Close
About
FAQ
Home
Collections
Login
USC Login
Register
0
Selected
Invert selection
Deselect all
Deselect all
Click here to refresh results
Click here to refresh results
USC
/
Digital Library
/
University of Southern California Dissertations and Theses
/
The Effects Of Group Experiences On The Aged
(USC Thesis Other)
The Effects Of Group Experiences On The Aged
PDF
Download
Share
Open document
Flip pages
Contact Us
Contact Us
Copy asset link
Request this asset
Transcript (if available)
Content
T i n : ' . ( i i . : >' ’ i ' l . 11 l- >i i h a s I > ■ * ■ 11 m i (■ r< ill 1111 ('(i ,is i< a s 11 \ < a I. \11c 1,1 :1M7 1 / . t n . l I l l ' l l . , , -i l l | I i I ! ( ■ 1 : ■ I ■ I ' ( ; H( >1 I 1 l . \ l - I ill i \ < I T i >\ 1 11 I M i i I >. I m \ (• r ; ; 1 1 \ , >1 : - o M l : i i i ' n T ., ! i f> > i n i , i ’ l l . I ) . , K i f t i l i ’:: \ c Iu > 1 < >^\ , i 1 i 111 (■ :i 1 University M iri'T lm s, lis' A im Aihnr, Michicjat THE EFFECTS OF GROUP EXPERIENCES ON TEE AGED by Zena Fella Ealek A Dissertation Presented to the FACULTY OF THE GRADUATE SCHOOL ‘ DIVERSITY OF SOUTHERN CALIFORNIA In Partial Fulfillment of the Requirement3 for the Deyree DOCTOR O F PHILOSOPHY (Psychology) January/ 1961 U N I V E R S IT Y O F S O U T H E R N CAL I F O R NIA ■ .HADUAl i SCHOOL UNIVERSITY PARK L.OS ANC.I L . F . S 7 CALIIORNIA /'Ins liisscrtiition, l iitttii by Zena Bella Male* i i i i t b r th,' til r,n t i o n fjf / / e r D i \ s n t u t i o n C o m nntti't', tint1 n p p i ' , : nni b y n i l its m< i t i h t i s , hns Ion'll pin-st-iit,nl l<, tin,I t.n i o p t , ni b v t h , ( > i ,i,ln,it,' S , h o o l , in f'.ii'titil I nl/illiiit'rit o f i i i i r, hi r ti t s I > , r th < • Jt',/1t,/ d o c t o r or rim.osorny f >, ,m P,n, J a n u a r y , 1 9 6 1 / I 'i ' I \ I :i )\ /'< > \! \ 11 I I J I t l t r f ' l t l T i ACKNOWLEDGEMENTS I should like to express my deepest gratitude to Dr. Herman Harvey of the Psychology Department of the University of Southern California and Chairman of my Dissertation Committee. Although I have incurred many debts of gratitude during the course of this project, there is no question but that the debt I owe to Dr. Harvey is of paramount and foremost importance. Dr. Harvey gave unstintingly of hi3 limited and valuable time to the successful completion of this undertaking, far beyond the routine call of duty. He gave careful and consistent help in theoretical matters, in trie resolution of problems in experimental design, and in the execution of the entire project. His thoughtful comments and penetrating criticisms were of immeasurable value in clarifying pertinent issues. Not the least of his contributions was his consistent support, high standard of excellence, inspiration, and personal encouragement which he gave so generously. Words cannot possibly express the deep gratitude and respect I feel for Dr. Harvey, without whose help this study could never have been accomplished. Thanks are due to the National Institute of Mental Health, United States Public Health Service, for the ii Predoctoral Research Fellowship MF 9^66 and for the Research Fellowship Special Allowance MF 339-60, which assisted invaluably in financing the project, I am especially grateful to Kiss Helen Gonzales for devoting her time, talents, and personal involvement in the leadership of the Arts-and-Crafts Class. My thanks go to the medical and administrative staff of the Rancho Los Amigos Hospital in Downey, California for their cooperation in supplying facilities and subjects for the study. Particular thanks go to Dr. Leonard Wendland, Chief Clinical Psychologist, and to Dr. Alfred Urmer, Research Psychologist, for their assistance in administrative, data collection, and statistical problems. In resolving many of the statistical and tech nical problems of data analysis, I received invaluable help from Dr. Philip Merrifield of the University of Joutnern California. My thanks go to the many friends and teachers who have reviewed the project in its first draft and who gave valuable criticisms and advice. Particularly helpful in this connection were the suggestions and comments of Dr. Alfred Jacobs and Dr. Karl F. Carnes, of the Universit of Jouthern California. Thanks are expressed to Mr, Theodore Palmer and Mr. Nathan Ilanit, who acted as raters for the Thematic Apperception Test scales, and to the nine friends who acted as subjects in order to obtain norms for the hearing test used in the study. To the patients who participated in this study, I owe a very special debt. Without their cooperation, this study would not have been possible. Last, but not least, I owe a great debt of gratitude to my husband, Leunard Kalek, and to my parents, Jacob and Thelma Chaitman, for their encouragement, support, and confidence in me. TABLE OF CONTENTS Page ACKNOWLEDGEMENTS ii LIST OF TABLES vi Chapter I. INTRODUCTION 1 Importance of the Study and Review of the Literature Purpose of the Study Statement of Hypotheses II. METHODOLOGY 12 The Clinical Setting for the Experiment The Subjects Used in the Experiment Sources of Data on Patients Description of Screening Procedures The Test Battery Matching the Groups Description of Activities Retesting .Vechsler Adult Intelligence Scale Thematic Apperception Test Self Sorts Hospital Adjustment Test Final Questionnaire IV. DISCUSSION AND SUMMARY........................ 129 Interpretation of Results Decline in the Control Group Limitations of the Study Summary APPENDIXES............................................. 172 BIBLIOGRAPHY.......................... 193 LIST OF TABLS3 Table Page 1. A Comparison of the Means and Standard Devi ations of the Vocabulary and Similarities Scaled Scores Between the Experimental Group and the WAI3 Normative Group ..... 3 2 2. Original Number of Patients in Bach of the Four Matched Groups.......................... 43 3. Characteristics of the Patients in the Three Groups........................................ 46 4. Matching Data on the Variables of Age, Edu cation, Vocabulary I.Q., D.I., Marital, Children, Religion, Birthplace, Acti vities, and Heart Condition.................. 44 3. Initial Matching on the Hospital Adjustment Test Prior to the Beginning of the Activity Period............................... ‘1 6. Initial Matching on the Nine Scales of the Thematic Apperception Test Prior to the Beginning of the Activity Period............ .02 7. Initial Matching on the Real-Ideal Self Sort Correlations prior to the Beginning of the Activity Period.......................... 33 8. Initial Matching on the Intelligence Measures Prior to the Beginning of the Activity Period......................................... 3 4 9. Changes in WAI3 Vocabulary Scaled Scores Following Activity Period.................... 68 1C. Changes in WAIS Similarities Scaled Scores Following Activity Period......... 70 11. Initial Matching on Vocabulary + Similarities Prior to the Beginning of the Activity Period......................................... 72 vi LIST OF TABLES--Continued Table Page 12. Changes in WAIS Vocabulary + Similarities Scaled Scores Following Activity Period 73 13. Difference Scores for WAIS Vocabulary Sub test Scores Between Groups.................... 76 14. Difference Scores for WAIS Similarities Sub test Scores Between Groups.................... 77 15. Difference Scores for WAIS Vocabulary + Similarities Subte3t Scores Between Groups... 78 16. Direction of Significant Changes of Three I.Q. Measures Within Three Groups........ 80 17. Difference Score Changes Between the Experi mental Groups................. 80 18. iiho's for Therapy and Control '.roups........... 82 19. Reliability of Four TAT measures............... 90 20. Reliability of Two TAT Rating Scales....... 91 21. Results on Emotional Tone Variable, Utilizing the Wilcoxon Matched-Pairs Signed-Ranks Test. 93 22. Results on Self Concept Variable, Using the Wilcoxon Hatcned-Pairs Signed-Ranks Test 95 23. .Results on Social Distance Variable, Utilizing the Wilcoxon Matched-Pairs Signed-Ranks Test. 97 24. Results on the Conflict Variable, Utilizing the Wilcoxon Matched-Pairs Signed-Ranks Test. 99 25. Results on the Average .Cumber of Words per Story Variable Using the Wilcoxon Matched- Pairs Signed-Ranks Test........ 100 26. Results on Number of Self References Variable, Utilizing the Wilcoxon Matched-Pairs Signed- Ranks Test...................................... 102 vii LIST OF TABLE3--Continued Table Page 27. Results on the Number of "Zwaang1 * Expressions Variable, Using Wilcoxon Matched-Pairs Signed-Ranks Test........ 104 23. Results on the Time Span Variable, Using Wil coxon Matched-Pairs Signed-Ranks Test........ 105 29. Results on the Space Span Variable, Using the Wilcoxon Matched-Pairs Signed-Ranks Test..... 107 50. Direction of Significant Changes from Pre testing to Post-testing on Nine TAT Measures Within Three Groups........................... 109 31. Difference Scores Between the Three Groups..... 110 32. Mean zfs for the Three Groups................... 113 33. Q-Sort Movement for Therapy Group, Craft Class and Control Group.............................. 115 34. Movement Differences Between the Groups using Mann Whitney U Test, Two Tailed.............. 116 35. Sources of Hospital Adjustment Test Ratings: Number of Tests Completed by Same and Different Raters............................... 120 3 0 . Comparison Between Groups after the Conclusion of Activities, on the Hospital Adjustment Te3t Measuring Instrument, Using the Mann- Whitney U Test (Two Tailed).................. 122 37. Comparison of Within Group Changes on the Hospital Adjustment Test, Using the Wil coxon Matched-Fairs Signed-Ranks Test........ 123 33. Results of Final Questionnaire.................. 124 39. Significant Differences Found Between Groups at the Conclusion of the Activity Period on All Measuring Instruments Employed in the Study....................................... 130 40. Significant Differences Found Within Groups at the Conclusion of the Activity Period on All Measuring, Instruments Employed in tte Study.. 132 viii LIST OF TABLES— Continued Table Page 41. The Relationship Between Certain Variables and Significant Decline in Scores of Tests Shown in the Control Group Utilizing the Mann Whitney U Test...................... 1^1 ix CHAPTER I INTRODUCTION Importance of the Study and Review ot the Literature There has been a marked increase in the aged population of the United States within the last century. One hundred years ago, only 2.6 per cent of the people living in this country were sixty-five years of age and older. By 1947, this figure had risen to 7.5 per cent. The Census Bureau forecasts that by 1990, 13.1 per cent of the inhabitants of this country will be sixty-five years of age or older (21). This increase in our aged population was most likely brought about by medical progress in the prevention and control of infectious diseases, advances in surgical and medical procedures, decreases in infant mortality, and a general improvement in the standard of living. Should medical research discover ways of dealing more effectively with heart disease, cancer, and chronic illnesses, this number will be even greater. There is every reason to expect that the size of this age group will continue to grow (126). 1 2 This increase in longevity has brought with it many social, medical and psychiatric problems. The grow ing awareness of these problems has evoked the production of a substantial number of popular books dealing with the subject of aging. Much of this material amounts to little more than an appeal to popular taste and demand (30). However, professional interest has mounted, also, and work in gerontology cuts across the demarcation lines of many professional disciplines. Psychologists, psychiatrists, social case and group workers, sociologists, economists, workers in geriatric medicine, and anthropologists have contributed in important manner to the growing body of gerontological and geriatric literature. Despite the recent plethora of professional literature in this field, it is meager as compared with studies in other fields, as, for example, in child development. Further, it is far from exhaustive in scope or even comprehensive (112, 41, 69). The known facts are few, of doubtful validity, contradictory, or poorly coordinated. Even in those areas which have been most fully explored, e.g., intelligence and sensory-motor skills, the findings are relatively meager (20). The authorities in the field are well aware of this fact, and point it out repeatedly. Thus, Watson states that studies in the field of personality of the aged are exceedingly rare, and that personality functions are still being examined in a naturalistic, exploratory way (130). Lawton points out that "while the problems associated with senescence are manifold . . . there is little experimental . . . evidence to guide us." (84) And Shock says, "Examination of research studies shows a striking lack of systematic investigations," and emphasizes that funda mental research is still urgently needed in basic areas, without the understanding of which we cannot really fathom the meaning of the aging process and its implications (112). Among the major problems of old age which require investigation is the problem of the psychoses of the aged. In terms of magnitude, psychoses of the aged constitute the foremost area of mental disorder affecting mental hospitals today. Geriatric psychoses are said to be the only group of commitable disorders for which commitment rates are known to have increased during the past cen tury (56). About half of the resident population of the nation’s mental health institutions are persons past sixty-five (80); almost a third of all first admissions to state institutions are past the age of sixty, and many others continue in highly deteriorated fashion in the homes of sons and daughters (127). If one looks not only at the.psychoses but also at the neuroses of old age, the problem as it affects the k mental health of the nation becomes a much greater one. The years of involution and decline are filled with many new and complicated problems of adaptation, problems which must be solved despite waning physical and mental capacities. While many old people can cope with the new stresses, there are also many who cannot do so, and, in conjunction with this, develop extensive behavioral disorganization. These individuals frequently do not require hospitalization, but the effects of their symptoms upon those around them could lead to widespread dis turbances in mental health (5 6). In light of the increased life expectancy for the general population, and in light of the increased mental health problem which accompanies it, there is great need for research into the mental and emotional debilitation which is often concomitant with aging. It is of equal importance to develop researches investigating methods of delaying or fully preventing the loss of mental abilities in those who are the "normal" aged (127). When searching through the literature, one quickly finds a lack of any fully developed or well formulated theory regarding mental or emotional deterioration in old age around which to center research hypotheses and experiments. What comes closest to a theoretical formulation is that presented by Anderson, who hypothesizes^ in general terms, that "energetic activity accompanied by deep concern delays deterioration for a measurable time." (3) He relates his conceptualization to the biological principle of great extension, namely, that use both increases and preserves functioning; in a living organism a minimal rate of interchange with the environment results in deterioration. Earlier, in 1921, Martin utilized a similar conception (without the biological implications) as the basis for the foundation of the first old-age clinic. She felt that if the present day-to-day living of old people is made more stimulating, this will combat the oldster*3 tendency to reverie and to mental deterio ration (94). The postulate that activity halts deterioration in the aged is by no means of recent origin; actually, such suggestion was made by Cicero, two thousand years ago (26). Yet, it is the most popular concept regarding aged deterioration today, and the "Keep Young— Stay Active" approach (62) finds many supporters among modern workers in the field of gerontology (2, 16, 18, 19, 46, 51, 55, 56, 71, 86, 90, 102, 107, 108, 118, 129), this despite the lack of any real experimental support. The literature is replete with statements such as the following Purposeful activity is the most potent agent in the fight against premature deterioration (1?). 6 There is gradual decay of personality in the later years when exercise of the intellectual and spiritual functions is allowed to decline (32). Where there is no impedance to vegetative inacti vity, further regression is the inevitable out come (89) • Inactivity is a catalyst for senility and death (131).. The keynote for mental hygiene of old age is to die with one's boots on (106). Although one is impressed with the communality of the idea, the concept is never fully developed theo retically except for minor attempts such as Andersonfe, listed above, or Donahue's (33), wherein she attempts to integrate the postulate within the framework of Thorndike's learning theory by evoking the law of exercise, that "the repeated use of a connection between a stimulus and a response strengthens it and disuse weakens it." (59) Some workers have qualified the postulate by saying that the activity must be meaningful and worthwhile to the subject if it is to be effective (79, SI). Others feel Ibe effectiveness of the activity is enhanced if it is performed in groups (22, 61, 74, 62). This point is best brought out by Lerakau, who states that "group activities . . . are a means of preventing, or greatly delaying the appearance of symptoms of mental disease and thus of 7 sparing society the high cost of hospitalization.n (65) Despite the popularity of this point of view, there has been surprisingly little pertinent experimental work evaluating it. Although many articles have been published dealing with the effectiveness of a variety of different kinds of group experiences, such as the effects of recreation (4, 32, 34, 45, 50, 67, 73, 74, 75, 63, 96, 117, 123); the effects of occupational therapy (54, 100); of day center activities (52); of sheltered workshops and other work experiences (17, 76, 116, 136); and of group psychotherapy (66, 90, 91, 92, 101, 104, 114, 125), these studies suffer from some major experimental inadeqacies. For example, many of the articles are simply descriptive and anecdotal in nature. Many involve only case studies, clinical observations, and impressions. A good many of the more experimental-type studies are service oriented and lack the careful manipulation and control of variables necessary to good experimental procedures. Some of the studies do not employ quantitative tests and measures to evaluate change. Among the few which do employ such measures are some which do not report their results statistically. Often, no attempt is made to define the sample in terms of such standard categories as education, socioeconomic status, or marital status. Many studies used volunteers as their subjects, in this way obtaining a presumably biased sample favorable to therapeutic improvement. Other studies used psychotic or psychiatric patients as subjects, thus limiting the generalisations capable of being made. Some of the studies utilized relatively unsophisticated questionnaires and rating scales. Other studies were cross-sectional, correlational in nature, and failed to give a longitudinal view of change. In studies wherein two types of activity are being compared, the subjects in the two groups are often not equated on important variables, such as the length of time they participated in the different activities. In experimentation with the aged, it is particu larly important to control for visual and auditory acuity. Visual acuity is known to have a considerable incidence of decrement with age, and there is a steady decrease of the average efficiency of all measurable visual functions with advancing age, even in otherwise healthy eyes (10, 12, 24, 26, 49, 76, 119)* There is also a decrease, extremely variable in amount, in hearing (9, 11, 57, 120, 132, 136). Psychological tests may be unsuitable, or even unutilizable with some aged people suffering from visual or auditory problems, because the individuals might be inaccessible or even incapable of responding to the stimuli (134). Yet, few studies in gerontology control for these variables, variables which 9 could easily affect the subjectvs responsiveness In the group activities or on the tests or measures employed. A major flaw which Is almost universal In the studies Is the lack of any control group, therefore making it difficult to ascertain whether the changes reported were brought about by the experimental procedures, by uncontrolled extraneous variables, or by chance. In brief, it may be concluded that the majority of studies as are available are merely exploratory in nature, and that documentary experimental evidence in the form of measured changes resulting from group activities is meager. An exceptionally well designed experiment as compared with most is that by Donahue, Hunter, and Coons (34). They investigated and measured the effects of an activity program upon the socialization of residents of homes for the aged. The activities were of a recreational nature, and took place daily for a period of seven months. The subjects were carefully selected; a control group was employed; and the groups were matched on such relevant variables as age and education. A sociometric technique was utilized to measure the social interaction of the subjects, in order to obtain the degree of social isolation or interaction prior to the onset of and following the period of group activities. The trends in the data 10 supported their hypothesis that group activities will increase socialization. This study offered no direct evidence, however, that this increased socialization acts to halt deteriorative processes, or that activity reverses deteriorative trends. Purpose of the Study The purpose of this study was to evaluate, in a controlled environment, the effects of two varieties of group experiences on: (1J intellectual functioning, (2) imaginal functioning, (3) self-concepts, and (4) varieties of hospital behavior of a group of non- psychotic old people in an institutional setting. The four abovementioned variables were measured by means of appropriate psychological tests, and the data thus obtained were examined statistically. Comparisons were made as to the degree and direction of change in these variables, between subjects undergoing group experiences and equated subjects not exposed to such experiences. Further, an attempt was made to evaluate the differential effectiveness of the two kinds of group experiences. Statement of Hypotheses It was hypothesized that participation in group activities would assist in halting or reversing cognative and conative debilitation in the aged subjects, as 11 measured by psychological tests* Specifically, it was hypothesized that those subjects who participated in either of two kinds of group experiences (group psycho therapy or arts-and-crafts classes) would show improvement on the four abovementioned variables as measured by the testing instruments; whereas subjects in the control group, who did not participate in either of the experimental conditions, would show decreases in scores or remain the same on the test measures. CHAPTER II METHODOLOGY The Clinical Setting for the Experiment Patients and facilities for the study were made available by the staff and administration of the Rancho Los Amigos Hospital in Downey, California. The Hospital, which began in 1887 as a "County Poor Farm" (1), is one of five hospitals operated by the Los Angeles Department of Charities. It is one of the largest hospitals in the United States specifically organized to care for patients with long-term and chronic illnesses. It has diagnostic and treatment facilities, surgery, clinical laboratory, full- and part-time professional staffs, and an attending staff. It handles most of the medical and surgical problems which arise among its patient population (1). The medical program presently consists of two basic levels of care: "active rehabilitation" and "convalescent" (custodial) care. Three hundred beds are devoted to the intensive treatment program; 1,700 beds are for long term illnesses and convalescent care; and approximately 500 beds are dormitory accomodations for patients receiving domiciliary care and medical care as 12 13 needed. Most of the patients are housed on ward-type facilities, although one building houses patients in single and double rooms. The "convalescent" part of the medical program is essentially a custodial one, designed to receive and give comfortable minimal care to patients with little potential for functional recovery or no place to go because of medical or social problems (1). The Hospital cares for patients of all ages from infants to centenarians, but almost half of the population, or about 1,100 patients, is over the age of sixty-five. The average age of these older patients at the time of the study was sixty-nine. Complete rehabilitation and return of these elderly patients to their home environments as independent individuals is not, in most instances, the expected treatment goal; and the problems confronting the staff vary from general medical care and prevention of regression to complete bed care. The Hospital offers recreational and activity programs to all patients, including those over the age of sixty-five. Such activities as church services, library facilities, occupational therapy, motion pictures, tele vision, and radio programs are offered (109). A reha bilitation workshop is available to handicapped patients for instructions in new vocations such as watch repair, 14 metal work, and radio repair. The Recreation Department operates a Craft Center which provides regularly scheduled classes in ceramics, textile painting, leather work, and other arts and crafts* Despite the array of activities, available to the patient population, it is found that the elderly patients take relatively little part in such activities. Literally, much more is available to the older persons than is being used by them. The lack of socialization and activity is apparent when one observes these elderly patients. One might imagine that the simple fact of the patients living together in groups on tKe wards would imply socialization in its therapeutic sense. That this is not the case is made evident by a visit to the wards, where the attitudes evidenced by the patients suggests extreme resignation and futility. The elderly patients tend to be apathetic and listless, and show marked passivity and disinterest. A good majority of them spend their days sitting on the porches and lawns of the Hospital, or remaining in bed. Disillusionment, melancholy, and hopelessness are expressed by many of them, and regressive behavior is frequently seen. Few of the patients venture to initiate contacts with others or to seek out recre ational and stimulating activities. The problem con fronting the staff is that of motivating the aged person to 15 want to take the Initial steps required to become members of programs and groups. However, with some outstanding exceptions, the hospital personnel do not seem to find sufficient challange in the aged population, and prefer working with the younger and, presumably, more promising patients. Many nurses and attendants express reluctance to disturb the elderly patient’s natural decline by intervention. Thus, the result on many wards is a simple program of care for the fundamental needs of the patients and nothing more. The Subjects Used in the Experiment There was available at the Rancho Los Amigos Hospital some 1,100 patients over sixty-five years of age who were in the institution for a variety of conditions. In each instance, there was an implication of indigence and a wide spectrum of complicating medical infirmities which required the close and constant supervision which would be available only in a hospital. In a small but significant proportion of the cases, however, the medical picture was not a definitive one, but the patients1 stay in the hospital came as the result of financial reasons or the unavailability of outside residential facilities. In order to obtain a sample for this study, twelve criteria for population selection were employed. 16 These criteria are as follows: Diagnosis.— At the outset of this study, serious consideration was given the problem of complicating experimental results with the variety of medical problems which were evidenced in the histories. In one sense, it was recognized that what is commonly referred to as a "random sample" would be desirable, but, on the other hand, it was not possible to overlook the possible complicating and ^influential features which might result from the various medical pictures. Indeed, as has been suggested previously, the purpose of this study was not to determine the effect of group experiences upon an aged population with severe psychological or psychiatric pathology, but rather the effect upon an aging population in the absence of such possibly complicating features. Indeed, attempting to proceed along such lines necessitated a number of decisions regarding subjects1 suitability which may well have been arbitrary. On the other hand, to suggest an extreme instance, the inclusion of patients with severe and protracted cerebrovascular accidents would seemingly provide little information relating to the question being asked in this study, even though the role of group activities upon such a population would in itself be an interesting question. Admittedly, it was necessary, frequently on an armchair basis, to 17 eliminate certain subjects from consideration because of a medical condition which the writer thought might possibly distort eventual conclusions regarding the role of group experiences on the "normal" aged. The writer is well aware of the enhanced effacacy of this study had it involved a distinctly non-medical aging population, but such facilities were not feasible at the hospital, and the only recourse was to exclude such psychiatric and medical features which were felt might complicate the meaningful ness of the findings. More specifically, the following medical conditions were excluded: Patients diagnosed as psychotic or with any form of organic brain involvement were excluded from the sample. Cases were rejected if they had any diagnosis such as the following: cerebral arteriosclerosis, chorea, chronic brain syndrome, epilepsy, mental deficiency, multiple sclerosis, paralysis agitans, senility, or any other neurological or psychiatric disorder which presumably might affect intellectual and emotional functioning. As stated above, the aim was to obtain a relatively "normal" sample of aged people, who were living in the hospital because of physical illness and/or inability to support themselves. Patients with the diagnosis of cancer in any of its forms were excluded from the study, in order to avoid 10 the problem of premature demise during the course of the experiment. Patients diagnosed as totally and un- correctably blind were also excluded, as were those patients diagnosed as totally and uncorrectably deaf. Those patients diagnosed as generalized arterio- sclerotics were included in the study, if the arterio sclerosis was peripheral and if the illness in no way affected their mental functioning, as reported by nursing personnel in constant contact with the patients. Appendix A, page 172, gives the diagnoses of those patients accepted for the study. It should be noted that most of the patients have multiple diagnoses, none of which can be designated as the major diagnosis, thus prohibiting the matching of groups on the basis of this variable. Also, some of the conditions are "latent," "arrested," "dormant," or "controlled." These diagnoses do not reveal the extent of the patients* involvement. In addition to the physicians* summaries regarding this, information was secured from ward nurses regarding exact prevailing status of the disorder. Having eliminated the above medical and psychiatric conditions, the remaining subjects were further screened on the basis of the following variables: Age.— Sixty-five years of age or older. Sex.— Female. Race.— Caucasian. Length of hospitalization.— Full-time in-patients at the hospital for at least one year prior to the beginning date of the experiment. This was to permit the patients to become acclimatized to the hospital, and to permit such hypothesized variables as "hospitalization effect* and "social isolation" to become established. Group activity.— Subjects were not to be involved in any formal group programs such as occupational therapy, recreational groups, or group psychotherapy. Generally, the patients selected were totally unoccupied, except for occasional church attendance, reading, or passive tele vision and motion picture viewing. A few patients did minor work around the hospital; none were members of any ongoing group activity. The aim was to use patients in this study who were operating at a markedly low level of active participation in the planned patient activity programs. Language.— Ability to speak, read, and understand Knglish. Ability to walk or be wheeled to the group meetings.— This was a necessary requirement, for the patients selected came from many different wards of the hospital. By virtue of this criterion, bedridden and roombound patients were excluded from the study, as were 20 incontinent patients and those unable to use a wheelchair. The study was designed to include only those patients physically able to take part in group activities* The ward physicians* written consent was obtained for each patient, in which was included the statement that there were no medical contraindications for such participation. Economic level*— It should be noted that all of these patients were indigent, and, consequently, were automatically matched for present economic level. I* Q.--0nly patients whose I. Q. was "Average” or higher, as estimated by the Wechsler Adult Intelligence Scale Vocabulary subtest, were accepted into the study. Vision.— All subjects had to have a satisfactory minimal visual acuity, so that they could see well enough to take some of the psychological tests; and also to ascertain that their vision was adequate for participation in any group activity which might require visual skill. Visual acuity was determined by means of testing procedures to be described later. Hearing.— All subjects had to have satisfactory auditory acuity, in order to eliminate those cases of advanced deafness who could possibly be hindered by their condition from full participation in the groups or in the testing procedures. Auditory acuity was determined by means of specific testing procedures which will be 21 described later. Sources of Data on Patients The data on patients* age, sex, race, length of hospitalization, and diagnoses were secured from the records of the medical record office through IBM pro cedures. The data on the patients* ability to speak English, on their ability to leave the wards, and some of the data on their activities were obtained through direct contact with the ward nurses and through correspondence with the ward physicians. The data on the patients’ I. Q., their vision, and their hearing were obtained through individual testing, to be described below. Description of Screening Procedures As a result of the IBM and hospital personnel screening, the available population of 1,100 patients was reduced to 63. These 63 patients were then seen by the examiner for Individual screening. Each patient was given a group of four tests to screen for the variables of vision, hearing, activities, and I. Q. If a patient failed to reach a specified level of performance on any of the measures utilized to evaluate these variables, she was eliminated from the study and given no further testing. If she succeeded on all of the four screening 22 measures, she was given a battery of tests which were subsequently utilised as measures of change resulting from group activity. The average testing time for patients completing the total battery of tests, including the screening measures, was four hours, usually requiring three testing sessions. Of the sixty-three patients available prior to individual test screening, only forty- seven were able to meet the criteria of test performance required. The tests were administered in the order listed below in every instance. The patients were informed that the purpose of testing was the hospitals desire to obtain more information about patients over sixty-five years of age. In no instance were patients informed that they were participating in an experiment. Screening for visual acuity.--The visual section of the Advanced Pre-Tests of Vision, Hearing and Motor Coordination (122) was used to screen for visual acuity. As the authors of the test point out, this is not a visual examination in any sense of the word. It is merely a quick, efficient manner of detecting persons with gross defects which would hinder the patient's performance on any subsequently administered te3ts. The test consists of ten groups of letters and numbers, progressively reduced in size. Each of the ten 23 sets contains four letters or numbers which are the stimulus figures, and nine larger numbers or letters located directly below the stimulus symbols. The subject is instructed as follows: "In each group of letters and numbers, put a circle around the letters and numbers in the second row that are the same as those in the first row." The authors suggest a three-minute time limit, and also suggest that the subjects must be able to complete the eighth set of figures without error, or "with errors probably due largely to chance" (122). In the present study, a less stringent level of perfor mance was accepted. Here, the subjects were required to complete the first five groups correctly, one error being permitted as chance fluctuation. Thus, patients earning a score of 19 items correctly identified were eligible for acceptance into the study. The fifth group of figures was selected as the criterion base because the tests administered later contained print of the same size as that found in the Group 5 figures. Appendix B, page 176, indicates the vision test scores of the patients finally selected for participation in this study. Screening for auditory acuity.— The first list of sentences from the Auditory Test No. 12 of the Psycho- Acoustic Laboratory of Harvard University (64) was adapted 24 for use in this study as a screening device, to measure the subject’s capacity to hear conversation or speech. The Auditory Test No. 12, List 1 consists of a group of twenty-one questions, utilizing familiar vocabulary. The subject is instructed to listen to the questions and to either answer them or to repeat the sense of them. The questions are relatively simple, and are designed so as to be answered by a single word. Appendix C, page 177, gives the Auditory Test No. 12, List 1, as obtained from Davis (31). In order to use this test effectively, norms had to be obtained with which to compare the elderly subjects. To obtain these norms, the following procedures were instituted. A recording was made of a short article from Holiday magazine (29). The Auditory Test No. 12, List 1 was also recorded phonographically on the same record by the examiner. Nine subjects (five men and four women) whose age ranga was between twenty-nine and forty-five years, and who were all non-hospitalized people with no history of hearing difficulties were used to obtain normative data. The recording of the Holiday magazine article was played to each of the nine subjects individually, the speaker being placed inches from the wall of the 25 16 foot by 13 foot room, and the aubjecta being seated 133 inches away from the speaker. The article was played to each subject four times: the first two readings were used to obtain norms for threshold level, and the last two readings to obtain levels for comfortable listening. Instructions for obtaining threshold level were as follows: "I am going to play a record for you. It is a story about New York’s harbor. I am going to start the record very loud and gradually decrease the sound. What I want you to do is to listen to this record closely and when you are unable to hear every singie word, then raise your hand. Any questions?" The instructions for the second playing were essentially the same as those for the first, except that the recording was to be started at a very low level of sound, the volume increasing until the subject could hear every word. In the third reading, the examiner obtained levels for comfortable listening by starting the record at a very loud level and gradually lowering the sound until the subject indicated a pleasant level. The record was then played further for the fourth reading, this time beginning at a very low level and increasing the sound volume until the subject indicated pleasant or comfortable listening. 26 To obtain the average threshold level, the two measures for each subject for the first two readings were summed and averaged. This average yielded the information on the amount of volume necessary for the average subject to barely discern speech. The same procedure was followed for the second two readings, to obtain the average level of sound required for comfortable listening for these subjects. These two sound levels were utilized in the experiment proper to screen for hearing difficulties in the elderly subjects. As a check on the effectiveness of the sound levels for threshold and comfortable listening obtained, the nine subjects were grouped together in a single room and the Auditory Test No. 12, List 1 was played to them twice — first at the threshold level and then at the comfortable listening level. The subjects were instructed to write the answers to the questions on a piece of paper supplied by the examiner. Four of the subjects were able to answer every question at the threshold level; the other five subjects missed from one to three questions at this level. These five subjects were, however, able to correctly answer the missed questions at the level of comfortable listening, suggesting that the obtained levels are effective in measuring auditory acuity. In the experiment proper, each elderly patient was 27 screened on the variable of auditory acuity by utilizing the same phonograph as was used for obtaining the norms; the speaker was placed at the same distance from the wall as in the normative study, and the subject,s chair was placed at the same 136 inches from the speaker. The room in which the subjects* acuity was tested was somewhat larger than the room of the normative work (IS feet by 26 feet) but it was not possible to control this variable. Each elderly subject was given the following instructions: "I am going to play a record for you. On this record are some short, simple questions, 3uch as, fHow many days in a week?1 I want you to tell me the answer to each question after I play it. Do you understand? I am going to play the record through two times. The first time, I will play it very softly; the second time, I will play it louder, so that you will have a chance to answer those questions which you could not hear the first time." It was arbitrarily decided that in order for a subject to qualify for the experiment, she had to be able to answer correctly fifteen out of the twenty-one questions at the comfortable listening level, the second playing. It was found necessary to select this rather lenient figure, for many of the potential subjects exhibited the hearing deficiencies found so often in 28 elderly people. Results of the hearing test for those subjects finally selected to participate in the study are shown in Appendix D, page 17*3. It should be emphasized that the aim of this procedure was not that of a detailed auditory assessment of patients. Rather, it was utilized as a crude screening device to provide at least a modicum of assurance that the ordinary conversational levels which prevail in the group activity situation could be apprehended by partici pating subjects. In this regard, there are indications that the cutoff levels used were exceedingly lenient, for there were some instances of hearing difficulties in patients accepted for the study. These were corrected by hearing aides early in the experiment proper. Screening for activity.— A Personal Data Question naire was designed for this study to provide a check on the mental alertness of the subjects, and to afford information as to the marital status, children, educational level, race, and religious affiliation of the patient3. It was particularly used to gain information from the patients directly as to the type and extent of activities in which she participated. The questions on the form were asked the patient by the examiner, and the replies obtained recorded by her. A copy of the Personal Data Questionnaire is seen in Appendix E, page 179. 29 Screening for intellectual level.— The Vocabulary subtest of the Vechsler Adult Intelligence Scale (133) was utilized to obtain an estimate of intellectual level, since it correlates very highly with the Full Scale I.Q. (3 5, 135), and because vocabulary skills have been shown in some experiments to decline less with age than do most measurable abilities (15, 25, 27, 35, 36, 70, 71, 134, 135). In administering this subtest, the standard instructions from the Wechsler manual were followed (133). The raw scores obtained for each patient were converted into scaled scores. The scaled scores were then multiplied by six (the total number of subtests in the Verbal portion of the test). The resulting figures were then checked in the Verbal I.Q. tables of the manual at the appropriate age level for each patient, to obtain the estimated Verbal I.Q. for each patient. Any patient earning less than an estimated Verbal I.Q. of 90 was eliminated from the study. Forty seven patients successfully completed all of the screening measures. These patients were then given the test battery proper, described below. The Test Battery Wechsler Adult Intelligence Scale. Vocabulary and Similarities subtests.--The Vocabulary and Similarities 30 subtests of the WAIS were used as a measure of intellectual impairment. Babcock (6) and Shipley (111) have both sug gested that mental impairment can be detected by con trasting two abilities: (1) contrasting a subject's mental ability in a task known to be relatively impervious to decline with (2) the subject's mental level in an ability known to be seriously and rapidly affected. Evidence suggests that vocabulary and abstraction tasks are two abilities which can be contrasted in this way (65, 66). As previously cited, many studies indicate that vocabulary skills tend to survive without appreciable impairment until late in life; while other studies indicate that ability to see abstract relationships and to do abstract reasoning declines rapidly (14, 15, 36, 47, 70, 72, 110, 115, 121, 124)- These findings suggest using the ratio between vocabulary and a measure of abstract thinking as an index of deterioration. In selecting specific vocabulary and abstraction tests, an effort was made to avoid those tests which had time limits wherein speed becomes a crucial variable, and also to avoid those motor tests which require fine manipulations. Older people are handicapped in test situations where speed of performance enters into the score, and they also 3how lengthening of reaction times and slowing down of psychomotor responses (5, 15, 93, 31 97, 98). In this experiment, the WAIS Vocabulary scaled score was utilized as the "hold** test, while the WAIS Similarities scaled score was used as the "don't hold" test. Neither of these tests are timed, nor do they require psychomotor abilities from the subjects. The index of intellectual impairment utilized in this study, referred to hereafter as the Deterioration Index, or the D.I., is the Similarities scaled score divided by the Vocabulary scaled score. A comparison was made of the means and standard deviations on the Vocabulary and Similarities scaled scores of the population in this study with those of the population used to standardize the WAIS for aged subjects. The data on the normative population are taken from the report by Doppelt and Wallace (35). The results of this comparison are found in Table 1, on page 32, and indicate that, at all age levels from sixty-five through seventy-five and up, the mean Vocabulary scaled score of the experimental subjects is significantly higher than that of the normative group; on the other hand, the Similarities scaled score showed no significant differences between the means of the experimental population and the standardization population. This finding suggests that the experimental population was at a higher intellectual 32 level than the normative population. The finding also suggests the presence of intellectual decline in the experimental subjects as compared with the normative group, if one accepts the assumption that Vocabulary- Similarities differential is a measure of intellectual debilitation. Edwards* formula (38) was utilized in obtaining the t*s. TABLE 1 A COMPARISON OF THE MEANS AND STANDARD DEVIATIONS OF THE VOCABULARY AND SIMILARITIES SCALED SCORES BETWEEN THE EXPERIMENTAL GROUP AND THE WAIS NORMATIVE GROUP Vocabulary Subtest Similarities Subtest M 6 6 m 6 d M 6 dm 6 d Age 65 - 69 WAIS Norms N - 59 9.10 2.89 .38 .26 8.20 3.23 .42 . 0 Exper. Subjs. N - 10 11.00 1.95 .65 •UL- 7.30 4.01 1.34 .90 t 2.533 1.84 .64 .82 Sign. Level .05 N.S. N.S. N.S TABLE 1— Continued 33 Vocabulary Subtest Similarities Subtest M 6 rfm 6d M *d Age 70 - 74 VAIS Norms N - 55 7.95 3.34 .43 .32 6.75 2.84 .38 .27 Exper. Subjs. N - 7 10.83 1.95 .80 .52 7.33 3.03 1.24 .81 t 3.13 2.28 .45 .22 Sign. Level .01 .05 N.S. N.S. M < r 6 m M 6 ^ m <fd Age 75 - up WAIS Norms N - 85 7.88 3 .20 .34 .25 5.76 3.07 .33 .24 Exper. Subjs. N - 20 9.48 2.82 .65 .44 5.71 3.21 .74 .51 t 2.19 .75 .06 .25 Sign. Level .05 N.S. N.S. N.S. 34 Thematic Apperception Teat.— The Thematic Apperception Test (99) was administered to the patients in order to obtain a measure of various imaginal and emotional functions. The instructions in the manual were adhered to, so as to achieve the maximum possible uni formity of administration. The following seven cards were administered to each patient, in the order indicated below: IBM: A young boy is contemplating a violin that rests on a table in front of him. 6BM: A short, elderly woman stands with her back turned to a tall young man. The latter is looking down ward with a perplexed expression. 7BM: A gray-haired man is looking at a young man who is sullenly 3taring into space. 12F: The portrait of a young woman. A weird old woman with a shawl over her head is grimacing in the background. 15: A gaunt man with clenched hands is standing among gravestones. 12M: A young man is lying on a couch with his eyes closed. Leaning over him is the gaunt form of an elderly man, his hand stretched out above the face of the reclining figure. 5: A middle-aged woman is standing on the 35 threshold of a half-opened door looking into a room. These particular cards were chosen for the study because of the experience of Murray and his associates that validity is increased if most of the pictures include a person of the same age range and/or sex as the subject. All but one of the abovenoted cards depict pictures of elderly or middle-aged persons. The subjects1 responses were recorded verbatim. Any questions by the subjects were handled in a non directive way. Each subject was allowed one story per card. At the completion of the first two stories, the examiner said, "anything else?" No further inquiry was given, since this might interfere with the scoring categories used and might influence the nature of the stories told. Encouragement and praise were given, how ever, to maintain rapport. Real Self-Sort and Ideal Self-Sort.--A series of one hundred self-referent statements, each typewritten on a separate 3 x 5 card, was presented to the subjects, in standard order, to serve as a measure of self-esteem or self-acceptance. These statements were designed to permit comprehensive and detailed personality description. They were revised from Rogers' set {23, 105) to suit an elderly population. An attempt was made to balance the statements with respect to positive and negative feeling 36 tones, so that half of the statements were positive in nature while the other half were negative. An attempt was also made to use simple vocabulary on the items, and it was found that for the most part, the items were easily comprehended by the subjects. However, when a subject did not understand a word, the standard dictionary definition was given her. A copy of the Self-Sort statements used in the study is seen in Appendix F, page 130. The subjects were instructed to classify each statement according to its applicability to themselves. This was referred to as the "Real Self-Sort." The cards were to be sorted into a series of five piles along a continuum of appropriateness or accuracy of self des cription from those that are "most like myself" to those that are "least like myself." Each subject was instructed to include the cards in each of the five categories such that the frequencies would be 6, 25, 33, 25, and 6. These figures approximate the normal dis tribution. Specific instructions given to the patients were, "Sort these cards to describe yourself as you really are. Place the exact number of cards in each pile as you see indicated." Further explanation was given as needed. The subjects were free to determine which cards went into 37 each of the five categories, and were also free to sort and re-sort the cards until satisfied with their arrange ments. After the subjects completed the Real Self-Sort, they were instructed to: "Sort these cards to describe yourself as you would like to be." This was referred to as the "Ideal Self-Sort," and the sorting procedures were identical with those used with the Real Self-Sort. It should be pointed out that the Self Sorts were the most difficult of all the tests administered to this elderly population. Patients often had difficulty deciding in which category to classify some of the cards. They found it necessary to give lengthy and time- consuming explanations about why they were placing a specific card into a specific category, and the examiner found it was not advisable to disrupt their explanations, for this appeared to interfere seriously with rapport. At times, it was necessary to go over instructions repeatedly. Although the great majority of the subjects expressed dissatisfaction with this test, and some of the items seemed to upset them, all of the subjects managed to complete both of the self-sorts, albeit with discomfort. Hospital Adjustment Test.— This test was utilized as a measure of behavioral change in the subjects. It is designed to obtain an objective evaluation of behavioral changes in chronic disease, elderly, non-psychotic patients. The test is based on the Hospital Adjustment Scale of Ferguson, McReynolds and Ballachey (42), and was adapted for this study. It was necessary to adapt, since the Ferguson scale was designed for use with a psychiatric population and many of the items simply were not applicable for a non-psychotic geriatric group. Consequently, only fourteen items were retained from the original scale, an additional six items were reworded, and five items were added. In conjunction with this, a different scoring system was developed. In view of the somewhat extensive changes, the reliability figures given by the authors of the original test could not be used here. Consequently, a separate determination of reliability was made.-^ Utilizing Ebel's statistic for determining rater relia bility (37), it was found that the reliability of the revised test was .94. The Hospital Adjustment Test, as used in this study, is in questionnaire form and was filled out by nursing personnel having close daily contact with the patients, with two weeks of direct observation. It took The reliability study for this scale was developed in conjunction with Drs. Alfred Urmer and Leonard Wendland of the Psychological Services Department, Rancho Los Amigos Hospital. At the time of this writing, the article on the rater reliability of this test is in pres3 (126). 39 approximately ten minutes to complete, and consisted of twenty-five behavioral descriptions of patients. The rater was asked to evaluate each item on the basis of its being True (T), Partly True (PTj, Partly False (PF), or False {F) for the patient. All four choices were desig nated for each item and the rater was asked to encircle the appropriate index. The scoring system consisted of giving four points to the ratings in the direction of good adjustment, and giving one point to the ratings in the direction of poor adjustment. The two items in between were scored two and three, respectively, depending on which item (T or F) is scored four. The score for any one patient was the total number of points received for the twenty-five items. The highest possible score was 100. A copy of the instructions to the raters is found in Appendix G, page I83, and a copy of the Hospital Adjustment Test itself is seen in Appendix H, page 18/*.. The scoring criteria are found in Appendix I, page 186. During the same period of time the patients were being tested individually, the Hospital Adjustment Test was sent out to the wards for nursing personnel to fill out. Each of two raters independently completed the question naire for each patient. In addition to the need presented by the reliability study, two ratings were obtained for each patient to safeguard against the possibility that one 40 of the raters would have left the hospital or would have been transferred to another ward and, consequently, would not be available for the ratings following the planned activity program. None of the hospital personnel were informed that the Hospital Adjustment Te3t was part of a research project; they were under the assumption that this was a new procedure instituted by the Psychological Services Department of the hospital. Matching the Groups Those patients who met the twelve criteria listed earlier were then divided into four equated groups. The patients were randomly assigned to one of the groups, so that there were twelve patients in each of three groups and eleven patients in the remaining group. There was to be one control group and three experimental groups. Two of the experimental groups were to receive group psycho therapy, two psychotherapy groups being U3ed instead of just one as a safeguard against the event of one of the groups disbanding for any reason. The third experimental group was to participate in arts-and-crafts classes. The control group was to receive no special program of acti vities other than that provided by routine hospital procedures. The four groups were matched on the ten variables 41 listed below. Each group was compared with every other group to see whether they matched on these ten variables. When no matching was achieved, patients were shifted from one group to another until no significant differences were found between the four groups on the matching variables. It should be noted that these matching procedures pre cluded the possibility of using parametric statistics to determine the significance of changes which might subse quently have occurred between the groups; for one of the assumptions of parametric statistics is that the obser vations must be independent--that is, the selection of any one case from the population for inclusion in the sample must not bias the chances of any other ca3e for inclusion. Therefore, non-pararaetrics were to be the statistics of choice in subsequent comparisons. The variables on which the .groups were matched are as follows: Number of years of education. Verbal I.Q.--as estimated by the WAI3 Vocabulary subtest. Deterioration Index.— WAI3 Similarities scaled score divided by the WAI3 Vocabulary scaled 3Core. Marital status.--Single and divorced patients were grouped together for matching purposes and contrasted 42 with widows. A majority of the patients had been married, but none had a living spouse at the time the study was undertaken. Children.--Those who had had children were con trasted with those who did not have them. Religion.— The two categories here were Protestant and Catholic. Birthplace.--Those born in the United States were compared with those born in a foreign country. Those patients born outside the U.S.A. had lived in this country for at least twenty years. Hospital activity.--This variable was evaluated in terms of the extent to which patients had participated in hospital activities in the past, prior to one year before the beginning of the study, or were partaking in activity in the present, such as church attendance or occasional movie viewing. The patients who had had or were presently engaged in at least minor activities were compared with patients who had never engaged in any activity in the hospital and were not doing so at the time of testing. Presence of heart condition.— It was felt that the groups should be matched on this variable to alleviate the possibility of uneven losses through death. There was no attempt to match for such factors as motivation for therapy or for arts-and-crafts class, or 43 for any personality variable other than those mentioned above. It was originally planned to have the same number of patients in each of the four groups. However, in the process of matching the groups, this did not prove feasible. At the beginning of the group activities, therefore, the composition of the groups was as shown in Table 2, below. TABLE 2 ORIGINAL NUMBER OF PATIENTS IN EACH OF THE FOUR MATCHED GROUPS Groups Number of Patients in Group First therapy group . . . Second therapy group . . Arts-and-crafts class . . Control group ........... During the course of the experiment proper, how ever, one patient dropped from the first therapy group; one patient left the second therapy group; three patients dropped from the arts-and-crafts class; and one patient in the art3-and-crafts class died. In order to maintain groip equivalence, it was necessary to exclude four patients from the control group. Selective exclusion of these four 44 patients was achieved so as to maintain the matching of the variables which had been achieved in the assignment of the initial forty-seven patients. For statistical pur poses, the two therapy groups were combined, since the form of therapy used was essentially the same in both groups. The final total population consisted of thirty- seven patients. For the population of both activity groups and control group, the mean age was 74.3 years; the mean educational level was 8.2 years; the mean Verbal I.Q. based on the WAIS Vocabulary subtest was 113*1; and the mean Deterioration Index was .60. Of the total group of thirty-seven patients, 27^ were single, 62% were widowed, and 11°% were divorced. Fifty-one percent had had children, while 49% had never borne children. With regard to religious affiliation, 73% were Protestant and 27% were Catholic. Eighty-one percent were bom in the United States and 19% were foreign born. Fifty-four percent had taken part in some form of activity one year prior to the beginning of the experiment or were participating in occasional activities such as motion picture viewing or occasional church attendance, while 1+6% had never participated in any activity in the hospital in the past, nor were they doing so at the time of the testing. None of the patients were participating in any ongoing organised regularly meeting group activity. Fifty-four per cent of the patients had some form of heart condition; 46# were free of heart disease. In Table 3, pages 46, 47, and 4$ are contained the data relative to the matching of the groups on the ten variables. For the first four variables, the Mann Whitney U Test was utilised as the statistic (113). For the remaining six variables, the statistics utilised in the matching were the Fisher Exact Probability (113) and Finney?s tables (43)• Statistical data are reported in Table 4, pages 49 and 50. No significant differences were found on any of the ten variables matched. There is, however, a tendency (non-significant) for the therapy group to contain more widows than the control group. While this was not considered initially, it is interesting to note that there is dependent variable matching. For example, the Hospital Adjustment Test scores of all three groups prior to activity are not significantly different, as seen in Table 5, page 51; nor are the TAT measures, except for two instances, as illustrated in Table 6, page 52; nor are the s scores of the Real Self-Sort and Ideal Self-Sort, as seen in Table 7, page 53* The I.Q. variables of Vocabulary and D. I. were matched, as reported earlier, and the Similarities TABLE 3 CHARACTERISTICS OF THE PATIENTS IN THE THREE GROUPS Therapy Group Pt. Edu Vocab. Child Relig Birth Acti Heart No. Age cation I. Q. D.I. Marital ren ion place vity Ailment 1 66 8 124 . 46 Single W/out Cath. U.S. Past No 2 70 12 130 .92 Single W/out Prot. U.S. Now Yes 3 81 7 92 .67 Widowed W/out Cath. U.S. Now No 4 85 8 110 .67 Divorced With Prot. U.S. Now Yes 5 84 12 110 .33 Widowed W/out Cath. U.S. None Yes 6 67 4 94 .25 Widowed With Cath. Canada Past No 7 69 8 124 .92 Widowed W/out Prot. U.S. Now No S 74 3 100 .3 8 Widowed W/out Prot. U.S. Past Yes 9 73 14 124 .75 Widowed With Prot. U.S. None Yes 10 8 3 8 110 .33 Widowed With Cath. U.S. Now No 11 69 7 118 .92 Widowed W/out Prot. U.S. None No 12 75 1 9$ .57 Widowed With Cath. Austria Now Yes 13 77 8 98 1.00 Widowed With Prot. Sweden None No 14 75 4 122 .55 Widowed With Prot. U.S. None Yes M - 74.86 7.43 110.0 .62 2 Single 7 With 8 Prot. 11 U.S. 5 None 7 Yes 6 - 6.16 3.50 12.39 .24 11 Widowed 7 W/out 6 Cath. 3 Out 6 Now 7 No 1 Divorced 3 Past ■p- TABLE 3— Continued Craft Class Pt. No. Age Edu cation Vocab. I. Q. D.I. Marital Child ren Relig ion Birth place Acti vity Heart Ailaent 15 77 4 98 .29 Widowed With Prot. U.S. Past No 16 78 8 122 .82 Single W/out Prot. U.S. Past No 17 78 8 92 .33 Widowed With Prot. U.S. None Tes 18 84 3 116 .40 Widowed With Prot. U.S. None Yes 19 75 12 145 .80 Divorced W/out Prot. England Now No 20 65 12 118 .92 Single W/out Cath. U.S. Past No 21 71 8 94 .86 Widowed With Prot. Norway None No 22 70 8 112 .60 Widowed With Prot. U.S. None Yes M - 74.75 7.88 112.12 .63 2 Single 5 With 7 Prot. 6 U.S. 4 None 3 Yes 6 - 5.52 3.02 16.44 .24 5 Widowed 1 Divorced 3 W/out 1 Cath. 2 Out 1 Now 3 Past 5 No TABLE 3— Continued Control Group Pt. Edu Vocab. Child Relig Birth Acti Heart No. Age cation I. Q. D.I. Marital ren ion place vity Ailweifc 23 77 10 139 •72 Single W/out Prot. U.S. None Yes 24 76 9 104 .38 Widowed With Cath. U.S. None Tee 25 79 10 134 .69 Single W/out Prot. U.S. Past No 26 67 12 118 .67 Widowed With Prot. U.S. Past No 27 65 7 94 .38 Single W/out Prot. U.S. Now Yes 28 81 7 92 .33 Widowed With Prot. U.S. None Yes 29 70 12 130 .69 Divorced W/out Prot. U.S. None Yes 30 66 12 124 1.00 Widowed With Prot. U.S. None Yes 31 75 H 134 .85 Single W/out Cath. U.S. Now No 32 85 10 110 .56 Single W/out Prot. U.S. None Yes 33 67 3 100 • 44 Divorced With Prot. U.S. None Yes 34 71 8 106 • 44 Widowed W/out Prot. U.S. Now No 35 68 8 106 .30 Widowed With Prot. U.S. Now No 36 78 8 104 .25 Widowed With Cath. Prance Now Yes 37 77 6 139 .64 Single W/out Prot. England None Yes M - 73.47 9.07 115.6 .56 6 Single 7 With 12 Prot. 13 U.S. 8 None 10 Yes 6 " 5.96 2.72 15.94 .22 7 Widowed 8 w/out 3 Cath. 2 Out 5 Now 5 No 2 Divorced 2 Past •r- oa 49 TABLE 4 MATCHING DATA ON THE VARIABLES OF AGE, EDUCATION, VOCABULARY I.Q., AND D. I. Matching for Age Groups Compared Ua df Significance Level Craft and Therapy Craft and Control Therapy and Control 52.5 53.0 95.0 20 21 27 Not Not Not Significant Significant Significant Matching for Education Craft and Therapy Craft and Control Therapy and Control 49.5 48.5 75.5 20 21 27 Not Not Not Significant Significant Significant Matching for Vocabulary I. Q. Craft and Therapy Craft and Control Therapy and Control 54.0 52.5 85.5 20 21 27 Not Not Not Significant Significant Significant Matching for D. I. Craft and Therapy Craft and Control Therapy and Control 42.5 49.5 90.0 20 21 27 Not Not Not Significant Significant Significant *Mann Whitney U Test, two tailed. 50 TABLE 4 — Continued MATCHING DATA ON THE VARIABLES OF MARITAL, CHILDREN, RELIGION, BIRTHPLACE, ACTIVITIES, AND HEART CONDITION Variable Therapy Craft Control Between Signif. Matched Group Class Group Groups Level N N N p« Marital Single & Divorced Widowed Children )hi: wTi itn Without Religion Proteatant Catholic Birthglace In' Outside USA Activities None Past & Now Heart Ailment With Without 3 3 8 Craft S c Ther. • 369 N.S. Craft S c Cont. •389 N.S. LI 5 7 Ther. S c Cont. .081 N.S. 7 5 7 Craft S c Ther. • 454 N.S. 7 3 8 Craft S c Cont. .389 N.S. Ther. S c Cont. .576 N.S. 6 7 12 Craft S c Ther. .161 N.S. 6 1 3 Craft S c Cont. .665 N.S. Ther. S c Cont. .177 N.S. LI 6 13 Craft S c Ther. .767 N.S. 3 2 2 Craft S c Cont. .435 N.S. Ther. S c Cont. .465 N.S. 5 4 8 Craft S c Ther. • 416 N.S. 9 4 7 Craft S c Cont. .611 N.S. Ther. S c Cont. .282 N.S. 7 3 10 Craft S c Ther. .454 N.S. 7 5 5 Craft Sc Cont. .183 N.S. Ther. S c Cont. .297 N.S. aFisher Exact Probability. 51 TABLE 5 INITIAL MATCHING ON THE HOSPITAL ADJUSTMENT TEST PRIOR TO THE BEGINNING OF THE ACTIVITY PERIOD Therapy Group Craft Class Control Group Pt. Pre-Activity Pt. Pre-Activity Pt. Pre-Activity No. Score No. Score No. Score 1 97 15 78 23 73 2 70 16 47 24 77 3 80 17 73 25 49 4 65 18 75 26 99 5 51 19 79 27 81 6 83 20 81 28 78 7 86 21 90 29 61 8 65 22 75 30 81 9 67 31 92 10 96 32 55 11 60 33 78 12 86 34 83 13 90 35 96 14 88 36 90 37 66 N*14 £-1084 N-- 8 £-598 N*15 £-1159 Mean 77.4 74.8 77-3 6 13.78 11.58 14.07 Groups Compared Ua df Significance Level Craft and Therapy 48 20 Not Significant Craft and Control 48 21 Not Significant Therapy and Control 103 27 Not Significant ^ann Whitney U Test, two tailed. 52 TABLE 6 INITIAL MATCHING ON THE NINE SCALES OF THE THEMATIC APPERCEPTION TEST PRIOR TO THE BEGINNING OF THE ACTIVITY PERIOD TAT Scale Groups Ua df Sign. Level Emotional Tone Craft and Therapy Craft and Control Therapy and Control 42 51 88.5 20 21 27 N.S. N.S. N.S. Self Concept Craft and Therapy Craft and Control Therapy and Control 42.5 47.5 93.5 20 21 27 N.S. N.S. N.S. Social Distance Craft and Therapy Craft and Control Therapy and Control 33 38.5 96.5 20 21 27 N.S. N.S. N.S. Conflict Craft and Therapy Craft and Control Therapy and Control 49.5 53.5 99.5 20 21 27 N.S. N.S. N.S. Average Number of Words per Story Craft and Therapy Craft and Control Therapy and Control 36 56.5 65 20 21 27 N.S. N.S. .05 Self References Craft and Therapy Craft and Control Therapy and Control 48 48.5 69.5 20 21 27 N.S. N.S. N.S. "zwaang" Expressions Craft and Therapy Craft and Control Therapy and Control 50.5 55 100.5 20 21 27 N.S. N.S. N.S. Time Span Craft and Therapy Craft and Control Therapy and Control 45.5 39.5 99 20 21 27 N.S. N.S. N.S. Space Span Craft and Therapy Craft and Control Therapy and Control 35 30 99.5 20 21 27 N.S. .05 N.S. ai4ann Whitney U Teat, two tailed. 53 TABLE 7 INITIAL MATCHING ON THE REAL-IDEAL SELF SORT CORRELATIONS PRIOR TO THE BEGIN NING OF THE ACTIVITY PERIOD Therapy Group Craft Class Control Group Pt. Pre-activity Pt. Pre-activity Pt. Pre-activity No. Correlation Ne. Correlation No. Correlation (in z scores) (in z scores) (in z scores) I • 4843 15 .2769 23 .8291 2 .2448 16 .4357 24 .2769 3 .6042 17 .2769 25 .4357 4 .3206 18 .6931 26 .4843 5 .4723 19 .3769 27 .4477 6 .3884 20 .2446 28 .3541 7 .2986 21 .4599 29 .7753 8 .2661 22 -.0300 30 -.2448 9 -.3096 31 .6329 10 .7250 32 .5361 11 .2027 33 .3317 12 .6931 34. .6575 13 .6184 35 .6624 14 .5101 36 .3096 37 .4973 N-14 M-.3942 N»8 M-.3416 N-15 M-.4657 Groups Compared Ua df Significance level Craft and Therapy 44 20 Not Significant Craft and Control 35. 5 21 Not Significant Therapy and Control 82. 5 27 Not Significant aMann Whitney U Test, two tailed. 54 subtest was also found to be not significantly different in the three groups* Table 6, below, reports the matching data in terms of scaled scores for the Vocabulary and Similarities subtests* TABLE 6 INITIAL MATCHING ON THE INTELLIGENCE MEASURES PRIOR TO THE BEGINNING OF THE ACTIVITY PERIOD Matching on Vocabulary Scaled Scores Groups Matched U* df Significance Levels Craft and Therapy 53 20 Not Significant Craft and Control 49 21 Not Significant Therapy and Control 62 27 Not Significant Matching on Similarities Scaled Scores Groups Matched U df Significance Levels Craft and Therapy 56 20 Not Significant Craft and Control 56 21 Not Significant Therapy and Control 104 27 Not Significant aMann Whitney U Teat, two tailed. Description of Activities The therapy and crafts groups each met for one and 55 one-half hour sessions twice a week over a period of four months. Thirty-three sessions were held in all, making a total of forty-nine and one-half hours of activity. The groups met on the same days (Tuesdays and Fridays). It was necessary to stagger the meeting times for the groups on these days in order to accomodate meal times, therapist and recreational worker availability, and the scheduling of the tram. Most of the patients were taken to and from the group sessions by means of a tram especially set aside for this purpose, although a few patients were brought to the meetings by their ward attendants, and a few patients walked. The arts-and-crafts class met from 8:30 A.M. to 10:00 A.M. in the Craft Center; the first therapy group met from 9:00 A.M. to 10:30 A.M.; and the second therapy group met from 1:00 P.M. to 2:30 P.M. The therapy groups met in one of the offices of the Psychological Services Department of the hospital. None of the patients were informed that they were participating in an experiment. It should be pointed out that none of the subjects were volunteers— they were both assigned to the study and to these particular groups, so that a volunteer influence is not to be considered as relevant here. Arts-and-crafts class.- -This group was led by a professional recreational worker whose specialty was the 56 teaching of arts and crafts. Ths general plan of the craft activities was decided beforehand, to make sure that the activities would be suitable for and capable of being effectively accomplished by aging and infirm individuals. The work did not require any unusual amount of accuracy, and demanded minimal sensory-motor integration and hand-eye coordination. The speed required from the patients was largely insignificant. In other words, the aim was to set up a program realistically geared to the limits of the aged. The projects that were planned for are described below: A. Ceramics. 1. Leaf candy bowls: The patients rolled out clay with a rolling pin and placed a paper design of a castor bean leaf over the clay. The clay was then cut out from this pattern, molded into the shape of a bowl, dried, then fired once, glased with various glases of different colors, and then fired again. 2. Leaf ash trays: The same procedure was followed here as outlined above, using two smaller ivy leaves in place of the castor bean leaf. 3* Planter bowls: Clay balls were pressed into a mold, permitted to dry, and then fired and glazed for the finished product. 4* Ceramic ash trays: The same procedure 57 was followed as with the planter bowls, utilising a different mold. 5. Individual projects. B* Textile painting. The patients transferred a pattern or design from different drawings to aprons, table mats, or other cloth objects. The designs were then painted to complete the projects. The ceramics and textile paintings were all indi vidual projects. They were, however, conducted in a group setting to provide the opportunity for mutual motivation and companionship. The program was designed to be activity-centered rather than individual-centered. The emphasis was placed on the production of attractive and useful items, and discussion of personal problems was specifically avoided. In the beginning, the recreational worker had to select most of the specific activities for each patient. The patients were encouraged to express their own preferences and soon they were developing ideas of their own. They were encouraged to contribute new ideas, and every effort was made to introduce opportunities for expression in color and design. In order to avoid the possibility that the craft activities would involve simply "busy work," the sale of the products in the Hospital Gift Shop was made available 53 to the patients. This was also done with the aim of enhancing feelings of usefulness and personal worth. The patients could wake any use they wished of the monies earned in this way. Initially, the patients expressed lack of confidence in their abilities to do the crafts. They approached the tasks with hesitance and disparagement of their abilities; they insisted that they lacked, most completely, all ability to do artistic or creative work. As they overcame their self-consciousness and fears of making mistakes, they became quite involved in the activities. Eventually, their delight and pride in accomplishment was marked. Some of their ceramic products were attractive enough to be included in the Arta-and- Crafts Show sponsored by the hospital. A few patients displayed their work in the Hospital Gift Shop, and sold them in this way to hospital visitors, thereby gaining financial reward for their crafts as well as personal satisfaction. Most of the patients, however, preferred to keep their products rather than sell them; they dis played them proudly on the wards, and gave them as gifts to their favorite staff members, friends, and relatives. A very positive emotional involvement was developed by the patients in this activity, and many continued attendance at other classes offered by the 59 Recreation Department of the hoapltal after the experi mental groups were disbanded. Group psychotherapy.— Therapy was conducted by the experimenter and was centered around the discussion of personal problems. The emphasis was placed on verbal communication, in contrast to the manual activities of the craft class. An attempt was made to tape-record the therapy sessions, as well as those of the craft class, but due to acoustical problems, this was discontinued after several sessions. As a substitute measure, the therapist and recreational worker took notes following each activity session. No notes were taken during the sessions them selves. While this substitute procedure served to provide a record of the groups* activities, it lacked the precision of analysis which tape-recordings could have provided, so that process analysis was not possible. At the beginning of the therapy, the patlots in the group were markedly suspicious and anxious. Indeed, they showed marked reluctance to enter into this type of treatment. As was previously noted, none of them had volunteered for the groups— they were arbitrarily assigned to them. However, many of the patients interpreted their assignment to psychotherapy as an indication that they were being viewed as psychologically suspect and, as such, tended to see this as somehow related to the extensive 60 psychiatric program which tha hospital had just concluded. One could not regard the patients as well motivated for group psychotherapy. The unstructured nature of the therapy situation made them even more uneasy. In order to alleviate the very high anxiety, and to bind the groups together, lectures had to be insti tuted. As a matter of fact, this was requested by the patients. The lectures took up the first fifteen minutes of each one and one-half hour therapy session. While the topics were of the patients' own choosing, they had a distinctly psychological emphasis, particularly those questions relating to aging. To a lesser extent, the topics dealt with certain aspects of physical illness. Following the brief lecture introductions, open discussion was provided for any topics the patients wanted to bring up. Such discussions only rarely related specifically to the preceding lecture; instead, they involved intimate and personal problems and the feelings connected with them. As the sessions progressed, the participants required less in the way of structured lecture introductions, although such lecture structure continued to the end. The therapy proper was primarily non-directive, with the therapist aiming for an atmosphere of tolerance and permissiveness, and encouraging as much spontaneity as possible from the patients. At times, a more active 61 role for the therapist was found necessary, particularly during the early sessions. The principles of non directive therapy were not adhered to with any rigidity. Where needed, supportive reassurance, direction, and even direct environmental modification were utilised, but attempts were made to keep these down to a minimum. The major aims of the therapy were to give the patients an opportunity to ventilate feelings, to develop insights, to compare their own states with those of others, and to rediscover hidden resources. The group was structured so as to focus the attention on the free expression of feelings of the patients toward each other and toward the therapist; and on the immediate patterns of feelings and behavior that emerged in the group. Current problems were dealt with more frequently than old problems, and no specific attempts were made to rekindle old, poorly solved problems unless they were brought out by the patients themselves. Interpretations were given when appropriate, but were of a more intellectual nature; so-called "deep" or "dynamic” interpretations were rarely made. Major goals were to reduce stress, to bolster weakened defensive systems, and to maintain emotional security in the patients, without their having to turn to behavioral patterns and reaction formations which would be unusually disturbing to others and to themselves. 62 It took a relatively long period of time Tor the patienta to open up and apeak freely; the development of group feeling was alao alow in ahowing itself. The patients tended to relate more to the therapist than they did to each other. In this relationship, the therapist was often viewed as a combination of parental and filial images, and the transference was generally strong and positive in nature. The patients looked to the therapist for security, counselling and direction many times. Negative transference m s rarely seen, and whatever resistance became manifest was handled gently. One of the major problem areas which served as a vehicle for strong affective involvement concerned the patients' feelings of uselessness and loss of personal worth, concretised in their shame at being in a hospital which was at one time the County Poor Farm. The desire to go home came up often in the sessions. They also often spoke of their physical conditions, their feelings of loneliness, their past experiences, their relationships (both positive and negative) with their children and other family members, death and their feelings about it, and the day-to-day problems in the hospital, including their relationships with the nurses, doctors, and aides. The patients were quite concerned about the secrecy of their statements despite the principle of privileged communication which prevailed, for, living in a hospital as they did, thsy feared loss of status through gossip of their fellow members. They also feared reprisals from the staff because of hostile feelings directed to them, reprisals in the form of poorer service or of being shifted from ward to ward. There were some very interesting qualitative changes in the patients, changes which commenced shortly after the beginning of the psychotherapeutic sessions. The patients began taking an interest in their personal appearance. They began to participate Increasingly in the other activities provided by the hospital (hospital newspaper, patient government, recreational entertainment). There was less preoccupation with physical complaints, and a more positive approach towards themselves and others. There was also a decrease in passivity, as evidenced in more aggressive attempts to direct their own lives. As the sessions continued, the patients became more interested in each other than they were at the beginning. Also, the therapy sessions became very important to them, and were jealously guarded by them. When other patients requested permission to Join the therapy groups, this was quickly voted down by the member patients. Although the patients knew that therapy would continue only for a limited number of sessions, 64 they were generally upset as the tiae for disbanding approached. Many of the patients continued to ask hospital personnel about the resumption of the therapy groups, months after they were disbanded. It should be emphasised that these impressions of the therapy and craft groups are not substantiated with precise and rigorous comparable observations between the groups. The group leaders* notes were available, of course but these were not as exact or precise as a tape-recording would have been. While the author had contact with the other groups at the end of testing and could not help but be impressed by the differences between the control group and the activity groups in such items as have been discussed previously, nevertheless, organised and exact recordings of these items were not achieved. Indeed, this would appear to be an important area for future investigation. If tape-recordings could have been made as initially planned, more precise data would have been available and, consequently, more precise and conclusive statements about the process of change in the groups could have been made. At the end of the experimental period, the WAIS subtests, the TAT cards, the two Self-Sorts, and the Hospital Adjustment Test were re-administered, using the 65 same method of admlnlatration, the same directions, and the same order of presentation as before. In addition, a confidential Questionnaire was filled out by each patient, evaluating the program in which they had parti cipated. A copy of the Questionnaire is to be found in Appendix J, page 137. CHAPTER III RESULTS Wechaler Adult Intelligence Scale It was hypothesised, earlier, that a measure of deterioration could be obtained by comparing the Vocabu lary with the Similarities subtests of the Wechsler Adult Intelligence Scale. The Vocabulary was assumed to "hold" with time, while the Similarities was assumed to be most susceptible to change, and was the "don*t hold" test. The ratio of Vocabulary/Similarities was the proposed measure of intellectual deterioration and was to be called the Deterioration Index (D.I.). Before utilizing the D.I. as a measure of intel lectual deterioration, it was necessary to see whether or not the Vocabulary did, indeed, hold after the experi mental procedures. If this were not so, then meaningful use of a D.I. ratio would not seem feasible. Therefore, a comparison was made between pre- and post-Vocabulary scaled scores for each group, utilizing the Wilcoxon Matched-Pairs Signed-Ranks Test (113)• The results, shown in Table 9, page 66, indicate that for the control group, Vocabulary does change significantly at the .10 level of 66 67 confidence (two tailed test).^ In thia group, the Vocabulary scores went down significantly. A further check was wade for each of the other two groups to see whether Vocabulary held or not. For the therapy group, Vocabulary scores of the subjects went up sig nificantly at the .05 level of confidence, two tailed test, using the Wilcoxon statistic. For the craft class, no significant differences were noted on the Vocabulary subtest. Here, the Sign Test (113) had to be utilized, for, after those cases in which no change occurred were eliminated, the N was reduced to 5, and the Wilcoxon tables begin with an N of 6.^ ^Within the context of psychological research, it has been traditional to view the 5% level of con fidence as the minimal acceptable statistical level. However, the major aim during the entirety of this study was to discover general trends in this new and relatively unexplored field of investigation. This aim, coupled with the rigorous matching of a large number of relevant variables, would seem to justify a serious consideration of the 10% level of confidence as suggestive of trends, and, consequently, through out the considerations which follow, the 10£ level of confidence shall be viewed as seriously suggestive of important trends. The traditional 5% leveJL of confidence will be viewed in the customary manner. 2 The Sign Test was used in place of the Wilcoxon Matched-Pairs 31gned-Ranks Test for. although it is not sensitive to the magnitude of differences as is the Wilcoxon statistic, it still reveals whether the direction of differences which might have occurred are significant. Both statistics are comparable in that both are applicable for use with ordinal data in comparing related samples. 66 TABLE 9 CHANGES IN VAIS VOCABULARY SCALED SCORES FOLLOWING ACTIVITY PERIOD Therapy Group Craft Class Control Group Pre Poet Poet -Pre Pre Post Post -Pre Pre Post Post -Pre 13 13 0 7 6 +1 14 11 -3 13 15 ♦2 11 11 0 6 5 -3 6 6 0 6 5 -1 13 12 -1 9 9 0 10 10 0 12 11 -1 9 10 +1 15 16 +1 8 6 -2 6 8 0 12 15 +3 6 6 0 13 16 ♦3 7 7 0 13 12 -1 8 6 0 10 9 -1 13 15 +2 12 15 +3 13 13 0 9 9 0 9 9 0 12 12 0 9 10 +1 7 9 +2 9 8 —X 7 7 0 10 9 -1 11 13 +2 8 8 0 14 12 -2 1 - 137 150 +13 78 81 +3 159 147 -12 M - 9.79 10.71 9.75 10.12 10.60 9.60 - 2.39 3.13 2.81 3.55 2.55 2.75 T - 0 - - 11.5 Sign. Level .05 N.S. .10 69 The reader is reminded that a requirement of the calcu lation of both the Wilcoxon Test and the Sign Teat la that all aero scores be eliminated— I.e., where no algnlflcant differences between two treatments occur, such pairs are dropped from the analysis. The pairs which are evaluated are correspondingly reduced, so that one is evaluating the significance of change of those pairs which actually did show change from pre- to post testing. From the results obtained, it can be seen that the Vocabulary scores did not hold in the control group, nor did they hold in the therapy group. Since the Vocabulary scores changed significantly, it would be inadvisable to use Vocabulary as the "hold" test, for, indeed, it did not do so. Consequently, the D.I. as a measure of intellectual decline had to be discarded. The data were then examined to see if any changes occurred in the Similarities subtest for the three groups. For the control group, it was found that no significant changes occurred following the experimental period on the Similarities scaled scores, using the Wilcoxon statistic. For the Therapy group, however, the Similarities scores following activity increased significantly, beyond the .01 level. The craft class Similarities scores showed no sig nificant changes. This is shown in Table 10, page 70. 70 TABLE 10 CHANGES IN WAI3 SIMILARITIES SCALED SCORES FOLLOWING ACTIVITY PERIOD Therapy Giro up Craft Class Control Group Pre Post Post Pre Post Post Pre Post Post -Pre -Pre -Pre 6 13 +7 2 2 0 11 8 -3 12 14 +2 9 10 ♦1 3 4 +1 4 4 0 2 3 ♦1 9 12 +3 6 9 ♦3 4 3 -1 8 6 -2 3 4 +1 12 12 0 3 2 -1 2 2 0 11 11 0 2 2 0 12 12 0 6 6 0 9 10 +1 3 6 +3 6 4 -2 13 13 0 9 12 +3 11 11 0 3 7 +4 5 6 +1 11 12 +1 4 2 -2 4 4 0 5 2 -3 7 7 0 3 5 +2 6 7 +1 2 2 0 9 10 +1 £ • SB 113 +25 52 51 -1 97 95 -2 M - 6.29 8.07 6.50 6.38 6.47 6.33 6 - 3.35 3.79 3.61 3.77 3.58 3.99 T - 0 - - 37 Sign. Level 01 N.S. N.S. 71 Thus, it can be seen that the Vocabulary and Similarities scores each changed following the acti vity period in the groups. The Vocabulary scores tended to go up in the therapy group, to go down in the control group, and to stay the same in the craft class. The Similarities scores tended to go up in the therapy group and to stay the same in the craft and control groups. From the available data, it was possible to get a broader measure of intellectual change than was afforded by using the two I. Q. subtests independently. This was done by summing the pre-activity Vocabulary with the pre-activity Similarities scaled scores for each group, and by summing the post-activity Vocabu lary with the post-activity Similarities scaled scores for each group. To see whether the three groups were equivalent on this combination score prior to the beginning of the activity period, the pre-activity Vocabulary + Similarities scores were compared between the three groups. No significant differences were found, suggesting that the combination of pre-activity Vocabulary + Similarities scores came from the same population for all of the three experimental groups. Data on these comparisons are found in Table 11, on page 72. 72 TABLE 11 INITIAL MATCHING ON VOCABULARY + SIMILARITIES PRIOR TO THE BEGINNING OF THE ACTIVITY PERIOD Group U* df Sign. Level Craft and Therapy Craft and Control Therapy and Control 56 56.6 100.5 20 21 27 Not Significant Not Significant Not Significant *Mann Whitney U Test, two tailed. To discover whether there were any significant changes of the combined scores following the experimental period for each group, the Wilcoxon statistic was calculated. The results, seen in Table 12, page 73, indicate that no significant changes occurred in the craft class, no significant changes occurred in the control group (althou^i the tendency was for the scores to decrease), and the scores in the Therapy group went up significantly, beyond the .01 level (two tailed test). A question could be raised as to the value of adding the Vocabulary and Similarities scores together after examining them separately— if there was a significant change in both separately, it would probably be for the sum. It was felt, however, that by combining the two I.Q. subtests, one would gain a broader estimate of overall intellectual change than would be available from 73 TABLE 12 CHANGES IN WAIS VOCABULARY ♦ SIMILARITIES SCALED SCORES FOLLOWING ACTIVITY PERIOD Therapy Group Craft Class Control Group Pre Post Post -Pre Pre Post Post -Pre Pre Post Post -Pre 19 26 +7 9 10 +1 25 19 -6 25 29 +4 20 21 +1 11 9 -2 10 10 0 8 8 0 22 24 +2 15 IS +3 14 13 -1 20 17 -3 12 14 +2 27 28 +1 11 8 -3 10 10 0 23 26 +3 8 8 0 25 26 +3 13 13 0 22 22 0 11 14 +3 16 13 -3 26 28 +2 21 27 ♦6 24 24 0 12 16 +4 14 15 +1 23 24 +1 13 12 -1 11 13 +2 14 10 -4 14 14 0 13 14 +1 17 20 +3 10 10 0 23 22 -1 £ - 225 263 +36 130 132 +2 256 242 - 14 M - 16.07 18. 79 16.24 16. 50 17-07 16.13 T - 0 8 17 Sign. Level .01 N.S. N.S. one subtest alone* Further, by referring to Table 12 with regard to the control group, it can be seen that the combined scores show no significant changes occurring in that group; whereas, when the subtests were examined separately, as shown in Tables 9 and 10, the Vocabulary score declined significantly in the control groqp. The results of the combined scores tends to suggest that overall intellectual changes in the control group did not occur, although the Vocabulary score did change. These results also suggest the hypothesis that had the Full Scale I.Q. been administered, no significant changes would have occurred on the Full Scale score in the control group, although changes might have occurred on one or two of the subtests. Whether the changes found after the activity period were significant between the three graips was the next question to arise. In other words, by referring to Table 9, it can be seen that the Vocabulary scores for the therapy group seemed to change in a positive direction— the post-activity scores tended to be higher than the pre-activity scores; whereas, in the control group, the scores tended to change in a negative direction. That is, the pre-activity scores tended to be higher than th® post-activity scores. To test the significance of such changes, difference score was developed for each patient in each of the three groups by subtracting the pre-activity score from the post-activity score on each variable. Thus, for the Vocabulary subteat, each patient's pre-activity Vocabulary score was subtracted from the post-activity Vocabulary score, the resultant figure being the difference score. If the resultant figure were positive, this indicated that the patient had shown improvement in score; if it were negative, the patient had shown decline; if it were zero, the patient had shown no change. This same procedure was followed on the Similarities subtest, and on the Vocabulary + Similarities scores. Next, the Mann Whitney U Test was applied to determine the effect of group psychotherapy and craft activities on the difference scores of the Vocabulary, Similarities, and Vocabulary + Similarities scores. For each measure, the therapy difference scores were compared separately with the craft and the control difference scores and the craft difference scores were compared with the control difference scores to see whether they came from the same population or not. The results, seen in Table 13, page 76, indicate that on the Vocabulary subtest, the craft and therapy groups were not significantly different from each other on their difference scores, while the craft and control groups' difference scores 76 were significantly different at the .10 level of confidence (two tailed test); and the therapy and control difference scores were significantly different at the .002 level of confidence (two tailed test). Thus, the therapy and craft Vocabulary difference scores are both significantly different from the control group's Vocabulary difference scores. TABLE 13 DIFFERENCE SCORES FOR WAIS VOCABULARY SUBTEST SCORES BETWEEN GROUPS Groups Ua df Sign. Level Which group had larger diff. sccree Craft and Therapy 42 20 N.S. tm t o — mm w Craft and Control 32 21 .10 Craft class Therapy and Control 35 27 .002 Therapy group aMann Whitney U Test, two tailed. Turning next to the Similarities subtest, it can be seen in Table 10, page 70, that the sum of difference scores on this subtest for the craft class subjects was -1, a slight drop in score; for the therapy group, this sum was +25, an increase; and for the control group, it was -2, a slight drop. To see whether the difference scores were significantly different between the groups, the Mann Whitney U Test was utilized, and the results 77 indicate that the craft and therapy groups* difference scores were significantly different at the .05 level of confidence (two tailed test); the craft and control groups* difference scores were not significantly different; and the therapy and control groups* difference scores were significantly different at the .05 level of confidence (two tailed test). These results are illustrated in Table 14, below. TABLE 14 DIFFERENCE SCORES FOR WAIS SIMILARITIES SUBTEST SCORES BETWEEN GROUPS Groups Ua df Sign. Level Which group had larger diff. score Craft and Therapy Craft and Control Therapy and Control 23 57.5 55 20 21 27 .05 N.S. .05 Therapy group Therapy group aMann Whitney U Test, two tailed. When the Vocabulary and Similarities pre-activity scores were summed, as were the post-activity Vocabulary and Similarities scores for each group, it can be seen in Table 12, page 73, that the sum of the difference scores of combined scores for the craft class was +2, a slight change in the positive direction. For the therapy group, the sum of the difference scores was +3B, a larger increase in the positive direction; and for the control group, the difference score sum was -Id,a decrease in scores. To see whether the trends in difference score changes were significantly different between the three groups, the Mann Whitney U Test was utilised, and the results Indicate that the difference scores of the craft and therapy groups were significantly different at the .02 level of confidence (two tailed test); the difference scores of the craft and control groups were not significantly different; and the difference scores of the therapy and control groups were significantly dif ferent at the .002 level of confidence (two tailed test). These results are illustrated in Table 15, below. TABLE 15 DIFFERENCE SCORES FOR WAIS VOCABULARY ♦ SIMILARITIES SUBTEST SCORES BETWEEN GROUPS Groups Ua df Sign. Level Which group has larger diff. scores Craft and Control 36 21 N.S. M l ~ Q Craft and Therapy 21.5 20 .02 Therapy group Therapy and Control IS 27 .002 Therapy group aMann Whitney U Test, two tailed. Summary on I. Q. measures.--In summary, for the 79 measures of intellectual function, the following was done: 1. The Deterioration Index was discarded as a measure of intellectual deterioration, since significant changes in the control group were found which discredited the "hold-don*t hold* procedure* 2. Vocabulary and Similarities scaled scores were then combined for each subject, to make a broader measure of intellectual function. 3. Within the groups, the following significant changes were seen, as illustrated in Table 16, page 80. The therapy group improved significantly on all I. Q. measures; the craft group showed no significant changes on all three measures; and the control group showed significant decline on Vocabulary scores and no significant changes on the other measures. 4. Difference scores were calculated for each patient on each of the three measures by subtracting the pre-activity score from the post-activity score. The Mann Whitney U Test was used to see if there were significant differences on these scores between the three groups. The results are suswuirized in Table 17, page 80. From this table it can be seen that on the Vocabulary 3ubtest, both the therapy and the craft groups were significantly different from the control group. On the Similarities test, the therapy group improved signifi- 80 TABLE 16 DIRECTION OF SIGNIFICANT CHANGES OF THREE I.Q. MEASURES WITHIN THREE GROUPS® Measures Therapy Craft Control Vocabulary Improvement (P - .05 No Signif. Change Decline (P - .10) Similarities Improvement (P - .01) No Signif. Change No Signif. Change Vocabulary + Improvement (P - .01) No Signif. Change No Signif. Change aAll significance levels two tailed TABLE 17 DIFFERENCE SCORE CHANGES BETWEEN THE EXPERIMENTAL GROUPS3 tests. Measures Therapy < f c Craft Craft & Control Therapy & Control Vocabulary Similarities Vocabulary + Similarities N.S. Sign at .05 {Therapy higher than Craft) Sign, at .02 (Therapy higher than Craft) Sign, at .10 {Craft higher than Control) N.S. N.S. Sign, at .002 (Therapy higher than Control) Sign, at .05 (Therapy higher than Control) Sign, at .002 (Therapy higher than Control) lAll significance levels two tailed tests. si cantly more than did either the craft group or the control group. On the Vocabulary + Similarities measure, the therapy group was significantly higher than either thr ~ craft group or the control group. Therefore, the therapy group tended to improve more than the control group on all measures used. The therapy group also improved more than the craft class on all but Vocabulary. The craft group tended to show higher scores than the control group only on the Vocabu lary subtest. Several explanations of the obtained results could be offered. First, it is possible that regression to the mean was in operation. Thus, by referring to Table 12, it can be seen that, although the pre-testing means of the therapy and control group were not significantly different, the therapy mean was lower than the control mean, initially. In the post-testing, the therapy mean went up, whereas the control mean went down. To check out the possibility that these post-testing trends are merely a regression to the mean, the pre-test scores of the therapy and control groups were combined, and the mean of the com bined scores was obtained— this mean equalled 10.21. If regression to the mean had occurred in post-testing, one could expect the post-testing therapy mean to increase to 10.21, but not to exceed this figure. Also, it could be expected that the control group’s post-testing mean would drop to, but not go below, 10.21. As can be seen from Table 12, the above described conditions did not prevail, throwing doubt on the regression to the mean hypothesis. Further, if there were regression to the mean, the post-testing standard deviations should decrease in both groups. However, for the therapy group, the standard deviations, in actuality, increased. As a further check on the regression hypothesis, rho’ s (5*) were calculated between the pre- and post-test scores for the therapy and for the control groups. If regression to the mean was operating, then the rho’s should be small. As can be seen in Table 16, below, the rho’s were quite high, again throwing doubt on the regression to the mean hypothesis. TABLE 16 RHO’S FOR THERAPY AND CONTROL GROUPS Tests Rho - Therapy group P Rho - Control group P WAIS Vocab. .93 .01 .66 .01 WAIS Simil. .65 .01 .86 .01 WAIS Vocab. + Simil. .97 .01 .91 .01 63 Another possible explanation of the increase of scores in the therapy group is that practice effects might have occurred. Were this the case, however, one might expect the same sort of increase in score to occur in the control group. That this did not take place in the control group can be seen in Table 12. It does not, therefore, seem likely that practice effects could explain the obtained results. Yet another possibility is that a certain amount of change could be expected merely by the nature of the reliability of the subtests. The WAIS manual (133) Indicates that for the Vocabulary subtest, the standard error of measurement is .67, and for the Similarities subtest, it is 1.32. Therefore, the chances are about two out of three that an obtained Vocabulary scaled score is within .67 score points of the true score. It is quite possible that the I. Q. score changes observed in this study are the result of weaknesses in the reliability of the measuring instruments employed, rather than a reflection of "true" changes. However, it should be stressed that the standard errors of measurement reported in the WAIS manual are based on a population whose ages range between forty-five and fifty-five, whereas, the mean age of the subjects used in this study is seventy-four. At the time of this writing, no reliability figures 84 were not available for subjects over the age of fifty-five. Whether one can validly utilise norms for fifty-five year olds on subjects aged sixty-five to eighty-five is questionable. Nevertheless, the possibility still remains that the I. Q. changes obtained in this study might reflect weaknesses in the reliability of the subtests. It is, therefore, suggested that caution be observed in interpreting the I. Q. findings. Thematic Apperception Test At the completion of the final testing, there was available, for each patient, fourteen TAT stories, seven of which had been obtained prior to the beginning of the experimental conditions; and seven of which had been obtained following the experimental period. The total number of stories available for all groups pre- and post testing was ^18. The following nine measures were used in scoring the TAT productions. It was felt that these represented relatively sensitive methods of analyzing and evaluating the data included in the TAT productions: (1) Emotional Tone, (2) Self-Concept, (3) Social Distance, (4) Conflict, (5) Average Number of Words per story, (6) Number of Self References, (7) Number of "Zwaang" Expressions, (8) Time Span, and (9) Space Span. Measures (1) through (8) represent 85 modifications of measures developed from the TAT rating scales used by Barr (8), Garfield and Eron (53), Hart man (60), Eron, Terry and Callahan (40^ Ballcin and Masserman (7), and LeShan (87)* The ninth measure is one that the author developed independently. A brief description of the measures is given below. For a more detailed description, the reader is referred to Appendixes K, L, and M, pages 188-92. The first measure, namely, "Emotional Tone," is a five point rating scale which evaluates, generally, the mood of the stories, ranging from unpleasant feeling tones to pleasant feeling tones. The more cheerful, pleasant or optimistic stories received a rating of 4, and the less cheerful stories received ratings of 3, 2, and 1, depending on the degree of the feelings expressed. The rating of zero was reserved for those stories in which there was either lack of affect, or in which the data was insufficient for judging. The second measure, "Self Concept," was a five point rating scale which evaluated self esteem as revealed by the treatment of the hero in the story. High self esteem received a rating of 4, moderate self esteem was rated 3 points, low self esteem received 2 points, and extremely low self esteem received 1 point. The rating of zero was for those stories in which self attitudes were not 86 expressed, or in which the data was insufficient for judging. The third measure, "Social Distance,” measured, on a five point scale, the degree of relationship, both positive and negative, which existed between the hero and other people in the TAT stories. Those stories which revealed the strongest relationships, either of a positive or of a negative nature, were given the rating of 4. The weaker the interpersonal relationship, the lower was the rating assigned, and the rating of zero was used when no relationships whatever existed between the hero and others. The fourth measure, "Conflict," was a five point rating scale which evaluated the quality of the relation ships between the hero and others in the story. A rating of 4 points was assigned to the stories which involved positive, mature relationships between the hero and others. The stories which revealed conflict or immature relations with others were rated 3, 2, and 1, depending on the type of conflict and the degree of unsatisfactory relations. The rating of zero was given to those stories which contained insufficient data for judging. The fifth measure, "Average Number of Words per Story," was not a rating scale. As its title indicates, it was merely the average number of words produced in the stories given by the patient. According to Balkin and S7 Masserman, from whose work this and the following two scales were obtained, it measures, simply, the length if not richness of the productions* The sixth measure, "Number of Self References," involves the number of occurrences of the first person pronoun and direct references to the narrator* It is described by Balkin and Masserman as a measure of ego- centricity— the greater the number of self references being indicative of greater egocentricity. The seventh scale, "Number of *Zwaang* Expression^," is the number of occurrences of the expressions 3uch as, "I have to," "I must," or projected, as, "He is forced," or "She finds it necessary." Balkin and Masserman suggest that a high incidence of such expressions indicates compulsive tendencies in the subjectfs fantasies. The eighth scale, "Time Span," is a seven point rating scale measuring the time spread over the stories. A rating of 7 was given to those stories which had a time span of one year or more. Stories with shorter time spans were given correspondingly lower ratings, and those stories that were constricted in time to one hour or less were given the rating of 1. The scale is a measure of time span in fantasy, as revealed in TAT productions. The ninth scale, "Space Span," is a five point 83 rating scale which measures the space spread of the stories. Those stories which involved wide movements in space, such as moving from one city or country to another, were given a rating of 5* The more constricted the space spread, the lower were the ratings which were assigned, and the rating of 1 was given to those stories which were restricted in space to one single place with little or no movement within that place. On the first four of the scales utilized in this study, substantial modification was made from the manner in which they were presented in the literature. Conse quently, it appeared necessary that separate reliability studies be completed on them before they could be used. Such reliability studies were, therefore, undertaken. Each subject’s group of seven stories was given a code number, all other identifying information being removed. For the reliability study, there were 74 sets of stories (37 sets of pre-activity and 37 sets of post-activity stories). The pre-activity stories for each patjmt were marked with one code number and the post-activity stories with another, so that the raters were not cognizant as to when the stories had been produced. The code numbers were then ordered in random fashion so that the therapy group, craft class and control group stories were intermixed. However, the pre-experimental and post-experimental stories 89 for each subject were kept together, although the raters were not so informed. Each of the TAT stories was rated independently by three raters. In addition to the experimenter, two doctoral candidates in psychology participated. One of these was completing training in clinical psychology, the other in measurement. In addition to the experimenter, both had had extensive working experience with the TAT. The raters were informed that the TAT stories were all produced by elderly women, and that they were produced either prior to or after experimental conditions. The raters were instructed to rate the stories in the same order as a list of code numbers which were previously randomly drawn, described above. They were further in structed to rate first all of the stories for TAT Card Number 1 on Emotional Tone, and then to proceed to Cards 7BM, 12F, lr, 12M, and 5, and rate them on Emotional Tone, in that order. This was the order in which the cards had originally been presented to the patients. The same procedure was followed in rating the stories on the variables of Self-Concept, Social Distance, and then for the Conflict variable. Each rater was supplied with a description of the four variables to be scored, the criteria to aid in the judging, and an ordered list of the subjects1 code numbers indicating to the raters which 90 subject*s productions they should score first, which patient's stories should be scored second, and so on through the total number of patients. Upon completion of the scoring of the stories by the three raters, there were available three independent ratings on every story produced by the patients both before and after the activity period, for each of the four variables of Emotional Tone, Self-Concept, Social Distance, and Conflict. The reliability of the ratings was then computed for each of these four variables, using Ebel's method (37). The results are shown in Table 19, below. In terms of actual reliabilities, the coefficients which are shown are comparable with those which are asso ciated with acceptability in the literature. TABLE 19 RELIABILITY OF FOUR TAT MEASURES Scale r Emotional Tone .76 Self-Concept .69 Social Distance .69 Conflict .56 For the measures of "Average Number of Words per 91 Story," "Number or Self-References," and "Number of fZwaang1 expressions," no reliability study was felt necessary, since the scoring of the TAT stories on these variables involved simply the direct counting of specific words. The measure of time span utilised in this study is an adaptation from LeShan*s work (87). both the Time Span and the Space Span ratings are reproduced in Appendix M. For these two scales, reliability investi gations were deemed necessary. Ten subjects* TAT groups, of seven stories each, were chosen at random. These were then rated independently by two raters— a clinical psychologist experienced with the TAT, and the experimenter RhoTs (58) were calculated and indicate that for the Time ratings, the rho was .85, and for the Space ratings, it was .68. These results are reported in Table 20, below. TABLE 20 RELIABILITY OF TWO TAT RATING SCALES Scale Rho Time Span .85 Space Span .68 It was felt that these scales are sufficiently 92 reliable to be utilised in this study in that other efforts of comparable scope have reported similar levels of reliability. The reader is reminded that, although no matching of TAT variables had been planned for, the three experi mental groups actually did not differ significantly on TAT variables prior to the beginning of the activity period, with the exception of two matchings. For the first four TAT scales (Emotional Tone, Self-Concept, Social Distance, and Conflict), the ratings obtained from each of the three raters on these variables were summed for each variable and each patient, and the means calculated for each patient*s pre-activity and post activity TAT*s. Results on "Emotional Tone".--The results for this scale, which measures the degree of pleasant feeling tone in the TAT stories, are shown in Table 21, page 93, where it can be seen that both the therapy and the crafts groups showed significant increases in score, at the .05 and .01 levels of confidence, respectively, while the control group1s scores decreased significantly at the .01 level. To determine whether these increases and decreases were significant between groups, difference scores were calculated for each patient in each group by subtracting the post-activity score from the pre-activity score. The TABLE 21 RESULTS ON EMOTIONAL TONE VARIABLE, UTILIZING THE WILCOXON MATCHED-PAIRS SIGNED-RANKS TEST Therapy Craft Control Pre Poat Poat- Pre Pre Poat Poat- Pre Pre Post Post- Pre 17.7 14.3 - 3.4 13.0 14.0 + 1.0 9.7 9.7 0.0 14.3 14.7 ♦ *4 18.7 19.0 ♦ .3 16.0 11.7 - 4.3 17.0 15.3 - 1.7 2.3 5.7 + 3.4 19.7 10.7 - 9.0 8.0 10.3 ♦ 2.3 9.3 12.7 + 3.4 10.0 13.0 + 3.0 12.0 13.7 + 1.7 12.7 15.3 + 2.6 16.0 9.7 - 6.3 12.3 15.7 ♦ 3.4 12.3 14.7 + 2.4 14.0 9.3 - 4.7 16.7 18.7 + 2.0 13.3 15.7 + 2.4 12.3 11.3 - 1.0 10.3 16.0 ♦ 5.7 6.3 13.7 ♦ 7.4 14.7 10.7 - 4.0 9.7 12.0 ♦ 2.3 16.0 14.0 - 2.0 13.0 15.3 ♦ 2.3 10.7 11.3 + .6 9.0 10.7 ♦ 1.7 10.3 10.3 0.0 9.0 12.3 ♦ 3-3 11.0 9.7 - 1.3 9.7 11.0 + 1.3 13.7 13.3 - *4 16.0 16.7 ♦ .7 14.7 13.7 - 1.0 9.7 5.0 - 4.7 ■*■22.0 +22.9 -35.1 M-12.5 14.0 11.0 13.6 13.2 10.9 T- 17.5 0 9 Sign. Level .05 .01 «01 (2-tailed) Results of Difference Scores Between Groups Groups U df Sign. Level (2 tailed) Which group ia higher Craft and Therapy Craft and Control 34 20 N.S. __________________ 6 21 Beyond .002 Craft class Therapy and Control 27 27 Beyond .002 Therapy group 9k Mann Whitney U Teat was then employed to ascertain whether the difference scores for the three groups were signifi cantly different. The results, also shown in Table 21, page 93, indicate that the craft and therapy groups were not significantly different from each other, while the control group was significantly different from both activity groups. Thus, both the therapy and craft group improved significantly as compared with the control group on the variable of Emotional Tone, as measured by the Thematic Apperception Test. Results on "Self Concept* 1. — Table 22, page 95, shows the changes on the second variable, that of "Self Concept," a measure of self esteem as revealed in the treatment of the hero of the TAT stories. It can be seen that both the therapy and the craft groups showed significant positive changes, at the .05 and the .02 levels of confidence, respectively, while the control group showed negative changes— significant only at the .10 level, however. Difference scores were calculated for each patient on the "Self Concept" variable, and the Mann Whitney U Test was calculated to ascertain the differences between groups. Results indicate that both the craft and the therapy groups improved more than did the control group, and, further, that the craft group improved significantly more than did 95 TABLE 22 RESULTS ON SELF CONCEPT VARIABLE, USING THE WILCOION MATCHED-PAIRS SIGNED-RANKS TEST Therapy Craft Control Pre Poet Post- Pre Pre Post Post- Pre Pre Poet Post- Pre 19.3 15.7 - 3.6 12.0 12.3 + .3 8.3 9.3 + 1.0 12.3 15.3 ♦ 3.0 13.7 17.7 + 4.0 11.0 10.0 - 1.0 13.0 14.3 + 1.3 1.3 6.7 + 5.4 15.3 11.7 - 3.6 7.3 9.3 + 2.0 8.7 12.3 + 3.6 10.0 12.3 + 2.3 11.7 12.3 + .6 14.0 18.0 + 4.0 16.3 10.3 - 6.0 14.3 12.7 - 1.6 8.0 7.0 - 1.0 7.0 8.7 + 1.7 18.7 21.0 + 2.3 14.0 19.0 + 5.0 13.0 11.3 - 1.7 8.0 13.0 + 5.0 6.0 14.3 + 8.3 12.3 9.0 - 3.3 10.7 12.0 + 1.3 15.3 13.3 - 2.0 13-7 15.7 + 2.0 10.3 7.3 - 3.0 10.3 10.7 + .4 9.0 7.0 - 2.0 8.7 10.3 ♦ 1.6 6.0 8.3 + 2.3 7.0 7.3 + .3 11.7 12.7 + 1.0 16.0 16.3 + .3 16.0 10.7 - 5.3 5.3 4.3 - 1.0 +14.9 +29.6 -19.9 M-12.2 13.3 9.7 13.4 11.1 9.8 T- 20.5 2 -30.5 Sign. Level .05 .02 .10 (2 tailed) RESULTS OF DIFFERENCE SCORES BETWEEN GROUPS Groups U df Sign. Level (2 tailed) Which group is higher Craft and Therapy 26.5 20 .10 Craft class Craft and control 11.5 21 .002 Craft class Therapy and Control 53-5 27 .05 Therapy group 96 the therapy group on the "Self Concept" variable. This is also illustrated in Table 22. Results on "Social Distance".— For the third variable, "Social Distance," a measure of the strength of interpersonal relations as revealed by the TAT stories, the therapy and craft groups again each showed significant positive changes, at the .10 and .01 levels, respectively, while the control group1s score decreased beyond the .01 level of significance. This is shown in Table 23, on page 97. Difference scores were calculated and the Mann Whitney U test shows that, between groups, both the therapy and the craft groups improved on the variable of "Social Distance" significantly more than did the control group (both P*s beyond the .002 level). There were no significant differences between the two activity groups. This is shown in Table 23, page 97. Results on "Conflict".— For this variable, which measures the degree of positive, mature relations between the hero and others in the TAT productions, the therapy group showed positive changes, significant at the .02 level of confidence. The craft class also showed positive changes, but not significantly so, while the control group*s scores changed in a negative direction, significant at the .01 level of confidence. These results are reported in 97 TABLE 23 RESULTS ON "SOCIAL DISTANCE" VARIABLE, UTILIZING THE WILCOXON MATCHED-PAIRS SIGNED-RANKS TEST Therapy Craft Control Pre Post Post- Pre Pre Post Post- Pre Pre Post Post- Pre 21.3 20.0 - 1.3 12.7 15.7 + 3.0 14.7 14.0 - .7 16.0 18.3 + 2.3 15.3 16.0 + .7 16.7 15.7 - 1.0 16.7 16.0 - .7 9.0 11.0 + 2.0 13.7 9.7 - 4.0 12.7 16.7 + 4.0 11.3 17.0 + 5.7 18.7 14.0 - 2.6 15.7 20.0 + 4.3 18.3 19.7 + 1.4 18.0 15.3 - 2.7 IB. 7 19.7 + 1.0 12.0 13.3 + 1.3 13.0 13.0 0.0 20.0 18.0 - 2.0 18.3 20.0 ♦ 1.7 19.3 15.0 - 4.3 11.3 17.3 ♦ 6.0 15.3 16.7 + 1*4 11.7 12.7 + 1.0 19.7 21.7 + 2.0 19.7 17.7 - 2.0 21.3 17.7 - 3.6 16.3 13.7 - 2.6 11.7 13.7 + 2.0 16.0 13.3 - 2.7 15.3 18.3 + 3.0 15.3 14.3 - 1.0 13.7 13.7 0.0 15.3 16.0 + .7 15.3 18.0 + 2.7 17.7 16.3 - 1.4 12.7 9.3 - 3.4 i- +19.7 +17.2 -28.5 K»16.4 17.8 14.0 16.2 15.9 14.0 T- 18 0 5.5 Sign. .10 .01 .01 Level (2 tailed) RESULTS OF DIFFERENCE SCORES BETWEEN GROUPS Groups U df Sign. Level (2 tailed) Which group i; higher Craft and Therapy 52.5 20 N.S. «■ a mm Craft and Control 1.5 21 Beyond .002 Craft class Therapy and Control 32 27 Beyond .002 Therapy group in Table 24, page 99* Difference scores were then calculated and the Mann Whitney U Test shows that, between groups, both the therapy group and the craft class improved more than did the control group (significant at the .02 and beyond the .002 levels, respectively). The craft and therapy groups did not differ significantly on this variable. This is also reported in Table 24, page 99• Results on "Average Number of Words per Story".— The next variable which was calculated was that of "Average Number of Words per Story." The experimenter counted the number of words for every story for each patient, and obtained for each patient the mean number of words for the group of seven pre-activity TAT*s, as well as the mean number of words for the post-activity TAT*s. Using the Wilcoxon Matched-Pairs Signed-Ranks Test, the significance of the differences in the pre- and post activity TAT1s were calculated within groups. Results are reported in Table 25, page 100, where it can be seen that no significant differences were found for either the therapy or the craft groups, while the average number of words per story for the control group declined significantly beyond the .01 level of confidence. As can be seen from Table 25, the difference scores show that the craft and control groups were 99 TABLE 24 RESULTS ON THE "CONFLICT" VARIABLE, UTILIZING THE WILCOXON MATCHED-PAIRS SIGNED-RANKS TEST Therapy Craft Control Pre Post Post- Pre Pre Post Post- Pre Pre Poat Post- Pre 20.7 16.7 - 4.0 8.7 8.7 0.0 9.3 8.0 - 1.3 10.3 14.0 + 3.7 14.3 13.0 - .7 9.0 9.7 + .7 12.7 13.3 + .6 4.3 6.0 + 1.7 12.0 10.7 - 1.3 9.7 12.0 + 2.3 5.7 12.0 + 6.3 12.3 11.7 - .6 11.3 16.0 ♦ 4*7 15.0 13.3 - 1.7 12.0 12.0 0.0 14.0 14.3 ♦ .3 11.7 12.7 + 1.0 12.0 11.7 - .3 12.0 14.0 + 2.0 14.7 18.3 + 3*6 13.3 9.3 - 4.0 4.3 13.0 + 8.7 5.0 11.0 + 6.0 10.3 11.7 + 1.4 8.7 11.0 + 2.3 14.0 11.0 - 3.0 13.3 19.7 ♦ 6.4 10.3 10.0 - .3 11.7 10.3 - 1.4 7.7 5.7 - 2.0 7.0 9.0 + 2.0 10.3 8.0 - 2.3 11.7 12.0 + .3 12.0 8.0 - 4.0 14.7 17.0 + 2.3 12.7 4.0 - 1.6 - 2.3 £- +30.2 +16.2 -20.9 M-11.6 13.7 9.9 11.9 11.0 9.6 T- 15 5.5 11 Sign. Level .02 N.S. .01 (2 tailed) Results of Difference Scores Between Groups Si<^n. Level Which group Groups U df (2--tailed) is higher Craft and Therapy 49 20 N.S. ------- Craft and Control 18.5 21 .02 Craft class Therapy & Control 28.0 27 .002 Therapy group 100 TABLE 25 RESULTS ON THE "AVERAGE NUMBER OF WORDS PER STORY" VARIABLE USING THE WILCOXON MATCHED-PAIRS SIGNED-RANKS TEST Therapy Craft Control Pro Post Post- Pre Pre Post Post- Pre Pre Post Post- Pre 172 138 - 34 63 40 _ 23 195 93 -102 97 84 - 13 54 69 + 1^ 39 48 + 11 55 58 + 3 24 33 + 9 50 33 - 17 37 37 0 103 111 + 8 115 51 - 64 181 215 + 34 163 159 - 4 48 66 + 18 94 77 - 17 46 51 + 5 35 31 - 4 120 64 - 56 61 71 + 10 144 74 - 70 51 57 + 6 49 46 - 3 95 74 - 21 70 103 + 37 107 96 - 11 70 56 - 14 107 97 - 10 52 21 - 31 72 28 - 44 74 39 - 35 55 60 + 5 75 62 - 13 61 46 - 15 68 84 + 16 12 5 77 - 48 126 29 - 97 *« -117 + 17 -471 M-86. ' 9 78.2 70. 4 72.5 91.6 60.2 T- 28.5 11.0 13 Sign. Level N.S. N.S. .01 (2 tailed) Results of Difference Scoresi Between Groups Groups U df Sign. Level (2 tailed) Which group is higher Craft and Therapy Craft and Control Therapy and Control 38 23-5 72.5 20 21 27 N. N*. S. 02 S. Craft Class 101 significantly different from each other (at the .02 level), but the therapy group was not significantly different from the control group or from the craft class. Results on "Number of Self References”.— For the next TAT variable, which is a measure of egocentrieity, the examiner counted the number of first person pronouns and direct references to the narrator for each patient1s total pre-activity stories, and for each patientTs total post activity stories. The Wilcoxon statistic indicates that there were no significant differences within either the therapy group or the craft class, while the control groins scores on this variable decreased significantly at the .01 level of confidence. This is shown in Table 26, page 102. Difference scores were also calculated for this variable, and the Mann Whitney U Test indicates that none of the groups were significantly different from the others. This is also illustrated in Table 26. on "Number of 1Zwaang1 Expressions".--For this variable, a measure of compulsivity, the examiner counted the number of expressions such as, "I have to," "I must," "He is forced to," etc. for the total pre- and post-activity TAT's for each group. The results of within group comparisons, utilizing the Wilcoxon statistic, indicate that no significant changes were seen in either the therapy or the craft group, while these expressions 102 TABLE 26 RESULTS ON "NUMBER OF SELF REFERENCES" VARIABLE, UTILIZING THE WILCOXON MATCHED-PAIRS SIGNED-RANKS TEST Therapy Craft Control Pre Post Post- Pre Pre Post Post- Pre Pre Post Post- Pie 12 12 0 23 14 - 9 39 25 -14 8 19 +11 13 7 - 6 16 6 -10 11 12 + 1 8 8 0 25 13 -12 7 3 - 4 27 17 -10 21 6 -15 55 63 + 8 41 17 -24 11 16 + 5 19 6 -13 15 19 + 4 9 8 - 1 14 12 - 2 18 20 + 2 30 18 -12 21 27 ♦ 6 6 6 0 29 20 - 9 22 23 + 1 21 19 - 2 1 2 ♦ 1 26 24 - 2 15 0 -15 7 12 ♦ 5 18 6 -12 12 13 + 1 23 13 -10 15 14 - 1 12 21 + 9 24 42 17 17 - 7 -25 im -19 -43 -99 M-17. 0 15.6 18. 5 13.5 21.8 15.2 T- 54 3 15 Sign. N.S. N.S. .01 Level (2 tailed) Results of difference scores between groups Groups U df Sign. Level (2 Tailed) Craft and Therapy 45 20 Not Significant Craft and Control 46.5 21 Not Significant Therapy and Control 89.5 27 Not Significant 103 decreased significantly, at the .05 level, in the control group. This is shown in Table 27, page 104. Difference scores were calculated, and the Mann Whitney U Test tuilized to examine the differences between groups. The results, also reported in Table 27, show that no significant differences were found between the craft and therapy groups, or between the craft and control groups, but the therapy and control groups were significantly different at the .10 level of confidence. Results on "Time Span”.— For this variable, which measures the broadness or the constriction of time per ception in fantasy as revealed in TAT productions, the experimenter rated the stories for each patient, summed the ratings for each patient*s pre-activity stories and calculated the means for each group. The same procedure was followed on the post-activity stories. Utilizing the Wilcoxon test, results show that no significant changes in time perception occurred within either the therapy or the craft groups, while there was a narrowing of time perception in the control group, significant at the .02 level of confidence. This is shown in Table 23, page 105. Difference scores were calculated, and the Mann Whitney U Test shows that, between groups, the craft group was not significantly different from the therapy group. The therapy group, however, was significantly 104 TABLE 27 RESULTS ON THE "NUMBER OF 'ZWAANG' EXPRESSIONS" VARIABLES USING WILCOXON MATCHED-PAIRS SIGNED-RANKS TEST Therapy Craft Control Pre Post Post- Pre Post Post- Pre Post Post- Pre Pre Pre 1 1 0 0 0 0 6 1 - 5 2 3 + 1 0 2 + 2 0 0 0 0 0 0 1 0 - 1 1 0 - 1 3 2 - 1 6 2 - 4 1 1 0 2 3 + 1 0 0 0 0 0 0 6 1 - 5 3 2 - 1 3 2 - 1 1 2 + 1 0 1 + 1 3 2 - 1 2 3 + 1 5 0 - 5 2 2 0 0 1 + 1 0 0 0 1 0 - 1 4 0 - 4 0 2 + 2 1 2 + 1 1 2 + 1 0 0 0 6 3 - 3 4 1 - 3 0 0 0 0 0 0 4 2 - 2 i- - 2 - 8 -16 M- 1.8 1.6 1.9 .9 1.9 .9 T- 30 6 2.5 Si.^n. N.S. N.S. .05 Level (2 tailed) Results of Difference Scores Between Groups Groups U df Sign* Level Which Group (2 tailed) is higher Craft and Therapy 42 20 N.S. Craft and Control 56.5 21 N.S. _ _ _ .■ M M Therapy and Control 62.5 27 .10 Therapy group 105 TABLE 28 RESULTS ON THE "TIME SPAN" VARIABLE, USING WILCOXON MATCHED-PAIRS SIGNED-RANKS TEST Therapy Craft Control Pre Poet Post- Pre Pre Post Post- Pre Pre Post Post- Pre 34 18 -16 13 10 - 3 13 7 - 6 33 33 0 15 16 + 1 8 8 0 14 13 - 1 8 8 0 18 14 _ L 8 8 0 8 8 0 14 8 - 6 22 28 + 6 9 29 +19 18 17 - 1 7 7 0 19 14 - 5 8 9 + 1 40 39 - 1 8 10 + 2 13 10 - 3 13 13 0 7 8 + 1 8 7 - 1 7 8 + 1 43 23 -20 16 14 - 2 17 8 - 9 8 11 ♦ 3 13 8 - 5 7 12 + 5 14 21 ♦ 7 8 8 0 14 7 - 7 17 28 +12 11 9 - 2 9 7 - 2 *- +15 + 7 -58 M-16.7' 17.2 10.9 12.8 14.7 10.9 T- 17 9 13.5 Sign. N.S. N.S. .02 Level (2 tailed) Results of Difference Scores Between Groups Groups U df Sign. Level Which Group (2 tailed) is higher Craft and Therapy 54 20 N.S. Craft and Control 26 21 .05 Craft class Therapy and Control 44 27 .02 Therapy group 106 different from the control group at the .02 level of confidence* Also, the craft group was significantly different from the control group, at the .05 level. These results are also shown in Table 26. Results on "Space Span11.— For this variable, which is a measure of the broadness or constriction of space perception in fantasy as revealed in TAT stories, the same statistical procedures were adhered to as with the "Time Span" variable. No significant differences were seen within either the Therapy group or the craft group, whereas the control group showed a shrinking of space perception, significant at the .10 level of confidence. These results are shown in Table 29, page 107. Difference scores were calculated and show that there were no significant differences between the craft and therapy groups, nor were there any between the craft and control groups, but there was a difference, significant at the .05 level of confidence, between the therapy and the control group. These results are also illustrated in Table 29. Summary on TAT measures.— In summary, for the nine TAT measures, the following was done: 1. Reliability studies were undertaken on six of the nine TAT scales used, the resultant reliability figures being deemed sufficiently high for the utilization 107 TABLE 29 RESULTS ON THE "SPACE SPAN" VARIABLE- USING THE WILCOXON MATCHED-PAIRS SIGNED-RANKS TEST Therapy Craft Control Pre Post Post- Fre Pre Post Post- Pre Pre Post Post- Pre 24 18 - 6 8 7 - 1 11 11 0 20 19 - 1 9 12 ♦ 3 8 7 - 1 11 13 + 2 8 7 - 1 12 12 0 9 9 0 9 9 0 15 8 - 7 9 15 + 6 10 9 - 1 9 11 + 2 8 12 + 4 8 11 + 3 12 12 0 15 + 1 10 8 - 2 16 15 - 1 3 9 + 1 8 7 - 1 8 9 + 1 11 14 ♦ 3 13 $ c 12 12 0 18 10 - 8 8 7 - 1 15 7 - 8 7 12 + 5 8 10 + 2 9 9 0 8 8 0 18 18 0 9 9 0 11 8 - 3 +14 0 -12 M-12.0 13.0 8.8 8.8 11. 5 9.7 14.5 13 11 Sign. N.S. N.S. .10 Level (2 tailed) Results of Difference Scores Between Groups Groups U df Sign. Level Which Group (2 tailed ) is higher Craft and Therapy 3 5 20 N.S. Craft and Control 51.5 21 N.S. Therapy and Control 58 27 .05 of the scales in the study. 2. For each of the three groups, within-group changes were calculated, on all of the nine variables, and the following significant changes were found, as illus trated and summarized in Table 30, page 109: The therapy group improved significantly on the first four measures and did not change significantly on the others. The craft class improved significantly on the first three measures and did not change significantly on the others. The con trol group declined significantly on all nine measures. 3 . Difference scores were calculated for each patient by subtracting pre-activity scores from post activity scores on each of the nine measures, and the Mann Whitney U Test used to test the significance of the differences of these scores between groups. The results are summarized in Table 31, page 110. From this table, it can be seen that the therapy and craft groups were not significantly different from each other on eight of the nine TAT variables. The craft and control groups were significantly different on six of the nine variables, with the craft class being significantly higher than the control group on these six. The therapy group was significantly higher than the control group on seven of the nine variab les and not significantly different on the other two. The meaning of these specific findings will be elaborated upon 109 TABLE 30 DIRECTION OF SIGNIFICANT CHANGES FROM PRE-TESTING TO POST-TESTING ON NINE TAT MEASURES WITHIN THREE GROUPSa Measures Groups Therapy Craft Control 1. Emotional Tone Improvement (P - .05) Improvement (P - .01) Decline (P ■ beyond .01) 2. Self Concept Improvement (P - .05) Improvement (P - .02) Decline (P - .10) 3. Social Distance Improvement (P - .10) Improvement (P - .01) Decline (P - .01) 4. Conflict Improvement (P - .02) No Signif. Change Decline (P - .01) 5. Average No. Words/Story No Signif. Change No Signif. Change Decline (P - .01) 6. No. of Self References No Signif. Change No Signif. Change Decline (P - .01) 7. No. of "Zwaang" Expressions No Signif. Change No Signif. Change Decline (P - .05) 8. Time Span No Signif. Change No Signif. Change Decline (P - .02) 9. Space Span No Signif. Change No Signif. Change Decline (P - .10) aAll significance levels two tailed tests. 110 TABLE 31 DIFFERENCE SCORES BETWEEN THE THREE GROUPSa Measures Craft & Therapy Craft & Control Therapy & Control 1.Emotional Tone N.S. Sign, beyond .002 (craft higher than control) Sign, beyond .002 (therapy higher than control) 2. Self Concept Sign, at .10 {craft higher) Sign, beyond .002 (craft higher) Sign, at .05 (therapy higher) 3. Social Distance N.S. Sign, beyond .002 (craft higher) Sign, beyond .002 (therapy higher) 4 • Conflict N.S. Sign, at .02 (craft higher) Sign, at .002 (therapy hi^ier) 5. Average No. Words/Story N.S. Sign, at .02 (craft higher) N.S. 6.No. of Self References N.S. N.S. N.S. 7. No. of "Zwaang* 1 Expressions N.S. N.S. Sign, at .10 (therapy higher) b. Time Span N.S. Sign, at .05 (craft higher) Sign, at .02 (therapy higher) 9. Space Span N.S. N.S. Sign, at .05 (thaapy hi^er ) aAll significance levels two tailed tests in the discussion chapter 111 Self Sorts The Self-Sorts were utilized as a means of evaluating the subject’s self acceptance by virtue of a comparison of their sortings of a standard group of 100 self-referent statements describing their real selves and by sorting the same statements to describe their ideal selves. As in the literature dealing with this evaluative method, it is assumed that a close concordance between real and ideal self descriptions suggests self-acceptance within the subjects. At the completion of the post-activity testing period, there were available for each experimental and control patient, four self-sorts: (1) a description of the patient’s real-self prior to the activity period, (2) a description of the patient’s ideal-self prior to the activity period, (3) a description of the patient’s real-self following the activity period, and (4) a description of the patient’s ideal-self following the activity period. For each patient, individual product moment correlation coefficients were calculated for each of the six combinations of pre-real, pre-ideal, post-real, and post-ideal self, taken two at a time. Thus, the following six combinations were calculated: (1) Pre-real: Post-real# 112 (2) Pre-real: Pre-ideal, (3) Pre-real: Post-ideal, (4) Post-real: Pre-ideal, (5) Post-real: Post-ideal, and (6) Pre-ideal: Post-ideal. Each correlation coefficient was then converted into Fisher,s z*s (44)» The z*s were then averaged for each of the three groups (therapy, craft, and control), and the average z*s were treated as scores. Next, the differences between pairs of mean zfs for the three groups were calculated, and Fisher t tests were computed to test the significance of the differences of mean z*s for the three groups. The mean z*s for the groups, the standard deviations, and the tfs obtained are presented in Table 32, page 113. It can be seen in that table that, except for the craft and therapy groups* pre-real: post-real mean z*s (which were significantly different at the .10 level), there were no significant differences found between the groups. In order to obtain information about the direction of change, the method used by Ends and Rage (39) was employed. What was needed was to obtain the differences between pairs of z*s. For example, by subtracting the pre-real: Pre-ideal z from the post-real: post-ideal z, it is possible to determine whether or not the real and ideal selves converged or diverged during the activity period. Therefore, the difference score between each TABLE 32 MEAN Z*S FOR THE THREE GROUPS 113 Sorts Correlated Craft S.D. Con- S trol .D. d t Sign. PreReal:PostReal .4210 .145 .4976 .194 -.0766 - .950 NS PreReal:Preideal .3416 .195 .4657 .250 -.1239 -1.167 NS PreReal:Postideal .3796 .156 .4364 .211 -.0566 - .651 NS PostReal:PreIdeal .4260 .146 .3967 .169 .0293 .394 NS PostReal:Postideal .5026 .106 .4372 .372 .0656 .463 NS Preideal:Postldeal .4705 .156 .5927 .228 -.1222 -1.317 NS Sorts Correlated Ther apy S.D. Con trol S.D. d t Sign. PreReal:PostReal .5547 .169 .4976 .194 .0571 .813 NS PreReal:Preideal .3942 .254 .4657 .250 -.0715 - .737 NS PreReal:Postldeal .3993 .267 .4364 .211 -.0371 - .367 NS PostReal:Preideal .4662 .294 .3967 .169 .0695 .760 NS PostReal:Postldeal .5061 .302 .4672 .372 .0709 .554 NS Preideal:Postldeal .5723 .261 .5927 .228 -.0204 - .217 NS Sorts Correlated Craft S.D. Ther apy S.D. d t Sign. PreReal:PostReal .4210 .145 .5547 .169 -.1337 -1.787 .10 PreReal: PreIdeal .3418 .195 .3942 .254 -.0524 - .481 NS PreReal:Postldeal .3796 .156 .3993 .28? -.0197 - .171 NS PostReal:Preideal .5028 .108 .5081 .302 -.0053 - .046 NS PostReal:Postldeal .4280 .146 .4682 .294 -.0402 - .345 NS Preideal:Postldeal .4705 .156 .5723 .261 -.1018 - .959 NS pair of z*s for each subject were summed algebraically for each of the comparisons made. Group mean differences were then calculated, hereafter called Indexes, and 114 significance of differences between uncorrelated group mean zfs were calculated, using McNemar's procedure {95) • The following indexes of change were utilized: Index 1* The Pre-real: Pre-ideal z was subtracted from the Post-real: Post-ideal z. This index would indicate whether or not the real and the ideal selves converged or diverged during the period of the activities or during the equivalent period for the control group where no activities took place. A plus score suggests that the concepts converged. Index 2. The Pre-real: Post-real z was subtracted from the Pre-ideal: Post-ideal z to indicate whether the real or the ideal self changed more. A plus sign indicates that the ideal is the more stable concept. Index 3- The Pre-real: Pre-ideal z was subtracted from the Post-real: Pre-ideal z to indicate whether the real self moved toward or away from the Pre-ideal during the course of the experiment. A plus score means the real self moved toward the pre-ideal. Index 4- The Pre-real: Post-ideal z was subtracted from the Post-real: Post-ideal z to indicate whether the real self moved toward or away from the Post-ideal during the course of the experiment. A plus score means the real self moved toward the Post-ideal. Index 5. The Pre-real: Pre-ideal z was subtracted 115 from the Pre-real: Post-ideal z to indicate whether the ideal tended to move toward or away from the Pre-real self during the experiment. A plus score means the Ideal moved toward the Pre-real self. Index 6. The Post-real: Pre-ideal z was subtracted from the Post-real: Post-ideal z to indicate whether the ideal moved toward or away from the Post-real self during i the experimental period. A plus score means that the ideal moved toward the Post-real self. The results of the statistical calculations on the Indexes are seen in Table 33, below. TABLE 33 Q-SORT MOVEMENT FOR THERAPY GROUP, CRAFT CLASS, AND CONTROL GROUP Index Index Index Index Index Index 1 2 3 4 5 6 Therapy Group Md .1139 .0761 .0740 .1038 .0051 .0399 t Signif. 2.1653 .32 1.75 2.11 .11 .70 Level .05 .76 .11 .06 .92 .50 Craft Class Md .1610 .0495 .0862 .1232 .0378 .0748 t Signif. 2.51 .85 1.10 1.50 .48 1.05 Level .04 .43 .31 .18 . 66 .35 TABLE 33--Continued 116 Index Index Index Index Index Index 1 2 3 4 5 6 Control Group Md -.0265 .0951 - .0670 .0006 -.0293 .0365 t -.41 1.43 -1.06 .01 -.63 .52 Signif. Level .69 .16 .30 .99 .55 .62 It can be seen from Table 33 that the therapy group showed significant change on the first and on the fourth indexes. The first index showed a significant convergence of the real and ideal selves, significant at the .05 level of confidence. The fourth index suggests that the real self tended to move in the direction of the Post-ideal self {significant at the .06 level). Index 3 also showed changes which came very close to the accepted significance level of .10 (.11), and suggests that the real self moved toward the Pre-ideal self during the experiment. Thus, in the therapy group, the real and ideal selves ten ded to converge, and the subjects apparently showed changes in the real 3elf so as to fall more in line with their ideal selves, both post- and pre-activity. For the craft class, Index 1 indicates that, as with the therapy group, the real and ideal selves 117 tended to converge during the experiment, significant at the .04 level of confidence. The data suggests that the direction of the change appears to be the real self*3 movement toward the Post-ideal self as seen in Index 4— while there is a slight suggestion of such movement, it is not statistically significant. Thus, the change in the craft class seems to be in the same direction as in the therapy group— i.e., a convergence of the real and ideal selves. A non significant tendency for the real self to move in a direction conforming more with the Post-ideal self was also found here. For the control group, no statistically significant changes were seen. The real and ideal selves tended to diverge, but not significantly, as indicated by Index 1. There are suggestions that the ideal self was the more stable concept than the real self, as shown in Index 2. With respect to Index 3, there is slight suggestion that the real self moved away from the pre-ideal self during the course of the experiment. None of these changes in the control group reached statistical significance, however. Movement differences between the three groups were also calculated, and these are reported in Table 34, page 118. As can be seen in that table, only two indexes are significantly different between the groups, namely, 118 Index 1 and Index 3* Thus, Tor Index 1, the craft and therapy groups1 real and ideal selves tended to converge significantly more than did the control groups*. Actually, both the experimental groups* real and ideal selves con verged, while the control group*s real and ideal selves tended to diverge. Further, there was no significant difference found in this trend of convergence between the craft and the therapy groups. On Index 3, it can be seen that, for both the therapy and the craft groups, a statistically significant tendency was found for the real self to change in a direction congruent with the relatively rcre stable Pre ideal self--and, actually, the trend in the control group is for the real self to move away from the Pre-ideal self after the experimental period. TABLE 34 MOVEMENT DIFFERENCES BETWEEN THE GROUPS USING MANN WHITNEY U TEST, TWO TAILED Groups Index 1 Index 2 Index 3 Index 4 Index 5 Index 6 Craft & Therapy (df - 20) U-43 NS U-47 NS U-56 NS U-53 NS U-51 NS U-56 NS Craft & fas^iu U-28 U-47 NS. Wr32 oign. at .10 U-46 NS U =44.5 NS U-59 M Q n O TABLE 34— Continued 119 Groups Index 1 Index 2 Index 3 Index 4 Index 5 Index 6 Therapy & U*63 u - a i U-43.5 U-7S U-7S U-105 Control (df - 27) Sign, at .10 NS Sign, at .02 NS NS NS Summary for the Self Sorts.— The following within- group changes were seen: in both the therapy and craft groups, the real and ideal selves converged significantly, with the 'eal self moving toward the ideal self; no sig nificant changes in the control group were found. Movement differences between groups show that the craft and therapy groups are each significantly different from the control group, in that both the experimental groups* real and ideal selves converged, whereas this was not the case in the control group— indeed, such trends as were evident in that group were in the direction of divergence. In both experi mental groups, the tendency for the real self to move to ward the relatively more stable ideal self was in evidence and was also significantly different from the control group. Hospital Adjustment Test At the completion of the post-activity testing period, there was available for all patients two separate ratings of the Hospital Adjustment Test completed by 120 nursing personnel for both pre-activity and post-activity phases. Therefore, when available, those pre- and post- activity tests were utilised in the study which were completed by morning-shift attendants or nurses. When such were not available, afternoon-shift nursing personnel forms were utilised. It should be noted that, with respect to five patients, the post-activity tests had been completed by different nursing personnel who had filled out the pre-activity Tests, due to transfer of such nursing personnel. The five cases in which the pre activity and post-activity Tests had been completed by different personnel were also included in the study, since they were, more or less, distributed evenly in the three experimental groups. These data are reported in Table 35, below. TABLE 35 SOURCES OF HOSPITAL ADJUSTMENT TEST RATINGS: NUMBER OF TESTS COMPLETED BY SAME AND DIFFERENT RATERS Therapy Group Craft Class Control Group Same Different Same Different Same Different Rater Raters Rater Raters Rater Raters AM PM AM PM AM PM 7 5 2 4 4 0 9 3 3 121 The Mann Whitney U Test was run to determine whether, prior to the beginning of the activities, there was any significant difference between the two activity groups and the control group scores on the Hospital Adjustment Test. These data are reported in Table 5, page 51, and the results indicate that there were no significant pre-activity differences between the three groups on this test. Using the differences between pre- and post-activity Hospital Adjustment Test scores, the same statistic was run, and it was ascertained that following the activity period, the difference between the craft and control groups was not significant; the difference between the craft and therapy groups was not significant; but the difference between the therapy and the control groups was significant at the .02 level of confidence. This is reported in Table 36, page 122. Next, the Wilcoxon Matched-Pairs Signed-Ranks Test was run for each of the three groups individually, to determine whether there were any changes within the groups. The results indicate the following: (1) the therapy group showed an Increase in scores following the activity period, significant at the .10 level, (2) the craft class showed no significant change in scores, and (3) the control group showed a decrease in scores, significant at the .05 level. These results are seen in 122 TABLE 36 COMPARISON BETWEEN GROUPS AFTER THE CONCLUSION OF ACTIVITIES, ON THE HOSPITAL ADJUSTMENT TEST MEASURE, USING THE MANN-WHITNEY U TEST (TWO TAILED) Therapy Craft Control Pre Post Post- Pre Pre Post Post- Pre Pre Post Post- Pre 97 99 ♦ 2 73 99 + 2 73 62 - 9 70 96 +26 47 69 +22 77 65 - 12 96 90 - 6 73 58 -15 49 68 + 19 SO 86 + 6 75 52 -23 99 83 - 16 65 55 -10 79 59 -20 81 80 - 1 51 76 +25 81 82 + 1 78 74 - 4 S3 96 ♦13 90 84 - 6 92 71 - 21 36 74 -12 75 85 +10 78 59 - 19 65 S3 +18 96 88 - 8 90 39 - 1 83 64 - 19 S3 90 + 2 90 75 - 15 67 65 - 2 66 59 - 7 36 93 + 7 61 76 ♦ 15 60 79 +19 81 68 - 13 55 54 - 1 ♦87 -10 -111 M-77-4 83.6 74.8 73.5 73-3 69.7 *"13.73 12.20 11.58 18.15 14.07 9.31 Results Between Groups Groups U df Sign. Level Which group (2 tailed) is higher Craft and Therapy 48.5 20 N.S. Craft and Control 40.5 21 N.S. » _ . . _ _ Therapy and Control 40.0 27 .02 Therapy group 123 Table 37, below. TABLE 37 COMPARISON OF WITHIN GROUP CHANGES ON THE HOSPITAL ADJUSTMENT TEST, USING THE WILCOXON MATCHED-PAIRS SIGNED-RANKS TEST Therapy Craft Control Pre Post Pre Post Pre Post M - 77.4 ^3.6 74.8 73.5 77.3 69.7 6 • 13.78 12.20 11.58 IB.15 14.07 9.31 Signif. at .10 level N.S. Signif. at .05 level Final Questionnaire The final questionnaire was administered to each craft and therapy patient at the completion of the activity period. This questionnaire was used to obtain some indication from the patients directly as to their positive and negative feelings about the activity in which they participated. The questionnaire consisted of twenty-six items, divided into three sections: (1) "Things I liked about the group", (2) "Things I disliked about the group", and (3 )"joining other groups like this one." The items were obtained from statements made by the patients during the course of the group activities. A copy of the final 124 questionnaire is reproduced In Appendix J, page 187. The questionnaire was administered to each of the patients in the experimental groups with the instructions that they check the items pertaining to their feelings about the activity. The questionnaire was confidential, and the patients were so informed; and they were requested to complete the questionnaires independently of other patients. They were not to affix their names on the forms, but each questionnaire was coded. The results of the questionnaire, utilising the Fisher Exact Probability statistic, are shown in Table 38, below. TABLE 36 RESULTS OF FINAL QUESTIONNAIRE41 Section 1: Things I Liked about the Group Question Group Checked P Signif. Yes No Level 1. Liked learning Therapy 12 2 .39394 N.S. new things Craft 8 0 2. Liked learning Therapy 6 8 .38853 N.S. re. myself Craft 4 4 3. Liked learning Therapy 8 6 .38853 N.S. re. others Craft 4 4 125 TABLE — Continued Question Group Checked Yes No P Signif. Level 4. Liked making Therapy 10 4 .38012 N.S. new friends Craft 7 1 5. Liked chance Therapy 12 2 .03226 .03 to speak ray Craft 3 5 mind freely without fear of the conse quences 6. Liked group Therapy 14 0 1.00000 N.S. leader Craft 8 0 7. Liked to talk Therapy 2 12 .70909 N.S. re. myself Craft 1 7 3. Liked helping Therapy 7 7 .67028 N.S. others Craft 4 4 9. Liked the Therapy 3 11 .07208 .07 chance to get Craft 5 3 out of bed more often 10.Liked the Therapy 12 2 .70909 N.S. chance to get Craft 7 1 away from the ward for a while 11.Liked using Therapy 11 3 .76714 N.S. ray head Craft 6 2 TABLE 36— 'Continued 126 Question Group Checked Yes No P Signif. Level. 12• Other Therapy 1 13 .63636 N.S. Craft 0 3 Section 2: Things I Disliked about the Groups 1. Problems get Therapy 5 9 .4696S N.S. ting to and Craft 2 6 from the group 2. Problems with Therapy 0 14 1.00000 N.S. having nurses Craft 0 3 got me ready for grop 3. The time of thet Therapy 3 11 .76714 N.S. meetings was Craft 2 6 not con venient 4* I’m too old Therapy 0 14 .36364 N.S. for this sort Craft 1 7 of thing 5. Poor health Therapy 5 9 .25594 N.S. interfered with Craft 1 7 enjoyment of group 6. Didn’t like the Therapy people I met in Craft the group 0 14 1.00000 N.S. 0 3 127 TABLE 38— Continued Question Group Checked Yes No P Signif. Level 7. Didn't like the Therapy 0 14 1.00000 N.S. group leader Craft 0 8 8, It made me Therapy 0 14 .36364 N.S. nervous Craft 1 7 9. I was bored Therapy 2 12 .39394 N.S. most of the Craft 0 8 time 10•Didn't like Therapy 2 12 .39394 N.S. talking about Craft 0 8 myself 11•Didn't like Therapv 6 8 .04025 .04 talking to or Craft 0 8 listening to others Section 3: Interest in other 1 Similar Groups 1. I would join Therapy 12 2 .39394 N.S. Craft 8 0 2* I would not join Therapy 2 12 .39394 N.S. Craft 0 8 3. I would ask my Therapy 10 4 .36012 N.S. friends to join Craft 7 1 aFisher Exact Probability 128 It can be seen from Table 38 that there are significant differences between the two groups on Item 5 of Section 1; on Item 9 of Section 1; and on Item 11 of Section 2. It is suggested from these results that the therapy group subjects enjoyed the chance to speak their minds freely without fear of the consequences significantly more than did the craft class; while the craft class subjects liked the chance to get out of bed more often significantly more than did the therapy group. Also of consequence is Item 6 in Section 1, where members of both groups unanimously agreed that they liked their respective group leaders; and Item 6 In Section 2, where unanimous agreement in both groups was found that they liked the people they met in the groups. Nevertheless, on Item 11, Section 2, there was a significant difference between the therapy and the craft subjects in that some of the therapy subjects did not like listening to or talking to others in the group, suggesting a certain amount of rivalry in these patients. Also of significance is the finding that neither group found any difficulty with having nursing personnel prepare them for the groups, once the activity sessions were under way. CHAPTER IV DISCUSSION AND SUMMARY Thia chapter will be divided Into three sections. The first section will deal with the interpretation of the quantitative findings and suggestions for future research based on these findings. The section following that will be devoted to a critical discussion of the methodology and consequent limitations of the study. The third section will be the summary. Interpretation of Results Tables 39 and 40, pages 130-32, report a summary of those findings which reached statistical significance between groups and within groups on all of the tests and measures employed. It can be seen that the general trends in the data tend to support the experimental hypotheses previously developed. Referring, first, to the differences between the groups which were found, it is seen that the therapy group earned significantly higher scores on thirteen of the measures as compared with the control group. The craft class earned significantly higher scores than the 129 130 TABLE 39 SIGNIFICANT DIFFERENCES FOUND BETWEEN GROUPS AT THE CONCLUSION OF THE ACTIVITY PERIOD ON ALL MEASURING INSTRUMENTS EMPLOYED IN THE STUDY* Variable Groups Compared Craft S c . Therapy Craft S c . Control Therapy & Control I.Q. Vocabulary Similarities Vocabulary + Similarities N.S. , P - .05? P - .02b P - .10 N.S. N.S. P - .002 P - .05 P - .002 T.A.T. Emotional Tone Self Concept Social Distance Conflict Average No. Words Per Story Self References "Zwaang" Expressions Time Span Space Span N.S. P - .10c N.S. N.S. N.S. N.S. N.S. N.S. N.S. P - .002 P - .002 P - .002 P - .02 P - .02 N.S. N.S. P - .05 N.S. P - .002 P - .05 P - .002 P - .002 N.S. N.S. P - .10 P - .02 P - .10 Self Sorts Did real & ideal selves converge N.S. P - .05 P - .10 Was ideal self more stable than real self N.S. N.S. N.S. Did real self move toward N.S. P - .10 P - .02 pre-ideal TABLE 39— Continued 131 Variable Groups Compared Craft & Therapy Craft & Control Therapy & Control Did real self move toward post-ideal N.S. N.S. N.S. Did ideal self move toward pre-real N.S. N.S. N.S. Did ideal self move toward post-real • CO e z N.S. N.S. Hospital Adjust ment Test e CO • z N.S. P - .02 Final Questionnaire A chance to speak my mind freely P - .03b A chance to get out of bed more often P - ,07c Didn»t like listen ing to others P - .04b aIn all instances where experimental and control f roups are compared and significant differences are ound, it is the experimental group*s scores which are significantly higher than the scores of the control group. bThe therapy group*s scores are significantly higher than the scores of the craft class. cCraft significantly higher than therapy. 132 TABLE 40 SIGNIFICANT DIFFERENCES FOUND WITHIN GROUPS AT THE CONCLUSION OF THE ACTIVITY PERIOD ON ALL MEASURING INSTRUMENTS EMPLOYED IN THE STUDY* Variable Therapy Craft Control Vocabulary P - .05 N.S. P - .10 Similarities P - .01 N.S. N.S. Vocabulary + P - .01 N.S. N.S. Similarities Emotional Tone P - .05 P - .01 P - .01 Self Concept P - .05 P - .02 P - .10 Social Distance P - .10 P - .01 P - .01 Conflict P - .02 N.S. P - .01 Average No. Words N.S. N.S. P - .01 per Story Self References N.S. N.S. P - .01 No* "Zwaang" N.S. N.S. P - .05 Expressions Time Span N.S. N.S. P - .02 Space Span N.S. N.S. P - .10 Did real and ideal P - .05 TJ 1 e o - p - N.S. selves converge Was ideal self N.S. N.S. N.S.(P - .18) more stable Did real move to N.S. N.S. N.S. pre ideal (P - .11) Did real move to P - .06 N.S. N.S. post ideal (P - .IS) Did ideal move to N.S. N.S. N.S. pre real Did ideal move to N.S. N.S. N.S. post real Hospital Adjust P - .10 N.S. P - .05 ment Test aIn all instances in the experimental groups, the post-testing scores were significantly higher than the pre testing scores; in the control group, the opposite was the case* 133 control group on nine measures. In no Instance did the control group earn significantly higher scores than either of the activity groups at the conclusion of the activity period. Further, it can be seen that significant differ ences were found between the therapy and craft groups on three of the measures, suggesting that the pattern of change between the two activity groups, while very similar, was not yet identical. Each of the findings will be discussed individually below, and explanations offered which might serve as the basis for further investigation. Intellective measures.— With regard to the I.Q. measures and the therapy group, the hypothesized result that group therapy would improve those intellectual functions represented by the measures used (Vocabulary and Similarities) was borne out. The Vocabulary subtest, which, according to Rappaport, Gill and Schafer (103) measures range of ideas, fund of information, and learning ability, improved significantly in the therapy group as compared with the control group. It is possible that the broad range of discussion over a wide area of topics, both intellectual and affectively laden, in the therapy sessions, served to reawaken old intellectual interests and skills in the therapy patients, and helped broaden 134 the range of Ideas within these elderly people, who had resided in a routine, intellectually unstimulating environment for at least one year prior to the onset of the therapy sessions* The therapy group also improved on the Similarities subtest, as compared with the control group. Rappaport, Gill and Schafer suggest that this subtest measures verbal concept formation— the ability to recognize and verbalize relations between two ostensibly disparate qualities. Since the process of psychotherapy involves precisely that skill, namely, the recognition and relating of feelings and behavior which were not so related earlier and which, on first glance, seem disparate— it is possible that the controlled utilization of such a skill in therapy reawakened it, resulting in improvement on the .-test scores. This, of course, is merely a tentative interpretation, not fully justified by the methodology employed, but offered as a possible explanation of the improvement found. When the Vocabulary and Similarities scores were combined, the resultant combined score was significantly higher in the therapy group than the similarly combined scores of the control group, suggesting overall intellec tual improvement in the therapy group. Improvement in I.Q. in conjunction with a psychotherapeutic regimen lias 135 been reported in the literature dealing with younger and emotionally disturbed patients (77)* The findings of the present study suggest that similar improvement can be brought about with aged people, not psychologically disordered, who were living in an intellectually barren environment. Turning to the craft class and intellectual measures, it can be seen in Table 39 that on one measure, Vocabulary, the craft class was significantly higher than the control group following the activity period. However, this difference was brought about, primarily, by the drop in Vocabulary score in the control group rather than by any significant changes in a positive direction in the craft class. On the whole, the craft class did not change significantly in I.Q. measures. It may have been that this particular craft activity was sufficient to halt any trend of debilitation in the intellectual processes which might have been present, but it was not sufficiently stimulating to reawaken old intellectual skills. The drop in Vocabulary score in the control group is of theoretical interest, since this subtest has been assumed to be the most stable and impervious to change of all the VAIS subtests. The obtained results suggest that a possible reconceptualiaation is necessary when dealing with elderly subjects and I.Q. variables. 136 Looking farther at the I.Q. measures, It can be seen that on two of the measures, the therapy group scored significantly higher than did the craft class, at the conclusion of the activities, suggesting that group psychotherapy was more effective than the craft class activities in elevating intellectual functioning. Possibly this can be explained by hypothesizing that the broader range of discussion taking place in the therapy group was more effective than the concentration in the craft class on the production of ceramics and textile paintings. While there was some conversational exchange in the craft class, the topics were generally restricted to problems involved in the production of the craft items, whereas discussion in the therapy group was not so restricted. This hypothesis, of course, requires further exploration through additional research. Had it been possible to have tape recordings of the sessions as originally planned, a more precise interpretation could have been offered, based on measurable changes. A note of caution should be entertained when evaluating the results of the I.Q. measures, since, at the time of this writing, there was no information available with regard to the reliability of the two I.Q. subtests used in the study for subjects sixty-five years of age or older. However, since the Intellective results 137 of the study appear to be consistent with the results found with the other measures, one might feel some degree of confidence regarding them. The results on the I.Q. test raise a number of pertinent questions regarding the nature and general composition of Intellectual processes in aged persons. While it is recognized that the obtained experimental results do not answer the questions they raise, it would seem at least to represent a modicum of support regarding the need for increased exploration in this area. In many respects, there seems considerable need for possible conceptual reevaluations, possibly reconceptualizations regarding the nature and trends of intellectual dimentions throughout human ontogony. ImagInal and emotional measures— comparisons between therapy and control groups.--Turning next to the TAT scales and a comparison of the therapy and control groups, it can be seen that the therapy group’s scores changed in the direction of improvement on seven of the nine TAT measures, as compared with the control group. Each measure will be discussed separately, below. For the first measure, "Emotional Tone," the therapy group’s stories changed in the direction of more cheerful or pleasantly toned stories as compared with the control group’s productions, which tended to become leas pleasantly toned. Assuming that TAT productions reflect the feelings of their authors. It could be concluded that the therapy patients were more cheerful and optimistic following the activity period than were the control group patients, since the groups had been matched initially on this variable. The question now arises as to what exactly in the therapeutic process led to this result. It is the author*s impression that the change in the therapy group was brought about as a result of the opportunity for catharsis, the gaining of insights, and, quite possibly, the additional attention the patients received. Which of these played the most important role is not revealed in the data at hand. Since no quantitative evidence is available in this regard within the context of the present study, these impressions offer an area for future investigation. For the second TAT measure, "Self Concept," the therapy group*s stories changed significantly in the direction of increased self esteem as compared with the control group, whose scores tended to decrease. To explain this trend, it is suggested that the opportunity to openly discuss and compare common problems in the group therapy situation served to counteract feelings of inferiority, insecurity, and inadequacy. Whether it was actually the factor of open discussion and mutual support, 139 or perhaps other influences in the psychotherapeutic situation which helped elevate self esteem is beyond the scope of the present experimental design, but needs to be investigated through further research. For the third measure, "Social Distance," the results indicate that the therapy group tended to develop stronger feelings toward other people, both of a positive and of a negative nature, as revealed in TAT productions, than did the control group. This trend might reflect within the therapy patients the reawakening of interest in the world around them and in people in particular. The ability to develop strong affectional relations may be a sign of renewed interest in life, as compared with the retreat from emotional involvement found in the control group. For the fourth TAT variable, "Conflict," there was a statistically significant increase in score for the therapy group as compared with the control group, suggesting an increase in capacity for positive and mature interpersonal relations within the therapy patients as compared with the control patients, who tended to lose this skill significantly. It seems likely that the therapy patients did, indeed, improve their interpersonal relations, as they improved in most of the measures employed in the study. 140 On the fifth TAT variable, "Average Number of Words per Story," no significant differences were found between therapy and control groups. There was a tendency in both groups for the length of the stories to decrease on the second testing— significantly so in the control group. The results on this variable should be viewed with some caution, however, for the two groups were not matched initially on this variable; the therapy group had initially received significantly higher scores. For the sixth variable, "Number of Self References," no significant differences were found between the control and therapy groups. The control group tended to lose such expressions to a significant degree, reflecting, possibly, an increased degree of apathy, or a loss of energetic ambition. For the seventh variable, "Number of fZwaang* Expressions," there was a significant difference between the control group and the therapy group, with the therapy group reporting more expressions of "zwaang" than the control group. However, much of the difference between the two groups can be accounted for by the significant drop in the number of such expressions in the control group. This finding, which suggests an increase of compulsive tendencies within the therapy subjects1 fantasies, and a decrease in the control groups1, i3 HI rather difficult to explain. Possibly the increase of such phrases as, "I hava to," or "I must" actually reflects a more energetic feeling within the therapy patients of this age, rather than the presence of com- pulsivity. Conversely, the loss of a feeling of internal pressure in the control group might reflect a loosening of ties with the world, a tendency to give up trying to deal with problems, a feeling of hopelessness in the face of overwhelming obstacles, and a turning toward a more passive and vegetative form of imaginal and emotional functioning. For the eighth TAT variable, "Time Span," there was a significant difference between the therapy and control group, accounted for primarily by a significant decrease in score in the control group. Possibly lack of activity and an isolated non-stimulating environment narrows older subjects* fantasies to a concentration on the immediate present in fantasy life. It has often been expressed in popular literature that elderly, non-active people, while perhaps not turning their fan tasies to plana for the future, will tend to ruminate about days gone by and review old happenings in their minds. The results shown on this test suggest that this is not the case. It is quite possible that the thought content of elderly, non-active people might be restricted, 142 rather, in a somewhat concrete fashion, to daily events- concern over aches and pains, interest in meals, and absorption in other daily and routine occurrences. This opens up a new area of speculation in relation to the fantasy life of older people which requires further research. For the ninth TAT measure, "Space Span," there was a significant difference on this variable between the control and therapy groups. The therapy group tended to show a broadened space span in their TAT productions, not statistically significant, while the control group's fantasies showed a significant shrinkage in space span. This tendency in the control group might reflect a narrowing of Interests to the immediate and concrete environment, congruent with the shrinking in time span. Ima^ingl and emotional measures--comparison between craft and control groups.--Turning now to a comparison of the craft group with the control group on the TAT variables, it can be seen that the craft class showed changes in the direction of improvement on six of the nine TAT variables, as compared with the control group. The craft class improved in "Emotional Tone," or in cheerfulness, as compared with the control group. 143 Apparently, the participation in an enjoyable activity is accompanied by more pleasant affect. The craft class improved on the "Self Concept" measure, or showed an elevation in self esteem as compared with the control group, suggesting that partici pation in such activity enhances feelings of worth in the aged subjects. The craft class and control groups differed significantly on the "Social Distance" variable, with the craft class improving significantly and the control group declining significantly. This suggests that working together in a group setting on similar projects, as was the case in the craft class, enhances the strength of feelings toward others, and, conversely, a lack of group activity leads to a weakening or blunting of feel ings toward other people, as revealed by TAT productions. The craft class and control grops differed significantly on the "Conflict" variable, due mainly to the decrease in score shown by the control group. Apparently, the control group lost some of the capacity for mature interpersonal relationships. On the fifth variable, "Average Number of Words per Story," the craft and control groups differed significantly. This difference can be accounted for primarily by a significant decrease of story length in 144 the control group, suggesting a narrowing of expressive function in that group* There were no significant differences between the craft and control groups on the variables of "Number of Self References" or "Number of 'Zwaang* Expressions On both variables, the two groups tended to decline in score, but only the control group showed significant decline. On the "Time Span" variable, the craft and control groups were significantly different, accounted for mainly by the significant decline in scores evidenced in the control group. No significant differences between the craft and control groups were found on the last TAT variable, "Space Span," but this result must be viewed with caution, as the groups were not initially matched on this variable. Imaginal and emotional measures— comparisons between therapy and craft groups.— Only one significant difference was found to exist between the therapy and craft groups on TAT measures, and that is the difference found on the variable of "Self Concept." It appears that, although the therapy group showed a significant improvement in self esteem, the craft class improved significantly more in this regard than did the therapy 145 group. This finding suggests that, for self esteem to improve in older persons, "actions apeak louder than words." Apparently, the actual evidence to the craft group patients of their still-remaining ability to be productive, to contribute, and to be of use was a greater boost to morale than simply the verbalisations of mutual support and encouragement of the therapy group. Self Sorts.— With regard to the results of the Self Sort test, it can be seen that the real and ideal selves converged significantly in the therapy group as compared with the control group, and in the craft class as compared with the control group. Further, it was the real self which changed to conform with the relatively more stable ideal. Thus, the member patients tended to improve in self esteem as measured by the relationship of the real and ideal self concepts. It will be remembered that a similar trend was found on the TAT variable of "Self Concept." In this regard, however, there is some evidence that the two measures of self esteem are not entirely equivalent. For example, while the TAT measure indicated that the control group tended to decline significantly in self esteem, this trend did not reach statistical significance in the self-sort measure. Further, on the TAT measure, the craft class showed significantly higher improvement than did the therapy group, whereas no such trend was seen with the self-sort measure. This discrepancy offers two alternative hypotheses which might explain the obtained results. The investigation of these hypotheses, while beyond the scope of the present study, suggests lines for future research which could broaden knowledge about self concepts in general and about self concepts in old age in particular. First, it is suggested that the two techniques actually measure two different aspects of the self concept, the self-sorts restricting their evaluation of self concept to the real-ideal self relationship. Second, it is possible that, with older subjects, the TAT is a more sensitive measure of self concept than is the self-sorting procedure. It will be recalled that, to a person, the elderly subjects disliked the self-sort test, while a majority of them enjoyed the TAT task, despite the somewhat traumatic stimulus value of the TAT cards employed. This could have resulted in better concentration and involvement on the TAT measure than on the self-sort measure for these older people. Hospital Adjustment Test.— The Hospital Adjustment Test results indicate significant differences between the therapy and control groups, with the therapy group tending to improve in behavior acceptable in the hospital 147 as rated by nursing personnel, and the control group tending to decline. No significant changes In the craft class were shown. It appears, therefore, that actual overt behavioral changes. In a positive direction, were achieved by the therapy patients, in addition to the inner intellectual and emotional changes measured by the other tests. Final Questionnaire.— On the final questionnaire, three significant differences were found when the therapy and craft groups were compared. First, the patients in the therapy group were different from the craft class in that they indicated, significantly, that they enjoyed the opportunity to speak their minds freely without fear of the consequences. This finding points to the freedom of expression felt in the therapy group and suggests that, dt least on a conscious level, the therapy patients valued the opportunity for catharsis which was afforded them in the therapy situation, rather than the social contacts made there, or the insights gained. The second statistically significant finding on the final questionnaire was that the craft class welcomed the opportunity to get out of bed more often to a greater extent than did the therapy group. Apparently, the chance for increased physical activity was of more 148 Importance to them* Of interest, also, is the fact that the therapy group was significantly different from the craft class in that some of the therapy patients did not like talking to or listening to the others in the group. However, they seemed to find little objection to talking about them selves, as shown in Item 10 of the final questionnaire* Apparently, there were some feelings of rivalry for the attention of the therapist found within some therapy patients. This was, indeed, brought out directly in the therapy situation itself, but only very hesitantly by a few of the patients. Had therapy continued over an extended period of time, this area of feeling would have come to the fore in much sharper fashion. It appears to be a good area for fruitful discussion for hospitalized patients living in ward facilities, who have to share with other patients the attention of limited nursing and medical personnel. Decline in the Control Group One unexpected finding which is rather alarming in its implications was the almost general decline on all tests evidenced by the control group. While it had been hypothesized that the activity groups would show improvement, it was not really expected that the control group would show such marked and widespread decline. 149 Other investigators (34), utilizing a sociometric tech nique, had reported measurable deterioration In sociali zation over a seven month period in residents of homes for the aged in which activities had not been supplied. The present study indicates that, in non-active aged patients, there is also deterioration in intellectual, imaginal, emotional, and behavioral functions. The results imply that in the course of several years of living under non-stimulating conditions, many older individuals will approach an extremely low level of functioning, indeed. There was felt the need to look further into the nature of the decline in the control group. Several relevant points might be mentioned in helping to explain the findings. First, it should be kept in mind that this is a truly geriatric population; the mean age of the control group patients was 73& years of age, the range being from 65 through 85, and the standard deviation being 5.96. Further, while none of the patients were critically ill, they did suffer from some form of chronic illness such as arthritis or heart disease. Also, while the activity sessions proper covered a period of four months, the pre- and post-activity testing sessions each took place during a two month period, so that the total time involved, including pre- and post-testing, was 150 eight months. It seems plausible to expect that within an eight month period, certain decline in function would occur in subjects of advanced age with chronic illnesses living in a non-stimulating environment. Further attempts were undertaken to clarify the nature of the decline of specific functions in the control group. It will be recalled that there was available infor mation regarding the number of years each patient had re sided in the hospital, the age of each patient, their edu cational level, their pre-activity Vocabulary I.Q., their marital status, if they had borne children, their religion, country of birth, participation in activity aside from group activity, and the presence or absence of a heart condition. These data were reexamined in an effort to determine whether any or all of these variables were in any way related to the decline found in the control group. £ach measure on which significant decline was found was compared with all of the abovenoted variables, independently, employing the Mann Whitney U Test. The results are shown in Table 41, page 151, and will be elaborated upon sepa rately below. It should be emphasised that the number of patients involved in these calculations is very small, and, therefore, the results obtained should be viewed with a great deal of caution, and only as tentative findings requiring further exploration in future research. 151 TABLE 41 THE RELATIONSHIP BETWEEN CERTAIN VARIABLES AND SIGNIFICANT DECLINE ON SCORES OF TESTS SHOWN IN THE CONTROL GROUP UTILIZING THE MANN WHITNEY U TEST Variable Testa which declined significantly I.Q. TAT TAT TAT TAT E.T. S.C. S.D. Conflict Length of hospi talization (df - 6) U-4.5 N.S. U-7 N.S. U-6 N.S. U-6.5 N.S. U-6.5 N.S. Age of patients (df - 6) U-7.5 N.S. U-6 N.S. U-7 N.S. U-7.5 N.S. U-6 N.S. Education (df - 6) U-6 N.S. U-3 P-.10 U-7.5 N.S. U-6 N.S. U-6 N.S. Pre-activity Vocab. I.Q. (df - 7) U-7.5 N.S. U-9 N.S. U-6 N.S. U-6 N.S. U-4 P-.10 Marital status (df - 13) U-23.5 N.S. U-26 N.S. U-15 P-.08 U-6 P-.005 U-20. N.S. Whether pt. had borne children (df - 13) U-16.5 N.S. U-21.5 N.S. U-23 N.S. U-14.5 P-.07 u-19 N.S. Religion (df - 13) U-17.5 N.S. U-15-5 N.S. U-12 N.S. U-14.5 N.S. U-16 N.S. Born in or out of U.S.A. (df - 13) U-12 N.S. U-10 N.S. U-8.5 N.S. U-9 N.S. U-8.5 N.S. Presence of any activity what ever (df-13) U-26.5 N.S, U-25.5 N.S. U-25 N.S. U-27.5 N.S. U-19. N.S. Presence of heart con dition (df - 13) U-24.5 N.S. U-23 N.S. U-15 N.S. U-21.5 N.S. U-12. P-.IO TABLE 41— Continued 152 Variable Tests which declined significantly TAT TAT TAT TAT TAT Hospital # Words S.R. "Zn Time Space Ad. Test Length of hospi talisation (df - 6) U-8 N.S. U-4 N.S. U-6.5 N.S. U-8 N.S. U-4 N.S. U-8 N.S. Age of patients (df - 6) U-6 N.S. U-7 N.S. U-5.5 N.S. U-8 N.S. U-6.5 N.S. U-5.5 N.S. Education (df - 6) U-6 N.S. U-4 N.S. U-5.5 N.S. U-3.5 N.S. U-8 N.S. U-4 N.S. Pre-activity Vocab. I.Q. (df - 7) U-4 P-.10 U-2 P-.03 U-9 N.S. U-2.5 P-.04 U-8 N.S. U-2.5 P-.04 Marital status (df - 13) U-20 N.S. U-2 5 N.S. U-23 N.S. U-13.5 P-.05 U-17 N.S. U-24.5 N.S. Whether pt. had borne child ren (df*13) U-27 N.S. U-23.5 N.S. U-20 N.S. U-22.5 N.S. U-26 N.S. U-20.5 N.S. Religion (df - 13) U-13 N.S. U-17.5 N.S. U-17 N.S. U-17.5 N.S. U-14.5 N.S. U-16 N.S. Born in or out of U.S.A. (df - 13) U-4 N.S. U-6 N.S. U-ll N.S. U-10 N.S. U-12 N.S. U-ll.5 N.S. Presence of any activity what ever (df-13) U-20 N.S. U-21 N.S. U-23 N.S. U-23*5 N.S. U-18 N.S. U-ll.5 P-.03 Presence of heart condition (df - 13) U-20 N.S. U-24.5 N.S. u-ia N.S. U-15.5 N.S. U-23.5 N.S. U-10 P-.05 153 Turning first to the I.Q. variable, comparisons were made between that variable and each of the matching variables. For example, a comparison was made between the I.Q. scores of the subjects who had resided in the hospital for the longest period of time with the Vocabu lary I.Q. scores of the subjects who were the most recent arrivals in the hospital. The same procedure was followed throughout on all variables and measures. On the Vocabulary I.Q. measure, no significant differences were found on any of the variables. Other studies have also found no relationship between vocabulary sise and either length of institutionalization or age (43)* Also, Howell had previously found no relation between the amount of education and intellectual deterioration (63) . Although the findings of the present study are in concordance with these studies, the data obtained herein reveal very little as to the basis for the decline in Vocabulary scores found in the control group. It may be that the rate of loss may vary with the individual. It is also possible that a combination of factors might apply— i.e., one might hypothesize that the oldest patients who were at the same time the least active would deteriorate significantly more than the youngest patients who were at the same time very active. The available data does not permit the examination of this hypothesis, 154 due to the small sample size, and also because there appeared to be no correlation between the age of the subjects and the amount of activity in which they par ticipated. Therefore, this hypothesis must await farther investigation in future research. With regard to the TAT variables, it was found, on the variable of "Emotional Tone," that the most educated subjects tended to produce the most pleasant feeling tone in their TAT productions in the control group. Further, single and divorced subjects were lower in self esteem than were widows, as revealed by the "Self Concept" measure. Single and divorced patients lost the ability to form strong emotional ties signifi cantly more than did widows, as revealed by the "Social Distance" measure. Those who had never had children also lost the ability to form strong emotional attachments significantly more than did widows, as indicated by the "Social Distance" measure. As shown in the "Conflict" variable, those with the lowest intelligence apparently felt less in conflict with others as time went on than did the brighter subjects. Those patients with heart ailments also had less conflict than those not so afflicted. With regard to the measure of "Average Number of Words per Story," those who had initially had the highest Vocabulary I.Q.’s tended to lose more words per 155 story with time than did those with the lower I.Q,'s. The brighter subjects also lost moire expressions of self reference in their TAT productions. In addition, they lost more in time span. Again with regard to time span, single and divorced subjects tended to lose time span in fantasy significantly more than did the widows. On the Hospital Adjustment Test, the results indicate that the less intelligent subjects received lower scores than did the more intelligent subjects in the control group. Further, those subjects who did not participate in any activity whatever tended to receive lower test scores than did those who did participate in some activity. Also, those patients with heart ailments received lower Hospital Adjustment Test scores than did the patients without heart conditions. These results suggest that the decline in the control group patients i3 not a uniform thing on all the measures and for all patients. For each measure, differerit variables seemed to play important roles in the decline found. The results obtained must, further, be viewed with caution because of the small sample size. Limitations of the Study An investigation organized along the lines of the present study has certain definite limitations. In this regard, a pertinent criticism could be raised in that 156 there might have been, on the part of the examiner, an unidentified, unconscious, and unintentional preferential treatment in the post-testing of the therapy patients, due to examiner familiarity. Further, it is possible that, by reason of the examiner's close and intense contact with the therapy patients, these patients might have felt more comfortable and at ease with the examiner in the final testing than did the patients in the other two groups, and, consequently, performed better on the tests. While this question can be raised with regard to the therapy group, it is not applicable to the craft class or to the control group, where, aside from pre- and post-testing, no contacts occurred between the examiner and the patients; yet, the craft class showed improvement on some of the measures utilized. There was one test used in the study which avoided this problem for the therapy group, namely, the Hospital Adjustment Test. This instrument was not administered by the examiner but by nursing personnel. The results on this test are not biased by the variable of examiner familiarity, since, to all intents and purposes, the examiner had no connection whatever with the administration of this test. The results of the Hospital Adjustment Test indicate that the therapy patients improved, the craft patients remained the same, and the control patients 157 declined. These results are generally consistent with the changes In the other test Instruments, and since this Is the case, it is plausable to choose the inter pretation that all the positive changes noted on all the tests used are resultant from genuine improvement, in congruence with the changes on the Hospital Adjustment Test, and that the negative changes in the control group are due to a genuine decline. However, in future research of a similar nature, it is strongly recommended that the examiner and the group activity leaders be different people, to avoid any question of a doubt regarding the obtained results as a function of examiner or subject bias. Another limitation of the study is brought about by virtue of the small sample size and the limited number of activity hours. However, the sample was carefully matched on a number of variables, and, judging from the consistency of the data, it is probable that larger samples and a longer experimental period would have yielded even more positive results. This, of course, is only conjecture, and needs experimental investigation. It is important to realize that the study deals with a select group of the elderly population. The subjects used in this study were all Caucasian, non- psychotic, indigent women of at least average intelligence, 158 residing in a hospital setting. Whether the same results would obtain with an elderly population which differed in these respects can only be determined by further investigation, and caution should be observed in generali zing to subjects differing in basic variables from those utilized here. Of particular importance is the question as to whether these results can validly be applied to non-hospitalized elderly people. Since only 3% of the elderly population of this country reside in hospitals, rest homes, or other institutions (30), it seems most important that researches be designed to investigate the functions of non-hospitalized people, despite the difficulties involved in obtaining samples of such subjects. Factors affecting the validity and reliability of the testa used should be considered. Specifically, questions can be raised with regard to using the Vocabulary as a measure of intellectual function which "holds" with time. The question of whether vocabulary "holds up" after age 65 is still being debated in the literature, with most authors saying it holds up better than other intellectual measures, as cited earlier, and other authors saying that even in vocabulary there is eventual decline (68, 137). The trends in the present study indicate that Vocabulary does not "hold." Normative data 159 is needed to clarify this issue. Incidentally, perusal of the responses given by the subjects on the Vocabulary subtest suggest that for the older people, the order of item difficulty of the words is different from that of the younger stan dardisation group. The older subjects tended to miss some of the easier items consistently while succeeding on some of the more difficult ones. This trend was not examined statistically, but offers suggestions for further research. The use of the Self Sort test with elderly patients is brought into question. Although the test yielded useful and significant information, it was very time-consuming, and the procedures seemed to confuse and upset the patients. Possibly other measures of self esteem would be more practical for use with elderly patients. One criticism which could be raised is that the age range in the patients was quite wide, extending from age 65 through age 85. It is possible that, as far as the direction taken by various functional dimen sions is concerned, between the ages of 65 and 85 there may be a number of distinct populations. Indeed, with respect to one age grouping within this range, increases in regard to certain functions might have occurred, while 160 on another age grouping, decreases in scores might have occurred* As a consequence, the 20 year range in population age may only have served to achieve important cancelling-out effects. Future studies should, if possible, arrange for groupings of age spans, and each age grouping should be independently studied. In the present study, attempts were made to limit the age span to a narrower range, but this had to be discontinued for it interfered with the matching on other variables. The effect of institutionalization on personality must be considered, regardless of the age of the subjects. It would be of interest to know if the same results could have been obtained using a younger hospitalized sample, say, a group of children, adolescents, or young adults. It might very well be that the deterioration found in the control group is due to a generalized "hospitalization effect" and that the age of the patient is really irrelevant. This study should be repeated with a younger sample to check out this possibility. It is entirely plausable that group activity is beneficial to isolated hospital patients, regardless of age. Other questions to which this study offers no quantitative information and which require further investigation are: (1) What exactly about the group activities are the effective variables in bringing about 161 the Improvement, (2) Would other typee of activities, such as individual psychotherapy, ministerial counselling, or merely regularly scheduled visits from "Gray Ladies" effect the same or similar improvement, and (3) What are the specific variables in the two activity conditions utilised in the present study which resulted in the differential improvement shown in the two activity groups. The results of this research raises these questions, but the answers to them must await future research. The study raises a number of practical questions regarding what can be done for gerontological subjects in a hospital setting. While in those instances previously noted, there would appear to be indicated the need to rerun some of the explorations described under differently controlled conditions, the overall pattern of results seem without question to suggest that important procedures are available which can, with relatively moderate expenditure of time and effort, bring about improvement and important patient benefits in a hospitalised gerontological population. While the results suggest a decisive improvement along particular psychological dimensions in this population as a result of group psychotherapy, it should not be overlooked that another procedure, somewhat less demanding of time and personnel, also is 162 productive of noteworthy therapeutic gains. Indeed, it would seem that with extensive consideration just developing in relation to gerontological problems, workers in various hospital settings would do well to establish in articulate and positive fashion the specific goals that they have in mind for such patients. Having decided upon these, there would be little question that budgetary considerations would be inevitable, and that, in any event, such resources as are available might be afforded along either of the two procedure patterns suggested to afford the greatest opportunity possible for patient improvement. Perhaps the major substance of this effort is to be viewed in terms of the finding that distinct and even exciting changes are possible with such a population within the context of at least two separate procedural orientations. More specifically, it would be noted that the question is not one of greater or lesser improvement with either of the procedures, but apparently improvement in different areas. Indeed, numerous avenues of additional investigation open to explore the possible relationship of the manner of activity in relation to dimensions of behavioral change. In terms of the work done, many of the instruments employed were initially established on a considerably younger population, a non-hospitalized population. At 163 least within the context of this study, therefore, the writer finds herself frequently superimposing conceptual systems upon these data which were arrived at from the context of another population or universe. As a matter of fact, the whole question as to whether or not current personality conceptualizations now in general use have meaning as the level of a gerontological population can be raised. Having suggested that there is a need for reconceptualization of personality variables in a gerontological population, it, of course, must follow that extensive revision of total existing personality theory must be forthcomingf if we are to have a conceptual system or theoretical system which is truly meaningful to human behavior in its totality. Summary The purpose of the study was to evaluate the effectiveness of two different types of group experiences on an elderly population. Specifically, the effects of group psychotherapy and arts-and-crafts classes were examined and compared. It was hypothesized that partici pation in such group activities would result in improvement on intellectual, imaginal, self-evaluative, and hospital behavior variables, as measured by appropriate tests, and as compared with a control group of subjects matched on 164 relevant variables. A total of 37 patients was used In the study. These had been screened so that each subject was 65 years of age or older; female; Caucasian; residing In the Rancho Los Amigos Hospital for at least one year prior to the beginning of the experiment; not participating in any formal group activities in the hospital; able to speak, read, and understand English; able to walk or be wheeled to group meetings; free from psychoses, organic brain involvement, or malignant neoplasms; indigent, economically; of average or higher intellectual Jarel; able to see well enough to participate in the study; and able to hear well enough to participate. While much of the above information was obtained from the hospital records or through contact with hospital personnel, special screening devices had to be utilised to screen for the four variables of visual acuity, auditory acuity, activity participation, and I.Q. estimate. Screening tests for these variables were administered by the examiner in individual testing sessions. For visual acuity, the visual portion of the Advanced Pre-Tests of Vision, Hearing and Motor Coordination was utilized. The Auditory Test No. 12, List 1 of the Psycho-Acoustic Laboratory was adapted, norms were obtained, and then this test was utilized to screen for auditory acuity. 165 A Personal Data Questionnaire was devised and used to screen for the type and amount of activity in which the subjects participated, in addition to yielding such data as the marital status, educational level, race, and religious affiliation of the subjects. The Vocabulary subtest of the WAIS was utilized in obtaining an estimate of I.Q. Those subjects who met all of the foregoing criteria were then given a battery of tests designed to measure intellectual functions, imaginal functions, self concepts, and hospital ward behavior. To measure intellectual functions, two non-timed, non-motor tests were used— the WAIS Vocabulary subtest mentioned previously, and the WAIS Similarities subtest. These measures were each examined separately, and an examination was also made of the combination of the two measures. There were available, then, three different measures of intellectual function: Vocabulary, Similari ties, and the combination score Vocabulary + Similarities. As a measure of imaginal and emotional functions, seven TAT cards depicting elderly people were administered to each subject, and the stories produced were recorded verbatim. These stories were evaluated on the basis of nine TAT measuring scales: (1) Emotional tone, (2) Self Concept, (3) Social Distance, (4) Conflict, (5) Average 166 Number of Words per Story, (6) Number of Self References, (7) Number of "Zwaang" Expressions, (S) Time Span, and (9) Space Span of the stories. Reliability studies on six of the nine scales were done; they indicated that the scales were sufficiently reliable for utilization in the experiment. The other three TAT scoring measures involved simple counting procedures, and, therefore, reliability studies were not felt necessary for them. As a measure of self concept, each patient sorted a series of 100 self-referent statements adapted for elderly subjects. Two sorts were made by each patient--the Real Oelf Sort and the Ideal Self Sort. As a measure of hospital ward behavior, each patient was rated by nursing personnel on the Hospital Adjustment Test, a revision of the Hospital Adjustment Scale designed to suit a geriatric, hospitalized, non- psychotic population. A separate determination of reliability indicated that the rater reliability of the revised test was sufficiently high to be utilized in the study. Neither participating patients nor hospital personnel directly involved were aware that they were taking part in an experiment. At the completion of the testing, the patients were divided into two therapy groups (combined for 167 statistical purposes), a craft class, and a control group. These groups were matched on the following variables: age; education; Vocabulary I.Q.; Deterioration Index; marital status; children; religion; country of birth; prior activity of any sort; and presence or absence of a heart condition. Dependent variables were also found to match--that is, there were no significant differences in the three groups on I.Q. measures; on Hospital Adjustment Test scores; on Real Self— Ideal Self corre lations; and on seven of the nine TAT measures. The activity groups each met for a total of 33 sessions of l£ hours each, over a period of four months. The subjects in the craft class, led by a professional recreation worker, participated in ceramic and textile painting activities. The crafts program was activity- centered, and discussions of personal problems were specifically avoided. The group psychotherapy was led by the experimenter and was primarily non-directive in orientation. Brief lecture introductions were instituted at the request of the patients, but most of the therapy time was devoted to discussion of feelings and personal problems. At the conclusion of the activity period, the measures employed were readministered to the patients, and, in addition, a confidential final questionnaire was 166 completed by each activity patient independently, evaluating the activity in which they had participated. The results indicate that the patients who had received group psychotherapy showed a significant intellectual improvement on all three VAIS measures used, as compared with the control group. Therapy patients also showed significant improvement on two of the intelligence measures as compared with the craft class. With regard to emotional and imaginal variables, the therapy group showed significant improvement on such variables as revealed by TAT measures as an increase in pleasant feeling tone, improved self esteem, an increase in the capacity for strong feelings toward other people, and an increased capacity for more positive and mature interpersonal relations. There were also tendencies for the therapy group to show an increased feeling of internal pressure or urgance, and an increased capacity to fantasise through wider ranges of time and space, as compared with the control group. The self concepts as measured by the Self Sorts showed significant improvement, with the real self tending to move toward the ideal self. Actual behavior of an acceptable nature, as measured by the Hospital Adjust®ant Test, also showed significant improvement in the therapy group as compared with the control group. 169 The final questionnaire indicated that the therapy group felt more free to speak their minds than did the craft subjects. There were also suggestions of member rivalry in the therapy group as indicated by this test, and suggestions that the increased physical activity involved in getting out of bed more often to come to group meetings was more important to the craft patients than to the therapy patients. With regard to the craft class, no significant changes were found on any of the measures of intelligence used, nor were there any significant changes found in overt hospital ward behavior, as measured by the Hospital Adjustment Test. Significant emotional and imaginal changes did occur within these craft patients, how ever, as revealed by the TAT and the self-sorting pro cedures. Specifically, there were increases in pleasant affect, an elevation in self esteem, an increased ability to form strong affectional relations. The self-sort results show a significant improvement in self esteem, with the real self tending to move toward the ideal self. The TAT measures of self esteem indicated, further, that the craft class showed a significantly greater improvement in self esteem than did the therapy group. It is suggested that the TAT "Self Concept" measure and the Self Sort technique tap somewhat different aspects 170 of the self concept. A rather startling finding was the marked drop in scores shown on almost all variables measured in the control group. This finding implies that over several years of inactivity, many older patients will approach a nearly vegetative state of existence if no activity intervenes. An attempt was made to analyze the relationship of this decline with various variables such as age, length of hospital stay, marital status, presence of a heart condition, and other variables. The findings obtained must be viewed with considerable caution due to the very small sample size involved, but point to the need for further investigations in this regard. In conclusion, it might be said that the study strongly suggests that activity of the sort employed here can halt and even reverse deteriorative trends in aged, hospitalized, non-active patients. However, whether the findings can be generalized to patients differing in qualities from the experimental patients cannot be concluded from this study. Indeed, in a sense, the present study raises more questions than it answers, for, although positive changes are clearly shown in the active patients, the design of the experi ment offers no concrete and measurable explanations 171 as to why it is that activity should bring about such changes, or why it is that lack of activity results in deterioration. The study raises other problems and questions— questions involving such issues as the nature of intellectual functioning in the aged, the effects of institutionalization on the aged, the need for normative studies, and the need for the revision of existing personality theories so as to make them truly meaningful to human behavior in its totality. These and other issues were pointed out as suggestions and hypotheses for future research in this new and important area of investigation. APPENDIX A DIAGNOSES OF SUBJECTS ACCEPTED IN THE STUDY Patient Number Diagnoses Therapy Group 1 a) Arteriosclerosis, generalized b) Hysterectomy, post operative c) Compression fracture of dorsal vertebrae 2 a) Arteriosclerotic heart disease b) Closed fracture of neck of femur 3 a) Foreign body in wound, right hip, following surgery b) Dental caries c) Possible osteoarthritis k a) Hypertensive cardiovascular disease b| Obesity of undetermined cause c) Open reduction of fracture with metal pin d) Deformity of distal portion of femur due to trauma 5 a) Deformity of lumbar spine due to old fracture b) Hypertensive cardiovascular disease c) Osteoarthritis d) Cataracts, bilateral, incipient 6 a) Rheumatoid arthritis, multiple joints b) Lues, treated cj Arteriosclerosis, generalized d) Diverticulosos of colon 7 a) Rheumatoid arthritis, multiple joints 8 a) Hypertensive cardiovascular disease b) Osteoplasty of upper ext. of femur (Proximal portion) APPENDIX A— Continued 173 Patient Number Diagnoses 9 a) Malnutrition bj Dental caries c} Arteriosclerotic heart disease 10 a) Repair of ventral hernia b) Deafness, cause undetermined (corrected by hearing aid) 11 a) Hypertensive cardiovascular disease bj Rheumatoid arthritis c j Hypothyroidism d) Open reduction with nailing for fracture, left hip 12 a) Diabetes mellitus b) Arteriosclerotic heart disease with anginal syndrome c) Absence of two legs 13 a) Decubitus ulcer of skin of ischial region b) Rheumatoid arthritis of knee 14 a) Arteriosclerosis, generalized Craft Class 15 S I Meningioma of spinal cord, excised Hypertensive cardiovascular disease c) Deformity of upper left femur due to fracture 16 a) Dental caries b) Stiffness (slight limitation of motion) due to trauma of leg 17 s j Essential vascular hypertension Obesity of undetermined cause c) Stiffness (slight limitation of motion) due to trauma of leg APPENDIX A— Continued 174 Patient Number Diagnoses 18 a) Essential vascular hypertension b) Deafness, cause undetermined (corrected by hearing aid) c) Open reduction of fracture with metal nail 19 a) Neurodermatitis— disseminata (atopic eczema) b Arteriosclerosis, generalized c) Stiffness (slight limitation of motion) of knee due to trauma d) Depressive reaction (neurotic) 20 a) Anxiety reaction with spastic bowel b) Pyorrhea alveolar!s 21 a) Rheumatoid arthritis, multiple joints 22 a) Diabetes mellitus bj Obesity c) Hypertensive cardiovascular disease d) Cataracts, bilateral, diabetic, incipient Control Group 23 a) Arteriosclerotic heart disease b) Arteriosclerosis, generalized 24 a) Diabetes b Arteriosclerotic heart disease c) Obesity 25 a l Arteriosclerosis, generalized Anemia, macrocytic of pernicious anemia type (nutritional or metabolic) b) C 1 Irritability of colon; spastic d) Osteoarthritis, degenerative joint disease, multiple, due to unknown cause 26 a) Ependymoma of upper thoracic spinal cord b) Laminectomy— complete ostectomy; complete excision of bone APPENDIX A— Continued 175 Patie nt Number Diagnoses 27 a) Hypertensive cardiovascular disease b) Varicose veins of superficial veins and venules 26 a) Osteoarthritis— degenerative joint disease, multiple, due to unknown cause b) Round back (with wedging of vertebrae) due to unknown cause c) Essential vascular hypertension 29 a) Fibrosis of lung following tuberculosis; arrested tbc. b) Arteriosclerotic heart disease 30 a) Arteriosclerotic heart disease b) Depressive reaction (neurotic) 31 a) Arteriosclerosis, generalized 32 a) Hypertensive cardiovascular disease b) Arteriosclerosis, generalised c) Rheumatoid arthritis, multiple joints 33 a) Arteriosclerosis, generalized b) Essential vascular hypertension c) Varicose veins of superficial veins and venules d) Obesity of undetermined cause 34 a) Arteriosclerosis, generalized b) Rheumatoid arthritis, multiple joints 35 a) Rheumatoid arthritis, multiple joints 36 a) Hypertensive cardiovascular disease, mild b) Arteriosclerosis, generalized 37 a) Arteriosclerosis, generalized b Essential vascular hypertension c 1 Displaced parotid gland d Diabetes a) Obesity of undetermined cause 176 APPENDIX B EARNED SCORES ON THE VISUAL SECTION OF THE ADVANCED PRE-TESTS OF VISION, HEARING, AND MOTOR COORDINATION Therapy Group Craft Class Control Group Pt. Pt. Pt. No. Score No. Score No. Score 1 20 15 20 23 20 2 20 16 20 24 20 3 20 17 20 25 20 4 20 18 20 26 20 5 20 19 20 27 20 6 20 20 20 28 20 7 20 21 20 29 20 8 20 22 20 30 20 9 20 31 20 10 20 32 20 11 20 33 19 12 19 34 20 13 20 35 20 14 20 36 20 37 20 M - 19.93 20.00 19.93 6 - .93 .00 .96 Differences Between Groups Groups U* df Significance Level Craft and Therapy Craft and Control Therapy and Control 52 56 78. 20 21 5 27 Not Significant Not Significant Not Significant aMann Whitney U Test, two tailed. 177 APPENDIX C AUDITORY TEST NO. 12, LIST 1 OF THE HARVARD PSYCHO-ACOUSTIC LABORATORY Questions Answers 1. What letter comes between A and C? B 2. Do flies have wings? Yes 3. What day comes after Sunday? Monday 4« How many colors are there in the American flag? 3 5. What number comes after 10? 11 6. What tool do you drive nails with? Hammer 7. What number cones between 6 and 8? 7 S. Are moths dangerous to clothing? Yes 9. What month comes after January? - February 10. How many pennies are there in a nickel? 5 11. Is there a lot of water in the desert? No 12. What is the opposite of strong? Weak 13. What number comes before 10? 9 14. Does a gun shoot flowers or bullets? Bullets 15. What is the opposite of new? Old 16. In what country is Paris? France 17. Do you climb mountains in a sailboat? No 18. What letter comes after W? X 19. What day comes after Monday? Tuesday 20. What is the opposite of dark? Light 21. What number comes after 11? 12 178 APPENDIX D EARNED SCORES ON THE AUDITORT TEST NO. 12, LIST 1 OF THE HARVARD PSYCHO-ACOUSTIC LABORATORY Therapy Group Craft Class Control Group Pt. Pt. Pt. No. Score No. Score No. Score 1 19 15 17 23 21 2 17 16 21 24 20 3 15 17 19 25 18 4 19 13 15 26 20 5 16 19 19 27 17 6 15 20 21 28 20 7 15 21 19 29 21 8 19 22 18 30 20 9 20 31 19 10 15 32 16 11 21 33 19 12 21 34 21 13 16 35 19 14 21 36 19 37 IB M - 17.86 6 - 2.44 18.62 1.86 19.20 1.42 Differences Between Groups Groups Ua df Significance Level Craft and Therapy 46 20 Not Significant Craft and Control 51.5 21 Not Significant Therapy and Control 71 27 Not Significant aMann Whitney U Teat, two tailed. APPENDIX E PERSONAL DATA QUESTIONNAIRE 179 1. Pt • * a Name______________________Examiner Date____ 2. Ia pt. married, single, widowed, or divorced at the preaent time? (please underline one) 3. Number of children patient has had (either living or dead)__________________Grandchildren____________________ 4. Educational level of patient, (number of years of grammar school, high school, college, other)_________ 5. Does patient participate in Occupational Therapy?___ Recreational groups? Group_Therapy?_______ - Hobby Cart?_________Gra^t Classes?__________• If so, approximately how often and for how long? Occupational Therapy_______________________________- Recreational Groups_____________________________________ Group Therapy____________________________________________ Hobby Cart Craft Classes____________________________________________ 6. Race and religious affiliation___________________________ 7. Can patient walk to therapy room, or must she be wheeled? _________________________ S. Any activity whatever that the patient participates in now, or has participated in in the past, dates of participation, and length of participation APPENDIX F SELF SORT STATEMENTS 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 16. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29- 30. 31. 32. 33. 34. 35. 36. 37. 38. 39. 40. 41. Usually In a crowd of people I feel a little bit alone• 1 am Intelligent. often feel aggressive, am different from others, am self-reliant, feel sick most of the time, understand myself. donvt look as nice as I would like feel adequate, think about the past a lot. like to get dressed up. feel out of date, feel cheerful. >eople don’t think my ideas are important, can take care of myself, have nothing to live for. am religious. feel like I’m just waiting to die. have accomplished a lot in my life, prefer to stay in bed all day. have a hobby. would much rather have been a man. try to be active, feel like I have been forsaken, sleep well at night. have had more than my share of bad breaks, have a good appetite, don’t think much of myself, can take teasing, feel defeated, share with others, feel useless. watch T.V. or listen to the radio, feel lonely. have been fortunate in my life. I am worthless. My friends and relatives are very interested in my welfare. 1 feel inferior. It is pretty tough to be me. I have a feeling of hopelessness. Had I tried a little harder, my life could have been a better one. 181 APPENDIX F— Continued 42. I often feel humiliated. 43. I don't fear death. 44» I am disorganised. 45> I feel helpless. 46. My memory is good. 47* I am often down in the dumps. 48. If I had my life to live over again, there is very little that I would want to keep the same. 49* I enjoy talking with people. 50. I often kick myself for the things I do. 51. I feel secure within myself. 52. I want to give up trying to cope with the world. 53* I respect myself. 54* My hardest battles are with myself. 55* I face up to crises or difficulties. 56. I tend to be on my guard with people who are somewhat more friendly than I had expected. 57. I can live comfortably with the people around me. 58. I am just sort of stubborn. 59. I am optimistic. 60. I am critical of people. 61. I am liked by most people who know me. 62. I have an underlying feeling that I'm not contributing enough to life. 63. I can usually make up my mind and stick to it• 64* My decisions are not my own. 65. I am sexually attractive to other people. 66. I often feel guilty. 67. I am poised. 68. I often feel resentful of my present situation. 69* I am a rational person. 70. I am impulsive. 71. I have a warm relationship with others. 72. I try not to think about my problems. 73. I am tolerant. 74. I am shy. 75* I am responsible for my troubles. 76. I need somebody else to push me through on things. 77* I am a responsible person. 78. I am no one. Nothing really seems to be me. 79. Other people's values and standards are most important to me. 80. I am afraid of a full-fledged disagreement with a person. 81. Self control is no problem to me. 82. I am afraid of what other people think of me. 83. I usually like people. 84. I am a failure. 162 APPENDIX F— Continued 65. I express my emotions freely. 66. I have always been uncomfortable with sex. 87• I am ambitious. 88. I am naturally nervous. 89. I have initiative. 90. All you have to do is just insist with me and I give in. 91. I am a dominant person. 92. I have to protect myself with excuses. 93• 1 take a positive attitude toward myself. 94* I no longer have any sexual interest whatever. 95* I feel superior. 96. I am satisfied with myself. 97* I am an aloof reserved person. 98. I am likeable. 99* I am really self-centered. 100. I feel relaxed and nothing really bothers me. 163 APPENDIX G INSTRUCTIONS FOR HOSPITAL ADJUSTMENT TEST Please fill out this questionnaire for each patient whose name appears at the top of the sheet. Mark each statement as follows: If the statement Is TRUE for the patient, put a circle around If the statement is PARTLY TRUE for the patient, encircle PT. If the statement is PARTLY FALSE for the patient, encircle PF. If the statement is FALSE for the patient, encircle F. The statement should be marked TRUE (T) if it is always ¥ resent or almost always present in the patient; If it s characteristic ot the patient. The statement should be marked PARTLY TRUE (PT) if it is sometimes present. The statement should be marked PARTLY FALSE (PF) if it is rarely present. The statement should be marked FALSE (F) if it is never present or almost never present. Marking the statements TRUE, PARTLY TRUE PARTLY FALSE, or FALSE should be based on actual observation by yourself of the patient within the last two weeks. Thus, the person filling out the form may be the nurse, LVN, or attendant who best knows the patient. It is necessary to mark all statements. Do not leave anv out. Please feel free to write in any comments you might have about any of the statements. APPENDIX H HOSPITAL ADJUSTMENT TEST 1. T PT PF F The patient Ignores the activities around her. 2. T PT PF F The patient gets dressed up for visitors. 3. T PT PF F The patient follows events in the daily papers. 4. T PT PF F The patient laughs if she is kidded. 5. T PT PF F The patient stays by herself. 6. T PT PF F The patient doesn’t mix with other patients. 7. T PT PF F The patient doesn’t seek social con tacts with other patients. 8. T PT PF F The patient can tease another patient back into good humor. 9. T PT PF F The patient remarks when it is time for visitors. O • T PT PF F The patient doesn’t have close friends on the ward. 11. T PT PF F The patient won’t discuss many subjects 12. T PT PF F The patient is always chatting with someone. 13. T PT PF F The patient knows the names of the doctors, nurses, and aides. 14. T PT PF F The patient writes letters. 15. T PT PF F The patient has to be reminded to attend to routine. 16. T PT PF F The patient offers to help others. 17. T PT PF F The patient yells at attendant when she’s dissatisfied. 135 APPENDIX H— Continued id. T PT PF F The patient shares with others. 19. T PT PF F The patient easily becomes upset If something doesn't suit her. 20. T PT PF F The patient anticipates activities of next day. 21. T PT PF F The patient takes part In ward games and other recreation. 22. T PT PF F The patient appears cheerful most of the time. 23. T PT PF F The patient would sit all day if not directed to do an activity. 24. T PT PF F The patient doesn’t like to get out of bed. 25. T PT PF F The patient stays neat and clean. 186 APPENDIX I SCORING CRITERIA FOR HOSPITAL ADJUSTMENT TEST Question Number Score T PT PF F 1 1 2 3 4 2 4 3 2 1 3 4 3 2 1 4 4 3 2 1 5 1 2 3 4 6 1 2 3 4 7 1 2 3 4 8 4 3 2 1 9 4 3 2 1 10 1 2 3 4 11 1 2 3 4 12 4 3 2 1 13 4 3 2 1 3* 4 3 2 1 15 1 2 3 4 16 4 3 2 1 17 1 2 3 4 18 4 3 2 1 19 1 2 3 4 20 4 3 2 1 21 4 3 2 1 22 4 3 2 1 23 1 2 3 4 24 1 2 3 4 25 4 3 2 1 187 APPENDIX J FINAL QUESTIONNAIRE 1. THINGS I LIKED ABOUT THE GROUP, (pleas* check the things you enjoyed in the group) Learning new or different things. Learning about myself. Learning about others. Making new friends. A place to speak my mind about things without fear of the consequences. Liked the group leader. Liked to talk about myself. Liked to help others. Liked the chance to get out of bed more often. Liked the chance to get away from the ward for a while. Liked using my head. Other (please write in:) 2. THINGS I DISLIKED ABOUT THE GROUP. (please check the things you did not like about the group) Difficulties getting to and from the group sessions (tram, pushers). Difficulties with having the nurses or attendants get me ready for the group. The time of the meetings was not convenient. I’m too old for this sort of thing. Poor health interfered with my enjoyment of the group. Didn’t like the people I met in the group. Didn’t like the group leader. It made me nervous. I was bored most of the time. I didn’t like talking about myself. I didn’t like talking about others, or listening to others. 3* If there are other groups like the one I attended: I would join one. I would not join one. I would ask my friends to join. 4. Type of groups I would like to join: (please indicate below) 188 APPENDIX K DESCRIPTION OF THE RATING SCALES OF EMOTIONAL TONE, SELF CONCEPT, SOCIAL DISTANCE, AND CONFLICT Rating Description Emotional Tone 0 Description, lack of affect, equal balance of positive and negative feelings, routine acti vities, impersonal reflection or exposition with no emotional involvement, data insuffi cient for judging. 1 Complete failure, complete hopelessness and submission to fate, death, suicide, severe guilt, complete frustration, uncontrolled emotionality, violent murder, extreme depression. 2 Conflict with attempt at adjustment, rebellion, fear, worry, departure, regret, illness, physical exhaustion, loneliness, self-pity, dissatisfaction, physical incapacity, reflect ion on worldly conflicts, thinking out solu tions to problems, requests for help but no constructive help or solution forthcoming, disappointment, anger, strong disagreement on issues, advice given but no solution reached, disagreeable advice which is not accepted. 3 Aspiration, desire for success, compensation for limited endowment, appreciation of world around, pleasant surprise, constructive advice accompanied by positive feelings or results, pleasant anticipation, mild disagreement on minor issues, desire for independence. 4 Justifiably high aspiration, reunion with loved ones, optimistic future, happy feelings, planning for happiness, vacation, complete satisfaction and contentment. APPENDIX K— Continued 189 Rating Description Self Concept as Revealed by Treatment of Hero Ambivalence toward self. Self-attitudes not expressed. Data insufficient for judging. Extremely low self-esteem. Strong feelings of insecurity, inadequacy, inferiority, lack of self-confidence, uncertainty in coping with frustrations. Acceptance of failure, lack of insight. Low self-esteem. Mild indication of insecurity or inadequacy. No evidence of growth in self esteem, or of changing views toward self. Moderate self-esteem. Desire for self- improvement, evidence of coping with inade quacies in a healthy way. Evidence of emotional maturity, high self esteem, confidence in ability to cope with frustrations successfully. Social Distance 0 No people mentioned or involved in story. Mere description of scenery or objects. Insuf ficient data for judging. 1 The only person mentioned in the story is the hero. Hero*s thoughts or actions involve no people other than himself. Withdrawal into unreality. Other people are used in a remote way. Use of fictional characters or great distances (physical or temporal) between hero and other people. 2 Relationships between hero and other people are on a surface level, with no emotional ties. Intellectualization rather than feeling motivates 0 1 2 3 4 APPENDIX K— Continued 190 Rating Description hero’s social relationships. 3 Mild relationships exist between hero and others. Desire for strong relations. Disagreement between hero and others. 4 Very strong positive or negative relationships exist between hero and other person or persons. Very strong interaction, conflict. Conflict 0 Story doesn't reveal nature of hero's relation ships with other people. Other people are re lated to hero in an ambivalent way. Insuf ficient data for judging. 1 Hero seems to be in strong conflict with others. He relates to others in a negative, immature manner, i.e., dependency, rejection, hostility, overaggressiveness, submissiveness, dominance, revenge. Hero is anxious in presence of others, fears others. Serious disturbances in inter personal relations. 2 Surface relationships good, but evidence of underlying negative attitudes towards people or society. Lack of overt conflict with others because of repressed hostility. Some conflict present, but not severe. 3 Mildly disturbed social relationships. Evidence of desire to improve interpersonal relations. No evidence of severe conflict at any level. 4 Hero has positive, mature relationships and positive attitudes towards other people. 191 APPENDIX L DESCRIPTION OF THE VARIABLES OF AVERAGE NUMBER OF WORDS PER STORY, SELF REFERENCES, AND "ZWAANG" EXPRESSIONS Variable Method of Scoring Deacriptiona Average Number of Words per Story Summing the words for each story for a sub ject and dividing the sum by seven, the total number of sto ries per patient. A measure of the length, if not the richness of the productions. Self References The number of occur- rances of the first person pronoun and direct references to the narrator, as, rtIt seems to me," "the way I see it," "Just like my own story." A measure of ego- centrlcity or re-introjection of the subject*s imagery. "Zwaang" Expressions Number of occurren ces of expressions felt as, "I have to," "I must," or pro jected, as "He is forced," or "She finds it necessary." A high incidence indicates com pulsive tendencies in the subject's fantasy. aBalkin and Masserman's descriptions ( ). 192 APPENDIX M DESCRIPTION OF THE VARIABLES OF TIME SPAN AN) SPACE SPAN Rating Description T i m Span 1 One hour. 2 From one hour to twelve hours. 3 From twelve hours to twenty-four hours. 4 From one day to seven days. 5 From one week to two weeks. 6 From two weeks to one year. 7 One year plus. Space Span 1 Within a single room, or one single place outdoors. 2 Movement to two rooms in a house, or looking from one room to another. 3 Movement to outside house in imediate environs (yard, barn). 4 Movement into different house— or to another spot just beyond immediate environs. 5 Movement to different city or country, requiring transportation other than walking. BIBLIOGRAPHY Affeld, J. E. "Rancho Los Amigos Hospital." Unpub lished article, Downey, California, February 28, 1958, 1-5* (Mimeographed.) Albrecht, Ruth. "Social Roles in the Prevention of Senility," Journal of Gerontology. VI, (1951), 380-386. Anderson, John E. "The assessment of Aging: Back- f round in Theory and Experiment," Psychological apects of Aflfog; Conference on Planning Research. ea.John E. Anderson. Washington, D.C.: American Psychological Association, 1956, 79. Andrus, Ruth. "Personality Changes in an Older Group," Geriatrics. I, (1955), 432-435. Arnhoff, Franklyn N. "Research Problems in Geron tology." Journal of Gerontology. I, (1955), 452-456. Babcock, H. "An Experiment in the Measurement of Mental Deterioration," Archives of Psychology. XVIII, (1930), 68. Balkin, Eva R. and Masserm&n, Jules H. "The Language of Phantasy: III The Language of the Phantasies of Patients with Conversion Hysteria, Anxiety State, and Obsessive Compulsive Neuroses," Journal of Psychology. X, (1940), 75-86. Barr, Lawrence. "Changes in Personality Test Measures Resulting from Participation of College Students in Group-Centered Psychotherapy." Unpublished Ph.D. dissertation, University of Southern California, 1952. Beasley, Willis C. "The General Problem of Deafness in the Population," Laryngoscope. L, (1940), 856-905. Belloc, N. B. "Blindness Among the Aged," Public Health Reports. LXXI, (1956), 1221-1225. 11. 12. 13 . 14. 15. 16. 17. 18. 19. 20. 21. 22. 194 Bentzen, 0. and Jelnes, K. "Incidence of Impaired Hearing in Denmark: An Evaluation Baaed on the Social Condition of Hearing for 5,000 Indi viduals," Acta.Oto-taryngologica. H H V , (1955), 189-197. Birren, J. E., Bick, M. V., and Fox, C. "Age Changes in the Light Threshold of the Dark Adapted Eye," Journal of Gerontology. Ill, (1948), 267-271. Bortz, Edward L. "Stress and Aging." Geriatrics. X. (1$55), 93-99. 4 Bowman, Karl M. "Alcoholism and Geriatrics," American Journal of Psychiatry. CXIV, (1958), 621-623. . "Mental Adjustment to Physical Changes with Aging," Geriatrics. XI, (1956), 139-145. Boyd, David A., Jr., and Braceland, Francis J. "The Practitioner and the Older Age Groups: Psycho- ° * North Boyle, Robert W., Schwart, Louis, and Prosser, Edna L. "A Sheltered Workshop Program in a Geriatric Hospital," Geriatrics. X, (1955), 436-439. Braceland, Francis J. "Age-Youth," The People in Your Life;— Psychiatry_and Personal Relations b Ten Leading Authorities, eel. Margaret Mary Hughes.New York: Knopf, 1951, 93-119. Bradshaw, Homer L. "Differentiating Characteristics of Superior Old People." Dissertation Abstracts. XVI, U956), 2208-2209.------------ -------- Bromley, Dennis B. "Research Prospects in the Psycho- 10^6®^ 272*274** Joarnal o1 Mental Science. CII, Burgess, Ernest W. "Growing Problems of Aging," Living Through the Older Years, ed. Clark Tibbitts. Ann Arbor, Michigan: "TTdiwsl ty of Michigan Press, 1949, 7-25 . "Social Relations, Activities and Personal Adjustment," American Journal of Sociology. CIX, (1954), 352-36T3T 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 195 Butler, John M., and Haigh, Gerard V. "Changes in the Relation Between Self Concepts and Ideal Concepts Consequent upon Client-Centered Counseling," Psychotherapy and Personality Change, eds. Carl R. Rogers ana Rosalind F. Dymondi Chicago: The University of Chicago Press, 1954, 55-75. Chapanis, Alphonse. "Relationship Between Age, Visual Acuity, and Color Vision," Human Biology. XXII, (1950), 1-3. Chearow, Eugene J., Wosika, Paul H., and Rienitz, Arthur H. "A Psychometric Evaluation of Aged White Males," Geriatrics. IV, (1949), 169-177. Cicero. Easav on Old Age. Cleveland, S., and Dysinger, D. "Mental Deterioration in Senile Psychosis." Journal of Abnormal and Social Psychology. XXXXlX, (1944),368-j7£. Collins, Selwyn D., and Britten, Rollo H. "Variations in Eyesight at Different Ages as Determined by the Snellen Test," Public Health Reports. XXXIX, (1924), 3189-319^ Cramer, Carl. "New York State," Holiday. XXI, (1957), 50-63. Curry, Octavia Muriel. "New Outlooks on Aging and the Aged: With an Annotated Bibliography of Articles from Recent Professional Journals (1953-1954)," Unpublished Ph.D. dissertation, University of Southern California, 1955, 1-4* Davis, Hallowel (ed.). Hearing and Deafness. A Guide for Laymen. New York! Murray Pill Books, Inc., 1947, 125-161 and 48O-48I. Donahue, Wilma. "An Experiment in the Restoration and Preservation of Personality in the Aged," Planning the Older Years, eds. Wilma Donahue and Clark Tibbitts. Ann Arbor, Michigan: University of Michigan Press, 1950, 167-189. . "Changes in Psychological Processes with Aging," Living Through the Older Years, ed. Clark Tibbitts. Ann Arbor, Michigan: University of Michigan Press, 1949, 63-84. 34. 35. 36. 37. 36. 39. 40. 41. 42. 43. 44. 45. 196 . Hunter, Woodrow W., and Coons, Dorothy. **A 3tudy of the Socialisation of Older People,” Geriatrics. VIII, (1953), 656-666. Doppelt, Jerome E., and Wallace, Wimburn L. "Standardisation of the Wechsler Adult Intelligence Scale for Older Persons.” Journal of Abnormal and Social Psychology. LI, (195$']. 312-3*6. Dorken, Herbert, Jr., and Greenbloom, Grace C. "Psychological Investigation of Senile Dementia II. The Wechsler-Bellevue Adult Intelligence Scale,” Geriatrics. VIII, (1953), 324-333. Ebel, Robert J. "Estimation of the Reliability of Ratings,” Psvchometrika. XVI, (1951), 407-424. Edwards, Allen L. Statistical Methods for the Behavioral Sciences. New fork: Rinenart and Company, Inc., 1^ 5 5• Ends, Earl J., and Page, Curtis W. "Group Psycho therapy and Concomitant Psychological Change,” Psychological Monographs. LXXIII, No. 460, 1959. Eron, Leonard D., Terry, D., and Callahan, R. "The Use of Rating Scales for Emotional Tone of TAT Stories," Journal of Consulting Psychology. XIV, (1950), 473-V76. Eysenck, Margaret Davies. "The Psychological Aspects of Ageing and Senility," Journal of Mental Science. LXXXXII, (1946), 171-181. Ferguson, J. T., McReynolds, P., and Ballachey, E. L. Hospital Ad-1 uatment Scale. Palo Alto, California: Lelana Stanford Junior University, 1953. Finney, D. J. "The Fisher-Yates Test of Significance in 2 x 2 Contingency Tables." Biometrika. XXIV. (1946), 149-154. ---- Fisher, Ronald A. Statistical Methods for Research Wg^kers. New York: Haf’ ner Publishing Company, Fogel, Ernest J. at $1* "Problems of the Aging: Conclusions Derive3 from Two Years of Inter- discplinary Study of Domiciliary Members in a Veterans Administration Center," American 46. 47. 46 • 49. 50. 51. 52. 53. 54. 55- 56. 197 Journal of Psychiatry. CXII, (1956), 724-730. Folsom, J. K., and Morgan, C. M. "The Social Adjust ment of 361 Recipients of Old Age Assistance," American Sociological Review. II, (1937), 223-229. Foulds, G. A., and Raven, J. C. "Normal Changes in the Mental Abilities of Adults as Age Advances," Science. LXXXXIV, (1946), 133-142. Fox, Charlotte, and Birren, James E. "Some Factors Affecting Vocabulary Size in Later Maturity: Age, Education, and the Length of Institutionalization," Journal of Gerontology. IV, (1949), 19-26. Friedenwald, Jones S. "The Eye," Problems of Ageing, ed. E. V. Cowdry. Baltimore: The Williams and Wilkins Company, 1942, 501-522. Fuchs, Dora and Levine, Harry. "The Hodson Community Center," Journal of Gerontology. I, (1946), 55-59. Furst, Ralph H. "Institutional Care of the Aged," Public Welfare of Indiana. LIX, (1949), 6-10. Gabriele, Anthony Benedict. "The Relationship of Day Center Attendance to Several Psychological and Socioeconomic Characteristics in a Group of Elderly Persons in New York Citv." Dissertation Abstracts. XIII, (1953), 516-517. Garfield, Sol L., and Eron, Leonard D., "Interpreting Mood and Activity in TAT Stories," Journal of Abnormal and Social Psychology. XXXlIll, (l94§). Ginzberg, Raphael. "Geriatric Ward Psychiatry: Techniques in the Psychological Management of K i L ^ T c S ? 1 )f!$-tga.9UTnal 9f Gorrite, Fernando. "Psicologia Agerasica. (The Psychology of Normal Old Age)," Archives of Medicine of Buenos Aires. XX, (1950), 193-206. Greenleigh, Lawrence F. Psychological Problems of Our Aging Population. Bethesda, Maryland: National Institute of Mental Health, U. S. Department of Health, Education, and Welfare, 1952, 1-76. 198 57. Guild, Stacy R. "The Ear." Problems of joeing. ed. E. V. Cowdry. Baltimore: the Williams and Wilkins Company, 1942, 523-532. 58. Guilford, J. P. Fundamental Statistics in Psychology gnd Edu^a^ion. New tork: rtcGraw Hill Book Company. 59. Harriman, Philip L. The New Dictionary of Psychology. New York: Philosophical Library, 1947, 117. 60. Hartman, A. A. "An Experimental Examination of the TAT Technique in Clinical Diagnosis," Psycholo gical Monographs. LXIII, No. 8, (1949). 61. Havighurst, Robert J. "Life Styles of Middle-Aged People," Vita Humana. II, (1959), 25-34. 62._______. "Old Age— an American Problem," Journal of Gerontology. IV, (1949), 298-304. 63. Howell, Robert J. "Sex Differences and Educational Influences on Mental Deterioration Scale," Journal of Gerontology. I, (1955), 190-193- 64. Hudgins, C. V. et al. "The Development of Recorded Auditory Tests Tor Measuring Hearing Loss for Speech," Laryngoscope. LVII, (1947), 57-89. 65. Hunt, William A. e£ al. "Further Standardisation of the CVS Individual Intelligence Scale," Journal of Consulting Psychology. XII, (1948), 35^-^9. 66. "The Clinical Possibilities of an Abbre- viated Individual Intelligence Test," Journal of_Consulting Psychology. XII, (1948), 1?1-173. 67. Hunter, Woodrow, Coons, Dorothy, and Tibbitts, Clark. "A Recreational-Educational Experiment," Planning the Older Years, eds. Wilma Donahue and Clark Tibbitts. Ann Arbor, Michigan: University of Michigan Press, 1950, 119-140. 68. Inglis, James. "Psychological Investigations of Cognitive Deficit in Elderly Psychiatric Patients," Psychological Bulletin. LV, (1958), 197-214. 69. Johnson, Virginia. "Factors to be Considered in the Guidance of the Older Adult." Unpublished thesis, University of Southern California, 1948, 8. 70. 71. 72. 73. 74. 75. 76. 77. 76. 79. 80. 199 Jones, H. E., and Conrad, H. 3. "Growth and Decline of Intelligence; a Study of a Homogeneous Group between the Ages of 10 and 60," Genetic Psychology Monographs. XIII, (1933), 223-296. . and Kaplan, Oscar J. "Psychological Aspects of Mental Disorder in Later Life," Mental Disorders in Later Life, ed. Oscar J. Kaplan. Stanford: Stanford University Press, 1956, 69-117. Kainin, Leon J. "Differential Changes in Mental Abilities in Old Age." Journal of Gerontology. XII. (1957), 66-70. ---------------- Kaplan, Jerome. A Social Program for Older People. Minneapolis: University oi Minnesota Press, 1953- _______. "The Effects of Group Activity on Psycho- genic Manifestations of Older People." Geriatrics. IX, (1954), 537-539. "The Significance of Group Activity on Psychogenic Manifestations of Old People," Old Age in the Modern World. Report of the Third Congress of the International Association of Gerontology. Edinburgh: E. &. S. Livingstone, Ltd., 1955, 596-597. Kleemeier, Robert W. "The Effect of a Work Program on Adjustment Attitudes in an Aged Population," Journal of Gerontology. VI, (1951), 372-379. Klopfer, Bruno et. al. Developments in the Rorschach Technique I. New York: World Book Company, 1^54, 355. Kornzweig, A. L. "Physiological Effects of Age on the Visual Process.” Sight Saving Review. XXIV. (1954), 130-138. ----------------- Kuhlen, R. G. "Psychological Trends and Problems in Later Maturity," An Introduction to Clinical Psychology, eds. L. A* Pennington and Trwin I. Berg. New York: The Ronald Press Company, 1954, 218-248. Kutner, Bernard, and Smillie, Wilson G. "The Problem of Mental Health Among the Aged." American Journal of Public Health. XXXXVI, (1956), 20F-2'03. 200 81. Lakin, Martin, and Dray, Melvin. "Psychological Aspects of Activity for the Aged," American 172*1$ XIX, (1958), 82. Landau, Gertrude. "Restoration of Self-Esteem," Geriatrics. X, (1955), 141-143. "The Restoration of Group Esteem through Social Group Work," Old Age in the Modern World. Report of the Third Congress of the International Association of Gerontology. Edinburgh: E. & S. Livingstone, Ltd., 1955, 595-596. 84. Lawton, George. "A Long Range Research Program in the Psychology of Old Age and Ageing," Journal of Social Psychology. XIX, (1940), 102. 85. Lemkau, Paul V. "The Mental Hygiene of Aging," Public Health Reports. LXVII, (1952), 237-241. 86. Lenzener, Abraham S. "Mental Health Problems of the Aging," Journal of the Jewish Communal Service. XXXIII, (1$$6)7 147-152. ------ 87. LeShan, Lawrence L. "Time Orientation and Social r f i i n k r 1 - ■ ■ 3 -°c -ial P»ycho1- 88. Linden, Maurice E. "Emotional Problems in Aging," Jewish Social Service Quarterly. XXXI, (1954), 80-89. 39. .. . "Geriatrics," The Fields of Group Psvchotherapy, ed. S. R. Slavson.New York: international Universities Press, 1956, 129-152. 90. . "Group Psychotherapy with Institutionalized Senile Women: Study in Gerontologic Human Relation ships," International Journal of Group Psycho therapy. Ill, i 195l) , I£d>-i?67 91* "The Significance of Dual Leadership in Gerontolic Human Relations, III," International Journal of Group Psychotherapy. IV, 92. . "Transference in Gerontologic Group .c Hunu of Group Psychotherapy: Studies in Gerontologic Human Relations, IV," International Journal 93. 94. 95. 96. 97. 93. 99. 100. 101. 102. 103. 104. 201 Psychotherapy. V, (1955), 61-79. Lorge, I. "The Influence of the Teat upon the Nature of Mental Decline aa a Function of Aging." Jgurn^l of Educational Paychology. XXVII, (1936), Martin, Lillien J., and De Gruchy. Clare. Salvaging Old Age. New York: The Macmillan Company, 1930* McNemar, Q. Psychological Statiatica. New York: Wiley Company, 194?V Menninger, William. "Recreation and Mental Health," Recreation. X, (1943), 340-346. Miles, W. R. "Measures of Certain Abilities Throughout the Life Span," Proceedings of the National Academy of Science. i!vil. (l93l), 657-633. . "Psychological Aspects of Aging," Problems of Ageing, ed. E. V. Cowdry. Baltimore: the Williams and Wilkins Company, 1942, 756-734. Murray, Henry A. "Thematic Apperception Test." Cambridge: Harvard University Press, 1943* O ’Reilly, P. 0., and Handforth, J. R. "Occupational Therapy with ’Refractory* Patients," American Journal of Psychiatry. CXI, (1955), 763-^66. Palmer, Harold D. "Mental Disorders of Old Age," Geriatrics. I, (1946), 60-79. Pressey, S. L., and Simcoe. Elizabeth. "Case Study Comparisons of Successful and Problem Old People," Journal of Gerontology. V, (1950), 16S-175. Rapaport. D., Gill, M., and Schafer, R. Diagnostic Psychological Testing; the Theory. Statistical Evaluation and .Diagnostic Application o^a featterv of Tests. Vol. I. New York: Year 5ook Publishers. W 5 . Rechtschaffen, Allan. "Psychotherapy with Geriatric Patients: A Review of the Literature," Journal of Gerontology. XIV, (1959), 73-34. 105. 106. 107. 106. 109. 110. 111. 112. 113. 114. 115. 202 Rogers, Carl R., and Dymond, Rosalind F. Psycho therapy and Personality Change. Chicago: The University of bhicago Frees, 1954. Ross, Mathew. "Some Psychiatric Aspects of Senescence: a Review of the Literature," Psychiatric Quarterly. XXVIII, (1954), 93-112. Rusk, Howard A. "America's Number One Problem- Chronic Disease and an Aging Population," Amgricyi Journal of Psychiatry. CVI, (1949) "Rehabilitation: Nature and Magnitude of the Problem," Rehabilitation of the Older Worker, eds. W. Donahue/J.Rae, and R. Berry. Ann Arbor, Michigan: University of Michigan Press, 1953, 14-26. Sacramento, California. Proceedings of the Governor's Conference on the Problems of the X g l' n g T" 'O&ofefT K a SfIgr'feTT 1 3 9 1 -------- Schaie, K. W., Rosenthal, F., and Perlman, R. M. "Differential Mental Deterioration of Factorially 'Pure' Functions in Later Maturity," Journal of Gerontology. VIII, (1953), 191-196. Shipley, Walter C. "A Self-Administoring Scale for Measuring Intellectual Impairment and Deterioration," Journal of Psychology. IX, (1940), Shock, Nathan W. "Psychology and Gerontology," Current Trends in the Relation of Psychology to Medicine.ed.Wayne Dennis et al.Pittsburgh: University of Pittsburgh Press, ±950, 146-162. Siegel, Sidney. Non Parametric Statistics for the Behavioral Sciences. N e w York:McGraw Hill Book Company, Inc., 1956. Silver, A. "Group Psychotherapy with Senile Psychotic Patients," Geriatrics. V, (±950), 147-150. Silverman, A., et al. "Physiological Influence on Psychic Functioning in Elderly People," Geriatrics. VIII, (1953), 370-376. 116. 117. 118. 119. 120. 121. 122. 123. 124. 125. 126. 203 Silverman, Maurice. "Psychological and Social Aspects of‘Psychiatric Disorders in the Aged," Journal of Mental Science. LXXXXIX, (19537, 257 -564. Smith. M. R., Bryant, J. E., and Tvritchell-Allen, Doris. "Sociometric Changes in a Group of Adult Female Psychotics following an Intensive Sociali- zation^Program," Group Psychotherapy. IV, (1951), Sorenson, H. "Mental Ability over a Wide Range of Adult Ages," Journal of Applied Psychology. XVII, (1933), 729-74TT Sorsby, A. The Causes of Blindness in England. London: Her Majestyvs Stationery Office, 1953. Steinberg, John C., Montgomery, Harold C., and Gardner, Mark B. "Results of the World’s Fair Hearing Tests." Journal of the Acoustical Society of Am4ricI7TTT7 fl^ffiT.' '2^0-TCI^' Strother, Charles R., Schaie, K. Warner, and Horst, Paul. "The Relationships between Advanced Age and Mental Abilities," Journal of Abnormal and Social Psychology. LV, (1^57)7 I66-17C). Sullivan, Elizabeth T«, Clark, Willis W., and Tiegs, Ernest W. "Pretests of Vision, Hearing, and Motor Coordination. Advanced. Grades 9 to Adult." Los Angeles: California Test Bureau, n.d. Tarrell, Peter. "Group Work with Older Persons," Jewish Social Service Quarterly. XXVI, (1950), 478-489. Thaler, Margaret. "Relationships among Wechsler, Weigl Rorschach, EEG Findings and Abstract Concrete Behavior in a Group of Normal Aged Subjects," Journal of Gerontology. XI, (1957), 404-409. Thewlis, Malford W. The Care of the Aged (Geri atrics) . St. Louis: The C. V. Mosby Company, 19 5if, 174-224. U. S. Federal Security Agency. Fact Book on Aging. Washington, D. C.: U. S. Government Printing Office, 1952, 4. 127. 128. 129. 130. 131. 132. 133. 134. 135. 136. 137. 138. 204 U. S. Federal Security Agency. Mail and his Years. Washington, D. C.: Health Publications Institute, 1950, 256. Urmer, Albert H., Malek, Zena, and Wendland, Leonard. "A Hospital Adjustment Scale for Chronic Disease Patients." Journal of Clinical Psychology, in press, (i960). Wachs, Moses. "A Day Activity Program in a Home and Hospital for the Aged." Geriatrics. II, (1956), 220-222.------------------------ Watson, Robert I. "The Personality of the Aged, A Review," Journal of Gerontology. IX, (1954) 309-315. Wayne, George J. "Work as Therapy with Special Reference to the Elderly." Mental Hygiene. XXXIX. (1955), 79-88. -------------- Webster, John C., Himes, Harold W., and Lichtenstein, Malcomb. "San Diego County Fair Hearing Survey," SocletY of Amerlc*> Wechsler. D. Manual for the Wechsler Adult Intelligence Scale. New York: Psychological Corporation, 1^*£. . "The Measurement and Evaluation of Intelligence of Older Persons," Old Age in the Modern World. Report of the Third Congress of the International Association of Gerontology. Edinburgh: E. Sc S. Livingstone, Ltd., 1955, 275-278. . The Measurement of Adult Intelligence. Baltimore:Williams and Wilkins Company, 1944• Wilkins, L. T. "The Prevalence of Deafness in England, Scotland, and Wal logia Suppliment. LXXXXVII England, Scotland, and WaJ-eSj^^Acta-^to-Larvngo- Yates, Aubrey. "The Use of Vocabulary in the Measurement of Intellectual Deterioration— A Review," Journal of Mental Science. CII, (1956), 409—440• Zivan, Morton. "The Effect of Work on the Chronically 205 111 and Aged: a Study of the Effect of Sheltered Workshop Employment on the Personal Adjustment of a Hospitalized Group of Chronically 111 and Aged People," Dissertation Abstracts- XIX. (1958), 178-1797^
Linked assets
University of Southern California Dissertations and Theses
Conceptually similar
PDF
A Study Of The Effects Of Generalized Expectancies Upon Accuracy Of Interpersonal Perception
PDF
The Relationship Of Dependency To Verbal Learning Without Awareness
PDF
The Concept Of Sexual Identity In Normals And Transvestites: Its Relationship To The Body-Image, Self-Concept And Parental Identification
PDF
A Study Of The Effectiveness Of Teaching Methods Of Study To Selected High School Freshmen
PDF
The Effects Of Sex, Assigned Therapist Or Peer Role, Topic Intimacy, And Expectations Of Partner Compatibility On Dyadic Communication Patterns
PDF
A Study Of The Effectiveness Of Group Counseling In Achieving The Goals Of Guidance In Education, Using Two Contrasting Formats
PDF
The Effects Of Feedback On The Communication Of Medical Prescription To Diabetic Patients
PDF
Intellectual And Cognitive Factors In The Production Of Psychological Stress Reactions
PDF
A Study To Compare The Effectiveness Of Individual And Group Counseling Approaches With Able Underachievers When Counselor Time Is Held Constant
PDF
Transfer Of The Partial Reinforcement Extinction Effect Across Tasks In Normal And Retarded Boys
PDF
The Effects Of Making Social Desirability Judgments On Personality Inventory Scores Of Schizophrenics
PDF
The Effects Of Prior Part-Experiences On Visual Form Perception In The Albino Rat
PDF
Effects Of Video Tape Feedback Versus Discussion Session Feedback On Group Interaction, Self Awareness And Behavioral Change Among Group Psychotherapy Participants
PDF
The Effect Of Motor Ability Loss On Cognition And Emotion
PDF
A Study Of Affective Sets: The Effects Of Family And Non-Family Verbal Contexts On Word-Need Stimuli In A Word Association Experiment With Reference To Pleasant And Emotional Tones Of Associated...
PDF
Anxiety Level And The Repression-Sensitization Dimension In Desensitization Therapies
PDF
Intellect After Lobotomy In Schizophrenia: A Factor-Analytic Study
PDF
Prediction Of Therapeutic And Intellectual Potential In Mentally Retardedchildren
PDF
Delinquency As A Function Of Intrafamily Relationships
PDF
The role of cues in the arousal of anxiety
Asset Metadata
Creator
Malek, Zena Bella
(author)
Core Title
The Effects Of Group Experiences On The Aged
Degree
Doctor of Philosophy
Degree Program
Psychology
Publisher
University of Southern California
(original),
University of Southern California. Libraries
(digital)
Tag
OAI-PMH Harvest,Psychology, clinical
Language
English
Contributor
Digitized by ProQuest
(provenance)
Advisor
Harvey, Herman (
committee chair
), Carnes, Earl F. (
committee member
), Jacobs, Alfred (
committee member
)
Permanent Link (DOI)
https://doi.org/10.25549/usctheses-c18-87758
Unique identifier
UC11357988
Identifier
6100397.pdf (filename),usctheses-c18-87758 (legacy record id)
Legacy Identifier
6100397.pdf
Dmrecord
87758
Document Type
Dissertation
Rights
Malek, Zena Bella
Type
texts
Source
University of Southern California
(contributing entity),
University of Southern California Dissertations and Theses
(collection)
Access Conditions
The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the au...
Repository Name
University of Southern California Digital Library
Repository Location
USC Digital Library, University of Southern California, University Park Campus, Los Angeles, California 90089, USA