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The development and evaluation of the goal attainment scaling process Hover, Gerald Robert 1981

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THE OF  DEVELOPMENT AND EVALUATION  THE GOAL ATTAINMENT SCALING  PROCESS  by GERALD ROBERT HOVER B.A • r Gonzaga M.A • r G o n z a g a  U n i v e r s i t y , U n i v e r s i t y ,  1969 1970  A THESIS SUBMITTED IN P A R T I A L F U L F I L L M E N T OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF EDUCATION in  The  The  F a c u l t y o f G r a d u a t e S t u d i e s F a c u l t y o f Education Department o f C o u n s e l l i n g Psychology  We  THE  accept t h i s t h e s i s to t h e r e q u i r e d  UNVERSITY  OF  a s conforming standard:  B R I T I S H  OeTOBERC' 1980 (C)  Copyright:  G e r a l d  Robert  COLUMBIA  , Hover,  1981  In p r e s e n t i n g an  advanced  the I  agree  scholarly  by  his  of  this  written  thesis  in p a r t i a l  fulfilment  at  University  of  the  make  that  thesis  purposes  for  it  freely  permission  representatives.  may  available  It  financial  is  for  for extensive  be g r a n t e d  by  the  understood  gain  shall  University  of  B r i t i s h Columbia  2075 Wesbrook P l a c e V a n c o u v e r , Canada V6T 1W5  the  requirements  reference copying  Head o f  that  not  be  c  of  of  B r i t i s h Columbia,  permission.  Department  The  degree  Library shall  further  for  this  of  I agree and this  or  allowed  without  that  study. thesis  my D e p a r t m e n t  copying  fo  or  publication my  i  ABSTRACT  The  purpose  process  of  to a s s i s t  approach  to  Process  clients  brief  (GASP)  this  described  part  inpatient  psychiatric  upon  the  The  theoretical  the  assumption  levels  they  Further,  for  as  this  unit.  An  with  that  as  attaining  clients  clarify to  decisions increase as  selves  to and  attained. clients anxious.  levels  over  anxious  about  their  and  choices  for  control,  provides  assume life  in  general  more  Then,  went wrong" o r  less  a  of  was  conducted,  GASP  minute at  steps  fate.  lower  serve  Thus as  goals, they As  there  sequential enthusiasm  their  are  they  is  an  as  goals  for  are  about  the less  expected such it  both  the  worrying  mistakes.  as  exercise  steps,  time  i s spent  of  responsible for  enthusiastic,  of p a s t  based  attainment.  self-reliant,  the g u i l t  is  their  goal  as  rise  an  voluntary  a concrete l i f e - f o c u s ,  would as  Scaling  the GASP.  lives.  small  clients'  Concomitantly, become  With  via  that  of  on  their  group  become  reinforcement w i l l  feel  GASP  logical  work  e x p e c t a t i o n s and  in assertiveness.  the  without  themselves  t h e y g a i n more c o n t r o l  to  u n d e r l y i n g the  higher  change,  likely  was  reinforcement  identify  their  Attainment  evaluation  Such  a  problem-solving  program  people  receive  clients  develop  paper  and  rationale  will  to  Goal  treatment  of g o a l a t t a i n m e n t .  impetus  The  in  hospitalization  progress  an  of  was  in a goal-oriented  therapy.  important  comparing  study  goals  is  themare  attained, and  less  "where  I  ii  This limited  process qoals,  ventilation, personal  talking  and  session  ventions  rapidly  a direct  requlate  of  t h e p r o b l e m and  their  own  combined  short-term fically,  outcome, t h e G o a l procedure  to  fosterinq  facilitative the  interproblem-  and  by  inter-  fostered  clients  examining  thera-  self-control  s t r a t e g y t h a t encouraqed  the  developing  the  clients  definition  afore-mentioned a  needed  hospitalization used  Attainment  aid  events,  time  administrative  tauqht  that  instrument  of:  skills.  was in  notions  manaqed  clients  behavior  psychiatric  an  therapist  GASP  coping  a  supportive  The  conclusion  be  The  assessment  to  The  present  appropriate  flexibility.  the  developing  directly;  screened  throuqh  could  about  relationship.  solvinq  peutic  i s c o n s i s t e n t with  to  measure  factors  therapy  for  proqram.  Speci-  psychotherapeutic  S c a l e , c o u l d be m o d i f i e d  voluntarily  a  hospitalized  into  a  psychiatric  patients. The of  the  s u b j e c t s were psychiatric  adaptation chosen.  of  the  32  unit  voluntarily of  Valley  non-equivalent  They were a d m i n i s t e r e d  the  Sixteen  admission, view.  and  Eleven  experimental  Personality  aqain  eiqht  subjects group  days  i n both  were  General  control  the  Locus o f C o n t r o l S c a l e , the T a r q e t and  hospitalized  patients  Hospital.  qroup  desiqn  An was  Rotter Internal-External Outcome A s s e s s m e n t  Factor after  Questionnaire their  treatment  administered  Sheet,  the  initial  qroups Ward  and  upon intera  pre-  Atmosphere  Scale.  The  purpose  hospitalization atmosphere o f It in  was  the  the  with  two  hypothesized  between  ference  in  goal,  well  the  t i m e would be  the  pretest be  months  scores  of  different.  admission durinq during  the  clients  goals;  that  the  analvsis  prior  the the  of  to  GASP c l i e n t s  differences durinq  no  differ-  would  be  a  "most  important"  there  dif-  would  scores more  of  be  self-  personality  enthusiastic,  length  and  less  of h o s p i t a l i z a t i o n  variance  of  eqo  the  most same  Also,  the  difference  achievement,  the  be  that  have  and  no  would  there  would  than  t e s t i n g and  subsequent  assertive and  be  clients'  other  the  categories  i n the  posttest  strength,  the  two  not  reveal  any  treatments  and  Further,  a d m i s s i o n were n o t  part  between  did  evaluation.  clients'  GASP were s t a t e d  significant  and  in  GASP.  Analvsis  astic,  the  during  GASP.  would  there  both groups at  For  were  the  different the  i n ward a t m o s p h e r e d u r i n g  six  atmosphere  shortened.  A multivariate  for  the  that  subjects'  more  anxious;  that  both  in  the  there  scores,  a l l their  be  differences  was  that  as  that  and  GASP  periods,  attaining  integration, quilty  if  s i x months b e f o r e  pretest  difference  control;  see  h o s p i t a l i z a t i o n without  evaluation  as  to  the  ward e n v i r o n m e n t  ences  a  was  the  qoals as  qoals  found  to  identified  at  those at  identified  admission  revealed groups  assertiveness,  Finally,  and  same d i r e c t i o n . there relative and  was to  quilt.  were s i g n i f i c a n t l y more i n t e r n a l , more  l e s s anxious.  the  no goal The  enthusi-  h o s p i t a l i z a t i o n with  the  iv  GASP was tically  shorter  by  significant.  16.3  per  cent,  but  this  was  not  statis-  V  TABLE  I.  OF CONTENT  INTRODUCTION  1  The H o s p i t a l Promising  A d m i n i s t r a t i o n ' s Need  Components  of  3  Short-Term  Psycho-  therapy  3  Promising  Developments  of  Problem-Solving  Therapies Goal  Attainment  Statement  II.  8 10  of the Problem  SURVEY OF THE Brief  Scaling  LITERATURE 12  Psychotherapy  Historical therapy  development  Characteristics therapy Outcome  common  r e s e a r c h with  of b r i e f  psycho-  to b r i e f  psycho-  brief  P r o b l e m - S o l v i n g Therapy Problems and s h o r t - c o m i n g s problem-solving research Historical Scale  psychotherapy  Theoretical underpinnings attainment scale  brief  and  Attainment  of  the  The GASP  s c a l e as  its  59 60  OF THE GASP 61  procedure o f t h e GASP  f o r cohesive treatment  Adoption  54 55  of the goal a t t a i n m e n t  Implementation Need  52  goal  Integration  DEVELOPMENT  19 43  therapy  III.  13  46 of  Development o f t h e G o a l  Development  7  of the g o a l  attainment  a d a p t a t i o n to group  Psychiatric Introduction  Unit, Valley o f GASP  69  approach scale  and  therapy General  Hospital  69 71 73  vi  Stability  o f GASP G o a l s  Comparative  7b  Evaluation  76  Hypotheses  related to control  Evaluation  hypotheses  Significance IV. EVALUATION  issues  77 80  levels  85  METHODOLOGY  Comparative  evaluation  o f t h e GASP  88  Design  88  Instruments Ward Atmosphere The  Target  Scale  91  Outcome A s s e s s m e n t  Sheet  95  The Rotter Internal-External Control Scale  Locus  The Sixteen naire  Question-  Personality  Factor  of 96 97  Procedure Subjects Test  99  administration  100  Therapists  102  Psychiatric  unit  103  Treatments Statistical Data  103 Analyses  preparation  Control  110  hypotheses  Evaluation  110  hypotheses  111  V. RESULTS Comparative  Evaluation  Preliminary  a n a l y s i s of c o n t r o l  Pre-treatment Summary  comparability  issues  113  of samples  115 115  vi i  VI.  DISCUSSION  AND  Summary  Results  of  SUMMARY 125  The  Development  of  The  Preliminary  Evaluation  Limitations  of  Recommendations  t h e GASP  125 of  t h e GASP  the Study f o r Further  126 131  Research  133  Conclusion  135  BIBLIOGRAPHY  136  APPENDICES  169  vi i i  LIST  Figure  1  Ward  Atmosphere  Fig ure  2  Actual  Fig ure  3  Test  OF  Test  FIGURES  89  Design  Administration  95  Schedule  F i g ure 4  Admission and D i s c h a r g e GASP G r o u p , May 1 - J u n e  Figure  Admission and Non-equivalent August 15  5  78  Schedule  Dates 15  for  Discharge Dates for Control Group, J u l y  the 104 the 1 105  ix  L I S T OF TABLES Table 1  Client  Table  GASP D a i l y  2  Characteristics  Table 3  Non-GASP  Table 4  Activities Group  101  Schedule  Daily  107  Schedule  of Non-Equivalent  108 Control 109  Table 5  Means and S t a n d a r d Three Test P e r i o d s sphere S c a l e  Table 6  M u l t i v a r i a t e A n a l y s i s o f t h e Ward A t mosphere S c a l e a t J a n u a r y , J u n e , and August  Table  7  D e v i a t i o n s o f the o f t h e Ward Atmo-  Univariate Analysis of Variance Ward A t m o s p h e r e S u b s c a l e s  114  114  on t h e  Table 8  Means and Standard Deviations of P r e t e s t Scores o f the F i v e Subscales o f the S i x t e e n P e r s o n a l i t y F a c t o r Questionnaire  Table 9  Multiple Analysis of Variance of Sign i f i c a n t D i f f e r e n c e s Between P r e t e s t Scores on the Sixteen P e r s o n a l i t y Factor Questionnaire  Table  10  Univariate F-Ratios o f D i f f e r e n c e on the P r e t e s t S c o r e s on t h e F i v e Subscales of the Sixteen P e r s o n a l i t y Factor Questionnaire  Table  11  Means and Standard Deviations of P r e t e s t S c o r e s on t h e L o c u s o f C o n t r o l S c a l e and t h e Number o f G o a l s on t h e T a r g e t Outcome A s s e s s m e n t S h e e t  Table  12  Multivariate Analysis o f Variance f o r S i g n i f i c a n t D i f f e r e n c e s Between P r e t e s t S c o r e o f t h e L o c u s o f C o n t r o l S c a l e and t h e Number o f G o a l s on t h e T a r g e t Outcome A s s e s s m e n t S h e e t  Table  13  A n a l y s i s o f V a r i a n c e and Means o f P o s t test Scores f o r the Target Outcome Assessment Sheet  Table  14  A n a l y s i s o f V a r i a n c e and Means o f P o s t t e s t Scores f o r t h e Locus o f C o n t r o l Scale  115  11 7  11 7  11 7  11 9  119  119  121  X  Table  Table  Table  15  16  17  Multiple Analysis of Variance f o r Postt e s t S c o r e s on t h e S i x t e e n P e r s o n a l i t y Factor Questionnaire  1 22  Means and S t a n d a r d D e v i a t i o n s f o r t h e Sixteen Personality Factor Questionnaire Posttest  123  A n a l y s i s o f V a r i a n c e f o r the Sixteen P e r s o n a l i t y Factor Questionnaire Posttest  123 124  Table  18  t - T e s t R e s u l t s f o r Lenqth o f  Table  19  Summary o f P o s t t e s t R e s u l t s  Stay  124  xi ACKNOWLEDGEMENTS L i k e most o f l i f e , the  help of  for  the  their  my  I am ment, o f  Their  I owe Knoxs,  friends,  P.  Patty  Horvath,  Carol and  crucial  to  for  sustenance  S.  and  like my  effort  Marks,  T.  responsible to  thank  my  colleagues  and  extended  Rogers,  attention  Dave my  and  L.  for  by  my  Greenberg,  to d e t a i l  the  of  Lynchs,  Dennis Beth  of  Hospital,  Bolles  have  Jon  Anderson,  Ken  Mel  Hugh A r m s t r o n g ,  and  a l l o f you  Jordan,  Pendergrafts.  My  I  am  also  Myles  the  "Thank  you."  as  Barb Helen being  grateful staff  Bzdek, and  H a r t l a u b , Jack  Norma Komar. I warmly s a y  and  Gubanc,  Virginia  Wise, Bud  Adam  people:  Bell, Don  the  acknowledged  effort.  whole  Hovers,  Janet  are  encouragethis  the  Zanchi,  following  Tausch,  to  the  O'Neill,  Reinhard Ames,  and  Dan  school the  throughout  gratitude  Sorenson,  and  s u p p o r t , and  brother  a debt  graduate  General  t o the l o v e ,  Gentile,  To  would  and  integrity  and  Stolte,  Valley  I  solely  through  work.  the  the  accomplished  I am  friends,  time  Drs.  parents  experience. Barons,  my  ever g r a t e f u l my  errors,  the  members: this  was  encouragement.  McKie.  enhanced  effort  Although  the  appreciate  committee D.  and  family,  h e l p and I  and  many p e o p l e .  content  committee,  this  at  Andy Myrna  Keating,  1  CHAPTER I  INTRODUCTION  Three  of  the  psychotherapy therapy, pies,  the  and  has  been  growth  of  to  meet  client from  of  response  accountability Lorion  Whether  number or  not  therapies. completed control  of  a search  psycho-  Goal  of  thera-  Scaling.  f o r a more  Problem-solving  therapy.  demands  reported found  of this  Mahonev research  therapies  Attainment  o f Goal Attainment  efficient  within  Attainment  measurement,  Brief  psychotherapy  therapy  that  that  the  the  Scalinq  precision,  for  National  979,000  contacts  with  a  is and  number o f  c o n t a c t s i s due  as  and  Arknoff  and  development  and  concluded  a technology  Scaling  has  been  Center  for  clients,  the  therapist  i t n e v e r t h e l e s s demonstrates  promise  brief  in  in psychotherapy.  (1974)  termination,  great  the  developments  of  research i n cognitive  Statistics  average  advancement  needs.  behavior  to  recent  problem-solving/self-control  is a result  developed  Health  the  the development  boundaries a  interesting  have  psychotherapy means  more  a  to  need  (1978) e x t e n s i v e l y  that  in  the  as  an  4.7.  premature for  brief  reviewed of  these approaches  for therapeutic used  area  was  selfshowed  change.  Goal  instrument  for  2  evaluating as  a  t h e outcome o f p s y c h o t h e r a p y  treatment  itself  Scaling  lends  because  i t i s a very concrete  Taken  together,  have  the  solving  are  suggests  Scaling the  aspects.  The  interventions and  process  should  the  in  goals.  psychotherapy  into  a  short-term  strategy behavior.  definition  that  synthesis,  study.  hospital;  psychotherapy;  and  rapidly  four  (2) e v a l u a t i n g  therapeutic into  account  about  present  developing  clients  coping issues  an  treatment  through  clients  were  a  to  should  skills.  (1) meeting  The direct  regulate emphasize  In  order  addressed  of  promising  to  i n the  the requirements  t h e components the  in  flexibility.  the therapy  identifying  literature  s h o u l d manage t h e  self-control  encourages  broad  Goal  Supportive administrative  therapeutic  These were:  (3)  take  problemand  The  goals, talking  Finally, and  should  appropriate  clients  of  many  The t h e r a p i s t  foster  teach  include  process  session directly.  should  this  successful.  limited  place  synthesis  psychotherapy,  ventilation,  should  quickly  present  Attainment  for establishing  a  should  relationship.  problem-solving  own  that  prove  synthesized  fostering  assessment  could  o f : time  interpersonal  pursue  used  as a t h e r a p e u t i c method  synthesized  brief  integration  importance  problem  Goal  developments  indications  psychotherapy,  Attainment  their  be  used system  three  to  1974).  be  procedure.  There  events,  to being  these  potential  treatment  the  itself  (Smith,  and can a l s o  of  short-term aspects  of  3  problem-solving Attainment  psychotherapy;  Scaling  The  The  of  Valley  General  number  of  chosen  f o r two  wanted sixty an  a  average  fit  into  milieu.  the  the  program  in  were  approached,  First,  the  that  could  that  clients  given  weeks.  The  as  the  empirically  be  be  ideas  process  validated  was  within  be  for  required  openness  the  was  to  and  ward  based  upon  the  hospital  effectiveness  of  procedure.  As  p e o p l e were b e i n g seen  sessions,  this on  daily  also  to  a  administrators  practices,  evaluate  site  hospitalized  was of  at  While  this  conducted  would  the  completed  hospital  procedure  c o n t r a c t e d to  was  of  Washington.  P r o m i s i n g Components o f S h o r t - T e r m  of  Goal  briefly  evaluation  procedure  Seattle,  administration's  administrators  the  components  subsequent  resulting  reasons.  o f two  the  hospitals  Second,  existing  the  and  procedure  the  of  Hospital  other  minutes,  examining  H o s p i t a l A d m i n i s t r a t i o n ' s Need  above,  effectiveness  (4)  procedure.  integration  described  and  need brief  (1978)  therapists  for brief and  noted  had  crisis-oriented that,  in  for a relatively  to develop  treatment.  spite  Psychotherapy  a  In t h e i r therapies, of  s m a l l number  technology review  of research  Butcher  differing  t o meet  and  Koss  theoretical  4  assumptions  and  treatment  strategies,  have a number o f c h a r a c t e r i s t i c s 1. time.  Therapy Butcher  client  of  goals. sible of  and  the  time  in a short  time  and  Wolberg  (1965a)  dices  of  of  depth"  personality  librium  and  therapeutic  Koss  dreams,  and  o n l y as  4. • The (1973)  brief  was  they  session  come t o bear i s managed  second  psychotherapy.  that  most  pos-  structure  Malan  "the  established  abanpreju-  for  brief  emotional  equi-  therapy.  that  on  in  the most  a  the  present.  goals  of  more o f t e n  than  not  after  frequent  Short-term  by  be  em-  problem.  the  therapist.  clarification, therapeutic behavioral  is a  memories,  transference should the p r e s e n t  if  exploration  Childhood  directly  brief  effectively  thorough  life.  on  (1963)  ideas of e x t e n s i v e  centered  a r e a , which  demonstrated the  is  of  a  and  establishing  client's  was  psychotherapy  with  suggested  interpretations  change  perfection"  accomplished  i n the  therapeutic  Both  brief  i s focused  problem  problem  guidance  be  attention  current  limited.  framework o f  (1978)  of  i n f o r m i n g the  two  that  period  end.  Goals to  that  therapy with  generated  content  could  primary  Strupp  are  limited  the time  psychotherapy  ployed  are  Therapeutic  Butcher  an  "therapeutic  are  within  3.  the  and  reconstruction.  psychotherapy  optimism  provided  are:  specified  suggested  reported that  that  a  treatments  These  accomplished  client  Therapeutic goals  notions  in  limits  brief  i n common.  within  (1978)  a beginning, a middle,  doned  of  Koss  I t encouraged  2. and  i s - managed  most  direct activity  therapists  5  are ly  also  significantly  oriented  therapists  & Whipple,  1975).  ing  brief  in  guide  a  Gelb  from  5.  client  the  makes  1965;  precipitating ior, and  the  Cristol,  (1967) argued  customary  Morley,  the  that  Small  of  the the  that  work-  therapists  must  interaction  that  and  Kalis,  Freeman, &  suggested  identified  behavior,  &  the  of  Brief  understand  Strickler,  (1971)  variations  early.  therapists  Schneider,  clients  causes,  the  Yorkston,  mode o f o p e r a t i n g .  rapidly  (Harris,  1975).  meaning  1963;  Sommer, tentative  complaint,  the  present  and  their  own  are  adapted  the  behav-  strengths  weaknesses. 6.  Therapeutic  requirements concluded  o f the  that  was  Consequently,  psychoanalysis,  Alexander  technical  adapting  the  techniques  psychology,  and  may &  not  Small,  Wolkon,  1972)  quickly  as  be  another  1965;  suggest possible.  which  to  requires  This  session. 1961;  i t i s advantageous  the  action  client. of  psychiatry,  (Wolberg,  1965b).  i s necessary  Many  researchers  Lindemann,  intervention  (1946)  a variety  from  to  the  in short-term  to  come  meet  French  principle  sociology  Caplan,  Prompt  and  treatment  I n t e r v e n t i o n i s prompt.  there  (Bellak  individual.  short-term psychotherapy  psychotherapeutic  7.  interventions  the p r i m a r y  psychotherapy  as  events  Wilner,  whereby  psychoanalytical-  framework,  i s assessed  i t imperative  Sifneos,  guides  Staples,  Oilman  the c l i e n t ' s  precipitating  Jacobson,  and  than  t o methods o f b e h a v i o r and  are d i f f e r e n t The  (Sloane,  psychotherapy  the c l i e n t  therapy  more d i r e c t i v e  treat  1 944 ;  people  parallels  as the  6  earlier  idea  centers  the emphasis  on c u r r e n t l i f e  should  offer  problem  therapy  and i s r e a d y  8. of  that  Emotional  t h e major  the c l i e n t  approaches  Maudal,  1976; F r a n k ,  Semrad,  Binstock,  and  to brief  was f o u n d  1946; B a k e r ,  1966).  the p r a c t i t i o n e r s  has awareness  tension i s ventilated.  French,  experience  when  and t h u s  psychotherapy  o f the  t o work on i t .  therapy, v e n t i l a t i o n  Lazarus,  problems  in brief  &  White,  Within  crisis-oriented  & Koss,  Lindemann,  their  (Alexander &  1978; B u t c h e r  1965b;  environment,  feelings  &  1944; Mann, 1973;  1966; W o l b e r g ,  a cathartic  express  and  t o be i m p o r t a n t  1947; B u t c h e r 1974b;  In r e v i e w i n g a l l  Wolpe  &  c l i e n t s can  spontaneously  and  naturally. 9. lished any  A facilitative quickly.  school  This  relationship  o f therapy  enhanced  by many  client's  expectation  interpersonal  (Bergin  factors.  Two  and t h e t h e r a p i s t ' s  1963,  1976a).  were  recognized  those  i n whom t h e b e h a v i o r a l p r o b l e m  previous to  adjustment  relate;  best  suited  h a s been  and t h o s e  with  1975) and may be  o f these  (1978),  factors (Lick  high  arethe  & Bootzin,  and i n v o l v e m e n t  four  types  of  with  motivation.  to the clients  psychotherapy:  i s acute; those those  (Malan,  According  for brief  good;  i s estab-  a s d e s i r a b l e by  are selected.  and K o s s  as  Suinn,  enthusiasm  10. A p p r o p r i a t e c l i e n t s by B u t c h e r  i s seen  of therapeutic gain  1975)  review  &  relationship  good  i n whom ability  Clients  whom  7 Butcher apy  and  Koss  were:  deeply ablv  thought  those  who  dependent, anxious;  who  persistently  those  mentally  are  who  i n t o most  ten  short-term Goal  i s to  se1f-centered,  or  self-destructive;  fifth  due  to i l l n e s s  have  generally  s y n t h e s i z e the with  enhance  1974a;  been  therapy  of and  clients Imber,  research  brief  t o change t h e i r  behav-  Stone,  behaviors  effective  process  roles  in brief  748).  (1978) s p e c u l a t e d  or  In  treatment this  an  Mahoney  c o q n i t i v e and  identified  as  therapies,  which  p s y c h o l o q i c a l problems  behavior,  b e h a v i o r a l , the  miqht  yield  the  & the  imple-  imDortant  approaches"  therapies  view  supports  that concrete is  reqard,  t h a t o f a l l the  Hoehn-Saric,  evidence  of  new  Therapies  of  mentation  ineffective  1978).  practice  directedness  therapists  of  integrated  & Koss,  contemporary  goal  Liberman,  "Available  p.  psychotic,  organicity.  problem-solving  the  i s to encourage  1974).  1978,  or  (Butcher  w i d e l y h e l d v i e w amonq b r i e f  Koss,  qrade,  and  Scalinq.  to  psychotherapy  Frank,  outspokenly  Developments of P r o b l e m - S o l v i n g  way  (Frank,  are u n r e s t r a i n -  psychotherapies  psychotheraDy  Promising  ior  toxic  r e c o n s t r u c t i o n , are  out,  beyond  components  Attainment  One  or  ther-  or  masochistic,  short-term  challenge  act  are  educated  defective,  These  The  not  for short-term  desire personality  passively-dependent, those  were u n s u i t e d  and  (Butcher and  &  Arnkoff  self-control  problem-solvinq as  most  the  result  encouraging  8  clinical  results.  upon p r o b l e m s a s The  Problem-solving  also  in  the  examine t h e  problems  which  therapists life.  client's  inadequate  may  suggested  effective  create  such  of  this  to:  1.  the  teaching of coping  2.  the d i r e c t  3.  an  4.  the  self-regulatory  es,  and/or  the  active  client  and  problem  and  as  outcome, t h e G o a l is  used  to  each  goal.  judgment or  the The  i s made  hindered  a  that  may  in  as  Arnkoff part  be  assessment,  nature of  these  approach-  responsible participation  behavioral  Attainment  of  Scale  Scaling  measure  final to  a  person  behaviors whether  person's  goal  or  of  therapeutic  ( K i r e s u k & Sherman,  therapeutic goals  behaviors  as  effects  therapist.  identify  step-by-step,  these  definition,  Goal Attainment  Intended  to solve  skills,  s t r a t e g i e s of  e m p h a s i s on  therapists  Mahoney and  nature  look  situational  undesirable  indecisiveness.  therapies  the  attempts  not  disturbance.  Problem-solving  due  5.  explore  client's  anxiety, depression, or (1 978)  do  abnormal b e h a v i o r o r e m o t i o n a l  problem-solving  problems  therapists  and  to  engages  are  then  not  the  attainment.  in  break to  down, achieve  charted, therapy  1968)  and  a  assisted  9  Using of  Goal  Attainment  some  behaviors  (Garwick  & Lampman,  anxiety,  4.  legal  18.  7.  15.  Smith  had  (1974,  Goal had  He  used  Smith's examined Scale) good  19.  1976)  effort  was  that  by  the  6.  marital 12.  14.  medical  17.  suicide,  Goal  Attainment  properties.  individuals  identifying improved  laudable the  possessed  the  Goal  instrument  a  He  who  had  and  those  who  goals  using  the  more  stated  than  if  they  he  (the Goal  conducive way,  Scale that  creatively Attainment  to  fostering  Smith  was  demon-  adjunctive  Smith  was  the  Further,  the Goal of  properties  Kiresuk  Attainment  Smith's  effort  was  unaware  Scale in to  of of  groups.  identify  o f the G o a l A t t a i n m e n t  to  only  the p s y c h o t h e r a p e u t i c p r o p e r t i e s  Scaling.  generalizability  that  preliminary  Attainment  (1977)  t o employ  in  properties  In  demonstrating  psychotherapeutic  or  3.  instrument.  researcher  The  use,  problems,  Scale i n therapy  clients  health.  attempts  family  sexuality,  between,  that  Kiresuk  any  change  decisions,  arrangements,  proposed  Scale,  Attainment  5.  psychotherapeutic  therapy.  Goal  for  list  work.  concluded  this  is a  alcohol  interpersonal  r e f e r e n c e s , 16.  Goal Attainment  itself  that  11.  living  the n o t i o n t h a t  mental  strated  identified  e d u c a t i o n , 9.  difference  Attainment not  8.  possessed  the the  not.  13.  and  itself  completed  use,  self  treatment,  evaluated  have  following  1. a g g r e s s i o n , 2.  finances,  problems,  Scale  1972):  drug  10.  problems,  clients  the  p s y c h o p a t h o l o g i c a l symptoms,  depression, concerns,  Scaling,  the  Scale i s  10 limited cents  to individual  i n guidance  increased  therapy  centers.  and t o s u b u r b a n  white  This g e n e r a l i z a b i l i t y  adoleswould  be  bv t h e s e o p e r a t i o n s :  1.  Employing  a different  2.  Examininq  more  3.  Representing d i f f e r e n t  4.  Delineatinq  5.  Examininq  treatment  setting,  subjects,  deqrees group  aqe  qroups,  of psycholoqical disturbances,  psychotherapy  instead  of  individual  t h e r a p y , and 6.  Inteqratinq articulate  relevant  research i n this  the process  Statement  Brief Attainment term, was  psychotherapv, Scalinq  possible  that  to develop  operationalized The usinq  problem-solvinq  used  a  exploratory  evaluation  therapeutic  procedure Scalinq  was  and  developed  in this  w h i c h qoes beyond G o a l A t t a i n m e n t  It be with  of c l i e n t s .  two-fold: briefly  second,  procedure.  (GASP),  short-  i t would  treatment  of this  Process  for a  Goal  treatment.  areas  described  unit;  and  therapeutic process  (two week) q r o u p  psychiatric  blocks  f o r use w i t h q r o u p s  developments  a short-term  Attainment  short-term  therapy,  qroup  these  of the c u r r e n t study  three  in a  combininq  objectives  purpose  the  develop be  o f the Problem  p r o v i d e the b u i l d i n q  bv  i n order to  specifically.  qoal-oriented, problem-solvinq thouqht  area  first,  above,  to  procedure t o  t o conduct  an  The name o f t h e studv  i s the  a multicomponent Scalinq.  Goal  therapy  11  Organization The  and  synthesized the  were  Dissertation  characteristics  therapies,  of  of  description  in  the  Scaling of  the  evaluation  results  in  VI.  Chapter  II.  i s presented,  addressed  brief  Attainment  i n Chapter  GASP  Attainment  Goal  of  In C h a p t e r f o l l o w e d by  Process.  are  Scaling  exploratory  design  and  used  presented  problem-solving are  I I I , the the  Chapter this  IV  of  the  which Goal  includes  evaluation.  i n Chapter  and  development  hypotheses  evaluation  for  reviewed  a The  V and d i s c u s s e d  12  CHAPTER I I  SURVEY OF  It brief  is  the  these for  to  psychotherapy,  Attainment of  necessary  Scaling  Goal  three the  GASP,  a  thorough  problem-solving  in order  t o have  Scaling  i s examined  and  LITERATURE  have  Attainment areas  THE  their  understanding  therapy,  a clearer  Process  and  the  implications  to  Goal  comprehension  (GASP).  in building  of  Each  of  justification the  GASP  are  identified.  Brief  Psychotherapy examples versus short.  are:  long-short defined and  as  brief  sessions  group  family; The  can  most  Psychotherapy  be  classified  versus  behavioral pertinent  distinction. treatment  (Butcher  individual;  & Koss,  child  ways.  Some  versus  adult  analytic;  long  versus  to  subject  hand  is  the  Long-term  is  many  versus  consisting  psychotherapy  in  of  therapy  more  distinguished  1978).  at  than by  is 25 less  the  usually sessions, than  25  13  Whereas b o t h to  change  sarily  brief  client  very  therapies  in  i s unlike  which  focus  on  although  Thus  long-term goals  brief  of  i t may is  be  often  the  They  goals  is of  neces-  therapy.  of  long-term  reconstruction"  or  a  (Wolberg,  1965a).  in various  settings,  concerned  i s not  with  limited  simply abbreviated  p r o c e s s e s may are  are designed  aspirations  applied  more  While  different.  the  oneself"  psychotherapy  therapy.  are  to  "personality  Therefore,  psychotherapy  treatment  psychotherapy  the broader  understanding  goals.  brief  regard  "thorough  brief  long-term  behavior,  specific  T h i s emphasis  and  separate  be  similar,  treatments  the alto-  gether. This d i s t i n c t i o n the  research  the  other  clinical  between  i n one  field.  field  upon  could  It certainly  application  depending  their  the  of  any  length  g o a l s does n o t mean  not  can  or  and  does does.  r e s e a r c h would of  time  not  influence  However,  look  therapy  that  is  the  different, expected  to  last. After is  the h i s t o r i c a l  presented,  the  psychotherapies efficacy  Historical Brief 1963;  examined.  psychotherapy  development  of b r i e f  psychotherapy  Wolberg,  analysis  characteristics  are  of brief  brief  development  1965a). by  i s not  common  Finally,  psychotherapy  to  most  evidence  brief  for  the  i s presented.  psychotherapy new  Ferenczi  instructing  of b r i e f  ( K a r d i n e r , 1941; (1920)  analysts  to  tried be  Malan,  to  active  keep and  14  directive The  i n therapy  effectiveness  Alexander t i m e by Malan  and  r a t h e r than  of  French  psychotherapy  (1946)  when  early  (1963) p o i n t e d  out  i n a review  initially  psychoanalysis  when  the  of  therapy  and  Koss  and  soon  led  Second  development that and  with  World  anxieties to  a  War  these  further  maladjustment  resulting  by  treatment in  clients.  psychotherapy became  symptom  longer  relief  to  of  historical  brief  The  three  i t s related  beginning  of  psycho-  free  events  transient  clinics;  modification techniques. combatants  suffered  and They  that  were u s u a l l y o f a s h o r t d u r a t i o n situation.  attempted  occurred.  symptoms,  Individuals provide  T h e i r aim  restore  (Grinker  to  &  severe  was  therapy to  self-esteem, Spiegel,  who as  decrease  and  1944a,  avoid 1944b;  1941).  World  War  the  Americans,  the  and  found  results  the  three  II,  (1951) d i d an from  to  War  soldiers  relieve  Kardiner,  and  particular  as d e c o m p e n s a t i o n  Janis  from  of psychology.  behavior  stress,  1945;  the  World  of  in  specific  worked  and  shifted  d i s t u r b a n c e s ; the  stresses  short  acceptance  the m a i n s t r e a m  into  argued  brief  to  therapy  the  was  of  pointed  that  emotional  shortened  (1978)  developments  the  explored  interpretation.  Butcher  were:  they  was  s i g n s of maladjustment  that  transference  and n o n - d i r e c t i v e .  brief  identifying  focus  passive  extensive study of emotional II.  British,  He the  reviewed  the  Germans,  and  strikingly  similar.  stress  literature the In  of  Japanese all  four  15  countries logical  a i r attacks  disorders  difference hospitals  in two  (Weatherby,  of  ly who  weeks  before  an  1941). acute  instances  missing  Janis  i n the  British  because  aid: rest,  sympathy,  and  Janis  (1951)  unable  locate  in  increased  Brown also  depression,  apathy,  festations  that  (1943), subject  anxiety,  to  and are  of  social  problems.  (Grossack, acute  war.  society  in  and  at  1965). nature,  and  attacks/  characteristic  In  results  of  fatigue these  are  not  cases high  be  the  86).  While of  any  accounts  of  depressive  mani-  to  Denny-  personnel of  are  were  exhaustion,  that  life are  stresses  in  Clients  of  According  noted  troubles  both  frequent-  evidence  military  (1976)  need  the  apathy  In  (p.  verbal  related  Maudal  and  and  anxiety.  definite  irritation.  large,  acute  took  pretext  suggestion"  English  two  after  in  bombings  the of  and  The  increase  transient conditions  Personal  weeks  civilians.  obtained  air  various  stress  the  followed  depression,  that  he  pessimism  Japanese  Butcher reactions  to  two  a treatment of " p s y c h i a t r i c  first  increase  an  no  psychiatric  disturbances  from work on  work  relatively  depression,  (1951) d e s c r i b e d  was  was  psychopatho-  to  and  (1941) c l a i m e d  anxiety  themselves  really  attack,  mild  Dunsdon  was  admissions  emotional  anxiety,  chronic  There  However, t h e r e  Transient  absented  were  civilians. of  1943).  produced  increase  number  acute  (Kardiner,  in  not  the  disturbances. form  did  the  not  stress  unlike  the  often  a  response  to  often  a  reaction  to  considered stress  anxiety  and  is  abnormal brief  the  loss  and of  16  control, this  and  reason  began  to  centers  i s often related Butcher  apply  to the  techniques working  the  Maudal  own  acute  clients.  Specifically,  Stanley  Hospital  is  programs  f o r emergency  1976a).  credited  Later,  crystalized  result  his  of  nightclub people  "The  lost  their  had  subsequently 1944).  stressed  Lindemann  at  h i s i d e a s on  and  service  in  one  the  1934  this  (Malan,  Cobb's  fire  large  fire.  early as  at  number  a  the of  S u r v i v o r s were  with g r i e f  emergency  early  intervention  A  for  General  these  devastating  Grove".  in  of  crisis  those  therapies  of  traumatized  organized  and  one  Lindemann,  lives  psychiatric  Massachusetts  developing  Coconut  therapists  war-front  theories  with  that  For  Therapists modified  psychiatric  involvement  called  the  Cobb  with  Erich  recruits,  of  clinics.  f i t their  situation.  (1976) argued  techniques  homefront  to  with  and  to a s p e c i f i c  (Lindemann,  facilities  to  assist  them. Another World  War  example  is  the  Harvard  School  of  Program  the  world  by  of  Community  of P u b l i c believed  meeting  this  adaptation Mental  Medicine people  stresses  and  transition life  points  cycle:  children leaving  getting  going home.  in  to The  the  must  normal  s c h o o l , death set  of  Program  to  development  of about  of a  the  spouse,  and  five of  the  first and  developing  Second at  the  Advocates  live  living  identified  birth  the  1967).  learn  strains  married,  school  Health  (Parad,  F o l l o w i n g much d a t a g a t h e r i n g , t h e y  from  in  the  change. critical family child, children  progams  in  17 preventive  intervention  predictable  family  The with  second  They,  Kane,  1975),  sought  h e l p from  drop-in  lines"  less  alcoholism life  separation, depression, (Slaby,  movement  The  drug  was  during  traditional  From  (Sloate,  crises  1974);  1974);  Rappaport,  of free  the  government  treatment. not  have  centers for  A  t o be t a k e n were  early,  large  "hot-  settings,  developed  to  (Klebler,  and  divorce,  adolescent  crisis,  or assaultive  behavior  was p a r t  & Trotter,  1974; M a l a n ,  amount o f monev was  i n t h e community  so t h a t  away  of a viqorous  community m e n t a l  health  access  center  prevention, rape,  mental  specifically  easy  people  s o u r c e s such  abuse  1977);  clinics  to establish  Located  &  1975).  1965; Chu  1977).  drug  homicidal,  changing  period,  been  suicide  social  Reifler,  informal  have  (1978)  to  and  health  these  homosexuality,  & Tahcred,  development  this  (Rappaport,  and s u i c i d a l ,  & Small,  these  1960's  and K o s s  and c r i s i s  programs  (Chafetz,  i n the  Raybin,  mental  movement i n t h e U n i t e d S t a t e s toward (Bellak  to  i n response  (Glasscote,  that  health  came  accessibility,  1977).  death,  Lieb,  respond  Butcher  "rap" groups,  o l d age  other  clinics.  mentioned  mental  people  development  others  (Rappaport,  confront:  or  and  centers,  short-term  1974);  this  in Dolitics ,  morals.  as  of free  out that  changes  help  stresses.  historical  t h e advent  pointed  to  from  their  required  health 1976a;  p r o v i d e d by centers f o r people  would  neighbourhoods,  these  to include  to psychotherapy  like  a  provision  the treatment  18  that  most  emergency  rooms  i n hospitals  offer  to  medical  clients. The (1978)  third  cited  behavior. Rayner  historical  They  (1920)  pointed  not  i n the mainstream a function  to  out  demonstrated  application  there  therapy,  f o r indeed  principles  (Holmes,  they  saying  behavior  change  Malan  Wolpe  talking  Malan  that  said  therapy  about  hoped,  technology gathering  will  be  techniques  able  learning  emotional  t o make  which  behavioral  brought  with  techniques  treatment.  principles these  1949).  What  the technology  facilitating  that  of  in brief  Essentially  have  therapy,  about  (Bandura,  quickly  no a t t e m p t  used  himself, which, i t future"  such  1971).  language,  and  process.  the b e h a v i o r i s t s  i t procedures, were  that  problems,  clinicians  rehearsal  process  use o f i n t h e  1976a, p . 2 4 ) . More d i r e c t l y ,  and  was  neurosis  had employed  "Not o n l y d o e s he l e a r n  is  term  Wolpe  a patient's experience  l e a r n s new ways o f s o l v i n g  modeling  examined  of learning  is a  with  he  developed  and  blossomed.  (1976a)  he  Watson  of "unlearning",  1931; T e r h u n e ,  after  to modify  to psychotherapy  clinicians  1936; J o n e s ,  (1976a) s t a t e s ,  (Malan,  and K o s s  T h i s was n o t t o s a y t h a t  application  i t s o p e r a t i o n s are concerned In  Butcher  though  (1958)  behavior.  other  was  even  principles  until  of learned  that  t h e phenomena  of learning  had been no e a r l i e r  were  that  was t h e use o f b e h a v i o r a l t e c h n i q u e s  the  as  development  and  have as This data  amenable  to short-  was made  to create  19  any  one  adapted  school  of  psychotherapy,  but  clinicians  t h e p h i l o s o p h y and t h e r e s e a r c h where t h e y c o u l d .  Characteristics An the  brief  common t o b r i e f  efficient  format  to review  presented  discussion relevant  way  of  brief  literature  psychotherapy this  i n Chapter  literature  I  f o r o r g a n i z i n g the  psychotherapy. i n these  areas  i s t o use  In  this  section  the  i s summarized.  Time By  definition  then  i s one  brief  psychotherapy  in  brief  of  sessions  research Koss brief  of  brief  from  therapy  on b r i e f  carefully  will  informed  In  the following  last.  that  with  In  studies,  sessions  with  therapists  summary  therapy,  o f therapy  o f the  limits for  clients  of that  time  i s demonstrated  cross-section  of  number  B u t c h e r and  the time  and p r o b l e m ,  change a  Most  their  Time  distinguishes  d e f i n e t h e maximum  although  client  a t the b e g i n n i n g  that  approaches.  and c r i s i s - o r i e n t e d  vary  be  i s of short duration.  variables  other  identified  therapy  thirteen  the primary  psychotherapy  ( 1 978 )  therapy  should limit.  i n one t o  clients  and  problems. Many first  therapists  session  brief  that  (Bellak  Cannon, reasons.  1 966; First  &  recommended  the therapy Small,  Spoerl,  1965; 1975).  telling  they  would  Frankel, This  was  i t was t o i n c r e a s e c l i e n t  clients receive 1973; done  i n the would  be  Koegler  &  f o r three  optimism  through  20  therapist time.  confidence  Secondly,  focused.  this  Thirdly  beginning, regarding  a  that time  such  middle,  time  change  a  was  definition structure  and  possible  an  was  was  end.  As  in  to  to  a  keep  give  Malan  short  therapy  therapy  (1976a)  a  wrote  limits:  ... A t i m e l i m i t ... h e l p s t o c o n c e n t r a t e b o t h the p a t i e n t ' s m a t e r i a l and t h e t h e r a p i s t ' s work, and to prevent t h e r a p y from becoming d i f f u s e and a i m l e s s and d r i f t i n g i n t o a l o n g - t e r m i n v o l v e m e n t . It enables the prospect of termination to be brought i n q u i t e n a t u r a l l y as t h e time f o r t h i s a p p r o a c h e s ; and o f t e n t h i s e n a b l e s a t h e r a p y t h a t had been i n d a n g e r o f becoming d i f f u s e t o become c l e a r and f o c a l a g a i n . (Malan, In l i n e  with Butcher  as many b r i e f lasting  clinicians  from  one  session  treatment"  between  those  sessions  and  to  studies  ized  from  the  will  d e a l with both Atkins  to  three  female areas to  and  change  sessions. and  She  clients  therapy  sessions  ability  to  follow-up  community's year over  longer  in  than  less  review  identify indicated  the  and  one  and  16  improvements  in  male  relations, In  a  and  case  seen  15  reported  client's  sessions,  16  reported  and  organ-  in  o l d widow was  problems  is  six  treatments.  treated  and  10-25  attention  i n homosexuals  reactions.  days  treatment  divides  The  group  of depression, anxiety, family  a 64  the  change  six sessions.  individual  homosexuals  (1977),  as  t o t h e g r e a t e s t number o f  individual  the  courses of  review  show  (1976) d e m o n s t r a t e d  confront  Brink  least  "...  this  257)  (1978) o b s e r v a t i o n t h a t  sessions,  730), that  than  Koss's  recommend  six  (p.  more  and  1976a, p .  f o r four an  solutions. progress  had  ability study  by  one-hour increased  A  two-year continued.  21  Werman, A g l e , M c D a n i e l , between  17  Treatment two  and  ranged  months  improved and  62  and  cent  (1975) 19  Clients  they  felt  five  weekly  Stein  (1974) a l s o  reported three  positive  types  reduction to  only  level  of  of  Griffin,  and  and  their  that  were  they  sense  of  (1975)  The  in  a decrease  i n h e a d a c h e s and  relax.  Thus,  c o n c l u s i o n may  evidence  for  change  in  therapy  They  compared  an  anxiety  was  limited  perceived  they  had  be  been Hayes,  students  treated  length. an  after  and  college  were  24.  alcoholics  clients'  21  group  was  helplessness.  students  minutes  a  and  that  felt  saw  reported  the  the  Cabral  peers  milieu,  psychotherapy  had  Newton  six sessions.  and  they  age  their  therapy with  a l l three  Parise  30  in  general  lowered  therapy.  whose mean  length.  brief  follow-up  using  two  group  a  improvement.  improvement  hours  clients therapy.  reported  by  In  was  no  In  more a c c e p t e d  of  80  individual  cent  clients  treatment:  overcome  individual  sessions  adult  sessions.  Mooney,  per  changes a f t e r  distress  to  75  reported  employed  approach,  six  helped  in  sessions  in  six sessions.  showed  with  (1976) t r e a t e d  age  to  treatment,  therapy.format stated  of  four  2 5 per  Patterson  Schoof  years  from  after  and  for six  All  clients  increased a b i l i t y drawn  i n the  that  range  of  there  one  to is  to  six  Turner  and  sessions. For Velkers after Thomas  therapy  lasting  (1975) were seeing (1976)  people  more  able in  than  to report group  demonstrated  that  six sessions, a decrease  therapy a  group  for  in  insecurity  seven  sessions.  therapy  program  of  22  eight  sessions  was  undergraduates and  Jacobs  were  seen  sufficient  report  (1976) in  students  to  a  also  eight  reported  an  increase  studied  one-hour a  decrease  Hannigan  (1976).  These  Pre-post  testing  demonstrated  socially  desirable a more  reduction, eight and  and  after  sessions  of  identified one-hour reported Deutsch  problem  sessions  of  either and  Kramer  problematic employing  a  12  d a y s when t h e y In ation,  of  they  period  10  like  one-hour  with  conflict  absence able  of  to  sessions  of  Spradlin  family  of  results  time.  do  that  Although  not  change  the  group  over  made of  had  an  After  10  clients conflict. reported  elderly  by  psychotherapy.  (1975)  problems  his  their  in  (1976)  who  decrease  loneliness,  over  sessions  people  psychotherapy,  and  highlight  goals  situation).  were t r e a t i n g h o s p i t a l i z e d  summary, t h e s e but  treatment  demonstrate  after  group  ninety-minute  frequency  the  of  clients  were  reduce  symptom  to  (a  more  control, a greater  able  (1977)  Porterfield,  were  Karle  or  Withersty,  they  length.  adolescents.  decrease  behaviors,  in  and  (1976)  (1975) worked  common  college  Foulds  hours  felt  Their  with  positive self-statements Bonetti  four  by  who  Smith  attainment  (1976) were  therapy.  were  Killeen  students  experience.  locus  female  Forty  sessions  clients  the  30  sessions.  anxiety.  weekly  sessions  a greater  individual  group  short  eight  internal  Woldenberg  more  in  college  therapy  in  were  for  in security.  women  group  students  reported  seen  number  were 13  able  to  consecutive  adolescents.  suggest  total  is possible  literature  from  recuperwithin  a  clinicians  23  suggested  that  therapy  i n the  of  time  the  process of this  identifying initial  limit  contention.  it  possible is  two  not  expected  s e s s i o n as  early  on  was  short-term therapy,  well an  that  within  as  time  frame  advising  important  an  of  clients  part  t h e r e were no d a t a  However t h e r e was  that demonstrates are  the  of  to  the  support  abundance o f r e s e a r c h  v a r i o u s k i n d s o f p s y c h o l o g i c a l change  a  brief  unreasonable  period  to  expect  of  time.  Consequently,  p s y c h o l o g i c a l changes  in  weeks.  Limited  goals  Due  t o the  therapy goals  explore such  dynamic  (1974)  found  about  brief that  short-term  According  to  Jacobson, Wolberg,  of  1965b)  therapy  Kris,  is  more  1960;  short-term  or  their  therapy  one  amelioration of  possible,  prompt  development  of  is  and  more  the an  and  &  1967;  nature.  Small,  1965;  Sifneos,  1972;  that  following  disabling  increase  Dressier  in  believe  clients'  are  explorative,  supportive  reestablishment  c u r r e n t d i s t u r b a n c e , and  ability.  Ursano  o r more o f the most  Long-term  o r i g i n s of behavior  therapists  the  long-term  restructuring  (Bellak  Parad,  and  nature.  personality  long-term  removal  equilibrium,  different  some' c l i n i c i a n s  1965;  therapy  psychotherapy.  could accomplish  as  brief  psychogenetic  therapy  soon  a  extensive  insights in  limitation,  goals  as  impossible  while  time  such goals:  symptoms of  as  previous  understanding in future  of  coping  24  One  must  restrict  work i n b r i e f to  put  their  it  back is  to  not  The  their  a  goal  there  data  to  support  appeared  to  be  the  clinicians  t h e r a p y must be  Focused  primary  of  was  area,  life.  maintenance important  that  to  therapy  is  as  quickly  therapy again of  until  all  t h e r e were limited  the  no  goals,  persuasiveness  says  as  both  goals of  brief  a  focus  pointed a  out  present  such  focus  Wolberg  (1965b) have  problem  should  be  a  be  complete  usually  a  (1971) can  reached  be  current wrote:  regarded  problem  as  short,  early  i n treatment.  the  early  client  the  in  this the  terms  the  in  the  f o c u s on  and  most Malan  therapy  Malan  first  and  single  (p. 121).  successful  that  of  "Achievement  psychotherapy..."  stressed  i f therapeutic  explanation  that  done  the  centeredness  could  on  Small  of  to  while  position  present  aspect of b r i e f  describing  in  overwhelming  therapy  focused  problem  client's  i n order  limited.  goals  attention  life  stay  So,  logic  i n t e r v i e w i n g and  The  (1976b)  and  normal  the  an  f o r change  object of b r i e f  to  problems are r e s o l v e d .  empirical  from  vision  psychotherapy.  people  possible;  one's  (1963) the  and  primary  interview  the  must  structure  when of  therapy. Harris, more  Kalis,  important  forms o f situation.  therapy  and  Freeman  differences was  Malan  the  (1963) s a i d  between  systematic  (1963,  1976b),  brief  that  one  and  traditional  f o c u s i n g on  the  Pumpian-Mindlin  of  the  current (1953),  25  Small  (1971),  therapy only  can  a  the  be  dreams,  successful  therapy"  keeps  of  much at  Activity  the  then  present  interest, of  giving  of  support  action  for  said:  will  the  directs  memories,  "Those and  lead  the  explores  or  childhood  brief  cases  have  to  present  problem-solving  are  vehicle  for  1975).  psychotherapy  the  brief  does  a  the  short,  therapist and  on  the  the  therapist  to  action  Sloane,  In  Malan's  point  i s made:  be  exploring  follow.  importance The  must  and  of  &  more  talking  developing Thus  a  the  methods  Ullman,  review  of  brief  teaching  Staples, C r i s t o l , extensive  put  areas  problem-solving (Gelb  this  (1978)  A c t i v e means  guidance,  client  maintain  Koss  therapists  conversation,  to  one  and  therapists.  methods.  & S i f n e o s , 1970;  Whipple,  How  Butcher  and  the  referred  client  &  that  topics  psychotherapists  McGuire  in  problem?  argument  directing  a  as  Thus  becomes:  t h a n many l o n g - t e r m  course  ignores  of  hand.  the  forward  more,  either  a focus e a r l y  203).  goals  therapist  This  conversation  question  on  active  the  (p.  i t .  the  i f the  (1976b)  present  through  that  and d i r e c t i v e n e s s  The focus  work  agreed  areas  Malan  s u c c e s s f u l who to  and  such  order.  motivation  problem  area  from  birth  (1965b)  accomplished  problem  away  or  t o be  Wolberg  best  primary  person  tend  and  1967;  Yorkston, of  . . . t h a t t h e a r e a o f g r e a t e s t agreement i n t h e whole literature on brief therapy was that p a s s i v i t y must be r e p l a c e d by a c t i v i t y i n v a r i o u s forms. T h i s s t a r t s w i t h the s t r a t e g i c p l a n n i n g o f  brief  26  a 1 i m i t e d aim from the b e g i n n i n g . E a r l i e r authors who emphasized this aspect were A l e x a n d e r and French (1946), F i n e s i n g e r ( " g o a l - d i r e c t e d p l a n n i n g and management," 1948), and D e u t s c h ( " g o a l - l i m i t e d a d j u s t m e n t , " " s e c t o r t h e r a p y , " 1949). The l i m i t e d aim can be formulated i n terms o f a desired t h e r a p e u t i c e f f e c t ... t h e r e a r i s e s the n e c e s s i t y f o r a more t a c t i c a l form o f " a c t i v i t y " , namely guiding the selective attention, and selective neglect. F o r t h i s I t " i s v e r y n a t u r a l t o use t h e m e t a p h o r i c a l verb " f o c u s " ; the t h e r a p i s t " f o c u s e s " a t t e n t i o n , and t r i e s t o c a u s e t h e p a t i e n t t o f o c u s a t t e n t i o n , on the c h o s e n a r e a . T h i s area itself t h e n becomes known by t h e m e t a p h o r i c a l noun, t h e " f o c u s " o f t h e t h e r a p y ... A l m o s t e v e r y a u t h o r who s t u d i e s b r i e f t h e r a p y comes t o r e a l i z e t h e need f o r p l a n n i n g and a c t i v i t y , and many o f them come to use t h e word f o c u s and i t s derivatives to d e s c r i b e these elements i n t h e i r t e c h n i q u e s . (Malan, Barten Swartz  (1971),  (1969) a r e  therapists  to  be  Harris,  32-33) (1963),  Kalis,  and  Freeman  a l l adamant about  the  importance  directive  t h e most s u c c i n c t ,  1976a, p .  and  active.  Perhaps  and  for brief Wolberg  is  stating:  [An] anathema to short-term therapy is passivity i n the t h e r a p i s t . Where t i m e i s no o b j e c t , t h e t h e r a p i s t can s e t t l e back and l e t the p a t i e n t p i c k h i s way t h r o u g h t h e l u s h j u n g l e s o f h i s psyche ... T r e a t m e n t f a i l u r e s are often the product of lack of proper a c t i v i t y . (Wolberg, Therapist tioned  development  important  Early  activity  direction,  behavioral  components o f t h e  and  the  technology  135) aforemenare  also  GASP.  assessment Establishing  an  of  and  1965b, p.  understanding  Clinicians  need  the  focus  in brief  o f the p e r s o n ' s full  knowledge  psychotherapy  psychiatric of  the  requires  classification.  precipitating  events  27  of a  the c r i s e s proper  assessment  Freeman,  1963;  Strickler Two  of  authors  1965; S i f n e o s ,  be  problematic.  Thus  interpersonal  potential The  &  Schneider,  type  of  and t h e meaning  a  listing  Wolberg  of the  (1965b)  recom-  to understand  what  b e l i e v e s that behavior to explored  self-esteem,  the degree  of  dependence-indepen-  relationships,  and  the  client's  t o decompensate. remainder  relative  as  He wanted  Wolberg  defensiveness,  Kalis,  for this  behavior,  well  does and how t h e c l i e n t  anxiety, dence ,  style.  Morley,  guides  and w e a k n e s s e s .  an a l t e r n a t i v e  (Harris,  t o make  the t a r g e t complaint, the  previous as  i n order  1972).  differing  (1971) e x p l o r e d  strengths  client  problems  Wilner,  to the c l i e n t ,  the  to c l i e n t s  their  provide  Small  a l l this  mended  of  this  section  will  explore  to the i s s u e o f dependence-independence.  dependence-independence  themselves  in relationship  perception  of  Extentialism existential to  of  f o r the c o m p l a i n t ,  client's  of  meaning  Jacobson,  & Sommer,  assessment. causes  and t h e i r  the  will  Rotter's  (1954)  to  how  t o the world  world be  concept  refers  i s an  briefly  discussed.  thinking  and r e s e a r c h  perceive  them.  existential  of self-responsibility  The i d e a  people  around  notions  This  viewpoint. Finally  will on  be  the  related  t h e Locus o f  Control. Relative large fervor  to  the  issue  number o f t h e o r e t i c i a n s that  people  of  dependence-independence,  argued  are actors  with  subject  v a r y i n g degrees  to certain  a of  environ-  28  mental  constraints.  (1965),  Perls  importance internal  the  of  act  them.  (1969), how  In  on  experience  clinicians  their  actions  change, readily was  The  one  The  existential  of  therapist  view,  the  world  behavior  People  acting  on  i s moderated  by  evaluate  their  own  evaluation.  In  essence,  the  that  everyone  responsible  for  people  was  of  goal  those  possess  clinicians of  the  actions.  power  believe  therapy,  between  to  that  is  an  i f they  The  control behavior  achieved  by e x t e r n a l actor  t h e o t h e r was  better  understanding basis  (Patterson,  differ, method.  and  According to t h i s  that  while  with  psychotherapy being  their  more  forces.  and  caused  a  to  perceived  It  marionperform.  themselves  strings attached".  therapy.  existential  and  the  evaluate  than  are not c o n t r o l l e d  i s the  common, t h e y  events.  the d i f f e r e n c e  concern world  perceive  rather  same  functioned  psychotherapy  tial  that  performed,  "no  emphasized  consequences  general  clients  the  the  i f people  as h a v i n g  of  and  These  the  (1961b)  a l l human  on  said  believe  much l i k e  ette:  world  act  above  themselves.  Rogers  perception.  and  clinicians  (1951), G l a s s e r  and  extreme,  subjective  Fiedler  external  the  the  (1973b),  individuals  needs and  persons  Ellis  the  i s to  of  1966).  Although so  an  client's  understand  "existential"  possible  to  existence. client  i s no  refer  with The  as  a  to one  have much i n  character of  i t i s concerned  the  approach  there  these approaches  fundamental  i s that  client's perception  However,  i t i s not  The  the  the  existen-  the  task  being  to  nature of  and  the as  a  29  being  i n h i s or her world.  understand reference  themselves  Clients  better  t o and s t r u g g l e  as  with  a  should  result  their  then  come t o  of  this  inward  directly  felt  exper-  iencing. Heine's what are  (1962)  i s important understood  independence evaluated help  therapist  who  A l l clients  therapies.  agreed  the  psychoanalytic,  perception  of  philosophy  perception  and  gone  reported  similar  and  had e x p e r i e n c e d  accounted  Heine  Adlerian  changes  relationship. and  have  psychotherapeutic  i s of i n t e r e s t here  understanding,  they  they  decisions.  for  that  o f how  whether  client-centered,  therapeutic  trust, they  had  this  and  choices  However what  the  that  independence in  by  i n making  therapists.  supports  are the c l i e n t s '  individuals  to  three  research  the  in  a l l  i s their  A l l clients feeling  of  f o r the changes  themselves. When  external  he  writes  evaluation,  of the importance Rogers  (1961b)  of  being  free  stated:  ... In a l m o s t e v e r y p h a s e o f o u r l i v e s — a t home, a t work - - we f i n d o u r s e l v e s u n d e r t h e r e w a r d s a n d punishments of e x t e r n a l judgements. "That's good." "That's naughty." " T h a t ' s w o r t h an A." "That's a f a i l u r e . " " T h a t ' s good counseling." " T h a t ' s poor c o u n s e l i n g . " Such j u d g e m e n t s a r e a part o f our l i v e s from infancy to o l d age. I b e l i e v e t h e y have a c e r t a i n s o c i a l u s e f u l n e s s t o i n s t i t u t i o n s and o r g a n i z a t i o n s s u c h a s s c h o o l s and professions. Like everyone e l s e , I f i n d myself a l l t o o o f t e n making s u c h e v a l u a t i o n s . B u t , i n my e x p e r i e n c e , t h e y do n o t make f o r p e r s o n a l growth and h e n c e , I do n o t b e l i e v e t h e y a r e p a r t o f a helping relationship. Curiously enough, a p o s i t i v e e v a l u a t i o n i s as t h r e a t e n i n g i n the long r u n a s a n e g a t i v e o n e , s i n c e t o i n f o r m someone he i s good i m p l i e s t h a t one a l s o h a s t h e r i g h t t o t e l l him he i s b a d . So I have come t o f e e l that  from  30 t h e more I can keep a r e l a t i o n s h i p free of j u d g e m e n t and e v a l u a t i o n , t h e more t h i s will p e r m i t t h e o t h e r p e r s o n t o r e a c h t h e p o i n t where he r e c o g n i z e s t h e l o c u s o f e v a l u a t i o n , t h e c e n t e r of r e s p o n s i b i l i t y , lies within himself. The meaninq and v a l u e o f h i s e x p e r i e n c e i s i n t h e l a s t a n a l y s i s s o m e t h i n g w h i c h i s up t o him, and no amount o f e x t e r n a l judgement can a l t e r t h i s . So I s h o u l d l i k e t o work toward a r e l a t i o n s h i p i n w h i c h I am n o t , e v e n i n my own f e e l i n q , e v a l u a t i n g him. T h i s , T b e l i e v e , can s e t him f r e e t o be a s e l f responsible person. ... T h e r e d o e s seem t o be within the b i o l o g i c a l organism feedback mechani s m s , e v a l u a t i o n a l s y s t e m s - - w h a t e v e r you m i g h t call them -- w h i c h e n a b l e t h e o r q a n i s m to d i s c r i m i n a t e , although not always with immediate a c c u r a c y , between e x p e r i e n c e s w h i c h a r e f a v o r a b l e t o i t s own g r o w t h and d e v e l o p m e n t and t h o s e w h i c h are u n f a v o r a b l e . A l t h o u g h such n a t u r a l t e n d e n c i e s can c e r t a i n l y be d e c e i v e d and thrown o u t o f k i l t e r by v a r i o u s d i s t o r t i n g e x p e r i e n c e s , n e v e r t h e l e s s , the fundamental ability of the organism to distinguish between e x p e r i e n c e s w h i c h f a v o r i t s own d e v e l o p m e n t and t h o s e w h i c h do n o t seem t o be t h e c a p a c i t y on which n o t o n l y t h e r a p y b u t . a q r e a t many o t h e r p r o c e s s e s d e p e n d . (p. Rotter's task  i s to  parallels lieves the  idea  increase the  the  notion  t h a t as  more  (1954)  satisfied  decide  for  their  likes The  determined themselves construct Locus  of  by is can  will  to  what  Control  or  than  measured Scale  they  people  themselves  be  The  locus  of  a bv  by  bv  rather  be-  to  do,  notion tauqht  than  to  of to  have  others.  persons  theoretical  (Rotter,  are  believed their  the  want  existential  like,  control  Rotter  they  Clients  determined  which  more  be.  stressed.  dislikes  degree  internal  self-responsibility.  is  themselves and  psychotherapeutic  a t t e n d more t o what  they  self-responsibility  another  client's  of  clients  that  108-109)  and  behavior  events  is  outside  construct.  The  Rotter Internal-External  1966).  If  people  believe  31 external  factors  external  locus  chance, or  of  luck,  or  partially  people  control  under  and  locus  control.  assess  what  component  or  the  most  thoughts of  control. fate,  believe  Such may  events they  are  people  also  said tend  suppose of  to  are  said  to  an  believe  in  an  If  their  own  an  internal  instrument  e x i s t e n t i a l c l i n i c i a n s consider  psychological  growth  and  totally  others. by  have  provided  have  are  powerful  determined  has  to  they  are  Thus R o t t e r  some  they  influence  feelings,  of  them,  change,  a  the  to  crucial locus  of  evaluation. Recent between  goal  (Prociuk, has  research  achievement  Breen,  also  shown and  & Lussier,  been  shown  internal  locus  research  indicate  command o f  has  of  an  that  their lives  positive  internal  1976).  between  control  a  A  locus  positive  successful  (Henson,  1976).  instructing  people  and  relationship  become more  of  control  relationship  therapy  and  an  These  areas  of  on  internal  how  to  should  take prove  bene f i c i a 1 . Therefore if  the  it  therapist  independence  a  is  client  self-control.  control  were  between  success their  could  lives,  If  a  internal  self-reinforcing.  experience  and  As of  of  of  assessment dependence-  to  increase  increasing  a positive  control  clients  early  tries  for  therapy,  locus  an  degree  method  into  be. e x p e c t e d . this  the  experiences  incorporated an  i n making  understands  client  ship  helpful  and  gained  self-  relationtherapeutic  control  self-determination  could  over be  32  Therapeutic Brief  flexibility and  crisis  who  can  benefit  from  No  one  therapeutic  therapists a diversity technique  clear-cut  relationship  1977) .  fact,  who  In  adheres  well  in  the  brief  to  of  has  a  set of  variety  been  shown  to  people  techniques setting  have  (Smith  been made t h a t  psychotherapy  of  therapeutic techniques.  a l l diagnoses  argument has  t o o n l y one  the  treat  &  a  would  a  Glass,  therapist  not  (Butcher  perform &  Koss,  1978) . In the  Barten's  importance  review  of  brief  of therapeutic  psychotherapy  he  described  flexibility:  Short-term t h e r a p i e s were i n e v i t a b l y rediscovered as psychiatrists embraced a growing e c l e c t i c i s m . . . T r a d i t i o n a l t e c h n i q u e s have by no means been d i s c a r d e d , b u t t h e y have come t o be used more j u d i c i o u s l y . In some c a s e s , t h e y have worked b e t t e r . B r i e f techniques themselves have expanded t o i n c l u d e b r i e f g r o u p and f a m i l y t h e r a pies, behavior t h e r a p i e s , drug t h e r a p i e s , sugg e s t i v e t h e r a p i e s such as h y p n o s i s , r e - e d u c a t i v e t h e r a p i e s , and r o l e - i n d u c t i o n t h e r a p i e s . The t r a d i t i o n a l p s y c h o t h e r a p i s t may v i e w t h i s as a r e g r e t t a b l e compromise, an i g n o b l e s u r r e n d e r t o the p r e s s u r e s o f c i r c u m s t a n c e s w h i c h produce t r a n s i e n t , s u p e r f i c i a l or token r e s u l t s . To t h e eclectic, brief t h e r a p i e s are i n n o v a t i v e , pragmatic d e v e l o p i n g approaches w h i c h may change o u r c o n c e p t i o n o f the n a t u r e , o b j e c t i v e s , possibilit i e s and l i m i t a t i o n s o f p s y c h o t h e r a p y . We s h o u l d neither exaggerate the results of short-term t h e r a p y n o r d e p r e c a t e t h e r a t i o n a l e and o b j e c t i v e s of long-term therapy. (Barten, A enced able  given  therapist  would  not  be  in a l l therapeutic techniques. to  expect  a  clinic's  staff  1971,  expected  p. to  I t does  collectively  3-4) be  experi-  seem  reason-  to  offer  a  33  range  of  techniques  needs.  Thus  hospital  should  provide  the  The  therapy  providing  Bellak  developed  to  life  quickly and  mobile  during  a  as  when  work  a  on  clinician  possible  Small  has  emphasized  a  by  client  intake  to  Wolkon  to  who  to wait  seeks  Butcher  1961;  are  and  urgency  people  seen  several  offer  Lindemann,  this  who  or  crises  to  support  (1972)  the  interviews  reach  clients  were asked  client's  Since the  (Caplan,  Empirical  r e m i s s i o n when  the  i t i s important  units  disaster.  people  on  (1965) r e c o g n i z e d  counseling  given  been  batteries.  problem,  faster  when t h e  client  psychiatric  solution.  multiple  was  symptom  has  therapy  recommendation  than  single  literature  assessment  a present  1944).  respective  short-term  any  therapy  The  psychometric  as  than  in brief  discouraged  therapy  a  the  flexibility.  i s motivated  about  of  to  intervention  of  (1978)  ately  better  problem.  timeliness  are  be  emphasis  immediate  lengthy  personnel  therapeutic  Promptness o f  Koss  appropriate  and  immedi-  for  this  demonstrated immediately days  f o r an  appointment. This that  evidence  engages  promptly, testing  in  suggests brief  avoiding  procedures.  that  any  psychotherapy  waiting  lists,  and  psychiatric should  facility  see  clients  minimizing  in-take  34 Ventilation Regardless attempt  to create  secure. ience and  of  A  atmosphere  as w e l l as a b r i e f Koss  (1 978)  recognizes  to  brief  emotional  tension"  empirical  support  catharsis  or  enhances  allowing  the c l i e n t ' s  for this  to  a l l manor  to ventilate  there  is little  psychotherapy,  experience  some  expression  psychotherapy  exper-  psychotherapy  although  and  feels  The B u t c h e r  "...  position in brief  that  and Shoben  that  the c l i e n t  Now  identification  Shaffer  therapists  the c l i e n t  crisis-oriented  (p. 737).  enhances a s h o r t - t e r m As  of  argue  i n which  acknowledged  and  the value  most  psychotherapy program.  review  clinicians  approach,  an e n v i r o n m e n t  secure  approaches  the  treatment  of  sort  of  feelings  proqram.  (1956) w r o t e :  It i s not s u r p r i s i n g , then, that t h e r a p e u t i c conversations are centered on the client's a n x i e t y , g u i l t f e e l i n g s , and f e e l i n g s o f i n f e r i o r i t y , o r i n a d e q u a c y , and on t h e o c c u r r e n c e s that engender them. Obviously, such topics are p r e c i s e l y t h e ones t h a t a r e most d i f f i c u l t f o r t h e c l i e n t t o t a l k ^about. One o f t h e h i d e r a n c e s t o successful counseling i s that i t depends on discussing the very things that the c l i e n t i s least inclined to discuss and which a r e most susceptible to repression. ( p . 529) Moreover, strong  therapists  emotions  1974; Among  some  Nichols these,  therapy proaches  had  to &  facilitate  Reifler,  Nichols received  including  purposely  1973;  (1974) n o t e d much  tension  release  Stampfl  &  therapy  but  to  (1970)  that  (Perls,  elicit  (Nichols,  Levis,  that Janov's  attention,  gestalt  attempted  1967). primal  other  ap-  1969),  new  35  identity  groups  (Jackins, the  1965),  release These  of  of  interest  (Zax  1947),  dependence  on  (Lowen,  emphasized  1967)  properties a  but  of  central  LaBarre,  aid  Catharsis  this  1964;  a  revival  ventilation.  role  in  healing  Zilboorg,  1941),  has  ventilation  of  &  therapy (Grinker  &  later  However,  memories  technique  (Moreno,  and  modern  his  psycho-  to reduce  tension  (Greenson,  1967).  in play  1958),  abandoned  used  therapy  (Levy,  traditional  group  1970).  been  approaches  he  (Brenman  & B r e u e r , 1966)  c a t h a r s i s as a t o o l  a major  (Yalom,  (Freud  hysteria,  remembering  psychodrama  hypnotherapy  abreactive  technique.  employs  i s also  There  1972),  Although Freud  the  psychotherapy  Cowen,  resolve  still  cathartic  counseling  a discovery  played  drug-assisted  1945). to  1943),  1961;  &  and  catharsis  to  therapeutic  (Frank,  Synanon  analysis  reevaluation  r e v i v a l i s m ( D a v e n p o r t , 1917), A l c o h o l i c s Anonymous  Spiegel,  and  the  are not  t e c h n i q u e s have  religious  Gill,  bioenergetics  approaches  in  rituals  and  and  1972),  emotion.  new  Cathartic in  (Casriel,  little  empirical  ( B u t c h e r & Koss,  up t o 1974,  Nichols  (1974)  research  1978).  on  the  In a r e v i e w o f  wrote:  As y e t , l i t t l e has been done t o base t h e v a r i o u s c a t h a r t i c a p p r o a c h e s on e m p i r i c a l e v i d e n c e o r even w e l l rounded t h e o r i e s . In f a c t , there d o e s n o t e x i s t a body o f c o n t r o l l e d s t u d i e s i n therapy i n which catharsis i s the independent variable. T h e o r e t i c a l r e p o r t s have o f t e n s i n g l e d out catharsis as one o f the key elements in s u c c e s s f u l t h e r a p y ( e . g . , F r a n k , 1971; R o s e n z w e i g , 1 9 3 6 ) , b u t o n l y a few s t u d i e s have shown c a t h a r s i s to be effective in leading to improvement in psychotherapy ( J a n o v , 1971; Lifshitz & Blair,  36  1 960; Symonds, 1951). ... In h i s work on " f o c u s i n g " , G e n d l i n and h i s c o l l e a g u e s have r e p e a t e d l y found that clients who express their feelings d i r e c t l y improve more t h a n t h o s e who m e r e l y r e p o r t them (Gendlin, Beebe, Cassens, Klein, & O b e r l a n d e r , 1968; G e n d l i n , J e n n y , & S c h l i e n , 1960; G e n d l i n & O l s e n , 1970). (p. As  was  mention  (1974)  of  article  he  improvement  were  university  o f 20.  five The  insight  therapy.  role-played, in  affect  movement  like  emotive  group  significantly  scores,  while  the  greater  remission of  reported ment.  The  one  half  results  study  similar  various  their  significantly  These  found  emotive  by  two  They  therapy times  was  a  41  week, one  to  an  twenty-  a  and/or  couch.  hour  engaged non-  pre-post  MMPI  significantly complaints their  and  treat-  for catharsis. Schwartz  clients The  clients  The  with  and  nine.  traditional  condition  support  conditions.  per  four  attained  Nichols, saw  compared  their  satisfaction  Bierenbaum,  leads  sessions being  phrases,  changed  to p a r t i a l  results.  cathartic hour  lead  from  behavioral target  more  1  a median  striking  group  catharsis He  treatment  laden  Nichols  years o l d , with  condition  In t h e e m o t i v e  In  two  Clients  individually  treatment  Here  treatment.  t h e mean number o f  repeated  expressive  that  therapy.  17-28  clinicians  detailed.  a g a i n s t a non-emotive students,  brief  important.  notion  short-term  with  non-emotive  the  as are  the  They were seen  sessions,  of  emotion  explored  in  treatment  22  of  many  i t s effectiveness  emotive  age  earlier  ventilation  examples  to  noted  403-404)  under  (1976) three  c o n d i t i o n s were once  per  week,  37 and  two  hours  conditions  pretested  Posttestinq  clients  were  tarqeted two  who  t h e most  times  per  Under  When  clients  Evidence  emotive  only  therapy  inhibits  their  required  Brief  written  by  two  most  of  their  o f one h a l f were  hours  abreaction  hour  the  every  most other  i s beneficial  Perhaps  their  anxiety  i n some and  However,  further  position.  Until  to  therefore  that an  to  people  studies  include  are  research  aspect  of  in  relation  Truax  r e l a t i o n s h i p i s fundamental (Berqin  i s characterized  of  Two e x t e n s i v e  variables  met  expres-  amount o f c h a n q e .  perspective  of a r e l a t i v e l y  importance  chanqed.  affective  scores  seen  therapeutic  psychotherapy  the  and a  therapeutic relationship  theoretical  relationship of  MMPI  i t i s prudent  facilitative  any  this  tarqet  i n t h e d e v e l o p m e n t o f t h e GASP.  A facilitative A  had  f o r some p e o p l e .  to re-evaluate  ventilation  and  the l e a s t  increases  switched  instruments  the c o n d i t i o n  were  proqress.  forthcominq,  these  t h e most  i s a v a i l a b l e that  psychotherapy  never  Under t h e one h o u r p e r week  clients'  week, t h e y d e m o n s t r a t e d  to  included  satisfied  week,  Clients  on t h e MMPI and t h e i r  expressed  objectives.  improved.  is  week.  ratinq of satisfaction.  condition sion  other  and were  complaints. client  every  the  short  & by  Suinn, a  duration.  facilitative  process  and M i t c h e l l  and  (1971)  therapeutic However  views  conditions  have  reviews o f the research to  on t h e r a p i s t  outcome  and  1975).  have  Parloff,  been  Waskow,  38 and  Wolfe  related client  (1978).  only are  to  necessary  studies  (1951, and  personality  required  serious and  client  should  of  first  The  therapist be  stated  of  these the  reqard,  the  client  research  independent  as  for  of  the  two  have too  aware  of  were  "atti-  The  been  fourth  attitudinal dropped  from  self-evident: each  other,  or  conditions  six  genuineness,  these  vulnerable,  sufficient  were  constructive  empathy.  perceive  beinq be  there  conditions  and  remaining  must  that  therapist:  to  inconqruent,  n e c e s s a r y and  the  and  the  anxious.  The  pared  the  was  to  three. The  very &  relevant  conditions  of  discussion  client  1975)  Three  positive  characteristics.  list  the  therapists  sufficient  characteristics"  condition  section  of  1961b,  change.  unconditional  any  this  hiqhlighted.  Rogers  tudinal  In  initial  research  r e s u l t s of Roqers  e n t h u s i a s t i c a l l y received  Carkhuff,  these Roqers'  basic  1967).  conditions  position.  pertinent  Scales  literature  Based up  on to  hypothesis  (Barrett-Lennard,  had  and  1  been  initial their  1970,  developed research  extensive  Truax  and  were  1962; to  Truax measure  confirmed  review Mitchell  of  the  (1971)  concluded: These studies taken toqether suqqest that therapists or counselors who are accurately empathic, n o n p o s s e s s i v e l y warm i n a t t i t u d e , and genuine are indeed e f f e c t i v e . Also, these f i n d mqs seem t o h o l d w i t h a wide v a r i e t y o f t h e r a p i s t s and c o u n s e l o r s , r e q a r d l e s s o f t h e i r t r a i n i n q o r t h e o r e t i c o r i e n t a t i o n , w i t h a wide v a r i e t y o f c l i e n t s or p a t i e n t s , i n c l u d i n q c o l l e q e underachievers, juvenile delinquents, hospitalized schizophrenics, colleqe counselors, mild to severe  39  outpatient n e u r o t i c s , and t h e mixed v a r i e t y of hospitalized patients. Further, the evidence suggests that these f i n d i n g s hold i n a v a r i e t y of therapeutic contexts and i n b o t h i n d i v i d u a l and group psychotherapy or c o u n s e l i n g .  310)  (P. Not  only  d i d Truax  and M i t c h e l l b e l i e v e  evidence  f o r the  overwhelming conditions They  of  also  believed  regardless Further, these  of  of  these  type  went  of  a  number  of  interpersonal  Bommert,  Bastine,  Wittmer,  1971;  doubt that  began were  Mitchell little  to in  Neville,  &  Workman,  Grummon,  1972;  1975).  Elkins,  as  1971; S l o a n e ,  Nickel,  other with  that  was  sufficient genuineness.  and  school  sufficient  of  low l e v e l s  to  &  support  therapy. o f any o f  (Cairns, &  1972;  Wargo,  Beutler,  Luborsky, Staples,  &  notion  Minsel, Truax  &  However,  offered  results  of  Truax  and  reported  there  was  (Beutler, Johnson,  Bergin,  & Auerbach,  Cristol,  1971;  1971).  conclusion  association  Garfield  1972;  Tausch,,  researchers the  the  i s r e l a t e d t o one o r more  investigators  o f an  1973;  Mintz,  or  studies  Wittmer,  Other  evidence  &  problem  dimensions  conflict  Workman,  Abeles,  grow  and  necessary  outcome  Langer,  Truax,  (1971) .  o r no  were  and  there  to c l i e n t d e t e r i o r a t i o n .  positive therapeutic these  warmth,  on t o c o n c l u d e  factors contributed are  necessary  empathy,  that  the  they  There that  accurate  that  Neville,  1971; 1971;  Yorkston,  Johnson,  Kurtz  &  Mullen  &  & Whipple,  40  Two  later  1973;  Parloff,  sions  i n that  related  empathy,  i s less  Wolfe  (Mitchell,  Waskow, & W o l f e ,  to c l i e n t  bility and  reviews  change  than  (1978)  warmth,  Bozarth, Truax,  &  Krauft,  1978) r e a c h s i m i l a r  conclu-  and g e n u i n e n e s s  but t h e i r  initially  potency  expected.  a r e seen  and  as  generaliza-  Parloff,  Waskow,  wrote:  In response to the f a c t that more r e c e n t studies have failed to support the initial enthusiastic claims f o r v a l i d i t y of the b a s i c h y p o t h e s i s c o n c e r n i n g t h e n e c e s s a r y and s u f f i c i e n t c o n d i t i o n s , i n c r e a s e d e f f o r t h a s been d e v o t e d t o trying to r e c o n c i l e the apparent discrepancies. Prominent among s u c h a n a l y s e s have been a t t e m p t s to identify f l a w s and l i m i t a t i o n s i n t h e nonc o n f o r m i n g s t u d i e s . ... Two o f t h e most f r e q u e n t l y cited objections [were]: (a) f a i l u r e to provide the prerequisite minimal levels of therapeutic c o n d i t i o n s , and (b) t h e use o f d i f f e r e n t s o u r c e s of ratings. (p. The require  time that  quickly.  the  kind  Client  of  short-term relationship  issue,  relationship  developed that the  i s very important.  psychotherapy  within  be  i t i s apparent  relationship  brief  psychotherapy  the  to  time  It  establish  constraints  a of  of therapy.  selection  treatment  works  r e s e a r c h e r s have a t t e m p t e d  f o r which  psychotherapy  undertaken for  a complex  therapeutic  Psychotherapy  Brief  of  facilitative  challenge  facilitative this  a  Although  facilitative is  constraints  248)  brief  projects  people  i s no  different.  to s p e c i f y  psychotherapy.  and under  who  to define  what  conditions.  Researchers  i s and who  what  have  i s not s u i t e d  41  Relative  to s e l e c t i o n , Butcher  and K o s s  (1978)  summar-  ized : S e l e c t i n g the a p p r o p r i a t e p a t i e n t s f o r b r i e f t r e a t m e n t i s an i m p o r t a n t c o n s i d e r a t i o n . Patients who have had a good p r e m o r b i d a d j u s t m e n t and an a c u t e o n s e t o f symptoms a r e c o n s i d e r e d by many t o be b e t t e r c a n d i d a t e s f o r s h o r t - t e r m therapy than t h e more s e v e r e l y d i s t u r b e d patients. However, recent evidence, both clinical and research, s u g g e s t s t h a t some s h o r t - t e r m therapeutic interventions m i g h t be highly successful with more severly disturbed patients. P a t i e n t s who have a good a b i l i t y t o r e l a t e a r e a l s o c o n s i d e r e d t o be b e t t e r c a n d i d a t e s f o r b r i e f t h e r a p y t h a n t h o s e who have d i f f i c u l t y f o r m i n g r e l a t i o n s h i p s . (p. The saying  that  tion,  that  scribed three is  remarks  of  Sifneos  (1972)  i t i s a necessary, the  client  problem.  have  1.  above  2.  at  ability he  conditions  one  an e m o t i o n a l  4.  an  ability and  meaningful  see  a  that  be met  condicircum-  at  i f the  least client  to  interact well  during  with  the  thera-  to express f e e l i n g s , t o c h a n g e , and  6.  a specific  chief  to  relationship  crisis,  motivation  person's  to  believed  must  5.  order  sufficient  by  lifetime,  3.  In  a  summarized  average i n t e l l i g e n c e ,  client's  pist  not  be  f o r treatment:  least  the  the  Additionally,  o f the f o l l o w i n g  t o be a c c e p t e d  but  may  740)  assess  willingness  to  complaint. motivation,  be  an  honest,  Sifneos  examined  realistic,  the  curious,  42  eager,  active  participant  who  recognizes  that  the  symptoms  are p s y c h o l o g i c a l i n n a t u r e . Malan  (1976a)  procedures. thus  very  He s a y s , complex,  formulated has  very  already  sufficient, psychosis]  A  certain  of  focus  to  and  at  Koss  selection  c a n be  suited  can r e a l l y  found,  i t positively,  specific  (1978)  [such  as  be  client is  active  (p. 256).  suggested  that  the  following  therapy:  i n whom t h e b e h a v i o r a l p r o b l e m  those  the  motivation  dangers  f o r short-term  the onset  of selection  the process o f assessment i s  do n o t seem i n e v i t a b l e "  those  2.  i n h i s summary  the process  responded  are best  1.  "Although  briefly:  and  Butcher people  i s more t e r s e  i s acute  of therapy,  whose  previous  adjustment  has  been  good , 3.  those  with  tively, 4.  those  Criteria also  serious  convinced  with  suicide  homosexual;  sional  was  Three istics  more  Malan  other  o f people  from  to  relate  was  required than  posi-  psychotherapy  one  a  course  drug  alcoholic;  r e s e a r c h e r s have  of  addict;  was  a  hospitalization; electro-convulsive  endured  ruinously  chronic  obses-  acted o u t .  identified  are i l l - s u i t e d  have  anyone who: had  long-term  symptoms; o r who  who  brief  (1976a) e x c l u d e d  attempts;  chronically  or phobic  ability  high motivations.  for exclusion  experienced  therapy;  good  and  been g e n e r a t e d .  made  had  a  the c h a r a c t e r -  f o r short-term  therapy.  43  This  would  include  struction, acts  out  is  the  hiqhly  (Wolbert,  who  anxious,  1965a);  passive-dependent,  wants  or  i s outspoken  1966);  education,  personality  persistently  masochistic,  (Castelnuovo-Tedesco, fifth-qrade  client  or  or  the  i l lfor  and  summary,  selection  Dumont's  i s important.  practiced,  requires  motivated,  one  less,  shares  excludinq The  who  the  the  or  verbal,  values of  health  exists  of  proqram  However,  a  caution  the  as  therapist,  that  from  those  health  centers are  lower  intelligence.  can  not  short-term  administration  orqanic  were  exclude  therapy  to  define  than  reasons,  about  i t is  i s verbal,  l o w e r - c l a s s person  mental and  who  less  1974b).  "Psychotherapy  a person  with  can d e l a y g r a t i f i c a t i o n ,  possibility  community  (1968)  client qenerally  insightful, and  who,  thereby  use  and  more o r virtually  treatment" who  (p.  the  25).  public  homely, o l d , u q l y , Obviously  everyone  proqram who  or  self-destructive  m e n t a l l y d e f i c i e n t , or p s y c h o t i c (Frank, In  anxious  self-centered,  client  toxic  recon-  from  miqht  a  and  mental  treatment.  succeed  i t would  non-  i f the  would  not  accept.  Outcome r e s e a r c h w i t h b r i e f Although therapy  and  differences Patterson, Nichols  &  comparative unlimited in  outcome  1972; Reifler,  studies  between  therapies  showed  effectiveness  Moleski 1973;  psychotherapy  &  Tosi,  brief  essentially  (Levene,  1976;  P a t t e r s o n , Levene,  behavioral  Breqer,  Nichols, & Breqer,  no &  1974; 1971;  44 Paul,  1966,  1967;  Sloan,  Whiople,  1975, 1 9 7 6 ) ,  and  term  lonq  Staples,  i t i s clear  psychotherapy  therapy  c a n r e a c h more p e o p l e  average  number  can  successfully  therapist  two  clients  may  to the  Loqistically easier  outcome easier  First,  o f events  research  design  than  short-term  either  specific  assumed  identified process  a  clearly  to help achieve  therapy, miqht  be  more  psychother-  or  i s curious f o r i s very  opportunity  Because  problems, For these  therapy.  notions  qleaned to  time  short-term  the  with  follow-uo  reasons  i t could could  be  S i n c e the  to the process of  from  lonq-term  of  to deal  procedure  i s similar  to  substantially  the t h e r a p e u t i c q o a l s .  therapy  applied  is  developed  defined  be  The c r i t e r i o n f o r  It  qoals.  f o r any could  long-term  of time.  been  to identify.  of short-term  lonq-term approach  populations  that  period.  psychotherapy  qoal-oriented.  t e c h n i q u e s have u s u a l l y  are e a s i e r  lonq-term  research f o r a short period  f o r a long period  to a r t i c u l a t e  the  procedure  does  i f the  therapist  the content  provides  therapy  be  while  consistent  It  basis;  during brief  short-term  monitoring  than  a  psycho-  short-term  Althouqh  &  psychotherapy Brief  of a defined process  research.  i s qenerally  criteria  one  s i x people,  differ,  This lack  reasons.  control  brief  on a p e r - c l i e n t  h a s n o t been e s t a b l i s h e d .  amenable  is  treat  Yorkston,  are d i f f e r e n t .  i s five,  the sequencing  established. two  that  c a n s e e o n l y one i n t h e same t i m e  Yet, apy  of v i s i t s  Criston,  the  short-term  therapy.  While  45 research  on  short-term  therapy  may  be  t e r m , i t does n o t mean t h e r e a r e no therapy.  T h e r e a r e , and  The therapy  second  reason  lacks  specificity  provides  an  therapists  both  entirely t o be  conduct  develop  i n the  the Do  we  developed such  technique,  not  followinq cisely  and  Now  modification  a  brief  the  research  a  The  the  someone  so e x a c t l y .  recipe,  where  the  helpful  as  explor-  It  appears  behavioral  process  therapy.  defined  process  processes,  answer  content  their  aspects  then  itself.  well  to"  as w e l l  specific  of  (1966)  "how  is  therapeutic process  is  c o u l d do  that  a  for  should  explicitly  Lazarus  a l r e a d y have s u c h  here  cookinq  the p r o c e s s  and  process  modification?  that  he  the  necessity  behavior  content  behavior  context of short-term  qone b e f o r e q i v e s t h e  beinq  The  d e l i n e a t i o n s are  followup  p o s s i b l e to  mentioned.  has  of  of  employed  from  These  psycho-  modification  to specify  particulars  Aqain  ly  continued  later.  behavior  Wolpe  have  lonq-  short-term  that short-term  Beqinninq  with  on  that  model.  approaches.  the  addressed  at s p e c i f y i n q  i n the  inq  be  i t i s odd is  than  problems with  have been qood  behaviorists their  why  excellent  techniques.  of  they w i l l  easier  --  a  desire  to  I t would  is  especial-  "no".  What  form.  What i s  very  detailed  replicate be  the  analoqous  the  directions  has  been  are  to  pre-  detailed. psychotherapy  elements of problem-solvinq  therapy  will  be  described, examined.  the  46  Problem-Solving  According three  major  learning  Of  to  divisions  within  the  problem-solving  2.  coping  3.  cognitive restructuring. three  skills  outcome  research  interest  here  developing  area  of  there  the  are  cognitive  have  learning  been  (Mahoney  because  to  the  link  broad  D'Zurilla  of  a  the &  the  most  viewpoint.  problem-solving  of  had  these for  on  long  clinical It  setting  goals.  problem-  by  1978) .  An  is  of  goals  and  attempt  is  e s t a b l i s h i n g goals  (the  problem-solving. (1971)  were  problem-solving After  the  supported  emphasis  Goldfried  explore  therapies,  Arnkoff,  process  notions  and  need, t o  behavioral  therapies,  a s t r a t e g y to achieve  made  GASP) t o  (1978) ,  therapies,  cognitive  therapies  and  Arnkoff  therapies:  solving  the  and  1.  the  being  Mahoney  Therapy  noting  been  of  c o g n i t i v e p s y c h o l o g i s t s , they  that  the  first  to  strategies the  interest  note  from  phenomenon  to  a of  experimental  concluded:  Much o f w h a t we view clinically as abnormal b e h a v i o r or ' e m o t i o n a l d i s t u r b a n c e ' may be v i e w e d as i n e f f e c t i v e b e h a v i o r and i t s consequences, i n which the i n d i v i d u a l i s unable t o r e s o l v e c e r t a i n situational p r o b l e m s i n h i s l i f e and his inadequate attempts t o do so a r e h a v i n g undesirable effects, such as anxiety, depression, and the c r e a t i o n of a d d i t i o n a l problems. (p. Spivack for  the  and  growth  his in  colleagues  deserve  problem-solving  much  therapies  of for  107) the their  credit work  47  with  pre-schoolers, emotionally disturbed children,  cents,  and  Scura, 1974;  institutionalized  & Hannon, Shure  Siegel  &  Spivack  & Spivack,  Shure,  1974).  were:  skills and  of  (1974)  evaluated  to  and  tion  skills with  The  children differing  condition  have  problempopula-  i n and in  MacPherson, where of  treatments. positive upon  aged  disobeyed will  children  a meditation  they  was  In  were g i v e n  not  chew gum'  were  exposed  essay.  If  50 to  they  an  six  three  to  lunch  behavior  reinforcement,  behavior.  Hohman  instructed  into  first  Lewis,  and  were  children  The  practice  (Kifer,  Candee,  aides  the  decreasing  the  m o d i f i c a t i o n p l u s a punishment  'I  several  supplemented  were e v e n l y d i v i d e d  contingent  ("Write  given  beneficial  behavior  example  behavior  were  p r e d e l i n q u e n t youths  experiment  If children  plus  in  "deviant"  Instruction  were  1974).  an  for  studies  others.  lunchroom  attention  third  and  important  problem-solving.  the  with  write  two  differences  "normal"  promising  Phillips,  modification,  used.  the  1976;  systematic  situations  condition  Shure,  subjects  &  and  &  "deviant"  problem-solving  periods  1971;  which  of S p i v a c k  thirteen.  & Jaeger,  in  number  manage  were  1973,  p r e l i m i n a r y success  Green,  to  Piatt,  1972b,  t h e r e was  in personal  conflict  Spivack,  (Piatt,  second,  training  of  the  clients  1972a,  Essentially there  between  in  research  Shure,  Spivack,  first,  projects  A  & Spivack,  1972;  1976;  conclusions  tions;  Piatt  Spivack, &  solving  1973;  psychiatric  adoles-  praise, second  essay  were  essay [ s i c ]  times"). behavior  disobeyed  In  the  modificathey  were  48  told  t o copy an e s s a y  did  I  do  wrong."  significantly the  aides,  Flick  three  with  three  a  effective  examined  small  hospitalized  group  a  Procedure.  increase  i t s score  cantly  fourth,  stays  group.  successful  taught  group.  alternatives, groups taped  treatment  End P r o b l e m -  c o n t r o l had  than  and  sessions  information  were p r e and p o s t t e s t e d situations.  Problem-Solving The  group  Schmidt  seeking  of  Pro-  signifi-  d i d the w a i t - l i s t (1975)  skills  i n two e l e m e n t a r y  the s e t t i n g  A l l  End P r o b l e m - S o l v i n g  information  In t h r e e  and  control.  d i d the treatment  Hinds,  were  problem-solving  Not o n l y  graders  tasks:  of  eight  There  on t h e Means  Stone,  and f i f t h  three  clients.  post-score  i n the h o s p i t a l  i n teaching  Coche and over  measure.  c h i l d r e n were r a n d o m l y a s s i g n e d  control  behavior.  t h e Means End  t h e Means  was  interruptions of  therapy  t h a t g r o u p and t h e p l a c e b o  shorter  control  on  on "What  condition  and a w a i t - l i s t  p r e and p o s t t e s t  Solving  both  group  psychiatric  control,  had t h e h i g h e s t  cedure,  cognitive  c o n d i t i o n s : the teaching  placebo  as  had d e v i s e d  i n reducing  g r o u p s were a d m i n i s t e r e d  Procedure  144  third  q u a r r e l i n g , and o u t o f s e a t  treatment  skills,  This  more  (1975)  sessions  the experimenters  to e i t h e r  were  to third,  schools. a treatment  the treatment  The or  group  was  seeking,  generation  of  personal  goals.  on t h e i r  responses  An example o f t h e q u e s t i o n s  Both  to video-  asked i s :  a.  How c a n Tommy q e t more i n f o r m a t i o n about h i s problem? Name t h e ways you c a n . (Facts)  b.  How many ways c o u l d Tommy s o l v e h i s p r o b l e m ? Name t h e ways you c a n . (Choices)  49  c.  What c o u l d Tommy do? (Stone,  The  results  frequencies  show  both  effect  solving  alone  Thirty-two randomly  than in  The  to  The  discussion  were  37)  had  and  the  a  higher  group  group  pre-post  The  and  exploratory  groups the  on  a  exception  of  wait  remained  unchanged. equivalent  group  on  and  how  a  pre-post  All  three  satisfaction  with  were  There  old)  was  The  defining  exploring  the  a plan.  The  the  effect anxiety  demonstrated  pencil no  test  their  of  difference with  g r o u p where a n x i e t y  with  two  treatment.  measure,  treatment  seven  desensitiza-  that  and  were  for  biases  group  paper  a  problem-  taught  career  had  indecision.  no  selecting  anxiety  control  or  both.  alternatives,  behaviors.  list  skills  anxiety-manage-  and  was  combination  differences  of  treated  results  the  were:  placebo  was  examined  management  combination  conditions  combination  alternatives,  control  that a  (18-25 y e a r s  groups  generating  decisions.  skills.  group  vocational  five  discussion  employment  reported  of  treatment  goals,  consequences of  between  anxious  problem-solving  problems'and  vocational  p.  anxiety-management  one  anxiety-management  tion.  1975,  problem-solving  undergraduates  three  groups  and  treating  assigned  control  treatment  either  problem-solving,  greater  the  & Schmidt,  S i e s s (1976) d i s c o v e r e d  university  sessions.  The  that  anxiety-management  greater  ment,  Hinds,  in a l l three categories.  Mendonca and of  (Solution)  groups  the level self-  problem-solving  50  Jacobson wait-list marital eight  (1977)  versus  treated  treatment  dissatisfaction. sessions.  interact  contingency  The  contracts.  group  behaved  and  more  satisfied  Finally,  Blechman  solving Turner  game.  Contract and  selection with  an  the  reversal  decreased  with  the  game was  be  by of  not  in  solved.  Clinical  same N=1  training  in  their  spouses. problem-  this  and  Family  and  contingently  beginning The  and  game This  with  the  i s to  end  i s a l l done  Using  the  N=1  that  the  interruptions  had  game, b u t Later,  treatment  also  were  increased  Blechman,  these  reversal  have  by  acceptable  demonstrated  effect.  practitioners  of  therapist.  (1976) were a b l e t o r e p l i c a t e the  other  Halsdorf,  mutually  prompts  the  each  the  i n t r a - f a m i l y problems  insults,  demands o f  written  family  a l l players. a  to  game f o r f a m i l y members  researchers  arguments,  s u b j e c t s , using  solving  to  signed  the  a  effectiveness  game  taught  respective  family interaction  assistance  of  Hellman  eight  The  for  treatment,  Schornagel,  identifying  problem  design  frequency  the  a  agreement  without  when  and  a chain of of  Olson,  seen  develop  toward  devised  to resolve s p e c i f i c  solutions.  reinforces  their  has  the  to  a  reported  was  were  following  game i s a b o a r d  conflict  problem  and  The  i s designed  reducing  with  (1974)  examined  Game.  they  positively  under  couples  group  and  weeks  more  Blechman,  (1976)  treatment  treatment  Nine  couples  All  problem-solve,  treatment were  married  design.  During  positively,  ten  Olson,  results  with  design.  included  packages  problem-  (Haley,  1976;  51  Weiss,  Hops, & P a t t e r s o n ,  strategy using  for  the  Mahoney,  For  of  SCIENCE  example,  obesity  has  (Mahoney,  an  effective  been  developed  1977b;  Mahoney  &  1976b):  S p e c i f y g e n e r a l problem Collect information I d e n t i f y causes or p a t t e r n s Examine o p t i o n s Narrow o p t i o n s and experiment Compare d a t a Extend, r e v i s e , or replace  the  various  develops  stages  additional  thinking, of  treatment  mnemonic  1976a,  S C I E N C E In  the  1973).  of  skills  problem-solving,  like  the  client  s e l f - m o n i t o r i n g , means-ends  evaluation of probable  consequences,  and  rehearsal  options. Mahoney  and  problem-solving because  they  skills,  the tive  and  that but  coping  argue  therapist  aspects  skills  are  as  of  the  from  both  Mahoney  taught  assessment  and  only  fact,  from  the  problem-solving  teaches  the  client  be  a  type  with (1978)  broad  problem  with  results  Arnkoff  strategies  that  the c o g n i t i v e In  and  not  to  opinion  encouraging  therapies.  the more g e n e r a l  such  that  are  yield  approaches,  clients  also  restructuring They  encompass  problem-solving  reported  (1978)  perspectives  also  restructuring the  Arnkoff  coping  cognitive  definition. of  student  approach of  effec-  self-regulation. As  solving  with  approaches  uniqueness. helping  brief  the  The  psychotherapy, allows focus  individual  the  substantial in  research room  problem-solving  discover  and  on  problem-  f o r the  client's  therapy  implement  is  on  whatever  52  adjustment approach and  strategies i s geared  Arnkoff  therapies than  others  extent  enhance  a changing  generalize their  broad  clients  "...  grow w i t h  noted  necessary. personal that  Thus  because  coping  skills,  this  learn  personal  their  independent  environment"  learning  this  type  effectiveness. the they  i n terms o f g e n e r a l i z a b i l i t y .  that  would  toward  (1978)  stress  are  of  Mahoney  problem-solving may  fare  That  adjustment  i s , t o the  skills,  ability  (p. 710).  better  to  they  cope  and  The c l i e n t s c a n  to other problems a t other  times i n  lives. In  summary  i t appears  problem-solving components: direct  (1)  therapies the  assessment;  engaging  clients  identifying  Problems  goals;  the have  teaching  of  data the  support following  broad  coping  (3) e m p h a s i s  on p r o b l e m  to  their  regulate  own  of brief  the  positive  skills;  (2)  definition;  (4)  behavior;  (5)  (6) d e v e l o p i n g a t r e a t m e n t  and s h o r t - c o m i n g s  that  plan.  and p r o b l e m - s o l v i n g  research Below both  the  suggest  of  and  that  of  brief  of c l i e n t  and  psychotherapy mobility  populations  that  from  therapies  that  of events i n  psychotherapy  a l l , Butcher  r e s e a r c h on b r i e f  heterogeneous  short-comings  the sequencing  earlier,  First  and  problem-solving  to a r t i c u l a t e  do n o t o n l y b e c a u s e the  of problems  the  As m e n t i o n e d  i t s problems.  cautioned to  brief  t h e need  therapy. has  is a listing  research  Koss  ( 1 978)  is difficult  but a l s o frequent  because brief  53  treatment easily  centers.  permit  difficult fit  client the  research  into  seen.  with  the  review  were  not  not  existing the  In  employed  the  therapies  type  of  cautioned  that  most  of  p s y c h o t h e r a p y . has  been  i t i s often  problem-solving have  Arnkoff,  fied  the  done  to permit There and  for a  for  the  most  and  plagued In  their  groups  were  control  group  important,  to d e l i n e a t e the  operations  further  of  two  is.  to  the  the of  examination  criticized  reasons. and  examine  and/or  First, sound  what  Consequently,  the  p r o b i em-so 1 v i n g  (1978)  specific  Second,  therapeutic  groups.  control  perhaps  Arnkoff  internal  1978).  that  review  difficult  therapy  poor  control  with  impossible.  and  lack  is  the  procedures  extensive  research  population  specifications  concerned  follow-up  Mahoney  not  not  out  i f not  does  do  T h i r d , and  difficult, their  solving  or  making  problem-solving  brief  of  outcome s t u d i e s f a i l  literature,  &  sample  reviewers  pointed  specified.  extremely  result  the  population  heterogeneous  designs  outcomes  authors  process,  model;  A  problems a s s o c i a t e d with the  either  research  on  client  because  Second,  research  mobile  follow-up.  to  neatly  A  the  external  procedures.  This  problem-  theoretical  the  domain  of  s t u d i e s which  validity  researchers  the  have  (Mahoney  not  speci-  u l t i m a t e l y must  be  replication.  seems  to  be  a  problem-solving  natural  compatibility  psychotherapies.  between It  should  the be  54  possible  to  combine  specifically standardized process  the  defined f o r use  should  2.  limited  3.  conversation  4.  direct  5.  rapid early  , 6.  therapeutic  7. prompt  each  approach  procedures  "in vivo"  which  clinical  into  could  a be  setting.  This  for  centered  i n the  present,  t h e r a p i s t management, assessment, flexibility,  intervention, of  a facilitative  10.  appropriate  11.  emphasis plans  therapy,  goals,  8. v e n t i l a t i o n  an  of  from  include:  a time l i m i t  12.  set  i n an  1.  9.  strengths  emotion, interpersonal relationship,  client  on  problem  to achieve  active  selection, definition,  the  goals,  and  goals,  therapist  using  direct  assessment  strateg ies.  H i s t o r i c a l Development of  Mention important  has  the  lives, been no  to or  made  earlier  identification  of  therapies.  The  problem-solving helpful  been  the G o a l A t t a i n m e n t  instruct exert  people  self  explicitly  as  goals  this are  to  literature  t o how  control.  in  they  However,  d e t a i l e d process  can as  Scale  chapter both  of  how  brief  and  suggests  it  regulate yet  to accomplish  there this.  is  their has  55  An  instrument  Attainment has  been  itself. the  Scale, shown  t o measure has  to  been  success of  possess  therapy  and  a process that  Attainment  Scale.  Theoretical  does,  and  and  outcome o f  Sherman  therapeutic  properties  Scale attempts  t o measure  might  prove  i s i n part developed  (1968) were  the m e n t a l  Mental  Health  Attainment  health  Service.  Scale.  charged  enterprise  Their  I t was  helpful from  at  from  the  and  They  dynamic  strive level  to of  upon  psychology  reach  some  aspiration  Festinger, actual  drew  and  Sears  performance  expectations.  of  by  (1969) who  developed  unique  the  indicate  end.  They  the  studies  of  the  (1965)  which  a  s u b j e c t to and  Sherman  attainment  achievement.  subject  in  the  area  the  hoped-for were  also Winter  measure  p r o g r e s s towards a s e t o f g o a l s t h a t  f o r each  the  Dembo,  s t u d i e s o f M c C l e l l a n d and a goal  people  compared his  of  the  following  upon  Lewin,  Goal  Hennepin  i s called  that  relied  to  measuring  schools of motivation  which  Kiresuk  influenced  determine  the  have  scale  with  solution  developed  way,  sources: 1.  Goal  instrument  in a preliminary  i t  the  that  u n d e r p i n n i n g s o f the g o a l a t t a i n m e n t  Kiresuk  Goal  some  properties,  articulate  County  developed,  S i n c e the Goal Attainment  psychotherapeutic  the  t h e r a p e u t i c outcome,  to was  economic  2. Cowle  Kiresuk (1971,  and  1972)  Sherman  who  were  employed  a  objectives  approach  Essentially  mangement-by-objectives  identified  goals,  to  and  influenced  management-by-  personal  a  by  management. presses  measurement  of  for their  a c h i evernent. 3. Ullman and  Kiresuk and  Krasner  Krasner  current ioral felt  problem  that be  (1965)  list  of  Ullman  of  of  the  Kiresuk  the  behav-  and  this  of  Sherman procedure  behavioral goals  in a  goal  format.  K i r e s u k and  Sherman  and  behavior  is a function  Mitchell  consequences  consequences. requires  work  documentation  extension  these  the  important.  achieved.  Pollard  or  was  specification  natural  to  believed  careful  and  t o be  a  attainment 4.  Sherman  required  change  would  and  and Thus  defining  drew upon  (1972) of  which  t h e work o f stated  the p r o b a b i l i t y  the  importance  the  Goal  expected  that  outcomes of  these  Attainment  Scale  levels  of  therapeutic  outcome. 5. (1966) or  who  of  and  stated  therapist  field that  Kiresuk  Sherman  that  uniformity  therapy  and  Sherman  on  assumptions  were  research.  general principles  Kiresuk  any  relied  of  fallacies  While  of behavior  (1968) a t t e m p t e d  Kiesler client in  the  also  believing  are  important,  t o honor  both  57  the  idiosyncratic  their  The  goal  attainment  The  Goal  following before  evaluation  manner.  a realistic  For  each  upon  an  goal,  a staff  i n that  a  Each  the c l i e n t individual  t o most  with  zero  1968,  tially  client,  directly  client's  goal  possible  outcome  possible  outcomes  may  an  with  once  observer  respect  [sic]" are to  a defined to  "less  determine  t o which  the  t o which  t o each  goal.  transformation  a random v a r i a b l e (Kiresuk  & Sherman,  specific  t o an  possible  outcome,  poten-  goal.  For  the c l i e n t  example,  on m o t h e r " ,  to school".  with  with  Writing  i s important  who h a s had no c o n t a c t  goal.  unfamiliar  be  dependency  "a r e t u r n  level  decided  whichever i s  can determine  i n terms o f e v e n t s  worker  to this  be  being  follow-up  tionship  that  scales  related  outcomes  i s also  i s t o be "a j u d g m e n t a l  with  decides  The s c a l e s a r e t o be p r e c i s e  the c l i e n t  These  and  f o r the c l i e n t .  o r the c l i e n t ,  so  and v a r i a n c e  process,  probable  favorable  has p r o g r e s s e d  477 ).  individual  goals of  i n the  selector  outcome, i n t o a p p r o x i m a t e l y  mean  p.  and  scale  therapeutic  in  outlined  the goal  scale  member  be  screening  health  institution.  the treatment  level  may  initial  s e t o f mental  o b j e c t i v e l y described  with  of  Scale  to treatment,  the l e a s t  by e i t h e r  customary and  After  specified from  traditions  system.  Attainment  upon  nomothetic  scale  assignment  ranging  and  a a  the  so t h a t a  the c l i e n t can  has advanced  in rela-  58  Kiresuk  and Sherman  goal  b u t no maximum  goal  might  problems  be  Kiresuk reflect  an  Sherman  the c l i n i c a l  Therapeutic after  assess Score  of  o f expected  unfavorable"  outcomes;  across  and  a l l goals  Attainment  They  found  Goal  Attainment  scaling  process  unit.  i s called  composite  who  Goal  t o the  can then Attainment  c a n be a s s e s s e d  Attainment  (1) a  o f weights  favorable"; (5) a  of goals,  irrespec-  Scale  has t h e  set of goals  f o r an  f o r these  goals  goals;  ranging  from  (3) a "most  (4) a f o l l o w - u p s c o r i n g o f  score  summarizing  t h e outcome  ( K i r e s u k , 1973).  Mauger, A u d e t t e , Goal  their  personnel,  outcomes f o r t h e s e  t o "most  t h e number  or  offered.  t h e Goal  (2) ,a s y s t e m  explicit  or vocational  t h e case  outcome  characteristics:  individual;  these  then,  have  t o be a d m i n i s t e r e d , and  unit  o f the type o f treatment  following  the  i s then  one  i s t h a t one  o f the treatment  interval,  so t h a t  who  dilemma,  t o have  realities  at least  rationale  clients  A standardized  Essentially,  set  hoped  the follow-up  i s derived  tive  with  treatment  progress.  Their  By n o t l i m i t i n g  a predetermined  attention  recommended  environmental  concerns. and  number.  sufficient  like  financial  (1968)  S i m o n i n i , and S t o l b e r g Scale  a correlation  against  for different  .70  after  Reliability  follow-up raters  two months,  t h e MMPI  for validity.  o f .30 between MMPI s c o r e s and t h e  Scale ratings.  .71  (1974) a n a l y z e d  and  was f o u n d  in initial  .47 a f t e r  goal  s i x months  t o be  setting, (Garwick,  59 1974a).  The  reported  two  week  test-retest  a s .57 (Sherman, B a x t e r , & A u d e t t e ,  Development o f the g o a l a t t a i n m e n t In itself  1974, Smith possessed  that  Goal  also  later  (1974, who  of  Scaling  reported  by C a l s y n  evaluated  a treatment  qroup  group  instruments Inventorv,  he  employinq  the Goal the Goal  When used  in this  o l d ) , Smith  psychotherapeutic qoals.  between  Attainment  Scale  the Goal were  Attainment way w i t h showed  He Scale  properties  Goal  S c a l e , and a Scale.  The  Orientation  o f f u n c t i o n i n g on  concluded  that  in individual  when  psycho-  itself therapeutic.  white  adolescents  Attainment  beyond  scores  of Control Scale, a  S c a l e was  suburban that  test  Personal  S c a l e , and t h e l e v e l Sheet.  Smith  individuals  Attainment  the  was  i n t h e r a p y and  Attainment  Attainment  This notion  (1978).  using the Goal  Assessment  therapy,  years  and D a v i d s o n  t h e N o r w i c k i - S t r i c k l a n d Locus  Outcome  Scale  had a t h e r a p e u t i c i m p a c t  was between  employed  Consumer S a t i s f a c t i o n the  Attainment  H i s comparison  not using  been  as t h e r a p y  the Goal  the d i f f e r e n c e  the Goal  had n o t .  treatment  that  Attainment  1976)  who  alleged  scale  has  1974).  psychotherapeutic properties.  had c o m p l e t e d  those  reliability  (13-17  Scalinq  t h e measurement  had of  60  Integration  A ture  review  showed  o f the l i m i t e d  that  Smith  Goal  (1974,  Attainment  1976) has been  Scale  litera-  able to explore  the p s y c h o t h e r a p e u t i c p r o p e r t i e s o f the i n s t r u m e n t . research  touched  on the i d e a  o f the measuring  therapeutic  (Greenberg  S> C l a r k e ,  question  as  t o whether  the Goal  expanded  into  From  a  ah a c t u a l review  psychotherapy, Attainment these  psychotherapy explicit brief  the  areas  into  seemed  treatment  a  the  I t would  u s i n g Goal Attainment  could  discussing  would  and  beneficial specified  possible.  process that  l e d to the  Scale  therapy,  clearly  entirely  as  be  process.  literature  integrating  psychotherapy.  nature,  therapeutic  instrument  This  Attainment  problem-solving  Scale,  three  of  1979 ).  Smith's  It  be aimed  brief  the  Goal  aspects  of  procedure  of  would  an  be  at c l i e n t s of  be o f a b r o a d p r o b l e m - s o l v i n g Scaling  as a m o d e l .  61  CHAPTER I I I  DEVELOPMENT  The  GASP  jointly  identify  procedure  1.  The GASP  procedure  procedure  whereby  the  involves  instructions  board,  is a  OF THE GASP  expected  14  steps,  client  outcome  listed  Obtain  a  room  with  chairs  of  below  t o be g i v e n t o p a r t i c i p a t i n g  and  therapist  therapy. in  the  The  form  of  therapists:  f o r everyone,  a  black-  and c h a l k .  2.  Introduce  new  members,  staff,  and  clients,  to the  commun i t y . 3.  Inform  new  either  by  them.  The p u r p o s e a.  telling  To  members  them  directly  goals  accomplished  b.  c.  4. before  To  the  purpose  o r by h a v i n g  for this  within  to solve  l e t the group  the  hospital.  To  inform  the  GASP,  a client  the  two  hospitalization  weeks.  It  a l l the c l i e n t ' s  tell  know  what  community  of  what  i s working  community  can s u p p o r t  the c l i e n t .  with  a new  remaining client.  i s n o t an  brings the person  the person  C o m p l e t e any t o p i c s  t o be  difficulties.  behaviors  starting  of  i s threefold:  identify  attempt  of  from  This  on  goals so  that  to  and the  t h e p r e v i o u s day i s a standardized  62  process most  to  be  clients  frame.  will  topics 5.  Ask  other  to  the 6.  the  q o a l s ; i f no  the  events  are  assist  probes  The  process  and  with  one  "events"  at  would  the  is  up  to t h i s  t o be  written  on  the  a.  idiosyncracies, to  like  finish  t o work  volunteers, identify  leading  be  time  client.  who  individual  client  expected  this  I t i s proper  a new  clients  is  within  therapist  events  the  may  this  It  a  on  person  procedure.  word  blackboard.  minutes.  more t i m e .  are  f o c u s f o r the  cipitating  To  require  i f there  Write  60  to c l i e n t  before startinq  their be  may  within  complete  However, due  some c l i e n t s all  completed  to  left  corner  enumerate  the  hospitalization.  board  in developing  top  by  this  the  staff  list,  the  of  preThese  person. following  helpful: What  b r i n g s you  to  the  hospital  at  this  time? b.  What  has  during c.  The to  Why  of  why  this  the  Meichenbaum understand  on  the  clients  i s seeking  treatment  client  that  situation.  blackboard  (1975). the  s i x months?  i s f o r the  their  events  nature  He of  life  list  are  these  your  now?  F u r t h e r , i t i s hoped present  in  here  time. in  happening  the p a s t  a r e you  purpose  understand  been  clients The  will  see  rationale  has  been  best  suggested  that  i t is  the  client's  and  in  staff  at why  this they  listing  articulated important  presenting  by to  problems  63  and  t o f o r m u l a t e an i n i t i a l  client's  anxiety  about  h i s or  Later  i n the p r o c e s s ,  along  with  the t h e r a p i s t  make  this  formulation  client  plan.  her  community  In t h i s  situation  members  7. column  Write  assist  group  members,  i s , t o understand  on t h e b o a r d .  feelings  s/he  following  probes a.  b.  had  written  of  t h i n g s happened?  client  is  Suggestions  felt  your  d i d you  feelings  which  event  different  feel  like  o f the next  t o recount the occurred.  The  f e e l i n g s 'as  when  to  the  client  "such  expresses  When t h e c l i e n t  and  events  accept  are  or  reject  these  are  be  to  t o be  the l i s t i s  members  had happened  accepted  are  believes  t o ask t h e g r o u p  i f these  free  some s e n s e o f  happened?  i t i s proper  have  the  used:  these  on t h e b o a r d .  complete,  To  happened.  i s now  previous  were  the  client  including  a t t h e head  What  What  what  individual  the  may be  such" All  "feelings"  The  as  the  i n the f o r m u l a t i o n o f g o a l s . the  t h e word  way t h e  i s lessened.  and t h e t h e r a p i s t , must be a b l e t o make  the b e h a v i o r , t h a t  might  treatment  what  they  t o them.  The  suggestions.  written  on t h e  blackboard. The  purpose  of  exercise  assists  both  standing  the c l i e n t .  helps  the c l i e n t  ceptualization  this  step  the c l i e n t  i s twofold. and  Second, having  explore  and  o f the problem  First,  the group  o t h e r s suggest  consolidate h i s or (Meichenbaum,  1975).  in  the  under-  feelings her  con-  64  helps  the c l i e n t  ceptualization 8. This  t h e word  exercise,  as  individual's  is.  thev are  i n the next  client  con-  1975).  indicates,  The  b.  What do o t h e r s  c.  You  have so  column.  focuses  may  be  on t h e  asked  the  say they  this  crisis?  you  think  for this  will  Next,  perceive t o be  exercisinq  realize  container  you?  have  you  q e t you  t o what that  to  through  i s t o permit he o r s h e  already  he o r she d o e s  possess  and t h a t he o r s h e i s n o t  be  filled  by  whatever  t h e community the c l i e n t ' s  editorial  on  members  strenqths the board  prerogative.  a r e asked  the  t o be.  T h e s e comments  without The  t o s a y what  the  reason  client's here  threefold: a.  the  can o f f e r .  transcribed an  about how  concentration  as addinq  should  empty  like  "x" y e a r s ;  a t t r i b u t e s and q u a l i t i e s an  yourself?  long?  do  rationale  about  lived  What  hospitalization 9.  caption  What do y o u l i k e  The c l i e n t  merely  (Meichenbaum,  a.  t o see therapy  positive  h i s or her  questions:  d.  client  the  consolidate  "strenqths"  strenqths.  lived  The  and  o f the problem  Write  followinq  explore  To d i r e c t themselves be  t h e members o f t h e g r o u p t o s e e i n some way  empathic with  similar  t o and t o  a n o t h e r human b e i n g ;  to  is  65  c.  To  10. W r i t e of  the  what  next  he  client  the  word  column.  or  may  induce group  she be  a.  by  Here, possible  areas the again,  by  problems list,  the  informed  list  to  no  two  goal  to  goal  i s , the  goal.  client  be  For  feelings"  of  had  the  As  you  have  is  to  it  four  be.  The  have  described,  their  developed?  of  as  desirable  i f they  that  about.  t h e n be  goals  perhaps  even  that The  the  more be  goal than  to "to  such  work  client  get  t o make  client  on  for  i t is  in  touch  " t o e x p r e s s my  the  each  specific  levels  is  helpful  perceives  behaviorally write  a  to f o c u s . The  identified,  By will  in a position  will  as  clients  With  the board. s/he  fully  problems.  difficulties,  thought  i t will the  do  a r e asked  list  hoped  g o a l s are  alleviating.  is less  list  to  participate  is  will  problems  example,  i s to  say you  community  " g o a l s " on  the  easier  head  d o e s not r e c o g n i z e .  not  client  than  the  questions:  would  comprehensive  the word  more  off  problems  c h o i c e r e g a r d i n g g o a l s on which  weeks.  check  at  client  p a t t e r n as h a v i n g  areas,  they  12. W r i t e  next  her  following  what  any  greater cognizance  complete  to  at  a  problem  board  the  a r e a s you  everyone  creating  identifying  a more  or  the  the  point  N e x t , the o t h e r s i n the  problem  some  see  on  with?  Looking you  gain  his  What a r e t h e  b.  see  this  assumes  problems  11.  "problem"  At  assisted  cohesion.  for with  anger."  a  that my  66  13. W r i t e on  the  staff in  the  board. member  at each  Clients in  success,  will  specifying  i  s t  level  reasonably The  of  require  what  n  -^2_,  the  0,  +1_,  +2",  assistance of  behaviors  they  will  the  engage  level.  L e v e l 2_ expected  levels  least  e  of  hope  more t h a n  n  expected  success  to  attain  expected  outcome.  ^J_;  is  within  level  what  the  The the  less-thanclient  hospitalization  of success  i s +J_, and  +_2  can i s _0.  i s the  most d e s i r e d outcome. In range  order  and  control  l e v e l ^J_, "express  the my  as  client,  "What  the  then  an  to  understand  of behavior,  the  less-than-expected i s used  example. are  client  the 2I.  s/he  over cell  now  now  of the  "never  with  The  goal  of  this  remainder  begins  to  her  the  express  by  asking this  anger - b u i l d  anger  the  goal?"  therapist my  their  start  success.  h i s or  issues,  clearly  will  in relation  lets  minor with  level  therapist  doing  more  therapist  throughout  The  you  says  "explodes"  complete  clients  anger"  section  If  for  up  should  except  to  explode." It of  may  success  the  case;  with  should the  flexible  anticipated  is  as to  clients  unfavorable identify  that be  client  the ^ J . l e v e l ,  much more  not  occur  the  the  in can  client  the  ^_  than  rigid  will as ^_  cell.  always  i t i s hoped  thinks  had  level.  This  initial i s never  become w o r s e . that  he  or  experience  they  the  the  client  she  is.  their  thought. "What  By will  level to  be  beginning see  how  Further,  i t is  c o n d i t i o n as  being  The  would  you  next be  movement doing  if  67  you  became  goal  of  this  level  is  expressing  "attempt  an  appropriate  angry  might  be  feelings,  "never  the  client  would  be  and  doing  the  With  the  possibilities  for  angry  therapist  i n order  feelings",  Finally,  +2  levels,  the  more-than-expected  expressing  For  two  example,  anger  may  will  or  the  the  client  the  what  expected  a s c e r t a i n the  and  the  have  identify  reach  0^.  expected.  the  to  success,  of  two  express  of  outcome  question.  suicide."  Now client  worse?"  most who  the level  +1_  and  favorable  has  following  the  goal  levels  of  success: -2  Attempt  -1  Express  0  List and  suicide. anger o n l y  each the  +1  Share  +2  Have  time  in explosive  I  feel  angry,  manner. the  situation,  reason.  the a  list  with  meeting  hospital  to  share  community. the  list  with  my  family. 14.  Once  a  week  ask  community  goals  and  their  goal  levels  which  they  think  they  are.  to  give  the  client's  receive ence  feedback  to  self  to  say  The  about whether  perception.  and  they why.  their they (See  to other  whether  perception  information  group  client's  as  and  members identify  read  the  community agree In  in  or this  behavior are  to  and  level  on  members  disagree way have  agreement  Appendix A  their  f o r an  are with  clients a  refer-  with  the  example  of  68  the  process.  Appendix  The fied  For  GASP  care  includes i n Chapter  in their  potential  referred  a broad  by to  the the  most  intervention  i s begun  of  definition,  goals,  o f stay  t h e r a p i s t must be a c t i v e l y  ing  information.  present,  There  with  This  necessitate  birth  engineered tion order  the  clients t o begin  what  are going  listing  to give  an  client  is  facility.  are told  emphasis  that  early  24 h o u r s o f  on  that  problem o f what  i s the average  t o use t h e GASP,  questions nor time,  that  and  solicit-  f o r passive,  the process  of  an  o r dreams.  h a s happened  event  This now  to r e c t i f y  ventilation  will  in be  up t o t h e h o s p i t a l i z a t i o n .  no a t t e n t i o n w i l l  to take  has  t o keep t h e c o n v e r s a t i o n  leading  e a r l y memories,  to assess  asking  part  the  within  In o r d e r  i s informed  the events  After  (2) an e s t i m a t e  i s no room,  b u t f o r t h e most  order,  and  In o r d e r  the c l i e n t  concerned may  (1) an  a t the h o s p i t a l .  listening.  identi-  increasing the  clients  i n two weeks, s i n c e  the  reflective  promptly  i s :  and p l a n s ,  be a c c o m p l i s h e d  earlier,  see  s k i l l s are  treatment  GASP s e s s i o n  t h e GASP  thus  psychiatrist,  appropriate  the  purpose  components  flexibility.  admitting  At the f i r s t  the  scales,  group o f treatment  psychiatric staff,  admittance.  length  completed  I I . The h o s p i t a l a d m i n i s t r a t i o n  f o r therapeutic  assessment  can  of  a l l the important  t o see t h a t  represented  Clinical  example  B.)  earlier  taken  an  s i x months be g i v e n is a  and what  process direc-  the problem.  to emotions,  to  In  the issue o f  69  the c l i e n t ' s believed plans,  feelings  that  the  by  i s addressed  assisting  clients  would  clients  find  this  Implementation  Need  f o r cohesive treatment In  General with and unit  April  of  Hospital  the  offer  cohesion  within  suggested  such and  suggestion sibility  of  individual  explore  training  He  other  the  the n e x t the  with  i n f o r m a t i o n gained  author.  about  The  Spring  of  from  head  to  gained  in  was  he  met  nurse,  treatment  the  the  need  for  treatment  and  from  employing  Scale.  given  the  That respon-  i t s implementation  scale  for  1975,  clients the  and  i t s adaptation  to  staff  became s k i l l e d  at  in  one-to-one  therapists'  sought  S c a l e from the  author  o p i n i o n s and every  staff  again  met  settings.  o b s e r v a t i o n s and  t h e o n e - t o - o n e p r o c e s s was  author  the Goal A t t a i n m e n t the  director,  Attainment  t w e l v e months the  goals  recommendations the  later  author  staff  Valley  clients.  developing The  be  by  A month  additional  (1968) G o a l and  helpful.  employed  therapeutic  could  A d o p t i o n of the goal attainment group therapy Over  was  pointed  client's  adopted  their  o f t h e GASP  medical  clients.  Sherman's was  to  cohesion  i t is  articulate  relationship  author  unit's  each  Finally,  approach  the  psychologist  could  to  as a p s y c h o t h e r a p i s t .  psychiatric  staff  Kiresuk  1974,  directly.  shared  comments  member. with  the  with about  Then, i n medical  70  director, request  the that  head the  nurse,  noted  that while  was  being  done e f f e c t i v e l y ,  staff  clients.  the  members  of  a  the  It  Attainment  (Kiresuk  f o r the  the  context  the  belief  offered forms  comment the  a  group the  on  and  group:  clients  to  This  h o s p i t a l ' s philosophy  monitored  this  in  group.  on  the  monthly  staff  opinions  of  improved.  By  the  The  was  goals  Spring  inary  e v a l u a t i o n of  three  years.  The  to the  1 976,  GASP a s was  could  be  the of Goal  bene-  the  for  economical,  the  each was  opted  to  other's  other  goals  the  staff  daily  the  how  end  developed  sitting  shared  result The  conduct over  standardized  of  be this  hospital  the the  in  in  their  i t could  GASP. and  with author  expressed  and  of and  a l s o congruent Again  in (b)  advantage  i n f o r m a t i o n was  the  as  the  i n g r o u p s by  standardize  process  had  process,  of  in  that  similar  openness.  where  identified  author  purpose  a n a l y s i s of  group  the  about  of goals  meetings  the  development requested  formation  more  (c)  of  instruct  openness  change was  experience  know  last  1968)  goals  efficient.  belief  author  was  and  of  to  with  It  i f i t were done i n  This  learning  therapy,  them.  unit  (a)  not  i t took  Sherman,  the  scaling  expressed  the  to  modified.  was  community, to  &  be  and  time  had  therapy.  vicarious  of  enabling  group  that  a  seemed  clients  of  the  psychologist  goals  procedure  unit  communication.  ficial  the  therapeutic  Scale  of  staff  identification  resented  Moreover,  philosophy  the  identification  was  Other  and  prelimprevious  October  of  71 1976.  In  tracted  April  with  whether  of  the  1977  the  author  for  hospitalization  psychiatric  unit  was  hospital a  in  more  six  administration  month  Valley  evaluation  General  beneficial  con-  with  as  to  Hospital's  or  without  the  Hospital  was  GASP.  Psychiatric  Unit,  Valley  General  Hospital  Purpose The opened  psychiatric in  1974.  facility  in  of  The  designed  population  end  as  an  the  end  the of  established  which  other  who  mental  mental  of  the  second  stable  and  standardized  of  w h i c h was  the  of  year of  GASP.  such  as  unit  Hospital  was  these  other  its  target and  was  programs.  professionals  treatment  abuse,  long-term  treatment  resource  operation,  and  identified  t w e l v e months o f  health  specialized  with  for  County,  alcohol  General  overlap  treatment  King  arson),  Valley  treatment  health  of  facilities  (assault,  or  its first  short-term  portion  volunteered  other  a  private  psychiatric  anyone for  unit  General  as  problems  duplicate  The  suitable By  to  and  particular  to  facilities.  was  southern  psychiatric not  Valley  serve  abuse, v i o l e n t b e h a v i o r  care.  not  the  at  to  Other p u b l i c  treatment  drug  I t was  for  Washington.  unit  the  in  the  an  was  it  community  turned.  unit  program,  operation,  By  the  offering  integral  a  part  72  CIientele The crisis  unit  treats  and b e l i e v e  people  they  who  need  help.  outside  the h o s p i t a l f o r therapy  chosen,  after  consulting  admit  themselves  period  o f time.  They  the approval  as  admitting  any  time  they they  The  length  mean  1974  to  occasion in  health  that  psychiatrist.  1976  was  regardless  after  only  12.4  i n order  of  reason  with  the therapy  short-term  Treatment  therapist  share access  General  Hospital  orientation.  may  likely  advice,  or  others.  Hospital  persons  leave  during  d i d leave  the l e n g t h i t may  on  of stay  be t h e o n l y  t o have.  be s p e c i f i c a l l y  For that geared  to  each  client  Treatment  regarding  information  does  n o t have  a  primary-  No one t h e r a p i s t works e x c l u s i v e l y  Rather,  therapist.  information to  must  as w e l l  the medical  Whatever  a r e ever  provided  they  they  philosophy  one c l i e n t .  every  they  to  treatment.  Valley  with  therapy  community  General  but  a few d a y s .  to leave  to themselves  at V a l l e y days,  have  practitioner,  However,  are not dangerous  see someone  f o r a short, self-defined  o f the t h e r a p e u t i c  o f stay  could  part, i n  a week, b u t t h e y  t h e p s y c h i a t r i c u n i t , f o r many p e o p l e  contact  of  a mental  are t o l d  desire,  provided  They  once  t o the h o s p i t a l  must have their  a r e f o r t h e most  i s the r e s p o n s i b i l i t y  i s very  the c l i e n t s ,  about  h i s or  open.  The  and each  h e r own  staff  c l i e n t has  case  during  73  "chart  group",  staff's  the time  remarks  i n o n e ' s own  Introduction  o f GASP  Between  October  the  administer  There  were  t h e GASP  10 p s y c h i a t r i c  staff.  was  p r e s e n t a t a l l 40 these  at  at  Due  trial  least  conducted  meeting  1976, t h e a u t h o r  runs. two  times  These meetings was  The  outline  session  sitting that  presented  concluded  i n on t h e i r  meetings  discussed sessions  over  individual these  reiterated. detail step.  was By  8,  progress times,  o f how  weeks)  week.  was p r e s e n t The  each.  important  author  the  GASP  At the f i r s t element  They were t h e n g i v e n  t h e 14-  the  that  weekly  of  training  feedback  of  t h e end o f t h e s e v e n t h  be  on  be At  their  Agenda) .  attention  as the r a t i o n a l e session  would  uniformity  perception of others'  d i s c u s s e d as w e l l  would  sessions.  for Training  importance  chapter.  t h e GASP a n d  problems  received C  this  the author  employed  staff's  (See A p p e n d i x the  f o r eight  this  the s t a f f  too,  member  member  at the beginning  seven  then.  staff  standardize  were 50 m i n u t e s  and  The s t a f f ' s also  per  s e s s i o n s as they  the next  2 through  staff  to  by mentioning  h i s observations  hospitalized  p e r week  trials  informed  a t the h o s p i t a l  not every  every  these  trained  and 10 p s y c h o t h e r a p i s t s on  rotation,  However  weekly  the s t a f f  nurses  (five  of  nurses  the c l i e n t s  u n i f o r m i t y was t o r e s e a r c h .  point  At  to s t a f f  eight  process.  to  day f o r r e a d i n g t h e  chart.  and November,  the  of  each  p s y c h o t h e r a p i s t s and p s y c h i a t r i c  to  of  set aside  was to  f o r each  a l lstaff  could  74  conduct staff  t h e GASP  from  discussed  process,  cues  and s h a r e d  Problems presented Interesting standardized.  be  therapists This the  had  developed  feelings  took  accomplished.  I t was  away from  had  remember t h e experience.  frame  t h e GASP was there  were  i n which  necessary  being  initial  the goals  to direct  the  global,  all-encompassing  life  was n o t g o i n g  t o be an a t t e m p t  to solve a l l  problems. be  this  when  shape,  the t i m e  could  about  to  session, the  when s t a n d a r d i z i n g  concerning  client's  brevity  their  At the e i g h t h  problems developed  experience  what  they  As t h e GASP  discrepancies should  memory.  Rather  accomplished  other  the p r o c e s s i n two  ramifications  was t o f o c u s  weeks.  which  changes.  The  will  upon  issue  be  of  addressed  later. Another focus  upon b e h a v i o r .  diverse, "best" was  problematic  i t was  ficulty  by  to  changes  changing  because  their  like  also  opening  they  behavior.  "talking  with  were  f o r the  The i s s u e o f b e h a v i o r experienced  the  how much e a s i e r  and what d i f f i c u l t y  This  t o observe  a forum  to  dif-  t h a t were n o t f o c u s e d o n  discovered  i n behavior,  i t i s easier  something  when  g o a l s and l e v e l s  The s t a f f  the s t a f f  therapeutic orientations  to avoid  the s t a f f  behavior.  had  to direct  school o f therapy.  of writing  observe  was  As t h e i r  important  or " r i g h t "  accepted  area  i n part  and a g r e e  people"  c o n s e n s u s t h a t someone i s " n o t g e t t i n g  might  i t was clients  have  been  someone i s d o i n g  than angry".  i t i s to  have  As m e n t i o n e d  75  above was  i t was n e c e s s a r y t o remind  t o f o c u s on what  The  importance  within  It  consolidating  GASP  i s open-ended  i n terms o f c o n t e n t . requires  therapist  One  way  must  this  was  brief.  Rather  than  examine  purpose  i s to create o f the p r e v i o u s  speeded  mentioned. that  these  lists  Finally, client a  wanted  t o make  the  of  rather  the s t a f f  forcing than  agenda.  o f the t h e r a p i s t . tightly.  listing  "Events"  of  whole  of  the  feelings  t o remind  life,  the  significant  The p r o c e s s  the c l i e n t ' s  noticed  what  staff  with  the concern  an o c c a s i o n a l  the c l i e n t  therapist  Stability  was  could  also  as they a r e  the t h e r a p i s t s  was c o n d u c t e d .  problem  "Goals".  to accept  what  wanted.  encouraged  when a  There the  was  staff  In an i n s t a n c e to  consult  other  and t h e n d e c i d e how t o p r o c e e d .  and I n t e g r i t y  t h e GASP had been  switched  a varied  the s e s s i o n  outline  the c l i e n t  the  clients  time  were n o t t o be e x h a u s t i v e , b u t o v e r v i e w s .  this  After  leaders'  t o membership b u t  the c l i e n t ' s  i t was i m p o r t a n t  like  tion  regard  would n o t o r c o u l d n o t a r t i c u l a t e  feeling  process  i n two weeks.  group  on the p a r t  rough  this  apparent.  s i x months.  up by l i s t i n g Again,  the  with  role  t o do  events  accomplish  therefore structure  a  that  I t d o e s n o t have  a more a c t i v e  The  be  could  t h e p r o c e s s a l s o became  The not  of  clients  the s t a f f  o f GASP  adopted,  I t was i m p o r t a n t  their  goals  Goals  a qualitative  evalua-  t o know w h e t h e r o r n o t  as a r e s u l t  of this  process.  76  If  clients  know  i f the goal  changed would  their  goals,  d i r e c t i o n s had been  in either  kind  or d i r e c t i o n ,  i t was  important  altered.  to  I f the g o a l s  the subsequent  results  be m e a n i n g l e s s . An  and  d i d n o t change  examination  those  identified  independent following  among  during  therapists  among  (1955) the  classified self,  raters  was  upon  with  the  admission  goals  There regard  was to  the  and work.  through a  Three  into  family, friends,  established  coefficient.  therapists  identified  t h e GASP was u n d e r t a k e n .  four categories:  Reliability Scott's  o f the g o a l s  .995  use  of  agreement  assignment  to  goal  identified  upon  category. It  was  admission, GASP. the  ascertained 90 p e r c e n t  A l l o f these  same  were  goals  direction  admission.  that,  as  The g o a l s  i n t h e same c a t e g o r y  identified  those  had  first  p u r p o s e s were  was  preceding  section.  comparative tion the  the GASP were i n  by  the c l i e n t s  t h e GASP  i n the present  o f t h e GASP  The second  GASP.  In  the  as  the  GASP  compared  referred  study.  as d e s c r i b e d  was t o c o n d u c t  following  is  at  Evaluation  to  as  the  i n the  hospitaliza-  to h o s p i t a l i z a t i o n discussion,  The  an e x p l o r a t o r y  e v a l u a t i o n o f the e f f e c t i v e n e s s o f  with  without  identified  addressed  the development  during  during the  stability.  Comparative  Two  o f the g o a l s  without  hospitalization non-equivalent  77  control  group.  sections  corresponding  evaluation  This  to  Initial control  control  to c o n t r o l  analysis for  of  divided  into  hypotheses,  two  and  five  First,  treatment  c o n d i t i o n ; and  t o o n l y one  issues  the  ward  environmental  reasons.  the  two  was  hypotheses.  Hypotheses r e l a t e d  to  evaluation  there  ward.  was  non-equivalent  press. a  lack  second,  These  two  control  atmosphere This of  was  random  hospital  reasons groups  was done  for  two  assignment  size  meant  performed  was  limited  t h a t the GASP  could  not  run  behaviors  the  clients  to  and  concurrent-  ly. Normal m o n i t o r i n g in  during  simple  the  part  press tain ently  GASP  monitoring  counter the  the  as  of  effect the  between  conducted. subscales of  of of  performed overt  any  by  the  client  the  times  but  i t was  behaviors  covert  For  the  The  the  was  staff.  perceived  whether  of  behaviors  that  reason,  clients perceived  was  press  t h e Ward Atmosphere  decided  not and  the  was  Scale:  a.  Involvement  b.  Support  c.  Spontaneity  d.  Autonomy  e.  Practical Orientation  enough  and  to on  environmental to  environment  was  that  attitudes  monitored,  the  when r e s e a r c h  environmental  was  engaged  was  measured  ascerdiffer-  not on  being  the  ten  78  Moos  (1974)  measured remain in  g.  Anger  and  Aggression  h.  Order  and  Organization  i.  Program  j.  Staff  Pierce,  of  even  client  that  the  Scale  there  and  The  that  Moos  environment  is  different  i n t h e same  (1972)  sensitive  instrument  Atmosphere  Scale  that  has been a c o m p l e t e  environment  t o be  programs.  h i s Ward  treatment  population;  Trickett,  Orientation  Control  though  t h e same  Atmosphere  Problem  Clarity  demonstrated  stable  perceived  in  Personal  aspects  the  ment  f.  may  turnover  populations  way.  Further,  demonstrated  the  Ward  t o changes  i n ward  treat-  i s discussed  i n more  detail  Chapter IV. Figure  1  presents  administrations 1977,  of  the c l i e n t  the  time  t h e Ward  population  sequence  Atmosphere was  sampled  for  Scale. with  the In  three  January  the  FIGURE 1 Ward A t m o s p h e r e January  1977  June  Test  Schedule  1977  August  1977  Pre-Experimental Condition  GASP Condition  Non-equivalent Control Condition  T e s t 1 w i t h Ward Atmosphere S c a l e  T e s t 2 w i t h Ward Atmosphere S c a l e  T e s t 3 w i t h Ward Atmosphere S c a l e  Ward  Atmosphere  pre-experimental June  Scale  to  provide  environment.  o f 1977, a f t e r  A  t h e GASP had  a  perception  second been  test  was  in operation  of made  the in  forsix  79  weeks. the  A  third  testing  Non-Equivalent  been  absent Since  was  taken  control  i n August  condition,  of  (when  1977, the  during  GASP  had  f o r s i x weeks). there  was  no  reason  The  hypotheses  was  no  prior  to p o s t u l a t e  research of  directionality  were t h e r e f o r e  written  the  GASP,  i n the  there  hypotheses.  i n the n u l l  form.  Hypothesis 1 There measured  is  by  no  the  difference  Ward  in  the  environmental  Atmosphere  Scale  i n January,  results  would  indicate  press  June,  and  that  the  August. Non-significant internal  validity  of  the  history,  person,  or  Hawthorne  therapists more  rigorous  threats  There GASP  Sixteen  by  effect,  and  interaction  of  for  &  Stanley,  controlling  increases  1963).  these  the potency o f the  This  extraneous study.  2 i s no  group  difference  and  the  the  non-equivalent  Factor  Locus  between  of  both groups  psychotics,  their  Non-significant  had  pretest  control  Questionnaire, Control  Scale,  the T a r g e t Outcome A s s e s s m e n t  Since  same.  contaminated  criterion  Internal-External  and  not  (Campbell  Personality  g o a l s on  was  treatment  to v a l i d i t y  Hypothesis  the  and  evaluation  the  scores results  group  and  and  scores  the  the  would  the  Rotter  number  of  Sheet.  same c o m p o s i t i o n o f were  on  of  anticipated indicate  neurotics to  that  be  the  the  two  80  groups  began  at essentially  t h e same  place  on  their  pre-  tests .  Evaluation  In  order  hypotheses  to test  psychiatric atric  the v i a b i l i t y  treatment  without  performances  o f each  measures  Locus  Assessment stayed  of  Sheet)  g r o u p were  Control  with  under  and  psychiatric  compared.  compared  and  The  on t h r e e  mean  dependent  Questionnaire,  the  the l e n g t h  hos-  Target  Outcome  of time  clients  each c o n d i t i o n .  GASP  a goal  a t t h e lower  type  of behavior  group  and t h e  posttest  scores  on t h e  increments  of  progress Attain-  mean  minute  clear  and c o n c r e t e  directions.  levels  of the goal  should  necessary  hierarchy.  treatment  t h e GASP  Sheet.  identifies with  between  group  Outcome A s s e s s m e n t  goal  were  Scale,  together  control  ment  which  GASP  i s no d i f f e r e n c e  non-equivalent  The  t h e GASP  3  There  toward  the  i n the h o s p i t a l  Hypothesis  Target  with  effective  the e f f e c t i v e n e s s of p s y c h i -  (The S i x t e e n . P e r s o n a l i t y F a c t o r  Rotter's  the  method,  hospitalization  pitalization  o f t h e GASP a s an  The  procedure  to a t t a i n present  the higher  hypothesis  produces  reinforce  the  levels  focuses  greater  the of  upon  reported  81  behavioral attaining  changes.  higher  Hypothesis  l e v e l s of  achieve  their  goals  by  success.  4  There  i s no  non-equivalent "most  Clients  d i f f e r e n c e between  control  important  group  goal"  of  the  mean  the  GASP g r o u p  posttest  Target  scores  Outcome  and  the  on  the  Assessment  Sheet. With second lower by  some c l i e n t s  place the  to  a  grand  particular  mean o f  concentrating  relative might  or  no  to  suggested. the  degree  on  goal.  each  In  their  "most  the  other  other  as  both  weighing  client and  process.  and  For  goal  instance  given to  a  to  have  to  Sheet  to  the  clients  goal"  and  not  having  them Sherman  weighting  may  they  this  one an  therapist  meaning,  Assessment  important  Kiresuk  therapist  permanent  and  goals.  or  implies  a  i t is possible  of  such  was  goals  take  Outcome  rest.  their  and/or  may  Thus  Target  consideration  client  therapeutic  goals  achievement  Rank-ordering  that  inherent  on  progress  rank-order  relative  which  the  progress  Therefore, clients  on  the  e x c l u s i o n o f the  make  little  a l l other  be  become  (1978) of  To  the  of  the  disrupt  the  aware  seriously  reason  weighted  procedure aware.  the  rank-ordering  was  excluded. In referred this  their to  early  weighting  problem might  be  work, the  Kiresuk  client's  solved.  and  goals  Originally  Sherman  i n such they  (1968)  a way  were  that  employed  82  as  evaluators,  and  responsibility asked  was  clients  had  a  cadre  to c o l l e c t  what  their  data.  have  such  information. bility  If  would  interest  a  was  and  of  approach  to  The  mark  understood  with  compromise  which  proceeding and  their  of  goals  The  was on  just  one  important", one  It  goal.  on  treatment the  was  client  obtain  used,  this  the r e s p o n s i primary  Moreover,  was  too  the  to  the  cumbersome  this  If  others. produces determines  there.  were  the  to  as  them  and  at  both  one  the  compared  is  focused  clients  identify  that  they  present most  and  to  of  mean  between  group.  finely  the  to  which  them and  clients  Thus,  asked  hypothesis  The  the  important"  from  control  more  asking  assessed  i t i s conceivable  than  did  o f knowing w h e t h e r  "most  important"  goal  is  to  is disruptive  by  clients  non-equivalent  3.  issue  at  was  times  for  Hospital  directions.  evaluation  this  sole  employed  members whose  no way  arrived  "most  rationale  Hypotheses  which  the  team  research.  this  goals  posttesting  t h e GASP and  that  their  with  achievement  with  was  been  staff  not  whose  General  w r i t t e n approach  the  The  available  had  i n a c c u r a t e s i n c e t h e r e was  A  goal  technique left  were.  Valley  team  psychotherapy,  therapy.  respondent  pre  the  have been  conversational course  research  employees  T h i s team o f e v a l u a t o r s  priorities  a v e r b a l / c o n v e r s a t i o n a l manner. not  of  to a  will  same be  work  with  important".  as  in  concerned  goal  hypothesis  change  "most  the  as  "most  harder  on  focuses  on  regard  to  the  83 Hypothesis  5  There  i s no d i f f e r e n c e between  non-equivalent the  Rotter As  clear,  I n t e r n a l - E x t e r n a l Locus o f C o n t r o l  was  stated  move  desired  both  qoals,  earlier,  Sheet,  experience  more  could  steps  the  t h e GASP  identified  that  people  the  Tarqet  for their  life  see t h e i r  than  by f a t e o r "bad karma," o r some o u t s i d e  particular locus  of control.  treatment  Hypothesis There  thouqhts  i t i s appropriate  treatment  qives  to  Outcome they  will  situations. behavior  determine qreater  hypothesis  focuses  as  rather  influence.  a  p r o d u c e s more i n t e r n a l i t y  As their  and f e e l i n q s ,  the c l i e n t  The p r e s e n t  a goal.  t o assume t h a t  would  small,  and t o w a r d  determined  evaluation  own  toward  more  this  by t h e i r  Scale.  identifies  itself  on  i t i s reasonable responsibility  expect  GASP  of proqress  throuqh as  Assessment  One  and t h e  c o n t r o l q r o u p on t h e mean p o s t t e s t s c o r e s o f  and c o n c r e t e  clients  t h e GASP q r o u p  In  i f one internal on  which  in clients.  6 a r e no d i f f e r e n c e s between t h e GASP q r o u p and t h e  non-equivalent  control  followinq  subscales  five  qroup  mean  posttest  o f the S i x t e e n  Questionnaire: a.  Factor  C, eqo s t r e n q t h  b.  F a c t o r E, a s s e r t i v e n e s s  c.  Factor  F, s u r q e n c y  scores  Personality  on t h e Factor  84  Cattell pointed  e.  Factor  Q^,  what  of  While  easy  the  for clients  Questionnaire  scales  t o mark.  met t h e s e  above  feel  clients their  less  pated.  With  small  clients' should  seemed  and  the  GASP  and  the  same  time  at and  enthusiasm as  Sixteen  assertiveness.  each  forselecting i t was and  quick  Personality  also and  Factor  life  f o r both step  As t h e c l i e n t s  their  future, life  in  i s attained.  are  as t h e GASP  i t i s logical themselves  they  likely As  for control of  assertiveness such  clarify  situation.  and c h o i c e s  focus  steps,  change on the f i v e sub-  f o r the  about  increases  sequential  rise  goals  decisions  a concrete  to i n d i c a t e  that  reliable,  f o r the d e s i r e d  their  situations,  The  five  criteria.  anxious  exercise  be  same  Questionnaire  Questionnaire,  a r e as f o l l o w s :  expectations  will  Factor  instrument  assumptions  listed  their  guilt  the  thought  self-direction,  Personality  that  The  I t was  of the  Questionnaire  Factor  they  (1970)  five  Factor  Therefore  because  and  on  t h i n k i n g was t h e main c o n s i d e r a t i o n  Sixteen  important  improvement  Personality  i n t h e GASP. anxiety  and T a t s u o k a  Personality  research  enthusiasm,  this  Eber  successful.  in this  decrease  increase  anxiety.  showed  the S i x t e e n  occurred  would  people  was  guilt  Cattell,  the S i x t e e n  therapy  were c h o s e n  via  0,  (1966) and  of  subscales  the  Factor  out that  subscales when  d.  anticiprovides  to expect  and l i f e  that  i n general  Concomitantly,  as  85  clients astic, time  becomes more s e l f - c o n f i d e n t , and  less  should  the g u i l t  and  i s no the  i n the In  for  worrying  difference  addition  to  the  GASP,  i s also  terms  the  issue  of a c c o u n t a b i l i t y ,  efficiency  of  of  control  attempt  the  that  was  bo  length As  I went  less  wrong"  group  mean  or  (GASP)  lengths  they w i l l  made  and  expense  the  and  behavioral  of  reasons  of  treatments  the  two  cost  the  efficiency?  On  to  this  o f h o s p i t a l i z a t i o n speaks people  identify  move t h r o u g h  ascertain  treatment  under  to  appropriate  those g o a l s v i a a c o n c r e t e l i f e  were d i s c h a r g e d more  Significance  which  focus, faster.  treatment  quickly.  levels  are  when  two  kinds of  testing  any  errors  former  error  suggests  a  The  latter  error  suggests  there  a difference  does  that  hypothesis:  The  fact  attained,  experimental  relative  effectiveness  attain  i s expected  against  the  theoretical  treatment.  g o a l s and  There  "where  between  important.  in  clients  about  are  mistakes.  same  An  goals  enthusi-  hospital.  procedures  it  their  non-equivalent  choosing  life  as  and  7  There  stay  spent  of past  Hypothesis  group  be  anxious  resilient,  exist.  Type  difference is  have  no  I  when  to  be  and none  difference  guarded Type  II.  exists. when  in  86  Every implicit an  i n these  evaluation  tions, of  researcher  errors.  of  i t would  the  be  significance.  not  loss  of  alpha  level,  increases. metal  same  of  effective?"  risks  as  asked  this  in  levels  very  a  metal  of  expensive, that  in a  setting  a  cannot  crash  and  conservative II  error  i s more l i k e l y  to  reject  job  a  if  Type  properly.  above  does  not  example,  exploratory  the  involving  conservative  result  however,  i s an  risk  condi-  "Is h o s p i t a l i z a t i o n  that  of  flight  be  of  could  the  the  is:  i n order  use  researcher  evaluation,  degree  under  the  probability  a c t u a l l y do  Since  possible  metal  aircraft  the  GASP, i t i s s u q q e s t e d as  actual  i s the  present  beinq  on  However,  .001, That  kinds  question  the  the  example, i n a s t u d y  to maintain  life.  t h a t would The  For  A Type I e r r o r c o u l d  s t r e s s i n an human  comprehend  stress  wise  catastrophic;  withstand  must  evaluation  involve because  with  should  be  the  the  evaluation  GASP  of  as  the  the  broad  to determine p o t e n t i a l areas  for  future  the  cost  of  II e r r o r s ,  was  set  at  research. Considerinq the  alpha  final  level  comparative  evaluations. with if  this no  By  larqer  lowerinq (.25)  alpha  are  equivalent  the  I and  Type  conventional  and  at  .25  for  .05 the  for  of  level,  i s reasonably  no  one  a Type I I e r r o r  differences  pretest.  the  control  probability  found,  at the  Type  the  evaluations,  differences  qroups are  the  exist;  sure the  87  After was  the  conducted.  subject  of  the  GASP The  had  been  formal  following  standardized,  testing  chapters.  and  the  evaluation  i t s results  are  the  88  CHAPTER IV  EVALUATION METHOD  Comparative As  a  e v a l u a t i o n o f t h e GASP preliminary  GASP a s a p s y c h i a t r i c psychiatric  evaluation treatment  hospitalization  hospitalization  without  (The S i x t e e n  Rotter's  Locus  Assessment stayed  of  Sheet),  i n hospital  followinq  the v i a b i l i t y  with  t h e GASP  t h e GASP  were  compared  toqether under  Scale, with each  and  psychiatric  compared.  and  The mean  on t h r e e  Personality Factor  Control  o f the  method, t h e e f f e c t i v e n e s s o f  p e r f o r m a n c e s o f e a c h q r o u p were measures  of  dependent  Questionnaire,  the Target  Outcome  the l e n q t h o f time treatment  clients  procedure.  i s a d i s c u s s i o n o f t h e method used  The  i n makinq  these  control  group  comparisons.  Design  An  adaptation  quasi-experimental was  employed  because  random  of  the non-equivalent  design  (Campbell  i n the e v a l u a t i o n . assignment  & Stanley, This  of subjects  design  1963, p . 42) was  t o treatment  chosen was n o t  89  possible.  Further,  available. physical  Both  could  been  additional  to  isolate  would  have  be  second  comparable  limited  a t any one  bed s p a c e ,  one t r i a l  trial  period,  Even  The c o n t a c t  period,  facility.  n o t have  i n contamination.  was• n o t The  t h e number o f p e o p l e  time.  i t would  both groups t o t a l l y . resulted  hospital  had t o use t h e same  o f the u n i t  treated  was seen d u r i n g the  second  groups  structure  that  a  i f there been  with  Therefore  possible  each  other  one  group  t h e s e c o n d was seen  as shown i n F i g u r e  had  during  2.  Figure 2  Actual  design  GASP g r o u p n=16  01  Non-equivalent n = 16  control  n  = Sample  01  X  02  1  group 01  X  2  02  size  = pretest  02 = p o s t t e s t X  1  X  2  = GASP i n t e r v e n t i o n = normal ward  o f 8 days  activity  (July  (May 1 t o J u n e 1 to August  15)  15)  90  Group who  one,  two,  the  first  and  August  and  June  treated ment  the 16  external  groups  16  June  g r o u p , was  people  of  treatment  in  in  to  r e s p e c t s the similar  1977.  composed  made a v a i l a b l e  were  and  control  1963).  not  employed  the  the  of  July May  groups  in psychological  measures  were  recruit-  composition  respect of  to  of  The  treatment  and  further,  of  groups  both  Rotter  Assessment  the  Locus  This  history,  the  the  Control  Scale,  i n the  modified  and  However,  group  could  be  effect,  and  bias. equivalences  comparability  evaluated.  the  specific  control  Hawthorne  therapist  at  non-equivalent  adaptation  The  Sixteen Personality Factor of  noted to  the  pre-treatment  the  was  are  (Campbell  posttests.  adaptation  and  i n f l u e n c e s of  attributed  an  to  the  differences  p r e t e s t and  treatment insure  for  instrumentation  usually  groups  s c a l e s of  Due  was  and  concurrently.  with  order  control  i f any  not  design.  interaction  two  Thus,  between t h e  run  criticized  to  testing,  are  events  group  In  attempts  they  design  group  The  first  and  sought  In a l l o t h e r  maturation,  posttest,  five  GASP was  (voluntary)  design  Stanley,  the  same.  May  control  voluntarily  The  only.  in  the  as many n e u r o t i c s as p s y c h o t i c s ) .  history,  the  treatment  who  1977.  procedure  could  c o n s i s t e d of  non-equivalent  group  This  the  sought  people  of  the  (twice  the  GASP g r o u p ,  voluntarily  Group  &  the  the  of  of  pretest  pretests  were  Questionnaire, Target  Outcome  non-equivalent  control  Sheet.  t o the  design,  shift an  additional  check  on  factors  that  might  91  influence the  the  Ward  group  validity  Atmosphere  and  the  relatively  employed  the to  the  Scale.  to  each  same  detect  The  subtle  a s s e s s whether o r not b o t h  was  gained  both  control  other,  time. any  results  Although  non-equivalent  close  precisely  of  the  group  were  were  Ward  Atmosphere  environments  not  of  were  using  experimental  they  influences  by  conducted  conducted Scale  history  at was  and  to  comparable.  Instruments  Ward A t m o s p h e r e S c a l e The  Ward  need-press selected  model  because  environmental shared  the  items  psychiatric the  of  items  S c a l e , which  the  instrument  scale each.  wards. are  most  consists  or  environment,  used  Designed of  ten  and  false  researched  psychiatric  asked  to  for  their  ward.  the  treatment  s u b s c a l e s from  are  was  t o measure  items d e s c r i b e t y p i c a l  Clients  true  of  and  widely  available.  perceptions  The  i n c o r p o r a t e d Murray's  individual  i t i s the  environmental  settings, twelve  Atmosphere  nine  to  behaviors  on  indicate  whether  (See  Appendix  D.) There  are  spontaneity) scales,  to  The  and  scales  measure  (autonomy,  orientation, program.  three  relationship  practical anger)  final  three  c o n t r o l ) measure v a r i a b l e s  (support,  involvement, variables.  orientation,  personal  assess  aspects  of  scales  (order, c l a r i t y ,  in administration  the  and Four  problem  treatment and  structure.  staff  92  the  The  scores  mean  used  (1974)  of as  assumed  accurate  Ward  Atmosphere  within the  internal  therapy Personal  on  two  Very  few  more.  when  This  measures remain  of  the  one  four  to  same  indicate  even  He  (1970)  the  an  averaqe  at  .55)  Stern's after  one  the  interclass  s e v e n months  intervals  that  the  treatment  with  a  were  complete  to  (1970) week  for  profile  of  correlations  .76  on  each  after  (Stern, tested  one  1970).  on  both  were s i x months  Ward  of  .83  administrations  week t h r o u q h  that  acceptable  test-retest  clients  The  indicated  within  .78).  different  is  internal  Stern  usinq  clients  A  test-retest  of  perception  (Spontaneity  42  after  at  would  stable  the  .92  the  aspects  of  Moos  perceptions.  items.  at  and  press.  adequate  by  calculating  .77  i f any  occasions  of  averaged  f o r P r a c t i c a l O r i e n t a t i o n to  by  from  have  all  Orientation.  scores  months t o  are  moderate  .68  obtained  standard  the  (Involvement  from  are  reliability.  for  reliabilities  proqram, r a n q e to  from  Problem  stability,  individual  consistencies  consistencies  ranqed  ward  consensual  Subscales  variances  stronq  test-retest  of  subjective  Scale  the  environmental  test-retest  varyinq  moderately  of  measure  internal  proqram  ranqe,  index a  than  and  calculated  an  that  more  consistency  a l l c l i e n t s on  Atmosphere  environment turnover  Scale  that in  or  may  client  population. Pierce, Trickett, Ward  Atmosphere  treatment  and  Scale  proqrams.  Moos (1972) d e m o n s t r a t e d  is In  sensitive  their  study,  to the  chanqes Ward  that in  the ward  Atmosphere  93  Scale the  was  first  used  environment  lower  others.  demonstrated  In was  was  the  effort  from  of  administered  of  three  assess  interaction  use  first GASP  been  in operation History  If  intervals  the  Ward  ence  the  That by  in  the  occurred  and Scale  in  the  were  the  the  the  the  virtue  of  were  the  way  in  in  June, the  month;  and  research  had  1,  p.  78) occurred  conditions  (Campbell  consideration offered  at  differences  and  August  events  of  as  during  measured  history  the  did  by not  press. are  itself may  was  that  being  environmental  environment  the  important  that  scale  to  one  events  not  June,  the  began;  Figure  significant  effects  the  of  treatment  e v a l u a t i o n process i s , the  phase  an  and  corresponding  (See  was  The  in  validity  effect,  for  Scale  Hospital  internal  research  operation  no  Scale,  General to  specific  groups  Atmosphere  Hawthorne  month.  among J a n u a r y ,  affect  Ward  Valley  second  History  there  Occasionally  1963).  scores  Atmosphere  had  research  second  Atmosphere  significantly  the  f o r one  treatment  the  from  some  therapists.  before  been  when  1963).  same t i m e .  and  of  and  at  the  the  had  first  Stanley,  stem  Ward  history,  included  the  both  the  threats  phase  in August,  since  raise  possible  treatment  again  &  times  i n January  the  between  to  changes  evaluation,  sources:  the  with  significant  present  to  three  when  manipulated  Subsequently,  directions.  administered  an  a diagnostic pretest.  Posttesting that  appropriate  as  shown (Campbell  exert  which  a  the  in &  subtle  research Stanley, differ-  experiment  is  94 designed.  The  differences  between  Atmosphere press was  was  e v a l u a t i o n may  Scale  the  involved  with  unique  and  an  different This  because could  may  therapist  of  be  evaluation  treatment  evaluation the  be  not  It  experience  that  was  such  pressure  would  measured  by  may  using  the  the  in  likely  this  to  a  to  be  or  that around  Atmosphere  Scale  demonstrate  about  the  alter  the in  Atmosphere  the  three  psychiatric unit  because  the  clients'  the  way.  f o r the  chanqes.  the a  team  same  the  could  be a  bias  under  research did  issues,  the  environment  and  Non-siqnificant using  that  whatever  this  interaction  perception  results.  team  research  periods  A  However i t  therapy  the  This  therapist  undermine  Scale.  test  therapy,  to if  demonstrated  Ward  Ward  unique  have  therapy  assist  pressure  the  environmental  criticized  produce  amonq  ment.  not  be  not  expected  the  significantly  that  what a c c o u n t s  differences  feelings  periods  t h e r a p i s t s ' r o t a t i n q work h o u r s .  pressures  effort.  Non-significant  effort.  combine  would  was  possible  particular  test  demonstrate  research  combination  obtrusive.  same w h e t h e r o r  Psychotherapy therapist  three  would  about the  be  of  the  the  the  Ward  team's did  not  environ-  95  The  T a r g e t Outcome A s s e s s m e n t The  oped  Target  f o r the purpose  criteria Derived in  from  essence  A that  Smith's the  staff  The  recorded.  within  this  Sheet  study  change  resulting  outcome"  t o the h o s p i t a l ,  This  was  Treatment 24 h o u r s  of  the c l i e n t  what  i t  the  ( K i r e s u k & Sherman,  him/her  i n each  therapy.  Sheet,  portion  asks  devel-  behavioral  in  (1974) Outcome A s s e s s m e n t  "expected  client's  (TOAS) was  to provide  member  be d i f f e r e n t  Initial  of  Scale followup guide  brought  tion.  Assessment  f o r determining  Attainment  to  Outcome  Sheet  is  Goal  1968).  the problems  are  and what  s/he e x p e c t s  a r e a a t t h e end o f t h i s  hospitaliza-  present  level  the sole  agenda  Conference.  o f admission  of  functioning  o f what  This  was  meeting  i s also called  took  an  place  (See F i g u r e 3 ) .  FIGURE 3 Tests Administration  Upon A d m i s s i o n  Initial Treatment Conference Within 24 H o u r s o f A d m i s s i o n  16 PF Locus o f C o n t r o l  At  behavior  his/her  behavior  client  i s asked  E i g h t Days A f t e r Goal I d e n t i f i c a t i o n  TOAS  post-treatment,  his/her  Schedule  i n each has  16 PF Locus o f C o n t r o l TOAS  the  client  i s asked  o f the o r i g i n a l  not reached  to c l a s s i f y  concern  the expected  the behavior  to  report  areas. level,  If the  i n one o f t h e f o u r  96  remaining  categories:  better. as  the  This  the  the  number were  In  level  to  see  (1974,  outcome  Rotter  Internal-External  number  difference  i f , there  work,  the  had  of  based  The  post-  been  any  one  Scale  of  the  measures  Nowicki-Strickland  Children.  In  this  more a p p l i c a b l e t o  Rotter  degree  to by  earlier, external  Locus which  other  Locus  research  adults  of  Control  people  people  events,  locus  of  internal  locus  of  t h e i r own  of  was  Control  and  Scale  believed external  i f most d e c i s i o n s were  external  by  yielded  Locus an  outcome  needed.  Scale  of  The  (Rotter,  selected.  determined  by  was  have  goals.  1976)  was  that  ed  for  expected  the  I n t e r n a l - E x t e r n a l Locus of C o n t r o l  measure  the  any  much  a l l the  than  Therefore  determine  of  Scale  The  Since  less  was  or  same manner  a n a l y s i s would  i f there  to  attainment  for  was  i n the  individuals identified.  Control  1966)  better,  guide.  (-1,  zero v a r i a n c e .  goals  Smith's  employed  same  prescore  analyzed  differential  Rotter  of  i s scored  follow-up  any  analyzed  worse,  Scale  the  success),  was  scores  The  at  same means, w i t h  goals on  began  of  much  five-point scale  Goal Attainment  clients level  worse,  i t was control.  control  t h o u g h t s and  said  seen that  People  i f their  was  used  their  were  was  mention-  determined  person  said  behavior  f e e l i n g s (Rotter,  As  being  that  measure  behavior  events. as  to  to  was 1966).  had  an  have  an  determined  97  The (See  Rotter  Appendix  and  F) i s composed  six filler  items.  1972)  have used  with  adult  normal.  risk  taking,  attitudes, gestion, retest  learning  skill and  and  reliability  Sixteen The  the locus  Locus o f C o n t r o l schizophrenic  Cattell,  Eber,  o f t h e 16  patients.  at  Scale  aspects  factors  In other  14  score  (Factor Q ) . 4  maturity  (Factor  F) , G u i l t  1966).  Ego  strength  refers  situations, changes  in  to  sugTest-  1966).  as t h e A lower  means more  Factory  score score  external.  Questionnaire  actual (1970)  personality  have  five  of  (Factor to  used  change. that  for osychaitric i n factors  usually  The f i v e  factors are:  (Factor  E ) , Surgency  0 ) , and A n x i e t y  personality  and i s o p e r a t i o n a l l y d e f i n e d  was  demonstrated  these  C), Assertiveness  proneness  behav-  (Rotter,  i s defined  as a r e s u l t o f p s y c h o t h e r a p y .  strength  of  resistance  days  are applicable  words,  through  Questionnaire  of  and T a t s u o k a  groups,  (Rotter,  a higher  Scale  the environment.  of control  Personality  various  known  rewards,  Personality Factor  Sixteen  test  among  .79  items  a r e l a t i o n s h i p between t h e  to control  was  Scale  1973; S t e p h e n s ,  s i t u a t i o n s , conformity  chance  attempts  means more i n t e r n a l ;  Ego  (Scheek,  from  has i n d i c a t e d  t h e Locus o f C o n t r o l  change  ranging  difference  Operationally,  five  Control  o f i n t e r n a l i t y / e x t e r n a l i t y and a v a r i e t y  including  to  of  o f 23 i n t e r n a l - e x t e r n a l  Researchers  populations  iors,  The  Locus  the Internal-External  The t e s t  concept  on  Internal-External  (Factor  integration  as t h e t o t a l  Factor  or C  98  score. and  Assertiveness  the  expression  i s operationally defined  Surgency  means  the  total  one  has  the  total  enthusiasm  Factor  after  feeling  F  Factor  0  and  G for  test.)  The  Sixteen  as  the  total  developed  final  by  form  Sixteen  f o r E,  0.78,  the  0.87  f o r F,  test-retest  between  in C  group,  terms and  0.79  Evidence of  between  anxiety,  0.93.  and  i s the  as  feeling  (See  and  at  and  0.93;  paranoia,  0.91  0.75,  for Q . 4  0.84,  between 0.84;  the  0.95;  and  from  groups. for At  0.78,  MMPI  and  C, two  0.77,  validity  between F  its  population  income  i t s construct with  to  representation,  family  and  was  were drawn  census  area  F  Norms f o r  seven d a y s were 0.74  were: of  revised  (1970).  American to  of  Appendices  (1950a) Tatsuoka  as  state  Questionnaire  masculine-feminine,  0  score.  Factor  correlations  introversion-extroversion, 0.91;  score.  4  f o r 0,  scores  E  wants  Operationally i t  Questionnaire the  reliabilities  Factor  affective  worried.  according  age  respectively.  provided  E b e r , and  exactly  density,  test-retest  months  Q  Cattell  represented  almost  population  0.85  who  i s the  and  Personality Factor  3,600 p e o p l e large  Cattell,  one  proneness  Anxiety  Factor  by  total  what  i s operationally defined  Personality  originally  The  and  of  operationally defined  Guilt  wrong  score.  the  is  uneasy, a p p r e h e n s i v e ,  defined  the  as  and  score.  doing  is  at  is  was  scales: E  and  hypomania,  between  Q^  and  99  Procedure  Subjects Of  the  evaluation the  80  clients  ( M a y - A u g u s t ) , 55  evaluation.  client's study, eight  refusal failure  days  accepted  (See  H.)  tion  Append i x final  for  the  1200  neurotic. a  criteria  months.  client of  duration  attributed  who  wanted  an  included  to  to  of  the  Of The  upon  hospital  these  1200,  assigning admission  World  Health  of  was  had 395 a  of  goals.  letter.  clients the  treated  over  the  psychotic  and  "psychotic" the  designa-  diagnostic  Organization.  The  ... i n c l u d e s t h o s e c o n d i t i o n s i n w h i c h i m p a i r m e n t o f m e n t a l f u n c t i o n s has d e v e l o p e d t o t h e d e g r e e that i t i n t e r f e r e s g r o s s l y with i n s i g h t , ability t o meet some o r d i n a r y demands o f l i f e . o r a d e q u a t e contact with r e a l i t y . I t i s n o t an e x a c t o r w e l l d e f i n e d term. Mental r e t a r d a t i o n excluded. Health  Organization,  for  composi-  psychotic:  (World  All  admitting  consent  on  the  requirement  were  based  in  the  neurotic  the  the  in  their  informed  two  either  remain  identifying  approval  of  to p a r t i c i p a t e  evaluation's  signed  clients  805  to  agreed  after  the  the  c l i e n t , a r a t i o which r e f l e c t e d  24  were  those this  had all  previous  tion  meet  sample  psychotic of  or,  hospitalization  and  every  clients  a t t r i t i o n was  to  psychiatrists  during  The  subjects  The  admitted  1974,  p.  19)  term  100  The upon the  assigning  admission World  of  was  Health  a  "neurotic"  also  based  on  Organization.  designation  the  The  to  diagnostic  term  a  client  criteria  of  neurotic:  ... i n c l u d e s m e n t a l d i s o r d e r s w i t h o u t any demons t r a b l e o r g a n i c b a s i s i n which the c l i e n t may have considerable insight and unimpaired reality t e s t i n g , i n t h a t he u s u a l l y d o e s n o t c o n f u s e h i s m o r b i d s u b j e c t i v e e x p e r i e n c e s and fantasies with external reality. Behavior may be greatly affected, although remaining within socially acceptable limits, but personality i s not disorganized. The principal manifestations include excessive anxiety, hysterical symptoms, p h o b i a s , obsessional and c o m p u l s i v e symptoms, and depression. Neuroses exclude physical disorders p r e s u m a b l y p s y c h o g e n i c ; and non-psychotic mental d i s o r d e r s associated with p h y s i c a l c o n d i t i o n s . (World As females the  in  in  GASP g r o u p ,  for  lent  the  mean  close  two age  to  years, of  representative  6:26  over  the  previous  Test  administration Each  Factor  client  24  was  Questionnaire  of  The  mean  clients and  This  here.  In  who  962  1:4  14 age  the  of  in  this  had  come  12  was  in 35.9  non-equiva-  seen  were  and  females  over  female,  male/female  terms  clients  clients  for  37).  males  and  1200  p.  four  males  years  were male  ratio  the  two  36.8  the  1974,  were  group.  years.  sample of  and  and  Of 238  36.5  the  there  control  group.  the  diagnosis,  1,  GASP g r o u p  control  previous a  the  Table  Organization,  shown  non-equivalent  years  Health  age,  the with  ratio  is  sex,  and  evaluation  was  to  the  hospital  months.  administered and  the  Locus  the of  Sixteen Control  Personality Scale  upon  101  Table 1 Client  GASP  Characteristics  Male  Sex  Female  4  Mean Age Age  Range  12  43.0  33.6  35.9  28-69  19- 57  1 9-69  Diagnosis  Psychotic Neurotic  Non-eguivalent C o n t r o l Group  Male  Sex Mean Age Range  67. 5  32.4  36. 8  51-84  20- 52  20-84  Psychotic Neurotic  admission.  These  the  clients  in their  all  clients  were  This on  tests  were  rooms.  seen  i n an  psychological histories i n t e r v i e w was  the  unit.  Sheet  was  Eight  days  ality Sheet,  At  conducted this  completed after  Factor and  posttest  Combined  14  Diagnosis  their  6 10  Female  2  Age  Combined  time  jointly  the i n i t i a l  Questionnaire,  the  Locus  (See F i g u r e  of  6 10  individually Within initial  24  administered  hours  interview  and g o a l s  of  to  admission  to determine  for hospitalization.  i n a p r i v a t e c o n s u l t a t i o n room the by  Target  the c l i e n t s  interview the  Control  3, p . 9 5 ) .  Outcome  the  the S i x t e e n  Target were  and  Assessment  Outcome  staff. Person-  Assessment  re-administered  Subjects  who  withdrew  as  a  from  102  treatment dropped  prior  from  to  the  the study.  posttest  eight  (See A p p e n d i c e s  days  later  were  I and J . )  T-herapists The  psychiatric  female). 10  The s t a f f  psychiatric  tional  therapist,  three  years. the  as d e s c r i b e d  the s t a f f  --  psychoanalytic,  centered, allowed  as  and  gestalt,  their  primary  therapeutic  therapists  away  chances  procedure procedures ly.  from,  were  minimal,  influencing  other  occupa-  admitting as a team  four  to ten  i n how t o c o n d u c t  to therapy  analysis, of  clienttraining  a number o f a l t e r n a t i v e s a s behavior  tool.  not toward,  and  from  approaches  of Valley  o f the t h e r a p i s t s  six  diversity  b u t none used  orientation  the  The  an  However, t h e members  traditional  t o employ  philosophical was  i n many  existential.  judgment d i c t a t e d ,  III.  was  together  ranging  by t h e r e s e a r c h e r  trained  the t h e r a p i s t s  and  had been  i n Chapter  had been  there  worker,  therapists  (13 m a l e , 7  o f 10 p s y c h o t h e r a p i s t s and  and had e x p e r i e n c e  of  their  social  A l l were t r a i n e d  GASP  20 t h e r a p i s t s  Additionally,  a  These  years,  employed  was composed  nurses.  psychiatrists. for  unit  biasing  If anything, General  i n favor  was  the  Hospital's  behaviorism.  the p o s s i b i l i t y procedures  modification  Thus,  o f t h e GASP of  equally  the  GASP  unlike-  103  Psychiatric The  psychiatric  clients. the  unit  These  unit.  toilet,  television, which  was  staff  although  accessible  had  were  client's  closet  members  depending  clients  The  and  unit  room  a  maximum  assigned  to private  consisted  f o r clothes.  capacity  No  of a  to a l l c l i e n t s .  available  on t h e number  per  room  on  had  a  room on t h e u n i t  The a v e r a g e  eight-hour  rooms  bed, p r i v a t e  private  t h e r e was a t e l e v i s i o n  f o r 14  shift  number o f was  four,  of clients.  Treatments As mentioned of  this  control  above, two g r o u p s  e v a l u a t i o n , t h e GASP group.  Figures  Both  w i t h i n each  30  no  were  clients  terminated  discharged.  To  group.  enlisted when  avoid  evaluation  contact  with  clients  t h e GASP were d i s c h a r g e d  dates  16 and J u n e  subjects.  evaluation  contamination,  g r o u p began o n l y a f t e r  the  The  subject  was  non-equivalent  who had had from  the h o s p i t a l .  condition Every  person  participated person all  as  groups.  and d i s c h a r g e  Between J u n e  the f i n a l  control  GASP  i n the course  and t h e n o n - e q u i v a l e n t  4 and 5 show t h e a d m i s s i o n  individuals  was  group  used  o f t h e s e g r o u p s were open e n t r y  of  GASP  were  of  admitted  t o the h o s p i t a l  i n the procedure  admitted  f o r treatment  the r e q u i r e d  described during  activities.  this  during  i n Table time  (Required  t h e GASP 2.  took  Every part i n  activities  are  104  FIGURE 4  for  A d m i s s i o n and D i s c h a r g e D a t e s t h e GASP Group, May 1 - June 15  DATES  14 12 10 8 6 4 June  2 31 29 27 25 23 21 19 17 15 13 11 9 7 5 3  May  1  —»—i—\—\—I—i—I—*—\ 1  2  3  4  5  6  7  Client  8  r — r  f  9 10 11 12 13 14 15 16  Number  105  FIGURE 5 A d m i s s i o n and D i s c h a r g e N o n - e q u i v a l e n t C o n t r o l Group,  Dates f o r t h e J u l y 1 - August  15  DATES 14 12 10 8 6 4 August  2 31 29 27 25 23 21 19 1 7 15 13 1 1 9 7 5 3  July  1 -I  '  1  2  .  3  4  5  6  7  Client  8  9101112  Number  13 14  1516  106  capitalized this  was  written facets  and  underlined;  "free  time".  the s t a f f  the  GASP  and  were  four  t o answer  Non-equivalent  The  Table time  3.  Every  took p a r t  activities any  as  group  person  not  were  the (See  single  course o f treatment  Within free-time. required  author  performance  they  might  with  have h a d .  o f a minimum  consisted  of  presented  in  schedule  during  activities.  the  time"  i n any  systematic  was  Sixteen  between  and t h e n o n - e q u i v a l e n t Group".  this  (Required  Schedule.)  difference  o f t h e "Goals  not d i s c u s s e d  The  f o r treatment  The  the presence  Table  i n the  on  f o r t h e GASP g r o u p  goals  do.  and u n d e r l i n e d ; " f r e e  schedule was  to conduct a l l  condition  listed  seen.  Group" i s  members.  admitted  were  i t means  treatment  outlined  subjects  qroup  their  i n a l l o f the r e q u i r e d  period  "Goals  told  usually  control  are c a p i t a l i z e d  time  i s listed  A GASP g r o u p c o n s i s t e d  non-equivalent  hospitalization  they  any q u e s t i o n s  and two s t a f f  control  were  t o observe  16 s u b j e c t s .  clients  as  daily  time  the schedule, Staff  of hospitalization  with  of  On  i n p l a c e o f GASP).  met  There  i f no  the  control  Therapeutic  fashion  during  o f the non-equivalent c o n t r o l  qroup.  2.) both  treatment  schedules,  T h i s was t r u e b e c a u s e , activities,  opportunities.  not  During  with  a l l clients these  clients  could  find  the exception o f the participated  free-time  periods,  i n the clients  TABLE 2 - GASP DAILY SCHEDULE MONDAY  TUESDAY  WEDNESDAY  THURSDAY  FRIDAY  107 SATURDAY  SUNDAY  6:45 M e d i c a t i o n s 6:45 M e d i c a t i o n s 6:45 M e d i c a t i o n s 6:45 M e d i c a t i o n s 6:45 M e d i c a t i o n s 6:45 M e d i c a t i o n s 6:45 M e d i c a t i o n s 7:30 B r e a k f a s t  7:30 B r e a k f a s t  7:30 B r e a k f a s t  7:30 B r e a k f a s t  7:30 B r e a k f a s t  7:30 B r e a k f a s t  7:30 B r e a k f a s t  8:00-9:00 00MMUN ITY MEET ING  8:00-9:00 00MMUN ITY MEET ING  8:00-9:00 OOMMUN ITY MEET ING  8:00-9:00 OOMMUN ITY MEET ING  8:00-9:00 OOMMUN ITY MEET ING  8:00-9:00 OOMMUN ITY MEET ING  8:00-9:00 OOMMUN ITY MEET ING  9:00-11:30  9:00-11:30  9:00-11:30  9:00-11:30  9:00-11:30  9:00-11:30  9:00-11:30  D D o c t o r s Rounds D D o c t o r s Rounds D D o c t o r s Rounds D D o c t o r s Rounds D D o c t o r s Rounds D D o c t o r s Rounds D D o c t o r s Round; 2) F a m i l y 4 2) Fam i I y 4 2)Family 4 2) Fam i I y 4 2) Fam i I y 4 2) Fam i I y 4 2) Fam i I y 4 Couples C o n f . Couples Conf. Couples C o n f . C o u p l e s C o n f . C o u p l e s C o n f . Couples C o n f . Couples C o n f . with Dr. w i t h D r . w i t h D r . w i t h D r . w i t h D r . w i t h D r . with Dr.  12:00  12:00  12:00  Med i c a t i o n s  Med i c a t ions  Med i c a t i o n s  12:15 Lunch  12:15 Lunch  12:15 Lunch  1:00-2:00 D o c t o r s Rounds  12:45-1:45 GOALS GROUP  12:45-1:45  12:00 Med i c a t i o n s 12:15 Lunch 12:45-1:45 GOALS GROUP  12:00  11:00-12:00 GOALS GROUP  12:00 Med i c a t ions  12: 0C Med i c a t i o n s  12: 15 Lunch  12:15 Lunch  2:00-2:50  1:00-1:50 B IBL IQTHERAPY  Med i c a t ions 12:15 Lunch 12:45-1:45 GOALS GROUP  GOALS GROUP  2:00-2:50  2 : 0 0 - 2 : 50 0CCUPAT ION AL  11:00-12:00 GOALS GROUP  THERAPY  Fam i I y 4 Couples Conference  2:00-2:50  OCCUPAT ION AL  Fam i I y 4  THERAPY  Coup Ies Conference  2:00-8:00 2:00-6:00 3:00-4:00 3:00-4:00 3:00-4:00 3: 00-4 : 00 3:00-4:00 V i s i t i n g Hours* V i s i t i n g Hours* V i s i t i n g Hours* V i s i t i n g Hours* V i s i t i n g Hours* V i s i t i n g Hours* V i s i t i n g Hours* 4:00-4:50  4:00-4:50  OCCUPAT ION AL  B IBL lOTHERAPY  THERAPY  4 : 0 0 - 4 : 50  4:00-4:50  Fam i I y 4  BIBL 10 . 4 O.T. COMBINED  Coup Ies Conference  5:00 M e d i c a t i o n s 5:00 M e d i c a t i o n s 5:00 M e d i c a t i o n s 5:00 M e d i c a t i o n s 5:00 M e d i c a t i o n s 5:00 M e d i c a t i o n s 5:00 M e d i c a t i o n s .5:00-5:15 CHART REVIEW 5:15 D inner  5:00-5: 15 CHART REVIEW  5: 0 0 - 5 : ' 5 CHART REV IEW  5:00-5:15 CHART REVIEW  5:00-5:15 CHART REVIEW  5:00-5: 15 CHART REVIEW  5:00-5:15 CHART REVIEW  5: 1 5 D inner  5: 15 D i nner  5:15 D i nner  5: 1 5 D inner  5:1 5 D i n n e r  5:1 5 D i n n e r  6:00-8:00 Conferences 4 V i s i t i n g Hours* V i s i t i n g Hours* V i s i t i n g Hours* V i s i t i n g Hours* V i s i t i n g Hours* Scheduled Rounds 6:00-8:00 6:00-8:00 6:00-8: 00 6:00-8:00 6:00-8:00 C o n f e r e n c e s 4 C o n f e r e n c e s 4 C o n f e r e n c e s 4 Conferences 4 Conferences 4 Scheduled Scheduled Scheduled Scheduled Scheduled Rounds Rounds O Round s Rounds Rounds  6:00-8:00  6:00-8:00  6:00-8:00  6:00-8:00  6:00-8:00  8: 15-9: 15  8: 15-9: 15  8: 15-9:15  8:15-9:15  8:15-9:15  EVEN ING GROUP 10:00 Med i c a t i o n s  EVEN ING GROUP 10:00 Med i c a t i o n s  EVEN ING GROUP 10:00 Med i c a t i o n s  EVEN ING GROUP  EVEN ING GROUP  10:00  10:00  Med i c a t i o n s  Med i c a t i o n s  5  8:15-9:15 EVEN ING GROUP 10:00 Med i c a t i o n s  6:00-8:00 Conferences 4 Scheduled Rounds  8: 15-9: 15 EVEN ING GROUP 10:00 Med i c a t i o n s  TABLE MONDAY  TUESDAY  108  3 - NON-GASP DAILY SCHEDULE  WEDNESDAY  THURSDAY  FRIDAY  SATURDAY  SUNDAY  6:45 M e d i c a t i o n s 6:45 M e d i c a t i o n s 6:45 M e d i c a t i o n s 6:45 M e d i c a t i o n s 6:45 M e d i c a t i o n s 6:45 M e d i c a t i o n s 6:45 M e d i c a t i o n s 7:30 B r e a k f a s t 7:30 B r e a k f a s t 7:30 B r e a k f a s t 7:30 B r e a k f a s t 7:30 B r e a k f a s t 7:30 B r e a k f a s t 7:30 B r e a k f a s t 8:00-9:00 COMMUN ITY MEET ING  8:00-9:00 COMMUN ITY MEET ING  8:00-9:00 COMMUN ITY MEET ING  8:00-9:00 COMMUN ITY MEET ING  8:00-9:00 COMMUN ITY MEET ING  8:00-9:00 COMMUN ITY MEET ING  8:00-9:00 COMMUN ITY MEET ING  9:00-11:30 9:00-11:30 9:00-11:30 9:00-11:30 9:00-11:30 9:00-11:30 9:00-11:30 D D o c t o r s Rounds D D o c t o r s Rounds D D o c t o r s Rounds D D o c t o r s Rounds D D o c t o r s Rounds D D o c t o r s Rounds D D o c t o r s Rounds 2) Fam TI y & 2) Fam i I y & 2) Fam i I y & 2) Fam i I y & 2) Fam i I y 4 2)Family & 2) Fam i I y 4 Couples Conf. C o u p l e s Conf. Couples Conf. C o u p l e s Conf. C o u p l e s Conf. Couples Conf. C o u p l e s Conf. with Dr. with Dr. w ith Dr. with Dr. w ith Dr. with Dr. with Dr. 12:00 Med i c a t i o n s  12:00  12:00  12:00  12:00  12:00  12:00  Med i c a t i o n s  Med i c a t i o n s  Med i c a t i o n s  Med i c a t i o n s  Med i c a t i o n s  Med i c a t i o n s  12:15 Lunch  12:15 Lunch  12:15 Lunch  12:15 Lunch  12:15 Lunch  12:15 Lunch  12:15 Lunch  1:00-2:00 D o c t o r s Rounds  2:00-2 : 50 OCCUPAT IQNAL THERAPY  2:00-2:50 " OCCUPAT IQNAL THERAPY  2:00-2: 50 Fam i I y & Coup Ies Con f e r e n c e  1:00-1:50 B IBL IQTHERAPY  3:00-4:00 V i s i t i n g Hours*  3:00-4:00 V i s i t i n g Hours*  3:00-4:00 V i s i t i n g Hours* 4:00-4:50  4:00-4:50  OCCUPAT IQNAL  B IBL lOTHERAPY  THERAPY  3:00-4:00 V i s i t i n g Hours*  3:00-4:00 V i s i t i n g Hours*  2:00-8:00 V i s i t i n g Hours*  4:00-4:50  2:00-2:50 Fam i I y 4 Coup Ies Conference 2:00-8:00 V i s i t i n g Hours* 4 : 0 0 - 4 : 50 Fam i I y 4  B IBL 10 . & O.T. 'COMB IN ED  Coup I es Conference  5: 00 Med i c a t i o n s 5: 00 Med i c a t ions 5: 00 Med i c a t i o n s 5: 00 Med i c a t i o n s 5: 00 Med i c a t i o n s 5: 00 Med i c a t ions 5: 00 Med i c a t i o n s 5:00-5:15 CHART REVIEW  5:00-5:15 CHART REVIEW  5:00-5:15 CHART REVIEW  5:00-5:15 CHART REVIEW  5:00-5: 15 CHART REVIEW  5:00-5: 15 CHART REVIEW  5:00-5:15 CHART REVIEW  5: 15 D inner  5: 15 D i nner  5: 1 5 D inner  5: 1 5 D inner  5:1 5 D inner  5:1 5 D i n n e r  5:1 5 D inner  6:00-6:00  6:00-8:00  6:00-8:00  6:00-8:00  6:00-8:00  6:00-8:00  6:00-8:00  V i s i t i n g Hours* 6:00-8:00  V i s i t i n g Hours* 6:00-8:00  V i s i t i n g Hours* 6:00-8:00  V i s i t i n g Hours* 6:00-8:00  V i s i t i n g Hours* 6:00-8:00  Conferences 4  Conferences 4  Conferences 4  Conferences 4  Conferences 4  Scheduled  Scheduled  Scheduled  Scheduled  Sched uIed  Rounds  Rounds  Round s  Round s  Round s  8:15-9:15  8:15-9:15  8: 15-9: 15 EVEN ING GROUP 10:00 Med i c a t i o n s  EVEN ING GROUP 10:00 Med i c a t i o n s  EVEN ING GROUP 10:00 Med i c a t i o n s  8: 15-9: 15 EVEN ING GROUP 10:00 Med i c a t i o n s  Conferences 4  Conferences 4  Schedu led  Scheduled  Rounds  Rounds  8:15-9:15 EVEN ING GROUP  8: 15-9: 15 EVEN ING GROUP  8: 15-9: 15  10:00 Med i c a t i o n s  10: 00 Med i c a t i o n s  10:00 Med i c a t i o n s  EVEN ING GROUP  o 00  109  Table 4 Activities  o f Non-Equivalent  C o n t r o l Group Per c e n t o f clients involved in activity  Activity Socialized Alone  with  psychiatrist  with  be  by  3.8  found or  visitinq other  business, qroup,  with  client  reasons. that  family  clients,  or  beinq  sleeping.  the author  and  meetinq  qrounds,  .1  with  the  to  These  conduct  non-equivalent  the c l i e n t s '  h i m s e l f i n the c e n t r a l  talkinq  psychiatrists,  on a p a s s  For  monitored  friends,  activities  area o f the u n i t activities  during  are l i s t e d i n  4. Staff  a  Sleepinq U n s u c c e s s f u l s u i c i d e attempt by w r i s t - s l a s h i n q (one p e r s o n )  u s u a l h o u r o f t h e GASP.  Table  7.7 7.7  stationinq  the  either  o r s t a f f member  on t h e h o s p i t a l  personal control  with  19.2  On P a s s  staff  walkinq  61.5  (watchinq t e l e v i s i o n , readinq, or s i t t i n q )  In c o n f e r e n c e  could  others  members were asked. First,  clients  required  and  available  This there  receive desired.  as  f o r c o n s u l t a t i o n whenever  procedure i s an much To  do  was  followed  ethical/therapeutic contact  with  otherwise,  staff Valley  f o r two concern as  they  General  110  Hospital  would  treatment  to  those  forthcoming. peutic  have  when  Second,  contact  time  been  guilty treatment  there  was  f o r both  denying  could  necessary  reasonably  a d e s i r e t o keep  groups  Statistical  Data  of  the  thera-  an  assis-  constant.  Analyses  preparation All  tant.  tests These  verified.  Control  were  hand  scored  were  then  scores  Files  were  and  verified  keypunched  by  and  100  per  hypotheses  examine  the  environmental  August.  The  10^dependent  subscales of  analyzed  press  differences  the  two  u s i n g one-way a n a l y s e s o f v a r i a n c e . employing  Wilk's  used  the  subscales  for  Control  January,  five  Questionnaire. Target Scale.  Outcome  used  June, to  to and  the  10  Scale.  between  analysis,  the  for  v a r i a b l e s corresponded  the Ward Atmosphere  Initial  Factor  cent  constructed.  A one-way m u l t i v a r i a t e a n a l y s i s o f v a r i a n c e was  for  be  likelihood of  the  ratio  groups  A multivariate criterion,  Sixteen  Univariate  analyses  Assessment  Sheet  and  were  was  Personality  were the  conducted Locus  of  111  Evaluation The in  the  hypotheses  r e s u l t s o f t h e above a n a l y s e s , next  chapter,  significance differences mental decided analysis run  there  among  periods to  analyze  the  of variance.  Assessment analyses  Univariate  computer  period  a  results  and  using  Analyses  were  experii t  was  one-way  analysis  was  Factor Target  Scale.  Multivariance:  of Variance, (Version VI)  completed  a t the U n i v e r s i t y o f B r i t i s h  a  f o r the  using  of  significant  and t h e Locus o f C o n t r o l  analyses  level  Personality  analyses  and R e p e a t e d M e a s u r e s  A l l computer  .25  multivariate  performed  in detail  Therefore,  o f the S i x t e e n  univariate  were  the  i n January  August.  Again,  Sheet  at  statistically  posttest  and M u l t i v a r i a t e  ance, R e g r e s s i o n , 1978).  and  subscales and  that  no  the p r e t e s t June  Questionnaire,  All  were  in  f o r the f i v e  Outcome  revealed  presented  on  Columbia.  Covari(Finn,  t h e Amdahl  112  CHAPTER V  RESULTS  First, of the  control  t h e Ward two  sented  Atmosphere  groups.  analyzed.  The  order  to  test  an  analysis  and o f t h e p r e t e s t s c o r e s o f evaluation  analyses  remainder  of this  a s t h e GASP  respectively. hypotheses  the  questions  are  o f the qoals  viability  of hospitalization  hospitalization  results  five  The q u a l i t a t i v e  effectiveness  to  Scale  through  then  are pre-  last.  In  to  i s s u e s a r e examined  without  paper,  qroup  and  Further,  are i n the n u l l  t h a t would  suqqest  these  with  the  of  the  GASP,  t h e GASP was  GASP.  compared  Throuqhout  two q r o u p s w i l l  be  the  the  referred  the n o n - e q u i v a l e n t  control  as  earlier, a l l  form  was  mentioned  owninq  qroup  to a lack of research  directionality.  113  Comparative E v a l u a t i o n  Preliminary  Hypothesis  i s no  d i f f e r e n c e i n the  measured  January,  The  by  January  on  atmosphere when  the  the  in  the  for  the  results 10  the  of  press  Scale  The  was  in  atmosphere  June of  employed.  the  middle  offered.  the  scores  the  For  of each  the Ward Atmosphere  subscales  among J a n u a r y ,  Atmosphere  middle  GASP  not  administrations of The  the  atmosphere  GASP was  environmental  in  August.  e v a l u a t i o n began.  evaluation  when  Ward  scores represent  the  reflect  the  J u n e , and  before the  issues  1  There as  a n a l y s i s of c o n t r o l  five are  months  measures  first  phase  The  August  scores  the  second  phase,  of  the  Scale,  of  three  J u n e , and  were  August  no as  significant shown  test  n=11.  multivariate analysis revealed  there  the  that  differences  in Tables  5,  6,  and  7. The was  F-statistic  for  0.5975, (p < 0.8923).  each v a r i a b l e r e v e a l e d (support)  (F = 2.21;  significant it  was  at  the  concluded  the  multivariate test  Separate  that with  p < .13),  the  analyses  .25  level  of  that  there  were no  of  subscales  significance.  equality  of variance  exception  a l l other  of  for  subscale were  2  non-  Consequently,  significant differences  114  Table 5  Means  and  WAS subscales  Standard  D e v i a t i o n s o f the Three t h e Ward A t m o s p h e r e S c a l e  Cell (Standard Means D e v i a t i o n )  Cell (Standard Means D e v i a t i o n )  January 1 2 3 4 5 6 7 8 9 10  9. 0000 6. 6363 5. 8181 5. 4545 7. 3636 7. 6363 6. 4545 5. 7272 6. 6363 1 .7272  (1 .6733) (1 .6293) (1 .4709) (1 .0357) (1 .1201 ) (0 .8090 ) (2 .0181 ) (1 .4894 ) (1 . 7477 ) ( 1.0091 )  Test  Periods of  Cell (Standard Means D e v i a t i o n )  June 8. 4545 7. 1818 5. 0909 6. 1818 7. 3636 7. 0909 7. 0000 5. 2727 6. 7272 1. 0000  (3. 2669 ) (0. 9817 ) (1 .6404 ) ( 1.9909 ) (1 .1201 ) ( 1 •3751 ) (1 . 5491 ) ( 1.6181 ) (1 .5551 ) (0. 8944 )  August 8. 2727 (1. 6788 ) 6. 0000 (1. 2650 ) 5. 7272 (1 .7373 ) 6. 1818 (0. 6030 ) 8. 0000 (0. 7746 ) 7. 3636 (1. 5015 ) 7. 5454 (0. 6876 ) 5. 0000 (2. 2361 ) 5. 7272 (1 •4206) 1. 6363 (1. 9633 )  Table 6 Multivariate  A n a l y s i s o f t h e Ward A t m o s p h e r e J a n u a r y , J u n e , and A u g u s t  Source of Variability  Multivariate F-test F df  Occasion  .5975  Within  Scale  at  Probability  20  0.8923  42 F  _ (20,42)=1.28 K  115  Table 7 Univariate  Analysis  Variable  of  Variance of Subscales  Mean S q u a r e wi t h i n  1 2 3 4 5 6 7 8 9 10  the  Univariate F  5.4303 1.7393 2.6242 1.8000 1.0363 1.6000 2.3151 3.2788 2.4970 1.8909  Ward  Probability  0.2902 2.2125 0.3460 1.0774 1.0819 0.5114 1.4136 0.4529 1.3471 0.9135  0.7503 0.1270 0.9660 0.3533 0.3519 0.6049 0.2591 0.6401 0.2753 0.4121 F  in  the  environment  among  Atmosphere  January,  June,  (2,30)=1.45  and  August  time  periods.  Pre-treatment  Hypothesis  There of  i s no d i f f e r e n c e  the  Control  were  group  Rotter  scale,  between  and  on t h e S i x t e e n  naire,  Target  o f samples  2  t h e GASP  group  In  comparability  and  the non-equivalent  Personality  t o examine  comparable  at  the  Factor  Internal-External the  Outcome A s s e s s m e n t  order  the p r e t e s t  number  of  scores control  QuestionLocus  goals  on  of the  Sheet.  whether  t h e two  beginning  of  groups  of  clients  their  respective  116  treatments, of  the  their  Sixteen  Locus  of  number  of  qoals  quently  on  of  are  Sheet  if  the no  clients could  significant  that  had  one  had  four.  compare  the  number  qoals"  less  on  than  In  the  in  For of  had  this  goals  one  It  each  client  of  was  had  the  ConseOutcome  qoals,  this  have  been  f o r therapy, i t  was  same p o i n t .  could  goal  reason,  beqan a t  the  the  Outcome  Tarqet  numbers  influential.  Sheet  outcome.  at  the  addition,  the  start  and  Tarqet  expected  different  client  subscales  Outcome A s s e s s m e n t  a l l clients  be  another  five  Questionnaire,  differences  since  difference  the  selected since a l l clients  success,  there  both  compared.  Tarqet of  on  Factor  were  the  Sheet was  Assessment However,  Scale  "Number  Assessment level  Personality  Control  examined.  -1  pretest scores  while  decided  before  to  treat-  ment. For  the  Sixteen  F-statistic  for  0.6586,  a  9).  Aqain,  was  to  selected.  greater of  with  no  (See equal  than  on  avoid The  1.38  8,  the  Questionnaire differences.  the  multivariate  computed  significant Tables  Personality Factor  9,  probability  a Type  (p  <  .25)  (See  d i f f e r e n c e s on and  10).  subscales pretest  of  test of  II error,  correspondinq  The the  because  Questionnaire, of  equality  0.6579  (See  a probability  u n i v a r i a t e F's Table  10.  The  p r e t e s t s was groups  could  Sixteen of  the  the  were  Table of  .25  never  hypothesis  not be  was  rejected  considered  Personality  Factor  non-significant  117  Table 8 Means and S t a n d a r d D e v i a t i o n s o f P r e t e s t S c o r e s on t h e F i v e S u b s c a l e s o f the S i x t e e n P e r s o n a l i t y F a c t o r Questionnaire  GASP Cell Means C E F 0  GASP Standard Deviation  4.1 8 3. 68 6.87 7. 18 6.00  NonEquivalent Control Group C e l l Means  2.55 1.89 2.30 2.15 2.1 9  NonEquivalent C o n t r o l Group Standard Deviation  3.93 4.00 6.12 7. 18 6.56  2.03 1.73 2.33 1 .91 1.86  Table 9 M u l t i p l e Analysis of Variance for Significant Differences Between P r e t e s t S c o r e s on t h e S i x t e e n Personality Factor Questionnaire Source of Variability  Multivariate F-test F df  Occasion  0.6586  Probability  5  Within  0.6579  26 F  Table Univariate the Five  4  0. 50 0.78 4.50 3.12 2.53  ( 5 , 2 6 ) = 1.42  10  F - R a t i o s o f D i f f e r e n c e on the P r e t e s t S c o r e s on Subscales of the Sixteen Personality Factor Questionnaire  Hypothesis Mean S q . C E F O Q  ? 5  Univariate F  Probability  0. 07 0.21 0.84 0.67 0.52  0. 78 0.64 0.36 0.41 0.47 F  > 7 5  (1,30)  =1.38  118  The  two  ment of  analyses  Sheet  .29  when and  and  the  1.10  compared 12).  Locus  to  on  of  f o r the  Target  Control  Scale  respectively. a  tabled  Therefore  equivalent of  and  of variance  the  the  Target  F  yielded  were  (1,30)  =  groups  were  7 5  two  These  Outcome  not  1 .38  AssessF-values  significant  (See  Tables  considered  Outcome A s s e s s m e n t  Sheet  11  to  and  be  Locus  Control Scale.  Evaluation  Hypotheses  Hypothesis  3  There GASP  is  no  and  significant  the  posttest  difference  non-equivalent  scores  of  the  between  control  Target  group  Outcome  the mean  Assessment  Sheet.  The  value  hypothesis significant was  not  was  admission.  "most  energy  the  (See  between Table  It on  important"  regard was  corresponding  to  this  Thus, the h y p o t h e s i s o f treatment  group  and  no  control  13).  4  hypothesized with  F-statistic  (p < 0.067).  difference  Hypothesis  achievement  more  3.59  rejected  Deleting It  was  of  t h a t t h e r e would to  thought  accomplishing goal,  and  goals that what less  be  a difference  the  client  defined  the  client  might  s/he on  the  identified remaining  in  upon  expend as  the  goals.  11 9  T a b l e 11 Means and S t a n d a r d of Control Scale  GASP Cell Means  D e v i a t i o n s o f P r e t e s t S c o r e s on t h e L o c u s and t h e Number o f G o a l s on t h e T a r g e t Outcome A s s e s s m e n t S h e e t  GASP Standard Deviation  TOAS 3.62 LOC 12.06  NonEquivalent Control Group C e l l Means  0. 72 3.40  NonEquivalent C o n t r o l Group Standard Deviation  3. 75 1 3.56  Table  0. 58 4.59  12  Multivariate Analysis of Variance for Significant D i f f e r e n c e s Between P r e t e s t S c o r e o f t h e L o c u s o f C o n t r o l Scale and t h e Number o f G o a l s on t h e T a r g e t Outcome Assessment Sheet Hypothesis Mean Sq. TOAS LOC  Univariate F  0.12 18. 00  Probability  0.29 1.10  0.59 0. 30 F  Table Analysis  of Variance Target  ? 5  (1,30)=1.38  13  and Means o f P o s t t e s t S c o r e s Outcome A s s e s s m e n t S h e e t  Degrees o f Freedom  F-Value  Probability  (1,30)  3. 59  0. 067 F  Mean P o s t t e s t GASP 3.05  Score  Non-Equivalent C o n t r o l Group 2.65  > 9 5  f o r the  (1,30)=4.17  120  However, o n l y  one p e r s o n  goal  "most  as  every  the  goal  to  important".  as t h e "most  differentiate t h e "most  i n both groups  important"  A l l other  important".  among t h e g o a l s goal  identified  a single  subjects  Given  this  failure  chosen, the hypothesis could  rated to  related  n o t be t e s t e d .  Hypothesis 5 There  i s no  significant  difference  GASP g r o u p and t h e n o n - e q u i v a l e n t measured  The  F-statistic  difference  i n Locus  the  GASP  The  GASP g r o u p  on did  Locus o f C o n t r o l  revealed of Control  and t h e g r o u p  the R o t t e r  that  attained  that  between  o f the Rotter  Scale.  there  was  a significantly  a  significant  the group  d i d n o t (F =  I n t e r n a l - E x t e r n a l Locus  t h e non-GASP g r o u p .  the  c o n t r o l group as  on t h e mean p o s t t e s t s c o r e s  Internal-External  between  receiving  6.70; p  < .01).  more i n t e r n a l  of Control  Scale  (See T a b l e 1 4 ) .  Hypothesis 6 There and  a r e no  differences  non-equivalent  score  of  Sixteen  the  between  control  following  Personality Factor  group  five  t h e GASP mean  subscales  Questionnaire:  a.  Factor  C, ego s t r e n g t h .  b.  Factor  E, a s s e r t i v e n e s s ;  c.  Factor  F, s u r g e n c y o r e n t h u s i a s m .  group  posttest of  the  score than  121  Analysis  of  Variance  and  Table  14  Means  of  Locus of  Degrees  Posttest  Control  Probability  6.70  0.01  Mean P o s t t e s t  Scores Non-Equivalent C o n t r o l Group  GASP 6.90  11.00 F  d.  Factor  0,  e.  Factor  Q^,  The  level  F-statistic of  rejected.  of  analysis 4.81,  factors  Table  15).  were  Examination  for  which The  the  Therefore,  which  ( 1 ,30)=4. 17  anxiety.  significance. between  > 9 5  guilt.  multivariate  differences  1971)  the  Scale  F-Value  (1,30)  an  for  of  Freedom  in  Scores  was  was  and  of  the  corresponding  to  univariate the  the  possible  contributing  five  to  two  groups  significant  hypothesis  GASP  it  the  of  at  no  the  the  group  explore  subscales  (Hummel of  the  was  further  significance  F-ratio  .05  significant  non-GASP to  resulted  &  (See  Sligo, Sixteen  122  Table Multiple  15  A n a l y s i s of Variance f o r P o s t t e s t Scores Sixteen Personality Factor Questionnaire  . Source of Variability  Multivariate F-test F df  Occasion Within  4.8143  on  the  Probability  5 26  0.0031 F. ,(5,26) =  1.42  in  16  and  Surgency  (F)  Q  Personality 17  Factor  Questionnaire  reveal differences  (F = For  5.14; the  p <  .03),  remaining  reported  in favor of and  the  Anxiety  three  (Q ) 4  tests,  Tables  GASP on (F =  the  8.11;  p <  F-values  .008).  were  not  significant.  Hypothesis  7  There  is  no  significant  GASP g r o u p and  the  t h e mean l e n g t h o f  The 13. 375  average  days,  and  non-equivalent ence  between  16.3  per  yielded .08).  cent  the  treatment  the  average  two  control  i n the  between  control  group  on  hospital.  hospital.for time  the  in  the  the  GASP g r o u p  hospital  was  15.5625 d a y s .  The  groups  was  2. 1875  This  1.338 of  A with  no  comparison  of  30  of  degrees  significant  g r o u p was  days.  not  these  rejected  (See  the  differwas  a  groups  freedom,  differences  was  for  group  difference.  hypothesis and  stay  i n the  a t-value of The  non-equivalent  time  control  difference  (p  <  between  Table  18).  123  Table Means and S t a n d a r d  C E F 0  Deviations f o r Sixteen Personality Questionnaire Posttest NonEquivalent Control Group Cell Means  GASP Cell Means  16  NonEquivalent Control Group Standard Deviation  GASP Standard Deviation  2.76 1.76 1 . 56 2.00 2.04  2. 88 2.07 1. 57 2.55 2.28  5.06 4.75 6. 50 6.63 7. 50  6.81 5.19 7.75 6.63 5.44  F  Table Analysis  of  C E F 0 °4  > 9 5  (1,30)=4.17  17  Variance f o r Sixteen Personality Questionnaire Posttest  Hypothesis Mean Sq. 24.50 1. 53 12.50 0. 00 34.03  Factor  Univariate F 3.20 0. 05 5.14 0. 00 8.1 1  Factor  Probability 0.08 0.49 0.03 1.00 0.008  124  Table t-Test Source  R e s u l t s f o r Length  Mean  GASP  18 of Stay  Standard Deviation  13.3750  t-Value  4.52953 -1.338  Non-equivalent C o n t r o l Group  15.5625  4.71832 t  Table  > 9 7 5  (30)  = ±2, 04  19  Summary o f P o s t t e s t R e s u l t s TOAS LOC Ego A s s e r t . S u r g .  Guilt  Anxiety Len.  Significantly Different  NO  Probability  .06  YES NO .01 .08  NO  YES  NO  .49  .03  1.00  YES  NO  .008  .08  Summary The GASP  group  Control, subscales (See  results was  higher  o f the p o s t t e s t hypotheses significantly on  the Surgency,  o f the S i x t e e n  Table 19).  more  internal and  reveal  t h a t the  on t h e L o c u s o f  lower  Personality Factor  on  the A n x i e t y  Questionnaire.  125  CHAPTER VI  DISCUSSION AND  Summary  This  study  development evaluation  The  parts.  and the second  was  to  for patients relevant  to  psychotherapy,  Attainment  Scaling.  areas  showed  group  procedure.  that  this  The  i t was This  came  analysis  process,  i s to a r t i c u l a t e  experienced  task  possible  the  hospitalization;  a  problem-solving  general  two weeks;  develop  hospitalized  following  within  The  first was  part the  was  the  preliminary  o f t h e GASP  objective  Literature  task  of Results  o f t h e GASP.  procedure  brief  two  o f t h e GASP  Development  The  has  SUMMARY  steps:  a  when t h e e v e n t s  goals  for a  term.  from  that  short three and  Goal  synthesis  of  these  a  short-term  consists  of the  to the c l i e n t can  be  of events  that  accomplished that  of the f e e l i n g s  happened;  areas:  therapy,  t h e GASP,  a list list  group  to develop  communicating  developing writing  and  standardized,  constructing  preceded  the  client  a list  of  126 the  client's  emotional  strenqths  trauma;  feelings  create;  lems;  listing  worse  and  ing  the  develop  what  a  of  the  1.  the  the  Rotter  Target  The  r e s u l t s of  The  environmetal  six  months  the  evaluation.  before  the  were  the  the  atmospheres  ment  of  months  before  the  evaluation  period.  to  thera-  were  into  qroup. Locus  Sheet,  and  32 of  a  non-  They  were  of  Control  the  Sixteen  admission,  and  again  interview.  was  evaluation  found  study  or  empirical  (Hypothesis  the  possible  divided  upon  psychiatric unit  six  was  the  psychiatric unit  GASP  preliminary press  objective,  evaluation  Internal-External  The  ward  the  and  initial  the  review-  GASP  Questionnaire  days a f t e r t h e i r  prob-  problem  multi-component  Outcome A s s e s s m e n t  Factor  the  problem;  It  preliminary  They  group  the  and  clients.  of  Hospital.  the  Personality eiqht  for  make  first  their  events  solve  the  achieved.  short-term  Evaluation  control  to  The  h o s p i t a l i z e d p a t i e n t s of  administered Scale,  do  survive  the  would  can  weekly.  GASP was  to  problems  done t o a l l e v i a t e  f o r groups of  General  equivalent  them  that  person  progress  subjects  voluntarily Valley  be  the  Preliminary The  the  the  goals  standardized  p e u t i c process  The  listing  client's  permit  listing  what can  development  that  to  be  different  durinq  both  phases  support  for  equivalent  1) meant t h a t was  research The  not  were:  the  essentially beqan,  three  and  different  of  environthe  same  throuqhout qroups  of  127  clients  saw t h e e n v i r o n m e n t  logical  press,  present.  Although  January,  June,  different those  on  their  considered point  were  to  on t h e i r  Three  found  cent  scores.  started  raters  time.  what The  goals  identified  Ninety  the c l i e n t s  direction  the  in selecting  achieved  higher  posttest scores  neither  the  be same  was  a l l their  results  f o r Hypothesis between goals  a 99.5 p e r  stayed  i n the  90 p e r  shift  cent,  know  direction.  b u t more  on t h e i r  both level  in helping  t h e two  showed groups  that  finely groups of goal  clients  there  in helping  for hospitalization.  as  does n o t  GASP  for hospitalization. 3  of  a r e t h e same  Although  superior  goals  and t h e  100 p e r c e n t  goals,  attainment.  achieve  their  could  of the  The  GASP.  of  achieve  differ-  i s t h a t most p e o p l e  admission  levels  difference  at  cent  Of t h i s  GASP.  defines  attainment,  was  per  on, and n e v e r  upon  during  There  at admission  the  t o work  identified  assist  groups  essentially  goals'.  a l l i n t h e same  have  i n the h o s p i t a l  the c a t e g o r i e s  The c o n c l u s i o n h e r e  they  those  rated  identified  same c a t e g o r i e s d u r i n g  the  in  not s u f f i c i e n t l y  Both  at  agreement.  goals  were  occurred  pretests.  inter-rater  goals  were  was  different.  of the c l i e n t s '  clients'  evaluation  events  they  psycho-  not t o be s i g n i f i c a n t l y  pretest have  t h e same  the  the environments  independent  direction  not  different  t o be seen as  groups  ent  or  and A u g u s t ,  t o cause  times  Both  whether  as h a v i n g  to The  was  no  clients  Perhaps i f  128  another  step  were  specification goal  goal",  would  failed the  to  of the l e v e l s  attainment  subjects  added  t h e GASP  improve  the  o f s u c c e s s d u r i n g t h e GASP,  be s i g n i f i c a n t l y  to d i f f e r e n t i a t e  "most  to  important  higher.  their  goal"  "most  (Since  important  hypothesis  was  dropped.) At  the  posttest,  different  on  compared  to  statistical GASP  the  the  sample  a of  control place  more  i s i n response  both  the  attainment  as  behaviors  hospitalization that  themselves. the  into  they  the  the  GASP  for their  they  more  put  and  own g o a l s may  responsible  of  self  In  how to  takes the  their other  goal words,  people  a r e r e s p o n s i b l e f o r what  intellectually  this  that  influences  to learn  for  that  learning  actually  group i n  sense  to the l e a r n i n g  The  that the  control control  practice.  The p o t e n t i a l  procedure  of  when  group.  5 indicated  increased  and  they  with  use o f g o a l s  are  GASP,  control  control  locus  This  significantly  of  the n o n - e q u i v a l e n t  internal  undergo  was  locus  f o r Hypothesis  clients.  clients  group  non-equivalent  than  during  believe  GASP  internal  support  i s better  inducing  the  to  to  happens t o understand  implement  the  clients  that  convince  f o r themselves  and  their  condition. At  the  posttest,  different statistical different  both  in increasing support than  the  groups ego  were  not  strength.  for stating  that  non-equivalent  statistically There  was  t h e GASP g r o u p control  group  no was on  129  Factor  C,  esting. tion  Ego  One would  should  was  Strength.  reduce  initally  feelings, clients  expect  themselves, involves  examination.  in  listing  and  greater  affective  The GASP  greater  expanded.  For  designed  s t a t e of c o n f u s i o n .  an a c t u a l  even  to  could  include  the  an  of  and  events,  goals  enabled  t h e GASP  of also  behavioral  self-  be c o n d u c i v e  integration strengths  exercise  It  understanding  possibly  personality  example,  i s inter-  psychiatric hospitaliza-  problems,  an  finding  but h o s p i t a l i z a t i o n w i t h o u t  clients  permitting  that  that  strengths, have  above  the c l i e n t ' s  believed  to  The  i f i t were  list  on  to  could  positive  be  self-  statements. At  the  posttest,  different  in  Assertiveness, was  more  possible complex  tiveness  merely  may  have  posttest, in  equivalent  control  significantly were  their  more  The  out that  the other.  There  decisions  been  a  the  that  counterparts.  the i n c r e a s e d  asser-  of  the  of the treatment group  when  compared  was  t h e members  It  of  about  clients' program.  significantly with  For Surgency,  enthusiastic  i s more having  GASP  group.  group  and  result  parts  on  are s e v e r a l  exercising and  data  neither  assertiveness  Surgency  demonstrated  statistically  for this:  i n other  different  data  E, p o i n t e d  than  not  assertiveness.  in a situation,  participation the  Factor  explanations than  g r o u p s , were  increasing  assertive  self-control  At  both  the  Factor  non-  F, t h e  t h e GASP  were  themselves  than  i s suggested  that  this  130  outcome  i s the r e s u l t  provides.  By p r o c e e d i n g  people's  enthusiasm  general  rises  should to the is and  hearing  others  At  posttest  the  difference control  Since  i t , appears  worked  statistically the  subjects'  posttest  group  subjects  higher  than  to  a  be  framework  result f o r how  problems  going  t o do  worry  their about  they  "what  was  lower  no  i n the  parts  of  Q^,  between  group. was  for anxiety This  subjects  came  the  to  what  seek they  GASP  lower  than  steps  control actually appears specific  treatment,  and p r o g r e s s decreases.  a  are  a  The  was  having  was  t h e GASP  outcome  the s i t u a t i o n .  t o do"  there  the non-equivalent  mean  a r e , and  specific  from  non-equivalent  other  f o r anxiety  GASP  t o remedy  come  there  tested  Factor  p r e t e s t mean. of  goals,  person.  the  control  while  posttest  their  that  0,  difference  mean  mean,  their  engage  f o r Anxiety,  non-equiva1 ent  pretest  the  t h e GASP  guilt.  significant  their  and  person  toward  about a  groups  that  t o lower  the p o s t t e s t  and  both  with  taken  Factor  GASP  in  It i s speculated  of s e l f - w o r t h like  life  Psychotherapy  demonstrated  they  the  and  that causes a  place.  for Guilt,  between  posttest,  At  s a y what  group.  program  spiral  of the s e q u e n t i a l steps feelings  t h e GASP  s e q u e n t i a l steps, the  i s attained.  enthusiasm  of p o s i t i v e  focus  themselves  i n the f i r s t  greater  a result  step  t h e downward  therapy  even  i n small  f o r both  as each  reverse  seek  of the c o n c r e t e  what  specifically  As  the  toward It i s  clients goals, apparent  131 that  without  situations and  this  this  and  type  of  concreteness,  problem-solving  vagueness  may  methods  increase  people's  remain  anxiety,  vague,  instead  of  lowerinq i t . 10.  There  was  between for  no  t h e GASP  lenqth  than e i q h t  have  control  qroup  o f GASP h o s p i t a l i z a t i o n This  d i f f e r e n c e , thouqh  fiscal  I t would  hypothesis  difference  implications for  be  f o r treatment  interestinq to periods  days, and/or f o r a time o f s t u d y  different  lonqer  than  weeks.  These Scale,  could  treatment.  examine t h i s  six  The l e n q t h  by 16.3 p e r c e n t .  siqnificant,  providinq  significant  and t h e n o n - e q u i v a l e n t  of stay.  was r e d u c e d not  statistically  preliminary  results  and some s u b s c a l e s  Questionnaire  suqqest  therapeutic treatment voluntarily  could  that  milieu  of  and a  of  procedure.  short-term  Factor  the  GASP  The G o a l A t t a i n -  and i n c o r p o r a t e d  inteqrated  Control  Personality  h o s p i t a l i z a t i o n with  be m o d i f i e d  procedure  the Locus  o f the Sixteen  showed p r o m i s e as a t h e r a p e u t i c ment S c a l e  from  i n t o a psycho-  successfully psychiatric  i n t o the unit for  h o s p i t a l i z e d people.  L i m i t a t i o n s o f the Study  The into  discussion  two p a r t s :  of limitations of this  study  i s divided  the l i m i t a t i o n s o f the development  GASP, and l i m i t a t i o n s o f t h e p r e l i m i n a r y  evaluation.  o f the  132  The  development  coming, to  of  t h e GASP  t h e myth o f o b j e c t i v i t y .  make  decisions  and  include,  and w h i c h  to exclude.  on  empirical  biases the more  data  could  fully  Although  approach  explored  such  and  clients.  GASP  The and  inherent  which  was  judgments  possible.  were  incorporated  could  be  into  use b y c l i n i c i a n s  with  based  personal  have the  been GASP.  the process  i s accessible  enhanced  to  the b e n e f i t s o f  t o psychotherapy might  consequently  required  However,  F o r example,  and  short-  literature  p s y c h o t h e r a p y may be e f f e c t i v e ,  time-consuming  appraisal  about These  n o t be a v o i d e d .  psychoanalytic  an  The d e v e l o p e r  choices  whenever  has  by  to  the  different  is  fewer  critical  theoretical  orientations. With  respect  limitations results.  which First,  selecting  the  conclusions who  t o the p r e l i m i n a r y  would  may  should true  be  recognized  random  sampling  psychiatric be  desire  evaluation,  psychiatric  only  are  in evaluating  the  was  clients.  generalized  there  not p o s s i b l e  Consequently, to c l i e n t s  treatment  at  of  Valley  in the  Seattle General  Hospital. Second, evaluation clients,  the was  and  psychotics  should  conducted  that  there  with were  i n the p o p u l a t i o n .  results  of t h i s  similar  population  concrete  reader  nature  evaluation were used  be  reminded  that  this  voluntarily hospitalized twice  as  many  neurotics  It i s conceivable  could  only  i n future  be  reconfirmed  studies.  o f t h e GASP i s a p p l i c a b l e  that  only  as the  i f a  Perhaps the f o r those  who  133  are  sufficiently  disturbed  or  confused  as  to  request  hospitalization. Third, brief  psychotherapy  have  enabled  results on  although  or r a t e  were  how  indicate  that  research  would  long-lasting  p o s s i b l y be b o l s t e r e d by  of r e t u r n  initially  follow-up  to assess  could  to  to therapy.  addressed;  lack  Both  of  of c l i e n t  the data these  partici-  l e d to inconclusive r e s u l t s .  Fourth,  there  differentially tion  research  i s important,  Research  recidivism  pation  is  the r e s e a r c h e r  were.  questions  there  i s no  perceived  (See A p p e n d i c e s  input  from  the e f f e c t s  clients  as t o how  of t h e i r  K and L f o r p o t e n t i a l  they  hospitaliza-  client  satisfac-  tion questionnaires). Fifth, exit might  was  conducted  be d i f f e r e n t  be  with  t h e sample achieved  psychiatric  a contained, size  with  a  entry,  As m e n t i o n e d the  long-term  GASP.  above,  small.  larger  results  t i m e - l i m i t e d group. Different  sample  of  for Further  results  comparable  the present  Research  results  e f f e c t i v e n e s s of treatment  By g a i n i n g  some t i m e , term  was  The  open  hospitals.  Recommendations  1.  as an open  g r o u p where membership was not r e s t r i c t e d .  Sixth, might  the group  i t would  the c o o p e r a t i o n be o f i n t e r e s t  e f f e c t i v e n e s s o f t h e GASP.  do n o t  address  employing the  of the c l i e n t s to assess  Further,  over  the long-  i t would  also  134  be  interesting  t o know  are  more s a t i s f i e d  The  preliminary  the  GASP  offers  does  them  such,  the  part  of  workshops, therapy, In  help of  them  the  areas  fruitful could  of  venture.  be o f f e r e d  career-planning and f a m i l y  of a p p l i c a t i o n .  recommendation with  i t would  larger  populations,  be  samples and  as n o n - h o s p i t a l i z e d  of a s s e s s i n g  process  is  researchers  content  not  to look  of the p r o c e s s .  conducted  to  refinement. beneficial  As  or  popula-  involuntarily  populations.  a  challenge  other  workshops,  such  psychotic  the area  as  to  t h e GASP  evaluations  It  problem-solve.  t h e GASP  previous  with  in c r i s i s .  i n t e r v e n t i o n procedures,  populations  more  of  GASP,  to  clients  hospitalization  on p e o p l e  p o s s i b l e that  to conduct  hospitalized  be  impact  life-planning  of  different  ties  hospitalization.  t o name b u t a few a r e a s  helpful  While  an  plan  marital  light  tions,  their  suggest  conditions  seems t o be a p o t e n t i a l l y  is entirely  as  the  have  a  which  findings  application  psychology It  with  under  see  Along to  as  this  line  those  deleting  Further  could  the v a r i o u s  in  steps  some, and s e e i f t h e r e s u l t s  research  evaluations  i s any  merit  of refinement,  steps  steps  such  properdoes  at b e t t e r a r t i c u l a t i o n of  t h e more  sequentially employ  new,  i f there  identify  well  psychotherapeutic  potent are  the  GASP.  such  i t might  be  of the  impotent  by  Thus  one  o f t h e GASP,  are s i m i l a r .  in  parts  that  could  excluding  135 5.  In t h i s total  evaluation  treatment  t h e GASP was an i n t e g r a l  program.  I t would  be  s e e i f i t h a s t h e same p s y c h i a t r i c  of a  interesting  examine t h e GASP on i t s own, i n d e p e n d e n t and  part  to  o f any program impact.  Conclusion  It be  adapted  assists to  may  brief  and  clients  from  the  goals,  present  centeredness,  does  brief  short  time  hospitalization. as  psychiatric  an  group  Scaling  duration,  affect  this  some  Hospitalization qroup  process  such a s :  interviewing, ventilation,  The r e s u l t s o f t h e  integration,  with  approach  problem-solving  focused  aspects  that  a l l the important  literature  coping s k i l l s .  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MMPI p a t t e r n s i n d r u g a b u s e r s b e f o r e and a f t e r t r e a t m e n t in therapeutic communities. J o u r n a l o f C o n s u l t i n g and C l i n i c a l P s y c h o l o g y , 1975, 4_3, 3, 286-296. Zusman, J . Some e x p l a n a t i o n s o f t h e c h a n g i n g a p p e a r a n c e o f p s y c h o t i c p a t i e n t s . In G.M. Bruenberg (Ed.), E v a l u a t i n g t h e e f f e c t i v e n e s s o f community m e n t a l h e a l t h services. New Y o r k : Mibank, 1966.  169  APPENDIX A  EXAMPLE OF ONE CLIENT'S COMPLETED  GASP  170  EVENTS Married shortly after she e n t e r e d nursing school. She s t a r t e d work a f t e r c o m p l e t i o n of schooling. Separated. C o u n s e l i n g t o save m a r r i a g e . Saw each o t h e r o n e / t w i c e p e r week Slept together. She said she wanted me to find someone e l s e . She filed for divorce t o save me the p a i n o f g o o d b y e . I had a d a t e w i t h a g i r l . Thought o f w i f e . Got n e r v o u s / t e n s e . Called friends — no answer. C a l l e d w i f e -- she r e f u s e d t o see me. T a l k e d on f r o n t lawn w i t h w i f e . S a i d I wanted one more c h a n c e she s a i d no. I turned by back and s l a s h e d my wrist. W i f e s t o p p e d my b l e e d i n g . Ambulance came. I came t o p s y c h i a t r i c u n i t . I decided to stay f o r h e l p . FEELINGS Hate m y s e l f , alone. Insecure, afraid. Lost, guilty, dirty. Empty, a n g r y , t i r e d . C o l d , l o n e l y , used. Jealous, set-up, trapped Desparate, confused, sad Helpless, disappointed.  STRENGTHS Gentle, empathic. *Determined. Affectionate. * P l a n ahead. Curious. Insight. Intelligent. Industrious. *Controlled. Good l i s t e n e r . Handsome. Trusting. Helpful. Dependable. Caring. Straightforward. Sexy. •Physically powerful. *High moral standard . L i k e to help o t h e r s . * = also problems.  causes  PROBLEMS H a r d to make f r i e n d s . IV S t i f l e a n g e r - back p a i n . Hate m y s e l f . II S t i l l love wife. III/IV D i v i s i o n of property. II/III/IV Easily distracted. I Job d i s s a t i s f a c t i o n . Bad temper. (Number a f t e r P r o b l e m r e f e r s to G o a l # t h a t a d d r e s s e s t h i s problem)  GOALS I. II. III. IV. V.  Finish projects I start. F e e l good about m y s e l f . Face d i v o r c e . Communication s k i l l s . E s t a b l i s h a new home f o r  myself.  171  APPENDIX  EXAMPLE TARGET  OF  OUTCOME  B  COMPLETED ASSESSMENT  SHEET  GOAL  LEVELS  CN  z (-2)  Increase Verbal Communication  Decrease Behavior  Spontaneously s p e a k to. no m o r e t h a n one p e r s o n per day  Effect  Suicide  Suicide  Increase personal  interRelations  C a n name no o n e except wife  Never anger  Expresses o n l y when raged  Spontaneously s p e a k t o no m o r e than 2 t o 4 people per day  Hospitalized for suicide attempt  C a n name 1 t o 3 p e o p l e he k n o w s personally (excluding wife)  Expected level of Success (0)  Spontaneously speak t o 5 t o 6 p e o p l e p e r day  C o n t a c t s t a f f when feeling suicidal; no s u i c i d e attempts  C a n name 4 t o 5 p e o p l e he knows personally  More t h a n pected ( + 1)  Spontaneou s l y speak t o 7 to 9 p e o p l e p e r day  No s u i c i d e feelings reported f o r 10 d a y s ; no a t t e m p t s  C a n name 6 t o 8 p e o p l e he k n o w s personally  Spontaneously s p e a k t o more than 9 people per day  I n d i c a t e s no s u i c i d e f e e l i n g s f o r 60 d a y s ; no a t t e m p t s  C a n name 9 o r m o r e p e o p l e he k n o w s personally  Less than pected (-1)  Most able  Ex-  Ex-  Favor( + 2)  ti  •  — •  Express Angry Feelings  express  anger en-  When I f e e l angry, list event, circumstances , and action . taken Share l i s t community  with  Have a m e e t i n g to share list w i t h my f a m i l y  APPENDIX C  TRAINING AGENDA  Session  1:  Introduction of  uniformity  In t h i s s e s s i o n t h e 14 p o i n t s were p r e s e n t e d . The f o c u s o f t h e s e s s i o n was t o u n d e r l i n e t h e n e c e s s i t y f o r c o n s i s t e n c y and u n i f o r m i t y o f presentation. Althouqh each c l i e n t ' s c o n t e n t would be d i f f e r e n t , t h e form o f t h e process must s t a y t h e same. The s e s s i o n was spent d e f i n i n g what t h e GASP p r o c e s s must i n c l u d e . Session  2:  Timing  --  b r e v i t y of  goals  As t h e n o t i o n o f GASP u n i f o r m i t y had been e m p h a s i z e d i n i t i a l l y , t h e g r o u p was now ready to i d e n t i f y a means o f c o n t r o l l i n g t h e t i m e f a c t o r of the p r o c e s s . T h i s was t o be accomplished by e m p h a s i z i n g t h a t c l i e n t goals s h o u l d be s u c h as t o be a c h i e v e d w i t h i n two weeks. The c o n t e n t o f t h e g r o u p was concerned with emphasizing t h i s p o i n t to clients. Their goals should be able to be a c h i e v e d w i t h i n two weeks, n o t two months o r one y e a r . The s t a f f r o l e - p l a y e d e x a m p l e s o f c l i e n t s with too expansive g o a l s . Session  3:  Timing  -- b r e v i t y o f  process  The g r o u p was i n s t r u c t e d how t o keep t h e GASP under s i x t y m i n u t e s . Thus i f a c l i e n t i d e n t ified "feelings" they should be instantly n o t e d on t h e b o a r d r a t h e r than w a i t i n g f o r the " F e e l i n g " a s p e c t o f the p r o c e s s . This i s a process that develops the lists, rather than a process that needs to have every aspect o f the c l i e n t emphasized. The staff was i n s t r u c t e d t o have c l i e n t s keep their comments b r i e f and t h e n t o move t o t h e n e x t point. Session  4:  How  to e l i c i t  answers  The g r o u p ' s t a s k was t o b r a i n s t o r m questions t h a t would a s s i s t t h e c l i e n t i n t h e p r o c e s s . The g r o u p d e v e l o p e d , and a g r e e d upon, q u e s t i o n s t h a t were i n c o r p o r a t e d i n t o t h e p r o c e s s as s u g g e s t e d questions. Session Session  5: 6:  Identifying behavioral Identifying behavioral  goals goals  Behavior c r i t e r i a f o r g o a l s was emphasized. I t was e x p l a i n e d t o t h e q r o u p how t o t u r n any goal into observable behavior. F o r example, i f t h e g o a l was "to f e e l b e t t e r " the staff  175 was i n s t r u c t e d t o a s k t h e c l i e n t what s/he would be d o i n g i f s/he f e l t b e t t e r . Within b o t h s e s s i o n s , t h e s t a f f was t o i d e n t i f y any g o a l and r e - d e f i n e t h a t q o a l i n t o o b s e r v a b l e behavior. The q r o u p ' s t a k s was t o i d e n t i f y t y p i c a l c l i e n t g o a l s and t o come t o an a g r e e ment a s t o w h e t h e r o r n o t t h e y r e f e r r e d t o observable behavior. Session  7:  Forcing  goals  As some c l i e n t s are r e s i s t a n t or find i t difficult to articulate qoals, the s t a f f e x p l a i n e d the problem o f a r t i c u l a t i n g goals f o r them — o r f o r c i n g g o a l s upon t h e c l i e n t . If, after exploring a l l potential alternat i v e s , the c l i e n t has not d e f i n e d a q o a l t h e therapist identified, i t was a g r e e d t o l e t t h e c l i e n t have h i s / h e r way. Session  8:  Memory c u e s ,  f e e l i n g s , and  conclusion  The s t a f f s h a r e d methods t h e y had d e v e l o p e d t o remember t h e GASP. I t appears that i n d i v i d u a l s use u n i q u e methods t h a t o n l y t h e y o r l i k e t h i n k i n g p e o p l e employ. Secondly, the staff's f e e l i n g s about t h e GASP were e x p l o r e d as w e l l as t h e i r f e e l i n g s about t h i s research. F i n a l l y , t h e GASP p r o c e d u r e was re-articulated i n t h e 14 s t e p s t o ensure uniformity. The regular shifts  8  one-hour  work  day.  were p a i d  In  performances generate  to  and were  general  curiosity, involved  that  to  were  worked  a  afternoon  a  focusing staff  week.  was  These  perceived  these  critiqued  sessions  problems.  on  were their  were u s e d t o The  typical  sessions.  o f t h e m e e t i n g s was one o f e x c i t e m e n t  generated  by  i n a learning  them and t h e p a t i e n t s .  o f the  and e v e n i n g  theme  i n t h e themes o f t h e w e e k l y  tone  part  to attend.  where  o f the past  solutions  sessions  having  sessions  problems are l i s t e d The  Staff  over-time  addition  problem-solving  weekly  the s t a f f ' s experience  notion  that  that  they  was o f v a l u e  to  176  APPENDIX D  THE WARD ATMOSPHERE SCALE  177  WAS  Subscale  Definitions  INVOLVEMENT  m e a s u r e s how a c t i v e and energetic patients are i n the day-to-day s o c i a l f u n c t i o n i n g o f t h e ward, b o t h as members o f t h e ward as a unit and as i n d i v i d u a l s interacting with other patients. P a t i e n t a t t i t u d e s such as p r i d e i n the ward, f e e l i n g s o f g r o u p s p i r i t , and g e n e r a l e n t h u s i a s m a r e a l s o a s s e s s e d .  SUPPORT  m e a s u r e s how h e l p f u l and s u p p o r t i v e p a t i e n t s are towards other patients, how well the staff understand p a t i e n t needs and are w i l l i n g t o h e l p and e n c o u r a g e p a t i e n t s , and how encouraging and c o n s i d e r a t e d o c t o r s a r e towards p a t i e n t s .  SPONTANEITY  m e a s u r e s the e x t e n t t o which the e n v i r o n m e n t encourages p a t i e n t s to act openly and to f r e e l y express t h e i r f e e l i n g s towards o t h e r p a t i e n t s and the s t a f f .  AUTONOMY  a s s e s s e s how s e l f - s u f f i c i e n t and independent patients are encouraged to be in their p e r s o n a l a f f a i r s and in their relationships w i t h s t a f f ; how much r e s p o n s i b i l i t y and s e l f direction patients are encouraged to e x e r c i s e ; and t o what e x t e n t t h e s t a f f i s i n f l u e n c e d by p a t i e n t s u g g e s t i o n s , c r i t i c i s m and o t h e r i n i t i a t i v e s .  PRACTICAL ORIENTATION  a s s e s s e s the e x t e n t t o which the p a t i e n t ' s environment o r i e n t s him/her towards p r e p a r i n g h i m s e l f f o r r e l e a s e from the h o s p i t a l and f o r the f u t u r e . Such t h i n g s as t r a i n i n g f o r new kinds of jobs, looking t o the future and goals setting and w o r k i n g toward p r a c t i c a l are c o n s i d e r e d .  PERSONAL PROBLEM ORIENTATION  measures the extent to which p a t i e n t s are encouraged to be concerned with their feelings and problems, and to seek to understand them through openly talking to o t h e r p a t i e n t s and s t a f f about t h e m s e l v e s and their past.  ANGER AND AGGRESSION  m e a s u r e s the e x t e n t t o w h i c h a p a t i e n t i s a l l o w e d and e n c o u r a g e d t o a r g u e w i t h p a t i e n t s and staff, t o become o p e n l y angry and to d i s p l a y other e x p r e s s i o n s of anger.  1 78 8.  ORDER AND ORGANIZATION  m e a s u r e s how i m p o r t a n t o r d e r i s on t h e ward, i n terms o f p a t i e n t s (how t h e y l o o k ) , s t a f f (what t h e y do t o e n c o u r a g e o r d e r ) and t h e ward itself (how w e l l i t i s kept); also measures o r g a n i z a t i o n , again i n terms o f p a t i e n t s (do t h e y f o l l o w a r e g u l a r s c h e d u l e , do t h e y have c a r e f u l l y planned activities) and s t a f f ( d o t h e y keep a p p o i n t m e n t s , do t h e y help patients follow schedules).  9.  PROGRAM CLARITY  measures the extent t o which the p a t i e n t knows w h a t to expect i n the day-to-day r o u t i n e o f h i s ward and how e x p l i c i t t h e ward r u l e s and p r o c e d u r e s a r e .  10.  STAFF CONTROL  measures t h e e x t e n t t o which i t i s n e c e s s a r y for the s t a f f t o r e s t r i c t p a t i e n t , i . e . , i n t h e s t r i c t n e s s o f r u l e s and s c h e d u l e s , i n t h e r e l a t i o n s h i p s between p a t i e n t and s t a f f , and in measures taken t o keep p a t i e n t s under effective controls.  \  179  The  Ward A t m o s p h e r e  Representative  Scale  Scales  Item  1.  Involvement  This  2.  Support  Staff  3.  Spontaneity  Patients feelings.  5.  Practical orientation  P a t i e n t s are encouraged doing t h i n g s .  6.  Personal problem o r i e n t a t ion  Personal  problems  often  is a lively  ward.  go o u t o f t h e i r are  to  patients. show  to learn  new  are openly talked  Anger  Patients  8.  Order  Most day.  9.  Program clarity  Ward rules patients.  are  10.  Staff control  Patients  break  who  to help  encouraged  7.  patients  way  their ways o f  about.  gripe. follow  a regular  clearly rules  schedule  understood are punished  by  each the  for i t .  180  WARD ATMOSPHERE  SCALE  QUESTIONS  Directions: T h i s i s an i n v e n t o r y . T h e r e a r e no r i g h t o r wrong a n s w e r s . P l e a s e answer T r u e o r F a l s e t o each q u e s t i o n as i t a p p l i e s t o you. 1. P a t i e n t s can l e a v e 2. D o c t o r s others.  spend  t h e ward whenever  more  time  with  some  3. T h e r e i s very little emphasis g e t t i n g o u t o f the h o s p i t a l . 4. S t a f f  don't order  they  patients  than  with  making  plans  for  on  the p a t i e n t s a r o u n d .  5. I t ' s hard t o g e t a other a c t i v i t i e s .  group  together  f o r card  6. Most p a t i e n t s f o l l o w a r e g u l a r s c h e d u l e 7. P a t i e n t s t a l k  very  little  about  8. P a t i e n t s p u t a l o t o f e n e r g y here.  their  into  9. P a t i e n t s sometimes p l a y p r a c t i c a l 10. T h i s 11.  is a lively  P a t i e n t s never  P a t i e n t s tend  know when a d o c t o r  to hide  they  T h i s ward  16. Once must 17.  emphasizes  a schedule follow i t .  19.  pasts.  what jokes  will  feelings this  training  i s arranged  Many p a t i e n t s l o o k  18. P a t i e n t s t e l l  each d a y .  they  do  on each  around other.  ask t o see them.  want.  their  14. The h e a l t h i e r p a t i e n t s on the l e s s h e a l t h y ones. 15.  games o r  ward.  12. P a t i e n t s can wear what 13.  want t o .  ward  from one help  f o r new k i n d s  another.  take  care o f  of jobs.  f o r a p a t i e n t , the p a t i e n t  messy.  each o t h e r  A l o t of patients just ward.  about seem  their  personal  t o be p a s s i n g  problems.  time  on t h e  181 20.  I t ' s hard  to get people  21.  The p a t i e n t s  22.  There  t o argue  around  know when d o c t o r s w i l l  i s no p a t i e n t  own  24.  D o c t o r s have v e r y l i t t l e  time  25.  Most with  concerned  26.  The s t a f f them.  27.  The ward  28.  Patients'  29.  Patients  30.  The p a t i e n t s  31.  Patients  32.  New  33.  Things  34.  The s t a f f  p a t i e n t s a r e more the f u t u r e . very  be on t h e w a r d .  government on t h i s  -23. P a t i e n t s s e t up t h e i r p r o d d e d by t h e s t a f f .  rarely  here.  ward.  activities  without  t o encourage  punishes  with  patients  being  patients.  the p a s t  than  by r e s t r i c t i n g  has v e r y few s o c i a l a c t i v i t i e s . a c t i v i t i e s are c a r e f u l l y hardly every discuss are proud  often  treatment  planned.  their  of this  sexual l i v e s .  ward.  gripe. approaches  are often  tried  a r e sometimes v e r y d i s o r g a n i z e d a c t on p a t i e n t  on t h i s  around  ward.  here.  suggestions.  35. When p a t i e n t s d i s a g r e e w i t h e a c h themselves.  o t h e r , t h e y keep i t t o  36.  The s t a f f  want.  3 7.  On t h i s  38.  P e r s o n a l problems  39.  Very  40.  Staff  41.  If a patient t o him.  42.  Very  43.  Patients  know what  ward  the p a t i e n t s  everyone  knows who's i n c h a r g e .  are openly talked  few t h i n g s around never  start  here  arguments  breaks  a rule,  about.  ever get people i n group  excited.  meetings.  he knows what  few p a t i e n t s have any r e s p o n s i b i l i t y  will  happen  on t h e ward.  s a y a n y t h i n g t h e y want t o t h e d o c t o r s .  1 82 44.  Patients  r a r e l y help  45.  There i s very practical.  46.  Patients  47.  This  48.  Patients staff.  49.  Discussions  50.  Patients  51.  People  52.  P a t i e n t s can are g o i n g .  53.  I t i s . hard ward.  54.  S t a f f are i n t e r e s t e d l e a v e the h o s p i t a l .  55.  Patients  are  encouraged  56.  Patients  who  break  57.  Patients  often  58.  The  sometimes g e t s v e r y  59.  S t a f f are feelings.  60.  Nobody e v e r  volunteers  61.  Patients  this  62.  If a p a t i e n t ' s medicine a l w a y s t e l l s him why.  63.  S t a f f r a r e l y give  64.  I t ' s OK  to  65.  Doctors  sometimes d o n ' t  66.  There doing  can  little call  i s a very  often  ward  emphasis  asked  pretty  do  mainly  on  act  the  tell  this  minds  here.  without  to p l a n  up  are  together  on  the  staff.  where  feeling  patients  f o r the  ward r u l e s  ward  saying  are  by  ward.  their  they  on  once  this they  future.  punished the  for i t .  week-ends.  messy. in learning  around rarely  more  names.  questions  the  patients  about  patients'  here. argue.  i s changed,  i n to p a t i e n t around  first  about  interested  crazy  their  joke  in following  things  patients  ward.  ward  how  the  ward  by  personal  or  always c h a n g i n g  to  making  i n t e r e s t i n g on  criticize  leave  on  staff  organized  rarely are  other.  nursing  well  are  are  each  a  nurse  or  doctor  pressure.  here.  show up  i s v e r y l i t t l e e m p h a s i s on a f t e r they l e a v e .  for their  appointments.  what p a t i e n t s  will  be  183 67.  Patients  may  interrupt a doctor  68.  The s t a f f make  69.  The p a t i e n t s r a r e l y t a l k with other p a t i e n t s .  70.  Patients  are p r e t t y  71.  On t h i s argue.  ward  72.  P a t i e n t s never t h i s ward.  73.  Patients  are expect  74.  Patients  tend  75.  Patients things.  76.  Patients w i l l be t r a n s f e r r e d d o n ' t obey t h e r u l e s .  77.  The ward ward.  78.  The d a y room  79.  P a t i e n t s are expected w i t h each o t h e r .  80.  Patients  81.  Staff  82.  Patients  83.  N u r s e s have v e r y  84.  S t a f f care more about how t h e i r p r a c t i c a l problems.  patients  feel  than  85.  Patients are r a r e l y kept appointments with s t a f f .  waiting  when  they  86.  The s t a f f  87.  I t ' s not safe f o r p a t i e n t s p r o b l e m s around h e r e .  88.  S t a f f sometimes a r g u e w i t h  sure  that  tell  i s always  their  neat.  personal  i t is a  they  t o take  t o hide  problems  will  to  learn  thing  be t r a n s f e r r e d  'new  from  to from  on t h e ward.  f e e l i n g s from  new p a t i e n t s  i s often  healthy  leadership  their  a r e encouraged  here  about  think  know when  help  t h e ward  busy a l l o f t h e t i m e .  staff  staff  when he i s t a l k i n g .  the s t a f f . ways  this  of  ward  doing  i f they  get acquainted  on t h e  messy. to share  their  personal  problems  r a r e l y become a n g r y .  patients  when t h e y  are encouraged little  s e t an example  are g e t t i n g  t o show t h e i r time  feelings.  t o encourage  f o r neatness  other.  patients. about have  and o r d e r l i n e s s .  to discuss  each  better.  their  personal  1 84 89.  Doctors don't patients.  explain  what  90.  Patients  here  91.  Patients around.  a r e c a r e f u l about what  92.  S t a f f go o u t o f t h e i r  93.  Patients  94.  It'sa boss.  95.  Staff strongly pasts.  96.  There  97.  I f a p a t i e n t argues with another i n t o t r o u b l e with the s t a f f .  98.  Ward  99.  The s t a f f  are encouraged  i s very  rules  idea  before  they  little  group  are c l e a r l y discourages  to  leaving  patients spirit  understood criticism.  s a y when s t a f f a r e  patients.  t o l e t the doctor  encourage  i s about  t o be i n d e p e n d e n t .  way t o h e l p  must make p l a n s good  treatment  the h o s p i t a l . know  to t a l k on t h i s  that  he i s  about  their  ward.  patient,  he w i l l g e t  by t h e p a t i e n t s .  185  APPENDIX E  THE TARGET OUTCOME ASSESSMENT  SHEET  186  TARGET  PROGRAM PROJECT  EVALUATION  LEVELS-WHERE ARE YOU ON T H E S C A L E ?  MUCH WORSE EXPECTED  THAN  SOMEWHAT L E S S EXPECTED  THAN  E X P E C T E D OR MOST L I K E L Y RESULT  SOMEWHAT B E T T E R THAN E X P E C T E D  MUCH B E T T E R EXPECTED  THAN  OUTCOME A S S E S S M E N T  GOAL  1  GOAL 2  SHEET  GOAL 3  GOAL 4  1 87  APPENDIX  THE  ROTTER  INTERNAL-EXTERNAL (Social  Reaction  F  LOCUS  OF  CONTROL  Inventory)  SCALE  Name  SOCIAL REACTION This  is a  questionnaire  certain  important  people.  Each  lettered pair  a  case  one  you  you  think  are  as  you  much  for  every  the  line  In both  a  answer  time  on  the  beside  some the  far  you're  Be  you  alternatives  to  rather  to  be  select  than  would  belief;  each  believe  sure  you  of  the  the  like  one  to  obviously  be  there  Be  sure  numbered a^ o r  the  but  do  to  find  question b,  not an  make  whichever  spend  you  answer an  X  on  choose  true. you  neither more  concerned. when making  your p r e v i o u s  one  which  different  statement  carefully  item.  each  instances  one  independently  items  e i t h e r the  or  of  strongly  personal  one  For  s t a t e m e n t most  the  in  affect  one  more  way  answers.  those  any  choice.  of  the  pair  concerned.  choose o r  o r wrong  select  by  you're  measure  statements as  you  out  society  of  select  which  should a  right  too  the  our  consists  one)  find  a c t u a l l y b e l i e v e t o be more t r u e  Please  as  to  in  Please  f a r as  This  no  b.  only  the  true.  item  or  (and  events  INVENTORY  may  discover  one.  In  such  strongly believe Also your  try  to  choice:  that cases, to  be  respond do  you  not  be  sure  to  the  case  as  to be  believe  each  item  influenced  choice.  REMEMBER  Select be  more  that  true.  a l t e r n a t i v e w h i c h you  personally believe  to  189 Children get into trouble p u n i s h them t o o much.  because  their  parents  The t r o u b l e w i t h most c h i l d r e n nowadays t h e i r p a r e n t s a r e t o o e a s y w i t h them. Many o f t h e unhappy t h i n g s p a r t l y due t o bad l u c k .  i n people's  People's make.  from  misfortunes  result  is  that  lives  are  the m i s t a k e s  they  One o f t h e m a j o r reasons why we have wars because people don't take enough interest politics. There will always be w a r s , p e o p l e t r y t o p r e v e n t them. In the long run, people deserve i n t h i s world.  get  U n f o r t u n a t e l y , an i n d i v i d u a l ' s u n r e c o g n i z e d no m a t t e r how h a r d The i d e a t h a t nonsense.  teachers  no  matter the  how  hard  respect  they  worth o f t e n he t r i e s .  are u n f a i r  is in  passes  to students i s  Most s t u d e n t s d o n ' t realize the e x t e n t t o which t h e i r g r a d e s a r e i n f l u e n c e d by a c c i d e n t a l happeni n g s. Without leader.  the r i g h t  breaks  one c a n n o t  be an e f f e c t i v e  C a p a b l e p e o p l e who f a i l t o become l e a d e r s have n o t taken advantage o f t h e i r o p p o r t u n i t i e s . No m a t t e r how h a r d l i k e you.  just  don't  P e o p l e who c a n ' t g e t o t h e r s t o l i k e them u n d e r s t a n d how t o g e t a l o n g w i t h o t h e r s .  don't  Heredity plays personality.  one's  It i s one's what t h e y ' r e  y o u t r y , some p e o p l e  the major  experiences like.  role  i n determining  in life  which  determine  190 I have o f t e n w i l l happen.  found  that  what  is  going  to  happen  T r u s t i n g t o f a t e has n e v e r t u r n e d o u t as w e l l f o r me as making a d e c i s i o n t o t a k e a d e f i n i t e c o u r s e of action. In the c a s e o f t h e w e l l p r e p a r e d s t u d e n t t h e r e i s r a r e l y , i f e v e r , s u c h a t h i n g as an u n f a i r t e s t . Many t i m e s exam q u e s t i o n s t e n d t o be so u n r e l a t e d to c o u r s e work, t h a t s t u d y i n g i s r e a l l y u s e l e s s . Becoming a s u c c e s s i s a m a t t e r o f h a r d has l i t t l e o r n o t h i n g t o do w i t h i t . G e t t i n g a good j o b d e p e n d s m a i n l y r i g h t p l a c e a t the r i g h t t i m e . The average citizen government d e c i s i o n s .  can  have  on an  work;  being  luck  in  the  influence  in  T h i s w o r l d i s run by t h e few p e o p l e i n power, and t h e r e i s n o t much t h e l i t t l e guy can do a b o u t i t . When I make p l a n s , make them work.  I am  almost  certain  that  I  can  It i s n o t always wise t o p l a n t o o f a r ahead b e c a u s e many t i m e s t h i n g s t u r n o u t t o be a m a t t e r o f good or bad f o r t u n e anyhow. There  are c e r t a i n  There  i s some good  people in  who  no  good.  everybody.  In my case getting what n o t h i n g t o do w i t h l u c k . Many t i m e s we m i g h t by f l i p p i n g a c o i n .  are j u s t  just  I  want  as w e l l  Who g e t s t o be t h e b o s s o f t e n l u c k y enough t o be i n t h e r i g h t  has  little  d e c i d e what t o  d e p e n d s on who place f i r s t .  or do was  G e t t i n g p e o p l e t o do the r i g h t t h i n g d e p e n d s upon a b i l i t y ; l u c k as l i t t l e o r n o t h i n g t o do w i t h i t . As f a r as w o r l d a f f a i r s a r e c o n c e r n e d , most o f us are t h e v i c t i m s o f f o r c e s we can n e i t h e r unders t a n d , nor c o n t r o l . By t a k i n g an a c t i v e p a r t i n p o l i t i c a l and social a f f a i r s , the p e o p l e can c o n t r o l w o r l d e v e n t s .  191 Most p e o p l e c a n ' t r e a l i z e t h e e x t e n t t o w h i c h t h e i r l i v e s a r e c o n t r o l l e d by a c c i d e n t a l h a p p e n i n g s . There  really  One s h o u l d It  i s no such  always  i s usually  It i s h a r d l i k e s you.  In are  be w i l l i n g  best  to cover  t o know  How many f r i e n d s p e r s o n you a r e .  thing  t o admit  h i s mistakes.  up o n e ' s  whether  y o u have  as " l u c k " .  mistakes.  or not a person depends  upon  t h e l o n g r u n , t h e bad t h i n g s t h a t b a l a n c e d by t h e good o n e s .  really  how  nice  happen  a  t o us  Most m i s f o r t u n e s a r e t h e r e s u l t o f l a c k o f a b i l i t y , ignorance, l a z i n e s s , or a l l three. With enough corruption.  effort  we  can  wipe  out  political  It is difficult f o r p e o p l e t o have much o v e r t h e t h i n g s p o l i t i c i a n s do i n o f f i c e . Sometimes I c a n ' t u n d e r s t a n d the g r a d e s t h e y g i v e . There study  how t e a c h e r s a r r i v e a t  i s a direct connection and t h e g r a d e s I g e t .  A good l e a d e r e x p e c t s p e o p l e s e l v e s what t h e y s h o u l d d o . A good l e a d e r makes t h e i r jobs a r e .  between  how  to decide  i t clear  to  Many t i m e s I f e e l t h a t I have l i t t l e t h e t h i n g s t h a t happen t o me.  There's people;  lonely  because  they  n o t much use t r y i n g i f they l i k e you, they  hard  what  influence  don't  too hard l i k e you.  I.  f o r them-  everybody  It i s i m p o s s i b l e f o r me t o b e l i e v e t h a t l u c k p l a y s an i m p o r t a n t r o l e i n my l i f e . People are friendly.  control  over  chance o r t r y to  to  be  please  192 T h e r e i s t o o much school.  emphasis  Team s p o r t s acter.  a r e an  What  t o me  happens  on  excellent  i s my own  athletics way  to build  high char-  doing.  Sometimes I f e e l t h a t I d o n ' t have o v e r t h e d i r e c t i o n my l i f e i s t a k i n g . Most o f t h e time I c a n ' t behave t h e way t h e y d o .  in  understand  much  why  control  politicians  In t h e l o n g r u n t h e p e o p l e a r e r e s p o n s i b l e f o r bad government on a n a t i o n a l as w e l l a s on a l o c a l level.  193  APPENDIX  THE  SIXTEEN  PERSONALITY (16  G  FACTOR PF)  QUESTIONNAIRE  1 94 Directions: T h i s i s an i n v e n t o r y . T h e r e a r e no c o r r e c t o r incorrect answers. Please c i r c l e t h e answer t o each q u e s t i o n as t h e y a p p l y t o y o u . Answer each q u e s t i o n w i t h your f i r s t i m p r e s s i o n . 1.  I t h i n k my memory a. y e s ,  2.  3.  i t e v e r was. c . no.  I c a n e a s i l y go a whole m o r n i n g speak t o anyone.  without  a. o f t e n ,  c. never.  b. sometimes,  b. l o s t ,  to  c . unknown.  I g e n e r a l l y go t o bed had a s a t i s f y i n g d a y .  at night  b. i n between,  I f I had p l e n t y o f money,  feeling  The w o r s t  punishment  that  I've  c. f a l s e .  I would:  a. be c a r e f u l n o t t o make o t h e r p e o p l e b. u n c e r t a i n c . show p e o p l e how t o l i v e w e l l . 6.  wanting  I f I s a y t h a t w a t e r i s " d r y " and t h e sun i s " c o l d " , I w o u l d s a y t h a t " f o u n d " means t h e same a s :  a. t r u e , 5.  than  b. i n between,  a. gone, 4.  i s better  envious,  f o r me would b e :  a. hard l a b o u r , b. u n c e r t a i n , c . t o be s h u t up a l o n e . 7.  I f my income were more t h a n enough f o r o r d i n a r y d a i l y n e e d s , I would f e e l I s h o u l d g i v e t h e r e s t t o a church or other worthwhile cause. a. y e s ,  8.  b. u n c e r t a i n ,  I'm t h e one who friendships. a. u s u a l l y ,  9.  On a f r e e  takes  the f i r s t  b. sometimes,  evening,  I would  prefer  c . no. step  i n making  c. never. to read  a. how t o t a l k t o p e o p l e from a b r o a d , b. u n c e r t a i n , c. m i l i t a r y d e f e n s e a g a i n s t t h e enemy.  about:  new  195 10.  Most p e o p l e with i t .  "go  a. y e s . 11.  l a z y " on b.  When I was  a job  i f they  uncertain,  a child,  c.  I more o f t e n  can  get  away  no.  spent  free  time:  a. b u i l d i n g s o m e t h i n g , b. i n between, c. r e a d i n g . 12.  I am able  much more f o r t u n a t e t h a n most t o do the t h i n g s I l i k e .  a. y e s , 13.  uncertain,  yes,  b.  i n between,  A s e a s i d e beach t h e r e were:  I f I were probably: a. b. c.  17.  would  mix  I often  be  more  jump t o  yes,  things  no.  t o c h a r i t y , I would  appealing  to  me  if  play.  alcoholic  drinks  at  a  party,  I'd  them,  conclusions. b.  i n between,  I have s o m e t i m e s , even if f e e l i n g s toward my parents. a.  no.  t r y t o make them e x a c t l y as p e o p l e want uncertain, s u r p r i s e p e o p l e by making them s t r o n g .  a. y e s , 18.  to  being  research,  a. no p e o p l e a r o u n d , b. i n between, c. l o t s o f f a m i l i e s a t 16.  in  unimportant c.  I f I had a l o t o f money t o g i v e give i t : a. a l l t o s c i e n t i f i c b. h a l f t o e a c h , c. a l l t o c h u r c h e s .  15.  c.  I can always forget t r i v i a l , t h a t I have done wrong. a.  14.  b.  people  b.  i n between,  c.  no.  briefly, c.  no.  had  hateful  196 19.  I would p r e f e r  t o be:  a.  a business executive a f t e r another, b. u n c e r t a i n , c. a r e s e a r c h s c i e n t i s t . -20.  21.  I think  the o p p o s i t e  who  of "right"  a. l e f t ,  b. wrong,  I feel  emotions a r e :  t h a t my  attends  one  meeting  i s the o p p o s i t e  of:  c. c o r r e c t .  a. w e l l s a t i s f i e d , b. o n l y p a r t l y s a t i s f i e d , c. v e r y l i t t l e s a t i s f i e d . 22.  I admire opinion:  more  the  a. wants t o be s u r e b. i n between, c. 23.  speaks r i g h t  I love  person,  laugh  with  b. i n between,  I t h i n k most p e o p l e t a k e a. t o o s e r i o u s l y , b. i n between, c. n o t s e r i o u s l y enough.  25.  During I:  asked  before  up, and shows where  24.  26.  when  o f the d e t a i l s  t o make p e o p l e  a. y e s ,  who,  he  funny  his  deciding,  stands. stories,  c . no.  life:  an i n t e r v i e w , w h e t h e r i t ' s i m p o r t a n t  a. b. c.  f e e l "on edge" and i l l a t e a s e , i n between, f e e l c o n f i d e n t and composed.  My  f r i e n d s a r e more  or not,  likely:  a. t o a s k me f o r a d v i c e , b. i n between, c . t o g i v e me a d v i s e . 27.  I think most people take community s e r i o u s l y enough. a.  true,  b . i n between,  their c.  duties false.  to  the  197 T h e r e a r e some l e f t alone. a. t r u e ,  areas  o f knowledge  b. i n between,  If I f e e l him, I :  like  telling  c.  someone j u s t  that  are  false. what  a . go r i g h t ahead and s p e a k t h e t r u t h , b. i n between, c . f i r s t c o n s i d e r t h e c o n s e q u e n c e s o f my I have more ups I know. a. y e s ,  and downs i n mood  b. i n b e t w e e n ,  better  I think of  doing  t h a n most  so.  people  c . no.  Today we need more l o g i c a l , c o o l t h i n k i n g i n s o c i a l m a t t e r s and l e s s attachment to o l d e r ideas and loyalties. a. y e s , I prefer  b. i n between,  c . no.  to eat l u n c h :  a. w i t h l o t s o f o t h e r b. i n between, c . by m y s e l f .  people,  I'm c a r e f u l and p r a c t i c a l a b o u t t h i n g s have fewer a c c i d e n t s t h a n most p e o p l e . a. y e s ,  b. i n between,  so  that  I  c . no.  When s o m e t h i n g u n e x p e c t e d h a p p e n s , I : a . r e m a i n v e r y composed b . i n between,  o r calm,  c . become e x t r e m e l y n e r v o u s o r It's  hard  a. y e s , Which  word  f o r me  tense.  t o admit i t when I'm  b. s o m e t i m e s , does n o t b e l o n g  with  wrong.  c . no. the o t h e r  two?  a . by, b. a f t e r , c. near. I have some s p e c i a l f e a r s , f o r e x a m p l e , o f c e r t a i n animals, or being shut i n , or crossing wide s t r e e t s , o r b e i n g a l o n e i n t h e d a r k , and so o n . a. y e s ,  b. i n between,  c.  no.  198 I r e a l l y c a n ' t blame p e o p l e they c a n . a. t r u e ,  f o rtrying  b . i n between,  I f I had t o choose was: a. r e l a x i n g , b . i n between, c. f i l l e d w i t h  what  c. f a l s e .  o n e , I'd p r e f e r  a v a c a t i o n which  activities.  I v a l u e good manners than easy l i v i n g . a. t r u e ,  to grab  and r e s p e c t  b . i n between,  for rules,  more  c. f a l s e .  When I'm i n a g r o u p o f s t r a n g e r s , I'm u s u a l l y one o f t h e l a s t t o e x p r e s s my o p i n i o n p u b l i c l y . a. y e s ,  b . i n between,  c. no.  I e n j o y l e a r n i n g t o work new g a d g e t s t h i n g s , from c a n o p e n e r s t o c a r s . a. y e s ,  b . i n between,  When p e o p l e  secretly  in  everyday  c. no.  s a y bad t h i n g s a b o u t me, I :  a. f o r g e t i t , b. i n b e t w e e n , c . t r y t o c a t c h them In  intellectual  at i t .  i n t e r e s t s , my p a r e n t s  a r e (were):  a . above a v e r a g e , b. a v e r a g e , c . a b i t below a v e r a g e . Many p o p u l a r m a g a z i n e s a r e c o n c e r n e d w i t h w r i t i n g what most p e o p l e want t o r e a d r a t h e r t h a n w i t h t h e truth. a. y e s , I never a. t r u e ,  b. i n between, l e t myself  g e t depressed  b . i n between,  c. n o . over  trifles.  c. f a l s e .  T h e r e a r e t i m e s , e v e r y d a y , when I want t o e n j o y my own t h o u g h t s , u n i n t e r r r u p t e d by o t h e r p e o p l e . a. y e s ,  b. i n between,  c. no.  199 50.  .When I'm talking to people, outside noises, p a s s e r s b y , e t c . , d o n ' t draw my a t t e n t i o n away from what I'm doing. a.  52.  When task a.  53.  true,  b.  i s to  60.  the  c.  right  sometimes,  slope,  b.  over  plain,  find  my  of  decisions  false.  i s to: c.  hill.  c.  slowly.  disappointments:  quickly,  true,  I take  I  seldom.  lots c.  "mountain"  false.  thing, c.  uncertain,  "warm" as  b.  b.  i t on  i n between,  i n between,  myself b.  to  liven  c. up  sometimes,  false.  a dull c.  in a large superior.  party,  never.  When I n e e d immediately the use of something b e l o n g i n g t o a f r i e n d but he's out, I think i t ' s a l l r i g h t t o borrow i t w i t h o u t h i s p e r m i s s i o n . a. y e s ,  59.  doing  b.  a. o f t e n , 58.  i n between,  I f I d o n ' t g e t my way with a c l e r k company, I d o n ' t h e s i t a t e t o go t o h e r a.  57.  I'm  always,  I get a.  56.  I know easy.  "Hot" a.  55.  b.  I'd p r e f e r a j o b w h i c h r e q u i r e s in d e a l i n g with people. a.  54.  true,  b.  I can e a s i l y g e r s i n a bus a.  yes,  As  a job,  i n between,  s t a r t to t a l k with o r w a i t i n g room. b.  I would  i n between,  c. a c:  no. group of  stran-  no.  prefer:  a. w r i t i n g o r e d i t i n g c h i l d r e n ' s b o o k s , b. u n c e r t a i n , c. r e p a i r i n g e l e c t r i c a l machines. 61.  Even i n an i m p o r t a n t game, I am more c o n c e r n e d enjoying i t t h a n w i t h who wins. a.  always,  b.  generally,  c.  with  occasionally.  200 62.  I would r a t h e r t h i n k i n a t h l e t i c games. a. y e s ,  63.  66.  67.  b. i n between,  I'm more I know.  easily  true,  When I'm w i t h i d e a s so t h a t a. b.  usually, i n between,  c.  I often  I would  When I'm  c . no.  c . no.  c.  people  false.  a group o f p e o p l e , I agree with no arguments w i l l a r i s e .  their  disagree.  rather  spend a f r e e  evening:  b. sometimes, criticized,  true,  c. r a r e l y .  i t d i s t u r b s me  b. i n between,  My mind d o e s n ' t work so c l e a r l y does a t o t h e r s . a.  70.  part  a . w i t h a good book, b. u n c e r t a i n , c . w o r k i n g on a hobby w i t h f r i e n d s . I l i k e t o f i n d e x c u s e s t o p u t o f f work and have f u n instead.  a. y e s , 69.  take  u p s e t by bad news t h a n most b. u n c e r t a i n ,  a. o f t e n , 68.  than  I t h i n k i t i s w i s e r t o keep t h e n a t i o n ' s m i l i t a r y f o r c e s s t r o n g t h a n j u s t t o depend on i n t e r n a t i o n a l goodwill.  a. 65.  ideas  b. i n between,  a. y e s , 64.  about my  b. i n between,  badly,  c . no. a t some t i m e s a s i t  c.  false.  I t a l k to people: a. t o make them f e e l c o m f o r t a b l e , b. i n between, c. o n l y when I h a v e s o m e t h i n g t o s a y .  71.  I t h i n k t h e p r o p e r number t o c a r r y on t h e s e r i e s 3, 2, 4, 3, 5, i s : a.  4,  b . 6,  c . 8.  1,  201 I have t h e f e e l i n g t h a t my b l o o d p r e s s u r e v e r y q u i c k l y when someone annoys me. a.  yes,  b. i n between,  goes  up  c . no.  If I had t o t e l l a person a d e l i b e r a t e l i e , I'd have t o l o o k away, b e i n g ashamed t o l o o k him i n t h e eye. a.  true,  b. u n c e r t a i n ,  I would rate myself lighthearted person. a.  yes, of  true,  I would  a  littered,  casual  and  c . no.  untidy  b. i n between, like  false.  relatively  b. i n b e t w e e n ,  The sight cross. a.  as  c.  streets c.  makes  me  false.  a j o b where I :  a.  have a l o t o f r e s p o n s i b i l i t y and c a n show my competence. b. i n between, c. would be g i v e n d e f i n i t e t a s k s so t h a t I a l w a y s know what I'm s u p p o s e d t o d o . I would  prefer  t o have:  a . more money, b. u n c e r t a i n , c. more t i m e If  anyone  for thinking  b e t r a y s my  about  t r u s t , I:  a. g e t v e r y a n g r y w i t h him, b. i n between, c. soon f o r g i v e him. Newspaper accounts o f everyday dents : a. make r a t h e r d u l l , t r i v i a l b. i n between, c. h o l d my a t t e n t i o n . I c a n do h a r d p h y s i c a l work o u t as q u i c k l y as most p e o p l e a. y e s ,  b.  life.  sometimes,  dangers  and  acci-  reading,  without do.  feeling  c . no.  worn  I don't f e e l d i d n ' t do. a.  true,  I would a. b. c.  guilty  i f I'm  scolded  b.  uncertain,  be  known f o r :  rather  for  c.  track,  a. y e s ,  b.  When I have t o  face  look  on  If  I can't  i t as  least  a hard  a  day  methods,  roughly,  sometimes,  a. w i s h i t would n e v e r b. i n between, c.  at  c. of  of  work,  I:  come,  challenge.  seem t o  true,  In my a. b. c.  spare  b. time  where  no.  solve  a problem,  I:  a. t r y h a r d e r , b. i n b e t w e e n , c. f e e l the p r o b l e m i s t o o h a r d f o r me. I may be l e s s c o n s i d e r a t e o f o t h e r p e o p l e are o f me. a.  I  false.  r e l y i n g o r d e p e n d i n g on w e l l - t r i e d i n between, a l w a y s t r i n g new ideas.  I l i k e t o keep money i s s p e n t .  something  sometimes, I would  rather  c.  than  they  false.  join:  a h i k i n g and e x p l o r i n g c l u b , uncertain, a community s e r v i c e o r g a n i z a t i o n .  I have p o t s numbered t w i c e as much as the pour from a f u l l 4 h a l f - f u l l 1's can I s t  1, 2, 3, and 4. Each h o l d s n e x t l o w e r number. After I into an empty 3, how many i l l f i l l from 4?  a.2,  b.4,  When I g e t up f a c e the day.  in  the  a.  b.  sometimes,  often.  c.8. morning,  I feel  c.  I  can  never.  hardly  203 I f we a r e l o s t i n a c i t y and my companions w i t h me on t h e b e s t way, I : a. h a p p i l y go my own way, b. i n between, c. make a f u s s , and f o l l o w I would  rather  listen  a. a l o n e a t home, b. u n c e r t a i n , c. w i t h an a u d i e n c e  a. b. c.  t o music:  I e n j o y i t as a s o r t o f v a c a t i o n , uncertain, I f e e l w o r r i e d and c o n c e r n e d a b o u t n o t w o r k i n g .  true,  a. y e s , Most people importance.  I'd a. b. c.  true,  a great deal o f d i f f i c u l t y an a u d i e n c e o f s t r a n g e r s .  b. u n c e r t a i n ,  Some o f t h e t h i n g s of danger.  a.  auditorium.  t h e f l u o r a bad c o l d :  I feel I would have g i v i n g a speech b e f o r e a.  them.  i n a large  When I'm i n bed w i t h  disagree  I enjoy  b. involve  b . i n between, get  too  upset  b. u n c e r t a i n ,  false. the the  thrill  c . no. over c.  things  of  no  false.  prefer: t o go c a m p i n g , i n between, t o a t t e n d an o u t d o o r m u s i c a l  When I have 1 ike , I:  to t e l l  a  friend  performance. something  he  won't  a. g e t i t done a t t h e f i r s t opportunity, b. i n between, c. p u t i t o f f a s l o n g as p o s s i b l e . I sometimes world. a. y e s ,  feel  sorry  f o r a l l the people  b . i n between,  c . no.  i n the  204 99.  I most  enjoy  a meal  i f i t consists of:  a. u n u s u a l , e x o t i c f o o d s , b. u n c e r t a i n , c. s t a n d a r d , r e g u l a r f o o d s . 100.  I enjoy being considered n e i g h b o u r s do a n y t h i n g . a. t r u e ,  101.  At times a.  102.  I feel  like  smashing  I may really  a test  104.  Which  word  a. l e a d , 105.  when  false.  things. c.  false.  up i n what's  by  being  b. s o m e t i m e s , does n o t b e l o n g b. w i n ,  with  coining,  friendly  when  b. aunt,  I  c . no. the other  two?  c. succeed.  I f Susan's mother's s i s t e r i s Judy's g r e a t what r e l a t i o n i s J u d y ' s g r e a t aunt t o Susan? a. grandma,  my  or examination, I:  deceive people d i s l i k e them.  a. y e s ,  c.  b . i n between,  a. g e t t e n s e and wrapped b. i n between, c. keep q u i t e calm. 103.  o f t h e goup  b . i n between,  true,  Before  part  c. mother.  aunt,  205 L i s t of Questions f o r F a c t o r s C, E, F, 0, Q 4  C  1.1  g e n e r a l l y go t o bed had a s a t i s f y i n g day. a. t r u e ,  E  2.  I f I had  b.  The  worst  4  5.  how  b.  6.  I've  to l i v e  envious,  well.  f o r me  would  be:  unimportant  i n between,  c.  no.  c.  no.  things  I o f t e n jump t o c o n c l u s i o n s . a. y e s ,  C  that  false.  t o make o t h e r p e o p l e  punishment  a. y e s , Q  c.  a. h a r d l a b o u r , b. u n c e r t a i n , c. t o be s h u t up a l o n e . 4. I can always f o r g e t trivial, t h a t I have done wrong.  0  feeling  i n between,  not  c . show p e o p l e 3.  night  p l e n t y o f money, I w o u l d :  a. be c a r e f u l b. u n c e r t a i n  F  at  I feel  b. t h a t my  i n between,  emotions  are:  a. w e l l s a t i s f i e d , b. o n l y p a r t l y s a t i s f i e d , c. v e r y l i t t l e s a t i s f i e d . E  7.  I admire opinion:  more  the  person,  who,  when  a. wants t o be s u r e o f t h e d e t a i l s b. i n b e t w e e n , c. speaks r i g h t  up,  and  8.  I l o v e t o make p e o p l e l a u g h w i t h a. y e s , b. i n b e t w e e n ,  O  9.  I have more ups I know. a.  yes,  and b.  stands.  funny s t o r i e s . c . no.  downs i n mood  i n between.  his  before deciding,  shows where he  F  asked  c.  than  no.  most  people  206 When s o m e t h i n g  unexpected  happens, I:  a . r e m a i n v e r y composed o r c a l m , b. i n between, c . become e x t r e m e l y n e r v o u s o r t e n s e . I have some s p e c i a l f e a r s , f o r example, o f c e r t a i n animals, or being shut in, or crossing wide s t r e e t s , o r b e i n g a l o n e i n t h e d a r k , and so o n . a. y e s , E  12.  b.  I r e a l l y c a n ' t blame p e o p l e they can. a. t r u e ,  F  13.  14.  I f I had t o choose was:  I never  c. no.  f o r t r y i n g to grab  b. i n between,  a. r e l a x i n g , b. i n between, c. f i l l e d w i t h 0  i n between,  I'd p r e f e r  false. a vacation  which  activities.  l e t myself  a. t r u e ,  one,  c.  what  get depressed  b. i n between,  over c.  trifles.  false.  15. When I'm talking to people, outside noises, p a s s e r s b y , e t c . , d o n ' t draw my a t t e n t i o n away from what I'm d o i n g . a. t r u e , C  16.  I get over a. q u i c k l y ,  E  18.  true,  I take  0  b . i n between,  b. i n between, to l i v e n  b. s o m e t i m e s ,  19. I'm more e a s i l y u p s e t I know. a. t r u e ,  false.  c.  slowly.  my way with a c l e r k h e s i t a t e t o go t o h e r  i t on m y s e l f  a. o f t e n ,  c.  disappointments:  17. I f I d o n ' t g e t company, I d o n ' t a.  F  b . i n between,  by bad  b. u n c e r t a i n ,  c.  false.  up a d u l l c. news  in a large superior.  party.  never. than  c.  most  false.  people  207 When I'm a.  criticized,  yes,  i t d i s t u r b s me  b . i n between,  badly.  c . no.  I h a v e t h e f e e l i n g t h a t my b l o o d p r e s s u r e v e r y q u i c k l y when someone annoys me. a. y e s ,  b. i n between,  goes  up  c . no.  I f I had t o t e l l a p e r s o n a d e l i b e r a t e l i e , I'd have t o l o o k away, b e i n g ashamed t o l o o k him i n t h e eye. a.  true,  b. u n c e r t a i n ,  I would r a t e m y s e l f lighthearted person. a.  yes,  as  c.  a  relatively  b . i n between,  I don't f e e l d i d n ' t do.  guilty  i f I'm  true,  If  I can't  a. b. c.  t r y harder, i n between, f e e l the problem i s too hard  b. u n c e r t a i n ,  i n the morning,  a. o f t e n ,  b. sometimes,  rather  listen  a. a l o n e a t home, b. u n c e r t a i n , c. w i t h an a u d i e n c e I sometimes world. a.  yes,  feel  f o r something I  c.  false.  f o r me. I feel  I can  hardly  c. never.  and my I:  a. h a p p i l y go my own way, b. i n between, c . make a f u s s , and f o l l o w I would  and  a problem, I :  When I g e t up f a c e the d a y .  I f we a r e l o s t i n a c i t y w i t h me on t h e b e s t way,  casual  c . no.  scolded  a.  seem t o s o l v e  false.  companions  disagree  them.  to music:  in a large  sorry  auditorium.  f o r a l l the  b. i n between,  people  c . no.  i n the  208 Q  4  30. B e f o r e  a test  or examination,  a. g e t t e n s e and wrapped b . i n between, c. keep q u i t e calm.  I:  up i n what's  coming,  209  APPENDIX H  INFORMED CONSENT LETTER  210 LETTER OF INFORMED CONSENT  Currently treatment We  three  collect during  that  brief  information  anonymous.  voluntary. say so.  tion  whenever Such  effective Your letter, this  at  and  once  to refuse  choose,  effort  surveys. of  after  Participation  and e f f i c i e n t  understand  this  i s confidential  information  signature  us w i t h  the beginning  You may s t o p you  t o up-grade our s e r v i c e s .  of information  I f you want  only  sions.  you h e l p  treatment, gathered  the e f f e c t i v e n e s s o f the  i n an e f f o r t  groups  information your  remain  are evaluating  on o u r u n i t  are asking  ing  we  We  and  there  and y o u r  will  help  surveys  be to  will is  y o u need  the requested  us  The  identity  these  will  later  leave.  to p a r t i c i p a t e ,  completing  wish t o  treatment, you  in  by c o m p l e t -  informa-  no  repercus-  offer  a  more  read  this  service to our c l i e n t s .  below  i n d i c a t e s that  i t s contents,  y o u have  and a g r e e t o p a r t i c i p a t e i n  effort.  patient's  signature  21 1  APPENDIX I  CHRONOLOGY OF EVENTS FOR THE GASP  212  An E s t i m a t e o f C h r o n o l o g y for  One P a t i e n t  o f Events  i n t h e GASP  Event 1)  Date Enter  hospital,  participate 2)  Intake  3)  Pre-test  sign  informed  consent  letter  to  in research.  4/15  interview. 16  PF  4/15  and  I-E  Scale  (Social  Reaction  Inventory)  4/15  4)  Initial  Treatment  5)  P r o b l e m s and l e v e l s Assessment  6)  7)  Conference.  4/16  determined  on T a r g e t  Outcome  Sheets  4/18  Problems c a t e g o r i z e d a c c o r d i n g t o : S e l f , peer,  and work.  Eight  days  4/18  following  p r o b l e m s and l e v e l s : Outcome  Assessment  (Social  Reaction  percentage upon (c) ment  identification (a) c l i e n t Sheet,  and  of  client's  completes PF  and  client  identified  o f percentage  of goal/problem.  Target  I-E  (b) c h e c k  between  goals  d e t e r m i n a t i o n made in direction  16  Inventory);  o f agreement  admission  family,  Scale  made  on  problems v i a GASP; of  agree4/26  APPENDIX  CHRONOLOGY  OF  NON-EQUIVALENT  J  EVENTS  FOR  CONTROL  THE  GROUP  214  An E s t i m a t e o f C h o n o l o g y In  o f Events  The N o n - E q u i v a l e n t  f o r One  Patient  C o n t r o l Group  Event  1)  Date  Enter  hospital,  participate  sign  Intake  3)  Pre-test  4)  Initial  5)  P r o b l e m s and l e v e l s  letter  to 5/1  interview.  Treatment  days  problems  5/1  16 PF and I-E S c a l e .  Assessment Eight  consent  in research.  2)  6)  informed  5/1  Conference determined  5/2 on T a r g e t  Outcome  Sheet following  and l e v e l s :  5/3 identification (a) c l i e n t  Outcome A s s e s s m e n t S h e e t ,  of  completes  client's Target  16 "PF and I-E S c a l e  5/11  APPENDIX  THE  CLIENT  K  SATISFACTION FOR  THE  GASP  QUESTIONNAIRE  216 Client  1.  Now  that  y o u have l e f t  relation  2.  Satisfaction Questionnaire  t o your  problem(s)?  1.  Much  2.  Somewhat  3.  No  4.  Slightly  5.  Much worse  If family  t h e h o s p i t a l , how do you f e e l i n  better better  improvement worse  or friends  were  how h e l p f u l d i d you f i n d  involved  this  i n your  treatment,  experience?  1.  Very  helpful  2.  Somewhat h e l p f u l  3.  Not h e l p f u l at a l l  4.  Made t h i n g s  worse  Comments 3.  During the with,  your  hospital  stay,  feeling,  from  hopeful that  your  problem(s)  d i d you g e n e r a l l y people could  you  were  be r e s o l v e d ?  1.  Yes  2.  C o n f l i c t i n g , y e s and no  3.  No  receive involved  217 4.  During to  hospital  stay,  t h e amount o f t i m e  how  that  d i d you  was  spent  feel with  therapist  and o t h e r s t a f f  1.  More  2.  S u f f i c i e n t t i m e was  spent with  me  3.  Not enough  spent with  me  Please placing 5*  your  evaluate an "X"  y o u by  your  members?  t h a n enough  the  in respect  time was  t i m e was  following  ward  spent with  program  me  activities  by  beside the a p p r o p r i a t e response:  Morning  Community  patients  and s t a f f  Meeting talk  (Large  about  1.  Very  2.  Moderately  3.  Not  4.  Made t h i n g s worse  5.  D i d not  meeting  where a l l  c o n c e r n s on t h e ward)  helpful helpful  helpful  participate  Comments o r s u g g e s t i o n s 6.  G o a l s Group staff  (Patients  to discuss  meet  with  only goals)  1.  Very  helpful  2.  Moderately  3.  Not  4.  Made t h i n g s worse  5.  D i d no,t p a r t i c i p a t e  helpful  helpful  Comments o r s u g g e s t i o n s  therapists  and  other  218 Evening  Group  1.  Very  helpful  2.  Moderately  3.  Not h e l p f u l  4.  Made  5.  Did not p a r t i c i p a t e  helpful  t h i n g s worse  Comments o r s u g g e s t i o n s Chart  Group  1.  Very  helpful  2.  Moderately  3.  Not  4.  Made t h i n g s worse  5.  Did not p a r t i c i p a t e  helpful  helpful  Comments o r s u g g e s t i o n s Did  you p a r t i c i p a t e  1.  Yes  2.  No  If  in family  y e s , how were f a m i l y  conferences?  1.  Very  helpful  2.  Moderately  3.  Not h e l p f u l  4.  Made t h i n g s worse  5.  Did not p a r t i c i p a t e  helpful  Comments o r s u g g e s t i o n s  conferences?  219 10.  Occupational  Therapy  1.  Very  helpful  2.  Moderately  3.  Not h e l p f u l  4.  Made t h i n g s worse  5.  Did not p a r t i c i p a t e  helpful  Comments o r s u g g e s t i o n s 11.  Individual  talks with  your  psychiatrist  members 1.  Very  helpful  2.  Moderately  3.  Not h e l p f u l .  4.  Made t h i n g s worse  5.  D i d not p a r t i c i p a t e  helpful  Comments o r s u g g e s t i o n s 12.  Informal  d i s c u s s i o n s with  other p a t i e n t s  1.  Very  2.  Moderately  3.  Not  4.  Made t h i n g s worse  5.  Did not p a r t i c i p a t e  Comments  helpful helpful  helpful  and o t h e r  staff  220 F r e e L e i s u r e Time «  Very  «  Moderately  1  2  helpful helpful  3.  Not  helful  4  *  Made t h i n g s worse  5  -  Did not  participate  Comments o r s u g g e s t i o n s Other  (Please  specify)  1•  Very  2.  Moderately  3.  Not  4.  Made t h i n g s worse  5-  Did not  Thinking  back  think  helpful  helpful  the  participated  in?  Do  any  how  we  participate  over  were  you have  helpful  your  three  general  c o u l d have h e l p e d  hospital  most  helpful  comments you  stay,  more?  or  what  do  activities  suggestions  you you  as t o  221  APPENDIX  THE  CLIENT THE  SATISFACTION  NON-EQUIVALENT  L  QUESTIONNAIRE CONTROL  GROUP  FOR  222 Client  1.  Now  that  relation  2.  Satisfaction Questionnaire  you have l e f t t o your  problem(s)?  1.  Much  2.  Somewhat  3.  No  4.  Slightly  5.  Much worse  If family  t h e h o s p i t a l , how do y o u f e e l i n  better better  improvement worse  or friends  were  how h e l p f u l d i d y o u f i n d  involved  this  i n your  treatment,  experience?  1.  Very  helpful  2.  Somewhat h e l p f u l  3.  Not h e l p f u l a t a l l  4.  Made  things  worse  your  hospital  stay,  hopeful  feeling,  from  Comments 3.  During the with,  that  your  problem(s)  d i d you g e n e r a l l y people could  1.  Yes  2.  C o n f l i c t i n g , y e s and no  3.  No  you  were  be r e s o l v e d ?  receive involved  223 4.  During to  hospital  stay,  t h e amount o f time  how  that  d i d you  was  spent  feel with  therapist  and o t h e r s t a f f  1.  More  2.  S u f f i c i e n t t i m e was  spent with  me  3.  Not enough  spent with  me  Please  evaluate  placing 5.  your  an  "X"  y o u by  your  members?  t h a n enough  the  i n respect  t i m e was  time was  following  ward  spent with  program  me  activities  by  beside the a p p r o p r i a t e response:  Morning  Community  patients  and s t a f f  Meeting talk  (Large  about  1.  Very  2.  Moderately  3.  Not  4.  Made t h i n g s worse  5.  D i d not  meeting  where a l l  c o n c e r n s on t h e ward)  helpful helpful  helpful  participate  Comments o r s u g g e s t i o n s 6.  Did  you  meet  with  patients  and  goals?  7.  1.  Yes  2.  No  Evening  Group  1.  Very  helpful  2.  Moderately  3.  Not  4.  Made t h i n g s worse  5.  Did not  helpful  helpful  participate  Comments o r s u g g e s t i o n s  staff  to discuss  only  224 8.  Chart  Group  1.  Very  helpful  2.  _____ M o d e r a t e l y  3.  Not  4.  Made t h i n g s worse  5.  D i d not p a r t i c i p a t e  helpful  helpful  Comments o r s u g g e s t i o n s 9.  D i d you p a r t i c i p a t e 1.  Yes  2.  No  If  y e s , how were  in family  family  conferences?  1.  Very  helpful  2.  Moderately  3.  Not  4.  Made t h i n g s worse  5.  Did not p a r t i c i p a t e  helpful  helpful  Comments o r s u g g e s t i o n s 10.  Occupational  Therapy  1.  Very  helpful  2.  Moderately  3.  Not  4.  Made t h i n g s worse  5.  Did not p a r t i c i p a t e  helpful  helpful  Comments o r s u g g e s t i o n s  conferences?  225 11.  Individual  talks  with your  psychiatrist  members 1.  Very  helpful  2.  Moderately  3.  Not h e l p f u l  4.  Made t h i n g s worse  5.  D i d not p a r t i c i p a t e  helpful  Comments o r s u g g e s t i o n s 12.  Informal d i s c u s s i o n s with other p a t i e n t s 1.  Very  helpful  2.  Moderately  3.  Not h e l p f u l  4.  Made t h i n g s worse  5.  Did not p a r t i c i p a t e  helpful  Comments 13.  F r e e L e i s u r e Time 1.  Very  helpful  2.  Moderately  3.  Not  4.  Made t h i n g s worse  5.  D i d not p a r t i c i p a t e  helpful  helpful  Comments o r s u g g e s t i o n s  and o t h e r  staff  226 14.  15.  Other  specify)  1.  Very  2.  Moderately  3.  Not  4.  Made t h i n q s  5.  Did not  Thinking  back  think  16.  (Please  were  helpful helpful  helpful  participate  over  the  worse  your  three  participated  in?  Do  you  have  any  how  we  could  have h e l p e d  general  hospital  most  helpful  comments you  stay,  more?  what  do  activities  or suggestions  you you  as t o  

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