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Conjoint group therapy and standard individual therapy for alcoholics and their partners Bowers, Tom 1978

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CONJOINT GROUP THERAPY AND STANDARD INDIVIDUAL THERAPY FOR ALCOHOLICS AND THEIR PARTNERS by TOM BOWERS B.Sc., 1975 University of Washington A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS i n THE FACULTY OF GRADUATE STUDIES Department of Psychology We accept this thesis as conforming to the required standard THE UNIVERSITY OF BRITISH COLUMBIA November, 1978 © Tom Bowers, 1978 In presenting th i s thes i s in pa r t i a l fu l f i lment of the requirements for an advanced degree at the Univers i ty of B r i t i s h Columbia, I agree that the L ibrary sha l l make it f ree ly ava i l ab le for reference and study. I further agree that permission for extensive copying of th i s thes is for scho lar ly purposes may be granted by the Head of my Department or by his representat ives. It is understood that copying or pub l i ca t ion of th is thes is for f inanc ia l gain sha l l not be allowed without my written permission. Department of P 3 y C h ° l 0 g y The Univers i ty of B r i t i s h Columbia 2075 Wesbrook P l a c e V a n c o u v e r , Canada V6T 1W5 D a t e December 14, ,1978 i i ABSTRACT S i x t e e n c o u p l e s , where one of the p a r t n e r s was an a l c o h o l i c , were a s s i g n e d to e i t h e r a s t a n d a r d i n d i v i d u a l therapy c o n d i t i o n o r a con-j o i n t group therapy c o n d i t i o n . Treatment outcome was a s s e s s e d on a l c o h o l consumption, s e l f - e s t e e m , spouse r e g a r d , r e l a t i o n s h i p o r m a r i -t a l adjustment, and r a t i n g s o f s o c i a l and work f u n c t i o n i n g . 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 the two t h e r a p y c o n d i t i o n s on a l c o h o l consumption f o r the a l c o h o l i c s or on a m u l t i v a r i a t e a n a l y s i s of the o t h e r dependent measures f o r both the a l c o h o l i c s and t h e i r p a r t n e r s . S i m i l a r l y , no s i g n i f i c a n t d i f f e r e n c e s i n r e sponse to therapy were found between the a l c o h o l i c s and t h e i r p a r t n e r s on the a d j u n c t i v e measures used. However, both therapy c o n d i t i o n s appeared to have s i g n i f i c a n t l y improved on a l l of the dependent measures. T h i s improve-ment appeared to be r o u g h l y p a r a l l e l . These r e s u l t s were d i s c u s s e d i n terms of i m p l i c a t i o n s f o r f u t u r e r e s e a r c h . i i i TABLE OF CONTENTS Page A b s t r a c t i i L i s t of T a b l e s i v Acknowledgements v i I n t r o d u c t i o n 1 Method 15 R e s u l t s 28 D i s c u s s i o n 51 R e f e r e n c e s 63 Appendix A. Forms used d u r i n g t h e r a p y , Consent Forms, A l c o h o l & Drug C o u n s e l l i n g I n f o r m a t i o n Form, M a r i t a l Adjustment S c a l e , I n t e r v i e w S c h e d u l e , Guttman S e l f - E s t e e m S c a l e , and o u t l i n e o f t h e r a p y p l a n 73 Appendix b. C o n s i s t e n c y and V a l i d a t i o n of the R e a l -I d e a l S e l f D i s c r e p a n c y Score 132 i v LIST OF TABLES Page T a b l e 1. Demographic and R e l a t i o n s h i p S t a t u s of Standard and C o n j o i n t Therapy on Intake 16 T a b l e 2. C o r r e l a t i o n s between 7-Poiut S c a l e o f M a r i t a l Adjustment ( M a r i t a l A d j u s t m e n t ) , 5-Item S c a l e Assessment o f R e l a t i o n s h i p or M a r i t a l Adjustment ( R e l a t i o n s h i p R a t i n g ) , and the M a r i t a l Adjustment S c a l e (MAS) 24 Table 3. ANOVA Table Cor Drinks per Week 29 T a b l e 4. Means and Sta n d a r d D e v i a t i o n s f o r D r i n k s per Week 30 T a b l e 5. Number and P e r c e n t a g e of A l c o h o l i c s i n Low Consumption or High Consumption D r i n k i n g C a t e g o r i e s a t Post-Therapy 31 T a b l e 6. ANOVA T a b l e on Pre-Therapy Sc o r e s 33 T a b l e 7. MANOVA T a b l e on A d j u n c t i v e Measures 34 T a b l e 3 . ANOVA T a b l e f o r R e a l - I d e a l S e l f D i s c r e p a n c y 35 T a b l e 9. Means and Standard D e v i a t i o n s f o r R e a l - I d e a l S e l f D i s c r e p a n c y Scores 36 T a b l e 10. ANOVA Summary T a b l e f o r R e a l - I d e a l P a r t n e r D i s c r e p a n c y Scores 37 T a b l e 11. Means and Standard D e v i a t i o n s f o r R e a l - I d e a l P a r t n e r D i s c r e p a n c y S c o r e s . 38 T a b l e 12. ANOVA Summary T a b l e f o r R e l a t i o n s h i p R a t i n g s 39 T a b l e 13. Means and Standard D e v i a t i o n s f o r 5-Item R e l a t i o n s h i p R a t i n g Scores 40 T a b l e 14. ANOVA T a b l e f o r R a t i n g s of S o c i a l F u n c t i o n i n g 41 T a b l e 15. Means and Standard D e v i a t i o n s f o r R a t i n g s o f S o c i a l F u n c t i o n i n g 42 T a b l e 16. ANOVA T a b l e f o r R a t i n g s of Work F u n c t i o n i n g 44 V LIST OF TABLES (continued) Page Table 17. Means and Standard Deviations for Ratings of Work Functioning 45 Table 18. MANCOVA Table with Pre-Therapy Scores Serving as Covariates 47 Table 19. MANOVA Summary Table for 2x2x2x2 Analysis 49 Table 20. Outcome on Alcohol Consumption and MAS Scores 50 ACKNOWLEDGEMENTS I am g r a t e f u l to Dr. Park Davidson for his support and encourage-ment as my thesis supervisor and department advisor. A d d i t i o n a l thanks are due to Dr. Lynn Alden, Dr. Tom Storm, and Dr. Don Dutton for t h e i r contributions as members of my thesis committee. Thanks are also due to Barbara J e t t e , Geoff Harrison, and Henry Kroeker who provided the therapy and contributed to the development of the study. Thanks are also due to the c l i e n t s who p a r t i c i p a t e d i n t h i s research, to Malcolm Greig for computer advice, and to Judy Hawkins for typing the thesis. The research was supported by a grant to Dr. Park Davidson from the Non-Medical Use of Drugs Directorate, Health and Welfare Canada (No. 1213-9-13). 1 INTRODUCTION In the past h a l f c e n t u r y of e v a l u a t i n g the treatment o f a l c o h o l i c p o p u l a t i o n s , the r e s u l t s have been d i s c o u r a g i n g . An e a r l y r e v i e w o f the treatment e v a l u a t i o n l i t e r a t u r e by V o e g t l i n and Lemere (1942) r e -v e a l e d a d i s c o r d a n t c o l l e c t i o n o f s t u d i e s w i t h vague, s u b j e c t i v e r e -p o r t s of outcomes and s e v e r e m e t h o d o l o g i c a l d e f i c i e n c i e s . As V o e g t l i n and Lemere (1942) c a u s t i c a l l y noted i n t h e i r c o n c l u s i o n : " I t i s i m p o s s i b l e to conduct a review as e x t e n s i v e as the f o r e g o i n g w i t h o u t f o r m i n g some r a t h e r d e f i n i t e i m p r e s s i o n s . The most s t r i k i n g o b s e r v a t i o n i s the apparent r e t i c e n c e w i t h which the E n g l i s h s p e a k i n g p s y c h i a t r i s t s have p r e s e n t e d s t a t i s t i c a l d a t a con-c e r n i n g the e f f i c a c y of t r e a t m e n t . " D e s p i t e t n i s l i m i t a t i o n , V o e g t l i n and Lemere (1942) r e p o r t an e s t i m a t e d improvement r a t e r a n g i n g from 25% to 75%. H i l l and Blane (1967), i n t h e i r more r e c e n t review, reached the r e l u c t a n t c o n c l u s i o n t h a t : "... we a r e unable to form any c o n c l u s i v e o p i n i o n as to the v a l u e o f p s y c h o t h e r a p e u t i c methods i n the treatment of a l c o h o l i s m . " While the r e t i c e n c e of p r e s e n t i n g s t a t i s t i c a l d a t a , so e v i d e n t b e f o r e 1942, no l o n g e r remained, H i l l and Blane (1967) f e l t t h i s i n a b i l i t y to form any o p i n i o n on the v a l u e of p s y c h o t h e r a p y f o r a l c o h o l i c s was due to the f a i l u r e of r e s e a r c h i n the a r e a to meet e s s e n t i a l r e q u i r e m e n t s of s c i e n t i f i c conduct. T h i s ambiguous s i t u a t i o n was f o l l o w e d by t h r e e major reviews e v a l u a t i n g the e f f e c t s of psychotherapy f o r a l c o h o l i c p o p u l a t i o n s . In h i s r eview of 58 e v a l u a t i o n s between 1951 and 1973, C o s t e l l o (1975a) found o n l y a 25% r a t e of s u c c e s s i n m o d e r a t i o n or t e r m i n a t i o n o f d r i n k i n g at a one year f o l l o w - u p . C o s t e l l o (1975b) found a s l i g h t l y 2 higher rate of success i n moderation or termination of drinking i n a s i m i l a r review of studies with a two year follow-up, but the rate re-mained low. Emrick (1975), i n a s i m i l a r review, reports higher rates of recovery with treatment, noting 24.5% abstinence rates and a 65.1% t o t a l improved rate with more than minimal treatment. While t h i s d i s -crepancy i s d i f f i c u l t to f u l l y resolve, Emrick (1975) noted that the sample i n his review was a r e l a t i v e l y well integrated and stable popu-l a t i o n , perhaps explaining the higher recovery rate than noted by C o s t e l l o (1975a, 1975b). Armor, P o l i c h , and Stambul (1976), i n th e i r c o n t r o v e r s i a l survey of alcohol treatment units, suggest that 70% of c l i e n t s treated at t y p i c a l alcoholism c l i n i c s improve, but the high a t t r i t i o n i n t h i s survey almost c e r t a i n l y i n f l a t e d t h i s improvement rate. Only 25% of the c l i e n t s i n the Armor et a l . (1976) study continued i n treatment as long as three months and an even smaller sample was a v a i l a b l e for s i x month follow-up. Current research (Moos & B l i s s , 1978) pointed out that such a sampling bias tends to exclude those c l i e n t s who are more l i k e l y to show poorer treatment outcome. While at f i r s t glance i t appears that the o v e r a l l e f f i c a c y of therapy for a l c o h o l i c s has either f a l l e n or at least remained stagnant i n the past f i f t y years, i t i s more l i k e l y that the e a r l i e r reports c i t e d by Vo e g t l i n and Lemere (1942) contained i n f l a t e d success rates due to the subjective and unempirical nature of the reports a v a i l a b l e at that time. Even so, i t i s d i f f i c u l t to argue that there i s convincing evidence of any global improvement i n the state of therapeutic approaches to alcoholism. The more recent reviews, with t h e i r widely divergent findings, suggest there exists either a broad range of a l c o h o l i c populations 3 who d i f f e r greater i n responsiveness to treatment, or a broad range of therapies which also d i f f e r greatly i n a f f e c t i n g some change i n a l c o h o l i c s , or some combination of these two fac t o r s . The we l l known pervasiveness of alcoholism (see Popham, 1956) makes this lack of knowledge about the sources of v a r i a t i o n i n the treatment of alcoholism even more disturbing. While the o v e r a l l reviews have been either inconclusive or some-what negative, some modes of treatment seem to meet with either consis-tent success or consistent f a i l u r e . For example, evaluation of aver-sive techniques has been generally negative. M i l l e r , Hersen, E i s l e r , and Hemphill (1973) found no s i g n i f i c a n t improvement of a l c o h o l i c s treated by e l e c t r i c a l aversive conditioning when compared to a pseudo-conditioning c o n t r o l and a group therapy c o n t r o l . Wilson, Leaf, and Nathan (1975) also found no evidence of conditioned aversion of al c o -h o l i c s to beverage alcohol following conditioned e l e c t r i c a l aversion to ethanol. Ewing, Rouse, and Beatrice (1976), while a t t r i b u t i n g the f a i l u r e of treatment to the " c o n t r o l l e d drinking" goal, also i l l u s t r a t e d the ineffectiveness of e l e c t r i c a l aversion techniques for reducing alcohol consumption. Some (Rachman & Teasdale, 1969) suggest aversive techniques may be useful i n the treatment of alcoholism provided the aversive s t i m u l i are appropriate to drinking behaviour. Consistent with t h i s view, Lamon, Wilson, and Leaf (1977) demonstrated the r e l a -t i v e s u p e r i o r i t y of a nausea-producing procedure i n comparison to an e l e c t r i c a l aversion procedure i n reducing beverage consumption. Even with this evidence, however, the c l i n i c a l usefulness of aversion techniques may be l i m i t e d , as "escape" behaviour may s t i l l be a highly 4 p r o b a b l e r e s p o n s e . E v i d e n c e f o r t h i s phenomenon can be found i n the h i g h drop-out r a t e s which o c c u r w i t h e l e c t r i c a l a v e r s i o n t e c h n i q u e s (Hedberg & Campbell, 1974). Reports on n o n - a v e r s i v e b e h a v i o u r a l therapy have been more p o s i -t i v e . M i l l e r (1972) p r o v i d e d a case r e p o r t which i n d i c a t e s an a l c o h o l i c was a b l e to reduce and m a i n t a i n h i s p r e t r e a t m e n t a l c o h o l consumption of s e ven to e i g h t beverages a day to z e r o to t h r e e d r i n k s per day by the use of a b e h a v i o u r a l c o n t r a c t . S t u d i e s have managed to show d r i n k i n g c o u l d be s u p p r e s s e d to o n e - h a l f of b a s e l i n e a l c o h o l consumption by u s i n g a time-out p r o c e d u r e ; even so, the s u b j e c t s t i l l drank t h r e e to e i g h t ounces of 95 p r o o f e t h a n o l d a i l y (Bigelow, L i e b s o n , & G r i f f i t h s , 1974; G r i f f i t h s , Bigelow, & L i e b s o n , 1974). Another r e p o r t of a case study ( P i c k e n s , Bigelow, & G r i f f i t h s , 1973) i l l u s t r a t e d the a c h i e v e -ment of a b s t i n e n c e by u s i n g time-out from s o c i a l a c t i v i t y . More p r o -m i s i n g e v i d e n c e from an e v a l u a t i o n by Hedberg and Campbell (1974) i l l u s t r a t e s an a b s t i n e n c e o r c o n t r o l l e d d r i n k i n g g o a l can be met by t w o - t h i r d s of s u b j e c t s p a r t i c i p a t i n g i n d i v e r s e b e h a v i o u r a l t h e r a p i e s . S o b e l l and S o b e l l (1973, 1976) i n d i c a t e d t h a t the use of i n d i v i d u a l i z e d b e h a v i o u r therapy r e s u l t e d i n s i g n i f i c a n t l y g r e a t e r improvement than more t r a d i t i o n a l treatment. T h i s improvement was found not o n l y i n a l c o h o l consumption, but i n a d j u n c t i v e a r e a s such as employment. V o g l e r , Conipton, and Weissbach (1975) i n d i c a t e d a comprehensive be-h a v i o u r a l treatment programme s i g n i f i c a n t l y improved outcome f o r a l c o h o l i c s when compared to a group of a l c o h o l i c s r e c e i v i n g a l c o h o l e d u c a t i o n , a l t e r n a t i v e s t r a i n i n g , and b e h a v i o u r a l c o u n s e l l i n g . Most r e c e n t l y , M i l l e r (1978) demonstrated reduced a l c o h o l consumption a c r o s s 5 t h r e e b e h a v i o u r a l treatment s t r a t e g i e s , a l t h o u g h t h e r e were no s i g n i -f i c a n t d i f f e r e n c e s between the t h r e e treatment s t r a t e g i e s . While these r e s u l t s imply c o n s i d e r a b l e promise f o r n o n - a v e r s i v e b e h a v i o u r a l therapy i n a l c o h o l i s m , Hamburg's (1975) comment t h a t broad spectrum approaches based on an a n a l y s i s of s p e c i f i c s t i m u l i which t r i g g e r e x c e s s i v e d r i n k i n g a r e more e f f e c t i v e than c o n v e n t i o n a l methods may be o p t i m i s t i c ; c a u t i o n seems more a p p r o p r i a t e w h i l e a w a i t i n g f u r t h e r r e p l i c a t i o n s . The i l l u s t r a t i o n of a l a c k of s i g n i f i c a n t d i f f e r e n c e s between a group of a l c o h o l i c s r e c e i v i n g treatment and a group r e c e i v i n g o n l y a d v i c e (Edwards, O r l a n d , E g e r t , G u t h r i e , Hawker, Hensman, M i t c h e s o n , Oppenheimer, & T a y l o r , 1977) p o i n t e d out the low l e v e l of c l i n i c a l impact c u r r e n t c o n v e n t i o n a l therapy has on a l c o h o l i s m and emphasizes the need f o r c a u t i o n i n the e v a l u a t i o n of t h e r a p y . C o n j o i n t m a r i t a l p s y c h o t h e r a p y f o r a l c o h o l i c s i s an example of a r e c e n t l y d e v e l o p e d treatment f o r a l c o h o l i c s which, some r e p o r t s i n d i -c a t e , may have some promise ( E s s e r , 1968, 1970). C o n j o i n t psycho-.therapy, as the name i m p l i e s , i s p s y c h o t h e r a p y c a r r i e d on w i t h two o r more f a m i l y members i n a combined f a s h i o n . In t h i s r e p o r t , the con-j o i n t t h e r a p y under c o n s i d e r a t i o n i s o r i e n t e d toward the a l c o h o l i c and the spouse o r l i v i n g p a r t n e r of the a l c o h o l i c . Thus, the c o n j o i n t therapy c o n s i d e r e d here i s more g e n e r i c than m a r i t a l t h e r a p y , but does not i n v o l v e as many f a m i l y members as does c o n j o i n t f a m i l y t h e r a p y . E a r l y i n d i c a t i o n s t h a t t h i s t h e r a p e u t i c o r i e n t a t i o n may be a p p r o p r i a t e come from f i n d i n g s t h a t e l e v e n of e i g h t e e n wives of a l c o h o l i c s e x p e r i -ence a mental d i s o r d e r s e v e r e enough to r e q u i r e h o s p i t a l i z a t i o n f o l l o w i n g the c e s s a t i o n or d e c r e a s e i n the husband's d r i n k i n g (Macdonald, 1958). 6 Other r e p o r t s , as Kogan and J a c k s o n (1965), p o i n t out the wives of a l c o h o l i c s a r e no more d i s t u r b e d than wives of o t h e r p e o p l e s e e k i n g mental h e a l t h s e r v i c e s . Even so, J a c k s o n ' s (1956) r e p o r t d e f i n e d the e f f e c t s of a f a m i l y member's a l c o h o l i s m on the f a m i l y u n i t , and p o i n t e d to a l o n g s t r e s s f u l p r o c e s s of d i s o r g a n i z a t i o n and r e o r g a n i z a t i o n . E v a l u a t i o n s of c o n j o i n t or f a m i l y therapy f o r a l c o h o l i c s have been g e n e r a l l y p r o m i s i n g , but most r e p o r t s a r e marred by methodology which p r e v e n t s a t t r i b u t i o n of outcomes to the p r o c e s s of t h e r a p y . E a r l y r e p o r t s , as Macdonald's (1958) d e s c r i p t i o n of p r o p h y l a c t i c group therapy f o r wives of a l c o h o l i c s , w h i l e b e i n g d e s c r i p t i v e and l a r g e l y s u b j e c t i v e , d i d note s p o r a d i c a t t e n d a n c e and a l a c k of "group c o h e s i v e n e s s . " A f t e r t h i s g e n e r a l l y u n s u c c e s s f u l and p r o b l e m - f i l l e d t r e a t m e n t , Macdonald (1958) recommended the group be more s t r u c t u r e d and the t h e r a p i s t take a more a c t i v e r o l e . A d d i t i o n a l l y , a l t h o u g h Macdonald (1958) does not d w e l l on the p o i n t , the a t t e n d a n c e of the two spouses was found to c o r -r e l a t e .804. Other e a r l y r e p o r t s , as V o g e l (1957), B u r t o n (1962), and Sands and Hanson (1971), s h a r e d t h i s vague and u n e m p i r i c a l q u a l i t y of e a r l y a r t i c l e s . V o g e l (1957) o n l y mentions some advantages to mixed groups f o r a l c o h o l i c s . B u r t o n (1962), i n h i s d e s c r i p t i o n of group c o u n s e l l i n g f o r a l c o h o l i c husbands and n o n a l c o h o l i c w i v e s , does advo-c a t e the development of measurement t e c h n i q u e s . Sands and Hanson (1971) d e s c r i b e i n some d e t a i l the treatment p r o c e s s I n v o l v e d i n p s y c h o t h e r a -p e u t i c groups f o r a l c o h o l i c s and t h e i r r e l a t i v e s , but p r o v i d e no d a t a to i n d i c a t e the r e s u l t s of such an approach. Gliedman (1957) attempted to e v a l u a t e such an approach by f o l l o w i n g n i n e a l c o h o l i c f a m i l i e s through a p r o g r e s s i o n of i n t a k e , c o n c u r r e n t t r e atment, combined t r e a t -7 and f o l l o w - u p on the monthly e x p e n d i t u r e s on a l c o h o l . Not s u p r i s i n g l y , as therapy p r o g r e s s e d t h e r e was a g e n e r a l r e d u c t i o n of monthly expen-d i t u r e s f o r a l c o h o l . Even so, t h r e e of the n i n e c o u p l e s were unable to be c o n t a c t e d a t the combined or c o n j o i n t s t a g e of therapy. Another c o u p l e was l o s t a t f o l l o w - u p . Of the f i v e c o u p l e s c o m p l e t i n g the p r o -g r e s s i o n and f o l l o w - u p , t h r e e showed marked improvement. In an o t h e r , more s y s t e m a t i c s t u d y by Gliedman, R o s e n t h a l , Frank, and Nash (1956), c o n c u r r e n t but s e p a r a t e l y conducted group meetings of a l c o h o l i c s and t h e i r wives had more p o s i t i v e e f f e c t s . Nine m a r r i e d a l c o h o l i c s and t h e i r wives were e v a l u a t e d by a d r i n k i n g c h e c k l i s t , a symptom check-l i s t , an a d j e c t i v e c h e c k l i s t , and a s o c i a l i n e f f e c t i v e n e s s s c a l e . Of the seven c o u p l e s who completed t h e r a p y , f i v e improved on the d r i n k i n g c h e c k l i s t and on the symptom c h e c k l i s t . There was o n l y s l i g h t m o d i f i -c a t i o n of s o c i a l i n e f f e c t i v e n e s s , but p o s i t i v e changes on the a d j e c t i v e c h e c k l i s t . E s s e r ' s (1971) e v a l u a t i o n of c o n j o i n t f a m i l y therapy w i t h f o u r t e e n a l c o h o l i c f a m i l i e s i n d i c a t e d most f a m i l i e s were b e t t e r i n t e -g r a t e d a f t e r t h e r a p y . E s s e r ' s (1971) r e p o r t must be r e g a r d e d as more p u z z l i n g than most, as i t i s u n c l e a r how many f a m i l i e s c o n s t i t u t e "most" and what c r i t e r i o n i n d i c a t e s " b e t t e r i n t e g r a t e d . " E s s e n t i a l l y , E s s e r has c o n t i n u e d the t r a d i t i o n o f e a r l y r e s e a r c h e v a l u a t i n g c o n j o i n t t herapy w i t h o u t a c o n t r o l o r comparison group, and compounded t h i s de-f i c i e n c y w i t h n e g l e c t of o b j e c t measures. T h i s i s made more u n u s u a l by the r e c e n t n a t u r e of the r e p o r t . However, a t t r i b u t i o n of these g e n e r a l l y p o s i t i v e r e s u l t s (Gliedman, 1957; Gliedman e t a l . , 1956; E s s e r , 1971) to therapy i s d i f f i c u l t to a c c e p t as t h e r e was no comparison group. A s i m i l a r r e p o r t by Meeks and 8 K e l l y (1969), e v a l u a t i n g a f a m i l y therapy approach, a l s o found p o s i t i v e r e s u l t s , n o t i n g a l l of the f i v e f a m i l i e s who completed the treatment showed e v i d e n c e of improved r e l a t i n g , h e a l t h i e r communication, and i n c r e a s e d mutual s u p p o r t . A l s o , e i t h e r a b s t i n e n c e or a r e d u c t i o n i n d r i n k i n g f r e q u e n c y o c c u r r e d i n a l l of the f a m i l i e s . While Meeks and K e l l y ' s (1969) r e s u l t s seem i m p r e s s i v e , the l a c k of a comparison c o n d i -t i o n and o b j e c t i v e outcome measures of known r e l i a b i l i t y made bo t h the improvement of the f a m i l i e s q u e s t i o n a b l e and the c o n t r i b u t i o n of therapy to the apparent improvement unknown. Smith (1969), i n a n o t h e r e a r l y r e p o r t , d i d d e s c r i b e e v i d e n c e i n d i c a t i n g t h a t a t t e n d a n c e of the w i f e of an a l c o h o l i c s i n t h e r a p y was a s s o c i a t e d w i t h b e t t e r outcome f o r the a l c o h o l i c . In t h i s s t u d y , however, the p a t i e n t s made the s e l e c t i o n of spouse a t t e n d a n c e o r non-attendance i n t h e r a p y , l e a v i n g the p o s s i -b i l i t y t h a t the two groups a r e not t r u l y e q u i v a l e n t . In t h i s c a s e, f o r example, i t may be p o s s i b l e t h a t the group c h o o s i n g not to i n v o l v e the spouse d i d so because of g r e a t e r d i f f i c u l t i e s i n t h e i r m a r r i a g e s , and, hence, have a p o o r e r p r o g n o s i s . In a n o t h e r study w i t h o b j e c t i v e outcome measures and a comparison c o n d i t i o n , Cadogan (1973) found m a r i t a l treatment e f f e c t i v e l y i n f l u e n c e d the development of a b s t i n e n c e when compared to a group not r e c e i v i n g m a r i t a l t h e r a p y , but found no s i g n i f i c a n t d i f f e r e n c e s i n communication or f a m i l y f u n c t i o n i n g . T h i s l a t t e r f i n d i n g i s s u r p r i s i n g i n l i g h t of the r e p o r t s of the a s s o c i a t i o n between f a m i l y f u n c t i o n i n g and a l c o h o l consumption (Burt o n & K a plan, 1968; Bromet & Moss, 1977). While Cadogan's (1973) f i n d i n g s a r e b e s t r e g a r d e d as e s s e n t i a l l y sound, u n t i l t h e s e r e s u l t s a r e r e p l i c a t e d , t h e r e s h o u l d be c a u t i o n i n a c c e p t i n g the 9 f i n d i n g s c o m p l e t e l y . In p a r t i c u l a r , i t i s not c l e a r whether the m a r i t a l treatment d e s c r i b e d by Cadogan's (1973) work would g e n e r a t e more improvement than an i n d i v i d u a l l y o r i e n t e d treatment of s i m i l a r d u r a t i o n and i n t e n s i t y . • A l o n g t h i s l i n e , Hedberg and Campbell's (1974) comparison of f o u r b e h a v i o u r a l treatment m o d a l i t i e s f o r a l c o h o l i s m , found m a r i t a l t h e r a p y f o r a l c o h o l i c s to be the most e f f e c t i v e m o d a l i t y . R e c a l c u l a t i o n o f t h e i r r e s u l t s on s l i g h t l y d i f f e r e n t c r i t e r i a e l i m i n a t e d t h i s d i f f e r e n c e and i l l u s t r a t e s the weak n a t u r e of the e f f e c t , however. By combining the g o a l a t t a i n e d and much improved c a t e g o r i e s of Hedberg and Campbell's (1974) d a t a , both s y s t e m a t i c d e s e n s i t i z a t i o n and b e h a v i o u r a l f a m i l y c o u n s e l l i n g r e s u l t e d i n a 87% t o t a l improved r a t e . S t a t i s t i c a l a n a l y s i s by F i s h e r ' s e x a c t p r o b a b i l i t y t e s t f o r the o r i g i n a l , most s u p p o r t i v e d a t a r e p o r t e d by Hedberg and Campbell (1974), performed by the p r e s e n t a u t h o r on the number of p a t i e n t s i n the " g o a l a t t a i n e d " c a t e g o r y f o r b e h a v i o u r a l f a m i l y therapy and s y s t e m a t i c d e s e n s i t i z a t i o n , a c h i e v e d o n l y p_ = .29, w e l l above c o n v e n t i o n a l l e v e l s of s i g n i f i c a n c e . B e h a v i -o u r a l f a m i l y therapy does exceed c o n v e n t i o n a l l e v e l s of s i g n i f i c a n c e (p = .02) when compared to e l e c t r i c a l shock treatment, but t h i s f i n d i n g i s not unexpected. Thus, c l o s e e x a m i n a t i o n of t h e s e r e s u l t s does not j u s t i f y the c o n c l u s i o n t h a t b e h a v i o u r a l f a m i l y therapy i s more e f f e c -t i v e than o t h e r b e h a v i o u r a l m o d a l i t i e s ; even so, the r e s u l t s do seem to show t h a t b e h a v i o u r a l f a m i l y therapy i s at l e a s t as e f f e c t i v e as o t h e r b e h a v i o u r a l methods. Case s t u d i e s by M i l l e r (1974, 1976) suggest t h a t m a r i t a l t h e r a p y may be e f f e c t i v e f o r a l c o h o l i c s . In a d d i t i o n , Burton, Kaplan, and 10 Hudd's ( 1 9 6 8 ) r e p o r t t h a t a l c o h o l i c c o u p l e s r e c e i v i n g group t h e r a p y have a much h i g h e r f o l l o w - u p r a t e than o t h e r m o d a l i t i e s must be r e -garded as an i m p r e s s i v e e f f e c t . Ewing, Long, and Wenzel ( 1 9 6 1 ) demon-s t r a t e d t h a t c o n c u r r e n t therapy r e s u l t e d i n g r e a t e r improvement when compared to male a l c o h o l i c s coming f o r i n d i v i d u a l t h e r a p y , but the r e s u l t s o n l y approached s t a t i s t i c a l s i g n i f i c a n c e ( x 2 = 3 . 4 6 , £ = . 1 0 ) . I t appears t h a t J anzen (1977) a c c u r a t e l y summarized the advantages o f f a m i l y involvement i n the treatment of a l c o h o l i c s by c i t i n g the l o n g e r a t t e n d a n c e w i t h f a m i l y involvement and the p o s i t i v e a s s o c i a t i o n be-tween a s t a b l e m a r r i a g e and s u c c e s s i n treatment. N e i t h e r o f th e s e advantages imply any unique t h e o r e t i c a l advantage f o r f a m i l y t h e r a p y , however. Not a l l r e p o r t s i l l u s t r a t e d these p o s i t i v e e f f e c t s . P i x l e y and S t i e f e l ( 1 9 6 3 ) , i n t h e i r e v a l u a t i o n of group therapy d e s i g n e d f o r wives of a l c o h o l i c s , encounter many of the same d i f f i c u l t i e s c i t e d by Macdonald ( 1 9 5 8 ) , e s p e c i a l l y a t the onset o f the group. In p a r t i c u l a r , P i x l e y and S t i e f e l ( 1 9 6 3 ) r e p o r t e a r l y problems w i t h a t t e n d a n c e , m i n i -mal i n t e r a c t i o n , and a r e c u r r e n t theme of "who had i t worse." D e s p i t e these e a r l y problems, P i x l e y and S t i e f e l ( 1 9 6 3 ) a l s o s t a t e t h a t the t h e r a p i s t s f e l t b oth the m a r i t a l r e l a t i o n s h i p and the husband's d r i n k i n g improved, but no d a t a was p r e s e n t e d to s u b s t a n t i a t e t h i s a t t r i b u t i o n . Even i f d a t a were a v a i l a b l e , t h a t l a c k of a c o n t r o l a g a i n p r e v e n t s any a t t r i b u t i o n of improvement to the th e r a p y . P a t t i s o n , C o u r l a s , P a t t i , Mann, and M u l l e n ( 1 9 6 5 ) a l s o e n c ountered l e s s p o s i t i v e r e s u l t s f o r d i a g n o s t i c - t h e r a p e u t i c i n t a k e groups f o r the wives of a l c o h o l i c s . I n t h i s s t u d y , the o n e - v i s i t phenomenon r e a p p e a r s (as 11 w i t h Macdonald, 1958) and i a t r o g e n i c e f f e c t s — a n t a g o n i s t i c f e e l i n g s of the husband toward the i n volvement of the w i f e — seemed to o c c u r . P a t t i s o n et a l . (1965) a t t r i b u t e d p a r t of these n e g a t i v e f i n d i n g s to the s o c i o e c o n o m i c c h a r a c t e r i s t i c s of the wives. However, the o c c u r r e n c e of s i m i l a r problems i n P i x l e y and S t e i f e l (1963) s u g g e s t s the lack, of t r u e c o n j o i n t therapy may be r e s p o n s i b l e f o r the n e g a t i v e f i n d i n g s . P a t t i s o n et a l . (1965) a l l u d e d t o t h i s p o s s i b i l i t y i n t h e i r recommenda-t i o n o f i n v o l v i n g the spouse at the i n c e p t i o n of t h e r a p y . While these r e p o r t s a r e g e n e r a l l y n e g a t i v e , the c o n c l u s i o n s s h o u l d be r e g a r d e d w i t h s k e p t i c i s m due to the e a r l y date of the r e p o r t s ( a l l b e f o r e 1965) and the r e t r o s p e c t i v e n a t u r e of the r e p o r t s . An a p p r o p r i a t e i n t e r p r e t a -t i o n a t t h i s time appears to be p s y c h o t h e r a p y f o r a l c o h o l - i n v o l v e d c o u p l e s needs to be both w e l l p l a n n e d and t r u l y c o n j o i n t f o r b e s t r e s u l t s . R e s e a r c h i n the a r e a of f a m i l y p r o c e s s s u p p o r t s the i d e a of f a m i l i a l i n t e r a c t i o n h a v i n g f u n c t i o n a l s i g n i f i c a n c e f o r a l c o h o l i s m . B u r t o n and K a p l a n (1968) d e s c r i b e the r e l a t i o n s h i p between e x c e s s i v e b e h a v i o u r arid f a m i l y p a t h o l o g y as seeming to be one of mutual r e i n f o r c e -ment. In d e m o n s t r a t i n g t h a t r e d u c t i o n of m a r i t a l c o n f l i c t was a s s o -c i a t e d w i t h r e d u c t i o n of d r i n k i n g , B urton and Kaplan (1968) have p r o -v i d e d s u p p o r t f o r t h e i r view. Bromet and Moos (1977) r e p l i c a t e d t h i s f i n d i n g by showing a more p o s i t i v e f a m i l y m i l i e u was a s s o c i a t e d w i t h g r e a t e r improvement i n the f u n c t i o n i n g of the a l c o h o l i c member. S i m i l a r r e s u l t s were found i n a r e p o r t by O r f o r d , Oppenheimer, E g e r t , Hensman, and G u t h r i e (1976) which demonstrated t h a t a composite measure of m a r i t a l c o h e s i o n was p r e d i c t i v e of outcome c l a s s i f i c a t i o n 12 f o r a l c o h o l i c s , w i t h c o h e s i v e m a r r i a g e s more l i k e l y to have good o u t -come. While j o b s t a t u s and s e l f - e s t e e m were not independent of m a r i t a l c o h e s i o n , p a r t i a l l y c o n t r o l l i n g f o r the c o n t r i b u t i o n o f j o b s t a t u s and s e l f - e s t e e m d i d not change the p r e d i c t i v e v a l u e of m a r i t a l c o h e s i o n f o r outcome. O r f o r d e t a l . (1976) noted t h a t the r e t r o s p e c -t i v e n a t u r e of t h e i r s t u d y makes judgement o f c a u s a l d i r e c t i o n u n c e r t a i n ; i t was p o s s i b l e t h a t good outcome i n treatment improved m a r i t a l c o h e s i o n . A d d i t i o n a l l y , i t i s p o s s i b l e t h a t a t h i r d unknown c o r r e l a t e a c c o u n t e d f o r t h e s e r e s u l t s . Other r e p o r t s , as Kogan and J a c k s o n (1965), n o t e d t h a t wives o f a l c o h o l i c s r e p o r t more c u r r e n t s t r e s s than c o n t r o l w i v e s . Some r e p o r t s , as McCord (1972) have argued t h a t the n a t u r e o f the i n t e r -a c t i o n between the c o u p l e i s the c r u c i a l element. McCord (1972) argued t h a t a l c o h o l i s m r e s u l t s from a c h a l l e n g e to poor s e l f - e s t e e m . Some r e c e n t i n v e s t i g a t i o n s a l s o imply t h a t i n t e r a c t i o n between c o u p l e s may have f u n c t i o n a l s i g n i f i c a n c e f o r a l c o h o l consumption. S t e i n g l a s s , D a v i d , and Berenson (1977) i n d i c a t e t h a t a l c o h o l consumption i n a l c o h o l i c c o u p l e s seemed to e l i c i t b e h a v i o u r from the spouse which c o u l d have f u n c t i o n a l s i g n i f i c a n c e f o r a l c o h o l consumption. While the r e p o r t by S t e i n g l a s s et a l . (1977) was from d i r e c t o b s e r v a t i o n of i n t o x i c a t e d b e h a v i o u r i n an i n p a t i e n t environment, the o b s e r v a t i o n s were not b l i n d and cannot be c a l l e d t r u l y s y s t e m a t i c . However, o t h e r r e p o r t s , as the Weiner, Tamerin, S t e i n g l a s s , and Mendelson (1971) o b s e r v a t i o n o f a f a t h e r and son d u r i n g e x p e r i m e n t a l i n t o x i c a t i o n , a l s o imply t h a t the f a m i l i a l i n t e r a c t i o n has f u n c t i o n a l s i g n i f i c a n c e f o r m a i n t a i n i n g a l c o h o l consumption. Hersen, M i l l e r , and E i s l e r (1973), i n n o t i n g the spouse of an a l c o h o l i c i n c r e a s e s d u r a t i o n of l o o k i n g a t 13 the p a r t n e r w h i l e d i s c u s s i n g a l c o h o l , f u r t h e r noted t h a t t h i s a t t e n -t i o n may be a f u n c t i o n a l element m a i n t a i n i n g i n t o x i c a t i o n . In a d d i t i o n to the e v i d e n c e of f a m i l y p a t h o l o g y i n a l c o h o l i c s , and the p o s i t i v e , but e x p e r i m e n t a l l y f lawed e v a l u a t i o n s of f a m i l y or m a r i t a l therapy f o r a l c o h o l i c s , t h e r e a r e i m p ortant t h e o r e t i c a l r e a -sons s u g g e s t i n g c o n j o i n t f a m i l y or m a r i t a l therapy may be e f f e c t i v e f o r a l c o h o l i c s . F i r s t o f a l l , m a r i t a l treatment i n g e n e r a l has been an e f f e c t i v e and s u c c e s s f u l m o d a l i t y f o r problems i n communication and c o n f l i c t s i n l i v i n g (Jacobson, 1977; Wieman, 1974). Second, s i n c e M i l l e r , Hersen, E i s l e r , and H i lsman (1974) demonstrated i n t e r p e r s o n a l s t r e s s i n c r e a s e d o p erant r e s p o n d i n g f o r a l c o h o l , i t seems t h a t the r e d u c t i o n of m a r i t a l c o n f l i c t might a l s o d e c r e a s e a l c o h o l consumption. T h i r d , as p o i n t e d out by P a t t i s o n (1968, 1976), Ger a r d (1962), and M i l l e r and Caddy (1977) r e d u c t i o n or even e l i m i n i a t i o n of a l c o h o l con-sumption i n a l c o h o l i c s does not y i e l d s o c i a l , v o c a t i o n a l , or psycho-l o g i c a l improvement. I t seems th e r a p y needs to be s p e c i f i c a l l y o r i e n t e d towards these a r e a s i f improvement i s to be e x p e c t e d . F o u r t h , i n v o l v e -ment of a s i g n i f i c a n t o t h e r might i n c r e a s e the g e n e r a l i z a b i l i t y of therapy as w e l l . F i f t h , s e v e r a l r e p o r t s ( M i l l e r , 1976; A z r i n , 1976; Hunt & A z r i n , 1973) d e s c r i b e comprehensive p s y c h o t h e r a p i e s f o r a l -c o h o l i c s u t i l i z i n g m a r i t a l or f a m i l y components i n the t h e r a p y . As t h e s e programmes appear to be e f f e c t i v e , the r e l a t i v e c o n t r i b u t i o n of m a r i t a l therapy to the e f f e c t s may be s i g n i f i c a n t . F i n a l l y , the work by S t e i n g l a s s and h i s a s s o c i a t e s i n d i c a t e s t h a t the i n t e r a c t i o n between c o u p l e s may have f u n c t i o n a l s i g n i f i c a n c e f o r a l c o h o l consumption. In l i g h t of the s u b s t a n t i a l weight which these t h e o r e t i c a l and 14 p r a g m a t i c arguments seem to c a r r y , the f u r t h e r e v a l u a t i o n of the e f f i -cacy of c o n j o i n t m a r i t a l therapy appears to be w a r r a n t e d . The purpose of t h i s r e p o r t w i l l be to i n v e s t i g a t e the e f f i c a c y of c o n j o i n t m a r i t a l therapy f o r a l c o h o l i c s and t h e i r p a r t n e r s i n an o u t p a t i e n t s e t t i n g . In p a r t i c u l a r , t h i s study w i l l a l l o w f o r e x a m i n a t i o n of changes i n d r i n k i n g p a t t e r n s f o r the a l c o h o l i c and changes i n p s y c h o l o g i c a l f u n c -t i o n i n g f o r both the a l c o h o l i c and the a l c o h o l i c ' s p a r t n e r . F u r t h e r , thus study w i l l compare the c o n j o i n t group to a s t a n d a r d i n d i v i d u a l o u t p a t i e n t treatment of a l c o h o l i c c o u p l e s . While e t h i c a l c o n s i d e r a t i o n s have r u l e d out the use of a no-treatment c o n t r o l group, r e p o r t s on the r a t e of spontaneous r e c o v e r y i n u n t r e a t e d a l c o h o l i c s (Emrick, 1975; Smart, 1975) w i l l be used to compare the p r o g r e s s of the a l c o h o l i c s r e c e i v i n g t h e r a p y . C o n s i d e r a b l e c a u t i o n must be e x e r c i s e d i n con-s i d e r i n g t h i s l a t t e r comparison as an i n d i c a t o r of treatment e f f i c a c y , as the samples may not be r e p r e s e n t a t i v e . However, such a comparison may y i e l d i m p o r t a n t i n f o r m a t i o n , as c u r r e n t e v i d e n c e i s b e g i n n i n g to c l a r i f y the r a t e of r e c o v e r y i n u n t r e a t e d a l c o h o l i c s (Armour, P o l i c h , & Stambul, 1976; Emrick, 1975; Emrick & S t i l s o n , 1977; Smart, 1976). In a d d i t i o n , t h i s comparison a v o i d s the d i f f i c u l t y of b e i n g u n a b l e to e v a l u a t e r e c o v e r y r a t e s , a problem noted by Bebbington (1976). As o t h e r e x t e n s i v e r e p o r t s i n d i c a t e t h a t psychotherapy can be e f f i c i o u s ( B e r g i n , 1971; G l a s s & Smith, 1977), t h i s e v a l u t i o n w i l l compare two t h e r a p e u t i c approaches to a l c o h o l i s m . 15 METHOD Subj e c t s S i x t e e n c o u p l e s w i t h one of the p a r t n e r s e x p e r i e n c i n g problems r e -l a t e d to a l c o h o l use a p p l y i n g f o r o u t p a t i e n t c o u n s e l l i n g a t an a l c o h o l treatment c e n t r e were c o n s e c u t i v e l y a s s i g n e d to e i t h e r c o n j o i n t t h e r a p y or s t a n d a r d i n d i v i d u a l o u t p a t i e n t t h e r a p y . These two t h e r a p i e s a r e r e f e r r e d to as c o n j o i n t nnd s t a n d a r d i n thiB r e p o r t , r e s p e c t i v e l y . Of the 16 i d e n t i f i e d p a t i e n t s , r e f e r r e d to as a l c o h o l i c s i n t h i s r e p o r t , 14 were male and 2 were female. The average age was 40 y e a r s f o r males and 38.6 y e a r s f o r fe m a l e s . The modal r e p o r t e d e d u c a t i o n was h i g h s c h o o l completed, w i t h h i g h s c h o o l and o t h e r t r a i n i n g the next l a r g e s t c a t e g o r y , and c o l l e g e e d u c a t i o n the t h i r d l a r g e s t c a t e g o r y . A l l of the c l i e n t s had a t l e a s t some h i g h s c h o o l . Seven of the c o u p l e s had e x p e r i e n c e d one or more s e p a r a t i o n s p r i o r to involvement i n tr e a t m e n t . T h i r t e e n o f the c o u p l e s were m a r r i e d , w h i l e the r e m a i n i n g t h r e e c o u p l e s were i n a s t a b l e common-law r e l a t i o n s h i p . Two c o u p l e s were s e p a r a t e d at the s t a r t of treatment. T h ere were no s i g n i f i c a n t d i f f e r e n c e s be-tween the c l i e n t s a s s i g n e d to s t a n d a r d therapy and the c l i e n t s a s s i g n e d to c o n j o i n t therapy on the measures of age, p r e v i o u s s e p a r a t i o n s , r e l a t i o n s h i p s t a t u s a t i n t a k e , o r e d u c a t i o n when e v a l u a t e d by F i s h e r ' s e x a c t t e s t . T a b l e 1 summarizes t h i s i n f o r m a t i o n . The c o u p l e s were r e c r u i t e d by a m a i l i n g to p r a c t i t i o n e r s and a g e n c i e s h a v i n g c o n t a c t w i t h p o t e n t i a l c l i e n t s , r a d i o a d v e r t i s e m e n t s i n the l o c a l urban a r e a , and from the normal r e f e r r a l s o u r c e s f o r the agency. The spouse o r p a r t n e r o f the a l c o h o l i c i s r e f e r r e d to as the p a r t n e r i n t h i s r e p o r t . 16 T a b l e 1 Demographic and R e l a t i o n s h i p S t a t u s of Sta n d a r d and and C o n j o i n t Therapy on In t a k e Therapy A r e a s S t a n d a r d C o n j o i n t Mean age i n y e a r s 37.88 40.00 E d u c a t i o n (No. co m p l e t i n g ) U n i v e r s i t y g r a d u a t e 2 2 High s c h o o l & o t h e r t r a i n i n g 3 4 High s c h o o l completed 9 10 Some h i g h s c h o o l 2 0 Prim a r y o n l y 0 0 P r e v i o u s S e p a r a t i o n s Yes 4 3 No 4 5 S t a t u s a t In t a k e S e p a r a t e d 2 0 M a r r i e d 5 5 Common-law 1 3 17 P r o c e d u r e P r i o r to a c t i v e i n volvement i n treatment, the c l i e n t s were asked to s i g n consent forms a g r e e i n g to p a r t i c i p a t e i n a t e l e p h o n e or i n -p e r s o n f o l l o w - u p a t one month, s i x months, and one y e a r a f t e r treatment. The c l i e n t s were a l s o asked to agree not to change the s t a t u s of t h e i r r e l a t i o n s h i p u n t i l the c o m p l e t i o n of treatment. At t h i s time p r i o r to t r e a t m e n t , the c l i e n t s completed the A l c o h o l and Drug C o u n s e l l i n g I n f o r m a t i o n Form and an a d j e c t i v e c h e c k l i s t f o r d e s c r i b i n g the r e a l s e l f , i d e a l s e l f , r e a l spouse or p a r t n e r , and i d e a l spouse or p a r t n e r . The A l c o h o l and Drug C o u n s e l l i n g I n f o r m a t i o n Form g a t h e r e d i n f o r m a t i o n on work f u n c t i o n i n g , s o c i a l f u n c t i o n i n g , r e l a t i o n s h i p , and a l c o h o l o r drug use. T h i s p r o c e d u r e was r e p e a t e d a t the end of treatment. In a d d i t i o n , the M a r i t a l Adjustment S c a l e (MAS) was a l s o a d m i n i s t e r e d p o s t - t r e a t m e n t . Appendix A c o n t a i n s these documents. The one month f o l l o w - u p was used to o b t a i n c o l l a b o r a t e d e s t i m a t e s of a l c o h o l consump-t i o n , i f any, and to i n s u r e t h a t a l l of the p o s t treatment measures had been completed. At the s i x month and one y e a r f o l l o w - u p , the c o u p l e was a g a i n i n t e r v i e w e d to o b t a i n c o l l a b o r a t e d e s t i m a t e s of a l c o -h o l consumption; a d d i t i o n a l l y , the A l c o h o l and Drug C o u n s e l l i n g I n -f o r m a t i o n Form, the MS, and the Guttman S e l f - E s t e e m S c a l e were ad-m i n i s t e r e d . Treatment The c o n j o i n t therapy was begun w i t h an a l l - d a y s e s s i o n l a s t i n g 8 hours f o l l o w e d by 8 subsequent e v e n i n g s e s s i o n s l a s t i n g 1*2 hours each. The g e n e r a l g o a l of the c o n j o i n t treatment was f o r the c l i e n t to r e a c h an u n d e r s t a n d i n g of how they came to be the persons they were and to 18 d e s c r i b e what changes the c l i e n t would l i k e to see i n f r i e n d s , work, f a m i l y , and l o v e l i f e . Q u e s t i o n n a i r e s were used as a g u i d e to the k i n d o f i n f o r m a t i o n u t i l i z e d (see Appendix A ) . The F a m i l y C o n s t e l l a t i o n q u e s t i o n n a i r e was d e s i g n e d to o b t a i n a d e s c r i p t i o n o f the c l i e n t i n r e l a t i o n to o t h e r members of h i s or her f a m i l y . The second q u e s t i o n -n a i r e was d e s i g n e d to o b t a i n i n f o r m a t i o n on how the c l i e n t would l i k e the s i t u a t i o n to be changed i n the a r e a s of f r i e n d s , work, and c l o s e r e l a t i o n s h i p s . Both the a l c o h o l i c and the spouse were exp e c t e d to come to the group s e s s i o n s , and a l l but one c o u p l e completed the 8 s e s s i o n s . A t t e n t i o n was devoted to communication between the c o u p l e , w i t h e x e r c i s e s used to i n c r e a s e the use of " I " s t a t e m e n t s , e x p r e s s i o n of f e e l i n g s , and feedback or r e f l e c t i o n . Role p l a y of p a r t i c u l a r s i t u a t i o n s and m o d e l l i n g of s p e c i f i c examples by the t h e r a p i s t s were used to develop t h e s e communication s k i l l s . Whenever p o s s i b l e , e x e r -c i s e s were drawn from r e c e n t events or s i t u a t i o n s which had o c c u r r e d i n the c o u p l e ' s l i f e . For both the a l c o h o l i c and the a l c o h o l i c ' s p a r t n e r , a s s e r t i v e n e s s was a l s o d e v e l o p e d by s i m i l a r methods. T h i s c o n d i t i o n has been c a l l e d c o n j o i n t therapy i n t h i s r e p o r t . In the s t a n d a r d therapy c o n d i t i o n , the c l i e n t s were seen over a p e r i o d of time r a n g i n g from 3 to 14 weeks, w i t h a mean of 7.43 weeks. C l i e n t s i n t h i s c o n d i t i o n were seen on an open-ended r a t h e r than a s e s s i o n - s p e c i f i c b a s i s . The g e n e r a l g o a l i n the s t a n d a r d treatment c o n d i t i o n was to e s t a b l i s h an 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 between the p a t i e n t and the c o u n s e l l o r . The s e s s i o n s were h e l d i n an i n d i v i d u a l r a t h e r than group s e t t i n g and the t h e r a p e u t i c f o c u s was on the a l c o -h o l i c , a l t h o u g h the spouse or p a r t n e r c o u l d and sometimes d i d a t t e n d 19 therapy s e s s i o n s . Case r e c o r d s i n d i c a t e spouse or p a r t n e r a t t e n d a n c e i n 29% of the s t a n d a r d treatment s e s s i o n s . The s t a n d a r d therapy c o n d i -t i o n a l s o devoted some a t t e n t i o n to e x p l o r i n g what changes the c l i e n t s would l i k e to see i n s i g n i f i c a n t a r e a s of t h e i r l i f e . Thus., the g r e a t e s t d i f f e r e n c e i n treatment was i n mode r a t h e r than method — i n d i v i d u a l v e r s u s group, and c o n j o i n t v e r s u s s e p a r a t e . Both c o n d i t i o n s were a d m i n i s t e r e d by the two same t h e r a p i s t s , w i t h no c l e a r e x p e c t a t i o n t h a t e i t h e r treatment was s u p e r i o r to the o t h e r . The f o l l o w - u p i n t e r -views and the p o s t - t r e a t m e n t c o l l a b o r a t i n g i n t e r v i e w s of a l c o h o l con-sumption were conducted by the a u t h o r . Dependent Measures: R e l i a b i l i t y and V a l i d i t y The dependent measures were a l c o h o l consumption, r a t i n g s of work f u n c t i o n i n g and s o c i a l f u n c t i o n i n g , r e l a t i o n s h i p r a t i n g s , r e a l - i d e a l s e l f d i s c r e p a n c y s c o r e s , and r e a l - i d e a l spouse or p a r t n e r d i s c r e p a n c y s c o r e s . A l c o h o l consumption. The a l c o h o l consumption was measured by a s e l f - r e p o r t questionnaire''' a d m i n i s t e r e d p r e - and p o s t - t r e a t m e n t . An i n t e r v i e w w i t h the c o u p l e a t one month, s i x months, and one y e a r f o l l o w - u p was used to v e r i f y a l c o h o l consumption or a b s t i n e n c e . C l i e n t s were i n s t r u c t e d to f i l l out the q u e s t i o n n a i r e i n as much d e t a i l as p o s s i b l e . Some r e p o r t s ( n o t a b l y Guze, Tuason, Stewart, & P i c k e n , 1963; Summers, 1970; M i l l e r , 1976) have been c r i t i c a l o f s e l f - r e p o r t e d We a r e g r a t e f u l f o r the s o c i a l l i f e s e c t i o n from a q u e s t i o n n a i r e used by V i c t o r i a L i f e Enrichment, and the p e r m i s s i o n of C h a r l e s Aharan, Ph.D., of t h a t agency f o r the use of t h a t s e c t i o n . 20 a l c o h o l consumption, a l t h o u g h these same s t u d i e s r e p o r t e d s u b s t a n t i a l c o r r e s p o n d e n c e between a l c o h o l consumption and o t h e r c r i t e r i a . M i l l e r (1976), f o r example, r e p o r t e d a c o r r e l a t i o n o f _r = .76 between s e l f -r e p o r t and u r i n e t e s t s . Guze e t a l . (1962) r e p o r t e d a 26% disag r e e m e n t between r e l a t i v e s ' r e p o r t s and male a l c o h o l i c c r i m i n a l s , which i n d i -c a t e s 74% agreement. Summers (1974) does show 14 of 15 a l c o h o l i c s changes t h e i r r e s p o n s e s to h a l f or more o f q u e s t i o n s when r e i n t e r v i e w e d i n two weeks. However, i n Summers' study , s e v e r a l s u b j e c t s were i n t e r -viewed when i n t o x i c a t e d and the author noted the sample was not a r e -p r e s e n t a t i v e one. Other r e p o r t s i n d i c a t e d a g r e a t d e a l of c o n s i s -tency of s e l f - r e p o r t s even over l o n g p e r i o d s o f time (Guze & Goodwin, 1972), e s p e c i a l l y when the a l c o h o l problem i s e x t e n s i v e . The most d e c i s i v e and b e s t - d e s i g n e d e v a l u a t i o n s ( S o b e l l , S o b e l l , & Samuels, 1974; S o b e l l & S o b e l l , 1975) i n d i c a t e d c o n s i d e r a b l e agreement between s e l f - r e p o r t s and primary i n f o r m a t i o n s o u r c e s such as a r r e s t r e c o r d s and s i m i l a r r e c o r d s . These r e p o r t s i n d i c a t e d c o n s i s t e n c y was 92% when compared a c r o s s d i f f e r e n t i n t e r v i e w s . I n a d d i t i o n , o n l y 14% o f the answers o b t a i n e d i n the i n t e r v i e w s were d i s c r e p a n t from o f f i c i a l r e -c o r d s , such as a r r e s t r e c o r d s . These f i n d i n g s i n d i c a t e d t h a t s e l f -r e p o r t under a p p r o p r i a t e c i r c u m s t a n c e s i s a r e l i a b l e and v a l i d method to e s t a b l i s h the c l i n i c a l s t a t u s of d r i n k i n g p a t t e r n s . In t h i s s t u d y , d r i n k i n g r e p o r t s of the a l c o h o l i c were c o l l a b o r a t e d by the p a r t n e r , w i t h agreement on the l e v e l of a l c o h o l consumption o c c u r r i n g i n 13 of the 14 j o i n t l y conducted p o s t - t r e a t m e n t i n t e r v i e w s , o r 93%. A d d i t i o n a l l y , the r e p o r t s of a l c o h o l consumption r e p o r t e d on the p o s t - t r e a t m e n t q u e s t i o n n a i r e agreed s u b s t a n t i a l l y w i t h the amount 21 r e p o r t e d i n the one-month f o l l o w - u p i n t e r v i e w , a l t h o u g h t h i s t a s k was made e a s i e r by the l a r g e number of s u b j e c t s who were not d r i n k i n g . F o r the s u b j e c t s who were d r i n k i n g , the d i f f e r e n c e between the number of d r i n k s per week e s t i m a t e d from the q u e s t i o n n a i r e and the number of d r i n k s per week r e p o r t e d i n the i n t e r v i e w d i d not d i f f e r by more than 3 d r i n k s per week. In the s i n g l e case of d i s a g r e e m e n t , the h i g h e r r e p o r t of a l c o h o l consumption was used. R e a l - i d e a l s e l f . A m o d i f i e d v e r s i o n of the " i n t e r p e r c e p t i ' o n m a t r i x " d e s c r i b e d by A l e x a n d e r and Dibbs (1977) was a d m i n i s t e r e d p r e - and p o s t - t h e r a p y . While A l e x a n d e r and Dibbs (1977) used c o r r e l a t i o n s to e v a l u a t e the d i s c r e p a n c y between the r e a l - i d e a l a d j e c t i v e s , t h i s r e -p o r t used the a b s o l u t e d i f f e r e n c e between the r e a l - i d e a l a d j e c t i v e s c h e c k l i s t , f o r reasons noted by Osgood (1957, p. 90). The Q - s o r t of the type used by A l e x a n d e r and Dibbs (1977) was f i r s t i n t r o d u c e d by J a c k B l o c k i n 1952 ( B l o c k , 1952; Heusch, B l o c k , & Bennett, 1953), and was found to be c o r r e l a t e d .82 w i t h the f i r s t Q - s o r t when r e p e a t e d a f t e r s e v e r a l weeks f o r a s i n g l e s u b j e c t . The m o d i f i e d a d j e c t i v e c h e c k l i s t v e r s i o n used i n the p r e s e n t study was found to have a s p l i t -h a l f r e l i a b i l i t y , u s i n g the Pearson p r o d u c t moment c o r r e l a t i o n , o f r_ = .895 when t e s t e d on 31 undergraduates by the p r e s e n t a u t h o r (see Appendix B). V a l i d a t i n g d a t a has i n d i c a t e d t h a t n a r c o t i c a d d i c t s ( A l l e x a n d e r & D i b b s , 1977) and a l c o h o l i c s (Gossop, 1976; Charalampous, F o r d , & S k i n n e r , 1976) seem to have a l a r g e r e a l - i d e a l s e l f d i s c r e p a n c y and low s e l f - e s t e e m . C o r r e l a t i o n s between the Guttman S e l f - E s t e e m S c a l e (Rosenberg, 1963) and the r e a l - i d e a l s e l f d i s c r e p a n c y was found to be 22 jr = .565, w i t h F i s h e r ' s r to Z t r a n s f o r m a t i o n y i e l d i n g Z = 5.24, p_ < .001 f o r t h i s c o r r e l a t i o n when t e s t e d by the c u r r e n t a u t h o r on a s e p a r a t e sample of 70 un d e r g r a d u a t e s . I n the same sample, no s i g n i f i -c a n t d i f f e r e n c e on d i s c r e p a n c y s c o r e s was found between males and females. T h i s f i n d i n g i s c o n s i s t e n t w i t h the f i n d i n g s r e p o r t e d by C l a r k e (1974), a l t h o u g h some a u t h o r s ( i . e . , Gossop, 1976) have r e p o r t e d lower s e l f - e s t e e m i n females than i n males. Both a s e p a r a t e sample of a l c o h o l i c s and the c u r r e n t sample of a l c o h o l i c f ) ' p a r t n e r s were found to d i f f e r s i g n i f i c a n t l y from the v a l i d a t i n g sample o f c o l l e g e under-g r a d u a t e s , F ( l , 5 1 ) = 4.12, £ < .02, and F ( l , 4 0 ) = 9.59, p_ < .005, r e s p e c t i v e l y . Appendix B summarizes the r e s u l t s of the v a l i d a t i o n o f the r e a l - i d e a l s e l f d i s c r e p a n c y s c o r e s . In g e n e r a l , these f i n d i n g s appear to be c o n s i s t e n t w i t h the f i n d i n g s of low s e l f - e s t e e m f o r d r u g , i n v o l v e d p a t i e n t s (Gossop, 1976; Charalampous, F o r d , & S k i n n e r , 1976). R e a l - i d e a l spouse or p a r t n e r . T h i s was a l s o a m o d i f i e d v e r s i o n of the " i n t e r p e r c e p t i o n m a t r i x " noted above. The d i s c r e p a n c y s c o r e s of the r e a l - i d e a l spouse r a t i n g s appeared to have f a c e v a l i d i t y as a measure of m a r i t a l adjustment or spouse r e g a r d . These d i s c r e p a n c y s c o r e s were found to be c o r r e l a t e d w i t h the MAS, £ = -.7897, when the MAS and r e a l - i d e a l spouse s c o r e s were compared f o r 16 a l c o h o l i c s and t h e i r p a r t n e r s on p r e - t e s t . M a r i t a l or R e l a t i o n s h i p Adjustment. Three s c a l e s e v a l u a t i n g m a r i t a l or r e l a t i o n s h i p adjustment were used i n t h i s s t u d y . One s c a l e was a b r i e f 7 - p o i n t s c a l e a s k i n g the c l i e n t s to r a t e t h e i r r e -l a t i o n s h i p on a continuum from e x c e l l e n t to t o t a l l y u n s a t i s f a c t o r y . A second s c a l e was s i m i l a r i n g e n e r a l c o n s t r u c t i o n , but asked the 23 c l i e n t s to r a t e t h e i r r e l a t i o n s h i p i n f i v e a r e a s , d e s c r i b e d as a f f e c t i o n , c o n f l i c t , e x p r e s s i o n of f e e l i n g s , c l o s e n e s s , and a c t i v i t y t o g e t h e r . The t h i r d s c a l e a d m i n i s t e r e d was the L o c k e - W a l l a c e M a r i t a l Adjustment S c a l e (MAS), a w e l l v a l i d a t e d and r e l i a b l e i n s t r u m e n t . The MAS has been found to be i n t e r n a l l y c o n s i s t e n t w i t h two components l o a d i n g h i g h l y on m a r i t a l adjustment, Kimmel and Van de Veen (1974) noted the two f a c t o r s appear to be s e x u a l c o n g e n i a l i t y and compati-b i l i t y . The s p l i t h a l f r e l i a b i l i t y , r_ = .90, and t e s t - r e t e s t r e l i -a b i l i t y , _r = .77, a r e both h i g h . A l s o , v e r b a l communication s c o r e s have been found to c o r r e l a t e h i g h l y (r = .91) w i t h the L o c k e - W a l l a c e MAS ( N a r r a n , 1967; Murphy & Mendelson, 1973), i m p l y i n g t h a t m a r i t a l adjustment and communication a r e h i g h l y r e l a t e d phenomena. The MAS was m o d i f i e d s l i g h t l y f o r common-law c o u p l e s . The measures of MAS appeared to be h i g h l y i n t e r c o r r e l a t e d m as shown i n the preassessment i n t e r c o r r e l a t i o n s i n T a b l e 2. S o c i a l F u n c t i o n i n g . S o c i a l f u n c t i o n i n g was e v a l u a t e d by s e l f -r e p o r t r a t i n g s on a 7-poirit s c a l e r a n g i n g from e x t r e m e l y good to e xtremely poor, w i t h the most f a v o u r a b l e r a t i n g b e i n g seven. The c l i e n t s a l s o r e c o r d e d t h e i r c u r r e n t l e v e l of s o c i a l a c t i v i t i e s and r e c o r d e d the l e v e l of a c t i v i t i e s they would i d e a l l y l i k e to e s t a b l i s h . The c l i e n t s a l s o r a t e d the s o c i a l l i f e o f t h e i r p a r t n e r on the same s c a l e . The i n t e r c o r r e l a t i o n s between the p a r t n e r s ' r a t i n g s and the r a t i n g of the o t h e r p a r t n e r s was low, however (r = .25). Work F u n c t i o n i n g . S e l f - r e p o r t r a t i n g s of work f u n c t i o n i n g were o b t a i n e d on a 7 - p o i n t s c a l e r a n g i n g from e x c e l l e n t to t o t a l l y un-s a t i s f a c t o r y . The most f a v o u r a b l e r a t i n g was seven, w i t h one i n d i c a t i n g 24 Table 2 Correlations between 7-Point Scale of M a r i t a l Adjustment (Marital Adjustment), 5-Item Scale Assessment of Rela-tionship or M a r i t a l Adjustment (Relationship Rating), and the M a r i t a l Adjustment Scale (MAS) Ma r i t a l Relationship Adjustment Rating Relationship Rating . 0.7904 MAS 0.7981 0.7804 25 the least favourable r a t i n g . In addition the number of s i c k days, unproductive days, drinking days, or other days missed from employment was recorded for both the c l i e n t and the partner. As i n the case of s o c i a l functioning, the spouse or partner of the c l i e n t also rated s o c i a l functioning. Again, the i n t e r c o r r e l a t i o n was only moderate, •r = .40. Data Analysis In order to compare the e f f i c a c y oE the two treatment approaches and to assess any d i f f e r e n t i a l response of the a l c o h o l i c s and t h e i r partners to therapy, the following analyses were conducted. Repeated measures ANOVA was conducted between standard and con-j o i n t therapy conditions on the number of drinks per week pre- and post-therapy for a l c o h o l i c s . Partners of a l c o h o l i c s were not included as there was no evidence of excessive alcohol use at pre-therapy and therapeutic e f f o r t was not directed at reducing drinking for the part-ners. Outcome for a l c o h o l i c s on drinking at post assessment was also assessed by comparing the d i s t r i b u t i o n of alcohol intake between standard and conjoint therapy conditions. Univariate analysis of variance (ANOVA) on the a v a i l a b l e pre-measures of r e a l - i d e a l discrepancy scores, r e a l - i d e a l spouse d i s c r e -pancy scores, ratings of s o c i a l functioning, ratings of work func-t i o n i n g , seven point r a t i n g of mar i t a l adjustment, and the r e l a t i o n s h i p ratings on f i v e items were conducted for the standard versus conjoint therapy conditions. A univariate ANOVA was also conducted on alcohol consumption pre-therapy for the a l c o h o l i c s i n the standard versus conjoint therapy. While this procedure elevates the p o s s i b i l i t y of 26 a s i g n i f i c a n t d i f f e r e n c e b e i n g found by chance, i t a l s o a l l o w s the g r e a t e s t p r o b a b i l i t y of d e t e c t i n g any p r e - t h e r a p y d i f f e r e n c e s between the c o n d i t i o n s . T h i s a n a l y s i s was i n t e n d e d to t e s t the degree to which the c o n s e c u t i v e assignment r e s u l t e d i n comparable c o n d i t i o n s . A r e p e a t e d measures MANOVA was conducted between the s t a n d a r d and c o n j o i n t therapy c o n d i t i o n s on the f i v e dependent measures of r e a l -i d e a l d i s c r e p a n c y , r e a l - i d e a l spouse d i s c r e p a n c y , r a t i n g s of s o c i a l f u n c t i o n i n g , r a t i n g s of work f u n c t i o n i n g , and f i v e - i t e m r e l a t i o n s h i p r a t i n g . Both a l c o h o l i c s and t h e i r p a r t n e r s were i n c l u d e d i n t h i s a n a l y s i s . T h i s a n a l y s i s was i n t e n d e d to e v a l u a t e any changes o c c u r r i n g from p r e - to p o s t - t h e r a p y and e v a l u a t e any d i f f e r e n t i a l e f f e c t o f the therapy c o n d i t i o n s . U n i v a r i a t e a n a l y s e s were conducted when i n d i c a t e d by MANOVA s i g n i f i c a n c e . Mult i v a r i a t e a n a l y s i s of covariance. (MANCOVA) was conducted be-tween the s t a n d a r d and c o n j o i n t t h e r a p y c o n d i t i o n s , u s i n g the p r e -ther a p y s c o r e s of each of the r e s p e c t i v e f i v e dependent measures des-c r i b e d above as c o v a r i a t e . T h i s p r o c e d u r e was i n t e n d e d to p r o v i d e an a n a l y s i s to a d j u s t or c o n t r o l f o r any between c o n d i t i o n p r e - t h e r a p y d i f f e r e n c e s , and hence p r o v i d e a h i g h e r power t e s t of therapy e f f e c t s . A 2x2x2 MANOVA was used to t e s t f o r any s i g n i f i c a n t d i f f e r e n t i a l r e s p o n s e to the therapy c o n d i t i o n s by e i t h e r a l c o h o l i c s or t h e i r p a r t n e r s . The g r o u p i n g f a c t o r s were therapy c o n d i t i o n ( s t a n d a r d v e r s u s c o n j o i n t ) , spouse c o n d i t i o n ( a l c o h o l i c v e r s u s p a r t n e r ) , and time ( p r e -v e r s u s p o s t - a s s e s s m e n t ) . The same f i v e dependent measures were used as i n the p r e v i o u s MANOVA. A c o n t i n g e n c y t a b l e was used to compare outcome of s t a n d a r d and 27 c o n j o i n t therapy on s u c c e s s f u l t r e a t m e n t . Success was d e f i n e d as p o s t -treatment d r i n k i n g o f l e s s than 10 d r i n k s per week, where a d r i n k was d e f i n e d as *s ounce of 100 per cent e t h a n o l , and a post treatment MAS s c o r e above 100. F i s h e r ' s exact p r o b a b i l i t y t e s t was used to e v a l u a t e the s i g n i f i c a n c e o f the d i s t r i b u t i o n . 28 RESULTS Outcome on D r i n k i n g In comparing the a l c o h o l i c c l i e n t s i n the s t a n d a r d and c o n j o i n t t h e r a p y , 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 on p r e - t h e r a p y l e v e l s of a l c o h o l consumption. There was a s i g n i f i c a n t d e c r e a s e i n r e p o r t e d a l c o h o l consumption from p r e - to pos t - a s s e s s m e n t , F ( l , 1 4 ) = 29.43, p_ < .01. However, t h e r e were no s i g n i f i c a n t d i f f e r e n c e s between the s t a n d a r d and c o n j o i n t t h e r a p y c o n d i t i o n s on the d r i n k i n g measures. T a b l e s 3-and 4 i l l u s t r a t e these r e s u l t s . An a d d i t i o n a l a n a l y s i s was conducted where the a l c o h o l i c s were c l a s s i f i e d as low consumption or h i g h consumption d r i n k e r s a t p o s t -therapy assessment. Low consumption was a s s i g n e d when b o t h the a l c o h o l i c and the a l c o h o l i c ' s p a r t n e r agreed t h a t the p o s t - t r e a t m e n t consumption was l e s s than 10 d r i n k s per week f o r the a l c o h o l i c . In t h i s sample, the r e m a i n i n g a l c o h o l i c s Were a l l consuming more than 30 d r i n k s per week, and hence were c l a s s i f i e d as h i g h consumption d r i n k e r s . T a b l e 5 shows the d i f f e r e n c e s between the two th e r a p y con-d i t i o n s as b e i n g n o n s i g n i f i c a n t , w i t h F i s h e r ' s exact t e s t y i e l d i n g a p_ = .36. Outcome on A d j u n c t i v e Measures A n a l y s e s of v a r i a n c e between the c l i e n t s i n s t a n d a r d and c o n j o i n t t herapy were made i n the premeasures of r e a l - i d e a l s e l f d i s c r e p a n c y , r e a l - i d e a l spouse d i s c r e p a n c y , m a r i t a l adjustment, r e l a t i o n s h i p r a t i n g , r a t i n g s of s o c i a l f u n c t i o n i n g , and r a t i n g s of work f u n c t i o n i n g . 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 on f i v e o f these s i x premeasures, 29 T a b l e 3 A n a l y s i s of V a r i a n c e T a b l e f o r D r i n k s per Week Source df Mean Square F Group E r r o r P r e - P o s t 1 4.. 13 14 871.25 1 34828.11 0.00 n.s. 29.43 .001 Group x P r e - P o s t E r r o r 1 86.79 14 1183.26 0.07 n.s. T a b l e 4 Means and St a n d a r d D e v i a t i o n s of D r i n k s per Week Group Standard C o n j o i n t Pre X = 78.46 X = 74.45 s = 55.14 s = 18.45 Po s t X = 9.19 X = 11.76 s = 18.66 s = 19.51 T a b l e 5 Number and P e r c e n t a g e of A l c o h o l i c s i n Low Consumption or High Consumption D r i n k i n g C a t e g o r i e s a t Post-Therapy * Consumption L e v e l Therapy Low High Standard 5(63%) 3(37%) C o n j o i n t 6(75%) 2(25%) F i s h e r s e x a c t t e s t p_ = .36, n.s. 32 but on the r e l a t i o n s h i p r a t i n g , the s t a n d a r d therapy c o n d i t i o n s c o r e d s i g n i f i c a n t l y lower than the c o n j o i n t therapy c o n d i t i o n , F ( l , 3 0 ) = 4.71, p_ < .05. While t h i s f i n d i n g may be due to chance, e s p e c i a l l y s i n c e , the two therapy c o n d i t i o n s d i d not d i f f e r s i g n i f i c a n t l y on any o t h e r v a r i a b l e s , i n c l u d i n g o t h e r r e l a t i o n s h i p measures, f u r t h e r a n a l y s i s c o n s i d e r e d t h i s d i f f e r e n c e . T a b l e 6 summarizes t h e s e p r e - t h e r a p y s c o r e s . The r e p e a t e d measures MANOVA comparing the s t a n d a r d and c o n j o i n t t h e r a p y on the f i v e dependent measures of r e a l - i d e a l s e l f d i s c r e p a n c y , r e a l - i d e a l spouse d i s c r e p a n c y , r e l a t i o n s h i p r a t i n g s , and r a t i n g s o f s o c i a l and work f u n c t i o n i n g i n d i c a t e d s i g n i f i c a n t changes from p r e -to p o s t - a s s e s s m e n t , _F(5,26) = 7.75, p_ < .0001, s i g n i f i c a n t group d i f -f e r e n c e s , F_(2,26) = 4.73), £ < .003, and no s i g n i f i c a n t i n t e r a c t i o n (see T a b l e 7 ) . U n i v a r i a t e a n a l y e s were conducted to examine which of the depen-dent v a r i a b l e s c o n t r i b u t e d to the s i g n i f i c a n t p r e - to p o s t - t h e r a p y d i f f e r e n c e s . There was a s i g n i f i c a n t p r e - to p o s t - t h e r a p y improvement on the r e a l - i d e a l s e l f d i s c r e p a n c y , F ( l , 3 0 ) = 19.86, _p_ < .0001, as shown i n T a b l e s 8 and 9. There was a s i m i l a r s i g n i f i c a n t r e d u c t i o n i n r e a l - i d e a l spouse d i s c r e p a n c y s c o r e s , as i l l u s t r a t e d by T a b l e s 10 and 11, F ( l , 3 0 ) = 4.57, p_ < >05. The r e l a t i o n s h i p r a t i n g s i l l u s t r a t e d a s i m i l a r p r e - t o p o s t - t h e r a p y improvement, F ( l , 3 0 ) = 11.20, £ < .002, f o r p r e - to p o s t - t h e r a p y assessment, as d i d the r a t i n g s of s o c i a l f u n c t i o n i n g , F ( l , 3 0 ) = 24.36, p_ < .0001 (see T a b l e s 12 and 13 and T a b l e s 14 and 14, r e s p e c t i v e l y ) . A l s o apparent i n the r e l a t i o n s h i p r a t i n g s and the r a t i n g s o f s o c i a l f u n c t i o n i n g were the s i g n i f i c a n t d i f f e r e n c e s between the s t a n d a r d and c o n j o i n t therapy c o n d i t i o n s , 33 T a b l e 6 ANOVA T a b l e s on Pre-Therapy S c o r e s Source df MS R e a l - I d e a l S e l f D i s c r e p e n c y Group 1 E r r o r 30 T o t a l 31 0.00 0.00 n.s. 403.85 Real-Ideal Spouse Discrepancy Group 1 E r r o r 30 T o t a l 31 1250.00 1.25 n.s. 1002.33 R e l a t i o n s h i p R a t i n g Group E r r o r T o t a l 1 30 31 185.28 4.71 39.36 .04 M a r i t a l Adjustment Group E r r o r T o t a l 1 30 31 3.78 1.66 n.s. 2.28 R a t i n g s of Work F u n c t i o n i n g Group 1 E r r o r 30 T o t a l 31 3.13 1.54 n.s. 2.03 R a t i n g s o f S o c i a l F u n c t i o n i n g Group 1 E r r o r 30 T o t a l 31 4.50 2.63 n.s. 1.71 34 T a b l e 7 MANOVA T a b l e on A d j u n c t i v e Measures W i l k s Summary T a b l e Source W i l k s Lambda df approx. F df £ Group .5224 5,1,30 4.73 5,26 .003 P r e - P o s t .4014 5,1,30 7.75 5,26 .0001 Group x P r e - P o s t .8581 5,1,30 0.86 5,26 n. s. E r r o r .0005 5,30,30 B a r t l e t t - B o x Homogeneity o f D i s p e r s i o n T e s t Standard v s . C o n j o i n t P r e D f l = 15 Df2 = 3623.7 F = 0.99 n.s. Po s t D f l = 15 Df2 = 3623.7 F = 1.50 n.s. 35 T a b l e 8 A n a l y s i s of V a r i a n c e T a b l e f o r R e a l - I d e a l S e l f D i s c r e p a n c y Source df_ MS F £ Group 1 5.06 0.01 n.s. E r r o r 30 492.88 P r e - P o s t 1 2525.06 19.86 .0001 Group x P r e - P o s t 1 5.06 0.04 n.s. E r r o r 30 127.13 T a b l e 9 Means and St a n d a r d D e v i a t i o n s f o r R e a l - I d e a l S e l f D i s c r e p a n c y Scores Group Sta n d a r d C o n j o i n t Pre X = 55.38 X = 55.38 s = 21.00 s = 19.15 Post X. = 42.45 X = 43.38 s = 15.30 s = 14.09 37 T a b l e 10 ANOVA Summary T a b l e f o r R e a l - I d e a l P a r t n e r D i s c r e p a n c y S c o r e s Source df MS F p_ Group 1 1785.06 0.90 n.s. E r r o r 30 1983.60 P r e - P o s t 1 506.25 4.57 .04 Group x P r e - P o s t 1 60.06 0.54 n.s. E r r o r 30 110.79 T a b l e 11 Means and St a n d a r d D e v i a t i o n s f o r R e a l - I d e a l P a r t n e r D i s c r e p a n c y S c o r e s Group Sta n d a r d C o n j o i n t Pre X = 62.69 X = 50.19 s = 37.18 s = 24.95 Po s t X = 55.13 X = 46.50 s = 39.12 s = 24.30 39 T a b l e 12 ANOVA Summary T a b l e f o r R e l a t i o n s h i p R a t i n g Source d_f MS F £ Group 1 365.77 5.94 .02 E r r o r 30 61.62 P r e - P o s t 1 293.27 11.20 .002 P r e - P o s t x Group 1 0.02 0.0006 n.s. E r r o r 30 26.17 T a b l e 13 Means and Standard D e v i a t i o n s f o r 5-Item R e l a t i o n s h i p R a t i n g Scores Group Standard C o n j o i n t Pre X = 15.44 X = 20.25 s = 4.13 s = 7.85 Po s t X = 19.75 X = 24.50 s = 7.41 s = 6.48 41 T a b l e 14 A n a l y s i s of V a r i a n c e T a b l e f o r R a t i n g s of S o c i a l F u n c t i o n i n g Source df MS F £ Group 1 19.14 10.66 .003 E r r o r 30 1.79 P r e - P o s t 1 31.64 24.36 .0001 P r e - P o s t x Group 1 1.89 1.46 n.s. E r r o r 30 1.30 42 T a b l e 15 Means and S t a n d a r d D e v i a t i o n s f o r R a t i n g s of S o c i a l F u n c t i o n i n g Group Standard C o n j o i n t P r e X = 3.44 s = 1.26 X = 2.69 s = 1.35 P o s t X = 5.19 s = 1.22 X = 3.75 s = 1.13 43 F ( l , 3 0 ) = 5.94, p_ < .02 f o r r e l a t i o n s h i p r a t i n g s and F ( l , 3 0 ) = 10.66, p_ < .003 f o r r a t i n g s of s o c i a l f u n c t i o n i n g . R a t i n g s o f work f u n c t i o n i n g a l s o demonstrated a s i g n i f i c a n t p r e - to p o s t - t h e r a p y improvement i n r a t i n g s , F ( l , 3 0 ) = 6.41, p_ <.02, w i t h no s i g n i f i c a n t d i f f e r e n c e s be-tween therapy c o n d i t i o n s e v i d e n t . W h i l e the a n a l y s i s o f the s c o r e s on work f u n c t i o n i n g appeared to have i n d i c a t e d a s i g n i f i c a n t i n t e r a c t i o n , F_(l,30) = 4.29, p_ < .05, m u l t i v a r i a t e a n a l y s i s had not i n d i c a t e d any s i g n i f i c a n t i n t e r a c t i o n or d i f f e r e n t i a l therapy e f f e c t , thus i n d i c a t i n g no s i g n i f i c a n t d i f f e r e n t i a l e f f e c t f o r s t a n d a r d or c o n j o i n t t h e r a p y o v e r a l l . T a b l e s 16 and 17 i l l u s t r a t e t h e s e r e s u l t s . Thus, a l l f i v e dependent measures i n d i c a t e d s i g n i f i c a n t improvement from p r e - to p o s t -therapy assessment, but t h e r e were no s i g n i f i c a n t d i f f e r e n c e s between the therapy c o n d i t i o n s i n a f f e c t i n g improvement. The therapy c o n d i -t i o n s themselves appeared to be s i g n i f i c a n t l y d i f f e r e n t on a measure of r e l a t i o n s h i p f u n c t i o n i n g and a measure of s o c i a l f u n c t i o n i n g , w i t h the s t a n d a r d therapy c o n d i t i o n s c o r i n g s i g n i f i c a n t l y p o o r e r than con-j o i n t t herapy on r e l a t i o n s h i p f u n c t i o n i n g and s i g n i f i c a n t l y b e t t e r than c o n j o i n t t h e r a p y on s o c i a l f u n c t i o n i n g when both p r e - and p o s t -therapy s c o r e s were c o n s i d e r e d . T h i s l a t t e r f i n d i n g , i n c o m b i n a t i o n w i t h the e a r l i e r f i n d i n g of p r e - t h e r a p y d i f f e r e n c e s between the s t a n -d ard and c o n j o i n t c o n d i t i o n s on the r e l a t i o n s h i p r a t i n g i n d i c a t e d the use of a m u l t i v a r i a t e a n a l y s i s o f c o v a r i a n c e to t e s t f o r d i f f e r e n t i a l t h e r a p y e f f e c t s . To c o n t r o l f o r these between therapy c o n d i t i o n d i f f e r e n c e s , a MANCOVA was conducted, u s i n g the r e s p e c t i v e p r e - t h e r a p y s c o r e s as c o v a r i a t e s to compare the s t a n d a r d and c o n j o i n t therapy c o n d i t i o n s on 44 T a b l e 16 A n a l y s i s o f V a r i a n c e T a b l e f o r R a t i n g s of Work F u n c t i o n i n g Source d_f MS F p Group 1 0.06 0.03 n.s. E r r o r 30 2.10 .02 P r e - P o s t 1 7.56 6.41 P r e - P o s t x Group 1 5.06 4.29 .04 E r r o r 30 2.28 45 T a b l e 17 Means and S t a n d a r d D e v i a t i o n s f o r R a t i n g s of Work F u n c t i o n i n g G r o u p Standard C o n j o i n t Pre X = 4.13 X = 4.75 s = 1.54 s = 1.29 Post X = 5.38 X = 4.88 s = 0.96 s = 1.26 46 the same dependent measures d e s c r i b e d e a r l i e r . Even w i t h t h i s p r o -cedure, as T a b l e 18 shows, the d i f f e r e n c e s between the two therapy c o n d i t i o n s on the f i v e a d j u s t e d post-assessment measures were not s i g n i f i c a n t , F(5,25) = 0.12, £ > .05. Outcome of A l c o h o l i c s and P a r t n e r s of A l c o h o l i c s A r e m a i n i n g p o s s i b i l i t y was t h a t e i t h e r a l c o h o l i c s o r t h e i r p a r t -n e r s were r e s p o n d i n g d i f f e r e n t l y f o r each therapy c o n d i t i o n . For example, p a r t n e r s of a l c o h o l i c s may have shown more improvement i n the c o n j o i n t therapy c o n d i t i o n when compared to the p a r t n e r s i n the s t a n -d a r d t h e r a p y , and the r e v e r s e may have been t r u e f o r the a l c o h o l i c s . In such a c a s e , the o v e r a l l outcome would be e q u i v a l e n t , but one therapy would have been s u p e r i o r f o r a l c o h o l i c s and the o t h e r f o r t h e i r p a r t n e r s . To examine the d a t a f o r t h i s p o s s i b i l i t y , a 2x2x2 MANOVA was used on the f i v e dependent measures of r e a l - i d e a l s e l f d i s c r e p a n c y , r e a l - i d e a l spouse d i s c r e p a n c y , r e l a t i o n s h i p r a t i n g s , and r a t i n g s of s o c i a l and work f u n c t i o n i n g . The f a c t o r s used were therapy c o n d i t i o n ( s t a n d a r d v e r s u s c o n j o i n t ) , spouse s t a t u s ( a l c o h o l i c v e r s u s p a r t n e r ) , and time ( p r e - v e r s u s p o s t - a s s e s s m e n t ) . I f t h e r e was a d i f f e r e n t i a l r e s p o n s e to th e r a p y , s i g n i f i c a n t i n t e r a c t i o n s would be expected. E x a m i n a t i o n o f the MANOVA t a b l e , however, r e v e a l s o n l y s i g n i f i c a n t therapy c o n d i t i o n and p r e - p o s t d i f f e r e n c e s , F(5,26) = 5.24, £ < .003, and F(5,26) = 8.66, £ < .001, r e s p e c t i v e l y , w i t h no s i g n i f i c a n t spouse e f f e c t and no s i g -n i f i c a n t i n t e r a c t i o n s . Thus, the a n a l y s i s d i d not s u p p o r t the hypo-t h e s i s t h a t the p a r t n e r o r the a l c o h o l i c may respond d i f f e r e n t l y i n e i t h e r the c o n j o i n t o r s t a n d a r d t h e r a p y c o n d i t i o n . As the e a r l i e r a n a l y s i s examined the p r e - p o s t and therapy c o n d i t i o n d i f f e r e n c e s , no 47 T a b l e 18 MANCOVA T a b l e w i t h Pre-Therapy Sc o r e s S e r v i n g as C o v a r i a t e s W i l k s Summary T a b l e Source W i l k s Lambda df Approx. F Group .9760 5,1,29 .12 n.s. \ 48 f u r t h e r u n i v a r i a t e t e s t s were used. T a b l e 19 i l l u s t r a t e s the MANOVA r e s u l t s . O v e r a l l Outcome In a d d i t i o n to the e x a m i n a t i o n o f outcome on s p e c i f i c c r i t e r i a an dependent measures, i t seemed u s e f u l to compare outcome between s t a n -d ard and c o n j o i n t therapy i n a more g l o b a l manner. F o r t h i s a n a l y s i s , c l i e n t s ware c l a s s i f i e d as s u c c e s s f u l and not s u c c e s s f u l a t p o s t -therapy assessment a l o n g two c r i t e r i a . To be c o n s i d e r e d s u c c e s s f u l , c l i e n t s must (1) s c o r e g r e a t e r than 100 on the p o s t - t h e r a p y MAS and (2) be d r i n k i n g l e s s than 10 d r i n k s per week a t p o s t - t h e r a p y a s s e s s -ment, where the d r i n k s were d e f i n e d as p r e v i o u s l y noted. The r e s u l t s of t h i s a n a l y s i s , i l l u s t r a t e d i n T a b l e 20, were t e s t e d f o r s t a t i s t i c a l s i g n i f i c a n c e by F i s h e r ' s e x a c t t e s t . T h i s t e s t y i e l d e d p_ = .16, somewhat above c o n v e n t i o n a l l e v e l s of s i g n i f i c a n c e . Thus, t h i s a n a l y s i s , l i k e the p r e v i o u s a n a l y s e s , i n d i c a t e d no s i g n i f i c a n t d i f -f e r e n c e s i n outcome between s t a n d a r d and c o n j o i n t therapy c o n d i t i o n s . 49 T a b l e 19 MANOVA Summary T a b l e f o r 2x2x2 A n a l y s i s W i l k s Summary T a b l e Source W i l k s Lambda Df Approx F Df £ Group .4565 5,1,26 5.24 5,22 .003 P r e - P o s t .3751 5,1,30 8.66 5,26 .0001 Group x P r e - P o s t .8483 5,1,30 0.93 5,26 n. s. Spouse .7758 5,1,26 1.27 5,22 n.s. Spouse x Group .8960 5,1,30 0.24 5,26 n.s. Spouse x P r e - P o s t .9558 5,1,26 0.51 5.22 n. s. Spouse x Group X P r e - P o s t .8063 5,1,30 1.25 5,26 n.s. E r r o r .0014 B a r t l e t t - B o x Homogeneity of D i s p e r s i o n T e s t S t a n d a r d v e r s u s C o n j o i n t P r e d f l = 15 df2 = 3623.7 F = 0.99, n.s. Po s t d f l = 15 df2 = 3623.7 F = 1.50, n.s. A l c o h o l i c s v e r s u s P a r t n e r Pre d f l = 15 df2 = 3623.7 F = 1.20, n.s. Po s t d f l = 15 df2 = 3623.7 F = 1.17, n.s. T a b l e 20 Outcome on A l c o h o l Consumption and MAS Scores * Outcome Group Success F a i l u r e T o t a l S t andard 7(44%) 9(56%) 16 C o n j o i n t 10(63%) 6(37%) 16 T o t a l 17(53%) 15(47%) 32 F i s h e r ' s exact t e s t j> = .16, n.s. 51 DISCUSSION The r e s u l t s of t h i s study p r o v i d e d no c o n v i n c i n g e v i d e n c e t h a t t h e c o n j o i n t therapy programme used i n t h i s agency s i g n i f i c a n t l y improved outcome on e i t h e r a l c o h o l consumption or a d j u n c t i v e measures when com-pared to the agency's more c o n v e n t i o n a l o u t p a t i e n t t h e r a p y . Compari-son of outcome between spouses ( a l c o h o l i c s v e r s u s p a r t n e r s ) a l s o d i d not i n d i c a t e any s i g n i f i c a n t d i f f e r e n c e s i n t h e r a p y e f f i c a c y , w i t h a l c o h o l i c s and p a r t n e r s of a l c o h o l i c s showing s i m i l a r l e v e l s of im-provement i n b o t h s t a n d a r d and c o n j o i n t t h e r a p y c o n d i t i o n s . W h i l e the a n a l y s e s used to a s s e s s f o r between-therapy d i f f e r e n c e s i n e f f i c a c y were c o n s e r v a t i v e , the r e s u l t s of the a n a l y s e s were c o n s i s t e n t , i n d i -c a t i n g no s i g n i f i c a n t d i f f e r e n c e s i n outcome f o r the two t h e r a p y con-d i t i o n s on a l c o h o l use, s e l f - e s t e e m , spouse r e g a r d , r e l a t i o n s h i p f u n c -t i o n i n g , s o c i a l f u n c t i o n i n g , o r work f u n c t i o n i n g . W h i l e t h e r e was no e v i d e n c e of any s i g n i f i c a n t d i f f e r e n c e s i n e f f i c a c y f o r the two therapy c o n d i t i o n s , t h e r e was prominent and s t a t i s t i c a l l y s i g n i f i c a n t e v i d e n c e of improvement f o r b o t h t h e r a p y c o n d i t i o n s from p r e - to p o s t - t h e r a p y assessment. A l c o h o l i c s i n b o t h t h e r a p y c o n d i t i o n s s i g n i f i c a n t l y r e duced t h e i r d r i n k i n g . Both the a l c o h o l i c s and t h e i r p a r t n e r s s i g n i f i c a n t l y improved by p o s t - t h e r a p y assessment on s e l f - e s t e e m , spouse r e g a r d , r e l a t i o n s h i p f u n c t i o n i n g , and r a t i n g s of s o c i a l and work f u n c t i o n i n g . W h i l e the l a c k of n o r m a t i v e d a t a on some o f t h e a r e a s made t h e judgement of c l i n i c a l s i g n i f i c a n c e d i f f i c u l t , the d a t a a v a i l a b l e f o r s e l f - e s t e e m and m a r i t a l adjustment d i d s u p p o r t the i n t e r p r e t a t i o n of the improvement as b e i n g c l i n i c a l l y 52 s i g n i f i c a n t . In p a r t i c u l a r , t h e p o s t - t h e r a p y MAS mean of 105 exceeded the g e n e r a l c u t - o f f p o i n t of w e l l - a d j u s t e d r e l a t i o n s h i p s of 100, and the mean r e a l - i d e a l s e l f - d i s c r e p a n c y s c o r e of 43 a t p o s t t h e r a p y com-pa r e d f a v o u r a b l y w i t h the average r e a l - i d e a l s e l f d i s c r e p a n c y s c o r e of 44, o b t a i n e d from c o l l e g e u n d e r g r a d u a t e s . As a programme e v a l u a t i o n of an e x i s t i n g programme and a newer t h e r a p e u t i c approach i n s t i t u t e d by the agency, t h e s e r e s u l t s were sub-j e c t t o a g r e a t e r number of l i m i t a t i o n s on t h e i r g e n e r a l i t y and i m p l i -c a t i o n s than would have been t h e c a s e i f the comparison had been done on a s t r i c t l y c o n t r o l l e d e x p e r i m e n t a l b a s i s . L i m i t a t i o n s A l t e r n a t i v e e x p l a n a t i o n s may be advanced t o e x p l a i n f o r the l a c k of s i g n i f i c a n t between th e r a p y d i f f e r e n c e s . Therapy "packages" of the s o r t used i n t h i s agency programme may not be as a p p r o p r i a t e o r e f f e c -t i v e as a more i n d i v i d u a l i z e d t h e r a p y p l a n ( S o b e l l & S o b e l l , 1973, 1976). For example, s e v e r a l o f the c o u p l e s i n v o l v e d i n t h i s s t u d y d i d not appear t o be e x p e r i e n c i n g s e r i o u s r e l a t i o n s h i p d i f f i c u l t i e s , thus perhaps m i n i m i z i n g the e f f e c t of the i n t e r v e n t i o n s on measures of r e l a -t i o n s h i p f u n c t i o n i n g . I n p a r t i c u l a r , the c l i e n t s t h a t had been a s s i g n e d to the c o n j o i n t t h e r a p y c o n d i t i o n s c o r e d s i g n i f i c a n t l y b e t t e r than c l i e n t s a s s i g n e d to the s t a n d a r d t h e r a p y c o n d i t i o n on a p r e - t h e r a p y r a t i n g of r e l a t i o n s h i p f u n c t i o n i n g . G i v e n t h i s d i f f e r e n c e , i t i s pos-s i b l e t h a t the c l i e n t s i n the c o n j o i n t t h e r a p y c o n d i t i o n were not i n a p o s i t i o n t o b e n e f i t as much from the c o n j o i n t i n t e r v e n t i o n as a sample t h a t was e x p e r i e n c i n g more r e l a t i o n s h i p d i f f i c u l t i e s . A second problem of i n t e r p r e t a t i o n f o r e v a l u a t i o n s o f package programmes, i s the 53 p o s s i b i l i t y o f complex i n t e r a c t i o n s between elements o f the package. I f s i g n i f i c a n t d i f f e r e n c e s a r e found between t h e c o n d i t i o n s , i t would be d i f f i c u l t t o determine which element made t h e g r e a t e s t c o n t r i b u t i o n to such a between group d i f f e r e n c e . I f no s i g n i f i c a n t d i f f e r e n c e s a r e found between c o n d i t i o n s , i t would be p o s s i b l e t h a t d i f f e r e n t package elements, w h i l e h a v i n g an e f f e c t , were c a n c e l l i n g out one a n o t h e r . I n t h i s agency, i t was p o s s i b l e t h a t t h e e f f e c t s o f time i n t h e r a p y , group or i n d i v i d u a l m o d a l i t y , and the degree of spouse i n v o l v e m e n t a c t e d i n such a way as to c a n c e l out the c o n t r i b u t i o n o f one a n o t h e r . F o r example, perhaps the hours i n therapy i n the c o n j o i n t c o n d i t i o n were not s u f f i c i e n t t o d e a l w i t h the i n c r e a s e d range o f problems d e a l t w i t h , thus o f f s e t t i n g any advantage o f c o n j o i n t i n v o l v e m e n t . A t h i r d problem f o r e v a l u a t i o n o f t h e r a p y packages i s t h a t the s p e c i f i c g o a l s of i n t e r -v e n t i o n may be a p p r o p r i a t e i n a g l o b a l sense, but miss or i g n o r e s p e c i -f i c c r u c i a l v a r i a b l e s . I n t h i s sense, t h e assessment measures used f o r t h i s agency i n c l u d e d a r e a s as s e l f - e s t e e m and m a r i t a l adjustment; o t h e r a r e a s of i n t e r e s t may i n c l u d e a s s e r t i v e n e s s or d i r e c t assessment of couple-communication p r o c e s s . Other i n f l u e n c e s may have a f f e c t e d the i n t e r n a l v a l i d i t y o f the stud y (Campbell & S t a n l e y , 1963). E f f e c t s o f t h e pre-assessment and the a d m i n i s t r a t i o n o f the dependent measures, w h i l e t h e same f o r b o t h t h e r a p y c o n d i t i o n s , may a l s o have i n f l u e n c e d or a c c o u n t e d f o r r e s u l t s by s e n s i t i z i n g t h e c l i e n t s t o the a r e a s under e v a l u a t i o n . The r e l i -a b i l i t y and v a l i d i t y of t h e s e measures appeared to be a t l e a s t ade-quate, and i n some cases s u b s t a n t i a l . However, d i r e c t b e h a v i o u r a l measures would c o n s t i t u t e an improvement, but i n t h i s agency an attempt 5 4 to i n t r o d u c e b e h a v i o u r a l methods was found t o be so time-consuming as to i n t e r f e r e w i t h s e r v i c e d e l i v e r y . The i n f l u e n c e o f r e g r e s s i o n t o -ward the mean c o u l d account f o r some of the improvement from p r e - to p o s t - t h e r a p y , because i n many cases extreme s c o r e s were r e c o r d e d on pre-assessment. R e g r e s s i o n appears t o be an u n l i k e l y e x p l a n a t i o n f o r a l l of the improvement i n t h i s s t u d y , however, as t h e r e was a re d u c -t i o n o f v a r i a b i l i t y o f s c o r e s as improvement on mean s c o r e s from p r e -to p o s t - a s s e s s m e n t . A more l i k e l y p o s s i b l e i n f l u e n c e was the consecu-t i v e assignment to therapy c o n d i t i o n s . W h i l e t h e r e was no r e a s o n t o assume t h a t t h i s would r e s u l t i n group d i f f e r e n c e s , pre-assessment e v a l u a t i o n d i d i n d i c a t e a s i g n i f i c a n t d i f f e r e n c e between the the r a p y c o n d i t i o n s on r e l a t i o n s h i p r a t i n g s . S t a t i s t i c a l c o n t r o l f o r t h i s p r e -th e r a p y d i f f e r e n c e , w h i l e h e l p f u l , i s riot e n t i r e l y s a t i s f a c t o r y , as t h i s i n i t i a l d i f f e r e n c e may i n f l u e n c e outcome by i n t e r a c t i n g w i t h the th e r a p y c o n d i t i o n . D i f f e r e n t i a l s u b j e c t m o r t a l i t y can be an i n f l u e n c e on outcome, as d i f f e r e n t i a l m o r t a l i t y may o p e r a t e as a s e l e c t i o n b i a s , t h i s d i d n o t appear to be the case i n t h i s s t u d y , though, as o n l y one c o u p l e dropped out the of t h e s t a n d a r d c o n d i t i o n and an o t h e r c o u p l e dropped out of the c o n j o i n t c o n d i t i o n . P l a c e b o or expectancy e f f e c t s can o f t e n be problems i n e v a l u a t i n g outcomes o f a g e n c i e s ' t h e r a p y programmes. P r o v i s i o n o f a n o n - s p e c i f i c o r p l a c e b o t h e r a p y c o n d i t i o n would c o n t r o l f o r t h e s e n o n - s p e c i f i c e f f e c t s , but such a c o n d i t i o n was not a c c e p t e d a t t h i s agency due to e t h i c a l i m p l i c a t i o n s . These p l a c e b o o r expectancy e f f e c t s a r e d i f f i -c u l t t o e l i m i n a t e from the p r e s e n t study d e s i g n , but t h e magnitude and c o n s i s t e n c y o f the r e s u l t s a c r o s s a v a r i e t y of measures argue a g a i n s t 55 g i v i n g t h e s e f a c t o r s prominent r o l e s . Hawthorne e f f e c t s to t h e new t h e r a p y m o d a l i t y can a l s o a f f e c t r e s u l t s i n outcome s t u d i e s . A Haw-th o r n e e f f e c t to a new m o d a l i t y c o u l d i n c r e a s e the e f f e c t i v e n e s s of outcome, making a m a r g i n a l l y s i g n i f i c a n t e f f e c t a h i g h l y s i g n i f i c a n t e f f e c t . To the e x t e n t t h a t the i n n o v a t i v e m o d a l i t y , the c o n j o i n t t h e r a p y c o n d i t i o n , d i d not d i f f e r s i g n i f i c a n t l y from more c o n v e n t i o n a l t h e r a p y , d e s p i t e the p o t e n t i a l of a Hawthorne e f f e c t , i n c r e a s e s the c e r t a i n t y t h a t the appearance of e q u a l t h e r a p y e f f e c t i v e n e s s i s t r u e . P r o v i s i o n of a n o n - s p e c i f i c p l a c e b o therapy c o n d i t i o n i s the u s u a l e x p e r i m e n t a l c o n t r o l f o r Hawthorne e f f e c t s . A w a i t i n g - l i s t , o r s i m i l a r no-treatment c o n t r o l , i s a l s o d e s i r a b l e to a s s e s s the e f f i c a c y of t h e r a p y , i n o r d e r to c o n t r o l f o r r e c o v e r y o r improvement which o c c u r s w i t h the passage of t i m e . Cadogan (1973) has i n d i c a t e d t h a t m a r i t a l t h e r a p y f o r a l c o h o l i c s and t h e i r spouses was s u p e r i o r to a w a i t i n g l i s t c o n t r o l f o r the development of a b s t i n e n c e . E t h i c a l c o n s i d e r a -t i o n s p r e c l u d e d the use of a w a i t i n g l i s t c o n t r o l i n t h i s agency. Another p o s s i b l e e f f e c t not y e t f u l l y a s s e s s e d i s the p o s s i b i l i t y o f d i f f e r e n t i a l e f f e c t s i n terms of maintenance of improvement. The e x p e c t a t i o n c u r r e n t l y i s f o r i n c r e a s i n g r a t e s of r e l a p s e as time from t h e r a p y i n c r e a s e s ( M a r l a t t & Gordon, 1978). One t h e o r e t i c a l c o n s i d e r a -t i o n i n the i n volvement o f the spouse of an a l c o h o l i c i n t h e r a p y f o r th e a l c o h o l i c , however, i s t h a t t h i s spouse involvement may i n c r e a s e maintenance or r e d u c e r e l a p s e . J u d g i n g from r e p o r t s on the n a t u r e o f r e l a p s e ( M a r l a t t & Gordon, 1978), t h i s p o s s i b l e i n c r e a s e i n main-tenance may be e s p e c i a l l y s i g n i f i c a n t f o r c o n t r o l l e d d r i n k i n g o r i e n t a -t i o n s . S i x month and one y e a r p o s t - t h e r a p y assessments a r e p l a n n e d , 56 f o r the programme, which may h e l p to a s s e s s p o s s i b l e d i f f e r e n c e s be-tween the t h e r a p y c o n d i t i o n s on t h e i r l o n g - t e r m maintenance. Q u e s t i o n s of g e n e r a l i t y , o r e x t e r n a l v a l i d i t y , a l s o a f f e c t the i n t e r p r e t a t i o n of the r e s u l t s . G e n e r a l i z i n g t h e s e r e s u l t s t o o t h e r t h e r a p y c o n d i t i o n s o r programmes h a v i n g m a r i t a l or c o n j o i n t components f o r a l c o h o l i c s and t h e i r spouses may not always be v a l i d . T h i s i s due b o t h t o the d i f f e r e n c e s and v a r i a t i o n s found i n m a r i t a l or c o n j o i n t approaches and to the d i f f e r e n c e s between packages o r i n d i v i d u a l i z e d approaches. Even the p r o v i s i o n o f p r e - and p o s t - t h e r a p y assessment may account f o r some of the changes shown, be r e a c t i v i t y , making genera-l i z a t i o n to programmes w i t h o u t p r e - and post-assessment r i s k y . M a r i t a l o r c o n j o i n t approaches to a l c o h o l i c s a r e g r e a t l y v a r i a b l e r a n g i n g from i n d i v i d u a l c o n c u r r e n t t h e r a p y to a c o u p l e s group (Sands & Hanson, 1971), to v i d e o - t a p e d and r o l e - p l a y p r a c t i c e o f a d a p t i v e s o c i a l i n t e r a c t i o n a l s k i l l s ( M i l l e r & Hersen, 1976), or to c o n c u r r e n t but s e p a r a t e group therapy approaches f o r a l c o h o l i c s and t h e i r wives (Gliedman, R o s e n t h a l , Frank, & Nash, 1956). A l t h o u g h a l l of t h e s e , and o t h e r , approaches s h a r e spouse i n v o l v e m e n t , the t h e r a p e u t i c methods d i f f e r e d c o n s i d e r a b l y . S t e i n g l a s s (1976) reviewed the range of f a m i l y t h e r a p y approaches to a l c o h o l i c s , and the range appeared to be c o n s i d e r a b l e . E x t e n d i n g the outcome of the p r e s e n t r e s e a r c h to o t h e r s i m i l a r l y t i t l e d , y e t d i f -f e r e n t c o n t e n t , t h e r a p i e s must be done w i t h c a u t i o n . In a d d i t i o n t o v a l i d i t y i s s u e s , i t may be t h a t the sample s i z e was not s u f f i c i e n t l y l a r g e to p e r m i t a p o w e r f u l a n a l y s i s o f between-therapy d i f f e r e n c e s . While i t i s t r u e the d a t a a n a l y s e s were c o n s e r v a t i v e , i n c r e a s i n g power may s i m p l y r a i s e the i s s u e of c l i n i c a l v e r s u s 57 s t a t i s t i c a l s i g n i f i c a n c e . T h i s seemed to be the case h e r e , as the s t a t i s t i c a l a n a l y s e s were p o w e r f u l enough to d e t e c t s i g n i f i c a n t e v i -dence of improvement, and even some r e l a t i v e l y s m a l l between-therapy c o n d i t i o n d i f f e r e n c e s on two measures. As Meehl (1978) p o i n t e d out i n h i s s p i r i t e d a r t i c l e , the n u l l h y p o t h e s i s i s always q u a s i - f a l s e and i n c r e a s e s i n sample s i z e o r power may o n l y l e a d to the g r a t u i t o u s r e j e c t i o n o f the n u l l h y p o t h e s i s . Of c o u r s e , i t was not the case t h a t t h i s s t u d y has e s t a b l i s h e d t h a t t h e r e a r e no d i f f e r e n c e s i n e f f e c t i v e -ness between c o n j o i n t o r more c o n v e n t i o n a l t h e r a p y f o r a l c o h o l i c s . I m p l i c a t i o n s f o r F u t u r e R e s e a r c h I n terms of i m p l i c a t i o n s f o r c o n j o i n t t h e r a p y f o r a l c o h o l i c s , perhaps the r e s u l t s of g r e a t e s t i n t e r e s t were the i n d i c a t i o n s t h a t the p a r t n e r s o f a l c o h o l i c s seemed to match and i n some a r e a s even exceed the a l c o h o l i c i n terms of p s y c h o l o g i c a l d e f i c i t . I n p a r t i c u l a r , the p a r t n e r s of a l c o h o l i c s and the a l c o h o l i c s themselves e x p e r i e n c e d h i g h l y d i s c r e p a n t r e a l - i d e a l s e l f d e s c r i p t i o n s , i n d i c a t i n g low s e l f -esteem. The f i n d i n g t h a t a l c o h o l i c s e x p e r i e n c e d low s e l f - e s t e e m r e l a -t i v e t o a n o r m a t i v e sample was not s u r p r i s i n g , as Beckman (1978) noted such a r e l a t i o n s h i p r e c e n t l y , but the f i n d i n g s of low s e l f - e s t e e m i n p a r t n e r s of a l c o h o l i c s , w h i l e not unexpected, have been l e s s e s t a b -l i s h e d p r e v i o u s l y . The o t h e r d a t a on s o c i a l f u n c t i o n i n g , m a r i t a l adjustment, and r e a l - i d e a l spouse d i s c r e p a n c i e s a l s o seemed to i n d i c a t e t h a t a l c o h o l i c s and t h e i r p a r t n e r s , i n t h i s sample, e x p e r i e n c e d d i f f i -c u l t i e s i n f u n c t i o n i n g . R a t i n g s i n the a r e a of w orking f u n c t i o n i n g were the o n l y e x c e p t i o n , w i t h b o t h a l c o h o l i c s and t h i e r p a r t n e r s i n t h i s sample r e p o r t i n g f a v o u r a b l e f u n c t i o n i n g . E s s e n t i a l l y , a l c o h o l i c s 5 8 and t h e i r p a r t n e r s seemed to e x p e r i e n c e s i m i l a r l e v e l s o f p s y c h o l o g i c a l d i s t r e s s . S u r p r i s i n g l y , however, p a r t n e r s of a l c o h o l i c s improved even i f the p a r t n e r s were a s s i g n e d to t h e s t a n d a r d t h e r a p y c o n d i t i o n which f a v o u r e d most t h e r a p e u t i c a t t e n t i o n on the a l c o h o l i c . T h i s i m p l i e s t h a t t h e d e f i c i t s e x p e r i e n c e d by the p a r t n e r s of an a l c o h o l i c — low s e l f - e s t e e m and low r a t i n g s on r e l a t i o n s h i p measures — may have im-proved as the a l c o h o l i c improved i n f u n c t i o n i n g . A t the same time, the c u r r e n t study d i d not p r o v i d e d i r e c t e v a l u a t i o n of t h i s p o s s i b i l i t y , but i t does i n d i c a t e a p o s s i b l e a r e a f o r f u r t h e r r e s e a r c h . An a d d i t i o n a l a r e a a l s o m e r i t s f u t u r e a t t e n t i o n : the d i r e c t e x a m i n a t i o n of the r e l a t i o n s h i p between i n t e r p e r s o n a l and m a r i t a l r e l a -t i o n s on a l c o h o l consumption. I n o t h e r words, the a s p e c t s of the m a r i -t a l r e l a t i o n s h i p t h a t a r e c a u s a l to the a l c o h o l i c s ' problem need to be a s s e s s e d so t h a t we can determine what the unique f o c u s or g o a l s of m a r i t a l therapy s h o u l d be. We c o u l d then e x p e r i m e n t a l l y examine whether the m a r i t a l t h e r a p y was a f f e c t i n g t h i s s p e c i f i c problem a r e a , and i f i t was a f f e c t i n g t h i s problem a r e a , what the e f f e c t s on consump-t i o n were. The a v a i l a b l e r e s e a r c h ( S t e i n g l a s s , D a v i s , & Berenson, 1977; H e i s e n , M i l l e r , & E i s l e r , 1973) -suggests t h a t spouse a t t e n t i o n o r f r i e n d l y , a f f e c t i o n a t e i n t e r a c t i o n d u r i n g i n t o x i c a t i o n may be impor-t a n t i n f l u e n c e s . C o n s i d e r a b l y more r e s e a r c h i s needed i n t h i s a r e a , however. Q u e s t i o n s s t i l l r emain whether i n t e r a c t i o n a l p a t t e r n s a r e even of c r u c i a l importance f o r t h e r a p y . For example, i t i s p o s s i b l e t h a t spouse involvement c o u l d a c t to i n c r e a s e s i t u a t i o n a l c o n t r o l f o r the a l c o h o l i c (as a v o i d i n g h i g h - r i s k r e l a p s e s i t u a t i o n s ) w i t h o u t t h e r e b e i n g any m a r i t a l or i n t e r a c t i o n p roblems. F u t u r e r e s e a r c h i s needed 59 to i n d i c a t e the r e l a t i v e importance o f g l o b a l m a r i t a l h a p p i n e s s , s p e c i f i c i n t e r a c t i o n a l p a t t e r n s , o r unique i n d i v i d u a l p a t t e r n s f o r the f u n c t i o n a l i n f l u e n c e on a l c o h o l consumption. Other r e s e a r c h i n d i c a t i n g s e l f - e s t e e m o r s e l f c oncepts of a l c o h o l i c s may be an a p p r o p r i a t e a r e a of i n t e r v e n t i o n (Tomsovic, 1976) has r e -c e i v e d s u p p o r t from the c u r r e n t s t u d y . The a l c o h o l i c s i n t h i s sample demonstrated low s e l f - e s t e e m and b o t h t h e r a p y c o n d i t i o n s appeared to have improved on s e l f - e s t e e m by p o s t - t h e r a p y assessment. However, as t h e r e were no between-therapy c o n d i t i o n d i f f e r e n c e s , i t was not pos-s i b l e t o a t t r i b u t e whether the s i g n i f i c a n t improvement i n s e l f - e s t e e m was due to the t h e r a p y or s h a r e d f a c t o r s i n f l u e n c i n g the contemporary h i s t o r y of the two t h e r a p y c o n d i t i o n s . T h i s l a c k of s i g n i f i c a n t d i f f e r e n c e s between a c o n j o i n t t h e r a p y c o n d i t i o n and a more c o n v e n t i o n a l i n d i v i d u a l t h e r a p y on the dependent measures used s u g g e s t s c r i t i c a l f u t u r e e v a l u a t i o n s . T h i s i s p a r t i c u -l a r l y t r u e as a c a r e f u l r e v i e w of the l a r g e l y e n t h u s i a s t i c l i t e r a t u r e on spouse involvement i n t h e r a p y f o r a l c o h o l i c s r e v e a l s t h a t a non-s i g n i f i c a n t outcome d i f f e r e n c e i s not an u n u s u a l f i n d i n g . E s s e n t i a l l y , the l a c k of s i g n i f i c a n t e v a l u a t i o n s of spouse involvement argues f o r c r i t i c a l assessment of the c o n t r i b u t i o n of spouse i n v o l v e m e n t i n t h e r a p y f o r a l c o h o l i c s . I n p a r t i c u l a r , spouse involvement needs to be compared to an i n d i v i d u a l l y o r i e n t e d t h e r a p y ; where the t h e r a p y c o n d i -t i o n s a r e matched i n terms of t h e i r r e l e v a n t d i m e n s i o n s . F o r example, a s s e r t i o n t r a i n i n g may be p r o v i d e d f o r a l c o h o l i c s i n a group, or w i t h a l c o h o l i c s and t h e i r p a r t n e r s c o n j o i n t l y a t t e n d i n g a group. A p l a c e b o or n o n - s p e c i f i c t h e r a p y c o n t r o l and a w a i t i n g - l i s t or s i m i l a r no 60 t reatment c o n t r o l c o n d i t i o n s would a l s o be d e s i r a b l e . The e t h i c a l i m p l i c a t i o n s f o r s uch a study a r e , o f c o u r s e , s e r i o u s . However, the l a r g e l y e q u i v o c a l f i n d i n g s to d a t e on the c o n t r i b u t i o n of spouse i n v o l v e m e n t and the growing p o p u l a r i t y of the approach s t r o n g l y urges the development of s uch a c a r e f u l e x p e r i m e n t a l e v a l u a t i o n . The r e s u l t s of t h i s s t u d y , however, d i d not imply t h a t c o n j o i n t t h e r a p y was w i t h o u t v a l u e . F o r b o t h the s t a n d a r d and c o n j o i n t t h e r a p y c o n d i t i o n s , t h e r e were r e p o r t s o f improvement on a l c o h o l consumption f o r the a l c o h o l i c s (63% and 75%, r e s p e c t i v e l y ) and some e v i d e n c e of s u c c e s s f u l treatment f o r b o t h the a l c o h o l i c and t h e p a r t n e r on more s t r i n g e n t c r i t e r i a (49% and 63%, r e s p e c t i v e l y ) . These r e s u l t s compare f a v o u r a b l y to r a t e s of r e c o v e r y f o r u n t r e a t e d a l c o h o l i c s (Armour, P o l i c h , & Stambul, 1976; Smart, 1976), a l t h o u g h the d i f f e r e n c e may be due to s e l e c t i o n or s a mpling f a c t o r s . N e v e r t h e l e s s , a competing e x p l a n a t i o n may be t h a t e i t h e r t h e r a p y c o n d i t i o n c o n t r i b u t e d to i n c r e a s e d r e c o v e r y r a t e s . In any c a s e, c o n j o i n t t h e r a p y appeared to be a t l e a s t as e f f e c t i v e as more c o n v e n t i o n a l t h e r a p y . C o n j o i n t t h e r a p y i n t h i s study had the a d d i t i o n a l advantage of b e i n g conducted i n a group s e t t i n g , and hence, r e p r e s e n t e d somewhat more e f f i c i e n t use of t h e r a p i s t time w h i l e a p p e a r i n g not to a p p r e c i a b l y a f f e c t outcome. However, the i n c o n c l u s i v e n a t u r e of t h e s e r e s u l t s do s t r o n g l y argue f o r more r i g o u r o u s e v a l u a t i o n . C a r e f u l c o n s i d e r a t i o n of the outcome measures used i n the e v a l u a -t i o n o f the c o n t r i b u t i o n of spouse involvement i n t h e r a p y f o r a l c o h o l i c s i s a l s o i n d i c a t e d . The outcome measures s e l e c t e d by the agency f o r t h i s e v a l u a t i o n a r e not the o n l y i n s t r u m e n t s a v a i l a b l e . Cromwell and O l s o n (1976) reviewed the v a r i o u s t e c h n i q u e s of e v a l u a t i o n a v a i l a b l e f o r 61 m a r i t a l and f a m i l y t h e r a p y . Measures of i n t e r e s t f o r f u t u r e c o u l d i n c l u d e b r i e f s c a l e s f o r e v a l u a t i n g a s s e r t i v e n e s s , m a r i t a l communica-t i o n , and work s a t i s f a c t i o n (McLachlan & Waldemann, 1976), and the m a r t i a l i n t e r a c t i o n c o d i n g system (Hops, W i l l s , P a t t e r s o n , & Weiss, 1976). F u t u r e r e s e a r c h may b e n e f i t from the use of d i r e c t b e h a v i o u r a l assessment, as the m a r i t a l i n t e r a c t i o n c o d i n g system. Use of d i r e c t b e h a v i o u r a l assessment may p r o v i d e g r e a t e r s e n s i t i v i t y than the s e l f -r e p o r t assessments used i n t h i s programme, because b e h a v i o u r a l a s s e s s -ment may a v o i d some of the problems a s s o c i a t e d w i t h r e a c t i v i t y to mea-surement . Summary The e s s e n t i a l f i n d i n g s of t h i s s t u d y , t h e n , i n d i c a t e d s i g n i f i c a n t improvement o f b o t h a l c o h o l i c s and t h e i r spouses o r p a r t n e r s , but no s i g n i f i c a n t d i f f e r e n t i a l e f f e c t s on t h i s improvement f o r e i t h e r c o n j o i n t t h e r a p y programme or the more c o n v e n t i o n a l t h e r a p y programme of the agency i n v o l v e d i n t h i s s t u d y . T h i s r e l a t i o n s h i p h e l d even when the r e s u l t s of p a r t n e r s and a l c o h o l i c s were compared s e p a r a t e l y a c r o s s t h e r a p y c o n d i t i o n s . W h i l e t h i s d e s i g n , a two group r e p e a t e d measures d e s i g n , c o n t r o l l e d f o r some t h r e a t s to i n t e r n a l v a l i d i t y , e x t e n d i n g t h e s e f i n d i n g s to o t h e r s i m i l a r t h e r a p i e s may s t r a i n t h e r o b u s t n e s s of the f i n d i n g s (see Campbell & S t a n l e y , 1963). As Cowan (1978) noted, u l t i m a t e c o n c l u s i o n s about i n t e r v e n t i o n s of the s o r t d e s c r i b e d h e r e may have to come about s l o w l y and c u m u l a t i v e l y , based upon co n v e r g e n t f i n d i n g s . I n t h i s sense, the r e s u l t s of t h i s study appeared to be con-s i s t e n t w i t h o t h e r r e s e a r c h , s u g g e s t i n g t h a t c o n j o i n t t h e r a p y i s a v i a b l e approach, but not d e m o n s t r a t i n g any s u p e r i o r i t y o f c o n j o i n t t h e r a p y 62 r e l a t i v e t o o t h e r approaches. 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D i f f i c u l t y of f o l i o w - u p and outcome of a l c o h o l i s m t r e a t m e n t . J o u r n a l of S t u d i e s on A l c o h o l , 1978, 39, 473-490. Murphy, D. & Mendelson, L. Communication and adjustment i n m a r r i a g e : I n v e s t i g a t i n g the r e l a t i o n s h i p . F a m i l y P r o c e s s , 1973, 12, 317-326. Nathan, P.E. & Lansky, D. Common m e t h o d o l o g i c a l problems i n r e s e a r c h on the a d d i c t i o n s . J o u r n a l o f C o n s u l t i n g and C l i n i c a l P s y c h o l o g y , 1978, 46, 713-726. Navran, L. Communication and adjustment i n m a r r i a g e . F a m i l y P r o c e s s 1967, 6, 173-184. O r f o r d , J . , Oppenheimer, E., E g g e r t , S., Hinsman, C , & G u t h r i e , S. The c o h e s i v e n e s s o f a l c o h o l i s m - c o m p l i c a t e d m a r r i a g e s and i t s i n f l u e n c e on treatment outcome. B r i t i s h J o u r n a l o f P s y c h i a t r y , 1976, 128, 318-339. Osgood, C , S u c i , G., & Tannenbaum, P. The measurement of meaning. Urbana: U n i v e r s i t y of I l l i n o i s P r e s s , 1964. P a t t i s o n , E. A c r i t i q u e of a b s t i n e n c e c r i t e r i a i n the tre a t m e n t of a l c o h o l i s m . I n t e r n a t i o n a l J o u r n a l o f S o c i a l P s y c h i a t r y , 1968, 14, 268-276. P a t t i s o n , E. N o n a b s t i n e n t d r i n k i n g g o a l s i n the treatment o f a l c o h o l i s m . A r c h i v e s o f G e n e r a l P s y c h i a t r y , 1976, 33, 923-930. P a t t i s o n , E., C o u r l a s , P. , P a t t i , R., Munn, B., & M u l l e n , D. D i a g -n o s t i c - t h e r a p e u t i c i n t a k e groups f o r wives f o r a l c o h o l i c s . Q u a r t e r l y J o u r n a l of S t u d i e s on A l c o h o l , 1965, 26, 605-616. P i c k e n s , R., Bigelow, G., & G r i f f i t h s ; D. An e x p e r i m e n t a l approach to t r e a t i n g c h r o n i c a l c o h o l i s m : A case study and one-year f o l l o w -up. B e h a v i o u r R e s e a r c h and Therapy, 1973, 11, 321-325. P i x l c y , J . & S t i e f e l , J . Group therapy d e s i g n e d to meet the needs of the a l c o h o l i c w i f e . Q u a r t e r l y J o u r n a l of S t u d i e s on A l c o h o l , 1963, 24, 304-314. Pophen, R. The J e l l n i c k A l c o h o l i s m e s t i m a t i o n f o r m u l a and i t s a p p l i -c a t i o n to C a n adian d a t a . Q u a r t e r l y J o u r n a l of S t u d i e s on A l c o h o l , 1956, 17, 559-595. Rachman, S. & T e a s d a l e , J . A v e r s i o n t h e r a p y and b e h a v i o r d i s o r d e r s :  An a n a l y s i s . C o r a l G a b l e s : U n i v e r s i t y of Miami P r e s s , 1969. Rosenberg, M. P a r e n t a l i n t e r e s t and c h i l d r e n ' s s e l f - c o n c e p t i o n s . S o c i o m e t r y , 1963, 26, 35-49. Ruesch, J . , B l o c k , J . , & B ennett, L. The assessment of communication. I. A method f o r the a n a l y s i s of s o c i a l i n t e r a c t i o n . J o u r n a l  of P s y c h o l o g y , 1953, 35, 59-80. Sands, P. & Hanson, P. P s y c h o t h e r a p e u t i c groups f o r a l c o h o l i c s and r e l a t i v e s i n an o u t p a t i e n t s e t t i n g s . I n t e r n a t i o n a l J o u r n a l of  Group P s y c h o t h e r a p y , 1971, 21, 23-33. Smart, R. Spontaneous r e c o v e r y i n a l c o h o l i c s : A r e v i e w and a n a l y s i s of the a v a i l a b l e r e s e a r c h . Drug and A l c o h o l Dependence, 1976, 1, 277-285, S o b e l l , L.C. & S o b e l l , M.B. O u t p a t i e n t a l c o h o l i c s g i v e v a l i d s e l f -71 s e l f - r e p o r t s . J o u r n a l of Nervous and M e n t a l D i s e a s e , 1975, 161, 32-42. S o b e l l , M. & S o b e l l , L. A l c o h o l i c s t r e a t e d by i n d i v i d u a l i z e d b e h a v i o r t h e r a p y : One ye a r treatment outcome. Behaviour Research and Therapy, 1973, 11, 599-618. S o b e l l , M. & S o b e l l , L.. Second y e a r treatment outcome of a l c o h o l i c s t r e a t e d by i n d i v i d u a l i z e d b e h a v i o r t h e r a p y : R e s u l t s . B e h a v i o u r R e s e a r c h and Therapy, 1976, 14, 195-215. S o b e l l , M. , S o b e l l , L., & Samuels, F.H. V a l i d i t y of s e l f - r e p o r t s of a l c o h o l - r e l a t e d a r r e s t s by a l c o h o l i c s . Q u a r t e r l y J o u r n a l of S t u d i e s on A l c o h o l , 1974, 35, 276-280. Smith, C. A l c o h o l i c s : T h e i r treatment and t h e i r w i v e s . B r i t i s h J o u r n a l of P s y c h i a t r y , 1969, 115, 1039-1042. S t e i n g l a s s , P. E x p e r i m e n t i n g w i t h f a m i l y treatment approaches to a l c o h o l i s m . 1950-1975: A r e v i e w . 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The a v e r s i v e c o n t r o l of e x c e s -s i v e d r i n k i n g by c h r o n i c a l c o h o l i c s i n the l a b o r a t o r y s e t t i n g . J o u r n a l of A p p l i e d B e h a v i o r A n a l y s i s , 1975, 8, 13-26. APPENDIX A Forms used d u r i n g t h e r a p y , Consent Forms, A l c o h o l and Drug C o u n s e l l i n g I n f o r m a t i o n Form, M a r i t a l Adjustment S c a l e , I n t e r v i e w S c h e d u l e , Guttman S e l f - E s t e e m S c a l e , and o u t l i n e o f t h e r a p y p l a n . 74 O u t l i n e o f Therapy P l a n f o r S t a n d a r d and C o n j o i n t Therapy C o n d i t i o n s C o n j o i n t Group Therapy S e s s i o n One. The f i r s t s e s s i o n was an a l l day (8 hour) group s e s s i o n . Both t h e a l c o h o l i c and t h e p a r t n e r of the a l c o h o l i c a t t e n d e d . Each member of the group v e r b a l l y responded t o the items on the f a m i l y c o n s t e l l a t i o n q u e s t i o n n a i r e s . Responses t o these items were used as a f o c u s of the group d i c s u s s i o n . When a l l members had f i n i s h e d w i t h t h e f a m i l y c o n s t e l l a t i o n q u e s t i o n n a i r e , the group members responded v e r b a l l y t o the s i g n i f i c a n t a r e a s q u e s t i o n n a i r e . Responses were a g a i n used as a f o c u s o f d i s c u s s i o n . The c o n s t e l l a t i o n q u e s t i o n n a i r e f o c u s e d on f a m i l y e x p e r i e n c e s i n c h i l d h o o d and a d o l e s c e n s e . The s i g -n i f i c a n t a r e a q u e s t i o n n a i r e f o c u s e d on work, f r i e n d s , p a r e n t s , r e l a -t i o n s h i p s , and d e s i r e d changes i n t h e s e a r e a s (see the q u e s t i o n n a i r e f o r s p e c i f i c i t e m s ) . S e s s i o n Two. The second s e s s i o n was a group s e s s i o n l a s t i n g 1% hours. A d i s c u s s i o n of the e a r l i e r e x e r c i s e s on s i g n i f i c a n t a r e a s and f a m i l y c o n s t e l l a t i o n c o n t i n u e d . I n t h i s s e s s i o n g o a l s e t t i n g was i n t r o d u c e d . The p a r t i c i p a n t s d i c s u s s e d and s e l e c t e d g o a l s i n the ar e a s of f a m i l y l i f e , r e c r e a t i o n l i f e , s o c i a l , and work l i f e . S e s s i o n T hree. T h i s s e s s i o n c o n t i n u e d g o a l s e t t i n g , w i t h s p e c i f i c s t e p s and methods to r e a c h t h e g o a l s d e f i n e d . Depending on the i n d i -v i d u a l member, some d i s c u s s i o n of the f a m i l y and s i g n i f i c a n t a r e a s c o n t i n u e d . S e s s i o n s Four and F i v e . These s e s s i o n s i n t r o d u c e d communication 75 and feedback e x e r c i s e s . A s s e r t i v e n e s s was i n t r o d u c e d , as w e l l as " f a i r f i g h t i n g . " ^ R o l e p l a y s were used t o p r a c t i c e r e s t a t i n g a p a r t n e r ' s e x p r e s s i o n or statement u n t i l the p a r t n e r agreed the statement was a c c u r a t e . A second r o l e p l a y was used f o r p a r t i c i p a n t s to p r a c t i c e g i v i n g n e g a t i v e feedback. The c o u p l e s were i n s t r u c t e d t o p r a c t i c e r e f l e c t i n g o r p a r a p h r a s i n g p a r t n e r statements b e f o r e r e p l y i n g to the statement a t ho.me. S e s s i o n s S i x and Seven. The s e s s i o n s c o n t i n u e d w i t h communica-t i o n t r a i n i n g . F o r these s e s s i o n s , the f o c u s t u r n e d t o the e x p r e s s i o n and a c c e p t a n c e of p o s i t i v e s t a t e m e n t s . R o l e p l a y s were used f o r the c o u p l e t o p r a c t i c e g i v i n g and r e c e i v i n g compliments i n a s t r a i g h t -f o r w a r d , u n a p o l o g e t i c manner. A t home, t h e c o u p l e s were r e q u e s t e d to make t h r e e p o s i t i v e or complimentary statements to each o t h e r a day. The statements were to be honest and s i n c e r e compliments. S e s s i o n E i g h t . The f i n a l s e s s i o n , o r s e s s i o n s , depending on the p r o g r e s s , f o c u s e d on maintenance o f change. The s e s s i o n was spent p l a n n i n g f o r meeting t h e g o a l s s e t out e a r l i e r . D i s c u s s i o n of t h e s p e c i a l i s s u e s r e l a t i n g t o the g o a l s was the main f o c u s o f the s e s s i o n . R e h e a r s a l of c o p i n g w i t h p r o b l e m a t i c s i t u a t i o n s was used i n the s e s s i o n . S t a n d a r d I n d i v i d u a l Therapy The s t a n d a r d i n d i v i d u a l t h e r a p y was an i n d i v i d u a l l y d e v e l o p e d t h e r a p y p l a n . The o r d e r o f the t o p i c s d e s c r i b e d h e r e was t y p i c a l , but the s e s s i o n - t o - s e s s i o n p r o g r e s s v a r i e d from i n d i v i d u a l to i n d i v i d u a l . ^"Bach, G. & Wyden, P. The i n t i m a t e enemy. New York: Avon Books, 1970. 76 The number of s e s s i o n s a l s o v a r i e d from i n d i v i d u a l to i n d i v i d u a l . S e s s i o n One. In the f i r s t s e s s i o n , a d r i n k i n g h i s t o r y and a h i s t o r y of the c u r r e n t s p e c i f i c d i f f i c u l t i e s of the a l c o h o l i c was g a t h e r e d . A l s o , a d e f i n i t i o n o f t h e r e s o u r c e s and the s t r e n g t h s of the c l i e n t was made. D e f i n i t i o n o f the t h e r a p y p l a n was f o r m u l a t e d a t t h i s time, w i t h an i n d i v i d u a l i z e d f o c u s . S e s s i o n s Two and T h r e e . The t h e r a p y p l a n was d e s c r i b e d . Most cases began w i t h g o a l s e t t i n g by the c l i e n t i n r e s p o n s e to open-ended q u e s t i o n i n g . Focus was t h e n on s p e c i f i c s t e p s t o meet the g o a l s d e f i n e d by the c l i e n t . S e s s i o n F o u r. Communication s k i l l s , a s s e r t i o n , and f e edback were d e f i n e d and d e s c r i b e d a t t h i s t i m e . The s k i l l s were d e f i n e d and d e s c r i b e d and the c l i e n t was encouraged to t r y out the s k i l l s o u t s i d e of t h e r a p y . S e s s i o n F i v e . T h i s s e s s i o n c o n t i n u e d development of communication s k i l l s , w i t h the f o c u s on u s i n g complements and feedback. Assignments f o r p r a c t i c e were g i v e n , w i t h t h e n a t u r e of the assignments depending on the i n d i v i d u a l c a s e . E x p r e s s i o n of f e e l i n g s was encouraged. S e s s i o n S i x . The s e s s i o n f o c u s e d on problem d e f i n i t i o n , d e l i n e -a t i o n of a l t e r n a t i v e s , a s s e s s i n g the l i k e l y outcome of the a l t e r n a t i v e s , and s e l e c t i o n of a p p r o p r i a t e a l t e r n a t i v e s . The p r o b l e m - s o l v i n g f o c u s e d on s p e c i f i c problems or events o c c u r r i n g i n the c l i e n t ' s l i f e . S e s s i o n Seven. The s e s s i o n f o c u s e d on g o a l s e t t i n g , w i t h the emphasis on d e f i n i n g s p e c i f i c s t e p s and a n t i c i p a t i n g problem a r e a s . Problem ar e a s were r e h e a r s e d i n the s e s s i o n s . 77 S e s s i o n E i g h t . The l a s t s e s s i o n was used t o a n t i c i p a t e f u t u r e p l a n s , p o s s i b l e problems, and s t e p s t h e c l i e n t might t a k e . The l a s t few appointments were g e n e r a l l y t a p e r e d , w i t h the appointments b e i n g s p r e a d out over two weeks or even a month. 78 2 F A M I L Y C O N S T E L L A T I O N ( 1 5 m i n u t e s ) D e s c r i b e t h e p l a c e w h e r e y o u w e r e g r o w i n g up a s a p r e a d o l e s c e n t . How many p e o p l e w e r e l i v i n g w i t h y o u a n d w h a t w a s i t l i k e ? Do y o u h a v e s i s t e r s o r b r o t h e r s ? W h a t b i r t h n u m b e r a r e y o u ? o l d e s t ? y o u n g e s t ? Who I n y o u r f a m i l y i s m o s t l i k e y o u ? Who i s m o s t d i f f e r e n t ? Who w a s b e s t a t s c h o o l ? Who w a s r e b e l l i o u s ? Who u s e d c h a r m t o g e t h i s / h e r own w a y ? Who w a s c r i t i c a l o f o t h e r s ? Who f e l t s o r r y f o r h i m s e l f ? Who w a s l e a s t a n d m o s t o u t g o i n g ? W h a t w a s f a t h e r l i k e ? Who w a s f a t h e r ' s f a v o u r i t e ? W h a t d i d f a t h e r e x p e c t o f y o u ? How d i d y o u r e a c t t o t h i s ? W h a t w a s m o t h e r l i k e ? Who w a s m o t h e r ' s f a v o u r i t e ? W h a t d i d m o t h e r e x p e c t o f y o u ? How d i d y o u r e a c t t o t h i s ? ^Questionnaire was developed by Robert Power of the Alfred Adler Institute of Chicago. 79, How d i d y o u r p a r e n t s g e t a l o n g ? Who w a s d o m i n a n t , made d e c i s i o n s , e t c ? D i d t h e y a g r e e o n how t o b r i n g up t h e c h i l d r e n ? D i d t h e y q u a r r e l o p e n l y ? W h a t t h i n g s d i d t h e y d i s a g r e e a b o u t ? How w o u l d t h e q u a r r e l s e n d ? W h i c h o f y o u r p a r e n t s w a s o i o - s o r t o y o u ? Why d o y o u t h i n k t h i s w a s s o ? W e r e t h e r e a n y o t h e r s i g n i f i c a n t p e o p l e i n y o u r h o u s e w h e n y o u w e r e g r o w i n g u p ? ; ; • W e r e t h e r e a n y s i g n i f i c a n t c h a n c e s i n y o u r f a m i l y a t y o u r a d o l e s c e n c e ? W e r e y o u i n f o r m e d a b o u t w h a t p h y s i c a l a n d e m o t i o n a l c h a n g e s y o u c o u I d e x p e c t i n y o u r s e I f ? How d i d y o u e x p e d i e n c e t h e c h a n g e s ? W h a t d i d t h e y m e a n t o y o u ? Who d i d y o u t h i n k h a d i t b e t t e r . , b o y s o r g i r l s ? Why? 8 0 S I G N I F I -C A N I A R E A S ( 1 0 mi n u t e s ) We w o u l d l i k e t o know f r o m e a c h p e r s o n h e r e a b o u t t h i n g s * t h e y w o u l d l i k e t o c h a n g e i n s i g n I f I c a n t a r e a s o f t h e i r l i v e s . Y o u w i l l be g i v e n 10 m i n u t e s t o a n s w e r t h e f o l l o w i n g q u e s t i o n s i n w h a t e v e r way y o u l i k e . T h e 10 m i n u t e s i s y o u r s a n d i f y o u c h o o s e n o t t o u s e I t a l l we w i I I w a i t . We w i I I t e l l y o u w h e n t i m e i s u p . L a t e r In t h e d a y w r i t e In y o u r a n s w e r s b u t f o r now s i m p l y s h a r e t h e m w i t h u s . I. F r l e n d s Who a r e y o u r f r i e n d s ? ( n o n e m o s ) W h a t s o r t o f p e o p l e a r e t h e y ? Iluw d o y o u H i I n k y o u c o m o a c r o s s t o p e o p l o ? W h a t w o u l d y o u l i k e t o s e e d i f f e r e n t a b o u t y o u r f r i e n d s h i p s ? W h a t c o u I d b e m o r e f u I f i I I i n g f o r y o u w i t h y o u r f r i e n d s ? 2 . W o r k W h a t k i n d o f a w o r k e r a r e y o u ? How d o y o u r c o - w o r k e r s s e e y o u ? W h a t d o y o u l i k e a n d d i s l i k e a b o u t y o u r J o b ? W h a t w o u l d y o u c h a n g e a b o u t y o u r w b r k i f y o u c o u l d ? W h a t j o b w o u l d y c u l i k e t o d o i f y o u c o u l d c h a n g e ? 81 How d i d y o u r p a r e n t s g o t a l o n g ? Who w a s d o m i n a n t , made d e c i s i o n s , e t c ? D i d t h e y a g r e e o n how t o b r i n g up t h e c h i l d r e n ? D i d t h e y q u a r r e l o p e n l y ? W h a t t h i n g s d i d t h e y d i s a g r e e a b o u t ? . ; How w o u l d t h e q u a r r e l s e n d ? W h i c h o f y o u r p a r e n t s w a s c l o s e r t o y o u ? Why d o y o u t h i n k t h i s w a s s o ? ; W e r e t h e r e a n y o t h e r s i g n i f i c a n t p e o p l e i n y o u r h o u s e w h e n y o u w e r e g r o w i n g u p ? _ W e r e t h e r e a n y s i g n i f i c a n t c h a n c e s i n y o u r f a m i l y a t y o u r a d o l e s c e n c e ? W e r e y o u i n f o r m e d a b o u t w h a t p h y s i c a l a n d e m o t i o n a l c h a n g e s y o u c o u l d e x p e c t i n y o u r s e l f ? How d i d y o u e x p e r i e n c e t h e c h a n g e s ? W h a t d i d t h e y mean t o y o u ? Who d i d y o u t h i n k h a d i t b e l t e r , b o y s o r g i r l s ? Why? L o v e Whom d o y o u l o v e ? Who a r e t h e m o s t I m p o r t a n t p e o p l e In y o u r l i f e ? W h a t p r o b l e m s d o y o u e x p e r i e n c e I n y o u r r e l a t i o n s h i p s ? W h n t d o o s m n s c u l l n o o r f e m i n i n e ) moon t o y o u ? How d o y o u f e e l y o u m e a s u r e up t o y o u r own i d e a s o f w h a t m a s c u l i n e o r f e m i n i n e s h o u l d b e ? 83 ALCOHOL AND DRUG COUNSELING INFORliATlOU FORM It i 3 essential for us to obtain certain basic information from everyone who participates in our program. This information helps us gain a complete understanding of your current situation and aids in our evaluation of our treatment program. In order to gather this information as quickly as possible, we would like you to complete this questionnaire. You may find some of the questions quite d i f f i c u l t to answer. Some w i l l be d i f f i c u l t because i t w i l l be hard to remember the answer, and some may be d i f f i c u l t because they are personal and perhaps even painful. The questionnaire i s very compre-hensive and therefore quite long. Please answer a l l questions by f i l l i n g in the blanks or checking the appropriate space. A l l information you provide, written or otherwise, is s t r i c t l y confidential and w i l l not be revealed to anyone without your written approval. 84 DATt, MIX. I (Last) (Given) ADDRESS PttCHli DATE OF iilRTu / / Day tlonth Year MAiiE Mi) ADDRESS OF A PEUSOd THROUGH i/UOil YOU COULD ALVJAYS Bii UliACHED S t U ' u S E / P A U T i I i i U ' S nAi-IE E i i P L O Y l I K W T This section has to do with work situations. If you are a housewife, treat your housework as your job. 1 . Please indicate the number of days off work in the last twelve months. Sick days Drinking days Unproductive days Suspension Other (specify) 2 . During the past twelve months I would rate my work productivity as: / / / / / / / Excellent Very Good Satisfactory Poor Very Totally Good Poor Unsatisfactory 3. Please indicate the number of days off work for your spouse in the last twelve months. S i c k days D r i n k i n g days . Unproductive days Suspension Other (Specify) A. During the past twelve months I would rate my spouse's work productivity as: / / / / / / / Excellent Very Good Satisfactory Poor Very Totally Good Poor Unsatisfactory 85 SOCIAL LIFE 1. Listed below are a c t i v i t i e s with other people which go together to make what most people c a l l a s o c i a l l i f e . Please indicate the frequency of your p a r t i c i p a t i o n i n these a c t i v i t i e s during the past twelve months i n the column labelled "now". Record what your i d e a l s o c i a l l i f e would be i n the " i d e a l " column. Use only one column per category. Daily Times/week Times/month J Times/year Never Now Ideal Now Ideal Now Ideal Now Ideal Now Ideal Entertain Friends ! : i I • i : V i s i t friends : 1 i 1 : Recreational a c t i v i t y with others (cards, bowling) ! j . . . . ( 1 I i i * | club meetings i 1 1 parties 1 t a l k i n g to people i n bars, beverage rooms ; ; 1 1 1 i i church related a c t i v i t y ; ; ; i 1 I j Other • •> ! 1 ' l i • 2. Over the past 12 months my s o c i a l l i f e has been: / / / / / / Extremely very good average poor very extremely good good poor poor 3. My spouse's s o c i a l l i f e over the past 12 months has been: / / / 4 / / / Extremely very good average poor very extremely good good poor poor 86 ALCOiiUL LSii k/lien did your alcohol use be^in? Frequency: In the last 12 months the number of times I drank more than 10 ounces of d i s t i l l e d liquor/day (or more than 25 ounces of wine or more than 12 beers/day) 1-11 days/year 1-4 days/month 1-6 days/week Typical Consumption per day Dis t i l l e d How often iiore than 13 oz. 10-14 oz. ~ 6-9 oz. 1-5 o^. 0 oz. Specific drink(s) beer iiore than 24 12-24 '_ 6-1/ 1-b U ~ Specific beer(s) 1-11/yr. 1-4/mo. 1-6/wk. daily How Often 1-11/yr. 1-4/mo. 1-C/wk. daily Wine iiore than 25 oz. 12-25 oz. 6-11 oz. 1-5 oz. 6 oz. Specific wine(s) How often 1-11/yr. _ 1-4/mo. 1-b/wk. daily Used in combination with: Barbiturates (phenobarbital, secobarbital) Tranquillizers (Valium, Librium) Auphetamines (diet p i l l s ) Opiates (coedine, heroin) Coffee, tea (more than Li cups/day) Other None Specify: Substance how taken: Oral Frequency: / day Dose: Injected Other /week 87 RELATIONSHIP This section pertains to your relationship to your partner. 1. Partner or spouse and I are currently: l i v i n g together separated 2. We have been married ( l i v i n g together) years months weeks 3. We have been separated • times 4 . Our current separation has been for years months weeks 5 . How many times have you moved i n the past two years A l l i n a l l over the past 12 months I would irate my relationship as being: / / / _/ / / / Excellent very good satisfactory poor very t o t a l l y good poor unsatisfactory A l l i n a l l over the past 12 months, I f e e l that my spouse/partner would rate his/her relationship with me as being: / / / /_ / / / Excellent very good satisfactory poor very t o t a l l y good poor unsatisfactory 88 Please rate the following areas of your relationship by c i r c l i n g the woru that best describes your relationship i n the past twelve months. 1. our expression of affection to eacn other has been: / / / / / / / Ideal Very Good Average Poor Very Totally Good Poor Unsatisfactory 2. Tlie decree of c o n f l i c t or arguments i n our relationship has been: / / / / / / / Ideal Very Good Average Poor Very Totally Good Poor Unsatisfactory 3. The general degree of expression of feelings i n our relationship has beer / / / / / / / Ideal Very Good Average Poor Very Totally Good Poor Unsatisfactory 4. Our degree of cohesiveness or closeness has been: / / / / / / / Ideal Very Good Average Poor Very Totally Good Poor Unsatisfactory Tae degree of our a c t i v i t y together has been: / / / / / / / Ideal Very Good Average Poor very Totally Good Poor Unsatisfactory 89 ADJECTIVE CHFCXLIST MATRIX Check the decree of agreement you have with the following descriptions. There are no right or uronf answers, and your f i r s t response i s usually the best. Ask for c l a r i f i c a t i o n i f you are unsure of the instructions. I. I am 1. ARSEIIT I-'JiTDED 1 2 3 4 never rarely s o m e t i r e s o f t e n 5 always . ACTIVE 1 2 3 4 5 never rarely sometimes often always 3. A1I-ITI0US 1 never 2 rarely sometimes 4 often 5 always ANGRY 1 never rarely sometimes 4 often 5 always 5. ASITALiED 1 never 2 r a r e l y s o n e t i n e s 4 often always t. BORED 1 never rarely sonetiTr.es 4 often 5 always 7. BOSSY 1 never 2 rarely sometimes often 5 always 8 . cm i 1 never 2 rarely sometimes A often 5 always 9. C A PABLE 1 never 2 rarely sometimes often 5 always 10. CAPJIIES OUT PLANS 1 never 2 rarely sometimes A often 5 always 11. CAUTIOUS 1 never 2 rarely sometimes A often 5 always 12. CJIAEHIHG 1 never 2 3 . A rarely sometimes often 5 always 13. C O M P E T I T I V E 1 never 2 3 A rarely some.imes often 5 always 1A. C01-JPLAINI1TG L never 2 rarely s o m e t i n e s A often 5 always 15. CONFIDENT 1 never 2 rarely 3 sometimes A often 5 always 16. CONSIDERATE 1 never 2 rarely sotnetiipes A often 5 always 91 17. CRUEL 1 never 2 rarely sometimes 4 often 18. DECISIVE 1 never 2 rarely 3 sometimes 4 often 19. DEPE:.IDE11T UPON OTHERS 1 never 2 rarely sometimes 4 often 20. EASILY PERSUADED 1 never 2 rarely sometimes 4 often 21. FAIR 1 never 2 rarely sometimes 4 often 22. FEMINIllE 1 never 2 rarely sometimes 4 often FRAJ1K 1 never 2 rarely sometimes 4 often 24. FRIENDLY 1 never 2 rarely 3 sometimes 4 often 25. HAPPY 1 never 2 rarely sometimes 4 often 5 always 5 always 5 always 5 always 5 always 5 always 5 always 5 always 5 always 2 6 . HARDHOPKIHG 92 1 never rarely sometimes 4 often 5 always 2 7 . H E L P F U L 1 never 2 rarely 3 sometimes 4 often 5 always 2C. H E L P L E S S 1 never 2 rarely sometimes 4 often 5 always 2 9 . I M A G I N A T I V E 1 never 2 rarely sometimes 4 often 5 always 30. I M P A T I E N T 1 never 2 rarely 3 s'bme times 4 often 5 alvrays 3 1 . INDEPENDENT 1 never 2 rarely sometimes 4 often 5 always 3 2 . I N T E L L I G E N T 1 never 2 rarely sonetimes 4 often 5 always 3 3 . I P J I I T A B L E 1 never 2 rarely sometimes 4 often 5 always 3 4 . JEALOUS 1 never 2 rarely sometimes 4 often 5 always 93 35. MASCULINE 1 never 2 rarely sometimes A often 5 always MATERIALISTIC 1 never 2 rarely soraetimes A often 5 always 37. MESSY 1 never 2 rarely sometimes A often 5 always 3R. Oil TOP OF SITUATIONS 1 never 2 rarely sometimes A often 5 always 39. OPEN ABOUT FEELINGS 1 never 2 rarely sometimes A often 5 always AO. PLAITS AHEAD 1 never 2 rarely sometimes A often 5 always Al. QUIET 1 never 2 rarely sometimes A often 5 always A2. PEASOMABLF. 1 never 2 rarely sometimes A often 5 always 43. RELIGIOUS OR SPIRITUAL 1 never 2 rarely sometimes A often 5 always 9.4 44. SIIY 1 never 2 rarely sometimes 4 often 45. SILENT 1 never 2 rarely sometimes 4 often 46. SULLEll 1 never 2 rarely sometimes 4 often 47. SECrETIVE 1 never 2 rarely sometimes 4 often 48. SELF-CRITICAL 1 never 2 rarely sometimes 4 often 49. SENSITIVE TO OTHERS FEELINGS 1 never 2 r a r e l y sometimes 4 often 50. SEXUALLY-ORIENTED 1 never 2 rarely sometimes 4 often 51. STRONG-WILLED 1 never 2 rarely sometimes 4 often 52. STUBBORN 1 never 2 rarely sometimes 4 often 5 always 5 always 5 always 5 always 5 always 5 always 5 always 5 always 5 always 95 5 3. SUCCES S-ORIENTED 1 never 2 rarely sometimes 4 often 5 always 54. SUPPORTIVE TO OTHERS 1 never 2 rarely sometimes 4 often 5 always 55. SUSPICIOUS 1 never 2 rarely sometimes 4 often 5 always 56. SYMPATHETIC 1 never 2 rarely sometimes 4 often 5 always 57. TRICKY 1 never 2 rarely sometimes 4 often 5 always 58. TRUSTWOPTTY 1 never 2 rarely sometimes 4 often 5 always 59. WARM 1 never 2 rarely sometimes 4 often 5 always 60. WORRIED 1 never 2 rarely sometimes 4 often 5 always 96 ADJECTIVE CHECKLIST MATRIX Check the depree of agreement you have with the followinp descriptions. There are no right or wronp answers, and your f i r s t response i s usually the best. Ask for c l a r i f i c a t i o n i f you are unsure of the instructions. II. Ideally, I would like to be 1. ABSENT MINDED 1 never rarely s o i r e t i m e s 4 often 5 always 2. ACTIVE 1 2 3 4 5 never rarely sometimes often always 3. AMBITIOUS 1 2 .3 4 5 never rarely sometimes often always 4. ANGRY 1 2 3 4 5 never rarely sometimes often always 5. ASHAMED 1 2 3 4 5 never rarely sometimes often always BORED 1 2 3 4 5 never rarely sometimes often always 7. BOSSY 1 2 3 4 5 never rarely sometimes often always 9 7 8 . G*U1 1 never 2 rarely sometimes A often 5 always 9. CAPABLE 1 never 2 rarely sometimes often 5 always 10. CARRIES OUT PLANS 1 never rarely sometimes 4 often 5 always 11. CAUTIOUS 1 never 2 rarely sometimes 4 often 5 always 12. CHARMING 1 never 2 rarely sometimes 4 often 5 always 13. COMPETITIVE 1 never 2 rarely sometimes 4 often 5 always 14. COKPLAINIITG L 2 3 4 5 never rarely sometimes often always 15. CONFIDENT 1 never 2 rarely 3 sometimes 4 often 5 always 16. CONSIDERATE 1 never 2 rarely sometimes 4 often 5 always 98 17. CRUEL 1 never 2 rarely sometimes 4 often 5 always 18. DECISIVE 1 never 2 rarely sometimes 4 often 5 always 19. DEPENDENT UPON OTHERS I never 2 rarely sometimes 4 often 5 always 20. EASILY PERSUADED 1 never 2 rarely sometimes 4 often 5 always 21. FAIR 1 never 2 rarely 3 sometimes 4 often 5 always 22. FEMININE 1 never rarely sometimes 4 often 5 always 23. FRANK 1 never 2 rarely sometimes 4 often 5 always 24. FRIENDLY 1 never 2 rarely sometimes 4 often 5 always 25. HAPPY 1 never 2 rarely sometimes 4 often 5 a1way8 99 26. 11ARJDH0PXIHG 1 never rarely sometimes 4 often 5 always 27. HELPFUL 1 never 2 rarely sometimes 4 often 5 always 2C. HELPLESS 1 never 2 rarely sometimes 4 often 5 always 29. IMAGINATIVE 1 never 2 rarely 3 , _ ; sometimes 4 often 5 always 3 0 . IMPATIENT 1 never 2 rarely sometimes 4 often 5 always 31. INDEPENDENT 1 never 2 rarely sometimes 4 often 5 always 32. INTELLIGENT 1 never 2 rarely sometimes 4 often 5 always 33. IRRITABLE 1 never 2 rarely sometimes 4 often 5 always 34. JEALOUS 1 never 2 rarely sometimes 4 often 5 always 100 35. MASCULINE 1 never 2 rarely 3 sometimes A often 5 always 36. MATERIALISTIC 1 never 2 rarely some times often 5 always 37. MESSY 1 never 2 rarely sometimes A often 5 always 38. Of! TOP OF SITUATIONS 1 never 2 rarely sometimes A often 5 always 39. OPEN ABOUT FEELINGS 1 never 2 rarely sometimes A often 5 always AO. PLANS AHEAD 1 never 2 rarely sometimes A often 5 always Al. QUIET 1 never 2 rarely sometimes A often 5 always A2. REASONABLE 1 never 2 rarely sometimes A often 5 always A3. RELIGIOUS OR SPIRITUAL 1 never 2 rarely sometimes A often 5 always 44. SHY 101 1 never 2 rarely sometimes 4 often 5 always 45. SILH1T 1 never 2 rarely sometimes 4 often 5 always 46. SULLEU 1 never 2 rarely sometimes 4 often 5 always 47. SECrETIVE 1 never 2 rarely sometimes 4 often 5 always 48. SELF-CRITICAL 1 never 2 rarely sometimes 4 often 5 always 49. SENSITIVE TO OTHERS FEELINGS 1 never 2 rarely sometimes 4 often 5 always 50. SEXUALLY-ORIENTED 1 never 2 rarely sometimes 4 often 5 always 51. STRONG-WILLED 1 never 2 rarely sometimes 4 often 5 always 52. STUBBORN 1 never 2 rarely sometimes 4 often 5 always 102 53. SUCCESS-ORIENTED 1 never 2 rarely sometimes 4 often 5 always 54. SUPPORTIVE TO OTHERS 1 never 2 rarely sometimes 4 often 5 always 55. SUSPICIOUS 1 never 2 rarely sometimes 4 often 5 always 56. SYMPATHETIC 1 never 2 rarely sometimes 4 often 5 always 57. TRICKY 1 never 2 rarely sometimes 4 often 5 always 58. TRUSTHOP.TW 1 never 2 rarely sometimes 4 often 5 always 59. WARM 1 never 2 rarely sometimes 4 often 5 always 60. WORRIED 1 never 2 rarely sometimes 4 often 5 always 103 ADJECTIVE CHECKLIST MATRIX Check the degree of agreement you have with the followinp descriptions. There are no right or wronp answers, and your f i r s t response i s usually the best. Ask for cl a r i f i c a t i o n i f you are unsure of the instructions. III. My Spouse i s 1. AT-SENT MBIPErt 1 never 2 rarely sometimes often 5 always 2. ACTIVE 1 never 2 rarely sometimes 4 often 5 always 3. AIIBITIOUS 1 never 2 rarely sometimes A often 5 always A. AJTGRY 1 never 2 rarely sometimes A often 5 always 5. ASHAtlEH 1 never 2 rarely 3 sometimes A often 5 always 6. T.ORE1? 1 never 2 rarely soretimes A often always 7. BOSSY 1 2 3 A 5 never rarely sometimes often always 104 8. c a u i 1 never 2 r a r e l y sometimes 4 often 5 always 9. CAPABLE 1 never 2 rarely sometimes often 5 always 10. CARRIES OUT PLANS 1 never 2 rarely sometimes 4 often 5 always 11. CAUTIOUS 1 never 2 rarely sometimes 4 often 5 always 12. CHARMING 1 never 2 rarely sometimes 4 often 5 always 13. COMPETITIVE 1 2 never r a r e l y sometines. 4 o f t e n 5 always 14. COKPLAINIMG L 2 never rarely sometimes 4 often 5 always 15. CONFIDEIIT 1 2 never rarely sometimes 4 often 5 always 16. CONSIDERATE 1 2 never rarely sometimes 4 often 5 always 105 17. CRUEL 1 never 2 , rarely sometimes A often 5 always 18. DECISIVE 1 never 2 rarely 3 sometimes often 5 always 19. DEPENDENT UPON OTHERS 1 never rarely sometimes 4 often 5 always 20. EASILY PERSUADED 1 never 2 rarely sometimes A often 5 always 21. FAIR 1 never 2 rarely sometimes A often 5 always 22. FEMININE 1 never rarely sometimes A often 5 always 23. FRANK 1 never 2 rarely sometimes A often 5 always 2A. FRIENDLY 1 never 2 rarely sometimes A often 5 always 25. HAPPY 1 never 2 rarely » 3 sometimes A often 5 always 26. < HARDWOPKIHG 106 1 never 2 rarely sometimes 4 often 5 always 2 7. HELPFUL 1 never 2 rarely sometimes A often 5 always 20. HELPLESS 1 never 2 3 A rarely sometimes often 5 always 29. IMAGINATIVE 1 never 2 rarely 3 4 sometimes often 5 always 30. INPATIENT 1 never 2 rarely sometimes A often 5 always 31. INDEPENDENT 1 never 2 rarely sonetimes A often 5 always 32. INTELLIGENT 1 never 2 rarely s o r e t i t n e s o f t e n 5 always 33. IRRITABLE 1 never 2 rarely sometimes A often 5 always 34. JEALOUS 1 never 2 rarely sometimes A often 5 always 107 35. MASCULINE 1 never 2 rarely sometimes A often 5 always 3G. MATERIALISTIC 1 never 2 rarely 3 A sometimes often 5 always 37. MESSY 1 never rarely 3. sometimes A often 5 always 38. 0?! TOP OF SITUATIONS 1 never 2 rarely sometimes A often 5 always 39. OPEN ABOUT FEELINGS 1 never 2 rarely sometimes A often 5 always AO. PLANS AHEAD 1 never 2 rarely sometimes A often 5 always Al. QUIET 1 never 2 rarely sometimes A often 5 always A2. REASONABLE 1 never rarely sometimes A often 5 always A3. RELIGIOUS OR SPIRITUAL 1 never 2 rarely sometimes A often 5 always 108 44. SIIY 1 never 2 rarely sometimes 4 often 5 always 45. SILENT 1 never 2 rarely sometimes 4 often 5 always 46. SULLEN * 1 never 2 rarely sometimes 4 often 5 always 47. SECTETIVE 1 never 2 rarely sometimes 4 often 5 always 48. SELF-CRITICAL 1 2 never rarely sometimes 4 often 5 always 49. SENSITIVE TO OTHERS FEELINGS 1 never 2 rarely sometimes 4 often 5 always 50. SE'CU ALLY-ORIENTED 1 never 2 rarely sc times 4 often 5 always 51. STRONG-WILLED 1 never 2 rarely so'metiraes 4 often 5 always 52. STUBBORN 1 never 2 rarely sometimes 4 often 5 always 109 53. SUCCESS-ORIENTED 1 never 2 rarely sometimes 4 often 5 always 54. SUPPORTIVE TO OTHERS 1 never 2 rarely sometimes 4 often 5 always 55. SUSPICIOUS 1 never 2 rarely sometimes I; often 5 always 56. SYMPATHETIC 1 never 2 rarely sometimes 4 often 5 always 57. TRICKY 1 never 2 rarely sometimes 4 often 5 always 58. TRUSTWOP.TTY 1 2 never rarely sometimes 4 often 5 always 59. HARM 1 never r a r e l y sometimes 4 often 5 always 60. WORRIED 1 never 2 rarely S5> • sometimes 4 often 5 always j i o ADJECTIVE CHECKLIST MATRIX Check the degree of agreement you have with the following descriptions. There are no right or wronp answers, ar.d your f i r s t response i s usually the best. Ask for cl a r i f i c a t i o n i f you are unsure of the instructions. IV. Ideally, I would like my spouse to be 1. ABSENT MINDED 1 never 2 rarely sometimes 4 often 5 always ACTIVE 1 never rarely 3 • >/ < sometimes 4 often 5 always AMBITIOUS 1 never 2 rarely sometimes 4 often 5 always 4 . ANGRY 1 never 2 rarely sometimes 4 often 5 always 5. ASHAMED 1 never 2 rarely sometimes 4 often 5 always 6. BORED 1 never 2 rarely sometimes 4 often 5 always 7. BOSSY 1 never 2 rarely sometimes 4 often 5 always Ill 8. G&LM 1 never 2 rarely sometimes 4 often 5 always 9. CAPABLE 1 never 2 rarely sometimes often always 10. CARRIES OUT PLANS 1 never 2 rarely sometimes 4 often 5 always 11. CAUTIOUS 1 never 2 rarely sometimes 4 often 5 always 12. CHARMING 1 never rarely 3 sometimes 4 often 5 always 13. COMPETITIVE 1 never 2 rarely 3 sor>i<2 times 4 often 5 always 14. COMPLAINING L never 2 rarely sometimes 4 often 5 always 15. CONFIDENT 1 never 2 rarely sometimes 4 often 5 always 1G. CONSIDERATE 1 2 3 . 4 5 never rarely sometimes often always 17. CRUEL 112 1 never 2 rarely sonetlmes 4 often 5 always 18. DECISIVE 1 neve r rarely sometimes A often 5 always 19. DEPENDENT UPON OTHERS 1 never 2 rarely sometimes 4 often 5 always 20. EASILY PERSUADED 1 never 2 rarely 3 sonetimes 4 often 5 always 21. FAIR 1 never 2 rarely sometimes 4 often 5 always 22. FEMININE 1 never 2 3 4 rarely sometimes often 5 always 23. FRANK 1 never rarely sometimes often 5 always 24. FRIENDLY 1 never rarely sometimes 4 often 5 always 25. HAPPY 1 never 2 rarely sometimes 4 often 5 always 26. HARIWOPKIHG 113 1 never 2 r a r e l y sometimes 4 often 5 always 2 7 . HELPFUL 1 never 2 rarely sometimes 4 often 5 always 20. HELPLESS 1 never 2 rarely 3 sometimes 4 often 5 always 29. IMAGINATIVE 1 never 2 rarely sometimes 4 often 5 always 30. IMPATIENT 1 never rarely sometimes 4 often 5 always 31. INDEPENDENT 1 never 2 rarely sometimes 4 often 5 always 32. INTELLIGENT 1 never 2 rarely sometimes 4 often 5 always 33. IRRITABLE 1 never 2 rarely sometimes 4 often 5 always 34. JEALOUS 1 never 2 rarely sometimes 4 often 5 always 114 35. MASCULINE 1 never 2 rarely sometimes 4 often 5 always 3G. MATERIALISTIC 1 2 never rarely sometimes often 5 always 37. MESSY 1 never 2 rarely sometimes 4 often 5 always 38. ON TOP OF SITUATIONS 1 never 2 rarely sometimes 4 often 5 always 39. OPEN ABOUT FEELINGS 1 never 2 rarely sometimes 4 often 5 always 40. PLANS AHEAD 1 2 never rarely sometimes 4 o f t e n 5 always 41. QUIET 1 never 2 rarely sometimes 4 often 5 always 42. REASONABLE 1 never rarely 3 4 sometimes often 5 always 43. RELIGIOUS OR SPIRITUAL 1 never rarely 3 , 4 sometimes often 5 alxvays 44. SHY 115 1 never 2 rarely sometimes 4 often 5 always 45. SILENT 1 never 2 rarely sometimes 4 often 5 always 46. SULLEN 1 never 2 rarely sometimes 4 often 5 always 47. SECrETIVE 1 never 2 rarely 3 sometimes 4 often 5 always 48. SELF-CRITICAL 1 never 2 rarely sometimes 4 often 5 always 49. SENSITIVE TO OTHERS FEELINGS 1 never 2 rarely sometimes 4 often 5 always 50. SE3CUALLY-0RIF.NTED 1 never rarely so:etimes 4 often 5 always 51. STRONG-WILLED 1 never 2 rarely sometimes 4 often 5 always 52. STUBBORN 1 never rarely sometimes 4 often 5 always 116 53. SUCCESS-ORIENTED 1 never 2 rarely sometimes 4 often 5 always 54. SUPPORTIVE TO OTHERS 1 never 2 rarely sometimes 4 often 5 always 55. SUSPICIOUS 1 never 2 rarely sometimes often 5 always 56. SYMPATHETIC 1 never 2 rarely sometimes 4 often 5 always 57. TRICKY 1 never 2 rarely sometimes 4 often 5 always 58. TRUSTWOP.TT'Y 1 never r a r e l y sometimes 4 often 5 always 59. HARM 1 never 2 rarely sometimes 4 often 5 always 60. WORRIED 1 never 2 rarely sometimes 4 often 5 always 117 1. Check the dot on the scale line below which best describes the degree of happiness, everything considered, of your present marriage. The middle point, ,;happy", represents the degree of happiness which most people get from marriage, and the scale gradually ranges on one side to those few who are:very unhappy in marriage, and on the other, to those few who experience extreme joy or f e l i c i t y in marriage. Very unhappy Happy Perfectly happy State the approximate extent of agreement or disagreement between you and your mate on the following items. Please c i r c l e the appropriate number. 2. Handling family finances: 1 2 always almost agree always agree 3 4 5 occasionally frequently almost agree disagree always ; disagree 3. Matters of recreation: 1 2 3 4 5 4. Demonstrations of affection: 1 2 3 4 5 5. Friends: 1 2 3 4 5 6. Sex relations: 1 2 3 4 5 7. Conventionality (right, good, or proper conduct): 1 2 3 4 5 6 always disagree 8. Philosophy of l i f e : 1 2 3 9. 1 Ways of dealing with in-laws: 2 3 4 5 6 118 Please check the appropriate space: • i i i . When disagreements arise; they usually result i n : . husband giving in wife giving in ______ agreement by mutual give and take - . 2. Do you and your mate engage in outside interests together? A l l of. them , some of them , very few of them , none of them 3. In leisure time do you generally prefer: to be "on the got: , to stay at home ? Does your mate generally prefer:. to be "on; the go" , to stay at home ? 4 . Do you ever wish you had not married? Frequently , occasionally , rarely , never . 5. If you had your l i f e to liv e over, do you think you would marry: the same person , marry a different person , not marry at a l l ? 6. Do you confide in your mate: almost never , rarely , in most things , in everything ? 119 RELATIONSHIP ADJUSTMENT SCALE 1. Check the dot on the scale line below which best describes the degree of happiness, everything considered, of your present relationship. The Middle point, "happy", represents the degree of happiness which most people get from the relationship, and the scale gradually ranges on one side to those few hwho are very unhappy, and ondthe other, to those few who experience extreme joy or f e l i c i t y in the relationship. Very unhappy l l a p n y Perfectly happy State the approximate extent of agreement or disagreement between you and your partner on the following items. Please c i r c l e the appropriate number. 2. Handling finances: —.- • ,r - • 1 2 3 U 4 5 6 always almost occasionally. frequently almost always agree always agree disagree always disagree agree disagree 3. Matters of recreation: 1 2 3 4 5 6 4. Demonstrations of affection: 1 2 3 4 5 6 5. Friends: •r v 1 2 3 4 5 6 6. Sex relations: 1 2 3 4 5 C; 7. Conventionality (ri£ht, good, or proper conduct): 1 2 3 4 5 6 S. Philosophy of l i f e : 1 2 3 4 5 6 9. Uays of dealing with in-laws: 1 2 3 cont'd 120 •[•'•• Please check the appropriate space: 1. \Jhen disagreements arise, they usually result in: mal« giving'.in female givinr. in _ aereemer t by mutual pive and take "  . t ''•< 2. Do you and your mate engage in outside interes:s together? A l l of •r thera_ , sone of them , very few of them , none of them_ . 3. In leisure time do you generally prefer: to be 'on the c°'' • t o stay at home ? Does your mate generally prefer: to be "on the go"__ , to stay at home ? 4. Do you ever wish you had not been involved as a couple? Frequently Occasionally ; rarely , never . 5. If you had your l i f e to live over, do you think you would establish a relationship with: the same person , marry a different per-son , not marry at a l l ? 6 . Do you onfide in your mate* al jost never , rarely , in most things , in everything ? SCORING KEY 121 MARITAL ADJUSTMENT T E S T 1. Check the dot on the scale l i n e below which best describes the degree of happiness, everything considered, of your present marriage. The middle pbint, ,:happy", represents the degree of happiness which most people get from mar-riage, and the scale gradually ranges on one side to those few who are very unhappy i n marriage, and on the other, to those few who experience extreme joy or f e l i c i t y i n marriage. 0 2 7 15 20 25 35 Very Happy P e r f e c t l y Unhappy Happy State the approximate extent of agreement or disagreement between you and your mate on the following items. Please check each column. . , Always Almost Occa- Fre- Almost A l -Agree Always s i o n a l l y quently Always ways Agree Disagree Disagree Disagree Dis-agree 2. Handling family finances 5 4 3 2 1 0 3. Matters of recreation 5 4 3 2 1 0 4. Demonstrations of a f f e c t i o n 8 6 4 2 1 0 5. Friends 5 4 3 2 1 0 6. Sex r e l a t i o n s 15 12 9 4 1 0 7. Conventionality ( r i g h t , good, or proper conduct) 5 4r- 3 2 1 0 8. Philosophy of l i f e 5 4 3 2 1 0 9. Ways of dealing with i n laws 5 4 3 2 1 0 10. When disagreements a r i s e , they usually r e s u l t i n : husband giving i n 0, wife gi v i n g i n 2, agreement by mutual give and take 10. 11. Do you and your mate engage i n outside i n t e r e s t s together? A l l of them 10, some of them 8, very few of them 3, none of them 0 . 12. In l e i s u r e time do you generally p r e f e r : to be "on the go" , stay at home _? Does your mate generally p r e f e r : to "on the go" , stay at home ? (Stay at home for both, 10 points: "on the go" f o r both, 3 points; disagreement, 2 p o i n t s ) . 122 Marital-Adjustment Test (cont'd) 13..Do you everwish you had not married? Frequently 0, occasionally . 3, 3 n r a r e l y 1 8, never .15. 14. If you had your l i f e to live over, do ybii think you would: marry the same person 15, marry a different person 0, not marry at a l l 1 ? 15. Do you confide in your mate: almost never 0, rarely 2, in most things 10, in everything 10? 123 ALCOHOL AND DRUG COUNSELING FOLLOW-UP FORti ^ MO. 6 MO. 1 YR NAME DATE ADDRESS ( i f new) PHONE ( i f new) ' ' 1. How have t, ings been going? I. DRINKING 1. I'd like some idea about how your drinking has been. you your partner/spouse No drinking this month No drinking this month Some drinking this month Some drinkinp this month 2. If drinking, what was last week like? for you- for your spouse/partner Ilonday Monday Tuesday Tuesday Wednesday Wednesday Thursday Thursday Friday Friday Saturday Saturday Sunday Sunday If drinking, cription of consumed. go the through the week day by day to get the person's des-specific number, kind, and ?.mount of drinks 3. Was this a typical week for you? For your spouse/partner? 124 EMPLOYMENT This section has to do with Work situations. If you are a housewife, treat your housework as your job. 1. Please indicate the number of days off work in the last month. ' Sick days Drinking days Unproductive days Suspension Other (specify) 2. During the past four weeks I would rate my work productivity as: I \ i i ! I I Excellent very good unsatisfactory poor very totally good poor unsatisfa'"-3 . Please indicate the number of days off work for your spouse in the last month. Sick days Drinking days Unproductive days Suspension Other (specify) 4 . During the past four weeks I would rate my spouse's work productivity as: Excellent very good unsatisfactory poor very totally good - poor unsatisfactory 125 SOCIAL LIFE 1. Listed below are activities with other people which go together to make what most people c a l l a social l i f e . Please indicate the frequency of your participation in these activities during the past four weeks in the column labelled "now". Record what your ideal social l i f e would be in the "ideal" column. Use only one column per category. Daily Times/week Times/month Times/year Never Now Ideal Now Ideal Now Ideal Now Ideal Now Idea2 Entertain Friends [ 1 ! i i 1 1 V i s i t friends : 1 1 I 1 I 1 Recreational activity with others (cards, bowling 1 1 1 1 1 1 1 club meetings ; ; I I 1 i ; parties 1 ] 1 | i talking to people in bars, beverage rooms 1 1 ; 1 1 1 1 : i i ! i church related activity 1 I l. 1 i I Other 1 1 1 i : 1 1 i 2 . Over the past month my social l i f e has been: I l ! I 1 1 1 Extremely very good average poor very extremely good good poor poor 3. My spouse's social l i f e over the past month has been: i ' i I . i . ' . ' Extremely very good average poor very extremely good good poor poor 126 RELATIONSHIP This section pertains to your relationship to your partner. 1. Partner or spouse and I are currently: li v i n g together separated^ 2. Ue have been married (living toper*>»rji years months weeks 3. We have been separated times U. Our current separation has been for years months weeks 5 . How many times have you moved in ^ .he past two years A l l in a l l over the past month I would rate my relationship as being: Excellent very good satisfactory poor very totally good poor unsatisfactory .'.11 in a l l over the past month, I feel that my spouse/partner would rate his/her relationship with me as being: Excellent very good good satisfactory poor very totally poor unsatisfactory 127 Flease rate the following areas of your relationship by c i r c l i n g the word that best describes your relationship in the past month. 1. Our expression of affection 1 0 eac'i other has been: Ideal Very Godd Good Average Poor Very Totally Poor Unsatisfactory 2. The degree of conflict or arguments in our relationship has been: JL Ideal Very Good Good Average Poor Very Totally Poor Unsatisfactory 3 . The general degree of expression of feelings in our relationship has been: Ideal Very Good Good Average Poor Very Totally Poor Unsatisfactory 4 . Our degree of cohesiveness or closeness has been: Ideal Very Good Good Average Poor Very Totally Poor Unsatisfactory 5. The degree of our activity together has been: Ideal Very Good Good Average Poor Very Totally Poor Unsatisfactory 128 Below are 10 descriptions. Read each one and decide whether or not i t might apply to you. Rate your degree of agreement or disagreement using the numbers frota the scale pictured below. 1 2 • 3 4 strongly agree agree disagree strongly disagree 1. On the whole, I am satisfied with myself. 2 . At times, I think I am no good at a l l . 3 . I feel that I have a number of good qualities. . 4 . I am able to do things as well as most people. 5. I feel I do not have much to be proud of. 6 . I certainly feel useless at tiiaes. 7 . I feel that I'm a person of worth, aft least on an equal plane with others. ii. I wish I could have more respect for myself. y. A l l and a l l , I'm inclined to think I am a failure. _ 10. I take a positive attitude toward myself. 129 Date I, , agree to p a r t i c i p a t e i n c o u n s e l i n g a t A l c o h o l and Drug C o u n s e l l i n g . I a l s o agree to f o l l o w - u p c o n t a c t s a t one month, s i x months, and one ye a r a f t e r c o u n s e l i n g . T h i s f o l l o w - u p w i l l be e i t h e r by t e l e p h o n e or i n p e r s o n , a t the c o n v e n i -ence of the p a r t i c i p a n t , and w i l l take about twenty minutes. The f o l l o w - u p w i l l a l l o w you to g i v e feedback on the c o u n s e l i n g and w i l l a s s i s t c o u n s e l i n g e f f e c t i v e n e s s . The f o l l o w - u p i n f o r m a t i o n , l i k e a l l i n f o r m a t i o n you g i v e , w i l l be c o n f i d e n t i a l . S i g n a t u r e DATE PRE 130 POST 6 MO. 1 YEAR 1. ALCOHOL USE: DRINKS PER WEEK COMMENTS ON PATTERN •  2. MARITAL ADJUSTMENT: MARITAL RATING (1-7) : RELATIONSHIP AREAS (5-35) : MAS (0-200) _. COMMENTS 3. SELF-ESTEEM: DISCREPANCY SCORE COMMENTS 4. REAL-IDEAL PARTNER: DISCREPANCY SCORE COMMENTS 5. WORK FUNCTIONING: (1-7) COMMENTS 6. SOCIAL FUNCTIONING: (1-7) COMMENTS By, 131 C o r r e l a t i o n M a t r i x f o r A d j u n c t i v e Dependent Measures on Post-Assessment R e l a t i o n s h i p R a t i n g S o c i a l R a t i n g Work R a t i n g R e a l - I d e a l R a t i n g S o c i a l R a t i n g 0.32 Work R a t i n g 0.58 0.24 R e a l - I d e a l S e l f -0.18 -0.36 0.08 R e a l - I d e a l P a r t n e r -0.51 -0.33 -0.37 0.17 132 APPENDIX B C o n s i s t e n c y and V a l i d i t y of the R e a l - I d e a l S e l f D i s c r e p a n c y S c o r e 133 In o r d e r to e s t a b l i s h the use of the r e a l - i d e a l s e l f d i s c r e p a n c y s c o r e as a u s e f u l c l i n i c a l measure, i t was n e c e s s a r y t o e v a l u a t e the i n t e r n a l c o n s i s t e n c y of the a d j e c t i v e c h e c k l i s t , the c o r r e l a t i o n o f the a d j e c t i v e c h e c k l i s t w i t h o t h e r measures, and to t e s t f o r d i f f e r e n c e s between p o p u l a t i o n s who were l i k e l y t o d i f f e r on the q u a l i t y the a d j e c t i v e c h e c k l i s t a s s e r t s to measure. Al e x a n d e r and Dibbs (1977) d e s c r i b e d the r e a l - i d e a l d i s c r e p a n c y as a measure of s e l f - e s t e e m , which was c o n s i s t e n t w i t h the use of t h a t a s p e c t of the Q - s o r t and a l s o has a c e r t a i n amount of f a c e v a l i d i t y . To f u r t h e r e v a l u a t e the r e l i a b i l i t y and v a l i d i t y of the a d j e c t i v e c h e c k l i s t v e r s i o n of t h i s measure, t h r e e s e p a r a t e comparisons were made. In the f i r s t comparison, an odd-even i t e m c o r r e l a t i o n was made f o r 31 c o l l e g e u n d e r g r a d u a t e s . In the second comparison, the a d j e c t i v e c h e c k l i s t was a d m i n i s t e r e d to 22 a l c o h o l i c s a p p l y i n g f o r o u t p a t i e n t c o u n s e l l i n g a t an a l c o h o l treatment c e n t r e on i n t a k e , and these r e s u l t s were compared o t the t o t a l s c o r e s of the 31 c o l l e g e undergraduates d e s c r i b e d p r e v i o u s l y . These a l c o h o l i c s were not p a r t i c i p a n t s i n the r e s e a r c h d e s c r i b e d i n t h i s t h e s i s . A l s o , the f i r s t 11 p a r t n e r s of a l c o h o l i c s p a r t i c i p a t i n g i n the t h e s i s r e -s e a r c h were compared to the undergraduate sample a t t h i s time. F i n a l l y , a s e p a r a t e sample of 70 undergraduates was a d m i n i s t e r e d the a d j e c t i v e c h e c k l i s t and the Guttman S e l f - E s t e e m S c a l e (Rosenberg, 1963). I f the a d j e c t i v e c h e c k l i s t was i n f a c t measuring what has been c a l l e d s e l f - e s t e e m , i t was expected t h a t (1) the odd-even c o r r e l a t i o n would be s u b s t a n t i a l , (2) t h a t b o t h a l c o h o l i c s and t h e i r p a r t n e r s would 134 s c o r e s i g n i f i c a n t l y h i g h e r than c o l l e g e u n dergraduates on the r e a l -i d e a l s e l f d i s c r e p a n c y s c o r e , and (3) t h e r e would be a p o s i t i v e and s i g n i f i c a n t c o r r e l a t i o n between the Guttman S e l f - E s t e e m S c a l e and the r e a l - i d e a l d i s c r e p a n c y s c o r e . In a l l a d m i n i s t r a t i o n s , the s u b j e c t s were t o l d t h a t t h e q u e s t i o n n a i r e s were b e i n g e v a l u a t e d or p r e - t e s t e d as t o t h e i r u s e f u l n e s s . I t was a l s o e x p l a i n e d t h a t the q u e s t i o n n a i r e s would have no e f f e c t on t h e i r s t a t u s as e i t h e r s t u d e n t s or c l i e n t s , and s e r i o u s a t t e n t i o n to the q u e s t i o n n a i r e was encouraged. R e s u l t s 1. The c o r r e l a t i o n between the s c o r e s based on the odd-even respo n s e s to the a d j e c t i v e c h e c k l i s t c o r r e l a t e d h i g h l y , r_ = .895. The mean d i s c r e p a n c y s c o r e f o r odd items (X = 22.20) and even items (X = 20.11) appeared to be s i m i l a r . 2. Both a l c o h o l i c s and p a r t n e r s of a l c o h o l i c s were found to d i f -f e r s i g n i f i c a n t l y from c o l l e g e u n dergraduates on r e a l - i d e a l s e l f d i s -c repancy s c o r e s , F ( l , 5 1 ) = 4.12, £ < .05 and F ( l , 4 0 ) = 9.59, £ < .005, r e s p e c t i v e l y , when a n a l y s e s of v a r i a n c e were used to compare the c l i n i c a l groups w i t h the u n d e r g r a d u a t e s . The mean d i s c r e p a n c y s c o r e s were 44.35 f o r c o l l e g e u n d e r g r a d u a t e s , 52.77 f o r a l c o h o l i c s , and 60.18 f o r p a r t n e r s of a l c o h o l i c s . 3. The c o r r e l a t i o n between the Guttman S e l f - E s t e e m S c a l e and the r e a l - i d e a l d i s c r e p a n c y s c o r e was r_ = -.565, a moderate, but s t a t i s -t i c a l l y s i g n i f i c a n t c o r r e l a t i o n when e v a l u a t e d by F i s h e r ' s r t o Z t r a n s f o r m a t i o n (_Z = 5.24, £ < .001). On t h i s sample, an ANOVA was run between males and females f o r the r e a l - i d e a l d i s c r e p a n c y s c o r e , and the d i f f e r e n c e s were not s i g n i f i c a n t , F_(l,68) = .005, n.s. 135 C o n c l u s i o n s T h i s p r e - t e s t i n g e v a l u a t i o n o f the r e a l - i d e a l a d j e c t i v e c h e c k l i s t i n d i c a t e d t h a t the c h e c k l i s t was i n t e r n a l l y c o n s i s t e n t , d i f f e r e n t i a t e d between groups who were expe c t e d t o d i f f e r on s e l f - e s t e e m , and c o r -r e l a t e d m o d e r a t e l y w i t h another measure of s e l f - e s t e e m . The c o n s i d e r a -t i o n of the r e a l - i d e a l s e l f d i s c r e p a n c y s c o r e as a measure of s e l f -esteem or s e l f - r e g a r d , then, seemed to be a r e a s o n a b l e use of the measure. Of c o u r s e , i t must be added t h a t t h i s p r e - t e s t i n g s h o u l d not be c o n s i d e r e d u l t i m a t e v a l i d a t i o n o f t h i s measure, but o n l y t h a t i t sup-p o r t e d the use o f the measure. The moderate c o r r e l a t i o n between the Guttman S e l f - E s t e e m S c a l e and the a d j e c t i v e c h e c k l i s t was a c a s e i n p o i n t . E x a m i n a t i o n o f the s c o r e s i n d i c a t e s a l i m i t e d range of s c o r e s f o r the Guttman s c a l e , r a n g i n g from 0 to A, w h i l e the a d j e c t i v e c h e c k l i s t d i s c r e p a n c y s c o r e s ranged from 20 to 75. A s i m i l a r e x a m i n a t i o n o f the c o r r e l a t i o n o f the Guttman s c a l e w i t h the a d j e c t i v e c h e c k l i s t measure may y i e l d more u s e f u l i n f o r m a t i o n i f t e s t e d on a c l i n i c a l p o p u l a t i o n . In g e n e r a l , however, the r e a l - i d e a l d i s c r e p a n c y appeared to be a r e a -s o n a b l e measure of s e l f - e s t e e m or s e l f - r e g a r d . F u r t h e r e x p l o r a t i o n of the v a l i d i t y o f the measure would p r o b a b l y s t i l l be f r u i t f u l , however. 

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