuliano
indicated that transference reactions could be used in group therapy

to begin a positive reorientation of the key family figures, which

reversed nontherapeutic processes of living experienced by the

 

1Elizabeth Mintz. Male-Female Co-Therapists: Some Values
and Some Problems. American Journal of Psychotherapy, 1965, l_9,
294.

2Elinor Demarest and Arthur Teicher. Transference in Group
Therapy: Its Use by Co-Therapists of Opposite Sexes. Psychiatry,
1954, l_7_, 195.

3Ide., 201.

41

client in his family. 1 The client was not allowed to repeat his life
theme of dividing and conquering his parents. 2 In the multiple
therapy group relationships between group members and the therapists
were sometimes strikingly similar to those that clients experienced
in their families:

Some members are more attached to one therapist than the

other. . . . some respond to one and not to the other: . . . some

wish to defeat the one and not the other; and. . . some are

hateful or fearful to one therapist and not the other. 3

The symbolization of the multiple therapy relationship as a
healthy marriage was considered by Sonne and Lincoln, whose
experiences in family therapy indicated that a multiple therapy team
must maintain a good relationship in order that clients who experi-
enced a " family image deficit" might benefit from therapy.4 A
strong multiple therapy relationship was necessary to prevent

therapists from being incorporated into the pathological processes

of the sick family:

 

1Hugh Mullan and Iris Sangiuliano. Multiple Psychothera-
peutic Practice: Preliminary Report. American Journal of Psycho-
therapy, 1960, $4, 552.

2Hugh Mullan and Iris Sangiuliano. The Therapists' Contri-
bution to the Treatment Process (Springfield, 111.: Charles C.
Thomas, 1964), 174.

31bid., 214.

4John C. Sonne and Geraldine Lincoln. The Importance of a
Heterosexual Co-therapy Relationship in the Construction of a
Family Image. Psychiatric Research Reports, No. 20, 1966, 197.

42

They can accomplish this, in part, by virtue of their mutual
validation and appreciation of the essential value present in
each one of them in his role as a helping human being, with
his own unique point of view. In addition to this, they are
able to give clear recognition and re- enforcement to each
other of their gender identification, and in so doing can
enjoy the male and female points of view.1

Summary

A review of descriptive literature indicated that multiple
therapy was a widely-us ed and well-liked approach to group
therapy. Therapists who participated in multiple therapy groups
reported it was effective, it facilitated the expression of feelings
regarding conflict with parents, it was helpful in resolving problems
in sex and role identification, clients were helped to form healthy
heterosexual relationships, and therapists benefited from the
experience of working together. Research data, however, was
lacking. In two studies with eighth grade boys and girls results
favoring the use of multiple therapists were not evident. Other
investigations were not completed. It was believed that the wide-
spread use of: multiple therapy groups merited experimental investi-
gation which would make available definitive information concerning
the nature of the multiple therapy experience.

In Chapter IV an experimental design to investigate the use of

multiple therapists in group therapy is presented.

 

116161., 199.

CHAPTER IV: DESIGN OF THE STUDY

The research hypotheses developed in the study were tested
by means of an experimental design in which outcomes of multiple
therapy in group therapy were compared with outcomes of single-
therapist group therapy. Three therapy groups were used, one with
a male therapist, one with a female therapist and one with the two
therapists working together as a multiple therapy team. It was
hypothesized that the work of the two therapists in combination
would account for differences in the therapeutic effectiveness of

the multiple therapy group over that of single-therapist groups.

Selection and Description of the Sample

Clients selected for the study were single, male and female
undergraduate students who visited the main Office of the Michigan
State University Counseling Center for the purpose of receiving help
for their personal and social problems. They were typical of students
who dropped in at the Counseling Center Office and did not require
referral, long-term depth psychotherapy or short-term educational
and vocational counseling. They were selected in accordance with
the following criteria: they had problems pertaining to relationships

with one or both parents; they experienced feelings of lowered
43

44

self-esteem or confused self-perceptions; they were distressed about
their handling of interpersonal relationships; and, they were willing
to be in a therapy group.

Clients were interviewed by intake counselors as a part of the
regular screening procedure established by the Counseling Center.
During the initial interview, a counselor made an evaluation of the
client's needs, then recommended an appropriate therapy procedure
in which he indicated the urgency of the need, the level of therapist
experience required (practicum student, counseling intern, or senior
staff) , the preferred sex of the counselor, and the desired form of
therapy (individual, multiple, or group). The recommendation was
reviewed by the Counseling Center Screening Committee, which was
composed of staff psychologists, a staff social worker, a counseling
intern and a consulting psychiatrist. The committee then made the
specific counselor assignment. Clients who met the previously stated
criteria were assigned to group therapy by this procedure.

As soon as the names of clients were acquired the two
therapists participating in the study jointly interviewed each client
and talked with him about the process for entering a therapy group.
Clients were told they would be expected to take some personality
tests before and after therapy, that the tests would be used in a
Counseling Center research program. The nature of the research was
notdiscussed with clients until the conclusion of their participation

in the study. Twenty-one clients were selected but three subsequently

45

declined participation in the study.

Clients' and therapists' schedules were collected and examined
to determine possible meeting times. Three different times were
chosen, and clients were assigned as they became available for
group therapy. Therapists were assigned to groups without regard
to group composition. Data describing clients by group, sex, age,
class, and number of sessions attended is presented in Appendix A.
A descriptive report of the activities that took place in the groups

may be found in Appendix B.

Setting and Procedures for Group Therapy

Each of the three groups began meeting for two-hour sessions
the first week in February, 1968, and continued through the third
week in May, 1968, for a total of thirteen meetings before the post-
tests were given. The time period spanned Winter and Spring Terms
at Michigan State University. Each group met at a designated time
of the week in the same Counseling Center office. The multiple
therapists' group met on Thursday afternoons , the male therapist's
group met on Monday evenings, and the female therapist's group
met on Wednesday afternoons .

The nature of the therapy was phenomenologically and inter-
personally-oriented, with attention being given to historical factors
when it was appropriate for working out conflicts being expressed in

the present moment. Clients were expected to talk about matters

46

important to them. The therapists were actively engaged in relation-
ships to individual clients and extended therapist-client interactions
often occurred. Socialization among clients took place in the

Counseling Center waiting area and sometimes after group meetings.

There was no interaction between clients of different groups .

Therapist Training and Experience

The study required the participation of two therapists who had
previous experience as multiple therapists and who had worked
together as a therapy team in a group . Of the available therapists
in the Counseling Center only the writer and another Counseling
Intern met these criteria. Having had previous experience and
having worked through their mutual needs and conflicts, the therapists
were able to concentrate primarily on facilitating client change and
growth.

The female therapist received her Ph.D. in March, 1968, and
was a clinical psychologist and senior staff member at the Michigan
State University Counseling Center. She was 27 years of age and
married. Prior to the study she had four and one—half years supervised
experience in group and individual psychotherapy. Work settings
included a Veterans Administration Hospital, a psychological clinic,

a University Counseling Center, and counseling practicum courses.
She had participated in group therapy as a member, had accrued two

years experience as a therapist in group counseling, and had three

47

years experience as a multiple therapist in treatment of both
individuals and groups.

The male therapist was a Counseling Intern at the Michigan
State University Counseling Center. He was 33 years of age,
married, and was completing the requirements for a Ph.D. degree
in Counseling Psychology. Preceding his enrollment in the doctoral
program he had been a counselor in a Veterans Administration
Hospital and in church-related programs for young people, for a
total of three years experience. He received his Master of Arts
degree in Guidance and Counseling from Michigan State University.
At the time of the study he had been supervised for one year as a
practicum student and for a year and a half as a counseling intern.
His work with university students included short-term and long-
term psychotherapy and educational and vocational counseling.
He had participated as a member in group therapy, and had two years
practice as a group counselor and therapist. He had one year of
experience as a multiple therapist with individual clients and with

groups .

The Instruments Used in the Study

There were three instruments used in the study: the Family
Relations Inventory, the Tennessee Self- Concept Scale, and the
Minnesota Multiphasic Personality Inventory. Each of the instruments

was administered to clients before and after their therapy.

48

Consistent with the theoretical position taken prior to the beginning
of the study only selected scales from the instruments were used in

the statistical analysis .

The Family Relations Inventory (FRI)

The FRI was originally developed by Brunkan and Crites for
the purpose of measuring the perceived parental attitudes defined by
Roe in her theory of vocational choice. The attitudes were: parental
acceptance, parental concentration, and parental avoidance. 1 The
authors decided to measure the perceived attitudes of each parent
separately, and to keep item content general enough so the FRI
would be applicable for both male and female subjects.2 They con—
structed a 202-item instrument that was scored on six scales: Father
Acceptance, Father Concentration, Father Avoidance, Mother Accep-
tance, Mother Concentration and Mother Avoidance. The purpose of
the instrument was: " . . .tO measure the individual's perceptions of
his parents' attitudes toward him in childhood and adolescence. "3
It was suggested that although the FRI was developed to assess

attitudes related to vocational choice

. .it would be interesting to determine whether a client's
perception of his parents change as a result of counseling

 

1Richard Brunkan and John O. Crites. An Inventory to Measure
the Parental Attitude Variables in Roe's Theory of Vocational Choice.
hurnal of Counseliansychology, 1964, Q, 2.

49

or psychotherapy and what the direction of the change is if
one occurs .

It was hypothesized in Chapter II that a client's healthy rela-
tionship to the multiple therapists would lead to feelings of being
more accepted by his parents. Two scales of the FRI were used to
assess this outcome: the Father Acceptance (FA) scale and the
Mother Acceptance (MA) scale. According to Brunkan and Crites:

Acceptance means that the parents regard the child as a

full-fledged member of the family, who needs a certain

degree of independence and who has the capacity to

assume responsibility. 2
Reliability Brunkan and Crites determined the test-retest
reliability on a sample of 72 male and female college students who
took the inventory twice with an intervening period of one month. 3
For the FA scale the reliability coefficient was . 93 . For the MA
scale it was .90.

A KR 20 internal consistency reliability on the FA and MA

scales was estimated from the pretest responses of students used

in the study. The results are listed in Table 4. l.

 

11bid., 11.
21bid., 3.

31bid. , 7.

50

Table 4.1 KR 20 Internal Consistency Reliability Estimate for
Students Participating in The Study: N = 20.

 

 

 

 

Scale Mean Standard Standard KR 20
Deviation Error of Reliability
Mea sure-
ment
FA 20.75 7.14 2.47 .880
MA 23.60 5.47 2.35 .815
Validity Brunkan and Crites selected items for the FRI scales on

the basis of content validity judgments of three psychologists. Of
the 202 items finally used, the judges reached unanimous agreement
on the content validity of 187 items. On the remaining 15 items,
which were added to the Father Concentration scale, two judges
reached agreement.1

On the basis of an analysis of intercorrelations of the FRI
scales, Brunkan and Crites concluded that acceptance and avoidance
scales were measures of different constructs. They also reported
that for two different samples of college students intercorrelations
for PTA and MA scales were .55 (N = 100) and .32 (N =142).2

The intercorrelation between the FA and MA scales on the pretests

used with clients in the study was .30 (N = 20).

 

1Brunkan and Crites, 1964, 5-6.

21bid., 8.

51

The data presented above indicated that the FA and MA scales
had high test-retest reliability (PA =. .93, MA = .90) , and good
internal consistency reliability (FA = .88, MA = .82) . Parental
acceptance was a construct defined by items in the FRI. The FA
and MA scales measured respectively separate characteristics of

parental acceptance.

The Ego Strength Scale of the MMPI (Es)

The Es scale was developed by F. Barron originally for the
purpose of predicting the response of psychoneurotic patients to
psychotherapy. The Es scale was not limited to this one usage,
however. Barron indicated that a broader psychological interpre-
tation could be made of the scale, that it would be useful for
assessment, "in any situation where some estimate of adaptability
and personal resourcefulness is wanted. "1

Variables which were measured by the scale were somewhat
global in nature. Dahlstrom and Welsh interpreted the ego strength
construct in the following manner:

Ego strength when high implies ability to deal with the

environmental pressures facing one, the motivational

pressures prompting one to various conflicting actions,

and the emotional pressures acting to disorganize and

disrupt usual patterns of behavior. It means sufficient

control to deal with others , to gain their acceptance and
create favorable impressions upon them. It means using

 

1F. Barron. An Ego-Strength Scale Which Predicts Response
to Psychotherapy. In G. S. Welsh and W. G. Dahlstrom (ed) Basic
Readipgs on the MMPI in Psychology and Medicine. (Minneapolis:
Univ. of Minnesota Press, 1956), 226.

52

available skills and abilities to full advantage. It means the

person can work within the cultural, social, and personal

limits of ethics and self-respect.

Dahlstrom and Welsh indicated, as did Barron, that the Es
scale could be used as a measure of improvement following psycho-
therapy. It was used in the study to assess outcomes in therapy
which pertained to the client's ego-integration, to his acceptance

of personal adequacy and responsibility after having placed his

childhood conflicts behind him.

Reliability The test-retest reliability of the Es scale, as reported

 

by Barron, was .72. The estimate was based on a sample of 30
cases, with a period of three months between tests .2
A Kuder-Richardson 20 internal-consistency reliability estimate
was obtained on a sample of 20, for the MMPI pretests used in the
study. The KR 20 reliability for the Es scale was .685, with a mean

of 43.15, a standard deviation of 6.07, and a standard error of

measurement of 3 . 41.

Validity Items for the scale were selected from the MMPI on the
basis of identification of pre-therapy attributes which correlated with
improvement in psychoneurotic patients who had undergone six

months of treatment. A group of 17 improved patients was compared

 

1W. Grant Dahlstrom and George S. Welsh. An MMPI Hand-
book. (Minneapolis: Univ. of Minnesota Press, 1960), 356.

zBarron, 1956, 226.

53

to a group of 16 unimproved patients on Es scale scores. The mean
score of the improved group was higher than that of the unimproved
group. Even though the sample was small, Barron concluded it was
well—enough studied it would be possible to base a new scale on
the data.1

In a study of the construct validity of the Es scale Kleinmuntz
obtained scores for a random sample of 50 adjusted male and female
college students and compared them with scores for a sample Of 33
maladjusted students. He found the mean Es scale score for
adjusted students was higher than the mean score for maladjusted
students.2

In a later study Stein and Chu used a cluster analysis of Es
scores obtained from a sample of 310 subjects classified as normals,
anxiety reactions, or schizophrenics. 3 Five oblique clusters were
isolated: emotional well-being or freedom from disabling anxiety and
depression, cognitive well-being or freedom from disabling primary
process thinking, physical well-being, religious attitude of non-

belief or non-participation, and, seeking heterosexual stimulation

and escape from boredom. In a discussion the authors stated:

 

1Barron, 1956, 226.

2Benjamin Kleinmuntz. An Extension of the Construct Validity
of the Ego Strength Scale. Journal of Consultipg Psychology, 1960,
_2_4, 463-464.

3Kenneth B. Stein and Chen-Lin Chu. Dimensionality of
Barron's Ego-Strength Scale. burnal of Consulting Psychology,
1967, _3_1_, 155.

54

Not all of the clusters in the present study could be related

empirically to the concept of ego strength. The first three

clusters, those pertaining to different facets of well-

being, showed consistent differences between the normal

and psychiatric groups across the initial and replicated

samples.

Comparisons among psychiatric subgroups did not fare as well.
The conclusion was that Barron's Es scale was related to the construct
ego strength "conceptually and empirically only in part. "2

The test-retest reliability ( r = . 72) and internal consistency
reliability '( r = . 69) scores for the Es scale indicated that some
caution needed to be exercised about the accuracy of measurement
of pretest-posttest changes in therapy. The reliability coefficients
were lower than the desired . 80. Data pertaining to the validity of
the Es scale indicated that it measured constructs representing a
sense of personal adequacy, emotional freedom and control, healthy
cognitive functioning, and physical well-being. The Es scale

differentiated normal college students from maladjusted students on

dimensions similar to the ones discussed in Chapter II of the study.

The Tennessee Self Concept Scale
The Tennessee Self Concept Scale was developed for the
purpose of providing a well-standardized measure of self-concept

that could easily be administered, was widely applicable, was

 

111618., 156.

21bid., 160.

55
multi-dimensional, and could be used for counseling and research
purposes .1 The author developed scores for twenty-nine scales,
some of which were summation, distribution and variability scores
for other scales, and some of which were scales pertaining primarily
to clinical variables not relevant for the study. According to the
manual, one of the most important scores was the "Total P Score, "
which reflected the overall level of self-esteem:

Persons with high scores tend to like themselves, feel that

they are persons of value and worth, have confidence in

themselves, and act accordingly. People with low scores

are doubtful about their own worth; see themselves as

undesirable; often feel anxious, depressed, and unhappy,

and have little faith or confidence in themselves.

The Total P Score was divided into eight subscaies ‘ which
reflected an individual's satisfaction with himself from both internal
and external frames of reference. Subscales pertaining to the
internal frame of reference were labeled as: Identity, how one per-
ceived himself; Self-Satisfaction, which reflected self-acceptance;
and, Behavior, how one viewed his functioning. Subscales which
reflected an external frame of reference were: Physical Self, one's
perception of his body, state of health, skills, and sexuality;

Moral-Ethical Self, feelings of being good or bad; Personal Self,

adequacy as a person of individual worth; Family Self, feelings of

 

1William H. Fitts. Tennessee Self Concept Scale, Manual.
(Nashville: Counselor Recordings and Tests, 1965) , 1 .

21bid., 2.

56
adequacy and worth as a family member and as a close friend to
others; and, Social Self, one's adequacy in relationships to people
. 1
1n general.
To measure the client's evaluation of himself as a person who

had achieved some degree of differentiation and self-acceptance the

Total P scale was used.

Reliability As reported in the manual reliability for the Total P
Score, based on test—retest data for 60 college students over a
two week period, was .92.2

A Kuder Richardson 20 internal consistency reliability estimate
was obtained on a sample of 20 clients on pretest scores from the
Total P scale. The reliability was .91, the mean 71.45, the

standard deviation 11 .15 , and the standard error of measurement

3.30.

Validity Items on the Tennessee Self Concept Scale were selected
from a pool of self-descriptive items from other self-concept
measures and from written descriptions by patients and nonpatients.
A two-dimensional 3x5 scheme was used by the author to classify
the items. The items utilized in the Total P part of the scale were

those upon which seven clinical psychologist judges had reached

 

57

perfect agreement regarding classification and scoring.1

In a study testing the effectiveness of the Tennessee Self
Concept Scale in discriminating between outpatients who had
received six to eight months of therapy ( N = 30 ) from outpatients
who served as a wait-control group ( N = 24 ), Ashcraft and Fitts
found that on a test-retest basis the experimental group changed
on the Total P score in a positive direction at the .005 level of
significance. The direction of change for the control group was
negative, and was not significant. Similar results, at signifi-
cance levels of .05 or better, were obtained for all the subscales
of the Total P scale.2

The Total P scale was found to have high test-retest reliability
( r = .92) and high internal consistency reliability ( r = .91 ). The
scale also appeared valid for assessing changes in therapy along
several dimensions of self-acceptance, when a non-therapy control

group was compared with a group receiving therapy.

The Social Introversion Scale of the MMPI (Si)
The Si scale, which was coded as Scale O, was developed by
Drake for the purpose of obtaining a measure of social introversion

and extroversion from the MMPI that would be useful in counseling

 

lFitts, 1965, 1.

2Carolyn Ashcraft and William H. Fitts. Self-Concept Change
in Psychotherapy. Ppychotherapy: Theory, Research and Practice,
1964, _1_, 115-118.

58

with students.1 Drake and Oetting wrote: "Since Scale 0 was
derived and cross validated on a college group, it is not surprising
to find that patterns including this scale are related to various
aspects of social adjustment in college. "2
For men, patterns with a high coding of Scale O were found
among persons showing introvertive characteristics, "especially

shyness, social insecurity, and social withdrawal. . . . Low
coding of the Si scale indicated adequate social adjustment. For
women the same general interpretations were applicable. High
coding indicated "social shyness, insecurity, shyness in the inter-
view, and lack of skills with the opposite sex. . . . "3 Low coding
indicated good general adjustment, especially socially.

In Chapter II it was hypothesized that an indication of the
client's therapeutic progress would be his increased openness to
establishing and maintaining close relationships with others . It

was believed that the Si scale would be appropriate for assessing

socialization .

Reliability Hathaway and McKinley reported: ” For the Si scale. . .

 

a test-retest reliability coefficient of +.93 has been found using 100

 

1L. E. Drake. Scale O (Social Introversion) . In George 8.
Welsh and W. Grant Dahlstrom. Basic Readirgp on the MMPI in
Psychology and Medicine (Minnesota: Univ. of Minnesota Press,
1956), 181-183.

2L. E. Drake and E. R. Oetting. An MMPI Codebook for
Counselors (Minneapolis: Univ. of Minnesota Press, 1959), 15.

31bid., 16.

59

normals with intervals of one day to four months between testings. "1
An internal consistency reliability was obtained on the Si scale

of the MMPI pretests used in the study ( N = 20 ). The KR 20 relia-

bility estimate was .85, with a mean of 34.2, a standard deviation

of 9.52, and a standard error of measurement of 3.675 .

Validity There were seventy items on the Si scale. They described
a person's uneasiness in social situations, they covered a variety

of special sensitivities, insecurities, and worries, and a high

scorer would be found to deny many impulses and mental aberrations.2

Items were chosen in the following manner:

An item analysis of the MMPI was made by contrasting the
percentage responses of two groups of students to the items.
One group consisted of 50 students who obtained centile
ranks of 65 and above on the T-S-E Inventory when scored
for social introversion- extroversion. The second group
consisted of 50 students who obtained centile ranks below
35 on the T-S-E Inventory. 3

Drake found that for females the correlation between the social
introversion- extroversion scores on the T-S—E and the Si scale was

- . 72, and for males it was — . 71.4 The negative correlation was

 

1S. R. Hathaway and J. C. McKinley. Minnesota Multiphasic
Personality Inventory Manual. (New York: The Psychological Corp. ,
1951), 6.

 

2Dahlstrom and Welsh, 1960, 77.
3L. E. Drake, 1956, 181.

41bid., 183.

60

attributed the Si scale being an inverted scale.

Drake and Thiede further validated the scale. They tested
594 female students then compared their scores to the number of
reported high school social activities. The Si scale significantly
discriminated between low-active and high-active groups. Similar
results were obtained on 283 cases where Si scores were compared
with participation in college social activities .1

The Si scale had an internal consistency reliability of .85 ,
and a test-retest reliability of .93. Validity data indicated it

differentiated socially active college students from students who

were not as active.
Statistical Hypotheses

There were five characteristics of client experiences in
multiple therapy groups which were tested: perceptions of father
acceptance, perceptions of mother acceptance, increase in ego-
strength, acceptance of self, and social introversion. Five
hypotheses pertaining to these outcomes were formulated for
investigation.

The following symbols were used in the hypotheses: HO =

= mean of the

null hypothesis; Ha = alternate hypothesis; Mmf

multiple therapy group; Mm = mean of the male therapist's group;

 

1L. E. Drake and w. B. Thiede. Further Validation of Scale 0
(Si). In Welsh and Dahlstrom, 1960, 184—186.

61

and, Mf = mean of the female therapist's group.

I. Perceptions of Father Acceptance
Null hypothesis: No difference will be found in adjusted mean
scores on a measure of father acceptance
between the multiple therapy group, and each
of the one therapist groups .

Symbolically: Ho : Mmf =

Mm = Mf

Alternate hypothesis: The adjusted mean score for the multiple
therapy group on a measure of father
acceptance will exceed that of each of the

one therapist groups .

Symbolically: H1a : Mmf > Mm = Mf

II. Perceptions of Mother Acceptance
Null hypothesis: No difference will be found in adjusted mean
scores on a measure of mother acceptance
between the multiple therapy group and each
of the one therapist groups .

Symbolically: H : M = Mm = M

o mf f

Alternate hypothesis: The adjusted mean score for the multiple
therapy group on a measure of mother
acceptance will exceed that of each of the
one therapist groups .

Symbolically: H2a : Mmf > Mm = Mf

62

111. Development of Ego Strength
Null hypothesis: No difference will be found in adjusted
mean scores on a measure of ego strength
between the multiple therapy group and
each of the one therapist groups.

Symbolically: Ho : Mmf

: Mm : Mf

Alternate hypothesis: The adjusted mean score for the
multiple therapy group on a measure of ego
strength will exceed that of each of the one

therapist groups .

Symbolically: H3a : Mmf > Mm = Mf

IV. Acceptance of Self
Null hypothesis: NO difference will be found in adjusted
mean scores on a measure of self-
acceptance between the multiple therapy
group and each of the one therapist groups.

Symbolically: Ho : M = Mm = Mf

mf

Alternate hypothesis: The adjusted mean score for the
multiple therapy group on a measure of self-
acceptance will exceed that of each of the

one therapist groups .

Symbolically: H4a : Mmf > Mm = Mf

63

V. Social Introversion

Null hypothesis: No difference will be found in adjusted mean
scores on a measure of social introversion
between the multiple therapy group and each
of the one therapist groups .

Symbolically: HO : Mmf = Mm = Mf

Alternate hypothesis: The adjusted mean score for the
multiple therapy group on a measure of
social introversion will be exceeded by that

of each of the one therapist groups

Symbolically: H5a : Mmf < Mm = Mf
Analysis to be Used

The design used in the study was a variation of the pretest :
posttest nonequivalent control group design which Campbell and
Stanley described as useful for studies in which the experimenter
had relative rather than absolute control over random assignment of
subjects to treatments.1 The design is represented schematically

as follows:

 

1Donald T. Campbell and Julian C. Stanley. Experimental and
Qiasi-Experimental Desigcgrs for Research. (Chicago: Rand McNally
and Co., 1963), 47-48.

01 X2 02
X1, X2, and X3 represent the multiple therapy group, the male

therapist group, and the female therapist group. 01 is the pretest.
02 is the posttest. The dotted lines indicate nonequivalence
between the groups. An improved design would have been possible
if subjects could have been randomly assigned to treatment groups
or to matched pairs.

The statistic used in the study was the analysis of covariance,
with pretest scores as the covariate. Covariance analysis is appro-
priate for use with a design in which it is desirable to make an
adjustment for sampling error when matching or blocking procedures
are not possible or when random sampling methods have to be
modified to suit situational limitations. In the study, subjects
were assigned to groups on the basis of their schedule availability,
which was not an ideal method of assignment. With a statistical
adjustment for the initial differences which occurred between the
groups, however, sampling differences were taken into account in
the analysis of results.

Another advantage of the covariance method is that it takes
into account the degree of correlation between pretest and posttest

variables, the size of difference between groups on pretest

65

variables, and variance in the posttest scores. 1 It is preferable
to gain score comparisons because the assumption of a correlation
between pretest and posttest of 1.00 does not have to be met.
Covariance analysis is less susceptible to unreliability.

Pretest and posttest data was tested for the purpose of
determining whether or not assumptions underlying the use of the
analysis of covariance had been met. The assumption pertaining
to linearity of regression was verified for all of the scales by
computer analysis. The assumption concerning the relationship of
pretest variables to posttest criteria was tested by Pearsonian
correlations . The results are reported in Table 4. 2 . Other corre-
lation data may be found in Appendix C.

Table 4.2 Pearsonian Correlations Between Pretest Scores and
Posttest Scores for the Father Acceptance Scale, the

Mother Acceptance Scale, the Ego Strength Scale, the
Total P Scale, and the Social Introversion Scale

 

 

 

Scale Pearsonian Correlation
Coefficient

Father Acceptance Scale r = .79

Mother Acceptance Scale r = . 69

Ego Strength Scale r = .46

Total P Scale r = .63

Social Introversion Scale r = .60

 

1“Quinn McNemar. Psychologgal Statistics (New York: John
Wiley and Sons, Inc., 1962), 372-372.

66

Only the Ego Strength Scale failed to meet the desired minimum
correlation of . 60.

A third assumption called for random assignment of clients to
the groups. This could not be done by absolute randomization, nor
could clients be blocked on pretest variables. They had to be
assigned to groups on the basis of times that were available in
their class schedules. While not a pure method of random assign-
ment, this procedure was accepted as adequate for the study.

An analysis of variance was obtained on the pretest variables
to test the equivalency of the groups . The results, which are
reported in Appendix D, indicated there were no differences between
any of the groups on any of the scales except that of Social Intro-
version (p = .031) .

A final assumption was met by giving the pretests before
group therapy began to assure that pretest scores were not influenced

by the treatment.
Summary

Clients were selected for participation in the study by the
criteria of expressed needs for help with problems pertaining to
relationships with parents, of lowered feelings of self-esteem, and
of impaired interpersonal interaction with peers. Clients were
assigned to one of three therapy groups on the basis of their time

availability. Two therapists met with one group together, and they

67

each met with one group by themselves. Therapists were found to
have somewhat similar approaches to therapy, and to have common
experience and training prior to the study.

Five scales from three instruments were used to measure
pretest to posttest changes in the following variables: father
acceptance, mother acceptance, ego strength, self-acceptance,
and social introversion. The scales were found to have adequate
validity and reliability. An analysis of covariance statistic was
selected for use in comparing outcomes of therapy between the
multiple therapy group and each of the single therapist groups.

Assumptions for use of the covariance statistic were found
to be verified. The exceptions were: the Es scale had a low
pretest-posttest correlation, and one of the groups differed
significantly from the others on the pretest Si scale.

In Chapter V, data pertaining to predicted outcomes will be

presented .

CHAPTER V: ANALYSIS OF RESULTS

An analysis of covariance was used to compare outcomes of
therapy between the multiple therapy group, the male therapist
group, and the female therapist group as measured by five scales.
Where F-tests were significant at the .05 level or better, ‘Logp
hgq comparisons were made to determine if the adjusted mean
score for the multiple therapy group differed from the adjusted

mean scores of each of the single therapist groups.

Hypothesis 1: Perceptions of Father Acceptance

The first null hypothesis was formulated as follows:

No difference will be found in adjusted mean
scores on the Father Acceptance scale of the
Family Relations Inventory between the multiple
therapy group and each of the one-therapist
groups.

The results, which are summarized in Appendix E, were
interpreted to mean the null hypothesis was rejected, which
indicated there were differences between the adjusted meah scores
for the multiple therapy group, the male therapist group and the

female therapist group. The obtained and adjusted mean scores

68

,69

are presented in Table 5 .1.

Table 5.1 Obtained and Adjusted Mean Scores for the Father
Acceptance Scale of the Family Relations Inventory

 

 

 

Group Pretest Posttest Adjusted
Mean Mean Mean
Multiple Therapy 23.33 29.16 27.38
Female Therapist 19.83 21.00 22.17
Male Therapist 20.50 18.66 19.28

 

To test for adjusted mean differences between the male
therapist group and the multiple therapy group, and the female
therapist group and the multiple therapy group, Sheffe's method of
multiple comparisons for an analysis of mean differences was used.1
On the basis of the test for differences between the multiple therapy
and male therapist groups the following alternate hypothesis was
accepted:

Hla : On a measure of perceptions of Father Acceptance,
the adjusted mean score for the multiple therapy group
is higher than the adjusted mean score for the male

therapy group .

No differences were found between the female therapist group

 

1William C. Guenther. Analysis of Variance. (Englewood
Cliffs, New York: Prentice Hall, Inc., 1964), 150.

 

70

and the multiple therapy group, nor were there differences between

the female therapist group and the male therapist group.

Hypothesis II: Perceptions of Mother Acceptance

 

The second null hypothesis was formulated as follows:

No differences will be found in adjusted mean scores
on the Mother Acceptance scale of the Family
Relations Inventory between the multiple therapy
group and each of the one-therapist groups.

The results of the covariance analysis, which are listed in
Appendix E, indicated the null hypothesis was not rejected, that
there were no differences in the adjusted mean scores. Failure to
reject the null hypothesis meant that the alternate hypothesis of
differences between the multiple therapy group and each of the one-
therapist groups on measures of mother acceptance was not accepted.
In Table 5.2, obtained and adjusted mean scores for the M.A.

scale are listed .

 

71

Table 5 .2 Obtained and Adjusted Mean Scores for the Mother
Acceptance Scale of the Family Relations Inventory

 

 

 

Group Pretest Posttest Adjusted
Mean Mean Mean
Multiple Therapy 21.33 24.00 25 .06
Female Therapist 24.17 23.83 23.03
Male Therapist 23.33 24.67 24.41

 

Hypothesis 111: Development of_Elo Strepgtp

The third null hypothesis was formulated as follows:

No difference will be found in adjusted mean scores
on the Ego Strength scale of the Minnesota Multi-
phasic Personality Inventory between the multiple
therapy group and each of the one-therapist

groups.

In accordance with the data summarized in Appendix E the
null hypothesis was not rejected. The alternate hypothesis of
differences in ego strength measures between the three therapy
groups was not accepted. See Table 5. 3 for obtained and adjusted

mean scores for the Es scale.

72

Table 5. 3 Obtained and Adjusted Mean Scores for the Ego Strength
Scale of the Minnesota Multiphasic Personality

 

 

 

Inventory
Group Pretest Posttest Adjusted
Mean Mean Mean
Multiple Therapy 48.33 59.17 60.06
Female Therapist 50.16 56.67 56.72
Male Therapist 52.33 56.67 55.72

 

Hypothesis IV: Self-Acceptance

The fourth null hypothesis was formulated as follows:

No difference will be found in adjusted mean scores
on the Total P scale of the Tennessee Self Concept
Scale between the multiple therapy group and each
of the one—therapist groups.

According to data summarized in Appendix E, the null
hypothesis was not rejected, indicating there were no differences
between the therapy groups on measures Of self-acceptance.
Obtained and adjusted mean scores for each of the groups may

be found in Table 5.4.

73

Table 5 .4 Obtained and Adjusted Mean Scores for the Total
Positive Scale of the Tennessee Self Concept

 

 

Scale
Group Pretest Posttest Adjusted
Mean Mean Mean
Multiple Therapy 37.00 46.50 48.00
Female Therapist 37.83 44.33 45.24
Male Therapist 42.50 45.83 43.43

 

Hypothesis V: Social Introversion

The fifth null hypothesis was formulated as follows:

No difference will be found in adjusted mean scores
on the Social Introversion scale of the Minnesota
Multiphasic Personality Inventory between the
multiple therapy group and each of the one-
therapist groups.

On the basis of data presented in Appendix E the null
hypothesis was not rejected. Failure to reject the null hypothesis
indicated there were no differences in social introversion among
the three therapy groups, and the alternate hypothesis was not

accepted. The data is presented in Table 5.5.

74

Table 5.5 Obtained and Adjusted Mean Scores for the Social
Introversion Scale of the Minnesota Multiphasic
Personality Inventory

 

 

 

 

Group Pretest Posttest Adjusted
Mean Mean Mean
Multiple Therapy 65.50 58.66 56.07
Female Therapist 63.50 59.00 57.29
Male Therapist 50.00 48.83 53.14
Summary

Five hypotheses pertaining to the following outcomes in group
therapy were tested: perceptions of father acceptance, perceptions
of mother acceptance, development of ego strength, self-acceptance,
and social introversion. An analysis of covariance was used to
determine differences between the multiple therapy group, the
female therapist group, and the male therapist group.

The hypothesis of no differences in measures of father

acceptance was rejected. Post hoc comparisons led to acceptance

 

of the alternate hypothesis that the multiple therapy group differed
from the male therapist group on perceptions of father acceptance.
None of the other null hypotheses were rejected.

In Chapter VI, the data presented above will be interpreted and

discussed, and implications for further research will be considered.

CHAPTER VI: SUMMARY, CONCLUSIONS, DISCUSSION,

SPECULATIONS, LIMITATIONS, AND IMPLICATIONS

Summary

The purpose of the study was to measure the effectiveness of
multiple therapy, using male and female therapists, in group therapy
with university counseling center clients. It was hypothesized that
the multiple therapy approach would be more effective than the
traditional one-therapist approach to group therapy on the following
outcomes: (1) perceptions of father acceptance; (2) perceptions of
mother acceptance; (3) improvement on a measure of ego strength;

(4) increase in feelings of self-acceptance; and, (5) decrease in
social introversion.

A history and theory of the multiple therapy experience
emphasized the symbolization of a family situation with both parents
present. The process of therapy was regarded as a process of
personal maturation in the context of a family—like setting. It was
believed that in the early stages of therapy conflicts pertaining to
clients' problems with parents would be brought into sharp focus .
Once a trusting relationship with the therapists was established

clients would be secure in regressing to deep levels of feeling.

75

76

Subsequently they would be encouraged to strengthen their adequacies
in coping with their feelings and their environment. Clients' self-
acceptance and self-differentiation would be helped by their experience
of the two therapists' sometimes contrasting and sometimes similar
perceptions of them. The final phase of the therapy process for
clients would be the establishment of close relationships to persons
outside of the therapy setting.

In a review of experimental studies no research evidence was
found which supported the effectiveness of multiple therapy.
However, authors of descriptive reports pointed out that in their
experience multiple therapy was an approach that appeared to be
consistently effective with both individual and group clients.

The design of the study was a pretest-posttest design in which
the multiple therapy group was compared with a group led by a male
therapist, and a group led by a female therapist, on five variables
of therapeutic outcome. The variables were: perceptions of father
acceptance, perceptions of mother acceptance, ego strength, self—
acceptance, and social introversion. Scales from three instruments,
the Family Relations Inventory, the Minnesota Multiphasic Personality
Inventory, and the Tennessee Self Concept Scale, were used as
operational statements of the five variables.

The clients were male and female undergraduate students who
were selected for participation in the study according to the following

criteria: (1) expressed needs for help with problems pertaining to

77
relationships with parents; (2) depressed feelings of self-esteem;
and (3) dissatisfaction with relationships to peers. Clients were
assigned to groups on the basis of their time availability. The groups
met for thirteen sessions, for twenty-six hours of therapy. There
were six clients in each group.

An analysis of covariance statistic was used to analyze data
obtained before and after therapy. Where results were statistically
significant, po_stg3_c comparisons of adjusted mean scores were
used to test differences between separate means. The results
showed that clients in the multiple therapy group perceived their
fathers as being more accepting than did clients in the male therapist
group. There were no statistically demonstrable differences between
the groups on measures of mother acceptance, ego strength, self-

acceptance, and social introversion.

Conclusions

On the basis of the analysis of results in Chapter V, four
conclusions were formulated and are presented below. They are
discussed in the next section of the chapter. Other data obtained in
the study was considered to have speculative value only, and is
presented in a section following the discussion. The conclusions

were:

78

1. Clients who were in the group led by multiple therapists
perceived their fathers as being more accepting than did clients in
the male therapist group. There was no difference between the one-
therapist groups on perceptions of father acceptance. There were
no differences between any of the groups on perceptions of mother
acceptance. The data provided partial support for the theoretical
notion that multiple therapy is effective in helping clients work

through impaired relationships with one or both parents.

2 . The use of multiple therapists was not proven to be more
effective than the use of one therapist in group therapy for increasing
feelings of ego strength, feelings of self-acceptance, and social

adjustment.

3. There was no indication that one-therapist groups improved
more than the multiple therapy group on any of the five variables
which were measured. The one-therapist method was not more effective

than the multiple therapy approach to group therapy.

4. There were no results which could be interpreted to mean
that the multiple therapy group deteriorated on any of the variables

used to assess therapeutic progress.

79

Discus sion of Results

The discussion of the results follows the same outline used

for the presentation of conclusions .

Perceptions of Parents It was concluded that clients in the group
led by multiple therapists had, by the end of therapy, perceived
their fathers as being more accepting of them than did clients in

the group with the male therapist.l The outcome partially supported
the notion that a unique characteristic of multiple therapy is its
effectiveness in creating a family—like milieu in which a client is
able to focus on problems he experienced with one or both of his
parents.

In theory, however, it had been postulated that clients would
change in their perceptions of both parents, not just the father. The
absence of meaningful change in mother acceptance scores makes it
necessary to consider an alteration of theory to include the following
hypothetical notion: A multiple therapy setting is more likely to
engender measurable changes in perceptions of father acceptance
than in mother acceptance because of the presence of a father-
surrogate who, contrary to clients' past experience and expectations,
is continually present in the group along with the mother-surrogate

and who is capable of helping clients sharpen reality perceptions

 

1See Appendix F for a sample of items from the Father Acceptance
Scale.

80

and strengthen adequacies in coping with their feelings and their
environments .

In many families in American society fathers are often absent
from the home or have not been adequate in helping guide the growth
and maturation of their children. A child might grow up experiencing
much more of a relationship with his mother than with his father,
especially if he is in a home where economic status and achievement
is highly valued and the father works for long periods Of time away
from the family. In such a situation, a child develops a rather acute
awareness of his mother's presence while his father remains some-
what undifferentiated in the general family gestalt. Since mastery of
developmental conflicts includes learning to recognize, understand
and cope with reality and with feelings about reality, the guidance
of one's father, who is the member of the family most likely to be in
touch with life outside of the family, becomes very important. If he
is in some way not available it is possible that a child will grow up
lacking personal adequacy and may experience incomplete or impaired
personality functioning. A common source of distress in college
students, for example, may be traced to their not having been taught
how to cope with their personal feelings and with the pressures
environmental situations place on them.

The student who requests counseling and is assigned to a
multiple therapy group finds he is confronted with a surrogate family

in which there is a major change from what he experienced in his

81

own family: the father figure is present along with the mother figure,
all the time, with equal adequacy. The client is at first acutely
aware of the female therapist and remains so throughout the therapy
process . He is not at first inclined to acknowledge the presence of
the male therapist, but by the end Of therapy he has been able to
relate to him as an accepting, caring person who does not absent
himself from the relationship. The work of the female therapist is
important in the process . She relates to the client as a good mother-
figure and permits him to develop confidence in himself. She supports
him in establishing a relationship with the male therapist.

When a client is asked where his perceptions have changed
the most, he is likely to report that his father has taken a place in
his life that heretofore was not occupied. Since the client's percep-
tions of his mother were always acute, it seems reasonable to
assume they might not change as much in the course of therapy as

would the client's perceptions of his father.

Ego Strengthy Self-Acceptance, and Social Acflustment The results
did not support hypotheses in which statements were made that
clients in the multiple therapy group would improve more than clients
in each of the one-therapist groups on measures of ego strength,
self-acceptance, and social adjustment. Adjusted mean scores were
higher for the multiple therapy group on measures of ego strength and

self-acceptance, but not for social adjustment. The implications of

82

the results involve speculations which are considered in the next

section of the chapter.

Improvement in One- Therapist Groups An examination of the data

 

pertaining to changes in mean scores on each of the five scales
(Chapter V, Tables 5 .1 through 5 .5) failed to indicate that either the
male therapist group or the female therapist group improved more than
the multiple therapy group. The implication was that the use of
multiple therapists did not prove to be less effective than the use

of one therapist in group therapy.

Absence of Deterioration There was no deterioration by the multiple

 

therapy group on any of the measures of improvement which were
used in the study. No support was provided for the contentions of
Slavson (Chapter III) that the use of two therapists would cause
clients to act out feelings in such a way it would be detrimental to
their therapy. There was also no repetition of the problems experienced
by Daniels and Staples in their studies with eighth-graders (Chapter
III) , where therapeutic improvement was impaired by client anxiety
about oedipal conflicts. It may have been that university students
in multiple therapy did not feel as anxious about oedipal conflicts as
did eighth-graders. It was also possible that using two therapists
who were relatively close in ages avoided a relationship which was

interpreted by the clients as that of parent-child.

83

Speculations About the Data

The following discussion is not a report of findings which are
supported by the data analysis used in Chapter V. It consists of
speculative interpretations formulated for the purpose of revising
theory, and making suggestions for further research. Because such
interpretations are based on results that are not free from experi-
mental error, caution must be exercised while they are being

considered .

The Fantasied Parent-Surrogate A comparison of adjusted mean
scores (Chapter V, Tables 5.1 and 5 .2) and of pretest to posttest
changes in Obtained mean scores (Appendix H) showed some
moderate but interesting differences between the three therapy
groups on measures of parental acceptance. Clients in the female
therapist group had an increased average score in perceptions of
father acceptance and a decreased average score in perceptions of
mother acceptance, while clients in the group led by the male
therapist had a decreased average score on perceptions of father
acceptance and an increased average score on perceptions of mother
acceptance. Multiple therapy clients showed increased average
scores on both variables.

The first tentative conclusion was that some of the clients in
the one-therapist groups experienced feelings of threat and

competitiveness because of their relationships to their therapists.

84

Their feelings led them to assign positive perceptions to a fantasied,
non-threatening parental figure of the opposite sex from that of

their therapist. In some instances, oedipal tones were present:
males in the male therapist group accounted for most of the change
toward increased negative perceptions of father and toward increased
positive perceptions of mother, and in the female therapist group

all of the change toward increased negative perceptions of mother
was accounted for by female clients .

A second speculation was that fantasy pertaining to the absent
parent-surrogate was a wish on the part of some clients to complete
the partial family image represented in the one-therapist groups.

The group with one therapist present symbolized a family with one
parent absent. Client fantasy pertaining to the absent member
could have been expressive of a need to continue a relationship with
a favored parent, Of a wish to experientially resolve a problem with
a person of the sex opposite to that of the therapist, or of a need to
have a healthy parental dyad on which they could depend for help.

Finally, it was possible that each therapist encouraged clients
to have increased positive perceptions of parents of the sex opposite
to the therapists' own. The therapist may have felt it necessary to
defend or support an opposite-sexed parent who was being rejected
or criticized by a client. Such an approach was attributed to the
therapists' feelings that clients may have inappropriately excluded

one parent, or clients may have experienced deprivation with the

85

absent parent.

The probable reasons that clients in the multiple therapy group
did not deteriorate on measures either of father acceptance or of
mother acceptance were that the family image was complete, clients
were given the opportunity to deal with both male and female
therapists and clients were supported in developing positive relation-
ships with both therapists. Feelings and conflicts pertaining to
competitiveness with therapists, to oedipal wishes, and to the
threats of confrontation were not confined to fantasy but were

openly expressed and resolved in the multiple therapy configuration.

Ego Strength The adjusted mean score for the multiple therapy

 

group was higher on the ego strength variable than were adjusted
mean scores for one-therapist groups (Chapter V, Table 5 . 3).
Also, examination of data in Appendix I revealed that none of the
six clients in multiple therapy deteriorated on ego strength scores,
while five of the twelve clients in the other groups did. A Sign
Test was used to determine whether the number of clients who
showed improvement was significant. The result supported the
contention for the multiple therapy group, but not for the one—
therapist groups . Only tentative speculations could be made from
the data. First, it was possible that because of the configuration
of multiple therapy as a symbolic family clients experienced develop-

mental maturation in which they clarified and resolved feelings

86

pertaining to infantile conflicts and anxiety, they established good
contact with reality, they became free to express feelings and
behaviors , and they felt adequate about their ability tO cope. Second,
the presence of two therapists instead of one gave clients extra
support in strengthening their feelings about ego functioning. Either
one or both of the reasons given could have accounted for the
improvement by the multiple therapy group, and for the number of
multiple therapy clients who improved.

The tentative conclusion was reached that multiple therapy
led to more improvement in ego strength than did the one-therapist
approach to group therapy. It was regarded as speculative because
analysis of covariance statistics did not demonstrate there were
differences between the groups , and because reliability coefficients

for the Es scale were lower than desirable.

Self-Acceptance and Self-Differentiation On the basis of adjusted
mean scores on the Total Positive scale, which was used as a global
measure of constructs pertaining to self-differentiation and self-
acceptance, the speculation was made that there was more improve—
ment in the multiple therapy group as a whole than in the other groups
(Chapter V, Table 5 . 4). There was tentative reason to believe that
multiple therapy clients regarded themselves more positively than did
clients in the one—therapist groups.

Interpreting the results of the data was complicated by the fact

87

that the Total P scale was a composite of eight subscales which had
overlapping items. An examination of data from two of the subscales,
reported in Appendix G, revealed some interesting information.
Adjusted mean scores pertaining to the subscales Personal Self and
Family Self were higher for multiple therapy clients than for one-
therapist clients, although they were not statistically significant.

The first subscale, the Personal Self subscale, was defined
as a measure of an individual's sense of personal worth apart from
his body or his relationship to others . High scores for the multiple
therapy group on the Personal Self subscale indicated that the
experience of self-differentiation might have occurred to a degree
it did not occur for one-therapist clients .

The second subscale, the Family Self subscale, was described
as a measure of the client's feelings of worth as a family member.
The construct was one which was meaningful in light of theoretical
notions that multiple therapy represented a family-like setting.
Speculation indicated that multiple therapy clients saw themselves
as being of more worth as family members than did clients in the
one-therapist groups , which provided additional even though very
tentative support to theoretical statements made in Chapter II, and to
claims made in the literature reviewed in Chapter III, that multiple
therapists symbolized the parental dyad.

Of the other subscales of the Total P scale the multiple therapy

group slightly improved on those which reflected the client's internal

88

frame of reference, the Identity, Self-Satisfaction, and Behavior
subscales. On the subscales Physical Self and Moral-Ethical Self,

there were no appreciable differences in improvement scores.

Social Introversion Multiple therapy clients changed more in the
direction of less social introversion than did one—therapist clients,
but the adjusted mean score of the multiple therapy group was not

as low as that for the male therapist group (Chapter V, Table 5 .5) .
Differences between the groups on the Si scale were less evident
than were differences on any of the other scales. Data from a

related scale, the Social Self subscale of the Tennessee Self Concept
Inventory, revealed the same trends.1 The tentative assumption

was made that social adjustment was a variable not likely to be

uniquely influenced by multiple therapy in a group setting.

Two Other Indications of Improvement A tentative conclusion was
made that the multiple therapy group improved more than the other
groups on each of the five outcome variables. The comparison was
made by examining changes in pretest to posttest mean scores ,
which are listed in Appendices H and I. On all five scales the
multiple therapy group showed a greater amount of average improve-
ment than did either one Of the one—therapist groups.

A second speculation was that more multiple therapy clients

 

1Appendix G

89

were improved than were one— therapist clients . A comparison of
clients whose mean scores demonstrated improvement on all five
scales showed that five multiple therapy clients improved, while
two of the male therapist's clients and two of the female therapist's
clients improved. The data may be found in Appendices H and I.
Implied in the above two speculations was a notion that the
use of multiple therapists had therapeutic value which went beyond
that of the one-therapist approach to group therapy. It was indicated
in two different ways: the amount of over-all improvement by the
multiple therapy group, and the number of multiple therapy clients

who improved .

The speculations in the preceding paragraphs were not based
on solid research data, since they were without statistical support.
The number of trends which were present seemed to be a function of
more than just chance occurrences, which presents some

intriguing possibilities for additional theory-building and research.

Limitations of the Study

There were some limitations placed on the study by virtue of
the situation in which it was undertaken. The first was that of
obtaining a sample of clients sufficiently large enough to increase
reliability in the statistical analysis, and to assign clients to groups

on a purely random basis. A second problem pertained to the

90

occurrence of high within-group variance because of the heterogeneity
of the clients in the groups. Finally, the treatments may have been
influenced because of the therapists' awareness of the nature of the
study.

Selecting enough clients for therapy groups to have a number
large enough for more reliable statistics was complicated by the
fact that clients who came to the counseling center did not expect
to receive group therapy, which was attributed to the relatively
infrequent occasions on which group therapy was offered to students
with personal and social problems . Several clients who would have
been appropriate for therapy groups refused because they were not
familiar with the process or they did not have confidence in it.

Those who accepted group therapy were not available to meet at
times which coincided with dictates of pure random assignment,

so they were placed in groups on the basis of times they had
available in their daily class schedules . It was possible that
selection bias was present in obtaining clients and in assigning them
to groups.

The second problem in the design was that of the heterogeneity
of the clients accepted into the groups . Several broad criteria were
used in selection: clients had to be single undergraduate students
with problems pertaining to relationships with parents or with peers ,
or to lowered feelings of self-esteem. It was decided that although

homogeneous groups would be better for the sake of a more adequate

91

research design, heterogeneous groups would be better for the clients
therapy. Male and female students of all class levels were,
therefore, included in the groups.

A third problem was that of possible therapist bias, which
could have been a factor influencing outcomes in the study since
both therapists were aware of the nature of the design. Some
control was exercised, however, by the therapists' not examining
the specific items of the instruments until after the posttests were
given. Their awareness Of the content which was being measured
was restricted to general rather than specific variables. A less
tangible control was that of the therapists' investment in having
their clients improve regardless of the type of group to which they
were assigned.

The question may be raised concerning the absence of a
wait-control group in the design. It was the policy of the Counseling
Center that where counselors were available clients would not be
asked to wait to receive therapy. Adequate counseling help was

available to all clients when the study began.

Implications for Further Research

In a replication of the study a design is needed that is some-
what sensitive to the moderate amount of change that must be
measured and evaluated after multiple therapy. How well it is

undertaken depends on the availability of a sufficient number of

92

clients to give statistical analysis the power to detect changes, the
availability d research instruments which can measure the nebulous
variables present in personal maturation, and the availability of
experienced competent multiple therapists who have established
healthy personal and professional relationships. Specifically, the

following suggestions should be considered:

1. Reduce the variability within groups by limiting the
criteria for selection Of clients to one presenting problem, such
as conflict concerning relationships with one or both parents ,

and by selecting clients of the same age, the same sex, or both.

2 . Use pretherapy tests to block clients within and across

groups on relevant variables.

3. Use therapists who are not aware of the purpose and

design of the study.

4. Include in the study an investigation of the effect of

the relationship between the therapists on therapeutic outcomes.1

 

1Jerry Treppa, 1968, initiated a study of the mutual needs of
multiple therapists, which would be useful in such an investigation.

93

5 . Use a modified design in which a second multiple therapy ‘
team works in a therapy group together, and in therapy groups
separately, in the same manner as the first therapy team. Such

a design is schematically represented as follows:

 

 

Multiple Male Female
Therapy Therapist Therapist
R1 AB A B
R2 CD C D

 

A Final Word

There were several indications that multiple therapy was more
effective than the one-therapist approach to group therapy, but they
were without statistical significance. The trends cannot be ignored,
however, and it remains for additional research to prove or disprove
the contention that more than just chance variation accounted for the
consistent improvement of clients in the multiple therapy group.

What was learned in the study, on the basis of responses to
written true-false questions, was only part of a story about the kinds
of experiences some students had in group therapy. As in all other
research only a part of reality was examined, not the whole. It may
well be that multiple therapy is about the same as other approaches

to therapy, or it is effective with some clients and ineffective with

94

others , or it is effective with just about any disturbed student
wanting help with his problems .

It is a rule of scientific procedure that if differences in therapy
outcomes are not proven significant, they can only be attributed to
chance. In adherence to this maxim all that might be said to have
taken place in the study is that clients who experienced multiple
therapy were able to say they felt better about their relationships
with their fathers . That in its elf, taken alone, in a society where
family life has weakened, where personal maturation and adequacy
is developed only with difficulty, and where interpersonal alienation

is a growing phenomenon, is a good place to begin.

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APPENDIX

APPENDIX A
DESCRIPTIVE DATA PERTAINING TO CLIENTS'
GROUP MEMBERSHIP, SEX, AGE, CLASS,

AND ATTENDANCE

 

 

Client Sex Age Class Number of Sessions
Code Attended
Group MF
AA Male 21 Senior 12
AB Male 2 3 Junior 1 2
AC Female 2 1 Senior 11
AD Female 18 Freshman 11
AE Female 2 0 Junior 13
AF Female 1 9 Sophomore 12
Mean Age 2 0 . 3 7 2
Group M
BG Male 18 Freshman 12
BH Male 21 Senior 13
BI Male 18 SOphomore 13
BJ Female 19 Sophomore 11
BK Female 22 Junior 13
BL Female 19 Sophomore 10
Mean Age 19 . 5 7 2
Group F
CM Male 21 Senior 13
CN Male 18 Freshman l 2
CO Female 21 Sophomore 10
CP Female 22 Senior 1 3
CO Female 18 Freshman 13
CR Female 1 9 Freshman 11
Mean Age 19 . 8 7 2

 

MF=Multip1e Therapy; M=Male Therapist; F=Female Therapist
99

APPENDIX B

A BRIEF DESCRIPTION OF THE GROUPS

Eighteen male and female clients participated in the study,
with six clients being assigned to each group. Clients' attendance
ranged from ten to all thirteen of the meetings. Each group had the
same average attendance of 12 sessions per client. The groups
developed their own identities when therapy began and remained
characteristically different throughout the therapy process.

The group led by the female therapist was from its inception
social, cohesive, and somewhat self-directing. The therapist
reported that after the Spring Term was underway the group had a
party, and they held another one about the time therapy ended. The
parties were planned spontaneously and without the therapist's parti-
cipation. In marked contrast to the other two groups clients in this
group congregated together in the Counseling Center waiting area
before therapy and were quite active in interacting with each other.
A good part of the therapy process was given over to clients' concern
about how they could be close to other people and still retain some
individuality. Feelings of loneliness and lack of identity were often

expressed. The therapist received very few requests for individual
100

101

extra-therapy sessions .

Clients in the male therapist's group were not as social or as
cohesive as were clients in the other groups. The problems and
feelings expressed by clients centered around themes pertaining to
symbiotic attachments to parents , girl friends and boy friends, to
self-depreciation and to mistrust of others. The therapist felt that
although clients related to him quite well they were reluctant to
talk with each other about their more disturbing problems. He
received requests for individual extra-therapy sessions from three
clients. One other client continued in individual therapy after the
group terminated.

Clients in the group led by the male and female therapists
were psychologically Open to each other and were helpful to one
another in resolving relatively disturbing conflicts. Problems
pertaining to relationships with parents, to feelings of loneliness
and isolation, and to difficulty in growing up were the ones most
often expressed in therapy sessions. All but one Of the clients
in the multiple therapy group showed improvement, and the one who
did not was able to benefit from short—term individual therapy after
the group terminated.

In the multiple therapy group there were aspects of client-
therapist interactions which elicited fantasies and behaviors
pertaining to feelings about parent-child and parent—parent

relationships . There were occasions when a male client would

102

attempt to have the female therapist side with him against the male
therapist, and when a female client would interact with the male
therapist in a hostile exclusion of the female therapist. When such
dyads were formed the excluded therapist would use the opportunity
to make the symbiotic or oedipal nature of the client— therapist
relationship evident to both participants.

In some instances the therapists were called on to help a
client express feelings regarding one parent who in some way was
absent and was badly needed.

There was considerable therapeutic interaction in the group,
which was attributed to the presence of both male and female
therapists . The two therapists were free to concentrate on their
relationships to the clients because of the mutual support they gave
each other. If one was tiring or was at an impasse with a client he
could relax while the other was active. The presence of male and
female therapists made it possible for clients to experience them-
selves in relationships to both a man and a woman, to be responded
to from perspectives that were sometimes similar and sometimes at
variance, and to strengthen appropriate masculine and feminine
identifications. It was also believed by the multiple therapists
that their combined sensitivities helped them understand clients'
feelings and conflicts in ways they could not have had they been

working alone .

APPENDIX C
PEARSONIAN CORRELATIONS FOR PRETEST AND POSTTEST
SCORES FOR THE FATHER ACCEPTANCE, MOTHER
ACCEPTANCE, EGO STRENGTH, TOTAL POSITIVE

AND SOCIAL INTROVERSION SCALES

 

Pre Post Pre Post Pre Post Pre Post Pre Post

Si Si Es Es TP TP FA FA MA MA
PreSi 1.00 .60 -.52 -.19 -.50 -.20 -.28 .01 -.23 -.14
PostSi -— 1.00 -.19 -.46 -.42 -.43 —.48 -.36 -.33 -.66
Pre Es -- -- 1.00 .46 .54 .22 .47 .16 .03 -.07
Post Es -- -— -— 1.00 .60 .47 .37 .38 .00 .22
Pre TP -- -- -- -— 1.00 .63 .33 .02 .03 .03
Post TP -— —- -- -- -- 1.00 .21 .24 .02 .35
Pre FA -— -- -- -- -- -- l .00 .79 .30 .47
Post FA -- -- -— -- -- -- -- 1.00 .21 .59
Pre MA -- -- -- -- -- -- -- -- l .00 .69
Post MA -- -- -- -- -- -- -- -— -- l .00

 

103

APPENDIX D
ANALYSIS OF VARIANCE DATA FOR PRETEST AND POSTTEST
SCORES FOR THE FATHER ACCEPTANCE, MOTHER
ACCEPTANCE, EGO STRENGTH, TOTAL POSITIVE

AND SOCIAL INTROVERSION SCALES

 

 

ssb ssW r p SDZ-MF SDz-M SDz-F
F.A.
Pre 41.4 815.7 .38 .690 28.2 52.3 82.6
Post 364.8 830.2 3.30 .065 19.8 56.7 89.7
M.A.
Pre 25.4 481.5 .40 .680 41.9 21.8 32.6
Post 2.3 416.2 .04 .959 28.3 12.3 42.5
E
Pre 48.1 1585.5 .23 .799 82.6 59.8 174.6
Post 25.0 1357.5 .14 .872 90.2 139.7 41.5

104

105

Appendix D (continued)

 

 

ssb ssW r p SDZ-MF SDZ-M SDZ-F
T.P.
Pre 105.4 1124.3 .70 .511 115.6 39.1 68.4
Post 14.8 1301.7 .09 .919 97.4 27.8 135.0
§1_

Pre 853.0 1445.0 4.43 .031 84.6 104.2 99.8

Post 400.3 1406.2 2.14 .153 146.7 44.6 90.1

 

SSb = Sum of Squares Between Groups

SSW = Sum of Squares Within Groups
= F-Ratio

p = Obtained Significance Level

SD2 = Variance

MF = Multiple Therapy Group

M = Male Therapist Group

F = Female Therapist Group

APPENDIX E
ANALYSIS OF COVARIANCE DATA FOR THE FATHER
ACCEPTANCE, MOTHER ACCEPTANCE, EGO
STRENGTH, TOTAL POSITIVE AND

SOCIAL INTROVERSION SCALES

Table E. 1 Analysis of Covariance Data for the Father Acceptance

 

 

 

Scale
Source of Sum of Mean Degrees F p Hypoth-
Variation Squares Square of esis
Freedom Tested
Between 195.37 97.69 2 5.50 .017 Reject
Within 248.73 17.77 14 -- -- --
Total 444.10 -- 16 -- -- --

 

106

107

Appendix E (continued)

Table E.2 Analysis of Covariance Data for the Mother Acceptance

 

 

 

 

Scale

Source of Sum of Mean Degrees F p Hypoth-

Variation Squares Square of esis
Freedom Tested

Between 12.38 6.19 2 0.42 .667 Fail to

reject
Within 207.69 14.83 14 -- -- --
Total 220.07 -- 16 -- -- --

 

Table E. 3 Analysis of Covariance Data for the Ego Strength Scale

 

 

 

Source of Sum of Mean Degrees F p Hypoth-
Variation Squares Square of esis
Freedom Tested
Between 60.30 30.15 2 0.41 .670 Fail to
reject
Within 1023.54 73.11 14 -- -— --

Total 1083.84 16 -— __ ..

 

108

Appendix E (continued)

Table E.4 Analysis of Covariance Data for the Total Positive Scale

 

 

 

Source of Sum of Mean Degrees F p Hypoth-
Variation Squares Square of esis
Freedom Tested
Between 59.35 29.67 2 0.57 .581 Fail to
Reject
Within 735.52 52.54 14 -- —- --
Total 794.87 -- l6 -- -- --

 

Table E.5 Analysis of Covariance Data for the Social Introversion

 

 

 

Scale

Source Sum of Mean Degrees F p Hypoth-

Variation Squares Square- of esis
Freedom Tested

Between 37.53 18.76 2 0.23 .794 Fail to

Reject
Within 1119.15 79.94 14 —- -- --
Total 1156.68 -— 16 -- -- --

 

APPENDIX E
A SAMPLE OF ITEMS FROM THE FATHER ACCEPTANCE

SCALE OF THE FAMILY RELATIONS INVENTORY

If I was right about something, my father generally told me so.

If I got into a quarrel my father would try to show me who was
right and why.

My father would explain things to me when I was working
with him.

I felt that my father understood me.

If I asked my father about sex matters he would explain them
in a manner that I understood.

My father tried to look at my companions through my eyes .

Some of the best times in my childhood were when my father
brought me toys as a surprise.

If I got into serious trouble my father would do what he could
to help me out.

I can remember my father encouraging me to make "small"
decisions when I was quite young.

My father had the knack of knowing just when to "put his foot
down. "

When my father promised me something, I knew that he would
keep the promise.

My father asked for my opinion and considered it seriously.

My father would explain things to me just to the point of
satisfying my curiosity.

109

APPENDIX G
ADJUSTED MEAN SCORES FOR THE
SUBSCALES OF THE TOTAL

POSITIVE SCALE

 

MF M F p
Identity 47.83 42.43 45.24 .537
Self—Satisfaction 51.53 48.29 51.51 .747
Behavior 43.90 40.45 38.16 .263
Physical Self 41.77 41.17 40.73 .957
Moral-Ethical Self 50.56 49.05 51.72 .795
Personal Self 51.81 43.14 46.39 .310
Family Self 49.08 40.85 43.41 .283
Social Self 46.30 48.85 45.68 .846

 

MF = Multiple Therapy Group
M = Male Therapist Group

F = Female Therapist Group

p = Obtained significance level

110

APPENDIX H
INDIVIDUAL SCORES, MEAN SCORES AND CHANGES IN
SCORES FROM PRETEST TO POSTTEST: FATHER

ACCEPTANCE AND MOTHER ACCEPTANCE

 

 

 

 

SCALES

Father Acceptance Mother Acceptance

Pre Post Change Pre Post Change
Group MF
AA 19 27 +8 17 20 +3
AB 22 31 +9 31 31 0
AC 31 34 +3 19 23 +4
AD 19 25 +6 13 22 +9
AB 20 24 +4 22 18 -4
AF 29 34 +5 26 30 +4
SE 23.3 29.2 +5.9 21.3 24.0 +2.7
GroupM
BG 18 14 -4 28 26 -2
BH 31 22 -9 19 23 +4
BI 18 21 +3 17 24 +7
BI 11 8 -3 27 23 -4
BK 18 17 -1 22 21 —1
BL 27 30 +3 27 31 +4
32 20.5 18.7 -1.8 23.3 24.7 +1.4

 

111

112

Appendix H (continued)

 

 

 

Father Acceptance Mother Acceptance
Pre Po st Change Pre Po st Change
Group F

CM 32 35 +3 33 33 0

CN 19 28 +9 24 30 +6

CO 21 18 -3 20 16 -4

CP 7 8 +1 19 20 +1

CO 27 21 -6 29 24 -5

CR 13 16 +3 20 20 0

X 19.8 21.0 +1.2 24.2 23.8 -.4

 

MF = Multiple Therapy Graip
M = Male Therapist Group
F = Female Therapist Group

APPENDIX I
INDIVIDUAL SCORES, MEAN SCORES, AND CHANGES FROM
PRETEST TO POSTTEST ON THE EGO STRENGTH, TOTAL

POSITIVE AND SOCIAL INTROVERSION SCALES

Ego Strength Total Positive Social Introversion
Pre Post Change Pre Post Change Pre Post Change

 

Group MF

AA 45 45 0 19 28 +9 82 77 -5
AB 32 56 +24 34 46 +12 62 47 -15
AC 54 64 +10 47 53 +6 64 50 -14
AD 51 70 +19 36 50 +14 64 49 -15
AB 58 67 +9 49 46 -3 54 68 +14
AF 50 53 +3 37 56 +19 67 61 -6

r 48.3 59.2+10.9 37.0 46.5 +9.5 65.5 58.7 -6.8

 

Group M

BG 54 64 +10 41 39 -2 68 53 -15
BH 62 56 -6 51 52 +1 44 47 +3
BI 41 56 +15 45 47 +2 54 48 -6
B] 47 42 -5 33 47 +14 45 56 +11
BK 51 47 -4 39 40 +1 50 52 +2
BL 59 75 +16 46 50 +4 39 37 -2
X 52.3 56.7 +4.4 42.5 45.8 +3.3 50.0 48.8 -1.2

 

113

114

Appendix I (continued)

Ego Strength Total Positive Social Introversion
Pre Post Change Pre Post Change Pre Post Change

 

Group F

CM 69 62 -7 44 48 +4 49 45 -4
CN 40 59 +19 32 55 +23 72 51 -21
CO 65 62 -3 41 44 +3 55 64 +9
CP 45 58 +13 48 57 +9 75 69 -6
CO 41 54 +13 37 35 -2 67 58 -9
CR 41 45 +4 25 27 +2 63 67 +4

T 50.2 56.7 +6.5 37.8 44.3 +6.5 63.5 59.0 -4.5

 

MF = Multiple Therapy Group
M = Male Therapist Group
F = Female Therapist Group

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