UBC Theses and Dissertations

UBC Theses Logo

UBC Theses and Dissertations

Recognition of loneliness as a basis for psychotherapy Petryshen, Patricia Rose 1977

Your browser doesn't seem to have a PDF viewer, please download the PDF to view this item.

Item Metadata

Download

Media
831-UBC_1977_A5_7 P48.pdf [ 6.23MB ]
Metadata
JSON: 831-1.0093957.json
JSON-LD: 831-1.0093957-ld.json
RDF/XML (Pretty): 831-1.0093957-rdf.xml
RDF/JSON: 831-1.0093957-rdf.json
Turtle: 831-1.0093957-turtle.txt
N-Triples: 831-1.0093957-rdf-ntriples.txt
Original Record: 831-1.0093957-source.json
Full Text
831-1.0093957-fulltext.txt
Citation
831-1.0093957.ris

Full Text

RECOGNITION OF LONELINESS AS A BASIS FOR PSYCHOTHERAPY ' by PATRICIA ROSE PETRYSHEN B.Sc.N., U n i v e r s i t y o f Windsor, 1975 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF NURSING i n THE FACULTY OF GRADUATE STUDIES (School o f N u r s i n g ) We a c c e p t t h i s t h e s i s as c o n f o r m i n g t o the r e q u i r e d s t a n d a r d THE UNIVERSITY OF BRITISH COLUMBIA A p r i l , 1977 © P a t r i c i a Rose P e t r y s h e n , 1977 In p r e s e n t i n g t h i s t h e s i s i n p a r t i a l f u l f i l l m e n t o f the r e q u i r e m e n t s f o r an advanced degree a t the U n i v e r s i t y o f B r i t i s h Columbia, I agree t h a t the L i b r a r y s h a l l make i t f r e e l y a v a i l a b l e f o r r e f e r e n c e and s t u d y . I f u r t h e r agree t h a t p e r m i s s i o n f o r e x t e n s i v e c o p y i n g o f t h i s t h e s i s f o r s c h o l a r l y purposes may be g r a n t e d by t h e Head o f my Department o r by h i s r e p r e s e n t a t i v e s . I t i s understood t h a t c o p y i n g o r p u b l i c a t i o n o f t h i s t h e s i s f o r f i n a n c i a l g a i n s h a l l not be a l l o w e d w i t h o u t my w r i t t e n p e r m i s s i o n . Department o f The U n i v e r s i t y o f B r i t i s h Columbia Vancouver 8, Canada Date Q^JL lof mf ABSTRACT T h i s s t u d y on the r e c o g n i t i o n o f l o n e l i n e s s as a b a s i s f o r p s y c h o t h e r a p y d e v e l o p e d a c o n c e p t u a l model f o r l o n e l i n e s s i n t e r v e n t i o n . S p e c i f i c l o n e l i n e s s b e h a v i o u r s and s u g g e s t e d l o n e l i n e s s i n t e r v e n t i o n s t o be implemented d u r i n g p s y c h o t h e r a p y were i d e n t i f i e d i n the c o n c e p t u a l model f o r l o n e l i n e s s i n t e r v e n t i o n . The r e v i e w o f the l i t e r a t u r e s u p p o r t e d the need f o r r e s e a r c h on c o n c e p t u a l i z i n g l o n e l i n e s s t o f a c i l i t a t e p s y c h o t h e r a p y w i t h l o n e l y c l i e n t s . A q u a s i - e x p e r i m e n t a l d e s i g n was employed i n the s t u d y . The Schmidt-Sermat L o n e l i n e s s S c a l e was u t i l i z e d to i d e n t i f y c l i e n t s who t e s t e d h i g h i n l o n e l i n e s s . In P a r t I o f t h e s t u d y , t h e c o n t r o l group, t h i r t e e n mental h e a l t h c l i e n t s who t e s t e d h i g h i n l o n e l i n e s s were i n v o l v e d i n p s y c h o t h e r a p y w i t h one o f f o u r t h e r a p i s t s . 1 Upon c o m p l e t i o n o f s i x p s y c h o t h e r a p y s e s s i o n s , t h e c l i e n t s were a g a i n t e s t e d f o r l o n e l i n e s s . An I n s e r v i c e E d u c a t i o n on l o n e l i n e s s and an e x p l a n a t i o n o f the implementing o f t h e c o n c e p t u a l model f o r l o n e l i n e s s i n t e r v e n t i o n d u r i n g p s y c h o t h e r a p y , as d e v e l o p e d by the i n v e s t i g a t o r , was g i v e n . S p e c i f i c l o n e l i n e s s b e h a v i o u r s and p o s s i b l e l o n e l i n e s s i n t e r v e n t i o n s were i n h e r e n t i n the model. A new group o f e l e v e n c l i e n t s who t e s t e d h i g h i n l o n e l i n e s s were i d e n t i f i e d t o t h e same f o u r t h e r a p i s t s who p a r t i c i p a t e d i n P a r t I o f the s t u d y . These c l i e n t s formed the comparison group f o r P a r t II o f t h e s t u d y . L o n e l i n e s s c o n s u l t a t i o n was p r o v i d e d on a weekly b a s i s by the i n v e s t i g a t o r t o f a c i l i t a t e t h e r a p i s t i m p l e m e n t a t i o n o f t h e c o n c e p t u a l model f o r l o n e l i n e s s i n t e r v e n t i o n . C l i e n t s were a g a i n i t e s t e d f o r l o n e l i n e s s a f t e r s i x t h e r a p y s e s s i o n s . A t t h e end o f P a r t I and P a r t I I , t h e r a p i s t s r a t e d t h e i r p e r c e p t i o n o f p r o g r e s s i n p s y c h o t h e r a p y and s a t i s f a c t i o n i n a t t e m p t i n g l o n e l i n e s s i n t e r v e n t i o n . Open e n d - i n t e r v i e w s on t h e i m p l e m e n t a t i o n o f t h e c o n c e p t u a l model f o r l o n e l i n e s s i n t e r v e n t i o n was a l s o c o n d u c t e d . A n a l y s i s o f t h e f i n d i n g s o f t h e s t u d y r e s u l t e d i n Hypotheses I , I I , and I I I b e i n g u p h e l d . P s y c h o t h e r a p y was more e f f e c t i v e i n r e d u c i n g l o n e l i n e s s when the c o n c e p t u a l model f o r l o n e l i n e s s i n t e r v e n t i o n was implemented. T h e r a p i s t s who u t i l i z e d l o n e l i n e s s i n t e r v e n t i o n w i t h c l i e n t s who t e s t e d high i n l o n e l i n e s s found the p s y c h o t h e r a p y s e s s i o n s more s a t i s f y i n g . T h e r a p i s t p e r c e p t i o n o f c l i e n t p r o g r e s s i n p s y c h o t h e r a p y i n c r e a s e d when t h e c o n c e p t u a l model f o r l o n e l i n e s s i n t e r v e n t i o n was implemented. The f i n d i n g s o f t h e study were s t r o n g l y s i g n i f i c a n t and i n d i c a t e d t h e u s e f u l n e s s o f a c o n c e p t u a l model f o r l o n e l i n e s s i n t e r v e n t i o n . The p r i m a r y recommendation o f the study was t h a t l o n e l i n e s s p s y c h o t h e r a p y be c o n d u c t e d w i t h mental h e a l t h c l i e n t s who a r e l o n e l y . The p r e s e n t a t i o n o f l o n e l i n e s s as a b a s i s f o r p s y c h o t h e r a p y r e q u i r e s t h a t the c o n c e p t o f l o n e l i n e s s be t h e o r e t i c a l l y and c o n c e p t u a l l y d e f i n e d . B a s i c a l l y , the s t u d y recommended t h a t t h e r e be f u r t h e r e x p l o r a t i o n o f t h e c o n c e p t o f l o n e l i n e s s i n t h e f i e l d o f mental h e a l t h . For f u r t h e r r e s e a r c h , i t was s u g g e s t e d t h a t t h i s r e s e a r c h be c o n d u c t e d i n a h o s p i t a l s e t t i n g on a p s y c h i a t r i c ward where on - g o i n g t h e r a p y i s conducted on a d a i l y b a s i s . T h i s would a l l o w f o r the f a c i l i t i e s a t t h e h o s p i t a l t o be r e a d i l y i n t e g r a t e d w i t h the l o n e l i n e s s i n t e r v e n t i o n s which would i n v o l v e i i t h e r a p i s t s t o d i r e c t l y o b s e r v e and p a r t i c i p a t e i n t h e l o n e l i n e s s i n t e r v e n t i o n s , i n a r o l e -model s i t u a t i o n , i f a p p r o p r i a t e . I n d i v i d u a l s have always e x p e r i e n c e d l o n e l i n e s s , many have s u f f e r e d from t h i s f e e l i n g . I t i s t h e i n h e r e n t goal o f h e a l t h p r o f e s s i o n a l s t o promote mental h e a l t h . By s e t t i n g a sound base f o r l o n e l i n e s s i n p s y c h o t h e r a p y , mental h e a l t h c a r e may be improved. T h i s can a l s o be a c h i e v e d by t h e r a p i s t s , e d u c a t o r s , and r e s e a r c h e r s f u r t h e r i n g t h e knowledge and c o n c e p t u a l i z a t i o n o f l o n e l i n e s s t o form a s t r o n g t h e o r e t i c a l base f o r t h i s c o n c e p t . ACKNOWLEDGEMENTS The w r i t e r wishes t o e x p r e s s her a p p r e c i a t i o n t o t h o s e who c o n t r i b u t e d t o t h e c o m p l e t i o n o f t h i s t h e s i s . She i s i n d e b t e d to the G r e a t e r Vancouver Mental H e a l t h S e r v i c e and West S i d e Community Care Team f o r making t h i s s t u d y p o s s i b l e . S p e c i a l thanks a re extended to the chairman o f my t h e s i s committee, Dr. Ruth Z i t n i k , f o r her e n d l e s s warmth and s u p p o r t , c o u p l e d w i t h her c l i n i c a l e x p e r t i s e , s e n s i t i v i t y f o r humanity, and depth o f knowledge. Dr. Jack Yensen was e s p e c i a l l y h e l p f u l i n h i s a d v i c e and c o u n s e l on n u r s i n g r e s e a r c h . H i s s t i m u l a t i n g and i n n o v a t i v e t h i n k i n g was e n c o u r a g i n g . A f i n a l thanks goes t o P r i m r o s e G o n t i e r , a p e r c e p t i v e and e f f i c i e n t t y p i s t . To my mother, f a t h e r , and s i s t e r P a u l i n e , I am e t e r n a l l y g r a t e f u l f o r t h e c o n f i d e n c e and l o v e they have g i v e n me. i v TABLE OF CONTENTS ABSTRACT i ACKNOWLEDGEMENTS . i v Chapter 1 INTRODUCTION 1 The Purpose 3 The Problem 4 Hypotheses 4 D e f i n i t i o n o f Terms • . - . 5 Assumptions 8 L i m i t a t i o n s 9 Methodology • 10 , Sample S e l e c t i o n , 12 Data G a t h e r i n g Instrument . . . . . . . 13 A n a l y s i s 14 Summary 15 Review o f Remaining C h a p t e r s 15 2 REVIEW OF THE LITERATURE 17 L o n e l i n e s s 19 Types o f L o n e l i n e s s 21 v L o n e l i n e s s A n x i e t y 24 The L o n e l y C l i e n t 29 Psy c h o t h e r a p y w i t h the L o n e l y C l i e n t . . . . 34 A Conceptual Model f o r L o n e l i n e s s I n t e r v e n t i o n . . 37 I d e n t i f i c a t i o n o f L o n e l i n e s s B e h a v i o u r s and L o n e l i n e s s I n t e r v e n t i o n 39 Te a c h i n g and L e a r n i n g a Co n c e p t u a l Model f o r L o n e l i n e s s I n t e r v e n t i o n 48 Measurements f o r L o n e l i n e s s 49 Summary . . . Chapter 3 THE STUDY 58 The Problem 58 Hypotheses 59 Sample S e l e c t i o n 59 The S e t t i n g 61 Methodology . . . . 62 Data G a t h e r i n g Instrument 64 A n a l y s i s o f Hypotheses 65 Summary 66 Chapter 4 ANALYSIS OF DATA 67 A n a l y s i s i n R e l a t i o n t o t h e P o p u l a t i o n Sample . . 68 A n a l y s i s o f Data i n R e l a t i o n to H y p o t h e s i s I 71 R e p o r t i n g from t he P r o g r e s s Notes C h a r t e d by T h e r a p i s t s 74 v i A n a l y s i s o f Data i n R e l a t i o n t o H y p o t h e s i s II . 76 A n a l y s i s o f Data i n R e l a t i o n t o H y p o t h e s i s I I I . . 76 R e p o r t i n g on S t r u c t u r e d E n d - I n t e r v i e w . . . . 79 Summary 86 Cha p t e r 5 SUMMARY, CONCLUSIONS, AND RECOMMENDATIONS . . . 87 Recommendations 90 SELECTED BIBLIOGRAPHY 94 P e r i o d i c a l R e f e r e n c e 98 Others 100 APPENDICES . : 101 A. Schmidt-Sermat L o n e l i n e s s S c a l e 102 B. C l i e n t P r o g r e s s Notes As C h a r t e d by T h e r a p i s t s , ? . 109 C. P r o g r e s s R a t i n g by T h e r a p i s t s I l l D. S a t i s f a c t i o n R a t i n g by T h e r a p i s t 113 E. L o n e l i n e s s I n s e r v i c e E d u c a t i o n : O b j e c t i v e s , - C o n t e n t , and T e a c h i n g A c t i o n . . ' . 115 F. T h e r a p i s t and C I i e n t T S e l e c t i o n Coding 132 G. Consent Form For Study P a r t i c i p a t i o n 134 H. T h e r a p i s t I d e n t i f i c a t i o n Sheet 136 I. C l i e n t I d e n t i f i c a t i o n Sheet 138 J . Short-Form o f Schmidt-Sermat L o n e l i n e s s S c a l e . . . 140 v i i K. Data Sheet on L o n e l i n e s s T e s t S c o r e s f o r C l i e n t s . . 143 Data Sheet f o r T h e r a p i s t s I d e n t i f i c a t i o n o f L o n e l i n e s s B e h a v i o u r ( s ) and I n t e r v e n t i o n s L. S t r u c t u r e d I n t e r v i e w Q u e s t i o n s f o r T h e r a p i s t s on U t i l i z i n g A C o n c e p t u a l Model For L o n e l i n e s s I n t e r v e n t i o n 146 M. Correspondence w i t h Dr. V e l i o Sermat 148 v i i i LIST OF FIGURES F i g u r e 1. A Conceptual Model f o r L o n e l i n e s s I n t e r v e n t i o n . . . 3 8 2. D a i l y L i v i n g S c h e d u l e : The Way I Spend My Time . . . . 4 2 3. A l t e r n a t i v e s t o D a i l y L i v i n g 43 4. Do P l a n 45 i x LIST OF TABLES T a b l e 1. Comparison o f Demographic Data f o r C o n t r o l and Comparison Groups . . . . . . . . 69 2. C l i e n t L o n e l i n e s s S c o r e s , P r e - T e s t and P o s t - T e s t S c o r e s f o r C o n t r o l and Comparison Groups . . . 7 2 3. The R e d u c t i o n i n C l i e n t L o n e l i n e s s Scores from t h e P r e - T e s t and P o s t - T e s t S c o r e s f o r C o n t r o l and Comparison Groups . . 7 3 4. Frequency o f C h a r t i n g by T h e r a p i s t s on L o n e l i n e s s Behaviours.and L o n e l i n e s s I n t e r v e n t i o n s f o r C o n t r o l and Comparison Groups . . . . . 7 5 5. T h e r a p i s t S a t i s f a c t i o n R a t i n g S c o r e s i n A t t e m p t i n g L o n e l i n e s s I n t e r v e n t i o n f o r C o n t r o l and Comparison Groups . . . . . . . . . . 77 6. Average T h e r a p i s t S a t i s f a c t i o n R a t i n g S c o r e i n A t t e m p t i n g L o n e l i n e s s I n t e r v e n t i o m ' f o r C o n t r o l and Comparison Groups . . . . . . . 78 7. T h e r a p i s t P r o g r e s s R a t i n g S c o r e s i n A t t e m p t i n g L o n e l i n e s s I n t e r v e n t i o n f o r C o n t r o l and Comparison Groups . . . . . . . 8 0 8. Average T h e r a p i s t P r o g r e s s R a t i n g S c o r e s i n A t t e m p t i n g L o n e l i n e s s I n t e r v e n t i o n f o r C o n t r o l and Comparison Groups • • • • • . . . . 8 1 x C h a p t e r 1 INTRODUCTION L o n e l i n e s s i s common t o a l l i n d i v i d u a l s i n t h a t a t some time everyone e x p e r i e n c e s a form o f l o n e l i n e s s . The f i e l d o f mental h e a l t h has n o t acknowledged l o n e l i n e s s as b e i n g a b a s i s f o r b e h a v i o u r s which d i s r u p t t he i n t e g r i t y o f an i n d i v i d u a l and t h e r e f o r e w a r r a n t i n g s p e c i f i c t r e a t m e n t i n p s y c h o t h e r a p y . A reason may be t h a t l o n e l i n e s s i s not l a b e l e d as an i l l n e s s o r does not have a d i s e a s e e n t i t y such as " d e p r e s s i o n " a n d " p s y c h o s e s . " T h i s r e s e a r c h w i l l attempt to implement a c o n c e p t u a l model f o r l o n e l i n e s s i n t e r v e n t i o n i n p s y c h o t h e r a p y . I t i s e x p e c t e d t h a t by i d e n t i f y i n g s p e c i f i c l o n e l i n e s s b e h a v i o u r and then u n d e r t a k i n g s p e c i f i c l o n e l i n e s s i n t e r v e n t i o n , p s y c h o t h e r a p y w i l l be more e f f e c t i v e . T h i s w i l l be i n d i c a t e d by a r e d u c t i o n o f l o n e l i n e s s i n i n d i v i d u a l s i n c u r r i n g l o n e l i n e s s . A l s o , t h e r a p i s t s who a r e i n v o l v e d w i t h p s y c h o t h e r a p y w i l l e x p e r i e n c e more s a t i s f a c t i o n i n c o n d u c t i n g p s y c h o t h e r a p y by implementing a c o n c e p t u a l model f o r l o n e l i n e s s i n t e r v e n t i o n and w i l l p e r c e i v e more p r o g r e s s i n t h e r a p y . A quote by I r a Tanner g i v e s reason t o t h e u n d e r t a k i n g o f a r e s e a r c h s t u d y based on the need to acknowledge l o n e l i n e s s r a t h e r than r e l a t e d symptomology o r d i a g n o s i s . "A&teA a plumbeA i>pent about two minuter in fiepaiAing the iixA.na.ciz in a houi>e. in Aubwibia, he. told the homeoimeA the. bill would be. $30. The ifiate bfie.adwi.nneA. pn.oce.eded to launch into a veAbal tuuade that coveAed the. bKoad fiange o^ "cwJjjoti" - {.nom inflation to the. plumbeA' & di&honeAty. "Vou jui>t looked at my Iwinace. and hit. it once, with youn. 1. 2 hammeAl" he. t>ton.mcd. "That'i> night," n.eptie.d the. plumbeA with coot dOYili.de.vice.. "I chan.ge.d you $5 Ion. the. vl&il and $25 faon. knowing whexe. to hit.." He. coMLe.cte.d."^ There i s a f a i r l y e x t e n s i v e body o f t h e o r e t i c a l knowledge on l o n e l i n e s s and s o c i o l o g y but the r e s e a r c h s t u d i e s on l o n e l i n e s s have been few. I t appears t h a t l o n e l i n e s s has been i n c o r p o r a t e d m a i n l y i n t o the r e s e a r c h on a g i n g , death and d y i n g . T h i s was a l s o acknowledged by 2 G l o r i a F r a n c i s i n her r e s e a r c h s t u d y on l o n e l i n e s s . L o n e l i n e s s appears t o be common to a l l i n d i v i d u a l s i n e v e r y l i f e s i t u a t i o n p o s s i b l e t h r o u g h o u t the v a r i o u s c u l t u r e s . Many groups o f i n d i v i d u a l s , i n s o c i e t y e x p e r i e n c e l o n e l i n e s s s p e c i f i c to them, such as 3 the d i v o r c e d and widowed. F r a n c i s found i n her r e s e a r c h s t u d y on e x p l o r i n g l o n e l i n e s s , both s u b j e c t i v e l y and o b j e c t i v e l y , t h a t l o n e l i n e s s i s not c o n c o m i t a n t w i t h age (51 y e a r s o f age and above) but tends t o be s t r o n g l y c o n c o m i t a n t w i t h b e i n g younger (50 y e a r s o f age and u n d e r ) . T h i s was i n t e r p r e t e d i n the study t o mean t h a t the younger group had a g r e a t e r i n v e s t m e n t i n m a t e r i a l i s t i c o b j e c t s , hence, when s e p a r a t e d from them they were l o n e l i e r . They had more l i v i n g f r i e n d s , r e l a t i v e s , and a c q u a i n t a n c e s , and were g e n e r a l l y more m a t e r i a l i s t i c a l l y o r i e n t a t e d . L o n e l i n e s s can be due to an i n d i v i d u a l ' s l i f e - s t y l e o r l i f e s i t u a t i o n s which may o r may not be w i t h i n the c o n t r o l o f the i n d i v i d u a l . As a r e s u l t , l o n e l i n e s s may be an u n c o m f o r t a b l e , p a i n f u l , o r d e v a s t a t i n g I r a Tanner, L o n e l i n e s s : The Fear o f Love (New York: Harper and Row P u b l i s h e r s , 1973), p. x i . 2 G l o r i a M. F r a n c i s , " L o n e l i n e s s : Measuring the A b s t r a c t , " I n t e r n a t i o n a l J o u r n a l o f N u r s i n g S t u d i e s 13 (1976):153. 3 I b i d . , p. 153. 3 e x p e r i e n c e . 4 A c c o r d i n g t o H i l d e g a r d P e p l a u i t i s more i m p o r t a n t t o deal d i r e c t l y w i t h a c l i e n t ' s l o n e l i n e s s than w i t h t h e d e f e n s e s t h a t the c l i e n t has formed a g a i n s t e x p e r i e n c i n g t he p a i n o f l o n e l i n e s s . She f u r t h e r p o s t u l a t e s t h a t a t h e r a p i s t ' s r e c o g n i t i o n and u n d e r s t a n d i n g o f how l o n e l i n e s s has e v o l v e d f o r the c l i e n t , f a c i l i t a t e s t h e e s t a b l i s h m e n t o f a more e f f e c t i v e t h e r a p e u t i c r e l a t i o n s h i p . The c a r e o f the l o n e l y c l i e n t r e q u i r e s the t h e r a p i s t t o u n d e r s t a n d the g e n e r i c development o f the l o n e l i n e s s f o r t h a t i n d i v i d u a l and the v a r i o u s ways l o n e l i n e s s m a n i f e s t s i t s e l f d u r i n g the p s y c h o t h e r a p e u t i c s e s s i o n . T h i s r e s e a r c h s t u d y w i l l attempt t o p r o c e e d beyond t h i s and i d e n t i f y l o n e l i n e s s b e h a v i o u r s and i n t e r v e n t i o n s w i t h t he development o f a c o n c e p t u a l model f o r l o n e l i n e s s p s y c h o t h e r a p y . Purposes The f i r s t purpose o f t h e s t u d y i s t o s t i m u l a t e an awareness i n t h e r a p i s t s o f the c o n c e p t o f l o n e l i n e s s , o f t h e i r own p e r s o n a l l o n e l i n e s s , and the l o n e l i n e s s e n c o u n t e r e d by t h e i r c l i e n t s . The second purpose i s t o r e c o g n i z e t h e importance o f c o n c e p t u a l i z i n g l o n e l i n e s s as a b a s i s f o r l o n e l i n e s s p s y c h o t h e r a p y . The t h i r d purpose i s t o promote e f f e c t i v e p s y c h o t h e r a p y by acknowledging l o n e l i n e s s as the b a s i s o f an i n d i v i d u a l ' s i l l n e s s o r d i f f i c u l t y r a t h e r than symptoms o r d i a g n o s i s . H i l d e g a r d P e p l a u , " L o n e l i n e s s , " American J o u r n a l o f N u r s i n g 55 (December 1955):1477. 4 The f i n a l purpose i s t o use the c o n c e p t o f l o n e l i n e s s as a b a s i s f o r communication w i t h i n d i v i d u a l s s i n c e l o n e l i n e s s i s common t o everyone. As a t h e r a p e u t i c medium, l o n e l i n e s s needs t o be i n v e s t i g a t e d i n the mental h e a l t h s e t t i n g and i n s o c i e t y . The Problem W i l l t h e r a p i s t s , u t i l i z i n g a c o n c e p t u a l model f o r l o n e l i n e s s i n t e r v e n t i o n w i t h c l i e n t s who t e s t h i g h i n l o n e l i n e s s , a t t a i n a g r e a t e r r e d u c t i o n o f l o n e l i n e s s i n c l i e n t s than w i t h o u t the use o f the model? Hypotheses H_ J_: I f a t h e r a p i s t u t i l i z e s a c o n c e p t u a l model f o r l o n e l i n e s s i n t e r v e n t i o n , p s y c h o t h e r a p y w i l l be more e f f e c t i v e i n r e d u c i n g l o n e l i n e s s i n c l i e n t s . H I I : I f a t h e r a p i s t u t i l i z e s l o n e l i n e s s i n t e r v e n t i o n w i t h c l i e n t s who t e s t h i g h i n l o n e l i n e s s , the t h e r a p y s e s s i o n s w i l l be more s a t i s f y i n g f o r the t h e r a p i s t . H I I I : I f a t h e r a p i s t u t i l i z e s l o n e l i n e s s i n t e r v e n t i o n w i t h c l i e n t s who t e s t h i g h i n l o n e l i n e s s , t he t h e r a p i s t w i l l p e r c e i v e more c l i e n t p r o g r e s s i n t h e r a p y s e s s i o n s . 5 D e f i n i t i o n o f Terms 1. LONELINESS - i s not f e e l i n g humanly i n v o l v e d w i t h o t h e r s as i n d i c a t e d by the d e s i r e t o o b s e r v e l i f e r a t h e r than p a r t i c i p a t e i n i t , t o l a c k 5 p e r s o n a l meaning i n r e l a t i o n s h i p s w i t h o t h e r s . 2. OPERATIONAL DEFINITION FOR LONELINESS - the Schmidt-Sermat L o n e l i n e s s  S c a l e (Appendix A) i d e n t i f i e s an i n d i v i d u a l ' s l e v e l o f l o n e l i n e s s , which i s a s c o r e between "0" and "60", "low" and " h i g h " l e v e l s o f l o n e l i n e s s , r e s p e c t i v e l y . For the purpose o f t h i s s t u d y , a s c o r e o f "20" o r above w i l l i n d i c a t e l o n e l i n e s s w a r r a n t i n g p s y c h o t h e r a p e u t i c l o n e l i n e s s i n t e r v e n t i o n . 3. ANXIETY - u n p l e a s u r a b l e a f f e c t c o n s i s t i n g o f p s y c h o p h y s i o l o g i c a l changes i n r e s p o n s e t o an i n t r a p s y c h i c c o n f l i c t . The danger o r t h r e a t i n a n x i e t y i s s t r e s s f u l . P h y s i o l o g i c a l changes c o n s i s t o f i n c r e a s e d h e a r t r a t e , a l t e r e d b r e a t h i n g , t r e m b l i n g , s w e a t i n g , and v a s c u l a r changes such as p a l e n e s s . P s y c h o l o g i c a l changes c o n s i s t o f an u n c o m f o r t a b l e f e e l i n g o f impending danger accompanied by overwhelming awareness o f b e i n g p o w e r l e s s , i n a b i l i t y t o p e r c e i v e the u n r e a l i t y o f the t h r e a t , p r o l o n g e d f e e l i n g o f t e n s i o n , and e x h a u s t i v e r e a d i n e s s f o r the e x p e c t e d danger. 4. LONELINESS ANXIETY - i s a d e f e n s e t h a t attempts t o e l i m i n a t e o r a l l e v i a t e l o n e l i n e s s as i n d i c a t e d by the i n d i v i d u a l no l o n g e r h a v i n g an i n t i m a t e sense o f r e l a t e d n e s s w i t h the f o o d e a t e n , c l o t h e s worn. There i s Edward E. Ford and Robert L. Zorn. Why Be L o n e l y ? ( I l l i n o i s : Argus Communications, 1975), p. 22. A. Freedman, H. K a p l a n , and B. Sadock, Modern S y n o p s i s o f  Comprehensive Textbook o f P s y c h i a t r y ( B a l t i m o r e : The W i l l i a m s and W i l k i n s Co., 1972), p. 753. 6 no l o n g e r a d i r e c t p a r t i c i p a t i o n i n the c r e a t i o n and p r o d u c t i o n o f the v i t a l need o f the person's f a m i l y and community. There i s a fundamental break between what one i s and what one preten d s t o be. A l i e n a t i o n between the i n d i v i d u a l and o t h e r s o c c u r s , as w e l l as between the i n d i v i d u a l and the e n v i r o n m e n t . 7 5. CONCEPTUAL MODEL - a c o n c e p t u a l r e p r e s e n t a t i o n o f r e a l i t y which p r o v i d e s t h e o u t l i n e f o r t h e o r y and d i r e c t i o n f o r p r a c t i c e , r e s e a r c h , and t e a c h i n g . 8 6. LONELINESS MODEL - a c o n c e p t u a l r e p r e s e n t a t i o n o f r e a l i t y which p r o v i d e s the o u t l i n e f o r l o n e l i n e s s t h e o r y and d i r e c t i o n f o r l o n e l i n e s s p s y c h o t h e r a p y , f o r t e a c h i n g t h e r a p i s t s t o i d e n t i f y l o n e l i n e s s b e h a v i o u r s . and implement l o n e l i n e s s i n t e r v e n t i o n . I t i s the b a s i s o f t h i s r e s e a r c h s t u d y . g 7. BEHAVIOUR - a c t i o n s o r r e a c t i o n s under s p e c i f i e d c i r c u m s t a n c e s . 8. LONELINESS BEHAVIOUR - a c t i o n s o r r e a c t i o n s when i n c u r r i n g l o n e l i n e s s . 9. COPING BEHAVIOUR - a re s p o n s e which i n d i c a t e s , d i r e c t l y o r by i n f e r e n c e , the way i n which an i n d i v i d u a l i s a t t e m p t i n g t o s a t i s f y a b a s i c u ^ 1 0 human need. 7 C l a r k E. Moustakas, L o n e l i n e s s (New J e r s e y : P r e n t i c e - H a l l I n c . , 1961), p. 24. g J . P. R e i h l and C. Roy, Conceptual Models f o r N u r s i n g P r a c t i c e (New York: A p p l e t o n - C e n t u r y C r o f t s , 1974), p. 6. 9 C a l l i s t a Roy, I n t r o d u c t i o n to N u r s i n g : An A d a p t a t i o n Model (New J e r s e y : P r e n t i c e - H a l l I n c . , 1976), pT 21. ^ T h e U n i v e r s i t y o f B r i t i s h Columbia Model f o r N u r s i n g August 1975. 7 10. COPING MECHANISMS - u n c o n s c i o u s and c o n s c i o u s ways o f d e a l i n g w i t h s t r e s s w i t h o u t c h a n g i n g one's g o a l s . 1 1 11. DEFENSE MECHANISM - u n c o n s c i o u s p r o c e s s , p r o t e c t i v e i n n a t u r e . I t i s used t o r e l i e v e the a n x i e t y and c o n f l i c t a r i s i n g from one's impulses and 12 d r i v e s . 12. INTERVENTION - t h e r a p e u t i c a c t i o n ( s ) . 13. LONELINESS INTERVENTION - a c t i o n ( s ) taken t o reduce l o n e l i n e s s . These s p e c i f i c a c t i o n s a r e p r e s c r i b e d approaches f o r l o n e l i n e s s i n t e r v e n t i o n as l o n e l i n e s s has been d e v e l o p e d i n the l o n e l i n e s s model. 14. THERAPIST - an i n d i v i d u a l p r o v i d i n g mental h e a l t h c a r e . 15. CLIENT - an i n d i v i d u a l , whether h e a l t h y o r i l l , r e c e i v i n g mental h e a l t h c a r e i n the community. 16. PATIENT - an i n d i v i d u a l , whether h e a l t h y o r i l l , r e c e i v i n g h e a l t h c a r e i n an i n s t i t u t i o n a l s e t t i n g . 17. PSYCHOTHERAPY - a form o f t r e a t m e n t f o r mental i l l n e s s and b e h a v i o u r a l d i s t u r b a n c e s i n which a t r a i n e d person e s t a b l i s h e s p r o f e s s i o n a l c o n t a c t w i t h the c l i e n t . Through d e f i n i t e t h e r a p e u t i c communication, both v e r b a l and n o n v e r b a l , the t h e r a p i s t attempts to a l l e v i a t e the e m o t i o n a l d i s t u r b a n c e , r e v e r s e o r change m a l a d a p t i v e p a t t e r n s o f b e h a v i o u r , and 13 encourage p e r s o n a l i t y growth and development. Freedman, Ka p l a n , and Sadock, Modern S y n o p s i s o f Comprehensive  Textbook o f P s y c h i a t r y , p. 760. 1 2 I b i d . , p. 762. 1 3 I b i d . , p. 788. 8-18. THERAPEUTIC RELATIONSHIP - a c o n s c i o u s r e l a t i o n s h i p between t h e r a p i s t and c l i e n t i n which the t h e r a p i s t aims to t r e a t , b r i n g about an improvement o r p r o v i d e a l l e v i a t i o n o f a d i s t r e s s i n g c o n d i t i o n o r s t a t e . Both t h e r a p i s t and c l i e n t agree t h a t t h e y need t o work t o g e t h e r by means o f i n s i g h t and 14 c o n t r o l t o h e l p the c l i e n t w i t h c o n f l i c t s . 19. THERAPY SESSION - a d e s i g n a t e d appointment, where t h e r a p i s t and c l i e n t a r e i n v o l v e d i n a one-to-one r e l a t i o n s h i p , and where the t h e r a p i s t c o nducts p s y c h o t h e r a p y . A t h e r a p y s e s s i o n i s u s u a l l y s c h e d u l e d on a weekly b a s i s f o r a p p r o x i m a t e l y an hour i n l e n g t h . T h e r a p i s t and c l i e n t attempt to r e s o l v e an a r e a o f c o n c e r n f o r the c l i e n t , which i s based on the c l i e n t ' s d i a g n o s i s , r eason f o r a t t e n d i n g t h e r a p y a t the mental h e a l t h c l i n i c , and l i f e - s i t u a t i o n o f the i n d i v i d u a l . Assumptions I t i s assumed t h a t a l l i n d i v i d u a l s have e x p e r i e n c e d some form o f l o n e l i n e s s . I n d i v i d u a l s i n c u r r i n g l o n e l i n e s s w i l l m a n i f e s t l o n e l i n e s s b e h a v i o u r , e s p e c i a l l y i n i n t e r a c t i o n w i t h o t h e r s . C l i e n t s w i l l be a b l e to respond to the Schmidt-Sermat L o n e l i n e s s S c a l e i n which " t r u e " o r " f a l s e " answers a r e r e q u i r e d . T h i s l o n e l i n e s s s c a l e w i l l i d e n t i f y t h o s e i n d i v i d u a l s who a r e e x p e r i e n c i n g l o n e l i n e s s . C l i e n t s w i l l be i n v o l v e d i n p s y c h o t h e r a p y w i t h a t h e r a p i s t . A t h e r a p e u t i c r e l a t i o n s h i p w i l l be e s t a b l i s h e d between c l i e n t and t h e r a p i s t . Freedman, Kaplan, and Sadock, Modern S y n o p s i s o f Comprehensive  Textbook o f P s y c h i a t r y , p. 797. L o n e l i n e s s i n c l i e n t s w i l l g i v e r i s e to i d e n t i f i a b l e l o n e l i n e s s b e h a v i o u r s which w i l l be p r e s e n t d u r i n g o n - g o i n g p s y c h o t h e r a p y . L i m i t a t i o n s L i m i t a t i o n s i n the s t u d y due t o t h r e a t s t o i n t e r n a l v a l i d i t y i n h e r e n t i n the d e s i g n were e v i d e n t . T h e r e were s e v e r a l p l a u s i b l e r i v a l e x p l a n a t i o n s f o r a d e c r e a s e i n l o n e l i n e s s as opposed t o t h o s e p o s t u l a t e d i n the h y p o t h e s e s . I t was known t h a t a c l i e n t c o u l d a t t a i n a h i g h e r l e v e l o f mental h e a l t h f u n c t i o n i n g w h i l e i n v o l v e d i n a t h e r a p e u t i c r e l a t i o n s h i p r e g a r d l e s s o f the competency o f the t h e r a p i s t o r the i n p u t from the t h e r a p i s t . Due t o u n c o n t r o l l e d e x t e r n a l l i f e s i t u a t i o n s o v e r t i m e , the p e r s o n may have improved o r decompensated. Repeated use o f the l o n e l i n e s s s c a l e may have caused the i n s t r u m e n t t o d e c r e a s e i n i t s power t o measure l o n e l i n e s s a l t h o u g h the i n s t r u m e n t measures emotional s t a t e and l i f e s i t u a t i o n r a t h e r than i n f o r m a t i o n o v e r time. Assuming t h a t the s c a l e was r e l i a b l e and v a l i d , a change i n an answer t o a s t a t e m e n t on the s c a l e i n d i c a t e d t h a t the person's l i f e s i t u a t i o n had changed. T h e r a p i s t s may have u t i l i z e d l o n e l i n e s s i n t e r v e n t i o n s d u r i n g the t h e r a p y s e s s i o n s o t h e r than t h o s e s u g g e s t e d i n the c o n c e p t u a l model f o r l o n e l i n e s s i n t e r v e n t i o n i n p s y c h o t h e r a p y . These i n t e r v e n t i o n s were enumerated and c o n s i d e r e d as e x t r a n e o u s v a r i a b l e s i n t h a t they may have caused a r e d u c t i o n i n l o n e l i n e s s . T h e r e f o r e , t h e s e i n t e r v e n t i o n s have somewhat confounded the i n f e r e n c e t h a t l o n e l i n e s s i n t e r v e n t i o n s a r e p u r e l r e s p o n s i b l e f o r the d e c r e a s e i n l o n e l i n e s s . L i m i t a t i o n s r e p r e s e n t i n g t h r e a t s t o e x t e r n a l v a l i d i t y were t h a t c l i e n t s who soughtmental h e a l t h c a r e a t a c l i n i c were a s e l e c t e d sample because they l i v e d w i t h i n a s p e c i f i c catchment a r e a . The catchment a r e a a p p l i c a b l e t o t h i s s t u d y i n v o l v e d s e v e r a l d i s t r i c t s w i t h major r e p r e s e n t a t i v e c h a r a c t e r i s t i c s b e i n g upper s o c i o - e c o n o m i c groups and e l d e r l y p e o p l e . A l a r g e p r o p o r t i o n o f the c l i e n t e l e were p s y c h o t i c and i t was d i f f i c u l t t o engage i n on-going p s y c h o t h e r a p y . A l s o , the p h i l o s o p h y o f the c l i n i c was t o a s s i s t c l i e n t s t o become community o r i e n t a t e d and a d j u s t t o community l i f e , t h e r e f o r e , t h e r a p i s t s were d i s c o u r a g i n g dependency from c l i e n t s . O f t e n t h e s e c l i e n t s s c o r e d h i g h i n l o n e l i n e s s b u t were not seen on a r e g u l a r b a s i s , and t h e r e f o r e were not p a r t o f the r e s e a r c h . T h i s was d i f f i c u l t to dea l w i t h d u r i n g the c o n t r o l p a r t o f the s t u d y s i n c e t he t h e r a p i s t s were not aware o f the methodology and purpose o f the s t u d y . Methodology T h i s s t u d y on l o n e l i n e s s as e x p e r i e n c e d by mental h e a l t h c l i e n t s employed a q u a s i - e x p e r i m e n t a l d e s i g n t o i n v e s t i g a t e c e r t a i n l o n e l i n e s s phenomena. The same f o u r t h e r a p i s t s p a r t i c i p a t e d i n P a r t I ( c o n t r o l ) and P a r t II ( e x p e r i m e n t a l ) o f the s t u d y . F o l l o w i n g P a r t I , an i n s e r v i c e e d u c a t i o n on l o n e l i n e s s and a c o n c e p t u a l model f o r l o n e l i n e s s i n t e r v e n t i o n was p r o v i d e d f o r t h e r a p i s t s t o f a c i l i t a t e and g u i d e p s y c h o t h e r a p y d u r i n g P a r t II o f the s t u d y . An e x p e r i m e n t a l group o f f o u r new c l i e n t s f o r each t h e r a p i s t were t e s t e d f o r l o n e l i n e s s and l o n e l i n e s s r e d u c t i o n . ( P a r t I I ) . Comparisons were made between the l o n e l i n e s s i n t e r v e n t i o n s and degree o f s u c c e s s i n r e d u c i n g l o n e l i n e s s i n c l i e n t s 11 between the c o n t r o l and e x p e r i m e n t a l groups. P a r t I: ( C o n t r o l Group) A s t a n d a r d i z e d l o n e l i n e s s s c a l e was g i v e n t o c l i e n t s and t h o s e who t e s t e d h i g h i n l o n e l i n e s s were i d e n t i f i e d t o t h e i r t h e r a p i s t . The t h e r a p i s t engaged i n a t h e r a p e u t i c r e l a t i o n s h i p w i t h the c l i e n t f o r s i x t h e r a p y s e s s i o n s o f a p p r o x i m a t e l y one hour i n l e n g t h and a week o r l e s s a p a r t . T h e r a p i s t s were asked t o c h a r t on two q u e s t i o n s a t each t h e r a p y s e s s i o n . These q u e s t i o n s were: "What was d i s c u s s e d ? " and "What s u g g e s t i o n s were made i n r e l a t i o n t o what was d i s c u s s e d ? " (Appendix B ) . The i n v e s t i g a t o r m o n i t o r e d the c o n t r o l group and p r o g r e s s o f t h e r a p y because no l o n e l i n e s s c o n s u l t a t i o n was p r o v i d e d d u r i n g P a r t I o f t he s t u d y . A t the end o f the s i x t h e r a p y s e s s i o n s , c l i e n t s were r e - t e s t e d f o r l o n e l i n e s s . T h e r a p i s t s e v a l u a t e d c l i e n t p r o g r e s s d u r i n g t h e r a p y (Appendix C) and t h e i r own s a t i s f a c t i o n w i t h t h e r a p y s e s s i o n s . (Appendix D). P a r t I I : (Comparison Group) A s t a n d a r d i z e d l o n e l i n e s s s c a l e was g i v e n t o a new c a s e l o a d o f c l i e n t s and those who t e s t e d h i g h i n l o n e l i n e s s were i d e n t i f i e d t o t h e i r t h e r a p i s t s . A l o n e l i n e s s i n s e r v i c e e d u c a t i o n o f a p p r o x i m a t e l y t h r e e hours i n l e n g t h was p r o v i d e d f o r the t h e r a p i s t s . (Appendix E ) . T h i s i n s e r v i c e d e v e l o p e d a b a s i s f o r l o n e l i n e s s p s y c h o t h e r a p y by d e a l i n g w i t h l o n e l i n e s s and a c o n c e p t u a l model f o r l o n e l i n e s s i n t e r v e n t i o n . The t h e r a p i s t s then engaged i n t h e r a p e u t i c r e l a t i o n s h i p s w i t h c l i e n t s i d e n t i f i e d as t e s t i n g h i g h i n l o n e l i n e s s . S i x th e r a p y s e s s i o n s o f a p p r o x i m a t e l y one hour i n l e n g t h and a week o r l e s s a p a r t were c o n d u c t e d . A f t e r each i n t e r v i e w , t he t h e r a p i s t l i s t e d the b e h a v i o u r ( s ) o f the c l i e n t t h a t were d e a l t w i t h i n the t h e r a p y s e s s i o n s 12 and the i n t e r v e n t i o n modes u t i l i z e d . A l s o , the c h a r t i n g was d i r e c t e d t o t h e s e two q u e s t i o n s , "What was d i s c u s s e d ? " and "What s u g g e s t i o n s were made i n r e l a t i o n t o what was d i s c u s s e d ? " A f t e r a l l s i x t h e r a p y s e s s i o n s were completed the c l i e n t s were r e - t e s t e d f o r l o n e l i n e s s . T h e r a p i s t s e v a l u a t e d c l i e n t p r o g r e s s d u r i n g t h e r a p y and t h e i r p e r s o n a l s a t i s f a c t i o n w i t h the t h e r a p y s e s s i o n s . The i n v e s t i g a t o r f u n c t i o n e d as a l o n e l i n e s s c o n s u l t a n t r e g a r d i n g the implementing o f a c o n c e p t u a l model f o r l o n e l i n e s s i n t e r v e n t i o n i n p s y c h o t h e r a p y and i t s s p e c i f i e d use. Weekly one-to-one i n t e r v i e w s o f a p p r o x i m a t e l y one hour i n l e n g t h were c o n d u c t e d f o r t he purpose o f p r o v i d i n g d i r e c t g u i d a n c e f o r t h e r a p i s t s on i d e n t i f y i n g l o n e l i n e s s b e h a v i o u r ( s ) and l o n e l i n e s s i n t e r v e n t i o n ( s ) a p p l i c a b l e t o each o f the c l i e n t s . A t t h i s time the o v e r a l l degree o f r e d u c t i o n i n l o n e l i n e s s comparing t h e c o n t r o l and e x p e r i m e n t a l group was o b s e r v e d . A second a n a l y s i s o f the t h e r a p i s t e v a l u a t i o n o f c l i e n t p r o g r e s s d u r i n g t h e r a p y and t h e r a p i s t s a t i s f a c t i o n w i t h t h e r a p y s e s s i o n s was compared from t h e c o n t r o l and e x p e r i m e n t a l groups i n t h e s t u d y . Sample S e l e c t i o n T h e r a p i s t s and t h e i r c l i e n t s were s e l e c t e d from a Community Mental H e a l t h Team i n the G r e a t e r Vancouver a r e a . (Appendix F ) . T h e r a p i s t s were v e r b a l l y approached t o p a r t i c i p a t e i n a r e s e a r c h s t u d y on " l o n e l i n e s s . " They then proceeded to approach the c l i e n t s . (Appendix G). The t h e r a p i s t s , who r e p r e s e n t e d v a r i o u s p r o f e s s i o n a l backgrounds (Masters o f S o c i o l o g y , Masters o f S c i e n c e i n N u r s i n g , B a c h e l o r s o f S o c i a l Work w i t h a P u b l i c H e a l t h C e r t i f i c a t e , and a R e g i s t e r e d Nurse were i n v o l v e d i n >3 p s y c h o t h e r a p y w i t h c l i e n t s . (Appendix H). The c l i e n t s a t the c l i n i c were t e s t e d f o r l o n e l i n e s s u n t i l f o u r c l i e n t s f o r each t h e r a p i s t were i d e n t i f i e d as t e s t i n g h i g h i n l o n e l i n e s s . These c l i e n t s were i n v o l v e d i n P a r t I o f the s t u d y . T h i s p r o c e s s f o r s e l e c t i n g c l i e n t s was r e p e a t e d f o r P a r t II o f the s t u d y . (Appendix I ) . Data G a t h e r i n g Instrument The s t a n d a r d i z e d l o n e l i n e s s s c a l e u t i l i z e d t o t e s t l o n e l i n e s s i n c l i e n t s was the Schmidt-Sermat L o n e l i n e s s S c a l e . The o r i g i n a l s c a l e c o n t a i n e d s i x t y items which was l e n g t h y f o r the i n i t i a l i d e n t i f i c a t i o n o f c l i e n t s t e s t i n g h i g h i n l o n e l i n e s s , t h e r e f o r e , the s c a l e was r e d u c e d (by p r o p o r t i o n a l random s a m p l i n g ) t o s i x t e e n s t a t e m e n t s . (Appendix J ) . The s h o r t form o f the s c a l e was p i l o t t e s t e d f o r v a l i d i t y and r e l i a b i l i t y . A c l a s s o f a p p r o x i m a t e l y 120 n u r s i n g s t u d e n t s were randomly a s s i g n e d i n t o group A t a k i n g the l o n g form o f the s c a l e and group B t a k i n g the s h o r t form o f the s c a l e . Both groups were r e - t e s t e d i n two weeks. The agreement between the l o n g and s h o r t form o f the s c a l e s c o r r e l a t e d a t 0.9, s i g n i f i c a n t a t a p l e v e l o f .01. The r e l i a b i l i t y on the t e s t r e - t e s t was 0.8, s i g n i f i c a n t a t a p l e v e l o f .01. For P a r t I and P a r t I I , a f t e r each t h e r a p y s e s s i o n , t h e r a p i s t s c h a r t e d the b e h a v i o u r s acknowledged d u r i n g the t h e r a p y as w e l l as the i n t e r v e n t i o n s u t i l i z e d to deal w i t h t h e s e b e h a v i o u r s (Appendix K). T h i s was then compared to the acknowledged b e h a v i o u r s i n d i c a t i n g l o n e l i n e s s and p o s s i b l e l o n e l i n e s s i n t e r v e n t i o n s c o m p i l e d by t h i s i n v e s t i g a t o r . In P a r t I t h e t h e r a p i s t s were unaware o f the l o n e l i n e s s b e h a v i o u r s and 14 i n t e r v e n t i o n s . In P a r t II the t h e r a p i s t s i d e n t i f i e d l o n e l i n e s s b e h a v i o u r ( s ) and s p e c i f i c l o n e l i n e s s i n t e r v e n t i o n ( s ) . At t he end o f the s i x t h e r a p y s e s s i o n s i n P a r t I , t h e r a p i s t s r a t e d t h e i r s a t i s f a c t i o n i n c o n d u c t i n g p s y c h o t h e r a p y w i t h c l i e n t s i d e n t i f i e d as t e s t i n g high i n l o n e l i n e s s . T h e r a p i s t . p e r c e p t i o n o f c l i e n t p r o g r e s s f o l l o w i n g the s i x p s y c h o t h e r a p y s e s s i o n s was a l s o r a t e d . In P a r t I I , a t t he end o f t h e s i x t h e r a p y s e s s i o n s , t h e r a p i s t s r a t e d t h e i r s a t i s f a c t i o n i n implementing a c o n c e p t u a l model f o r l o n e l i n e s s i n t e r v e n t i o n w i t h c l i e n t s i d e n t i f i e d as t e s t i n g h i g h i n l o n e l i n e s s . T h e r a p i s t p e r c e p t i o n o f c l i e n t p r o g r e s s f o l l o w i n g t h e s i x p s y c h o t h e r a p y s e s s i o n s where t h e y implemented a c o n c e p t u a l model f o r l o n e l i n e s s i n t e r v e n t i o n was a l s o r a t e d . A s t r u c t u r e d i n t e r v i e w upon c o m p l e t i o n o f the r e s e a r c h was conduct e d by the i n v e s t i g a t o r w i t h the t h e r a p i s t s . (Appendix L ) . The purpose o f t h i s i n t e r v i e w was t o a s s e s s the v a r i o u s r e a c t i o n s t o u t i l i z i n g a c o n c e p t u a l model f o r l o n e l i n e s s i n t e r v e n t i o n . A n a l y s i s H_ I_: The r e d u c t i o n o f l o n e l i n e s s a f t e r p s y c h o t h e r a p y u t i l i z i n g a c o n c e p t u a l model f o r l o n e l i n e s s i n t e r v e n t i o n was c h a l l e n g e d by a o n e - t a i l e d t - t e s t a t t h e .05 l e v e l o f s i g n i f i c a n c e , on t h e mean p r e - t e s t p o s t - t e s t r e d u c t i o n i n each o f the two groups. H. H_: A n a l y s i s o f t h e r a p i s t s a t i s f a c t i o n from the p s y c h o t h e r a p y s e s s i o n s and s a t i s f a c t i o n from u t i l i z a t i o n o f a " c o n c e p t u a l model f o r l o n e l i n e s s i n t e r v e n t i o n " d u r i n g p s y c h o t h e r a p y s e s s i o n s , was c h a l l e n g e d by a p a i r e d t - t e s t a t t h e .05 l e v e l o f s i g n i f i c a n c e , by comparing the mean from t h e r a p i s t s a t i s f a c t i o n s c o r e s from t h e p s y c h o t h e r a p y s e s s i o n s t o t h e p s y c h o t h e r a p y s e s s i o n s where a c o n c e p t u a l model f o r l o n e l i n e s s i n t e r v e n t i o n was implemented. H I I I : A n a l y s i s o f t h e r a p i s t p e r c e p t i o n o f p r o g r e s s from t h e p s y c h o t h e r a p y s e s s i o n s and p e r c e p t i o n o f p r o g r e s s from u t i l i z a t i o n o f a c o n c e p t u a l model f o r l o n e l i n e s s i n t e r v e n t i o n d u r i n g p s y c h o t h e r a p y s e s s i o n s , was c h a l l e n g e d by a p a i r e d t - t e s t a t the .05 l e v e l o f s i g n i f i c a n c e , by comparing the mean'of t h e r a p i s t p e r c e p t i o n o f p r o g r e s s s c o r e s from the p s y c h o t h e r a p y s e s s i o n s t o t h e p s y c h o t h e r a p y s e s s i o n s where a c o n c e p t u a l model f o r l o n e l i n e s s i n t e r v e n t i o n was implemented. Summary I t was t h e i n t e n t o f t h i s r e s e a r c h study to i n v e s t i g a t e the i m p l e m e n t a t i o n o f a c o n c e p t u a l model f o r l o n e l i n e s s i n t e r v e n t i o n i n p s y c h o t h e r a p y w i t h an i n d i v i d u a l who was e x p e r i e n c i n g l o n e l i n e s s . L o n e l i n e s s was viewed from a t h e o r e t i c a l p e r s p e c t i v e as a b a s i s f o r i d e n t i f i c a t i o n o f l o n e l i n e s s b e h a v i o u r s and l o n e l i n e s s i n t e r v e n t i o n s . Review o f Remaining C h a p t e r s C h a p t e r One has i n t r o d u c e d the problem o f l o n e l i n e s s w i t h mental h e a l t h c l i e n t s and l o n e l i n e s s i n t e r v e n t i o n to reduce c l i e n t l o n e l i n e s s . The problem and purpose o f t h e r e s e a r c h s t u d y as w e l l as t h e hypotheses d e f i n i t i o n o f terms, assumptions and l i m i t a t i o n s have been s t a t e d . The methodology o f t h e r e s e a r c h study was e x p l a i n e d and proposed a n a l y s i s s u g g e s t e d . C h a p t e r Two w i l l p r e s e n t a r e v i e w o f the l i t e r a t u r e based upon t h e o r e t i c a l knowledge and a l i m i t e d body o f r e s e a r c h on l o n e l i n e s s . C h a p t e r Three f o l l o w s w i t h an e x p a n s i o n o f the methodology o f the r e s e a r c h s t u d y . Chapter Four w i l l c o n t a i n the a n a l y s i s o f the d a t a c o l l e c t e d from the r e s e a r c h s t u d y . F i n a l l y , C h a p t e r F i v e p r o v i d e s the summary, c o n c l u s i o n s , and recommendations from the s t u d y . C h a p t e r 2 REVIEW OF THE LITERATURE L o n e l i n e s s has been one o f the l e a s t c o n c e p t u a l i z e d p s y c h o l o g i c a l 15 phenomena. I s o l a t i o n , a l i e n a t i o n , lonesomeness, and a l o n e n e s s have been used synonymously w i t h l o n e l i n e s s , thus c o n f u s i n g i t s meaning. V a r i o u s t y p e s o f l o n e l i n e s s have been i d e n t i f i e d , such as g e n e r a l l o n e l i n e s s , the l o n e l i n e s s o f s o l i t u d e , i n t e r e s t l o n e l i n e s s , and e s s e n t i a l l o n e l i n e s s , but the " f e e l i n g " l o n e l i n e s s has been d e f i n e d by few. L o n e l i n e s s i s a f e e l i n g which u t i l i z e s a p e r s o n ' s energy and 16 r e s o u r c e s . Much s t r e n g t h and endurance i s n e c e s s a r y . The e x p e r i e n c e o f l o n e l i n e s s appears t o be f r i g h t e n i n g and p a i n f u l , thus the p e r s o n attempts t o a v o i d i t i n whatever way p o s s i b l e . The l o n e l y person i s sometimes c h a r a c t e r i z e d as b e i n g shy, withdrawn, s e l f - p i t y i n g , and i n t e n t i o n a l l y r e c l u s i v e . 1 7 T h i s may remove t h e i n d i v i d u a l even more from o t h e r s , thus i n c r e a s i n g f e e l i n g s o f l o n e l i n e s s . 15 F r i e d a Fromm-Reichmann, " L o n e l i n e s s , " P s y c h i a t r y 22 ( F e b r u a r y 1959):1. 1 g J . B. H o s k i s s o n , L o n e l i n e s s - An E x p l a n a t i o n - A Cure (London: Thorsons P u b l i s h e r s L t d . , 1963), p. 28. 1 7 M o u s t a k a s , L o n e l i n e s s , p. 24. 17 L o n e l i n e s s can cause a person t o become po w e r l e s s i n l i f e s i t u a t i o n s . In o r d e r t o cope w i t h t h e s e s i t u a t i o n s , the person may d e v e l o p defense mechanisms to f a c i l i t a t e c o p i n g w i t h t h i s f e e l i n g o f p o w e r l e s s n e s s . U n l e s s an attempt i s made t o d e a l w i t h the l o n e l i n e s s b e i n g e n c o u n t e r e d and d i r e c t l i f e i n a n o t h e r way, the f u t i l i t y and emptiness o f l o n e l i n e s s may be e x p e r i e n c e d o v e r and o v e r a g a i n . Thus the i d e n t i f i c a t i o n o f l o n e l i n e s s and l o n e l i n e s s b e h a v i o u r s becomes a b a s i s f o r l o n e l i n e s s i n t e r v e n t i o n s which can be implemented i n p s y c h o t h e r a p y . I t i s the purpose o f t h i s r e v i e w t o examine t h e v a r i o u s dimensions o f l o n e l i n e s s i n c l i e n t s and d e s c r i b e them as a b a s i s f o r s u c c e s s f u l p s y c h o t h e r a p y . L o n e l i n e s s and l o n e l i n e s s a n x i e t y a r e d e f i n e d and the types o f l o n e l i n e s s i d e n t i f i e d . T h i s p r o v i d e s t h e means f o r d e p i c t i n g the l o n e l y c h a r a c t e r and u n d e r s t a n d i n g the b e h a v i o u r a l components o f l o n e l i n e s s . The c h a r a c t e r o f the l o n e l y c l i e n t i s d e v e l o p e d and t h o s e i n d i v i d u a l s who a r e a t r i s k w i t h l o n e l i n e s s i d e n t i f i e d . T h i s g i v e s r i s e and c r e d i b i l i t y to the need f o r p s y c h o t h e r a p y to f o c u s on l o n e l i n e s s b e h a v i o u r s and p o s s i b l e i n t e r v e n t i o n s by implementing a c o n c e p t u a l model f o r l o n e l i n e s s i n t e r v e n t i o n . O t h e r a r e a s c o n s i d e r e d a r e a s s e s s i n g an i n d i v i d u a l ' s l e v e l o f l o n e l i n e s s by a s p e c i f i c i n s t r u m e n t and the dynamic i n t e a c h i n g and l e a r n i n g l o n e l i n e s s i n t e r v e n t i o n . The r e v i e w s u p p o r t s the r e c o g n i t i o n o f l o n e l i n e s s i n c l i e n t s as a b a s i s f o r p s y c h o t h e r a p y . As i t has been a l l u d e d t o p r e v i o u s l y , the r e s e a r c h s t u d i e s on Jurgen Reush, T h e r a p e u t i c Communication (New York: W. W. Norton Co., I n c . , 1961), p. 110. 19' l o n e l i n e s s have been few. A r e a s o n f o r t h i s may be due t o l o n e l i n e s s 19 b e i n g a r e l a t i v e l y new a r e a o f i n t e r e s t . Robert S i s e n w e i n i n h i s r e s e a r c h study on l o n e l i n e s s s t a t e d t h a t d e s p i t e t h e a t t e n t i o n g i v e n t o l o n e l i n e s s by t h e o r i s t s , the l i t e r a t u r e i s a l m o s t d e v o i d o f e m p i r i c a l r e s e a r c h i n t h i s a r e a . Thus i t appears t h a t c l i n i c a l r e s e a r c h s t u d y on l o n e l i n e s s i s o f the utmost importance f o r f u t u r e development o f t h i s c o n c e p t . L o n e ! i n e s s 20 Henry von W i t z l e b e n s t a t e s t h a t t h e r e i s no c l e a r , u n i v e r s a l d e f i n i t i o n o f l o n e l i n e s s , t h e r e f o r e many unique meanings f o r l o n e l i n e s s 21 have been d e r i v e d , a l m o s t to the p o i n t o f c o n f u s i o n . Robert Weiss d e f i n e s l o n e l i n e s s as a c o n d i t i o n t h a t knows no b o u n d a r i e s and i s s e v e r e l y d i s t r e s s i n g . A n o t h e r d e f i n i t i o n f o r l o n e l i n e s s a c c o r d i n g t o 22 P e p l a u i s an u n n o t i c e d i n a b i l i t y t o do a n y t h i n g w h i l e a l o n e . 23 Klaus B e r b l i n g e r s t a t e s t h a t l o n e l i n e s s i s a compound o f unhappy p e r s o n a l e x p e r i e n c e s , such a s : l o s i n g . o n e ' s p o i n t s o f r e f e r e n c e s ; 19 Robert J . S i s e n w e i n , " L o n e l i n e s s and the I n d i v i d u a l as Viewed by H i m s e l f and O t h e r s " (Ph.D d i s s e r t a t i o n , Columbia U n i v e r s i t y , 1964),p. 10. 20 Henry von W i t z l e b e n , "On L o n e l i n e s s , " P s y c h i a t r y 2 (1958):38. 21 Robert Weiss, L o n e l i n e s s - The E x p e r i e n c e o f Emotional and S o c i a l  I s o l a t i o n ( M a s s a c h u s e t t s : The MIT P r e s s , 1973), p. 10. 22 P e p l a u , p. 1476. 23 Klaus B e r b l i n g e r , "A P s y c h i a t r i s t Looks a t L o n e l i n e s s , " P s y c h o s o m a t i c s 9 ( M a r c h - A p r i l 1968):96. 20 • s u f f e r i n g i n d i v i d u a l and c o l l e c t i v e d i s c o n t i n u i t y ; l i v i n g t h r o u g h a c r i s i s o f i d e n t i t y ; o r e m o t i o n a l l y d y i n g t o the p o i n t o f a l i e n a t i o n from o n e s e l f . 24 Ford and Zorn d e f i n e l o n e l i n e s s as not f e e l i n g humanly i n v o l v e d w i t h o t h e r s as i n d i c a t e d by the d e s i r e t o o b s e r v e l i f e r a t h e r than p a r t i c i p a t e i n i t , t o l a c k r e l a t e d n e s s to o t h e r s , and to l a c k p e r s o n a l meaning i n r e l a t i o n s h i p s w i t h o t h e r s . For the purpose o f t h i s r e s e a r c h , t h i s d e f i n i t i o n w i l l be u t i l i z e d . R o s a l e e B r a d l e y i n her r e s e a r c h s t u d y on l o n e l i n e s s i d e n t i f i e d f o u r c a t e g o r i e s o f l o n e l i n e s s t h a t have emerged from the l i t e r a t u r e : " ( 1) d i s c r e p a n c i e s between the b e h a v i o u r a l r o l e an i n d i v i d u a l p o r t r a y s and h i s i n n e r e x p e r i e n c e s , (2) f e e l i n g s o f l a c k o f purpose and meaning i n l i f e , (3) f e e l i n g s o f l a c k o f h i g h l y p e r s o n a l i z e d r e l a t i o n s h i p s i n one's l i f e , (4) a p e r s o n a l need o f an absence o f p h y s i c a l c l o s e n e s s and c o n t a c t w i t h o t h e r s . " Due t o the v a r i o u s d e f i n i t i o n s o f l o n e l i n e s s , i t becomes n e c e s s a r y to s e l e c t an a p p r o p r i a t e meaning t o f i t the c i r c u m s t a n c e s a t hand. I d e n t i f y i n g the t y p e s o f l o n e l i n e s s i s u s e f u l because i t a p p l i e s t o the v a r i o u s s p e c i f i c s i t u a t i o n s o f l o n e l i n e s s . Ford and Z o r n , Why Be L o n e l y ? , p. 22. R o s a l e e B r a d l e y , "Measuring L o n e l i n e s s " (Ph.D. d i s s e r t a t i o n , Washington S t a t e U n i v e r s i t y , 1969), p. 21. 21 Types o f L o n e ! i n e s s The l i t e r a t u r e e x p l i c i t l y i d e n t i f i e s v a r i o u s t y p e s o f l o n e l i n e s s such as p r i m a r y and se c o n d a r y l o n e l i n e s s , g e n e r a l l o n e l i n e s s , and the l o n e l i n e s s o f s o c i a l i s o l a t i o n . Some ty p e s o f l o n e l i n e s s f u n c t i o n i n a p o s i t i v e way t o a s s i s t the i n d i v i d u a l i n p e r s o n a l growth and s e l f - a w a r n e s s , whereas, o t h e r types o f l o n e l i n e s s can be ver y d i s r u p t i v e to s e l f - i n t e g r i t y . 26 H o s k i s s o n has i d e n t i f i e d many t y p e s o f l o n e l i n e s s . General L o n e l i n e s s i s an u n s p e c i f i e d l o n e l i n e s s comprised o f a g e n e r a l d e s i r e f o r s o c i e t y and companionship. I t may i n d i c a t e the l a c k o f r e l a t i o n s h i p w i t h o t h e r s o r not b e i n g a s a t i s f a c t o r y o r s a t i s f i e d member o f any group o r f a m i l y . T h i s person s u f f e r s from not hav i n g a f a m i l y o r o c c u p a t i o n t o f i l l t i me. I f l o n e l i n e s s becomes too p a i n f u l o r i n t o l e r a b l e , the person may attempt t o a l l e v i a t e the l o n e l i n e s s through s i c k n e s s , i n s a n i t y , o r s u i c i d e . The s u f f e r e r from g e n e r a l l o n e l i n e s s can be he l p e d i n p s y c h o t h e r a p y . 27 Another type o f l o n e l i n e s s d e f i n e d by H o s k i s s o n " i s c a l l e d i n t e r e s t l o n e l i n e s s , the d e s i r e f o r r e l a t i o n s h i p o r companionship. Sometimes t h i s t y p e o f l o n e l i n e s s i s seen i n a per s o n w i t h t a l e n t and a b i l i t y who i s s o c i a l l y w e l l - a d j u s t e d w i t h t h e i r s p e c i f i c i n t e r e s t . An example o f i n t e r e s t l o n e l i n e s s may be t h e " E i n s t e i n s " who g a t h e r t o d i s c u s s the work t h e y have undertaken i n d e p e n d e n t l y i n the p a s t y e a r s . H o s k i s s o n , L o n e l i n e s s - An E x p l a n a t i o n - A Cure, p. 28. I b i d . , p. 28. A n o t h e r example i s the a d o l e s c e n t p a r a p l e g i c , who e x p e r i e n c e s p a r t i c u l a r p e r s o n a l problems because o f t h i s d i f f i c u l t y , and can be u n d e r s t o o d by someone e l s e w i t h s i m i l a r problems. I t i s a r e l i e f t o c o n s o r t w i t h o t h e r s s i m i l a r l y handicapped. 28 H o s k i s s o n d e f i n e d the l o n e l i n e s s f o r a p a r t i c u l a r environment o r s i t u a t i o n as n o s t a l g i c l o n e l i n e s s . There may be a l o n g i n g t o r e t u r n home, t o a t t a i n r e a s s u r a n c e because one c r a v e s the f a m i l i a r . Home may mean a d w e l l i n g , a j o b , a p e r s o n , a r o u t i n e , o r a l i f e s i t u a t i o n . The e x i s t e n t i a l p h i l o s o p h e r p o s t u l a t e s t h a t i f the whole u n i v e r s e c o u l d be one's home and i f one c o u l d be a t home i n o n e s e l f , t h i s t y p e o f l o n e l i n e s s would not e x i s t . The need f o r a f a i t h , a hope, a g o a l , o r "a man w i t h o u t a cau s e " 29 was d e f i n e d by H o s k i s s o n as f a i t h l e s s l o n e l i n e s s . The person may f e e l t h a t t h e r e i s no purpose t o l i f e u n l e s s one i s l i v i n g f o r a cause. There appears to be a need t o f i n d work which produces p r a c t i c a l r e s u l t s and s a t i s f y i n g e m o t i o n a l needs. Three types o f i n d i v i d u a l s s u f f e r from f a i t h l e s s l o n e l i n e s s , t h e a p a t h e t i c person who has n ' t the energy t o c a r e , the s u p e r i o r person who c y n i c a l l y d i s c o u n t s and d i s c r e d i t s t h e " f r u i t s o f l i f e " , and the s u g g e s t i b l e p e r s o n who assumes someone e l s e ' s goal i n a 1 i f e s i t u a t i o n . 30 H o s k i s s o n i d e n t i f i e s two ty p e s o f s p e c i f i c l o n e l i n e s s . Real 28 H o s k i s s o n , L o n e l i n e s s - An E x p l a n a t i o n - A Cure, p. 30-29 " i b i d . , p. 31. 3 0 I b i d . , p. 31. s p e c i f i c l o n e l i n e s s i s the d e s i r e f o r the u n a t t a i n a b l e i n one's l i f e . I f a r e l a t i o n s h i p was t e r m i n a t e d , not o f the per s o n ' s c h o o s i n g , then a sense o f f a i l u r e and f u t i l i t y because o f the l o s s may be e x p e r i e n c e d . The p e r s o n must then come t o the r e a l i z a t i o n t h a t l i f e has something e l s e t o o f f e r . F a n t a s y s p e c i f i c l o n e l i n e s s i s the d e s i r e f o r the i d e a l o r imagined. T h i s r e f e r s to somebody c r e a t e d i n t h e per s o n ' s own mind. When the p e r s o n r e j e c t s the r e a l f o r the f a n c i f u l , then t he s i t u a t i o n p r o g r e s s e s toward u n r e a l i t y . The sense t h a t one i s not f u l f i l l e d has been d e f i n e d by 31 H o s k i s s o n as i n c o m p l e t i o n l o n e l i n e s s . The i n d i v i d u a l may be w e l l a d j u s t e d s o c i a l l y but may not know what i s n e c e s s a r y t o o b t a i n f u l f i l l m e n t i n a c h i e v i n g a sense o f c o m p l e t i o n i n l i f e d e s i r e s . 32 Fromm-Reichmann d e f i n e s a p h y s i c a l l o n e ! i n e s s which i s the need, or a t l e a s t the wish to have, a t t i m e s , p h y s i c a l c o n t a c t w i t h a n o t h e r . People who g i v e massages o r o s t e o p a t h i c t r e a t m e n t o f t e n a s s i s t t h e i r c l i e n t s e m o t i o n a l l y by r e l i e v i n g p h y s i c a l l o n e l i n e s s . 33 Von W i t z l e b e n d i s t i n g u i s h e d between two t y p e s o f l o n e l i n e s s , t h a t i s p r i m a r y l o n e l i n e s s and secondary l o n e l i n e s s . P r i m a r y l o n e l i n e s s i s t h e l o n e l i n e s s o f one's " s e l f " which i s common t o e v e r y i n d i v i d u a l . I t i s the f e e l i n g o f b e i n g a l o n e and h e l p l e s s i n the w o r l d . The per s o n may u t i l i z e innumerable d e f e n s e mechanisms to keep from c o n s c i o u s 31 H o s s k i s s o n , L o n e l i n e s s - An E x p l a n a t i o n - A Cure, p. 36. 32 Fromm-Reichmann, p. 6. O J v o n W i t z l e b e n , p. 38. 24 r e c o g n i t i o n o f l o n e l i n e s s . Secondary l o n e l i n e s s i s caused by the l o s s o f an o b j e c t . I t i s e x p r e s s e d i n g r i e f due t o the l o s s o f the o b j e c t . Whether the o b j e c t l o s t o r r e a l e x i s t s o n l y i n t h e f a n t a s y o f the n e u r o t i c o r p s y c h o t i c mind, the e f f e c t o f l o n e l i n e s s i s the same. 34 F r a n c i s i n her r e s e a r c h s t u d y on the l o n e l i n e s s e x p e r i e n c e d by h o s p i t a l i z e d p a t i e n t s found t h a t s e c o n d a r y l o n e l i n e s s v a r i e s i n a d i r e c t manner w i t h the amount o f mental o r e m o t i o n a l i n v e s t m e n t p a t i e n t s have i n the persons and t h i n g s from whom they a r e s e p a r a t e d . T h i s can be e x p l a i n e d i n t h a t the more one has from which t o be s e p a r a t e d , t h e more one has t o m i s s , and the l o n e l i e r he w i l l be. T h i s i s the e s s e n c e o f c a t h e c t i c i n v e s t m e n t . The v a r i o u s t y p e s o f l o n e l i n e s s p r o v i d e a b a s i s f o r f u r t h e r e x a m i n a t i o n o f the r e a s o n s why l o n e l i n e s s can be d e v a s t a t i n g f o r an i n d i v i d u a l , e s p e c i a l l y when i t has p r o g r e s s e d t o l o n e l i n e s s a n x i e t y . These v a r i o u s s p e c i f i c s i t u a t i o n s o f l o n e l i n e s s g i v e s u b s t a n c e to the l o n e l y c h a r a c t e r t y p e s t h a t d e p i c t the d imensions o f l o n e l i n e s s found i n c l i e n t s . E a r l y p e r s o n a l i t y t r a i t s , the l o n e l y c h a r a c t e r t y p e s , as w e l l as l o n e l y l i f e s i t u a t i o n s a l l s u p p o r t the e v o l u t i o n o f l o n e l i n e s s a n x i e t y . L o n e l i n e s s A n x i e t y The c o n c e p t o f l o n e l i n e s s a n x i e t y , d e v e l o p e d and r e s e a r c h e d by Fromm-Reichmann, and l a t e r by Moustakas, i s v i t a l t o t h i s r e s e a r c h . I t p r o v i d e s the b a s i s and purpose f o r i d e n t i f y i n g l o n e l i n e s s b e h a v i o u r and c o n d u c t i n g s u c c e s s f u l p s y c h o t h e r a p y w i t h t h o s e who s u f f e r from l o n e l i n e s s F r a n c i s , p. 156. a n x i e t y . B r a d l e y J J i n her r e s e a r c h s t u d y on l o n e l i n e s s p o s t u l a t e s t h a t l o n e l i n e s s i s v e r y b a s i c and t h a t i t may o f t e n u n d e r l i e c o n c e p t s o f d e p r e s s i o n and a n x i e t y . Moustakas c o n s i d e r s l o n e l i n e s s i n two ways, the f i r s t b e i n g e x i s t e n t i a l l o n e l i n e s s which i s i n e v i t a b l y a p a r t o f human e x p e r i e n c e and v a l u a b l e f o r s e l f - u n d e r s t a n d i n g . H i s second p e r s p e c t i v e o f l o n e l i n e s s i s t h a t o f s e l f - a l i e n a t i o n and r e j e c t i o n which i s not a l o n e l i n e s s but a d i s r u p t i o n t o the i n t e g r i t y o f the i n d i v i d u a l and produces a vague and d i s t u r b i n g a n x i e t y . The per s o n withdraws from s e l f and from s o c i e t y . T h i s t h e n causes t h e development o f mental d e f e n s e s t o attempt to a l l e v i a t e t h e a n x i e t y . V a r i o u s t h e o r i e s on a n x i e t y have e v o l v e d which s u p p o r t the t h e o r y 37 o f l o n e l i n e s s a n x i e t y . Freud viewed a n x i e t y from the s t a n d p o i n t t h a t both r e a l and n e u r o t i c a n x i e t y o c c u r r e d i n response t o a danger t o the organism. In r e a l a n x i e t y , t he t h r e a t a r i s e s from a known danger o u t s i d e t he p e r s o n ; n e u r o t i c a n x i e t y i s p r e c i p i t a t e d by an unknown danger o f t e n g e n e r a t e d from i n t e r n a l problems w i t h i n t he person's psyche. Freud d i s t i n g u i s h e d between two kinds o f a n x i e t y p r o v o k i n g s i t u a t i o n s . The f i r s t i s the a n x i e t y t h a t o c c u r s as a r e s u l t o f e x c e s s i v e i n s t i n c t u a l s t i m u l a t i o n t h a t the i n d i v i d u a l cannot cope w i t h , t h e r e f o r e t h i s o v e r r u n s t h e p r o t e c t i v e b a r r i e r s o f the ego, and a p a n i c s t a t e 3 5 B r a d l e y , p. 22J 3fi Moustakas, L o n e l i n e s s , p. 24. 37 Sigmund F r e u d , An O u t l i n e o f P s y c h o a n a l y s i s (W. W. Norton Co., New York, 1949). 26 l e a d i n g t o trauma r e s u l t s . T h i s u s u a l l y o c c u r s i n i n f a n c y o r c h i l d h o o d when the .egois immature o r d u r i n g a p s y c h o t i c t u r m o i l due t o a p a n i c s t a t e when the ego i s overwhelmed. The second a n x i e t y p r o v o k i n g s i t u a t i o n which o c c u r s a f t e r the d e f e n s e system has matured i s the a n x i e t y t h a t a r i s e s i n a n t i c i p a t i o n o f danger r a t h e r than as i t s r e s u l t . The a n x i e t y may a r i s e because the per s o n has l e a r n e d t o r e c o g n i z e , a t a p r e c o n s c i o u s o r unc o n s c i o u s l e v e l , a s p e c t s o f a s i t u a t i o n t h a t were once t r a u m a t i c . The i n d i v i d u a l may employ a v o i d a n c e mechanisms t o escape from a r e a l o r imagined danger from w i t h o u t . On the o t h e r hand, the i n d i v i d u a l may u t i l i z e ego d e f e n s e s from w i t h i n t o guard a g a i n s t o r reduce t he q u a n t i t y o f i n s t i n c t u a l e x c i t a t i o n l o n e l y c i r c u m s t a n c e s , r e a l o r i m a g i n a r y , have the a b i l i t y t o promote. 38 S u l l i v a n ' s I n t e r p e r s o n a l Theory views, a n x i e t y as a p e r c e p t u a l response a r o u s e d by the emerging power o f f o r m e r l y r e p r e s s e d , -u n a c c e p t a b l e t h o u g h t s , f e e l i n g s , d r i v e s , w i s h e s , and a c t i o n s . S u l l i v a n c o n s i d e r e d t h e s e f o r b i d d e n i n n e r e x p e r i e n c e s to be i n t e r p e r s o n a l ones, whereas Freud viewed them as r e p r e s s e d i n s t i n c t u a l o r i n n a t e d r i v e s . A c c o r d i n g t o S u l l i v a n ' s t h e o r y , a n x i e t y i s e x p e r i e n c e d as an a n t i c i p a t e d d i s a p p r o v a l o r l o s s o f l o v e . f r o m t he s i g n i f i c a n t p e o p l e o f an i n d i v i d u a l ' s e a r l y l i f e r e l a t i o n s h i p s from whom the an x i o u s person l e a r n e d t o d i s c r i m i n a t e between a c c e p t a b l e b e h a v i o u r s . S u l l i v a n f u r t h e r p o s t u l a t e s t h a t , i n o r d e r to escape from l o n e l i n e s s , t he person may r e s o r t t o a n x i e t y - a r o u s i n g e x p e r i e n c e s . Harry S t a c k S u l l i v a n , The I n t e r p e r s o n a l Theory o f P s y c h i a t r y (New York: Norton Co., 1953), p. 290. Karen Horney r e l a t e s a n x i e t y and h o s t i l i t y . D u ring c e r t a i n i n t e r a c t i o n s , h o s t i l i t y i s a n t i c i p a t e d by o t h e r s and sensed by the anx i o u s p e r s o n h i m s e l f . A n x i e t y i s c o n n e c t e d w i t h a n t i c i p a t e d f e a r o f d i s a p p r o v a l and punishment, withdrawal o f l o v e , d i s r u p t i o n o f i n t e r p e r s o n a l r e l a t i o n s h i p s , and i s o l a t i o n . H o s t i l i t y becomes a de f e n s e t h a t the anxious person demonstrates t o ward o f f the f e a r s mentioned. Fromm-Reichmann' r e l a t e s a l l o f t h e s e e x p l a n a t i o n s o f a n x i e t y to s u p p o r t her t h e o r y t h a t a n x i e t y has a c l o s e p s y c h o l o g i c a l a f f i n i t y to l o n e l i n e s s . She b e l i e v e s t h a t t he emotional s t a t e s r e f e r r e d t o as a n x i e t y by t h e o r i s t s a r e a c t u a l l y s t a t e s o f l o n e l i n e s s o r f e a r o f l o n e l i n e s s . The f e a r o f l o n e l i n e s s has become an a c t u a l problem today because man has l o s t i n many ways, the e x p e r i e n c e o f n e i g h b o u r r e l a t i o n s h i p s and community l i f e . 41 Fromm-Reichmann f e e l s t h a t i l l n e s s may r e s u l t from i n a d e q u a t e f u l f i l l m e n t o f the need f o r human i n t i m a c y , p o s s i b l y b e g i n n i n g i n the f o r m a t i v e y e a r s . When an a d u l t , t h e r e i s a f a i l u r e t o r e l a t e to o t h e r s on a genuine, l o v i n g b a s i s . She f u r t h e r p o s t u l a t e s t h a t l o n e l i n e s s endured f o r l o n g p e r i o d s o f time may cause t he person t o m a n i f e s t p s y c h o t i c b e h a v i o u r . L o n e l i n e s s c a n , however, be c o n c o m i t a n t w i t h an ° 3Karen Horney, Our Inner C o n f l i c t s (New York: W. W. Norton Co., 1945). " ~ 4 0Fromm-Reichmann, pp.1-7. 4 1 I b i d . , p.4. 28 extreme p s y c h o t i c d i s t u r b a n c e . Due to i n t e r p e r s o n a l detachment i n c u r r e d by some p s y c h o t i c i n d i v i d u a l s , t h e y may be more s e n s i t i v e and o b s e r v a n t o f p e o p l e i n t h e i r environment. O c c a s i o n a l l y , the h y p e r a l e r t n e s s o f the i n d i v i d u a l s u f f e r i n g from l o n e l i n e s s produces an o v e r s e n s i t i v i t y to l i f e s i t u a t i o n s . T h i s h y p e r a l e r t n e s s may i n i t i a t e the tendency t o m i s i n t e r p r e t o r e x a g g e r a t e the h o s t i l e - a f f e c t i o n a t e i n t e n t i o n s o f o t h e r s , thus deepening the e x p e r i e n c e o f l o n e l i n e s s . 42 Moustakas views l o n e l i n e s s a n x i e t y as a common c o n d i t i o n . For the purpose o f d e f i n i n g l o n e l i n e s s a n x i e t y i n t h i s r e s e a r c h s t u d y , t h i s d e f i n i t i o n by Moustakas was u t i l i z e d . L o n e l i n e s s a n x i e t y i s i n d i c a t e d by the i n d i v i d u a l no l o n g e r h a v i n g an i n t i m a t e sense o f r e l a t e d n e s s to t h e f o o d e a t e n , the c l o t h e s worn. Th e r e i s no l o n g e r d i r e c t p a r t i c i p a t i o n i n the c r e a t i o n and p r o d u c t i o n o f the v i t a l needs o f the person's f a m i l y and community. L o n e l i n e s s a n x i e t y r e s u l t s from a fundamental break between what one i s and what one p r e t e n d s t o be. T h i s a l i e n a t i o n i s o c c u r r i n g between the i n d i v i d u a l and o t h e r s as w e l l as between the i n d i v i d u a l and the environment. The f e e l i n g o f a l i e n a t i o n from o t h e r s may e v e n t u a l l y r e s u l t i n a type o f c h r o n i c i l l n e s s caused by p e r s i s t e n t l o n e l i n e s s a n x i e t y . 43 Weiss p o s t u l a t e s t h a t the p e r s o n s u f f e r i n g from l o n e l i n e s s a n x i e t y i s d e e p l y s u s p i c i o u s and the s m a l l e s t c r i t i c i s m h u r t s . Due to the c o n s t a n t f e e l i n g o f f a i l u r e , t h e person attempts to r a i s e t h e i r l e v e l Moustakas, L o n e ! i n e s s , p. 24. 'Weiss, The E x p e r i e n c e o f S o c i a l and Emotional I s o l a t i o n , p.21. 29 o f achievement t o win p r a i s e and a p p r o v a l . The d e v i c e s and s t r a t e g i e s the p e r s o n uses o f t e n r e s u l t s i n f u r t h e r a l i e n a t i o n from o t h e r s and i n c r e a s e d attempts t o h i d e i n n e r f e e l i n g s o f a n x i e t y . L o n e l i n e s s a n x i e t y r e s u l t s from t he p a i n o f l o n e l i n e s s and the need f o r r e l a t e d n e s s and s e c u r i t y . The L o n e l y C I i e n t As e v i d e n c e d by w r i t e r s and p o e t s , such as Lynn C a i n e 4 4 and 45 Rod McKuen l o n e l i n e s s may be a chosen s t a t e to enhance t h e i r AC c r e a t i v i t y . U s u a l l y l o n e l i n e s s i s not a chosen s t a t e . P e p l a u s u g g e sts t h a t o f t e n t h e l o n e l y person i s not aware o f t h e reason why_> 47 he does what he does when i n c u r r i n g l o n e l i n e s s . A c c o r d i n g t o Weiss i t t h e r e f o r e becomes easy to view the l o n e l y person as out o f s t e p , as u n w i l l i n g t o make n e c e s s a r y attempts t o communicate w i t h o t h e r s , and l a c k i n g i n q u a l i t i e s t o s a t i s f y human r e l a t i o n s h i p s . 48 David Reisman a s s e r t e d t h a t t h e p r e s e n c e o f o t h e r s and the a c c e p t a n c e o f t he i n d i v i d u a l by h i s own group does not n e c e s s a r i l y r e l i e v e him from 44 / Lynn C a i n e , Widow (New York: W i l l i a m Morrow and Co.,Inc., 1974), AX Rod McKuen, A l o n e (New York: Pocket Books I n c . , 1975). 4 6 P e p l a u , p. 1476. 47 Weiss, L o n e l i n e s s - The E x p e r i e n c e o f S o c i a l and Emotional  I s o l a t i o n , p. 74. 48 David Reisman, The L o n e l y Crowd (New Haven: Y a l e U n i v e r s i t y P r e s s , 1950). l o n e l i n e s s . S i s e n w e i n i n h i s r e s e a r c h study on l o n e l i n e s s i n t h e i n d i v i d u a l , as viewed by h i m s e l f and o t h e r s , found t h a t l o n e l y p e o p l e see themselves as l e s s p o p u l a r , whether they are o r not. A n o t h e r f i n d i n g was t h a t l o n e l i n e s s appears more r e l a t e d to how a p e r s o n views 50 h i m s e l f and e x p e r i e n c e s the r e s p o n s e s o f o t h e r s . F r a n c i s i n her r e s e a r c h w i t h h o s p i t a l i z e d p a t i e n t s , s t u d i e d the l o n e l i n e s s caused by temporary s e p a r a t i o n from the p e o p l e and o b j e c t s t h a t i n d i v i d u a l s were a t t a c h e d t o . She found t h a t women were more l i k e l y to be l o n e l y than men, and t h a t l o n e l i n e s s was c o n c o m i t a n t w i t h b e i n g younger. 50 Seabrook d e s c r i b e s v a r i o u s case h i s t o r i e s o f i n d i v i d u a l s r e l a t i n g the l o n e l i n e s s t h e y have e x p e r i e n c e d . Because l o n e l i n e s s i s a vague term, t h e r e a r e no c r i t e r i a to a s s e s s t h e p r e v a l e n c e o r i n t e n s i t y o f l o n e l i n e s s t h a t p e o p l e admit t o . I t t h e r e f o r e becomes n e c e s s a r y t o have each i n d i v i d u a l d e f i n e l o n e l i n e s s as they e x p e r i e n c e i t . In h i s book, Seabrook r e l a t e d the c a s e h i s t o r y o f a t h i r t y y e a r o l d s p a s t i c , who i s female and m a r r i e d . T h i s p e r s o n s t a t e s , " L o n e l i n e s s when you're., a l o n e i s r e a s o n a b l e , something t o be overcome, but l o n e l i n e s s when you are w i t h someone i s a g r e a t l e s s t o l e r a b l e . " T h i s acknowledges t h a t the i n d i v i d u a l e x p e r i e n c e s v a r i o u s degrees o f l o n e l i n e s s , but i t does not e n a b l e a n o t h e r person to a s s e s s the l o n e l i n e s s , as Seabrook p r e v i o u s l y p o s t u l a t e d . The l o n e l i n e s s e n c o u n t e r e d by a p e r s o n i s u s u a l l y 49 S i s e n w e i n , p. 35. ^ F r a n c i s , p. 156. 51 Jeremy Seabrook, L o n e l i n e s s (New York: U n i v e r s e Books,1973), p.144. a p a r t o f p e r s o n a l l i f e e x p e r i e n c e s , and t h e r e f o r e i t can be d i f f i c u l t f o r the i n d i v i d u a l t o r e l a t e t h e s e l o n e l y s i t u a t i o n s . L o n e l i n e s s i s o f t e n used as a synonym f o r l a c k o f f u l f i l l m e n t , u n h a p p i n e s s , o r f a i l u r e i n many a r e a s o f l i f e e x p e r i e n c e s . I t i s a s u b j e c t surrounded by p r o h i b i t i o n s and embarrassments so t h a t t h o s e who a r e a f f e c t e d by i t a r e caught up i n a s p i r a l o f s e l f - r e i n f o r c i n g i s o l a t i o n . Many who s u f f e r from l o n e l i n e s s f e e l t h a t i t i s t h e r e s u l t o f p e r s o n a l u n w o r t h i n e s s , t h a t l o n e l i n e s s i s something t o be ashamed o f and i n o r d e r t o t a l k about i t , t h e y may r e q u i r e c i r c u m s t a n c e s o r 52 i n d i v i d u a l s t o blame. I t i s t h e r e f o r e t he i n t e n t o f t h i s r e s e a r c h t h a t l o n e l i n e s s must be d i s c u s s e d as an e n t i t y i n and o f i t s e l f w i t h i n the t h e r a p e u t i c r e l a t i o n s h i p , and t h a t t h e r a p i s t s have a r e s p o n s i b i l i t y t o i n i t i a t e t h i s t y p e o f communication. L o n e l i n e s s may c r e a t e f e e l i n g s o f u n e x p l a i n e d d r e a d , o f d e s p e r a t i o n , o r o f extreme r e s t l e s s n e s s . These f e e l i n g s can be so i n t e n s e and u n b e a r a b l e t h a t a u t o m a t i c a c t i o n s a r e p r e c i p i t a t e d . The problem e v e n t u a l l y becomes how t o handle the bad f e e l i n g s which come from l o n e l i n e s s and u n s u c c e s s f u l a t t e m p t s to be humanly i n v o l v e d 53 w i t h o t h e r s . Ford and Zorn e x p l a i n how l o n e l i n e s s and bad f e e l i n g s a r e c y c l i c , i n t h e f o l l o w i n g way. L o n e l i n e s s causes bad f e e l i n g s which t e n d t o overwhelm the p s y c h e , making i t hard to know what t o do to a l l e v i a t e o r cope w i t h the bad f e e l i n g s . In o r d e r to deal w i t h o r overcome t h e s e f e e l i n g s , one has t o f i n d r e l i e f , p o s s i b l y by Seabrook, L o n e l i n e s s , p. 24. Ford and Zorn, Why Be LOiiely? p. 23-27. d e c r e a s i n g the l o n e l i n e s s . I f n o t , t he bad f e e l i n g s tend t o make the p e r s o n f e e l worse, which may l e a d t o i n c r e a s i n g t h e l o n e l i n e s s f o r t h a t i n d i v i d u a l . Ford and Zorn f u r t h e r p o s t u l a t e t h a t the bad f e e l i n g s from l o n e l i n e s s tend t o d r a i n the i n t e r n a l p h y s i c a l and emotional s t r e n g t h n e c e s s a r y to handle the l o n e l i n e s s o r the bad f e e l i n g s . 54 Tanner p o s t u l a t e s i n her t h e o r y o f r e l a t i n g T r a n s a c t i o n a l A n a l y s i s t o l o n e l i n e s s , t h a t l o n e l i n e s s has i t s b e g i n n i n g i n c h i l d h o o d , sometime between the age o f one and t h r e e . I t i s a r o o t c o n d i t i o n o f l i f e and i t i s d u r i n g t h e s e e a r l y y e a r s t h a t we f i r s t b e g i n t o 55 e x p e r i e n c e doubt as to our s e l f - w o r t h . Townsend s t a t e s t h a t a f i v e y e a r span o f s u s t a i n e d l o s s o f an e s s e n t i a l t i e , such as l e a v i n g home, r e g a r d l e s s o f the o t h e r t i e s , w i l l d etermine i f u n r e s o l v a b l e 56 l o n e l i n e s s i s to o c c u r . Weiss i d e n t i f i e s two s o c i a l s i t u a t i o n s which are a r i s k f o r l o n e l i n e s s . The f i r s t i s the s i t u a t i o n o f the u n m a r r i e d , i n which t h e r e i s no committed i n t i m a t e r e l a t i o n s h i p w i t h a c l o s e o t h e r t o f e n d o f f e m o t i o n a l i s o l a t i o n . The second h i g h r i s k s i t u a t i o n i s the i n d i v i d u a l who has no l i n k t o the community, because o f r e c e n c y o f a r r i v a l , p e r s o n a l u n a c c e p t a b i l i t y , o r f o r o t h e r r e a s o n s . V a r i o u s groups o f peop l e i n s o c i e t y a r e a t r i s k w i t h l o n e l i n e s s . One group o f t h e s e p e o p l e a r e thos e who have a g r e a t deal o f f r e e time 54 Tanner, L o n e l i n e s s : The Fear o f Love, p. xv. 55 P. Townsend, F a m i l y L i f e o f O l d People (London: R o u t l e d g e and Kegan P a u l , L t d . , 1957T 56 Weiss, L o n e l i n e s s - The E x p e r i e n c e o f Emotional and S o c i a l  I s o l a t i o n , pp. 71-85. 33 but have not l e a r n e d t o use i t , and t h e r e f o r e s u f f e r from boredom. Some p e o p l e do not know how t o make and m a i n t a i n good f r i e n d s h i p s . For o t h e r s , the f a m i l y group no l o n g e r c o m p r i s e s the extended f a m i l y but f o c u s e s on 57 the n u c l e a r f a m i l y , thus p o s s i b l y d e c r e a s i n g s u p p o r t systems. F r a n c i s i n her r e s e a r c h s t u d y on the l o n e l i n e s s e x p e r i e n c e d by h o s p i t a l i z e d p a t i e n t s , found t h a t temporary s e p a r a t i o n from p e o p l e and o b j e c t s produced groups a t r i s k from l o n e l i n e s s . These groups i n c l u d e d m i n o r i t y c u l t u r e s , younger age g r o u p s , and persons who had accumulated m a t e r i a l goods i n a f a s t - f l o w i n g l i f e s t y l e . The s t u d y i d e n t i f i e d l o n e l i n e s s r i s k groups but d i d not s u g g e s t t h e r a p y o r i n t e r v e n t i o n modes a p p l i c a b l e t o them. Tanner i d e n t i f i e s v a r i o u s groups o f p e o p l e who i n c u r l o n e l i n e s s . S t u d e n t s who a r e f o r the f i r s t time away from home f o r a l o n g p e r i o d may s u f f e r from l o n e l i n e s s . R e - d i s c o v e r i n g t h e i r i d e n t i t y i n an a d u l t w o r l d may be d i f f i c u l t . Women who remain s i n g l e t h r o u g h no c h o i c e o f t h e i r own may have t o overcome not b e i n g a b l e to have c h i l d r e n o r a mate to c a r e about. The d i v o r c e d and widowed a r e o f t e n more l o n e l y than t h o s e who n e v e r m a r r i e d . T h i s deeper l o n e l i n e s s c o u l d be due, not o n l y t o the l o s s o f a c l o s e companion, but, i f m a r r i e d young the p e r s o n may never have l e a r n e d to l i v e a l o n e o r f a c e up t o the l o n e l i n e s s e x p e r i e n c e d i n e a r l i e r l i f e . For some, r e t i r e m e n t marks the o n s e t o f l o n e l i n e s s because 59 i t appears to be the end o f a u s e f u l working l i f e . 57 F r a n c i s , p. 10. CO Tanner, L o n e l i n e s s : The Fear o f Love, p. 75. 59 0 3 I b i d . , p. 83. P s y c h o t h e r a p y w i t h t he L o n e l y C l i e n t A c c o r d i n g t o Fromm-Reichmann the s e c r e t i v e n e s s and l a c k o f communication about l o n e l i n e s s i n the g e n e r a l p o p u l a t i o n seems t o i n c r e a s e t he t h r e a t f o r t h e l o n e l y p e r s o n . Due t o t h i s l a c k o f mention, t h e y come to b e l i e v e t h a t o t h e r s have not e x p e r i e n c e d s i m i l a r f e e l i n g s . I t t h e r e f o r e seems a p p a r e n t t h a t t h e r a p i s t s s h o u l d acknowledge and i d e n t i f y a c l i e n t ' s l o n e l i n e s s i n p s y c h o t h e r a p y , fil Moustakas s u g g e s t s t h a t e v e r y r e a l e x p e r i e n c e o f l o n e l i n e s s i n v o l v e s a c o n f r o n t a t i o n f o r the i n d i v i d u a l and f o r c e s t he person t o use new e n e r g i e s and r e s o u r c e s t o cope w i t h l i f e . By e x p e r i e n c i n g l o n e l i n e s s and g a i n i n g i n s i g h t from t h i s , a person can a c h i e v e a h i g h e r l e v e l o f i n t r a p e r s o n a l u n i t y . The t h e r a p i s t can a s s i s t a c l i e n t to a t t a i n t h i s l e v e l through l o n e l i n e s s i n t e r v e n t i o n as opposed to not acknowledging the l o n e l i n e s s and h a v i n g the c l i e n t c o n t i n u e t o f a c e l o n e l i n e s s fi? s i t u a t i o n s i n l i f e . Moustakas f u r t h e r b e l i e v e s t h a t t he l o n e l y i n d i v i d u a l c o n t i n u e s t o o p p r e s s l o n e l i n e s s and t h e r e f o r e responds w i t h whatever s u r f a c e o r approved b e h a v i o u r p r e v i o u s a c t i o n s were based upon. CO Von W i t z l e b e n p o s t u l a t e s t h a t the t h e r a p i s t i n p s y c h o t h e r a p e u t i c and a n a l y t i c a l work i s so p r e o c c u p i e d w i t h t h e dynamics u n d e r l y i n g a symptom which may l e a d to n e g l e c t i n g to view the t o t a l p e r s o n a l i t y o f t h e i n d i v i d u a l . He f u r t h e r b e l i e v e s t h a t the p s y c h o t h e r a p i s t does not always 6 0Fromm-Reichmann, p. 6. 6 1 M o u s t a k a s , L o n e l i n e s s and Love, p. 20. 6 2 I b i d . , p. 31. 6 3 v o n W i t z l e b e n , p. 37. pay enough a t t e n t i o n t o p r i m a r y l o n e l i n e s s beca.use i n s i g h t i n t o p e r s o n a l l o n e l i n e s s f o r the p s y c h o t h e r a p i s t i s l i m i t e d . In o t h e r words, the t h e r a p i s t may be r e l u c t a n t to admit o r f a c e a p e r s o n a l l o n e l i n e s s . T h i s i n t u r n makes i t d i f f i c u l t f o r the t h e r a p i s t t o i d e n t i f y and work w i t h the l o n e l i n e s s i n c l i e n t s . The o l d b i b l i c a l s t a t e m e n t , " F i r s t remove the beam from t h i n e own eye t h a t ye may see c l e a r l y to remove the mote from thy n e i g h b o u r ' s eye" i s i n e s s e n c e , s i m i l a r i n meaning. 65 F r a n c i s i n her r e s e a r c h study on the l o n e l i n e s s e x p e r i e n c e d by h o s p i t a l i z e d p a t i e n t s , due t o the temporary s e p a r a t i o n from p e o p l e and o b j e c t s , s t a t e s as a f i n d i n g , " I f one says he i s l o n e l y , he i s l o n e l y . " She compares t h i s to the a b s t r a c t c o n c e p t o f p a i n , as no one can a d e q u a t e l y e v a l u a t e a n o t h e r ' s p a i n , no one can e v a l u a t e a n o t h e r ' s l o n e l i n e s s . The t h e r a p i s t must a c c e p t the s u f f e r i n g i n d i v i d u a l ' s a p p r a i s a l o f l o n e l i n e s s a t f a c e v a l u e . T h i s can be more e a s i l y done i f the t h e r a p i s t has a c c e p t e d p e r s o n a l l o n e l i n e s s , as t h i s a c c e p t a n c e can then be t r a n s f e r r e d t o the c l i e n t d u r i n g t h e r a p y s e s s i o n . She f u r t h e r p o s t u l a t e s t h a t l o n e l i n e s s p r e v e n t i o n would mean l e s s h o s p i t a l i z a t i o n and t h a t l o n e l i n e s s p o s s i b l y a c t s as a d e t e r r e n t t o medical p r o g n o s i s . A n o t h e r f i n d i n g o f i n t e r e s t was t h a t t h o s e p a t i e n t s who were r e a s o n a b l y c e r t a i n as t o when they would be d i s c h a r g e d from h o s p i t a l were s i g n i f i c a n t l y more l o n e l y than t h o s e who had no i d e a when they might go home. She t h e r e f o r e c o n c l u d e s t h a t p a t i e n t knowledge o f r e l a t i v e d i s c h a r g e d ate i s somehow a c r u c i a l v a r i a b l e i n the g e n e r a t i o n o f l o n e l i n e s s . A well-known b i b l i c a l p r o v e r b . ' F r a n c i s , p. 157. F r a n c i s ' f i n d i n g s i n d i c a t e the r e s e a r c h a b l e u n d e r s t a n d i n g o f l o n e l i n e s s i s most l i m i t e d . The undocumented dimenions o f l o n e l i n e s s a r e many and e x p a n s i o n o f the few f i n d i n g s a v a i l a b l e i s most n e c e s s a r y . rc Audrey Brennan i n her r e s e a r c h s t u d y on i n v e s t i g a t i n g t he r e s p o n s e o f h o s p i t a l i z e d p a t i e n t s t o l o n e l i n e s s , found t h a t extended c a r e r e s p o n d e n t s p e r c e i v e d many l o n e l i n e s s - a s s o c i a t e d changes i n t h e m s e l v e s but did not f e e l e i t h e r the need o r freedom t o communicate t h e s e p e r c e p t i o n s t o the n u r s e . M a t e r n i t y r e s p o n d e n t s r e p l i e d to v e r y few o f . t h e l o n e l i n e s s - a s s o c i a t e d changes i n b e h a v i o u r . P s y c h i a t r y r e s p o n d e n t s p e r c e i v e d many l o n e l i n e s s - a s s o c i a t e d changes i n t h e i r b e h a v i o u r and p e r c e i v e d a hig h degree o f freedom t o communicate w i t h the nurse and a sense o f r e l a t e d n e s s t o t h e nu r s e . 67 Seabrook p o s t u l a t e s t h a t i t may be i m p o s s i b l e to p r e v e n t o l d age, bereavement, o r the decay o f r e l a t i o n s h i p s , but t h e i r e f f e c t upon t h e i n d i v i d u a l can be m i t i g a t e d i f an e f f o r t i s made. The case h i s t o r y o f a f i f t y y e a r o l d m a r r i e d female who had been h o s p i t a l i z e d i n a p s y c h i a t r i c s e t t i n g , r e l a t e d the ty p e s o f t h e r a p y t h a t she r e c e i v e d d u r i n g her h o s p i t a l i z a t i o n , " I hpent ieveAal month* In hospital. TotutunateJLy I wa& in a p&ychiatAic wcuid in a Qd.mA.aJL hospital, which 7 think id a good idea. It go2A> a long way to siemove. the. Atigma o£ mental illneAi,. I had p&ychotheAapy, electAotheAapy, dtags - I wa& t>ent home, only two day* a^teA the. eZzctA.otheAa.py. Then anotheA kind ofi lonelineA* began. alt the tAe.atme.nt I had, I think the mot>t helpful wai> CO being able to talk about thing*." Audrey Brennan, "The L o n e l i n e s s o f the H o s p i t a l i z e d P a t i e n t " (Master's T h e s i s , U n i v e r s i t y o f B r i t i s h Columbia, 1975), pp.81-92. 67 Seabrook, L o n e ! i n e s s , p. 9. 6 8 I b i d . , p. 87. T h i s s tatement s u g g e s t s t h a t p s y c h o t h e r a p y was t h e most e f f e c t i v e t r e a t m e n t and t h a t " a n o t h e r k i n d o f l o n e l i n e s s began" upon r e t u r n i n g home. I t appears t h a t the p a t i e n t may have been s a y i n g t h a t she was s u f f e r i n g from l o n e l i n e s s and t h e r e f o r e she needed c o n t a c t w i t h a n o t h e r o r p s y c h o t h e r a p y t o c u r e her i l l n e s s . 69 As Roy B o n i s t e l l s t a t e d on h i s t e l e v i s i o n program, "Man A l i v e " , " l o n e l i n e s s i s the d i s e a s e o f our t i m e , r e a c h i n g e p i d e m i c p r o p o r t i o n s . " T here i s a need f o r l o n e l i n e s s p s y c h o t h e r a p y t o a s s i s t an i n d i v i d u a l t o a l l e v i a t e o r cope w i t h the f e e l i n g s o f l o n e l i n e s s . A c o n c e p t u a l model f o r l o n e l i n e s s i n t e r v e n t i o n has been d e v e l o p e d i n t h i s study t o a s s i s t t h e r a p i s t s t o i d e n t i f y l o n e l i n e s s b e h a v i o u r s i n c l i e n t s and then implement l o n e l i n e s s i n t e r v e n t i o n s . To undertake t h i s t a s k r e q u i r e s t h e r a p i s t s to l e a r n t o i d e n t i f y l o n e l i n e s s b e h a v i o u r s and implement a p p r o p r i a t e l o n e l i n e s s i n t e r v e n t i o n s . A Conceptual Model f o r L o n e l i n e s s I n t e r v e n t i o n as Developed By The I n v e s t i g a t o r As d e p i c t e d i n F i g u r e 1, a t h e r a p i s t may t a k e one o f two r o u t e s when engaging i n p s y c h o t h e r a p y w i t h c l i e n t s i d e n t i f i e d as t e s t i n g h i g h i n l o n e l i n e s s . I f Route #1 i s t a k e n , t h e t h e r a p i s t w i l l a s s i s t t h e c l i e n t t o deal w i t h the s t r e s s e s t h a t the per s o n i s e n c o u n t e r i n g as w e l l as the symptoms r e l a t e d t o the per s o n ' s mental f u n c t i o n i n g . I f Route #2 i s t a k e n , t he t h e r a p i s t w i l l i d e n t i f y s p e c i f i c l o n e l i n e s s b e h a v i o u r ( s ) o f the c l i e n t and a s s i s t t he person t o a l l e v i a t e o r cope w i t h the l o n e l i n e s s b e i n g e n c o u n t e r e d by implementing a p p r o p r i a t e l o n e l i n e s s i n t e r v e n t i o n . W JCHEK, "Man A l i v e , " November 8, 1976, " A l o n e , Not J u s t Me," Roy B o n i s t e l l . A Conceptual Model For L o n e l i n e s s I n t e r v e n t i o n PSYCHOTHE -5 a> NORMAL LEVEL OF FUNCTIONING ROUTE #1 INVIDIDUAL ENCOUNTERING U m i J E S S „ KEY: ROUTE #1 ROUTE #2 LEVEL OF FUNCTIONING WHEN X LONELINESS ; / I S RESOLVED NORMAL LEVEL OF FUNCTIONING STRESS ROUTE #2 : T _ _ 3 / \ Route #1 Psychotherapy i n which symptom r e l i e f i s sought by the t h e r a p i s t ' s i n d i v i d u a l " s t y l e " o f i n t e r v e n t i o n . Route #2: Psychotherapy i n which l o n e l i n e s s i s c o n s i d e r e d and v e r i f i e d as the source o f symptomatic b e h a v i o u r and i n t e r v e n t i o n i s based on the psychodynamics o f l o n e l i n e s s . CO CO 39 I d e n t i f i c a t i o n o f L o n e l i n e s s B e h a v i o u r s and L o n e l i n e s s I n t e r v e n t i o n s as Developed by the I n v e s t i g a t o r Implementation o f t h e "Conceptual Model f o r L o n e l i n e s s I n t e r v e n t i o n " n e c e s s i t a t e s the i d e n t i f i c a t i o n o f s p e c i f i c l o n e l i n e s s b e h a v i o u r . T h i s then g i v e s d i r e c t i o n f o r p o s s i b l e l o n e l i n e s s i n t e r v e n t i o n s f o r use i n p s y c h o t h e r a p y s e s s i o n s w i t h c l i e n t s i d e n t i f i e d as t e s t i n g h i g h i n l o n e ! i n e s s . LONELINESS BEHAVIOUR LONELINESS INTERVENTION SOMATIC COMPLAINS Somatic d i f f i c u l t i e s based upon the body's e x p r e s s i o n o f : l o n e l i n e s s : - Insomnia and i n t e n s e i n t e r e s t i n s l e e p i n g a r e o b s e r v e d a t t h e same time. - H y p e r s e n s i t i v i t y t o n o i s e o r t o s t u f f i n e s s i n a c l o s e d room may l e a d to t h e c l i e n t o p e n i n g and c l o s i n g windows innumerable times i n a day. - V o m i t i n g and b e l c h i n g . - May c o m p l a i n o f p a i n i n the head, arm, and/or stomach. - Loss o f Weight. Observe c l i e n t ' s s l e e p i n g p a t t e r n s . R e l i e f from l o n e l i n e s s can be a t t a i n e d from s l e e p but dreams c o n c e r n i n g t h e l o n e l i n e s s may be e x p e r i e n c e d , thus k e e p i n g the c l i e n t awake. I f e x p e r i e n c i n g bad dreams, then s e d a t i o n may not be the answer to the i n s o m n i a . The c l i e n t may f e e l r e j e c t i o n . E s t a b l i s h a t h e r a p e u t i c r e l a t i o n s h i p s p e c i f y i n g the l i m i t s o f the r e l a t i o n s h i p and a d h e r i n g t o the l i m i t s because the c l i e n t w i l l t e s t and r e - t e s t them. S i n c e r i t y , i n t e g r i t y , and h o n e s t y o f the t h e r a p i s t a r e i m p o r t a n t . 40 LONELINESS BEHAVIOUR LONELINESS INTERVENTION ABBERRANT BEHAVIOUR TO MASK LONELINESS Because l o n e l i n e s s can be an u n b e a r a b l e e x p e r i e n c e , the c l i e n t may engage i n a l t e r n a t i v e b e h a v i o u r s , t o mask l o n e l i n e s s , such a s : - drug abuse - e x c e s s i v e d r i n k i n g - gambling - p r o s t i t u t i o n - Deal d i r e c t l y w i t h the l o n e l i n e s s r a t h e r than w i t h the a l t e r n a t e b e h a v i o u r s o r the d e f e n s e s a g a i n s t the p a i n o f l o n e l i n e s s . - Understand how the l o n e l i n e s s has e v o l v e d f o r the c l i e n t . - A l l o w the c l i e n t t o d e v e l o p i n s i g h t i n t o p e r s o n a l 1 o n e l i n e s s . - Acknowledge and v a l i d a t e w i t h the c l i e n t the p o s s i b l e causes o f l o n e l i n e s s . HIGHLY STYLIZED, PRECISE AFFECT O v e r p l a n n i n g : emphasis on p e r s o n a l d r e s s i n g f o r s o c i a l a p p e a r a n c e s , a l m o s t as i f the c l i e n t was a r r a n g i n g a c a r e f u l l y guarded and r a r e l y d i s p l a y e d p i c t u r e o f h i m s e l f . E s t a b l i s h a t h e r a p e u t i c r e l a t i o n s h i p where the c l i e n t can work on g e t t i n g i n t o u c h w i t h o t h e r i n d i v i d u a l s , f e e l i n g r e l a t e d t o them, and working c o l l a b o r a t i v e l y w i t h them. 41 LONELINESS BEHAVIOUR LONELINESS INTERVENTION TIME-ORIENTED COMPLAINTS The c l i e n t makes c o m p l a i n t s r e l a t i n g t o : - the e n d l e s s n e s s o f each day - the f e e l i n g o f " p u t t i n g i n time." - A s s i s t t he c l i e n t t o have a v a r i e t y o f o p p o r t u n i t i e s t o d e s c r i b e , i n t e r p r e t , and v a l i d a t e what i s happening i n a c u r r e n t s i t u a t i o n . - Have the c l i e n t complete a " D a i l y L i v i n g S c h e d u l e " ( R e f e r to F i g u r e 2) to de v e l o p c l i e n t awareness o f how time i s b e i n g u t i l i z e d d u r i n g a day. - Have c l i e n t then complete " A l t e r n a t i v e s t a D a i l y L i v i n g S c h e d u l e " ( R e f e r t o F i g u r e 3) to d e v e l o p c l i e n t awareness o f how time c o u l d be u t i l i z e d d u r i n g a day. DAILY LIVING SCHEDULE  The Way I Spend My Time 7:00 Get up, have b r e a k f a s t 8:00 Leave f o r work 8:30 A r r i v e a t work 10:00 C o f f e e break 12:00 Lunch 12:30 Back to work 4:30 Leave work 5:30 Din n e r a l o n e 7:00 Do l a u n d r y and v a r i o u s c h o r e s around the apartment 8:00 Watch t e l e v i s i o n 11:00 Watch the l a t e news 11 :30 Go t o bed * Do f o r weekdays * Do. f o r weekends, o r days o f f from work i f d i f f e r e n t than week days. F i g u r e 2 Ford and Zorn, Why Be L o n e l y ? p. 80. 43 ALTERNATIVES TO DAILY LIVING TIME THE WAY I SPEND MY TIME ALTERNATIVES TO THE WAY I SPEND MY TIME 7:00 Get up, have b r e a k f a s t Get up, have b r e a k f a s t 8:00 Leave f o r work Leave f o r work i n a c a r pool 8:30 A r r i v e a t work A r r i v e a t work 10:00 C o f f e e break C o f f e e break w i t h a pe r s o n a t work 12:00 Lunch break Lunch break w i t h a d i f f e r e n t person a t work 4:30 Leave work Leave work, d r i v e home i n c a r pool 5:30 Dinn e r a l o n e D i n n e r w i t h a f r i e n d o r nei g h b o u r 7:00 Do l a u n d r y and v a r i o u s c h o r e s around the apartment Do l a u n d r y and v a r i o u s c h o r e s around the apartment 8:00 Watch t e l e v i s i o n Watch t e l e v i s i o n , i n v i t e someone to watch t e l e v i s i o n w i t h you 9:30 Phone a f r i e n d 10:00 W r i t e a l e t t e r to a f r i e n d , penpal 11:00 Watch l a t e news Watch l a t e news 11:30 Go t o bed Go t o bed F i g u r e 3 71 Ford and Z o r n , Why Be L o n e l y ? p. 80. 44 LONELINESS BEHAVIOUR LACK OF DIRECTION IN LIFE The c l i e n t e x p e r i e n c e s p l a n l e s s n e s s t o l i f e , as i f l i f e was viewed and l i v e d as one c o n t i n u a l a c c i d e n t , based upon an e x p e c t a t i o n t h a t something i s g o i n g t o happen. Sometimes the p e r s o n responds to minor d e t a i l s t h a t a c t u a l l y do o c c u r , but does n o t h i n g t o p r e v e n t o r produce them. Many problems c o n f r o n t the p e r s o n a l l a t once, e v e r y t h i n g l o o k s i m p o s s i b l e , f r u s t r a t i o n s grow, and t h i s f u r t h e r i n c r e a s e s the c l i e n t ' s d i f f i c u l t y i n making wise c h o i c e s . LONELINESS INTERVENTION Make a "Do P l a n " : which c o n s i s t s o f c l i e n t g o a l s as e s t a b l i s h e d by the c l i e n t i n c o n j u n c t i o n w i t h the t h e r a p i s t . Goals s h o u l d be i n p o s i t i v e terms because i t makes them e a s i e r to remember as w e l l as c r e a t e s p o s i t i v e f e e l i n g s i n t he c l i e n t when a t t a i n e d . The g o a l s s h o u l d i n v o l v e a c t i o n s o f s h o r t d u r a t i o n . ( R e f e r t o F i g u r e 4 ) . S i x elements to a "Do P l a n " : 1. SMALL: i t i s manageable, both i n terms o f time and what the c l i e n t i s g o i n g t o do. 2. SPECIFIC: I t i s d e f i n i t e and d e t a i l e d , something the c l i e n t can v i s u a l i z e doing.. 3. POSITIVE: I t i s not what the c l i e n t i s not g o i n g t o do, but what t h e c l i e n t i s g o i n g t o do. 4. REASONABLE: I t makes se n s e , the c l i e n t sees v a l u e i n d o i n g i t . 5. REPETITIVE: I t i s something t h e c l i e n t can do f a i r l y o f t e n . 6. INDEPENDENT: I t i s not dependent on what someone e l s e does w i t h the c l i e n t . 45 DO PLAN DO PLAN JANUARY 1 2 3 4 5 6 7 8 S m i l e and say h e l l o t o a t l e a s t one per s o n s i t t i n g i n the w a i t i n g room o f the c l i n i c Have l u n c h w i t h someone a t work e v e r y day J J J J J V o l u n t e e r to h e l p S a t u r d a y and Thursday n i g h t a t the c h u r c h bingo . s y C a l l one f r i e n d on the phone each day J y y y y y Ask a f r i e n d o r n e i g h b o u r o v e r to d i n n e r once a week o r more y y F i g u r e 4 Ford and Z o r n , Why Be L o n e l y ? p. 45. LONELINESS BEHAVIOUR jlfL LONELINESS INTERVENTION REPORTING ACTS OF DISENGAGEMENT I n a b i l i t y t o ob s e r v e o n e s e l f i n a c t i o n , f u n c t i o n s as a s p e c t a t o r , w a t c h i n g , w a i t i n g , and hoping. P r o t e c t s s e l f by not r e c o g n i z i n g own b e h a v i o u r . R e j e c t i o n , no l o n g e r an o b j e c t o f l o v e due t o a husband, p a r e n t , f r i e n d o r c h i l d d y i n g o r i s o t h e r w i s e withdrawn from i n t e r a c t i o n w i t h the c l i e n t . A homesickness f o r a s t y l e o f l i f e o r some s e t o f a c t i v i t i e s f o r m e r l y c a r r i e d out w i t h o t h e r s . P o s s i b l e disengagement from a p r i o r l i f e s t y l e may be due to a s t a t u s drop as a r e s u l t o f not s h a r i n g i n a p r e v i o u s 1 i f e s t y l e . Be aware o f c l i e n t ' s d e f e n s e mechanisms so t h a t they a r e not r e i n f o r c e d i n t h e r a p y s e s s i o n . A s s i s t c l i e n t t o change " r o l e " by f o c u s s i n g on a newly r e v i t a l i z e d s o c i a l r o l e . T h i s can be f a c i l i t a t e d by a "DO PLAN" A s s i s t the c l i e n t t o i n t e g r a t e i n t o s o c i a l networks which p r o v i d e s u p p o r t f o r a c c e p t i n g r e a l i t y . 47 LONELINESS BEHAVIOUR LONELINESS INTERVENTION REPORTING INABILITY TO MEET OTHERS - Absence o f anyone to c a r e f o r o r be the r e c i p i e n t o f l o v e . - I n a b i l i t y t o make f r i e n d s due to l a c k o f s k i l l s n e c e s s a r y to b u i l d new p a t t e r n s o f r e l a t i o n s when o l d ones become broken, s t r a i n e d , o r not e a s i l y a v a i l a b l e . - Lack o f s e l f - c o n f i d e n c e , see no c h o i c e f o r a h a p p i e r tomorrow. The f a i t h and a b i l i t y to c r e a t e a new f u t u r e i s gone. B u i l d s u f f i c i e n t i n t e r n a l s t r e n g t h and c o n f i d e n c e i n th e c l i e n t so t h a t e v e n t u a l l y t h e c l i e n t can handle problems w i t h o u t a s s i s t a n c e . The c l i e n t may make a 1 i s t on "BUILDING NEW LIFE SITUATIONS" by c o n s t r u c t i n g a "DO PLAN" which s l o w l y e v o l v e s i n t o new l i f e e x p e r i e n c e s f o r the c l i e n t . IDOLIZATION OF OTHERS The e f f o r t t o e s t a b l i s h c o n t a c t or p r o x i m i t y w i t h p e o p l e may l e a d t o t h e c l i e n t i d o l i z i n g c e r t a i n i n d i v i d u a l s . - In an e f f o r t t o e s t a b l i s h c o n t a c t , undertake " r o l e r e v e r s a l " t o a s s i s t c l i e n t t o p r a c t i c e t h i s communication. - A l l o w c l i e n t t o know the t h e r a p e u t i c i n t e r e s t t h a t t h e r a p i s t , has about c l i e n t ' s a c t i v i t i e s . REPORTING INABILITY TO COMMUNICATE D i f f i c u l t y communicating t o p e o p l e . F r i g h t e n e d s e c r e t i v e n e s s and l a c k o f communication i n c r e a s e s t he t h r e a t to t a l k about l o n e l i n e s s . Suggest f o u r g u i d e l i n e s f o r c o n v e r s a t i o n : 1. be nonjudgemental when l i s t e n i n g t o a n o t h e r p e r s o n , 2. l i s t e n w i t h i n t e r e s t , 3. don't r u s h t h e c o n v e r s a t i o n , g i v e t he person a chance to make a p o i n t , 4. l e t the o t h e r person know what you t h i n k . 48 The p r e c e d i n g i d e n t i f i c a t i o n o f s p e c i f i c l o n e l i n e s s b e h a v i o u r and p o s s i b l e l o n e l i n e s s i n t e r v e n t i o n s p r o v i d e the b a s i s and g u i d e l i n e s f o r l o n e l i n e s s p s y c h o t h e r a p y . The i n t e r n a l i z a t i o n o f the c o n c e p t u a l model f o r l o n e l i n e s s i n t e r v e n t i o n o c c u r r e d by means o f the t h e r a p i s t s on t h e r e s e a r c h team engaging i n weekly t h e r a p y s e s s i o n s w i t h l o n e l y c l i e n t s as w e l l as weekly c o n s u l t a t i o n s w i t h t h e i n v e s t i g a t o r . Guidance and f u r t h e r u n d e r s t a n d i n g i n t h e o p e r a t i o n a l i z a t i o n o f the model was p r o v i d e d d u r i n g the c o n s u l t a t i o n . T e a c h i n g and L e a r n i n g a C o n c e p t u a l Model f o r L o n e l i n e s s I n t e r v e n t i o n To conduct e f f e c t i v e p s y c h o t h e r a p y w i t h c l i e n t s i d e n t i f i e d as t e s t i n g h i g h i n l o n e l i n e s s , i t was n e c e s s a r y f o r t h e r a p i s t s t o i n t e r n a l i z e t h e c o n c e p t u a l model f o r l o n e l i n e s s i n t e r v e n t i o n . 73 Barbara Redman s t a t e s t h a t t e a c h i n g i s an i n t e r a c t i v e p r o c e s s between t e a c h e r and one o r more l e a r n e r s . She f u r t h e r s t a t e s t h a t t h e r o l e o f the l e a r n e r i s t o p a r t i c i p a t e i n o r i n i t i a t e a c t i v i t i e s t h a t l e a d toward the d e s i r e d b e h a v i o u r change. T h e r e f o r e , an i n s e r v i c e e d u c a t i o n on l o n e l i n e s s f o r the t h e r a p i s t s who were engaged i n p s y c h o t h e r a p y w i t h c l i e n t s i d e n t i f i e d as t e s t i n g h i g h i n l o n e l i n e s s was p r e p a r e d . 74 Jean Schweer s t a t e s t h a t a c r e a t i v e t e a c h i n g - l e a r n i n g m i l i e u p r o v i d e s the freedom o f d i s c o v e r y so v i t a l to l e a r n i n g t h o s e t h i n g s B arbara Redman, The P r o c e s s o f P a t i e n t T e a a c h i n g i n N u r s i n g ( S a i n t L o u i s : The C. V. Mosby Company, 1972), pp.14-18. 7 4 J e a n Schweer, C r e a t i v e T e a c h i n g i n C l i n i c a l N u r s i n g ( S a i n t L o u i s : The C. V. Mosby Company, 1972), p.143. 49 e s s e n t i a l t o the f u l f i l l m e n t o f p r o f e s s i o n a l r e s p o n s i b i l i t i e s i n a r a p i d l y c h a n g i n g s o c i e t y . The i n s e r v i c e e d u c a t i o n on l o n e l i n e s s g i v e n i n t h i s s t u d y employed a v a r i e t y o f t e a c h i n g methods, i n c l u d i n g group d i s c u s s i o n s , g u e s t s p e a k e r s who had e x p e r t i s e i n l o n e l i n e s s , a c t i v e l o n e l i n e s s e x e r c i s e s , and p e r s o n a l l o n e l i n e s s mood media such as poems and songs. T h i s t e a c h i n g - l e a r n i n g p r o c e s s f o r t h e r a p i s t s p r e c l u d e d implementing t he c o n c e p t u a l model f o r l o n e l i n e s s i n t e r v e n t i o n . The group t e a c h i n g was f o l l o w e d by i n d i v i d u a l t h e r a p i s t c o n s u l t a t i o n on a weekly b a s i s t o enhance the u n d e r s t a n d i n g and i m p l e m e n t a t i o n o f the model. Measurements f o r L o n e l i n e s s A measurement f o r l o n e l i n e s s was v i t a l t o t h i s r e s e a r c h s t u d y , s i n c e , t h e r e d u c t i o n o f l o n e l i n e s s i n c l i e n t s was a major d e t e r m i n a n t i n i n d i c a t i n g t he e f f e c t i v e n e s s o f the "Conceptual Model f o r L o n e l i n e s s I n t e r v e n t i o n " i n p s y c h o t h e r a p y . An i n s t r u m e n t which would measure the r e d u c t i o n o f l o n e l i n e s s i n c l i e n t s was n e c e s s a r y . 75 S i s e n w e i n d e v e l o p e d a l o n e l i n e s s s c a l e to measure " l o n e l i n e s s i n the i n d i v i d u a l " as viewed by h i m s e l f and o t h e r s . The s c a l e was formed by h i s q u e s t i o n i n g twenty p s y c h o l o g i s t s who s u b m i t t e d s t a t e m e n t s t h a t d e s c r i b e d how t h e y f e l t when t h e y e x p e r i e n c e d l o n e l i n e s s . A l s o , s t a t e m e n t s on l o n e l i n e s s were taken from t he l i t e r a t u r e . T h i s s c a l e was t e s t e d on 225 freshman c a d e t s from t he U n i t e d S t a t e s Merchant Marine Army. The q u e s t i o n n a i r e i d e n t i f i e d the l o n e l i n e s s s c o r e s o f each c a d e t •Sisenwein,, p. 59-74. 50 which was then compared t o the l o n e l i n e s s r a t i n g o f t h e c a d e t by h i s roomate and by a s i g n i f i c a n t o t h e r who never l i v e d w i t h t h e c a d e t . The q u e s t i o n n a i r e y i e l d e d r e l i a b i l i t y c o e f f i c i e n t s o f 0.83 and 0.85 and a v a l i d i t y c o e f f i c i e n t o f 0.72. B r a d l e y 7 6 i n her r e s e a r c h s t u d y d e v e l o p e d a l o n e l i n e s s s c a l e based on p a r t i c i p a n t ' s e v a l u a t i o n o f l o n e l i n e s s s t a t e m e n t s on a L i k e r t s c a l e . The L o n e l i n e s s S c a l e (LS) was d e r i v e d from an o r i g i n a l l i s t o f 134 sta t e m e n t s on f e e l i n g s or e x p e r i e n c e s o f l o n e l i n e s s and b e l o n g i n g n e s s . Of the 134 statements f o r m i n g t h e s c a l e , 35 were deducted from s e n t e n c e c o m p l e t i o n and peak e x p e r i e n c e r e s p o n s e s by s u b j e c t s i n a p r e l i m i n a r y s t u d y w h i l e most o f t h e r e m a i n i n g s t a t e m e n t s were c o n s t r u c t e d o r s e l e c t e d by B r a d l e y based on her d e f i n i t i o n o f l o n e l i n e s s . T h i s l i s t o f statements was th e n a d m i n i s t e r e d t o 94 male j u n i o r c o l l e g e s t u d e n t s and t h e r e s u l t s were used f o r i t e m s e l e c t i o n and r e l i a b i l i t y . On the b a s i s o f t h e i r a b i l i t y t o d i s c r i m i n a t e , p ^ . 0 0 0 5 on o n e - t a i l e d t - t e s t between the 10 h i g h e s t and 10 lowe s t s c o r e s made by t h e j u n i o r c o l l e g e s t u d e n t s , 38 f i n a l items were s e l e c t e d f o r the l o n e l i n e s s s c a l e ( L S ) . With the s c o r e s on t h e LS from the s c o r e s o f the p r e v i o u s 94 male c o l l e g e s t u d e n t s who p a r t i c i p a t e d i n t h e p r e l i m i n a r y s t u d y , she u t i l i z e d t h e s p l i t - h a l f method t o o b t a i n a measure o f r e l i a b i l i t y . The items f o r t h e two h a l v e s were s e l e c t e d t o equate the sum o f the mean d i f f e r e n c e s (56.0 and 56.9 f o r the two h a l v e s ) and the sum o f t h e s t a n d a r d e r r o r f o r the d i f f e r e n c e between the means (113.4 and 109.56 f o r the two h a l v e s ) . B r a d l e y , p. 15-22. The r e s u l t was a c o r r e l a t i o n c o e f f i c i e n t o f 0.90 ( p ^ . 0 0 1 ) , and v a l u e o f 0.95 as an e s t i m a t e o f f u l l - s c a l e r e l i a b i l i t y f o r the 38 LS i t e m s , was y i e l d e d by t h e Spearman-Brown prophecy f o r m u l a . T h i s s p l i t - h a l f c o r r e l a t i o n i n d i c a t e s t h e LS items a r e i n t e r n a l l y c o n s i s t e n t . B r a d l e y ' s L o n e l i n e s s S c a l e (LS) was not a p p r o p r i a t e f o r t h i s c u r r e n t s t u d y as the s u b j e c t s would not have been a b l e to d i f f e r e n t i a t e the degrees o f l o n e l i n e s s asked f o r i n a L i k e r t s c a l e . The r e a s o n f o r t h i s i s t h a t " many o f the s u b j e c t s were p s y c h o t i c and d e c i s i o n - m a k i n g was v e r y d i f f i c u l t as w e l l as b e i n g p o t e n t i a l l y a n x i e t y p r o d u c i n g f o r them. In a f o l l o w - u p s t u d y , B e l c h e r 7 7 t e s t e d 117 g r a d u a t e s t u d e n t s w i t h the L o n e l i n e s s S c a l e (LS) d e v e l o p e d by B r a d l e y , and r e t e s t e d a g a i n i n 14 days. T h i s y i e l d e d a rho o f 0.89 ( p < . 0 0 1 ) . In a d d i t i o n a l e x p l o r a t o r y work, B e l c h e r used the Pearson r to c o r r e l a t e the LS s c o r e s o f 16 s t u d e n t s who were a g a i n t e s t e d and r e t e s t e d a f t e r e i g h t weeks. He o b t a i n e d a c o r r e l a t i o n c o e f f i c i e n t o f 0.83 ( p ^ . 0 0 1 ) . B e l c h e r then took B r a d l e y ' s L o n e l i n e s s S c a l e (LS) o f 38 s t a t e m e n t s and added t o i t a S e l f - R a t i n g S c a l e (SRS) and f o u r i n c o m p l e t e s e n t e n c e s . The SRS and f o u r i n c o m p l e t e s e n t e n c e s were drawn from B r a d l e y ' s o r i g i n a l L o n e l i n e s s S c a l e c o n t a i n i n g 134 s t a t e m e n t s . B e l c h e r v a l i d a t e d t h e BELS on f o u r groups o f undergraduate s t u d e n t s from the I l l i n o i s I n s t i t u t e o f T e c h n o l o g y . Group 1 (N=371) and group 2 (N=31) were r e c r u i t e d from lower d i v i s i o n p s y c h o l o g y and s o c i o l o g y c l a s s e s and g i v e n the BELS. N e i t h e r group c o n t a i n e d s u b j e c t s who had o r were 7 7 J a y B e l c h e r , "The Measurement o f L o n e l i n e s s : A V a l i d a t i o n Study o f the B e l c h e r Extended L o n e l i n e s s S c a l e (BELS)" (Ph.D. d i s s e r t a t i o n ; I l l i n o i s I n s t i t u t e o f T e c h n o l o g y , 1973), p. 163-215. 52 c u r r e n t l y r e c e i v i n g s e r v i c e s from the u n i v e r s i t y c o u n s e l l i n g c e n t e r . Group 2 was v o l u n t a r i l y r e t e s t e d e l e v e n weeks l a t e r . Group 3 (N=22) and group 4 (N=18) were s u b j e c t s who had r e q u e s t e d t h e r a p y a t the u n i v e r s i t y c o u n s e l l i n g c e n t e r . They were t e s t e d w i t h t h e BELS and then a s s i g n e d a t h e r a p i s t f o r i n d i v i d u a l t h e r a p y . Group 4 s u b j e c t s v o l u n t a r i l y t e r m i n a t e d t h e i r t h e r a p y b e f o r e e i g h t weeks had e l a p s e d . Group 3 s u b j e c t s were s t i l l i n t h e r a p y a f t e r e i g h t weeks had e l a p s e d and were v o l u n t a r i l y r e t e s t e d by t h e i r t h e r a p i s t between n i n e and e l e v e n weeks. A f a c t o r a n a l y s i s was performed on group 1 d a t a , and e i g h t f a c t o r s were s u b s e q u e n t l y o b t a i n e d , P a t h o l o g i c a l L o n e l i n e s s , A l i e n a t i o n , L o n e l i n e s s A n x i e t y , E x i s t e n t i a l L o n e l i n e s s , Estrangement, Anomie, L o n e l i n e s s D e p r e s s i o n and S e p a r a t e n e s s . U s i n g t h e f a c t o r s and a t o t a l s c o r e f o r the BELS s c a l e , t h e f o u r groups were compared on t h e b a s i s o f t h e i r f i r s t a d m i n i s t r a t i o n (pre) s c o r e s . No s i g n i f i c a n t d i f f e r e n c e s were found between group 1 and group 2. Group 3 had c o n s i s t e n t l y s i g n i f i c a n t l y ( p < . 0 5 ) h i g h e r p r e s c o r e s than group 1 and group 2. Group 4 was c o n s i s t e n t l y h i g h e r than group 1 and 2. Group 2 and 3 p r e s c o r e s were compared w i t h t h o s e from t h e r e t e s t ( p o s t ) . While no s i g n i f i c a n t d i f f e r e n c e s between pre and p o s t s c o r e s were found f o r group 2, a t r e n d toward group 3 p o s t s c o r e s r e s u l t e d i n s i g n i f i c a n t l y ( p ^ . 0 5 ) lower p o s t s c o r e s . Pre and p o s t s c o r e s f o r each group were c o r r e l a t e d , and i t was found t h a t a l l the r e s u l t i n g c o r r e l a t i o n c o e f f i c i e n t s were p o s i t i v e and h i g h l y s i g n i f i c a n t ( p < . 0 0 1 ) . The f i n d i n g s i n d i c a t e d t h a t l o n e l i n e s s can be used t o d i f f e r e n t i a t e between non-therapy and s e l f - s e l e c t e d t h e r a p y s u b j e c t s . The d e c r e a s e i n l o n e l i n e s s s c o r e s a f t e r n i n e weeks o f t h e r a p y s u p p o r t s t h e w i d e s p r e a d assumption t h a t i n d i v i d u a l t h e r a p y reduces l o n e l i n e s s . T h i s s c a l e was not a p p l i c a b l e t o t h i s c u r r e n t s t u d y s i n c e the s c a l e i n d i c a t e d the t y p e o f l o n e l i n e s s which an i n d i v i d u a l may be s u f f e r i n g from. In t h i s s t u d y th e i n v e s t i g a t o r was c o n c e r n e d about t h e causes o f l o n e l i n e s s r a t h e r than t h e t y p e s o f l o n e l i n e s s which may a f f e c t an i n d i v i d u a l . 78 F r a n c i s d e v e l o p e d a r e l i a b l e g r a p h i c r a t i n g s c a l e , "Schedules f o r the Measurement o f L o n e l i n e s s and C a t h e c t i c Investment" to i d e n t i f y s e c o ndary l o n e l i n e s s among a group a t p o t e n t i a l r i s k from l o n e l i n e s s . She s t u d i e d persons s e p a r a t e d from l o v e d ones and o b j e c t s . The s c a l e was t e s t e d on n o n - i n t e n s i v e c a r e , h o s p i t a l i z e d , a d u l t m e d i c a l p a t i e n t s i n two g e n e r a l , s h o r t - t e r m urban medical c e n t e r h o s p i t a l s . Data were c o l l e c t e d on 133 p a t i e n t s i n each h o s p i t a l t h r o u g h f o c u s s e d i n t e r v i e w s by F r a n c i s and a g r a d u a t e s t u d e n t . A t e s t - r e t e s t r e l i a b i l i t y c o e f f i c i e n t f o r t h e c a t h e c t i c i n v e s t m e n t items was r = 1.000. The - 7Q c o e f f i c i e n t f o r the l o n e l i n e s s items was r = .980. F r a n c i s s t a t e s t h a t t h e s e e x t r e m e l y h i g h c o e f f i c i e n t s a r e p o s s i b l y f u n c t i o n s o f a number o f t h i n g s o t h e r than t h e p o s s i b i l i t y t h a t t h e s c a l e i s r e l i a b l e . Only 15 p e r c e n t o f the beds were s t i l l o c c u p i e d by t h e same p a t i e n t s a t r e t e s t t ime. A l s o , t h e p e r s o n a l n a t u r e o f t h e items t e n d to l e n d themselves t o t h e same r e s p o n s e s independent o f the i n d i v i d u a l b e i n g 78 F r a n c i s , p. 156-160. 79 I b i d . , p. 6. s e p a r a t e d by h o s p i t a l i z a t i o n . S i n c e the c l i e n t e l e i n t h i s c u r r e n t s t u d y were not h o s p i t a l i z e d and F r a n c i s 1 s c a l e was d e v e l o p e d f o r h o s p i t a l i z e d p a t i e n t s , n e i t h e r was i t a p p l i c a b l e . 80 V e l i o Sermat and Nancy Schmidt d e v e l o p e d t h e Schmidt-Sermat L o n e l i n e s s S c a l e , which was used f o r the purpose o f t h i s s t u d y by the i n v e s t i g a t o r . P a s t r e s e a r c h has shown t h a t i t c o r r e l a t e d +.70 and +.73 w i t h S i s e n w e i n ' s L o n e l i n e s s Q u e s t i o n n a i r e . (Appendix M) The s c a l e s t a r t e d w i t h 320 i t e m s , h a l f worded p o s i t i v e l y on l o n e l i n e s s , h a l f worded n e g a t i v e l y on. l o n e l i n e s s . The o r i g i n a l s c a l e was t a k e n by i n d i v i d u a l s a t the O n t a r i o S c i e n c e C e n t r e i n T o r o n t o , a p u b l i c s c i e n c e museum. The q u e s t i o n n a i r e was completed by 275 s u b j e c t s o f a p p r o x i m a t e l y equal numbers o f males and females aged 25 and o v e r . The items which c o r r e l a t e d more h i g h l y w i t h t h e f o l l o w i n g f o u r c o n c e p t s : d e p r e s s i o n , a n x i e t y , s e l f - e s t e e m , and s o c i a l d e s i r a b i l i t y ; than w i t h t h e t o t a l l o n e l i n e s s s c o r e o f t h e 81 p r e l i m i n a r y s c a l e were e l i m i n a t e d . The b e s t 60 items o b t a i n e d formed the " S c h m i d t - S e r m a t - L o n e l i n e s s S c a l e . " The l o n e l i n e s s s c a l e c l a s s i f i e d t ypes o f i n t e r a c t i o n i n t o f i v e f a c t o r s : I. P resence vs. Absence o f the R e l a t i o n s h i p . T h i s f i r s t , g e n e r a l c a t e g o r y i n c l u d e s items i n t e n d e d t o a s s e s s whether o r not a p a r t i c u l a r r e l a t i o n s h i p need i s b e i n g f u l f i l l e d a t a l l . I t i n c l u d e s items 80 V e l i o Sermat, P r o f e s s o r , t o P a t r i c i a P e t r y s h e n , York U n i v e r s i t y , F a c u l t y o f A r t s , Department o f P s y c h o l o g y , Downsview, O n t a r i o , p e r s o n a l l e t t e r , November 14, 1976. 81 I b i d . , the f o u r c o n c e p t s c o r r e l a t e d h i g h l y w i t h t h e J a c k s o n S c a l e s 55 p e r t a i n i n g t o a t o t a l l a c k o f a p a r t i c u l a r r e l a t i o n s h i p and items c o n c e r n i n g an absence o f r e l a t i o n s h i p due t o s i t u a t i o n a l f a c t o r s . I I . Approach vs. Avoidance o f the R e l a t i o n s h i p . T h i s c a t e g o r y i s composed o f items p e r t a i n i n g t o the t y p e s o f approach o r a v o i d a n c e b e h a v i o u r s i n which the i n d i v i d u a l engages w i t h r e f e r e n c e to a p a r t i c u l a r r e l a t i o n s h i p . The c a t e g o r y i s c o n c e p t u a l i z e d as i n c l u d i n g items l y i n g a l o n g a continuum from i n i t i a t i n g b e h a v i o u r s , t h r o u g h p a s s i v e b e h a v i o u r s , t o a v o i d a n c e b e h a v i o u r s . I n c l u d e d i n t h i s c a t e g o r y a r e items r e g a r d i n g the i n d i v i d u a l ' s p e r c e p t i o n s o f the approach o r a v o i d a n c e b e h a v i o u r s towards h i m s e l f o r s i g n i f i c a n t o t h e r s i n t h e r e l a t i o n s h i p . I I I . C o - o p e r a t i o n vs. Antagonism i n the R e l a t i o n s h i p . T h i s c a t e g o r y c o v e r s items d e s c r i b i n g the p r o v i s i o n o f h e l p i n g b e h a v i o u r s to o t h e r s and the r e q u e s t i n g o f h e l p i n g b e h a v i o u r s from o t h e r s ; items i n v o l v i n g the i n d i v i d u a l i n working t o g e t h e r w i t h o t h e r s towards the achievement o f common g o a l s ; items r e f l e c t i n g the i n d i v i d u a l ' s p e r c e i v e d s u p p o r t from o t h e r s ; and f i n a l l y , items i n v o l v i n g f e e l i n g s o f r a p p o r t i n t h e r e l a t i o n s h i p . IV. E v a l u a t i o n i n the R e l a t i o n s h i p . T h i s c a t e g o r y i n c l u d e s items c o n c e r n i n g the i n d i v i d u a l ' s e v a l u a t i o n o f h i m s e l f i n the r e l a t i o n s h i p , the i n d i v i d u a l ' s e v a l u a t i o n o f o t h e r s i n v o l v e d i n t h e r e l a t i o n s h i p , and the i n d i v i d u a l ' s p e r c e p t i o n o f o t h e r s ' e v a l u a t i o n o f h i m s e l f i n the r e l a t i o n s h i p . V. Communication i n t h e R e l a t i o n s h i p . T h i s c a t e g o r y i s composed o f items d e a l i n g w i t h the i n d i v i d u a l ' s p e r c e i v e d u n d e r s t a n d i n g o f o t h e r s , h i s 56 p e r c e p t i o n s o f o t h e r s ' u n d e r s t a n d i n g o f h i m s e l f , and h i s p e r c e i v e d a b i l i t y t o e x p r e s s h i s own f e e l i n g s and t h o u g h t s towards o t h e r s i n the r e l a t i o n s h i p . The t y p e s o f r e l a t i o n s h i p s were i n c l u d e d under f o u r major c l a s s i f i c a t i o n s : A. Romantic-Sexual B. F r i e n d s , n o n - s e x u a l , hOn-rOmantic C. F a m i l y D. L a r g e r g r o u p s , community These c l a s s i f i c a t i o n s c o n t a i n e d statements which c o r r e l a t e d both p o s i t i v e l y and n e g a t i v e l y w i t h l o n e l i n e s s . The s c a l e a s s e s s e d the f o u r b a s i c l i f e s i t u a t i o n s mentioned which are r e p r e s e n t a t i v e o f i n d i v i d u a l s s u f f e r i n g from l o n e l i n e s s . I t c o n t a i n e d s h o r t , e x p l i c i t , s tatements which r e q u i r e d o n l y a t r u e o r f a l s e r e s p o n s e . T h e r e f o r e , the Schmidt-Sermat L o n e l i n e s s S c a l e was a p p r o p r i a t e t o a d m i n i s t e r t o the c l i e n t e l e a t the c l i n i c who p a r t i c i p a t e d i n t h i s s tudy. The t o o l was d e v e l o p e d f o r the g e n e r a l p o p u l a t i o n and c o r r e l a t e d f a v o u r a b l y w i t h the S i s e n w e i n s c a l e . I t s items -deal w i t h r e a l l i f e s i t u a t i o n s which determine l o n e l i n e s s r a t h e r than w i t h s u b j e c t i v e emotional r e s p o n s e s which d e t e r m i n e f e e l i n g s which may be u n r e l a t e d to the r e a l l i f e s i t u a t i o n . The Schmidt-Sermat L o n e l i n e s s S c a l e was w e l l d e v e l o p e d and a d e q u a t e l y t e s t e d f o r r e l i a b i l i t y and v a l i d i t y , t h e r e f o r e , i t was a p p r o p r i a t e f o r u t i l i z a t i o n i n t h i s s t u d y . Summary I t i s i m p o r t a n t f o r t h e r a p i s t s to acknowledge a c l i e n t ' s l o n e l i n e s s by i d e n t i f y i n g l o n e l i n e s s b e h a v i o u r ( s ) and u t i l i z i n g s p e c i f i c l o n e l i n e s s i n t e r v e n t i o n s w i t h c l i e n t s t e s t i n g high i n l o n e l i n e s s . As a r e s u l t p s y c h o t h e r a p y d e a l s d i r e c t l y w i t h t he c l i e n t ' s l o n e l i n e s s r a t h e r than w i t h t h e d e f e n s e s t h a t the c l i e n t has formed a g a i n s t the p a i n o f l o n e l i n e s s . A t h e r a p i s t ' s r e c o g n i t i o n and u n d e r s t a n d i n g o f how l o n e l i n e s s has e v o l v e d f o r the c l i e n t f a c i l i t a t e s t h e e s t a b l i s h m e n t o f a more e f f e c t i v e t h e r a p e u t i c r e l a t i o n s h i p . The c a r e o f the l o n e l y c l i e n t r e q u i r e s t he t h e r a p i s t t o un d e r s t a n d the g e n e r i c development o f the l o n e l i n e s s f o r t h a t i n d i v i d u a l and t h e v a r i o u s ways l o n e l i n e s s m a n i f e s t s i t s e l f d u r i n g DO p s y c h o t h e r a p y . The i n h e r e n t need f o r l o n e l i n e s s to be d e a l t w i t h d i r e c t l y i n p s y c h o t h e r a p y w i t h a l o n e l y c l i e n t i s t h e e s s e n c e o f t h i s study. The purpose o f t h i s c h a p t e r was to p r o v i d e a b a s i s f o r t r e a t m e n t o f th e l o n e l y c l i e n t . R e s earch s t u d i e s on l o n e l i n e s s have been few a l t h o u g h the c o n c e p t u a l i z a t i o n o f l o n e l i n e s s has been e x p l i c i t i n i t s many forms. The v a r i e t y o f l o n e l i n e s s s c a l e s p r e s e n t e d i n d i c a t e s t he broadness o f the term l o n e l i n e s s and the need t o d i r e c t l o n e l i n e s s i n t o a s p e c i f i c frame o f r e f e r e n c e . L o n e l i n e s s can become a c o h e r e n t , w e l 1 - d e s e r v e d phenomena i n t he f i e l d o f mental h e a l t h i f i t i s acknowledged and worked w i t h i n a p r a c t i c a l way. T h i s study i s an attempt t o c l a r i f y the c o n c e p t , a p p l y the e x i s t e n t t h e o r y , and f o r m u l a t e c o n c l u s i o n s through s c i e n t i f i c i n v e s t i g a t i o n o f the p r o c e s s o f l o n e l i n e s s p s y c h o t h e r a p y . 82 P e p l a u , p. 1477. 83 I b i d . , p. 1480. C h a p t e r 3 THE STUDY T h i s study on l o n e l i n e s s employed a q u a s i - e x p e r i m e n t a l d e s i g n . A c o n t r o l and e x p e r i m e n t a l group o f mental h e a l t h c l i e n t s were both engaged i n s i x p s y c h o t h e r a p y s e s s i o n s . P s y c h o t h e r a p y i n the c o n t r o l group was conducte d a c c o r d i n g to the t h e r a p i s t ' s usual i n d i v i d u a l s t y l e . In the e x p e r i m e n t a l group, p s y c h o t h e r a p y was co n d u c t e d by implementing a c o n c e p t u a l model f o r l o n e l i n e s s i n t e r v e n t i o n . Comparisons between t h e c o n t r o l and e x p e r i m e n t a l groups were then made by e v a l u a t i n g l o n e l i n e s s r e d u c t i o n i n c l i e n t s b e f o r e and a f t e r p s y c h o t h e r a p y . The p r o g r e s s o f c l i e n t s i n p s y c h o t h e r a p y as p e r c e i v e d by t h e r a p i s t s , and the s a t i s f a c t i o n f o r t h e r a p i s t s i n c o n d u c t i n g l o n e l i n e s s p s y c h o t h e r a p y were a l s o r a t e d . P r e v i o u s t o u n d e r t a k i n g t h i s s t u d y , t he i n v e s t i g a t o r d e v e l o p e d a c o n c e p t u a l model f o r l o n e l i n e s s i n t e r v e n t i o n which i d e n t i f i e d l o n e l i n e s s b e h a v i o u r s and p o s s i b l e l o n e l i n e s s i n t e r v e n t i o n s s p e c i f i c t o each b e h a v i o u r . The Problem W i l l t h e r a p i s t s u t i l i z i n g a c o n c e p t u a l model f o r l o n e l i n e s s i n t e r v e n t i o n w i t h c l i e n t s who t e s t high i n l o n e l i n e s s , a t t a i n a g r e a t e r r e d u c t i o n o f l o n e l i n e s s i n c l i e n t s than w i t h o u t t he use o f t h e model? 58 59 Hypotheses jH U I f a t h e r a p i s t u t i l i z e s a c o n c e p t u a l model f o r l o n e l i n e s s i n t e r v e n t i o n , p s y c h o t h e r a p y w i l l be more e f f e c t i v e i n r e d u c i n g l o n e l i n e s s i n c l i e n t s . Dependent V a r i a b l e : l o n e l i n e s s b e h a v i o u r s Independent V a r i a b l e : l o n e l i n e s s i n t e r v e n t i o n H I I : I f a t h e r a p i s t u t i l i z e s l o n e l i n e s s i n t e r v e n t i o n w i t h c l i e n t s who t e s t h i g h i n l o n e l i n e s s , t h e t h e r a p y s e s s i o n s w i l l be more s a t i s f y i n g f o r the t h e r a p i s t . Dependent V a r i a b l e : t h e r a p i s t s a t i s f a c t i o n Independent V a r i a b l e : l o n e l i n e s s i n t e r v e n t i o n H I I I : I f a t h e r a p i s t u t i l i z e s l o n e l i n e s s i n t e r v e n t i o n w i t h c l i e n t s who t e s t h i g h i n l o n e l i n e s s , t he t h e r a p i s t w i l l p e r c e i v e more c l i e n t p r o g r e s s i n t h e r a p y s e s s i o n s . Dependent V a r i a b l e : p e r c e i v e d c l i e n t p r o g r e s s i n terms o f r e s o l u t i o n o f l o n e l i n e s s b e h a v i o u r s Independent V a r i a b l e : l o n e l i n e s s i n t e r v e n t i o n Sample S e l e c t i o n T h e r a p i s t s and c l i e n t s who p a r t i c i p a t e d i n t h e s t u d y were s e l e c t e d from a Community Mental H e a l t h Care Team which f u n c t i o n s under the a u s p i c e s o f 60 the G r e a t e r Vancouver Mental H e a l t h S e r v i c e . The team was approached by t h e i r Research C o o r d i n a t o r f o r t h e i r c o n s e n t t o p a r t i c i p a t e i n a r e s e a r c h study on l o n e l i n e s s . Four t h e r a p i s t s v o l u n t e e r e d t o form t h e r e s e a r c h team f o r the s t u d y , two males and two f e m a l e s . The t h e r a p i s t s r e p r e s e n t e d v a r i o u s p r o f e s s i o n a l backgrounds, Masters o f S o c i o l o g y , B a c h e l o r o f S o c i a l Work w i t h a C e r t i f i c a t e i n P u b l i c H e a l t h , Masters o f S c i e n c e i n N u r s i n g , and a R e g i s t e r e d Nurse. Each t h e r a p i s t had been employed by t h e team f o r o v e r two y e a r s , t h e r e f o r e , t h e y had an e x t e n s i v e c a s e l o a d o f c l i e n t s . T h i s p r e s e n t e d d i f f i c u l t i e s i n a t t a i n i n g t h e c l i e n t sample s i n c e t h e r a p i s t s were not c o n d u c t i n g p s y c h o t h e r a p y w i t h t h e i r c l i e n t s on t h e r e g u l a r weekly b a s i s as d e s c r i b e d i n the r e s e a r c h d e s i g n . The c l i e n t s i n v o l v e d i n t h e study were approached by t h e i r t h e r a p i s t s ' t o p a r t i c i p a t e i n a r e s e a r c h p r o j e c t on i n t e r p e r s o n a l r e l a t i o n s h i p s . The t h e r a p i s t s then proceeded to have t h e i r c l i e n t s s i g n the "Consent Form" f o r p a r t i c i p a t i o n i n a "Survey on I n t e r p e r s o n a l R e l a t i o n s h i p s , " o t h e r w i s e known as t h e "Schmidt-Sermat L o n e l i n e s s S c a l e . " D u r i n g t h e f i r s t f o u r weeks, each t h e r a p i s t i d e n t i f i e d a maximum o f f o u r c l i e n t s and a minimum o f two c l i e n t s who t e s t e d high i n l o n e l i n e s s . These c l i e n t s were then i n v o l v e d i n P a r t I o f the s t u d y . T h i s p r o c e s s f o r s e l e c t i n g c l i e n t s was r e p e a t e d f o r P a r t II o f the s t u d y . The c l i e n t e l e o f t h i s Community Mental H e a l t h Care Team was m o s t l y s c h i z o p h r e n i c , a l t h o u g h t h e r e were a l s o some d e p r e s s e d c l i e n t s . The c l i e n t sample was d i f f i c u l t to a t t a i n f o r v a r i o u s r e a s o n s , such a s , some s c h i z o p h r e n i c p a t i e n t s became p s y c h o t i c and were then h o s p i t a l i z e d . Many o f t h e c l i e n t s were p a r a n o i d and t h e r e f o r e would not complete the s u r v e y . C l i e n t s s u f f e r i n g from h a l l u c i n a t i o n s and p o s s i b l y d e l u s i o n s were unable t o 61 c o n c e n t r a t e on answering q u e s t i o n s s i n c e t h e i r a t t e n t i o n span and c o n c e n t r a t i o n a b i l i t y was e x t r e m e l y poor. T h e r a p i s t s s t a t e d t h a t some c l i e n t s were f o l l o w i n g an e s t a b l i s h e d t r e a t m e n t p l a n and because o f t h i s they were u n w i l l i n g t o d i s r u p t t h i s c o n s i s t e n c y as i t may have proved d e t r i m e n t a l f o r t h e c l i e n t . For t h e purpose o f t h i s s t u d y , c l i e n t s had to be seen on a r e g u l a r weekly b a s i s . C l i e n t a b i l i t y t o r e a d and c o n c e n t r a t e on the s c a l e was n e c e s s a r y . E x t r e m e l y p s y c h o t i c i n d i v i d u a l s were not i n v o l v e d i n the s t u d y s i n c e t h e i r c o n t a c t w i t h t h e r e a l i t y o f t h e i r l i f e was d i f f i c u l t f o r them t o e x p r e s s i n the form o f a w r i t t e n q u e s t i o n n a i r e even though o n l y " t r u e " and " f a l s e " answers were r e q u i r e d . At times even t h i s d i s c r i m i n a t i o n was too d i f f i c u l t f o r them. Due to the above r e a s o n s , i t was d i f f i c u l t f o r t h e r a p i s t s to a t t a i n t h e i r f o u r c l i e n t s f o r P a r t I and f o u r c l i e n t s f o r P a r t II o f t h e s t u d y . The S e t t i n g The G r e a t e r Vancouver Mental H e a l t h S e r v i c e i s composed o f e l e v e n Community Mental H e a l t h Care Teams. The teams a r e l o c a t e d w i t h i n the catchment a r e a t h a t i t s e r v e s . One team was s e l e c t e d f o r the purpose o f t h i s study. C l i e n t s who r e c e i v e d mental h e a l t h c a r e from t h e team were a s e l e c t e d sample because they l i v e d w i t h i n t h e b o u n d a r i e s o f t h e a r e a t h a t t h e team s e r v e d . T h i s a r e a i n v o l v e d s e v e r a l d i s t i n c t c i t y d i s t r i c t s w i t h the major r e p r e s e n t a t i v e groups r a n g i n g from upper s o c i o - e c o n o m i c f a m i l i e s and e l d e r l y p e o p l e to lower s o c i o - e c o n o m i c groups and young p e o p l e who were r e s i d i n g i n b o a r d i n g homes. The team was s i t u a t e d i n an a p a r t m e n t - t y p e b u i l d i n g which c o n t a i n e d numerous i n t e r v i e w i n g rooms. C l i e n t s came t o the team f o r one-to-one p s y c h o t h e r a p y o r f o r f a m i l y t h e r a p y . A t t i m e s , t h e r a p i s t s made home v i s i t s f o r such reasons as t h e i n a b i l i t y o f a c l i e n t t o t r a v e l t o t h e c e n t r e f o r a t h e r a p y s e s s i o n o r i n a time o f c r i s i s . Methodology T h i s study on l o n e l i n e s s i n v o l v e d f o u r t h e r a p i s t s and t h e i r s e l e c t e d c l i e n t s who were i d e n t i f i e d as t e s t i n g h i g h i n l o n e l i n e s s . One group o f c l i e n t s p a r t i c i p a t e d i n P a r t I o f the s t u d y . A new group o f c l i e n t s p a r t i c i p a t e d i n P a r t II o f the st u d y . An i n s e r v i c e e d u c a t i o n on l o n e l i n e s s was p r o v i d e d f o r the t h e r a p i s t s p r i o r to P a r t II o f t h e s t u d y . P a r t I: ( C o n t r o l Group). A s t a n d a r d i z e d l o n e l i n e s s s c a l e was g i v e n t o c l i e n t s by t h e i r t h e r a p i s t s . Those c l i e n t s who t e s t e d h i g h i n l o n e l i n e s s were i d e n t i f i e d . T h e r a p i s t s then engaged i n p s y c h o t h e r a p y w i t h t h e i r i d e n t i f i e d c l i e n t s f o r s i x s e s s i o n s o f a p p r o x i m a t e l y one hour i n l e n g t h and a week o r l e s s a p a r t . A f t e r each t h e r a p y s e s s i o n , t h e r a p i s t s c h a r t e d on two q u e s t i o n s : "What was d i s c u s s e d ? " and "What s u g g e s t i o n s were made i n r e l a t i o n t o what was d i s c u s s e d ? " The i n v e s t i g a t o r m o n i t o r e d t he c o n t r o l group and p r o g r e s s i n t h e r a p y because no l o n e l i n e s s c o n s u l t a t i o n was p r o v i d e d i n P a r t I o f the study. At the end o f the s i x t h e r a p y s e s s i o n s , c l i e n t s were r e - t e s t e d f o r l o n e l i n e s s . T h e r a p i s t s e v a l u a t e d c l i e n t p r o g r e s s d u r i n g t h e r a p y and t h e i r own s a t i s f a c t i o n w i t h t h e r a p y s e s s i o n s . I n s e r v i c e E d u c a t i o n on L o n e l i n e s s : P r i o r to t h e t h e r a p i s t s c o n d u c t i n g P a r t II o f t h e s t u d y , an i n s e r v i c e e d u c a t i o n on l o n e l i n e s s was p r o v i d e d f o r th e t h e r a p i s t s . The i n s e r v i c e e x p l a i n e d t he c o n c e p t s o f l o n e l i n e s s and 63 l o n e l i n e s s a n x i e t y . A c o n c e p t u a l model f o r l o n e l i n e s s i n t e r v e n t i o n which i d e n t i f i e d l o n e l i n e s s b e h a v i o u r s and p o s s i b l e l o n e l i n e s s i n t e r v e n t i o n s was i n t r o d u c e d t o t h e t h e r a p i s t s . P a r t I I : (Comparison Group) A s t a n d a r d i z e d l o n e l i n e s s s c a l e was g i v e n to c l i e n t s by t h e i r t h e r a p i s t s . Those c l i e n t s who t e s t e d h i g h i n l o n e l i n e s s were i d e n t i f i e d . T h e r a p i s t s then engaged i n p s y c h o t h e r a p y w i t h t h e i r c l i e n t s f o r s i x s e s s i o n s o f a p p r o x i m a t e l y one hour i n l e n g t h and a week o r l e s s a p a r t . D u r i n g p s y c h o t h e r a p y , t h e r a p i s t s implemented a c o n c e p t u a l model f o r l o n e l i n e s s i n t e r v e n t i o n by i d e n t i f y i n g t h e l o n e l i n e s s b e h a v i o u r s o f each c l i e n t and u t i l i z i n g t h e s p e c i f i c l o n e l i n e s s i n t e r v e n t i o n s s t a t e d i n the c o n c e p t u a l model. Weekly l o n e l i n e s s c o n s u l t a t i o n was p r o v i d e d by the i n v e s t i g a t o r t o f a c i l i t a t e the use and u n d e r s t a n d i n g o f the model and to s u p p o r t t h e i n t e r n a l i z a t i o n and o p e r a t i o n a l i z a t i o n o f l o n e l i n e s s i n t e r v e n t i o n s by t h e r a p i s t s i n p s y c h o t h e r a p y . A f t e r each t h e r a p y s e s s i o n , t h e r a p i s t s c h a r t e d on two q u e s t i o n s : "What was d i s c u s s e d ? " and "What s u g g e s t i o n s were made i n r e l a t i o n to what was d i s c u s s e d ? " The i n v e s t i g a t o r m o n i t o r e d the comparison group and p r o g r e s s i n t h e r a p y by means o f c o n s u l t a t i o n . A t the end o f s i x t h e r a p y s e s s i o n s , c l i e n t s were r e - t e s t e d f o r l o n e l i n e s s . T h e r a p i s t s e v a l u a t e d c l i e n t p r o g r e s s d u r i n g t h e r a p y and t h e i r own s a t i s f a c t i o n w i t h t h e r a p y s e s s i o n s . A s t r u c t u r e d e n d - i n t e r v i e w was conducted w i t h each t h e r a p i s t f o r a p p r o x i m a t e l y an hour i n l e n g t h . Open-ended q u e s t i o n s on the i m p l e m e n t a t i o n o f a c o n c e p t u a l model f o r l o n e l i n e s s i n t e r v e n t i o n were asked. S i n c e t he t h e r a p i s t s had the o p p o r t u n i t y t o i n t e r n a l i z e and o p e r a t i o n a l i z e the 64 i d e n t i f i c a t i o n o f l o n e l i n e s s b e h a v i o u r s and implementing o f s p e c i f i c l o n e l i n e s s i n t e r v e n t i o n , t h e i r r e s p o n s e s t o t h i s e x p e r i e n c e was o f importance. Q u e s t i o n s were d i r e c t e d towards t h e use, d i f f i c u l ty, a d v a n t a g e s , d i s a d v a n t a g e s , and r e a c t i o n s to implementing a c o n c e p t u a l model f o r l o n e l i n e s s i n t e r v e n t i o n . Data G a t h e r i n g Instruments Schmidt-Sermat L o n e l i n e s s S c a l e The s t a n d a r d i z e d l o n e l i n e s s s c a l e u t i l i z e d t o t e s t l o n e l i n e s s i n c l i e n t s was the "Schmidt-Sermat L o n e l i n e s s S c a l e . " The o r i g i n a l s c a l e c o n t a i n e d s i x t y items which was l e n g t h y f o r the i n i t i a l i d e n t i f i c a t i o n o f c l i e n t s t e s t i n g high i n l o n e l i n e s s , t h e r e f o r e , t h e s c a l e was reduced t o a s h o r t form which c o n t a i n e d s i x t e e n s t a t e m e n t s . The s h o r t form o f t h e s c a l e was p i l o t t e s t e d f o r v a l i d i t y and r e l i a b i l i t y . A c l a s s o f 120 t h i r d y e a r n u r s i n g s t u d e n t s were randomly a s s i g n e d i n t o group A t a k i n g t h e l o n g form o f the s c a l e and group B t a k i n g t he s h o r t form o f the s c a l e . Both groups were r e - t e s t e d i n two weeks. The agreement between the l o n g and s h o r t form o f t h e s c a l e s c o r r e l a t e d a t 0.9, s i g n i f i c a n t a t a p l e v e l o f .01. The r e l i a b i l i t y on t h e t e s t r e - t e s t was 0.8, s i g n i f i c a n t a t a p l e v e l o f .01. C l i e n t s were i d e n t i f i e d as t e s t i n g h i g h i n l o n e l i n e s s w i t h t h e s h o r t form o f t h e s c a l e , which was 16 sta t e m e n t s from the "Schmidt-Sermat L o n e l i n e s s S c a l e . " The r e m a i n i n g 44 sta t e m e n t s o f t h e s c a l e were then g i v e n t o t he c l i e n t d u r i n g t he next t h e r a p y s e s s i o n to accommodate the o p e r a t i o n a l d e f i n i t i o n o f l o n e l i n e s s . A s c o r e o f "60" i n d i c a t e d t he h i g h e s t l e v e l o f l o n e l i n e s s , "0" i n d i c a t e d the l o w e s t l e v e l o f l o n e l i n e s s . 65 For the purpose o f t h i s s t u d y , a s c o r e o f "20" o r above i n d i c a t e d an i n d i v i d u a l t e s t i n g h i g h i n l o n e l i n e s s . C l i e n t s meeting t h i s r e q u i r e m e n t were i n v o l v e d i n the s t u d y . P r o g r e s s R a t i n g by T h e r a p i s t s The p r o g r e s s i n p s y c h o t h e r a p y w i t h a c l i e n t i d e n t i f i e d as t e s t i n g h i g h i n l o n e l i n e s s was r a t e d by t h e r a p i s t s on a L i k e r t t y p e s c a l e . The r a t i n g s c a l e was from "1" to "6" where "1" i n d i c a t e d t h e l e a s t amount o f p r o g r e s s and "6" i n d i c a t e d the most amount o f p r o g r e s s . S a t i s f a c t i o n R a t i n g by T h e r a p i s t s The s a t i s f a c t i o n i n a t t e m p t i n g l o n e l i n e s s i n t e r v e n t i o n w i t h a c l i e n t t e s t i n g h i g h i n l o n e l i n e s s was r a t e d by t h e r a p i s t s on a L i k e r t t y p e s c a l e . The r a t i n g s c a l e was from "1" t o "5" where "1" i n d i c a t e d v e r y low s a t i s f a c t i o n and "5" i n d i c a t e d v e r y h i g h s a t i s f a c t i o n . A n a l y s i s o f Hypotheses H I_: The r e d u c t i o n o f l o n e l i n e s s a f t e r p s y c h o t h e r a p y u t i l i z i n g a c o n c e p t u a l model f o r l o n e l i n e s s i n t e r v e n t i o n was c h a l l e n g e d by a o n e - t a i l e d t - t e s t a t the .05 l e v e l o f s i g n i f i c a n c e , on the mean p r e - t e s t p o s t - t e s t l o n e l i n e s s r e d u c t i o n i n both the c o n t r o l and comparison groups. H I I : Comparison o f t h e means from t h e r a p i s t s a t i s f a c t i o n from P a r t I p s y c h o t h e r a p y s e s s i o n s and s a t i s f a c t i o n from P a r t II p s y c h o t h e r a p y s e s s i o n s , i n which t h e c o n c e p t u a l model f o r l o n e l i n e s s i n t e r v e n t i o n was implemented, was c h a l l e n g e d by a p a i r e d t - t e s t a t t h e .05 l e v e l o f s i g n i f i c a n c e . H I I I : Comparison o f the means from t h e r a p i s t p e r c e p t i o n o f p r o g r e s s from t he P a r t I p s y c h o t h e r a p y s e s s i o n s and p r o g r e s s from P a r t II p s y c h o t h e r a p y s e s s i o n s , i n which t h e c o n c e p t u a l model f o r l o n e l i n e s s i n t e r v e n t i o n was implemented, was c h a l l e n g e d by a p a i r e d t - t e s t a t t h e .05 l e v e l o f s i g n i f i c a n c e . Summary Upon c o m p l e t i o n o f t h e r a p i s t i m p l e m e n t a t i o n o f the c o n c e p t u a l model f o r l o n e l i n e s s i n t e r v e n t i o n , a n a l y s i s o f Hypotheses I , I I , and I I I was undertaken. The r e d u c t i o n o f l o n e l i n e s s f o r c l i e n t s who were i n v o l v e d i n t h e l o n e l i n e s s p s y c h o t h e r a p y was i n v e s t i g a t e d . T h e r a p i s t s a t i s f a c t i o n i n u n d e r t a k i n g l o n e l i n e s s p s y c h o t h e r a p y was i n v e s t i g a t e d . T h e r a p i s t p e r c e p t i o n o f c l i e n t p r o g r e s s when u t i l i z i n g t h e model was a l s o i n v e s t i g a t e d . The r e s u l t s o f t h e study w i l l be r e p o r t e d i n C h a p t e r 4. C h a p t e r 4 ANALYSIS OF DATA The purpose o f t h e s t u d y f o c u s s e d on the i d e n t i f i c a t i o n o f l o n e l i n e s s b e h a v i o u r s and suggested l o n e l i n e s s i n t e r v e n t i o n s w i t h t h e development o f a c o n c e p t u a l model f o r l o n e l i n e s s i n t e r v e n t i o n i n p s y c h o t h e r a p y . A f o u r - f o l d purpose f o r the s t u d y was s t a t e d p r e v i o u s l y i n C h a p t e r 1. The purpose o f t h e study was f i r s t , t o s t i m u l a t e an awareness i n t h e r a p i s t s o f the c o n c e p t o f l o n e l i n e s s , o f t h e i r own p e r s o n a l l o n e l i n e s s , and t h e l o n e l i n e s s e n c o u n t e r e d by t h e i r c l i e n t s . The second purpose was t o r e c o g n i z e t h e importance o f c o n c e p t u a l i z i n g l o n e l i n e s s as a b a s i s f o r l o n e l i n e s s p s y c h o t h e r a p y . The t h i r d purpose was t o promote e f f e c t i v e p s y c h o t h e r a p y by acknowledging l o n e l i n e s s as the b a s i s o f an i n d i v i d u a l ' s i l l n e s s o r d i f f i c u l t y r a t h e r than symptoms o r d i a g n o s i s . The f i n a l purpose was t o use the c o n c e p t o f l o n e l i n e s s as a b a s i s f o r communication w i t h i n d i v i d u a l s s i n c e l o n e l i n e s s i s common t o everyone. As a t h e r a p e u t i c medium, l o n e l i n e s s w a r r a n t e d i n v e s t i g a t i o n i n t h e mental h e a l t h s e t t i n g and i n s o c i e t y ; The problem, w i l l t h e r a p i s t s u t i l i z i n g a c o n c e p t u a l model f o r l o n e l i n e s s i n t e r v e n t i o n w i t h c l i e n t s who t e s t h i g h i n l o n e l i n e s s a t t a i n g r e a t e r r e d u c t i o n o f l o n e l i n e s s t h a n w i t h o u t t h e use o f t h i s model was i n v e s t i g a t e d . A q u a s i - e x p e r i m e n t a l d e s i g n was u t i l i z e d to d e t e r m i n e the 67 68 e f f e c t o f implementing a c o n c e p t u a l model f o r l o n e l i n e s s i n t e r v e n t i o n d u r i n g p s y c h o t h e r a p y . T h e r a p i s t p e r c e p t i o n o f c l i e n t p r o g r e s s and t h e r a p i s t s a t i s f a c t i o n when implementing a c o n c e p t u a l model f o r l o n e l i n e s s i n t e r v e n t i o n was e x p l o r e d . A n a l y s i s i n R e l a t i o n t o the P o p u l a t i o n Sample Four t h e r a p i s t s , two females and two males, engaged i n p s y c h o t h e r a p y w i t h c l i e n t s i d e n t i f i e d as t e s t i n g h i g h i n l o n e l i n e s s . T h i r t e e n mental h e a l t h c l i e n t s , n i n e f e m a l e s and f o u r males, p a r t i c i p a t e d i n the c o n t r o l group, P a r t I o f t h e study. E l e v e n c l i e n t s , seven females and f o u r males, p a r t i c i p a t e d i n t h e comparison group, P a r t I I o f t h e s t u d y . ( R e f e r t o T a b l e 1 ) . The c o n t r o l and comparison groups were s i m i l a r when compared. Many o f t h e c l i e n t s were under 45 y e a r s o f age and s i n g l e . The p l a c e o f b i r t h f o r most o f the c l i e n t s was Canada, t h o s e who had not been born i n Canada had r e s i d e d i n Vancouver f o r a t l e a s t two y e a r s . C l i e n t s v a r i e d from r e l i g i o u s t o n o n - r e l i g i o u s i n both groups. The e d u c a t i o n a l p r e p a r a t i o n a l s o v a r i e d from t h o s e who h e l d u n i v e r s i t y d e g rees t o t h o s e who d i d not complete grade s c h o o l . Both groups were s i m i l a r i n t h i s r e s p e c t . Most o f t h e c l i e n t s were unemployed, u s u a l l y f o r l e n g t h y p e r i o d s o f t i m e . H a l f o f t h e c l i e n t s f o r both groups were i n v o l v e d i n some form o f a hobby. The l i v i n g s i t u a t i o n was i n t e r e s t i n g i n t h a t c l i e n t s who l i v e d w i t h a n o t h e r p e r s o n d i d so because t h e y were g i v e n a placement i n a p s y c h i a t r i c b o a r d i n g home by a mental h e a l t h worker. The o t h e r c l i e n t s l i v e d a l o n e , u s u a l l y i n apartments. F a m i l y c o n t a c t was i n f r e q u e n t , o t h e r w i s e t h e r e was no c o n t a c t a t a l l . T h i s s i t u a t i o n was s i m i l a r w i t h t h e s i g n i f i c a n t o t h e r s 69 Comparison o f Demographic Data f o r C o n t r o l and Comparison Groups CONTROL COMPARISON DEMOGRAPHIC DATA GROUP GROUP N=13 N=ll SEX Female 9 7 Mai e 4 4 AGE 1 7 - 2 4 3 2 25 - 34 5 6 35 - 44 2 1 45 - 54 1 1 55 - 64 1 1 65 and above 1 0 MARITAL STATUS S i n g l e 10 8 M a r r i e d 0 1 Widowed 2 0 D i v o r c e d 1 2 PLACE OF BIRTH Canada 8 10 O u t s i d e Canada 5 1 RESIDENCY IN More than two y e a r s 11 11 VANCOUVER Less than two y e a r s 2 0 RELIGION Very r e l i g i o u s 1 0 R e l i g i o u s 8 5 No R e l i g i o n 4 6 EDUCATION U n i v e r s i t y 5 4 Hig h s c h o o l 3 2 Grade s c h o o l 5 5 EMPLOYMENT Employed 1 1 Unemployed 10 10 R e t i r e d 2 0 T a b l e 1 70 Comparison o f Demographic Data f o r C o n t r o l and Comparison Groups (C o n t i n u e d ) CONTROL COMPARISON DEMOGRAPHIC DATA GROUP GROUP N=13 N=ll HOBBIES At l e a s t one 7 6 None 6 5 LIVING L i v e s w i t h a t l e a s t 4 6 SITUATION one o t h e r (3 l i v e i n a (4 l i v e i n a p s y c h i a t r i c p s y c h i a t r i c b o a r d i n g home) b o a r d i n g home) L i v e s a l o n e 9 5 FAMILY CONTACT Frequent c o n t a c t 1 1 I n f r e q u e n t c o n t a c t 7 5 No c o n t a c t 5 5 SIGNIFICANT S t a b l e f r i e n d s h i p s 2 3 OTHERS U n s t a b l e f r i e n d s h i p s 3 2 No f r i e n d s h i p s 8 6 REFERRAL SOURCE H o s p i t a l 8 8 FOR CLIENT TO Mental h e a l t h worker 2 1 BE SEEM BY THE S e l f 2 2 COMMUNITY TEAM R e l a t i v e 1 1 DIAGNOSIS S c h i z o p h r e n i c 10 8 Depressed 3 2 N e u r o t i c 0 - 1 PREVIOUS Many h o s p i t a l i z a t i o n s 4 . 6 PSYCHIATRIC One h o s p i t a l i z a t i o n 5 3 HISTORY No h o s p i t a l i z a t i o n 4 2 T a b l e 1 ( c o n t i n u e d ) 71 f o r the c l i e n t s . U s u a l l y t h e c l i e n t s were r e f e r r e d to t h e Community"Mental H e a l t h Care Team by a h o s p i t a l , a l t h o u g h t h e r e were two s e l f - r e f e r r a l s f o r both t h e c o n t r o l and comparison groups. The d i a g n o s i s o f the c l i e n t s was c o n c o m i t a n t w i t h the c l i e n t mandate f o r the team, which was m a i n l y s c h i z o p h r e n i c c l i e n t s w i t h a few d e p r e s s e d and one n e u r o t i c a l s o p a r t i c i p a t i n g i n the s t u d y . The p r e v i o u s p s y c h i a t r i c h i s t o r y o f t h e c l i e n t s ranged from many h o s p i t a l i z a t i o n s t o no h o s p i t a l i z a t i o n . T h i s means t h a t some o f the c l i e n t s had been i n v o l v e d i n a v a r i e t y o f p s y c h i a t r i c t r e a t m e n t , such a s , e l e c t r o c o n v u l s i v e t h e r a p y , group t h e r a p y , whereas o t h e r c l i e n t s had not e x p e r i e n c e d p s y c h o t h e r a p y p r e v i o u s l y . A n a l y s i s o f Data i n R e l a t i o n t o H y p o t h e s i s I H U I f a t h e r a p i s t u t i l i z e s a c o n c e p t u a l model f o r l o n e l i n e s s i n t e r v e n t i o n , p s y c h o t h e r a p y w i l l be more e f f e c t i v e i n r e d u c i n g l o n e l i n e s s i n c l i e n t s . A n a l y s i s : The r e d u c t i o n o f l o n e l i n e s s a f t e r p s y c h o t h e r a p y u t i l i z i n g a c o n c e p t u a l model f o r l o n e l i n e s s i n t e r v e n t i o n was c h a l l e n g e d by a o n e - t a i l e d t - t e s t a t the .05 l e v e l o f s i g n i f i c a n c e , on t h e mean p r e - t e s t p o s t - t e s t l o n e l i n e s s r e d u c t i o n i n both the c o n t r o l and comparison groups. R e s u l t s : P r e - t e s t and p o s t - t e s t c l i e n t l o n e l i n e s s s c o r e s f o r the c o n t r o l and comparison groups ( R e f e r t o T a b l e 2) i n d i c a t e s t h a t c l i e n t s i n c r e a s e d o r d e c r e a s e d i n l o n e l i n e s s . ( R e f e r to T a b l e 3) A p o s i t i v e r e d u c t i o n s c o r e i n d i c a t e s t h a t the c l i e n t has d e c r e a s e d i n l o n e l i n e s s . A n e g a t i v e r e d u c t i o n s c o r e i n d i c a t e s t h a t t h e c l i e n t i n c r e a s e d i n l o n e l i n e s s . 72 C l i e n t L o n e l i n e s s Scores  P r e - t e s t and P o s t - t e s t S c o r e s f o r C o n t r o l and Comparison Groups CONTROL GROUP ;- •  N-l 3. COMPARISON GROUP . N=ll PRE-TEST POST-TEST PRE-TEST POST-TEST 24 22 39 26 37 45 45 46 28 . 26 40 25 32 34 25 8 30 25 23 25 31 32 24 11 30 28 30 21 38 44 45 39 32 33 40 31 20^ ; 14 32 22 22 27 35 30 21 26 26 23 T a b l e 2 73 The R e d u c t i o n i n C l i e n t L o n e l i n e s s S c o r e s from t h e  P r e - t e s t and P o s t - t e s t S c o r e s f o r C o n t r o l and Comparison Groups CONTROL GROUP N=13 COMPARISON GROUP N=ll +2 +13 -8 -1 +2 +15 -2 +17 +5 -2 -1 +13 +2 +9 -6 +6 -1 +9 . +6 +10 -5 +5 -5 +3 A p o s i t i v e r e d u c t i o n s c o r e i n d i c a t e s t h a t t h e c l i e n t has d e c r e a s e d i n l o n e l i n e s s . A n e g a t i v e r e d u c t i o n s c o r e i n d i c a t e s t h a t t h e c l i e n t has i n c r e a s e d i n l o n e l i n e s s . T a b l e 3 74 A n a l y s i s o f t h e l o n e l i n e s s s c o r e s , by t h e Equal V a r i a n c e Formula, r e s u l t e d i n a t - v a l u e of-3.619, s i g n i f i c a n t a t a p l e v e l o f 0.0014, w i t h 23 degrees o f freedom. T h i s t - v a l u e i n d i c a t e s t h a t H y p o t h e s i s I was upheld and was s t r o n g l y s i g n i f i c a n t . T h e r a p i s t s u t i l i z i n g a c o n c e p t u a l model f o r l o n e l i n e s s p s y c h o t h e r a p y was more e f f e c t i v e i n r e d u c i n g l o n e l i n e s s . R e p o r t i n g from the P r o g r e s s Notes C h a r t e d by T h e r a p i s t s In P a r t I and P a r t II o f the s t u d y , t h e r a p i s t s completed p r o g r e s s notes a f t e r each t h e r a p y s e s s i o n . The two q u e s t i o n s which gui d e d the c h a r t i n g were, "What was d i s c u s s e d ? " and "What s u g g e s t i o n s were made i n r e l a t i o n t o what was d i s c u s s e d ? " The i n v e s t i g a t o r m o n i t o r e d the c h a r t i n g f o r the i d e n t i f i c a t i o n o f l o n e l i n e s s b e h a v i o u r s and i m p l e m e n t a t i o n o f l o n e l i n e s s i n t e r v e n t i o n s by t h e r a p i s t s . ( R e f e r to T a b l e 4) For the c o n t r o l group p s y c h o t h e r a p y s e s s i o n s o n e and two, t h e r e was no e v i d e n c e o f l o n e l i n e s s b e h a v i o u r i d e n t i f i c a t i o n . For two c l i e n t s d u r i n g p s y c h o t h e r a p y s e s s i o n s t h r e e t o s i x , one l o n e l i n e s s b e h a v i o u r was i d e n t i f i e d and a l o n e l i n e s s i n t e r v e n t i o n was implemented. For the c l i e n t s i n t he comparison group, two l o n e l i n e s s b e h a v i o u r s were i d e n t i f i e d and two l o n e l i n e s s i n t e r v e n t i o n s were implemented t h r o u g h o u t the s i x p s y c h o t h e r a p y s e s s i o n s . The comparison group was c o n s i s t e n t i n implementing the c o n c e p t u a l model f o r l o n e l i n e s s i n t e r v e n t i o n , by i d e n t i f y i n g s u g g e s t e d l o n e l i n e s s b e h a v i o u r s and implementing s p e c i f i c l o n e l i n e s s i n t e r v e n t i o n s . Frequency o f C h a r t i n g by T h e r a p i s t s on  L o n e l i n e s s B e h a v i o u r s and L o n e l i n e s s I n t e r v e n t i o n s  f o r C o n t r o l and Comparison Groups (1) FREQUENCY ( f ) OF LONELINESS BEHAVIOURS(L.B' PSYCHOTHERAPY SESSION 1 2 3 4 5 6 PER CLIENT. (2) FREQUENCY ( f ) OF LONELINESS INTERVENTIONS ( L . I . ) PER CLIENT. (1 ) CONTROL GROUP: 0/11 0/11 0/11 0/11 f OF L.B./CLIENT 0/13 0/13 2/2 2/2 2/2 2/2 TOTAL N=13 CLIENTS (13) 0 3 ) 0 3 ) 0 3 ) 0 3 ) 0 3 ) (2) CONTROL GROUP: 0/11 0/11 0/11 0/11 f OF L.I./CLIENT 0/13 0/13 2/2 2/2 2/2 2/2 TOTAL N=13 CLIENTS (13) (13) 0 3 ) (13) 0 3 ) 0 3 ) (1) COMPARISON GROUP: f OF L.B./CLIENT 22/11 22/11 22/11 22/11 22/11 22/11 TOTAL N=ll CLIENTS (ID (11) OD 01)' OD OD (2) COMPARISON GROUP: f OF L.I./CLIENT 22/11 22/11 22/11 22/11 22/11 22/11 TOTAL N=ll CLIENTS 0 1 ) OD OD OD OD T a b l e 4 A n a l y s i s o f Data i n R e l a t i o n t o H y p o t h e s i s II 76 h[ XL: I f a t h e r a p i s t u t i l i z e s l o n e l i n e s s i n t e r v e n t i o n w i t h c l i e n t s who t e s t h i g h i n l o n e l i n e s s , t he t h e r a p y s e s s i o n s w i l l be more s a t i s f y i n g f o r th e t h e r a p i s t . A n a l y s i s : ' Comparison o f t h e means o f t h e r a p i s t s a t i s f a c t i o n from t h e P a r t I p s y c h o t h e r a p y s e s s i o n s and s a t i s f a c t i o n from P a r t II p s y c h o t h e r a p y s e s s i o n s , i n which the c o n c e p t u a l model f o r l o n e l i n e s s i n t e r v e n t i o n was implemented, was c h a l l e n g e d by a p a i r e d t - t e s t a t t h e .05 l e v e l o f s i g n i f i c a n c e . R e s u l t s : The comparison o f t h e means o f t h e r a p i s t s a t i s f a c t i o n from t h e P a r t I p s y c h o t h e r a p y s e s s i o n s and s a t i s f a c t i o n from P a r t II p s y c h o t h e r a p y s e s s i o n s , i n which the c o n c e p t u a l model f o r l o n e l i n e s s i n t e r v e n t i o n was implemented ( R e f e r t o T a b l e 5) i n d i c a t e s an i n c r e a s e o f t h e r a p i s t s a t i s f a c t i o n . ( R e f e r t o T a b l e 6) A n a l y s i s o f t h e means from t h e s a t i s f a c t i o n r a t i n g s c o r e s , by the P a i r e d Comparisons t - T e s t , r e s u l t e d i n a t - v a l u e o f -4.84 s i g n i f i c a n t a t a p l e v e l o f 0.017; w i t h 3 degrees o f freedom. T h i s t - v a l u e i n d i c a t e s t h a t H y p o t h e s i s II was upheld and was s t r o n g l y s i g n i f i c a n t . T h e r a p i s t s who u t i l i z e d l o n e l i n e s s i n t e r v e n t i o n , w i t h c l i e n t s who t e s t h i g h i n l o n e l i n e s s , found the t h e r a p y s e s s i o n s more s a t i s f y i n g . A n a l y s i s o f Data i n R e l a t i o n t o H y p o t h e s i s I I I H I I I : I f a t h e r a p i s t u t i l i z e s l o n e l i n e s s i n t e r v e n t i o n w i t h c l i e n t s who t e s t h i g h i n l o n e l i n e s s , the t h e r a p i s t w i l l p e r c e i v e more c l i e n t p r o g r e s s 77 T h e r a p i s t S a t i s f a c t i o n R a t i n g S c o r e s i n A t t e m p t i n g L o n e l i n e s s  I n t e r v e n t i o n f o r C o n t r o l and Comparison Groups THERAPIST NUMBER THERAPIST SATISFACTION RATING IN ATTEMPTING LONELINESS INTERVENTION/CLIENT 1 VERY LOW 2 LOW 3 AVERAGE 4 HIGH 5 VERY HIGH CON 1RUL GROUP N=13 1 1/1 2/1 3/1 2 1/1 2/2 4/1 3 1/2 2/1 4/1 4 1/1 2/1 COMPARISON GROUP N=ll 1 3/1 5/1 2 3/1 F 4/2 5/1 3 1/1 5/1 4 3/1 4/2 The same t h e r a p i s t s p a r t i c i p a t e d i n the c o n t r o l and comparison groups. New c l i e n t s were i d e n t i f i e d f o r the comparison group. T a b l e 5 78 Average T h e r a p i s t S a t i s f a c t i o n R a t i n g S c o r e i n A t t e m p t i n g L o n e l i n e s s  I n t e r v e n t i o n f o r C o n t r o l and Comparison Groups i THERAPIST NUMBER THERAPIST SATISFACTION RATING IN ATTEMPTING LONELINESS INTERVENTION SATISFACTION RATING SCORES TOTAL NUMBER OF CLIENTS RATED SATISFACTION RATING AVERAGE CONTROL 1 6 3 2 GROUP 2 9 3 3 3 9 3 3 N=13 4 3 2 1 .5 COMPARISON 1 8 2 4 GROUP 2 16 4 4 3 8 2 4 N=ll 4 11 3 3.7 The same t h e r a p i s t s p a r t i c i p a t e d i n the c o n t r o l and comparison g r o u p s . New c l i e n t s were i d e n t i f i e d f o r the comparison group. T a b l e 6 \ 79 i n t h e r a p y s e s s i o n s . A n a l y s i s : Comparison o f the means f o r t h e r a p i s t p e r c e p t i o n o f p r o g r e s s from t he P a r t I p s y c h o t h e r a p y s e s s i o n s . a n d p r o g r e s s from P a r t II ps y c h o t h e r a p y s e s s i o n s , i n which t h e c o n c e p t u a l model f o r l o n e l i n e s s i n t e r v e n t i o n was implemented, was c h a l l e n g e d by a p a i r e d t - t e s t a t t h e .05 l e v e l o f s i g n i f i c a n c e . R e s u l t s : The comparison o f the means f o r t h e r a p i s t p e r c e p t i o n o f p r o g r e s s from the P a r t I p s y c h o t h e r a p y s e s s i o n s and p r o g r e s s from P a r t II ps y c h o t h e r a p y s e s s i o n s , i n which the c o n c e p t u a l model f o r l o n e l i n e s s i n t e r v e n t i o n was implemented ( R e f e r to T a b l e 7) i n d i c a t e s an i n c r e a s e i n t h e r a p i s t p e r c e p t i o n o f p r o g r e s s , ( R e f e r to T a b l e 8) by the P a i r e d Comparisons t - T e s t , r e s u l t e d i n a t - v a l u e o f -6.53:, s i g n i f i c a n t a t a p l e v e l o f 0.007 w i t h 3 degrees o f freedom. T h i s T - v a l u e i n d i c a t e s t h a t H y p o t h e s i s I I I was upheld and was s t r o n g l y s i g n i f i c a n t . T h e r a p i s t p e r c e p t i o n o f p r o g r e s s i n c r e a s e d when the c o n c e p t u a l model f o r l o n e l i n e s s i n t e r v e n t i o n was implemented. R e p o r t i n g on the S t r u c t u r e d E n d - I n t e r v i e w Upon c o m p l e t i o n o f t h e s t u d y , t h e f o u r t h e r a p i s t s responded to s i x open-ended s t r u c t u r e d q u e s t i o n s on t h e i m p l e m e n t a t i o n o f the c o n c e p t u a l model f o r l o n e l i n e s s i n t e r v e n t i o n . T h e r a p i s t r e a c t i o n s , t h e ad v a n t a g e s , d i s a d v a n t a g e s , u s e f u l n e s s , and the i m p l e m e n t a t i o n o f the model d u r i n g p s y c h o t h e r a p y was c h a l l e n g e d by t h e r a p i s t s i n the e n d - i n t e r v i e w . Q u e s t i o n 1: What i s y o u r r e a c t i o n t o implementing t h e c o n c e p t u a l model f o r l o n e l i n e s s i n t e r v e n t i o n ? . T h e r a p i s t P r o g r e s s R a t i n g S c o r e s i n A t t e m p t i n g L o n e l i n e s s I n t e r v e n t i o n f o r C o n t r o l and Comparison Groups 80 THERAPIST NUMBER THERAPIST PROGRESS RATING IN ATTEMPTING LONELINESS INTERVENTION/CLIENT 1 LEAST AMOUNT 2 MUCH LESS 3 LESS 4 MORE 5 MUCH MORE 6 MOST AMOUNT CONTROL 1 2/1 3/1 4/1 GROUP 2 2/2 4/1 5/1 3 2/1 3/3 N=l 3 4 3/1 5/1 COMPARISON 1 1/1 6/1 GROUP 2 4/1 ' 5/2 N=ll 3 4/1 5/2 4 4/1 6/1 The same t h e r a p i s t s p a r t i c i p a t e d i n the c o n t r o l and comparison groups. New c l i e n t s were i d e n t i f i e d f o r the comparison group. T a b l e 7 81 ,Average T h e r a p i s t P r o g r e s s R a t i n g S c o r e s i n A t t e m p t i n g L o n e l i n e s s  I n t e r v e n t i o n f o r C o n t r o l and Comparison Groups THERAPIST NUMBER THERAPIST PROGRESS RATING SCORES IN ATTEMPTING LONELINESS INTERVENTION .PROGRESS RATING SCORES TOTAL NUMBER OF CLIENTS RATED PROGRESS RATING AVERAGE CONTROL GROUP N=13 1 6 3 2 2 13 4 3.3 3 11 4 2.7 4 8 2 4 COMPARISON GROUP N=ll 1 12 3 4 2 14 3 4.7 3 14 3 4.7 4 10 2 5 The same t h e r a p i s t s p a r t i c i p a t e d i n the c o n t r o l and comparison groups. New c l i e n t s were i d e n t i f i e d f o r the comparison group. T a b l e 8 82 Responses: \ T h e r a p i s t 1: "I have mixed f e e l i n g s about implementing t h e c o n c e p t u a l model f o r l o n e l i n e s s i n t e r v e n t i o n . " T h e r a p i s t 2: "The c o n c e p t u a l model f o r l o n e l i n e s s i n t e r v e n t i o n was an i n t e r e s t i n g a pproach. The l o n e l i n e s s b e h a v i o u r s and i n t e r v e n t i o n s have h e l p e d me to be more aware and t o l o o k f o r l o n e l i n e s s b e h a v i o u r s i n my o t h e r c l i e n t s . I t has been a l e a r n i n g e x p e r i e n c e f o r me." T h e r a p i s t 3: 'I found the c o n c e p t u a l model f o r l o n e l i n e s s i n t e r v e n t i o n h e l p f u l when I was d o i n g p s y c h o t h e r a p y . " T h e r a p i s t 4:> "My r e a c t i o n t o implementing the c o n c e p t u a l model was t h a t i t was a v a r i a t i o n o f what I have been d o i n g . The model r e i n t e g r a t e s p e o p l e on a h i e r a r c h y b a s i s where you f i r s t e s t a b l i s h t h e i r l e v e l o f f u n c t i o n i n g . Then r e a l i s t i c g o a l s , i n terms o f s o c i a l r e i n t e g r a t i o n , a r e s e t w i t h the c l i e n t . To be a b l e t o meet t h e s e g o a l s , t h e r a p i s t s must t r y t o i d e n t i f y the k i n d s o f b e h a v i o u r s you i n d i c a t e d i n y o u r c o n c e p t u a l model f o r l o n e l i n e s s i n t e r v e n t i o n . The l o n e l i n e s s i n t e r v e n t i o n i n the model i s not v e r y d i f f e r e n t from the way t h a t I work as a t h e r a p i s t , a l t h o u g h I do c o n c e p t u a l i z e l o n e l i n e s s d i f f e r e n t l y than you do i n y o u r model." Q u e s t i o n 2: What do you view the advantages t o implementing the c o n c e p t u a l model f o r l o n e l i n e s s i n t e r v e n t i o n ? Responses: T h e r a p i s t 1: "I t h i n k t h a t the model i s g r e a t f o r a l l o f us, and e s p e c i a l l y f o r p s y c h o t h e r a p y w i t h m o d e r a t e l y i l l p e o p l e , n e u r o t i c s , m i l d d e p r e s s i v e s , and p e o p l e who have a p o t e n t i a l i t y f o r d e p r e s s i o n . O f t e n , i t i s up to t h e c l i e n t t o d e c i d e whether the y want t o c a r r y out the p l a n o f t h e i r t h e r a p y , and t h a t d e c i s i o n f s ; b a s e d upon good i n s i g h t , good judgement, and a c e r t a i n l e v e l o f i n t e l l e c t , which I f e e l i s r e q u i r e d by y o u r model." 83 T h e r a p i s t 2: "The model p r o v i d e d me w i t h a d e s i g n a t e d means t o t r y and use s p e c i f i c approaches f o r l o n e l i n e s s i n t e r v e n t i o n . I am used t o implementing the t h e r a p e u t i c approaches t h a t come ou t o f my head. I had to t r y and use y o u r s e t model, and t h a t was k i n d o f an i n t e r e s t i n g way t o do i t . I t a l s o was k i n d o f a j a z y way i n t h a t I knew what I was supposed t o do, as f a r as the r e s e a r c h was c o n c e r n e d . A n o t h e r major advantage was t h a t the l o n e l i n e s s b e h a v i o u r s were s p e c i f i c and t h e r e f o r e i t was easy to measure whether the i n t e r v e n t i o n was a p p r o p r i a t e f o r the b e h a v i o u r change t o o c c u r r . " T h e r a p i s t 3: "I t h i n k t h a t the advantage t o implementing y o u r model was t h a t i t was h e l p f u l t o c l i e n t s i n t h a t i t was c o n c r e t e . I c o u l d a s s e s s my t h e r a p y s e s s i o n by r e f e r r i n g back t o the e s t a b l i s h e d l o n e l i n e s s b e h a v i o u r s and i n t e r v e n t i o n s . As a r e s u l t , I c o u l d measure what I s e t out t o do w i t h a c l i e n t . " T h e r a p i s t 4: "In f o c u s s i n g on l o n e l i n e s s , one i s i n e s sence f o c u s s i n g on i n a d e q u a c i e s i n s o c i a l i z a t i o n . B u i l d i n g h i e r a r c h i e s , whereby you can h e l p the c l i e n t to educate themselves and one can e d u cate t h e c l i e n t i n more f u n c t i o n a l methods o f i n t e r a c t i n g , i s the advantage t o y o u r model. In terms o f s o c i a l p s y c h i a t r y , t h a t i s t h e o n l y r e a l w orkable a s p e c t . In d e a l i n g w i t h s e v e r e mental d i s o r d e r s , one must c o u p l e the one s u c c e s s f u l t r e a t m e n t m o d a l i t y , which i s chemotherapy, w i t h something t h a t one can work on, and one t h i n g t h a t c a n . be always worked on i s s o c i a l i z a t i o n s k i l l s . L o n e l i n e s s i n my o p i n i o n i s f o c u s s i n g on the inadequacy o f t h e s e s o c i a l i z a t i o n s k i l l s . " Q u e s t i o n 3: What do you view the d i s a d v a n t a g e s t o implementing the c o n c e p t u a l model f o r l o n e l i n e s s i n t e r v e n t i o n ? Responses: T h e r a p i s t 1: "I t h i n k t h a t the d i s a d v a n t a g e t o the model was t h a t some c l i e n t s d i d n o t l i k e the b e h a v i o u r a l approach d u r i n g p s y c h o t h e r a p y . I t t h e r e f o r e was i m p o r t a n t as t o how I i n t r o d u c e d the l o n e l i n e s s i n t e r v e n t i o n s d u r i n g p s y c h o t h e r a p y . " 84 "I t h i n k t h a t the d i s a d v a n t a g e o f the model was t h a t i t was d i f f i c u l t f o r me to i d e n t i f y what l o n e l i n e s s b e h a v i o u r s were a p p r o p r i a t e to each c l i e n t . I t t h e r e f o r e became d i f f i c u l t f o r me to d e s i g n a t e which o f the l o n e l i n e s s b e h a v i o u r s I was r e a l l y working on. I am s t i l l n ot c o n v i n c e d t h a t i d e n t i f i c a t i o n o f a l o n e l i n e s s b e h a v i o u r and then implementing l o n e l i n e s s i n t e r v e n t i o n i s g o i n g t o work f o r everyone." "I d i d not view any d i s a d v a n t a g e s t o implementing the c o n c e p t u a l model. I needed more d i r e c t i o n when c o n d u c t i n g l o n e l i n e s s i n t e r v e n t i o n w i t h a p s y c h o t i c c l i e n t than w i t h one t h a t was n e u r o t i c . " " L o n e l i n e s s can be a symptom o f a mental o r emotional d i s o r d e r which i s d r i v i n g the person i n t o i s o l a t i o n r a t h e r than i t b e i n g the cause o f the mental d i s o r d e r . The cause o f the d i s o r d e r may be l o n e l i n e s s , but i t may not be. I f you b e l i e v e t h a t l o n e l i n e s s i s c a u s i n g s p e c i f i c b e h a v i o u r , you may deal w i t h i t by y o u r l o n e l i n e s s i n t e r v e n t i o n r a t h e r than w i t h o t h e r m o d a l i t i e s o f t r e a t m e n t . T h i s may be a d i s a d v a n t a g e a l t h o u g h you have d e v i s e d a b e h a v i o u r a l and p s y c h o t h e r a p e u t i c model, which l o o k s a t b e h a v i o u r s i r r e s p e c t i v e o f the e t i o l o g y o f the mental d i s o r d e r . Your model t r e a t s those b e h a v i o u r s as d i s c r e e t e n t i t i e s i n a p r o b l e m - s o l v i n g a p p r o a c h , which I do f i r m l y agree w i t h . " Do you f i n d the c o n c e p t u a l model f o r l o n e l i n e s s i n t e r v e n t i o n "I found the model u s e f u l when working w i t h n e u r o t i c and d e p r e s s e d c l i e n t s . " "The model was u s e f u l . I t i d e n t i f i e d l o n e l i n e s s b e h a v i o u r s and p r o v i d e d a p l a n f o r i n t e r v e n t i o n when d e a l i n g w i t h those b e h a v i o u r s . " 85 T h e r a p i s t 3: " I t was a u s e f u l model because i t was c o n c r e t e and h e l p f u l - t o c l i e n t s . A l s o , i t a l l o w e d me to a s s e s s what I s e t o u t to do w i t h my c l i e n t s . " T h e r a p i s t 4: "I found the l o n e l i n e s s i n t e r v e n t i o n s u s e f u l . C h o o s i n g p h e n o m e n a l . e v e n t s i n the everyday l i f e o f the c l i e n t and i s o l a t i n g t h e s e e v e n t s , f i n d i n g out which a r e l e a s t t h r e a t e n i n g t o the c l i e n t , and then b e i n g a b l e t o gauge the i n t e r v e n t i o n s , was ver y u s e f u l . " Q u e s t i o n 5: Do you f i n d t he c o n c e p t u a l model f o r l o n e l i n e s s i n t e r v e n t i o n d i f f i c u l t t o implement? Responses: T h e r a p i s t 1: "I d i d not t h i n k t h a t i t was a " d T f f i c u l t model to implement, p r o v i d e d t h a t as i t was i n t r o d u c e d i n t h e r a p y , p r o p e r assessment o f the c l i e n t ' s needs was made. A l s o , i t was n e c e s s a r y t o keep the model i n p r o p e r p e r s p e c t i v e . " \ T h e r a p i s t 2: "The model was not d i f f i c u l t to implement, e x c e p t f o r i d e n t i f y i n g the l o n e l i n e s s b e h a v i o u r s . " T h e r a p i s t 3: "I d i d not f i n d i t d i f f i c u l t to implement the model. I found i t d i f f i c u l t t o c o n c e p t u a l i z e what I was d o i n g and t h e n f i t t i n g i t w i t h i n t he framework o f the model." T h e r a p i s t 4: "I d i d not f i n d t he model d i f f i c u l t t o implement because I l o o k e d a t i t from a b e h a v i o u r a l p e r s p e c t i v e . Q u e s t i o n 6: What s u g g e s t i o n s would you make f o r l o n e l i n e s s i n t e r v e n t i o n ? 86 Responses: T h e r a p i s t 1: "I t h i n k t h a t w i t h i n t h i s s e t t i n g where our team's mandate was s e v e r e l y m e n t a l l y i l l c l i e n t s , i t was d i f f i c u l t to use y o u r c o n c e p t u a l model, b u t , I t h i n k i f we were t o implement t h i s model f o r a w h i l e l o n g e r , i t would be u s e f u l . I t h i n k t h a t y o u r model c o u l d be used to t e a c h l o n e l i n e s s c o p i n g s k i l l s to s e v e r e l y i l l p e o p l e . L o n e l i n e s s i s such an a b s t r a c t c o n c e p t . " T h e r a p i s t 2: "I would s u g g e s t t h a t the model be used i n a more c o n t r o l l e d s e t t i n g , i n f a c t , I t h i n k t h a t i t would be f a n t a s t i c f o r a Token Therapy h o s p i t a l ward i n a t h e r a p e u t i c m i l i e u . In the community, i t i s hard t o o b s e r v e c l i e n t s c a r r y i n g o u t t h e i r p l a n s , whereas on a ward you c o u l d . " T h e r a p i s t 3: "I would l i k e t o see y o u r model more d i s e a s e o r i e n t e d . I do t h i n k t h a t the model works e s p e c i a l l y w e l l w i t h s c h i z o p h r e n i c s . As f o r a n e u r o t i c , I t h i n k t h a t the l o n e l i n e s s i n t e r v e n t i o n s would need t o be a l i t t l e d i f f e r e n t , a l t h o u g h I guess i t depends on how you use the i n t e r v e n t i o n . " T h e r a p i s t 4: "Over and above the l o n e l i n e s s i n t e r v e n t i o n s s t a t e d i n the model, I t h i n k t h a t everyday community mental h e a l t h programs, such as e n c o u r a g i n g a person i n t o the system o f a d r o p - i n c e n t e r , o u t - p a t i e n t u n i t s o f h o s p i t a l s , a r e i m p o r t a n t l o n e l i n e s s i n t e r v e n t i o n s . In a s u p p o r t i v e f a s h i o n , you encourage the p e r s o n t h r o u g h t h e r a p y t h a t you have s u g g e s t e d i n t o a program where s o c i a l i z a t i o n w i l l be more i n t e n s e . " Summary Ps y c h o t h e r a p y i n which t h e r a p i s t s implemented a c o n c e p t u a l model f o r l o n e l i n e s s i n t e r v e n t i o n r e s u l t e d i n a g r e a t e r r e d u c t i o n i n l o n e l i n e s s f o r t h e s e c l i e n t s . T h e r a p i s t s found p s y c h o t h e r a p y s e s s i o n s more s a t i s f y i n g and p e r c e i v e d more c l i e n t p r o g r e s s from t h e r a p y when l o n e l i n e s s b e h a v i o u r s were i d e n t i f i e d and s p e c i f i c l o n e l i n e s s i n t e r v e n t i o n s were implemented. C h a p t e r 5 SUMMARY, CONCLUSIONS, AND RECOMMENDATIONS In t h e f i e l d o f mental h e a l t h , l o n e l i n e s s has been one o f t h e l e a s t c o n c e p t u a l i z e d p s y c h o l o g i c a l phenomena. Th e r e e x i s t e d a need t o acknowledge l o n e l i n e s s as a b a s i s f o r b e h a v i o u r s which d i s r u p t t h e i n t e g r i t y o f an i n d i v i d u a l . T h i s l o n e l i n e s s w arranted s p e c i f i c t r e a t m e n t i n p s y c h o t h e r a p y . The i m p l e m e n t a t i o n o f a c o n c e p t u a l model f o r l o n e l i n e s s i n t e r v e n t i o n f a c i l i t a t e d p s y c h o t h e r a p y w i t h l o n e l y c l i e n t s because l o n e l i n e s s b e h a v i o u r s were i d e n t i f i e d and s p e c i f i c i n t e r v e n t i o n s were s u g g e s t e d . L o n e l i n e s s i s a f e e l i n g common t o a l l i n d i v i d u a l s i n e v e r y l i f e s i t u a t i o n p o s s i b l e 1 through v a r i o u s c u l t u r e s . Many t y p e s o f i n d i v i d u a l s i n s o c i e t y e x p e r i e n c e l o n e l i n e s s s p e c i f i c t o them, such as t h e u n i v e r s i t y s t u d e n t who l e a v e s home f o r the f i r s t t i m e . Each i n d i v i d u a l ' s e x p e r i e n c e o f l o n e l i n e s s i s unique to him o r her. A t h e r a p i s t ' s r e c o g n i t i o n and u n d e r s t a n d i n g o f how l o n e l i n e s s e v o l v e s f o r a c l i e n t , f a c i l i t a t e s t h e e s t a b l i s h m e n t o f a t h e r a p e u t i c r e l a t i o n s h i p . The c a r e o f t h e l o n e l y c l i e n t r e q u i r e s t h e t h e r a p i s t t o un d e r s t a n d the g e n e r i c development o f the l o n e l i n e s s f o r t h a t i n d i v i d u a l and the v a r i o u s ways l o n e l i n e s s m a n i f e s t s i t s e l f d u r i n g t h e p s y c h o t h e r a p e u t i c r e l a t i o n s h i p . L o n e l i n e s s i n t h i s s t u d y was d e f i n e d as not f e e l i n g humanly i n v o l v e d w i t h o t h e r s as i n d i c a t e d by t h e d e s i r e to o b s e r v e l i f e r a t h e r than . 87 p a r t i c i p a t e i n i t , t o l a c k r e l a t e d n e s s t o o t h e r s , and to l a c k p e r s o n a l 84 meaning i n r e l a t i o n s h i p s w i t h o t h e r s . I n d i v i d u a l s may have s u f f e r e d from v a r i o u s t y p e s o f l o n e l i n e s s , such as g e n e r a l l o n e l i n e s s , n o s t a l g i c l o n e l i n e s s , p r i m a r y and secondary l o n e l i n e s s . L o n e l i n e s s a n x i e t y was d e f i n e d as a common c o n d i t i o n i n d i c a t e d by the i n d i v i d u a l no l o n g e r h a v i n g an i n t i m a t e sense o f r e l a t e d n e s s t o t h e f o o d e a t e n , t h e c l o t h e s worn, nor d i r e c t p a r t i c i p a t i o n i n t h e c r e a t i o n and p r o d u c t i o n o f t h e v i t a l needs o f the p e r s o n ' s f a m i l y and community. L o n e l i n e s s a n x i e t y r e s u l t s from a fundamental break between what one i s and what one p r e t e n d s to be w i t h a l i e n a t i o n o c c u r r i n g between t h e i n d i v i d u a l and o t h e r s as w e l l as between the i n d i v i d u a l and the environment. The f e e l i n g o f a l i e n a t i o n from o t h e r s e v e n t u a l l y r e s u l t s i n a t y p e o f c h r o n i c 85 i l l n e s s c aused by p e r s i s t e n t l o n e l i n e s s a n x i e t y . I t was n e c e s s a r y f o r t h e r a p i s t s t o deal w i t h a c l i e n t ' s l o n e l i n e s s and l o n e l i n e s s a n x i e t y i n p s y c h o t h e r a p y . S e c r e t i v e n e s s and l a c k o f communication about l o n e l i n e s s i n c r e a s e d t h e t h r e a t f o r t h e l o n e l y p e r s o n t o r e v e a l t h e i r l o n e l i n e s s s i n c e t h e y b e l i e v e d t h a t o t h e r s had not e x p e r i e n c e d s i m i l a r f e e l i n g s . I t t h e r e f o r e was i m p e r a t i v e t h a t t h e r a p i s t s i d e n t i f i e d and acknowledged a c l i e n t ' s l o n e l i n e s s i n p s y c h o t h e r a p y . T h e r a p i s t s a s s i s t e d c l i e n t s to a t t a i n a h i g h e r l e v e l o f p e r s o n a l u n i t y by h a v i n g t h e c l i e n t s d e v e l o p i n s i g h t and ways o f Ford and Z o r n , Why Be L o n e l y ? p. 22. Moustakas, L o n e l i n e s s , p. 24. 89 a l l e v i a t i n g o r c o p i n g w i t h the l o n e l i n e s s t h e y were e n c o u n t e r i n g r a t h e r than not acknowledging t h e l o n e l i n e s s and h a v i n g t h e c l i e n t s c o n t i n u e t o f a c e l o n e l i n e s s s i t u a t i o n s i n t h e i r l i f e w i t h o u t s u p p o r t . To a s s i s t a t h e r a p i s t i n d e a l i n g w i t h t h e l o n e l i n e s s w i t h i n a c l i e n t , i n s i g h t i n t o h i s own p e r s o n a l l o n e l i n e s s was n e c e s s a r y . An I n s e r v i c e E d u c a t i o n on l o n e l i n e s s was t h e r e f o r e p r o v i d e d f o r the t h e r a p i s t s t o f a c i l i t a t e t h e i r c o n c e p t u a l i z a t i o n and u n d e r s t a n d i n g o f l o n e l i n e s s . The t h e r a p i s t s then proceeded to i d e n t i f y l o n e l i n e s s b e h a v i o u r s and i n t e r v e n e w i t h s p e c i f i c l o n e l i n e s s i n t e r v e n t i o n s r a t h e r than w i t h the symptoms o r d i a g n o s i s d e f i n i n g t h e c l i e n t ' s i l l n e s s . The means t o i d e n t i f y l o n e l i n e s s b e h a v i o u r s and s p e c i f i c i n t e r v e n t i o n s t o be used d u r i n g p s y c h o t h e r a p y were p r o v i d e d by a c o n c e p t u a l model f o r l o n e l i n e s s i n t e r v e n t i o n . C o n s u l t a t i o n was n e c e s s a r y as t h i s new approach t o l o n e l i n e s s p s y c h o t h e r a p y was u n f a m i l i a r f o r the t h e r a p i s t s . H y p o t h e s i s I, i f a t h e r a p i s t u t i l i z e s a c o n c e p t u a l model f o r l o n e l i n e s s i n t e r v e n t i o n , p s y c h o t h e r a p y w i l l be more e f f e c t i v e i n r e d u c i n g l o n e l i n e s s i n c l i e n t s , was u p h e l d . A n a l y s i s o f the,means o f t h e l o n e l i n e s s s c o r e s by t h e Equal V a r i a n c e Formula, r e s u l t e d i n a t - v a l u e o f -3.619 s i g n i f i c a n t a t a p l e v e l o f 0.0014, w i t h 23 degrees o f freedom, was s t r o n g l y s i g n i f i c a n t . P s y c h o t h e r a p y was more e f f e c t i v e i n r e d u c i n g l o n e l i n e s s when t h e c o n c e p t u a l model f o r l o n e l i n e s s i n t e r v e n t i o n was implemented. H y p o t h e s i s I I , i f a t h e r a p i s t u t i l i z e s l o n e l i n e s s i n t e r v e n t i o n w i t h c l i e n t s who t e s t h i g h i n l o n e l i n e s s , t h e t h e r a p y s e s s i o n s w i l l be more s a t i s f y i n g f o r the t h e r a p i s t , was up h e l d . A n a l y s i s o f the means from the 90 s a t i s f a c t i o n r a t i n g s c o r e s , by t h e P a i r e d Comparisons t - t e s t , r e s u l t e d i n a t - v a l u e o f -4.84 s i g n i f i c a n t a t a p l e v e l o f 0.0T7- w i t h 3 degrees o f freedom, was s t r o n g l y s i g n i f i c a n t . T h e r a p i s t s who u t i l i z e d l o n e l i n e s s i n t e r v e n t i o n w i t h c l i e n t s who t e s t h i g h i n l o n e l i n e s s found the t h e r a p y s e s s i o n s more s a t i s f y i n g . H y p o t h e s i s I I I , i f a t h e r a p i s t u t i l i z e s l o n e l i n e s s i n t e r v e n t i o n w i t h c l i e n t s who t e s t h i g h i n l o n e l i n e s s , t h e t h e r a p i s t w i l l p e r c e i v e more c l i e n t p r o g r e s s i n t h e r a p y s e s s i o n s , was u p h e l d . A n a l y s i s o f t h e means from t h e p r o g r e s s r a t i n g s c o r e s , by t h e P a i r e d Comparisons t - t e s t , r e s u l t e d i n a t - v a l u e o f -6.53 ;. s i g n i f i c a n t a t a p l e v e l o f 0.007 w i t h 3 degrees o f freedom, was s t r o n g l y s i g n i f i c a n t . T h e r a p i s t p e r c e p t i o n o f p r o g r e s s i n c r e a s e d when the c o n c e p t u a l model f o r l o n e l i n e s s i n t e r v e n t i o n was implemented. Recommendations The p r i m a r y recommendation o f t h i s s t u d y i s t h a t l o n e l i n e s s p s y c h o t h e r a p y be c o n d u c t e d w i t h mental h e a l t h c l i e n t s who a r e l o n e l y . The l o n e l i n e s s , r a t h e r t h a n the d i s e a s e e t i o l o g y , s h o u l d be acknowledged by t h e r a p i s t s t o promote e f f e c t i v e p s y c h o t h e r a p y . The p r e s e n t a t i o n o f l o n e l i n e s s as a b a s i s f o r p s y c h o t h e r a p y r e q u i r e s t h a t the c o n c e p t o f l o n e l i n e s s be t h e o r e t i c a l l y and c o n c e p t u a l l y d e f i n e d . S i n c e l o n e l i n e s s i s one o f the l e a s t c o n c e p t u a l i z e d p s y c h o l o g i c a l c o n c e p t s , c l a r i t y o f the c o n c e p t f o r t h e r a p i s t s i s n e c e s s a r y . P r i o r to implementing the c o n c e p t u a l model f o r l o n e l i n e s s i n t e r v e n t i o n , i t i s recommended t h a t an i n t r o d u c t i o n t o t h e b e h a v i o u r a l - a p p r o a c h i n p s y c h o t h e r a p y be g i v e n . S i n c e the c o n c e p t u a l model f o r l o n e l i n e s s i n t e r v e n t i o n has a b e h a v i o u r a l b a s i s , t h e r a p i s t s s h o u l d have an u n d e r s t a n d i n g o f the b e h a v i o u r a l - a p p r o a c h . L o n e l i n e s s c o n s u l t a t i o n i s n e c e s s a r y upon i n t r o d u c t i o n o f the c o n c e p t u a l model f o r l o n e l i n e s s i n t e r v e n t i o n as w e l l as when t h e r a p i s t s i d e n t i f y l o n e l i n e s s b e h a v i o u r s i n c l i e n t s and implement s p e c i f i c l o n e l i n e s s i n t e r v e n t i o n s i n p s y c h o t h e r a p y . Encouragement and s u p p o r t must be g i v e n t o t h e r a p i s t s when they a r e implementing t h e model as l o n e l i n e s s p s y c h o t h e r a p y i s u s u a l l y u n f a m i l i a r t o them. E x p l a n a t i o n s on the phenomena o f l o n e l i n e s s w i l l a s s i s t t h e r a p i s t s t o c l a r i f y t h i n k i n g . For e f f e c t i v e use o f t h e model, t h e r a p i s t v a l i d a t i o n w i t h the c l i e n t o f t h e l o n e l i n e s s and l o n e l i n e s s b e h a v i o u r t h a t t h e c l i e n t e x h i b i t s i s s t r o n g l y recommended. T h i s f a c i l i t a t e s l o n e l i n e s s i n t e r v e n t i o n , as t h e n , both the c l i e n t and t h e r a p i s t can s e t up a c o n t r a c t to work on t h e l o n e l i n e s s t o g e t h e r . A c l i e n t ' s i n s i g h t on l o n e l i n e s s w i l l enhance l o n e l i n e s s p s y c h o t h e r a p y . I t i s recommended t h a t t h e c o n c e p t u a l model be u t i l i z e d i n t h e f o l l o w i n g way. F i r s t , t he s p e c i f i c l o n e l i n e s s b e h a v i o u r s a r e i d e n t i f i e d and then i n d i v i d u a l i z e d f o r each c l i e n t . An u n d e r s t a n d i n g as t o how t h e l o n e l i n e s s has e v o l v e d f o r each c l i e n t must be a r r i v e d a t by t h e t h e r a p i s t . Second, l o n e l i n e s s i n t e r v e n t i o n s s p e c i f i c t o each l o n e l i n e s s b e h a v i o u r s h o u l d be i d e n t i f i e d . These i n t e r v e n t i o n s a r e c o n c r e t e a c t i o n s , t h e r e f o r e , once the a p p r o p r i a t e l o n e l i n e s s b e h a v i o u r s a r e i d e n t i f i e d , i n t e r v e n t i o n can be implemented w i t h much more ease. I t i s suggested t h a t t h e r a p i s t s r e c e i v e adequate c o n s u l t a t i o n when i d e n t i f y i n g b e h a v i o u r s , as t h i s p r o v i d e s t he b a s i s and g i v e s d i r e c t i o n t o the l o n e l i n e s s p s y c h o t h e r a p y s e s s i o n s . T h e r e a r e v a r i o u s views t o the development o f l o n e l i n e s s . I t i s su g g e s t e d t h a t a l l p e r s p e c t i v e s be a c c e p t a b l e , s i n c e the r e s u l t , l o n e l i n e s s , i s t h e same and w a r r a n t s i n t e r v e n t i o n . I t i s not o f importance whether t h e pe r s o n became p s y c h o t i c and then l o n e l y o r whether the p e r s o n was l o n e l y and the n became p s y c h o t i c . T h i s c i r c u l a r f e u d which a g a i n a r i s e s , "What comes f i r s t , t h e c h i c k e n o r the egg?" has always been e v i d e n c e d i n p s y c h i a t r y , e s p e c i a l l y s i n c e t h e r e a r e a v a r i e t y o f s c h o o l s o f tho u g h t . Should t h i s s t u d y be a g a i n u n d e r t a k e n , I would recommend t h a t i t be conducted i n a h o s p i t a l s e t t i n g on a p s y c h i a t r i c ward. In t h i s s i t u a t i o n , o n -going t h e r a p y i s conduc t e d on a c o n s i s t e n t day-to-day b a s i s . A l s o , the f a c i l i t i e s a t t h e h o s p i t a l c o u l d be r e a d i l y i n t e g r a t e d w i t h t h e l o n e l i n e s s i n t e r v e n t i o n which would i n v o l v e t h e r a p i s t s t o d i r e c t l y o b s e r v e and p a r t i c i p a t e i n t h e l o n e l i n e s s i n t e r v e n t i o n , i n a ro l e - m o d e l s i t u a t i o n , i f a p p r o p r i a t e . The c o n c e p t u a l model f o r l o n e l i n e s s i n t e r v e n t i o n was based on t h e b e h a v i o u r a l - a p p r o a c h . Many t h e r a p i s t s do not conduct p s y c h o t h e r a p y u t i l i z i n g b e h a v i o u r a l t e c h n i q u e s . I t i s t h e r e f o r e recommended t h a t t he l o n e l i n e s s i n t e r v e n t i o n s be expanded to i n c l u d e b e h a v i o u r a l a c t i o n s as w e l l as a c t i o n s based upon o t h e r p s y c h o t h e r a p e u t i c a p p r o a c h e s . T h i s would t h e n enhance t h e r a p i s t i n d i v i d u a l i z a t i o n i n implementing l o n e l i n e s s p s y c h o t h e r a p y . I t i s a l s o recommended t h a t t h e c o n c e p t o f l o n e l i n e s s be t a u g h t t o 93 s t u d e n t s i n e d u c a t i o n a l s e t t i n g s . C o n c e p t s , such as l o s s o f body image, d e p e r s o n a l i z a t i o n , and s e n s o r y d e p r i v a t i o n a r e a l l r e l a t e d to l o n e l i n e s s . T h i s approach by e d u c a t o r s c o u l d a l s o mean t h a t l o n e l i n e s s would be i n c o r p o r a t e d i n t e x t b o o k s and would become a b e t t e r e s t a b l i s h e d and more a c c e p t a b l e c o n c e p t . B a s i c a l l y , I recommend t h a t t h e r e be f u r t h e r e x p l o r a t i o n o f t h e c o n c e p t o f l o n e l i n e s s i n t h e f i e l d o f mental h e a l t h . I n d i v i d u a l s have always e x p e r i e n c e d l o n e l i n e s s , many have s u f f e r e d from t h i s f e e l i n g . I t i s our i n h e r e n t goal as h e a l t h p r o f e s s i o n a l s t o promote mental h e a l t h . By s e t t i n g a sound base f o r l o n e l i n e s s i n p s y c h o t h e r a p y , mental h e a l t h c a r e may be improved. T h i s can be a l s o a c h i e v e d by t h e r a p i s t s , e d u c a t o r s , and r e s e a r c h e r s f u r t h e r i n g t he knowledge and c o n c e p t u a l i z a t i o n o f l o n e l i n e s s to form a s t r o n g t h e o r e t i c a l base f o r t h i s c o n c e p t . SELECTED BIBLIOGRAPHY SELECTED BIBLIOGRAPHY B e l c h e r , J a y . "The Measurement o f L o n e l i n e s s : A V a l i d a t i o n a l Study o f the Bender Extended L o n e l i n e s s S c a l e . " D o c t o r a l d i s s e r t a t i o n , I l l i n o i s I n s t i t u t e o f T e c h n o l o g y , 1973. B r a d l e y , R o s a l e e . "Measuring L o n e l i n e s s . " D o c t o r a l D i s s e r t a t i o n , Washington S t a t e U n i v e r s i t y , 1969. Brennan, Audrey. "The L o n e l i n e s s o f t h e H o s p i t a l i z e d P a t i e n t . " Master's t h e s i s , U n i v e r s i t y o f B r i t i s h Columbia, 1975. C a i n e , Lynn. Widow. New York: W i l l i a m Morrow and Company, 1974. de J a n o s , Sigmund, and Brooks, B r i a n . L o n e l i n e s s and Communication. T o r o n t o : Web O f f s e t P u b l i c a t i o n s L t d . , 1971. Duensbury, W i l l i a m . The Theme o f L o n e l i n e s s i n Modern American Drama. G a i n s v i l l e : The U n i v e r s i t y o f F l o r i d a P r e s s , 1960. Edwards, M a r i e , and Hoover, E l e n o r . The C h a l l e n g e o f B e i n g S i n g l e . Los A n g e l e s : J.P. T a r c h e r I n c . , 1974. F a s t , Judy. Body Language. New York: M. Evans and Company I n c . , 1970. F o r d , E., and Z o r n , R. Why Be L o n e l y ? I l l i n o i s : Argus Communications, 1975. F r a n k l , V i c t o r . Man's Se a r c h For Meaning. New York: Washington Square P r e s s , 1970. . The Unconscious God. New York: Simon and S c h u s t e r Co., 1975. Freedman, A l f r e d M.; Kaplan, H a r o l d I . ; and Sadock, Benjamin J . Modern S y n o p s i s o f Comprehensive Textbook o f P s y c h i a t r y . B a l t i m o r e : The W i l l i a m s and W i l k i n s Co., 1972. F r e u d , Sigmund. An O u t l i n e o f P s y c h o a n a l y s i s . New York: W.W. Norton Co., 1949. Fromm, E r i c . Escape From Freedom. New York: H o l t , R i n e h a r t and Winston, I n c . , 1941. Green, Hannah. I Never Promised You A Rose Garden. New York: H o l t , R i n e h a r t and Winston I n c . , 1964. 96 H a l l , R a d c l y f f e . The Well o f L o n e l i n e s s . London: T r a n s w o r l d P u b l i s h e r s L t d . , 1974. Horney, Karen. Out Inner C o n f l i c t s . New York: W.W. Norton Co., 1945. H o s k i s s o n , J.B. L o n e l i n e s s , An E x p l a n a t i o n - A Cure. London: Thorsons P u b l i s h e r s L t d . , 1963. J o s e p h s o n , E r i c , and J o s e p h s o n , Mary., ed. Man A l o n e . New York: D e l l P u b l i s h i n g L t d . , 1975. J o u r a r d , S i d n e y . The T r a n s p a r e n t S e l f . New York: Van N o s t r a n d R e i n h o l d Co., 1971. K l e i n , M. On The Sense o f L o n e l i n e s s I n : Our A d u l t World. New York: B a s i c Books I n c . , 1963. K u b l e r - R o s s , E l i s a b e t h . On Death and Dying. New York: M a c M i l l a n Co., 1969. L o t z , Johannes B. The Problem o f L o n e l i n e s s . E n g l a n d : S t . Paul P u b l i c a t i o n s , 1967. Lyons, B e t t y . Three Women A l o n e . New York: U n i v e r s a l - A w a r d House, I n c . , 1975. McKuen, Rod. A l o n e . New York: Simon and S c h u s t e r I n c . , 1975. / . Lonesome C i t i e s . New York: Random House I n c . , 1965. Manfreda, M a r g u e r i t e Lucy. P s y c h i a t r i c N u r s i n g . P h i l a d e l p h i a : F.A. D^avis Co., 1973. Mannin, E l i z a b e t h . L o n e ! i n e s s . London: H u t c h i s o n Co., 1966. Moustakas, C l a r k E. L o n e ! i n e s s . New J e r s e y : P r e n t i c e - H a l l I n c . , 1961. . L o n e l i n e s s and Love. New J e r s e y : P r e n t i c e - H a l l I n c . , 1961. . The Touch o f L o n e l i n e s s . New J e r s e y : P r e n t i c e - H a l l I n c . , 1975. P r a t h e r , Hugh. I Touch The E a r t h , The E a r t h Touches Me. New York: Doubleday and Co., I n c . , 1972. Redman, B a r b a r a . T h e P r o c e s s o f P a t i e n t T e a c h i n g In N u r s i n g . S a i n t L o u i s : The C.V. Mosby Co., 1972. R e i h l , J.P. and Roy, C. Conceptual Models For N u r s i n g P r a c t i c e . New York: A p p l e t o n - C e n t u r y - C r o f t s , 1974. Reisman, David. The L o n e l y Crowd. New Haven: Y a l e U n i v e r s i t y P r e s s , 1950. Reush, J u r g e n . T h e r a p e u t i c Communication. New York: W.W. Norton and Co., 1961. 97 Rogers, C a r l . Freedom To L e a r n . Columbus: C h a r l e s E. M e r r i l l Pub. Co., 1969. Roy, C a l l i s t a . I n t r o d u c t i o n To N u r s i n g : An A d a p t a t i o n Model. New J e r s e y : P r e n t i c e - H a l l I n c . , 1976. Rubin, Theodore I s a a c . L i s a and David J o r d i . New York: Random House T n c , 1975. S c h u l t z , W i l l i a m C. J o y : Expanding Human Awareness. New York: Grove P r e s s I n c . , 1974. Schweer, Jean. C r e a t i v e T e a c h i n g i n C l i n i c a l N u r s i n g . S a i n t L o u i s : The C.V. Mosby Co., 1972. Seabrook, J . L o n e l i n e s s . New York: U n i v e r s e Books: 1973. Sermat, V e l i o , and Schmidt, Nancy. The Schmidt-Sermat L o n e l i n e s s S c a l e . S i s e n w e i n , R.J. " L o n e l i n e s s and the I n d i v i d u a l as Viewed by H i m s e l f and O t h e r s . " D o c t o r a l d i s s e r t a t i o n , Columbia U n i v e r s i t y , 1964. S l a t e r , P h i l i p E. The P u r s u i t o f L o n e l i n e s s . Boston: Bacon P r e s s , 1970. Spence, Inez. Coping With L o n e l i n e s s . M i c h i g a n : Baker Book House Co., 1970. S u l l i v a n , H arry S t a c k . The I n t e r p e r s o n a l Theory o f P s y c h i a t r y . New York: Norton P r e s s , 1953. Tanner, I r a . L o n e l i n e s s : The Fear o f Love. New York: Harper and Row P u b l i s h e r s , 1973. Townsend, P. F a m i l y L i f e o f O l d P e o p l e . London: Routledge and Kegan P a u l , L t d . , 1957. The U n i v e r s i t y o f B r i t i s h Columbia Model f o r N u r s i n g , August 1975. T o u r n i e r , P a u l . Escape From L o n e l i n e s s . P h i l a d e l p h i a : Westminster P r e s s , 1948. Trumbo, Dal t o n . Johnny Got His Gun. New York: L y l e S t u a r t I n c . , 1970. T u n s t a l l , J . O ld and A l o n e . London: R o u t l e d g e , 1966. Weiss, Robert. L o n e l i n e s s , The E x p e r i e n c e o f S o c i a l I s o l a t i o n . Cambridge: The M i t P r e s s , 1973. Wood, Margaret. Paths o f L o n e l i n e s s . New York: Columbia U n i v e r s i t y P r e s s , 1953. 98 PERIODICAL REFERENCE B a r r y , M. " D e p r e s s i o n , Shame, and L o n e l i n e s s . " American J o u r n a l o f  P s y c h o t h e r a p y 16 No. 4 (1962):72-84. B e r b l i n g e r , K l a u s . "A P s y c h i a t r i s t Looks a t L o n e l i n e s s . " P s y c h o s o m a t i c s ( M a r c h - A p r i l 1968):96-102. Bowman, Clau d e C. " L o n e l i n e s s and S o c i a l Change." American J o u r n a l o f  P s y c h i a t r y 112 (September 1955):194-98. B u h l e r , C h a r l o t t e . " L o n e l i n e s s i n M a t u r i t y . " J o u r n a l o f H u m a n i s t i c  P s y c h o l o g y 9 No. 2 (1969):167-81. B u r n s i d e , I r e n e . " L o n e l i n e s s i n O l d Age." Mental Hygiene 55 No. 3 ( J u l y 1971 ):391-97. Bu r t o n , A. "On The Nature o f L o n e l i n e s s . " American J o u r n a l o f  P s y c h o a n a l y s i s 21 (1961):34-39. F e r r i e r a , A n t o n i o . " L o n e l i n e s s and P s y c h o p a t h o l o g y . " American J o u r n a l o f  P s y c h o a n a l y s i s 23 No. 2 (1962):201-207. F r a n c i s , G l o r i a M. " L o n e l i n e s s : Measuring The A b s t r a c t . " I n t e r n a t i o n a l J o u r n a l o f N u r s i n g S t u d i e s 13 (1976):153-160. Fromm-Reichmann, F r i e d a . " L o n e l i n e s s . " P s y c h i a t r y 22 (1959):1-15. Gunderson, Edward.- "Emotional Symptoms o f I s o l a t e d Groups." A r c h i v e s o f General P s y c h i a t r y 9 (1963):362-68. Gunn, A l i c e . " L i v e s o f L o n e l i n e s s . " N u r s i n g Times 64 No. 12 (March 22, 1968):391 . " L o n e l y O l d P e o p l e . " N u r s i n g Times 61 No. 42 ( O c t o b e r 15, 1965): 1405-6. . "The L o n e l y , A d o l e s c e n t . " N u r s i n g Times 66 No. 44 ( O c t o b e r 29, 1970):1397-98. Gupta, Margaret. "An I n t e r r u p t i o n i n L o n e l i n e s s : The Use o f C o n c r e t e O b j e c t s i n t h e Promotion o f Human R e l a t e d n e s s . " J o u r n a l o f  P s y c h i a t r i c N u r s i n g 9 No. 4 ( J u l y - A u g u s t 1971 ):23-27. Hazz a r d , M.E. and K e r g i n , J.D. "An Overview o f Systems Theory." N u r s i n g C l i n i c s o f North America 3 (September 1971):392. Hobson, R.F. " L o n e l i n e s s . " J o u r n a l o f A n a l y t i c P s y c h o l o g y 19 No. 1 (Janu a r y 1974):71-89. Hoeschen, Rhoda, and Knipe, Mary. "Combating P o s t h o s p i t a l L o n e l i n e s s . " N u r s i n g O u t l o o k 15 No. 6 (June 1967):28-29. Kane, A.H. " L o n e l i n e s s i n Young Mothers." N u r s i n g M i r r o r 118 No. 3089 (August 28, 1964):489-90. Lo p a t a , Helena. " L o n e l i n e s s : Forms and Components." S o c i a l Problems 17 (1969):248-62. P e p l a u , H i l d e g a r d . " L o n e l i n e s s . " American J o u r n a l o f N u r s i n g 55 No. 12 (December 1955):1476-81. Ru b i n s , J a c k . "On P s y c h o p a t h o l o g y o f L o n e l i n e s s . " American J o u r n a l o f  P s y c h o a n a l y s i s 24 No. 2 (1964):153-166. S h e i n , Harvey M. " L o n e l i n e s s and I n t e r p e r s o n a l I s o l a t i o n : Focus f o r Therapy w i t h S c h i z o p h r e n i c P a t i e n t s . " American J o u r n a l o f  Ps y c h o t h e r a p y 28 No.l (January 1974):105-107. S i a s s i , I . ; C r o c e t t i . ; S p r i o , H.; and Picataway. " L o n e l i n e s s and D i s s a t i s f a c t i o n i n a Blue C o l l a r P o p u l a t i o n . " A r c h i v e s o f General  P s y c h i a t r y 30 No. 2 ( F e b r u a r y 1974):261-65. S t r i c k l a n d , M a r t i n , and L a s o r , B e t s y . "The Concept o f Loss i n C r i s i s I n t e r v e n t i o n . " Mental Hygiene 54 No. 2 ( A p r i l 1970):30-35. Wayne, D. "The L o n e l y School C h i l d . " American J o u r n a l o f N u r s i n g 68 No.4 ( A p r i l 1968):774-77. W e i g e r t , E d i t h . " L o n e l i n e s s and T r u s t : B a s i c F a c t o r s o f Human E x i s t e n c e . " P s y c h i a t r y 23 (1960):121-127. W i l l , O t t o . "Human L o n e l i n e s s and t h e S c h i z o p h r e n i c P a t i e n t . " P s y c h i a t r y 22 (1959):205-25. Woodward, H.; G i n g l e s R.; and Woodward, J.C. " L o n e l i n e s s and the E l d e r l y as R e l a t e d t o Housing." G e r o n t o l o g i s t 14 No. 4 (August 1974):349-51. Wri g h t , L.M. "A Symbolic T r e e : L o n e l i n e s s i s t h e Root; D e l u s i o n s a r e the Leaves." J o u r n a l o f P s y c h i a t r i c N u r s i n g 13 No. 3 (May-June 1975): 30-35. Wygant, W.E. "Dyi n g , But Not A l o n e . " American J o u r n a l o f N u r s i n g 67 No.3 (March 1967):574-577. von W i t z l e b e n , H. "On L o n e l i n e s s . " P s y c h i a t r y 21 No. 2 (1958):37-43. Z i l l b o r g , Gregory. " L o n e l i n e s s . " A t l a n t i c Monthly 61 (1938):45-54. OTHERS 100 CHEK. "Man A l i v e . " November 8, 1976, "Alone, Not J u s t Me," Roy B o n i s t e l l . CHEK. "Man A l i v e . " November 15, 1976, "Alone: Your C h o i c e and Mine," Roy B o n i s t e l 1. F r a n c i s , G l o r i a , A s s o c i a t e P r o f e s s o r , N u r s i n g R e s e a r c h , V i r g i n i a Commonwealth U n i v e r s i t y , Richmond, V i r g i n i a . P e r s o n a l l e t t e r ; August 23, 1976. McLauchlan, Murray. The B o u l e v a r d . "As L o n e l y as You," High Romance Music L t d . , 1976. Sermat, V e l i o , P r o f e s s o r , Department o f P s y c h o l o g y , York U n i v e r s i t y , Downsview, O n t a r i o . P e r s o n a l l e t t e r , J u l y 5, 1976. . P r o f e s s o r , Department o f P s y c h o l o g y , York U n i v e r s i t y , Downsview, O n t a r i o . P e r s o n a l l e t t e r , August 18, 1976. . P r o f e s s o r , Department o f P s y c h o l o g y , York U n i v e r s i t y , Downsview, O n t a r i o . P e r s o n a l l e t t e r , September 21, 1976. . P r o f e s s o r , Department o f P s y c h o l o g y , York U n i v e r s i t y , Downsview, O n t a r i o . P e r s o n a l l e t t e r , November 5, 1976. . P r o f e s s o r , Department o f P s y c h o l o g y , York U n i v e r s i t y , Downsview, O n t a r i o . P e r s o n a l l e t t e r , November 14, 1976. 101; APPENDICES APPENDIX A SCHMIDT-SERMAT LONELINESS SCALE 103 Code s h e e t f o r SURVEY OF INTERPERSONAL RELATIONSHIPS which i s a LONELINESS SCALE d e v e l o p e d by Nancy Schmidt and V e l i o Sermat. TYPES OF INTERACTION The types o f i n t e r a c t i o n were c l a s s i f i e d i n t o f i v e f a c t o r s : I. P r e s e n c e vs. Absence o f the R e l a t i o n s h i p : T h i s f i r s t , g e n e r a l c a t e g o r y i n c l u d e s items i n t e n d e d t o a s s e s s whether o r not a p a r t i c u l a r r e l a t i o n s h i p need i s b e i n g f u l f i l l e d a t a l l . I t i n c l u d e s items p e r t a i n i n g to a t o t a l l a c k o f a p a r t i c u l a r r e l a t i o n s h i p and items c o n c e r n i n g an absence o f r e l a t i o n s h i p due to s i t u a t i o n a l f a c t o r s . I I . Approach vs. A v o i d a n c e o f the R e l a t i o n s h i p : T h i s c a t e g o r y i s composed o f items p e r t a i n i n g t o the t y p e s o f approach o r a v o i d a n c e b e h a v i o u r s i n which t h e i n d i v i d u a l engages w i t h r e f e r e n c e to a p a r t i c u l a r r e l a t i o n s h i p . The c a t e g o r y i s c o n c e p t u a l i z e d as i n c l u d i n g items l y i n g a l o n g a continuum from i n i t i a t i n g b e h a v i o u r s , t h r o u g h p a s s i v e b e h a v i o u r s , t o a v o i d a n c e b e h a v i o u r s . I n c l u d e d i n t h i s c a t e g o r y a r e items r e g a r d i n g the i n d i v i d u a l ' s p e r c e p t i o n s o f the approach o r a v o i d a n c e b e h a v i o u r s toward h i m s e l f o r s i g n i f i c a n t o t h e r s i n the r e l a t i o n s h i p . I I I . C o - o p e r a t i o n vs. Antagonism i n the R e l a t i o n s h i p : T h i s c a t e g o r y c o v e r s items d e s c r i b i n g the p r o v i s i o n o f h e l p i n g b e h a v i o u r s t o o t h e r s and the r e q u e s t i n g o f h e l p i n g b e h a v i o u r s from o t h e r s ; items i n v o l v i n g the i n d i v i d u a l i n working t o g e t h e r w i t h o t h e r s toward the achievement o f common g o a l s ; items r e f l e c t i n g the i n d i v i d u a l ' s p e r c e i v e d s u p p o r t from o t h e r s ; and f i n a l l y , items i n v o l v i n g f e e l i n g s o f r a p p o r t i n the r e l a t i o n s h i p . 104 IV. E v a l u a t i o n i n the R e l a t i o n s h i p : T h i s c a t e g o r y i n c l u d e s items c o n c e r n i n g the i n d i v i d u a l ' s e v a l u a t i o n o f h i m s e l f i n the r e l a t i o n s h i p , the i n d i v i d u a l ' s e v a l u a t i o n o f o t h e r s i n v o l v e d i n the r e l a t i o n s h i p , and the i n d i v i d u a l ' s p e r c e p t i o n o f o t h e r s ' e v a l u a t i o n o f h i m s e l f i n the r e l a t i o n s h i p . V. Communication i n t h e R e l a t i o n s h i p : T h i s c a t e g o r y i s composed o f items d e a l i n g w i t h the i n d i v i d u a l ' s p e r c e i v e d u n d e r s t a n d i n g o f o t h e r s , h i s p e r c e p t i o n s o f o t h e r s ' u n d e r s t a n d i n g o f h i m s e l f , and h i s p e r c e i v e d a b i l i t y t o e x p r e s s h i s own f e e l i n g s and thoughts toward o t h e r s i n the r e l a t i o n s h i p . Type o f R e l a t i o n s h i p The types o f r e l a t i o n s h i p were: A. Romantic-Sexual B. F r i e n d s , n o n - s e x u a l , non-romantic C. F a m i l y D. L a r g e r groups, community Each o f the t y p e s o f r e l a t i o n s h i p formed a: (1) p o s i t i v e c o r r e l a t i o n w i t h l o n e l i n e s s (2) n e g a t i v e c o r r e l a t i o n w i t h l o n e l i n e s s STATEMENT NUMBER AND FACTOR FOR THE SURVEY OF INTERPERSONAL RELATIONSHIPS (SCHMIDT-SERMAT LONELINESS SCALE) TYPE OF RELAT-IONSHIP CORRE-LATION STATEMENT NUMBER AND.FACTOR A POSITIVE 5 ( I ) 15 (V) 28 ( I I I ) 35 (IV) 41 (V) 58 ( H I ) -NEGATIVE 9 ( I I I ) 18 (IV) 21 (I ) 31 ( I I I ) 45 (I) 52 ( H I ) B POSITIVE 3 ( I I ) 13 ( I I ) . 16 ( I ) 19 ( H I ) 26 (V) 30 (I) 33 ( I I I ) 43 (V) 46 ( H I ) 51 (I) 53 ( I I ) 55 (IV) NEGATIVE 4 (V) 7 ( I ) 11 ( H I ) 22 (V) 24 ( I I ) 37 (I ) 39 ( H I ) 48 (I) 60 ( H I ) C POSITIVE 6 ( I I I ) 10 (ID 20 (V) 25 ( H I ) 32 (V) 34 (IV) 40 (V) 44 (IV) 54 (I) 57 ( I I ) NEGATIVE 1 (V) 14 (V) 23 ( I I I ) 29 ( I I I ) 36 (I ) 42 (I ) 47 (IV) 50 ( H I ) 59 (IV) D POSITIVE 2 ( I ) 8 ( I I I ) 12 (V) 27 (IV) 38 (IV) 49 ( H I ) NEGATIVE 17 ( I I I ) 56 (V) 106 SURVEY OF INTERPERSONAL RELATIONSHIPS  (SCHMIDT-SERMAT LONELINESS SCALE) I f i n d i t easy t o e x p r e s s f e e l i n g s o f a f f e c t i o n toward f a m i l y members. Most everyone around me i s a s t r a n g e r . I u s u a l l y w a i t f o r a f r i e n d t o c a l l me up and i n v i t e me out b e f o r e making p l a n s t o go anywhere. Most o f my f r i e n d s u n d e r s t a n d my m o t i v e s and r e a s o n i n g . My c u r r e n t r o m a n t i c and/or s e x u a l r e l a t i o n s h i p i s r e a l l y o n l y f o r c o n v e n i e n c e . I don't g e t a l o n g v e r y w e l l w i t h my f a m i l y . I have a t l e a s t one good f r i e n d o f the same sex. I c a n ' t depend on g e t t i n g moral o r f i n a n c i a l s u p p o r t from any group o r o r g a n i z a t i o n i n a time o f t r o u b l e . I am p r e s e n t l y i n v o l v e d i n a r o m a n t i c / m a r i t a l r e l a t i o n s h i p where a genuine e f f o r t a t c o o p e r a t i o n i s made by both p a r t n e r s . I o f t e n become shy and r e t i r i n g i n the company o f my r e l a t i v e s . Some o f my f r i e n d s w i l l s t a n d by me i n a l m o s t any d i f f i c u l t y . P e o p l e i n my community a r e n ' t r e a l l y i n t e r e s t e d i n what I t h i n k o r f e e l . My t r y i n g to have f r i e n d s and t o be l i k e d seldom succeeds t h e way I would l i k e i t t o . I spend time t a l k i n g i n d i v i d u a l l y w i t h each member o f my f a m i l y . I f i n d i t most d i f f i c u l t to t e l l anyone t h a t I l o v e him o r her. I don't have many f r i e n d s i n the c i t y where I l i v e . I work w e l l w i t h o t h e r s i n a group. I am an i m p o r t a n t p a r t o f the e m o t i o n a l and p h y s i c a l w e l l - b e i n g o f my l o v e r / s p o u s e . I don't f e e l t h a t I can t u r n t o my f r i e n d s l i v i n g around me f o r h e l p when I need i t . I don't t h i n k t h a t anyone i n my f a m i l y r e a l l y u n d e rstands me. I have a l o v e r / s p o u s e who f u l f i l l s many o f my emotional needs. 107 22) My f r i e n d s a r e g e n e r a l l y i n t e r e s t e d i n what I am d o i n g , a l t h o u g h not t o t h e p o i n t o f b e i n g nosy. 23) Members o f my f a m i l y e n j o y meeting my f r i e n d s . 24) I a l l o w m y s e l f t o become c l o s e t o my f r i e n d s . 25) My r e l a t i v e s a r e g e n e r a l l y too busy w i t h t h e i r c o n c e r n s t o worry about my problems. 26) Few o f my f r i e n d s u n d e r s t a n d me the way I want to be u n d e r s t o o d . 27) No one i n the community where I l i v e r e a l l y c a r e s much about me. 28) P r e s e n t l y I am f i n d i n g i t d i f f i c u l t to get a l o n g w i t h my l o v e r / s p o u s e . 29) Members o f my f a m i l y g i v e me the k i n d o f s u p p o r t t h a t I need. 30) A l o t o f my f r i e n d s h i p s u l t i m a t e l y t u r n o u t t o be p r e t t y d i s a p p o i n t i n g . 31) My r o m a n t i c / m a r i t a l p a r t n e r g i v e s me much s u p p o r t and encouragement. 32) I am not v e r y open w i t h members o f my f a m i l y . 33) I o f t e n f e e l r e s e n t f u l about c e r t a i n a c t i o n s o f my f r i e n d s . 34) I am embarrassed about the way my f a m i l y behaves. 35) People who say they a r e i n l o v e w i t h me a r e u s u a l l y o n l y t r y i n g to r a t i o n a l i z e u s i n g me f o r t h e i r own p u r p o s e s . 36) I have a good r e l a t i o n s h i p w i t h most members o f my immediate f a m i l y . 37) In my f r i e n d s h i p s , I am g e n e r a l l y a b l e t o e x p r e s s both p o s i t i v e and n e g a t i v e f e e l i n g s . 38) I don't get much s a t i s f a c t i o n from the groups I a t t e n d . 39) I get p l e n t y o f h e l p and s u p p o r t from my f r i e n d s . 40) I seem t o have l i t t l e t o say t o members o f my f a m i l y . 41) I don't have any one s p e c i a l l o v e r e l a t i o n s h i p i n which I f e e l r e a l l y u n d e r s t o o d . 42) I r e a l l y f e e l t h a t I b e l o n g t o a f a m i l y . 43) I have few f r i e n d s w i t h whom I can t a l k o p e n l y . 44) My f a m i l y i s q u i t e c r i t i c a l o f me. 45) I have an a c t i v e l o v e l i f e . 108 46) I have few f r i e n d s t h a t I can r e a l l y depend on t o f u l f i l l t h e i r end o f mutual commitments. 47) G e n e r a l l y I f e e l t h a t members o f my f a m i l y acknowledge my s t r e n g t h s and p o s i t i v e q u a l i t i e s . 48) I have a t l e a s t one r e a l f r i e n d . 49) I don't have any ne i g h b o u r s who would h e l p me o u t i n a time o f need. 50) Members o f my f a m i l y a r e r e l a x e d and e a s y - g o i n g w i t h each o t h e r . 51) I have moved around so much t h a t I f i n d i t d i f f i c u l t to m a i n t a i n l a s t i n g f r i e n d s h i p s . 52) I tend t o get a l o n g w e l l w i t h p a r t n e r s i n r o m a n t i c r e l a t i o n s h i p s . 53) I f i n d i t d i f f i c u l t t o i n v i t e a f r i e n d t o do something w i t h me. 54) I have l i t t l e c o n t a c t w i t h members o f my f a m i l y . 55) My f r i e n d s don't seem t o s t a y i n t e r e s t e d i n me f o r v e r y l o n g . 56) There a r e pe o p l e i n my community who un d e r s t a n d my views and b e l i e f s . 57) As much as p o s s i b l e , I a v o i d members o f my f a m i l y . 58) I seldom g et the emotional s e c u r i t y I need f o r a good r o m a n t i c / s e x u a l r e l a t i o n s h i p . 59) My f a m i l y u s u a l l y v a l u e s my o p i n i o n when a f a m i l y d e c i s i o n i s t o be made. 60) Most o f my f r i e n d s a r e g e n u i n e l y c o ncerned about my w e l f a r e . APPENDIX B CLIENT PROGRESS NOTES AS CHARTED BY THERAPISTS PROGRESS NOTES THERAPIST CODE NUMBER: CLIENT CODE NUMBER: DATE: LENGTH OF SESSION: CHARTING: ( I ) WHAT WAS DISCUSSED? ( I I ) WHAT SUGGESTIONS WERE MADE TO THE CLIENT IN RELATION TO WHAT WAS DISCUSSED? APPENDIX C PROGRESS RATING BY THERAPISTS PROGRESS RATING BY THERAPISTS C o n t r o l E x p e r i m e n t a l Rate y o u r p r o g r e s s i n p s y c h o t h e r a p y w i t h a c l i e n t i d e n t i f i e d as t e s t i n g high i n l o n e l i n e s s . The r a t i n g s c a l e i s from "1" t o "6" where "1" i n d i c a t e s the l e a s t amount o f p r o g r e s s and where "6" i n d i c a t e s t he most amount o f p r o g r e s s . T h e r a p i s t ' s Code Number C l i e n t ' s Code Number L e a s t amount o f p r o g r e s s Much l e s s Less More Much more Most amount o f p r o g r e s s APPENDIX D SATISFACTION RATING BY THERAPIST SATISFACTION RATING BY THERAPISTS C o n t r o l T h e r a p i s t ' s Code Number E x p e r i m e n t a l C l i e n t ' s Code Number Rate y o u r s a t i s f a c t i o n i n a t t e m p t i n g l o n e ! i n e s s ' i n t e r v e n t i o n w i t h a c l i e n t i d e n t i f i e d as t e s t i n g h i g h i n l o n e l i n e s s . The r a t i n g s c a l e i s from "1" t o "5" where "1" i n d i c a t e s v e r y low s a t i s f a c t i o n and "5" i n d i c a t e s v e r y h i g h s a t i s f a c t i o n . \ Very low s a t i s f a c t i o n Low Average High Very h i g h s a t i s f a c t i o n 115 APPENDIX E LONELINESS INSERVICE EDUCATION: O b j e c t i v e s , C o n t e n t , and T e a c h i n g A c t i o n INSERVICE ON LONELINESS 116 L e a r n e r s ' Readiness Mental h e a l t h t h e r a p i s t s who were employed a t a Community Mental H e a l t h Care Team f o r the G r e a t e r Vancouver a r e a p a r t i c i p a t e d i n an " I n s e r v i c e on L o n e l i n e s s . " The t h e r a p i s t s were o f v a r i o u s p r o f e s s i o n a l backgrounds ( P s y c h i a t r y , S o c i o l o g y , N u r s i n g , S o c i a l Work) and had e x p e r i e n c e i n the f i e l d o f mental h e a l t h . The f o u r t h e r a p i s t s i n v o l v e d i n t he r e s e a r c h s t u d y p a r t i c i p a t e d i n t h e " I n s e r v i c e on L o n e l i n e s s " as t h i s was the b a s i s f o r PART II o f t h e r e s e a r c h s t u d y . They e x p r e s s e d t h a t they were not f a m i l i a r w i t h t h e c o n c e p t o f l o n e l i n e s s . The " I n s e r v i c e on L o n e l i n e s s " was conducted on two days f o r two hours each day. A L o n e l i n e s s Manual ( d e v e l o p e d by t h e i n v e s t i g a t o r ) supplemented the I n s e r v i c e . The f o u r t h e r a p i s t s who were i n v o l v e d i n the r e s e a r c h s t u d y each r e c e i v e d a r e f e r e n c e manual which e x p l a i n e d l o n e l i n e s s , l o n e l i n e s s a n x i e t y , l o n e l i n e s s b e h a v i o u r s , and l o n e l i n e s s i n t e r v e n t i o n s . P r e v i o u s t o t h e " I n s e r v i c e on L o n e l i n e s s , " t h e r a p i s t s completed t h e Schmidt-Sermat L o n e l i n e s s S c a l e and t h e r e f o r e t h e y were aware o f t h e i r own l o n e l i n e s s s c o r e . They a l s o were aware o f c l i e n t s who t e s t e d high i n l o n e l i n e s s , and c o u l d d i s c u s s t h e s e c l i e n t s a t the I n s e r v i c e . OBJECTIVES 117 UPON HAVING PARTICIPATED IN AN "INSERVICE ON LONELINESS," A THERAPIST WILL BE ABLE TO: 1. SUPPORT THE PHENOMENA OF LONELINESS AS HAVING RELEVANCE TO MENTAL HEALTH: 1.1 d e f i n e l o n e l i n e s s based upon p e r s o n a l e x p e r i e n c e o r o b s e r v a t i o n . 1.2 u n d e r s t a n d t h e phenomena o f l o n e l i n e s s as e x p l a i n e d by e x p e r t s i n the f i e l d o f l o n e l i n e s s , such as F r i e d a Fromm-Reichmann and C l a r k E. Moustakas. 1.3 i d e n t i f y a t l e a s t t h r e e t y p e s o f l o n e l i n e s s . 1.4 e x p l a i n a t l e a s t t h r e e t y p e s o f l o n e l i n e s s . 1.5 g i v e an example o f a s i t u a t i o n where an i n d i v i d u a l may e n c o u n t e r a s p e c i f i c t y p e o f l o n e l i n e s s . 1.6 d e f i n e p r i m a r y and secondary l o n e l i n e s s . 1.7 d i s t i n g u i s h between p r i m a r y and s e c o n d a r y l o n e l i n e s s i n l i f e s i t u a t i o n s . 1.8 i n t e g r a t e knowledge on f e e l i n g s w i t h the f e e l i n g o f l o n e l i n e s s . 1.9 f o r m u l a t e a new p e r s p e c t i v e towards t h e phenomena o f l o n e l i n e s s i n mental h e a l t h . 1.10 g e n e r a t e an i n t e r e s t i n the need f o r the acknowledgement o f the phenomena o f l o n e l i n e s s i n mental h e a l t h . 118 2. JUDGE IF A CLIENT IS INCURRING LONELINESS: 2.1 i d e n t i f y the c h a r a c t e r i s t i c s o f an i n d i v i d u a l i n c u r r i n g l o n e l i n e s s . 2.2 i d e n t i f y a t l e a s t t h r e e groups o f i n d i v i d u a l s i n s o c i e t y who a r e hig h r i s k s f o r l o n e l i n e s s . 2.3 understand the f e e l i n g s b e i n g i n c u r r e d by an i n d i v i d u a l e x p e r i e n c i n g l o n e l i n e s s . 2.4 understand the f i v e r e a s o n s why bad f e e l i n g s o c c u r due t o l o n e l i n e s s . 2.5 r e c o g n i z e t he c h a r a c t e r i s t i c s o f l o n e l i n e s s i n c l i e n t s p r e v i o u s l y i d e n t i f i e d as t e s t i n g high i n l o n e l i n e s s by the Schmidt-Sermat L o n e l i n e s s  S c a l e . 2.6 i n t e g r a t e knowledge o f c l i e n t s ' l i f e s i t u a t i o n s w i t h c l i e n t s ' l o n e ! i n e s s . 3. JUDGE THE LONELINESS ANXIETY OF A CLIENT AS A BASIS FOR PSYCHOTHERAPY: 3.1 d e f i n e l o n e l i n e s s a n x i e t y based upon p e r s o n a l e x p e r i e n c e o r o b s e r v a t i o n . 3.2 understand the phenomena o f l o n e l i n e s s a n x i e t y as e x p l a i n e d by e x p e r t s i n the f i e l d o f l o n e l i n e s s , such as F r i e d a Fromm-Reichmann and C l a r k E. Moustakas. 3.3 r e l a t e c u r r e n t knowledge o f a n x i e t y t o l o n e l i n e s s a n x i e t y . 3.4 r e c o g n i z e t he l o n e l i n e s s a n x i e t y b e h a v i o u r b e i n g e x h i b i t e d by a c l i e n t . 3.5 r e l a t e a c l i e n t ' s l o n e l i n e s s t o the l o n e l i n e s s a n x i e t y p o s s i b l y b e i n g e x p e r i e n c e d by the c l i e n t . 3.6 p l a n l o n e l i n e s s i n t e r v e n t i o n i n p s y c h o t h e r a p y based on a c l i e n t ' s l o n e l i n e s s a n x i e t y . r-119 3.7 propose a p l a n f o r , l o n e l i n e s s i n t e r v e n t i o n t o d e c r e a s e a c l i e n t ' s l o n e l i n e s s a n x i e t y . 4. JUDGE THE LONELINESS BEHAVIOUR OF A CLIENT: 4.1 i d e n t i f y s p e c i f i c l o n e l i n e s s b e h a v i o u r . 4.2 d e s c r i b e t he l o n e l i n e s s b e h a v i o u r . 4.3 r e c o g n i z e t h e l o n e l i n e s s b e h a v i o u r o f a c l i e n t who had p r e v i o u s l y been i d e n t i f i e d as t e s t i n g h i g h i n l o n e l i n e s s by the Schmidt-Sermat  L o n e l i n e s s S c a l e . 4.4 f o r m u l a t e an o v e r v i e w o f the g e n e r a l b e h a v i o u r o f c l i e n t s i n c u r r i n g l o n e l i n e s s and l o n e l i n e s s a n x i e t y . 4.5 r e l a t e l o n e l i n e s s b e h a v i o u r t o l o n e l i n e s s a n x i e t y f o r a c l i e n t t e s t i n g h i g h i n l o n e l i n e s s . 5. JUDGE THE NEEDS OF THE CLIENT INCURRING LONELINESS: 5.1 r e c o g n i z e t he l o n e l i n e s s o f a c l i e n t based upon t h e l i f e - s t y l e o f the c l i e n t . 5.2 r e c o g n i z e t he p r o b l e m ( s ) o r d i f f i c u l t i e s b e i n g e n c o u n t e r e d by t h e l o n e l y c l i e n t . 5.3 e v a l u a t e the p a i n o f l o n e l i n e s s which a c l i e n t may i n c u r . 5.4 i n t e g r a t e knowledge o f l o n e l i n e s s w i t h r e a l i s t i c s u g g e s t i o n s t o a s s i s t a c l i e n t to d e c r e a s e l o n e l i n e s s and/or l o n e l i n e s s a n x i e t y . 1 20 6. JUDGE APPROPRIATE LONELINESS INTERVENTION IN PSYCHOTHERAPY WITH THE CLIENT WHO IS INCURRING LONELINESS AND/OR LONELINESS ANXIETY: 6.1 know s p e c i f i c l o n e l i n e s s i n t e r v e n t i o n f o r s p e c i f i c l o n e l i n e s s b e h a v i o u r . 6.2 r e c o g n i z e t he need t o a l l e v i a t e o r a s s i s t the c l i e n t t o cope w i t h l o n e l i n e s s and/or l o n e l i n e s s a n x i e t y . 6.3 r e c o g n i z e t he need t o implement a p p r o p r i a t e l o n e l i n e s s i n t e r v e n t i o n f o r t he most l i k e l y t h e r a p e u t i c b e n e f i t f o r the c l i e n t . 6.4 propose a p p r o p r i a t e l o n e l i n e s s i n t e r v e n t i o n based on l o n e l i n e s s b e h a v i o u r demonstrated by the c l i e n t . 7. CONDUCT PSYCHOTHERAPY WITH A CLIENT WHO IS INCURRING LONELINESS AND/OR LONELINESS ANXIETY: 7.1 i d e n t i f y a c l i e n t who i s i n c u r r i n g l o n e l i n e s s and/or l o n e l i n e s s a n x i e t y . 7.2 r e c o g n i z e t h e need f o r l o n e l i n e s s i n t e r v e n t i o n i n p s y c h o t h e r a p y . 7.3 u n d e r s t a n d v a r i o u s c o n c e p t u a l i z a t i o n s o f the psychodynamics o f l o n e l i n e s s d e v e l o p e d by v a r i o u s e x p e r t s i n t h e f i e l d o f l o n e l i n e s s as w e l l as by t h i s w r i t e r . 7.4 c o n c e p t u a l i z e t he phenomena o f l o n e l i n e s s based upon v a r i o u s c o n c e p t u a l i z a t i o n s o f l o n e l i n e s s . 7.5 implement l o n e l i n e s s i n t e r v e n t i o n t o a s s i s t t he c l i e n t t o cope w i t h o r a l l e v i a t e l o n e l i n e s s and/or l o n e l i n e s s a n x i e t y . 7.6 a p p l y a c o n c e p t u a l i z a t i o n o f t h e psychodynamics o f l o n e l i n e s s when i n i t i a t i n g l o n e l i n e s s i n t e r v e n t i o n . 8. DEMONSTRATE CONFIDENCE IN IMPLEMENTING LONELINESS INTERVENTION DURING PSYCHOTHERAPY WITH A CLIENT IDENTIFIED AS TESTING HIGH IN LONELINESS BY THE SCHMIDT-SERMAT LONELINESS SCALE. 8.1 a c c e p t r e s p o n s i b i l i t y f o r m a i n t a i n i n g a p s y c h o t h e r a p e u t i c r e l a t i o n s h i p w i t h a c l i e n t t e s t i n g h i g h i n l o n e l i n e s s . 8.2 conduct l o n e l i n e s s i n t e r v e n t i o n i n p s y c h o t h e r a p y w i t h a c l i e n t t e s t i n g h i g h i n l o n e l i n e s s . 122 TEACHING CONTENT AND TEACHING ACTION FOR INSERVICE ON LONELINESS CONTENT TEACHING ACTION GENERAL APPROACH: 1. F a c i l i t a t e d i s c u s s i o n on: - l o n e l i n e s s - l o n e l i n e s s a n x i e t y - l o n e l i n e s s i n t e r v e n t i o n i n r e l a t i o n t o s p e c i f i c l o n e l i n e s s b e h a v i o u r 2. Encourage a c t i v e p a r t i c i p a t i o n i n " l o n e l i n e s s e x e r c i s e s . " E x e r c i s e 1: (See page 127) An e x p e r i e n c e o f " s i t u a t i o n a l l o n e l i n e s s . " The means to e x p e r i e n c e a t y p e o f l o n e l i n e s s and what one can do t o a l l e v i a t e o r cope w i t h l o n e l i n e s s a n x i e t y . The p r o c e s s o f c o p i n g w i t h v a r i o u s l e v e l s o f l o n e l i n e s s . P r o v i d e d i r e c t i o n s f o r E x e r c i s e 1. Conduct the e x e r c i s e . What f e e l i n g s d i d you e x p e r i e n c e i n : ( i ) t h e f i r s t minute? ( i i ) t h e second minute? ( i i i ) the t h i r d minute? ( i v ) t he f o u r t h minute? ( l i s t f e e l i n g s t h a t were e x p e r i e n c e d d u r i n g t he e x e r c i s e ) . Can you d e s c r i b e t he p r o c e s s o f l o n e l i n e s s t h a t you i n c u r r e d i n E x e r c i s e #1? How was the l o n e l i n e s s a l l e v i a t e d ? D e f i n e l o n e l i n e s s . Can you d e f i n e l o n e l i n e s s drawing upon y o u r p e r s o n a l e x p e r i e n c e w i t h l o n e l i n e s s o r o b s e r v a t i o n s t h a t you have made? 123 CONTENT 'TEACHING ACTION E x p l a i n t h e phenomena o f l o n e l i n e s s as d e s c r i b e d by Fromm-Reichmann, Moustakas, and o t h e r e x p e r t s on l o n e l i n e s s . Are t h e r e q u e s t i o n s ? Do you agree o r d i s a g r e e w i t h w i t h the views e x p r e s s e d by: - Fromm-Reichmann? - Moustakas? Types o f l o n e l i n e s s . The e x e r c i s e on " s i t u a t i o n a l l o n e l i n e s s " was a t y p e o f l o n e l i n e s s . Can you s u g g e s t o t h e r t y p e s o f l o n e l i n e s s ? D e f i n e p r i m a r y and s e c o n d a r y l o n e l i n e s s . Given an example o f l o n e l i n e s s i n a l i f e s i t u a t i o n . R e l a t e t h i s t o p r i m a r y and s e c o n d a r y l o n e l i n e s s . Can you d i s t i n g u i s h between p r i m a r y and secondary l o n e l i n e s s i n a l i f e s i t u a t i o n ? E x e r c i s e 2: (See page 128) Draw a " L i f e - L i n e " on l o n e l i n e s s i n y o u r 1 i f e . G i v e d i r e c t i o n s on how t o draw a l i f e - l i n e on l o n e l i n e s s . A l i f e - l i n e on l o n e l i n e s s f o r m y s e l f w i l l be on a b r i s t l e board f o r r e f e r e n c e . E x e r c i s e 3: (See page 131) A means to f a c i l i t a t e f u r t h e r d i s c u s s i o n by l i s t e n i n g t o a song which i s r e c o r d e d . C h a r a c t e r i s t i c s o f t h e l o n e l y . What c h a r a c t e r i s t i c s o f l o n e l i n e s s were e v i d e n t i n t h e female p o r t r a y e d as b e i n g l o n e l y i n t h e song? Groups o f i n d i v i d u a l s i n s o c i e t y who a r e h i g h r i s k s f o r l o n e l i n e s s . What types o f i n d i v i d u a l s i n s o c i e t y have you o b s e r v e d as b e i n g l o n e l y ? 124 CONTENT TEACHING ACTION F e e l i n g s i n c u r r e d by the i n d i v i d u a l e x p e r i e n c i n g l o n e l i n e s s . F i v e r e a s o n s why an i n d i v i d u a l e x p e r i e n c e s bad f e e l i n g s w i t h l o n e l i n e s s ? L i f e s i t u a t i o n s as an i n f l u e n c e on l o n e l i n e s s . What t y p e s o f f e e l i n g s does a l o n e l y i n d i v i d u a l e x p e r i e n c e ? The f i v e r e a s o n s w i l l be l i s t e d on a b r i s t l e board (see page 129) What types o f l i f e s i t u a t i o n s were the c l i e n t s who t e s t e d h i g h i n l o n e l i n e s s i n v o l v e d i n ? D e f i n e l o n e l i n e s s a n x i e t y . E x p l a i n the phenomena o f l o n e l i n e s s a n x i e t y a c c o r d i n g t o e x p e r t s on l o n e l i n e s s a n x i e t y such as Fromm-Reichmann and Moustakas. D e f i n e l o n e l i n e s s a n x i e t y based upon y o u r p e r s o n a l e x p e r i e n c e s w i t h l o n e l i n e s s o r upon y o u r e x p e r i e n c e w i t h c l i e n t s . Can you draw upon y o u r knowledge o f a n x i e t y and r e l a t e i t t o l o n e l i n e s s a n x i e t y ? I n t r o d u c t i o n t o a: " Conceptual Model f o r L o n e l i n e s s I n t e r v e n t i o n . " ( d e s i g n e d by t h i s i n v e s t i g a t o r ) U n d e r s t a n d i n g t h i s framework as i t would be implemented i n p s y c h o t h e r a p y w i t h a c l i e n t t e s t i n g high i n l o n e l i n e s s w i l l be e x p l a i n e d . A b r i s t l e board w i t h the c o n c e p t u a l model w i l l be u t i l i z e d . Is t h e r e a need to d e c r e a s e a c l i e n t ' s l o n e l i n e s s a n x i e t y ? What p o s s i b l e s u g g e s t i o n s would you g i v e t o d e c r e a s e the a n x i e t y ? Draw upon e x p e r i e n c e s w i t h c l i e n t s who were e x p e r i e n c i n g l o n e l i n e s s a n x i e t y . 125 CONTENT TEACHING ACTION I d e n t i f y s p e c i f i c l o n e l i n e s s b e h a v i o u r . D e s c r i b e s p e c i f i c l o n e l i n e s s b e h a v i o u r s . R e l a t e l o n e l i n e s s b e h a v i o u r t o l i f e - s i t u a t i o n s . The need t o a l l e v i a t e o r a s s i s t a c l i e n t t o cope w i t h l o n e l i n e s s and/or l o n e l i n e s s a n x i e t y . What b e h a v i o u r s would i n d i c a t e l o n e l i n e s s and/or l o n e l i n e s s a n x i e t y ? Can you d e s c r i b e l o n e l i n e s s b e h a v i o u r ? Why would you see a need t o a l l e v i a t e o r a s s i s t a c l i e n t t o cope w i t h l o n e l i n e s s and/or l o n e l i n e s s a n x i e t y ? E x e r c i s e 4: (See page 130) "Twenty a c t i v i t i e s one does": a means to acknowledge what one does and t o d e v e l o p i n s i g h t i n t o how one f e e l s . B r i s t l e board t o d e s c r i b e the assessment o f t h e a c t i v i t i e s . The need t o u t i l i z e a p p r o p r i a t e l o n e l i n e s s i n t e r v e n t i o n f o r the most l i k e l y t h e r a p e u t i c e f f e c t i n p s y c h o t h e r a p y . A p p r o p r i a t e l o n e l i n e s s i n t e r v e n t i o n s f o r each l o n e l i n e s s b e h a v i o u r . Have t h e r a p i s t s complete a: - "Do-Plan" - " D a i l y L i v i n g S c h e d u l e " - " A l t e r n a t i v e s t o a D a i l y L i v i n g S c h e d u l e " The need t o b u i l d on the p o s i t i v e s t r e n g t h s o f a c l i e n t . P r o v i d e t h e r a p i s t s w i t h a p e r s o n a l r e f e r e n c e manual which d e s c r i b e s : - l o n e l i n e s s - l o n e l i n e s s a n x i e t y - l o n e l i n e s s b e h a v i o u r - l o n e l i n e s s i n t e r v e n t i o n s (as d e v e l o p e d by t h i s i n v e s t i g a t o r ) CONTENT TEACHING ACTION ' Summary: S h o r t o v e r v i e w on: - l o n e l i n e s s - l o n e l i n e s s a n x i e t y - l o n e l i n e s s b e h a v i o u r - l o n e l i n e s s i n t e r v e n t i o n Answer q u e s t i o n s C l o s i n g Quote: I r a Tanner, L o n e l i n e s s : v The F e a r o f Love, (New York: Harper and Row P u b l i s h e r s , 1973), p. x i . (See page 1)• Read quote t o t h e r a p i s t s . E x e r c i s e 1 ( D i r e c t i o n s ) Awareness o f "SITUATIONAL LONELINESS" (A f o u r minute e x e r c i s e ) D i r e c t i o n s : - w a l k a i m l e s s l y around a room - do not v e r b a l l y communicate t o anyone - f o l l o w i n s t r u c t i o n s b e i n g g i v e n d u r i n g t h e e x e r c i s e ( i ) f o r t h e f i r s t minute: - do not l o o k a t anyone i n t h e room, you may l o o k a t o b j e c t s i n t he room. - keep w a l k i n g ( i i ) f o r the second minute: i - l o o k a t the p e o p l e i n the room, no v e r b a l communication. - keep w a l k i n g ( i i i ) f o r t h e t h i r d minute: - l o o k the p e o p l e d i r e c t l y i n the eye and say o n l y " h i . " - keep w a l k i n g ( i v ) f o r the f o u r t h minute: - l o o k the p e o p l e i n t h e eye and say hi by name, shake hands w i t h the p e r s o n , and t a l k f r e e l y . - keep w a l k i n g 128 E x e r c i s e 2 L i f e - L i n e ( P e r s o n a l Awareness o f L o n e l i n e s s ) B i r t h Grade One THE BAD FEELINGS CREATED BY LONELINESS LONELINESS CREATES BAD FEELINGS BECAUSE THEY 4r DO NOT TELL US WHAT TO DO TO FEEL GOOD AGAIN THE PAIN OF BAD FEELINGS TENDS TO OVERWHELM THE PSYCHE, MAKING IT HARD TO KNOW WHAT TO DO TO ALLEVIATE OR COPE WITH THE BAD FEELINGS IN ORDER TO ALLEVIATE, COPE WITH, OR OVERCOME THE BAD FEELINGS, ONE HAS TO LEARN WHAT TO DO BECAUSE BAD FEELINGS TEND TO MAKE US FEEL WORSE Edward Ford and Robert Z o r n , Why Be L o n e l y ? p.23-37. 4> E x e r c i s e 4 L i s t twenty a c t i v i t i e s you l i k e t o do: 1. Swim 2. K i s s 3. Go t o the t h e a t r e 4. Eat a p p l e s 5. W a t e r - s k i 6. Snow-ski 7. Read n o v e l s 8. T a l k to my mother 9. Go s h o p p i n g w i t h my s i s t e r 10. D i s c u s s p o l i t i c s w i t h my f a t h e r 20. Ride my b i c y c l e . Rate the twenty a c t i v i t i e s a c c o r d i n g t o : R = R i s k i n v o l v e d W = I f you d i d i t l a s t week A = I f you do i t a l o n e 0 = I f you do i t w i t h o t h e r s B = I f you would l i k e t o do i t b e t t e r 131 AS LOMELY AS YOU Song by. MunAay McLauchliXn I think oi youn n.oom, I think oi you. thefie, I think oi you dnagging YouA body upAtcuAA, With yout bed and youn chain. And youn. Atale. peAiume., I neveA know anybody A* lonely ai> you. Youn loveAA leave, Be.ion.z it'A daylight, They want it ion. iun, You want it ion. Hie., And you get -60 angn.y li the.y tell you the. tAutk, I neveA knew anybody AA lonety a* you. In my mind, youn. iace. di&appeaAA, But I &till &ze. youn. e.yeA, The.y look like. the.y've. hean.d too many lie*, The.y neveA *e.em to look JbtAoight into mine., Thesy have nothing le.it to lote. by waiting time.. I can't &tand to i>e.e, I can't look when you cAy, I can't help you no how, I'm too &eJLiit>h to tn.y, I wi&h theAe. WOA something Somebody could do, I've. neveA known anybody Ai lonely a* you. I've neveA known anybody Ai> lonely ai> you. Murray McLauchlan, The B o u l e v a r d "As L o n e l y as You," High Romance L t d . , 1976. APPENDIX F THERAPIST AND CLIENT SELECTION CODING THERAPISTS AND CLIENTS CODE SHEET 133 THERAPIST NUMBER THERAPIST'S CODE NUMBER CLIENT'S CODE NUMBER CONTROL EXPERIMENTAL 1 10 11 15 12 16 13 17 14 18 2 20 21 25 ?? 26 23 27 24 28 3 30 31 3R 32 36 33 37 34 38 4 40 41 45 42 46 43 47 , 44 48 134' APPENDIX G CONSENT FORM FOR PARTICIPATION IN RESEARCH CONSENT FORM FOR EARTICIPATION IN A SURVEY OF INTERPERSONAL RELATIONSHIPS I c o n s e n t t o p a r t i c i p a t e i n t h i s "Survey o f I n t e r p e r s o n a l R e l a t i o n s h i p s . " I agr e e t o complete a q u e s t i o n n a i r e which w i l l t a k e a p p r o x i m a t e l y f i v e t o f i f t e e n minutes. A t a l a t e r date I may be asked to complete a n o t h e r q u e s t i o n n a i r e . / I u n d e r s t a n d t h a t I do not have t o p a r t i c i p a t e i n t h i s s u r v e y and t h a t a t any time I may withdraw. My i d e n t i t y i n t h i s s u r v e y w i l l be kept anonymous. Date S i g n a t u r e Witness APPENDIX H THERAPIST IDENTIFICATION SHEET IDENTIFICATION: THERAPISTS 137 THERAPIST'S CODE NUMBER: SEX: ADDRESS: AGE: MARITAL STATUS: PLACE OF BIRTH: RELIGION: LENGTH OF TIME LIVING IN VANCOUVER: LANGUAGE(S): SPOKEN WRITTEN EDUCATION: LENGTH OF EMPLOYMENT AT THE CLINIC: PAST EMPLOYMENT: FAMILY OR SIGNIFICANT OTHERS: LIVING SITUATION: PAST HOSPITAL ADMISSION(S): HOBBIES, SPORTS, OR AREAS OF INTEREST: APPENDIX I CLIENT IDENTIFICATION SHEET IDENTIFICATION: CLIENT 139 CLIENT'S CODE NUMBER: SEX: ADDRESS: AGE: MARITAL STATUS: PLACE OF BIRTH: RELIGION: LENGTH OF TIME LIVING IN VANCOUVER: LANGUAGE(S): SPOKEN / WRITTEN EDUCATION: DATE OF REFERRAL TO THE CLINIC: REFERRAL SOURCE: REASON FOR REFERRAL: PRESENT DIAGNOSIS: PREVIOUS HOSPITAL ADMISSIONS: PREVIOUS PSYCHIATRIC HISTORY: FAMILY AND SIGNIFICANT OTHERS: EMPLOYMENT SITUATION: FINANCIAL SITUATION: LIVING SITUATION: HOBBIES, SKILLS, SPORTS, AREAS OF INTEREST: APPENDIX J SHORT FORM OF SCHMIDT-SERMAT LONELINESS SCALE SURVEY STATEMENTS WHICH COMPRISE THE SHORT FORM OF SURVEY OF INTERPERSONAL RELATIONSHIPS 141: RELATION-SHIP TYPE CORRELATION WITH LONE-LINESS TWO STATEMENTS SELECTED FROM LONELINESS SCALE BY RANDOM SAMPLING NUMBER 1 NUMBER 2 A POSITIVE 15 (V) 41 (V) NEGATIVE 9 ( I I I ) 21 ( I ) B POSITIVE 46 ( I I I ) 53 ( I I ) NEGATIVE 24 ( I I ) 60 ( I I I ) C POSITIVE 32 (V) 44 (IV) NEGATIVE 29 ( I I I ) 47 (IV) D POSITIVE 8 ( H I ) 12 (V) NEGATIVE 17 ( I I I ) 56 (V) SURVEY OF INTERPERSONAL RELATIONSHIPS (SHORT FORM) 1) I c a n ' t depend on g e t t i n g moral o r f i n a n c i a l s u p p o r t from any group o r o r g a n i z a t i o n i n a time o f t r o u b l e . 2) I am p r e s e n t l y i n v o l v e d i n a r o m a n t i c / m a r i t a l r e l a t i o n s h i p where a genuine e f f o r t a t c o o p e r a t i o n i s made by both p a r t n e r s . 3) P e o p l e i n my community a r e n ' t r e a l l y i n t e r e s t e d i n what I t h i n k o r f e e l . 4) I f i n d i t most d i f f i c u l t t o t e l l anyone t h a t I l o v e him o r her. 5) I work w e l l w i t h o t h e r s i n a group. 6) I have a l o v e r / s p o u s e who f u l f i l l s many o f my e m o t i o n a l needs. 7) I a l l o w m y s e l f t o become c l o s e t o my f r i e n d s . 8) Members o f my f a m i l y g i v e me the k i n d o f s u p p o r t t h a t I need. 9) I am not v e r y open w i t h members o f my f a m i l y . 10) I don't have any one s p e c i a l l o v e r e l a t i o n s h i p i n which I f e e l r e a l l y u n d e r s t o o d . 11) My f a m i l y i s q u i t e c r i t i c a l o f me. 12) I have few f r i e n d s t h a t I can r e a l l y depend on t o f u l f i l l t h e i r end o f mutual commitments. 14) I f i n d i t d i f f i c u l t t o i n v i t e a f r i e n d to do something w i t h me. 15) There a r e p e o p l e i n my community who u n d e r s t a n d my views and b e l i e f s . 16) Most o f my f r i e n d s a r e g e n u i n e l y c o n c e r n e d about my w e l f a r e . \ APPENDIX K DATA SHEET ON LONELINESS TEST SCORES FOR CLIENTS DATA SHEET FOR THERAPIST'S IDENTIFICATION OF LONELINESS BEHAVIOUR(S) AND INTERVENTIONS C l i e n t L o n e l i n e s s Scores  P r e - t e s t and P o s t - t e s t S c o r e s f o r C o n t r o l and Comparison Groups 144-CONTROL GROUP ' COMPARISON GROUP PRE-TEST POST-TEST PRE-TEST POST-TEST 145 Frequency o f C h a r t i n g by T h e r a p i s t s on  L o n e l i n e s s B e h a v i o u r s and L o n e l i n e s s I n t e r v e n t i o n s  f o r C o n t r o l and Comparison Groups (1) FREQUENCY ( f ) OF LONELINESS BEHAVIOURS (L.B.) PER CLIENT (2) FREQUENCY ( f ) OF LONELINESS INTERVENTIONS ( L . I PER CLIENT) PSYCHOTHERAPY SESSION 1 2 3 4 5 6 (1) CONTROL GROUP: f OF L.B./CLIENT TOTAL CLIENTS (2) CONTROL GROUP: f OF L.I./CLIENT TOTAL CLIENTS (1) COMPARISON GROUP: f OF L.B./CLIENT TOTAL CLIENTS (2) COMPARISON GROUP: f o f L.I./CLIENT TOTAL CLIENTS -.146 APPENDIX L STRUCTURED END INTERVIEW WITH THERAPISTS 147 S t r u c t u r e d E n d - I n t e r v i e w With T h e r a p i s t s What i s y o u r r e a c t i o n t o implementing t h e c o n c e p t u a l model f o r l o n e l i n e s s i n t e r v e n t i o n ? What do you view the advantages t o implementing the c o n c e p t u a l model f o r l o n e l i n e s s i n t e r v e n t i o n ? What do you view the d i s a d v a n t a g e s t o implementing the c o n c e p t u a l model f o r l o n e l i n e s s i n t e r v e n t i o n ? ~y Do you f i n d the c o n c e p t u a l model f o r l o n e l i n e s s i n t e r v e n t i o n u s e f u l ? Do you f i n d t h e c o n c e p t u a l model f o r l o n e l i n e s s i n t e r v e n t i o n d i f f i c u l t t o implement? What s u g g e s t i o n s would you make f o r l o n e l i n e s s i n t e r v e n t i o n ? APPENDIX M CORRESPONDENCE WITH DR. VELLO SERMAT Please return to: Prof. V. Sermat Department of Psychology Office York University phone: Downsview, Ont. M3J IP3 Canada A Survey of Interpersonal Experiences [Form IVa, 19741 Your name (omit, i f you prefer anonymity) _ Q male | | female Age Education: Your country of birth: Town: How long have you lived in your / „ ... (province, state) _ , „ * l»«lr>« TVc. ivtulTrtA present home country? Years .J ' Some high school: Completed high school: Some college: Years: College degree (B.A.) Some graduate school: Graduate degree:M.A. PhD_ Other (explain: -_ Father's country of birth: Mother's: Primary language spoken between your parents: Second :_ Primary language spoken in your present home: Another language? In what other languages do you read books? Newspapers? often: ometimes : seldom: spoken Below, put a (l/) mark in the appropriate slot after each language in which you have even a limited ability, and write them in empty rows below. Check on (1) speaking, (2) reading, and (3) writing. Do you speak it? Can you read in it? Can you write in it? fluently moderate-ly, well a little none, or almost none fluently 1 rH rt in U 01 o> >& -O rH O 01 6 4J a little none, or almost none Eluently nodera-tely well a little none, or almost none English French cn o e^Part I: Below are descriptions of various l i f e situations and experiences. We would like to have you answer two questions about each of them: (1) Have you experienced i t in your personal l i f e (if so, put a check mark in the square before the item, like this :(~pf), and (2) To what extent did you feel lonely at the time, or immediately after such an event? By "loneliness" we mean a feeling or mood, which in your opinion corresponds to i t — not whether you simply were "alone" (i.e., nobody else was around). We know that there can be various feelings aroused by such events: anger, bitterness, fear, insecurity, sadness, excitement, apathy etc. We are interested in the extent to which you felt lonely, and under which circumstances — whether or not loneliness occurred separately, or together with other feelings. If you have had the experience we are describing \7C> but f e l t no loneliness at the time or as a result of i t having occurred, then enter the number "1" (= not at a l l ) in the second slot (above the line, in front of the item). If you felt intensely lonely, even i f i t lasted for only a brief period, enter "9" or "]0" (= felt very lonely) on the line *ty . If you experienced loneliness only sometimes, but not always when such situations occurred, or the loneliness feeling wasn't particularly intense, choose an intermediate number from the intensity scale shown below (for ex., between "3" and "7", depending on your subjective feelings at the time of the experience). If you are not sure which number is correct, go by your f i r s t impulse, which is more likely to be accurate than a prolonged analysis. If you have never experienced the situation described, leave the box empty, but then try to imagine how you would feel (in terms of loneliness) i f you would encounter this situation one day. Choose the number from the scale that corresponds to your imagined feeling of loneliness for the item. We are interested in finding out whether people who have actually not had the experience, imagine being lonely in i t to about the same degree as people who have gone through i t . Please do not try to guess how others might respond; we want to know how you felt, or how you imagine you would feel, personally! Scale: 1 2 3 A 5 6 7 8 9 10 felt no seldom, or to a medium degree rather strongly f e l t very loneliness to limited extent lonely I | (1) being completely (in a physical, spatial sense) away or separated from other people f~~] (2) being faced with a di f f i c u l t decision, which no-one else could make for you, and for which no-one else could share the responsibility or consequences with you |_ tZ] (3) feeling that no-one could possibly fully understand the experiences you have had o . • • . • . • . 4) preparing to leave a place and people you were fond of, and had become accustomed to 5) thinking of places where you had l i v e d , which were associated with deep emotional experiences; places where you fe e l you had "grown roots" feeling that i t was impossible, or useless to talk to anyone about your most important and deepest feelings, concerns, thoughts etc., because you expected that other*would not understand, or would not be interested and sympathetic, or might even react negati-vvely feeling ignored or rejected by people whom you did not know very well — feeling that you did not "belong" where you were; that people around you were "strangers" who had no interest i n you as a person feeling that there was no place i n the thole world which you could c a l l your "home" feeling that you had not liv e d up to your own expectations; that you had l e f t yourself down while thinking about some other people who had started out i n comparable circumstances with you, but seemed to have done much better, or been more successful when people who were important to you, seemed to have a low opinion of you, or expressed unfavorable or unpleasant opinions or judgments about you 3) when you f e l t that your behavior i n the company of others was awkward and unsure .4) 5) when a close friend (someone you were not romantically involved with) l e f t for a dis t a n t feeling lonely i n the company of a person with whom you were supposed to have a close, intimate relationship (for ex. your spouse, lover, boyfriend or g i r l f r i e n d ) 6) when your relationship with g i r l f r i e n d , boyfriend or marital partner broke up (opposite \sex onlv) 7) To what extent have you IN THE PAST FEW MONTHS f e l t a basic lack of i n t e r e s t v ^ -i n everything and everybody, so that even those people you knew you didn't bother to look up, and you seemed to lack any goal i n l i f e , anything that would have provided \lT63l S3, t i s f 3C t i o n ? 8) while being i n an unfamiliar place (away from home and old f r i e n d s ) , * 1 a l l by yourself, you saw someone you were very attracted to and would have li k e d to get to know, but you did not dare to show your interest, or did not know how to go about i t . (19) generally at those times when you lacked a romantic relationship with opposite sex (20) at a time when you wanted to talk to a good old fr i e n d and realized that they were a l l l i v i n g far away, outside an easily reachable distance T~l (21) while wanting to belong to some society, group or cause and to p a r t i c i p a t e a c t i v e l y with others i n working for something more important than just your own personal w e l l -being or the immediate family c i r c l e (for ex., a desire to dedicate yourself to a c u l t u r a l , national, religious or other cause) | | (22) To what extent do you f e e l that YOU ARE NOW INVOLVED i n such a larger cause or community? | | (23) Feeling lonely when someone close to you died (parent, c h i l d , spouse or f r i e n d ) . Part II: Generally speaking, would you describe yourself as a person who experiences loneliness 1 2 3 A 5 6 7 8 9 10 never rarely occasionally an average amount quite a b i t very much (not at a l l ) (please c i r c l e onemmber above) Part I I I : Using the same number scale (from "1" to "10"), indicate how important i t i s for you... (24) to date or to marry someone who is of the same ethnic (or re l i g i o u s ) background as you (25) to learn more about the history, culture, l i t e r a t u r e and country of your ancestors (26) to v i s i t (or perhaps even to l i v e in) the country where your ancestors came from (27) to f i n d people who share the sair.o ethnic or reli g i o u s interests with you, and to share your thoughts with them (28) to what extent have you found i t i r r i t a t i n g , boring or depressing to l i s t e n to the views of your parents or t h e i r friends on ethnic, p o l i t i c a l or re l i g i o u s issues, because they seem to be either unwilling or unable to understand and to accept your viewpoints? (29) how often are you together with others of about your own age, with whom you share common views and goals i n important matters, concerning ethnic, r e l i g i o u s or p o l i t i c a l problems? (30) To what extent do you i d e n t i f y yourself with a s p e c i f i c ethnic group? Which? You are presently l i v i n g : With your parents: With friend(s) or roommate(s): Other (explain b r i e f l y ) : Married, and l i v i n g with your spouse: Not married, but livingwith someone of the opposite sex: Alone by yourself Are there any comments or additions you would l i k e to suggest for this questionnaire?(use other' side) G e n e r a l l y s p e a k i n g , I would d e s c r i b e m y s e l f as a person who e x p e r i e n c e s l o n e ! i n e s s 1 2 3 4 5 6 7 8 9 10 never r a r e l y o c c a s i o n a l l y an average amount q u i t e a b i t v e r y much always (PLEASE CIRCLE ONE NUMBER ABOVE) 

Cite

Citation Scheme:

        

Citations by CSL (citeproc-js)

Usage Statistics

Share

Embed

Customize your widget with the following options, then copy and paste the code below into the HTML of your page to embed this item in your website.
                        
                            <div id="ubcOpenCollectionsWidgetDisplay">
                            <script id="ubcOpenCollectionsWidget"
                            src="{[{embed.src}]}"
                            data-item="{[{embed.item}]}"
                            data-collection="{[{embed.collection}]}"
                            data-metadata="{[{embed.showMetadata}]}"
                            data-width="{[{embed.width}]}"
                            async >
                            </script>
                            </div>
                        
                    
IIIF logo Our image viewer uses the IIIF 2.0 standard. To load this item in other compatible viewers, use this url:
http://iiif.library.ubc.ca/presentation/dsp.831.1-0093957/manifest

Comment

Related Items