E. ._ ugh? 1.11.. h”; 'T‘HltSlS fin...“ v’ ‘ \ HEREBY I Efiekfgzan State I University '\ f" fl This is to certify that the dissertation entitled Object Representations in Clients' Verbal Discourse-An Exploratory Study presented by John Filak has been accepted towards fulfillment of the requirements for Ph.D. Psychology degree in Major professor Norman Abeles Date 7/ l 0/ 85 MS U i: an Affirmative Action/Equal Opportunity Institution 0- 12771 W W Mil/Will 0786 MSU LIBRARIES .——. V RETURNING MATERIALS: Place in book drop to remove this checkout from your record. FINES will be charged if book is returned after the date stamped below. l ! SEPIBI‘M‘E « *1 a A." ‘4 Z Iv 1" a] 1:.) } Object Representations in Clients' Verbal Discourse: An Exploratory Study. BY John Filak A DISSERTATION Submitted to Michimn State University in partial fulfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY Department of Psychology 1 985 ABSTRACT Object Representations in Clients' Verbal Discourse: An Exploratory Study. By John Filak This work explored clients' representations of self and others in brief excerpts from psychotherapy seesions. A stratified random sample involving 10 minutes of clients' conversation in r ly sessions and also in later sessions was made by typescripts of tape- recorded psychotherapy meetings for 48 completed outpatient files from MSU's Psychological Clinic. The goal was to determine whether the assessment of clients' object representations in verbal discourse wuld provide useful information regarding psychopathology and response to psychotherapy. The findings encourage the assessment of object representations from verbal discourse. The clearest results were obtained using Krohn and Mayman's Object Representation Scale (0R5). A single judge's 0R8 ratings of clients' representational material were notably stable (r =- .87) from early to late in therapy and showed several expected but modest (mean r = .34) significant correlations with measures of psychopathology. These findings suggest that object representations reflecting an incrmed capacity to understand the thoughts and motivations of self and others link positively to the individual's degree of ego-strength and frwcbm from psychological distress. Clients‘ evaluations of their psychotherapy experience were also positively linked to their object- relational level. Post-hoe analyses reveeled that lower 0R5 groups reported feeling less valued by their therapists and less emotionally involved in their psychotherapy yet also more intense anger toward thermists. Unexpectedly, clients' 0R5 scores, which are sumtive of their internal object relational development, regressed to a small mgree (nonsignificantly) from early to late in therapy. Analyses of the content of verbal representations along dimensions of warmth and acceptance showed a preponderance of significant positive associations between acceptance of both self and others and lesser degrees of psychological distress. It was also found that the degree of warmth and mptance in clients' early-therapy representations of others played a significant positive role in eventual response to the therapy. An attempt to investigate the frequency of clients' use of content categories (e. 9. ,"family", "spouse", "social others") was hampered by frequencies so low that mostly nonsignificant findings resulted. Nevertheless, psychological distress was associated with clients' frequency of negative references to "generalized others" (a. g., "people are ) early in therapy and also to their frequency of negative references to "social others" (e. g. , "my friend Pat is ) at therapy's end. Finally, the study investigated clients' degree of articulation of their ideas and the degree of qualification in their statements. A composite articulation measure assessed clients' level of clarity and specificity of expressions, and their development of themes and ideas. While neither related either to psychological distress or to outcome measures, significant correlations were obtained between clients' articulation and their 0R5 scores. To Sallie lii' ACKNOWLEDGEMENTS i would like to thank my committee members. Each has contributed substantially to my model of professional competence. Norm Abeles, who chaired my dissertation committee, has done another excellent job in this capacity. He presided graciously yet competently not only over the dissertation but also over my graduate training. John Hurley has contributed greatly to the quality of this work and has also helped me considerably throughout my graduate training. He was there to befriend me when I went through some rough times early in the program. Donald Grumman helped the organization of the written presentation and provided direction to the project when it most needed it. He is someone I am also fortunate to have known the whole time I was at Michigan State. My thanks goes to Ralph Levine who trekked over from industrial psychology to have a forceful presence among the clinical faculty members. Thanks goes also to Judie Shepherd who transcribed the sessions, to Edna, my undergraduate assistant, who did high quality work and helped the project get off the ground, to Suzy Pavick, always an outstanding secretary, who helped make various arrangements, and to Sallie and Wendy, graduate students like myself, who took time to help me with a part of this project. TABLE OF CONTENTS Page LIST OF TABLES ............................ viii LIST OF FIGURES ............................ x INTRODUCTION ............................. 2 REVIEW OF THE LITERATURE ....................... 4 Measures of Self and Other Representation and Psychological Development . . 4 A. Precursor: Warner's Developmental Theory ........... 4 8. Theory and Research on Object Relations ............. 6 C. Loevinger's Theory of Ego Development: Appraisal and Critique . . . . l2 D. Cognitive Complexity of Interpersonal Constructs ...... . 18 E. Self- Acceptance and Acceptance of Others: Two Major Interpersonal Dimensions ......................... 20 Psychotherapy Research ....................... 22 A. Client—Centered Therapy Research ................ 22 B. Other Relevant Psychotherapy Research .............. 27 I. Chang in Internal Object Relations from Psychotherapy ..... 27 2. Pre-Therapy Interpersonal Attitudes and Psychotherapy Outcome . . 28 3. Changes in Personal Constructs from Psychotherapy ....... 30 The Projective Hypothesis ...................... 31 Overview of Study ......................... 33 A Summary Perspective ..................... 34 B. Summary of Study's Purpose .................. 35 C. Overview of Object Representational Variables ........... 35 I. Structural Variables ................... 35 2. Content Scales ...................... 36 3. Category Counts ..................... 37 4. Krohn and Mayman's Object Representational Scale for Dreems . . . 38 HYPOTHESES ............................... 39 METHOD ................................ 43 vi Data .............................. 43 Clients ............................. 44 Therapists ............................ 45 Raters .............................. 46 Instruments ........................... 47 A. Object Representational Scales ................. 47 I. Object Representational Scale for Dreams ............ 47 2. Structural Scales .................... . 47 3. Content Scales ....................... 47 4. Category Count Variables ................... 48 5. ARO, ARS ......................... 48 B. Rater Pathology Ratings .................... 48 C. Paper-and -Pencil Measures of Pathology ............. 49 I. SCL-90R (Symptom Checklist) ............ . . . 49 2. Interpersonal Checklist (ICL) ................ 49 D. Outcome Measures ...................... SO I. Posttherapy Ouestionaire Client Form ............. SO 2. Posttherapy Ouestionaire Therapist Form ............ 50 Procedure ............................ 50 RESULTS ................................ 5i Interrater Reliabilities ....................... SI Pre-Poat Stability Correlations for the Variables ............. 52 Correlations among Types of Object Representational Variables ....... 54 Object Representations and Psychopathology ............... ' SS AHypothasisISS 8.Hypothesisll...........................57 C.Hypothesislll...........................57 D.HypothesisIV...........................59 Object Reprwentations and Psychotherapy Outcome ............ 61 AHypothesisVSI BHypothesisVI SI C.HypothesisVII..........................6l D.HypothesisVlII..........................SI EHypothesisX63 Vll APPENDICES F. Sample Ratings of Krohn Scale .................... Object Representations andlnternal Object Relations . . . 70 A. HypothesisIX . . . . . . . 70 DISCUSSION.......... 72 OverviewofStudy ........................... 72 Object Representational Variables .................... 75 A. Krohn and Mayman's Object Representational Scale for Dreams ..... 7S 1.Description.... ..7S 2.Findings......... .76 B. The Content of Object Representations Along the Dimensions of Acceptance and Warmth Versus Rejection and Ooldness . . . . . . . . . 82 C. Object Representational Category Use. . . . 84 D. Structural Scales: Definity, Specificity, Articulation, and Clarity . . . 86 REFERENCES ................................. 88 A. The Structural Scales: Definity, Articulation, Specificity, and Clarity . . . 95 8. Content Scales ........................... 102 C. Psychopathology Scales ....................... 106 D. Sample Transcript ......................... 108 E. Client Data ............................ 115 119 Table l2. 13. 14. 15. 17. LIST OF TABLES Pace Krohn and Mayman's Object Representations in Dreams Scale with a Comparison of Mahler's Stages of Object Relations Development ....... 1 1 Some Milestones of Ego Development .................. l4 Sentence Completion Stems ( for Women) Used in Deriving Ego Development ........................... l7 Raimy's Scoring Scheme for Classifying Client Statements ......... 23 Sheerer's Illustrations for the S-Point Degree of W Scale . . . . 24 Sheerer's Illustrations for the S-Point Degree of W Scale . . . 25 Schema for Classifying Referents Towards "Others" ............ 27 Interrater Reliabilities for Object Representational Scales ......... SI Pre-Post Reliabilities for Object Representational Variables ....... 53 Pre-Post Correlations for Category Count Variables ........... 53 Correlations Among the Structural Object Representational Variables for Pre and Post Therapy .................. S4 Correlations Among the Content Object Representational Variables ...... SS Correlations Between Structural Object Representation Measures and Pre- Therapy Psychopathology Indices. .............. 56 Correlations Between Structural Object Representation Measures and Pasl- Therapy Psychopathology Indices. .............. 56 Correlations Between Content Object Representation Variables and Pre- Therapy Psychopathology Indices ............... 88 Correlations Between Content Object Representation Variables and Past- Therapy Psychopathology Indices ............... S8 Correlations Between Oatemry Count Variables and Pre- Therapy Psychopathology lndices ....................... S9 viii 18. 20. 21. 22. 23. Correlations Between Catecpry Count Variables and Pasl- Therapy Psychopathology Indices ....................... 6O Correlations Between Structural, Krohn, and Content Measures at Pre- and Post-Therapy and Client-Rated and Therapist- Rated Outcome . . . 62 Correlations Between Category Count Variables at Pre- and Post-Therapy and Client-Rated and Therapist-Rated Outcome .............. 62 Analysis of Variance Scores for Therapists' Post-Therapy Evaluations Based On Clients' Grouped by Krohn Scale Scores ............. 65 Analysis of Variance Scores for Clients‘ Post-Therapy Evaluations Bwed On Clients' Grouped by Krohn Scale Scores ............. 67 Correlations Between Clients' Scores on the Krohn Scale and Other Indices Which Assessed Object Representations ........... 7i LIST OF FIGURES Figure Page I. The Relationship Between the Mean Ratings of the ”Self" Scale and the "Others" Scale in the Ten Successful Cases Combined ...... 26 INT ROD UCT ION The rational procem function under certain optimum conditions only, and thm are rarely encountered in 'thinking about' the self or about other persons for any remn particularly significant to the self. (Sullivan. 1 1930]. 1972, p. 37). When a person makes a reference or set of references about the self or about others, what kinds of inferences can be drawn about the speaker based on those references? If one were to examine a person's set of references made within a certain time period, devoid of any knowledge about the actual people involved, and avoid of the interpersonal context in which those references were mam, would it be possible to learn anything about that person's psychological organization? Would it matter, for instance, whether a person talked much or little about the self or about others in a given time period? Would it matter, provided the opportunity to talk freely, whether a person confined other representations to his or her mother, father, friends, or some generalized other? Could one dimern a difference in the psychological organizations of a speaker who generally represented others as kind, warm, and caring, and that of a speaker who represented others as harsh, cold, and rejecting? Would a speaker's expressive qualities relate to various psychological organizations? For example, would it matter whether the speaker was definite versus equivocal, articulate versus diffuse, specific versus general, or clear versus vague and ambiguous? A good mal of psychological evidence indicates that self and other representations, or what is now referred to as "object representations," reflect levels of psychological development as well as different kinds of developmental psychopathologies such as psychotic, borderline, narcissistic, neurotic, and normal functioning. These findings have been obtained from responses to psychological tests such as the Rorschach, Thematic Apperception Test, Loevinger‘s Washington University Sentence Completion Test, and other writing tasks, as well as from people's reports of early memories and dreams. The present investigation, utilizing the groundwork set by projective test investigators. attempts an analysis of the kinds and qualities of object representations found in the verbal material clients provide in psychotherapy. This material is likely to provide information important in understanding clients' personality and psychological processes Part of the task of this investigation involves the development of a methodological appromh to analyze the highly unstructured verbal material provided in psychotherapy, and another part of this task involves the selection of relevant variables which could be used to differentiate representations. The present investigation also attempts to examine the relationships between indices of object representation, psychopathology, and patients‘ response to psychotherapy. A major purpose of this study is to determine whether clients' level of object representational functioning is an important client variable in psychotherapy outcome. REVIEW OF THE LITERATURE The first pct of this review, ”Rm aid Thmry on Self aid Other Reprewntations Ind Psychological Development“, examines resatrch and theory from which relevant varidilss aid/or dimensions will be attracted The second section, “Psychotmrqu Research" reports on psychothermy march which cm be used to with the present inveatiwtion. The third section, "The Protective Hypothesis”, axunines the clinical theory, assumptions, and issues involved in the analysis of object representations and mvelopmental levels from client verbal discourse; aid the last section of this review provicbs an overview of the varidiles and methodology of this investigation. Measures of Self and Other Raprmntetion and Psychological Development. It Precursor -- Warner's cbvelopmantal theory Someoftherasearch linastobediscussadheveprocaathdfrom thetheoreticelworkof Heinz Warner (1948, 1957). From psychological and anthropological sources, Werner pmtulatm that mental development prams from a state of relative globality md link of differentetion to a state of increasing differentiation, trticuletion, and hierarchic integration. Werner used the following chairiptive pairs to polarize this postulated continuum between primitive aid advanced mental Melopment- syncretic—discreta, diffuse-articulate, infinite-definite, rigid-flexible, mdldiile-stdile (Werner,l948). Syncretic function or syncretic phenomena mply to contents or functions of mental phenomena “which would appear as distinct from etch other in a mature state of consciousness, [but] are merged without differentiation into one activity or one phenomma“ (Werner, 1948, p.53). Werner used as an emnple a person“: than imqps which re fuss! to be representative of afew people in thedeuner's waking life. The converse, labeled “discrete," refers to all mental contents, acts aid meanings which represent something relatively specific, singular, aid unambiguous. The “diffuse-articulate" dimension refers to the formal structure of the mental content. Articulate structure chimes a formal cmstruction of such a nature that distingiishdile parts constitute the whole. A ”diffuse” structure represents the opposite. a structure ”relatively uniform and homogneous, one in which the parts have become more or lees indistinct and are no lonmr charmterized by a clear self-subsistence (Warner, 1948, p.54). “Indefinite-Minna" was not cbfined by Werner. Like the two other axioeptual pairs, it implies a wrtain developmental movement which may be inscribed in the direction of increasing differentiatim. Werner used the conceptual pairs “rigid-flexible" and "Mile-stable" to refer to dynanlc (politics. he believed that the more differentiatw and hiera‘chicelly armim the mental structure of an organism, the more flexible (or plastic) its behavior. Flexibility or plasticity refers to the mility to vry wtivity, to mesh or comply, or to lint with the mm of a varying situation. Werner used the pair 'ldJiIe-sthle" to connote aid contrast mite different psychological meetings. The less differentiated aid lees hierrchically petmrned, the more rigid aidyet less stalls the behavior is theorized to be. Werner states that “stdiility of behavior requires a flexibility of response in ormr to preserve the functional equilibrium of the omnism in the face of mutdile situations" (Werner, 1948, p. 55). Another importmt colicept by Warner is that in the mental life of the normal amt there is some wiation from time to time in the level of mvelopment of mental activity. As Werner stated Even ifaidistatesofcumimasuiem redimchd,tlnmrma1 man was not always function on the same level of mental activity. The same normal individual, repending on inner or outer circumslmces may be chumterizad by entirely different levels of development. His mentality, mnetically consimrad, is not the same when he is utterly distracted as W he is in a state of perfectly ormnizad consentration. It varies as he moves from sober scientific and practical work to emotional surrenthr to people or things. It may be said that mental life has different strata At one time man behaves 'primitively‘ aid at matter he becomes relatively 'culturad’ or 'civilized'. In mnerel, than, mvelopmental psychology attempts to unmetrate that primitive moths of behavior in the normal eiult not only mper under certain extrmrdinary conditions, but we continually prmnt as the bsis of all mental being, aid are of vital importmoe in supporting the highest forms of all mentality (Warner, 1948, p. 4). Werner also noted that the malty for more m mental life lies in increasing specialization in mutation to an organism's surroundings. Warner points out that those species which ultimately Meloped into hiaer forms of life were not specialized as eu‘ly tineewhich did not rise beyond a lower level. Werner concluths that the lower branch ofmy wistic group is charderizad by specialization on a more primitive level. ‘The lower g‘wp remains low becatise it adjusts itself throum specialization of the meme it alrael/ pom, whereas the higher group cbvalops new means“ (Warner, 1948, p. 18). ‘A primitive, himly balmcad, 'one—track' culture links that friction between individual and environment, that flulblllty mo fruhm in "amino attempts to Must, which Is the very life all essence of hidier, shamed cultures.“ (Warner, 1948, p. 19). 8. Theory aid Research on Object Representation Object relations theory has become a major psyclmlytic am psychology aid a major psyctmlytic formulation raprding psychopathology. Hrtmann (1964, Chintar 7) is credited with laying the (ratindwork for object relations theory in psychomalytic thinking by focusing attention on the existence of an inner world of mental representations of the self and of objects attached by emotional interest to that self (Ryan at Bell, 1984). Klein (1948), Fairbairn (1952), and l'lahler (1971) focused on the tbvelopment of object relations and posited that the manner of object seeking and the orgnization of self-object representations in the first two years of life affect adult oranization of object relations. Ryan and Ball ( 1984) did Kornberg (1966, 1976) followed up on their work by more strongly emphasizing the importmceof “internal object relations." Kornberg (1972) stetedthat rly main thesis [of paper, Early Em lntewation and Object Relations] is that the structures mterminad by internalized object relations constitutes a crutial cbterminmt of am intag‘ation and an danormal mvelopment of internalized object relations (etermines varying types of psychopathology (p. 233). Early maternal aprivation mtermiries dinormal personality development through the intermediate variable represented by faulty inhrnalizad object relations (p. 233). Clinical evitbnce from studies of child‘en with autistic and symbiotic psychoses aid from psychomalytic exploration of enleeoents and cults with severe chractar pathology and borcbrline conditions indicates that the types aid severity of psychological illness is, inched, largely the expression of pathological structuringof internalized object relationships (p. 233-234). Developments in research using projective tasting cute himlimt the funthnental importance of object representations no internal object relations. This promising work has been based on psychosialytic theory, Wernerian principles, aid on the evolution of Rorschach scoring calemries. A developmental approach has been implied to many scoring categaries on the Rorschach (Hernmendlnmr at Schultz, 1977). duming the m of quality of a Rorschmh response, as, for instance, its level of form mality, has been a fundsnental way of malyzing structural upsets of the Rorschch. A primry arean these inveaigtions, one most eligiad with object representational investigations, has been the analysis of the human figure responses. Such analysis primarily with road to human movement, has emermd as a highly important Rorschezh catemry. Rorschtm movement responses have been related to intelligence, creativity, fantasy, mdmality of interpersonal relations (i.e., orientationstowrdspeople mdaconcarn with positiveandclose relationships) (Data, 1982). Blatt, Brennis, Schimik and click (1976) studied the human figure response from the perspective of Wernerian principles of differentiatim, e‘ticulation, aid intawation. "Differantiation' was thfinad in terms of the nature of the response, ranging from prtial tbtails with qumi-humui figures throuui pctial retails of human fiwres to full human figures. “Articulation" was scored for the specification of perceptual (eg, size, posture, aid clothing) aid functional retails (eg, sex, role, and specific itentity). “intention" was scored in four ways. “(a) the three of internality of the motivation of the estion (unmotivated, ramtive, aid intentional); (b) the degree of intew‘ation of the object moths action (fused, imuent, nonspecific endowment); (c) the nature, and; (d) thecontent of the integration of the interaction with another object (active-naive, estive-ramtive, alive-active, aidmalevolant-banevolant) (Blatt, etal., 1976, p. 365). Studying a sample of "normal" indivimals over a 20-year period from early ubiescence to young withmd, these authors found importmt mvelopmental chums; nunely, "a mrkad increase in the number [mm] of wcurately perceived, well-articulated, full human fiwres involved in appropriate, integeted, positive (benevolent vs. malevolent) and meaningful interactions (aid) asimificmt decline in the number of inactive humai figures" (Blatt, etal., 1976, p. 367). These wthors also studied a (soup of disturbed ablasssnts aid young emits III oompred their scores to the normal mp. A number of differences were observed between the normal mpmdthepetient mp. Patientsproducadsimificmtly more human figpresthetwere inmourateiy perceived, distorted, and partial and that were seen as inert or as enmd in unmotivated, incong‘uent, nonspecific, ald malevolent activity. An unexpected findingwas that patients we simificantly more human responses at ibvelopmentaliy lower levels on assurately perceived responses and simificantly more human rwponses at (bvelopmentally «Named levels of inwcurately perceived raponsss thin normals. Examination revealed that the more advanced responses were essentially preformed imams bearing little relationship to external reality (i.e., the cards). The authors conclucbd that “psychotic patients mpar more disormlized when they are strumling to deal with and integate a painful reality and less disorgllized when disorbed in unrealistic experiences" (Blatt, etal., 1976, p. 372). Blatt et al.‘s ( 1976) study is consitbred to involve the structural wpects of the humm figure resmsa. Another line of object reprmtational resarch hm involved humm content alalyses. In feet, one of the major recommendations in object relations research has been to fmus on both thwfl'lt content and thoufitt form in attempting to assess levels of objmt rapremntations (saaSpaar etquiuis, 1981). Content analyses research was initiated by Mayman's (1967) miding theoretical formulations related to an ”object-relational view”. Mayman collsicerad the role of object representation as central to the psycholmloal life of the person. Haymm states that the existence within the self of images of others is a precondition of social development The level of representation is consichrad to be related to “the availability of a repertoire of personal immy, the rum aid emotional quality of one's representations of otters, the day-ea of fusion which tends to nor between self no others, the Minion of selfuid 001813, UK! the kinds of ellpectalcies one carries into each encounter with people aid thing of his world" (Ne/mm, 1967, p. 17). l'iayman tl'laorizedthetaperson's most reulily wcaesibla object lO. representations calls! up under unstructured conditions, reveal the person's inner world of objects, aid the quality of relationships with these inner objects towed which the person is predisposed, «1d a person's moi cmacity for forming object relationship. A less or lack of these representations is equivalent to a total disappetrance of support I'layman believes that 'without stwle internalize! and objmts, the child (mo psychotic wit) would be left to his own bewilcerad, pane-stricken state of aloneness and disintegrating sense of self“ (l‘iayman, 1967, p. 19). On the other hand, the cmacity for empathy which involves, in put, self/other differentiation aid awa‘eness of mother's need: (even if those news run munter to one's own) is consicered the highest attainment of object representation (see also, Clark, 1980). According to l‘layman, the more empathic representations of others in a Rorschmh protocol will, on the whole, be more varied in content, more objectively ascribed, and more likely to express warmth, interest, pleasure and amusement at the things of others, but in a way that makes it clear that the perceiver is talking moot adistinctivesaperatepersonfl‘layman, 1967, p. 21). A key contribution of l'laymm Hid his collaqpes has been the mvelmment aid valichtion of the Object Relations Scale (Krohn 8: "mm, 1974; Rym, 1970, 1973; Rym 8: Ball, 1984; Trimal 8t Ryan, 1979; see also Spec at twice, 1981 ). This scale, originally chvissd by Rym and implied to early memories, has been suited Uld conibnsad by Krohn aid Mayman (1974) aid implied to teams, erly memories, aid Rorschach material. This scale, summarized in Tillie 1 (p. 11), is divitbd into five major lavelsof object relations. psychotic, bormrline, nircissistic, neurotic, and normal. The continuum (hoists the emotional mality of the representations of self aid others. the intawity of these representations, and the guilty of the inmrmtion represented between self aid others. The scale has ban correlated with Mist/supervisor ratings of patients' psychopathology ll Tuile l Krohn aid Maymm's Object Representations in Dreans Scale with a Comps-ism of l‘ldiler‘s Stqps of Object Relations Development (Spas and Lqiims, 1981 ). Krohn and Mayman Object Representation Scale Mahler's Stems 8. Emotional mutuality, m of others' needs, nondistorted intimaw Indivimation 7. Affective relateaiess but with childlike trmsference distortions 6. Awareness of unique others but only with rms— length interstices 5. smreotypical relationships with interchmpdile 13001319. "W‘s-DY" 4. Vane awreiiess of need-(ratifying others arms-length inurmtions Symbiosis 3. Some awareness of ephemeral others in nonbizarre ways 2. Awreness of vqpe others only as primitive mmifestations of bizrre, malevolent, and smistic self-impulses 1. Isolated, lifeless, alien, unpredictable world, alone with no others 12 (Krohn&11ayman, 1974) aidwithlevelsofemcbvelopment (Trimm&Rym, 1979). The following mutations himliuit findings and uncbrstandings reading the level of object representations. The fundlnental conclusion is that level of object representation mpears to be a salient, consistent, reserchable personality dimension that expresses itself throum relatively diverse set of psychological avenues, ranging from a realm as private m life to one as interpersonal as psychotherqiy. Moreover, it is not a redunthnt construct synonymous with levels of psychopathologyor severityof symptomology (Krohn & Hayman, 1974, p. 464). . The explicit or implicit slapstion in much of this work is that object-relations patterns are set tbwn in eu-ly childiood, become consolidated through late chilchood and ableemnce, aid remain relatively fixed througiout amt life as the transference pareiignsof W. Adilt functioning, whether normal, neurotic or psychotic, is assumed to be mpelxbnt on the maturityof one's object relations, that is, on the relatively smile level one he mhieved along the tbvelopmental continuum. From this point of view, improvement in object relations is possible only as a result of a mutative maturational process, wpcrently limited to natural mvelopmental prsssssss and/or psychotlurqay (Rm 8: Bell, 1984, p. 210). C. Loevinpr's Theory of Ego Development Appraisal and Critime The present wthor hm mixed feelings about including Loevinwr's theory of em development The desire to incluth it is related to the mpliodiility of it's conceptions to what wpea‘s to be a central aspect of pwchological life and (Evelopmentu internal object relations. The theirs to excluth it is related to this author's dismpointment in the thaory's priorities comptrad bath to internal object relations theory of chvelopment end to what is here thought to comprise much of psychological life. Lmvinmr (1966) asserts that am chvelopment is not just “one intresting pu‘sonality trait unong mmy, but is a master trait It is second only to intelligncs in anointing for humm wideility.‘ She states further in the same pirarqih: 13 We owe it to our discipline to be faithful to reality, not only in mtails but also where we invest our lives as scientists. When Brunswick said, let the ormrofour imasbethesameastheorcbrofthings, hedidnotmeananything so utilitvian or sobmal asthatthe importmceofen area in our science must reflect its importance in life. Surely he meant rather that the structure of our science should reflect the structure of life. On this basis em (svelopment must become a focal construct in psychological theow and research (p. 205-206). The mestion is (hes Loevinmr's calmption of em (Evelopment prioritize the salient aspects of psychological life and maturation or cbvelopment? To use Loevinmr‘s words: ches the structure of her theory reflect the structure of life? My impression is that it (hes not insofa‘ as it (hes not mistely embody the importmce of aid priority of internal object relations to the psychological life of the person. Perusal of masters of am mvelopment (see Table 2, p. 14) (Loevingr, 1976) hio‘iliuits the impression that Loevinwr's theory is more tied to a cognitive aid/or moral epistomology thm it is to a social or psychological one. The steps labeled Presoclol, Impulsive, self-protective, Conform ist, Se/f- swore, Conscientious, Individushstio, Autonomous, and Integrated, (b have aspects related to intaer object relations and social chvelopmant with the evaluation of concepts such as self vs. nonself, inbrpersonal perspective tuning, interpersonal morality, empathy, individualism, aid wtoiiomy. However, the emphasis is on a comitive or moral epistomology aid a can vis-a-vis the world more that on in am that starts in relation to itself aid in relation to others. To use Helms existential terminology on the three bale moths of cheein (being), Loevingr has prioritized her theory in the UNWELT--the surrounding environment, the world of everymy and praztical conssrns, over the l‘llDWELT--the modality of being—with-otMrs, the communal world, the world of perml colurn, and the ElOENWELT--tha world of self relatethess, self-consciousness, the world of clxicarn. This criticism cm be unthrstood better if one tries to imply the steps to psychological 14 TABLE 2 Some Milestones of Em Development (Loevinwr, 1976). STAGE OWE Prasocisi Synliiotic l-i inpulsiva 1-2 Self- Protective Conformist 1—3 Conscient- 1-3/4 ious- Conformist Conscient- 1-4 10115 individiai- iatic W 1'5 IMLSE C(NTRCL impulsivaJar Far of being caugit, external- izing blues. opportunistic Conformity to external rules. shuns. guilt for landing rules DifTarantistion of norms. goals Self-evaluated stmdrdssalf- criticism,guilt for consamisncas. long-term goals lid ideals m: Respect for mummy M: Coping with conflicting inner nesds.tolerstion m: Reconciling imsr conflicts reiesicistion of isisttsinwla INTEH’ERSGIAL Autistic Symbiotic Receiving. dependent. exploitiva Wl'y. mmipuls- tivs. exploitive Belonging. apar- flcial nicanass Awra of self in relation to m. helping intensive, ra- sponsiblamutusi concern for com- mieilcatlon M3 Dependence as emotional problem M1: Respect for autonomy. inter- dependem Ag: Cherishing of indivimality couscous A Self vs. normal! Bodily feelings. especially sexual aid massive Self-protection. bottle. wishes things. advlita- gss. control Anal-lice. soc- ial acceptdiility, blial feelings. bsilvior Adjustment, pro- blems. reasons. opportiisiitias (vows) DifTarsntiatad feelings, motives for behavior. self- raspact. achieva- msnts. traits. expression M: Development. social probleiris. differentiation of inner life from outer COGNITIVE Stareotyping. conceptual confusion Conceptual slimlicity. stereotypes. cliches mitiplicity Conceptual complexity. idea of patterning MDistinc- tion of pro- cess from outcome Vividly convayad faei- increased con- ings. intag‘stion of physiological lid csptusi com- plexity. com- psychological, psydio- plsx pattari'is. logical causation of be- tolsretion for havior. role conception. lnbiguity, self-fulfillment, self broad scope. in social context 5g: identity objectivity 15 material. sums aid corresponding concerns such as conformity, cixiscieiitiousnees, aid indivimalism (b not typify the issues which cat be gtherm from what is consitbrad to be representative aid Wistic psychological material found in teams, early memories, Rorschach material, or patients' verbal discourse in psychotherqiy (to be presented). Rather, issues such as the mility or lack of mility to comprehend others' actions and motivations, the (hires of seeing others in terms of individual people versus incomprehensible andfrajnentedoronly in armsofthe needstheysatisfy, aidthecbgeeofbeingdileto comprehend one's own internal working aid motivations seem more salient In the seven for a theory which could enhance the insidits into internal self and social (svelopment gined from Krohn aid Hayman's (1974) object relations scale for (beans, Loavingr's prior (1966) WHOM imme- Yet Loevingr's conceptions re useful when reflecting on their striking similarity and corresponihnce to conceptions used to inscribe object representation and cbvelopment. The ime of a 'master trait“, in indivimal's integrative pm and overall frame of reference cribrad along a nonvariant ibvelopmental continuum mpeers to resemble conceptions of internal object relations did to maribe the levels of object repremhtation. The mscriptim of the signs as “mirkad by a more differentiated mrception of one's self, of the social world, aid of the ralationsof one's feeling aid thoughts to thine of others" (Dame, 1974, p. 621), the sigificant relationship between eg gvelopment and empathy (Oarlozzi, Gas, 8. Liberman, 1983), lid the mility of the test to show differences between mlinment versus Whitman girls (Fraik & Quinlan, 1976) as well as the simificant relationship found batwwn levels of aggvalopmantmd lavelsof object representation (Triman 8. Ryan, 1979), all hidiligt the similarities of construct and convergnt validities between these two conceptions of . gvelopment. 16. Why is Loevinger's theory more cognitive or more moral rather than psychological or social? Why has it prioritized a self vis-a-vis the world rather than a self being-with-others, or a self trying to comprehend its own self? Why does it have limited utility as a clinical theory? And why does Loevinger assert that the levels do not correspond to various degrees of psychopathology? (An assertion which the author thinks is likely to be false; seee.g., Gold,l980). i think an understanding of the limits involved in the methodology used to assees ago level will show the problem with this theoretical conception. Like the factor analytic understanding that what factors are derived depend on what items you analyze, the methodology upon which one builds a theory can limit the theory to the extent that it limits and organizes the original data. Perusal of the sentence stems shown in Table 3 ( p. 17) suggests the problem. Besides the limits imposed on experience by the structure of the sentence stems themselves, the abstraction of ego development is based on an analysis that involves giving equal weight between such stems as "My father" and "Most men think that women." First of all, an attempt to abstract along similar lines for 36 sentence stems, which are a combination of self-references (“What gets me in trouble is", "I feel sorry"), specific other references ("My father", "If my mother"), and non-human category references ("Education", “A woman's body"), will prima facie and a priori lead to a conception of the human psyche along more mnitive, unstract and moral lines then along more personal, psychological, and social lines. This approach is in line with a conception that confounds variables such as inteer object relations and morality and intellect, and prioritizes human intellect and abstraction over a more in depth understanding of the human psyche based on internal object relations. The reason that Loevinger‘s thmry is not a satisfactory theory of social development is because its methodology has axed the depth of internal object relations from its proported representative 17 Male 3 Sentence Completion Stems ( for Women) Used in Deriving Em Level 1. Raising a family 19. When a child won't join in wow activities 2. float men think that women 20. Hen are lucky because 3. Whentheyavoichdme 21. Whentheytelkeddioutsex, 4. if my mother 22. At times she worried diout 5. Being with other people 23. I am 6. The thing I like about myself is 24. A women feels mod an 7. My mother I!“ 25. My main problem is 8. What mts me into trouble is 26. Whenever she was with her mother. she 9. Education 27. The worst thing Uncut being a women 10. When people we helpless 28. A mod mother 1 1. Women are lucky became 29. Sometimes she wished that 12. Hyfather 30. Whenlemwithemen 13. Apremantwomen 3i. Whenshethoughtofhermother,she 14. When my mother spanked me, 32. If 1 can't mt what I want 15. A wife should 33. Usually she felt that sex 16. Ifeelscrry 34. Forawomenecereer is 17. When i unnervous 36. Hyconscience bothers me if 18. A womm's body 36. A women should always “structure of life“ both in terms of the constriction placed on experience by the simple aid structure of attem stems and by its attempt to cunprehend psychic life war. a with rm of phenmiene An even more problematic aspect of the methotblogy used to extract em evelopment is the use of «1 analysis that gives aqua weig'it to self references, specific other references, and malized other references. The assumption that specific other references such as "My father" and wherelized other references such as “Host men think that women" we wivalent in thriving in umbrstmding cf the self or am is, I believe, a false assumption. Rather, while 18 both we alike in that they will both elicit the person to project internal experience, I propose thatthemalizedother refersnceby itsvery netureofbeing more distraztaidwieral, will elicit a different kind of internal phenomeme, one more likely to be of a lower mvelopmentel level and more pwchopathological. Recalling Blatt et a1.'s (1976) finding that disturbed patients we simificmtiy mus humai responses at mveiopmentally lower levels on murately perceived raponses and simificaitly more human moonsas at (bvelopmentelly advanced levels of inusurately perceived responses that normals, it can be hypothesized that Loevimr's mntence stems confound stimulus quality. A Rorschmh scoring equivalent would be to give anal weimt to humm responses to both am mt! pair sumtive Rorsdmh forms. The finding by Gold (1982) that both obsessive-compulsive and parmoid chermterize higher am levels mdthe finding by Ken, Stroud, aid Holstein (1973) that both mfense mechanisms such as intellectualization aid projection simificantly increase with em levels, amt that there may be a confounding of increased psychological revelopment aid premid projection. D. Oomitive Ounplexity of lnterpersmel Constructs The term "comitive complexity“ has received a number of vu'ying cbfinitions, yet the major raserch on this varidile ha been mounted in Warner's avelopmental psychology (Crockett. 1965). A comitive system is consimrad complex if it contains a relatively term number of elements or constructs (three of differentiation) and the elements are integrated hiera‘chicelly by relatively utensive bonds of ralatiomhips (m of hiera‘chic intqretion) (Crockett, 1965). Thus comitive complexity involves an increased differentiation aid a‘ticulation of elements, and simultaneously. in increased intermpenthnoe of elements by virtue of their infarction into a hierarchically orgliizad system. Therea‘eafew findings in thisrasarchreewhichu‘erelevmttotheprasahtcmcern. An l9 indivimal's constructs re more complex for those mrsons with whom he or she inmrmts freqmtly and intimately than are his or her constructs relevant to categpriee of people with whom he or she intermts lees intenmly (Crmkett, i965). Aim, evithnce inmate that individuals him in comitive complexity 5 compared to those who as low in complexity, are more likely to use both favordile and unfavorable constructs in their inscriptions of others (Crockett, 1965). Cognitive complexity reserch, like Warner's (Evelopmentel psychology is based on a premise of emit mvelcpment. The present investigation is based on a similar belief in «hit tbvelopment. The following statement is a mod summry of how this chvelopmeht takes place, and stigpsts, to the preeent either, what is likely to be an important viriable for client M or changuotdte plane in psychotherapy. [cogiitive development] apatite upon the interstion between at existing mom of cognitive orgnization with respect to some chmain of events and the individuals mtuel experience with events in that «main. To the exmnt that a person selmm or never encounters events in some dimein, his cogiitive wstem with respect to those events may remain global, undifferentiated, ind loosely mind. However, such luck of avelopment is not at all likely to the same person's comitive system with respect to Maine whose events he meets fractiently or whose eventsare functionally importmt to him. The increased differentiation and rticulation of constructs with rapect to such mains reflect the indivimal's (rowing awareness of subtle differences in the mpects of these events aid, at the same time, helps him identify and reewid differentially to such subtle differences. The relationship that avelops enong constructs reflects relationships among the aztual events (at least uthe indivitkial has experienced them and, (A) enable him to achieve a subjectively satisfying 'unchrstaiding' of complex events and (8) provide the bais on which he mates inferences that extend beymd the limited set of events he is dile to observe at some particulr time (Crockett, 1965, p. 54). 20 The preeent author sees elements of the wave statunmt as pertaining to how psychotherqiy is likely to stale m or chum in one's interpersonal constructs or to repair internal object relations. Whether the purpose of psycliotliemy is stated to be improved self umbrstmding, or to be dale to work aid to love, or more realism and a better mementofstreesandproblems, awntralfactuqapwstobeaclmwyowthrelatedto incremed differentiation, a‘ticuiation, aid awvenees of xii, others, Hid patterns of interaction. Good psychothermy facilitates and contributes to the overcoming of impediments in inalt cbvelopmentmd impediments in inteer object relations primrily, i think, because of the illuminations mined from the inmrpersonal experience. Chaim aid wowth is broug'n moot not only throum icentification, corrective emotional experiences, aid the working throum of pest materiel elicited through the tMrwist/client inmrmtion (Kell & i'iueller, 1966), but also because psychotherwy and other types of interpersonal experiences provim the friction between the indiviCMai aid other which promotes incremed flexibility, fresmm, differentiation, aid mplexity in incrmsing attempts to ruijust aid to unit. This viewpoint asserts that involvement in interpersonal experiences is a esntral fmtor related to emit thvelopment and supports the contention by Sullivm aid many other theorists that the 'personal relationship betwwn patient and tiurqaist is the most importmt tbtermining factor, positivelyornemtively, inthefateofthe patient" (Oresnberg 8t Mitchell, 1983, p. 93). E. Self-mptmoe aid Accaptmce of Others Two Major inmrparsonal Dimensions In the mini prmosai thus fr, internal object relations to hypothetical psychic structures (r irritations built up thromi the vars of interpermi living lid experience These inferred psychic structures with a person's constructions or interpretations of self no others. In other words, these inferred psychic structures mmifest themselves throum a 21 colierenm or pattern in the kind and quality of a person's object representations. Similarly, to the three that one's thoudtts aid unmistendings affect one's behavior, these inferred psychic ermizations manifest dunselves in the kind and reality of a person's interpersonal functioning Among likely interpersonal cumulus of thvelopmental objwt relations, marchers in the field of interpersonal functioning have uncovered the fat that two major variables mount for mproximately ninety-one percent of the variance in inmrmrsonal inmrections (Conte& Plutchik, i981). Leary (1956) and his colleagues were the first to conceptualize them dimensions, which they ldJeled as “affiliation versus hostility” or 'love versus hate" and "cbminmce versus submission." Other reserclnrs noted that that the eminence dimension or a person's three of mininance was representative of or related to the person's was of self mptence. Hurley (1980), who reviewed the literature which investigltad major interpersonal dimensions, renamed the minim-submissim dimension as "mptance versus rejection of self" (ARS) aid the affiliatim-hostility dimension as "mptanoe versus rejection of others' (ARO). In Hurley's schema, ARS is composedof a summary score from the bipolar scales, ”shows feelings-bias feeling”, “expressive-mad", "mtive-pmsive", and "dxninmt—submissive.‘ Acesptance versus rejection of others is composed of e summery score from the bipolar scales "wrm-cold', “helps others-harms others", “antic—harsh", and 'mcepts enters-rejects others." Because of the salienceof these two interpersonal dimensions in human interaction, these varidiles are likely to be closely allied with mvelopmental object relations. Besichs the theoretical convemnce between idles like empathy and woreciation of unime others, and eaceptmce of others, resau‘ch also supports the importmce of theARO mdARS dimensions. For instance, ARO aid ARS have bun found to be importmt mimics in pa‘entai behavior md 22 attitumstowrrdschila‘en (Hurley, 1965, 1967; Symonds, 1939), in ueeeeing the effectiveness of professional and pare-professional mental health workers (Hurley, 1976; Small & Hurley, 1978) no in .«ming interpersonal chums mub by unrbrwaflete prticipmts in university-base experimental mos (Hurley, 1978; Hurley & Force, 1973). Psychotherqry Reearrch This section reviews psychotherwy reeeerch involving analyses of clients' self and other representations. An overview of this resea‘ch surmsts that this reearrch tree is unrbrmvelopad Besirhs the early client-centered research on self and other acesptmce and the more rant work by Krohn, Haymen, Rym, aid colleges, there have been few reserch investigrtions. This seems surprising in light of the salience of humm content and movement responses in Rorschach reserch aid in the assessment of psychological functioning In psychotherwy, clients usually focus on feelings and "units diout themselves aid others who we affmting their lives. Rich aid memingfui representations of self aid others seem apacially likely to oesur in clients‘ verbal discouse during psychotquJy, especially in cornpu‘ison to the somatic human responses to the Rorschach. A Client-Dantred Thaquy Reeaarch Raimy ( 1948) was the first to measure chum in self-cormt as an important vu‘iable in psychotherwy. His work initiated a series of successful studies on claims in self and other acceptmoe by the truly researchers of the client-centered school. Raimy postulated the importmce of in indivickral's self-concept, specially on the dimensions of self-approval vs. self-dismproval. His scoring scheme, listed in Title 4 ( p. 23), was melted to 14 completely 23 Table 4 Raimy's (1948) Scoring Scheme for Classifying Client Statements" 1] . l . P Positive self-reference (SR) indicating a positive or favoring attitude toward self. N Negative SR indicating a negative or dismproving attitude toward self. Av Ambiguous SR in which some self-reference is manifesbd but either the value is too vague to be classified or the response lacks value altogether. O Other or External Reference in which the client himself is not implicated. Q A nonrhetorical question in which the client is actually asking for information—if e ginstion is only put of a complete response. the question is iglored in the classification. j Em “All words spoken by the client between two responses of the comeeior. recormd counseling cases. Each client steternent (i.e., all words spoken between two responses of the counselor) were scored For successful eeeee, Raimy found an increase in positive self-statements at the end of therapy and a increase in nemtive and ambivalent self- references. This was not true of unsuceessful cases. Shearer (1949) expmrbdon Raimy's research in two ways. For one, shewas conesrned "not merely with an investigtion of the tone of valence of the clients' self reference in 24 successful counseling but also with the clmging content of the self cumpt" (p. 169). In other words, Slmrer postulates degrees of acceptance in client statements. Secondly, she postulated a positive correlation between self-acceptance aid acceptance of others. Shearer (Eveloped five—point scales for aelf-wceptmce aid mptmce of others to teet her hypothesee. The scales are not listed in the publication but representative examples are shown in Table 5 and Tdile 5 Sheerer's (1949) Illustrations for the 5-Point Deg‘ee of WScfle. Step1 'I haven't gotwhatit Utes tobeanormally accepted person.‘ Stap2 'All thetime withmym. 11mm unwary thatthey're going tojtanponmywadtpoints ...l\dldontassertmyself. um nothingtosay because of a far of condeimtion. of ridicule md what I'm looking for is release from this indility or fridtt of just being a him being." Step3 '1 think I'm seeingratherclerly nowthatmostof the painlsuf'fer is becausel-nnoone. ndllnnotfollowingepetterntlltisreallyme. but justalotofpattevmthetpeople-fltumtivem‘s. doyousee. mdthat'snot averygoodwaytobe.‘ Step4 'Whenyou‘reinaf-nilywhereyoirbrotherhesgonetocollegemd everyonelusegoodmind. lwonderifitisriwttoaeelhatI-n-lcnnd lcn't achievesuchthings. lVe alwaysb‘ledtobewhatotherslhotmtl shouldbebutllnwondu'ingwhemerlshoulmtjustseethatllnwfntl Steps 'Well. We jutmticedsuchadiffme. lflndthatwhenlfeel "Imps-wwhenlfeelhatr-ldon't cre. Idon't mind. lfeelmcref'ree now. ldon't feel giiltyfioutthingsf 25 Tfllo 6 Sheerer's (1949) Illustrations for the S-Point Deg-ea of WSflle. Step 1 'l getsomlserdile. lldlcm'l stmdtoherhertalk-flfhy? Andshe‘s so foolish.“ I keep saying to myself. 'I‘m W that she's so foolish.’ I keep yelling at her ltd pointing out to her where she's inconsistent lid the misties.’ SW2 ‘Hymotherismwawidowwithoutnyfriends.l'llhavetotrymdseeifl cm't gtherinabettersocialsihltion. Wellvebeenpreechingetherfor alumtimultdnflustgetherselfintoabettarsocialsihltion. butldon‘l thlftshecm.’ Step3 'I mayhevenopatience with rows. orlittle M; lcerteinlyhave patience with chilti‘en. with child-en lid minuls.’ Step4 'lbelievatl'iatsl'ieisaratherselfishwum. lidlcmseeherinalidit possiblethatwould excise her. meymderstmdherbetter.‘ Step5 'lcmecceptEvelynndherlove more. IsmposemyreactlonwithEvelyn we really a violent case of rejection which I dith‘t realize but now I do. aid I accept her.’ Tune 6. As didwn, step 1 on both the self-meantance and the elm-mm scales represent climt uprassion of a lack of woeptance and rapact, wheres both step fives raprmntmexpraeeimofmwptanceuflrapect Sheererratadatotalof1,3663tatemmtsbasedmtenwccessfulcasesmtailimatotalofSQ interviews. She found that 77.1! of the statements were relevmt for the 'self‘ scale and 16.8! were found relevmt for the “outer" scale. ibr findings indicated a simificmt cwrelatimbatwaanclimtscwasmthetwoscalee (rllOl -.51,p (.01) indicatinga 26 ‘positive relationship between the expressed attituces of mptmce of self and the expressed attitumof mceptmceof others" (p. 173). In atliticn, Shesrer founda'ma'kad increase in selfaacaptmceandrespact thrumouteigitafthe teneueemda ma‘ked increase inwcaptmce ofmdraspactfcrothersin six e-ee' (p. 173) (seefigure1). FIGURE 1. The relationship between the mom ratings of the ”self“ scale aid the 'others" scale throum the course of psychotlierqiy in the an succeesful casescombined (sailed from Shearer. 1949). S DEGREE or 4 ACCEPTANCE 3 AND RESPECT OTHERS 12345678910 DECILE Stock (1949) furthered this reserch also by differentiating the mural was of “feelings diout others' into more specific categiriee. Table 7 (p. 27) shows this useful WY scheme. Stmk (1949) supported Sharer's (1949) findingscf apositive correlation between each person's self-scale score aid other-scale score for each interview. In a more detailed dialysis, Stock found the self score to correlate the highest with referents rqiresanting social relationships (I' 8 .40) (W B in TING 7 (0.27)). III tome extent with referents Wmalizadother (r- .35) (Calm D) mdcounselor (r- .35) team E). 27 Table 7 Scheme for Classifying Referents Town-d5 'Others' ( Stock. i949). .> Referents representing primry personal relationships: ordinry menters of theimmedlate funny—husband. wife. mother. chiliren. etc. 8. Referents representing sacondry social relationships: as individuals or as occipying certain roles. ordinry persons with whom there is less emotional involvement Hill the wove-friends. employees. schoolmates. etc. C. Referents representing impersonal relationships: with 'distract' individuals or ma-personsinservice occwatimssuchubusdrivers. saieswomen. etc .. with whom contact is quite fleeting. Individuals sureotypes such as 'Newoes'. 'Germlis' etc. D. Referents representing the 'generalized other‘: whom the client refers to as 'peopie'. "'.everybody 'eiybody'. etc. E. Statements referring to the counselor or couisaling situation. Stock concluded that ‘attitudas towa‘ds individuals in a social relationship correlated more highly with self attituths thm did feelings in the areas of family relationships and more impersonal relatimships" (Stock. 1949, p. 180). B. Other Relevant Psychotl'erqiy Resea‘ch 1. Chums in internal object relations from psychotherqiy. A study by Rym aid Bell (1984) closely wallels the line of investigation being developed tiers These wthors investigated the stages in object representational thvelopmentai level over the course of psychomalyticaily oriented psychothrmy for inpatient whimphrenies Chums in object rapresuitationai level wasassessadat intdte. mrmination. 28 and 6 months after treatment ented Object representational cpality was messed via patients early memories; specifically. the earliest memory. eu‘liest memory of mother. and the earliest memory of father. obtained at sch of the data collection points. These authors used the Ryan Object Relations Scale (Ryan. 1973) which is the parent of the Krohn and i‘layman Object Representations Scale. The authws found a simificant difference from intake to followup on the earliest memory only in the direction of positive chum. Using a cut-off point to divicb patients into relatively him versus relatively low object reprmntational level for the au‘ieet memory, the authors found a significant pre-post pattern of most scores going from low to him; them that were him remained high, aid no scores went from mm to low. Amin. no simificant differences were observed on the father or mother memory. in edition. the authors found that those scoring low compared to him at follow-up were mproximately twice as likely to have been rehaspitallm in all, among this group of schizophrenic subjects, only 14% remained at the psychotic level of object relational functioning from intdte to follow-up, which averamd one and one half years. Theauthorsconclucbtt The results aim that object relations in psychotic patients as mmurad using their early memories can chem over a relatively short period of time from bradttbwn to recovery. We may be observing the chum from the bradtmwn of the patient's innarworld into psychotic disorganization of self-other representations to a reconstitution at an interpersonally barren but narcissistically satisfying cbfensive level of object relations that allows some chaos of psychic equilibrium (Rym at Bell. 1984. p. 213). 2. Pre-thamy interpersonal attitucbs and psychotherqay outcome. It is likely that the kinds of self inscriptors a person checks on a psychological 29. qestionnaire is likely to be interwoven with the person's internal object relations. In this read, a study by F ildt. Abeles. aid Noiwist (in press) appears relevant These authors W clients' pretharqiy intarparmnal attituchs in relation to psychotharmy butane. The attitums asseased were almg the interpersonal dimensions affiliation versus hostility. or mums versus rejection of others. and diminmce versus submission. or mptuice versus rejection of self. The mestion was to what extent would clients' pretherwy attitutes of affliation versus hostility be prapotant varideles in response to psychotherapy? The authors found that 728, or 21 out of 29. of the patients whose pretbminant pmtherqiy lnterpersmal stun was Win! as affiliative ha! awful outcomes. fatal by both tiermist aid client. wheres only 388. or 10 out of 26. of the clients whose pramminant pretherqiy interpersonal staice was characterized hostile had successful outcomes. No simificmt differences were found on the pretherqay tbminmt-submissive dimension in reldion to outcome; however. a simificuit number of successful thermy clients showed a pre- versus post-thermy shift in their interpersonal attituths from one of submission to one of thminmce. The raults aim the importmce in psychotherqiy (aid in other interpersonal relatiomhips) of prapotant attituibs wout the self . uncut the self in relation to others, aid clout otters which will affect the course of the intera:tion. In the move study it was found that a person's (Inscription (or unthrstanding or interpretation) of their interpersonal attittlts reflecting affiliation versus hostility. W to effect their Imitation to thorny. ln utiltlm. to tin extent that intarparmnal attittlts chum a a result of W. a was eviwit in clients' chums from a submissive to a tbminant orientation reported move. it can be m to what axtmt M clients' internal object relations ( la ( hypothesized ) relatively Ming psychic structures aid civilizations) chamd or been altered? 30 3. Chums in personal constructs from psychotherqay Law's (1976) single case study of psychotherqiy outcome using the Kelly Role Construct Repertory Grid is suggestive of and relevant to the area of reserch being invalopad hare. Lam lookadat chums in the kindof constructs andconfiguration cfconstructs from a six-month participation in a small psychotquiy group. Lem found at postthermy that there was a (fanatic chum in the client's constructs. There was no longer a nun clustering ofconstructsalong onedimansion. but ratMr ag‘eater ranmofconstructs varying in themes. There was also an inclusion in the construing system of more interpersonal types of constructs. While there were similar assessments of the self on the old mping constructs (Dre-psychothermy constructs). there was a more positive view of self in relation to the newer post-psychotherqay constructs. The patient in this study he! man: no chums in symptom improvement The prmnting prailen‘ls were exhibitionism aid fmlings of misty, fireman, inamqumy. low self-esteem. ed a poor body imqp. No symptom charms were evicbnt on the Eysenck Pmlity lnvantrry or the Beck Depression Inventory. Yet. both the patient mdtharqiist were left with a subjective impression of psychotherqiy chum. Lugs points out that this is not in uncommon experience in psychotherwy. These “claims“ in the client were evitbnt on the Repertory test. The test results reflected the "imprauion that the patient hut become laee (bfaiisive aid he! shown some personality wowth, cropping his emphasis of m aid wicbning his view of the world. becomingamore accepting. woessible person" (Lem. 1976, p. 319). meonclumsthet the stud/'8 findings reflect client chums not covered by more wstrct inventories aid symptom bound criteria aid lent: support to more subtle and subjective impressions of chum Lam's finding cm be used to highlight a few iaues relevant to the prunt investimtim. 31 for one. Lam found changes from psychotherqiy that are not usually studied directly in the psychotherqiy outcome assessment. These chains in the client's self (aid perims other) constructs. aid in the client's shift to a wimr rm of constructs sugpst that the change occurred in the m of current comm: self and other repreaentations. As Lam proposed, these chimes may usually be reflected only in broad outcome mestions such as clients' mo therapists reports of Clients' “improvement" or "idiotic: While a (mailed list of symptom musteoftedusadintheassassnentofoutcome. psychotherqayraserchhmnot objectified or differentiated chums in self aid other repreaentations. Horowitz (1979) points out the inconsistency that psychotherqiy is lmly m interpersonal enterprise but that outcome is based primarily on diqiostic and symptom criteria In line with the other literature reported here, Larm's (1976) study semis the importmce of self aid other representations in unthrstanding psychothermy outcome. While Lm found his chum measure to be unrelated to symptom chums. it should be kept in mind that his research involved primarily pinpointing an area of assessment and charm not covered by traditional outcome measures. It was not an intensive investigtion of symptom-construct correlates. Based on the theory presented erlier, we are more likely to think that there is sane correspontence between self did other representations and psychological symptoms. The Projective Hypothesis This section is included to orientate the rearbr to the projective hypothesis involved in this I‘mch. This mtlon also himlimts the fact that the rationale of this silly. that is, the projective investimtion of clients' self and other representations. could be owned in the theory of projective technique as restily as in the theory of psychomalytic psychology. The idea that one's personality. motivation. attituiee, etc. influence our perceptions of 32 the outer world has been a cornerstone of psychological thinking for some time. The term ”projection" was initially given to the psychopathological elements of this phenomena by Freud in 191 1, but later. Freud ind others brouhnad the mplicdile phenomena labeled projection (Main. 1981). Projection canetocbfine. a radiated continuum... extending from the internalization of a specific type of tension in pamioid projection to that of my kind of tension in infmtile projection, to that of a whole system of attitudes and tensions in trmsference phenomena, to wmre it. inperwptibly shaibs into externalizetion in the form of a private world defined by the oranizing principles of one's personality (Rupert, 1952 cited in Robin, 1981). The two major areas in which people's projective material has been explored has m in psychotherqiy unter the rubric of transference and in the area of projective tests. The essential feature of a projective test or technime is that “it evokes from the subject what is in variouswayseiipreasive of his private worldand personality processes" (Frank. 1948, cited in Mid, 1981). actually. a keyaspact of theelicitation prcaesswas considered to been inherent ambiguity in theprojective mvice. be it the aialyst or the projective test it is beyond the scope of this investigtion to (blermine whether it is ambiguity per se ind/or stimuli which may elicit various interpretations which is the importmt ing‘ediant of a projective device. Nevertheless. with the expaiding horizons of what is consicbrad unmr the rubric of projection. aid the unterstaiding of traisference phenomena as being a central upset of all human relations. comes the unthrstmding that all interpretations or constructions of self and others may have a prathminant projective component Few would disputethat one's unmrstmdingof others is. in pet, a reflection of one's personality, needs. etc. in momrn psychology. the issue is the extent to which representations we reality-based 33 and the extent to which they are projective (or "narrative"). Some schools of thinking, for instance, the narrative school of psychoanalysis, would either discard the issue of reality versus projective-based perceptions as irrasolvable or irrelevant to treatment, or else take the extreme view that all perceptions of self, others, and personal history are constructions or projections (wefor instance, Spence, 1982; we also, Greenberg & Mitchell, 1983 for issues bearing on this topic). The view taken here is that a person's self and other representations, in themselves (a. g., without a consideration of the actual objects impinging on or having affected the person), can illuminate the psychological life and development of the person. Overview of Study This study attempts to assess the quality of object representational level directly from client's verbal discourse in psychotherapy. One can imagine some potential difficulties of this task. One difficulty is that in comparison to projective assessment using tests, verbal discourse appears lass structured than the most unstructured projective tests. Clients appear free to talk about anything they wish, and it can be imagined that there is probably a great rarm in the content and process of clients' discourse. Organizing such unstructured material is likely to present me initial difficulty. in addition, in the assessment of representations from verbal discourse, there appear to be no natural stimulus properties along which to assess the quality of response, as for instance with Rorschach comparing form versus color activated responses. Probably the greatest difficulty is the lack of previous research upon which known variables in verbal discourse have been established. For instance, when ming Rorschach analyses, an investigator knows that responses vary in form quality, quality of human figures, and human movement, etc. The relatively novel approach of assessing the kind and 34 quality of object representations in verbal discourse involves both the selection of likely relevant variables along both structural and content considerations, and the development of suitable methodology with which to implement the task. Nevertheless, the fact that there are other projective approaches enables the use of analogies from projective assessment to setup relevant kinds of investigation. The potential advantages of assessing object representations via verbal discourse can also be imagined. For instance, unlike the Rorschach which contains one general category for human figures and responses, verbal diwourse analyses allow the possibility of a number of categories such as mother, father, and generalized other categories. Verbal discourse also more clearly parallels a natural and spontaneous setting as opposed to whatever limitations are imposed by the introduction of a specific test or task, and whatever limitations are imposed by the structure of the particular task. in addition, regarding the viability of psychotherapy outcome research, the client, therapist, and the clinic setting are unencumbered by the introduction of projective testing Outside of the consent to be taped, clients are not burdened with lengthy testing and are not asked to take the same test through the course of treatment. The analysis of representations from verbal discourse, if viable, provides one of the least intrusive methods of psychotherapy investigation. A. Summary perspective From its origin in concrete experience and a real interpersonal situation, emh personification has itself had a developmental history which is in turn completely untbrstanmble in terms of the functional schism of the person in the series of interpersonal situations which he has had to live (Sullivan, 1936, p. 79). 35. The way a person ascribes others and self, that is, the particultr content aid cpalityof the thscriptions is likely to reflect some psychological aspects of the speaker. The reviewed literature mts that what is reflected in the speaker may be nothing short of the psychological life, orwnization, or Melopmental level of the spouter. This perspective has two key features. One is that object representations are proposed to reflect psychological enacts of the spatter. The other is that psycholmical features portrayed are likely to be fundlhental aspects of psychological functioning Remrding the later point, the author consimrs it importmt to propose the 'meteconstruct" nature of the psychological aspects thoudit to be reflected by object representations. Not to attempt this mpears to unmrmine the potential worth of this veriwle. 8. Summtry of study's purpose This study he two major purposes. One is to attempt toobtain meaningful dimensions of object representaions from client's verbal discourse in psychotherapy. The other purpose is to investiwte the relation between the kirxis aid qualities of object representations aid psychopathology aid psychotherqu outcome. 0. Overview of object representational wisbles This section provichs m overview of the object representational variables that will be used to client’s verbal discourse. The varidalas are rouped into four types. structural, content, UK! cateuiry measures, and the Krohn aid Haymai's Object Representational Scale for Drauns. 1. Structural varieties 36 Structural varidiles refer to those variables that wpear to assess more of the formal aspects of representational material then to its content consicbration. Similar to the formal aspects of Rorschach investimtion, there mpear to be naturally oesuring formal dimensions in verbal speesh. Among perths numerous formal va‘idiles, the present author noticed four va'iwles that occur in verbal speech. Three of these, articulation, specificity, aid clarity, mpear related to Warner's theoretical icbas involving increasing differentiation and specificity with increasing Melopmant The other varidila, definity, wm mvisad based on the author's observation that a mod permta of verbal speech contains qualification. These scales are discussed further in the method section aid in Appendix A. 2. Content Scales The ima that object representations which show warmth and mptmce towards others we on a higher developmental level and/or are more indicative of psychological health is a recurrent theme throughout the literature review. The following content scales are used in this sum: 1) self-mm (1‘ level of self-esteem, 2) level of self-efficacy, 3) movement towu‘ds otMrs versus movement away, 4) hostile versus affiliative, 5) cold versus wtrm, 6) mntle versus harsh, aid 7) tempting versus rejecting In atlition to these scales, the stud/ employs Hurley's (l980) scales related to self-acceptance versus rejection of self (ARS) aid self-incaptmca versus rejection of others (ARO). All the content scales are simple bipolar dimensions (shown in Appendix B). The alt-mow scale aid the level of mlf-efficmy are scales assessing attitums m the self. These two scales are likely to be pooled to represent the self-acceptance dimension. Movement towsds others aid hostile versus affiliative scales asses the dimension of ”[93 other: The other three scales, cold versus warm, mntle versus harsh, aid wcepting 37 versus rejecting, tuten from Hurley‘s (l980) scales, will be utilizedto-leshow otners are represented to be in contradistinction to how one relates to others. This enwles, for one, 81 mination of whether there are similarities aid differences between how the spadtar orients towcrds others (self-acceptance-rejection of otters) aid how others are represented as being towards others, including the spedter (others' mptmce versus rejection of others). The Hurley scales ARO and ARS will be used in their entirety also in the more traditional way of .-\ ing spadters attitutb towards self aid others. 3. Oategiry Ownts The catagxy counts was sumted by the client-centered research (Raimy, l949; Sharer, I949; Stock, I949) which investiptad both the number of positive aid neptive refenences and also looked for differences between catemries, such as primary relationships versus secoixlry social relationships or wieralized other. One interesting finding using the categiry mproach wes that attituths towrds the self correlated more highly with attituths m social relationships aid pneralized others that it did team other catamries such as funily relationships. it is likely that different mtegiries vary in their unity as projective divices aid that some categiries such as generalized otner may be specially suited for ridiing the self of certain feelings or thwuits. When a person says, for instmce, “people we maochists', we can woncbr ifthe statement is used by thaspadter asa vehicle for discharg of some psychic tension. It may be that all object representations, both malized ones aid references diout specific people, besim being reflective of a permn's (Evelopmental psychological mitotim, are used as vehicles for working out uncomfortdile pwchic tensions or feeling. 38 4. Krohn aid Naymm‘s Object Representational Scale for Dream (The Krohn Scale) The Krohn scale has been usedwith Rorschwh, TAT, aid early memories material, and it wpea‘s easily suited to my type of verbal material. This scale «were to measure a dimension of psychic material not assessed by the other scales in this study. it is based on a Mailed proposition of psychic cbvalopment beginning with a sin in which the world mpars totally charlie and ram and progressing to a developmental stu in which the pram appears dale to comprehend quite well the thoughts, feelings, and motivations of another. The tbvelopmentel m of the stag also correspond to psychomalytic thvelopmentel psychology ranging from a psychotic psychic orpnizetion throug'l various other feulty orgmizetions to a fully developed psychic enmity. The Krohn scale mpears to be a measure of internal object relations. It seems to measure the unthrlying psychic orwlizetion from which object repreantetions re mated, which is the definition of internal object relations proposed by Karnbarg As a measured internal object relations, this va'idile not only cm be used to its relation to psychopathology and response to trmtment but can also be used to explore the relation between internal object relations and the various masures of object representations used in the study. HY POT HESES The purpose of the present study is to mate in exploratory investimtion into the relationship between the kinds and melitiss of object representations found in a sample of clients' verbal discourse aid 1) clients' psychopathology, and 2) the outcome of psychotherqyy. Four kinds of veridiles serve in the investimtion of object representations in clients' verbal discourse. These are l) the Krohn and rtaymm Object Representational Scale which is proposed by the present author to be a measure of internal object relational cbvelopment, 2) the structural variables, Jenn ity, articulation, specificity, aid clarity, which more of the formal oinlities of a person's epessh, 3) the content va‘idiles which primarily the Games of warmth and mptence in clients' object reormntations. and 4) the catemry count variables which provitb an estimate of clients' use; of various object representational catagirias. The study usesmite afew measuresof clients' psychopathology. Theseus 1) clients' responses to a symptom chwklist which are scaled on nine symptom dimensions aid a global pathology inch, 2) clients' interpersonal pathology scores on the Interpersonal Checklist (the intensity measure called A!” ), 3) rating of clients' psychopdhology provichd at prethequy by the clients' intdte workers and at post-thermy by clients' psychotquiists, aid 4) ratings of clients' psychothemy based on jumes readingsof sample verbal discourse. Psychdtherqiy outcome is assessed using selected clients' and thermists‘ posttinrwy ratings of outcome. Baed on thawove discussion, there areeimt hypotheses thus fer-- a coinpa‘ison of the four kincB of object representational measures with both clients' psychopathology aid psychotherwy outcome. Each of the four object representational varidiles will be measured 39 in thesanewayior both the psychopathologyend psychotherwy outcome coinpa‘isons. For the former ( i.e., psychopdhology comparisons), (Ilia sets as available to provicb analyses at both pre- and post-May. The first eidit hypotheses formally listed are 5 follows. Hypothesis l: The Krohn scale will be significantly related to clients' psychopathology. Hypothesis II : The structural scales articulation, definity, specificity, and clarity will be significantly related to clients' psychopathology. Hypothesis Ill : The content scales will be simificmtly related to clients' psycho- pdhology. Hypothesis IV : There will be a discerneble pattern of significant relationships between clients' use; of referents within various categories, particularly nemtive referents and Willow!”- Hypothesis IV is more of Ul exploratory hypothesis, thus it is stated very wally. it is set up to make a mural investigation to mtermine whether clients' user of referents within vu‘ious categries (for axunple, the welized other categiry) is associated with psychological distress. Hypothesis V: The Krohn scale will be significantly related to both client-rated aid tlerqfist- rated outcome. Hypothesis VI: The structural scales articulation, atefinity, specificity, and clarity will be simificantly related to both client- rated and tiierqiist- rated outcome. Hypothesis VII: The conmnt scales will be significantly related to both client-rated and thermst- rated outcome. Hypothesis VIII: There will be e discerneble pattern of simificant relationships between clients' usqp of referents within various catemriee particularly negative referents and both 41 client-rated and therapist- rated outcome. in adiition to the move analyses, two other analyses are planned using the Krohn scale. One analysis is based on the fact that the Krohn scale is likely to provide a significant measure in its own right of psychological functioning and psychological development. The scale is likely to be a measure of internal object relations development which has ban proposed to be not quite synonymous with psychopathological versus normal functioning and apparently also inclucbs some aspects of ego-psychological development. The other object representational measures, such as level of warmth and acceptance in representations, or level of articulation Of statements, unlike the Krohn scale, have not as yet been consistently related to any kincB of psychological organizations. A comparison of clients' Krohn mores with these other measures of object representations could provim important information along two perspectives. One would be the determination of which easily observable object representational variables in speech, as for example, use of mneraltzed other statements, are related to internal object relational development. Conversely, correlations obtained between the Krohn scale and the object representational measures may help illuminate some object representational variants of internal object relational development. In more abstract terms, the first adiitionel thta analysis can provicb information on the relation between internal object relational development and object representational variables. Hypothesis Ix: The object representational measures hypothesized to be related to psychopathology and psychotherapy outcome will be related to mores on the Krohn scale. The other mta analysis involves further investigation betwwn clients' scores on the Krohn scale and client functioning and response to psychotherapy. This hypothesis was developed post-hoe to the ratings of the transcripted material but previous to the statistical analyses 42 involving the Krohn scale. Post-therapy client and therapist questionnaires are available which can provide a more detailed examination between client and therapist response evaluations and clients' chvelopmental functioning. it is hypothesized that clients' analyses of their psychotherapy and their relationship with their therapist will be significantly affected by their psychological developmental level. This analysis involves a prediction that developmental level will affect post-therapy ratings and so an analysis of variance design is in order. All other data analyses in this study involve correlations. Hypothesis X: An analysis of variance using groups divicbd on level of psychological development as the independent variable and using post-therapy clients' and therapists questionnaire responses as the dependent measures will show many significant relations. It is predicted specifically that; 1) both clients' and therapists‘ assessments of clients' functioning will be significantly affected by clients’ developmental functioning, and that 2) clients' post-therapy assessments of their psychotherapy experience will be affected by their developmental functioning. METHOD This study used alts collected over a twoyear period (September, 1978 throum dune, i980) for resetrch purposes at the Michimn State Psychological Clinic, an outpatient clinic serving non-sturbnt members of the Hich‘imn State University community and surroundings. The clinic is a training and research mncy of the Department of Psychology and serves as a low cost clinic to uhlts, child‘en, and funilies. The original this collection was based on the premise of obtaining relatively nonintrusive information on clients coming to the clinic. The purpose of the (lite collection was to provicb later information on the prossss and outcome of tlnrwy. The thta for the prmnt invastimtion consisted of psychotherapy twes and pre- and post-therapy mmures. The psychotherapy sessions at the clinic were taped on the first, third, and then every fifth session until termination. Occasionally a defective record required an alternative twing near one of these sessions. For this study, the time points of inurest were the beginning and theendof therapy. The first twotwad sessions (usuallythe ist and 3rd andcccasionallythe 8th) and the last two wed sessions (eg, 18th and 23rd) were considered, respectively, the beginning wd the end of therapy. From thetwo twee (sessionally one) used to represent the beginningof therwy andtwo tapes (occasionally one) used to raprawnt the end of therapy, client trwscript material was mrived (see Appendix E for more Mailed inscription of twee used). Approximately 20 minutes of client verbal discourse was obtained per client: 10 minutes representing the beginning of therapy and 10 minutes representing the and of therapy. The sample of client material was obtained using a stratified rumm sunpling procedure. On a two racorchr ere 43 the counter averamd 800 units per session, samples were obtained at wproximately points 200-225, 300-325, 400-425, 500-525, and 600-625. When asaction of blank twe was found, the typist would rewind to a nonblank section. The typist sampled until, an the map, a pap and a quarter was obtained per session. This yielcbd wproximately 5 page of verbal material per client. The typist was instructed as follows: 'Write mwn everything the client says except last names and pws over therwist remarks. Organize parqaphs or statements on the basis of all client words spoken between therapist remarks or until there is more than a few seconds pause in client's speech, sugpsting a natural break in a paragraph or statement." The typist was also asked to number the sections 2 through 6, corresponding to the stratified samples (i.e., 200-225, 600-625) obtained The division of these sections proved useful for rating some of the scales. The typist reported no difficulty in completing the assignment. The typist's work was not monitored; however, the product quality appeared satisfactory. A sample transcript is shown in Appendix D. In attiition tn the trmecripts obtained, there were a number of paper-and-pencil mastimmiras. The chta set at the beginning of therwy consisted of the transcript material plus client's SOL-90R aid ICL, and intdter's SOL-90A The arts set at the end of therwy consisted of the transcript material plus client's SOL-90R and ICL, triel‘wist's SOL-90A and client and tlerwist posttmrwy questionnaires. Besides client aid therwist date, each set of transcripts was rated on a number of object relations scales. The trwscript material was also utilized to rate client's psychwdhology using questions selected for this study (see Appendix 0). Clients F arty-eimt amlt clients who received outpatient individual psychotherwy served as 45. subjects in this study. The mean number of sessions was 24, mlly offered on a once-a-wwk basis, andthe ranm was from 5 to 7i sessions. The 48 clientswerccomposedof 28 women (588) and 20 men (422). The mean a; ofthe samplewas 29.4 with a ranmof 20 to 57. The majority of these clients he! an annual income of $10,000 or less. However, diverse income levels were represented, ranging from an annual income of $2,000 to $73,000, with a mean of 812,500 (more specific client this can be found in Appendix E, p. 114). These 48 clients represented 36! of all aiult patients who he! received an intake interview at the clinic and who used to pa‘ticipate in rasawch. Thirty-six peresnt represented those clients who had not only all pretherwy and posttherapy forms needed for this study but also audible early and late psychotherwy twes. This percentam is much lower than other reported university psychotherwy projects such as at the University of Pennsylvania where 668 of an available pool was used for a comparable inveetimtion (Luborsky, Mint: and Auerbwh, etal, l980). Partofthediscrepency between the reported Penn statisticandthe present figure is that the Penn statistic excluthd all clients who hazl not begun therapy. In this ample, the attrition from intake participation was the primarily to referals to other wise because of lwk of openings, lack of a coordinated aid vimrous followup to obtain posttherwy forms from clients, early a‘opouts ( 0-2 sessiom), aid seven clients who he! either incomplete or inaudible audio twee. Therwists The therwists were comprised of all clinicians at the clinic who consented to tune part in the clinic's research. This inclubd the full rm of staff from beginning prwticum stlxents to uperianwd Ph.0. clinical psychologists. Yet, the pracbminmca of the case involved therwist: who were chased clinical psychology Ph.D. cmdimtee serving half-time internships at the clinic. These indivichals were usually fourth aid fifth yer clinical stuchnts with n. A wees. The 48 clients were seen by a total of twenty-four therapists. The avers; number of clients per therwist was two, with a ran of one to five. Seven of the therapists worked with three or more clients for a total of 24. Raters The author math all object representational scale ratings. The structural scales, Definity, Specificity, Clarity, and Articulation were rated first. After completion of these for all clients, the content scales were rated, and after their completion the Krohn scale was rated Theauthor haino knowledpoiwypsychopathology or psychotherapy outcomescoresofthe therwy subjects. All ratings were cbnc prior to investigtion of these scores. A small subsunple of the transcripts was rated by another rater to obtain interrater reliability estimates. The second rater was an untbrmnlate stucbnt who was interested in mining research experience aid who received research credits for her participation. The second rater‘s scores were used to obtain the interrater reliability estimates only. The wtual ratingscores used for subsecpent a'lalysas wereexclusively rated by the author. For mother set of scales, which inclutbd Hurley's ARO and ARS males and psychopathology scales for extarllal 1m, two gamma some in clinical psychology did the ratings. Both Unsestumntahaitwoyaa‘sofpsycmtherwyexperiencewdbothheiMA (buses in psychology. The categry wiwle counts, which involved listing the positive and nemtive references for each categiry coup, were man by the unmrmmata rater mentioned wave. The decisions ragrding which catemry ( eg, mother versus father catemry ) the referent was 47 assigned to, as well as deciding whether the referent was positive or mm in tone, was fairly straightforward and did not appear to require a reliability check. The present author reviewed some of the rater's arrangement of the data into the categories and into positive and negative groups, and was satisfied with the rater's organization of the data. Instruments A. Object Representational Scales 1. Object Representational Scale for Dreams (Krohn & Mayman, 1974). This scale ranmd from a low of one to a high of eight. Ratings roughly correspond to the continuum of psychotic, borderline, narcissistic, neurotic, and normal. The scale was accompanied with detailed clinical descriptions of each scale point, as well as two illustrative dreams for each point. Good construct validity has been established for the scale (see Krohn and Mayman, l974). (Appendix 0 shows example ratings of transcript material). 2. Structural Scales: Definity, Specificity, Clarity, and Articulation. Tm scales were devised for this study based mostly on the theoretical ideas of Heinz Warner. The scales were devised after the author examined client material both from his own clinical work and from some of the transcripts in the study. The scales were based on what appeared to be naturally occurring features of the verbal material. Appendix A shows the structural scales, and their description. 3. Content Scales: These scales were also deviwd for this study based on what the literature sogpsted were common important content dimensions. The content scales are shown in Appendix B. 48. 4. Oategiry Count Variables: These catamries were devised based on the client-centered work listed in the text. The catemriss in the present stuw are self, mother, father, other family members, intimate, social relationships, therapist, and generalized other. Other family momocrs inclutbs child‘en, siblings, and wanwarents. Intimate refers to the person's past and present primary relationship(s), if any, such as spouse. Social relationshipsincludes friends, acquaintances, teachers, stumnts, andother typesof role relationships. l’hcraprls't includes all therwists, M and present. The general/2M other catagiry refers to references such as people, ”they", everyone, aryone, etc, plus all woupsof peoplesuchastawhers, psychologists, Negroes, policemen, foreigners, bus drivers, etc. 5. ARO. ARS( Hurley, l980 ): ARO andARS are construct names which refer to the two salient dimensions found in interpersonal relating (see Wimins, 1983; Conte and Plutchik, i981). Acceptance vs. Rejection of Self was composed of asummary score from the following bipolar scales, Show: feelings-moles Foe/Inga, fxprossivc- Ooaroeo', Active-Passive, and Oom inant-Sohm tools/e Accop tancc vs. Rejection of Others was composed of a summary score from the following bipolar scales, Warm -Oold, Help: Others-Harms Others, Oan (lo-Harsh, and Accepts Others-Rejects Others The bipolar scales range from i to 7; ARO aid ARS therefore can range from 4 to 28. The bipolar scales are shown in Appendix B. s. Rater Pathology Ratings in uhition to intdters' , tl'larwists' , aid clients' own self- ratings of psychopdhology, external jumps rated psychopathology ratings pm on transcripted material. These jumps, who were l‘lA level clinicians with two years of psychotherapy experience, were not trained 49. for these ratings. Similar to other investigations involving psychologists as raters, these raters were asked to rate clients' psychopathology from their own established and professional point of view. General questions assessing pathology ( shown in Appendix C) such as ”How disturbed ch you think this client is?“ were mthered. Composite psycmpathology ratings were planned to be pooled from these items. C. Paper-and-Pencil Heasureeof Pathology 1. SOL-90(Symptom Checklist, Deromtis, 1977). a) Client form (SOL-90R): This measure consisted of 90 statements of problems. The problems comprised and loaded nine symptom dimensions and a global severity inthx. The symptom dimensions were somatization, obsessive-compulsiveness, interpersonal sensitivity, (nor-aim, anxiety, hostility, phobic anxiety, paranoid icbation, and psychoticism. Clients were instructed to check those statements that were current problems for them aid to rate the m of distrnl (0-4) miatw with anti problem. Deratis ( 1977) provimd extensive evicbnce of the validity of this instrument. b) Clinician form. (501.9%, Deromtis, 1977). This consists of the same nine symptom dimensions and one global pathology intbx. Clinicians rate clients directly on these dimensions on the three of symptomatology prmnt on a 0-6 scale. 2. Interpersonal Checklist (ICL, Leary, 1957). The ICL contains 128 behavioral objectives intenmd originally to correspond to 16 or 8 interpersonal styles. Two major fmtors, Mimi-submissive, aid love-hate, untbrgird the circular oraring of the ICL items. In this study, the octant formula ( Leaiy, 1957) for mriving axes scores was used '50. D. Outcome Measures. 1. Post-Therapy Questionnaire Client Form. A 56-item client form (Strupp, Lessler & Fox, 1969, shortened version) was given to clients at the termination of therapy. This form tapped the client‘s subjective beliefs about the effectiveness of their therapy. Four questions (”How much have you benefitted from therapy?", "How satisfied are you with the results of your pwchotherapy experience?", "To what extent have your complaints or symptoms chanmd?", and "How much have you changed as a result of your psychotherapy experience?) were pooled to represent client-rated outcome. 2. Post-Therapy Questionnaire Therapist Form. A Eli-item therapist form inclucbd ten questions on the SOL-90A and 23 questions relating to the therapist's subjective beliefs about the effectiveness of therapy (Strupp et al, 1969, shortened version). Two questions ("Degree of client symptomatic improvement?" and "Overall success of the therapy?") were pooled to represent therapist-rated outcome. Procedure Adults who requested therapy at the clinic received an intake interview. At this time, the clients who agreed to partake in the clinic's research completed the SOL-90R, among other questionnaires. Intake workers were also rmuired to write a case inscription and the case then became available for distribution. Clients were then selected by therapists, usually on an availability basis, and in consultation with supervisors. Some clients were assigned for therapy to their intake workers, but most were assigned to other therapists. At termination, clients and therapists completed posttherapy questionnaires which included their versions of the SOL-90R. These research forms were coded and filed, and neither clients nor therapists hadaeaaasto thesemdforms. RESULTS I nterrater Reliabilities The interrater reliabilities for the object representational scales are shown in Table 8. These reliabilities are based on a comparison of a small sample of the author's ratings ( 12 out of 96) with rating by an unchrgraduata research assistant. The assistant was given only doout an hour's instruction on the theory underlying the Krohn scale before using that scale. For the rest of the scales the assistant used the accompanying instructions and cefinitions only. Results show that statistically significant but only marginal to fair reliabilities were obtained for the structural scales and the Krohn scale, and gnerally weaker and nonsignificant reliabilities were obtained for the content scales. Table 8 Interrater Reliabilities for the Object Representational Scales Scale J1 W m N Correlation STRUCTURAL SCALES CGITENT SCALES Definity 13 .50“ Self-Acceptance 12 .29 rticuletion 13 .79“ “ “ Self -Ef'flcecy 12 .12 Specificity 12 .67“ “ Mutant Towrds 12 .32 Clerity 12 .49“ Others KRGN SCALE 14 .66“ “ Afflietive vs. Hostile 12 24 VII-m vs. Cold Others 12 .47 Hrsh vs. Gentle Mrs 12 .17 Accepting vs. Rejecting 12 .53“ Others “ [H .05; ““ p< .02; “““ [K .01 51 52 Remrding the reliabilities between the graduate stucbnt raters on the Hurley scales and on the psychopathology ratings of clients, correlations were surprisingly low and often negative to a statistically significant was. The author can not explain why the interrater reliabilities wereso low. In part, these scales seem to have beenthe most adversely affected by theweak training given raters in the study. These raters appeared to be rating psychopathology from quite different perspectives. Further examination of their ratings showed little corresponcbnce between either raters' ratings and therapist or client ratings. This sugpsts that rating clients from these sample transcripts may have been difficult. The author's incision to crop these variables from the stuw did not threaten the Integrity of the stuw. The content scales basically overlap with the Hurley scales, which mm the test of the dimensions self-acceptance and acceptance of others to be preserved. The raters' psychopathology ratings of clients was meant only to provicb an additional perspective. The study retained psychopathology rating by clients‘, therapists, ' and intdte workers‘. Pre-Post Stwility Correlations for the Vu-iwles. Tails 9 (p. 53) shows the pre-post stability correlations for the Krohn scale and the structural aid mntent scales. Vriables “SELF-ACCEPTANCE“, ”LIKES OTHERS”, AND ”KIND OTHERS” are composites of the respective measures listed above each. Only these composites were used in subsaqmnt malyses. Tails 9 shows that the Krohn scale but very mod stability, aid the structural aid content scales ha] fair stability. These findings need to be “lifted by the fazt that the author rated each pre and post client transcript sequentially for each scale and consequently these stability correlations were likely inflated. Tulle 10 (p. 53) shows pre-post stability correlations for the category count variables. Catemry count variables are the number of references mete within each rupective categxy. As 53 Table 9 Pre-Post Correlations for All Object Representational Measures ( n - 48). Scale CQEEQlaHQn Scale Correlation STRUCTURAL SCALES Movement Towards .37“ “ Definity .50“ “ “ Others Articulation .58“ “ “ Affliative vs Hostile .32“ Specificity .61“ “ “ LIKES OTHERS .41“ “ Clarity .62“ “ “ Warm vs. Cold Others .43“ “ KROHN SCALE .8?“ “ “ Gentle vs. Harsh Others .43“ “ CONTENT SCALES Accepting vs. Rejecting .33“ Self -Acceptance .46“ “ “ Others Self -Ef ficecy .40“ “ KIND OTHERS .43“ “ SELF -ACCEPTANCE .46“ “ “ “ p< .05; ““ p< .01; “““ [H .001 Table 10 Pre-Post Correlations for Categpry Count Variables ( n = 48). Category leation Mm Correlation Self Positive -.l l Intimate Positive -.01 Self Negative .17 intimate Negative .01 "other Positive -.14 Social Positive .01 "other Negative .27 Social Negative .46“ “ “ Father Positive .1 1 General Positive -.06 Father Negative .13 General Negative .18 Family Positive .10 Therapist Positive .07 Family Negative .33“ Therapist Negative .1 l “p<.05; ““ p<.01; “““p<.001 54 illustrated, only two showed perceptible pre-post consistency. Correlations Among Types of Object Representational Variables. Table II (below) shows the structural sceles' pre— and post-correlations. As can be seen, the variables Articulation, Specificity, and Clarity were substantially correlated, implying that these variables could be aggregted to form a measure -— ARTICULATION. This vriable measured the Mac to which an itba, thought, or feeling in verbal discourse is articulated, developed, and explained 'Definity", which measured the (agree to which the speaker makes a commitment to a statement, was not significantly related to the other three scales. Table l 1 Correlations Among the Structural Object Representational Scales for Pre and Post Therapy ( n = 48). PRE POST Def. Art. Spec. Clar. Def. Art. Spec. Clar. Daf'tnity - .24 .35“ 23 - -.14 .17 .1 l Articulation - - .72“ “ “ .80“ “ “ - - .60“ “ “ .78“ “ “ Specificity - - - .74“““ - - — so"- Clarity - - - - - ‘ - - - “ [H .05; ““ p< .01; “““ p< .001 Tmle 12 (p. 55) shows the pre- aid post-correlations between the three composite content variables. These variables were I) the cbgree of self-mptmce or self-liking (SELF-ACCEPTANCE), 2) thethgree of other-liking (LIKES OTHERS), ms) the degreato which others were represented as benign (KIND OTHERS). As shown, there were simificant relationships between these VU‘ldlles. This needs to be mallfia! by the fact that the author mark all content ratings for each client on the same owesion, increasing the likelihood of $5 Tdile 12 Correlations among the Content Object Representational Verimles ( n = 48). P RE POST SELFACC UKEOT OVER SELFACC LIKEOT OTI'ER SELF ~ACC£PTING - .30“ .41 ' I - .36“ ,39a I LIKES OMRS - - .48“ a a - - 54s a a KIM) OTFERS - - - - - - “ [H .05; ““ p< .Ol; “““ p¢ .001 confounding them. Nevertheless, the relationships between these variables can be taken as memingful. As would be expected from the literature, self-acceptance and other-acceptance (LIKES OTHERS) were momstly correlated (but shared only about 163 of their covariance). Also, the degree to which a person likes others was simificantly correlated with how benignly 3118/ he (boicted others. Another set of correlations involved comparisons between the category count variables for both pre- and post-tram. The findings showed that the positive counts of a catemry (e. g, social) usually correlated with the negative counts of the same category. This finding may merely be an a‘tifmt of clients' use; of the categiries. In other words, a client who talked about his father, for instance, relative to a client who did not, was more likely to make both positive and newtive father references. No other consistent relationships were found among the categiry count variables. Object Representations and Psychopathology A Hypotheses I (The Krohn scale will be simificently related to clients' psychopatholow.) Hypothesis I compared the relationship between clients' scores on the Krohn scale and clients' psychopathology ratings (note some of the therapists' psychopathology ratings of clients 56 are covered in Hypothesis X). The first line of numbers in Tables 13 and 14 shows the results. Variables 50177 through 6’P/ refer to the 10 specific symptom scales of the SOL—90R. A/N refers to the ICL intensity index, with higher intensity mores reflecting greater interpersonal pathology. Intake and Mar refer to global pathology ratings made by intake workers at pre-therapy and therapists at post—therapy. The results show that the Krohn scale related significantly to 3 of these 12 psychopathology measures on both occasions and that a total of 10 out of the 24 comparisons were significant. Using GPI scores to represent the SCL-90R's Table 13 Correlations Between Structural Object Representation Measures and Pre-therapy Psychopathology Indices ( 0:48). .Snm__CL_Iat__Osa__Jdnst_Aqa__Eboh_Eaca_Esy_fiEI_Am_Jntake KROHN -.39‘-.so -.18 -.2s -.05 -.26 -.se -.23 -.24 -.so -.s7 -.33 DEFINITY -.Ol .03 .12 -.os .03 -.oa -.14 -.o4 -.09 -.os .05 -.oo ARTICU -.os -.07 .0e .00 .11 -.10 -.15 .oo .03 -.01 -.05 -.2a “ Significant correlations in boldface( r2 .28. M .05; re .37. p< .Ol). Teble14 Correlations Between Structural Object Representation Measures and Post-therapy Psychopathology Indices ( 0:48). Wench—Race Psy 4591 M room -.18 -.I3 -.2a'-.24 -.11 —.19 -.35 -.25 -.2a -.2a -—.2a -.so DEFINITY .19 -.04 .l4 .06 .23 .16 .12 .16 .04 .15 .41 .18 ARTICU -.13 -.06 -.10 -.02 .08 -.07 .07 .11 -.03 -.02 .14 .03 “ Significant correlations In boldface( r2 .28. [H .05; r2 .37, p< .01; N .45, p< .001). 57 best single psychopathology index (Derogatis, 1977), the Krohn scale correlated significantly with five out of six intertbpendent assessments (the SCL-9OR pre- and post-, the ICL's AIN measure pre- and post-, and intake workers‘ and therapists' psychopathology ratings) of clients' psychopathology. However, the amount of covariance shared between the Krohn scale and these psychethology measures was mnerally small and averemd only 12 percent. Nevertheless, the pattern of results provicbd support for the proposed relationship between clients' object relational mvelopment as measured by the Krohn scale and psychopathology. B. Hypothesis II (The structural scales will be significantly related to clients psychopathology.) Tables 13 md 14 (p. 56) also mve these results. Because only one of these 22 correlations was statistically significant, the hypothesis must be rejected. C.Hypothesis III (The content scales will be significantly related to clients' psychmathology). Hypothesis III was proposed to investigate the relationship between the content of object representations along the dimension of acceptance, and psychopathology. Here three composite content variables were (Mined. Sflf-AMPM/Vdf -- the (bores of self-mptmce, self-esteem, and (agree of self-efficacy, HATS 0777275 -- the mgree of affliation, and movement towards others, and KIND 07}!ka -- the chase to which other people are reprewntad by the client as being gentle versus harsh, warm versus cold, and acsspting versus rejecting. As mentioned earlier, these three composites showed moast overlap. This wanted that, taken tomther, these content variables may have been assessing clients' prediminent psychic styles or psychic mizetions along a mneral dimension of warmth, affiliation, self-regrd, mdwptance versus hostility, resentment, and rejection. 58 Tables 15 and 16 show the pre- and post—therapy relationships between the content variables and the psychopathology measures used in this study. As shown in Table 15, these variables linked significantly to so many psychopathology indicators at pre-therapy that it was difficult to discern any particular relationships between the different content indices and particular symptom scales. Table 16, which shows the same relationships at post-therapy, identified many fewer significant relationships (5 vs. 26) although near ly all (33 of 36) these linkams remained negative. Taken together, these pre-therapy and post-therapy results supported this hypothesis. Table 15 Cor relations Between Content Object Representation Variables and Pre-Therapy Psychopathology Indices ( I7 = 48). Sam Ob 101- DID—HOSL—Anx—Ehnb—Eml—ESN—fifl—AIW Self -Acc -.35 -.41 -.43 -.52 -.12 -.23 -.40 -.39 -.41 -.44 -.02 -.08 Like 0th -.33 -.33 -. 12 -.31 -.34 -.36 -.30 -.34 -.33 -.37 -.37 .12 Kind 0th -.40 -.40 -.22 -.40 -.25 -.31 -.35 -.29 -.37 -.40 -.19 .09 “ Significant correlations in boldface( r) .28, p, .05; re .37, p< .01; re .45. p< .001). Table 16 Correlations Between Content Object Representation Variables and Past- Therapy Psychopathology Indices ( n = 48). Sam on lot Jan—MW 95! fiPl _Aibl_msc Self-Act ~.os .01 -.I4 -.13 .10 ~.12 ~24 ~.32 -.17 ~.14 ~20 -.16 LikeOth ~25 ~21 -.15 -.18 ~.15 --.13 ~32 -.s4 ~.37 ~27 ~27 -.46 KindOth ~.o7 -.02 -.15 ~.04 .22 .01 -.18 ~25 -.17 ~08 ~27 ~24 “ Significant correlations in boldface( N .28. p, .05; re .37, p< .01; r2 .45, pt .001). 59 D. Hypothesis IV (There will be a discerneble pattern of significant relationships between clients' use of referents within veriws content catemries, particularly nemtive referents md psychopathology.) Hypothesis IV was develwed to explore the relationships between the categiry wont va‘idales and the psychopathology indices. Tables 17 and 18 (p. 60) show the findings. As shown in Table 17, only one of these 16 measures (negative mneral other references) was mistently associated (9 of 11 instances) with psychological distress rating. However, this pattern was not maintained at post-therapy (Table 18). The results at post-therapy showed TdJle I7 Correlations Between Category Count Variables and Pre-Therapy Psychopathology Indices ( n = 48). We. Se|f+ .l 1 - .07 -.03 -.01 . 10 .02 .08 -.06 -.04 .01 -.00 Self+ 26 .09 .04 .21 .23 .22 .04 .24 .17 20 .19 Moths” -.11 -.07 -.09 -.13 -.04 -.15 -.08 -.06 -.02 -.10 -.06 Father- .06 -.11 -.15 -.18 .01 -.09 -.10 -.13 -.05 -.11 .06 Father+ .32 .18 .08 .06 '. 12 .18 .02 .07 .19 .12 -.09 Father- .17 .15 .08 .12 -.04 .12 -.04 .11 .22 .12 .07 Fl'nily+ -.05 -.09 -.02 '24 .11 .02 -.06 .04 -.16 .06 -.01 Finily- .09 .07 .13 -.03 .20 .08 -.04 .10 -.03 .08 .01 Intimate+ -.09 -.03 -.01 -.02 .06 .0 1 -.05 .01 .03 -.0 l -. 15 Intimate- .02 -.09 -.03 .01 .09 .14 .04 .03 .1 1 .07 - 08 Socia1+ .00 -.01 .02 03 .28 .17 -.02 .19 .03 .10 14 Social- .23 .09 .17 09 .24 .17 .16 .20 .16 .20 .fl Therapist+ .04 -.01 -.15 .04 -.05 .02 -.02 - 09 04 Thermist- .10 .23 .12 .27 -.08 .20 .04 .24 .05 6eneral+ .16 .08 .24 05 .18 .10 .16 .26 .22 .20 .07 Guieral- .44 .33 .21 29 .23 .40 .46 38 “ Simificant correlations in boldface( re 28. p. .05; r: .37. M .01; rt .45. p < .001). 60 Table 18 Correlations Between Category Count Variables and P05(- Therapy Psychopathology Indices ( n . 48). Sam (I: Int Wax—M Pay 6131 Ain Self + -.01 .l l -.07 .08 .05 .01 - .02 -.17 -.07 -.OO —.21 Self- .Ol .19 -.06 .14 -.01 .03 -.01 .00 -.O6 .04 -. 18 Mother+ .27 .06 .15 . 12 .02 .03 .1 l .10 -.05 .l l - .09 Mother- .10 .04 .05 .04 .37 .04 .11 .29 .10 .16 .16 Father+ .03 -. l 7 .01 -. 12 .27 -. 15 .08 -.O6 - .07 -.O2 .03 Father- - .09 .08 -.O9 .05 -. I 4 .07 .09 -.O4 - .03 -. 12 -. 15 Famin+ .OO -.16 -.08 -.08 .24 -.13 -.O4 -.16 -.11 -.O6 -.02 Family- .12 .27 .13 .23 .24 .07 -.01 -.O3 -.10 .14 .15 Intimate+ .06 -.12 -.03 .01 -.04 .03 -.15 -.10 ~20 ~.O7 -.05 Intimate- .11 -.06 .08 -.05 -.12 -.O4 -.01 -.05 -.15 -.05 -.Ol Social+ .l l -.01 .13 .02 .06 .19 .40 .39 .17 .18 .59 Social- .39 . 1 9 .34 .30 .25 .34 .63 .52 .6 l .46 .63 Thar .+ -.O3 .01 .08 .08 .09 .14 -.1 l -.02 .01 .05 -.12 Ther.- -.18 -.10 -.07 ~.14 -.11 -.08 .02 -.14 -.13 -.13 -.20 General+ -.20 -.09 -.29 -.21 -.18 -.23 -.12 -.22 -.12 -.23 .03 General- -.05 -.05 -.18 -.21 .19 -.O9 .07 -.09 -.09 -.O7 -.09 “ Significant correlations in boldface( re .28. p< .05; 7'2 .37, p< .01; again that most of these variables were not associated with psychopathology. Two variables which were related to psychopathology were "social other" references (9 of l l for native; 3 of l I for positive). Taken together, these results weakly supported the hypothesis. Clients' use in terms of frequency of the number of either positive or negative self, therapist, or family references (including father and mother references) showed no relation to psychopathology. However, clients' use in terms of frequency of the number of negative generalized other references and the number of social references bmr some relation to clients' psychopathology. The pattern suggests re .45. p< .001). that more pathological clients may have produced more generalized other references at the 61 beginning of therapy and shifted to the use of nemtive social references near the end of therapy. Object Representations and Psychotherapy Outcome A Hypothesis V. The Krohn scale will be signifiwitly related to both client-rated and therapist-rated outcome. 8. Hypothesis VI. The structural scales Articulation, Definity, Specificity, and Clarity will be significmtly related to both client-rated and therapist-rated outcome. C. Hypothesis VII. The content scales will be significantly related to both client-rated and therapist-rated outcome. D. Hypothesis VIII . TMre will be a discerneble pattern of significant relationships betwwn clients' use of referents within various categories, particularly negative referents and both client-rated and therapist-rated outcome. The results of all four of the move hypotheses are shown in Tables 19 and 20, (p. 62). The results for Hypothesis V (Table 19) showed that clients' scores on the Krohn scale at both pre- and post-therapy correlated significantly but weekly with therapist-rated outcome, and showed only a trend towards being emaciated with client-rated outcome. This finding wally supported the hypothesis. The results for Hypothesis VI (Table 19) show that neither Definity nor the ARTICULATION composite were related to outcome, resulting in rejection of the hypothesis. The results for Hypothesis VII (Table 19) showed some linkems between outcome and the content varidiles. Results sugpsted that clients' representations which reflected warmth and acceptance towards others were a significant pre-therapy outcome related variable from only the cl ients' view, whereas cl ients' acceptance towards self was significantly related to outcome when assessed at post-thequy. 62 Table 19 Correlations Between Structural, Krohn, and Content Measures at Pre- and Post-Therapy and Client- Rated and Therapist-Rated Outcome (n - 48). Structural Krohn Content ___¥snm1es__5ule____lmmlss DEFINITY ARTICU- KRCHN SELF- LIKES KIND WW. .211 CI. .07 .06 .24 .20 .47“ ' * .33“ ' Th. -.09 .05 .31 " -.08 .04 .26 lost. Cl. .13 -.ll .23 .29“ .25 .14 Th. -.ll .03 .31“ 29" .19 26 " p‘ .05; "' p< .001 Table 20 Correlations Between Cetegpry Count Variables at Pre- and Post-Therapy and Client- Rated and Therapist-Rated Outcome (n = 48). CetegoryCount Vriebles SELF HO. FA. FAN. INT. Tl-ER. SOC. GEN. O + - + - + — + - + - + - + - + - Ens Cl. -.05-.47"'.03 -.18 -.O4 .03 .12 -.12 23 .l2 -.16 -.21 .04 .16 .08 .15 Th. -.05 -.10 -.04 -.23 -.23 -.05 .17 -.i4 -.25 -.H -.lO .18 -.16 .04 -.09 .03 Best Cl. .19 -.08 .03 -.22 .00 -.lO —.l4 —.ll .21 .lo -.06 -.ll -.31'-29' .14 .26 Th. .40".03 .08 .05 .10 .10 .13 .09 .18 -.2O -.02 -24 -.ll -.16 .17 .16 ' p< .05; '”' [H .01; “" p< .001 The results for Hypothesis Vlll (Table 20) showed very few (4 of 64) simificant findings and did not support the hypothesis. However, one feature of these correlations was consistent with at earlier finding reported for Hypothesis IV. Table 20 showed that clients' use of social other references at post-therapy whether negative or postive, was associated with poorer 63 psychotherapy outcome as rated by clients only. Earlier, it had been reported that frequency of use of social other references at post-therapy was associated with greater psychopathology. E. Hypothesis X. An analysis of variance using groups divided on level of psychological development as the independent variable and using post-therapy clients' and therapists' questionnaire responses as the dependent measure will show many significantly relationships. It is predicted specifically that both clients' and therapists' assessments of clients' functioning will be significantly affected by clients‘ developmental functioning, and that clients' post-therapy assessments of their psychotherapy experience will be effected by their developmental functioning. Hypothesis X was developed post-hoe to provide a more detailed examination of the relationship between clients' object representational developmental level as measured by the Krohn scale and the process and outcome of therapy. The later was assessed through client and therapist post-therapy questionnaires. For these analyses, clients were divided into four developmental level groups based on their total pre and post scores on the Krohn scale. The groups were divided on a combination of the following factors: 1 ) naturally occurring breaks in the data, 2) a selection that would give adequate]! in each group, and 3) mmewhat along the lines of the theory underlying the scale. This resulted in Group 1 (lowest [ 1.48] through 2.81 , n = 8) representing primarily psychotic and low borcbrline functioning, Group 2 (2.92 through 3.72, n = 16) representing primarily borderline functioning, Group 3 (3.80 through 4.41, n: 14) representing primarily narcissistic functioning, and Group 4( 4.59 64 through higiestl6271), fl= 10) representing primarily neurotic functioning Results of the Analyses of Variance for these groups are shown in Table 21 (pgs. 65-66) for post-therapy therapist responses and in Table 22 (p.67-69) for post-therapy client responses. Table 21 shows that many of the therapists' post-therapy descriptors of clients were significantly related to clients' developmental level. Thirteen of 33 responses were significant, providing support for the hypothesis. Although the mta showed some variations, many of the compaisons showed the amps ordered as expected, with the lower developmental groups being rated as more disturbed by the therapists. In no instance was the lowest group rated higher than the highest group on any of the psychopathological ratings. in several instances, such as the ratings of Paranoid lcbation, Somatization, Psychoticism, and Global Pathology, the data showed that the lowest thvelopmental group (thoa scoring in the psychotic- low bortbrline level of object developmental functioning) was rated more disturbed than each of the three others. Table 22 (pgs. 67-69) shows the Analyses of Variance for the developmental groups and clients' post-therapy responses. Here 11 out of 49 correlations were significant, providing support for the hypothesis. Among the results an interesting pattern emerged in clients' evaluations of the therapy relationship. This pattern was that issues related to clients' perceiving the therwist as warm versus cold and distant, as thinking that their therapist remrcbd her/him as a worthwhile person, and clients' ratings of the degree of anger and emotional involvement in the therapy, appeared related to clients' developmental level. Questions such as “Degree to which intense anger was experienced toward therapist?" and the ”Degree to which you felt the therapist thought you were a worthwhile person?“, were basically Mad as expected with the lower the mvelopmentel group feeling more W and feeling the therapist thougit they were less worthwhile. Other questions such as ”Degas to which therapy was an intensely emotional experience?", “Degree to which therapy was a painful emotional We W93— 1)Somatization “ 2) (Itsessive-compulsiveness 3) interpersonal Sensitivity 4) Depression 5) Anxiety 6) Hostility 7) Phobic Anxiety 6) Paraniod ldaation 9) Psychoticism 10) Global Pathology index 01' l' 811' | 011 Cl" 1 1 l) Defensiveness l2) Anxiety 13) Ego strength 14) Degree of disturbance 15) Capacity for insight 16) Over-all adjustment 17) Personal liking for patient 18) Motivation for thorny 19) Improvement expected 20) Degree to which counter- transferancs was a problem 21) Degree to which you usually enjoy working with this kind of patient 22) Degree of symptomatic improvement 23) Degree of change in basic personality structure 65 Table 21 Analysis of Variance Scores for Therapists' Post-Therapy Evaluations Based on Clients Grouped by Krohn Scale Scores AMWWW 42 43 45 4a 44 44 43 4 1 42 45 44 43 43 42 42 39 42 4 1 43 45 46 42 5 .08 6 . 1 3 1 .88 0.58 4.45 2.07 2 .50 3 .50 5 .22 6.36 l .28 3.53 6 .77 4.76 l .66 2 .59 l .88 .02 2. 1 5 2 .72 .53 3 .30 .53 .005 .002 . 15 .63 .009 . 12 . 10 .02 .004 .00 1 .29 .02 .0009 .007 . 19 .07 . 15 .99 .1 l .06 .66 .03 .66 2.33. 0.57. 1.50. 0.80 3.17. 1.13. 2.08. 1.00 3.63. 1.86. 2.25. 1.50 2.25. 0.69. 0.82. 0.30 2.63. 0.73. 0.54. 0.30 5.00. 2.87. 2.93. 2.11 5.00. 4.21. 3.23. 3.13 4.13. 5.46. 5.92. 7.00 5.13. 3.86. 2.82. 3.11 4.50. 5.15. 5.92. 6.00 4.00. 5.20. 6.45. 5.60 Table Con't Table 21 (can't) W 24) Degree to which you felt wrmly 43 toward patient 25) Dawes of emotional investment in patient 42 26) Dares to which you think patient felt. 42 warmly towards you 27) MI“ success of therapy 42 28) Working relationship with patient 42 29) Patient's satisfaction with therapy results 45 30) Form of thorny with patient 44 (apportive (low) vs. analytic (high) 31) Degree of pleasant experiences with patient 40 32) Degree of utplaesant experiences with 39 patient 33) Overall expat'iellcas with patient 44 66 l .53 2 .58 2.03 1 .74 2 .08 5.09 1.17 .53 2.82 .22 .07 .13 .17 .72 .12 .005 .34 .67 .bL EntisSichLacmemlLLw WW 3.75. 6.27. 5.41. 4.00 4.88. 6.80. 6.54. 6.00 ' Statistically Significant Items in Boldface experience?”, “Games to which you remember the retails of therweutic work?", ”Deg‘ee to which therwist's attitude was cold aid distant?“, plus feeling warmth from the therapist, were shown to be simificently different for the lowest mvelopmantel woup. This group felt fairly uninvolved emotionally in the therapy, felt that it was hardly a painful experience, remembered few details of the experience, and 1811 the therwist was cold lid distfllt in comparison to how the other three groups viewed her/him. Wallis 1) Felt need for further therapy 2) What lead to termination of therapy 3) Degree of benefit from therapy 4) Satisfaction with therapy experience 5) Impression of therapist's level of experience 6) How were you getting along before therapy? 7) How long were you in need of help before starting therapy? 8) How disturbed you were at thebeginning of therapy 9) Degree of anxiety felt when started therapy 10) Degree of internal pressure to do something when first entered therapy 1 1) Degree of change from therapy 12) How are you getting along now? 13) Adequacy in dealing with present problems 14) Degree of change in symptoms as a result of therapy 15) Time after start of therapy before a marked change was felt 16) Degree to which you would recommend therapy to a friend with problems 17) Degree to which therapy was an intensely emotional experience 67 Table 22 Analysis of Variance Scores for Clients Post-Therapy Evaluations Based on Cl ients' Grouped by Krohn Scale Scores. .bL Lcat'm Slum! WM 45 37 45 43 44 45 43 44 42 41 31 43 3.75 .48 2.17 1 .35 2.37 .58 1 .74 1.01 .24 .22 .94 3 .05 .86 2 .25 1 .32 2.17 4.53 I" l) | . 'E | .02 4.71. 5.93. 4.23. 3.40 (higher shows greater need) .70 .11 .27 .08 .63 .17 .87 .88 .43 .04 3.00. 3.27. 2.85. 2.11 (lower denotes better) .47 .10 .29 .11 .008 5.50. 2.00. 2.00. 2.11 (lower = more intense) Table con't Bail-Wm 11!) Dewae to which therapy was a painful emotional experience 19) Deree to which you remember details of titerqieutic work 20) Degree to which therapist used technical terms 21) Dawes to which feelings were experienced during therapy 22) Dawn to which intense anger was experienced toward therapist 23) Degree to which therapist was active 24) Mes to which therapist respected me as a person 25) Dewee to which therapist was interested in helping 26) Dawes to which you felt like just another patient 27) Degree to which therwist wu attentive 28) Dag-u to which uiarapist used abstract lineage 29) Fwy with which therwist ei'iglged in small talk 30) Deg‘ee to which therapist was stiff and formal 31) Woe to which thermist’s mmner was natural lid unstudied 32) Dawn to which thermist understood feelings 33) Down to which therwist was passive 34) Degree to which thermist's attitude was cold and distant Table 22 COM .11). 44 2.98 43 3.20 45 1 .59 41 2.47 43 3.17 42 2. 1 4 44 1 .00 44 1 .1 0 44 1 .64 44 1 .9 45 44 .24 43 1 .97 42 2.03 44 1 .02 44 .64 42 2.95 68 MWWW I'lll “5| .04 5.00. 2.00. 2.00. 3.70 (lower . more painful) .03 4.67. 7.42. 7.93. 7.00 (higher - remember more) .21 .03 3.67. 3.86. 5.57. 7.44 (lower . more anger) .11 .37 .20 .14 .87 .13 .13 .39 .39 .05 6.50. 8.50. 8.23. 8.78. (higher = less cold md distant) Table con't Wm 35) Degree to which therapist talked too much 36) Dewee to which you felt the therapist thought you were a worthwhile person 37) Dme to which you trusted therapist's integrity 38) Deg-ea of wI-mth you felt in the way the therwist talked with you 39) Degree of coldness in tone of the thermist's statements 40) Amomt of neutrality in thermist's statements 41) Amomt of advise given in how to conduct life 42) Deg‘ee to which therapist talked about psychomalytic theory 43) Degree to which the major emphasis in thorny was your attitudes aid feelings towards the therapist 44) Degree to which a major Wis was relationships with people eta-rently in your life 45) Der» to which a major empiusis was childtood experiences 46) Woe to which a major emphasis was upon gestwestone of voice shifts. lid bodily experiences 47) Dare. to which you were given reesswmces 48) Dewee to which therwist showed interest in chains and fantasies 49) Deree to which you felt accepted by the therapist Table 22 con’t 69 fl. MWWW 44 45 1 .09 2.80 .88 3.40 1 .09 1.90 .77 .18 .80 5.27 .73 1.16 4.50 2.00 2.49 .004 I' l) | . '1] | .36 .05 6.29. 8.27. 7.92. 8.80 ()1in = less questioning) .03 7.50. 8.33. 8.54. 8.60 (ms 2.3.4. more warmth) .37 .15 .52 .91 .50 4.14. 1.47. 2.54. 2.30 (lower = more emphasis) .34 5.57. 8.20. 7.38. 8.80 (m I felt less reassured) .13 .08 70 Object Representations and internal Object Relations A. Hypothesis IX. The object representational measures hypotlmized to be related to psychopathology and psychotherapy outcome will be related to scores on the Krohn scale. This hypothesis involved an investigation among the experimental variables in this study. In particular, this hypothesis was used to investigate the relationships between the Krohn scale, which but been proposed by the present author to be a measure of inteer object relations, and the other measures in the study. The other measures, particularly the content scales and the category count variables, were object representational measures. Since internal object relations but been proposed to be a psychological variable in its own right -- not quite synonymous with psychopatholmy, the variable was treated in this hypothesis as a criteria with which to assess the other variables. The results are shown in Table 23 (p. 71). Nine of 42 comparisons reached significance. squsting that most of the significant correlations did not occur by chance. Clients' Krohn scale mores correlated positively and significantly with 1) clients' pre and post ARI/CUMIION scores; 2) the post-therapy block of content variables: self-mptance, other mptence (Likes Others) and how benign others were represented to be (Kind Others); and 3) the number of positive family references at post-therapy. Clients' Krohn scale scores correlated nemtively and significantly with l) the number of welized other references at pre-therapy; 2) the number of native trermist references at post-therapy; and 3) a lower number of positive walized other references at post-therapy. Since all of these associations were in the direction expected, the findings we basically in support of the hypothesis even though only the ARTICULATION variable showed a significant pattern at both pre- and pat—therapy. 71 Table 23 Correlations Between Clients' Scores on the Krohn Scale and Other Object Representational lndiees ( n = 48).* Structural Content Category Count Variables Variables Variables D ART SELF LIKE OTI-ER SELF HOTKR FAMR FAMILY INTIMATE THER SOCIAL GEN OTl-IR Mic OTHERS + - + - + - + - + - + — + - + - Pre .11.44 .21 .18 .15 -.08 -.26.23 .08 .05 .10 .26 .16 .24 .19-.11-.18 .06 -.27 -.02 -.39 Post -.11 .32 .32 .40 .43 -.25 .05 .13 -.12-.06 -.07 .30 -.05 .14 .14 .11-.37-.05-.19 -.30 -.06 *Significant correlations in boldfwe (r z .28, p ,.05; r 2 .37, p < .01). DISCUSSION The purpose of the present study was to explore whether certain aspects of a person's psychological functioning mold be identified by analyzing a sample of his or her verbal diwourse. Clients' self and other representational diwourse in psychotherapy was utilized and investimted as if it was projective-test material. There was a deliberate sichstepping about the actual past and present objects that may have affected this object-representational material. The areas investigted were clients' psychopathology, response to psychotherapy, and the relation between internal object relations and object representations. Overall, the findings of the study were promising and encourage further exploration of this sector. The first part of the discussion involves an overview of the methodology of the study and its strengths Hid weaknesses in light of the finding, while the second section involves a discussion for each set of variables used in the study. Overview of Study The following propositions regarding the study's methodology are based on an overview of the study and its findings. 1) Clients' object representations reflected, and were utilized to assess, important aspects of personal functioning such as level of general psychopathology or likely response to pwchotherapy. The clearest results were obtained using the Krohn scale which appears to be a promising measure of internal object relational development 2) An dialysis of clients' object representations through a sampling of their psychotherapy speech appears a promising way to investigate the phenomena. The extent to which this 72 73 mproach was as mod as other projective approaches was not determined. However, there were no mntraindications that this method could not be as rich for psychological investigation as other mproaches. Even though only a few of the varimles showed promise, the methodology gained credibility. The fact that about half of the study's variables did not lead to meaningful results may have been due to psychometric difficulties. The investigation of verbal discourse appears limited only by the lack of established research in this area. 3) The proposition that the self and other representations contained in speech could be analyzed as if it were projective material received support from the study. Such a finding supports the contention that representations are partially projective in nature. It was found that the analysis of representations outside of their interpersonal context and separated from the individual's social history provicbd useful information. 4) A major limitation was the lack of precision in the study which made it impossible to provide more specific and detailed information that may have been present in the chta. For example, the use of a walizad other statement such as "people are masochists" appeared a chvelopmentally lower statement compared to more personal reprmntetions. But the study did not allow one to infer important issues such as the following: Was a generalized other reference always indicative of a lower ormr of thinking? Was it ever reflective of fatigue, distraction, or anxiety? In other words, the study lacked more precision remrding the conditions when statements were indicative of lower psychological mvelopment and when were they not? These considerations sugpst that the present investimtion proviibd only a lead for future research and did not answer some important questions. 5) The extent to which the object representations were largely projective and indicative not of fact but psychological ormization and chvelopment was not ascertained. Similarly undermined was the extent to which a vital aspect in uncbrstanding the representations was 74 missing because of the exclusion of past and present objects which may have affected these representations. This is certainly an important area towards which future research may be directed. 5) Whether or not the sampling approach used in this study was the best way to investigate object representational variables was not ascertained. The stratified random sampling approach seemed best for most of the variables. However, it was not suitable for the category count variables since the N was very low for most categories. 6) The design of the study favored stable variables over those which were more likely reflective of clients' moods and transient psychological states. The reason for this was that the study did not employ more session-oriented evaluations such as rating of clients during a particular seesion, or satisfaction with a particular session. This could be an important avenue for future research. 7) The study was hampered by low pre- versus post-therapy reliabilities for some of the variables (such as the category count variables) and it was not determined fully whether this was due to inherent instability in the memures or because of unsuitability of the sampling proeees. 8) The other raters employed in the study appeared insufficiently trained in most instanees. interrater reliability was a weak point. Determination of some variables contributions was precluw bmuse of this. A few variables had to be dropped. Some weaker reliabilities were partially offset by aggregating measures that had mocbrate correlations with each other. 9) To the extent that there was significant loss of variance in the study, it is difficult to mt an accurate picture of how much variance was shared by the study's variables. 10) Using solely the author's ratings for the testing of the hypotheses made this study 75 easier, and reduced some of the training problems. However, this approach puts limited confimnce in external validity. The extent to which the findings could be replicated by mother resetrcher remains much less predictable then would be the case if more than one rater had been used. ll) While the significant relationships between some of the praent variables provided some validity to the constructs in the way of concurrent validity, and to some extent reduced the need for interrater reliability, this was a fortunate consequenm of some significant results. Had fewer significant results been obtained, it would not have been readily mterminible whether poor results were due either to inadequate ratings or lack of support for the hypotheses. Object Representational Variables A) Krohn and Mayman‘s Object Representational Scale for Dreams i) Description The Krohn scale emergd as the most promising measure. The author views it as a likely indicator of internal object relations due to its properties and the configuration of results. The aspect of functioning measured by the scale appeared to be a social-chvalopmantal level, similar to Loevingr's notion of ego development, which organins, constrains, and limits the ways individuals' experience and interpret their own and others' behavior and motivations. A key aspect unmrlying the Krohn scale appears to be how well a person is able to see the world from another's point of view. In other words, the major upset of internal object relational development appears to be how well a person is psychologically capable 76 of taking the perspective of others around him or her. Intertwined with this capacity to see the world as others may is one's psychic integrity and maturation. Development of the self and the capacity for empathy appear to go hand in hand. The author noted that the eight- point Krohn scale reprwented approximately five diagnostic groups on its continuum which is congruent with what was proposed by the developers of the scale. in fact, the scale apparently offers the reader a good grasp of some vital psychopathological phenomena. The first level is the disorganized and chaotic world of the psychotic in which most human motivations and behaviors are incomprehensible. The second level is the low-borderline level where people seem to act out of vicious intent. People's motivations and behaviors appear ghastly and destructive. Level three is the borderline level where people's motivations and behaviors are essentially lifeless and meaningless. The person is not able to comprehend one's own or another's identity which guides one's actions. Level four is the narcissistic level where human motivation appears solely based on self—interest and need. The fifth level is a neurotic-hysteric one where people are understood as having a personality which motivates them but only the most superficial reasons are given for their actions. Here stereotypes predominate. Level six is the beginning of any real understanding of another, but on this level there are noticable transference distortions. People are often interpreted in terms of one's own motivations or are compared to someone else in the person‘s world. The last two levels, (seven and eight), which were found to be rare in this study of outpatients, characterize increasing levels of sophistication and psychological understanding of motivations and behaviors. 2) Findings 77 The properties of the Krohn scale were good, especially regarding its stability. Clients' scores on this measure were highly stable, even to the point of appearing unaffected by the psychotherapy (rpre vs. post = .87). These findings need to be qualified by the fact that both the pre- and post-therapy ratings for each client were made consecutively by a single judge (the author) who was not blind to the clients' code numbers. (It was initially planned this way to provide the rater with additional context and understanding of the client when making ratings.) Nevertheless, the author observed little variation in individuals' scores on the scale. A person woring in the borderline range, for instance, typically varied from low borderline-high psychotic at the lower end to only the high borderline-low narcissistic at top. Rarely, if ever, was it observed that someone who averaged in the borderline range would be able to make a statement rated as high as the neurotic range. Other properties of the scale were favorable. Clients' mean mores across their set of transcripts ranged from 1.48 to 6.27 and they were fairly well distributed. The higher scores on the Krohn scale were underreprwented, as might be expected in a clinical population. Usually eight or more representations undergrid a client's score at each time point which would appear to contribute to accuracy and stability in the ratings obtained. Across a client's set of ratings there would be about twenty to thirty reprwentations on which to base his or her average score. This high number on which to obtain a Krohn score appeared for more advantageous than previous dream research with the instrument which tended to base the individual's developmental score on only two dreams. The strong stability of the measure does sumst, however, that basing a score on a few representations would be adequate. The low inter—rater reliability perhaps due to the little training of the second rater and the fact that this rater had no clinical or 78 gamete training, was the central weakness of the variable. Clients‘ Krohn scores showed a consistent pattern of relationships with several clinical varidlles. For one, clients' Krohn scale scores correlated significattly with their self-ratings on several of the SCL-90R's symptom scales, including somatization, obssssive—compulsiveness, phobic anxiety, and the global pathology index at pre-therapy plus interpersonal sensitivity and phobic anxiety at post-therapy. There was also a trend (p. < .10) for many of the other SOL-90R scales to be related to this measure. The significant associations with the various scales was likely to be due to the singular psychological distress factor which has been found to untbrgrid the SOL-90R (Holcomb, Amms, & Pontbr, l983). It seems reasonable to conclum that object relational cbvelopment is inversely correlated with mneral psychological distress. This finding was also supported by clients' post—therapy responses which showed clients' Krohn scores inversely associated with their perceived need for further therapy and their ratings to the question ”How well as you getting along now?" The associations with the various SOL-90R scales makes it difficult to discern any particular relationship between the propomd object relational development and the symptom indim other than the consistent relationship with the phobic anxiety scale. its itemst fee/Ina afraid in open sum or in the streets; Fee/mo afraid to on out of your house alone; Feeling afraid to travel on buses, subways, or trains; Haring Io ovoid wriain (lungs , places, or xiiyitiea amuse they frighten you; feeling uneasy in crows , sue/7 as snooping or at a tonne; feel/no nervous when you are lefi alone; and feeling afraid you will faini in public) sugpst that this scale measures extreme social anxiety or panic. Krohn ratings also correlated significantly at both pre- and poet-therapy with the 79 ICL's AlN index. AIN measures the degree of exaggerated interpersonal behaviors along the dimensions of dominance versus submission, and love versus hate. The significant association here sugmsts that lower scorers on inteer object relational tbvelopment may exhibit more exaggerated and inappropriate interpersonal behaviors. Krohn scores were also significantly associated with ratings mace by intake workers and therapists. These linkages were generally stronmr than to the self-ratings, sugatihg that the behaviors associated with thwe ratings by psychologists may be especially salient in the interpersonal sphere. Object representational development significantly related to most (10 of 16) therapist post-therapy ratings of psychopathology. One of the most significant relationships was in the area of ego-strength (p < .0009). The group of clients assessed as functioning at a low object representational level were rated by therapists as having some to moderate ego strength. Those groups in the midrange of object representational functioning were rated by therapists as having moderate em-strength, and those clients who scored more in the upper (neurotic) rang of object representational functioning were rated by therapists as having ”fairly great" ego-strength. The post-therwy therapist ratings enable slightly more precision regarding the specific psychopathological characteristics associated with object- relational tbvelopment. Therapists differentiated clients grouped by their Krohn scale scores on the somatization, obsessive-compulsive, anxiety, paranoid itbation, and psychoticism scales. The first three appear related to an anxiety factor. The author's examination of the somatization and obsessive-compulsive scales revealed that many of the items appwred related to an anxiousstateor symptoms caused by anxiety (see Deromtis, 1977, for these items and for the SOL-90A which contains the specific cbfinitions used by therapists in rating 80 clients). These results suggest that the mneral psychological distress mentioned above as being inversely correlated with object relational development may involve a considerable anxiety component. Surprising, however, therapists showed only a trend (p. < 10) to differentiate the Krohn groups on the phobic anxiety scale, somewhat inconsistent with a stronger relationship found in clients' self- report. Further scrutiny of therapists' ratings showed that the Krohn groups were basically ordered by therapists on their over-all adjustment, degree of disturbance, and global pathology. Also, as expected by the theory underlying the Krohn scale, therapists' rated the lowest Krohn group much higher in psychoticism and paranoid imation than they rated the other groups. According to therapists' ratings, the other groups showed a virtual disence of paranoid idaation. An interesting pattern of post-tha‘apy client evaluations also seemed to be dependent on clients' inteer object relations as measured by the Krohn scale. The results showed that groups differed significantly on a cluster of items related the evaluations of the therapy relationship and rating remrding the (horse of emotional involvement in the therapy. The tencbncy was for lower developmental scoring groups, in particular the group composed of psychotic-low borderline clients, to rmd their therapists as feeling less warm and more cold and distant towards them, to provide less reassurance, and to value them less. They also rated themselves as feeling less emotionally involved in the therapy but also reported feeling more anger towards the therapist. These findings fit clinical theory on severe narcissistic disorders, including the theory uncbrlying the Krohn scale. Clinical theory retarding narcissistic disturbances has reported that waster narcissistic injury is accompanied by greater narcissistic ram towards others. In the theory untbrlying the Krohn scale, the lower the level on the scoring schema, the 81 more difficulty with self issues such as feeling valuw and respected, and the more difficulty feeling connected and involved with others because of the insubstantial feelings accompanying experience. Regarding the latter, it was also found that the lowest group reported remembering little details of their psychotherapy experience. These findings on clients' evaluations of their psychotherapy sugpst that the evaluations may have been partially bwed on clients' transferenm phenomena. Clients may have interpreted their therapists' behaviors within their own developmental organimtions and perhaps thw would have experienced the therapists as such remrdlees of how the therapists may mtually have been. It is also possible that when evaluating the therapy, clients‘ tenancies were to rate it along the lines of how they interpret these kindsof experiences; that is , for instance, to report feeling less valuw because that's how they think people respond to them. Another possibility is that the therapists were mtually more cold and distant towards these more disturbed clients. The present data do not permit clarification of this issue, but the possibility exists that therafists were acting-out counter-tranference feelings. In other words, therapists may have responded to those who felt less certain of their own value by valuing them less. The only available pertinent this are therapists' post-therapy responses. Examination of these responses showed that therapists' reported being more emotionally invested in psychotic—low borderline group then with the other clients, but also reported not having as satisfactory experiences with this group as therapists reported with other groups, and thought they provimd more supportive psychotherapy and expmted less improvement. These later points ( i.e., expecting less and being more 'supportive") hint that therapists may have been more distant with this amp, although this culnot be determined from the present this. lndepencbnt ratings of 82 therapist-client interaction might clarify this issue. Whether as a client or therapist process variable, clients' Krohn scores were positively linked with benefit from therapy. This was found for both pre- ( r = .3l , p< .05) and post-therapy (r - .3l, p< .05) Krohn scores and therapist-rated outcome. The correlations with client-rated outcome were similar but nonsignificant ( r= .24, r= .23). These findings are consistent with other psychotherapy research which has linked benefit from psychotherapy with lesser degrees of psychopathology. One of the more intriguing unexpected findings of this study involved the link of change in clients' Krohn scores from the early to later sessions. There was even a slight but nonsignificant decline in clients‘ scores. This finding can not be mmprehenibd am on earlier speculation remrding the benefits of psychotherapy. Even though the Krohn variable proved extremely stable, and it can not be expected that an average of 24 sessions will chm a more characterological aspect of psychological functioning (the few psychotic individuals remained unchanmd and so did not move to a narcissistic orientation as in Ryan and Bell's [1984] study), nevertheless, these results are unexpected and open the possibility for a more rigorous investimtion of the benefits of psychotherapy. B) The Content of Object Raprmntations Along the Dimension of Amptance and Warmth Versus Rejection and Ooldnsss. The content of clients' object representations were also caused along the dimension of acceptance and warmth versus rejection and coldness. This dimension was assessed for clients' self-representations, other-representations (that is; how clients' felt towards others), and reprmntations related to how others were represented to be towards others, includingtheclient The tbgreeofacssptanmandwarmth mrossthesearaaswas 83 significantly related, but this needs to be qualified by the fact that a single rater made all of these jumements on the same owesion for each client which might account for their agreement. Thm variables also showed significant but modest pre-post stability, but this was also contaminated by the contiguity of ratings for each client's pre- mo post-transcripts. The scales which composed these measures were simple bipolar scales with little description. Poor inter-rater reliabilities were obtained with them. The loss of variance from the weak reliability of the scales was partly corrected by pooling a group of males together for each of the three areas. Even though week, these memures mve a general indication of the degree of warmth and acceptanm of clients' representations, permitting a fair test of the relevant hypothwes. Findings showed that the agree of acceptance and warmth in representations was negatively and significantly related to most of clients' self-ratings of psychological distress at pre-therapy, although this relationship did not hold at post-therapy (see Tables 15 and 16). Clients' post-therapy ratings of acceptance and warmth towards others were the only significant linkage between m content measures and psychologists‘ ratinwflable 16). Nevertheless, the overall results supportan inverse relationship between the agree of warmth and acceptance in representations and (agree of psychological distress. The content variables were also related to outcome. Findings showed a differential pattern between self md other representations. Results showed that the mgree of warmth in clients‘ other representations at pre-Uierapy was positively and significantly related to client- rated outcome, and that clients' post-therapy self-representations were related to both client- rated and thermist- rated outcome. The later mpears merely to support the fat that the bettm‘ the client felt about him or herself, the more favorable 84 were pwchotherapy evaluations. The significant relationship between outcome and the more of warmth and acceptance in clients' arty Macy reprmntations of others supports a prior finding with this same samole. Filak, Abelee, & Norquist (in press) found that clients' pre-therapy ratings of their interpersonal attitudes towards others on the ICL's love-hate (Lov) dimension was strongly predictive of their response to psychotherapy. The present finding, utilizing a different assessment prMure, supports the earlier work. In addition, the current finding was that the relationship held for client-rated but not therapist-rated outcome. This suggests that therapists' may have little awareness of the importance of clients' negative or hostile attitudes towards others as it may eventually impact unfavorably on the psychotherapy. The relationship between clients' content scales and their Krohn object developmental level scores was statistically significant at post-therapy but not at pre-therapy (see Table 23). This magnets that warmth and acceptance in representations is not a major fmtor in object Melopmental level. The association at post-therapy but not at pre-therapy suggests that the Mae of warmth and mceptance in a person's representations is associated with their object developmental functioning but cannot be taken as a fixed characteristic of lower object developmental functioning. C) Object Representational Cetemry Use The original impetus to investigate clients' pattern of use of object representational catecpries was to explore whether there might be a relationship between the frequency of clients' use of va‘ious categprias and their kind of difficulty (a. g, morassion versus pumpid icbation). Also, it was thougit that some pattern might exist between cl ients‘ 85 usam frequency and the (agree of Wit from psychotherapy. . Unfortunately, while the stratified random sampling yielded a body of late sufficient to test the other variables, this was untrue for the category variables. The letter measures were hampered by low frequencies of representations per category (see Appendix E). These variables also showed wnerally poor pre-post stability which may also have been the result of the low frequency of representations per categpry. Consequently, the study was unable to provitb definitive answers to the original formulations mentioned above. F indinm were generally nil, which appeared primarily the result of unsuitable methohlogy for these variables. The principal significant relationships between the catemry count variables and psychopathology involved the number of negative "@neralized other " references and the number of nemtive “social references". The findings were that clients' frequency of newtive "mneralized other” references correlated with psychopathology at pre-therapy but not at post-therapy, while conversely, clients' frmuency of negative “social other” references correlated with psychopathology at post-therapy but not at pre-therapy (see Tables l? 8! l8). Each of these catngries correlated with a wide group of symptom scales, suggesting that they correlated more with general symptom distress than with any particular kind of symptomatology. A likely interpretation is that clients with more mneral symptom distress math more nemtive “pneralized other” references at pre- therapy that somehow switched to negtive “social referenm" at post-therapy. Another shortcoming of the study which appears worth mentioning was that the original conesption of the study was to assess the quality of object representational ormnization among the woup of persons that are reprmntad in the client's life. This may have mulled an investiption of conflict and psychological regression. This was not 86 investigated beseuse of the limited number of representations within ewh categry group. Perhaps not to examine this was a misjutmment since their may have been enough representations for a portion of the clients. Such an investigation is open to future research. 0) Structural Scales: Defintiy, Specificity, Articulation, andClarity. The structural scales in this study were thrived from an examination of what appeared to be naturally occuring variables in verbal speech. Clients ' spmh seemed to vary considerably in the degree to which ideas were expressed clearly and articulately, the decree to which there was preciseness in the communication, and the chores to which there were qualifications in the person's communications (Definity). The three scales related to articulation of ideas -- Articulation, Clarity, and Specificity, appeared also to be grounded in Werner's developmental psychology in which emphasis is placed on the differentiation of objects in consciousness. The hypotheses were that clients' level of rticulation of speech, as assessed by these dimensions, would have some relation to psydiopathological functioning and that the chase to which clients' expressed their lines well would be assmieted with the outcome of their psychotherapy experience. The extent that clients were vague and obscure would seem to reduce their ability to profit from a verbal experience. The finding did not support the hypotheses. The structural variables were found unrelated either to any symptom dimension such as cepression or anxiety (Tables 13 6t 14), or to the outcome of psychotherapy (Table 19). This was a surprising disqipointment of the stud/, specifically for egregted ARTICULATION widlle. The present author expected that this observable and measurable aspect of human 87 communication would hold much promise in the psychopathological minain. Since flaws were not wparent in the measurement and testing of the structural variables, the results suggst that clients' level of articulation of igas and the degree of qualification of their statements appears unrelated either to clients' symptomatic functioning or their ability to profit from a psychotherapy experience. The wmposite ARTICULATION measure, but not the definity dimension, was positively related to clients' Krohn rating. The correlations were significant for both pre- (.44) md post-therapy (.32) comparisons. This combination sumts that ARTICULATION may relate to the broader ego developmental aspects of object gvelopmental functioning but not to the psychopathological aspects of object tbvelopmental functioning. ARTICULATION migt show more promise in a sample of higher functioning clients. REFERENCES Blatt, 5U, Brennis, C. 8., Schimet, d. 0. at Click, r1. (I976). Normal gvelopment and psychopathological impairment of the concept of the object on the Rorschach. Journal of Abnormal Psychology , 85, 364- 373. Clark, K.B. (l980). Empathy: Aneglectedtopic in psychological research. Amer/ban Psycnologl'sl, 35. 187-190. Conte, HR. at Plutchik, R. (I981). Acircumplex model for interpersonal personality traits. Journal of Personality and Serial Raj/analogy, 59, 70 I - 71 l. Crockett, W.H. (I965). Corylitivecomplexityandimpression formation. In BA. Maher (Ed ), Progress in [xparflnental Personality Research, Vol l2. New York: Acatbmic Press. Data, R. H. (1982). A Human Science Howl for (no Amman! wit/7 Projxtiva lean/um Springfield, Illinois: Charles C. Thomas. Derogtis, L. R. (I977). .562 -90: Mlnlalraliofl, Scoring, and Procedures flanual - l for the R (owned) Version. Baltimore: John Hopkins University School of Medicine, Clinical Psychometries Unit. Fairbairn, W.R. (I952). An Object Relations Theory of Personality New York: Basic Books. 88 89 Filak, J., Abeles, N. ,. 8tNorquist, 5.. Clients' pretherepy interpersonal attitumsmd psychotherapy outcome, Professional Psychology, in press. Gresnberg, d. R. & Mitchell,S. A. (1983). Object Relations in Ryxnoanalytic Ineory. Canbridg, Massachusetts: Harvard University Press. Holcomb, w. R., Amine, N. A., andPonder, H. M. (1983) Factor structure of the Symptom Checklist-90 with acute psychiatric inpatients. Journal of Consulting and Clinical Psycnology, 47, 5- 15. Hartman, H. (l964). Essays on [go Psychology. NewYork: International Universities Press. Hemmendingr, L. & Schultz, KC. (1967). Developmental theory andtheRorschach method In MA Rickers-Ovsiankina (Ed) Rorscnxn Psychology. New York: Robert E. Krieger Publishing Co. Horowitz, LM. (1979). Onthe cognitive structureof interpersonal problemstreatedin psychotherapy. Journal of Consulting and Clinical Psychology, 51, 5-15. Hurley, JR. (I965). Parental mptance—rejection andchildren's intelligence. Merrill-Palmer auartarly, _L1,, 19- 31. 90 Hurley, JR. (1967). Parental malevolenceandchildren's Intelligence. Journal of Consulting and Clinical Psycnology, 31, 199- 204. Hurley, JR. (1976). Two prepotent interpersonal dimensions and the effects of trainers on T-groups. Small wroup Cenayior, 1, 77-98. Hurley, JR. (1978). Toward seeingourselvesasothersseeus. In LR. Wolberg, I‘LL. Aronson, 8t AR. Wolberg (Eds), Croup Therapy NewYork: Stratton Medical Books. Hurley, JR. (1980). Two interpersonal dimensions relevanttogroupandfamily therapy. In LR. Wolberg & M.L.Aronson (Eds) Croup and family inerapy. New York: Brunner-Hazel. Hurley, J.R. & Force, E. J. (1973). T-Group mine in acceptance-rejection ofself and others. International Journal of Croup Psychotherapy , 23, 166- 176. Kell, B. L. 8: Mueller, w. J. (1966) Impact and Cnange: A Stuoy of Counseling Relationships Englewood Cliffs, New Jersey: Prentice Hall. Kernberg, 0. (1966). Structural chrivativeof object relationships. International Journal of Psychoanalysis, $1, 236- 253. 91 Kornberg 0. (1976). Object relations anci clinical psycnoanalysis . New York: Aronson. Kernberg, 0. (I972). Early ego integration and object relations. Annals of Me New YorkAcademyoi Sciences , 123, 233-247. Klein, M. (1948). Contribution to psychoanalysis . London: Hogarth. Krohn, A. & Mayman, M. (1974). Object representationsin dreams and projective tests. Bulletin of Me Nenninger Clinic, 38, 445-466. Large, RO. (I976). The use of the role construct repertory grid in studying changes during psychotherapy. Australian and New Zea/and Journal of Psycniatry , _1_Q, 315-320. Linville, P.W. (T982). The complexity-extremity effect and age- based stereotyping. Journal of Personality and Social Psycnology, 32( 2), 1 93- 2 I 1 . Loevinger, J. (1966). The mmningand measurement of ego development. American Psycnologist , 21, 195-206. Loevinger,J. (1976). Ego Development: Conceptions and Theories. San Francisco: Jmey- Boss Publishers 92 Mahler, M .S. (1968 ). 0n Human Symbiosis and toe Vic/ssituoes of Ino'ivio'uat/on . New York: International Universities Press. Mahler, MS. ( I971 ). A study of the separation-individuation process and its possible application to borderline phenomena in the psychoanalytic situation. Psycnoanalyt/c Stuoy of Me Cni/o, 26, 403- 424. Mayman, M. (1967). Object-representations and object-relationships in Rorschach responses. Journal of Pro/active recon/goes and Personality Assessment, 1],, 17-24. Rabin, A.I. (Ed) ( 1981) Assessment wit/7 Project/ye fecbn/gues- A Concise /ntroo’uction. New York: Springer. Ryan, E.R. (l970). Object relations in early memories. Unpublished Masters Thesis. University of Michigan. Ryan, ER. (1973). The capacity of the patient to enter an elementary therapeutic relationship in the initial psychotherapy interview. Unpublished Doctoral Dissertation, University of Mlchigan. Ryan ER. & Bell, (1984) Changesin object realations from psychosis to rwovery, Journal of Abnormal Pyscbologv, 9.3, 209- 2 I S. 93 Raimy, v.c. (I948). Self referencein counselinginterviews. Journal of Consulting PsyC/Iblbgy , .12, 153- 163. Shearer, E.T. (I949). An analysis of the relationship between acceptance of and respect for self and acceptance of and respect for others in ten counseling cases. Journal of Consulting Psycnolmy, .131, 169-175. Small, D.J. & Hurley, JR. (I978). Work effectiveness and personal attributes of mental health professionals. In K.M. Nash, N. Lifton, & SE. Smith (Eds) fne Paraprofessional- Selected Readings. New Haven: Advocate Press. Spear, W.E. & Lapidus, LB. (I981). Qualitative differences in manifest object representations: Implications for a multidimensional model of psychological functioning. Journal of Abnormal PsycbolDW, 9.0. 157-167. Spence, D. P. (1982) Narrative frutb and Historical frutn: Meaning and /nter,oretation in Psycnoanalysis. New York: W. W. Norton Stock, D. (1949). An investigation into the interrelations between the self concept and feelings directed toward other persons and groups. Journal of Consulting Psycnology, 11, 176- 180. Strupp, H.H. & Hadley, S.E. (I977). Atripartate model of mental heelthandtherapeutic outcomes. American Psychologist , 187-196. 94 Sullivan, HS. (1972) Personal Psychopatnolow- [arly Formulations. New York: W. W. Norton Co. Triman, D. E., & Ryan, E. R. ( 1979) [go developmental and object relations.- A tneoretical ano' correlational stuoy. Unpublished manuscript, Yale University. Werner, H. (1948) Comparative Psycnology of Mental Development New York: International Universities Press. APPENDICES Appendix A The Structural Scales: Definity. Articulation. Specificity, and Clarity Appendix A: The Structural Scales: Definity, Articulation, Specificity, and Clarity. A. Definity 1. Description The Definity scale was developed to attempt to measure the degree to which the person makes a commitment to a statement or phrase. In an initial examination of transcripts. it was noted by the author that a fair percentage of a person's spoken communication contained qualifiers such as "perhaps" or “I guess“ or “I just kinda". This scale was developed to quantify the degree of qualification found. The degree of qualification was ordered based on an examination of the range of the phenomena as well as observation of co-occurrences of various items. For instance. aspeaker might say "I guess I hope" in one sentence and "I just more or less“ in the following sentence. Among the four structural scales developed for this study. Definity-appears conceptually different from the others. In contrast to the other three scales. Definity does not appear to assess an articulate dimension of the person's expressions. The scale is shown on page 99. 2. Scoring As with all the scales, Definity was used only on statements that contained one complete sentence or thought. Every separate statement on the transcript was rated. The author rated a statement by reading it and searching for certain examples or markers withinit (e.g. think, just. kinda, etc). From thisanoverall rating of the statement would be made. As with all the structural scales. a mean score taken from the clients' set of scores formed the Definity score. 95 B. Articulation 1. Description The Articulation scale was developed to score the quality of clients' theme development. Like the other scales. it was based on an examination of some transcripts and consideration of the range and coherence of the phenomena found. Usually the initial theme was the one considered. For example, a person may start off the statement with the sentence "I'm angry at my father". The person may then elaborate why he‘s angry with more or less degree of articulation, or perhaps the person may then proceed with a tangential or unrelated thought such as "I don't like many people" or “Different parts of me are on fire“ or "I feel cheery". The Articulation scale involved not only initial development. but especially how well the whole series of statements are used to either elaborate or constrict the person's ideas. This scale is likely to have some relation to a depth or experiencing scale. but it is intended to be used on any verbal output and «uses more of a cognitive dimension. The scale is shown on page 100. Z. Scoring The scoring for this scale was done more broadly then the other scales. If a statement contained enough sentences it was usually rated by itself unless the same theme continued through to other statements in the time segment. The time segment was the one minute sample within the transcript and each transcript contained five time segments. A rating never crossed time segments. Often. when the client made short statements within a time segment. at least two, and often the whole segment was used to obtain one rating. Whether or not the statements were rmd together depended also on whether the same theme was carried across segments. However, a segment which contained only very short and unrelated statements w“ given one low score. since lack of elaboration is equivalent to poor elaboration in this scoring system. As with the other structural scales. an average score was given for the pre-therapy and for the post-therapy transcripts. C. Specificity 1. Description The Specificity scale was devised to assess the degree to which there was specificness or preciseness in the communication or the degree to which object phrases in sentences an spelled out. For instance, a person may say "I feel confused“ or "I feel confused My" or "I feel confused about things" or “I feel confused about my feelings“ or "I feel confused when Jim says he doesn't love me“. These statements show increasing precision regarding the object phenomena to which the person is reacting to. It is likely that such specificity leads to resolution or understanding of difficulties as the person becomes knowledgeable about the antecedents of their reactions. The idea of this scale was developed from the author's listening to clients and others talk about various feelings and experiences. The ordering of the scale was based on the apparent increase in object phrase development. The scale is shown on page 101. 2. Scoring Every statement is rated separately and the mean score is used to represent the Specificity score for the transcript. D. Clarity 1. Description The Clarity scale (p. 101) was devised to deal with varying degrees of clearness in communication. The author noted that often there were varying degrees of clarity in communications even when people were talking as if they were being easily understood. For instance. the person might say “That's the way it works" without giving a clear sense as to what the "it“ might refer to. The scale was also used to assess if part of the content of the communication was making sense in terms of appropriately meshing with other parts of the communication. For example, if a person is talking about their family and then mentions something supposedly in connection with this but which the listener or reader cannot either explicin or intuitively fathom, then the communication was rated relatively unclear because of the juxtaposition of its parts. 2. Scoring This scale. like the Articulation scale. was used broadly over the material. The author typically examined the whole series of statements within a time statement and rated the whole segment as one. As with the other structural scales. an average score was given for each of the set of transcripts for the client (pre and post). SCORING DEFINITE-IIDEPINITE The degree to which a Description bonafide commitment is made to a statement. Examples Feel chit or think, some qualification. 6 highest score for past or future tense. highest score for self in relation to others. I am a louse l have an awful feeling about myself I feel punished 1 get hell from her. t t. too. I felt that. really. I feel both ways. still I think that jift out o! I don‘t like it I felt myself locTed In for sentence I don't think extended periods of time. . I didn't know He have I was I'd like I would letter thifi SUI liked ‘Tfiife‘s e good‘Ehance'?het. I found myself} it statements I'm basically feeling. I can. but. there Mostly. I did notice that. lfind that. assertive stion ask- 1' m prett sure. I can force myself (some hypothe- ing of sel . contin- I feel 11 e. tical - less to it). There is 5 gencies (e. g. “the more it hap ened. the worse I felt Passive vs. active voice Sentence begins with long phrase. Hould Lacking subject It looks like. but. ....leceuse (when by itself). I enjoyed it.....l think (later qualification) At least. It was. The more worse. I usually. It‘s like. There are times when. .1 hope I don' t. It seems. "Pee le do things like she did to me. Also feel. I s time he's ready- 1' m u set again. Also. slot en though she likes me. 1 ts her. I would like to. 1 hope I don‘ t. Got a feeling They would if it was not for me. about that. Specifically fixed in time or place. Past 4. 5 or future (not present) "You" or "one" substitu- ted for self. Many "ing" verbs. Distant past. Some rehability 4 usual v less than $01 1 Hypotheticals. shoulds Haybes (exce t me be rl) Hay (except may 3 it an ambivalent state- ment with qualities. multiple reasons put forth. :D5:ile qualifiers 2 Alot ofq distancing from stat-ant These sessions have one differgntly. Qiistion askifig of tgirapist when really a statement is in order. I used to feel I would like It doesn't In the past There ien‘ t It doesn't seem I'm starting to feel I don' t feel like I'm beginning“ to feel A long time ego8 I felt lt' s l ke I in I‘ ll eep tryng I think eventually It's almost ike There is some chance that. Just. That' a part of it. Sometimes I feel. I feel partly. or in part. 1 think that perha s. Alot. I guess. Pretty much. lt' a somewhat like y. A little a little bit. pretty. It's possible that. Sort of. Sugpose. I wish. Maybe 1..... not particularly. 0 some extent. Probably. To a point. Perhaps I. For all I know. Kinda, kind of For some reason In some we s If (as hypot t ca on y at g: I wouldnt come here. it I admitted t t. Night. or. maybe. my be. Should. could (when used hggothetically) no. yes. me be no. Per ps I am or am not. a l I don't w whether it was that H The cha as or 1 was homesick or what. I guess chit maybe I 333': EESw if I guess I hope I'm not sure what I I just kinda feel. lshould jus at I just more or less Unacknowledgment 1 Uhacceptence Denial I don' t know (when used in a disclaiming way) I have no idea if this is true but If anything..... Hho knows? Who knows if ARTICULAT! (DEVELOPED) VS. DIFFUSZ (UNDEVELOPED) A sentence or group of sentences on a similar theme The de res to which the theme. Description idea or feelin is devel ed. Consider how we 1 a series of statements get together is 0; rticulate my. Theme develops well. Some real thoughtfulness is expressed. It 8 has to have the feel of a real nice development of a theme. smooth. It can be concise. I feel like I have some personal things that I want to work on. But if I'm trying so hard to be perfect and articu- late. and sa ever hing just right. I he M't know i l wi l accomplish my goals re. 7. 5 In'umu Theme is developed but there is There' a slot going on in my life. Is- some excess baggage. Some repeti- assessing my values and l eel shakey tion. Zach sentence does not nec- about that. I'm looking at my career 7 essarily add. Theme gets slightly goals and that' s Igetting shifted. I'm stuck. (or) concise development real confused. oing through alot. and articulation but little lt' s like 1 deserve tter than this. elaboration. I keep feeling like just because I'm not a hous e l shouldn' t have to put up with dirty dishes. I deserve some better shake. 6.5 ln-between Articulate but a fair amount of repetition on a theme. Some develo t. Instead of develop- 6 ment t rough one incident. there I‘m angry to my father. he threw an ashtray at me once. he threw hot water on me once. he forced me to have sex with him and has called me a whore is 3 ing around to other examples since. which eeps the feeling fr“ develmt. 5.5 In- between Articulate but not wall-developedi l‘m angry at my father. He threw an (or) monotonic and repetitive (or) ashtraz.:t me once which cut the side 5 jumping around as above but in a of my d. I hate him for it. serial- like monotonic fashion where the feeling is not developed. epoint with excess baggage” I feel lost. Sometimes I feel I'm the 4. 5 lacking much development last to know what's going on. I just lnibitween (or) theme is loosely ‘ cognected. Gets somewhat lost y a . feel lost. ’l'have suEh a Sea-Iblz_fiiling about elf. I don't know how that comes to d alot. and most peo le don' t see that. I'm glad about t t. l'm 1leased that m friends don't know me 3 5 ln-between. ’lmpoverished develop- ment. TE—ée gets lost (or) theme’is rarely understandable between 2 3 sentences (or) just more than one sentence (or) only one sentence with a decent subordinate clause. I'm getting caugt up in this relation- ship with my roe-ate. this woman 1 live with. and I'm not real comfortable tith. f I am but :;:‘no:. Dean tohaving a or o str e t s ppenu been doing.:‘lot of meditating and alot of running. 1 don't know how to lain it. Just feel different partso my- self. Oh wow! t' s so abstract. That bugsme. ldon'tknowiflcango into detail. This person is alot of why I'm here 2.5 ln-between W loose. nearly “1:..— Wu so incom- ulste. One sentence or a vary 2 brief statement with little or no attempt at development incoherent str of sentences. 1 Statements said a series but unrelated in any apparent way. fortable with me and lenry. youand these are my differences. and believe me 1' m not pushing lenry as a beau or husband or anything. but that I think a bit of the discomfort has to do with. because of the insistence we 've mentioned. or some sort of involvement 1 feeleheer;i You’know what l’mean. eremces between you and as. hot ieve me. 101 W The degree to which there is specificness or preciseness in the communication. or conversely. the degree to which generalities are involved. Ioderately Global Somewhat Global A Little Global Very Reference Vague Generalities Role Specific Precise and Global to an ““All Context Groups SpecificStstements l I I l l I I 1 2 3 4 5 6 7 I feel always. I feel confused about values, I feel confused confused everyone. things with Jim career goals when Jim says he It's tough etc. (3) (4) I feel confused about doesn't love me Jim's feelings towards me W The degree to which a statement or a series of statements are clear and unambiguious. Does the reader know exactly what is being talked about? Does the language tent to hide more than it reveals? How vague is the content? ' Very Moderately Somewhat A Little Clear and Precise Vague Vague Vague Vague Little to Wonder About I t l t I t I l 2 3 4 5 6 7 Appendix B Content Scales Appendix 8: Content Scales 1) Self -accaptance-rejection or level of self-esteem low low-medium medium medium-high high 2) Level of self-efficacy low low-medium medium medium-high high I 2 3 4 5 person seems to person seems mixed person appears feel helpless and about ablility to capable( through incapable of mas- master enviroment self-statements) tering enviroment ‘ of achieving goals and mastering enviroment 3) Movement towards others vs. movement away low low-medium medium medi um-high high l 2 3 4 S appears to be mixed about movement wants to move moving away from towards or movement towards others others away 102 4) Hostile vs. affliative l03 _hostile m low low-medium medium medium-high high 1 2 3 4 5 appears rejecting shows mixed acceptance appears mcept- of others vs. rejection of others ing of others 5) Gold vs. warm (Unless warmth is shown, tend to rate on the cold side.) ng warm low low-medium medium medium-high high I 2 3 4 S 6) Harsh vs. gentle low low-medium medium medium-high high 1 2 3 4 5 harsh neither harsh mntle nor gentle 7) Accepting vs. rejecting low low-medium medium medium-high high I 2 3 4 5 rejecting accepting lO‘l Hurlg Scales Please rate the client on the following 7 point bipolar scales ("4" is somewhat neutral). l 2 3 4 5 6 7 hichs feelings shows feelings l 2 3 4 5 6 7 guarded hostile l 2 3 4 5 6 7 passive active 1 2 3 4 S 6 7 submissive diminant l 2 3 4 5 6 7 cold warm I 2 3 4 S 6 7 harsh wotle 105 l 2 3 4 5 6 7 harms others helps others 1 2 3 4 5 6 7 rejects others accepts others Appexdix C Psychopathology Scales Appendix C: Psychopathology Scales Please rate the client on the following: Melon: 1. How disturbed ch you think this client is? 0 i 2 3 4 5 6 7 very moderately somewhat mildly disturbed disturbed disturbed disturbed 2. Please rate client on the SOL-90R global pathology index. 8 9 shows little disturbmce 3. Please rate the seriousness of client‘s problems, i. e., the degree to which they reflect personality disorganization. O i 2 3 4 5 6 7 8 9 very moderately somewhat mildly no personality serious serious serious serious disturbance 4. Degree of client's subjective distress. 0 l 2 3 4 S 6 7 8 9 grave high moderate some little-none personality disorganization 5. Degree of defensiveness. 0 l 2 3 4 5 6 7 8 9 none little mme morbrate high 106 107 tholgical Health 1. How psychologically healthy do you think the person is? 0 i 2 3 4 S 6 7 8 9 no little some moderate high apparent strength 2. How creative do the client's expressions seem? 0 i 2 3 4 5 6 7 8 9 none little some motbrate high 3. Degree of comfort in interpersonal relations. 0 l 2 3 4 5 6 7 8 9 low some moderate high very high low -— person feels extremely uncomfortable, with others, feels that relationships with others are strained, never flow easily and relaxedly, are chvastating to a sense of contentment. Relating to others is a source of dissatisfaction to him/her. Ego-Developmental Level (see Loevinmr chart) very high -- the person expresses a basic contentment with respect to relationships with others. In mneral his/her experience of interaction is of a smooth interpersonal flow - an experience of comfort and satisfaction in his/her personal and social exchanges. 0=l-l; l=|-2; 2=a; 3=|-3; 4=|-3/4; 5=|-4; 6=|-4/S; 7=|-S; 8=|-6. Appendix D: Sample Transcript 8013-1 2 - i guess l'm feeling that I missed alot not having my dad around. it was really hard when I was younger cause I remember people talking about things that he did. He would ask what your father did and where is your father. I would say my father is crazy and in a mental institution. There isn't a whole lot of people who understood that. Yes, it really does. 3 - But there's not anybody that my brother took me to. It's rather difficult. i think the reason is cause the messages that I get is like male people. It's like their either incompetent type of, I shouldn't say incompetent. It's like they don't stay around. In my life they never stayed around or if they are around they use people to get to where they need to be and then they move out. It's {tinny because i was in a relationship when lwas about 16. l was going with a guy then and he was a few years older then I was. lie was around 21 and time pushed him out of my life and I think I was scared because he was saying that he loved me and let's settle down. and I wasn't ready for that. I think part of the thing that scared me was that that didn't seem to lit in. it wasn't normal for a male person to be saying that to me. I just. it didn't click right. Everytime somebody was nice to me. you‘re just saying that. you're gonna go away too. I think that ties in with what I. with why I was reluctant to work with a male therapist, because it's like everytime somebody like that comes along. they just. they're going to use me. or else they're not going to be around long. so 108 Appendix D Sample Transcript 109 that': why I was reluctant to work with a therapist. cause that would tie in these messages. Then if you did stay around. then that says gosh. there is something that really must be wrong with me. Because it's not true and you're still staying around. It's like a cycle, I just want to get out of it. 4 — What's in my head. what lwant to say is. the first thing that came into my mind was that this fragile little female that came in here referring and couldn't handle her or control her life. and I don't know. I don't think I'm that way . 5 - I think so, I mean yea there is. If] was in the water drowning I would probably ask somebody to help at the last minute. But you know it‘s like I may be hurting inside but I'll be damned if all the people are going to know it. And yet when I think about it I'll be doing little things that, well my roommates can tell when I've upset. It's the way! go around the house and everything, with a solemn look on my face and don't feel like eating and I don‘t know. just different mannerisms and things that I do that I guess give way and tell people that hey. something is bothering me. but for me to come and go up and say hey I want to talk about this I wasn't used to doing that. 6 - I can remember when I was young and I asked my mom things she would just the only thing I got from her was because I told you so. And if you carry that on further and you say why. she says because that's the way it is. And I told you so or that': God's will. I mean you learn to just not say anything. It doesn't get you anywhere. so you either ask other people outside and that's kind of risky. Okay. 110 Right now it is. I'm looking at getting a new job. so it may change. Like I should know in a few weeks. If it did it may have to be after 3 o‘clock. Anyday after 3 o‘clock. Right now this is a good day and time. 8031 - 4 2 - I could step outside myself and see what I want to see. I see myself most of the time as a pretty good person. 3 - You mean is this gonna go away too? Maybe I expected it. I think that's normal. 4 - Maybe it would be impossible. But if it wasn't you would probably make it turn out to be right. By telling myself that I was worse off. See me extra twice a week. Anything that's good I just. Yea I don't either. 5 - No. it's like if I could see myself slipping into it before daring me to do something. I still think I can, but it‘s a heck of a lot harder. I need to communicate to other peoplewhatlneedinagiven time. Iflneedtotalkorifl'mfeelingbadandtobe able to say that but I usually do all these nonverbal things. Then I withdrawn. My family was like that. we never talked about it when it was happening or trying to get what you needed. I don't know good people? I won't stay in the same room. 111 6 - I remember when 1 got to my. I made it through it and then I felt good. Then I went on to the paramedic program and I got through that. Then I took the state boards and I'm still thinking of taking it but I did some thinking before I did that. Why I would and why I wouldn't go through it. There is some logical reasons. not just mentally. Probably to me. it's my mother. Cause it doesn't matter what I do. she just says go ahead and do it and that's okay. If I was a plumber or sdoctor. big deal as long as I was happy. “13 - 23 2 - There is she. Don't worry I'll pick them up later. This is fun. I don't know how. I don‘t like feeling excluded from things. I don't care if I'm the one to fall or not, I just don't like it. Yes. it does. it makes me really angry. I feel like I'm being condemned for something in the past. it's in the past as far as I'm concerned. I'm changing now. I'm working on, I'm attempting so I don't want that being helded against me. I feel it is. I don't think that's fair. See I have a real problem with that because you know I'm not sure if they're having a relationship, physical relationship or whatever. that bugs the hell out of me. It's almost like I don't know and I remember asking Linda once before if that occurred at a certain period of time when we were still in a relationship and she said nothing was going on then. Whether it is or not now. it's like if it is maybe it's my business. maybe it isn't. Yet if it's going on it's like I feel like I've been dumped. 112 3 - Well it may come down to. No it's like if this continues and there's just this big distance between us it's gonna come down to I'm gonna leave or it's gonna change. I mean if I'm making an effort to change and they're still responding to me in an old way then that's not good. It's not good for me. But if they start responding to me differently, if I respond in a different way and they respond differently than I may stay there. I think I know now that there is no way they can meet all my needs. they don't. Especially Linda. and if she's not willing to work on a relationship then fine. there's other people out there. It hurts a whole lot. No. it really hurts. 4- lhatehertolietomeaboutit. That's right. I hate your guts. 60 die here. I hate you for no being strict with me when you were pissed. You were pissed. Just cry, you said my poor kids, wasn't for my kids I'd be somewhere else. Pile of shit! You got pregnant. I didn't get you pregnant. You married my dad. it wasn't my fault. Quit blaming so much. 5 - You can all go to hell. Don't sit here and poor me for my dad. You don't know what it felt like not to have a dad around. Try to get one from somebody else's dad or somebody else out there. Even if something goes wrong with your car at least ask. Never around for anything. If he would have been there maybe things would have been better between mom and I. I'm sick for thinking that way. Compete with her for my dad cause I think she considered that real well too. She never admits any of these things. The way you avoid everything. that everything is God's will and you avoid all my questions. 113 6 - They wanted me to save their marriage. All the time I remember my mom saying Oh how much she wanted a little girl. she had my brother but she wanted a little girl. This is her second marriage you know, maybe it was falling apart. Ane the bits and pieces I got form all the times I had to be cute for everyone. Must have been it. huh? Didn't want me. Just wanted some little machine to run around and do everything that you wanted it to do. If it didn't work out between you you could always get Sara, she'll fix it for you. Well that sucks. 8.13- 17 Z - There is. there definitely is. I guess that's why it's kind of sad. Kind of feels to me like I'm losing a friend in some ways. And yet I'm not you know. It's like you're gonna go on and continue and grow and change in your life and that's what I'll do. 3 - I guess that's why it's important for me to have another relationship. Cause then maybe I could kick some of my ideas arond with them and it could be an exchange and yet I don't know. it just seems like it would help things. Maybe it would balance things out. Maybe to make. you know there's this special closeness between Linda. Pat. and I that somehow I just feel that I don't fit in in some ways, so maybe that would take care of expressing my feelings to them. I don't want to talk about it anyway. But I'm saying I've done alot of blaming in the past and said that they did this and they did that. There were times when they were available to me and I said forget you. They didn't meet my needs the way I wanted them to be met and to hell with them. Maybe some of that really wasn't 114 fair. I put up some walls you know. I'd isolate myself. I have the pastyear for a long time and it’s almost like I feel like I don't know how to have fun anymore. Maybe I have to learn how to have fun in a new way becuase I‘ll go out once in a while and do things with other groups and then I'll get to the point and I'll just feel really out of it and I'll just. come back home. I'll get really angry about it cause part of me wants to stay and is almost like the saying ifyou've been hurt you don't want to be hurt again. It‘s really scary for me. 4 - The hard part is deciding what does hurt me and what doesn‘t. You know what really pisses me off? People who have it so easy. 5 - I don't understand how to do that. Why would I pull in like that? Maybe I can see it with my mother. but I do that everytime that I'm hurt. then I really am playing with other people. 6 - It's gonna take another 50 goddamn years. The rem of my life I've gotta look for security in myself? I guess cause I don't see people being secure without other people. Appendix E Client Data Appendix E: Client Data Client Code ° 8004 8007 8008 8013 8015 8018 8019 8022 8025 8032 8035 8036 Age 24 35 29 23 57 29 24 23 22 26 23 25 Sex (lamen. 2=women) 2 2 2 2 2 2 2 1 2 1 2 2 ’ of sessions 42 28 15 27 16 43 34 43 26 43 1 l 46 TmedsessionsusedearlyHJ 3 1.3 1.4 1.3 1.3 1.3 1.3 1.3 1.3 1.3 1.3 (late) 39.42 23.28 13.15 23.27 13 41.43 28.34 23.28 24.26 39.43 8 44.46 outcome (1-high. l 2 - 1 3 1 2 1 2 1 - 2 2=med.. 3=low) Pre (malts) Definity 5.6 5.2 4.9 4.2 4.8 4.8 4.4 4.5 4.0 4.6 4.4 4.8 Articulation 5.9 5.9 3.7 4.9 4.2 5.7 4.7 4.7 4.4 4.3 4.6 3.5 Specificity 4.8 4.8 3.4 4.0 3.6 4.8 4.8 3.9 3.4 3.1 4.1 3.9 Clarity 5.0 4.1 3.3 4.5 3.7 4.7 4.8 3.9 4.0 3.8 3.8 3.4 Krohn score 4.4 4.6 2.9 2.9 2.3 4.1 3.3 3.4 2.7 3.1 3.5 2.9 Self -Acceptance 4.0 4.5 7.5 4.0 3.0 4.0 6.0 5.0 2.0 3.5 7.5 5.5 Likes-Others 9.0 6.0 10.0 5.5 7.0 6.0 6.0 8.0 3.0 6.0 6.5 5.5 Kind Others 10.0 3.5 11.0 6.0 3.0 4.0 8.0 5.5 4.5 8.0 8.5 8.0 Post (means) Definity 4.7 4.6 4.8 4.8 4.9 5.0 4.4 4.7 4.0 4.5 4.8 4.4 Articulation 5.1 4.9 3.5 5.8 4.3 2.9 4.1 5.1 3.7 3.8 4.0 3 .6 Specificity 4.4 5.3 3.1 4.9 3.8 3.2 3.6 3.5 4.2 3.4 4.0 3.7 Clarity 4.2 4.1 3.2 5.4 3.2 2.0 3.3 3.5 3.8 3.0 3.4 3.2 Krohn score 3.4 4.2 2.1 3.3 2.4 3.8 3.3 4.3 2.5 2.0 3.5 2.9 Self-Acceptance 9.0 5.5 8.0 7.0 5.0 8.5 6.5 5.0 2.0 2.0 4.5 8.0 Likes-Others 6.0 6.0 2.0 6.0 4.0 8.0 8.0 6.5 4.0 7.0 7.0 7.0 Kind Othesr 14.0 5.0 4.0 5.5 3.0 4.0 7.5 7.5 4.0 9.0 10.5 7.0 Category Comts Pre Self+- 9.27 5.9 14.1710.17 10.1313.31 131512.30 11.30 6.11 15.19 10.30 Mother + - 0.8 4.7 0.0 1.1 0.3 0.0 0.1 0.0 0.0 0.0 0.0 0.4 Father + - 0.3 0.0 0.0 0.2 0.0 0.0 0.0 0.1 0.0 0.0 0.0 0.0 Funily + - 1.4 2.8 0.0 0.1 0.0 1.1 3.2 0.0 0.0 0.0 1.3 0.0 Intimate + - 3.1 1.3 6.8 1.3 0.0 3.18 0.0 0.0 0.0 0.0 0.0 0.11 Therapist + - 0.0 0.0 0.0 0.0 0.0 0.0 0.0 2.2 1.1 2.0 0.0 0.0 Social Relationships + - 1.3 0.1 1.0 0.1 0.1 0.1 0.9 4.5 0.0 0.0 0.0 2.1 Generalized other + - 2.5 0.1 0.2 0.5 0.4 1.0 0.0 0.4 1.6 0.4 3.4 0.0 Post Self+- 19.7 20.17 4.12 11.29 5.5 15.7 6.12 8.16 14.12 7.18 15.21 22.17 Mother + - 0.4 0.0 0.0 0.8 0.0 0.0 0.0 0.0 0.1 0.0 0.0 3.3 Father + - 2.0 0.2 0.0 0.1 0.0 0.0 1.0 0.0 1.1 0.0 0.0 0.0 Funin + - 3.1 0.2 0.0 0.0 0.0 1.0 0.2 2.3 0.1 0.0 0.0 0.0 Intimate + - 0.0 0.3 0.0 0.1 0.0 0.0 0.0 4.5 0.0 0.0 0.0 1.1 Therapist + - 0.0 1.0 1.5 . 0.0 1.0 0.0 0.0 1.4 1.0 0.0 0.0 1 0 Social Relationships + - 0.0 0.0 0.0 1.4 0.6 0.1 2.3 0.0 1.0 0.0 1.2 0.0 Gawalized other + - 0.4 0.0 0.2 1 2 1.0 0.0 0.0 0.0 0.1 0.0 1.2 0.0 115 Client Code ‘ Age Sex ' of sessions 8037 8038 8041 8044 29 2 24 Taped sessions usedtearly) 1.3 (late) 23.24 6 outcome (1=high. 2-rned.. 3-low) Pre Definity Articulation Specificity Clarity Krohn score Self -Acceptance Likes-Others Kind Others Post Definity Articulation Specificity Clrity Krohn score Self -Acceptance Likes-Others Kind Others Category Counts Pre Self + - Mother + - Father + - Fanily + - Intimate + - That-mist + - Social Relationships + - Generalized other + - Post Self + - ”other + - Father + - Family + - intimate 4» - Therapist + - Social Relationships + - Generalized other + - 2 4.6 4.6 4.5 3.8 5.7 7 .0 2.5 5.5 4.5 4.3 3.6 3.5 4.6 6.0 6.5 21 2 6 1.3 3 4.5 6.1 4.7 4.7 3.6 2.5 4.0 3.0 4.3 6.0 4.6 4.6 4.0 2.0 4.5 12.0 8.0 10.29 7.26 0.0 0.0 0.0 4.8 0.0 6.3 0.4 1 . 10 2.0 0.2 0.3 0.0 0.0 0.0 16.21 4.22 0.0 0.0 0.0 1 . l 4.0 1 .2 0.0 0.3 0.0 0.1 0.1 0.0 5.0 0.5 4.6 5.1 4.1 4.3 7.0 6.5 5.0 9.0 4.8 3.9 3.3 2.8 5.6 8.5 7.0 11.0 20.24 1 1.37 0.0 0.0 0.0 1 .4 0.0 2.0 1 .0 15.8 2.3 0.0 0.0 0.0 3.0 1.1 0.1 4.3 4.0 3.4 2.9 1 .5 5.0 2.0 5.0 4.6 3.3 3.1 2.5 1.5 3.0 2.0 5.0 0.2 0.1 0.3 0.1 0.0 3.20 0.7 5.8 0.1 0.0 0.0 0.0 0.1 1.10 0.1 116 8047848A84888057 8060806280658067 25 1 17 1 54 1 17 1.3 55 1 18 3.8 13.1413.1714 1 4.7 4.8 4.2 4.0 5.2 5.0 6.0 5.0 4.7 4.3 3.3 3.0 5.0 3.5 6.0 7.5 1 .1 1 2.7 4.8 0.0 1 .3 0.0 0.0 0.3 10.15 14.22 19.31 0.0 0.0 0.0 1 .2 0.0 0. 1 0.0 2 4.7 4.4 4.1 3.3 3.7 3.0 4.0 5.5 4.6 3.8 4.0 3.4 3 .8 4.5 5.0 6.0 9.26 0.0 0.0 3.5 1 .6 1 .0 1 .0 0.2 0.0 0.0 0.5 0.1 1 .0 0.0 0.2 2 4.6 4.1 3.5 2.9 3.3 4.5 5.0 8.0 4.4 3.7 4.3 3.2 3.3 4.0 6.0 9.0 4.9 0.0 0.0 0.0 1.0 0.1 1.0 0.1 0.0 0.0 1.3 2.2 0.0 1.1 2.2 34 1 19 1.3 18.19 1 4.1 3.4 3.5 2.9 2.6 2.0 5.0 7.0 4.3 4.1 3.6 3.3 2.8 5.0 8.0 8.5 8.15 1.0 0.0 0.0 0.0 0.0 0.1 0.2 17.6 0.0 0.0 0.0 0.0 1 .0 0.0 2.2 31 2 46 1.3 28 1 36 2.4 24 1 16 1.3 27 2 18 1.3 39.46 33.36 13.16 13.18 1 4.5 4.3 3.9 3.1 4.4 4.9 3.3 3.7 4.4 2.3 3.1 3.8 3.9 3.0 5.1 4.5 8.0 7.0 7.0 4.5 5.5 7.5 8.0 8.0 4.3 4.5 4.3 3.9 4.4 5.4 3.1 3.2 4.4 2.6 2.6 4.0 4.0 3.3 5.5 7.0 6.5 8.0 4.5 5.5 6.0 8.5 8.5 12.0 1 1.9 12.25 8.10 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 2.0 1.2 0.0 0.4 0.0 0.0 0.0 3.0 0.0 0.0 0.1 0.2 0.4 15.1214.19 30.21 0.0 0.0 2.1 0.0 0.0 1.1 0.0 0.0 2.0 1.2 0.0 0.0 0.0 0.0 0.0 0.0 1.0 2.4 0.0 0.0 0.4 1 1 1 4.2 4.7 3.0 3.0 3.4 4.0 7.0 5.5 3.8 4.6 3.1 3.0 4.2 2.5 4.5 5.5 12.1 1 0.0 0.0 0.0 0.3 0.0 2.1 3.3 16.19 0.0 0.0 0.0 0.0 1.5 0.3 117 ClientCode ' 8076 8078 8091 8094 8095 8099 8100 8104 8105 8113 8114 8116 Age 26 41 48 23 22 34 20 35 28 28 22 26 Sex 1 1 1 1 1 2 2 2 2 2 1 2 'ofsessions 18 12 21 15 10 42 43 23 71 18 48 20 qudsessionsusederlyHJ 2.3 2.3 1.3 1.3 1.3 1.3 1.4 1.3 1.3 1.3 1.3 11818) 13.1841.4318.2113.15 8.10 38.4238.4318 70 13.1843.4818.20 outcome ( 1-high. 2 1 2 1 1 l 1 2 2 1 1 1 2=med.. 3=lowl Pre Definity 5.0 4.2 4.8 4.6 4.5 4.9 4.5 5. 1 4.7 4.5 4.5 4.8 Articulation 5.2 3.5 4.7 5.0 4.3 5.3 5.9 4.8 4.8 5.7 5. 1 6.5 Specificity 4.3 2.7 4.7 4.4 3.8 4.4 5.6 3.7 4.7 5.6 3.7 5.6 Clarity 2.9 2.7 3.7 3.8 3.5 4.4 5.4 4.2 4.1 5.2 3.2 5.9 Krohn score 2.0 3.5 4.1 4.8 3.6 4.1 2.8 3.4 3.8 4.9 3.9 5.7 Self -Acceptance 5.5 3.0 8.0 6.0 5.0 3.5 2.5 2.0 2.5 6.0 4.5 4.0 Likes-Others 6.0 7.0 8.0 8.5 7.0 6.0 3.0 5.5 6.0 9.0 5.0 8.0 Kind Others 9.0 9.0 9.0 12.5 9.5 7.0 7.0 5.0 8.5 7.5 6.0 6.5 Pos Definity 4.2 4.2 4.0 4.5 4.6 4.8 5.1 5.1 4.1 4.5 4.3 4.6 Articulation 5.3 4.3 4.9 5. 1 4.4 5 .3 5 .7 4.9 4.9 4.4 4.6 6 .7 Specificity 4.2 3.3 4.2 3.9 4.1 4.1 5.4 4.2 3.3 4.8 3.8 5 .7 Clarity 3.2 2 .6 3.6 3.3 3 .0 4.2 5 .0 4.1 3 .5 3.8 3.4 5.7 Krohn score 2.3 4.2 4.1 4.3 3.5 3.6 2.8 3.6 3.1 4.7 3.5 6.7 Self -Acceptance 5.0 9.5 9.0 8.0 5.0 6.0 2.0 4.0 4.0 4.0 4.0 6.0 Likes-Others 4.5 4.5 9.0 8.5 5.5 8.0 3.0 8.0 5.0 7.0 7.0 7.0 Kind Others 6.5 7.5 11.0 12.0 6.0 12.0 5.0 8.0 6.0 7.0 7.5 9.0 Category Counts Pre Self + - 18.3439 18.21 9.27 8.5 12.27 20.31 7.24 7.29 6.20 7.11 8.7 Hotter + - 1.3 0.0 0.2 0.2 1.1 0.3 1.0 0.0 0.0 3.9 0.0 2.1 Father 4 - 1.0 0.0 0.3 0.0 4.1 0.2 0.0 0.0 0.2 0.0 0.0 1.0 Flnily + - 1.0 1.0 1.0 5.5 2.0 2.5 2.0 0.0 2.7 0.1 0.0 0.0 Intimate + - 0.0 0.0 1.1 0.1 0.1 0.0 0.0 0.1 0.0 1.0 0.0 1.3 Thermist + - 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.1 1.0 0.0 0.0 Social Relationships + - 0.2 0.1 0.0 0.0 0.0 0.1 1.3 0.0 3.4 0.1 1.9 0.0 Generalized other + - 0.1 0.0 0.0 1.0 0.4 0.0 2.7 1.4 0.0 0.0 0.1 0.0 Post Self+ - 8.32 17.12 17.25 28.20 7.12 23.23 8.15 6.9 14.26 11.1110.9 9.27 "other + - 0.0 0.0 0.0 0.0 0.1 0.3 0.0 0.0 1.3 0.0 0.0 0.0 Father + - 0.1 0.0 0.1 0.0 1.1 0.1 0.0 0.0 0.1 0.0 0.0 0.0 ramily s - 0.0 0.0 0.0 1.0 0.1 0.0 0.1 0.0 0.1 0.0 0.0 0.0 Intimate + - 0.0 2.2 0.1 2.2 0.0 3.2 0.0 1.0 1.3 4.3 0.1 0.2 Thermist + - 1.7 0.0 1.0 0.0 0.0 0.0 0.0 0.0 1.1 0.0 0.0 0.0 Social Relationships + - O 1 0.0 0.0 1.1 0.0 0.0 7.13 1.0 1.2 0.0 0.0 0.3 Generalized other 4» - 3 4 0.0 0.1 0.0 1.2 0.0 0.0 0.1 0.1 0.0 0.0 0.1 118 ClientCode ’ 8121 8126 8130 8131 8132 8133 8140 8146 8147 8152 8157 8160 Age 26 23 26 26 21 24 43 22 35 3O 32 29 Sex 1 2 1 2 2 1 1 2 2 2 2 2 ' ofsessions 34 3O 16 43 10 14 20 23 28 14 5 18 Twed sessions used(early) 1,4 1,3 1,3 1,3 1,3 1.3 1,3 1,3 1,3 1.3 2 1,3 (late) 33.34 28.31 13.16 38.45 9 13.1418.2018.23 232813.14 5 8,18 outcome (1=high. 1 1 1 1 1 2 1 3 1 2 3 1 2-med., 3-low) Pre Definity 4.0 4.5 4.2 4.1 4.0 4.7 4.6 4.1 5 .0 4.5 4.8 4.7 Articulation 4.5 4.5 4.6 6.2 5.2 5.0 5.4 5.4 5.3 4.4 5.3 5.8 Specificity 4.1 3.8 4.5 4.6 3.5 4.9 4.6 3.7 4.8 4.7 5.0 4.3 Clarity 3.1 3.0 3.9 5.4 3.8 4.3 4.2 4.1 4.6 3.1 3.6 4.3 Krohn score 4.4 3.1 4.0 3.8 3.5 3.8 5.1 4.4 3.9 4.8 4.4 5.8 Self -Acceptance 3.0 3.5 3.0 5.0 6.0 6.0 4.5 2.5 2.5 4.0 3.0 5.5 Likes-Others 6.0 7.0 4.5 8.0 7.5 6.0 9.0 3.5 5.5 7.5 3.5 6.0 Kind Others 7.5 6.0 7.5 9.0 6.0 6.0 9.0 7.5 3.0 7.5 4.5 7.5 Post Definity 3.7 4.4 4.2 4.4 4.5 4.2 4.6 4.0 4.7 4.2 4.8 4.3 Articulation 5.7 4.7 4.3 5.6 4.8 5.3 4.5 5.6 5.7 5.5 4.6 4.8 Specificity 4.0 3.5 3.3 3.6 3.6 4.1 3.8 3.4 4.5 5.0 4.0 3.3 Clarity 3.3 3.2 3.4 4.2 3.7 4.2 3.7 4.0 4.1 4.2 3.3 2.8 Krohn score 4.4 3.7 3.0 3.3 3.0 3.4 5.1 4.3 3.8 5.5 4.1 6.0 Self-Acceptance 4.0 6.5 3.5 3.5 4.0 7 .5 6.5 2.0 4.5 8.0 6.0 7.0 Likes-Others 8.0 8.0 3.5 6.5 6.0 7.0 10.0 3.0 6.0 9.5 2.0 6.0 Kind Others 9.0 9.5 7.5 7.5 6.0 9.0 7.5 7.5 6.0 12.0 6.0 7.5 Category Counts Pre Self+- 12.12 9,22 15.23 23.39 8.13 9.11 6.13 15.31 15,156.12 9.19 13.6 Mother + - 0.0 0,0 0,1 0,3 0,0 1,0 2,1 0,0 0.0 1,1 0,0 0,0 Father + - 0,0 2,2 0,0 0.4 0.0 1.3 0,0 0.0 2.3 0,1 0,0 0,0 Fanily + - 0,0 0,1 0,0 0,0 0,0 0.2 1,2 0.1 1,7 1.3 0,0 7,5 intimate + - 1,2 0.2 1,2 0.0 0,0 0,0 3,3 0.0 3.4 0,0 0,0 0,4 Therapist + - 0,0 0,1 1.0 0,0 0,0 0,0 0,0 0.0 0,0 0.0 0,0 0.0 Social Relationships + - 0.2 0,0 1.2 0,2 3.2 0,2 0.0 0,3 1.1 2,10 1,2 0,0 Generalized other + - 0.0 0.2 1,1 1,0 0,0 0,0 0,0 0,1 0,0 0,0 0,3 0.1 Post Self+~ 15.15 26,167.26 12.21 6.2 13,184.10 12.29 7.21 14.8 12.2 10.12 Nether + - 0,0 0,0 0.1 0,0 0.0 0.0 0,0 0,0 0,0 0.0 0.0 0,0 Father + - 0.0 0,4 0,0 0,0 0.1 0.0 0.0 0,0 0,0 0,0 0,0 0.0 Family + - 0.0 0,0 0,0 0.0 0.0 0,0 2.1 0,0 0.1 4,0 0.0 0.0 Intimate + - 0.0 0,0 1,2 0,0 1,7 0,0 1.7 0,0 1,14 0,0 0,0 0,0 Therapist + - 0,0 0,1 2.3 1,0 1.0 1,1 0,0 0.0 1.0 0,2 0,0 3.0 Social Relationships + - 0,0 0,0 0,1 0,1 0,0 0,3 0,0 0,4 1.0 0,2 0,0 1.0 Generalized other + - 0,2 0,0 0,2 0,0 0,0 0.0 0,0 0.0 0,0 0,1 1,0 0.0 Appendix 1' Sample Ratings of Krohn Scale Appendix 1‘: Sample Ratings of Krohn Scale 4 - You can be on guard all the time but I'm also afraid that I guess I never okay when I was about 14 I went with this guy, the very first guy I went with, it was the very first time in my life that I ever felt like a real human being and people even treated me like a human being they didn't treat me like some kind of outcast. And he sort of just up and dumped me really quickly without any warning and I felt like the biggest rug had been pulled out from under me. And I felt like everybody was laughing at me for trusting him. for being so naive. so gullable. I never wanted that to happen to me cause I almost killed myself over that to. And I was only l4, l5. I'm moped for months about that. I didn't want to live anymore. I've watched as if it would make any difference to see it coming and all thatwatching. Makes whoever it is miserable because usually he has the world's best intentions and feels like he's been teased for something he hasn't done. So the slightest little things feel like major rejections and I feel like daddy doesn't love me anymore. I'm afraid it will happen. I'm afraid i‘ll just really I‘ll trust some man and then he'll leave me and then there I'll be again. People will laugh at me . I'd carry on this affair in public. I was less then discreet about it for 4 people knew that I was getting a divorce. I didn't care what they thought. Iatiag - Z.) 5 - But I expect another real job. in a couple of weeks. Maybe this time it'll be good. It‘s a long long involved sort of thing. I could ramble for ages. You may neen a score card to keep track of all these people. then I told my last therapist she kept them straight. Rating - 3.5 6 - You know it isn't easy to have your own mother tell you she wants to get rid of you. 119 120 and have her laugh in your face and have her say your husband never loved you. ha ha ha. You own mother. I mean that takes an awful lot of hate to do to anybody. I can't imagine hating anybody that much. I knew I killed my husband. I hated him at that time I did. lacing - 2.0 2 - They didn't know. they knew John and they had known me but they knew me when I was married and Bob was living here and all that sort of good stuff and they had no idea that some of them didn't even know Bob had moved to California much less that I was getting a divorce and I was having an affair with John. So they were a little surprised and we'd get double takes from people still. Well we were together we sat together and thnced together and we were there together obviously. That's terrible, that‘s terribly tacky that I don't behave and yet . 3 - But I don't want to tell them right away. I really don't want them to be angry. There's no need for them to know I don't think. Not yet and I don‘t want my husband to find out. I've never in my life confronted my father with something I did. something major that he didn't like. Some parents accept the fact that their kids do drugs or live with their boyfriends or girlfriends and some parents are really cool about it. I never found out whether mine were or not, Iassume they're not because like my sister has this boyfriend that they really don't like and the thought that she would be sleeping with him, which she is. but they don't know that. drives my father right up the wall. He just really gets angry even at the thought and I just sort of keep quiet. You know I'm not supposed to know anything. Yes. I think he would be very very angry. I think if I waited awhile and then said I'm going with this guy named John. My mother has met him before along with some of my other friends and he's very very nice. I think they would like him fine. I 121 think they'd think he was a good guy, but I think they'd be angry with me if they knew I had been carrying on an affair all the time I was married. and that sort of shit. Rating - 7.0 2 - Not frightening no. it's irritating. I tell him to stop it and grow up. One time I tried to intervene and I'll never do that again because they don't listen to you anyway. Then she's gonna go ahead and do whatever they do until they. it's like you've wound up two dolls, and until that unwinds they're not gonna stop. So usually everybody just says um. let them go at it and when they get done they'll be done. My sister and brother-in-law disagree about something just some minor thing. he'll get in on it and he'll tell Pat she's wrong and he has no right to do that. he should keep his big mouth shut and I‘ve told him that. But he still has to get in there boy he just has to let her know she's wrong and I don't know if he sees alot of himself in her. That's kind of a copout and my mother uses it alot and she says to my sister you‘re just like your father. Well she does have alot of his characteristics but she's not just like him. She's still herself and she hates that when they say that to her. Even though she admires and respects him very much in many ways, there are many ways that she doesn’t. Rating - 2.) 2 - I think children take more out of you then anything else. Cause you have to be constantly on alert and ready for anything. I had a kid once. I was right there with him and all the time I said no running, went up to the door, you know how you have to regiment children all your life, you just have to. ButI stood there by the door and he filed out and one little kid he stopped at the drinking fountain and he just rolled around and away he came and the door came shutand he justlikethat . . .OhGodwhatamessallover. 122 So everybody at the softball we got this kid to the hospital. One kid got lost at Greenfield Village. So the bus was a half hour late getting home and parents were there sitting there calling the police wondering if we had an accident. It's just life with children, all ages too. not just the little ones. In fact I think it's easier with the little ones. they are most apt to do what you say. Rating - 2.0 6 - Like I'm doing the right thing in terms of their needs as opposed to letting themselves take care of themselves. The thing I think of right now which is really interesting to me is an experience I had especially during the. between Christmas and New Years last year. I'm an organist and the only time during Septamber and June I can go away is between Christmas and New Years. Cause I don't have rehearsals at the church so I always go away. So I went to visit my friend Nancy in New Orleans and Nancy and I spent the week and the day Iwas to leave we had lunch and we had a really pleasent lunch and then just before we were to finish having lunch she said you know I think you are really really self-centered. I said well what do you mean. She said all you do is talk about yourself. And I said well you asked me and I'll tell you and she said well I don't feel like you paid attention to my needs. Rating - 4.0 5 - It's like especially with my parents, they have a whole lot of feeling at present right now. I feel alot closer to them then I've ever felt. I really feel like they're my parents. I really feel like they're my family for the first time. It's like my anger. I can feel it but I can also feel. I feel like I see my parents so clearly now and see how tied up they are by their own problems and how all of their own pmblems. not touching. not being physically affectionate. not talking about sex like they just handed to me. here this is how it is. I feel really sad right now. I feel like I look at them and I say well you know you poor people, you're both in your late fifties and 123 you're never going to change now. You're going to live your lives out alot of oblivion about how things can be. I'm sure they are okay but it's like some of my anger just goes away. I look at them and I feel sorry for them. Rating - 6.0 "Ii'illllllll'iil’lltli