University of Southern California Dissertations and Theses

Effects Of Video Tape Feedback Versus Discussion Session Feedback On Group Interaction, Self Awareness And Behavioral Change Among Group Psychotherapy Participants

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Effects Of Video Tape Feedback Versus Discussion Session Feedback On Group Interaction, Self Awareness And Behavioral Change Among Group Psychotherapy Participants

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Content I This dissertation has been microfilmed exactly as received 6 8 — 1 2 ,0 5 7 ROBINSON, M a rg a re t B a lla n tin e , 1915- E F F E C T S O F VIDEO T A P E FEED B A C K VERSUS DISCUSSION SESSION FEED B A C K ON GROUP IN TER A C TIO N , S E L F AW ARENESS AND BEHAVIORAL CHANGE AMONG GROUP PSYCHO THERAPY PA R T IC IPA N T S. U n iv e rsity o f S o u th ern C a lifo rn ia , P h .D ., 1968 P sy c h o lo g y , c lin ic a l U niversity M icrofilm s, Inc., A nn Arbor, M ichigan C o p y r ig h t (c) b y M A R G A R E T B A L L A N T IN E R O B IN S O N 1968 EFFECTS OF VIDEO TAPE FEEDBACK VERSUS DISCUSSION SESSION FEEDBACK ON GROUP INTERACTION, SELF AWARENESS AND BEHAVIORAL CHANGE AMONG GROUP PSYCHOTHERAPY PARTICIPANTS by Margaret Ballantine Robinson A Dissertation presented to the FACULTY OF THE GRADUATE SCHOOL UNIVERSITY OF SOUTHERN CALIFORNIA in Partial Fulfillment of the Requirements for the Degree DOCTOR OF PHILOSOPHY (Psychology) January 1968 U N IV E R SIT Y O F S O U T H E R N C A L IF O R N IA T H E G R A D U A T E S C H O O L U N IV E R S IT Y PA R K L O S A N G E L E S . C A L IF O R N IA 9 0 0 0 7 This dissertation, written by ............. M a E g a.r e t . £ a II a n t i n e _ _R _o b in s. o n .............. under the direction of h&x....Dissertation Com mittee, and approved by all its members, has been presented to and accepted by the Graduate School, in partial fulfillment of requirements for the degree of D O C T O R OF P H I L O S O P H Y g ...... Dean Dflte...January,. . 19.68............ DISSERTATION COMMITTEE Chairman ACKNOWLEDGMENTS A number of individuals have contributed to the successful completion of the present dissertation study. I am most deeply indebted to Dr. Alfred Jacobs, my doctoral committee chairman, whose creative bent, incisive percep tion and scholarly insistence on clarity of expression and experimental precision were invaluable to both the formula tion and fruition of this work. I am also grateful to my other committee members, Drs. Douglas De Nike and Don Smith for their sustained interest and helpful suggestions. As my training supervisor, Dr. Frederick Stoller became both the model and inspiration for this study during its formative stage; his enthusiasm and encouragement in addition to his own innovative work in this area were impor tant contributions to the data gathering process and final results. I am particularly grateful to Dr. Benjamin A. Siegal, Chief Psychologist, Camarillo State Hospital, who through 'his active support of staff research and development has established a climate uniquely favorable to the pursuit of dissertational investigations. My appreciation also to other staff members who contributed so generously of their time and professional talents. A special word of thanks to Donn Yarrow, my faithful co-therapist and camera artist who supported me steadfastly during the demanding weeks of video taped group therapy we shared together. I am also indebted to Robert Hadley, my friend and statistical mentor for many years, whose special skills and insightful observations have been constant sources of assurance to me during my current endeavor. And to my sons, Michael and Whitney Robinson, my admiration and gratitude for their cheerful surrender of many creature comforts during my protracted period of educational involvement. Finally, I wish to express my loving appreciation to my husband, Bartlett Robinson, for his unwavering support and encouragement in the face of the many personal sacri fices he has tolerated as a result of my academic commit ments. That our relationship has continued to flourish over the years is a tribute to his generosity, patience and understanding. Malibu, California Margaret Robinson iv TABLE OF CONTENTS Page ACKNOWLEDGMENTS....................................... ii LIST OF TABLES..............................' ......... Chapter INTRODUCTION .......................................... 1 I. STATEMENT OF THE PROBLEM...................... 2 II. REVIEW OF RELATED CONCEPTS..................... 5 Personality Theories and Group Psychotherapy Group Psychotherapy and Interpersonal processes The Selfj Self-Conceptj and Self-Awareness Reality Testing Cognition Communication Dimensions of Feedback III. REVIEW OF RELATED STUDIES.................... 28 Present Status of Self-Concept Televised Group Psychotherapy Empirical Uses of Feedback Techniques IV. HYPOTHESES AND PREDICTIONS 49 Chapter Page V. METHOD OF INVESTIGATION..................... 52 The problem Subjects General Design and Methods Therapist Bias Rating procedures and Measuring Instruments Statistical Operations Mechanical Equipment Therapy and Feedback procedures using VTR VI . RESULTS.................................. 80 VII . DISCUSSION................................ 89 Behavioral and Attitudinal Change Positive and Negative Direction Scores Videotape Feedback Versus Discussion Session Feedback Descriptive Material Implications for Treatment and Research APPENDIXES I. Demographic Table for Individual Subjects . . Ill II. Sex Distribution^ Means and Standard Deviation of Age, Length of Hospital Stay., Meeting Attendance and Educational Level of Experimental and Control Subjects .... 113 III. Means, Standard Deviations, Pearson r's and Fisher z's of Paired Raw Score Rater Ratings on the Full Scale HIM-G.........................115 IV. Means, Standard Deviations and t_ Test of Raw Score Ratings on the HIM-G for Comparison of Experimental and Control Groups on Therapist Performance items ............................ 116 vi APPENDIXES— CQntd. Page V. Example of Feedback Item Derivation List . . 117 VI. Amount of Rater Agreement on the Number of First Session Feedback Items for Subjects in All Groups as Perceived by the Raters and by an Independent Judge5 and the pairing by the Judge of items Agreed upon by the Raters as Clear Feedback Items ...................... 118 VII. Example of Rater Rating Scale and scoring . . 119 VIII. Example of Self Rating Scale and Scoring . . 120 IX. Frequency Table of the Number of Instances in which Raters Checked Individual Feedback Items for Subjects Appearing on a Model Video T a p e ..................................122 X. Questionnaire................................125 XI. Number of Positive and Negative Feedback Itemsj Rater Determined positive and Negative Direction and No Change Items, and Adjusted Scores for Subjects in Experimental and Control Groups . 126 XII. Sample of Randomly Selected Feedback items Evaluated by Therapists and Independent Judge as Positive or Negative in Terms of Being Adaptive or Maladaptive in Interpersonal Situations................................... 130 XIII. Adjusted Rater Rating Scores for Experimental and Control Subjects ........................ 131 XIV. Adjusted Self Rating Scores for Experimental and Control Subjects ........................ 135 XV. Camera principles ............................. 139 vii Page LIST OF REFERENCES...................................... 142 LIST OF TABLES Table Page 1. Overall Means, Standard Deviations and Significance of Differences between Age, Length of Hospital Stay, Meeting Attendance and Educational Level of Experimental and Control Group Subjects ...................... 58 2. A Comparison of Inter-Rater Agreement with an Independent judge's Perception of Inter- Rater Agreement on a Random Sampling of Feedback Items ............................... 67 3. Rater Agreement on the Number of Instances in Which Behavior of a Subject Characterized by Any Given Feedback item occurred on a Model Video Tape , ........................ 70 4. Means and Standard Deviations of Adjusted Change Scores for Experimental and control Group Subjects............................... 81 5. Analysis of Variance of Differences in the Behavioral Change index for Rater Ratings between Experimental and Control Groups . . 83 6. Analysis of Variance of Differences in the Behavioral Change index for Self Ratings between Experimental and Control Groups . . 84 7. Analysis of variance of Differences in Adjusted positive Direction Scores between Experimental and Control Groups ........... 86 ix Table Page 8. Analysis of Variance of Differences in . Adjusted Negative Direction Scores between Experimental and Control Groups .......... 88 x INTRODUCTION Within the past few years the scientific and educa tional communities have begun to recognize the potential value of television. Technical developments such as the videotape machine, which provides an audio-video recording instantly available for replay, are opening new vistas for scholarly investigations. As with any other tool, the ad vantages and limitations of video-tape require close study, and a theoretical framework and associated techniques for its use must be developed. Clinical psychology, because of its concern with the human being and his ways of functioning in his world, may well have much to gain from a better understanding of the impact on an individual of being able to perceive such a recording of his social behavior. It appears to be of value, therefore, to explore some of the implications which video-tape recordings have when used as an adjunct to psychotherapy for treatment of patients in a mental hos pital. CHAPTER I STATEMENT OF THE PROBLEM The present research was designed to investigate behaviors which facilitate or hinder interpersonal interac tion. People rarely examine objectively their personal characteristics and behavior in interpersonal situations. Acknowledgment of the need for change and subsequent correc tive behavior is even more unusual. Such growth-producing but often painful experiences frequently occur within the context of psychotherapy, and the feedback provided to evoke modifications is primarily of a verbal type and has few visual components. Thus, video tape recordings (VTR) may add an important dimension to the feedback process. Video tape feedback with its advantages of immediacy and objectivity would appear to contribute to an optimal climate for self-exploration. Stoller (1967a) takes the position that a therapist or other skilled observer must call the viewer's attention to the significant aspects of 2 his impact on others, and that when cognitive awareness has been specifically elicited by VTR, people find it difficult to deny the substance of the confrontation. This study proposed to provide mental hospital patients with an opportunity for self-viewing accompanied by directed comment within the context of group therapy, and to compare the effects of the VTR experience with those evolving from other kinds of feedback. On the theoretical level, the present investigation stems from three lines of development. The first is the interpersonal approach stressed by Leary (1957), Mead (1934), and Sullivan (1947) which produced the rationale for group psychotherapy. Another is based on self and self- concept theories developed by Lecky (1945), Raimy (1943), and Rogers (1963) among others. The third theoretical base places particular emphasis on feedback and communication skills (Benne, Bradford and Lippitt, 1964; Stoller, 1966b; Whitaker and Lieberman, 1964) as therapeutic techniques and as basic to human adjustment. These three areas conceive of adaptive- or maladaptive behavior as learned through social experiences and presumably modifiable by such correc tive techniques as feedback. The present investigator made the broad general prediction that there would be greater decreases in maladaptive responses and increases in adaptive responses following treatment among experimental subjects who received video taped feedback than among control sub jects who had not received this kind of feedback. Specific hypotheses are stated in a later section. CHAPTER II REVIEW OF RELATED CONCEPTS personality Theories and Group Psychotherapy The techniques of group psychotherapy have evolved from personality theories. The trend in contemporary theorizing about personality has shifted from the Freudian concern with instinctual drives and intrapsychic events more and more toward the individual as he appears within the con text of his cultural and social environment. Horney, Fromm, Erickson, and Sullivan attest to the importance of inter personal actions and perceptions to an individual's level of functioning. It is Sullivan, however, who has made the most profound contribution to the concept of interpersonal beha vior. He defined personality as that "relatively enduring pattern of recurring interpersonal situations which charac terize a human life" (1958, p. Ill) and psychiatry as "the study of processes that involve or go on between people" (1947, p. 5). Whereas Freud saw the instinctual impulses 5 as sources of anxiety and, therefore, warded off from con sciousness, for Sullivan, the things which are kept selec tively from awareness are the interpersonal processes, or feelings which are potentially anxiety arousing. Sullivan introduced the notion of "consensual validation" to describe a situation where two people concur in their pertinent per ceptions, of each other. He labeled this interactional pro cess as the syntaxic mode, his third and most adaptive experiential level of functioning. Kurt Lewin (1935) made a unique contribution to personality theory. Lewin described "life space," one of the basic constructs of his field theoretical system, as the interaction between the person and the environment as it exists for him. Lewin limited the term "environment" to that part of the world which the individual objectively perceives. For Lewin, all psychological behavior is a func tion of the field. For example, he conceived of a person as distorting events through his own perceptual inaccuracies rather than being acted upon by forces outside of himself. Video taped feedback with appropriate accompanying discus sion can contribute directly to minimizing perceptual dis tortion as Lewin describes it. Allport (1961, p. 2) argues that accurate perception of self is related to accurate perception of others. He further observes that "much of our lives is spent in trying to understand others (and in wishing others understood us better than they do)." The process of mutual understanding requires both the opportunity and the willingness to adapt to interperson al encounters. Hill (1965) views the therapy group as the appropriate milieu for such experiences: The goal of group psychotherapy as we see it is a change on the part of individual members from behavior that is maladaptive, anti-social or self destructive to behavior that allows the group mem bers to live a more useful, socially accepted and personally rewarding life. Groups are formed with the expectation that through participation in them, the group members will be helped toward such change. (P- 16) Hill proposes that the goal of group therapy is not to have a strong group with insightful discussions about emotional problems, but is rather the improvement of indi vidual members through the achievement of self-understanding acquired in interaction with other members. Group therapists argue that the group therapy situa tion with its potential for consensual validation is the optimal setting for encouraging and inducing change. Group members respond supportively to the struggles of an individ ual as he makes tentative gestures toward change, and they reinforce his emerging behavior. Group accord also has an exhilarating effect for those who experience themselves and their behavior as valued and validated. For this reason, the more socially adept patient and the therapist benefit from the group interaction. Whitaker and Lieberman (1964) suggest that shared affect among participants develops into commitment to the group which is always in a "state of becoming." Group Psychotherapy and Interpersonal processes A principal value of group psychotherapy as dis tinct from individual therapy is the opportunity group therapy affords for participants to observe the impact of their behavior on others. People are not ordinarily aware of how they appear to others or of the impression they make on others. Nor do they readily recognize the expressive qualities they elicit from those around them. One might conceptualize a therapy group as a microcosm of the real world wherein an individual reveals his expressive style. "No other setting," says Bach (1954, p. 3), "affords the opportunity to observe the self in interpersonal contact, to discover one's pattern of personality in social action, and to check the private observation about oneself against the impression of others." Within the group, the individual exposes himself to what he fears most, self-exposure, the presence or absence of group belonging, and a sense of closeness with others. Bach argues that group therapy may represent the optimal context for the discovery of the necessity of change in what Bach calls "self-other social contact opera tions." The individual is often forced into new ways of be having in order to receive reinforcing responses and accep tance from his fellow group members. However, neither behavioral nor attitudinal change is easily accomplished. McClelland (1965) observes that acquisition or change of complex characteristics in adult hood is extremely difficult but not impossible. He points to the many instances where the motivational structure of adults has been radically and permanently altered by educa tional efforts of various religious and political groups. People may demonstrate an infinite variety of behavioral strategies which may be subsumed under the term, "resis tance," in any situation where pressures for change exist. In the therapeutic setting, resistant maneuvers occurring within the framework of the patient's ambivalent demands for help and health often seem specifically designed to negate 10 treatment benefits (Bach, 1954), Such strategies are reminiscent of Lecky's emphasis on self-consistency (1945), and his observation that if a new idea is inconsistent with the present concept of self, it meets resistance and will tend to be rejected. Berne conceptualizes the group as a family constellation within which the patient reacts variously as a parent, child or adult. Berne has imaginatively described and labeled many resistance maneuvers as "Games people Play" (1964) with one another in the process of social intercourse. In an overview of recent trends in psychotherapy, Rotter (1963) observes: The tendency is no longer to regard group therapy as a kind of mass situation with the same goals as individual psychotherapy. Rather it is regarded as a special situation where the patient has the opportunity to learn group norms, where he can be reinforced for social interest, and where he is able to learn about others' reactions to his own social behavior. (p. 819) Kelman (1965) refers to the commitment each person makes to the group therapy situation and attributes this commitment, in part, to the extended range of stimulation which the group provides. Stoller (1966) conceives of group therapy membership in terms of roles which reflect balance and flexibility in interpersonal interaction. He proposes that each participant at different points in time plays the part of the spectator, patient or therapist,, and that the essence of each of these roles parallels and may toe extrapolated to real life situations. The goal of the therapy group, according to Stoller, is to help the individ ual toward more appropriate functioning in each role. The proportionateamount of time a person spends in each role, his skills in shifting from one role to another, and in communicating his intentions without ambiguity are central to optimal social functioning. "When he can visualize and conceptualize the differences between what he intends to present to others and what he actually does, a participant is in a position to make concrete and specific adjustments, Stoller observes. "Similarly, when he can see himself be having in line with his intentions, such behavior receives support and a person obtains an enhanced view of himself" (p. 45). Slavson (1953) agrees with this statement and illustrates the importance of clarity of expression both verbal and nonverbal in his comment that "truth can be begotten from error but seldom, if ever, from confusion" 12 The Self, Self-Concept, and Self-Awareness A person's willingness or refusal to examine himself and his behavior meaningfully is crucial to the therapeutic endeavor. The way a person perceives himself and uses available information about himself in his relationships with others may become the focal aspect of group inter action. In the context of the present study, it is of value to review past and current theorizing about the self and re lated terms in order to conceptualize the conditions and operations which may induce behavioral changes. Raimy (1943, p. 331) describes the self as "a learned perceptual system which functions as an object in the perceptual field of the behaver." Snyggs and Combs (1949) define the self as composed of the individual's per ceptions about himself and speculate that this organization of perceptions, in turn, has vital and important effects upon his behavior. Rogers (1951) speculates that the structure of the self develops through interaction with the environment, particularly as a result of evaluational interaction with other people, and forms the basis of an individual's value system. 13 In 1948, Raimy introduced the notion of self-concept which he defines as "the map which each person consults in order to understand himself especially during moments of crisis or choice" (p. 155). English and English (1958) enlarge on Raimy's description when they refer to self- concept as a person's view of himself; the fullest descrip tion of himself of which a person is capable at any given time. A person's self-concept is particularly vulnerable when he is interacting with others who might influence him to reevaluate or change himself in certain ways. At such times he becomes particularly vigilant in his defense of his self-concept. Rogers (1963), like Lecky, states that material which is significantly inconsistent with the self- concept often cannot be admitted to awareness. Thus, the denial and distortion which develop in the individual's view of himself create incongruence between the self and experience, and can lead to psychological maladjustment. Congruence of self and experience results when self experi ences are accurately perceived and symbolized and are incor porated into the self concept in this form. Psychological adjustment is congruence viewed from the social frame of reference, Rogers continues, and maturity is the end result of congruence. 14 Cooley (1922) described a man's sense of personal identity as "a looking glass self," a reflection of his at tributes as they are mirrored in his social environment. For example, an individual, if he is repeatedly treated as inferior, begins to perceive himself as truly inferior. Mead (1934) took the related position that man becomes a self insofar as he can take the attitude of another person and act toward himself as other people act. Coutu (1951) elaborated on Mead's initial concept labeling the process "role-taking," and Shibutani (1961) differentiated role taking from role playing as follows: Thus, role-taking is an important part of role- playing. The two concepts are not to be confused. Role playing refers to the organization of conduct in accordance with group norms; role-taking refers to imagining how one looks from another person's standpoint. It involves making inferences about the other person's inner experiences— pretending to be someone else and perhaps even sympathizing with him. (P- 48) However, the notion of awareness both of the self and of others remains a knotty problem. The difficulties in dealing objectively with such introspective processes have been attacked conceptually in various ways. Farber (1963, p. 196) warns that "the search for 'real' awareness is a search for a chimera." He suggests that we consider degrees of awareness in relation to the variations in the 15 behavior of specific individuals rather than seek a global and non-existent abstraction. Fisher and Cleveland (1958, p. 206) discuss awareness and impact of body image on the individual and on how he sets himself off from others. "The whole concept of body image boundaries has implicit in it the ideas of the structuring of one's relations with others." They conceive of the body image as a sensitive indicator which reflects many of a person's basic social relationships,, particularly those involved developmentally in the identity process. Cameron (1963) talks about the somatic estrangement that may develop as a result of the discrepancies in awareness and inconsistent interaction between body image, self image, social roles, and external reality representations. The resulting distortion in self perception generates both intrapsychic and social maladjust ment . Bugental (1965) sees awareness as evolving from lower physical to higher psychological levels. According to this author the sequence portrays an emergence from reac tivity to activity* from response to initiation, from being an object to becoming the subject of one's actions. In the reactive condition, the person splits himself into an ob server and an observed, a maneuver which represents an 16 alienation from an integrated sense of self. Such a person is cut off from the direct experience of his feelings and is reduced to fruitless and non-productive speculations about himself and his behavior. The active person, on the other hand, experiences himself as uniquely himself,, yet related to all others, and is free to be aware and self-actualizing. Allport (1955) proposes that awareness is a bridge between personal constriction and achievement. "Psychother apy, " he states, "gives hope that a corrected self-image, a more rational assessment of one's behavior, will reduce com pulsions, induce order, and free channels of development to accord with chosen aims" (p. 84). Reality Testing Reality testing may be considered an important ele ment of the therapeutic experience to the extent that it enables patients to differentiate between - the true and fan- tasied consequences of behavior. Reality testing has equal value for the therapist, who, through his techniques of role-taking, must be constantly aware of the reality experi enced by each of his patients. According to Rogers (1959) individuals who fail to test reality through interaction with those around them, 17 may see experience in absolute terms, overgeneralize, be dominated by beliefs, confuse fact and opinion and rely on abstractions. Such individuals develop a system of de fenses, and various kinds of rigidities tend to result. Freud (1948) described the distinctions between what is perceived and what is conceived. In his system, the secondary system represents realistic thinking and assesses whether an experience is true or false. On the other hand, the primary process is identified with the pleasure principle and is concerned only with whether an experience is painful or pleasurable. The reality principle can override the pleasure principle temporarily since the latter is eventually served when the current need is grati fied, but the struggle is always present.. Ruesch and Bateson (1951) explain the difference between assumed reality and perceived reality as being due to the limitations and peculiarities of the human observer. Mowrer (1953) sums up this point of view when he observes that the reality of a given situation can be ascertained only by seeing reality as an interaction of the living, acting human being, along with the other persons or objects which constitute his environment. "This point," he contin ues, "has profound and crucial bearing on the methodology to 18 be used in psychotherapeutic research . . ." (p. 30) . The therapist's ability to be useful to those who seek his help may well depend on his skill in recognizing and taking advantage of the critical point at which thera peutic learning can be achieved for his patient. Such a point may occur when external pressures such as those repre sented by group feedback experiences succeed in pinpointing discrepancies between one's view of reality and the per ceived reality of others, and may represent an occasion when it becomes possible to penetrate the individual's defense system to produce changes. Cognition The process of reality testing is implemented by cognitive controls, awareness and acceptance. According to Katz and Stotland (1959, p. 444); The cognitive elements will be congruent with the behavioral tendency in describing the most effective and appropriate channels of action. The expression of the behavioral components in overt behavior will, in turn, test out the attitudinal beliefs. The feedback from behavior will lead to a modification of the cognitive map to make it a better guide to behavior in the future. Gardner, Holzman, Klein, Linton and Spence (1959, p. 10) state that the process of search, feedback, and research includes conceptual and motor activity and that 19 cognitive controls underlie the total adaptive effort. These authors also assert that "since the influence of cog nitive controls is very much a matter of highlighting certain environmental features and reducing the effective ness of othersj it is precisely in the regulation of atten tion that the influence of cognitive controls may be the most apparent." They proceed to discuss the concepts of "leveling" (the maximal dedifferentiation of the cognitive field) and "sharpening" (the maximal complexity and differentiation of the field), stating that perhaps the ability to attain and maintain a fixed amount of attention is relatively low in levelers. It seems to the present investigator that such an individual's susceptibility to change could be enhanced by appropriate stimuli such as certain feedback procedures which might serve a "sharpening" function. Katz and Stotland (1959, p. 444) emphasize the strong interrelation ship of cognitive processes and their correlates particular ly in regard to attitudes and values. in such a context, they say, "affective, cognitive, and behavioral components . . . represent a molar unit of psychological functioning." 20 Communication Ruesch (1957) describes communication as a social matrix which precipitates fundamental and infinitely diverse events ranging from minute int^apersonal happenings to the most intricate and extensive social interactions. Through messages one precipitates action and reaction of various kinds. Also, through messages, one distorts reality and produces confusion and misunderstanding. Within t'he context of his "social behaviorism," Mead (1934) placed the origin of communication in the "conversation of gestures" which may express much that cannot be translated into articulate speech. Communication develops from the non-conscious language of gestures to the highly conscious significant symbol which, in turn, evolves into language and meaning. Sapir (1927) warns of the pit falls inherent in verbal communications. We are taught that when a man speaks, he says something that he means to communicate. That, of course, is not necessarily so. He intends to say something, as a rule, yet, what he actually com municates may be measurably different from what he started out to convey. We often form a judgment of what he is by what he does not say, and we may be very wise to refuse to limit the evidence for judgment to the overt content of speech. (p. 893) For Stoller (1965a), expressive style, the manner in which a person communicates rather than what he says, 21 determines in a large part, the individual's reception by others. Once established, such behavior becomes relatively autonomous, and if it does not accurately project the mes sage intended by the sender, confusion, frustration and com munication breakdown ensue. In this vein, Shibutani (1961, p. 48) observes; "Communication is that exchange that pro cures the cooperative assistance of others, making possible coordinated action of great complexity." On the cognitive level, Osgood, Suci, and Tannenbaum (1957) emphasize that in human communication, whether it be through linguistic, aesthetic or other channels, meaning is critically involved at both the initiation and the termina tion of any communication act. Ruesch (1957) sees good com municative skills as basic to adjustment when he observes; Successful communication with self and with others implies correction by others as well as self correction. In such a continuing process, up-to-date information about the self, the world, and the rela tionship of the self to the world leads to the acqui sition of appropriate techniques, and eventually in creases the individual's chances of mastery of life. Successful communication, therefore, becomes synony mous with adaptation and life. (p. 18) Dimensions of Feedback Feedback is a descriptive term and is ubiquitous in nature having to do with the communication processes which 22 govern much of our day to day living. Feedback has been de fined alternately as "knowledge of results," "coenesthesia," "proprioception," "kinesthesia," and "homeostasis” (English and English, 1958; Homans, 1950), and has been used in the field of electronics and cybernetics in studies of sensory and motor skills, vigilance, tracking, functioning of the nervous system, etc. Only recently, however, have social scientists introduced the term, feedback, as a construct facilitating, both conceptually and practically, the study of more global and complex behavior functioning. Feedback is essential to any communication process. People are often unaware of the degree to which we depend on such information to correct and control our actions or re actions. However, certain kinds of feedback are easier to obtain than others. For example, conventional social inter action represents feedback on a fairly superficial level. In a more structured situation such as that represented by group therapy, interaction becomes more selective. The group is committed to talking about themselves and each other in a special way which enhances the meaningfulness of the feedback. When another dimension such as VTR is added, the feedback experience can be objectified and amplified, and visual and verbal referability is present. As a result. 23 it is possible to focus upon areas of behavior where accurate feedback heretofore has been difficult if not im possible to achieve. Common examples of such experiences are seen reg ularly on televised sports events. The "instant replay" has become a byword for the sports announcer, and reveals in detail the intricacies of a complex series of motor events. The value of this information is probably greater for any given participant than for the audience and enables him to validate or correct his actions and strategies. The relationship of such practices to the operations of electronic computers and servo-mechanisms is obvious. Electronically, feedback has long been considered the agent for change in an electrical circuit. Borko (1962, p. 613) defines feedback as the "transmission of a fraction of the output of a machine, system or process to the input, to which the fraction is added or subtracted. This procedure can result in self-correction and control of the process." Wiener (1948) has speculated upon the implications of computer analogies for the understanding and treatment of mental and emotional disorders. An even clearer compari son emerges when Borko1s citation is compared to a behavior al definition presented by Benne et al. (1964, p. 24). For 24 these writers, feedback is: verbal and non-verbal responses from others to a unit of behavior provided as close in time to the behavior as possible, and capable of being per ceived and utilized by the individual initiating the behavior. It may serve to steer and give direction to subsequent behavior. it may also serve to stimulate changes in the behavior, feel ing, attitude, perception and knowledge of the initiator. The same writers also point out that learning prin ciples are reflected in the immediacy of feedback to a per son's exploratory response. Such a process accelerates learning and adds a dimension of urgency to behavioral and attitudinal changes. However, when we say something to someone else, the feedback we receive from that person still may not be immediate nor does it always express whether or not he heard what we intended. For we are now working through what Leavitt (1958) calls "the perceptual filters of another person." His output in relation to our input may be greatly distorted. VTR by virtue of its immediate availability and precise and objective content may well circumvent these difficulties. The term, feedback, as it is used in the present study refers to human behavior and may be assumed to contri bute information to special kinds of problem solving related to interpersonal interactions. For such feedback to be 25 effective, cognitive elements must prevail. Whitman (1964;, p. 319) stresses cognitive acceptance of feedback when he observes: "The crucial test of understanding is whether a person can utilize what has been said to create a new thought or insight." In relation to group psychotherapy, Whitaker and Lieberman (1964, p. 173) describe feedback as a source of information distinct from interpretation and of special significance in group interaction. By feedback, they mean "both the reactions a patient's behavior elicits from others and their verbal reports of such reactions." It may be ex pressed verbally or non-verbally and may be implicit or explicit. The paradigm for feedback used by these writers is "I feel this in response to your behavior and comments" rather than the interpretive "This is what you are doing." Feedback may be an accurate expression of the manner in which one person reacts to another, and is most useful when it can be made explicit, for then it is more difficult for the person to ignore the information offered him. A person can evaluate his interpersonal patterns in a new and more productive fashion if he can gain information about his effect on others. Coleman (1960, p. 207) states that feedback may indicate whether we are "on or off the beam." He describes "convergent" feedback as information telling us that we are progressing satisfactorily toward our goal or that the goal has been reached. "Divergent" feedback indicates that we are not reaching our goal as efficiently as we might or per haps we are even defeating our purposes by engaging in inappropriate behavior. in discussing the dispensing of information, this writer speaks of feedback as a condition which tends to improve performance and to increase con fidence unless it is too highly divergent. In the latter case there is no apparent way to improve the course of ac tion. Such a condition points up failure without indicating a pathway to success. Stoller (1966b) agrees with this observation substi tuting the terms "discrepant" and "non-discrepant" feedback, and insists that offering a person an alternative to his un wanted behavior is essential to the success of the feedback process. in helping the person toward changes of various kinds, it is important to make it clear to him that his dif ficulties are not due to certain deficiencies, but that they are problems which he has created for himself, and is capable of changing. Although corrective feedback is usual ly given to the person, his good points should also be 27 stressed. The feedback climate itself should always be positive in nature. Otherwise, the person feels attacked and will defend against rather than accept the effects of his behavior on the group. The-end goal, according to Lecky (1945, p. 253) "must be to break down the structure of rationalization and bring the contradictory ideas into intimate relationship." The importance and impact of differential feedback and its role in interpersonal dynamics and behavioral change is explored in the present study. Feedback of any kind provides not only a corrective experience and motivational impetus; it also serves as immediate reinforcement for learning, and as a reference point for patient and thera pist. By objectifying and increasing the amount of informa tion available to an individual and by pinpointing partic ular behavioral patterns, video tape playback in conjunction with specific and directed comment may well represent a new and powerful accessory to psychotherapeutic procedures. In the following section, current research in relat ed areas is reported. Studies addressing themselves to self-concept, televised group psychotherapy, and various empirical uses of feedback techniques are described and discussed. CHAPTER III REVIEW OF RELATED STUDIES Present Status of Self-Concept Self-concept has a compelling quality for many clinical investigators although the related scientific evi dence available up to the present is far from impeccable. Concept of self is difficult to pin down and objectify., but is too important and pervasive to abandon because of meth odological problems. Wylie 1s review of the literature (1961) reflects a generally pessimistic overview of the value and meaning of self-concept in addition to the mea surement difficulties. Specifically3 she found little mean ingful experimental evidence for a relationship between psychological learning and the development of self-concept^ and she deplores the lack of rigor in pursuing this area of research. It may, indeed,, be argued that a more empirical approach to self-concept is long overdue. However, the 28 29 selection of explicitly defined variables, the formulation of sharp and relevant hypotheses, the development of more sophisticated measuring instruments and pristine research designs and methodology so far have eluded the ingenuity of most investigators. Rather than a single abstract and static entity of some kind, self-concept appears to repre sent a complex and dynamic composite of attributes or quali ties such as values (Katz and Stotland, 1959; Leary, 1951; Rogers, 1959), social reflection (Mead, 1934), transcendent function (Jung, 1953), etc. Nevertheless, attempts have been, and continue to be made to study certain discrete aspects of self-concept. In considering the effects of psychotherapy on change in self-concept, Rogers and Dymond (1954) found that at the beginning of therapy, the self-concept is defensively organized and denies certain experiences to awareness. At the conclusion of therapy defensiveness is decreased and less experience is denied to awareness. Behavioral change was found to be concomitant with or subsequent to a change in self-concept. Butler and Haigh (1954) studied the discrepancy between self-assessment and self-ideal and found that dif ferences had decreased significantly as a result of therapy. 30 According to these investigators, low correlations between self and ideal ratings are based on a low level of self esteem which results, in turn, in a low level of adjustment. Miller (1963), in a study having to do with confrontation, conflict and body image, observed that consistent confronta tion with reality reinforces the strength of underlying mature self-representation. Gergen (1963) sees the conflict between self- consistency and social demands as a major conflict a person faces in presenting himself to the world. He found that under conditions of social feedback, the positive character of a subject's self-description increased to a greater ex tent than under the condition of no feedback. He also ex plored the subject's awareness of degree of positive change in self-concept and the generalization of such change in terms of new and positive self-sustaining attitudes and be havior. The on-going positive effects were measurable even though such effects were artificially induced in the sense that certain subjects were instructed to ingratiate them selves with the interviewers. Tannenbaum and Bugental (1963) used dyads to facili tate the process of learning about the self and others, and found that dyads had as high or higher learning impact as 31 had the T groups. Tannenbaum and Bugental concluded that learning is the key to development and change in self- concept, and the authors emphasize that the hierarchical nature of such processes unfolds through social interaction and feedback. Frank (1961) discusses thought reform and describes it as an indoctrination process, usually unrelated to the individual's needs and goals, which is designed to create distress and disorganization in its subjects in the process of attaining its aims. He describes psychotherapy, on the other hand, as a method of treatment which attempts to help people in distress. in the nonjudgmental climate of psycho therapy, the patient is offered a choice. He has the option of continuing his maladaptive patterns of thinking and be having, or with the help of the therapist, he may seek more appropriate and productive ways of conducting his life. Televised Group Psychotherapy Research in the area of group psychotherapy has been a source of frustration and intellectual dismay to its pro ponents since its inception. The real and apparent diffi culties involved in any serious evaluation of psychothera peutic effectiveness appear to be compounded in an almost 32 geometric progression when one attempts to assess systemati cally the impact of group psychotherapy. It is not surprising that among those interested in group functioning, the emphasis has shifted from concern with classical and intrapsychic operations where privacy has been a prerequisite for treatment to a less artificial social setting where the study of interpersonal processes prevails. Mowrer (1963) has; for some time, been advocating rejection of secrecy operations in psychotherapy. He states that privacy implies withdrawal and denial and that by not revealing himself and his behavior to significant others, a person enhances his guilt feelings and conflicts. Moreno (1946) has been a pioneer in removing psychotherapy from the cloistered and protected office environment to a more public arena with theatrical overtones. psychodrama, Moreno's clinical model, is an ingenious and creative conceptualiza tion, but its effects have received, for the most part, only anecdotal reports. Stoller (1966b) asserts that the heretofore accepted need for confidentiality and privacy can be challenged. In relation to televised group sessions which may well repre sent the ultimate in public therapy, Stoller (1967a, p. 158) 33 notes: . . . The anticipatory anxiety so common with public performance was soon overcome once the actual per formance commenced. ... It would seem that perfor mances of this sort tend to bring out the potential of individuals; that people tend to rise to the occa sion when they are on public display. Goffman (1959) expressed a similar point of view when he stated that social roles can be likened to a per formance before an audience, and that individuals band to gether to maintain a common impression before a larger social group. In a recent study by Kadis, Krasner, Winick and Foulkes (1953), the investigators observed that the activi ties of groups tend to proceed with little regard for the presence of observers, recording devices or mirrors. These authors imply that group members seem relatively unconcerned about the actual privacy of their surroundings because they become so engrossed in their interactions. The above is consistent with Stoller's findings (1957a) that among tele vised group participants, a high level of involvement in group interaction exists in spite of the many distractions inherent in the studio situation such as the operation of technical equipment and the presence of studio observers. Moreno (1945) has used observers as participants in the 34 conduct of his psychodrama groups, but in televised therapy this kind of interaction is not feasible. instead, the patient joins with others in performing before an audience which is representative of the outside world, or as Stoller (1967a., p. 161) describes it, "the larger social scene we all face." Empirical Uses of Feedback Techniques One of the most difficult technical problems con fronting practitioners in psychotherapy is providing a patient with an objective view of his behavior, goals, and attitudes, and how these goyern his way of being in the world. Developing techniques and tools both to provide such experiences and to gain information about human behavior has long been a cornerstone of the clinical and psychothera peutic enterprise. It is somewhat surprising that in con trast to the complex testing devices and sophisticated therapeutic ploys which have evolved from the continuing study of human beings, techniques for presenting various kinds of feedback to clients or patients are still in the fledgling stage. An underlying reason for such a tardy con sideration of feedback operations may be rooted in the therapist's traditional distrust of the patient combined 35 with the conviction that the patient is fragile, and there fore incapable of coping with self-confrontation. Psycho analytic principles militate against revealing such "secrets" to the patient, and tend to preserve the ascen dancy of the therapist and an aura of magic and mystery in the therapeutic situation. Recently, however, there have been attempts to study, describe, and systematize feedback operations, and to measure and evaluate the effects of these variables. Verbal feedback Gergen (1965) compared the effects of social feed back (reflective reinforcement) during interview sessions to the effects under no feedback conditions. He found that the constructive character of self-description increased to a greater extent as a result of the feedback. In a concep tually related experiment Backman, Secord and Pierce (1963) studied the relationship of self-concept to feedback in an investigation in which "interpersonal congruence theory" (the stability and change in self) is discussed. Experi mental evidence gathered by these investigators indicates that the greater the number of significant others who approve and agree in their perception of some aspects of a 3 6 person's self, the greater will be that person's resistance to changing that part of himself. Hastorf (1965) attempted experimentally to modify group structure by reinforcing dif ferentially behavior of individuals while they were partici pating in a group problem solving situation. The investi gator was interested both in behavioral change and whether it was reflected in the perceptions of group members. By using differential feedback in the form of reinforcement, he found that as the incidence of a person's talking was in creased, it also increased the likelihood that that person would be perceived as a leader in the group. People have been furnished with feedback in the form of sociometric ratings of them made by others (Lifton, 1961). For each subject, the author provided specific examples of behavior which illustrated the reasons for the disparities which appeared between the subject's self- concept and the way others perceived him. Pinney (1963) developed a "feedback" technique in which he read verbatim notes of the previous session to patients in group psycho therapy. The patients were diagnosed as severely ill, re lapsing schizophrenics. He reported large changes in beha vior as a consequence of such sessions. In a study by Segal (1965) patients undergoing psychoanalytically oriented 37 therapy were presented with their projective productions elicited by the TAT and Rorschach. Segal postulated that such operations would aid patients in making decisions and understanding their own feelings. Some of the earliest studies on social feedback and self-perception in groups emerged from the context of T or training groups. Gibb and Platts (1950) conducted sever al laboratory studies which were designed to test the ef fects of role playing and feedback on such variables as self-insight, the capacity to conceptualize a new role, and role flexibility. The authors concluded that self-insight can be improved by special training and feedback. Other T group studies by Gibb (1960), Lippitt (1960), and Miles (1958) investigated the effects of negative versus positive feedback, amount of group training in relation to feedback effects, direction of behavioral changes as a result of feedback versus no feedback conditions, and certain motiva tional factors which are necessary to produce optimal change. These studies found that feedback of any kind is more valuable than none, that feeling oriented positive feedback resulted in greatest efficiency, least defensive ness, and greatest spread in participation. The studies concluded, however, that strong negative feedback may be 38 more effective in producing behavioral change when motiva tional factors are taken into account. Audio tape feedback and discussion groups Certain mechanical tools have been used on occasion to supplement the interactional processes in addition to the traditional verbal feedback which the patient receives dur ing individual and group therapy sessions. Audio tape has been used for years as a residuum of early Rogerian studies, but primarily as a device to record permanently various kinds of interaction. As a rule, these recordings are made with the notion that the therapist will replay the tape to study individual and group processes in addition to his own performance. According to available evidence, groups have rarely been exposed to a replay of their own therapy ses sions nor have they systematically discussed previous ses sions. Recently, however, some therapists have reported such practices and have even attempted to measure the effects. The therapist in one study (stone, 1963) did permit occasional "rehash" or discussion sessions after the group meetings and found them moderately useful. Another study (Kidorf, 1963) used audio tape feedback and found that it 39 helped patients to recognize certain traits and feelings previously resisted. Armstrong (1964) found that audio tape playback of parts or of whole sessions aids the group to interpret certain behavioral patterns, ties group meetings together and prevents cancelling of meetings should the therapist be absent. Audio tape feedback can also be used as a springboard for future discussions and provides the therapist with an opportunity to evaluate his own tech niques. During long term psychotherapy, Cameron (1958) discovered that repeated playback of audio tapes made in previous sessions "resulted in both the patient's and therapist's being able to perceive and understand meanings in communications which they could not detect when the mate rial was played back for the first time." Each individual heard significant aspects of his own communication against which he had previously defended himself. Griver, Robinson, and Frankel (1965) conducted a study using "structured feedback," a technique in which interview, audio tape, and statistical data information was fed back to participants in real-life industrial setting. These investigators found that feedback procedures, when accompanied by accepting and nonjudgmental behavior on the interviewer's part, produced dramatic behavioral changes. 40 The authors attribute the initial sharp decrease in docu mented error rates of the participants primarily to the use of audio tape playback in conjunction with "structured feed back" techniques— that is, a personal confrontation with existing performance errors. The enduring nature of such training techniques is reflected in the on-going improved performance level among trainees maintained and measured over a period of eighteen months following the initial training sessions. The authors ascribe the self-sustaining aspect of the program to training given in-house personnel in structured feedback techniques. Film and video tape feedback Films have been used as training instruments pri marily in sports, educational, and industrial settings where audio-visual materials appear to be particularly effective. A number of studies in the educational field suggest that some teachers can learn as well from filmed teaching demonstrations as from direct observations (Lumsdaine, Sulzer, and Kopstein, 1961). However, it also has been recognized that what the individual learns depends, in part, upon what aspect of a film or demonstration his attention is directed to, and that cognitive awareness and acceptance are 41 crucial to the learning experience. In an early study Wolff (1943) obtained photographs of subjects' clasped hands, facial silhouettes and other features difficult to identify. He also secured samples of handwriting and voices, and took movies of the subject walking or performing which were disguised to prevent def inite recognition. When later asked to judge personality traits from the unidentified films or recordings, almost none of the participants recognized themselves. They did, however, tend to reveal subliminal judgments of themselves by attributing certain traits to the person viewed or heard. Often a subject showed a marked increase in unfavorable ratings when unknowingly rating aspects of himself. Johnson (1960) failed to find differences when the impact of sound film was compared with that of audio tape in a situation where teachers were confronted with both kinds of playback of their own previous performance. in addition, those individuals whose earlier presentations were rated with a critical program analyzer, received lower rat ings on the second presentation than others who were not so rated. Such findings point up the importance of immediate feedback and cognitive acceptance. Also apparent is the necessity for presentation of alternative ways of behaving 42 occurring in an emotional climate where the threat of dis approval or punishment is at a minimum. Ruesch and Kees (195 6., p. 11) state that the "use of motion pictures of real and unstaged events is almost mandatory if accuracy and fresh insights are to be achieved." However, they deplore the fact that few films deal honestly and directly with human events in that they do not permit us to look at human beings as they actually are rather than as someone else thinks they are or wants them to appear. Cornelison and Arsenian (1960) studied the responses of psychotic patients to a photographic self-image experi ence. The authors reported a wide range of responses and some change in the psychopathological conditions of the sub jects. In an effort to devise symbolic representations of body language, Birdwhistell (1954) explored communicative responses involving gestures, movements and facial expres sions. He discovered consistent correlations between cer tain commonly used gestures and underlying emotional events. Ekman (1965, p. 726) discusses patterns of nonverbal behavior and the differential communication of affect- produced head and body cues. He discovered that "head cues carry information primarily about what particular affect is 43 being experienced, and relatively little about intensity of affect or level of arousal." "Body cues/1 he observes, "re verse this pattern. . . ." Photographic stimuli were drawn from a series of stress interviews and were rated on three dimensions of emotion. Films, however, lack the crucial element of imme diacy because of the time interval involved in developing them. Video tape does not require processing, and offers a direct, objective and immediate review of human events. The person presented the video tape feedback has no opportunity to mobilize his resistance to new learning or to rationalize or deny the self-evident errors he is making. One might describe the video tape feedback situation as one in which the individual can no longer avoid cognitive dissonance. The latter may be defined as the discrepancy between an individual's opinion and his knowledge of argu ments in favor of the opposite view. According to Brehm and Lipsher (1963), in order to avoid uncomfortable situations, the person may attempt either to discredit the credibility of the source of such conflicting information or may change himself in some way in order to be more consonant with the information source. The pattern, according to Moscovici (1963), is such that certain information changes attitudes 44 which, in turn, influence behavior. It is also possible that behavior might change first and this would be followed by attitudinal changes. Kagan, Krathwohl, and Miller (1963) have introduced a technique called "interpersonal process Recall" (IPR). The authors video tape a real psychotherapy interview and play the tape back immediately for both patient and thera pist who are in separate rooms. Each sits with a different interrogator who elicits feeling states of both participants at points in the tape when a significant aspect of the dyad ic process is being shown. The investigators report a "breakthrough in methodology" for studying important aspects of the psychotherapy process. Woody, Krathwohl, Kagan, and Fazuhar (1965) in a related study found that IPR during video tape replay was enhanced by the concomitant use of hypnotic suggestion. Moor, Chernell and West (1965) inter viewed hospital patients who were being video taped during individual psychotherapy sessions. One half of the subjects saw themselves during a playback; the other half did not. Impartial raters judged the view group to be significantly more improved during their hospital stay than the non-view group. Farson (1966) has employed VTR with rehabilitation 45 groups, and Schiff and Reivich (1954) are using video tape for training and supervision in psychotherapy. Walz and Johnston (1963) have also used video tape as a training tool with counselor candidates. Evidence suggested that participants gained confidence in their interviewing skills, a greater awareness of their personal qualities and an in creased desire for self-study. After video tape feedback the counselors' self-ratings more nearly approximated their superiors' ratings of their performances as trainees. Spitzer (1954) who has been engaged in family therapy, states that video taped feedback to patients has tremendous impact. He contends that showing the patient "how he behaves while the therapeutic session is still vivid is worth endless hours of attempting to describe a non-verbal expression, and is much more convincing. . . The playback was the starting point of effective therapy." Ian Alger, during a recent presentation (1966), demonstrated his use of VTR as an integral part of the therapeutic process in his conduct of family and marital interviews. The feedback process also had been video taped, and the results of self-viewing in the therapeutic context were both moving and dramatic. In an unpublished study, Stoller, Robinson, and 46 Myerhoff (1966) explored the effects of video tape feedback on graduate student participants in a two day marathon group. problems related to feedback techniques, actual conduct of the feedback sessions,, measurement of change, technical difficulties, and meta-group which emerged as a result of non-participating, but always present studio per sonnel are discussed. Analysis of objective measures of changes in behavior and attitudes is incomplete at present, but significant excerpts from twelve hours of continuous video taping graphically illustrate the growth-inducing ef fects of self-viewing in the stress situation represented by marathon group interaction. The investigators believe that participants were able to discard inappropriate and un wanted behaviors and recognize and express their feelings more openly and honestly as a result of this experience. Stoller (1967a, p. 160) presents a meaningful and explicit rationale and technique for video tape feedback to participants in televised group psychotherapy. He observes that the use of video tape offers an opportunity for "imme diate self-viewing and self-evaluation of one's impact on others which is unequalled by any other modality." Stoller introduced the notion of "focused feedback" which encom passes the therapists' directed comments and interpretations to patients of their behavioral patterns, because he had previously noted that passive viewing of the self produced minimal understanding of the significant aspects of one's impact and behavior. Geertsman and Reivich (1965) agree with Stoller and insist that the therapist must direct attention to cues he considers important in the playback tapes. Such comments may take the form of positive reinforcement for desirable and adaptive behavior or may be concerned with pointing out less appropriate patterns. stoller always includes suggest ed alternatives for behavioral change during the feedback session in order to help the patient to avoid feelings of entrapment. Focused feedback techniques in conjunction with video tape viewing appear to facilitate and accelerate a new awareness, and, therefore, potential modification of behavior, attitudes and traits by giving each individual a concrete and objective view of what went on in the imme diately preceding group session in terms of his own reac tions and those of other group members. As a consequence, participants can develop improved attitudes toward the self, social skills, and interpersonal communication. In view of the questions prompted by the concepts and research mentioned above, it seemed of value to compare, in some detail, the effects of video tape feedback with a basically verbal type of feedback. The following chapters are devoted to stating hypotheses and predictions, describ ing the development and function of experimental methods and techniques, and presenting the results of such empirical operations. CHAPTER IV HYPOTHESES AND PREDICTIONS Two general hypotheses and several specific predic tions were generated in order to study systematically the effects of focused feedback and VTR on the individual group participants. v Hypothesis A Following group psychotherapy sessions, the subjects (Ss) who receive focused feedback and VTR will make fewer maladaptive responses and more adaptive responses than control Sj3_ who participate in a discussion session instead of receiving video tape feedback. prediction 1 Ratings of behavior of the first and fifth video taped therapy sessions will demonstrate that there will be more instances of adaptive or positive 49 50 directional change in the behavior on which feedback has been focused among experimental Ss than among control Ss. prediction 2 Ratings of behavior of the first and fifth video taped therapy sessions will demonstrate that there will be fewer instances of maladaptive or negative directional change in the behavior on which feedback has been focused among experimental Sj= than among control Ss. Hypothesis B Experimental S_s will perceive and rate them selves as behaving more adaptively after treatment than control S_s_ who participate in discussion periods. Prediction 1 Self ratings of feedback item lists on a rating scale presented to participants at the end of treat ment will demonstrate that experimental S_s experi ence a greater overall increase in adaptive behavior than control Ss. In the following section, the methodology, prelim inary controls, and statistical operations devised to ex plore and evaluate the hypotheses and predictions are de scribed and assessed. CHAPTER V METHOD OF INVESTIGATION The Problem Three major events occur in the context of group psychotherapy which provide the rationale for VTR feedback operations. First., the subject responds with adaptive or maladaptive behavior. Second, the therapist behaves in a manner directed toward modifying inappropriate actions or reinforcing adaptive behavior. Finally, the patient may or may not modify his behavior. In the present study, additional phases are injected into the psychotherapy process. The S_ is given an oppor tunity to visually review his responses to which he may or may not attend. The therapist responds to the patient and the review in such a manner as to focus or aid the patient's discrimination. Therapist comments also may have rewarding, emphasizing or punishing value. Feedback is most effective when it is immediate, 52 53 specific and corrective (Gibb, 1960). Video tape feedback fulfills these requirements and offers both patient and therapist objective evidence of certain aspects of events occurring at any given moment in a therapy group. The video tape cannot capture all interaction, but it does effectively mirror significant kinds of behavior when the equipment is operated perceptively by a cot'herapist. VTR and focused feedback increase the amount of information presented to a person and make it difficult for him to rationalize or deny the aspects of himself with which he is confronted (Stoller, 1965b; Spitzer, 1965). The ultimate objective of the present study was to determine the value of VTR as an accessory to psychothera peutic techniques in promoting self-awareness and behavioral change. Research procedures focused on diagnosis of mal adaptive behavior, the efforts to modify this behavior and the results of such experimental manipulations. Subjects The experimenter interviewed 119 patients suggested by medical, nursing and psychology staff members and asked for volunteers. Patients selected were relatively verbal and in good contact. Ss demonstrating extreme behavior 54 of any kind were not included^ and there were no known instanpes of brain damage among the selected Ss. All participants were between twenty and forty-nine years of age,, had completed at least nine years of education and had been hospitalized no longer than eighteen months immediately preceding their participation in the investigation. It was necessary to alter certain preconditions of the subject selection criteria. Initially it had been planned to include as participants only patients who had been hospitalized six months or less since their original admission date. However, recently instituted hospital policy contributes to rapid turnover in patient population so that periods of hospitalization are reduced in duration but occur more frequently. As a consequence it was more meaningful to select S_£ whose sporadic periods of hospitali zation had occurred within the eighteen months immediately preceding their participation in the investigation. Also, in three cases, the forty-five year old age ceiling origi nally stipulated was raised to accommodate participants who were forty-six, forty-seven and forty-nine years of age. A pool of names of eighty-six volunteer patients currently hospitalized and conforming to S _ requirements was assembled and was continually replenished using the 55 described S_ criteria and selection procedures during the four and one-half months of experimentation. Ss were selected from this list for group membership immediately prior to the treatment period. Since groups were run in succession, and there was constant turnover in hospital patient population, there was no opportunity for random assignment over all groups. The order of running groups was determined randomly following assignment of s_s to groups. The final order in which groups were conducted was as follows; Experimental, control, experimental, 1 experimental, control, control. Any randomized order of running groups still pre sents problems with regard to possible therapist bias since the therapist would need to be aware of treatment require ments for each group in order to fulfill experimental and control conditions. The therapist also played a major role in subject selection by conducting and evaluating initial interviews. In any case, the therapist would be aware of the conditions for the two final groups in the series, and conceivably, both subject selection and treatment bias might result. In considering these problems as they pre sented themselves in the present study, it was decided that the most effective manner in which to deal with the vari ables described above would be careful attention to con trolling subject selection procedures and therapist treat ment bias. Methods used for such controls are described in the following sections. Problems A number of research difficulties are always present in any investigation which must be coordinated with hospital routines. Special treatment such as immunization,, ECT, medication, turnover in staff personnel, inadequate communi cation patterns, etc., contribute to subject problems. As a result, efforts to maintain steady attendance at six group meetings for each of six patients over a period of even two weeks were confronted by the previously mentioned hazards in addition to the often undependable attendance of the Ss themselves. In order to compensate for such vicissitudes, the present investigator began each group with eight to ten Ss with the hope that data on at least six of these partici pants would be complete. Fortunately this proved to be so. Although not every S_ attended every meeting, each S^ whose data were analyzed attended at least five of the six meet ings including the first and fifth sessions, and the extra members made up a group of not less than six at any given time. In order to determine what statistical influences subject selection procedures might have on the composition of the various groups, means and standard deviations were found for subject variables for each group. A t_ test was also performed to ascertain the level of significance in differences between subject variable means in the experi mental and control groups. All results proved to be non significant (see Table 1 and Appendixes I and II). Thus individual ratings could be made with a reasonable degree of assurance that conditions for subject selection had been achieved. General Design and Methods Two sets of groups of the selected hospital patients, three groups in each set, met over a period of two successive weeks in tri-weekly one hour video taped therapy sessions with a therapist and cotherapist. Each group consisted of six or seven patients, and the total number of Ss participating was forty. One hour of video taped feedback was given to the three experimental groups immediately following each therapy session. A therapist-led discussion period of one hour was substituted for focused feedback and VTR following the televised therapy sessions in the control groups. The decision to schedule group meetings at the intervals described above was the result of several pilot 58 TABLE 1 OVERALL MEANS, STANDARD DEVIATIONS AND SIGNIFICANCE OF DIFFERENCES BETWEEN AGE, LENGTH OF HOSPITAL STAY, MEETING ATTENDANCE AND EDUCATIONAL LEVEL OF EXPERIMENTAL AND CONTROL GROUP SUBJECTS Experimental Control Groups Group s Age Overall mean 31.76 33. 42 Overall SID 8.08 7. 98 t test . 5259 JP NS Weeks in hospital Overall mean 16. 09 20.84 Overall SD_ 15 . 39 19. 92 t test . 7562 P NS Meeting attendance Overall mean 5.67 5.74 Overall SD .47 .44 t test 1. 22 £ NS Educational level Overall mean 11.48 11.11 Overall SD 1.40 1. 16 t test 1. 22 P NS 59 studies already completed by the author which suggested that massed meetings are more effective than an extended period of meetings in reducing resistance to, or producing change. Experience also suggested that video replays gradually lose their therapeutic effectiveness after approximately six ses sions. It may be that periodic rather than continuous in troductions of VTR into on-going group sessions would pro vide the most meaningful experience for participants; when used in this fashion, the VTR could alert the individual to changes already achieved and the possibility of further be havioral modifications. All feedback sessions for both experimental and con trol groups were audio taped. video and audio tapes of the first, third and fifth group therapy and feedback sessions were retained temporarily for rating as group protocols, and for deriving feedback lists. Audio tapes of the second ses sions were also set aside for the purpose of determining, in part, the feedback items. Measures of both quantitative and qualitative data were made using the tapes as sources of in formation to be evaluated. After feedback item lists had been derived from the audio tapes for each S_, another set of four raters rated each patient on the number of maladaptive or adaptive responses he made which fell into the list of items attrib uted to him. One rater viewed the first video taped ses sion,, and another rater viewed the fifth video taped session for each group. Neither rater was informed of which session he was viewing, nor of the treatment conditions for any given group session he rated. Raters were rotated so that they viewed either first or fifth group sessions randomly. Editing of tapes to eliminate references which might identi fy the kinds of feedback presented to any one group was con sidered but discarded when it appeared that the transparent nature of the interaction made such editing useless. The continuity of the video taped therapy sessions would have been destroyed by systematically editing out subject refer ences to treatment conditions. In experimenting with such editing on a pilot study tape, one rater was distracted by the blacked out areas on the tape, and expressed the feeling that due to the information withheld from him, he was unable to perform efficiently on the rating scale. Another rater who viewed the same tape prior to editing expressed no such complaint, and his ratings- appeared, at least, to have more face validity than did those of the former observer. prior to the actual therapy and feedback sessions, each participant was interviewed and informed of dates and 61 times of the video tapes sessions and feedback conditions. Following the final therapy and feedback sessions, each S_ evaluated himself on a rating scale designed specifically for him^ and answered three questions relating to his group experience which represented a written assessment of his feelings about himself, the group and the feedback session he had engaged in. After all measures had been completed S s in each control group viewed selected segments of their previously video taped therapy sessions. The present investigator postulated that a decrease in the number of objective (rater) ratings of maladaptive responses and an increase in adaptive response ratings would indicate an improvement in social functioning. A decrease in the number of subjective (self) ratings of maladaptive responses and an increase in adaptive responses would be an index of improvement in self concept. Therapist Bias Therapist bias was operationally defined as mea surable discrepancies in treatment and feedback emphases be tween experimental and control groups. The Hill interaction Matrix-G (HIM-G)j a group therapy rating scale, provided the source for the evaluation of therapist performance and 62 2 possible control for therapist bias. On-going ratings on the HIM-G supplied the therapist with information which enabled her to attempt to correct differences between her 3 treatment of the experimental and control groups. The following information has been included in order to provide an assessment of the reliability of thera pist bias ratings. The HIM-G is an adaptation of the Hill Interaction Matrix in the form of a six point rating scale. Reliability for the HIM using percentages ranges from 70 percent to 91 percent. Validity of the HIM has been established through studying protocols of therapy groups whose therapists repre sent different "schools" of therapy. The HIM scores were different for different "schools" characterizing, to a con siderable degree, the orientation of the therapist conduct ing the groups being evaluated. Undergraduate level college students volunteered their services for making ratings on the HIM-G. Raters were asked to become thoroughly familiar with the theoretical and procedural aspects of the Hill Interaction Matrix as pre sented in the Hill Manual (Hill, 1965). They were then trained in scoring techniques through discussion sessions with the investigator and actual experience in rating model tapes. Agreement between raters was assessed by comparing their full scale HIM-G ratings of selected video taped group sessions. Not every rater was compared to every other rater on the same tape, due to the prolonged period of experimen tation. Instead, agreement between pairs of raters on a given video tape was assessed and correlations were averaged for an overall correlation coefficient for all raters (Guilford, 1953, pp. 325-326). Pearson rs for pairs of raters were determined on group scores made by raters and then converted into Fisher z_ coefficients. When the aver aged jz scores were reconverted into r_ = .64 and jo < . 01 (see Appendix III). The HIM-G also yielded other data of interest on group process and interaction which will be reported at a later date. Group VI, an extraneous control group in which no 63 According to Hill (1965), the therapist's task is to foster and encourage members to interact, particularly when a group is composed of mental hospital patients who have difficulty in responding appropriately in social situations. This may be done in a variety of ways. Hill has included thirty-seven items in two categories on the HIM-G which re fer specifically to the activity level of the therapist. "Therapist sponsored" items refer to occasions when the therapist initiates action or encourages patients to inter act within the group setting. "Therapist participation" items refer to group interaction in which the therapist takes part. items falling into these categories will be referred to as therapist performance items. For the present study, the thirty-seven items were rated on the HIM-G six point scale with values ranging from zero through five, and were scored separately in order to evaluate therapist performance over all groups. Raw scores on therapist performance items were combined for the first feedback of any kind was given, was conducted as part of a related study on group process. The group and its partic ipants are not relevant to the present study except as a possible factor in therapist bias as it might be related to order of running groups. There were no significant differ ences in therapist performance between Group VI and the other groups involved in this investigation. 64 and third therapy sessions of each group, and the mean and standard deviation of all therapist scores for each group was found. When a t test was performed comparing the com bined means of raw scores for experimental and control groups, there were no significant differences in therapist performance under the two conditions (see Appendix IV). Rating procedures and Measuring instruments During feedback sessions, the therapist focused upon maladaptive behavior which was defined as ways in which a person behaves and perceives himself which prevent him from meeting the demands of his social environment appropriately. Similarly, the therapist pointed out and reinforced specific strengths exhibited by the participants. Disruptive and adaptive behavior patterns of individuals were determined by evaluating the kinds of comments made to the patient by the therapist during the feedback sessions. Derivation of feedback lists Audio tapes of the first three sessions for both ex perimental and control groups were presented to two under graduate students who identified the therapist responses which could be classified as feedback. The criteria pre sented to the raters for classifying any individual 65 therapist response as feedback to a group member were three fold: (1) the therapist response must refer to a specific behavior or behavioral component which is directly obser vable; (2) the therapist response should be confrontive in nature, i.e., it confronts a member with aspects of his be havior which are usually avoided; (3) the therapist response should be oriented toward either changing maladaptive or re inforcing adaptive behavior. The two raters listened to the audio tape protocols together, but independently listed therapist responses which they perceived as conforming to the feedback item criteria. Therapist responses were clearly identifiable due to the fact that the raters quickly became familiar with the thera pist's audio taped voice and style. After the independent judgments had been made, the raters discussed their lists with each other. if any feedback item precluded inter-rater agreement as to its presence, appropriateness, subject matter or intent, it was considered unclear feedback and discarded. Although the raters' expressions of feedback units varied somewhat in structure, i.e.-, "You interrupt too often," "Interrupts inappropriately," there appeared to be little difficulty in determining that both items evolved from the same therapist response. Four raters in all were 66 used for these judgments, and all were third or fourth year psychology majors with no previous rating experience. There was 75 percent agreement between the raters themselves as to what was and was not clear therapist feedback when the feed back item data for the first feedback session of each group were evaluated (see Table 2). Samples of feedback item lists generated by the raters may be found in Appendix V. In an effort to check objectively the level of agreement of the feedback item raters, an outside judge was asked to review the raters' feedback item lists derived from the audio tape protocols of the first feedback session for all Ss in each experimental and control group. The judge was instructed to decide how many feedback items on each of the two lists for each group represented agreement be tween the raters. The outside judge agreed with the raters 95 percent of the time as to how many of their feedback items were comparable. The judge was then asked to pair feedback items on raters 1 lists which presumably referred to the same therapist response in order to assess the dif ficulty of such a pairing task. The judge was able to des ignate which items on each list agreed with each other 98 percent of the time (see Table 2). None of the items not agreed upon were discarded because of the post hoc nature TABLE 2 A COMPARISON OF INTER-RATER AGREEMENT WITH AN INDEPENDENT JUDGE'S PERCEPTION OF INTER-RATER AGREEMENT ON A RANDOM SAMPLING OF FEEDBACK ITEMS Inter-Rater Agreement on Feedback Items Independent Judge's independent Judge's perception of Feedback Perception of Feedback Items Which Items Which Could Agreed Be Paired Numbers of items 63 60 59 Percentage of Agreement 75 95 98 cn ' • j 68 of the analysis above. A more detailed presentation of rater agreement on feedback items may be found in Appendix VI. Rater agreement on behavioral changes on feedback lists The feedback items for each S_ were compiled into lists. Two lists were prepared for each one for rating by outside judges and one to be rated by the himself. Examples of each of the two lists are presented in Appen dixes VII and VIII. The four outside judges or raters selected for the ratings about to be described were undergraduate college students majoring in the behavioral sciences, but were not the same raters as the four who derived the feedback lists. A video tape recording of a pilot study group therapy ses sion was used as a model and as an estimate of the degree of agreement among the raters. The feedback lists were pre sented to the four raters who were asked to determine which items on the list described behavior visible on the tape for each group member, and how often each behavioral re sponse appeared. This rating task was relatively simple since the raters were asked only to be familiar with the individual feedback lists and to count and check off the number of instances each feedback item was reenacted. Raters were encouraged to stop the tape and replay certain portions if they were in doubt about any item. When the raw scores (the number of times each feedback item was checked off) were evaluated for the four raters on the model tape, all raters agreed on 65 percent and three of four raters agreed on 84 percent of all item score totals. Two of four raters agreed on 99 percent of all item score totals, and the other two agreed with each other (see Table 3 and Appendixes VI and IX). Self ratings on behavioral changes on feedback lists and questionnaires When treatment was completed, each evaluated himself in terms of the feedback lists which had been de rived from the feedback supplied to him. He was asked to judge whether he was making more or fewer of the listed adaptive or maladaptive responses following the treatment experiences. In addition, a brief open-ended questionnaire was administered which sampled a S's judgment about himself in relation to his group experiences in order to attempt to elicit information which could not be derived from the more TABLE 3 RATER AGREEMENT ON THE NUMBER OF INSTANCES IN WHICH BEHAVIOR OF A SUBJECT CHARACTERIZED BY ANY GIVEN FEEDBACK ITEM OCCURRED ON A MODEL VIDEO TAPE Number of Raters Agreeing with Each other 2 All 4 Raters 3 of 4 Raters of 4 _ . Raters of 4 No Agreement percentage of agreement on item score totals on 98 feedback items 65% 84% 99% 1% •-J o 71 structured rating scales. The present investigator agrees with McLuhan (1964) that the content of writing is speech; and that there seems to be a number of advantages in written activities for those who resist verbal communication. Ques tionnaire items are presented in Appendix X. Each list of feedback items attributed to any given S_ was analyzed separately for that so that a number of hypotheses emerged for each individual as treatment pro gressed. predictions were formulated for ratings by others of individual responses and subjective (self) ratings in order to compare the responses of experimental Ss with those of control Ss. positive and negative direction scores When treatment was completed for each group, the therapist and cotherapist made independent judgments as to whether the selected feedback items for each represented positive or negative feedback. A positive feedback item referred to a response which the therapists considered as adaptive and deserving reinforcement. A negative feedback item referred to a response which was considered maladaptive and in need of change. This procedure was followed to verify value judgments on feedback items. Therapists, in 72 generalj must make decisions in the course of any treatment. In the present situation the therapist's value judgments represented" diagnostic evaluations of each patient^ and the therapy proceeded along diagnostic lines to deal with spe cific and verbalized feedback items idiosyncratic to each £3. A detailed accounting of the numbers of positive and nega tive feedback items is presented in Appendix XI. In order to support the therapists' value judgments^ a list of 100 feedback items drawn randomly from the indi vidual feedback lists was presented to a naive and impartial judge who was asked to check which items he would judge positive and which items negative in terms of adaptive or maladaptive behavior in interpersonal situations. Agreement between therapists' value judgments and the impartial judge's evaluations was found to be 99 percent. A sampling of the randomly selected feedback items along with accompa nying therapist and independent judge ratings as to the negative or positive qualities of each item appears in Appendix XII. Statistical Operations In order to deal statistically with rater and self ratingsj a Behavioral Change Index (BCI) which represented 73 an increase or decrease in adaptive or maladaptive responses was derived for each S_. The BCI for each S^ on each rated video tape was that person's total score after the number of instances in which feedback items identified as maladaptive had been checked and subtracted from items identified as adaptive. The decimal fraction Sum of Sum of Positive Feedback Items Negative Feedback items Total Number of Feedback Items x 10 was computed for each S in order to adjust scores for the differing numbers of feedback items per subject, and to facilitate comparisons between rater and self ratings. In order to determine the percentage of total feed back items which changed in a positive direction for each subject the fraction Total positive Direction Scores for Each S_ Number of Feedback Items per S was multiplied by 100. A similar adjustment process was performed for negative direction scores. (See Table 4 and Appendixes XIII and XIV.) Ratings by self and others of changes in behavior referred to during therapy feedback were made following 74 the fifth rather than the sixth or final therapy session. Such a plan was followed in order to control for what Stoller (1966a) has called the "closing phenomenon," the tendency for the group interaction to level off when members realize that they are meeting for the final session. Such an occurrence may be a function of the collective feeling in the time-limited group that an interactional asymptote has been reached beyond which the participants are presently unwilling or unable to proceed. The result is a reduced therapeutic work level characterized by a somewhat passive, relatively comfortable group atmosphere not observable in earlier sessions. Ratings following the fifth session were made in all cases but one when a severe storm made it impossible for the therapist and some S s to attend. The cotherapist was present to conduct the session, but only three Ss appeared, so the meeting was canceled. Ratings were then scheduled for session six, and an extra meeting was held to counter the closing phenomenon. This variation is procedure oc curred in Experimental Group IV. Rater ratings were made of the video tapes of ses sions one and five for each group. Ratings consisted of checking the number of times a given feedback item specific 75 to any one S_ was displayed in behavioral form during the session rated. "Covers up his true feelings with wise cracks" and "Reacts warmly to other group members" are ex amples of negative and positive feedback items respectively. After all ratings were completed and counted, ratings of video tapes of session one were subtracted from those for session five for all Sjs in all groups. Reductions in the number of instances in which a feedback item evaluat ed as negative had occurred and increments in the number of instances in which a feedback item evaluated as positive had occurred were added, and were considered as positive direction scores. Increases in the negative items or de creases in the positive items were subtracted from each in dividual's score, and were considered as negative direction scores. Feedback items on which no change occurred were scored zero. Further information in regard to positive and negative direction scores is presented in Appendix XI. Two irrelevant feedback items selected from other Ss1s protocols, were added initially to each participant's rater and self feedback list to control for what Cronbach (1953) has described as tendencies toward response style or response set. These items, however, were not given numeri cal values and were not included in the scoring. in only 76 four cases (all-self ratings) was any irrelevant item check as changing, an indication, perhaps, that on lists composed of personalized behavioral feedback items it is difficult to mislead either raters or the participants themselves by pre senting material which is not descriptive of a given per son's specific behavioral patterns. It was generally assumed that each scored item was equally important for each individual £ > _ . For example, there was no attempt made to weight verbal over nonverbal items. Self ratings were made on the same items used for rater ratings after treatment was completed. A five point scale was devised ranging from "much less often" to "much more often" and weighted zero through four with four always being at the most adaptive end of the scale. For example, the high point "much more often"was weighted four on a posi tive feedback item. "Much less often" was weighted four on a negative item. Numerical values were added for the total self scores (see Appendix XIV). Mechanical Equipment The instrument used for carrying out the operations of the present study was a Sony videocorder TCV-2010. The machine recorded both picture and sound on tape and was 77 capable of playing back the VTR at any given moment. The mechanism was transistorized,, portable, and relatively simple to operate. In addition to the video re cording device, the main unit included a built-in nine inch television set which also served as a monitor for the VTR. Basic accessory equipment consisted of a video camera kit, VCK-1000, which included a Sony camera with standard lens, camera cable, tripod, microphone and AC cord. All equipment operated on regular household AC current. An Angenieux Zoom and Wide Angle lens with a 2.2 opening was used to add de tail and definition to the recorded protocols. The Sony video Tape had a recording or playing time of one hour, and could be stored for future replay and ref erence. The fidelity of reproduction was excellent, and there were no instances of failure or inadequate function ing. Indeed, the reliability of the equipment was much greater than the investigator had anticipated. Therapy and Feedback procedures Using VTR The setting Each group of six or seven participants met in a room approximately twelve by fifteen feet. No supplemental lighting was necessary beyond the usual flourescent illumination. Chairs were arranged in a semicircular design with the camera and videocorder placed six to eight feet in front of and between the two end seats. The therapist generally occupied the central position in the semicircle, and the Ss1s positions on either side of her were varied from ses sion to session. The cotherapist sat beside the VTR machine and operated the camera on a tripod by his side by watching the group action on the monitor. It was important to have the monitor facing the cotherapist, but hidden from the view of the participants who quickly became distracted by behaving and seeing them selves on the monitor simultaneously. Group therapy session and recording The group therapist interacted with the group and at no time became involved in the taping of group processes. The cotherapist attended to the camera work and recording tasks. He made notes of the footage at which significant events occurred which could profitably be replayed later on. The cotherapist also participated to some degree in group interaction. With the aid of the Zoom lens, he was able to focus on a wide variety of shots and angles, picking up the 79 group as a whole with a wide angle adjustment or zooming in for a detailed recording of an individual response. The feedback session The tape was rerun and the playback began after the therapy session had been conducted and recorded. Again, the cot'herapist was responsible for the mechanical equipment, stopping the tape at the points of greatest interest as in dicated by his footage notes. The therapist then took over and engaged in focused feedback to the individual or groups of individuals imme diately involved in the VTR. Each subject was asked to express his response to seeing himself, then the group was urged to respond to what was seen on the tape and finally, the therapist made her observations, comments and interpretations. Thus, the group interaction was constantly fostered in the feedback session as well as in the therapy phase. A brief discussion of camera principles may be found in Appendix XV. CHAPTER VI RESULTS The means and standard deviations of the combined experimental Ss1s Behavioral Change Index (BCI) scores were determined and compared to the combined control Ss1s BCI scores. (BCI scores were derived by adjusting raw scores for number of feedback items and subtracting negative direc tion from positive direction scores for each S. The section on statistical operations and Appendixes XI, XIII and XIV present these operations in detail.) An inspection of Table 4 reveals a large discrepancy between the means of Adjusted Rater Rating Scores (Behavioral Change Indexes) for experi mental and control groups. Similar differences do not appear in the means of Adjusted Self Rating Scores. Adjust ed positive Direction Scores again show marked discrepancies in means, and Adjusted Negative Direction Scores show a ten dency toward notable differences. An analysis of variance was performed using a 80 TABLE 4 MEANS AND STANDARD DEVIATIONS OF ADJUSTED CHANGE SCORES FOR EXPERIMENTAL AND CONTROL GROUP SUBJECTSa Adjusted Scores Groups Rater Rating (BCI) M SD Self Rating M SD Positive M Direction SD Negative M Direction SD Experimental 9.14 5.14 28.54 3.61 102.33 51.06 11.48 18.73 Control 3.57 5.68 28.53 6.27 58.16 38.73 23.95 24.30 asee section on statistical procedures for description of score adjustment procedures. 82 Groups within Treatment Design (Lindquist, 1953) in order to test the hypothesis that raters would observe after treatment in the video feedback groups fewer maladaptive and more adaptive responses than in the control Ss. This design avoids any possible contamination of any one treat ment by another, and takes into consideration not only the fluctuations resulting from random sampling of Ss, but also the result of extraneous factors having a systematic effect on all Ss within the same group. As indicated in Table 5, the obtained F value for treatment was highly significant ( R < .01). In addition, the obtained non-significant F value for Groups within Treatments suggests that differ ences between experimental and control subgroups contributed minimally to the achieved results. The hypothesis and prediction that experimental groups 1 S_s would rate themselves on a rating scale as be having more adaptively after treatment than control Ss also were evaluated by the same statistical procedures. BCI scores on self rating feedback lists for experimental groups were combined and compared to the combined control groups' BCI scores. Table 6 indicates that video tape feedback (treatments effects) were not significant and that the hypothesis and prediction relating to self ratings were not TABLE 5 ANALYSIS OF VARIANCE OF DIFFERENCES IN THE BEHAVIORAL CHANGE INDEX FOR RATER RATINGS BETWEEN EXPERIMENTAL AND (E>C) CONTROL GROUPS Source DF Sums of Squares Mean Squares F P Treatments 1 308.77 308.77 16. 22 <.01 Groups 5 414.29 82.86 Groups within treatments 4 105.52 26. 38 1. 39 NS Ss within groups (error term) 36 685.65 19.04 c o u> TABLE 6 ANALYSIS OF VARIANCE OF DIFFERENCES IN THE BEHAVIORAL CHANGE INDEX FOR SELF RATINGS BETWEEN EXPERIMENTAL AND CONTROL GROUPS (E>C) Source DF Sums of Squares Mean Squares F P Treatments 1 ,81 . 81 . 03 NS Groups 5 108..80 21.76 Groups within treatments 4 107,. 99 26.99 1.07 NS Ss within groups (error term) 36 902..50 25.06 85 supported. Once again there appear to be no significant differences which could be attributed to between subgroup variables. The predi-ction that raters would observe more posi tive directional change among experimental than among con trol S_s in behavior on which feedback had been focused, was also tested by means of Groups within Treatments analysis of variance. Adjusted positive direction scores for experi mental groups were combined and compared to the combined control group adjusted positive direction scores. An in spection of Table 7 indicates that Treatments effects once again were highly significant (jo < .01) , and the differences between subgroup variables contributed minimally to the results. Results were not so clear when the related predic tion, that raters would observe greater decreases in nega tive behaviors among experimental than among control Ss, was evaluated in a statistically similar fashion. Between subgroup variables still remained at a minimum but Treatment effects only approached traditional significance levels (p < .10). Although there is a trend toward significance, one cannot assert with a high degree of confidence that the second prediction has been supported by the data (see TABLE 7 ANALYSIS OF VARIANCE OF DIFFERENCES IN ADJUSTED POSITIVE DIRECTION SCORES BETWEEN EXPERIMENTAL AND CONTROL GROUPS (E>C) Source DF Sums of Squares Mean Squares F P Treatments 1 20357.17 20357.17 13.43 <.01 Groups 3 28680.12 5756.02 Groups within treatments 4 8322.95 2080.74 1. 37 NS Ss within groups (error term) 36 54565.71 1515.71 CO 87 Table 8) . In summary, the assumption related to Hypothesis A that Ss in groups receiving focused feedback and VTR would make fewer maladaptive and more adaptive responses than Ss in groups engaging in discussion sessions following group therapy meetings, was significantly supported by the data. However, the assumption incorporated in Hypothesis b and the related prediction 1 that S_s in groups receiving focused feedback and VTR would perceive and rate themselves as be having more adaptively after treatment than S_s_ in groups participating in discussion sessions following group therapy meetings was not supported by the statistical results. prediction 1 related to Hypothesis A that positive increases in amount of directional change behavior would be greater among experimental among control S_s_ was strongly up held by the data. prediction 2 related to Hypothesis A, that fewer instances of persistence of negative behavior would occur among experimental than among control S_s_, was not strongly supported by the results, although the scores were in the predicted direction. In all analyses, subject variables played a minimal and non-significant role in the obtained results. TABLE 8 ANALYSIS OF VARIANCE OF DIFFERENCES IN ADJUSTED NEGATIVE DIRECTION SCORES BETWEEN EXPERIMENTAL AND CONTROL GROUPS (E<C) Source DF Sums of Squares Mean Squares I F P Treatments 1 1551.41 1551.41 3.48 <.10 Groups 5 2527.15 505.43 Groups within treatments 4 975.74 243.94 . 55 NS Ss within groups (error term) 36 16053.04 445.92 CD 00 CHAPTER VII DISCUSSION Behavioral and Attitudinal Change The most provocative question which emerges from the data is that having to do with the discrepancies between rater and self ratings. An inspection of the data indicates that behavioral improvement according to rater ratings was significantly greater for experimental S_s than for control Ss. Self ratings revealed no such differences between E an<3 - C - . Ss although the feedback items presented for self ratings were identical to those rated by the raters. Such results imply that under the present experimental condi tions, there is a tendency toward adaptive behavioral change which occurs in the absence of, or at least prior to attitudinal shifts or willingness to accept the responsibil ity for whatever such changes might imply. Therapists, in general, assume that the patient must become aware to some degree of the need or possibility 89 for change before substantial changes of any kind can occur. This kind of self-consciousness, according to Stoller (in press), must necessarily precede the fumbling attempts toward new and more adaptive ways of behaving. The present investigator suggests that self-consciousness as such may not, however, represent actual awareness of, or personal commitment to the process of change. Experimentation in terms of new kinds of responses may take place, and behavior may be changing some time before attitudinal changes occur when these are reflected on an instrument such as the self rating scales. All Ss saw themselves as moderately improved as a consequence of treatment. Raters, however, perceived more radical and specific changes in both .experimental and control S j = _ . One might speculate then, that although partic ipants were aware of the need for change, they were unaware of the degree to which they actually changed in either a positive or negative direction. Another possibility is that the Ss were reluctant to report their felt improvement pos sibly fearing it might not last or that it might result in premature discharges. However, group members were not the typically failure-oriented hospital patients, and most participants expressed a strong desire to leave the hospital as soon as possible. 91 Justification for the results of the present study may be found in the theoretical acumen of a number of authors. In their comprehensive statement on attitudes; Katz and Stotland (1959) suggest that people often become aware of their behavior after they have engaged in it. "The phenomenological approach does not enable us to predict a fairly common occurrence in social life, namely, that atti tudes develop to justify behavior which is imposed on the individual^" they argue. "The technique of the 'fait accompli' is certainly as old and as common as the technique of trial balloons" (p. 464). The same investigators also propose that cognitive elements need not always be present for an attitude to have an action orientation; and that motor outlets which are the essence of behavior may lack attitudinal representation. Incorrect inferences about predispositions toward certain kinds of behavior may arise when one attempts to study action orientations and measure attitudes simul taneously. The S_ may have an action orientation but it may not be the one he communicates to the investigator. Such a situation may push the S_ into conflict; and while he searches for a resolution to his dilemma he engages in a kind of cognitive compromise. In the process he dilutes to 92 some degree his involvement in the enterprise at hand. Individuals characteristically look for and often must find rationalizations before they act or feel comfortable about their actions. The self rating results may well be a prod uct of this intervening phase. Katz, Sarnoff, and McClintock (1956) have observed that behavior becomes available for change through increas ing information and action, but self evaluations which are bolstered by the ego defenses are likely to be resistant to information and action, and are far more susceptible to change through methods designed to improve self-insight. This notion is supported by evidence in Griver and Robin son’s study of improvement in job performance and job atti tudes among purchasing personnel in an aerospace company (1965) . Their data indicated that positive behavioral changes could be effected through action-oriented proce dures, but accompanying attitudinal changes appeared later after the individual had accepted the beneficial conse quences of his behavioral changes. In the present study, objective ratings indicate that the behavior of individual group members improves as the level of therapeutic interaction and information increases. Such results are supported by Bach's (1954) 93 contention that group members tend to push each other away from pathology. Hill (1965) observes that at the high therpeutic work levels, with particular reference to a confrontive style of interaction, a person is often making a direct appeal for meaningful feedback by specifying what ever behavior has caused his reactions or stimulated his interest. The possibility of behavioral changes occurring is enhanced when such interaction takes place, even over a short period of time. Positive and Negative Direction Scores No attempt has been made in the present study to determine which Ss received proportionately greater amounts of positive or negative feedback, nor to estimate which be havioral categories lent themselves specifically to positive or negative directional change. It is impossible without further rigorous analysis of the data to make any conclusive statement with reference to the adaptive or maladaptive value of either positive or negative feedback since the treatment effects were many and varied and the scoring pro cedures complex. The fact that the three experimental groups demonstrated significantly greater total increases in adaptive behavior, whether due initially to increases 94 in positive item scores or decreases in negative item scores, suggests that any kind of feedback may be effective and that the specificity of a feedback item rather than the evaluative judgment involved may be an important considera tion . Differences between IS and c group negative direc tional change scores showed only a tendency toward signifi cance. One might speculate that cognitive dissonance became a factor in the responses of some Ss. It is possible that certain participants who devalued themselves found it diffi cult to accept positive feedback, and that certain other members inclined toward more grandiose self-concepts found it equally difficult to accept negative feedback. In either case, the discrepancy between the individual's own attitudes and his knowledge of opposing arguments might well have in duced confusion and resistance which resulted in maladaptive behavior and negative directional scores. In regard to both positive and negative direction scores, motivational elements appear to play a central role. The challenge is to account not for behavior as such, but for the patterning, timing, and direction of behavioral change (Hebb, 1953; McClelland, 1953). Videotape Feedback Versus Discussion Session Feedback It is a generally accepted therapeutic axiom that for certain individuals there seems to be a period during therapy when behavior deteriorates before it improves. In the process of trying out new ways of acting or reacting, many patients engage in variable behaviors which often appear to be less adaptive than their initial responses. One might suggest that among the experimental Sj3, this be havioral phase was worked through rapidly due to the imme- diacy, specificity and corrective nature of the VTR. Among the control Ss the limitations imposed by the discussion sessions made such operations more difficult. Cartwright (1949) has discussed the creation of a specific behavior structure in addition to cognitive and motivational structures. He observes that the more specifi cally defined a path of action is toward a goal, the more likely it is that the structure will gain control of the behavior. It is possible in the present study that, as treatment progresses, the person begins to recognize that there are certain changes available to him. Behavioral alternatives can be clearly structured and made readily apparent with VTR and focused feedback. The subject can 96 confront himself in an immediate and powerful fashion. Discussion session feedback, however, represents a kind of talking-about rather than a re-experiencing of affect and behavior. For this reason, the discussion sessions tended to inject an emotional distancing into the situation which was not present in the VTF groups. It is of value, at this point, to enlarge upon the disparity in impact between the VTF and discussion sessions for both the subjects and the therapist. video tape repre sents initially an attention-getting device, or dither sig nal (Turner, 1966) which arouses the S sufficiently to take stock of himself and how he presents himself to the world. The difficulties in instituting similar operations in the control group were highlighted in this study. Efforts to duplicate in some meaningful form interactions which took place one-half to one hour earlier without VTF as both a mnemonic device and a focusing technique were seldom suc cessful. Few discussion group Ss were able to remember or concentrate upon past events when these were only verbally called to their attention. in this sense an extra burden was placed on the therapist not only to recall significant events for each S_, but to describe and interpret them as well. 97 Although the VTR equipment was present and operating t - during all therapy meetings and present during all feedback sessions, the actual use of the VTR with the experimental ^s during feedback sessions seems to have created a higher level of involvement for participants. One might speculate that the explicit nature of VTR and focused feedback may have indicated more concern and caring on the therapist's part when compared to the more diffuse patterns of the dis cussion session feedback. Specific statements and suggested alternatives in regard to individual behavior are difficult to conceptualize and deliver, and the VTR makes a substan tive contribution to this task. (The therapist thus im proved her techniques for focusing and clarifying her own observations and comments.) Ss may well have perceived such feedback as more closely related to their personal needs and goals than the feedback offered during the discussion ses sions. As one patient stated, I feel that they [VTF sessions] are much more effective than ordinary group therapy meetings. I find that the interaction reflects a higher mood within the group as a whole. As a result I feel greater freedom to be an individual. . . . it has given me a chance to use adult judgment about myself in retrospect. 98 Descriptive Material Subject and group variables An overview of the present study raises a question regarding the possible influences of individual differences in group participants and of group composition. Although neither of these effects were statistically significant;, it may be of value to report some of the author's clinical impressions. When subject scores were added for each group, Group I, an experimental group, had the highest BCI, 75.42. Group V, a control group, had the lowest BCI, 4.7. Thera pist observations of Group I indicated that 3 of the 7 Ss were highly and often irritatingly verbal to the point of eliciting considerable negative feedback from other group members. Of these 3 S_s, and benefited, according to the raters, to a moderate degree from the group experience. S , however, was seen by raters as regressing to less adaptive behavior. it appeared that those gaining the most from the sessions were the quieter group members, S2 and S^, who may have (1) disliked seeing themselves as passive persons imposed upon by others, (2) developed con fidence in their ability to hold their own in a situation 99 where aggressive verbal behavior was common and (3) used their more verbal associates as models in learning to speak more often and more assertively for themselves. The quieter S s also seemed less distracted by their own verbalizations, appeared to watch and listen more closely than the talkative Ss, and may have been able to use the VTF more effectively to their own advantage. For the most part the quiet Ss re ceived more positive and supportive feedback from group members than the verbal S_s_j and as a consequence may have developed a different and perhaps stronger motivation to change, The composition of Group II, a control group, was similar to that of experimental Group I. However, during the discussion sessions following the therapy sessions, it was impossible to deal with feedback in a manner consistent with the techniques used in the E_ groups. With no video tapes of the therapy sessions to pinpoint specific feedback and anchor comments, both the therapists and the Ss were forced to depend upon their memory of what had taken place during the previous hour of interaction. The result was a communication gap in the form of forgetfulness and denial on the S_s' part, and difficulties for the therapist in making feedback comments precise, relevant and meaningful for the 100 participants. To go back in time one needs, it appears, some source of visual and auditory referability which is what the video tape provides. Thus while control Group II did gain to some degree from the sessions (the group's BCI was 37.19), there were serious deficits in benefits which could have been remedied by having the VTR as a focus for discussion and interaction. Control Group V Ss with the lowest BCI (4.7) appeared to be particularly prone to resistance and denial in relation to behavioral change. After viewing, at the end of treatment, selected segments of their previously video taped therapy sessions and discussing with the therapists their reactions to themselves and their behavior, all Ss in Group V expressed the feeling that this was the real begin ning of their understanding of themselves and their accep tance of the therapist's earlier comments. All Ss stated that they wished the sessions could be continued using the VTR as an aid to self-improvement. Experimental Groups III, IV, and Control Group VII were quite similar in member composition with few outstand ing or unusual characteristics. However, here, again, Group VII Ss suffered from difficulties in comprehending and consistently accepting therapist feedback, and 101 subsequently in taking action toward behavioral change. The result was lower group BCIs than those in the experimental groups. It is of interest to speculate about the meaning of negative total scores, an indicator of increment in rater ratings of negative behavioral change. One S_ in the E_ groups and five in the C_ groups received negative total rater scores (TRS). In each case, denial and resistance were the basis of the individual's defensive maneuvers. Three of four of the negatively rated S_s in the control groups were members of the previously mentioned C_ Group V. All three resented the VTR equipment primarily, they stated, because they were not permitted to see themselves until after all sessions were completed. One female S_ participat ed only minimally and another was highly voluble in resist ing therapist attempts to provide effective feedback; the other patient, a male, was suspicious of the therapist's motives and was only able to accept feedback after seeing himself at the end of treatment. The fourth S_ was a female in C Group II with a TRS of -1.2 who appeared to have difficulty in concentrating on group interaction. Although she participated, it was with a notable lack of commitment to the therapy goals, 102 which represents another form of defense. These factors were also characteristic of one experimental and one control participant whose total rater scores were zero. One might conclude that interest and involvement are crucial to be havioral change on the part of a group member regardless of direction. The lone S_ in the E groups with a negative score had sociopathic tendencies and made determined efforts to dis rupt the group. As the group (I) gained in strength and was able to deal with his hostility and verbosity he began to change his behavior. However, such attempts still resulted in inappropriate and negatively perceived behavior. At the end of treatment he was still floundering in his attempts to deal more effectively with other people. There were no significant differences in a similar comparison between self ratings of experimental Sjs and self ratings of control group Ss (see Table 6) . All S_s in all groups perceived themselves as having benefited from the group sessions. There was a slight trend among _E Ss toward higher BCI scores than among C_ Ss, but the overall differ ences were negligible. The degree to which all Ss_ uniform ly tended to see themselves as having improved behaviorally as a result of treatment in contrast to rater scores which 103 indicated broadly varying positive and, in some cases, negative changes, suggests that, in the present setting, denial and distortion may be fixed attributes of the self rating scales. Other factors such as desire to present oneself in a favorable light, wish to please the therapist, and the placebo effect also may have contributed to the non significant findings. Questionnaires The expressive statements elicited by the question naire demonstrate differences in levels of insight and self- understanding between _ E and c : participants. Comments such as "I appear to be a stronger and more effective person than I thought I was" and "Now I see why other people say I look and act angry all the time" are illustrative of two effects which appear to follow, with some consistency, the video tape feedback experience; 1. A person may see himself as being less effective than he thought he was and be motivated to change his behavior. 2. A person may see himself as more effective than he thought he was and decide to use himself in a more satisfying and productive fashion. 104 One highly verbal and skillfully evasive experimen tal S. observed that seeing himself in action forced him to accept responsibility for the person he saw. As he watched himself he realized he could choose to change certain aspects of his behavior or continue behaving in maladaptive ways. Examples of other responses from £. Ss were: "very exciting and revealing to see myself interacting with others"; "It's a relief to view and hear myself"; "So much shows on the outside, I’m not so afraid any more"; "One of the most effective forms of therapy I have seen, Comments among the control S_s were limited, for the most part, to discussion of their own reaction to group processes. They were positive in nature but much less spe cific. There seemed to be a general tendency to say it was a "good" or"valuable" experience but little effort to de scribe reactions in greater detail. Examples of control Ss1 responses were: "I can express myself better in the group"; "It [the group] broke down barriers"; "Group dis cussion has helped me face reality"; "Real good experience." ' ' ‘ Qualitative statements were not immediately and systematically scored because of the number of blanks which were returned. Further analysis of the questionnaire data might provide sufficient evidence for a comparative evalua tion of written responses. 105 Implications for Treatment and Research There are always limitations to generalizations and in the present study even relatively verbal mental hospital patients in good contact represent a substrate of the normal population. One might inquire to what degree the character istics of the S_s_ were responsible for the results. The explicitness of the VTF with its emphasis on on-going behavioral patterns suggests that it may be of particular value in working with mental patients. The very process of focusing attention upon the explicit rather than the inferred meaning of a statement or an act can break through the wall of obfuscation which the mental patient so effectively maintains. Stoller (1967a) has used VTR and focused feedback with severely regressed mental hospital patients and found that such procedures do, indeed, show great promise. "The urge to look at oneself is apparently an irresistable one," he observes, "and even patients who seem to have abandoned a considerable amount of their self esteem cannot turn away from this" (p. 160). Cameron (1950) emphasizes that the ability to recog nize and appraise one's own behavior decreases with the presence of psychopathology. In the context of the present 106 study, self ratings were incongruent with behavioral ratings. The discrepancy between experience and the outer manifestation of it was clearly documented by the VTR. One might theorize along Rogerian lines that mental patients in particular would be expected to lack congruence between the view they have of themselves and the perceptions others have of them. According to Rogers (1959), when an individual is in a state of disorganization resulting from incongruence between the self-concept and experience, the tension between the two is expressed in a confused regnancy, first the self- concept and then the experience supplying the feedback by which the person regulates his behavior. Such confusion and double messages are characteristic of the hospitalized psychiatric patient (Haley, 1963; Stanton and Schwartz, 1956). Theoretically, one might venture to extrapolate the data to predict that more congruent self-actualizing persons with lower thresholds of rigidity and defense could use video tape feedback more rapidly and creatively than hos pital S_s (Rogers, 1963; Maslow, 1961). Recent clinical experience has indicated that VTF techniques are more powerful in their demonstrable effects with normals than with mental patients (Stoller, 1967b; Rogers and Stoker, 1967). Acceleration of behavioral change 107 is also more rapid with normal Ss. Indeed, it appears that VTF has the greatest impact for those persons who are open to self-confrontation and are most able to engage in role- taking. For less adept people, VTF can be a new and valuable tool for learning such skills. In the present study, the treatment procedures provided the Ss with an opportunity to explore, in a rela tively structured situation, new ways of behaving and expe riencing themselves. But such operations cannot and should not stand alone either from a treatment or research point of view. On-going psychotherapy is indicated with increas ing emphasis on insightful discussion in order to bolster attitudinal components and to enhance and consolidate be havioral changes. vital to the treatment procedures are ap propriate research techniques designed to identify critical learning points, motivational factors and specific areas of change. VTR as a tool is still new and much research needs to be done. An audio versus video tape paradigm is ripe for exploration. Optimum time span and frequency of VTF proce dures present challenging questions. Use of VTF with chil dren, adolescents and in nonverbal types of therapy offers a vast array of possibilities. In the context of the 108 marathon group, VTF appears to be a dramatic and rewarding therapeutic accessory, but here, again, systematic investi gation has been nonexistent. Other contexts within which VTF has been used but not empirically evaluated include groups of institutionalized and private patients, college students, families, couples, alcoholics, drug addicts, etc. (Myer'hoff, 1967) . The educational possibilities are limit less, and there is no substitute for VTF in training thera pists and counselors (walz and Johnston, 1963; Rogers and Stoker, 1967). We are, at present, on the brink of a proliferation of new technical instruments particularly in the field of communication. The challenge is great, the potential infinite. The manner in which we perceive our world and ex perience ourselves may be permanently altered by our con frontations with the new technology. McLuhan (1967) states it succinctly when he says, "Media, by altering the environ ment, evoke in us unique ratios of sense perception. The extension of any one sense alters the way we think and act— the way we perceive the world. When these ratios change, men change" (p. 41). implicit in the present investigation and in all of the areas suggested for study is the concept of change. 109 But we would do well to heed Strauss' warning (1959, p. 43) when he says that 1 1 it is not change that needs to be ex plained but its specific directions; and it is not lack of change that needs to be taken for granted, but change itself." A P P E N D I X E S 110 APPENDIX I DEMOGRAPHIC TABLE FOR INDIVIDUAL SUBJECTS Experi mental S# Sex Groups Age Weeks in Hospital Meeting Atten dance Educational Level (Years) 1 M 32 12 6 11 2 F 26 52 6 12 3 M 27 32 5 13 4 F 40 8 6 14 5 M 22 32 6 12 6 M 31 56 5 10 7 F 24 6 5 12 1 F 49 7 6 13 2 M 36 32 6 12 3 M 32 16 5 10 4 F 26 3 6 10 5 M 46 1 6 12 6 F 29 4 6 10 7 F 47 4 5 13 1 M 23 16 6 12 2 F 32 3 6 12 3 F 31 8 6 9 4 F 30 12 6 12 5 M 35 16 6 13 6 M 21 6 5 13 7 M 28 12 5 9 111 112 APPENDIX I— Continued Control Groups s# Sex Age Weeks in Hospital Meeting Atten dance Educat: Levi (Yea. II 1 M 34 24 5 9 2 F 28 12 6 12 3 M 31 1 6 13 4 F 41 52 6 11 5 F 34 20 6 12 6 M 27 3 6 10 7 M 20 8 6 10 V 1 M 33 78 5 12 2 F 28 52 5 12 3 M 41 5 6 12 4 F 44 2 6 10 5 M 45 3 6 12 6 M 26 12 5 9 VII 1 F 26 24 6 12 2 M 43 32 6 10 3 F 45 16 6 12 4 M 40 12 6 12 5 F 21 12 12 6 M 28 28 6 10 APPENDIX II SEX DISTRIBUTIONj MEANS AND STANDARD DEVIATION OF AGE, LENGTH OF HOSPITAL STAY, MEETING ATTENDANCE AND EDUCATIONAL LEVEL OF EXPERIMENTAL AND CONTROL GROUP SUBJECTS Experimental Groups Control Groups Sex Group # Males Females Group # Males Females I 4 3 II 4 3 III 3 4 : V 4 2 IV 4 3 VII 3 3 Age Group # Mean SD Group # Mean SD I 28. 86 5.62 II 30.71 6.13 III 37.86 8.71 V 36.17 7 . 56 IV 28. 57 4. 62 VII 33.83 9. 19 113 114 APPENDIX II— Continued Experimental Groups Control Groups Weeks in Hospital Group # Mean SD Group # Mean SD I 28. 29 19. 02 II 17.14 16. 22 III 9.57 10 . 21 V 25. 33 29. 21 IV 10.43 4.59 VII 20. 67 7.80 Meeting Attendance Group # Mean SD Group # Mean SD I 5 . 57 . 50 II 5.85 . 35 III 5 .71 .45 V 5.50 . 50 IV 5 .71 .45 VII 5.83 . 37 Educational Level Group # Mean SD Group # Mean SD I 12 . 00 1. 20 II 11.00 1. 31 III 11.43 1. 29 V 11.17 1. 21 IV 11.00 1.51 VII 11.17 . 90 APPENDIX III MEANS, STANDARD DEVIATIONS, PEARSON r'S AND FISHER z'S OF PAIRED RAW SCORE RATER RATINGS ON THE FULL SCALE HIM-G Raters 1 2 Means Ml M2 Standard Deviations SDl SD2 Pearson r Fisher z A B 2.04 1. 75 1. 68 1. 80 . 5136 . 58 A C 2. 22 2. 21 1. 67 1.45 . 5955 . 68 D E 2.05 1.71 1. 27 1. 10 .7309 . 93 E F 2. 11 1. 95 1. 33 1. 21 . 3268 . 34 D G 1. 77 1.78 1. 22 1. 57 . 6266 .73 Average r = .65 p < .01 115 APPENDIX IV MEANS j STANDARD DEVIATIONS AND t TEST OF RAW SCORE RATINGS ON THE HIM-G FOR COMPARISON OF EXPERIMENTAL AND CONTROL GROUPS ON THERAPIST PERFORMANCE ITEMS Groups Means Standard Deviations t . Value S ignificanee Level Experimental 1. 97 . 11 . 25 NS Control 2 . 02 . 22 116 APPENDIX V EXAMPLE OF FEEDBACK ITEM DERIVATION LIST Lora Barbara Tom Mary Arthur Vernon Steve Speaks too Reacts warmly Talks Too quiet Needs to Seems tense Tries to get loudly abstractly speak more and fearful attention of Digresses Very clearly the group Doesn't talk when she Too perfec- cautious Speaks well about her talks tionistic Doesn't risk Laughs at Makes own feelings anything inappropri Seems to speeches Can be very Seems very ate times feel inferi Covers up amusing tense and Looks or to others insists feelings by pressured fearful Needs to people don't laughing at Not always speak for Needs to like him sad things clear in Makes Speaks too himself express him what she speeches softly and more often self more Thinks says quoting other people slowly often people in the group are "prose cuting" him Rater's Initials JM 117 APPENDIX VI AMOUNT OF RATER AGREEMENT ON THE NUMBER OF FIRST SESSION FEEDBACK ITEMS FOR SUBJECTS IN ALL GROUPS AS PERCEIVED BY THE RATERS AND BY AN INDEPENDENT JUDGE ^ AND THE PAIRING BY THE JUDGE OF ITEMS AGREED UPON BY THE RATERS AS CLEAR FEEDBACK ITEMS - Number Number Judge's Judge's of Items of items Perception , , Pairing Identified Agreed Upon Items Agreed of Agreed by Each Rater by Raters Upon by Raters Upon items A B I 17 16 14 13 13 II A 17 B 14 11 11 11 III A B 16 14 12 11 10 IV C 15 D 12 9 9 9 V A T3 " 15 12 9 8 8 VII C 10 D 11 8 8 8 118 APPENDIX VII EXAMPLE OF RATER RATING SCALE AND SCORING Play back the video tape, check the number of times BEATRICE demonstrates each of the following kinds of behavior. If the behavior is visible on the tape and continues with out interruption for more than five consecutive minutes, check it twice. Rater's initials: R F Score in this column first. Fold under and score in column Kinds of Behavior BCI Score pos or Neg j Group III, Tape Code #: 5 BYl at the left. Group III, 1 Tape Code #: LYl Explores her personal needs and goals 3 P xxxx X Varies her vocal tone 0 P X X Enjoys herself in the group 2 P X X Is cautious about revealing herself and her feelings 0 N Interprets the experiences of other people 3 N X X xxxxx Uses big abstract words 1 N X Is spontaneous in expressing herself 1 P xxxx X X X Interrupts other people rudely I [Irrelevant] BCI Total 10 APPENDIX VIII EXAMPLE OF SELF RATING SCALE AND SCORING NAME: DATE: Beatrice September 2 2 , 1966 As a result of my experiences in I feel that I: (CHECK ONE) these therapy feedback group meeting! 3. pos. or Neg. Explore ray personal needs and goals Much 0 1 less often Less often 2 No change 3/ More often Much 4 more often P Much Vary my vocal tone 0 1 less often Less often 2 No change / I'/ More often Much 4 more often P Much Enjoy myself in the group 0 1 less often Less often 2 No change 3 More often Much 4 , more'often P Am cautious about revealing myself and my feelings Much 4 less often Less often 2 No change 1 More often Much 0 more often H* to O APPENDIX VIII— Continued As a result of my experiences in these therapy feedback group meetings I feel that I: (CHECK ONE) 1 3 Pos. or Neg. Interpret the experiences of other people 4 3 X" 2 Much less often Less often No change 1 More often Much 0 more often N Use big abstract words 4 3/X^ 2 / Much less often Less often No change 1 More often Much 0 more often N Am spontaneous in expressing myself 0 1 2 Much less often Less Often No change 3//" More often Much 4 more often P Interrupt other people rudely Much less often Less often No change More often Much more often a I irrelevant BCI Total = 22 H H APPENDIX IX I FREQUENCY TABLE OF THE NUMBER OF INSTANCES IN WHICH RATERS CHECKED INDIVIDUAL FEEDBACK ITEMS FOR SUBJECTS APPEARING ON A MODEL VIDEO TAPE s Raters 1 2 3 4 5 Item Numbers 6 7 8 9 10 11 12 13 14 1 c 0 2 1 2 1 1 0 2 1 0 0 1 0 0 JW 0 2 0 0 0 0 2 1 0 0 1 0 0 B 0 2 1 1 0 0 0 2 1 0 0 1 0 0 JD 0 1 1 1 0 0 0 2 1 0 0 1 0 0 2 C 1 2 4 0 0 1 2 0 2 3 1 0 1 2 JW 1 2 4 0 0 0 2 0 1 2 0 0 1 1 B 1 2 4 0 0 0 1 0 1 2 0 0 1 1 JD 1 2 4 0 0 0 1 0 1 1 0 0 1 1 to ro APPENDIX IX— Continued Item Numbers s Raters 1 2 3 4 5 6 7 8 9 10 11 12 13 14 3 C 1 1 2 1 1 0 0 0 0 0 0 1 0 0 JW 1 1 2 0 0 0 0 0 0 0 0 1 0 0 B 1 1 2 1 1 0 0 0 0 0 0 1 0 0 JD 1 1 2 0 0 0 0 0 0 0 0 1 0 0 4 C 2 2 0 1 0 1 1 2 0 0 1 1 1 0 JW 2 1 0 1 0 0 1 1 0 0 0 1 1 0 B 2 2 0 1 0 0 1 1 0 0 0 1 1 0 JD 2 2 0 1 0 0 1 2 0 0 1 1 1 0 5 C 4 2 1 2 1 2 1 1 1 0 1 2 1 0 JW 3 1 0 1 0 1 0 1 1 0 1 2 1 0 B 3 2 1 2 0 1 0 1 1 0 1 2 1 0 JD 2 2 0 2 0 2 i 1 0 1 0 1 2 1 0 123 APPENDIX IX— Continued s Raters 1 2 3 4 5 Item 6 Numbers 7 8 9 10 11 12 13 14 6 C 3 1 2 1 2 5 2 3 0 2 1 0 2 0 JW 2 1 1 1 1 3 1 2 0 2 1 0 1 0 B 3 1 1 1 2 3 1 2 0 2 1 0 2 0 JD 2 1 2 1 1 3 1 2 0 2 1 0 2 0 7 C 3 0 0 2 0 2 0 4 0 0 1 1 2 1 JW 3 0 0 1 0 1 0 3 0 0 1 1 1 1 B 3 0 0 2 0 1 0 3 0 0 1 1 1 1 JD 3 0 0 1 0 2 0 4 0 0 1 1 1 1 H APPENDIX X QUESTIONNAIRE I. What do you feel these group therapy meetings have meant to you? II. How do you feel about the feedback sessions we have had after the therapy sessions? III. How do you see yourself interacting with other people? 125 APPENDIX XI NUMBER OF POSITIVE AND NEGATIVE FEEDBACK ITEMS, RATER DETERMINED POSITIVE AND NEGATIVE DIRECTION AND NO CHANGE ITEMS, AND ADJUSTED SCORES FOR SUBJECTS IN EXPERIMENTAL AND CONTROL GROUPS E Group S Nuraber of Feedback Items + Direction Changes3 + No Change Items*5 c Directional Adjusted Scores + I 1 5 2 7 0 2 100 0 2 6 1 13 0 0 186 0 3 2 3 7 0 1 100 0 4 2 7 11 1 0 122 11 5 1 8 1 6 4 11 86 6 4 3 12 0 0 171 0 7 2 4 9 0 1 150 0 L 22 30 60 7 8 840 97 I - - * to s T 2 3 4 5 6 7 1 2 3 4 5 6 7 APPENDIX XI— Continued Number of Directional0 Feedback Direction No Change Adjusted Items Changes3 Items*3 Scores + - + + - y 5 5 10 1 4 100 10 4 6 3 3 5 30 30 6 4 7 2 2 70 20 7 2 7 1 3 78 11 5 5 9 0 2 90 0 9 2 5 1 5 45 9 5 5 18 0 0 180 0 41 29 59 8 21 593 88 I 6 6 10 1 3 83 8 7 5 16 0 2 133 0 7 5 6 1 6 50 8 6 6 7 2 5 58 17 4 9 12 3 1 92 23 2 10 24 0 1 200 0 7 5 12 1 6 100 8 !9 46 87 8 24 716 64 127 s T 2 3 4 5 6 7 1 2 3 4 5 6 APPENDIX XI— Continued Number of Directional0 Feedback Direction No Change Adjusted Items C'hangesa Itemsb Scores + - + + I 5 4 3 3 3 33 33 0 8 5 1 4 63 13 1 8 5 3 4 56 33 4 5 3 4 4 33 44 1 6 5 2 2 71 29 6 3 15 0 1 167 0 3 5 5 4 2 63 50 20 39 41 18 20 486 202 5 5 3 6 3 30 60 7 3 2 3 6 20 30 8 2 2 0 7 20 0 3 7 1 8 5 10 80 5 5 8 0 3 80 0 4 3 4 0 4 57 0 32 25 20 17 28 217 170 128 APPENDIX XI— Continued C Group S Number of Feedback Items + Direction Changes3 + No Change Items^ Directional0 Adjusted Scores + VII 1 4 2 3 0 3 50 0 2 1 5 1 3 2 17 50 3 2 4 5 2 1 83 33 4 1 5 4 0 3 67 0 5 4 2 2 0 4 33 0 6 v 4 2 8 0 0 133 0 1 16 20 23 5 13 383 83 aNumber of instances in which raters checked feedback items as changing in a positive or negative direction. ^ N u m b e r of instances in which rater rated items did not change in either a positive or negative direction. c See section on statistical procedures for description of score adjustment procedures. APPENDIX XII SAMPLE OF RANDOMLY SELECTED FEEDBACK ITEMS EVALUATED BY THERAPISTS AND INDEPENDENT JUDGE AS POSITIVE OR NEGATIVE IN TERMS OF BEING ADAPTIVE OR MALADAPTIVE IN INTERPERSONAL SITUATIONS , Independent Therapists' , Judge s Evaluation . . . Evaluation Apologizes unnecessarily - + Can be amusing + - Tries to direct group interaction - - Does not listen to other people - - Acts like a clown - Uses big abstract words - - Blames other people for his problems - + Accepts his own strengths + - Labels himself - - Says one thing and means something else - Makes vague or obscure statements - Is afraid of being wrong - - Talks in a tentative, questioning way - Intellectualizes - - Puts himself on a pedestal - + Thinks before she speaks + Needs everyone to admire her - - Tries to be friendly with everyone + - Looks cool and hostile - - Is set in his ways and ideas - Sounds like a little boy - + Wants to be self-sufficient + 130 APPENDIX XIII ADJUSTED RATER RATING SCORES FOR EXPERIMENTAL AND CONTROL SUBJECTS5 1 BCI Adjusted Score score 1 7 1.43 7 10.01 2 7 1.43 13 18. 60 3 7 1.43 7 10.01 4 9 1.11 10 11.10 5 9 1.11 -5 -5.60 6 7 1.43 12 17.20 7 7 1.43 9 12. 90 Modal Number of Number of E Group I Feedback Items (10) r Feedback ------—-:----: -------— S Items Total Number of Feedback Items per S H* 0 - > H APPENDIX XIII— Continued E Group III Number of Feedback Items Modal Feedback Number of Items (10) BCI Adjusted S Total Feedback Number of ; items per S Score Score 1 10 1.00 9 9. 00 2 10 1.00 0 0 3 10 1.00 5 5.00 4 9 1.11 6 6. 70 5 10 1.00 9 9.00 6 10 1.00 4 4.00 7 10 1. 00 18 18.00 E Group IV 1 12 .83 10 8.30 2 12 .83 16 13. 30 3 12 .83 5 4. 20 4 12 .83 5 4. 20 5 13 .77 9 6. 90 6 12 .83 24 19. 90 7 12 . 83 11 9.13 H ( j J N> s T 2 3 4 5 6 7 O ' 1 2 3 4 5 6 APPENDIX XIII— Continued Number of Feedback Items Modal Number of Feedback Items (10) Total Number of Feedback Items per S BCI Score 9 1.11 0 8 1. 25 4 9 1. 11 2 9 1.11 -1 7 1.43 3 9 1.43 15 8 1.25 1 10 1.00 -3 10 1.00 -1 10 1.00 2 10 1.00 -7 10 1.00 8 7 1.43 4 APPENDIX XIII— Continued C Group VII S Number of Feedback Items Modal Number of Feedback Items (10) Total Number of Feedback Items per S BCI Score Adjusted Score 1 6 1. 67 3 5.01 2 6 1. 67 -2 -3. 30 3 6 1. 67 3 5.01 4 6 1.67 4 6.70 5 6 1.67 2 3. 30 6 6 ........................ . . . 1.67 8 13.36 aSee "Statistical Operations/' pp. 72-76 above. APPENDIX XIV ADJUSTED SELF RATING SCORES FOR EXPERIMENTAL AND CONTROL SUBJECTSa E Group I Number of Feedback Items Modal Number of Feedback Items (10) BCI Adjusted S Total Number of Score Score Feedback Items per S 1 7 1.43 20 28. 60 2 7 1.43 24 34. 32 3 7 1.43 19 27.17 4 9 1.11 24 26.64 5 9 1.11 26 28.86 6 7 1.43 23 32.89 7 7 1.43 18 25.74 ! —1 CjO U1 I APPENDIX XIV— Continued E Group III S Number of Feedback Items Modal Number of Feedback Items (10) Total Number of Feedback items per S BCI Score Adjusted Score 1 10 1.00 31 31.00 2 10 1.00 21 21.00 3 10 1.00 29 29.00 4 9 1.11 30 33. 30 5 10 1.00 32 32.00 6 10 1.00 25 25.00 7 10 1. 00 32 32.00 E Group IV 1 12 .83 33 27.39 2 12 .83 40 33. 20 3 12 .83 38 31.54 4 12 .83 32 26.56 5 13 . 77 30 23.10 6 12 .83 31 25.73 7 12 .83 32 26.56 u> CT> s T 2 3 4 5 6 7 ‘ O' 1 2 3 4 5 6 APPENDIX XIV— Continued Modal Number of Num er o Feedback Items (10) BCI Feedback ------ ; — : ----: ----■ — — Total Number of score I t6ms Feedback Items per S 9 i —t i —t l —1 20 8 1.25 17 9 i —1 i —1 i —1 26 9 1.11 23 7 1.43 18 9 1.43 30 8 1. 25 19 10 1.00 23 10 1.00 22 10 1.00 33 10 1.00 24 10 1.00 38 7 1.43 18 I APPENDIX XIV— Continued C Group VII S Number of Feedback Items Modal Number of Feedback Items (10) BCI Score Adjusted Score Total Number of Feedback Items per S 1 6 1. 67 19 31.73 2 6 1. 67 14 23.38 3 6 1.67 21 35.07 4 6 1. 67 19 31.73 5 6 1. 67 21 35.07 6 6 1. 67 22 36.74 g See "Statistical Operations}" pp. 72-76 above. U) CO APPENDIX XV CAMERA PRINCIPLES A brief review of camera principles used in the present investigation may offer the reader a clearer under standing of the mechanical operation. In general the co therapist (the same for all groups) tended to open the ses sion with a wide angle shot of the entire group,, although there was no rigidly defined format. The wide angle shot was sustained for only several moments because the figures were small and poorly defined at that lens distance. A short period of scanning the group at closer range followed as verbal and nonverbal behavior and initial group interac tion began to develop. As the group activity grew, the camera zoomed in on the talker(s) or actor(s) most immedi ately involved. During monologues or long verbal exchanges, the camera moved to other group members recording informa tion about body movements and expressive gestures which could be of value to talkers, actors and listeners. An 139 effort was made to capture meaningfully on tape each group member at some time during the session. The most signifi cant taped segments were noted on the footage meter and played back following the therapy session'. Camera opera tions were held as constant as possible among all groups while still attempting to preserve the fluid nature of the group interaction and the unique character of each group. LIST OF R E F E R E N C E S 141 LIST OF REFERENCES Alger, ian. involvement and insight in family therapy. Paper presented at Los Angeles Group psychotherapy Society,, March, 1966. Allport, G. Becoming. New Haven: Yale University press, 1955 . ________ . Pattern of growth and personality. New York: Holt, Rinehart, and Winston, 1961. ________ . personality; A psychological interpretation. New York: Henry Holt, 1937. Armstrong, R. G. Playback technique in group psychotherapy. Psychiatric Quarterly Supplement, 1964, 38, 247-252. Asch, S. E. A perspective on social psychology. In S. 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Creator Robinson, Margaret Ballantine (author)

Core Title Effects Of Video Tape Feedback Versus Discussion Session Feedback On Group Interaction, Self Awareness And Behavioral Change Among Group Psychotherapy Participants

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 Jacobs, Alfred (committee chair), De Nike, L. Douglas (committee member), Smith, Don C. (committee member)

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c18-620245

Unique identifier UC11360178

Identifier 6812057.pdf (filename),usctheses-c18-620245 (legacy record id)

Legacy Identifier 6812057.pdf

Dmrecord 620245

Document Type Dissertation

Rights Robinson, Margaret Ballantine

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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...

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