ABSTRACT

AN INVESTIGATION OF SOME OF THE DYNAMICS OF THE
INTERPERSONRL RELATIONSHIP BETWEEN PAIRS
OF MULTIPLE THERAPISTS

By Jerry A. Treppa

The purpose of the present investigation was to
examine how therapists who have chosen to work together in
multiple therapy fulfill each other in terms of their needs.
The first part of the study compared the interaction of
needs among pairs of multiple therapists with the inter-
action of them among randomly paired therapists. The second
part of this investigation was concerned with the relation-
ship between a therapist's satisfaction in the multiple
therapy relationship and the needs of his co-therapist.

Two groups of subjects were selected for the study.
The multiple therapy group consisted of 12 teams of multiple
therapistso The control group consisted of 12 teams of indivi—
duals who were paired SO that no individual, who did multiple
therapy, Would be paired with his co-therapist from multiple
therapy. The two groups are comparable with re5pect to age
and the amount of time engaged in individual therapy.

Two instruments were used to examine the variables

of this study. The Thematic Apperception Test (TAT) was used

Jerry A. Treppa

to study the needs of the therapists. Eleven cards of the
TAT were administered to each subject, and the strength of
each need was obtained. The subjects' stories were scored
in terms of the following needs: abasement, achievement,
affiliation, aggression, autonomy, deference, dependence.
dominance, heterosexuality, nurturance, and passivity. Two
raters were used; the interrater reliability for the scoring
of the TAT needs was of sufficient magnitude to warrant the
use of this scoring system. The Interpersonal Satisfaction
Scale (183) was developed in the context of the present
research and is an index of a therapist's satisfaction with
his co-therapist in multiple therapy. Each individual in
the multiple therapy group was asked to rate on a one to
seven scale the degree of satisfaction he felt in inter—
acting with his co-therapist. Based on a two—week interval
separating the two administrations. the stability coefficient
for the 188 is .99.
The results of this study can be summarized as follows:
I. The needs of pairs of multiple therapists do not
complement each other more on a dominance-receptive
dimension than those of the randomly paired thera-
pists.
II. Tentative support was given to the proposition that
pairs of multiple therapists complement each other
more along a dominance-passivity dimension than

randomly paired therapists.

 

 

Jerry A. Treppa

III. Some support was found for the idea that pairs of
multiple therapists complement each other more on a
dependence—nurturance dimension than randomly paired
therapists.

IV. Pairs of multiple therapists are not more similar in
their needs for abasement, achievement, aggression,
dependence, and heterosexuality than randomly paired
therapists.

V. Pairs of multiple therapists were found to be more
similar in their needs for affiliation, autonomy,

and nurturance than randomly paired therapists.

VI. The amount of satisfaction derived from interacting
with one's co-therapist is not related to his co—
therapist's needs for abasement, achievement.
affiliation, and heterosexuality.

VII. Satisfaction with one's partner in multiple therapy
is positively related to his co—therapist's needs
for autonomy, dependence, and nurturance.

It was concluded that certain needs in an individual
partially determine the selection of his co—therapist and
that satisfaction in the multiple therapy relationship is
related to Some of his co—therapists' needs. A general
conclusion of this investigation is that the mutual relation—
ship that exists between pairs of multiple therapists is
affected by the needs of both therapists. The present paper
raised questions about multiple therapists in general and
about the interaction between pairs of multiple therapists and
gave suggestions which should prove helpful to further investi-

cations-

 

 

 

 

 

 

AN INVESTIGATION OF SOME OF THE DYNAMICS OF THE

INTERPERSONAL RELATIONSHIP BETWEEN PAIRS

OF MULTIPLE THERAPISTS

BY
nu”
P

Jerry A: Treppa

A THESIS

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

DOCTOR OF PHILOSOPHY
Department of Psychology

Winter, 1969

 

 

fi—VMH, —‘ .

 

 

 

 

To my wife Ann and to Bill and Jbsephine,
my multiple therapists, who have cared

 

 

ACKNOWLEDGEMENTS

To Bill Kell, the Chairman of my Committee, who
nurtured my ideas and fantasies and who supported my attempts
to change and learn, I express my sincerest warmth and caring.

To Bertram Karon, whose help and creative ideas
have benefitted me throughout my graduate training, I offer
my thanks.

To William Mueller, whose skills as a person, thera—
pist, supervisor, and researcher have benefitted me in more
ways than I can clearly say, I present my admiration and
gratitude.

To Dozier Thornton, who chose to be a member of my
committee without really knowing me and who supported my
endeavors, I am thankful.

To my co-therapists, who have experienced much with
me and who have helped me to change, I acknowledge my appreci-
ation and respect.

To the therapists who readily participated in this
study, I extend my thanks.

To Robert Kurtz and Richard Morrill, who rated the

tapes in this study, I am grateful.

 

 

 

 

 

 

 

TABLE OF CONTENTS

INTRODUCTION . . . . . . . . . . . . . . . . . . . .

History of Multiple Therapy
The Application of Multiple Therapy in Various
Therapeutic Situations

Individual Therapy
Group Therapy
Family Therapy

Definition of Multiple Therapy: Multiple
Therapy vs. Co-therapy
The Importance of the Relationship between
Two Therapists in Multiple Therapy
Professional vs. Dynamic Attraction in the
Selection of a Co-therapist
Definitions of the Needs Employed in This Study
Complementary Need Patterns between Pairs
of Multiple Therapists

The Dominance—Receptive Dimension
The Dependent-NUrturant Dimension

Similar Need Patterns between Pairs of Multiple
Therapists

Need for Achievement and Autonomy
Need for Abasement and Aggression
Need for Affiliation and Heterosexuality

The Relationship between a Therapist's
Satisfaction in a Given Multiple Therapeutic
Relationship and the Needs of His Co-therapist

HYPOTIIESES a o o a o o o o o u o o o a o o o a o o I

Page

21
28

30
30
32
34
34

34
36

39

 

 

 

 

 

METHOD . . . . . .

Subjects

 

a o - o o o o o o o o o o o o I

The Multiple Therapists' Sample
The Control Sample

Measuring Instruments

The Thematic Apperception Test (TAT)
Interpersonal Satisfaction Scale (158)

Procedures

The Thematic Apperception Test (TAT)
Interpersonal Satisfaction Scale (188)

Procedures for
Hypothesis
Hypothesis
Hypothesis
Hypothesis

RESULTS . . . . .

Hypothesis 1:

Statistical Analysis of the Data
1
2
3
4

o o o o o o n n o o o o a o o o

Complementary Needs Along A

Dominance—Receptive Dimension

Hypothesis 2:

Complementary Needs Along A

Dependence—Nurturance Dimension

Hypothesis 3:
Hypothesis 4:

Multiple Therapy Related to His Co-therapist's

Needs

.DISCUSSION . . . .

Similarity of Needs
Therapist's Satisfaction in

o o o a n o o o o c o o o o o 0

Suggestions for Further Research

SUMMARY . . . . .
REFERENCES . . . .

APPENDICES . . . .

Page

41
41

41
41

42

42
42

44

44
47

48

48
50

51

52

52
54
56
57
60
74
77
80

87

 

 

 

 

Table

 

 

LIST OF TABLES

Pairs of needs that are seen as satisfying
each other along a dominance-receptive
dimension . . . . . . . . . . . . . . . .

Interrater reliability of the TAT needs . . .

Conceptual form for data in which no. of
pairs of therapists who are similar or
bipolar on a given need are presented . .

Bipolarity of needs: proportion and between
group Z values (both corrected for dis-
continuity) for the (N = 12) pairs of
therapists in the multiple therapist and
control samples who have a bipolar relation-
ship with respect to their needs derived
from the TAT for deference, dominance and
passivity . . . . . . . . . . . . . . . .

Complementary needs: Pearson product moment
correlations and between group Z values
between the multiple therapist and control
samples on the dominance-passivity and
dominance—deference complementary
dimensions . . . . . . . . . . . . . . .

Pearson product moment correlations and between
group Z values between the multiple
therapist and control sample on the
dependence-nurturance dimension . . . . .

Similarity of needs: proportions and between
group Z values (both corrected for dis-
continuity) for the (N = 12) pairs of
therapists in the multiple therapist and
control samples who are similar in their
needs derived from the TAT for abasement,
achievement, affiliation, aggression,
autonomy, dependence, heterosexuality,
and nurturance . . . . . . . . . . . . .

vi

Page

31

47

49

53

54

55.

57

4 k1

 

 

 

 

Table Page

8. Pearson product moment correlations between
the satisfaction score of each indivi-
dual in the multiple therapist sample
(N = 12) on the ISS and his co-
therapist's needs derived from the TAT . 58

vii

.fi‘ *- -w
r" A,” L: -_

 

 

 

 

Table

A.

No.

 

 

LIST OF APPENDIX TABLES

of pairs of therapists in the ,
multiple therapist sample (N = 12)
and in the control sample (N = 12)

who are similar or bipolar in terms
of their need for deference .

of pairs of therapists in the
multiple therapist sample (N = I2)
and in the control sample (N = 12)

who are similar or bipolar in terms

of their need for deference . . . . . .

of pairs of therapists in the ,
multiple therapist sample (N = 12)
and in the control sample (N = 12)
who are similar or bipolar in terms

of their need for passivity . . . . . .

of pairs of therapists in the'
multiple therapist sample (N = 12)
and in the control sample (N = 12)
who are similar or bipolar in terms
of their need for abasement . . . . . .

of pairs of therapists in the-
multiple therapist sample (N = 12)
and in the control sample (N = 12)

who are similar or bipolar in terms

of their need for achievement . . . . .

of pairs of therapists in the multiple
therapist sample (N = 12) and in the
control sample (N = 12) who are similar
or bipolar in terms of their need for
affiliation . . . . . . . . . . . . . .

of pairs of therapists in the multiple
therapist sample (N = 12) and in the
control sample (N = 12) who are similar
or bipolar in terms of their need for
aggression . . . . . . . . . . . . . .

viii

Page

88

88

89

91

91

92

92

 

of pairs of therapists in the multiple
therapist sample (N = 12) and in the
control sample (N = 12) who are similar
or bipolar in terms of their need for
autonomy . . . . . . . . . . . . . . .

of pairs of therapists in the multiple
therapist sample (N = 12) and in the
control sample (N = 12) who are similar
or bipolar in terms of their need for
dependence . . . . . . . . . . . . . .

of pairs of therapists in the multiple
therapist sample (N = 12) and in the
control sample (N = 12) who are similar
or bipolar in terms of their need for
heterosexuality . . . . . . . . . . . .

of pairs of therapists in the multiple
therapist sample (N = 12) and in the
control sample (N = 12) who are similar
or bipolar in terms of their need for
nurturance . . . . . . . . . . . . . .

ix

 

93

93

94

94

 

 

 

 

INTRODUCTION

Some therapists prefer to work alone, while a
minority prefer, at times, to engage in the psychothera-
peutic venture as a team of two therapists. As utilized
in this paper, the use of two therapists who are involved
spontaneously in the treatment of an individual, a couple,

a family, or a group is defined as multiple therapy. The
therapeutic value of multiple therapy is an important subject
which has gained increasing attention in the last twenty
years. However, it is neither the purpose of this paper to
evaluate the merits of multiple therapy as compared to indi—
vidual therapy nor to defend the former's usage. The present
paper will attempt only to examine how therapists who have
chosen to work together in multiple therapy fulfill the needs

of each other.

History of Multiple Therapy

As pointed out by Dreikurs (1950), and Dreikurs,
Schulman, and Mosak (1952a), the earliest use of the
principles of multiple therapy occurred in the early 1920's
by Adler and his associates at the Vienna Child Guidance
Clinic. When emotional blocking and resistance occurred,

the parents and the child were seen by two counselors.

 

 

 

 

 

They discovered that frank discussion of the child's diffi-
culties in the presence of him accelerated the therapeutic
process--that the child responded more readily in such a
situation. Hewever, it was not until 1939 that anyone else
reported using such an approach. At this time, Reeve (1939)
reported that he was stimulated by a discussion at the National
Conference of Social Workers in 1933 on the value of having

a social worker and a psychiatrist work together with a
patient for the purpose of training the social worker to
think further about the implications of such an interview.
After some consideration of this matter, he came to the con-
clusion that such an interview, which he called the ”joint
interview”, carried ”. . . values beyond that of teaching
social workers how to conduct an interview" (Reeve, 1939,

p. 743). and he began to experiment with this method of
treatment. He reports that this experiment produced thera-
peutic as well as educational benefits. In addition to being
better able to gain a clearer understanding of the facts in
the patient's situation than in individual psychotherapy,
this treatment method provided. . .

a Wider opportunity for identification, and thera-
peutically, a parental situation is set up insofar .
as the social worker and psychiatrist may be indenti-
fied as such. While at first it may seem to repre-
sent a greater complexity, as a matter of fact, it.
presents greater flexibility to the patient by giVing
him an opportunity to react to one or the othefi.
Theoretically, it affords an Opportunity for t et
patient to love and hate without haVing to direch.
this toward any one person. It further afforgs im
an opportunity to react with a minimum fear 0 re

taliation (Reeve, 1939. p. 747).

 

 

 

 

Hadden (1947) too was primarily concerned with

adequately teaching students about psychotherapeutic
practices and included a medical student in his therapy
groups for this reason. Hadden was pleased with the results
he obtained. He found that the inclusion of the students in
therapy groups made their training shorter and more effective,
gave them a better understanding of the power of psycho-
therapy, gave them experience under supervision, and helped
them to recognize their own interpersonal difficulties. While
the trainees, for the most part, did not direct the group
sessions, Hadden believed that the effectiveness of the
sessions was increased by the student's presence.

Whitaker, Warkentin, and Johnson (1949) reported
the first intensive use of multiple therapy as a means of
treating patients. At the time they wrote their first
article they had been using multiple therapy experimentally
for three years. Whitaker et a1. state that they had two
major objectives for experimenting with multiple therapy.
Their primary objective was to develop a means of treatment
which would enable the therapists to share with one another
the emotional impact of the therapeutic interview and to
enhance the capacity of the therapist. The second and more
". . . long-range objective was to develop concepts that
would facilitate the teaching of psychotherapy" (Whitaker et a1.,
1949, p. 439). They report that initially the second thera-

pist was a critical observer who did not participate very

 

 

actively in the therapeutic process. Because the second

therpaist became unhappy with this role, they came to the
conclusion that it would be better to allow him to partici-
pate more actively. They found that having two therapists
working together did not disturb the therapeutic process
but facilitated it--that the participation of the two thera-
pists held greater significance for the patient than using
only one therapist. They discovered that multiple therapy
enabled them to see more of their own emotional functioning
in the interview and that this recognition helped them to
grow professionally. This and subsequent articles by
Whitaker and his associates did much to bring multiple
therapy to the attention of the professional community.

A year after Whitaker et a1. published their original
article, Dreikurs (1950) wrote a paper, which is often cited,
on the techniques and dynamics of multiple therapy. Dreikurs
initially introduced multiple therapy into his practice as a
result of certain emergency situations. His experiences
with this form of treatment lead him to conclude that multiple
therapy was useful for teaching therapists and that it benefited
the patients as well as the therapists. Dreikurs proposed
that multiple therapy had four advantages which usually
characterize dynamic psychotherapy. He believed that multiple
therapy: (1) created the proper transference relationship
which was conducive to the patient's growth; (2) helped the

patient to gain a better understanding of himself: (3) helped

 

 

 

the investigation of the patient's problems by providing two
people who were sincerely trying to evaluate the facts for
the patient's benefit; and (4) stimulated the patient to
change his attitudes, goals, outlook and approaches in his
life (Dreikurs, 1950, p. 791). Haigh and Kell (1950), who
were influenced by Warkentin, focused on multiple therapy
primarily as a method for training and research in psycho-
therapy. While they felt that multiple therapy raised a
number of questions that were worthy of investigation, they
also recognized its therapeutic usefulness.

In the same year, Whitaker, Warkentin, and Johnson
(1950) published an article in which they discussed the use

of multiple therapy for a different purpose. In their ex-

 

perimentation with this method, they found that it was useful

in resolving the therapeutic impasse which sometimes arises
in individual psychotherapy. They believed that the thera—
peutic impasse occurs as a result of a disturbance in the
human relationship between the patient and the therapist.
Sometimes this disturbance becomes so great that the thera—
peutic process is blocked. If the therapist is unable to
learn what the difficulty is and act accordingly, to change

it, a "stalemate" occurs which frustrates both the patient

and the therapist in their quest for growth. Whitaker et al.

report that at such times the introduction of a second thera-

pist breaks the impasse. The second therapist may be present

for one session or for several-—as long as he is needed.

 

 

If the patient and therapist are able to
express their mutual difficulty, the consultant
[the second therapist] is more likely to become an
effective catalyst to the relationship. In this
triangular situation it has seemed logical that
the therapist should question his own motives first,
so as to provide a better basis for the patient's
participation. The presence of the consultant is
also valuable because he is able to carry part of the
reSponsibility for the patient, so that the thera-
pist can express what he had suppressed from fear
of his own immaturity (Whitaker et a1., 1950,
pp. 644-645).

Dyrud and Rioch (1953) and the present writer have
also found that using multiple therapy when a therapeutic
impasse arises in individual psychotherapy is helpful in
getting the patient and the therapist through the impasse.

The Application of Multiple Therapy in Various
Therapeutic Situations

Individual Therapy

The benefits of using two therapists have been noted
in a variety of therapeutic situations. A number of articles
have appeared that discuss the therapeutic advantage of having
tWQ therapists when dealing with psychotic patients. Work-
ing with psychotics is not an easy task. As Dyrud and
Rioch (1953) point out, it is easy for a therapist to become

tired, discouraged and angry because of the rigidity and

uncommunicativeness that these patients display. Some

therapists feel that the expenditure of effort and emotional

resources that are required in treating a psychotic patient

is too great for one therapist alone (Hayward, Peters, and

 

 

Taylor, 1952; Whitaker, Malone, Warkentin, 1956; Mullan and

Sanguiliano, 1964; Fielder, 1967, Warkentin, 1967). One

of the major advantages of using multiple therapists with
psychotics is that it offers both moral and physical support
to the therapists. "With the overtly psychotic and actively
suicidal patient, the presence of more than one therapist
makes possible a treatment experience which otherwise would
be a hazardous undertaking" (Mullan and Sanguiliano, 1964,

p. 170). This mutual support frees the therapists to function
in a way that is most helpful to the patient and allows him
to react to a wider range of the therapeutic relationship.
Whitaker and his associates have found that multiple therapy
has been so effective in treating severely disturbed patients
that they state that it is preferred treatment with psycho—
paths and psychotics. "When a patient is severely ill, so
that all the pertinent material is hidden and disguised, the
presence of more than one doctor can do much to pick up a
greater number of clues as to the conflicts involved"
(Hayward et al., 1952, p. 247).

Whitaker et al. also believe that multiple therapy
allows each therapist to be more professionally and emotionally
involved with such patients. Such involvement intensifies
the patient's and therapist's emotional experiences with
each other and makes the impact of the therapists upon the
patient more noticeable and powerful (Whitaker et al., 1956;

Mullan and Sanguiliano, 1964). When a therapist feels free

 

to be deeply involved with a patient, he can exert a stronger
integrative force upon the patient: multiple therapy seems
to provide this freedom (Hayward et al., 1952).

Therapists who use multiple therapy with severely
disturbed patients (psychotics, psychopaths, suicidal patients)
believe that multiple therapy is useful in helping these
patients, in particular, to clarify their ambivalent feelings.
For these patients the experience of intense ambivalent feel—
ings is unreasonable and intolerable. "When working with a
single therapist, the patient will often show great diffi-
culty in expressing any feelings, because of this intolerable
mixture of love and hate. When two or more physicians are
present, the patient can split his feelings, so that strong
affection is expressed for one physician and hostility for
another” (Hayward et al., 1952, p. 245). In this way, the
patient learns to deal with both kinds of feelings and grows
emotionally.

Another advantage of using multiple therapists with
severely disturbed patients is that it is a method of treat-
ment which supports and "gives expression to the patient's

regression”, while it provides the control for him and demands

that he become responsibly involved with others (Mullan

and Sanguiliano, 1964). One therapist may deal with primary

Process material while his co-therapist focuses on the

Secondary process content (Frame, 1965). "It appears that

one therapist can be selected to represent the reality

 

 

principle, allowing the patient to give fantasy reactions

free play with the other threapist. A stable relationship
with one therapist seems to provide a framework, or a safe
anchorage, permitting the patient to feel and explore violent
reactions which under other circumstances might be restrained
through fear of a complete break with reality" (Mintz, 1963a.
p. 127). In this way tw° different and conflicting ends can

be incorporated together.

Group Therapy

The use of two therapists in psychotherapy has been
applied to other areas of treatment besides individual psycho—
therapy. As seen in the literature, interest in multiple .
therapy groups has been increasing. Group therapy with two
therapists has been used to treat: chronic neurotic patients
in a mental hospital (Cameron and Stewart, 1955): eighth
grade behavior-problem boys (Daniels, 1958) and girls
(Staples, 1959); psychotics (Lundin and Aronov, 19527
Demarest and Teicher, 1954; Orange, 1955); marital couples
(Kadis and Markowitz, 1966; Gottlieb and Pattison, 1966);
acting-out adolescent boys (Kassoff, 1958; Adler and
Berman, 1960); and college students (NUnnelly, 1968). For
the most part, articles on the use of multiple therapists in
group therapy have been favorable to this method of treat-
ment.

The use of two therapists in group therapy has im—

pressed many therapists with the intensity and variances of

 

 

 

 

 

   

10

transference that can occur in a group (Demarest and Teicher,
1954: Hulse, Lulow, Ruidsberg, and Epstein, 1956; Pine, Todd,
and Boenheim, 1963: Mintz, 1963b, 1965). In this regard,
such a method of treatment seems to provide a greater dynamic
base for interaction than is possible in group therapy with
one therapist. As Solomon, Loeffler, and Frank (1954) have
pointed out, the interaction which takes place in this
setting nurtures both the therapists and the group.

The presence of a male and female therapist in the
group provides more of an opportunity for patients of both
sexes to identify with an adequate person of the same sex
and to work out whatever problems they may have with both
sexes. While the two therapists provide a positive stimulus
for transference reactions, ". . . they [also] stand for
masculine and feminine authority; real people against whom
family stereotypes of male and female can be tested; and
models for an enhanced understanding and acceptance of sexual
role" (Mintz, 1965, p. 294). ”The technique of using co-
therapists of different sexes also allows for a reversal of
the roles that the patient anticipates that figures of either
sex must adopt in order to relate to him. . . When the
patient is faced with the problem of modifying, in the presence
of therapists of both sexes, his expectations of the roles of
a man and a woman, he is presented with a situation that
actually exists in the family" (Demarest and Teicher, 1954,

p. 202). Another advantage of having two therapists in a

 

 

 

11

group is that it helps the patient confront the therapist

of "the dreaded sex", and about whom he has anxieties, with
the support of the other therapist who belongs to the less
frightening sex. As Mintz (1963a, 1965) states, the patient
chooses the therapist of the less dreaded sex to support

him in his attempt to deal with the therapist of the dreaded
sex whom he fears will destroy him.

Still another advantage of using this method in group
therapy is that it helps the therapist's understanding and
appreciation of the individual and group effects (Pine et al.,
1963). While it may be true that more complex patterns of
resistance and interaction occur in multiple-therapy led
groups than in usual group therapy, it also seems true that
multiple therapy provides more opportunity to understand
this complexity than does regular group therapy (Rabin,
1967a). The two therapists are more able to evaluate the
"interplay" of the transference phenomenon in the group than
one therapist because the two therapists are able to focus
on more patients in a group at the same time, with the same
personal contact, than a single therapist can (Lundin and
Aronov, 1952). "By having two observers who can view the
same phenomenon from different angles, it is possible to
more accurately appraise the stimulus field existing in the
group at a given time and thus distinguish between reality
reactions and transference reactions" (Demarest and Teicher,

1954. p. 201).

 

 

 

12

The use of two therapists in group therapy has proven
to be effective with patients who need a lot of authority to
control their actions. Kassoff (1958) and Adler and Berman
(1960) began using two therapists in a group setting as a
matter of necessity with acting-out adolescent boys, whom
these authors characterized as having a low tolerance for
their feelings of ambivalence. One of the difficulties in
treating such a group of individuals is that their intense
ambivalent feelings usually block the therapist in his attempt
to have them respond to the world in a different way. The
therapist's relationship with such an individual usually
remains intact only if the therapist is seen in a positive
light and does not stimulate negative feelings at the same
time. The fulfillment of such a goal is almost impossible
and even if this goal could be met, one would certainly
question its therapeutic value. Kassoff, and Adler and
Berman discovered that using two therapists in a group was
effective in dealing with the great ambivalent feelings of
the delinquent boys they were treating. ”In the dual leader-
ship situation, however, the ambivalent feelings could be
handled by expressions of hostility toward one of the group
leaders, while the relationship between the group and the
other leader would remain relatively intact. This kept
channels of communication open . . ." (Adler and Berman,
1960, p. 218).

The use of two therapists in group therapy has been

criticized by Slavson, a leading psychoanalytic group

 

 

13

therapist, on the grounds that it "splits off" the patient's
transference feelings between the two therapists (Slavson,
1950, 1960). He argues that the patient's ambivalent feelings
cannot be resolved because the presence of the two therapists
tend to dilute the transference and may encourage abreaction
rather than help the patient. As indicated above, many writers
do not agree with Slavson's viewpoint. NUnnelly (1968), who
did the first experimental study of the use of multiple
therapy in group counseling, obtained results that certainly
suggest that Slavson is wrong. Nunnelly found no evidence

to indicate that the multiple therapy group did not make as
many gains as the group counseling experience led by indivi—
dual therapists. In fact, he has some evidence which suggests
that group counseling with multiple therapists produces more
over-all improvement (in terms of ego strength, social intra—
version, perception of mother and father acceptance, and self—
acceptance) than those led by single therapists. It is this
writer's contention that the use of multiple therapists in

a group setting clarifies and dramatizes the transference
relationship and actually helps in its resolution. Further,

" . . the splitting of transference between a male and
female therapist cannot be viewed as an objection inasmuch
as every human being develops, biologically and psychologi-

cally, in a tWO-parent family" (Mintz, 1965, p. 293).

 

 

 

14

Family Therapy

Multiple therapy has become the preferred method of
treatment in family therapy (Belmont and Jasnow, 1961:
Rubinstein, 1964: Whitaker, Felder, and Warkentin, 1965;
Framo, 1965; Sonne and Lincoln, 1966; Rubinstein and Werner,
1967). One of the major advantages of using multiple thera-
pists in treating a family is that it prevents the therapist
from being engulfed by the family. By working together, the
two therapists are better able to deal with the family's
maneuvering and problems than one therapist could alone
(Rubinstein, 1964). "By virtue of their maintenance of
unity in a symbolic 'healthy marriage', the therapists can
help each other resolve their experience of dispair, and
save each other from being incorporated, against their will,
into a family system in psychopathological dyads” (Sonne and
Lincoln, 1966, p. 199). If the therapy is not done by multiple
therapists, the therapist may become bound by the dependency
of the family. A single therapist may often feel helpless
in dealing with a family and can be easily seduced in such
a situation to support and share various pathological family
beliefs. "In breaking the congealed 'people salad' by the
addition of another person, the therapist may become free
to move in and out of his involvement with the family rather
than frozen into it" (Whitaker et al., 1965, p. 339). The
presence of two therapists allows one therapist to withdraw

when necessary while the other carries on.

 

 

 

 

15

Another advantage of using multiple therapists in
the treatment of a family is that it leads to more accuracy
in understanding dynamics and in the selection of thera-
peutic approaches. The use of two therapists enables them
to intervene more effectively into the family system and to
understand what needs to be done to break up the pathological
alliances that have been formed to the detriment of all of
its members (Rubenstein and Werner, 1967). Still another
advantage of this approach is that it ". . . helps allay
family anxiety so that the members can more freely explore
the depths of their relationships" (Framo, 1965, p. 201).

Definition of Multiple Therapy:
Multiple Therapy vs Co—therapy

At this point, it seems necessary to discuss more
thoroughly what multiple therapy means in the context of this
paper. As Spitz and Kopp (1963) point out, the use of more
than one therapist at one time in a treatment situation has
been called by many names: multiple therapy, co—therapy,
role-divided therapy, three-cornered therapy, joint inter-
view, co-operative psychotherapy and dual-leadership. Hew-
ever, it is this writer's belief that it is a mistake to
think automatically that multiple therapy is synonymous with
the approaches implied by these other terms. While it is
true that in all of these approaches two therapists are used,
the similarities between multiple therapy, as defined here,

and the other approaches are slight. Multiple therapy is

 

 

16

more than just having two therapists work together: In this
writer's opinion, one of the serious theoretical mistakes
that has been made by some writers in discussing multiple
therapy is the equation of multiple therapy with c04therapy.
’ Multiple therapy refers to the use of two therapists who are
involved intimately, affectively, and spontaneously with
each other and their patient(s). The real impact of this
approach occurs as a result of the therapists' spontaneous
and reciprocal interaction.

Multiple therapy is the simultaneous thera—

peutic 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 but 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,
there is offered an unlimited possibility to
search for and to find new meanings (Mullan and
Sanguiliano, 1964, p. 164).

Agreeing with Mullan and Sanguiliano, the present
writer views co-therapy as a limited form of multiple therapy.
. The relationship between the two therapists in multiple
therapy is often existential in nature, while in co—therapy
the two therapists rely on distance by role playing. In
co—therapy, the two therapists are not oriented toward a
phenomenological process but toward fulfilling certain pre-
arranged functions. The therapists' roles are deliberately

set up by the therapists to solve a specific situation

(Mintz, 1963b). The usual situation in co-therapy is for

 

.111!
lllfl I
I'll!)

 

17

one therapist to act in a supportive, passive, and good
manner while the other therapist plays an aggressive,
dominant role. Such an approach: (1) is artificial in
nature; (2) limits the therapists' freedom to be themselves
and thus grow; (3) depersonalizes the patient by depersonali—
zing the therapists; (4) may prove to the patient what he

has always thought--that he is inadequate in his attempt

to change his environment, since he cannot change his
therapists; and (5) encourages our cultural stereotype about
how a man and woman should be and feel. As Haigh and Kell
(1950) state one of the major characteristics of multiple
therapy is that ". . . we have a genuine therapeutic situation
where each therapist is ego-involved and in contact with the
direct experience of therapy" (Haigh and Kell, 1950, p. 660).
The demands of multiple therapy in contrast to co—therapy

are much greater in terms of the involvement required of

the therapists. The intensity of the therapeutic situation
is increased by such involvement which adds to the depth of
the encounter. "The relationship between the two therapists
in multiple-therapy in contrast to co—therapy calls upon

each therapist to be more totally present. . . In co-
therapy, this relationship in all of its complicated nuances
is more apt to be partly avoided or entirely ignored” (Mullan
and Sanguiliano, 1964, p. 184). The outline which follows
that presents the differences between co-therapy and multiple
therapy in a concise form is taken from Mullan and Sanguiliano

(1964: PP9 184-185).

 

 

18

MULTIPLE-THERAPY CO—THERAPY
Transactional, leading to en— Interactional and self-
counter (change in all) actional (change in patient(s))
[Such an activity is existen- [Such a way of behaving is
tial in mood. All members of characterized by self—deception
the situation are active par— in the therapists and their
ticipants who exist only in patient(s). These deceptions
relationship to each other] are manifested in their inter—

action. The effort seems to
be on changing the patient]

Non-teleological Teleological
Phenomenological Pseudo—Scientific

Intimate Less intimate

Tendency away from role Tendency to role play
playing

Status mobility Status fixity

Function: Satisfaction of Satisfaction limited to a
all participants through change in patient toward a
deep modification of exist— set goal

ing relationships

Overt and continuous use of Covert use of the therapists'
the participants' unconscious unconscious and overt use
of the patient's some of the
time.

The Importance of the Relationship between Two
Therapists in Multiple Therapy

While it has been recognized that the crucial factor
in the success of multiple therapy is the relationship between
the two therapists, very little has been written about it.

The study of the dynamics of this relationship deserves more
attention. Each team of multiple therapists must have a
mutual relationship, in which both are deeply involved with

each other, if they are to be effective. Mullan and Sanguiliano

 

19

believe that the deep feeling the two therapists have
”. . . for one another causes them to respond to the patient
in a meaningful and integrated manner. . . . Moreover, it
seems important for the two therapists to be closer to each
other than to any one of the patients they are with” (Mullan
and Sanguiliano, 1960, pp. 561—562). The therapists need

this kind of relationship in order to prevent the patient

from repeating his life long pattern of separating and
conquering his parents and in order to help the therapists
realize their growth wishes. By being involved with each
other in a healthy manner, the therapists help the patient
recognize the self-defeating aspect of separating the multiple
therapists. Multiple therapy ceases to be effective at those
times when the two therapists are in an emotional conflict.
While the patient may be extremely able to increase the dif-
ficulties between his therapists, he is not the cause of

their emotional conflict. The patient's attempts to separate
his therapists could not work unless the relationship between
them contained the seeds of conflict before the patient was
seen (Kell and Burow,in press). At the times that the conflict
occurs in the therapeutic process feelings of pain, betrayal,
jealousy, anger, competition, fear, etc. may be felt by one

or both of the therapists. Such feelings of hostility,
rejection, etc. stemming from the conflict may be transferred.
If the two therapists develop a situation which makes the

patient a scapegoat for their unresolved conflicts (a situation

 

 

 

20

that "simulates" the original family group), ". . . then the
basic purpose of the co-therapist method will have been lost.
The patient will have no recourse but to further strengthen
sick defenses which were erected during his childhood”
(Lundin and Aronov, 1952, p. 79). If the conflict between
the therapists is very intense and shows no signs of resolu-
tion, the therapists may have to terminate their working
together or the patient may leave therapy. However, in most
cases, the conflict is worked out to the benefit of the
therapists and the patient. The therapists benefit by the
resolution of the conflict because it has helped to push
their growing edge and to restore their ability to under-
stand their patient again. The therapists show the conflict
is resolved when they can feel pleased with their inter-
action. Anything which furthers the therapists' growth in
the interaction helps the patient also. One of the major
things a patient may learn from the resolution of the con—
flict is that ". . . an adult man and woman can be puzzled,
anxious, or even in conflict, and that these same adults

can resolve their problem by talking to each other. Such

an outcome between adults, particularly a man and a woman,
is likely to have been more rare in such a client's past

experience” (Kell and Burow, in press, p. 405).

 

 

21

Professional vs Dynamic Attraction in the
Selection of a Co—therapist

The preceding discussion about the effect of the
therapists' interaction in multiple therapy raises questions
about the factors that cause them to choose each other and
that allow them to work together effectively. The multiple
therapy relationship cannot be built upon the professional
similarities which exist between the two therapists; the
relationship demands more than that. “The multiple therapy
relationship is not mutual because of similar training or
identical experience. Rather, it becomes mutual in our need
to exist simultaneously and as a unit in an on—going process"
(Mullan and Sanguiliano, 1960, p. 562). However, professional
similarities do seem to create a basis for the initial pro-
fessional attraction between two therapists. Similar
experiences, therapeutic approaches, theoretical viewpoints,
views about life, etc. seem to function to select for each
therapist the sort of colleague with whom he is likely to
interact. Borrowing a concept from Winch (1958) it seems
that these similarities define for each therapist a "field
of eligible co—therapist candidates" within which he is
likely to choose his partner for multiple therapy. The
next logical question is, what are the factors that cause a
therapist to choose his partner rather than another person
for multiple therapy? Professional similarities may define

the "field of eligibles”, but it is important to know the

 

 

 

22

psychological factors that set the limits of the field and
that determine the selection within that field. It is this
writer's belief that each therapist's selection of his co-
therapist from this "field of eligibles" is based upon
dynamic factors. When two people engage in multiple therapy,
one can surmise that there is something about the relation-
ship which causes each of them to want to be with the other.
If two therapists do multiple therapy together, it seems
reasonable to believe that each therapist derives some
gratification in the interaction with the other. "If it is
reasonable to speak of gratification, then it makes sense to
postulate some needs in each which the interaction (and
hence the behavior of the other) may gratify" (Winch, 1958,
p. 16).

Of all the needs which could be mentioned only a
few seem to be relevant to the present study. Eleven needs
were examined in this study. The definitions of the needs
used in this study have been modified from those cited by
Murray (1938) and Edwards (1953). The needs that were used

and the definitions of them are given below.

Definitions of the Needs Employed in This Study

Abasement (Aha): A person with a need for Abasement values
himself little, is highly self-critical, and is depressed
by feelings of unworthiness. The goal of this need is to

admit inferiority, error, wrong-doing or defeat in order

 

 

23

to avoid blame, pain, or punishment and to gain forgiveness
and approval. A person with a need for Abasement tends to:
suffer an insult or injury without fighting back; feel compel—
led to confess, apologize, or promise to improve; adopt a

meek or humble attitude; feel guilty when he does something
wrong; accept blame when things go wrong; desire punishment
for mistakes or errors; feel better for giving in than
fighting and complaining about his rights; feels depressed

by inability to handle difficult situations; blame, belittle,
or humiliate himself; and feel inferior to other people in

most respects.

Achievement (Ach): A person with a need for Achievement has
a desire or a tendency to work at something as rapidly and

as well as possible. The aim of such a person is to try to
do everything well and to accomplish something that is
creditable. An individual with a need for Achievement desires
to attain tasks that require skill and effort; wants to
overcome any obstacle; likes to work at difficult tasks;
enjoys competition; sets difficult goals for himself which

he attempts to reach; wants to be recognized as an authority;
wants to belong to a profession; continually strives to be
successful; displays a determination to win; wants to do
things better than other people and wants to write a great

play, novel, etc.

Affiliation (Aff): A person with a need for Affiliation

wants to be with and interact with other people. This is

 

24

the type of person who seeks to form and maintain intimate
relationships with people. The aim of the need for affilia—
tion is to form a mutually enjoyable, enduring, and reciprocal
relationship with another individual. A person with a need
for Affiliation will participate in friendly groups, form

new friendships, ask people to do things with him, share
things with friends, enjoy cooperating with others more than
working alone, enjoy social gatherings, is loyal to friends

and institutions.

A ression A ): An individual with a need for Aggression
has a tendency to push forward his own goals, interests, or
beliefs, despite opposition; he attacks rather than avoid

a threatening situation. The need for Aggression is accom-
panied by anger which gets the individual to forcefully prose-
cute his own ends if such action is necessary for a goal to
be reached. Such an individual displays self-confidence and
boldness in action and in expressing himself. An individual
with a need for Aggression will attack contrary points of
view; show anger; attack, injure or kill an animal or person;
tell other people what he thinks of them; speak in a forceful
way; destroy a physical object; express or show hatred; get
revenge for insults; injury or moral wrongs; criticize others
publicly; like sports with physical contact--e.g., football,
boxing, etc.; curse or blame individuals who get in his way;

read about violence; enjoy arguing.

 

 

   

 

25

Autonomy (Aut): An individual with a need for Autonomy
wishes to have self-government without outside control. The
aim of such a person is neither to direct others nor be led
but rather to be left to do things in his own way, without
restriction or coercion-~in other words, he wishes to be
independent and free to behave in a manner that suits him
at any given time. An individual with a need for Autonomy
wants to remain unattached, does not ask others for their
opinions in making his decision, avoids domineering authorities,
defies authority, feels free to do what he wants, avoids
reSponsibilities and obligations, goes against convention,

and seeks environments with few rules.

Deference (Def): The aim of a person with this need is to
move towards, salute, and conform to the wishes of someone

he sees as superior to him. An individual with a need for
Deference follows suggestions, admires great men, accepts
suggestions rather than insist on working things out on his
own, accepts the leadership of a more experienced or know-
ledgeable person, chooses a superior ally, attempts to do
something by copying an idolized leader, follows instructions
and does what is expected, attempts to find out what others
think, tells others they have done a good job, reads about

great men, believes in conformity, and cooperates eagerly.

Dependence (Dep): A person with a need for Dependence craves
affection, understanding, and tenderness and seeks out people

on whom he can rely. The goal of this need is to be dependent

 

26

upon someone who will gratify one's desires or who will help
with one's pains. Such a person tends to depend upon others
for aid, advice, forgiveness, support and protection. A
person with a need for Dependence will ask to have others
provide help when in trouble, enjoy receiving sympathy,
nourishment, and understanding about personal problems,

accept favors cheerfully, seek help when depressed, like
others to feel sorry when he is sick, feel lonely in solitude,
receive a great deal of affection, will like others to be

concerned when he is hurt or suffering from hardships.

Dominance (Dom): A person with a need for Dominance desires
to influence or control the feelings, ideas, and/or actions
of other individuals. The aim of the need for Dominance is
to induce individuals to behave in a manner which conforms
with one's feelings and desires. A person who displays this
need will argue for his cause against another; try to lead;
govern, manage people; enjoy organizing or directing the
actiVities of a group; take initiative to get people to
co-operate; seek to have his ideas prevail; try to get
individuals to see him as the leader; try to supervise and
direct the behavior of others; work to be the leader of a
group and dislike a secondary role; endeavor to be elected
to various offices; will make laws and set standards for
others, and will stimulate or initiate various programs or

ideas.

 

27

Heterosexuality (Het): A person with a need for Hetero-

sexuality is attracted to and interested in persons of the
opposite sex. The goal of such an individual is to form and
encourage a relationship with the opposite sex. A person
with a need for Heterosexuality will enjoy the company of

the opposite sex; be fond of dancing; engage in social activi-
ties centered around both sexes; wishes to embrace, kiss,

hold hands, and engage in other sexual activities; wishes

to be in love; participates in discussions about sex; has
erotic dreams and/or fantasies; seeks to be regarded as
physically attractive by those of the opposite sex; and reads

materials about sex.

Nurturance (Nur): A person with a need for Nurturance aids,
protects, supports, encourages any individual who can be
described as being weak, disabled, tired, inexperienced,
defeated, humiliated, lonely, dejected, sidk or threatened

by danger. A nurturant person is one who is tolerant toward
people who are distressed and/or hurt. Such a person helps
when people are in trouble, assists others less fortunate,
treats people with kindness and sympathy, forgives others,
does small favors, is generous, sympathesizes with individuals
who are hurt or sick, and has others confide in him about

their problems.

Passivity (Pas): An individual with a need for Passivity
feels most comfortable in those situations in which his

behavior is externally rather than internally initiated and

 

 

 

 

 

 

 

 

28

controlled. The goal of such a person is to be the object
of action rather than the cause of action; he is a person who
is characterized by a lack of spontaneous activity. An
individual with a need for Passivity enjoys secondary roles,
lets others dominate, avoids exerting himself, and wants to
be free of making a decision. An individual with this need
will let others take the lead, does not participate readily,
will wish to receive benefits without effort or without
making his wishes known, may submit without resistance, will
wait for external stimulation before acting, will relax or
daydream rather than reach out for what he wants, and will

make no effort to control events.

Complementary and Supplementary Needs

A number of writers have indicated how multiple
therapists seem to supplement and complement each other's
personalities and resources (Demarest and Teicher, 1954;
Linden, 1954; Solomon et al., 1954; Gans, 1957; Mintz, 1963b;
Mullan and Sanguiliano, 1964; Kell and Burow, in press).
Solomon et a1. advocate that it is essential that the
relationship between the two therapists be complementary
for their proper functioning in multiple therapy. "It is
logical to assume that one therapist's assets and limitations
will not be exactly similar to another's. . ." and that the
personality differences between them add greatly to their

relationship (Demarest and Teicher, 1954, p. 200; Mullan and

 

29

Sanguiliano, 1964). Kell and Burow believe that the word
"complement" is a key concept in any discussion of multiple
therapy. They believe that successful multiple therapy
requires that the two therapists respond to each other in
complementary and collaborative ways over time. This writer
believes that the two therapists in multiple therapy could
not respond in such a complementary manner unless they comple-
ment each other at a dynamic level. Complementary, as used
here, means that as one therapist engages in a certain be—
havior, which has been aroused by his needs, his co—thera—
pists's needs will be gratified by this action and vice
versa. Another way of stating this is that each therapist
has certain needs, which when fulfilled, provide satisfaction
to the other therapist.

From a theoretical standpoint, it is only reason-

able to expect that the more Person A wants to

give what Person B wants to receive (and the more

B wants to give what A wants to receive), the

easier it will be for the pair to form and main-

tain a viable relationship. The more that such

conditions exist, the greater will be the mutual

reward of the pair members and the lower the

cost of achieving it (Levinger, 1964, p. 154).
Complementarity of needs can occur in two ways. The first
way two individuals' needs may complement each other occurs
when they differ in degree of the same need. For example,
when one individual has a high need and the other has a low
need for dominance, the difference between them on this need

is seen as complementary. The second way two individuals'

needs can complement each other occurs when they differ in

 

30

the kind of need expressed. For instance, when one person
has a high need for nurturance and another individual has a
high need for succorance, their needs can be seen as comple—
mentary (Winch, 1958; Tharp, 1963).

Complementary Need Patterns between Pairs
of Multiple Therapists

The Dominance-Receptive Dimension
It is thought that the therapist-therapist inter—

action will be optimal when the two therapists' needs com-
plement each other on a dominance-receptive dimension. The
receptive cluster of needs is represented by the needs for
deference and passivity (Winch, 1958). Gans (1963), super-
vising teams of psychiatric residents who did group therapy
together, found that the two therapists did poorly together
when they were in conflict along a dominance-passivity di—
mension. He states that such a conflict disrupted their
co-operative venture and led to feelings of resentment. It
seems reasonable to expect that two therapists would not
function well together in multiple therapy if they both were
high in the need for dominance or high in the need for
passivity.

Two therapists who are at the same time dogmatically

active may find themselves competing with each other

for the attention . . . [of the patients]. Conversely,

two passive therapists may similarly fail to fulfill

the needs . . . [of their patients]. Furthermore,

they will neither support nor complement each other

at those times when adequate handling of the problems

. . . [of their patients] is impeded by the personality

difficulty or "blind spot" of an individual therapist
(Solomon et al., 1954, p. 177).

 

31

Since this writer and other investigators (Linden,
1954; Sonne and Lincoln, 1954; Rabin, 1967a) have made an
analogy between a good multiple therapy relationship and a
healthy marriage, it seems appropriate to consider the
studies investigating the patterns of needs of marital
partners to see if these studies can shed any light on the
present investigation.

One of the major findings that Winch (1958) derived
from his exhaustive work on mate selection was that the
Spouses needs tended to complement each other in terms of
dominance-deference and that this complementarity influenced
mate selection. From his work, Levinger (1965) concludes that
marital partners function well together when one of them
needs to dominate the other needs to accept such domination.
Thus the above seems to offer some support for the belief
that therapists who have chosen to work together in multiple
therapy fulfill each other's needs along a dominance-receptive
dimension. Table 1 shows the ways two individuals' needs
can satisfy each person in terms of this dimension.

Table 1. Pairs of needs that are seen as satisfying each
other along a dominance—receptive dimension.

 

 

Person A Person B
1. High need for dominance 1. Low need for dominance
2. High need for passivity 2. Low need for passivity
3. High need for deference 3. Low need for deference
4. If A is high in need for 4. B is high in need for
dominance passivity
5. If A is high in need for 5. B is high in need for

dominance deference

 

 

32

The Dependent-NUrturant Dimension

The second complementary need pattern that seems
relevant to the multiple therapeutic relationship is the
dependent—nurturant dimension. The multiple therapeutic
relationship, in order to be enjoyable and profitable, must
contain the seeds that enhance the well—being of the two
therapists. In order for the relationship to be truly
"mutual", the dependency needs of each therapist must be
met. "Our OWn experience as well as that of others who
have done multiple therapy tells us that being able to
depend on each other is often times vital to the multiple
therapeutic venture" (Kell and Burow, in press, p. 408a).
Experience with multiple therapy suggests that each co-
therapist attaches importance to his partner because he
recognizes at some level that he receives something from
his partner that is of consequence and that he appreciates
what his partner has to offer (Mullan and Sanguiliano, 1964).
Successful multiple therapy seems to occur when each thera—
pist feels free to be the therapist or the patient of the
co-therapist (Warkentin, Johnson and Whitaker, 1951). As
Kell and Burow indicate, the relationship between the two
therapists provides an opportunity for both therapists to
satisfy their nurturant and dependent needs.

Evidence from studies dealing with the patterning
of needs in marriage indicate that the dependent—nurturant

dimension is an important variable in understanding intimate

 

 

33

relationships. Katz, Glucksberg, and Krauss (1960) found
that wives' satisfaction with their marriage was positively
related to their husband's need for nurturance and that the
husband's satisfaction in this relationship was positively
related to their wives need for nurturance and dependence.
Winch's Work (1958) led him to conclude that complementarity
of needs along the dependent—nurturant dimension was very
important in the selection of one's spouse. From the above
information, it seems that studying the dependent—nurturant
dimension for complementarity of needs among teams of
multiple therapists may be helpful in gaining greater under—
standing the multiple therapeutic relationship.

It seems necessary to point out that the present
writer does not view nurturance and dependence as polar
opposites. It is not necessarily true that a highly nurturant
person is automatically low in his need for dependence. It
is quite probable that a highly nurturant person would great—
ly like to have his dependency needs met. What the above
statements imply is that if complementarity of needs exist
between two therapists along a dependent-nurturant dimension,
it occurs because one therapist's need for dependence is
complemented by his co—therapists' need for nurturance and
not because they differ in their need for dependence or
nurturance.

There is no basis for theorizing that 311 of the
needs of the teams of multiple therapists should be comple-

mentary. In fact it is thought that the therapeutic

 

34

relationship demands that the two therapists be similar on

some of their needs if they are to function well together.

Similar Need Patterns between Pairs
of Multiple Therapists

Need for Achievement and Autonomy

 

It would not be expected that two therapists would
function well together in multiple therapy if they differed
in degree in their need for achievement or in their need
for autonomy. As Levinger (1964) points out, it does not
make sense to posit that two individuals function best to—
gether when one is high and the other is low in their need
for achievement. "For a maximal coordination of their
efforts, maximum similarity of achievement motivation might
be most advisable" (Levinger, 1964, p. 155). Also, it seems
highly unlikely that a therapist with a high need for
autonomy would choose to work with a co—therapist with a
low need for autonomy. It seems that if they differed
greatly on this particular need, the relationship would be
frustrating to both of them; one therapist would be striving
for independence while the other would be trying to form

a dependent relationship.

Need for Abasement and Aggression

Since our society and many of our theories of per-

sonality have spent a considerable amount of energy focusing

 

35

on the issue of aggression, it seems appropriate to consider
what role aggression plays in the relationship between the
two therapists who do multiple therapy together. A number
of writers (Leary, 1957; Winch, 1958) have reasoned that
two individuals will be attracted to each other when one
individual has a high need for aggression and the other has
a high need for abasement.

There exists a large number of individuals who

are most comfortable . . . when they are tied to

a hostile partner. . . . An intense symbiotic

relationship exists between those who are least

anxious when hurting or derogating and those who

are least anxious when receiving negative actions

(Leary, 1957, p. 344).
While such a dyadic relationship can be described as recipro—
cal or complementary, it does not appear to be conducive
to the individuals' emotional growth and well—being. It is
believed that the multiple therapeutic relationship is not
based upon such a destructive interaction. It is hard to
think that pairs of multiple therapists are so disturbed
in their interpersonal relationships that they chose to
work together in order to satisfy these devastating needs.
In a similar way, it is unlikely that an individual would
choose to work with someone whose need for aggression dif—
fered greatly from his OWn, since working together may pro—
duce undue tension and anxiety. As Whitaker (1967) stated,
the relationship between the therapists must be such that
both therapists feel equally strong. It is believed that

the two therapists will view each other in that way when

they are similar in their need for aggression.

 

36

Need for Affiliation and Heterosexuality

It is expected that therapists who choose to work
together will be similar in their needs for affiliation and
heterosexuality. Talking to multiple therapists, the author
has observed that one of the major factors that many thera-
pists use in selecting a co-therapist is the degree to which
they feel an individual wants to associate with people.

Some therapists have indicated that they have avoided working
with certain people because they feel the latter places

too many demands on them to be friendly, close, etc., while
other therapists have said that they could not work with an
individual because he wanted too much distance from people

to suit him. It is thought that feelings of anger, depriva-
tion, disapproval, distrust, etc. would arise in the multiple
therapy relationship if the two therapists differed in their
need to form and maintain intimate relationships. For these
reasons, it is believed that two individuals who differed in
their need for affiliation would not choose each other as
partners in multiple therapy.

This writer believes that two therapists could not
work together if they operated at different levels of sexual—
ity. It is believed that both therapists must enjoy the company
of the opposite sex to roughly the same degree in order for
each of them to feel appreciated as male and female. "It
is my hunch that perceiving your opposite sexed co-therapist

as attractive (including sexuality) and feeling comfortable

 

37

with your feelings of attraction is one factor in a more
successful co-therapy relationship . . .“ (Rabin, 1967b).
It is also thought that the two therapists could not be
comfortable with each other if one therapist had a high
need and the other had a low need for heterosexuality.

It would seem that their needs in such a situation would
conflict and drive them away from each other.

The Relationship between a Therapist's Satisfaction
in a Given Multiple Therapeutic Relationship

and the Needs of His Co-therapist

This writer contends that a therapist's satisfaction
in doing multiple therapy is a function, in part, of his co-
therapist possessing certain needs. The second part of this
investigation will examine the relationship between a thera—
pist's satisfaction in a given multiple therapeutic relation—
ship and the needs of his co-therapist. If one views
multiple therapy as a symbolic healthy marriage, then it is
logical to expect that each therapist will be satisfied in
the relationship to the degree that his co—therapist possesses
needs which enhance him. Another way of saying this is that
each therapist will be happy in the multiple therapeutic
relationship when his co—therapist has needs that make him
a more fully functioning person. If this relationship is
true, one would think that a therapist's satisfaction in the
relationship would be positively related to his co-therapist's

needs for achievement, heterosexuality and nurturance and

 

38

negatively related to his need for abasement. One would also
think that a therapist would be satisfied with his co-thera-
pist when his co—therapist possessed certain needs which
caused him to strive to increase the interpersonal relation-
ship between them. If a therapist's satisfaction is related
to his co-therapist's needs to form a closer relationship
with him, it is expected that a therapist's satisfaction is
positively related to his co-therapist's needs for affilia—
tion and dependence and negatively related to his need for

autonomy.

to work
in each

1.

 

HYPOTHESES

This study proposes that therapists who have chosen

together in multiple therapy fulfill certain needs

other.

It is hypothesized that pairs of multiple therapists

complement each other more on a dominance—receptive

dimension than randomly paired therapists.

a.

It is hypothesized that the strength of the bi—
polar relationship in terms of the needs for
deference, dominance, and passivity will be
greater in pairs of multiple therapists than
randomly paired therapists.

It is hypothesized that the strength of the
relationship between dominance and passivity
will be greater in pairs of multiple therapists
than randomly paired therapists.

It is hypothesized that the strength of the
relationship between dominance and deference
will be greater in pairs of multiple therapists

than in randomly paired therapists.

It is hypothesized that the strength of the relation-

ship between dependence and nurturance will be greater

for pairs of multiple therapists than randomly paired

therapists.

39

 

40

It is hypothesized that pairs of multiple therapists
are more similar in terms of their needs for abase-
ment, achievement, affiliation, aggression, autonomy,
heterosexuality, and nurturance than randomly paired
therapists.

It is hypothesized that a therapist's satisfaction

with his partner in multiple therapy is related to

his co-therapist's needs.

a. It is hypothesized that a therapist's satis-
faction with his co-therapist is positively
related to his co-therapist's needs for achieve-
ment, affiliation, dependence, heterosexuality,
and nurturance.

b. It is hypothesized that a therapist's satisfaction
with his co-therapist is negatively related to
his co-therapist's needs for abasement and

autonomy.

 

METHOD

Subjects

The Multiple Therapists Sample

In the present study, 12 pairs of multiple therapists
who volunteered to be in this investigation at Michigan State
University were included in this sample. The mean age of
these therapists is 33 and the average amount of experience
that each therapist has had in individual therapy is 3.8
years. Each one of the therapists chose his co—therapist
because he thought that their working together would be
pleasing to him.

These pairs of therapists vary in the amount of

time they have worked together from a few months to 3 years.

The Control Sample

The control sample is composed of another set of 12
male therapists and 12 female therapists from Michigan State
University. The mean age of this group of therapists is 29
and the average amount of experience that each therapist has
had in individual therapy is 3.6 years. Some of these
therapists have done multiple therapy while others have not
and do not wish to do so. From this sample of 24 therapists,

each individual was paired with a therapist of the opposite

41

 

42

sex in such a way that no individuals would be paired with

their co—therapist from multiple therapy.

Measuring Instruments

The Thematic Apperception Test (TAT)

The selection of a measuring instrument to examine
the variables in this study was based primarily on three
criteria. The first criterion was required for this study
was that the instrument should provide for the measurement
of the needs of the subjects, since inferences were to be
made at this level. Secondly, because the subjects in this
study were psychologically sophisticated, it was thought
that the instrument should be ambiguous enough to prevent
them from unwillingly influencing the results. Finally,
it was thought that the testing for each subject should take
no longer than one hour since the people who volunteered
for this investigation had many professional responsibilities
to meet. Based upon the above criteria, it seemed logical

to utilize the TAT.

Interpersonal §§tisfaction Scale (185)

The ISS is an index of a therapist's satisfaction
with his co-therapist in multiple therapy. This scale re—
quires that each multiple therapist rate himself as to the
degree of satisfaction he derives from the relationship he

has with his co-therapist.

 

43

The degree of satisfaction a therapist feels toward

his co-therapist was rated on a one to seven scale, seven

indicating the greatest amount of satisfaction. The directions

and the 188 are:

On the following scale, you are asked to rate the
amount of satisfaction you derive from inter-
acting with your co—therapist in multiple therapy.
Satisfaction in this context relates to how happy
you are with what your co-therapist is generally
able to offer you as a person. Circle the number
(no "in between" ratings please) which best des-
cribes the amount of satisfaction you derive from
working with your co-therapist. A "1” indicates
that you wish to continue with your co—therapist
because you believe he has the potential to fulfill
your basic needs. While you may be anxious about
how the relationship will develop, you feel satis-
fied enough with your co-therapist that you are
ready to explore some of your feelings and attitudes
with him. If you were to circle this number, you
would be indicating that you respect and like your
co-therapist but that you do not know each other as
well as you would like to. A "4” indicates that
your relationship with your co-therapist has been
so satisfying to you that you have complete trust
in him. Such a score indicates that your co-
therapist is able to satisfy your basic needs--
that he is able to reSpond in a helpful way to the
things that are very important to you. A "7” indi—
cates that an almost ideal relationship. If you were
to check this number, it would indicate generally
you could not be happier with what your co-therapist
supplies you. Such a relationship would yield
maximum satisfaction. Try to fill out this scale
as honestly as possible.

How satisfied you are with your co-therapist

 

 

 

44

Procedure

The Thematic Apperception Test (TAT)

Eleven cards of the TAT were administered to each
subject. All subjects Were given cards 1, 2, 38M, 4,

10, 12M, 13MF, l6, and 20. In addition, the males were
given cards 6BM and 7BM, While the females were given 6GF
and 7GF. The instructions to the subjects were as follows:

I am going to show you some pictures, one at

a time; your task will be to make up as dramatic

a story as you can for each. Tell me what has led
to the event shown in the picture, describe what is
happening at the moment, what the characters are
feeling and thinking; and then give the outcome.

Do you understand? Since you have sixty minutes
for eleven pictures, you can devote approximately
five minutes to each story. Here is the first
picture (Modified form from Murray, 1943, p. 3).

The stories were electrically recorded, and these
recordings were used to analyze the stories in terms of the
needs of each subject. Two raters were used to score the
content of the stories. Prior to the training sessions, the
raters Were given the definitions of each need and Were
asked to memorize these definitions so that they would have
a clear understanding of the meaning of each need.

During the first training session, the raters were
instructed in how to score the content in terms of Murray's
scoring system. This system analyzes the needs of "the
hero" in each story to determine the strength of the various
needs of an individual. The strength of each of the eleven

needs with which the study is concerned was rated on a zero

to five scale. A score of five is the highest possible

 

45

score that a need can be given in a story while the score
of zero indicates that the need is not expressed. The
strength of a need is determined by the intensity, frequency,
duration, and importance with which it appears in a story.
"The slightest suggestion of a variable (e.g., flash of
irritability) is given a mark of 1, whereas an intense
form (e.g., violent anger) or the continued or repeated
occurrence of a milder form (e.g., constant quarreling)
is scored 5. Marks of 2, 3, and 4 are given for intermediate
intensities of expression" (Murray, 1943, p. 8). In order
to help the raters rate the strength of a need when it was
determined by the frequency with which it appeared in the
story, the following rules were established:

1. One vague statement of a need: score 1

2. One clear statement of a need: score 2

3. Two clear statements of a need: score 3

4. Three clear statements of a need: score 4

5. Four or more clear statements of a need: score 5

The raters were also instructed that if they were
undecided between two ratings on a need (e.g., 2 or 3)
they should choose the lower of the two.

Once these instructions were explained to the raters,
they listened to three practice protocols. In these training
sessions, they were asked to identify the needs expressed
by "the hero" in each story without scoring them for their

strength. Once they identified the needs, which they did

 

 

46

extremely well, the author explained to them his reasons
for rating the needs as he did. Following this procedure,
the raters listened together to four protocols from both
samples and were asked to rate independently the strength of
the needs expressed in each story. At the end of each story,
the raters discussed the discrepancies between their ratings
while the author helped them to resolve their differences.
After proceeding through the four protocols in this manner,
the training sessions ended, and the raters scored the
remaining protocols.

Since each need can be rated on a zero to five scale
for each of the eleven cards, the total score can range
from 0-55. Murray's correction factors for equating for
the average length of the subject's stories were then
applied to the total scores (Murray, 1943). If these
correction factors were not applied, an individual's relative
position on a need would depend more on the length than the
content of his stories. The two corrected total scores were
averaged and this latter value was used as a basis for
analyzing the results.

Based on the two judges' independent scoring of the
needs of all the individuals in both samples, an estimate
of the interrater reliability was obtained. Table 2
summarizes the interrater reliability for the scoring of

the TAT needs as defined in this study.

 

47

Table 2. Interrater reliability of the TAT needs.

 

 

r
TAT Need (n = 48)

Abasement .94
Achievement .77
Affiliation .87
Aggression .90
Autonomy .73
Deference .85
Dependence .83
Dominance .70
Heterosexuality .71
Nurturance .81
Passivity .75

 

The above reliability coefficients indicate a rela—
tively high degree of association between the two sets of
ratings and Suggest that the scoring system for the needs

studied in this paper is quite reliable.

Inter ersonal Satisfaction Scale 188

The ISS was not given to the control sample since
the sCale was designed specifically for the multiple thera—
pist sample. The latter group of subjects (N - 24) took the
ISS twice with a two—week interval separating the two ad-
ministrations. TWo administrations were required in order
to obtain the stability coefficient for this instrument.

The first administration of this scale occurred immediately
after the subject had completed the TAT. The stability

coefficient for the ISS is .99 which indicates that the 188
is a highly reliable instrument for measuring a therapist's

satisfaction with his co-therapist in multiple therapy.

 

48

Procedures for Statistical Analysis of the Data

Hypothesis 1

In sub-hypothesis la, the multiple therapy sample
and the control sample were treated as two separate distri-
butions. To test sub-hypothesis la, the median score for
each sample on each need was obtained (i.e., the median of
all scales in each distribution). Then the scores for each
sample were dichotomized at the median, and each pair of
therapists were split into two mutually exclusive categories:
the one category represented the number of pairs of thera—
pists who are similar on a given need, and the other category
represented the number of pairs of therapists who were bi—
polar on a need. A pair of therapists were seen as similar
on a need if pppp their scores were above or below the median
of their sample. A pair of therapists were seen as being
bipolar on a need if one member of the pair had a score above
the median while the other individual's score was below the
median. Data dichotomized in such a manner for both samples
would resemble those given in Table 3.

To test sub-hypothesis la that pairs of multiple
therapists have a more bipolar relationship in terms of their
needs for dominance, deference, and passivity than randomly
paired therapists, the proportion of pairs who were bipolar
on a given need was determined for each sample. The data
were then analyzed using the significance test for the

difference between two proportions.

 

 

 

 

 

 

49

'Table 3. Conceptual form for data in which no. of pairs of
therapists who are Similar or bipolar on a given
need are presented.

 

 

Multiple Therapist Control
Sample Sample

 

No. of pairs of thera—
pists who are similar A C
on a given need

No. of pairs of thera-
pists who are bi- B D
polar on a given need

 

To test sub-hypothesis lb and 1c that pairs of multiple
therapists have certain needs which are more complementary
to one's partner than randomly paired therapists, inter—
therapist correlations for the multiple therapist and
control samples were obtained for these two sub-hypotheses.
In order to obtain these correlations, each pair of thera-
pists was examined on one of the two needs appropriate to
each sub-hypothesis. The score of the member of each pair
that was higher on this need was paired with his partner's
score on the other need relevant to the complementary sub-
hypothesis. A hypothetical example, using sub-hypothesis
lb as a base, may help clarify the operation. Suppose John
and Laura are one pair of therapists from a given sample and
Jehn has a score of 20 on need for dominance while Laura's
score is 15 on this need. Since thn's score on dominance

is higher than Laura's, his score on dominance would be

 

 

50

paired with Laura's score on passivity. Such a procedure
was performed for each pair of therapists in a given sample,
and the product-moment correlation between the two variables
relevant to the sub—hypothesis (in the above example, the
correlation between dominance and passivity) was determined.
Then the multiple therapist and control samples were com—
pared on the sub-hypothesis by testing the significance of
the differences between the two correlation coefficients

obtained from these samples.

Hypothesis 2

To test the hypothesis that pairs of multiple thera-
pists complement each other more on a dependencevnurturance
dimension than randomly paired therapists, a product-moment
correlation based on an individual's score on dependence
and his partner's score on nurturance was obtained for each
group. The hypothesis was statistically tested by using the
significance of the differences between the two correlation

coefficients obtained from the samples.

Hypothesis 3

To test the hypothesis that pairs of multiple thera-
pists are more similar in terms of their needs for abase—
ment, achievement, aggression, autonomy, dependence, hetero-
sexuality, and nurturance then randomly paired therapists,

the proportion of pairs who are similar on a given need was

 

 

51

obtained for each sample. The data were analyzed using the

significance test for the difference between two proportions.

Hypothesis 4

To test the hypothesis that a therapist's satisfaction
with his partner in multiple therapy is related to his co—
therapist possessing certain needs, the ISS scores of each
individual in the multiple therapist sample was correlated
with his co-therapist's needs. A t-test of the hypothesis
of zero correlation was computed for each need in each sub-

hypothesis.

 

 

RESULTS

Hypothesis 1: Complementary Needs Along a
Dominance-Receptive Dimension

In Hypothesis 1 it was proposed that pairs of multiple
therapists complement each other more on a dominance—receptive
dimension than randomly paired therapists. This hypothesis
was divided into three parts. The first part predicted that
pairs of therapists have a more bipolar relationship in terms
of their needs for deference, dominance, and passivity than
randomly paired therapists. The tables in Appendix A show
the raw data of the number of pairs of therapists in each
sample Who are similar or bipolar in terms of their needs
for deference, dominance, and passivity.

The data reported in Table 4 Show the results of the
significance tests for the difference between the proportion
of pairs of therapists in the multiple and control samples
Who have a bipolar relationship with respect to their needs
for deference, dominance, and passivity.

There were no significant differences between the
groups in the proportion of pairs of therapists who have a
bipolar relationship in their needs for deference, dominance,
and passivity. Sub-hypothesis la, that states that pairs

of multiple therapists have a more bipolar relationship in

52

 

 

53

regards to these needs than randomly paired therapists,

was not confirmed.

Table 4. Bipolarity of needs: proportion and between—group
Z values (both corrected for discontinuity) for
the (N = 12) pairs of therapists in the multiple
therapist and control samples who have a bipolar
relationship with respect to their needs derived
from the TAT for deference, dominance and passivity.

 

Proportion of Proportion of
Pairs of Multiple Pairs of Randomly

 

TAT Need Therapists who Paired Therapists Betweeg-group
Have a Bipolar Who Have A Bipolar
Relationship Relationship
Deference .458 .458 .00
Dominance .458 .375 .41
Passivity .500 .500 .00

 

The second part of hypothesis 1 (lb) predicted that
the strength of the relationship between dominance and
passivity will be greater in pairs of multiple therapists
than randomly paired therapists. The third part of this
hypothesis (1c) proposes that the strength of the relation-
ship between dominance and deference will be greater in pairs
of multiple therapists than randomly paired therapists.

The data reported in Table 5 Show the results of the signifi-
cance tests for the differences between the Pearson product
moment correlation coefficients of the two groups on the

dominance-passivity and dominance-deference dimensions.

 

 

54

Table 5. Complementary needs: Pearson product moment cor-
relations and between group Z values between the
multiple therapist and control samples on the
dominance—passivity and dominance-deference
complementary dimensions.

 

Correlation on Correlation on Between-

 

the two vari- the two vari- group Z

Complementary Need ables for ables for
Pattern (N=12) pairs of (N=12) pairs of
therapists in therapists in
the multiple the control
therapist sample
sample

Dominance-Passivity .320 -.286 1.33
Dominance-Deference .307 .199 .246

 

As Table 5 indicates, neither of the two comparisons
made resulted in significant differences between the groups.
Thus, one can conclude that sub-hypothesis 1b and 1c were
not confirmed. However, inspection of this table shows that
the result in the dominance—passivity dimension (related to
sub-hypothesis lc) was in the predicted direction
(2 = 1.33, P g .092).

Based on the results of sub-hypotheses la, 1b, and
1c, Hypothesis 1, which proposed that multiple therapists
complement each other more on a dominance—receptive dimension
than randomly paired therapists, was not supported.

Hypothesis 2: Complementagy Needs Along A Depgndence-
Nurturance Dimension

Hypothesis 2 proposed that pairs of multiple therapists

complemented each other more on a dependence-nurturance

 

55

dimension than randomly paired therapists. This hypothesis
predicted that the strength of the relationship between
dependence and nurturance will be greater in pairs of multiple
therapists than in randomly paired therapists. The date
reported in Table 6 presents the findings of the significance
tests for the differences between the Pearson product-

moment correlation co-efficients of the two groups in the
dependence-nurturance dimension.

Table 6. Pearson product moment correlations and between

group Z values between the multiple therapist and
control sample on the dependence—nurturance

 

 

 

 

 

dimension.
Correlation between Correlation between Between-group
dependence-nurturance dependence-nurturance Z
for pairs of therapists for pairs of thera-
in the multiple thera- pists in the control
'pist sample (N = 24) sample (N = 24)
.385 .110 1.28

 

There was no significant difference between the cor-
relations of the groups on the dependence-nurturance dimension.
While Hypothesis 2, which states that multiple therapists
complement each other more on a dependence-nurturance di-
mension than randomly paired therapists, was not confirmed,

the results were in the predicted direction (Z = 1.28, P §_.100).

 

 

56

Hypothesis 3: Similarity of Needs

Hypothesis 3 predicted that pairs of multiple thera—
pists are more similar in terms of their needs for abasenent,
achievement, affiliation, aggression, autonomy, dependence,
heterosexuality, and nurturance than randomly paired thera-
pists. The tables in Appendix B show the raw data of the
number of pairs of therapists in each sample who are similar

or bipolar with respect to these needs.

The data reported in Table 7 show the results of the
significance tests for the difference between the proportion
of pairs of therapists in the multiple therapist and control
groups who are similar in their needs for abasement, achieve—
ment, affiliation, aggression, autonomy, dependence, hetero—
sexuality, and nurturance.

No significant differences between the groups were
found in the proportion of pairs of therapists who are simi—
lar in their needs for abasement, achievement, aggression,
dependence, and heterosexuality. Three significant dif-
ferences between the groups were found in their needs for
affiliation (z = 1.642, p g .05), autonomy (z = 1.69, P g .05)
and nurturance (Z = 2.07, P g .05). Pairs of therapists in
the multiple therapy group were more similar in their needs
for affiliation, autonomy, and nurturance than those in the
control groups. Hypothesis 3 which states that pairs of

multiple therapists are more similar with respect to their

 

57

needs for abasement, achievement, affiliation, aggression,
autonomy, dependence, heterosexuality and nurturance was

partially confirmed.

Table 7. Similarity of needs: proportions and between-
group Z values (both corrected for discontinuity)
for the (N = 12) pairs of therapists in the
multiple therapist and control samples who are
similar in their needs derived from the TAT for
abasement, achievement, affiliation, aggression,
autonomy, dependence, heterosexuality, and

 

 

nurturance.
Proportion of Proportion of
(N=12) Pairs (N=12) Pairs
of Multiple Randomly Between—
TAT Need Therapists Paired Thera- Group Z
Who Are pists Who Are
Similar Similar
Abasement .625 .458 .82
Achievement .542 .542 .00
Affiliation .625 .292 1.64*
Aggression .500 .500 .00
Autonomy .542 .208 1.69*
Dependence .666 .666 .00
Heterosexuality .375 .542 -.82
Nurturance .792 .375 2.07*

 

* P §_.05, one-tailed

Hypothesis 4: Therapist's Satisfaction in Multiple
Therapy Related to His Co—therapist's Needs

Hypothesis 4 predicts that a therapist's satisfaction
with his partner in multiple therapy is positively related to
his co-therapist's needs for achievement, affiliation,
dependence, heterosexuality, and nurturance (sub—hypothesis
4a) and negatively related to his co—therapist's needs for

abasement and autonomy (sub—hypothesis 4b). The data

 

58

reported in Table 8 Show the Pearson product moment cor—

relations between the satisfaction score of each individual

in the multiple therapist sample on the ISS and his co—

therapist's needs.

Table 8. Pearson product moment correlations between the
satisfaction score of each individual in the

multiple therapist sample (N = 24) on the ISS
and his co—therapist's needs derived from the TAT.

 

Correlation between A Therapist's
TAT Need Satisfaction in Multiple Therapy
and His Co—therapist's Need

 

Abasement (a) .065
Achievement .074
Affiliation .036
Autonomy (a) .545*
Dependence .526*
Heterosexuality .143
Nurturance .345**

 

(a) Predicted negative correlations.

* P .005, one tailed

** P .05, one tailed

Sub-hypothesis 4a, which proposes that a therapist's

satisfaction in multiple therapy, is positively associated
with his co-therapist's needs for achievement, affiliation,
dependence, heterosexuality, and nurturance, was partially
confirmed. While no significant correlations appeared between
an individual's satisfaction in multiple therapy and his
co-therapist's needs for achievement, affiliation, or
heterosexuality, the correlations associated with needs for
dependence (r = .526, P g .005) and nurturance (r = .345,
P g .05) were significant. It would appear that the

amount of satisfaction derived from interacting with one's

 

59

co-therapist is definitely related to the latter's needs for
dependence and nurturance. Sub—hypothesis 4b, which states
that a therapist's satisfaction with his partner is nega-
tively related to his partner's needs for abasement and
autonomy, was not confirmed. The predicted relationship
between satisfaction and need for abasement did not material-
ize. It can be seen that a significant correlation between
satisfaction and need for autonomy (r = .545, P g .005)
was in a positive, rather than in the predicted negative,
direction. This finding suggests that satisfaction with
one's co-therapist is positively related to the latter's
need for autonomy.

The above findings offer partial support for Hypothesis
4 which proposes that a therapist's satisfaction with his
partner in multiple therapy is related to his co-therapist

possessing certain needs.

 

DISCUSSION

The present study was based on the proposition that
therapists who have chosen to Work together in multiple
therapy fulfill certain needs in each other. This proposition
was divided into two central parts. It was suggested first
that there will be more patterning of needs among pairs of
multiple therapists than randomly paired therapists. Second,
it was proposed that a therapist's satisfaction in the multiple
therapy relationship will be related to some of the needs of
his co—therapist.

In order to test the validity of the first part of
this premise, three hypotheses, established on the theoretical
orientation discussed earlier, were developed. In Hypothesis
1 it was postulated that therapists who have chosen to Work
together in multiple therapy will complement each other's
needs along a dominance-receptive dimension more than randomly
paired therapists. No support was found for Hypothesis 1.
Pairs of multiple therapists do not differ from randomly
paired therapists along the dominance-receptive dimension.
Some multiple therapists have chosen co-therapists who are
similar to them in their needs for deference, dominance, or
passivity, while other therapists appear to have sought

persons who were higher or lower than themselves in terms

60

 

61

of these needs. It was also found that pairs of multiple
therapists do not complement each other more than randomly
paired therapists in terms of their needs for dominance and
deference. Thus, based on these findings, it can be said
that complementarity along a dominance-receptive dimension
is not basic to the multiple therapeutic relationship and
does not influence the selection of one's co-therapist in
multiple therapy.

waever, the results in terms of the interaction
between dominance and passivity for pairs of therapists were
in the predicted direction (P g .09). The present evidence
offers tentative support to the proposition that pairs of
multiple therapists complement each other more along a
dominance-passivity dimension than randomly paired thera-
pists. It is thought that this complementarity influences
the selection of one's co—therapist and has a bearing on
how they function together in multiple therapy. The present
data indicate that a therapist with a high need for dominance
chooses a co-therapist who has a high need for passivity and
vice versa. The author believes that the therapist-
therapist interaction is optimal when the therapists' needs
for dominance and passivity complement each other. If the
needs of a pair of therapists do not complement each other
along a dominance-passivity dimension, a conflict may arise
between them and make their relationship competitive rather

than co-operative. This conclusion is congruent with

 

62

Solomon et al.'s (1954) and Gans' (1962) idea that therapist-
therapist conflicts are minimal when the hierarchy of domis
nance over passiVity is reconciled.

The importance of keeping the therapist-therapist
conflicts to a minimum was discussed earlier. At that time,
it was pointed out that multiple therapy becomes impotent
when the two therapists are in an emotional conflict. While
resolution of a conflict, if it is possible, is beneficial
to the therapists and the patient, lack of conflict between
the therapists is generally more productive to the thera—
peutic interaction. Perhaps therapists unconsciously seek
to decrease the probability of a conflict in terms of the
hierarchy of dominance over passivity by dynamically select-
ing a co-therapist who will complement their needs in this
area. This evidence indicates that the dominance-passivity
dimension as it relates to multiple therapy needs to be
examined further.

An interesting fact about the therapists included
in this investigation emerged when Hypothesis 1 was examined.
Most of the therapists (28 out of 48) had a score of 0 on
their need for deference and the average score for all thera-
pists on this need was 1.08. To the degree that one can
generalize from the present sample of therapists to thera-
pists in general, the above findings suggest that therapists
are people who prefer to work things out in a manner that

suits them instead of doing what is expected of them. Since

 

 

63

therapists are engaged in an activity that generally encourages
individuals to conform to their own standards rather than to
conform to someone else, it is not surprising that they Should
behave in such a manner and that their need for deference
should reflect this pattern--that their need for deference

is almost non—existent.

In Hypothesis 2 it was postulated that pairs of
multiple therapists complement each other more on a dependence—
nurturance dimension than randomly paired therapists. While
this hypothesis was not confirmed, the results indicate a
trend in the predicted direction (P g .10) and provide some
support to the idea that the dependence—nurturance dimension
is an important variable in understanding the dynamics of
the interpersonal relationship between pairs of multiple
therapists. The results indicate that teams of multiple
therapists are paired in such a manner that a therapist's
need for dependence is positively related to his co-thera-
pist's need for nurturance. Thus, it seems that the higher
a therapist is in his need for dependence the greater the
probability is that he will choose a co-therapist who is
highly nurturant--a person whose need for nurturance is
comparable in strength to his need for dependence. Based
on this complementary need pattern, both therapists in a team
appreciate the dependent and nurturant needs of their co-

therapist becauseeach therapist is enhanced by them.

 

64

The mutuality that exists in multiple therapy is
clearly evident in the interaction of the therapists' needs
for dependence and nurturance. The relationship is mutual
only when the two therapists add to each other by accepting
what the other therapist has to offer at a given time--
whether the manifestation arises from dependent or nurturant
needs. Mutuality in multiple therapy exists when one person
feels free to call on his co-therapist and vice versa (Mullan
and Sanguiliano, 1964). Unless each individual can draw on
his co—therapist's resources to the degree he needs to and
believes that his co—therapist generally wants what he is
emotionally able to give, their multiple therapy venture will
be unsuccessful. Multiple therapy ". . . will be helpful
to the patient only when they move during the sessions in
the direction of increased mutuality (Mullan, 1967, p. 131).
It is believed that such mutuality cannot develop if the
therapists' needs for dependence and nurturance are not com-
plementary.

In order for each therapist to be as strong and whole
as possible in multiple therapy, the therapists must be
comfortable with the dependency needs of each other. When
therapy is emotionally exhausting and trying, it is nice to
know that you can rely on your co-therapist for nourishment.
Such a relationship epitomizes the meaning of intimacy in
the deepest sense because the two individuals' responses to

each other are complementary and collaborative over time.

 

 

65

Many therapists would argue that such emotional
experiences as regression, abreaction, and primary process
must occur in order for effective therapy to take place.
Agreeing with Kell and Burow (in press), the author believes
that multiple therapy provides a way of promoting such ex-
periences so that they facilitate the patient's growth.
Experience in multiple therapy indicates that such experiences
occur faster, are more intense, and produce more beneficial
results than in individual therapy. It is thought these
experiences are not as complete in individual therapy because
the single therapist is faced with an almost impossible task
of being in contact with reality (so that he can pull the
patient out of the unconscious material) and of regressing
with the patient at the same time. As all therapists know,
it is indeed difficult to be two things at once. In con-
trast, in multiple therapy one therapist is more able to
tolerate and enter into the regression with the patient than in
individual therapy because he does not have to defend as
much against losing himself in the patient's unconscious,
since he can depend upon his co—therapist to be integrated
with reality and to know when the regression, etc. have
served their purpose. Thus, it can be seen that the inter—
action of the therapists needs for dependence and nurturance
is important in multiple therapy, since ". . . the freedom
to depend is the basis on which a therapist may enter into

a regressive feeling experience with a client in which both

 

66

permit themselves to lose contact with emotional reality"
(Kell and Burow, in press, p. 409).

In Hypothesis 3, it was postulated that pairs of
multiple therapists are mona similar in terms of their needs
for abasement, achievement, affiliation, aggression, autonomy,
dependence, heterosexuality, and nurturance than randomly
paired therapists. This hypothesis was partially confirmed.
It was found that pairs of multiple therapists are not more
similar in their needs for abasement, achievement, aggression,
dependence and heterosexuality than randomly paired therapists.
Thus, the evidence suggests that similarity between pairs of
therapists in terms of these needs is not a determining
factor in the selection of a multiple therapy partner.

Pairs of multiple therapists were found to be more
similar in their needs for affiliation, autonomy, and nur—
turance than randomly paired therapists. It would appear
that an individual selects a partner for multiple therapy
Who is similar to him in his needs for affiliation, autonomy
and nurturance. Earlier an analogy was made between the mul-
tiple therapy relationship and a healthy marriage. In this
regard, it is interesting to note the similarity of Katz
et al.'s (1960) findings with married couples to the present
study. In their study, Katz et a1. discovered that married
couples were similar to each other in terms of their needs
for abasement, affiliation, autonomy, and nurturance.

It was earlier theorized that two individuals who

differed greatly in their need for affiliation would not

 

 

 

 

67

select each other for multiple therapy. The results tend
to support thta belief. Multiple therapy is a co—operative
effort; it cannot be effective unless both therapists feel
comfortable with their co-therapist's needs for intimacy.
If two therapists differed in their need for forming inti-
mate and reciprocal relationships and chose to work together,
the relationship would not endure because each therapist
would distrust and disapprove of his co-therapist. If a
therapist with a low need for affiliation were coupled with
a therapist Who had a high need for affiliation, he would
probably feel that his co-therapist demanded too much
involvement from him and would struggle to keep from being
engulfed. On the other hand, the therapist who has high
needs for affiliation may feel deprived and angry in a re-
lationship in which his co-therapist does not want to be as
intimately involved as he does. In this situation, one
therapist would be striving for greater closeness and the
other for more distance. Such a relationship would breed
competition rather than co-operation and companionship
which are needed for successful multiple therapy.

The results of this investigation indicate that an
individual chooses a co-therapist who is similar to him in
his need for autonomy. Unless the two therapists were similar
to each other in their need for autonomy, they would have
difficulty in reSpecting and appreciating each other and

would be in conflict when it came to dealing with the

 

 

68

autonomous strivings of their patients. The individual with
a high need for autonomy would be unwilling to submerge his
individuality.

"A person seeking an expression for his self-expansive
tendencies through any form of behavior will resent and re-
sist any intrusion into his activities . . . [and will] in
general resist any encroachment of his sphere of freedom and
mastery" (Angyal, 1965, p. 10). Such an individual would
probably encourage a patient to express his or her drives
for eXpansion and mastery; his partner, if low in need for
autonomy, would have contradictory needs to the first and
this basic conflict between them would manifest itself in
the patient's lack of growth. An individual with a low
need for autonomy would be more Willing to limit the eXpres-
sion of his needs so that they fit into the environment in
which he finds himself. If extremely low in his need for
autonomy, the individual may invite exploitation to the cha-
grin of his co-therapist who has a high need for autonomy.
It is thought that two therapists could not work together
effectively when their needs are so different-—when they
approach their environments so differently. It is predicted
that the more similarity between the therapists in their
need for autonomy, the greater the mutual reward they will
experience, the lower the cost of achieving it, and the more
they will help the patient develop competence and self-

reliance, without guilt.

 

69

As predicted, the findings indicate that pairs of
multiple therapists were more similar in their need for
nurturance than randomly paired therapists. This result
suggests that Similarity between individuals in terms of
their need for nurturance is one of the determining factors
in selecting a partner for multiple therapy.

One of the ways a therapist's need for nurturance is
expressed in therapy is in terms of the individual's general
Willingness to become involved in a patient's problems; the
Willingness to become involved in another individual has a
definite bearing on how a therapist interacts With a patient.
One would surmize that the greater the difference between
a pair of therapists the more they would differ in their
goals in therapy and in their approach to the patient's
concerns. Similarity between the therapists in their need
for nurturance would add to their feelings of appreciation
of each other in terms of each recognizing the potential
of what the other has to offer.

Most therapists want to be needed and have chosen a
profession that rewards this desire. In multiple therapy,
the desire to be needed can be greatly rewarded or frustrated
since the therapist has two people available to react to
him--the patient and his co-therapist. In a multiple
therapy relationship in which the therapists differ in their
need for nurturance, the individual with the low need for

nurturance may feel "un-needed“ at the level of involvement

 

 

70

in which he is operating. Suffering from the feeling that he
is not really needed may engender feelings of inadequacy,
jealousy, anger, etc. in this individual. He may respond

to such feelings by unconsciously withdrawing from the
relationship in some way or by striving to give more to the
patient than he wants to (or more than the patient needs at

a given time). On the other hand, the therapist with a

high need for nurturance may feel disappointed with his
co-therapist because the latter is not as involved with the

patient as he is. In such a situation, the therapist

 

with the high need for nurturance may make the following
mistakes which will compound the problem: (1) he may view
his co-therapist as lacking "something" and may try to dis-
cover what it is so that he can change him; (2) he may hold
himself responsible for his co-therapist's behavior and feel
inappropriate guilt; and (3) he may decrease what he gives

to the patient with the hope that his co-therapist will feel
better-—all of which makes the two therapists and the patient
feel inadequate. It is thought that the probability of avoid-
ing such a damaging conflict is increased when the therapists
are similar in their need for nurturance.

The second major part of this investigation was con-
cerned with the relationship between a therapist's satis—
faction in the multiple therapy relationship and the needs
of his co-therapist. In Hypothesis 4, it was proposed that

satisfaction with one's co—therapist is positively related

 

 

71

to his co-therapist's needs for achievement, affiliation,
dependence, heterosexuality and nurturance and negatively
related to his.needs for abasement and autonomy. There is
no evidence to indicate that satisfaction with one's co-
therapist is related to one's co-therapist's need for abase-
ment, achievement, affiliation, or heterosexuality. Pre-
viously it was shown that pairs of multiple therapists are
more similar in their need for affiliation than randomly
paired therapists. Based on this finding, it was theorized
that this need influences the selection of one's co-therapist
and is important to the multiple therapy relationship. If
this is true, one wonders why satisfaction with one's co-
therapist is not related to his partner's need for affilia-
tion. Perhaps the need for affiliation is a necessary but
not a sufficient factor in the multiple therapy relationship.
The results indicate that the amount of satisfaction
derived from interacting with one's co-therapist is positively

associated with his co—therapist's needs for autonomy, de—

pendence, and nurturance. It was predicted that satisfaction

. a I
with one's co-therapist is pOSitively related to the latter 3

need for dependence and negatively related to his need for

autonomy because the direction of these needs are different:

the direction of the need for autonomy is toward more self—

assertiveness, while the direction of the need for dependence

is toward decreasing the separation from another person.

While the direction of these two needs may seem conflictual,

in reality they are not. These two needs can be complementary

in an individual.

72

Both in the homonomous and autonomous trends
the person aims at overcoming his separation from
the "object," but the object is not the same in
the two kinds of reunion, even when it is "physi-
cally” identical. The object of mastery is nothing
pgp_an object. It is foreign and dissimilar to the
person--meaningful only insofar as it can be made to
serve him and thus be assimilated into his sphere.
The object of homonomous strivings is conceived of
as having a "selfhood," a meaningful experience of
its own--either that of another human being or some
other intrinsically valuable entity with which it is
possible to form a community. . . As one strives
to master and govern the environment, one discovers
that one cannot do this effectively by direct appli-
cation of force, by sheer violence. One must under-
stand and respect the laws of the environment, go
along with them, so to say, which means assuming a homo-
nomous attitude. On the other hand, bringing one's
best to a loving relationship requires not only a
capacity for self-surrender but also a degree of
proficient mastery of one's world, of resourcefulness
and self-reliance. Without these qualities one does
not have much to offer the other, and the relationship
may deteriorate into dependency and exploitation
(Angyal, 1965, Pp. 28-29).

In order for multiple therapy to be effective, each
therapist must possess needs which cause him to want to be
a separate individual and yet motivate him to become a part
of a larger unit. In a good multiple therapy team, each
therapist wants his co-therapist to be a separate individual

Who also has a desire to belong to a relationship that is

more than himself.
”Thus, though there is separateness as individuals,

there is a human relationship between them, which is not

either one of them separately. The realness of the relation-

Ship and its uniqueness is highly related to their separate-

ness as individuals, and is also highly related to the meaning

of their relationship to the therapeutic endeavor" (Kell and

 

 

73

Burow, in press, p. 408). In this light, it is understandable
that a therapist's satisfaction with his co-therapist is
positively related to both the autonomous and dependency
needs of his co-therapist.

If the autonomous and dependency needs of a thera—
pist are not well integrated (do not balance each other),
the interaction between the two therapists will not be too
satisfying. If the need for autonomy predominates, the
individual will have difficulty in accepting the help of
his partner. Such an individual will be separate when it is
inappropriate and unconsciously reject his partner for seek-
ing to become a unit with him. If this need is excessive
in relationship to the need for dependence, the mutuality
of the relationship will be destroyed and will impair the
patient's capacity to depend upon others. On the other hand,
if the need for dependence is excessive in relationship to
the need for autonomy, the individual will resent his co-
therapist's separateness as an individual and will make un-
realistic demands upon him. Such a relationship, if actualiz-
ed, would be symbiotic in nature and would prevent separa-
tion and individuation that are needed for growth—-both the
therapists' and the patient's.

Based on the preceding discussion, it is not sur-

prising that the results Show that the amount of satisfaction

a therapist derives from interacting with his co-therapist

is positively related to his co-therapist's needs for de-

pendence and nurturance. If effective multiple therapy

74

requires that each therapist must be able to give and re-
ceive something from his partner, it is logical that an
individual will be satisfied in this relationship to-the
degree that his partner has needs which allow the former
to give and take something from him.

A general conclusion of this investigation is that
there are dynamic factors operating in the interpersonal
relationship in teams of multiple therapists. The present
evidence indicates that certain needs in the individual
influence the selection of his co-therapist and that satis—
faction in the multiple therapy relationship is partially

determined by some of the needs of his co-therapist.

Suggestions for Further Research

A logical question which arises when one thinks about
multiple therapy is whether or not multiple therapists have
a greater need for dependence than therapists who do not
engage in multiple therapy. Kell (1968) and the present
writer do not believe this is true. We believe that multiple
therapists may be more conscious of their needs for dependency
than other therapists and that one of the ways the former
seek to have their dependency needs met is by doing multiple
therapy. FUrther research should focus on this question
and on the broader issue of whether or not multiple therapists

differ psychologically from therapists who do not engage

in multiple therapy.

MW".

J71“ .IJ—I:

‘ _ ‘A.v-.

 

75

It was previously stressed that multiple therapy
becomes ineffective when the two therapists are in conflict.
The writer believes that the degree of congruence between a
therapist's perception of himself and his co-therapist's
view of him and vice versa has a bearing on how they inter-
act with each other and their patient(s). This conceptualiza-
tion raises the following questions: Will a team of therapists
have difficulty in helping a patient resolve a conflict in
a particular area if a therapist's view of self and his co-
therapist's view of him are incongruent in this area? Does
the discrepancy between these perceptions change with the
length of time a team of multiple therapists have worked
together? What factors determine whether or not these dis-
crepancies become conscious and what effect do they have?

A fruitful approach to further investigations would be to
seek answers to these questions.

While he has no statistical evidence to offer to
support this observation, the writer has observed from the
data in this study that the females were generally more
satisfied with their co-therapist than the males were.
Further research is needed to determine if this observation

is a correct one. If it is, many interesting questions

arise as to why such a discrepancy exists.
This study has not examined the relationship of male

pairs of multiple therapists. Perhaps the factors that operate

in two males choosing to work together, besides not having a

female co-therapist to work with, are different than those

 

76

found for the heterosexual pairs of therapists used in this
study. The writer feels this is an interesting topic and
should be explored.

Repeating this investigation with more subjects
could increase precision and add to our knowledge. One
major advantage of having more subjects is that it would
allow us to use multiple regression theory to investigate
the degree to which the needs considered together account

for the variance of an individual's satisfaction with his

 

co—therapist.

SUMMARY

The purpose of the present investigation was to
examine how therapists who have chosen to work together in
multiple therapy fulfill each other in terms of their needs.
The first part of the study compared the interaction of needs

among pairs of multiple therapists with the interaction of

 

them among randomly paired therapists. The second part of
this investigation was concerned with the relationship be—
tween a therapist's satisfaction in the multiple therapy
relationship and the needs of his co-therapist.

Two groups of subjects were selected for the study.
The multiple therapy group consisted of 12 teams of multiple
therapists. The control group consisted of 12 teams of indi-
viduals who were paired so that no individual, who did multiple
therapy, would be paired with his co-therapist from multiple
therapy. The two groups are comparable with respect to age
and the amount of time engaged in individual therapy.

Two instruments were used to examine the variables
of this study. The Thematic Apperception Test (TAT) was

used to study the needs of the therapists. Eleven cards of

the TAT were administered to each subject, and the strength

of each need was obtained. The subjects' stories were scored

in terms of the following needs: abasement, achievement,

77

 

 

78

affiliation, aggression, autonomy, deference, dependence,
dominance, heterosexuality, nurturance, and passivity. Two
raters were used; the interrater reliability for the scoring
of the TAT needs was of sufficient magnitude to warrant the
use of this scoring system. The Interpersonal Satisfaction
Scale (ISS) was developed in the context of the present
research and is an index of a therapist's satisfaction with
his co-therapist in multiple therapy. Each individual in
the multiple therapy group was asked to rate on a one to
seven scale the degree of satisfaction he felt in interacting
with his co-therapist. Based on a two—week interval separat-
ing the two administrations, the stability coefficient for
the ISS is .99.
The results of this study can be summarized as follows:
I. The needs of pairs of multiple therapists do not
complement each other more on a dominance—receptive
dimension than those of the randomly paired therapists.
II. Tentative support was given to the proposition that
pairs of multiple therapists complement each other
more along a dominance-passivity dimension than ran-
domly paired therapists.

III. Some support was found for the idea that pairs of
multiple therapists complement each other more on a
dependence-nurturance dimension than randomly paired
therapists.

IV. Pairs of multiple therapists are not more similar in

their needs for abasement, achievement, aggression,

 

 

79

dependence, and heterosexuality than randomly paired

therapists.

V. Pairs of multiple therapists were found to be more
similar in their needs for affiliation, autdhomy,
and nurturance than randomly paired therapists.

VI. The amount of satisfaction derived from interacting
with one's co-therapistis not related to his co-
therapist's needs for abasement, achievement,
affiliation, and heterosexuality.

VII. Satisfaction with one's partner in multiple therapy
is positively related to his co-therapist's needs
for autonomy, dependence, and nurturance.

It was concluded that certain needs in an individual
partially determines the selection of his co-therapist and
that satisfaction in the multiple therapy relationship is
related to some of his co-therapists' needs. A general con—
clusion of this investigation is that the mutual relation-
ship that exists between pairs of multiple therapists is
affected by the needs of both therapists. The present paper
raised questions about multiple therapists in general and
about the interaction between pairs of multipletherapists
and gave suggestions which should prove helpful to further

investigations.

 

REFERENCES

Adler, J. & Berman, I. R. Multiple leadership in group
treatment of delinquent adolescents. Int. J. Group
Psychother., 1960, 10, 213-225.

Alexander, L. & Moore, M. Multiple Therapy in private
psychiatric practice. Amer. J. Psychiat., 1957, 113,

Bellak, L. The Thematic Apperception Test and the Children's
Apperception Test in Clinical Use. New York: Grune
and Stratton, 1954.

Belmont, L. P. & Jasnow, A.. The utilization of co—therapists
and of group therapy techniques in a family oriented
approach to a disturbed child. Int. J. Group Psychother
1961, 11, 319-328.

 

Bowerman, C. E. & Day, Barbara R. A test of the theory of
complementary needs as applied to couples during
courtship. Am. Sociol. Rev., 1956, 21, 602-605.

Brooks, W. W. Satisfaction of the manifest dominance and
deference needs in competitive situations. Dissert.
Abstr., 1964, pp, (5), 3121.

Cameron, J. L. & Steward, R. A. Y. ‘Observations on group
psychotherapy with chronic psychoneurotic patients
in mental hospitals. Int. J. Group Psychother.,
1955, i. 346-360.

Carmen, P. M. The relationship of individual and husband-
wife patterns of personality characteristics to
marital stability. Dissert. Abstr., 1955, 1;,
Part 1, 1113.

Daniels, M. The influence of the sex of the therapist and
of the co-therapist technique in group psychotherapy
with boys: an investigation of the effectiveness
of group psychotherapy with eighth grade, behavior-
problem boys, comparing results achieved by a male
therapist, by a female therapist, and by the two
therapists in combination. Dissert. Abstr., 1958,
.;§, 1849, Part I.

80

 

 

 

81

Demarest, E., 8. Tercher, A. Transference in group therapy;
its use by co-therapists of opposite sexes.
Psychiat., 1954, 11, 187—202.

Dreikurs, R. Techniques and dynamics of multiple psycho-
therapy. Psychiat. Quart., 1950, 14, 788—799.

Dreikurs, R., Schulman, B. H., & Mosak, H. Patient-therapist
relationship: I. Its advantages to the therapist.
Psychiat. Quart., 1952, gp, 219-227. (a)

Dreikurs, R., Schulman, B. H. & Mosak, H. Patient-therapist
relationship in multiple psychotherapy. II. Its
advantages for the patient. Psychiat. Quart., 1952,
pp, 590-596. (b)

Dyrud, J. E. & Rioch, M. Multiple therapy in the treatment
program of a mental hospital. Psychiat., 1953, 1Q,
21_26 0

Edwards, A. L. Manual for the Edwards Personal Preference
Schedule. New York: Psychological Corporation, 1953.

Framo, J. L. Rational and techniques of intensive family
therapy. In I. BQSZOrmenyi—Nagy and J. L. Framo

(Eds.). Intensive family therapy. New York:
Harper and Rowe, 1965, pp. 143-212.

Demarest, E. & Teicher, A. Transference in group therapy:
its use by co—therapists of opposite sexes. Psychiat.,
1954, 11, 187-202.

Gans, R. W. The use of group co—therapists in the teaching

of psychotherapy. Am. J. Psychother., 1957, 11,
618-625.

Gans, R. W. Group cotherapists in the therapeutic situation:
a critical evaluation. Int. J. group Psychothgp.,
1962, 11, 82—88.

Gottlieb, A. & Pattison, E. M. Married couples group psycho-
therapy. Arch. Gen. Psychiat., 1966, 14, 143-152.

Greenback, R. K. Psychotherapy using two therapists. Amer.
J. Psychother., 1964, 18, 488—499.

Hadden, S. B. The utilization of a therapy group in
teaching psychotherapy. Amer. J. Psychiat., 1947,
103, 644—648.

Haigh, G. & Kell, B. L. Multiple therapy as a method for
training and research in psychotherapy. J. Abnorm.
Soc. Psychol., 1950, 4;, 659-666.

 

 

82

1"Ia‘i’Ward, M. L., Peters, J. J., & Taylor, J. E. Some values
of the use of multiple therapists in the treatment
of psychoses. Psychiat. Quart., 1952, pp, 244-249.

Heiss, J. S. & Gordon, M. Need patterns and the mutual
satisfaction of dating and engaged couples. J. Marr.
Fam., 1964, pg (3), 337-338.

Hulse, W. C., Lulow, W. V., Rindsberg, B. K., & Epstein, N. B.
Transference reactions in a group of female patients
to male and female co—leaders. Int. J. Group Psychother.,
1956, p, 430-435.

Issacs, G. Team conflict--a recapituation of conflict in
the home: a descriptive clinical case study in
nursing therapy. Dissert. Abstr., 1965, g; (4), 6545.

Kadis, A. L. & Markowitz, M. The therapeutic impact of
co-therapist interaction in a couples group. In
J. L. Mareno (Ed.), International handbook of group
psychotherapy. New York: Philosophical Library,
1966, 446-455.

Kassoff, A. Advantages of multiple-therapists in a group
of severely acting-out adolescent boys. Int. J.

Katz, 1., Glucksberg, S., and Krauss, R. Need Satisfaction
and Edwards PPS scores in married couples. J. Consult.
Psychol., 1960, 14, 205-208.

Kell, B. L. & Burow, Josephine Morse. Human Developmental
Therapy. Boston: Houghton Mifflin, in press.

Kell, B. L. Personal Communication. 1968.

Kerchoff, A. C. & Davis, K. E. Value consensus and need
complementarityin mate selection. Amer. Sociol.
Rev., 1962, 11, 295—303.

Kritzer, H. & Phillips, C. A. Observing group psycho-
therapy-—an affective learning experience. Am. .

Leary, T. Interpersonal diagnosis of personality. New York:
TheRonald Press Co., 1957.

Levinger, G. the on need complementarity in marriage.
Psychol. Bull., 1964, 91 (2), 153-157.

 

83

Llnden, M. E. The significance of dual leadership in
gerontolic group psychotherapy: studies on gerOntOIic
human rational, III, Int. J. Group Psychother., 1954,
3, 262-273.

Loeffler, F. & Weinstein, H. M. The cotherapist method:
special problems and advantages. Group Psychother.,
1954, p. 189-192.

Lundin, W. H. & Aronov, M. The use of cotherapists in group
psychotherapy. J. Consult. Psychol., 1952, 1Q, 76-80.

MacLennan, B. W. Co-therapy. Int. J. Group Psychother.,
1965, 1;. 154-166.

Mintz, Elizabeth A. Special values of co—therapists in
group psychotherapy. Int. J. Group Psychother.,
1963' J-_31 127-132 (a).

 

Mintz, Elizabeth A. Transference in co-therapy groups.
J. Consult. Psychol., 1963, 11, 34—49 (b).

Mintz, Elizabeth A. Male-female co—therapists: some values
and some problems. Amer. J. Psychother., 1965, 12,
293-301.

Mullan, H. & Sanguiliano, Iris. Multiple psychotherapeutic
practice: preliminary report. Amer. J. Psychol.,
1960, 14, 550—565.

Mullan, H. & Sanguiliano, Iris. The therapist's contribution
to the treatment process. Springfield, 111.: Charles
C. Thomas, 1964.

Mullan, H. Discussion Voices: The Art and science of
psychotherapy, 1967, 1 (2), 12-13.

 

Murray, H. A. Explorations in Personality. New York:
Oxford University Press, 1938.

Murray, H. A. Thematic Apperception Test Manual. Cambridge,
Mass.: Harvard University, 1943.

NUnnelly, K. G. The use of multiple therapy in group
counseling and psychotherapy. Unpublished doctoral
dissertation, Michigan State University, 1968.

Orange, A. J. A note on brief group psychotherapy with
psychotic patients. Int. J. Group Psychother., 1955,
p, 80-83.

 

84

Palonen, Donna J. Interpersonal perceptions and marital
adjustment. Unpublished Master's thesis, Michigan
State University, 1966.

Pine, 1., Todd, W., & Boenheim, C. Special problems of
resistance in co—therapy groups. Int. J. Group
Psychother., 1963, 1Q, 334-362.

Rabin, H. M. How does co—therapy compare with regular group

psychotherapy. Am. J. Psychother., 1967, £1 (2),
244—255 (a).

Rabin, H. M. Personal communication. 1967 (b).

Reeve, G. H. Trends in therapy: V. A method of coordinated
treatment. Amer. J. Orthopsychiat., 189, 2, 743—747.

Rosow, I. Issues in the concept of need—complementarity.
Sociometry, 1957, 29, 216-233.

Rubinstein, D. Family therapy. Int. Psychiat. Cliniqg,
1964, 1 (2), 431—442.

Rubinstein, D. & Weiner, O. R. Co-therapy teamwork relation—
ships. In G. H. Zuk and I. Boszormenyi-Nagy (Eds.).
Family therapy and disturbed families. Palo Alto:
Science and Behavioral Books, 1967, pp. 206—220.

Rychlak, J. F. The similarity, compatibility, or incom-
patibility of needs in interpersonal selection.
J. Pers. Soc. Psychol., 1956, g (3), 334—340.

Sabath, G. Intertransference: transference relationship
between members of the psychotherapy team. Int. J.
Group Psychother., 1962, 1; (H), 492-495.

Slavson, S. R. Analytic grouppppychotherapy with children,
adolesggnts and adults. New York: Columbia University
Press, 1950.

Slavson. S. R. Discussion. Int. J. Group Psychothg£., 1960,
1Q, 225h226.

Solomon, A., Loeffler, F. J., & Frank, G. H. An analysis
of co-therapists interaction in group psychotherapy.
Int. J. Group Psychother., 1954, 1, 171—180.

Sonne, J. C. & Lincoln, Geraldine. The importance of
heterosexual co—therapy relationship in the con—
struction of a family image. Psychiatric Res. Rep.,
1966, 19, 196-205.

 

85

313121;, H. H. & Kopp, S.B. Multiple psychotherapy. In
M. Rosenbaum and M. Berger (Eds.). Group Psychotherapy
and group functions. New York: Basic Books, Inc.,
1963: pp. 391-406.

Staples, E. J. The influence of the sex of the therapist
and of the co-therapist technique in group psycho—
therapy With girls: an investigation of the
effectiveness of group psychotherapy with eighth
grade, behavior problem girls, comparing results
achieved by a male therapist, a female therapist,
and by two therapists in combination. Dissert.
Abstr., 1959, 12, 2154.

Stein, M. H. The unconscious meaning of the marital bond.
In V. W. Eisenstein (Ed.). Neurotic interaction
in marriage. New York: Basic Books, Inc., 1956,
pp. 65-80.

Tharp, R. G. Psychological patterning in marriage. Psychol.
Bull., 1963, §Q_(2), 97-117.

Tharp, R. G. Reply to Levinger's note. Psychol. Bull., 1964,
Q1 (2), 158-160.

Warkentin, J., Johnson, Nan,L., & Whitaker, C. A. A comparison
of individual and multiple psychotherapy. Psychiat.,
1951, 14, 415-418.

Warkentin, J. Partners in psychotherapy. Voices: The art
and science of Psychotherapy, 1967, 1 (2), 7—12.

Whitaker, C. A., Warkentin, J. & Johnson, Nan L. A philosoph-
ical basis for brief psychotherapy. Psychiat. Quart.,
1949, 11, 439—443.

Whitaker, C. A., Warkentin, J., & Johnson, Nan L. The
psychotherpeutic impasse. Amer. J. Orthopsychiat.,
1950, 19, 641-647.

Whitaker, C. A., Malone, T. P., & Warkentin, J. Multiple
therapy and psychotherapy. In F. Fromm—Reichmann and
J. L. Moreno (Eds.). Progress in ppychotherapy.
Vol. 1, New York: Grune and Stratton, 1956, pp. 210-216.

Whitaker, C. A., Felder, R. E., and Warkentin, J. Counter—
transference in the family treatment of schizophrenia.
In I. Boszormenyi-Nagy and J. L. Framo (Eds.).

Intensive family therapy. New York: Harper and Row,
1965, pp. 323-341.

   

86

Vflaitaker, C. A. Personal communication. 1967.

‘Winch, R, F. and Mere, D. A. Does TAT add information to
'interviews?_ Statistical analysis of the increment.
J. Clin. Psychol., 1956, 12, 316-321.

Winch, R. F. Mate selection: a study of comp1ementary needs.
New York: Harper & Brothers, 1958. ,

 

 

 

 

APPENDIX A

The Raw Data of the No. of Pairs of Therapists
in each sample Who Are Similar or Bipolar in
Terms of Their Needs for Deference, Dominance,
and Passivity.

 

Table A.

APPENDIX A

Number of pairs of therapists in the multiple
therapist sample (N = 12) and in the control
sample (N = 12) who are similar or bipolar in
terms of their need for deference.

 

 

Multiple Therapist Control
Sample Sample
No. of pairs of therapists
who are similar in their
need for deference 6 7
No. of pairs of therapists
who are bipolar in their
need for deference 6 5

 

Table B.

NUmber of pairs of therapists in the multiple
therapist sample (N = 12) and in the control
sample (N = 12) who are similar or bipolar in
terms of their need for deference.

 

 

 

Multiple Therapist Control
Sample Sample
No. of pairs of therapists
who are similar in their
need for deference 6 8
No. of pairs of therapists
who are bipolar in their
need for deference 6 4

 

as

 

89

Table C. NUmber of pairs of therapists in the multiple
therapist sample (N = 12) and in the control
sample (N = 12) who are similar or bipolar in
terms of their need for passivity.

 

 

 

 

Multiple Therapy Control
Sample Sample
No. of pairs of therapists
who are similar in their
need for passivity 6 6

No. of pairs of therapists
who are bipolar in their
need for passivity 6 6

 

 

APPENDIX B

 

Fl-Eflli—
Vs...—

The Raw Data of the No. of Pairs of Therapists
in Each Sample who are Similar or Bipolar in
Terms of their Needs for Abasement, Achievement,
Affiliation, Aggression, Autonomy, Dependence,
Heterosexuality, and NUrturance

 

APPENDIX B

Table D. Number of pairs of therapists in the multiple
therapist sample (N = 12) and in the control sample
(N = 12) who are similar or bipolar in terms of
their need for abasement.

 

 

 

Multiple Therapist Control
Sample Sample
No. of pairs of therapists
who are similar in their
need for abasement 8 5
No. of pairs of therapists
who are bipolar in their
need for abasement 4 7

 

Table E. Number of pairs of therapists in the multiple
therapist sample (N = 12) and in the control
sample (N = 12) who are similar or bipolar in
terms of their need for achievement.

 

 

Multiple Therapist Control
Sample Sample
No. of pairs of therapists
who are similar in their
need for achievement 7 6
Nb. of pairs of therapists
who are bipolar in their
need for achievement 5 6

 

91

 

Table F.

92

No. of pairs of therapists in the multiple
therapist sample (N = 12) and in the control
sample (N = 12) who are similar or bipolar in
terms of their need for affiliation.

 

 

 

Multiple Therapist Control
Sample Sample
Nb. of pairs of therapists
who are similar in their
need for affiliation 8 3
No. of pairs of therapists
who are bipolar in their
need for affiliation 4 9

 

Table G.

No. of pairs of therapists in the multiple
therapist sample (N = 12) and in the control
sample (N = 12) who are similar or bipolar in
terms of their need for aggression.

 

 

 

Multiple Therapist Control
Sample Sample
No. of pairs of therapists
who are similar in their
need for aggression 6 6

No. of pairs of therapists
who are bipolar in their
need for aggression 6 6

 

 

Table H. No. of pairs of therapists inwthe multiple

 

93

 

therapist sample (N = 12) and in the control

sample (N = 12) who are similar or bipélar

in terms of their need for autonomy.

No. of pairs of therapists
who are similar in their
need for autonomy

'No. of pairs of therapists
who are bipolar in their
need for autonomy

4*

 

Multiple Therapist Control
Sample Sample
7 2
5 10

 

Table I. No. of pairs of therapists in the multiple

therapist sample (N = 12) and in the control

sample (N = 12) who are similar or bipolar

in terms of their need for dependence.

No. of pairs of therapists
who are similar in their
need for dependence

No. of pairs of therapists who
are bipolar in their need
for dependence

 

Multiple Therapist Control
Sample Sample

8 8

4 4

 

 

 

94

'Dable J. ‘No. of pairs of therapists in the multiple
therapist sample (N = 12) and in the control
sample (N = 12) who are similar or bipolar
in terms of their need for heterosexuality.

 

 

No. of pairs of therapists
who are similar in their
need for heterosexuality

No. of pairs of therapists
who are bipolar in their
need for heterosexuality

Multiple Therapist Control

 

Sample Sample
4 7
8 5

 

Table K. No. of pairs of therapists in the multiple
therapist sample (N = 12) and intzhe control
sample (N = 12) who are similar or bipolar
in terms of their need for nurturance.

 

 

 

 

No. of pairs of therapists
who are Similar in their
need for nurturance

No. of pairs of therapists
who are bipolar in their
need for nurturance

 

Multiple Therapist Control
Sample Sample
10 4

 

 

 

 

 

 

 

l'l ICHIGRN STHT

E UNIV. LIBRARIES
HI I" WWW\IHIIIWIHW
03126357

 

312931