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Interpersonal trust and group psychotherapy : an outcome study Tognazzini, Paula Mary 1983

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INTERPERSONAL TRUST AND GROUP PSYCHOTHERAPY: AN OUTCOME STUDY by PAULA MARY TOGNAZZINI B.Sc.N., University of B r i t i s h Columbia, 1977 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF ' THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE IN NURSING i n THE FACULTY OF GRADUATE STUDIES (The School of Nursing) We accept t h i s thesis as conforming to the required standard THE UNIVERSITY OF BRITISH COLUMBIA A p r i l 1983 © Paula Mary Tognazzini, 1983 In presenting t h i s thesis i n p a r t i a l f u l f i l m e n t of the requirements for an advanced degree at the University of B r i t i s h Columbia, I agree that the Library s h a l l make i t f r e e l y available for reference and study. I further agree that permission for extensive copying of t h i s thesis for scholarly purposes may be granted by the head of my department or by his or her representatives. It i s understood that copying or publication of t h i s thesis for f i n a n c i a l gain s h a l l not be allowed without my written permission. Department of l\URSi/\J 6> The University of B r i t i s h Columbia 1956 Main Mall Vancouver, Canada V6T 1Y3 Date DE-6 (3/81) i i ABSTRACT This study examined the e f f e c t s of an intensive group psychotherapy program on selected patients' interpersonal t r u s t as measured by the Inter-personal Trust Scale. A review of the l i t e r a t u r e indicated that i n t e r p e r -sonal tru s t was a m u l t i f a r i o u s construct which needed to be further developed and understood. This study used a quasi-experimental control group design. Data were obtained from twenty patients who had been referred to an intensive group psychotherapy program. Ten patients who completed t h i s program were assigned to the experimental group and ten patients who did not enter the program were assigned to the control group. The Interpersonal Trust Scale was given to a l l the patients at the time of assessment and s i x to eight weeks l a t e r . The data were analyzed using non-parametric s t a t i s t i c s . The r e s u l t s indicated that the group psychotherapy program had no 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 f f e c t on selected patients' interpersonal t r u s t as measured by the Interpersonal Trust Scale. A discussion of the findings and recommendations for further study were included. i i i TABLE OF CONTENTS Page CHAPTER I. INTRODUCTION 1 Statement of the Problem 3 D e f i n i t i o n of Terms 3 Purpose of the Study 3 Relevance of the Study 4 Limitations of the Study 4 Assumptions of the Study 5 CHAPTER I I . LITERATURE REVIEW 6 Part I 6 Early Research on Interpersonal Trust 6 Studies i n Communication Research 7 Studies i n Therapeutic Settings 10 Part I I 13 Conceptual Framework: S o c i a l Learning Theory 13 Summary 19 CHAPTER I I I . THE DAY HOUSE PROGRAM 22 Referrals 23 Day House Rules 23 The Groups 24 Summary 28 i v . Page CHAPTER IV. METHODOLOGY . 30 Research Design . . . . . . . . . 30 Sample S e l e c t i o n 31 Procedure for Data C o l l e c t i o n 31 Instrument: the Interpersonal Trust Scale 32 Summary 34 CHAPTER V. DATA ANALYSIS AND DISCUSSION OF FINDINGS 35 Data Analysis 35 Discussion of the Findings 41 Summary 42 CHAPTER VI. SUMMARY, CONCLUSIONS AND RECOMMENDATIONS FOR FURTHER.STUDY 43 Summary 43 Conclusions 44 Recommendations for Further Study 45 BIBLIOGRAPHY 46 APPENDIX A. INTERPERSONAL TRUST SCALE 50 APPENDIX B. INFORMATION AND CONSENT FORM 55 V LIST OF TABLES Table Page 1. Pretest and Posttest Scores for the Experimental Group . . . 36 2. Mean and Standard Deviation for Experimental Group 36 3.. Pretest and Posttest Scores for the Control Group 38 4. Mean and Standard Deviation for Control Group 38 5. Pretest and Posttest Scores of the Experimental Group on the Factors of P o l i t i c a l Trust, Parental Trust and Trust of Strangers 39 6. The Results of the Wilcoxon signed-rank t e s t on the Factors of Parental Trust, P o l i t i c a l Trust and Trust of Strangers for the Experimental Group 39 7. Pretest and Posttest Scores of the Control Group on the Factors of P o l i t i c a l Trust, Parental Trust and Trust of Strangers 40 8. The Results of the Wilcoxon signed-rank test on the Factors of Parental Trust, P o l i t i c a l Trust and Trust of Strangers f o r the Control Group 40 v i ACKNOWLEDGEMENTS I wish to express my sincere thanks to the members of my thesis com-mittee for t h e i r guidance, support and willingness to give of t h e i r free time: to Dr. Joan Anderson, Chairperson, and to Helen E l f e r t and Darlene Steele. I also wish to g r a t e f u l l y acknowledge the co-operation of the Day House s t a f f . In p a r t i c u l a r , I wish to thank a l l the patients who volunteered to p a r t i c i p a t e i n th i s study. To my husband, Hugh P a r f i t t , I express very s p e c i a l thanks f o r h i s constant encouragement and support which helped me get through the d i f f i -c u l t times. A s p e c i a l thanks also goes to my daughter Robin who ch e e r f u l l y tolerated her mother's d i s t r a c t i o n s . I would also l i k e to express my thanks to my friends who cheered me on throughout t h i s study. 1 CHAPTER I INTRODUCTION For three decades, health professionals have regarded the construct of t r u s t as an e s s e n t i a l component of s o c i a l i n t e r a c t i o n . In t h e i r attempts to reach an understanding of human re l a t i o n s h i p s and group process, psychol-ogists and s o c i o l o g i s t s have studied interpersonal t r u s t i n various set-tings. However, l i t t l e a t tention has been given to the study of int e r p e r -sonal t r u s t i n i n d i v i d u a l and group psychotherapy. The layman's meaning of tr u s t encompasses a v a r i e t y of interpersonal and intrapersonal phenomena. Synonyms for trust common i n everyday language are confidence, b e l i e f , r e l i a b i l i t y , dependence, and f a i t h . These concepts have been used to describe tru s t i n i n d i v i d u a l s , groups, organizations, d e i t i e s , animals, and inanimate objects. For example, t r u s t can r e f e r to a b e l i e f i n a friend's promise, f a i t h i n the a b i l i t y of a mechanic to adjust the brakes of one's car, confidence i n the j u d i c i a l system or the c r e d i b i l -i t y of a verbal or written statement. Trust can also imply s e l f confidence or s e l f - r e l i a n c e . The numerous meanings given to the construct of tr u s t have made i t d i f f i c u l t to a r r i v e at an agreed d e f i n i t i o n . G i f f i n and Patton (1971) observed that " t r u s t has t r a d i t i o n a l l y been viewed as a somewhat mystical and untangible factor defying c a r e f u l d e f i n i -t i o n " (p. 376). Other researchers (Kee & Knox, 1970) have pointed out that the precise meaning of trust i s not i d e n t i c a l from one s i t u a t i o n to another. Deutsch (1958) stressed the importance of a d e f i n i t i o n of trust which includes both everyday connotations of the language and also s c i e n t i f i c 2 terms. This has been a challenging task because concepts such as., confidence and dependence are d i f f i c u l t to operationalize. S o c i a l exchange theory, a t t r i b u t i o n theory, and s o c i a l learning theory have been used as t h e o r e t i c a l frameworks for understanding and defining t r u s t . Each theory has i t s advantages and l i m i t a t i o n s for the explanation of the complex construct of t r u s t . The l i t e r a t u r e on tru s t research leaves some aspects of tru s t unexplainable. Thorslund (1976) points out that the conceptualizations of t r u s t are incomplete not only because t r u s t i s d i f f i c u l t to define but also because the d e f i n i t i o n s established are only s u i t a b l e for p a r t i c u l a r studies i n p a r t i c u l a r s i t u a t i o n s . This l i m i t s the generalizations that can be made from these studies. Nevertheless, research on the construct of i n t e r p e r -sonal t r u s t continues. Interpersonal t r u s t i n the nurse-patient r e l a t i o n s h i p i s emphasized i n the l i t e r a t u r e . However, there has been l i t t l e empirical i n v e s t i g a t i o n of t h i s construct. Interpersonal t r u s t i s i d e n t i f i e d as a construct because i t i s an " a t t i t u d e toward another person [that] may not always be r e f l e c t e d by one's observable actions" ( G i f f i n & Patton, 1971, p. 376). Thus, the a t t i t u d e of trus t i s the " i n t r o s p e c t i v e o r i e n t a t i o n which i s a p o t e n t i a l for a c t i o n " (p. 376). This p o t e n t i a l for action can be i n f e r r e d from observed behavior but i s not the behavior i t s e l f . In t h i s study, the construct of t r u s t i s viewed as an a t t i t u d e or generalized expectancy that the "word, promise, verbal or written statement of an i n d i v i d u a l or group can be r e l i e d upon " (Rotter, 1967, p. 651). This d e f i n i t i o n of t r u s t i s derived from Rotter's s o c i a l learning theory, which i s used as a framework for t h i s study. 3 "Many psychotherapists believe interpersonal t r u s t i s a major deter-minant i n the success of psychotherapy. . . . I t seems evident that an adequate measure of i n d i v i d u a l differences i n interpersonal t r u s t would be of great value to research" (Rotter, 1967, pp. 651-652). Rotter's Inter-personal Trust Scale, used i n t h i s study, attempts to measure these i n d i -v i d u a l d i f f e r e n c e s . This research hopes to contribute to further understanding of the con-str u c t of interpersonal t r u s t and, i n p a r t i c u l a r , the extent to which i t i s influenced by group psychotherapy. Statement of the Problem What are the e f f e c t s of an intensive group psychotherapy program on selected patients' interpersonal t r u s t as measured by the Interpersonal Trust Scale? D e f i n i t i o n of Terms Interpersonal Trust. "The expectancy that the word, promise, verbal, or written statement of another i n d i v i d u a l or group can be r e l i e d upon" (Rotter, 1967, p. 651). Group Psychotherapy Program. An intensive six-week integrated group psychotherapy program c a l l e d Day House located on the campus of The U n i v e r s i t y of B r i t i s h Columbia. Purpose of the Study This study w i l l examine the e f f e c t s of the Day House program on selected patients' interpersonal t r u s t as measured by Rotter's Interpersonal Trust Scale. The patients w i l l be i n two groups, an experimental group (those who complete the Day House program) and a co n t r o l group (patients who do not enter the program). The s p e c i f i c objectives of the study are: 1. To measure the interpersonal t r u s t scores of the experimental group within three days of entering the program and within two weeks of completing i t . 2. To measure the interpersonal t r u s t scores of the control group on the day of th e i r assessment by the s t a f f of the program and s i x to eight weeks l a t e r . 3. To compare the interpersonal t r u s t scores obtained from the two groups. Relevance of the Study I t i s hoped that the information gathered from t h i s study w i l l a s s i s t group therapists i n furthering t h e i r understanding of the concept of trus t and i t s s i g n i f i c a n c e i n group psychotherapy. I t i s also hoped that t h i s study w i l l encourage other health profes-sionals to do further research on'.interpersonal tru s t p a r t i c u l a r l y i n the area of psychotherapy. Limitations of the Study The i n t e r n a l v a l i d i t y of t h i s study i s l i m i t e d because the subjects were not randomly assigned to the two groups. The sample used for t h i s study was l i m i t e d to people r e f e r r e d to a s p e c i f i c group psychotherapy program. The r e s u l t s are not generalizable to c l i e n t s i n other programs or to other populations. 5 Assumptions of the Study 1. Trust i s a learned experience. 2. People expect that the word, promise, verbal or written statement of another i n d i v i d u a l or group w i l l come to f r u i t i o n . 3. People w i l l t r u t h f u l l y express th e i r opinions on the Interpersonal Trust Scale. 4. People are capable of changing t h e i r b e l i e f s , values and ideas. 5. People value the construct of t r u s t . 6. Trust i s an important v a r i a b l e i n interpersonal r e l a t i o n s h i p s . 7. Group psychotherapy can provide a c o r r e c t i v e experience through which i n d i v i d u a l s can learn to change behaviors, b e l i e f s and a t t i t u d e s . 8. The patients i n the experimental and control groups are assumed to be comparable. 6 CHAPTER II LITERATURE REVIEW Trust has been studied i n various settings and from d i f f e r e n t points of view. Thus, a large body of research has accumulated. I t i s beyond the scope of t h i s study to include a l l the research pertaining to t r u s t . This l i t e r a t u r e review has focused on studies dealing with the tr u s t of others. In doing so, Part I of the discussion w i l l cover the early research on interpersonal t r u s t followed by the studies i n communication research and i n therapeutic s e t t i n g s . The aim of the discussion i s to i l l u s t r a t e the various research approaches undertaken i n order to increase the understand-ing of t h i s m u l t i f a r i o u s construct. Part II of the l i t e r a t u r e review w i l l include an examination of the construct of trust using s o c i a l learning theory as a framework. Given that group psychotherapy i s the dependent v a r i a b l e i n t h i s study, p a r t i c u l a r a t t e n t i o n w i l l be given to i t s s i g n i f i c a n c e i n s o c i a l learning theory. Part I Early Research on Interpersonal Trust Morton Deutsch (1958) was one of the f i r s t people to research the con-st r u c t of interpersonal t r u s t . He and h i s colleagues studied t r u s t i n laboratory settings using modified prisoner's dilemma games. From these studies, Deutsch concluded that: an i n d i v i d u a l may be said to have trust i n the occurrence of an event i f he expects i t s occurrence and h i s expectation leads to behavior which he perceives to have greater negative motiva-t i o n a l consequences i f the expectation i s not confirmed than p o s i t i v e motivational consequences i f i t i s confirmed. (p. 266) 7 This implies that an i n d i v i d u a l weighs the p o s i t i v e and negative conse-quences of h i s or her d e c i s i o n before t r u s t i n g another person. The i n d i -v i d u a l then makes a choice to trust or not to t r u s t according to the expected outcome. Since the outcome i s uncertain, an element of r i s k i s involved. Deutsch (1958) also found that people were more ready to t r u s t i f they believed that they had some power over the outcome of the t r u s t i n g s i t u a -t i o n , or i f i t was apparent that the person being trusted had nothing to gain i n betraying the t r u s t . Variables which increase the degree of interpersonal t r u s t include the a b i l i t y to communicate an expectation of r e c i p r o c a l t r u s t (Loomis, 1959) and the communication of cooperative rather than competitive res-ponses (Solomon, 1960). These va r i a b l e s provide feedback about the amount of r i s k involved i n a decision to t r u s t another i n d i v i d u a l . G i f f i n and Patton (1971) suggest that a person w i l l be more l i k e l y to take the r i s k of t r u s t i n g another person i f that i s the only way to accom-p l i s h a c e r t a i n goal. The greater the value placed on the goal, the greater the l i k e l i h o o d that the r i s k w i l l be taken. These studies led to further examination of the construct of i n t e r p e r -sonal t r u s t w i t h i n the context of communication research. Studies i n Communication Research Communication research has increased the understanding of interpersonal trust by examining variables which a f f e c t interpersonal r e l a t i o n s h i p s . Hovland and his associates (1953) found that " t r u s t i s based upon a l i s t e n e r ' s perception of a speaker's expertness, r e l i a b i l i t y , i ntentions, activeness, personal attractiveness and the majority opinion of the l i s t e n e r ' s associates" (p. 104). G i f f i n and Patton (1971) supported t h i s 8 f i n d i n g , concluding that the "general c r e d i b i l i t y of group opinion expressed" (p. 387) influenced the degree of trustworthiness of an i n d i -v i d u a l . Gif fin,(1967a) showed that expertness, r e l i a b i l i t y and dynamism were three-major c h a r a c t e r i s t i c s which determined whether a person would be trusted. Dynamism was defined as."behavior perceived as more active than passive and more open or frank than closed or reserved" (p. 104). Gibb (1961) found that defensive behavior "engenders defensive l i s t e n -ing and t h i s i n turn produces postural, f a c i a l and verbal cues which r a i s e the defensive l e v e l of the o r i g i n a l communicator" (p. 141). When entering a s i t u a t i o n that involves t r u s t , defensive behavior communicates the inten-t i o n of non-trustworthiness and, therefore, encourages suspicion rather than t r u s t . Gibb (1961) i d e n t i f i e d a number of intentions which increased the l i k e l i h o o d of a person being perceived as trustworthy. These were being: (1) non-judgmental; (2) problem oriented rather than s o c i a l control oriented; (3) spontaneous rather than s t r a t e g i c ; (4) empathic rather than neutral; (5) on an equal basis rather than on an unequal basis; and (6) p r o v i s i o n a l or tentative rather than c e r t a i n (pp. 141-148). Gibb's (1961) findings led G i f f i n and Patton (1971) to conclude that interpersonal t r u s t i s a "function of perceived acceptance by valued others" (p. 381). I f t h i s acceptance cannot be communicated v e r b a l l y or non-verbally, the t r u s t i n g r e l a t i o n s h i p i s l i k e l y to break down (Bennis et a l . , 1964). Mellinger (1956) looked at interpersonal t r u s t as a factor i n communi-cation. He found that a person who trusted another person was able to pre-d i c t that person's at t i t u d e s more accurately. A questionnaire which asked subjects to judge others on the basis of t h e i r s i n c e r i t y , motives and 9 dependability of communication was found to measure t r u s t . This question-naire was a precursor of Rotter's Interpersonal Trust Scale which w i l l be discussed i n Chapter IV. Schlenker,-Helm:and:-Tedeschi (1973) studied the e f f e c t s of personality and s i t u a t i o n a l v a r i a b l e s on behavioral t r u s t . They found that when highly c r e d i b l e promises were made and kept, subjects trusted more than when low c r e d i b i l i t y promises were made. A serie s of prisoner's dilemma games and Rotter's Interpersonal Trust Scale were used i n these studies. In North American society, a p o s i t i v e self-concept i s regarded as a sign of mental health. G i f f i n and Patton (1971) argue that self-concept i s "based i n part upon communication with other people" (p. 381). One study showed that c h i l d r e n , whose parents suppressed t h e i r attempts to communi-cate, developed poor self-concepts (Heider, 1968). Children, whose parents encouraged t h e i r attempts to communicate, developed p o s i t i v e self-concepts. In a t r u s t s i t u a t i o n , the approval of the person who i s to be trusted w i l l increase the l i k e l i h o o d of t r u s t i n g behavior. Studies i n communication research have influenced the understanding of interpersonal tru s t by examining the e f f e c t s of communication upon a t t i -tudes and behaviors i n human r e l a t i o n s h i p s . In summary, the research has pointed out that when tr u s t e x i s t s between two people, p r e d i c t i o n of each other's a t t i t u d e s can occur. Trust was also increased when highly credible promises were made and kept between two i n d i v i d u a l s . Attitudes and behav-i o r s which f o s t e r trust i n r e l a t i o n s h i p s have been i d e n t i f i e d as acceptance, caring, equality, empathy, and f l e x i b i l i t y . The l i t e r a t u r e i n communication research has also indicated that the self-concept of the i n d i v i d u a l i s influenced by responses from valued people. Interpersonal tru s t a f f e c t s communication i n r e l a t i o n s h i p s among i n d i v i d u a l s and, thus, i n d i r e c t l y a f f e c t s one's self-concept. The con-str u c t of interpersonal t r u s t i s complex and d i f f i c u l t to operationalize because i t v a r i e s with each i n d i v i d u a l i n t e r a c t i o n . The v a r i a b l e s 1: discussed i n communication research provide a portion of a framework i n which to understand t h i s construct. A branch of communication research i s studies i n therapeutic s e t t i n g s . These studies have contributed to further i n s i g h t into interpersonal t r u s t . Studies i n Therapeutic Settings Trust i s an important component of psychotherapy (Rogers, 1961; Yalom, 1970). An element of trust i s i m p l i c i t i n the act of seeking help and i s required f o r the di s c l o s u r e of personal information (Jourard & Friedman, 1970). Therapists must be able to convey t h e i r trustworthiness to c l i e n t s i n order to b u i l d a climate of trust (Witherspoon, 1981). Carl Rogers (1961) observed that the trust which the patient has for the therapist i s a major factor accounting for the changes experienced by the patient during therapy. Before t r u s t can develop, both p a r t i c i p a n t s must give something to the re l a t i o n s h i p (Swinth, 1967). Swinth (1967) asserted that t r u s t between two people i s established when one of them exposes himself or h e r s e l f to the r i s k of personal l o s s . When t h i s s e l f exposure i s repeatedly met with acceptance, each person then gains confidence that he or she w i l l not be i n t e n t i o n a l l y hurt by the other (Bennis, Schein, Berlew, & Steele, 1964). Jourard and Friedman (1970) investigated the r e l a t i o n s h i p between s e l f - d i s c l o s u r e and experimenter-subject "distance." They found that when an experimenter i s l i k e d and trusted by the subject, distance between them was decreased. The subject's d i s c l o s u r e time increased as the distance between the subject and experimenter decreased (p. 282). 11 The e f f e c t of the counselling approach on trust behavior was studied by E l l i s o n and Firestone (1974). Trust was equated with s e l f - d i s c l o s u r e and measured by Jourard's S e l f - D i s c l o s u r e Questionnaire. There was no diff e r e n c e between d i r e c t i v e and non-directive counselling approaches i n th i s study. Witherspoon (1981) r e l a t e d therapist effectiveness to the trustworthi-ness of the therapist as perceived by the patients. He found that arrogant therapists are seen as nontrustworthy, leading to defensive communication by the patient which greatly reduces the effectiveness of the therapy. Studies of therapeutic groups have revealed several i n t e r e s t i n g aspects a f f e c t i n g interpersonal t r u s t . Gibb (1962) found that people had four basic goals i n common during s o c i a l i n t e r a c t i o n s i n human r e l a t i o n s t r a i n i n g groups (T-groups). These were acceptance, information, goal-achievement, and s o c i a l control (p. 281). Acceptance i s rel a t e d to i n t e r -personal and intrapersonal t r u s t . Group cohesiveness increased as accep-tance among group members increased. Kessel (1971) studied interpersonal t r u s t i n T-groups using Rotter's Interpersonal Trust Scale. The r e s u l t s of t h i s study showed no r e l a t i o n -ship between t r u s t , s e l f - d i s c l o s u r e , and group cohesiveness. Kessel con-cluded that the kind of t r u s t measured by Rotter's scale was not the same as the intragroup t r u s t that the study had attempted to measure. Piper (1972) conducted a study which evaluated the e f f e c t s of s e n s i -t i v i t y t r a i n i n g on group composition according to interpersonal t r u s t (measured by Rotter's s c a l e ) . Subjects who p a r t i c i p a t e d i n a high-trust s e n s i t i v i t y group increased t h e i r a b i l i t y to r o l e play p o s i t i v e i n t e r p e r -sonal behaviors. No increased a b i l i t y to r o l e play p o s i t i v e interpersonal behavior was found i n low trust groups. 12 One study showed that aceombination of non-verbal a c t i v i t i e s and group discussion were as e f f e c t i v e i n b u i l d i n g interpersonal t r u s t i n small groups as group discussion (Clarke, 1971). Further studies on the v a r i a b l e s a f f e c t i n g interpersonal t r u s t need to be conducted i n order to increase the understanding of t h i s complex construct. The r e l a t i o n s h i p between interpersonal t r u s t and leadership s t y l e was investigated by Roegiers (1972). He found that group leaders could b u i l d or destroy the climate of t r u s t i n t h e i r groups according to the perception of their personality c h a r a c t e r i s t i c s by group members. These c h a r a c t e r i s t i c s were expertness, r e l i a b i l i t y , and dynamism, as i d e n t i f i e d previously by G i f f i n and Patton (1971). The s t y l e of the therapist i n group counselling can f a c i l i t a t e the therapeutic i n t e r a c t i o n of either high or low t r u s t i n g people (Chatwin, 1971). When a group i s leader-centered, the i n t e r a c t i o n of low-trust per-sons i s f a c i l i t a t e d . High-trust people i n t e r a c t more f r e e l y when leader-ship i s group-centered. Studies i n therapeutic settings have increased the understanding of the construct of t r u s t by examining the r e l a t i o n s h i p between s e l f - d i s c l o s u r e and interpersonal t r u s t , t r u s t behavior, counselling approaches, leadership s t y l e , and climate of t r u s t i n small groups. These studies were also con-cerned with therapist c h a r a c t e r i s t i c s and perceived trustworthiness of the therapist which d i r e c t l y r e l a t e d to the effectiveness of therapy. The review of the relevant research on interpersonal t r u s t has pro-vided some understanding of t r u s t behavior as well as a t t i t u d e s about communication of t r u s t i n human i n t e r a c t i o n s . The next part w i l l examine interpersonal t r u s t as a s o c i a l a t t i t u d e or generalized expectancy viewed within the framework of s o c i a l learning theory. Part II Conceptual Framework: S o c i a l Learning Theory In t h i s study, the construct of trust i s derived from s o c i a l learning theory. S o c i a l learning theory i s a model for the understanding of human behavior. The theory i s well systematized and consists of basic assump-tions and constructs which lead to the understanding and p r e d i c t i o n of human actions. Reinforcement theory, cognitive or f i e l d theory, and le a r n -ing theory are combined i n order to explain complex human behavior. The s o c i a l learning theory of personality uses an expectancy construct and an empirical law of e f f e c t (Rotter, Chance & Phares, 1972, p. 95). This law defines reinforcement as "any action, condition or event which a f f e c t s the i n d i v i d u a l ' s movement towards a goal" (p. 95). Emphasis i s placed both on i n t e r n a l and s i t u a t i o n a l c h a r a c t e r i s t i c s i n the p r e d i c t i o n of behavior. The i n d i v i d u a l ' s past experiences play an important r o l e i n the understanding of present behavior. New experiences may lead to changes i n p ersonality or behavior. These changes may or may not occur within the context of psychotherapy. Assumptions of S o c i a l Learning Theory S o c i a l learning theory has three basic assumptions. The f i r s t i s that the u n i t of i n v e s t i g a t i o n for the study of personality i s the i n t e r a c t i o n of the i n d i v i d u a l with h i s or her meaningful environment (Rotter, 1975, p. 94). The p r e d i c t i o n of behavior i s based on the immediate s i t u a t i o n as well as on past experience. The second assumption i s that while personality i s generally stable i t can be modified through experience (p. 95). This assumption also empha-size s the i n t e r a c t i o n of the i n d i v i d u a l with h i s or her environment. The t h i r d assumption i s that behavior i s goal directed (p. 96). 14 These assumptions lead to the development of the four major constructs of s o c i a l learning theory. Constructs i n S o c i a l Learning Theory The four major constructs r e l a t e d to the p r e d i c t i o n of behavior are (1) behavior p o t e n t i a l (need p o t e n t i a l ) ; (2) expectancy (freedom of move-ment); (3) reinforcement value (need value); and (4) s i t u a t i o n (Rotter, 1975, p. 113). These constructs are f l e x i b l e and are used on "whatever l e v e l of generality that i s necessary for a p a r t i c u l a r purpose" (p. 113). They are linked c l o s e l y together. According to s o c i a l learning theory, behavior i s broadly defined as "actual motor acts, cognitions, verbal and nonverbal behavior', emotional reactions, etc." (p. 96). Behavior p o t e n t i a l i s "the p o t e n t i a l for any given behavior to occur i n a p a r t i c u l a r s i t u a t i o n or s i t u a t i o n s as calculated i n r e l a t i o n to any sin g l e reinforcement or set of reinforcements" (p. 96). An example i n the group psychotherapy s e t t i n g would be the systematic reinforcement of s e l f -d i s c l o s i n g behavior. An i n d i v i d u a l i n the group might engage i n any number of behaviors which demonstrate s e l f - d i s c l o s u r e . Each behavior has a cer-t a i n p o t e n t i a l f or that i n d i v i d u a l and i s more or l e s s l i k e l y to occur than other behaviors depending on the i n d i v i d u a l ' s d i f f e r e n c e s , past experiences, and needs, at that p a r t i c u l a r moment i n time. Although the behaviors vary from one group member to another, the d i r e c t i o n i s the same: s e l f - d i s c l o s u r e leads to increased t r u s t i n others. Expectancy i s defined as "the p r o b a b i l i t y held by the i n d i v i d u a l that a p a r t i c u l a r reinforcement w i l l occur as a function of a s p e c i f i c behavior on h i s or her part i n a s p e c i f i c s i t u a t i o n or s i t u a t i o n s " (p. 96). A per-son's expectancy i s based on previous experience. 15 For example, i n a group psychotherapy s i t u a t i o n , two group members may both wish to please the therapist. One member's past experience may have included an i n a b i l i t y to please authority f i g u r e s . Therefore, t h i s person does not expect to succeed i n pleasing the therapist i n sp i t e of h i s or her best e f f o r t s . This i s ref e r r e d to as low freedom of movement. The other member's past experience may have been the reverse. The person's expec-tancy to please the therapist w i l l be high. This person has high freedom of movement. Although the goals of the two group members are i d e n t i c a l , t h e i r expectations d i f f e r and the i r behavior w i l l also be l i k e l y to d i f f e r . Expectancies, although they vary with each person, may be s p e c i f i c or general. An example of a s p e c i f i c expectancy would be the cessation of s t u t t e r i n g following intensive group psychotherapy. A generalized expec-tancy i s one which i s held by the i n d i v i d u a l i n a v a r i e t y of s i t u a t i o n s (p. 97). Interpersonal trust i s such a generalized expectancy. I f a mem-ber of a psychotherapy group has the generalized expectancy that the other members of the group cannot be^trusted, h i s or her behavior towards them w i l l be affected. Relationships outside the group may also be impaired. The construct of expectancy incorporates past and present experiences i n a va r i e t y of s i t u a t i o n s . The t h i r d construct i n s o c i a l learning theory i s reinforcement value. This i s defined as "the degree of preference for any reinforcement to occur i f the p o s s i b i l i t i e s of t h e i r occurring were a l l equal" (p. 97). According to Rotter (1975) , reinforcements usually do not occur independently of each other. In f a c t , one reinforcement may e l i c i t behavior which leads to f u r -ther reinforcements. For example, a person who receives p o s i t i v e feedback from other members of a therapy group whenever he or she behaves a s s e r t i v e l y may become more ass e r t i v e at work or i n other personal r e l a t i o n s h i p s . This 16 may lead to a higher standard of l i v i n g , increased work s a t i s f a c t i o n or other e f f e c t s which r e i n f o r c e the behavior. The fourth construct i s the psychological s i t u a t i o n . This construct incorporates the assumptions that i n d i v i d u a l s learn through experience and that they perceive s i t u a t i o n s i n t h e i r own characteristicr:ways. I t i s assumed that behavior i s learned and not g e n e t i c a l l y acquired or due to i n t e r n a l states such as the i d , ego, and superego r e f e r r e d to i n Freudian theory. In a psychotherapy group, a p a r t i c u l a r i n t e r a c t i o n w i l l have d i f -ferent meanings for each person present. These four basic constructs contribute to the understanding and pre-d i c t i o n of behavior i n r e l a t i o n to s p e c i f i c reinforcements. Each has been em p i r i c a l l y tested i n co n t r o l l e d laboratory experiments (Rotter et a l . , 1972). In summary, s o c i a l learning theory i s a well systematized theory of personal i t y . The basic assumptions and constructs are linked together and can be tested. Emotions and f e e l i n g s , although not d i r e c t l y addressed, are conceptualized as "behaviors having a p o t e n t i a l or occurrence i n various s i t u a t i o n s " (Rotter et a l . , 1972, p. 112). The question remains whether the theory can a c t u a l l y predict behavior as w e l l as such constructs as the emotions of anxiety and fear, i n t e r n a l states referred to by other theor-i s t s . In t h i s study, interpersonal t r u s t i s viewed as a generalized expec-tancy or s o c i a l a t t i t u d e . The next section w i l l further explore how these at t i t u d e s are formed and how they can change. Generalized Expectancies f o r Interpersonal Trust S o c i a l learning theory allows for the p r e d i c t i o n of s p e c i f i c behaviors. Rotter et a l . (1972) states that "the process of generalization accounts for the consistency and s t a b i l i t y of behavior across s i t u a t i o n s " (p. 445). Generalized expectancies are related to i n d i v i d u a l s ' past experiences and the reinforcements (negative or posi t i v e ) connected with these experiences. In psychology, generalized expectancies have t r a d i t i o n a l l y been known as s o c i a l a t t i t u d e s . Thus, generalized expectancies are s o c i a l a t t i t u d e s f u n c t i o n a l l y related to b e l i e f s about a class of animate or inanimate objects (Rotter et a l . , 1972). Generalized expectancies are learned i n childhood and continue to develop with experience i n varying s i t u a t i o n s . A c h i l d experiences a v a r i e t y of s t i m u l i which he or she learns to recognize and place i n cate-gories. For example, a c h i l d learns that a c e r t a i n stimulus indicates a f f e c t i o n and another indicates r e j e c t i o n . The c h i l d learns concepts which can eventually be described by words. Rotter et a l . (1972) claims that "when a se r i e s of objects or events has been s i m i l a r l y l a b e l l e d , new exper-iences with one of these w i l l generalize to others so that gradually a c o l l e c t i o n of generalized expectancies i s b u i l t up" (p. 337). S o c i a l a t t i -tudes can also be learned i n d i r e c t l y by observing the experiences of others. The i n d i v i d u a l ' s a t t i t u d e s and b e l i e f s may change or remain stable depend-ing on the perception of the ^situation and the reinforcements attached to the s i t u a t i o n . I t has already been stated that interpersonal t r u s t i s viewed as a generalized expectancy. Each i n d i v i d u a l develops t h i s expectancy through i n t e r a c t i o n with others (e.g. parents, teachers, p r i e s t s ) and through exposure to mass media such as t e l e v i s i o n and newspapers. When an i n d i v i -dual believes that the word, promise, verbal or written statement of another i n d i v i d u a l or group can be r e l i e d on, i t i s assumed that he or she has received p o s i t i v e reinforcement for these b e l i e f s i n past s i t u a t i o n s . 18 The i n d i v i d u a l i s then said to have t r u s t i n others. The converse i s assumed to be true. These generalized expectancies are measured by Rotter's Interpersonal Trust Scale. In summary, generalized expectancies determine behaviors because "as a r e s u l t of repeated experience, i n the same or s i m i l a r s i t u a t i o n s , the i n d i v i d u a l b u i l d s up reinforcement which extends across s i t u a t i o n s " (Hamsher, Ge l l e r , & Rotter, 1968, p. 211). Thus, i f enough new experiences are pro-vided with, powerful reinforcements attached to them, the i n d i v i d u a l can change h i s or her at t i t u d e s . I t was assumed i n t h i s study that psychother-apy i s one area i n which an i n d i v i d u a l can change; these: generalized expec-tancies. The next section w i l l b r i e f l y discuss how t h i s change may occur. S o c i a l Learning Theory and Psychotherapy According to Rotter, (1975) , s o c i a l learning theory provides a framework for psychotherapy i n which old behaviors can be understood and new behaviors acquired so that s p e c i f i c therapeutic goals can be achieved. The therapist and the patient must both p a r t i c i p a t e i n t h i s process. Appropriate r e i n -forcement provides incentive f o r learning new behaviors. The therapist's objective i s to increase the patient's freedom of move-ment. Adopting the r o l e of teacher, the therapist may a c t i v e l y suggest a l t e r n a t i v e behaviors as w e l l as helping the patient to understand why past behaviors were unsuccessful. The therapist also helps the patient to set achievable goals, thus ensuring that p o s i t i v e reinforcements are obtained. I f the patient's generalized expectancies are changed, changes i n behavior may occur which a f f e c t many areas of h i s or her everyday l i f e . Rotter (1975) emphasizes that no si n g l e therapeutic technique i s applic a b l e to a l l patients. In Chapter I I I , i t w i l l be demonstrated that the Day House program incorporates various therapies i n order to teach 19 patients new behaviors which may lead to greater l i f e s a t i s f a c t i o n and goal achievement. Summary Part I of t h i s chapter has reviewed the relevant research on in t e r p e r -sonal t r u s t i n order to increase the understanding of t h i s complex con-s t r u c t . The early studies by Deutsch (1958) revealed that r i s k taking and per-ception of the outcome of a s i t u a t i o n were important variables of interp e r -sonal t r u s t . Loomis (1959) and Solomon (1960) added that the communication of an expectation of trust and cooperative responses were also e s s e n t i a l v a r i a b l e s i n a t r u s t s i t u a t i o n . These studies led to further i n v e s t i g a t i o n of interpersonal tru s t i n the areas of communication research and thera-peutic s e t t i n g s . . S-taudi.es i n communication research attempted to provide answers as to what makes people trus t one another. Studies by Gibb (1961) revealed that being non-judgmental, problem oriented, spontaneous, empathic, p r o v i s i o n a l , and on an equal basis with another person increased tru s t i n a r e l a t i o n -ship. G i f f i n and Patton (1971) were able to conclude that expertness, r e l i a b i l i t y , and dynamism were three c h a r a c t e r i s t i c s which determined whether a person could be trusted. Other researchers found that p r e d i c t i o n of others' attitudes increased or decreased t r u s t i n r e l a t i o n s h i p s (Mellinger, 1956). Trust was also increased when highly c r e d i b l e promises were made and kept between two i n d i v i d u a l s (Schlenker et a l . , 1973). One branch of communication research was studies i n therapeutic set-tings. These studies attempted to further increase the understanding of 20 the v a r i a b l e s a f f e c t i n g interpersonal t r u s t . Factors such as s e l f -d i s c l o s u r e (Jourard & Friedman, 1970), group cohesiveness (Kessel, 1971), verbal and non-verbal a c t i v i t i e s (Clarke, 1971) were a l l studied i n group set t i n g s . The r e s u l t s provided c o n f l i c t i n g points of view as to the var-i a b l e s that e f f e c t interpersonal t r u s t . Further research i n these areas was highly recommended. However, there was consensus as to what f a c i l i t a t e s t r u s t i n thera-peutic s e t t i n g s . Roegiers (1972) found that expertness, r e l i a b i l i t y , and dynamism (previously i d e n t i f i e d by G i f f i n and Patton, 1971) of the group leader can b u i l d or destroy the climate of t r u s t i n small groups. Chatwin (1971) showed that group centered leadership f a c i l i t a t e d i n t e r a c t i o n of high trust people i n group setti n g s . Arrogant therapists were viewed as non-trustworthy by t h e i r patients (Witherspoon, 1981) which negatively affected the climate of tru s t i n therapeutic r e l a t i o n s h i p s . There are many questions l e f t unanswered as to why and how people t r u s t . The studies reviewed i l l u s t r a t e d some of the research approaches to t h i s complex area. Part II of the l i t e r a t u r e review discussed the construct of tru s t using s o c i a l learning theory as a framework. This theory was based on the i n d i -vidual's learned behavior, an expectancy construct, and reinforcement theories (Rotter et a l . , 1972). In t h i s study, the construct of t r u s t was defined according to t h i s theory as an "expectancy held by an i n d i v i d u a l or group that the word, promise, verbal or written statement of another i n d i -v i d u a l or group can be r e l i e d on" (Rotter, 1967, p. 444). P a r t i c u l a r attention was given to the a p p l i c a t i o n of s o c i a l learning theory i n group psychotherapy. The aim of t h i s study was to increase the understanding of interpersonal t r u s t i n t h i s s e t t i n g . The next chapter w i l l describe the intensive six-week group psycho therapy program c a l l e d Day House. 22 CHAPTER III THE DAY HOUSE PROGRAM Treatment at the Day House consists of an intensive six-week group psychotherapy program developed and directed by Dr. F. Knobloch. The pro-gram i s structured i n order to incorporate the philosophy of integrated psychotherapy developed by Ferdinand and J i r i n a Knobloch and documented i n thei r book Integrated Psychotherapy (1979). Integrated psychotherapy encompasses a v a r i e t y of techniques including psychodrama, psychomime, d i a r i e s , autobiographies, Gestalt, fantasy games, abreaction, and int r o s p e c t i o n . These techniques are employed i n groups which range i n s i z e from s i x or eight people to the en t i r e community of eighteen to twenty-two patients. I t i s assumed that the behavior seen i n these groups w i l l resemble that displayed by the patients i n the everyday world. The two major concepts used i n integrated psychotherapy are group schemas and rewards and costs. These concepts w i l l be described l a t e r i n the chapter. During t h e i r s i x weeks at the Day House, patients attend Monday to Friday from 9:00. a.m. to 5:00 p.m. A l l patients are expected to p a r t i c i -pate i n the groups, sports, work, music therapy, and other a c t i v i t i e s which make up the program. Psychotherapy i n the Day House i s viewed as a learning process. Neuroses and s i m i l a r disorders are assumed to be learned behaviors which can be changed through the process of re-learning i n psychotherapy (Knobloch & Knobloch, 1979, p. 328). With the assumption that people learn:.in diverse ways, integrated psychotherapy employs a v a r i e t y of techniques which f a c i l i t a t e the learning of new behaviors more conducive to goal achievement and self-understanding. Referrals Patients are referred to the Day House program by community agencies, family p r a c t i t i o n e r s , p s y c h i a t r i s t s , psychologists, or other sources. Patients may have experienced m a r i t a l problems, sexual d i f f i c u l t i e s , eating disorders, i n a b i l i t y to manage s t r e s s , depression, or general d i s s a t i s f a c -t i o n with t h e i r l i f e s t y l e . Patients who are thought to be psychotic are not accepted into the Day House program. Patients r e f e r r e d to the Day House range from ages twenty to s i x t y . A l l patients are assessed by Day House s t a f f to ensure that they are appro-p r i a t e for the program and p o t e n t i a l l y motivated to become act i v e p a r t i c i -pants. Patients must be w i l l i n g to make c e r t a i n commitments. These include abstention from alcohol and drugs and the avoidance of s u i c i d a l behavior for the duration of the program. The therapeutic community (the e n t i r e patient group) plays an a c t i v e part i n the acceptance of new members: com-mitments are made v e r b a l l y to the community before the patient enters the program. Patients must also agree to attend three sessions i n an aftercare or follow-up group. Day House Rules 1. Speak openly and frankly about everything i n meetings of the whole community. 2. Take care not to do anything which would make i t d i f f i c u l t either for yourself or others to speak openly. 3. Use every opportunity to be with the whole community. Do not i s o l a t e y ourself. 24 4. Do not form subgroups. Do not form any sexual attachments. Meeting group members outside i s almost always harmful to therapy. Use free time f o r meeting other people. 5. Help others to become members of the community as quickly as possible. 6. L i s t e n to the opinions and recommendations of others, but take r e s p o n s i b i l i t y for your own decisions. 7. You may not leave the program unless you f i r s t discuss i t with the group. You are part of the program and your separation a f f e c t s everybody. 8. While i n the program, a l l medical care and drugs are given by the s t a f f . Any other appointments and drug use should be discussed with the s t a f f . 9. Keep your contract, which includes: f u l l p a r t i c i p a t i o n i n the program, i n v i t i n g r e l a t i v e s and attending at le a s t three a f t e r c a r e meetings. 10.. You do not have to believe i n the therapy - ju s t s t i c k to the rules and see. (Day House, 1980) A l l patients must abide by these r u l e s . Those who do not may be asked to leave the program. The Groups 1. Families When a patient i s accepted into the Day House, he or she i s assigned to a "family". A "family" may include s i x to ten people. There are no more than three such " f a m i l i e s " at any one time. A therapist i s assigned to each "family". Each week one or two new members j o i n the "family" as one or two others complete the program and j o i n the aftercare group. 2. Open Group The e n t i r e therapeutic community has a four-hour meeting once a week. Those attending include the " f a m i l i e s " , new members who have been accepted but have not a c t u a l l y begun the program, members who are s t a r t i n g that day, and members who are i n after c a r e . Nurses, medical p r o f e s s i o n a l s , students, and other guests may also attend t h i s group. 25 The committee (see below), presents p o s i t i v e awards (rewards) and nega-t i v e reminders (costs) to the group members. Patients i n aftercare t a l k about t h e i r personal experiences i n the program and make recommendations to new members of the community. 3. The Committee Every week, each "family" e l e c t s one representative to the committee. These people are "responsible for the smooth running of the program and [are] deeply involved i n a l l parts of the community l i f e and i n the whole therapeutic process" (Knobloch & Knobloch, 1979, p. 184). The duties of the committee are to organize a l l domestic routines, promote punctuality, and ensure that work tasks are completed. The major r e s p o n s i b i l i t y of the committee i s to fos t e r "norms (basic and others) by generating the group's approval and disapproval and by r e g u l a r l y evaluating the patients' thera-peutic progress" (Knobloch & Knobloch, 1979, p. 184). This i s accomplished by means of a system of costs and rewards. Every week, the committee evaluates each patient's progress i n the group. Those who have been working on t h e i r problems and p a r t i c i p a t i n g f u l l y i n the program are given " p o s i t i v e awards" (rewards) during the open group meeting. These awards vary from hand made posters to other symbols which may be meaningful to the person r e c e i v i n g the award. "Negative reminders" (costs) are given to patients who are not p a r t i c i p a t i n g f u l l y or who haye broken the r u l e s . An explanation of each award or reminder i s given with the presentation. Patients are encouraged to share t h e i r f e e l -ings with the whole community as they receive these awards and reminders. The committee meets with the therapeutic community each day and records the "negative points" (costs) acquired by patients. Behaviors such as a r r i v i n g l a t e , not completing autobiographies or d i a r i e s , and breaking 26 rules are assigned points. I f a patient accumulates a c e r t a i n number of points, he or she may be put on probation and assigned extra tasks to com-pensate for them. The committee r u l e s state that: only e a s i l y i d e n t i f i a b l e acts of breaking the contract which the patient made with the community and on the basis of which was admitted are included. They a l l are destructive to the treatment of the i n d i v i d u a l and a threat to the morale and successful work of the group. Of course, having no negative points does not i t s e l f guarantee successful treatment. (Knobloch & Knobloch, 1979, p. 191) As can be seen, the committee i s the d r i v i n g force behind the thera-peutic community. Through a powerful system of costs and rewards, the patient i s helped to abandon destructive behaviors i n favor of new behaviors which lead to the achievement of group and personal goals. 4. Group Schemas The group schema i s a "model for rehearsing, t r a i n i n g and problem sol v -ing" (Knobloch & Knobloch, 1979, p. 57). Each patient constructs a cogni-t i v e map of the s i g n i f i c a n t people i n his or her l i f e (either past or pre-sent) . The patient then assigns other patients to play the r o l e s of these s i g n i f i c a n t people. Through r o l e playing, the patient i s able to re-enact c o n f l i c t s , anger, sadness, and other emotions associated with a p a r t i c u l a r past pr present r e l a t i o n s h i p . The parent figures are s i g n i f i c a n t i n the group schemas. "Improvement i n the r e l a t i o n s h i p to the parent schema i s usually a byproduct of successful psychotherapy" (Knobloch & Knobloch, 1979, p. 58). The enactment of the group schemas i s done i n a meeting of the e n t i r e therapeutic community. 5. Autobiographies and D i a r i e s Patients write t h e i r autobiographies and present them to the community during the f i r s t week of the program. Therapists help the patient to iden-t i f y s i g n i f i c a n t events which can be reenacted through r o l e playing, psychomime, or psychodrama. Patients record t h e i r thoughts and f e e l i n g s i n diary form each day. These d i a r i e s are read by s t a f f and can be seen by other patients. Secrecy i s not encouraged at the Day House. 6. Family and Friends Group One evening a week i s set aside for family members or s i g n i f i c a n t others to come as guests of each patient i n the Day House. Patients and t h e i r guests meet as a group with others i n the same "family" and discuss various problems of s i g n i f i c a n c e to each patient. The therapist assigned to each "family" leads these groups. 7. Work Group The " f a m i l i e s " j o i n together for a work group each day. Patients do a l l the maintenance and cleaning i n the Day House and the surrounding grounds. Once a week there i s a car wash to r a i s e money for outings or other functions. "Families" eat lunch together and are responsible for the preparation of t h i s meal and the clean up which follows. Group members volunteer to supervise the work groups and one of the therapists i s s p e c i -f i c a l l y assigned to t h i s a c t i v i t y . 8. Music Therapy Once a week the patients meet for an hour of music therapy. This group includes such a c t i v i t i e s as music appreciation, dancing, singing, and body movements. 9. Sports Swimming, basketball, f l o o r hockey, and other a t h l e t i c a c t i v i t i e s are organized two to three times a week. 10. Plays Every Friday afternoon each "family" performs a short play before the e n t i r e therapeutic community. A patient from each family volunteers to be 28 the d i r e c t o r and the other members a s s i s t i n w r i t i n g the s c r i p t and acting the various r o l e s . Summary The Day Rouse i s an intensive six-week group psychotherapy program which uses the framework of integrated psychotherapy i n order to help patients who are s u f f e r i n g from neuroses and s i m i l a r disorders. The steps that a patient follows during the course of treatment are: 1. Admission into the Day House (acceptance by patients and s t a f f , verbal and written commitments). 2. Attendance at the Open Group. 3. Joining a "family". 4. Writing and presenting autobiography. 5. I n v i t i n g s i g n i f i c a n t people to Friends and Family Night. 6. P a r t i c i p a t i o n i n sports, work groups, music therapy, and other a c t i v i t i e s . 7. Keeping a d a i l y diary of thoughts and f e e l i n g s . 8. Attendance at the aftercare group. 9. Joining the Friends of Day House (optional). S o c i a l learning through reinforcements (rewards and costs) i s ca r r i e d out by the Committee of Patients elected by the therapeutic community. The expectations of the Day House program are c l e a r l y stated and patients are expected to make verbal commitments to the therapeutic community before they enter the program. Patients are expected to .be honest and t r u t h f u l about t h e i r f e e l i n g s and to respect personal information about another mem-ber of the group. Interpersonal t r u s t i s highly regarded i n th i s program.' The r o l e of the therapist i s that of teacher. This r o l e i s s i m i l a r to that emphasized by Rotter's s o c i a l learning theory. Knobloch's theory of integrated psychotherapy i s also i n agreement with Rotter's b e l i e f that various techniques should be used i n psychotherapy i n order to help the patient learn new behaviors which lead to goal achievement. The next chapter w i l l describe the methodology used i n t h i s study. 30 CHAPTER IV METHODOLOGY This study was conducted to examine the e f f e c t s of the Day House pro-gram on s e l e c t e d p a t i e n t s ' i n t e r p e r s o n a l t r u s t as measured by Rot t e r ' s I n t e r p e r s o n a l Trust Scale. The independent v a r i a b l e i n the study was an i n t e n s i v e six-week group psychotherapy program (Day House). The dependent v a r i a b l e was i n t e r p e r s o n a l t r u s t . The study took place over a four-month period between October 1982 and February 1983. Twenty p a t i e n t s volunteered to p a r t i c i p a t e i n the study. Ten completed the six-week group psychotherapy program (experimental group) and ten d i d not attend the program ( c o n t r o l group). This chapter describes the research design, sample s e l e c t i o n , procedure f o r data c o l l e c t i o n , and the instrument used to c o l l e c t the data. Research Design A quasi-experimental non equivalent c o n t r o l group design (Campbell & Stanley, 1963, p. 47) was used. The design examined any change i n the dependent v a r i a b l e ( i n t e r p e r s o n a l t r u s t ) a f t e r the independent v a r i a b l e (Day House program) was introduced. This type of design c o n t r o l s such extraneous v a r i a b l e s as h i s t o r y , maturation, t e s t i n g , and instrumentation (Campbell & Stanley, 1963, p. 47). I n t e r n a l v a l i d i t y i s l i m i t e d i n t h i s design because the subjects have been s e l e c t e d i n s t e a d of randomly assigned to the two groups. Another r e s t r i c t i o n i s that the r e s u l t s of t h i s study are not g e n e r a l i z a b l e to p a t i e n t s o u tside the Day House program. 31 Sample Sel e c t i o n A convenience sample (n = 20) was obtained from the population of patients referred to the Day Hbuse program. I t was assumed that a l l twenty patients had been referred because they had a need to receive group psycho-therapy. Patients are assessed by s t a f f on the day they a r r i v e for o r i e n t a t i o n to the program. There are opportunities to t a l k with other patients as well as with s t a f f . Acceptance i s based on mutual agreement between s t a f f and prospective patients. People who choose to attend the program must also be accepted by the e n t i r e therapeutic community (this takes place two days a f t e r the o r i e n t a t i o n ) . People who choose not to attend the program are able to discuss t h e i r d e c i s i o n with the s t a f f , but they do not meet with the e n t i r e therapeutic community. Reasons for r e f u s i n g to attend vary from the b e l i e f that the program might not be useful to the i n a b i l i t y to make a f u l l - t i m e commitment for s i x weeks. Ten patients who were accepted i n t o the program were assigned to the experimental group. Ten others who chose not to attend volunteered to p a r t i c i p a t e i n t h i s study, making up the control group. Procedure for Data C o l l e c t i o n The researcher was introduced to patients by one of the Day House therapists. The researcher then explained the study to each patient and provided them with an information and consent form (see Appendix B) i n order to ensure that t h e i r r i g h t s were protected. Ten patients (male and female) who had been assigned to the experi-mental group completed the Interpersonal Trust Scale within three days of 32 s t a r t i n g at Day House and again within two weeks a f t e r graduation from the six-week program. The ten patients (male and female) assigned to the con-t r o l group completed the Interpersonal Trust Scale on the day of t h e i r assessment and again s i x to eight weeks l a t e r . Instrument: the Interpersonal Trust Scale Rotter's Interpersonal Trust Scale (see Appendix A) i s an a d d i t i v e scale consisting of f o r t y items. A Likert-type format i s used for each item. Twenty-five items are t r u s t items and f i f t e e n are f i l l e r items used to disguise the purpose of the scale. Possible scores range from a mini-mum of twenty-five to a maximum of one hundred and twenty-five. Internal consistences are reasonably high, based on s p l i t - h a l f r e l i a b i l i t y corrected by the Spearman-Brown formula (Rotter, 1967, p. 655). The t e s t - r e t e s t r e l i a b i l i t y (time between tests three months) has a c o r r e l a t i o n of 0.68 (p>0.01). This scale has r e l a t i v e l y good construct and discriminant v a l i d i t y . I t has been v a l i d a t e d i n laboratory s e t t i n g s , s e l f - r e p o r t s , peer r a t i n g s , and questionnaires (Wright & Maggied, 1976, p. 446). The dimensionality of Rotter's Interpersonal Trust Scale has been explored by several researchers (Chun & Campbell, 1974; Walker & Robinson, 1979b; Wright & Tedeschi, 1975). Walker and Robinson suggested that "the dimensionalized interpersonal t r u s t construct i s better suited for examin-ing the r o l e of t r u s t i n outcomes and process for group counselling" (1979b, p. 424).. Wright, and Tedeschi (1975), using samples of u n i v e r s i t y students, found three stable factors i n the Interpersonal Trust Scale. These were P o l i t i c a l Trust, Parental Trust, and Trust of Strangers. The items for each factor are as follows: 33 P o l i t i c a l Trust 4. This country has a dark future unless we can a t t r a c t better people into p o l i t i c s . 16. Most people would be h o r r i f i e d i f they knew how much news the p u b l i c hears and sees i s d i s t o r t e d . 21. Even though we have reports i n newspapers, radio and t e l e -v i s i o n , i t i s hard to get objective accounts of p u b l i c events. 29. Many major nationa l sport contests are f i x e d i n one way or another. Parental Trust 6. Parents usually can be r e l i e d upon to keep th e i r promises. 23. Most experts can be r e l i e d upon to t e l l the t r u t h about the l i m i t s of t h e i r knowledge. 24. Most parents can be r e l i e d upon to carry out t h e i r threats of punishment. 31. Most i d e a l i s t s are sincere and usually p r a c t i c e what they preach. 32. Most salesmen are honest i n describing t h e i r products. 39. Most people answer pu b l i c opinion p o l l s honestly. Trust of Strangers 3. In dealing with strangers one i s better o f f to be cautious u n t i l they provide evidence that they are trustworthy. 8. Using the honour system of not having a teacher present during exams would probably r e s u l t i n increased cheating. 14. I t Is safe to believe that i n spite of what people say most people are p r i m a r i l y interested i n t h e i r own welfare. 26. In these competitive times one has to be a l e r t or someone i s l i k e l y to take advantage of you. The Parental Trust factor i s " e s p e c i a l l y important since i t has s i x items whose content deals e x p l i c i t l y with b e l i e v i n g others. Thus i t i s the fa c t o r which most c l o s e l y represents Rotter's d e f i n i t i o n of interpersonal t r u s t " (Wright & Tedeschi, 1980, p. 114). These three factors were 34 separately analyzed using the Wilcoxon signed-rank test i n order to examine any changes i n the pretest and posttest scores of each group. Summary A quasi-experimental non equivalent control group design was employed i n this study. A convenience sample (n = 20) of patients r e f e r r e d to the Day House program was used. Ten patients who entered the program were assigned to the experimental group and ten patients who did not were assigned to the control group. Rotter's Interpersonal Trust Scale was completed by each patient during the period of assessment at Day House (pretest) and again s i x to eight weeks l a t e r (posttest). The Mann-Whitney U test was used to compare the two groups on the pretest and posttest scores. Using the Wilcoxon signed-rank t e s t , the twenty-five items on the Interpersonal Trust Scale were analyzed for the differences i n pai r s of scores within each group. The r e s u l t s are discussed i n the next chapter. 35 CHAPTER V DATA ANALYSIS AND DISCUSSION OF FINDINGS What were the e f f e c t s of the Day House Program on selected patients' interpersonal t r u s t as measured by Rotter's Interpersonal Trust Scale? This research question i s answered i n the discussion of the findings. Data Analysis As discussed i n Chapter IV, data were obtained through completion of Rotter's Interpersonal Trust Scale at s i x to eight week i n t e r v a l s (pretest arid posttest) by both the experimental and control groups. Items were scored on a f i v e - p o i n t scale from strongly agree to strongly disagree. Twelve of the twenty-five items indicated t r u s t i f there was agreement. These were scored from 5 = strongly agree to 1 = strongly disagree. The remaining t h i r t e e n items indicated mistrust i f there was agreement and so the scoring was reversed. In t h i s s c a l e , high scores i n d i c a t e high trus t and low scores i n d i c a t e low t r u s t (Rotter, 1967). The ten patients i n the experimental group ( f i v e males and f i v e females) obtained t o t a l scores ranging from 55 to 78 on the pretest and from .49 to 84 on the posttest. Table 1 shows the t o t a l scores of the experimental group. Table 2 shows the mean and standard deviation for the pretest and posttest scores of t h i s group. The ten patients i n the c o n t r o l group (s i x females and four males) obtained t o t a l scores ranging from 63 to 82 on the pretest and from 61 36 Table 1 Pretest and Posttest Scores f or the Experimental Group Ss Pretest Scores X Posttest Scores y Differences (y-x) 01 78 84 +6 02 55 49 -6 03 65 79 +14 04 61 57 -4 05 60 73 +13 0.6 66 71 +5 07 76 71 -5 Q8 62 67 +5 09 64 61 -3 10 67 83 +16 Table 2 Mean and Standard Deviation for Experimental Group . N . Time M S.D. 10 10 Pretest Posttest 65.4 69.5 6.67 10.74 37 to 89 on the posttest. The t o t a l scores of t h i s group are shown i n Table 3. Table 4 shows the mean and standard deviation for the pretest and posttest scores of the control group. The data were analyzed by means of non-parametric s t a t i s t i c s using the p<.05 l e v e l of s i g n i f i c a n c e . The Mann-Whitney U Test was used to compare the experimental and control group on the pretest and posttest scores. On the pretest, the groups d i f f e r e d s i g n i f i c a n t l y (p<.05) i n d i -cating that the patients i n the c o n t r o l group were more tr u s t i n g than those i n the experimental group. No s i g n i f i c a n t d i f f e r e n c e was found when the posttest scores were compared. The Wilcoxon signed-rank test was used to examine the changes i n the scores from pretest to posttest i n each group. The experimental group had a T value of 13.5 (p<.087) and the control group had a T value of 17.5 (p<.18). The change i n the experimental group approached but did not reach s t a t i s t i c a l s i g n i f i c a n c e . The conclusion was that the Day House program had no s i g n i f i c a n t e f f e c t on the patients' interpersonal t r u s t as measured by Rotter's scale. The Wilcoxon signed-rank test was used to analyze the differences i n pretest and posttest scores of each group on the factors of Parental Trust, P o l i t i c a l Trust and Trust of Strangers. Tables 5 and 6 show the scores, T values, and l e v e l of s i g n i f i c a n c e for the experimental group. Tables 7 and 8 show these findings for the control group. The factor of P o l i t i c a l Trust increased s i g n i f i c a n t l y (p<.0391) i n the control group. The d i r e c t i o n of change was s i m i l a r for the factors of Parental Trust and Trust of Strangers, but did not reach s t a t i s t i c a l significance.. In the experimental group there were no s i g n i f i c a n t changes. 38 Table 3 Pretest and Posttest Scores f or the Control Group Ss .Pretest Scores X Posttest Scores y Differences (y-x) 01 77 89 +12 02 78 72 -6 03 63° 74 +11 04 69 68 -1 05 78 85 +7 06 73 75 +2 07 82 80 -2 08 78 83 +5 09 66 61 -5 10 65 66 +1 Table 4 Mean and Standard Deviation for Control Group .N Time M S.D. 10 10 Pretest Posttest 72.9 75.3 5.98 8.48 39 Table 5 Pretest and Posttest Scores of the Experimental Group on the Factors of P o l i t i c a l Trust, Parental Trust and Trust of Strangers Ss POLITICAL TRUST PARENTAL TRUST TRUST OF STRANGERS Pretest Posttest Pretest Posttest Pretest Posttest 01 8 9 21 17 4 4 Q2 15 14 15 19 10 10 03 8 9 14 18 8 10 04 9 11 15 16 9 10 05 15 9 18 21 10 7 06 10 10 19 17 7 9 07 13 13 16 21 14 14 08 9 9 26 25 5 7 09 7 12 26 14 6 6 10 11 12 23 21 9 14 Table 6 The Results of the Wilcoxon signed-rank test on the Factors of Parental Trust, P o l i t i c a l Trust and Trust of Strangers for the Experimental Group FACTOR N of ranked pairs T P Parental Trust 10 25.5 .4229-.4609 P o l i t i c a l Trust 7 9.5 .2344-.2891 Trust of Strangers 6 5 .1563 40 Table 7 Pretest and Posttest Scores of the Control Group on the Factors of P o l i t i c a l Trust, Parental Trust and Trust of Strangers Ss POLITICAL TRUST - PARENTAL TRUST •TRUST OF STRANGERS Pretest Posttest Pretest Posttest Pretest Posttest 01 14 16 18 19 8 12 02 9 9 19 20 13 10 03 7 12 19 22 10 11 04 9 10 22 17 9 10 05 10 15 19 21 12 14 06 !0 11 20 19 10 10 07 16 14 20 22 9 9 08 13 14 20 22 10 10 09 8 8 17 17 11 12 10 11 13 17 21 8 9 Table 8 The Results of the Wilcoxon signed-rank test on the Factors of Parental Trust, P o l i t i c a l Trust and Trust of Strangers for the Control Group FACTOR N of ranked pairs T P Parental Trust P o l i t i c a l Trust 9 8 11 5 .1016 .0391 Trust of Strangers 7 6 .1094 41 Discussion of the Findings There was no s t a t i s t i c a l l y s i g n i f i c a n t degree of change i n the patients' interpersonal t r u s t scores a f t e r completion of the Day House Program. This f i n d i n g may be a function of a small sample s i z e . Also, Surwillo (1980) noted that tests for o r d i n a l data such as the Wilcoxon signed-ranks test are l e s s powerful because "the magnitude of the d i s -tance between scores i s discarded i n the process of ranking them" (p. 51). One speculative explanation for the lack of s i g n i f i c a n t change i n the posttest scores of either group i s that interpersonal t r u s t , as measured by Rotter's scale, might be a stable personality c h a r a c t e r i s t i c which does not change over a short period. Another explanation for the lack of change i n the experimental group r e l a t e s to the time when the second questionnaire was administered. As stated previously, t h i s occurred within two weeks of completing the Day House program when patients were attending the aftercare group and were i n the process of termination. The termination process may have caused f e e l -ings of anxiety and loss,^adversely a f f e c t i n g the i n d i v i d u a l ' s i n t e r p e r -sonal t r u s t score. Proshansky and Seidenberg (1965) point out that "even i n s i t u a t i o n s where an a t t i t u d e has been aroused, there may be s i t u a t i o n a l factors that lead to the arousal of stronger, competing attitudes or needs" (p. 101). Completion of the questionnaire several weeks a f t e r termination at Day House would have avoided t h i s p a r t i c u l a r source of e r r o r . The f i n d i n g that the patients i n the control group were more t r u s t i n g on the pretest than those i n the experimental group i n d i c a t e that the two groups d i f f e r e d . This f i n d i n g may be a r e s u l t of the experimental design i n which the patients were not randomly assigned to the two groups. The s i g n i f i c a n t increase i n the score for the fa c t o r of P o l i t i c a l Trust i n the control group may be due to a s t a t i s t i c a l aberration caused by small sample s i z e . This sample s i z e was further reduced when several of the scores were found to be equal. Summary The r e s u l t s of t h i s study led to the conclusion that interpersonal t r u s t as measured by Rotter's Interpersonal Trust Scale was not affected by the Day House program. Possible explanations f o r t h i s conclusion may be that interpersonal t r u s t i s a stable personality c h a r a c t e r i s t i c which may not change over a period of eight weeks. Other factors discussed were small sample s i z e , decreased power of non-parametric s t a t i s t i c s , and lack of randomization. 43 CHAPTER VI SUMMARY, CONCLUSIONS AND RECOMMENDATIONS FOR FURTHER STUDY Summary The construct of Interpersonal tru s t has been regarded as an e s s e n t i a l component of a l l s o c i a l i n t e r a c t i o n . During the past twenty years, the research on tr u s t has shed some l i g h t on t h i s complex construct. Much has been l e f t unanswered as to why and how people t r u s t . This study has focused on the e f f e c t s of a group psychotherapy program (Day House) upon interpersonal t r u s t . Within a framework of s o c i a l l e a r n -ing theory, t r u s t was defined as an "expectancy held by an i n d i v i d u a l or group that the word, promise, verbal or written statement of another i n d i -v i d u a l or group can be r e l i e d on" (Rotter, 1967, p. 444). This expectancy was measured by Rotter's Interpersonal Trust Scale. The Day House program was described i n Chapter I I I . This program was chosen because of i t s emphasis on s o c i a l learning theory through which a system of costs and rewards, used as reinforcements, would d i r e c t the patient towards change. Also, the expectancy that the i n d i v i d u a l ' s word, promise, verbal and written statement could be r e l i e d upon, was emphasized throughout t h i s program. This study used a quasi-experimental non-equivalent control group design (Campbell &.Stanley, 1963). More s p e c i f i c a l l y , t h i s study examined any change i n the dependent v a r i a b l e (Interpersonal Trust) a f t e r the independent v a r i a b l e (Day House program) was introduced. Twenty patients who were referred to the Day House program were assigned to two groups. The experimental group consisted of ten patients who attended and completed the Day House program. Ten patients who did not attend t h i s program were assigned to the control group. Rotter's Interpersonal Trust Scale was completed by the patients i n both groups at s i x to eight week i n t e r v a l s . The pretest and posttest scores were analyzed using non-parametric s t a t i s t i c s . Three factors within the Interpersonal Trust Scale were i d e n t i f i e d i n the l i t e r a t u r e . These were Parental Trust, P o l i t i c a l Trust and Trust of Strangers. The Wilcoxon signed-rank test was used to analyze the scores of these factors i n both groups. Conclusions The r e s u l t s of t h i s study were: 1. The Day House program had no 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 f f e c t upon interpersonal t r u s t as measured by the Interpersonal Trust Scale. 2. The two groups d i f f e r e d s i g n i f i c a n t l y on the pretest scores. The patients i n the c o n t r o l group were more t r u s t i n g than the patients i n the experimental group. This d i f f e r e n c e may have been a r e s u l t of experimental design i n which the patients were not randomly assigned to the two groups. 3. The factor of P o l i t i c a l Trust was found to change s i g n i f i c a n t l y i n the control group. The factors of Parental Trust and Trust of Strangers were not found to be s t a t i s t i c a l l y s i g n i f i c a n t i n either group. This may have been caused by s t a t i s t i c a l aberration r e s u l t i n g from small sample s i z e . The i n t e r n a l v a l i d i t y of t h i s study was l i m i t e d because the patients were not randomly assigned to the two groups. Also, g e n e r a l i z a b i l i t y was l i m i t e d to the patients i n the Day House program. 45 Small sample s i z e and the use of non-parametric s t a t i s t i c s also a f f e c t e d the accuracy i n which the v a r i a b i l i t y i n pretest and posttest scores could be measured. Rotter's Interpersonal Trust Scale measured trus t a t t i t u d e s . These atti t u d e s may be r e l a t i v e l y stable personality c h a r a c t e r i s t i c s that do not change over a short period of time. A t r u s t scale which focused on t r u s t behavior s p e c i f i c a l l y within the group s e t t i n g would have been more useful i n measuring outcomes of group psychotherapy. To t h i s day, no such scale e x i s t s . The researcher recommends that a study be done i n order to develop a scale which measures interpersonal t r u s t behavior. Other recommendations for further study are l i s t e d below. Recommendations for Further Study 1. This research be r e p l i c a t e d using larger samples of patients from t h i s and other group psychotherapy programs. 2. A time study be done with a large sample of patients who have been attending the Day House program. More s p e c i f i c a l l y , the researcher could have the patients complete the Interpersonal Trust Scale before, a f t e r and several months following completion of t h i s program. 3. A study be done to compare the patients' interpersonal t r u s t with evaluation of t h e i r progress during the phases of group psychotherapy. 4. A study be conducted i n order to compare the e f f e c t s of group psychotherapy and i n d i v i d u a l therapy on patients' interpersonal t r u s t . 46 BIBLIOGRAPHY Baldwin, A. Behavior and development i n childhood. New York: Dryden Press, 1965. Bennis, W., Schein, E., Berlew, D., & Steele, F. Interpersonal dynamics:  Essays and readings on human i n t e r a c t i o n . Homewood, 111.: Dorsey Press, 1964. Bridges, J . , & Schoeninger, D. Interpersonal tru s t behavior as re l a t e d to subjective c e r t a i n t y and outcome value. Psychological Reports, February 1977, 41, 677-678. Campbell, D. T., & Stanley, J. C. 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Trust and suspicion. Journal of C o n f l i c t Resolution, 1958, 2, 265-279. Deutsch, M. The e f f e c t of motivational o r i e n t a t i o n upon trust and suspicion. Human Relations, I960, .13, 123-139. (a) Deutsch, M. Trust, trustworthiness and the F-scale. Journal of Abnormal  and S o c i a l Psychology, 1960, 61, 138-140. (b) Distefano, M. K., Pryer, M. W., & Garrison, J. L. C l i e n t s s a t i s f a c t i o n and interpersonal tru s t among h o s p i t a l i z e d p s y c h i a t r i c patients. Psychological Reports, 1981, .49 (2), 420-422. 47 E l l i s o n , C. W., & Firestone, I. J . The development of interpersonal t r u s t as a function of self-esteem, target status and target s t y l e . Journal  of Personality and S o c i a l Psychology, 1974, 29_y 655-663. Gibb, J . Defensive communication. The Journal of Communication, September 1961, JUL (3), 141-148. Gibb, J . Climate for t r u s t formation. In L. P. Bradford, J . Gibb, & K. D. Bennis (Ed.), T-group theory and laboratory method: Innovation i n r e - education. New York: Wiley Co., 1962. G i f f i n , K. The contribution of studies of source c r e d i b i l i t y to a theory of interpersonal t r u s t i n the communication process. Psychological  B u l l e t i n , 1967, 68, 104-120. (a) G i f f i n , K. Interpersonal t r u s t i n small group communication. Quarterly Journal of Speech, October 1967, 53, 224-234. (b) G i f f i n , K. Interpersonal t r u s t i n the helping professions. American  Journal of Nursing, 1969, 69 (7), 1491-1492. G i f f i n , K., & Patton, B. Personal t r u s t i n human i n t e r a c t i o n . Basic  Readings i n Interpersonal Communication. New York: Harper & Row Publishers, 1971. G i f f i n , K., & Patton, B. Fundamentals of interpersonal communication. New York: Harper & Row Publishers, 1976. Hamsher, J. H., G e l l e r , J . D., & Rotter, J . B. Interpersonal t r u s t , i n t e r n a l - e x t e r n a l c o n t r o l and the Warren Commission Report. Journal  of P e r s o n a l i t y and S o c i a l Psychology, 1968, _9, 210-215. Heider, M. An i n v e s t i g a t i o n of the r e l a t i o n s h i p between speech anxiety i n adults and t h e i r i n d i c a t i o n of parental communication suppression  during childhood. Unpublished M.A. t h e s i s , The U n i v e r s i t y of Kansas, 1968. Hovland, C. I., Janis, I. L., & K e l l e y , H. H. Communication and persuasion: Psychological studies of opinion change. New Haven, Conn.: Yale U n i v e r s i t y Press, 1953. Jourard, S. M., & Friedman, R. Experimenter-subject "distance" and s e l f -d i s c l o s u r e . Journal of Personality and S o c i a l Psychology, 1970, 15, 278-282. Kaplan, R. M. Components of t r u s t : Note on use of Rotter's scale. Psychological Reports, 1973, J33, 13-14. Kee, H. W., & Knox, R. E. Conceptual and methodological considerations. i n the study of t r u s t and suspicion. Journal of C o n f l i c t Resolution, 1970, 14, 357-366. 48 Kessel, E. V. Interpersonal tru s t and a t t i t u d e toward the expression of p o s i t i v e and negative a f f e c t within the T-group. D i s s e r t a t i o n  Abstracts I n t e r n a t i o n a l , 1971, 32 (4-A), 1855-1856. Knobloch, F., & Knobloch, J. Integrated psychotherapy. New York: Jason Aronson Inc., 1979. Kruglanski, A. W. A t t r i b u t i n g trustworthiness i n supervisor-worker r e l a t i o n s . Journal of Experimental Psychology, 1970, j), 214-232. Loomis, J . Communication, the development of tru s t and co-operative behavior. Human Relations, 1959, _12, 305-315. Mellinger, G. D. Interpersonal tru s t as a factor i n communication. Journal of Abnormal and S o c i a l Psychology, 1956, 52, 304-309. Pasewark, R., F i t z g e r a l d , B., & Sawyer, R. V a l i d i t y of Rotter's Interpersonal Trust Scale: A study of paranoid schizophrenics. Psychological Reports, 1973, 32 (3), 982. Piper, W. E. Evaluation of the e f f e c t s of s e n s i t i v i t y t r a i n i n g and the e f f e c t s of varying group composition according to interpersonal t r u s t . D i s s e r t a t i o n Abstracts International, December 1972, _33 (6-B), 2819. Proshansky, H., & Seidenberg, B. Basic studies i n s o c i a l psychology. New York: Holt, Rinehart & Winston, 1965. Roegiers, C. L. An experimental study i n interpersonal tru s t and leadership i n problem-solving small groups. D i s s e r t a t i o n Abstracts International, 1972, 33 (6-B), 2827-2828. Rogers, C a r l . On becoming a person. New York: Houghton M i f f l i n Co., 1961. Rotter, J . B. A new scale for the measurement of interpersonal t r u s t . Journal of P e r s o n a l i t y , 1967, 3_5, 651-665. Rotter, J . B. Generalized expectancies for interpersonal t r u s t . American  Psychologist, 1971, 26, 443-452. Rotter, J. B. Personality. New York: Scott, Foresman & Co., 1975. Rotter, J . B., Chance, J. E., & Phares, J . E. Applications of s o c i a l learning theory of personality. New York: Holt, Rinehart & Winston, 1972. Sawyer, R., Pasewark, R., Davis, F., & F i t z g e r a l d , B. Relationship of Rotter's Interpersonal Trust Scale and s o c i a l c l a s s . Psychological  Reportsy 1973, 32 (3), 989-990. Schlenker, B. R., Helm, B., & Tedeschi, J . T. The e f f e c t s of personality and s i t u a t i o n a l v a r i a b l e s on behavioral t r u s t . Journal of Personality  and S o c i a l Psychology, 1973, 25, 419-427. 49 Solomon, L. The influence of some types of power r e l a t i o n s h i p s and game strat e g i e s upon the development of interpersonal t r u s t . Journal of  Abnormal and S o c i a l Psychology, 1960, &1, 223-230. St r i c k l a n d , L. H. Surveillance and t r u s t . Journal of Per s o n a l i t y , 1958, 26, 200-215. Surwillo, Walter. Experimental design i n psychiatry: Research methods for  c l i n i c a l p r a c t i c e . New York: Grune and Statton Inc., 1980. Swinth, R. L. The establishment of the t r u s t r e l a t i o n s h i p . Journal of  C o n f l i c t Resolution, 1967, 11, 335-344. Tedeschi, R., & Wright, T. Cross-validation of the Wright-Tedeschi factors of the interpersonal t r u s t scale. Psychological Reports, 1980, 47, 111-114. Thorslund, C. Interpersonal t r u s t : A review and examination of the concept. Goteborg Psychological Reports, 1976, 6^ (6), 1-28. Walker, B., & Robinson, R. Dimensions of interpersonal t r u s t and group variables i n short-term counselling. Education Research Quarterly, 1979, A 03), 58-68. (a) Walker, B., & Robinson, R. U t i l i z i n g dimensions of the Rotter Interpersonal Trust Scale i n i n v e s t i g a t i o n of t r u s t : V a l i d a t i o n of suggested methods. Psychological Reports, 1979, 44 (2), 423-429. (b) Witherspoon, K. D. Interpersonal t r u s t i n psychotherapy: The determinants of therapist trustworthiness. D i s s e r t a t i o n Abstracts International, 1981, 41 (7-B), 2786. Wright, T. L., & Maggied, P. An unobtrusive study of interpersonal t r u s t . Journal of Personality and S o c i a l Psychology, 1976, J32, 446. Wright, T. L., & Tedeschi, R. G. Factor analysis of the interpersonal t r u s t scale. Journal of Consulting and C l i n i c a l Psychology, 1975, 43 (4), 470-477. Yalom, I. D. The theory and p r a c t i c e of group psychotherapy. New York: Basic Books Inc., 1970. APPENDIX A INTERPERSONAL TRUST SCALE 51 INTERPERSONAL TRUST SCALE This i s a questionnaire to determine the attitudes and b e l i e f s of d i f f e r e n t people on a v a r i e t y of statements. Please answer the statements by giving as true a pi c t u r e of your own b e l i e f s as possible. Be sure to read each item c a r e f u l l y and show your b e l i e f s by checking the appropriate column. I f you strongly agree with an item, put a check mark (/) in:the f i r s t column. Put a check mark (/) i n the second column i f you mil d l y agree with the item. That i s , put a check mark (/) i n the second column i f you think the item i s generally more true than untrue according to your b e l i e f s . Put a check mark (/) i n the t h i r d column i f you f e e l the item i s about as equally true as untrue. Put a check mark (V) i n the fourth column i f you mild l y disagree with the item. That i s , put a check mark (/) i n column four i f you f e e l the item i s more untrue than true. I f you strongly disagree with an item, put a check mark (/) i n column f i v e . Most people would rather l i v e i n a climate that i s mild a l l year around than one i n which winters are cold. 6 0 a CL) O CU U H. • u M | en <! •H CD •a cu • H till S < CO §1 W T J (3 CD ca <D K CD 60^ CD cd U CO 6 0 * H < o CD CD CO . . TH 2. Hypocrisy i s on the increase i n society. 3. In dealing with strangers one i s better o f f to be cautious u n t i l they provide evidence that they are trustworthy. 4. This country has a dark future unless we can a t t r a c t better people into p o l i t i c s . 5. Fear of s o c i a l disgrace or punishment rather than conscience prevents most people from breaking the law. 6. Parents usually can be r e l i e d upon to keep t h e i r promises. 7. The advice of elders i s often poor because the older person doesn't recognize how times have changed. 8. Using the Honour System of not having a teacher present during exams would probably r e s u l t i n increased cheating. 52 9. The United Nations w i l l never be an e f f e c t i v e force i n keeping world peace. 10. Parents and teachers are l i k e l y to say what they believe themselves and not j u s t what they think i s good for the c h i l d to hear. 11. Most people can be counted on to do what they say they w i l l do. 12. As evidenced by recent books and movies, morality seems on the downgrade i n t h i s country. 13. The J u d i c i a r y i s a place where we can a l l get unbiased treatment. 14. I t i s safe to believe that i n s p i t e of what people say most people are p r i m a r i l y interested i n t h e i r own welfare. 15. The future seems very promising. 16. Most people would be .horrified i f they knew how much news the p u b l i c hears and sees i s d i s t o r t e d . 17. Seeking advice from several people i s more l i k e l y to confuse than i t i s to help one. 18. Most elected public o f f i c i a l s are r e a l l y sincere i n t h e i r campaign promises. 19. There i s no simple way of deciding who i s t e l l i n g the truth. 20. This country has progressed to the point where we can reduce the amount of competitiveness encouraged by schools and parents. 21. Even though we have reports i n newspapers, radio and t e l e v i s i o n , i t i s hard to get objective accounts of p u b l i c events. 00 S cu O cu 4-1 oil CO <tj H cu T3 CU rH U •H M| cd oi W C <D cd CU u. CU 0£| <u cd U CO 00 -H < p (U CU ^ H. rH M| T3 cd i H CO •H i H S P 60 C O U 4-1 CO P CU 60 cd CO 53 22. I t i s more important that people achieve happiness than that they achieve greatness. 23. Most experts can be r e l i e d upon to t e l l the truth about the l i m i t s of the i r knowledge. 24. Most parents can be r e l i e d upon to carry out th e i r threats of punishment. 25. One should not attack the p o l i t i c a l b e l i e f s of other people. 26. In these competitive times one has to be a l e r t or someone i s l i k e l y to take advantage of you. 27. Children need to be given more guidance by teachers and parents than they now t y p i c a l l y get. 28. Most rumors usually have a strong element of truth. 29. Many major nationa l sport contests are fixed i n one way or another. 30. A good leader molds the opinions of the group he i s leading rather than merely following the wishes of the majority. 31. Most i d e a l i s t s are sincere and usually p r a c t i c e what they preach. 32. Most salesmen are honest i n describing t h e i r products. 33. Education i n this country i s not r e a l l y i preparing young men and women to deal with the problems of the future. 34. Most students i n school would not cheat even i f they were sure of getting away with i t . 60 C CD O CD M M 4-1 6t co <; H CD •d CD H H. H 6tJ ct) d w a CD cd CD CD &q CD cd u co 60 *H < a CD CD S P CD H CD 60 U C 6£ O cd U CO 4 J T H c/> P 54 35. The hordes of students now going to college are going to f i n d i t more d i f f i c u l t to f i n d good jobs when they graduate than did the college graduates of the past. 36. Most repairmen w i l l not overcharge even i f they think you are ignorant of t h e i r s p e c i a l t y . 37. A large share of accident claims f i l e d against insurance companies are phony. 38. One should not attack the r e l i g i o u s b e l i e f s of other people. 39. Most people answer pu b l i c opinion p o l l s honestly. 40. I f we r e a l l y knew what was going on i n i n t e r -n a t i o n a l p o l i t i c s , the public would have more reason to be frightened than they now seem to be. 60 ti QJ O CD U U, 4J 60| CO <i i-H CL) TJ QJ r-H !-l •H 60| S <! cfl tr w XI ti CD ctj QJ CD 60| CD ctj U W 60 tH <C P Q) QJ >. U r H 60 T3 cd rH CO •rl -H a o >, 0) H QJ 60 U ti ,60 O cd U CD 4-1 -H c/3 O APPENDIX B INFORMATION AND CONSENT FORM 56 INFORMATION AND CONSENT FORM University of B r i t i s h Columbia School of Nursing Vancouver, B r i t i s h Columbia Dear My name i s Paula Tognazzini. I am a graduate student i n nursing at the University of B r i t i s h Columbia. I am interested i n conducting a research study which i d e n t i f i e s general opinions of people who are referred to the Day House program. Your p a r t i c i p a t i o n i n t h i s study would involve completing two question-naires. Each questionnaire requires approximately f i f t e e n minutes to com-plete. The f i r s t questionnaire w i l l be given to you at the Day House either on the day of your assessment interview or ju s t before you begin the Day House program. The second questionnaire w i l l be given to you s i x weeks f o l -lowing the f i r s t questionnaire. For t h i s second questionnaire, I w i l l make arrangements with you as to whether you would prefer to be contacted by mail or by telephone. You do not have to attend the Day House program i n order to p a r t i c i p a t e i n t h i s study. You would not be i d e n t i f i e d by name i n t h i s study. This consent form w i l l be placed i n my f i l e and the data i n the questionnaire w i l l be coded, that i s , w i l l not include your name. This i s done i n order to ensure you c o n f i d e n t i a l i t y . A l l o r i g i n a l material w i l l be destroyed upon completion of th i s study. Findings of th i s study may be published but your i d e n t i t y w i l l not be revealed. Your p a r t i c i p a t i o n i n th i s study i s voluntary and w i l l i n no way e f f e c t your treatment at the Day House. There w i l l be no payment offered for p a r t i -c i p a t i o n i n t h i s study. You are free to withdraw from t h i s study at any time without jeopardizing your therapy at the Day House or afterwards. I f you have any further questions about t h i s study, please contact me through the Day House, by phone, i n person or i n w r i t i n g . The findings of t h i s research study w i l l be av a i l a b l e to you upon request. I f you wish to p a r t i c i p a t e i n t h i s study, please sign your name at the bottom of th i s form. Sincerely yours, Graduate Student Masters of Nursing Program Univ e r s i t y of B r i t i s h Columbia I understand the nature of my p a r t i c i p a t i o n i n th i s study and give my consent to p a r t i c i p a t e . Signature Date Address Phone no. 

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