|Table of Contents|
Table of Contents
List of Tables
List of Figures
Chapter 1. Introduction
Chapter 2. Review of literature
Chapter 3. Methodology
Chapter 4. Findings
Chapter 5. Summary, discussion, limitations, and recommendations
Appendix A. Counseling survey items
Appendix B. Experimental schedule
Appendix C. Counseling booklet
Appendix D. Counselor talk
Appendix E. Participants’ written comments
THE EFFECTS OF INFORMATION ON COUNSELING
EXPECTANCIES AND WILLINGNESS% A STUDY OF HIGH SCHOOL YOUTH
CAROL LEE KLOPFER
A DISSERTATION PRESENTED TO THE GRADUATE COUNCIL OF
THE UNIVERSITY OF FLORIDA
IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE
DEGREE OF DOCTOR OF PHILOSOPHY
UNIVERSITY OF FLORIDA 1977
Carol Lee Klopfer
To my family
And to Calvin, Karen, Chris, Richard, and Lynn, youngsters who taught me more about the art of counseling than any one else . and much about life and love
Upon completion of this study, appreciation is owed to a number of people who made the study possible.
To Dr. E. L. Tolbert, a man who has made genuineness,
empathy, and unconditional positive regard a way of life, for assisting me in the decision to earn the PhD degree, for serving as my doctoral committee chairperson, and for his inspiration.
To Dr. Larry Loesch, who also served on my supervisory
committee, for his incisive counsel, good humor, and friendship.
To Dr. Everette Hall, third member of my committee, for the benefit of his experience as a therapist, warmth, and support.
To the faculty of the Department of Counselor Education who provided the facilitative petri dish in which this
To two friends, one new and one old: Barbara Rucker,
who gave many hours of help with computer programs, and Marie Dence, the only person from whom I can gracefully accept editorial criticism.
To Sharon Zahner for keypunching and to Arden Goettling for agreeing to do the typing from long distance.
To Linda Moni and the counselors of the Alachua County schools whose interest and time expenditure came when they iv
were desperately needed: Margaret Albritten, Art Stirrat, Wil Griffin, Bob Ream, and Phyllis George. And to Lee Rosenstein and Dean Mark Beard for the same reasons.
To the teachers who allowed me to work in their classrooms: Robert Ayer, Pat Powers, Mary Sharp, George Wilson, Patricia Robarts, Nancy Lakey, William Monahan, Albert Losch, and especially Pat Baxter and Barbara Allen.
To the students who participated in the study and welcomed me into their high schools. Also to Fitz Conners and the members of Young Life who participated in the development of the questionnaire.
And to two dear mentor/friends Dr. Margaret Korb and
Dr. Robert Lee--Pat and Bob--whose personal and professional example and whose caring and understanding have meant more than I can express.
Finally, to the others who in big and small ways shared the work: Alejo Vada, Gary Klopfer, Maggie Klopfer, Betty Jo Spoto, Mary Ganikos, Lyn Clawson, Nancy McGinness, and Louis Haynes.
TABLE OF CONTENTS
ACKNOWLEDGEMENTS ...................................... iv
LIST OF TABLES ........................................ x
LIST OF FIGURES ....................................... xii
ABSTRACT .............................................. xiii
I INTRODUCTION .................................
The "Need" for Psychotherapy Versus the Use
of Psychotherapy ............................ 2
Factors Differentiating Therapy Seekers from
Nonseekers .................................. 4
The Relationship of Information to Therapy
Predisposition .............................. 6
The Present Study: Purpose and Overview .... 9 Notes on Terminology ........................ 10
Counseling and Psychotherapy ........... 10
Perceptions of Counselingi Expectancies
and Willingness ........................ 12
II REVIEW OF LITERATURE .......................... 14
Perceptions of Counseling ................... 15
Perceptions of College Counseling
Services ............................... 17
Perceptions of School Counselors ....... 21 Public Perceptions of Psychotherapy .... 25
Effects of Mental Health Information:
Nunnally's Findings ......................... 36
Acceptance of Information ................ 37
Major Variables in Message Transmission- 39 Other Communications Variables ........... 42
Permanence of Message Effects ............ 45
Methods of Preparing Clients for Counseling ... 47
Behavioral Techniques .................... 47
Procedures Related to Client Expectancies 49 Special Procedures for Orienting Clients. 51
Providing Information to Potential Help
Seekers .................................. 57
Summary ....................................... A
III METHODOLOGY ..................................... 61
Hypotheses .................................... 61
Subjects ...................................... 63
Measurement ................................... 64
Part I: Counseling Expectancies .......... 65 Part II: Counseling Willingness .......... 67
Procedures .................................... 68
Counseling Information Presentations ..... 69 Collection of Data ....................... 72
Pilot Study ................................... 72
Analysis ...................................... 73
IV FINDINGS ........................................ 75
Statistical Description of the Sample ......... 75 Analysis of Experimental Results .............. 76
Expertise ................................ 78
Outcome .................................. 80
Trust .................................... 82
Genuineness .............................. 84
Acceptance ............................... 86
Understanding ............................ 88
Vocational-Educational Willingness (VE).. 91 Personal and Social Willingness (PS) ..... 92
Summary of Experimental Results ............... 95
Effects of Treatment on Expectancies ..... 96 Effects of Treatment on Willingness ...... 97 Effects of Grade Level ................... 97
Effects of Sex ........................... 98
Effects of Race .......................... 98
Interaction Effects ...................... 98
School Differences ............................ 99
Sample Norms .................................. 99
Participants' Subjective Responses ............ 100
V SUMMARY, DISCUSSION, LIMITATIONS, AND
RECOMMENDATIONS ................................. 103
Discussion .................................... 106
Limitations ................................... 111
Recommendations ............................... 113
Conclusions ................................... 115
REFERENCES .............................................. 117
APPENDIX A COUNSELING SURVEY ITEMS .................... 127
APPENDIX B EXPERIMENTAL SCHEDULE ...................... 131
APPENDIX C COUNSELING BOOKLET ......................... 134
APPENDIX D COUNSELOR TALK ............................. 139
APPENDIX E PARTICIPANTS' WRITTEN COMMENTS ............. 150
BIOGRAPHICAL SKETCH .................................... 164
LIST OF TABLES
I Composition of Comparison Groups by Sex and Race,
Grade, and School .................................. 77
2 Expertise Score Factorial Analysis of Variance..... 79 3 Expertise Score Means by Treatment ................. 79
4 Expertise Score Means by Sex ....................... 80
5 Outcome Score Factorial Analysis of Variance ....... 81 6 Outcome Score Means by Treatment ................... 81
7 Outcome Score Means by Race ........................ 82
8 Trust Score Factorial Analysis of Variance ......... 83 9 Trust Score Means by Treatment ..................... 83
10 Trust Score Means by Sex ........................... 84
11 Genuineness Score Factorial Analysis of Variance ... 85 12 Genuineness Score Means by Treatment ............... 85
13 Genuineness Score Means by Sex and Race ............ 86
14 Acceptance Score Factorial Analysis of Variance .... 87 15 Acceptance Score Means for Treatment Groups Duncan's Multiple Range Test Comparisons ........... 87
16 Acceptance Score Means by Sex ...................... 88
17 Understanding Score Factorial Analysis of Variance. 89 18 Understanding Score Means by Treatment ............. 89
19 Understanding Score Means by Grade Duncan's Multiple Range Test Comparisons ........... go
20 Understanding Score Means by Sex and Race .......... go
21 Vocational-Educational Willingness Score (VE) Factorial Analysis of Variance ................... 91
22 Vocational-Educational Willingness Score Means by Treatment ........................................ 92
23 Vocational-Educational Willingness Score Means by Race ............................................. 92
24 Personal-Social Willingness Score (PS) Factorial Analysis of Variance ............................. 93
25 Personal-Social Willingness Score Means for Treatment Groups Duncan's Multiple Range Test
Comparisons ...................................... 94
26 Personal-Social Willingness Score Means by Grade Duncan's Multiple Range Test Comparisons ......... 15 27 Personal-SDcial Willingness Score Means by Sex and Race ......................................... 95
28 Expectancy Scale Values .......................... 101
29 Willingness Scale Values ......................... 102
LIST OF FIGURES
1. Schedule followed for each set of four matched
classes ........................................... 69
Abstract of Dissertation Presented to the Graduate Council of the University of Florida in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy
THE EFFECTS OF INFORMATION ON COUNSELING
EXPECTANCIES AND WILLINGNESS: A STUDY OF HIGH SCHOOL YOUTH
Carol Lee Klopfer
Chairman: Dr. E. L. Tolbert
Major Department: Counselor Education
The effects of counseling information on perceptions of counseling were investigated. It was hypothesized that three forms of information--written, oral, and a combination of written and oral--would favorably influence high school students' counseling expectancies and willingness to use counseling. Effects of sex, race, and grade level were also studied.
Twenty-eight high school classes, seven sets of four
matched classes, were selected by school counselors. Classes in each set differentially received four treatment conditions: a booklet discussing counseling, a talk by a counselor, both the booklet and the talk, or no information. From the total 645 students data were collected consisting of responses to questionnaire items assessing six types of counseling expectancy and two types of counseling willingness.
A series of factorial analyses of variance indicated that the effects of information were inconsistent and the experimental groups often, were not significantly different from the
control group. Across the four comparison groups, regardless x iii
of information, females responded more favorably to the measures of perceptions of counseling than males. Black students more often responded favorably than Caucasians, and underclassmen more often responded favorably than upperclassmen. Calculation of scale norms for the total sample showed that, on the average, students viewed counseling in a positive way. In their subjective written comments, however, some students were highly critical of school counseling.
The delivery of mental health services, while improving, falls far short of its possibilities. In the field of counseling it is difficult to ignore that, of the many who could conceivably benefit from psychotherapy, most do not receive it. Disquieting social realities give this issue urgency: prisons full of individuals who have never had a single session with a personal counselor; numbers of unhappy people, destined for psychiatric institutions, who will not contemplate psychotherapy until forced into it by overwhelming dysfunction; men and women struggling and foundering in the face of rapidly changing culture and economic hard times.
Psychotherapy of course is not the sole solution to wasted human potential, but undoubtedly the goals of mental health would more adequately be served if larger segments of the population were reached--the severely disturbed as well as average people coping with the normal vicissitudes of life. Providing more effective public information is an important step toward abating what Ewalt (1960) has called "the vast unmet meed of the American people for help in recognizing and dealing with mental and emotional problems" (p. xxvi). If people understood counseling services better, perhaps they would use them more.
Users of psychotherapy generally go into it of their own
volition. It is estimated that fewer than 10 percent of clients experience heavy outside pressure to enter therapy (Kadushin, 1969). Szasz (1970) has argued most convincingly that, in a free society, this control must be kept in the hands of the individual. The decision to apply for professional help, however, requires that one's expectations of benefit not only justify the expenditure of time and effort but also override fear and resistance of many kinds. Currently most potential clients are not sufficiently knowledgeable about psychotherapy to perceive it as relevant to their concerns or to consider it an appropriate source of help. Without an informed public, then, democratic client self-selection becomes an unworkable process. "Inasmuch as present services tend to gravitate toward the best informed," Ewalt (1960) has written, "it would appear that the psychologically rich get richer and the poor get poorer" (p. xxvi).
The "Need" for Psychotherapy Versus the Use of Psychotherapy
Because of the "submerged" nature of psychological
phenomena and the absence of a standard measure for what is normal and what is abnormal, no satisfactory data exist on the mental health status of this, or any, society (Hollingshead & Redlich, 1958). The number of individuals in need of psychotherapy is equally inaccessible, but indications are strong that there are many more who could benefit from psychotherapy than receive it.
Comm-unity epidemiological research has attempted to assess mental. health needs; but as Goldberg's (1972) review of psychiatric case identification studies points up, varying screening methods and criteria have yielded disparate results. The extensive Midtown Manhattan Study (Srole, Langer, Michael, Opler, & Rennie, 1962) is often cited in discussions of prevalence of mental disorder. In this survey, 23.4 percent of respondents were designated as psychologically impaired to the extent that performance of adult roles was observed or inferred as deficient.
Of this one-fourth of their sample labeled impaired, the Manhattan researchers said,
On the criterion of observed or inferred performance
deficiencies in adult roles, these people in most cases can be assumed to need professional help of
some kind, at best, to relieve the distress implied
by their symptoms and to improve their capacities for adult functioning, and at the least, to reduce possibilities of future deterioration under normal
or crisis circumstances of life. (pp. 145-6)
The researchers made a rough assessment of orientation toward seeking professional help by asking respondents what they would advise two hypothetical friends with personal problems to do. Of the help-needy who had never had psychotherapy, nearly one-half did not indicate professionals as a source of help and, therefore, implied that they were unlikely to seek psychotherapy on their own initiative. The researchers state that their data appear consistent with estimates made in comparable big-city studies.
Other investigators have found evidence of large numbers of people disinclined to request psychotherapy. In a national
survey by Gurin, Veroff, and Feld (1960), 5 percent of adults said they "worried all the time," but less than one-fourth of them had gone to professional helpers and one-eighth said they "did not want" professional help. Also, of one-fifth who reported feelings of impending breakdown, only one-third sought psychotherapy. In Eilson, Padilla, and Perkins' (1965) study of New Yorkers, one-half could name a surgeon but only 15 percent, a psychologist. While 25 percent were able to name a mental health clinic, usually they could only cite Bellevue Hospital. In two other studies, approximately one-third of the clients judged to be in need of psychotherapy, and to whom it was offered, refused treatment (Garfield & Kurz, 1952; Rosenthal & Frank, 1958).
Studies of therapy duration reveal that an additional number of potential clients enter therapy but do not remain past an intake interview or the initial few sessions considered crucial for getting the therapeutic process under way, and many clients leave counseling without mutual agreement with their therapist or even discussion of termination (cf. Sullivan, Miller, & Smelser, 1958).
Factors Differentiating Therapy Seekers from Nonseekers
Since only an estimated two to four percent of the population go into therapy, the sheer infrequency of clients creates a difficulty in finding statistically comparable samples of nonclients for study of the factors differentiating the two groups. We can infer a general understanding of the characteristics
of therapy seekers and nonseekers by comparing actual clients with others who nearly accepted therapy but rejected referral or dropped out of therapy early. These studies reinforce the contention that it is not relative need for better psychological adjustment which draws people to therapy.
Socioeconomic variables have repeatedly been shown as
most significantly related to therapy orientation. Entrance into therapy, duration in therapy, and perceived satisfaction and improvement all rise concomminantly with socioeconomic level, whether measured in terms of income or status. Therapy is by and large an activity of middle-and-above class people who are relatively well educated and possess a degree of what is "success" in this society. This is despite statistics which indicate that the "need." for therapy is distributed in a diametrically opposite way (Auld & Myers, 1954; Cartwright, 1955; Cole, Branch, & Allison, 1962; Hollingshead & Redlich, 1954, 1958; Hunt, 1960; Redlich, Hollingshead, Roberts, Robinson, Freedman, & Myers, 1953; Robinson, Redlich, & Myers, 1954; Sullivan, Miller, & Smelser, 1958).
Intelligence, a related variable, is the only other
factor which has been found to predict therapy predisposition. Users of therapy produce higher intelligence test scores and also tend to be better educated than nonusers (Dana, 1954; Heilbrun, 1961a, 1961b, 1970; Kirtner & Cartwright, 1958; Rosenberg, 1954; Strickland & Crowne, 1963; Taulbee, 1958).
Attempts to use personality testing and assessments of
counseling readiness to predict client participation have not
provided a reliable indicator. It does appear from personality studies, however, that the most psychologically "needy" are less likely -to become clients than their better adjusted peers (Affleck & Mednick, 1959; Barron, 1953a, 1953b; Gallagher, 1954; Heilbrun, 1961a, 1961b, 1964, 1966; Heilbrun & Sullivan, 1962; Hiler, 1959; Libo, 1957; Resnikoff, Brady, & Zeller, 1959; Roberts, 1954; Rogers & Hammond, 1953; Rogers, Knauss, & Hammond, 1.951; Windle, 1952).
The Relationship of Information to Therapy Predisposition
The greater use of psychotherapy by socially advantaged
perople can be accounted. for, to a large degree, by this group's proximity to therapy-predisposing information. According to the sociological model of help seeking provided by Kadushin (1969), people are likely to move from the experience of personal distress toward the office of a therapist to the extent that their position in society exposes them to sources of information which promote the efficacy of professional help. Better educated and higher socioeconomic-level people, because of their schooling, the books they read, the lectures the attend, are prepared to accept psychodynamic explanations for their problems. Also, their circle of friends and associates is prone to discuss life issues in "mental" terms, and their acquaintances may include individuals who have undergone therapy as well as workers in mental health professions. Thus, advantaged people are socially situated to identify their problems as psychological, to receive answers to their questions about the process of therapy, and even to be directed to particular practitioners.
Quite a different orientation toward problems is found in the lower socioeconomic milieu. Living considerably at the mercy of the environment, an individual of little means is disposed to view life difficulties as beyond personal control. For a person with little education, there is no rationale for viewing stress psychodynamically. Friends and associates, who also have limited resources, are apt to share this externalized perspective and reinforce passive acceptance of "fate." Among unaffluent people, professional help is likely to be defined as the services of familiar agencies which provide physical rather than psychological assistance.
For the lower socioeconomic-level person, moreover, lack of knowledge and distance from sources of information are not the only barriers to psychotherapeutic help. Riessman and other writers have furnished extensive evidence that, in dozens of ways, psychotherapy is geared to and biased in favor of middle- and upper-class clients (Riessman, Cohen, & Pearl, 1964). If the poor are slow to recommend psychotherapy to their friends, this may be a result of the well-documented insensitivity of professionals to cultural orientations different from their own.
It would, however, be incorrect to assume that a propensity to use psychotherapy is inherent and widespread among people who are well off. Redlich, Hollingshead, and Bellis (1955) observed misunderstanding and hostility toward psychotherapy in all strata of society, including the supposedly well-informed: in panels of lawyers, clergymen, and teachers,
for example, and in over one-third of medical men. In pretherapy interviews with psychiatry applicants, Redlich and colleagues found little difference between the attitudes of middle-class people--small business proprietors, white collar workers, and skilled laborers--and the fear and reluctance of poorly educated unskilled and semiskilled workers from the most crowded sections of New York. Both groups were also largely ignorant about therapy. Although more of the middle-class applicants had some understanding of the treatment, their knowledge consisted of little more than that the -therapist employs "mental" techniques. Typical or both groups were such comments as, "Psychiatry is fine for crazy people but it can't help me."
Persons from all walks of life are disinclined, if not
hostile, toward psychotherapy. The infrequent use of therapy is a complex issue, but it is reasonable to assume that people are not quick to avail themselves of services which they only vaguely comprehend. Nunnally (1961) surveyed a large sample of the American population and concluded that the average citizen is not grossly misinformed about mental health, but certain groups--notably, the less educated--hold many beliefs that are inaccurate; furthermore, while not misinformed, most people are considerably uninformed. Gurin and others (1960), analyzing the help-seeking patterns of a national sample, found distribution of services to lower status people so inferior that it constitutes a "special social problem." Another finding was that nine percent of their sample at some time in their lives were "ready for self-referral" but did not
apply for psychotherapy. A major reason which these people gave for not seeking help was "lack of knowledge about where to go or what to do in order to get help."
The Present Study. Purpose aiid Overview
Writers on the subject of help seeking have repeatedly
said that potential clients need to be apprised of what occurs behind the therapist's closed door. Client constituencies also are entitled to information on when and how to apply for help. As Shertzer and Stone (1974) have expressed it, "an important objective for every counselor is enlightening our society as to the legitimate goals and realistic limitations of counseling" (P. 87).
The present study is one of the first research attempts
to assess the efficacy of disseminating counseling information to potential clients. Brief and economical presentations of information are given and the responses of the recipients analyzed. It is not expected that a single informational experience will have sweeping impact upon therapy-seeking behavior but that a presentation of information can facilitate the ongoing process of "learning about therapy" which Kadushin (1969) has called essential to the decision to enter therapy. One presentation of information, if effective, may incline an individual to seek and accept further information and predispose him or her to make an informed decision to use counseling, should it at some point in life be appropriate.
Participants in the study are school adolescents in their usual classroom settings. The presentations of counseling information they receive are in three forms: a booklet, a talk given by a counselor, and a combination of the booklet and -the talk. In general content, the booklet and the talk are identical, covering the following topics:
1. The range of appropriate uses of counseling
2. Types of counseling and counseling activities
3. The counseling process
4. How counseling help may be obtained.
Six hypotheses are tested by comparing the recipients of each form of information and a control group (receiving no presentation), using measures of counseling expectancies and willingness to use counseling. Results are discussed in terms of the usefulness of information in altering perceptions of counseling which may facilitate help seeking.
Notes on Terminology
Counseling and Psychothera-Dv
The use of the terms "counseling" and "psychotherapy" in this study requires explication. In general and theoretical discussions, the two terms are used interchangeably. In references to previous research, the term chosen by the investigator being reviewed is retained. In the experimental presentations of information delivered to high school youth, only counseling is mentioned.
In each case, the concept denoted is the same: the psychological helping process which aims "to help individuals toward overcoming obstacles to their personal growth . and toward achieving optimum development of their personal resources" (American Psychological Association, 1956).
For broad discussions of the delivery of mental health
services to the public, the choice of one term over the other could only be arbitrary. As Patterson (1966) writes,
There are no essential differences between counseling
and psychotherapy in the nature of the relationship,
in the process, in the methods or techniques, in
goals or outcomes (broadly defined), or even in the
kinds of clients involved. (p. 3)
The terms "counseling" and "psychotherapy" arise from two historical streams which have developed into present-day psychological services: "counselir%6" from the mental health and vocational guidance movements in our society and "psychotherapy" from the medical tradition. It was found, in reviewing the literature backgrounding this study, that investigators in hospital clinics most often referred to psychotherapy while those in educational and other nonmedical settings spoke of counseling.
Some writers (e.g., Tyler, 1958) restrict the focus of counseling to growth and actualization processes, removing from it the repair-of-damage implications associated with therapy. This emphasis on the positive makes an important point. There does exist a connotative difference between the terms "counseling" and "psychoth.erapy.11 Research into client views of differently titled help givers, for example, indicates that
counselors are seen as more understanding and warm, less probing and powerful. (See Chapter II.) Because of this benign counselor image, it was decided to refer only to counseling in the informational presentations used in this study with school youth.
Perceptions of Counseling: Expectancies and Willingness
COU11Seling perception, as the concept is used in this
study, simply refers to how an individual views counselors and their work, either generally or along specific dimensions. Perceptions, opinions, conceptions, attitudes, and feelings about counseling are kin concepts; all are used to describe level. of positive-negative disposition toward counseling, and all comprise both direct and intuitive cognitions. It is assumed that perceptions of counseling have two origins, actual experience with counselors and information received formally or informally from other sources.
Perceptions of counseling are explored in this study in
terms of two instrumentally defined types of counseling orientation, expectancies of counseling and willingness to use counseling. Expectancies (or expectations) of counseling are future-oriented beliefs about counseling. They are notions the potential client has of what will happen if he or she should enter counseling; for example, "I expect to get the help I need." The expectancy measure that is used is a list of positive expectancies related to eight dimensions of counseling. High degree of agreement with the items is taken to be an indication of positive orientation toward counseling.
Willingness to use counseling is an individual's readiness, receptiveness, or motivation toward making use of counseling services. The willingness measure is a list of topics often discussed in counseling. High degree of expressed willingness to discuss these issues with a counselor is taken as an indication of positive orientation toward counseling.
The meaningfulness of counseling perceptions is discussed in Chapter II. Details of the instrument used to measure expectancies and willingness are given in Chapter III.
REVIEW OF I]TERATURR,
In the field of counseling, little is known about the use of information to help potential clients understand the services available -to them. The first study evaluating the
influence of information upon people's perceptions of counseling appeared only a few years ago. The researchers, Gelso and McKenzie (1973), prefaced their report by saying,
No research heretofore has examined the efficacy of various modes of information dissemination in
correcting the miscommunications between counselors
and other groups. Thus, much time and effort have
been spent identifying the problem, but little
energy has been exerted in studying means of
remedying it. (p. 406)
Several related lines of investigati on, however, form a background against which the effectiveness of counseling
information can be assessed. Some surveys have been done to assess perceptions of therapy held by certain counseling constituencies and the general publl.c, showing that there is widespread inadequacy of knowledge regarding counselors and their work. Also, experiments on the transmission of mental health information have demonstrated the capability of sjinple communications to modify people's conceptions of psychological issues. Additionally, a number of pretherapy procedures designed -to rear-Jy counselees for their role have been found successful. The conclusions of these studies point to provision 14
of information as a promising method of facilitating help seeking.
Perceptions of Counseling
Psychotherapy literature has always contained the idea that the client's comprehension of therapy is essential to treatment. ifreud, in his writings, expressed his belief that the intelligent patient was most suited to psychoanalysis (cf., 1950, pp. 249-263). Subsequent attempts to identify the successful client have consistently pointed to the person who is quick to learn and perceptive of therapy as a source of relief. Carl Rogers (1951, 1957) in his client-centered therapy, emphasized the provision of therapeutic conditions which would work personality change with any client--but only within the context of "psychological contact," a relationship in which the client perceives the warmth, accurate empathy, and congruence emitted by the therapist.
Rotter (1954), Kelly (1955), Frank (1959, 1961), Lennard and Bernstein (1960), and Goldstein (1962a, 1962b) have most significantly spoken to the importance of the client's understanding as a determinant of the course of therapy. Rotter (1954) declared the necessity of what he called "successive structuring" of the therapy process, periodic discussion to clarify goals, roles, plans, responsibilities, and attitudes with the client. Kelly (1955) theorized that response to therapy is dependent upon the client's initial ways of conceptualizing the interaction, especially in terms of role
expectancies. Frank (1959, 1961) described the dynamics of the therapeutic relationship as related to the client's belief or faith in the power of the process. He was also among the first -to explain how divergent therapist anmd client expectancies can produce a breakdown in communication anrd lead to therapy failure. Lennard and Bernsteirn (1960) provided a systematic view of therapeutic communications as interrelated with expectations, showing that dissimilar client and therapist expectations produce strain, or disequilibrium, on the structure of communication. Goldstein (1962a, 1962b) extensively examined the accumulated theoretical and experimental work on patient and. therapist expectancies in the light of what is known about other forms of anticipatory himian behavior and confirmed expectancies to play "clearly . a significant
role in psychotherapeutic interaction, demonstrably accounting for a portion of improvement" (1962a, p. 79); specifically, his research review indicated that the most therapeutic change can be predicted in clients whose role expectancies are coinpatible with the therapist's and Whiose outcome expectancies are moderate and realistic.
Thus, clients approaching psychotherapy conceptualize
the process in differing ways, and it is generally accepted tfist early perception of therapy is atn important determinant of the course and outcome of treatment. Less is known, however, about the period prior to therapy entry, when the prospective client makes -the decision to seek help. Conceivably, cognitive variables have their strongest influence at this point,
when anticipation of benefit must win out over resistance to change and fear of self-confrontation. Perceptions of College Counseling Services
Part of our knowledge of potential clients' perceptions of counseling comes from a number of surveys conducted among student groups. Most of these were the efforts of college counseling center personnel and secondary school counselors, concerned that their image limited student use of their services. By the 1960's, the counseling profession had thoroughly outgrown its -traditional function of vocational and educational testing and advising; and counselors, trained in the psychology of personality and in psychotherapeutic theory and practice, made themselves available for work in personal development as well. Yet, as Bordin (1955) had pointed out earlier, student clients were making a distinction between "counseling" and "psychotherapy"; they saw counseling as an informationoriented resource, helpful in reasoning through a particular decision, but not appropriate for the in-depth exploration of personal problems and emotional issues. Bordin called for the use of campus media to clarify the counselor's role and recommended further study into client anticipations and expectations.
In one assessment of campus counseling views by King and Matteson (1959), a representative sample of students rated their willingness to take each of 40 problems to the university counseling center. The results supported Bordin's assertion; students preferred educational, vocational, social, and personal problems--in that order--for discussion at the center.
Individuals tended to select either educational and vocational types of' problems or social and personal types, but not both, as appropriate for counseling. The students who were most willing to use campus counseling facilities were those who had previously visited -the counseling center.
Similar conclusions were reached 'by Warman (1961). Using a check list of problems related to three factors--college routine, vocational choice, and personal-social adjustment-he compared several campus groups' perceptions of counseling topic appropriateness. Counseling center staff, college personnel workers, teaching faculty members, and counseled and uncounseled students, all agreed that vocational counseling was most appropriate for the university counseling center; but the counselors rated personal and social adjustment problems as significantly more appropriate for counseling than did any other group. Echoing Brodin, Warman suggested that practitioners orient other groups to the kinds of problems with which they feel they can be helpful.
A decade later, Resnick and Gelso (1971) replicated the Warman study to determine whether counselors were closing the communication gap between themselves and other university people. Using the revised Counseling Appropriateness Checklist (Warman, 1961), they found. that counselors still viewed personal and social adjustment as more appropriate for discussion at the counseling center than did other groups; however, the perceptions of others, particularly student personnel workers, had moved somewhat closer to those of the
Two other surveys using Warman's check list have reconfirmed that the function of college counselors is not seen as they would like it to be seen. Student clients and nonclients (Gelso, Karl, & O'Connell, 1972) and several campus groups including students, parents (Wilcove & Sharp, 1971) all rated personal and social matters as appreciably less appropriate for the counseling center than did center staff.
Research on student perceptions of their university counseling services has also examined how the counselors themselves are seen. Bordin (1951) had called attention to the title "counselor" as distinguished in the student mind from the term "therapist.,, He reported that college students viewed the counselor as "fatherly, someone you could lean on . understanding and forgiving" but, at the same time, "impersonal and objective" (p. 17). This contradiction was not troublesome, Bordin explained, because students expected to discuss in counseling only rather superficial, decision-oriented issues and, therefore, assigned little importance to the counselor's personal characteristics.
Strong, Hendel, and Bratton (1971) have provided current data on college students, views of campus help givers. On a 100-item adjective check list and list of nine problem topics which might be discussed with helping persons, female undergraduates rated their perceptions of counselors, advisors, and psychiatrists. The women regarded counselors as more like advisors than like psychiatrists. They considered counselors to be friendly, polite, warm "nice guys," comfortable to be
with; but they felt psychiatrists were intelligent, decisive, analytical, cold, humorless, and rejecting. Vocational and educational problems might be taken to an advisor or a counselor; but -the psychiatrist, not the counselor, was clearly the most likely choice for such difficult personal concerns as getting along witn friends, uncomfortable feelings and emotions, and sexual distress.
Gel-so and Karl (1971.) extended the work of Strong et 2,.1., using more helper labels: high school counselor, advl, or, college counselor, counseling psychologist, clinical psychologist, and psychiatrist. Their use of the same 100-item check list and nine problem items with male and female students produced no "nice guy" distinction for the counselor. More difficult personal problems were again perceived to be within the domain of the psychiatrist first, with the two psychologists next likely to be consulted. These three professionals were described as more knowledgeable, inquisitive, and analytical than the counselor; the counseling psychologist was considered more casual and flighty; and the psychiatrist, more powerful, interesting, tactful, and accurate.
Since university counseling staff are often trained in clinical and counseling psychology and offer more than vocational and educational services, Gelso and Karl recommended that counselors more adequately inform the public of their role and clarify the meaning of their title.
The above studies imply that students are not aware of the full range of services available from their counseling
centers. Bearing this out further, a survey of reasons students do not use university counseling facilities (Snyder, Hill, & Derksen, 1972) found that undergraduates were generally in favor of the concept of counseling and unafraid of stigma attached to seeking therapy i; yet they reported little knowledge about their college counseling center or about the counseling process, and they preferred to turn to friends and close relatives for help with personal and social problems rather than to professionals. Related findings from a study of undergraduates, expectations of counseling (Tinsley & Harris, 1976) showed that students believe that counseling is in general a helpful service, but they are rather doubtful that it could be useful to them. They strongly believed in the expertise of counselors and that counselors are genuine, accepting, and trustworthy, but they did not expect that they could be understood or helped in counseling. Perceptions of School Counselors
The first school counselors were teachers; and, since the professionalization of the school counseling specialty. counselors in secondary schools have had a most difficult time establishing themselves as a resource for students with other than school-related matters. Especially during the 1960's, an outpouring of counseling literature declared the central concern of school counselors to be the developmental and emotional needs of the total youngster (e.g., American School Counselor Association, 1963; Wrenn, 1962). This prompted a number of studies into how the school counselor is perceived.
Dunlop (1965) surveyed opinions of what school counselors should do. Counselor educators, secondary school admilinistrators, counselors, teachers, college-preparatory and job-bound seniors, and mothers of students, all agreed that educational and vocational counseling were appropriate, snd a11 except job-bound students and their mothers were in favor of testing as a counse].or's task. Personal counseling received general approval, but students showed significantly less enthusiasm for this service. The college-bound seniors indicated by their remarks that the school counselor was "a good choice for personal counseling when no one else was available" (p, 1026). Furthermore, students, parents, and teachers rejected some behaviors which counselors consider integral to the therapist role. They did not want counselors to allow counselees to speak freely without fear of punishment or correction. They condoned advice-giving, and they felt that counselors should teach students the difference between right and wrong.
Dunlop concluded that the counselor is perceived in the school as merely "a helpful person whose function is largely one of providing assistance to students in their efforts to achieve academic success" (p. 1027). If counselors are to be distinguished from teachers, he wrote, they must educate other school personnel and the public about their competencies.
How the school counselor is regarded by colleagues is likely to influence student use of counseling services. A recent paper by Wittmer and Loesch (1975) described teachers'
lack of trust and respect for counselors as related to inadequate
understanding. Their survey revealed that a number of teachers view counselors as secretive and involved too little with disciplinary and teaching duties. Although teachers in elementary schools were more satisfied than secondary school teachers with the performance of counselors, many of the educators considered counselors to be privilegede" people and tended to wonder what counselors do with their time. With this evidence, the researchers stated that counselors could improve their relationships with teachers by applying their human relations skills to better role communication.
A group of school principals, Schmidt (1962) found, agreed that the counselor's main activity should be counseling students, rather than teaching or clerical tasks. In this study, principals and counselors concurred that school counseling is primarily vocational arid educational work, but both reported that they would prefer counseling to focus on personal and social problems.
Students themselves, s, however, have not perceived the
school counselor as a particularly good resource for personal matters. Surveys by Gibson (!962), Grant (1954), and Kennedy and Fredrickson (1969) have clearly shown that high school students are most willing to discuss educational and vocational planning with their counselors but would rather approach nonschool people, usually friends and family, for personal help. Graduating seniors responding to a questionnaire by Roemmich and Schmidt (1962) reported, moreover, that parents and family had given -them more assistance in selecting and planning for
college than had counselors. Junior high school students in a study by Van Riper (1971) said that, overall, counselors had been more helpful to them than other school personnel but less helpful than other students.
Perhaps students are reluctant to go to their counselors with emotional issues because they mistakenly believe that professional assistance is reserved for people who are very disturbed or dysfunctional. Heilfron (1960) found support for this contention. Using a questionnaire devised by Robinson (1953), Heilfron asked a group of high school students to rate brief descriptions of hypothetical adolescents, specifying the degree of counseling indicated in each case. The students recommended minimal counseling for attractive youngsters doing well in school and displaying no overt emotional handicaps. They prescribed more frequent counseling for youngsters with obvious problems, but they reached strong agreement for maximum counseling, regular sessions or referral to an outside therapist, only in the case of a boy who was clearly behavior disordered. Heilfron concluded that students associate intense counseling with extreme deviance and are unaware of the role developmental counseling might play in helping those who are functioning adequately.
Perrone, Weiking, and Nagel (1965) administered the same questionnaire to junior high school students, teachers, and parents. The resulting opinions of counseling need were similar to those found by Heilfron, but parents preferred somewhat more intensive counseling than did their children, while teachers
favored less. The counseling needs of student participants in the study, inferred from self-report on the Mooney Problem Checklist, were largely unrelated to their, or their parents', estimates of hypothetical youngsters' need for services.
Apparently, the school counseling specialist is not seen as an essential resource for the developmental and emotional needs of students. The studies cited show that the counselor is not highly regarded in the school, not trusted, not understood, and not sought out. School counselors are undoubtedly performing important, if not highly visible, functions. The fact remains, however, that lack of student recognition severely limits the counselor's capability to provide psychological help. It has been said that "word-of-mouth advertising"
is the primary mode of promoting the counselor's image in the school (Morgan, 1974). It seems this form of publicity is insufficiently conveying the message of counselor availability and competence.
Public Perceptions of Psychotheranpy
By cultural definition, psychotherapy is the designated
treatment in this society for certain forms of human distress. The public, however, is not of one mind in its perceptions of
therapy. People with dissimilar lifestyles and associates are likely to have divergent view of therapy. City dwellers, for
example, do not view therapy in the same way as rural inhabitants. Workers in the occupational fields of health, education, communications, and art often thinA differently about therapy than those in engineering, law, and busIness, Sophisticated
and well read people discuss therapy in ways that others might not comprehend.
Social influence is powerful in the formation of perceptions. It is particularly a determinant of perceptions regarding psychotherapy because, lacking firsthand knowledge, most people must rely -upon impressions gathered from others. An explanation of how social influence is related to therapy orientation is Kadushin's (1969) theory of the "Friends and
Supporters of Psychotherapy." In a Study of nearly fifteen hundred applicants to New York psychiatric clinics, Kadushin found that talking with others often precedes help seeking. Many applicants had several characteristics in common:
1. Knowing others with proble-mos similar to their own.
2. Knowing a friend who had been in therapy.
3. Having discussed going to a clinic with some other people.
4. Having asked friends for recommendations to clinics or practitioners.
Kadushin hypothesized the existence in urban society of indirect chains of acquaintance through which people become therapy "insiders," not necessarily users of psychotherapy themselves but sophisticated promoters of its efficacy. Insiders transmit their knowledge arid endorsement of psychotherapy to colleagues and social contacts, forming a bridge between potential clients and professional help.
Insiders share a number of perceptions related to therapy use. They see value in discussing personal matters with others
and perceive themselves as having problems for which a therapist might be sought. They do not dislike psychiatric patients and
are unafraid to admit that they themselves might benefit from therapy. Also, their expectations of therapy are in line with those of therapists. They do not thiA k of' th erpy as 'advice giving, and they feel that the client, not the therapist, should do most of the talking.
According to Kadushin, il3siders are usually well educated, successful people who move in social circles which support their high regard for therapy. Others, for example lower socioeconomic-level people, can become insiders as well, but they must enter therapy by some other means than through acquaintances and then become insiders due to the experience. It should be made clear, however, that the network of friends which Kadushin describes is a small phenomenon, relatively ineffectual in the total society. Most people are "outsiders" who have little familiarity with the use of psychotherapy.
Lower socioeconomic-level perceptions. The therapy
perceptions of lower socioeconomic-status people have received particular study because of this group's disinclination to use psychotherapy. Lack of knowledge anrd understanding of therapy is a probable factor in their reluctance. Incongruity between lower socioeconomic life experience and the basic concepts of therapy is another.
The irrelevance of traditional therapy for the concerns of the poor has been discussed in a number of papers (EBrager, 1964; Cole, Branch, & Allison, 1962; Hunt, 1960; Riessman,
Cohen, & Pearl, 1964). Psychotherapy has been, in Brager's (1964) words, "owned and operated by middle class persons" (p. 415) and inflexible to the style and needs of low-income culture. Lists of the characteristics of likely clients, compared with the qualities of low-income people, show this clearly. The persons for whom traditional therapy seems to have been designed, for example, tend to internalize their problems, blaming themselves and not their environment. They are active participants, not passive cooperators. They value self-control, ego strength, individual-ism, and motivation. They are, in short, upward-striving individuals imbued with middle-class mentality. People closer to the struggle for sheer survival are inore concerned with solutions to day-to-day matters. Often in crisis, the-\T are in need of immediate help offered in direct and forthright terms, not insight development.
Lower socioeconomic people's lack of information about therapy is no doubt related to their lower level of formal schooling. Nunnally's (1961) large-scale survey of American mental health conceptions showed that adults with less than a high school education are most likely to have inaccurate beliefs about psychological matters. Research on perceptions of psychotherapy, however, has not found lower socioeconomic-status people differing greatly from -the middle class.
Redlich et. al. (1955), comparing views of middle class and lower socioeconimic-level psychiatric patients in pretherapy interviews, found much similarity in the expectations of the two groups. Both groups were fearful and ashamed, associating
therapy with "craziness." The middle-class interviewees were only slightly more knowledgeable about therapy. Both groups presented somatic problems and asked for "pills and shots"; both lacked confidence in the "talking treatment" and wanted sympathy, authority, and practical advice. Followed thro-ugh the course of therapy, however, the middle-class clients more. often came to accept their therapists' notions of the therapeutic process, while lower socioeconomic-level patients tended
to remain dissatisfied.
Some years later, Overall and Aronson (1962) surveyed the therapy.expectations of 40 lower socioeconomic-level clients entering psychiatric clinics. The results were puzzling. The
respondents tended to answer positively to most of the 35 items of the questionnaire, indicating--at face value--simultaneous anticipations of active, medical, supportive, dynamic, and passive -therapist behavior. The researchers speculated that there might have been a general set among those surveyed to reply "Yes." A finding which especially surprised the investigators was that the potential clients reported strong expectations that they would deal with emotional and dynamic material in therapy.
Conceivably, the research over the years represents a trend in which psychiatric outpatient clinic applicants are becoming more sophisticated regarding treatment. In a recent survey, Lorion (1974) uncovered no significant differences in help-seeking orientation or treatment expectancies among clinic applicants of middle-, lower middle-, and lower socioeconomic
status. On a measure of help-seeking attitudes, all groups expressed confidence in the efficacy of treatment, recognized the need for help, perceived little stigma attached to therapy, and showed a willingness to discuss personal matters. On a questionnaire similar to that devised by Overall and Aronson, their scores showed that they did not anticipate a highly supportive, problem-solving therapist, that they could differentiate psychotherapy from medical care, and that they expected to focus on emotional issues.
General perceptions. Two extensive investigations of
perceptions related to therapy are Gurin, Veroff, and Feld's (1960) survey of mental health adjustment and help-seeking modalities and Nunnally's (1961) series of studies into popular conceptions of mental health.
Gurin, Veroff, and Feld (1960) examined the mental health orientation of 2,460 representative American adults. One focus of this study was to determine the methods people use to handle life problems, providing a broad perspective on the use of professional help. In general, the researchers concurred with what is found throughout the literature on help seeking,
The tendency to tGurn to professional help when
faced with personal problems was found to be
associated with introspection, with structuring
distress in personal and interpersonal rather than
external terms, with self-questioning more than a
dissatisfied or unhappy reaction toward life roles,
with psychological rather than physical symptoms.
Their data show that desire for therapeutic change is not
wieped Only 14 percent of those interviewed reported that
at some time in their lives they had gone to a professional
resource for assistance with a personal problem. In two-thirds of these cases, the helper sought was not a mental health professional. Sources of help most often mentioned were clergymen and physicians. Respondents also recalled seeking counsel from lawyers, teachers, nurses, policemen, and judges. Choice of a professional was apparently dependent upon the content of the problem; for example, trouble with a child might prompt a parent to confer with a schoolteacher. Less than one-fourth of the help seekers considered themselves to be the locus of the problems they discussed; even a "nervous breakdown" was more often defined as a collapse in the face of some external stress than as a personal adjustment difficulty. Most who asked for help indicated that they wanted comfort, reassurance, or advice, not self-examination.
Aside from the help seekers, a segment of their sample which particularly interested Gurin and his colleagues was a "critical group" --rnine percent of respondents who said they believed that a professional could have been useful to them with a problem in the past, but did not go for help. The reasons these people gave for not applying for assistance were ones commonly cited by mental health experts as deterrents to the help-seeking process: lack of knowledge about where to go or what to do in order to get help, aversion to shame and stigma, and desire to work problems out alone. The critical group appeared to be as psycho.ogically accessible as the people who actually sought help, but they tended to have less money and less education and were more often from rural areas. Half
of them attempted in some way to solve their difficulties on their own. Others reported withdrawing from the distress situation or doing nothing.
Among the large group which had never made use of professional help, most stated that they probably would not use it in the future. This so-called "self help" group did not actually make unusual use of their own or informal resources for troubles, particularly if -they were old, uneducated, or poor; nor were they happier than help seekers. They were less introspective and less inclined to phrase problems in psychological terms. Like the critical group, they tended to have lower incomes than help seekers and to be rural people.
Examining the characteristics of the three groups--help
seekers, those who almost sought help, and those who would not seek help--the researchers identified two types of factors operating in the use of mental health resources. Psychological factors were subjective perceptions associated with the desirability of professional help: introspectiveness, phrasing of distress in terms of personal problems and self-questioning, focusing on personal and interpersonal aspects of life, and reporting psychological rather than physical symptoms. Facilitating factors were circumstantial considerations connected with help accessibility: actual availability of resources in the community, knowledge of these resources, and the extent to which going for help is the "thing to do" in one's social group.
Psychological and facilitating factors effect the helpseeking process in different ways. This can be seen if help
seeking is viewed as a sequence of three decisions:
1. Whether or not the problem will be defined as a mental health problem.
2. Whether or not to go for help with the problem.
3. Choosing where to go.
Psychological considerations, the researchers hypothesized, are most clearly relevant to the first decision point, while facilitating factors are more influential in the last two decisions. This analysis of psychological and facilitating factors implies that potential clients need -two types of mental health information, education on how to recognize mental health problems and instruction on how to obtain help.
The second large-scale examination of the mental health
orientation of the public is a series of investigations reported by Nunnally (1961). Nunnally and his research team applied diverse data-gathering methods to such topics as public knowledge of mental health matters, views of mental illness and treatment, and mass media presentations of mental health issues. Although -this work does not focus directly on the use of psychotherapy, the conclusions are helpful in understanding therapy perceptions and, it will be seen, provide important preliminary information for the second phase of Nunnally's research in which mental health communications variables are explored.
To study general mental health knowledge, the investigators administered a 50-item questionnaire of possible mental health beliefs to several groups considered to resemble a
cross-section of the general population. (In most of Nunnally's studies, subjects were selected from a pool approximating the United States population in terms of education, age, sex, and other demographic characteristics.) I.ridividual responses contained many inconsistencies, and overall responses produced low correlations under factor analysis, leading the researchers to conclude that the public's mental health information is not highly structured or crystalized and that people are tentative and uncertain in their opinions. As previously mentioned, although most people were not grossly misinformed on mental health issues, they were rather uninformed; and certain groups, notably the older and less well educated, did possess much erroneous knowledge.
Another group of studies assessed attitudes toward the
mentally ill, using rating scales, ranking methods, the Semantic Differential technique, and "free association" tests. The results revealed that the notion of stigma associated with mental illness is well entrenched in reality. Young and old, the well educated and the relatively unschooled, all tended'to regard the mentally ill person as comparatively dangerous, dirty, unpredictable, and worthless.
Using similar techniques, the researchers then examined attitudes toward psychological experts and treatment. They found that all types of professionals were highly regarded, particularly by less well educated people; but mental health professionals were held in less esteem 4 Chan those who treat physical problems. Reactions to mental health institutions
and treatment, including psychotherapy, were generally less favorable than attitudes toward physical treatment methods. Also, distinctions between the mental health subprofessions were poorly understood.
Before describing Nunnally's media studies, it should be noted that they were carried out in the mid-1950's and, no doubt, the situation today is changed. Through content analysis of television and radio broadcasts, national magazines, and daily newspapers, the researchers discovered a highly distorted view of mental health issues being propagated by commercial media. For example, presentations often suggested that a person with a psychological problem looks and acts in different ways than does a "normal" person. Especially in television dramas (which are more likely to be viewed than mental health educational programs), mentally ill persons were often portrayed with highly stylized and bizarre behavior, glassy eyes, uncontrollable laughter, and strange phobias and obsessions. The depicted causes of mental problems were frequently situational or organic: a single stressful incident, an old battle wound, physical privation such as hunger or thirst. The treatment was likely to be assistance from a professional-a psychiatrist, physician, or nurse--or, just as commonly, the application of timely advice or a bit of homespun philosophy.
The impact of -these media presentations, however, did not appear -to be critical. Public views of mental health matters found in Nunnally's other research were far less extreme than media depictions, reflecting the consumer's ability to withstand
the influence of unrealistic dramatic conventions. Furthermore, in the overall media, information concerning psychological issues was infrequent. The researchers found only 120 relevant items in 49 newspapers, 16 in a radio station's weekly output, 17 on one television channel watched for a week, and 49 Items in 91 issues of national magazines.
Effects of Mental Health Information: Nunnally's Findings
After their investigations of public mental health views, Nunnally and his colleagues conducted a series of pioneering studies in the field of mental health communications. The second half of Nunnally's (1961) report is an examination of the communication variables involved in attempts to expand popular knowledge and improve general attitudes regarding mental health issues. Its essential message was summarized as follows,
Communicating mental health information may, on first
thought, seem to be a relatively straight-forward
task--merely presenting facts in a clear and interesting manner. Unfortunately, the problem is much
more complicated than that, and there are many
stumbling blocks in the communication process. For
example, the attitudes that people have toward mental disorders and afflicted individuals make them resistant to certain kinds of new ideas and to some types
of communications. Because the direct approach
often fails to change people's attitudes and opinions in desired directions, new appeals and communication strategies must be found. (p. 2)
The following review of Nunnally's findings includes several focuses; (a) general acceptance of mental health information-public interest, discrimination of true from false information,
individual differences in receptiveness, effectiveness of types of information; (b) major variables in message transmission-anxiety, solution provision, message certainty, and negation effects; (c) other variables related to mental health communications; (d) permanence of message effects. Acceptance of Information
In their studies of mental health viewsNunnally and his research, team found popular knowledge of psychology space, unsystematically structured, and uncrystalized. Uncertain and eager to learn more, the public tends to be susceptible to any authoritatively presented mental health information. Despite their curiosity, however, people are likely to be frightened by such topics as mental disorder and resistant to unpleasant messages.
On an interest questionnaire, 200 raters indicated as
much willingness to receive information on mental health as on several other popular subjects, including physical health. Asked to rate interest in different aspects of mental health, respondents indicated more enthusiasm for information related to immediate personal issues; the more distant the topic from an individual's own concerns, the less interest it generated. Of particular interest was material related to the early stages of mental illness, causes and initial signs.
A further study of public interest in mental health used written information sheets describing treatment methods. The descriptions were designed with varying combinations of three message variables: high- or low-anxiety arousal, personal or
impersonal phrasing, and provision of solutions or no solution. Ranking the communications in order of preference, 288 participants in the experiment showed least interest in personal, highanxiety messages providing no solution and most interest in impersonal, low-anxiety messages including solutions. Receptivity to mental health messages, therefore, seems tied to the degree of threat produced.
False information may be as readily accepted as true. An experiment which demonstrated this used four written accounts of treatments for catatonic schizophrenia, two plausible in the light of current evidence and two concocted from the imaginations of the researchers. Four groups of college students read these reports, presented as expert explanations, while control groups read messages unrelated to mental health. The readers of both true and false reports made similar ratings of their information on convincingness, and more than 75 percent of each group answered "Yes" when asked whether they thought the treatment described to theya would work. Additionally, the four groups, compared with control groups, indicated more favorable attitudes on a Semantic Differential, both for the concept of "a person with catatonic schizophrenia" and for general mental health topics. Nunna11y suggested that even false information can serve a useful purpose.
Measuring the effects of types of information upon attitudes and knowledge, the researchers used 'Lour paragraphs designed to promote accurate understanding about four popular misconceptions: (a) that the mentally ill look and act different,
(b) that willpower is a deterrent to mental illness, (c) that avoidance of morbid thoughts brings relief, and (d) that the mentally disturbed are hopeless. Each of four groups of high school students read one message, and a control group was exposed to no message. On a mental health information test, students usually scored high on the factor to which they had been educated but not on others. (An exception was that most students, including controls, were convinced that the mentally ill are not hopeless.) The attitudes of informed students differed in a generalized way from those of the control group, but changes were often in a negative direction. The researchers attributed the worsening of attitudes to the content of the messages not having been controlled for such variables as arousal of anxiety.
In the course of their studies, the researchers attended to individual differences in respondents. The general finding was that there were large differences among people's attitudes and knowledge prior to communications experiments, but subjects tended to change by the same amounts when exposed to similar mental health messages. Initial differences in information corresponded strongly to years of formal schooling and intelligence test scores. Initial mental health attitudes, however, were not significantly related to educational sophistication, age, sex, and other prominent dimensions of individual difference. Major Variables in Message Transmission
Having found that nonthreatening mental health messages
are most acceptable to the public, Nunnally's group set out to
determine how people's knowledge and attitudes are affected by several message variables: anxiety arousal, provision of solution, message certainty, and negation effects.
One study explored the inflLience of messages put in anxiety-arousing terms upon attitudes toward specific and general mental health concepts. For two topics, psychoanalysis and "shock therapy," written information was composed with combinations of high- or low-anxiety phrasing and provision of a solution or no solution. Each of 392 high school students read one of the eight messages, then reacted on a Semantic Differential to several concepts related to mental health. Highanxiety messages clearly produced more negative orientations toward all of the concepts. When a solution was provided, however, it promoted favorable attitudes in the high-anxiety condition. Because the researchers had surmised from pilot studies that mental health messages usually raise anxiety, they recommended inclusion of solutions whenever mental problems are brought up in public communications.
Nunnally also reported on the.effects of message certainty, the degree to which a message is delivered as proven "fact" rather than tentative belief. Message certainty is highly relevant to mental health communications because solid information in the field is considerably lacking, new data and ideas are continually appearing, and thus messages do tend to be tentative. From a number of studies, two of which are described below, Nunnally drew three general conclusions:
1. The more certainty with which mental health information is stated, the more favorable will be the attitudes toward concepts related to mental health.
2. Destruction of' information about mental health without
supplying new information results iv'i negative attitudes, toward related concepts.
3. Even if available information may turn out to be incorrect, it is better to give such information -to the public than to withhold it.
Experimenting with message certainty, the research team designed written descriptions of two psychological treatment methods, each explained to be effective in both high- and lowcertainty phrasing. Each of four classes of high school students read one of the four messages, and two other classes read control messages irrelevant to mental health. On a Semantic Differential, students who had received high-certainty communications demonstrated more favorable attitudes toward the treatment method described and toward general mental health concepts. Two weeks later, the investigators returned with new messages negating the information which had been supplied originally. When administration of the Semantic Differential was repeated, negating messages produced less favorable attitudes on specific and general mental health concepts for all groups, including controls; however, students who previously had read high- and low-cortainty messages did not differ in amount of attitude change.
Negation of information proved significant in further experimentation. Undergraduates read explanations of
schizophrenia which contained high-certainty assurance of effective treatment immediately followed by a statement casting doubt on the validity of the information. Compared with control groups who received no mental health informatio n, the message recipients indicated generally unfavorable attitudes toward mental health concepts on a Semantic Differential.
Other Communications Variables
To test the notion that contact with the mentally ill might improve attitudes toward mental health concepts, an experiment was conducted involving visitors to high school classrooms who made brief talks about mental illness. Each speaker presented herself in three ways, either beginning the talk by stating that she was a former mental patient or making this announcement at the end, or making no such statement. An additional experimental condition was that half of the talks were given in a personal way, enlisting active identification of the audience with ("he issues mentioned, while half were delivered impersonally, allowing the audience to feel remote from the events.
Later, as a supposedly unrelated event, a researcher administered the Semantic Differential to assess attitudes toward mental health concepts and an information test in each class. A clear finding was that late revelation of mental patient status affected attitude-s far more favorably than initial disclosure. Late disclosure also promoted slightly better attitudes than no disclosure. Information scores were
unaffected by disclosure, but were somewhat lowered by the personal, and presumably more anxiety-producing, approach.
In another study, the personal-impersonal variable was
found to have no impact. Experimenters used two versions of a paragraph about mental illness. One employed an impersonal approach ("What is mental illness . .?"); the other, a personal approach ("Have you ever thought how it would be if you were mentally ill?"). High school. students who read each paragraph did not differ in their attitudes expressed through the Semantic Differential.
Presentation style may affect the power of a message to change people. Using an elaborate factor analysis process on stylistic variables found in 70 diverse messages, the researchers determined two stylistic features of probable significance in mental health communications, easy versus difficult wording and negative versus positive tone. Messages judged to have average difficulty and neutral tone were presented in, five forms: the original version and variations combining easynegative, easy-positive, difficult-negative, and difficultpositive composition styles. Groups of college students each read one message in one form and responded on a Semantic Differential to "the message you have just read" and one concept related to their respective messages. They also rated the extent to which they would like to read more about the topic of the message and took a comprehension test on the material.
Although the college students in the study are unlikely
to represent the general population, attitudinal results were
interesting. Difficult negative messages induced more favorable ratings. Difficult negative messages also led to greater preference for further reading. On the comprehension test, however, the students showed they understood less from the negative versions of messages. The significant finding of the study was that larger differences occurred due to the style of the message than due to the ideas and other characteristics contained in it.
During the course of their research, Nunnally became
cognizant of a number of' problems in the terminology available to the general public for describing mental health phenomena. He identified four weaknesses in the language, which affect research as well as public communication) 3:
1. There is a shortage of terms. For the general public, there are no standard equivalents for such terms as "regression" and "catharsis." Thus, even though average people may be able to understand and discuss such matters, they are limited by having a inadequate psychological vocabulary.
2. The language suggests misleading explanations. A valid system for psychological understanding is hindered by the loose and biased usage of some terms in common parlance. The word "intelligence,, is inexactly used. Other terms suggest inco-crect causes, manifestations, and social effects of mental conditions.
3. The language is not well anchored semantically. Although most people use a word such as "neurotic," it is doubtful that they attach it to real-life behaviors. New
terms could be tied to sound, semantic referents, thus decreasing their possibility of misinterpretation.
4. The terms bear strong negative connotations. Some terms such as the word "insane" seem permanently linked with negative attitudes. The public should ben encouraLed to abandon such strongly unfavorable symbols and adopt new ones connotatively neutral.
To illustrate the contention that labels are important
to message communication, Nunnally's group conducted an experiment among 440 high school students. Two paragraphs were designed describing troubled men. Each description had four versions, one introducing the individual as simply "a man," the others referring to him as "mentally ill," "emotionally disturbed," and "insane." Each student read one of the eight versions and reacted to the man on a Semantic Differential. Predictably, labels had a decided effect on ratings, but the effect was less in -the case of the man whose description indicated less disturbance. The -esearchers drew two conclusions from the study:
1. Labels are more influential determinants of attitudes when applied to relatively unfamiliar phenomena.
2. Labels are more influential. determinants when they
are perceived as being realistically related to the phenomena described.
Permanence of Message Effects
When a communication appears to be producing the desired impact, the next consideration is the duration of its effects.
The Nunnally project was composed mainly of short-range investigations, usually the presentation of a very brief message followed immediately by outcome measures. The researchers chose to conduct multiple short--duration experiments, they said, for reasons of practicality and because the early stages of mental health communications research required careful control of variables and ongoing adjustment of experimental designs impossible in. longitudinal studies.
In order to investigate -the permanence of information
effects, the researchers performed a follow-up assessment of the change produced 'by high school psychology classes. Students from seven sections of a psychology course responded to information questiornaires and mental health attitude scales prior to the semester-long course, at the end of the semester, and again six months to one year later. Measured against themselves, the students gained in correct knowledge during the semester (they responded more like psychologists and psychiatrists), and they continued to gain in the following months. Findings were inconclusive, however, because a control group of art students showed approximately the same amount of improvement over the semester's time.
Attitudinal results were similar. Both psychology and art students developed more favorable zittitudes over the semester. On most significant concepts, change scores for the two groups were exactly the same. Tile researchers speculated that pre-test sensitization accounted for the nonpsychology students' increases. Sheer educational maturity was ruled out
as an explanation because correctness of information, but not attitudinal change, is believed to correlate with years of schooling.
The researchers also conducted a shorter term controlled experiment on permanence of attitude change. High school students' favorable mental health attitudes induced by highcertainty messages were found to be undiminished after two and one half months.
According to Nunnally, one way to regard the duration of communication effects is to think of each small message as a "dose." Administration of successive doses with known characteristics can produce powerful arid enduring results. Short messages which are compounded to take advantage of the differential effects of relevant content variables are likely to promote more desirable changes than communication bombardments which are heavy and continual but uncontrolled.
Methods of PreT)aring Clients for Counselin
A recent and promising line of counseling research is the development of systematic procedures for preparing people to understand and use therapy more beneficially. In the last dozen years, reports have been published covering a wide range of therapy-orientation techniques. By far, most of these approaches have been aimed at people already identified as clients, but they have relevance for potential clients as well. Behavioral Techniques
Behavioral techniques in several forms have been put to therapy use. Zarle and. Willis (1975) used "induced affect
training,' a desensitization procedure, with college volunteers to reduce neurotic response to stress in a subsequent eighthour marathon encounter group. Truax and colleagues (1965,
1966, 1968) found evidence that ,Jicarious therapy pretraining," exposure to tape recorded clients modeling high 'Levels of group therapy behavior, raised the "ideal. self concepts" of hospitalized psychiatric patients and incarcerated boys, thus conceivably
producing stronger motivation for therapy.
Behavioral modeling has also been employed to teach clients verbal skills useful in counseling. IVIIyrick (1969) designed a counseling orientation program for eighth graders, the main feature of which was a tape recording of a peer being directed to use self-referencing language. Youngsters exposed to the model, compared with others who received -the program with no tape, made more self-references in a thirty-minute interview. Stone and Stebbins (1975) used procedures similar to Myrick's in a study with college volunteers arid reported similar results. Marlatt, Jacobson, Johnson, and fMorrice (1970) employed a live model who was variously reinforced by a counselor for making problem statements. Neutral reinforcement of the model, and positive encouragement to a lesser extent, induc-ed more problem statements from volunteer clients than negative and discouraging response to the model.
Whalen (1969) compared modeling and instruction as methods of increasing personal openness and concluded that a filmed model preceded by detailed instructions facilitated personal
discussion in groups, while either -the film or detailed
instructions alone were no better than minimal instructions. Doster (1972) assessed the relative efficacy of three methods of eliciting desired client behavior. His results showed that detailed instruction was more effective in producing verbal self-expression than either a taped model client or pretherapy rehearsal through roleplay.
Procedures Related to Client Expectancies
Other approaches have focused on the client's initial anticipations for counseling. Greenberg (1969; Greenberg, Goldstein, & Perry, 1970) experimented with induced pretherapy expectancies by randomly telling clients that they would have therapists who were warm or cold, experienced or inexperienced. Both psychology student volunteers and hospitalized psychotics became more receptive to therapeutic influence when expecting to see warm, experienced counselors. Similarly, Savitsky, Zarle, and Keedy (1976) showed that undergraduate women were
more self-disclosing when they were persuaded to expect an interviewer who was eager to be helpful and from a stressful family background than when anticipating someone with a happy past but unwilling to help. Other researchers (Imber, Pande, Frank, Hoehn-Saric, Stone, & Wargo, 1970), however, attempted without success to manipulate perceptions of improvement by informing outpatients that, on the basis of "psychological tests," they would experience therapeutic change in either
four weeks or four months.
Heilbrun (1972) tested the effects of pretherapy briefing regarding therapist control. Briefing consisted of a booklet
designed to make the client aware that counselors use varying levels of directiveness, any of -y flicjj -an be highly effective, and to encourage the client to be flexible in expectation of
counselor control.. The booklets iere given to iioon and women, rather either high or iow on counseling readiness, likelihoodd of' remaining in therapy), as they applied to a university counseling center. Compared with a control group of clients who received no booklets, only women of high counseling readiness were inore satisfied with their first counseling inter-view, given preliminary briefing. However, briefed low-readiness men and women had less incidence of premature termination than their control counterparts.
Krause (1,968) tried early clarification of client expectations as a means of enhancing motivation for therapy. At the point of telephone intake, agency workers tried to modify client anticipations which were unrealistic and supplement those which were space, using restatement of problem descriptions and probing for implicit or additional problems. The technique did not increase the appearance of clients foxcounseling; nor did it produce high motivation or satisfaction ratings among those who kept their appointments, but therapists observed clients who received clarification to be slightly more open, informed, and responsive than others. In a second study, Krause, Fitzsimmons, and Wolf (1969) extended clarification procedures into the first 6 to 12 counseling sessions and found tentative evidence -that active focusing on positive and negative therapy experiences can raise client motivation.
Special Procedures for Orienting Clients
Research has demonstrated that systematic preparation of clients can help them remain in therapy longer and participate in it more productively. Some procedures were not specifically
designed for pretherapy use but have possble application prior to counseling; for example, teaching clients internalization behavior (Pierce, Schauble, & Farkas, 1970) and "focusing" (Gendlin, 1969; Gendlin & Olson, 1970). One especially elaborate means of assisting clients during therapy, intervention through "structuring and stabilizing," has shown effectiveness with low-prognosis clients. This process, described by Warren and Rice (1972), consists of two types of extratherapy meetings with the client: (a) brief stabilizing sessions, in which a second therapist encourages the client to discuss any problems occurring with the primary therapist or with the therapy, and
(b) structuring session, in which the client is generally informed about therapy procedures and roles and the nature of personality change and then taught, through practice with feedback, to perceive experiences in terms of immediacy and internal focus.
Warren and Rice found that stabilizing alone was highly
successful in preventing therapy defection in the low-prognosis clients but of no particular advantage to therapy results. Clients who received both structuring and stabilizing, however, not only remained in therapy longer b-ut also had high participation levels and experienced considerable therapeutic gain.
Systematic preparation of clients for group therapy has taken several forms: providing participants with written
material on groups (Martin & Shewmaker, 1962), inviting a potential member to attend a trial meeting (Bach, 1954), or using a series of lectures or an instrumental program to explicate therapy and insight (Bettis, Malamud, & Malamud, 1949; Malamud & Machover, 1965).
Yalom, Houts, Newell, and Rand (1967) tested the impact of a 25-minute orientation lecture on groups of middle socioeconomic level psychiatric outpatients. The informal lecture, which allowed for questions and comments, included a brief history of group therapy, research evidence of its effectiveness, general goals, a rationale for understanding the group as a microcosm of interpersonal life, a warning that group
therapy would sometimes be difficult, and advice to be honest and direct with other members. In addition, the participants
were told, deceptively, that their groups were composed of members chosen for maximum compatibility and liking. Compared with control. groups who attended only a 25-minute registration session prior to group therapy, the groups which had received orientation displayed significantly more here-and-now interpersonal interaction and indicated somewhat more faith in group therapy, but increased cohesiveness did not result from the suggestion of compatible group composition.
A seminal development in the preparation of clients for
psychotherapy was Orne's (Orne & Wender, 1968a, 1968b) "articipatory socialization" approach. Orne conceptualized readiness for therapy as a special form of socialization. That is, to use psychotherapy, one must have knowledge about the process
itself, beliefs about its effectiveness, shared values regarding its importance, and particular role expectations--just as it is necessary to have learned appropriate perceptions about one's culture in order to live successfully in it.
As a means of explicit socialization for the client anticipating therapy, Orne designed a pre-therapy interview with three major purposes: (a) to provide some rational basis for the client to accept therapy as a means of help with problems, (b) to clarify the roles of client and therapist, and (c) to provide a general outline of the course of therapy, including its vicissitudes.
The first step in Orne's interview is a rapport-establishing period. While taking a brief history, the therapist indicates sympathetic understanding for the client's problems and makes a few simple comments which would seem highly insightful to the client. The intent in being immediately helpful, reassuring, and supportive is to provide a basis for thp acceptance of the therapist's subsequent statements. This step in the interview, according to Orne, takes a short -time and, fits into the model of the medical relationship already familiar to the client.
Next, the therapist gives -the client an explanation of psychotherapy. In Orne's thinking, "It matters little what rationale is given to help the patient understand psychotherapy. It is important, however, that some rationale be given" (p. 1207). The main points to be covered are that therapy is a learning process and that the goal is to create permanent change rather than immediate, transitory effects. To get these ideas across,
the therapist may provide illustrations alluding to what the client has said earlier.
Questions which arise from the discussion of the therapy
process will undoubtedly lead to the thi-rd step, explicating the therapist's and client's roles. Alt -this stage it is important *to clarify the difference between a psychotherapist and a medical professional% psychotherapy is done not to the client but with the client. It should also be explained that the client's role is to be active, the Th1,erapist's job is to help but not -to advise, the client will always make the decisions, and the client should expect to discuss issues honestly, even though they may be painful, private, or embarrassing.
Before concluding the interview, it is particularly important to address those aspects of therapy which might terminate it permaturely during the early session-s. The client should be cautioned that it is common to feel hopeless or negativistic at times during -therapy and -that, although there may be occassions when it seems impossible to keep an appointment, it is unwise -to interrupt therapy or to end it without mutual discussion, The client, then, is primed to expect "ups and downs" and to bring dissatisfactions with therapy into -the sessions.
Orne's interview has been -the Dasi",s for several studies. One group of researchers modified the procedure, calling it the "Role Induction Interview," and used it experimentally with 20 psychiatric clinic patients (Hoehn--Saric, Frank, Imber, Nash, Stone, & Battle, 1964; Nash, hoehn-Saric, Battle, Stone, Imber, & Frank, 1965). In an extensive analysis of subsequent
therapy behavior and outcome, the clients who received role induction compared favorably with 20 other patients who had no preliminary interview. Major findings were significantly better therapy attendance, session participation patterns, and therapist relationship ratings, as well as higher therapistrated global improvement, self-rated symptom reduction, and social effectiveness as rated in independent interviews. A further investigation into therapist factors revealed that role induction was especially helpful in making clients, particularly males, more attractive to their therapists. The researchers did not determine whether clients are best prepared by their own -therapists or by others, but they did conclude
-that it is most effective to prepare a client specifically for the therapist who will be seen.
Unlike Orne's original anticipatory socialization interview, the Role Induction Interview had conveyed to clients the expectancy that -therapeutic improvement would occur within four months. To determine what part such a time-limited suggestion in itself might play in therapy gain, another group of researchers set up an experiment with four pretherapy conditions: Orne's procedure alone, induced expectation of better functioning in four months alone, both procedures, and no procedure (Sloane, Cristol, Pepernik, & Staples, 1970). Psychiatric clinic clients who received anticipatory socialization showed slightly but significantly more improvement after four months -than clients who were given the time expectation, on measures of social, sexual, and. work adjustment. There
was no difference among groups in symptomatic change or therapy attendance, but clients who received the four-months suggestion were rated by therapists as less likeable than those who did not.
Orne had proposed that other antic ipatory socia.iz~ation
procedures--for example, motion picture films or group methods-might prove helpful. Following this suggestion Strupp and. Bloxom (1973) developed a group version of the Role Induction Interview as well as a role induction film and found both to be highly successful with lower socioeconomic level clients.
The film Turning Point (black and white, 16 millimeter,
32 minutes), depicting a troubled truck driver who reluctantly turns to a mental health center and receives help, was aimed, at community people who were unlikely to seek or accept therapy. It was designed to serve the major purposes of anticipatory socialization outlined by Orne and, specifically, to encourage viewers to consider a number of concepts related -to mental health: that talking about difficulties can be helpful; that
personality change requires work one must do oneself; that some troubles are self-inflicted; that there are adaptive and maladaptive ways of expressing anger, hostility, resentment, and aggression; that peers are potential allies and friends; that personality change takes time and no miracles should be expected;
that medication provides no solutions to the problems of living; that life difficulties are common and can be dealt with by talking about them; and that -there are no "cures" for life stress, only more adequate ways of handling it.
Participants in the study were 122 clients of 12 community agencies, identified as needing psychological counseling in order to reach agency rehabilitation objectives, but minimally motivated to use mental health services. Most had multiple problems of long standing. One third viewed the role-induction film; another third received a group presentation patterned after the Role Induction Interview; and another third, serving as controls, viewed a film on the subject of early marriage.
There was consistent evidence from postinduction, intherapy, and outcome measures that the two role-induction procedures facilitated a more favorable therapy experience. Turning Point was superior to the group presentation on several measures. Prior -to -therapy, for example, both role-induction groups were rated by therapists as more attractive, more strongly motivated, and more likely to improve than control clients. Both groups also rated themselves better along such dimensions as willingness to begin therapy, anticipation of satisfaction with the first session, estimated global improvement, and realistic expectations of improvement. Furthermore, those who were in greatest need of help, according to therapist ratings of' severity of disturbance, tended to experience the most positive reaction to the role-induction procedures. ProvidingInformation to Potential Help Seekers
Research into large-scale provision of counseling information has been scarce, It has also been limited to the college campus. Findings, nevertheless, support the effectiveness of broad, information dissemination and point to the relative worth of several methods.
To evaluate the impact of general counseling center
brochures, Bigelow, Hendrix, and Jensen (1968) distributed brochures to a group of 599 first-year university students but not to a similar group of 865 housed dn a separate dormitory. After six weeks, the informed students had made four times as many counseling appointments as the uninformed students; and informed clients used counseling proportionately more for emotional issues rather than educational and vocational problems. The contents of the brochure, however, were not reported.
At another university, Gelso and McKenzie (1973) did the first comparison of methods for delivering counseling information to potential clients. They devised written and oral presentations to promote student use of their counseling center and, specifically, to underscore the appropriateness of presenting personal problems for counseling. Students living on selected dormitory floors received brief talks which emphasized the appropriateness of presenting both "normal" and "severe" personal problems at the counseling center. The day after, these students received in their mailboxes "a rather typical three-page counseling center brochure" along with a letter from the center's director reinforcing the main points of the oral presentation. A second, comparable group of students received this written matirdal but no oral presentation. A control group was given no information.
On Warman's (1961) Counse-Iii'L A
the students who received both the tulk and the written
information indicated personal adjustment to be appropriate for counseling discussion, more than either other group. On additional questionnaire items, this group was also more in
favor of seeking help with severe peychological problems and, although this item did not attain statistical significance, normal problems; further, they expressed more willingness to seek counseling for personal problems.
During the next six weeks, counseling center records
showed that more students from each information group appeared for counseling than did those from the control group. Students who had received only written information, however, presented
fewer personal adjustment problems than those who received the combination oral and written information.
Duckro, Beal, and Moebes (1976), in a third study, assessed the persuasiveness of a written communication with a highly personal tone. Their study involved a month-long campus media campaign which focused on the services of? the counseling center and particularly on the appropriateness of taking personal and social problems to college counselors. A group of 240 student volunteers had been pretested on the Warman check list prior to the campaign. During the campaign, one-half of the volunteer group received letters similar in content~ to the media messages but more personal in tone. Posttested on the Warman instrument, the letter recipients were more in favor of discussing
personal problems at the counseling center than were the other volunteers.
S urm-a ar v
Although little previous research has explored the disseinination of information as a means of facilitating client self-referral, professional literature has pointed up -the need for reaching potential users of counseling and demonstrated that communications can play an important part in shaping perceptions related to help seeking. It has been shown that the public is not well informed on mental health matters in general or about sources of psychological help. Nor is the public favorably inclined toward psychotherapy. However, there are indications that people are amenable to information which will fill the gaps in their knowledge and that their attitudes can be changed. Specially designed materials and techniques, many of which are primarily informational, have been successfully employed in teaching psychological concepts, promoting positive attitudes regarding mental health issues, and preparing clients for therapy. On college campuses, beginning evidence has been found that presentations of information can influence students, use of counseling center services. Thus the foundation has been laid for the present investigation into the effects of information on potential clients' perceptions of counseling.
This study assessed the effects of written and oral
information upon perceptions of counseling. Groups of high school students were exposed differentially to four treatment conditions:
1. Written information--a booklet describing counseling
2. Oral information--a talk presented by a counselor
3. Combination--both the booklet and the talk
4. Control--neither presentation
The students then completed a questionnaire reflecting their expectancies of counseling and their willingness to use counseling services. It was predicted that students receiving information would demonstrate more positive counseling expectancies and willingness.
A review of the limited research previous to this study
has indicated that information can favorably influence orientation toward counseling. The literature on counseling perceptions shows that, while most individuals regard counselors as helpful people, they are reluctant to seek their services. The public's views of counseling, however, are generally lacking in firmness and clarity. As Nunnally (1961) wrote, such loosely formulated
ideas are subject of modification by communications posed in
an authoritative but nonthreatening way. Therefore, it was
predicted that the informational presentations used in this
study would favorably influence high school students' counseling expectancies and their willingness to use counseling,
as outlined in the following hypotheses:
1. Students receiving -the written presentation of
counseling information (counseling booklet) will
score significantly higher on six measures of
counseling expectancy than control students.
2. Students receiving the oral presentation of
counseling information (counselor talk) will
score significantly higher on six measures of
counseling expectancy than control students.
3. Students receiving the combination form of
counseling information (counseling booklet plus
counselor talk) will score significantly higher
on six measures of counseling expectancy than
4. Students receiving the written presentation of
counseling information will score significantly higher on two measures of counseling willingness
than control students.
5. Students receiving the oral presentation of
counseling information will score significantly higher on two measures of counseling willingness
than control students.
6. Students receiving the combination form of
counseling information will score significantly higher on two measures of counseling willingness
than control students.
The study also explored the comparative effectiveness of
the three forms of information and the main and interaction
effects of -the variables, sex, race, grade level, and school
High school students were chosen as the experimental population because they are an easily accessible group who
represent all segments of a community. high school youngsters, it appears from previous research, hold ill-conceived and often unfavorable perceptions of counseling. They are similar to the general public in this regard.
Participating in the study were 28 classes of high school students, seven sets o:f 4, matched classes, comprising a total
of 645 ninth- through twelfth-grade youngsters. Selection and assignment to treatment groups proceeded by the following steps:
1. Permission to conduct the study in the public schools of Alachua County, Florida, was gained through the Assistant Superintendent's Office of Administration, School Board of Alachua County.
2. Administrators in each of the six county high schools were contacted for approval of the research proposal. Four
schools agreed to host the study: one large comprehensive high school in the urban center of Gainesville and three schools in outlying rural communities. A fifth school could not accommodate the research schedule but did permit the pilot study at an earlier date. The remaining school, whose administration opposed the use of classroom time for the research, was omitted
from the study.
3. In each of the four host schools, the opinion of a
school counselor familiar with the master class schedule determined
the selection of matched sets of four classes. Selecting counselors iised the following guidelines:
a. Select four classes which are approximately
equivalent in student composition.
b. Classes considered "typical" are desired, not
those composed of advanced or exceptional students. Insofar as possible, choose four sections
of a general course in which students are routinely enrolled; e.g., required English or science.
C. Check the four classes for approximate equivalence in sex, race, grade level, and age of
Three schools contributed two sets of four matched classes, and the smallest school provided one set.
4. The four classes in each set were randomly assigned one to each of the four treatment conditions.
The resulting sample consisted of "typical" high school students, heterogeneous in sex, race, grade level, and age, and accessible in their regularly scheduled classes. Two sets of four matched classes were in one urban school, and five sets were in three rural schools. Within each set, the four classes were randomly assigned to the four treatment conditions. Thus, seven classes composed each experimental and control group.
To assess the effects of counseling information, this study employed a questionnaire based closely on the work of previous researchers in the area of perceptions of counseling. Entitled "Counseling Survey," the questionnaire has two parts. Part I measures six differential expectancies of counseling,
and Part II measures two types of counseling willingness (see Appendix A).
Part I: Counseling Expectancies
Part I of the questionnaire consists of 37 statements which begin with either "If I went to a counselor, I would expect to . .11 or "If I went to a counselor, I would expect the counselor -to . ." The respondent is asked to rate each item on a 5-point scale from "not true" to "definitely true." The items represent expectancies of counseling along six dimensions:
1. Counselor Expertise (5 items; e.g., "I would
expect the counselor to know a lot about people
arid their problems. 11)
2. Outcome of Counseling (5 items; e.g., "I would
expect to get the help I want.")
3. Trust in Counseling (6 items; e.g., "I would
expect to speak freely about my problems.,,)
4. Counselor Genuineness (6 items; e.g., "I would
expect the counselor to be a 'real' person, not
just a person doing a job.,,)
5. Counselor Acceptance (7 items; e.g., "I would
expect the counselor to think I am worthwhile.")
6. Counselor Understanding (8 items; e.g., "I would
expect the counselor to know how I feel, at
times, without my having to speak.")
The 37 items were taken from Howard E. A. Tinsley's (1976) revised counseling expectancies questionnaire. Development of the Tinsley instrument was in three stages. Initially, Tinsley collected 88 statements related to counseling perception, a majority of which had been previously evaluated by Lazarus (1971), Truaz and Carkhuff (1967), and Volsky, Magoon, Norman, and Hoyt (1965). He arranged these items into several categories,
administered them as a questionnaire to 109 undergraduate college students, and then calculated the reliability index of each item and the internal consistency of each category. As a result of this analysis, Tinsley produced an 82-item questionnaire with eight scales, six corresponding to the dimensions of counseling expectancy listed above and two others related to counseling procedures and counseling directiveness.
Tinsley next conducted a study among 287 undergraduate
psychology students, using the 82-item instrument. For seven scales, excluding the Counseling Procedures scale, he found internal consistency reliabilities ranging from .69 to .89 and, applying a series of t-tests, determined the mean scale value for each to be significantly different from each other,
except in the case of Trust and Acceptance.
Finally, Tinsley performed an. extensTive item analysis, based on data obtained from 490 subjects, and produced a 43-item version of the instrument, consisting of seven scales having the following Alpha coefficient reliabilities: Expertise (.87), Outcome (.76), Trust (.88), Genuiness (.90), Acceptance (.92), Understanding (.87), Directiveness (.84).
Part I of the questionnaire used in the present study is
essentially Tinsley's short form, except that the Directiveness scale was omitted. To accommodate high-school-aged respondents, two minor deviations from Tinsley's version were made. The original 7-point Likert-type scale was reduced to a 5-point scale. Also, in three items, vocabulary was simplified: "Experience a significant change" was modified
to "have a big change"; "Speak frankly regarding" was changed
to "speak freely about"; "initiate" became "begin."
Fry's (1968) readability formula, applied to Part I,
found the items to be approximately at seventh-grade level of reading comprehensibility.
The questionnaire was subjected to a test of stability,
using the test-retest method, Participants in the reliability study were twenty-two members of a Young Life Christian Club, composed of adolescents attending two urban Gainesville high schools. Five boys and sixteen girls, ranging in age from 14 to 19 (mean age: 16.8), responded to 1.,he questionnaire on two occasions separated by a time interval of three weeks. Productmoment correlations calculated for each scale of the questionnaire resulted. in the following reliability coefficients for the six expectancy dimensions: Expertise (.79), Outcome (.85), Trust (.37), Genuineness (.75), Acceptance (.46), Understanding (.62).
Part Ha: Counseling Willingness
Part II of the questionnaire, evaluating willingness to use counseling, lists ten topics which people often discuss in counseling. Fiv\e items are vocational and educational issues: school work and grades, looking ahead and planning your life, how you feel about teachers and classes, jobs now and in the future, and money matters. Five are personal and social concerns, personal worries, knowingS and understanding yourself better, how you get along wilth your family, how you get along with others your age, and uncomfortable feelings
that you have. The respondent is asked, "If you were concerned with these -things, how willing would you be to talk each one over with a counselor?" For each item, the subject indicates willingness of a 5-point scale ranging from "not at all
willing" to ,very willing.",
This willingness measure, designed for the present study, was modeled after a list of nine problem topics developed and used by Strong, Hendel, and Bratton (1971) and again used by Gelso and Karl (1974) in studies of college student views of found less willingness to discuss personal and social problems with counselors than vocational and educational problems.
Test-retest reliabilities for the willingness scales were
determined by the same procedures described for the expectancies section of the questionnaire, using the same Young Life youngsters. The resulting reliability coefficients were .56 for, Vocational--Educational Willingness (yE) and .71 for Personal-Social Willingness (PS).
The research was carried out during a period of two and one-half weeks in the last term of the public-school year (April 25-IMay 17, 1-977) following a timetable arranged with thie teachers of the participating classes in the four schools (see Appendix B).
Experimental activities for each set of four matched
classes (each set representing the four treatment conditions) required two days' time. On the first day, classroom teachers
distributed the counseling information booklet to two classes. On the second day, the researcher presented the counselor talk to two classes and gathered the questionnaire data in each of the four classes. Figure 1 details the two-day schedule for each four-class set.
Treatment Condition First Day Second Day
1. Written Information Booklet Questionnaire
2. Oral Information Talk, Questionnaire
3. Combination Booklet Talk, Questionnaire
4. Control Questionnaire
Figure 1. Schedule followed for each set of four matched
Counseling Information Presentations
The counseling booklet and talk used in the study were
designed to be brief, simple, economiical, and easily replicable, representing rather traditional counseling information presentations. Their aim is not to "sell" counseling or to persuade people to use it but to help potential clients to feel more comfortable and knowledgeable about counseling services, their availability, and their use. Counseling was realistically presented as a form of assistance for the person desiring to explore and clarify personal issues. In view of the range of
counseling situations which clients may encounter, information regarding therapeutic techniques and underlying theory is non,,pecif'ic.
Development of the information booklet and talk took into consideration the work of Orne and Wender (1968) and Strupp and Bloxom (1973) and the experience of counselors who have worked with youth. The researcher submitted a preliminary draft of
the booklet to five school counselors and several other experienced counselors for feedback, then revised it. The manuscript of the counseling talk also underwent revision, based on the responses of -the students in the pilot study.
The booklet, four typewritten pages illustrated with
line drawings, has a simple text and is entitled "Sometime You May Want to See a Counselor" (see Appendic C).
The content of the booklet is in four parts:
1. When to See a Counselor. The first section explains that a counselor can be consulted for a particular problem or simply to discuss living in general. It reflects the exploratory nature of couseling and emphasizes that whatever is important to the client is worthwhile material for counseling. The purpose is -to make the client feel welcome in counseling and to counter common misconceptions about the limitations of problem appropriateness. This part of the booklet is illustrated with examples of statements which might be made to counselors.
2. Kinds of Counseling. The second part of the booklet describes three types of counseling; one-to-one counseling, group counseling, and family counseling. It goes on to explain
that counseling focuses on both ideas and feelings and that counseling may include both quiet (e.g., talking) and active
(e~g., role-playing) experiences.
3. What Happens in Counseling. The next section gives the reader an outline of what generally occurs during the
course of counseling, from the initial building of a relationship through the final good-bye, an.] it- provides 12 "Do's and, Don'ts" for using counseling effectively (e.g., "Don't expect your counselor to do all the talking. Your counselor will want to do a lot of listening.'). Tjese instructions encourage the client to expect an open and honest interaction and to participate actively in the process.
4. How to Get Counseling. The final section discusses
self-referral. It encourages the individual to "ask around and shop around" in choosing a counselor and suggests three ways to find a counselor: through one's school counselor; by consulting family, friends, teachers, and others; by telephoning. The telephone number of a local free information and referral service is provided.
The booklet was distributed to designated classes on the
first day of the two-day experimental schedule, as explained above, by their classroom teachers. Teachers gave the booklet the following brief introduction: Here is a booklet that you
may find interesting. It is about personal counseling--what happens in counseling and how to gxet counseling if you should want to try it. Teachers provided their students wvith approximately 15 minutes of class time in which to read the material.
The 15-minute counseling information talk covered the same ideas as the booklet, with additional information on who a counselor is and how a counselor is trained (see Appendix
D). It was presented to designated classes, on the second experimental day, by the researcher herself, who was introduced as a counselor from the community who had come to inform the students about counseling. Following the prepared talk, the speaker requested comments and questions from the students and conducted a class discussion for 15 to 20 minutes. Collection of Data
In the classes which received the counselor talk, administration of the questionnaire immediately followed the discussion period. In other classes, it was the sole experimental activity of the second. day. The researcher presented the questionnaire as "a way that you can let us know how you feel about counseling," then explained the instructions and the use of the 5-point scale, and read the survey items aloud to the students. Students were also invited to make written comments at the end of the questionnaire form.
As a preliminary trial of the experimental procedures and materials, a pilot study was conducted with 92 students in four sections of a biology course in an urban Gainesville high school. Student participants were heterogeneous in race, sex, and grade level, and ranged in age from 14 to 19, with a mean age of 15. Each class section received one of the four treatment conditions (written, oral, combination, or control) and responded to the two-part questionnaire. One-way analysis of variance comparing
group responses on each of the 8 questionnaire scales found no significant treatment differences. It was felt that a study
involving a larger and more heterogeneous sample and more indepth statistical analysis warranted completion.
The experience with the pilot group led to three modifications in methodology:
1. A 7-point questionnaire scale had been used in**the
pilot study (as well as in the reliability tests and in Tinsley's original work with counseling expectancies). The scale was simplified to 5 points for easier comprehension by young respondents.
2. The counselor talk, which had been 20 minutes in duration, did not sustain the pilot group's attention well. Consequently, the prepared talk was reduced to 15 minutes followed by a 15- or 20-minute discussion period.
3. At the end of the questionnaire, a space was added for further written comments by the respondents.
Dependent variable scores were obtained from the questionnaire data by summation of the item scores for each scale, as follows:
Part I: Expectancies
Expertise Score Items 1, 26-29
Outcome Score Iitems 2-6
Trust Score Ttems 7-12
Genuinaness Score Items P3-18
Acceptance Score, Items 19-25
Understanding Scorye Izems 30-37
Part II: Willingness
VE Score Items 1, 3, 5, 8, 10
PS Score Items 2, 4, 6, 7, 9
For each of the eight dependent variables, a 4 x 4 x 2 x 2 multiple regression factorial analysis of variance was performed to determine the main and interaction effects of treatment, grade level, sex, and race. Where significance was found involving treatment or grade level, Duncan's new multiple range comparison test was applied to locate sources of difference among means. An alpha level of .10 was accepted for significance in all tests. While this level allowed greater potential for false conclusion than more traditional levels of confidence, the criterion was realistic and practical for the exploratory purpose of the research.
In addition, three other procedures were performed to
explain the data: (a) for each of the eight dependent variables, a 2 x 2 factorial analysis to assess treatment differences by school, (b) post hoc examination of the demographic characteristics of the sample and each treatment group, and (c) calculation of sample norms for each questionnaire scale, in terms of relative scale values.
The purpose of the research was to investigate the
effectiveness of three forms of information--written information, oral information, and the combination of written and oral information--on experimental participants' responses to measures of counseling expectancy and willingness. In addition, the study assessed the effects of grade level, sex, race, and school membership.
The data resulting from the study are presented as
follows: (a) statistical description of the sample, (b) analysis of the experimental results, (c) summary of the experimental results, (d) analysis of school differences, (e) report of sample norms for each questionnaire scale, and (f) summary of the participants' subjective responses.
Statistical Description of the Sample
A post hoc analysis of the demographic characteristics
of the experimental participants determined the composition of the sample by sex, race, grade level, school, and age. It should be noted that 25 students, or 3.9 percent of the sample, failed to provide all personal information requested by the questionnaire; therefore, cases are missing from the descriptive data.
Table I shows sex and race, school, and grade level breakdowns for tI)e four comparison groups. Of the 630 students reporting sex and race, 186 were male Caucasians, 105 were male ethnic minority group members, 217 were female Caucasians, and 122 were female ethnic minority group members. Minority students proved, with only two exceptions, to be Black Americans. Grade level was reported by 633 students. There were 183 participants from the ninth grade, 199 from the tenth grade, 178 from the eleventh grade, but only 73 from the twelfth grade. The disproportionately small numbe-r of twelfth-grade students was the result of school scheduling of mixed-graded classes. School representation was 181 students from School A (urban school) and 167, 199, and 98 students from Schools B, C, and D, respectively (rural schools). The lower number of students from School D reflects the participation of only one set of four classes in this smaller institution.
The mean age of the participants was 15.9. Mean ages
for the comparison groups were as follows: Written information group, 15.9; Oral information group, 15.3; Combination information group, 15.9; Control group, 15.4.
Analysis of Experimental Results
For each of the eight dependent variables, a separate 4 x 4 x 2 x 2 factorial analysis of variance (treatment by grade by sex by race) was performed, applying multiple regression procedures to correct-, for unequal cell size. Where factor effects were found to be significant at the chosen .10 confidence
Composition of' Comparison Groups by Sex and Race, Grade, and School
Written Oral Coamb. Control Total
Males 73' 86 78 54 291
Caucasian 53 51 49q 33 186
Minority 20 35 29 21 105
Females 89 73 87, 9039
Caucasian 55 44. 61 57 21.7
Minority 34 29 26 33 122
Grade 9 40 4b 37 62 183
Grade 10 53 30 63 53 L'99g
Grade 11 28 72 52 26 178
Grade 12 40 15 1.5 3 73
School A 47 51L4 41 181
School B 52 45 117 23 167
School C 4.o 50 56 53 199
School D 24 24 2-3 27 98
level, group means were assessed, and comparison tests employed as required, to locate sources of difference.
The following is a report of the data analysis for the
six expectancy variables--Expertise, Outcomre, Trust, Genuiieness, Acceptance, and Understanding--and two willingness variables--Vocational-Educational (VE) and Personal-Social
(PS). It should be noted that scores from subjects who did not complete all items of a que tionnaire scale were omitted from the analysis of that scale. Expertise
Ninety.-one percent of the sample completed the Expertise scale of the questionnaire. The highest possible Expertise score was 25, and the total sample score mean was 19.8.
For this dependent variable, the factorial analysis of variance indicated no significant main effects for treatment (F=1.795; df'=3; p> .10). A s ignii'icant difference was found for the main effect of sex (F=2.925; df=l; p<.10). There was also one significant interaction, treatment with sex (F=1.968; df=e; p. 1.0). The Expertise score f:actorial analysis of variance is presented in Table 2.
The absence of significant main effects for treatment
provided no support for the experintental prediction that information would affect counseling expectanci.es. Treatment means are reported in Table 3.
The sI gnificant effect of sex wa i further evaluated by referring to mean scores for males and females. As Table 4 shows, females' Expertise scores were. higher.
Expertise Score Factorial Analysis of' Variance
Source of Variation SS df MS F
Main Effects 192.45 8 24.06 1.509
Treatment 85.81 3 28.60 1.795
Grade 4.44 3 1.48 0.093
Sex 46.61 1 46.61 2.925*
Race 4.86 1 4.86 0.305
Two--way Interactions 464.58 22 21.12 1.325
Treatment Grade 282.34 9 31.37 1.968*
Treatment Sex 12.17 3 4.o6 0.255
Treatment Race 33.47 3 11.16 0.700
Grade Sex 64.09 3 21.36 1.340
Grade Race 45.01 3 15.00 0.941
Sex Race 21.46 1 21.46 1.346
Explained 804.36 30 26.81 1.682
Residual 8876.98 557 15.94
Total 9681.34 587 16.49
Expertise Score Means by Treatment
Written 157 20.01
Oral 155 19.52
Combination 161 18.93
Control 138 20.59
Expertise Score Meajns by Sex
Males 275 19,37
Females 328 20.08
Ninety-one percent of the sample completed the Outcome scale of the questionnaire. The highest possible Outcome score was 25, arnd the total sample score mean was 16.5.
For this dependent variable, the factorial analysis of
variance indicated no significant main effects for treatment (F=1.842; df'=3; p>.10). Significance was found for the main effect of race (F=14.308; df=l; p<.10). There were also two significant interactions, treatment by sex (F=4.252; df=3; p<.10) and grade by race (F=2.424; df=3; p <.10). The Outcome score factorial analysis of variance is presented in
The absence of significant main effects for treatment furnished no support for the experimental prediction that information would influerce counseling expectancies. Treatment means are reported in Table 6.
The significant effect of race was evaluated by referring
to score means for Caucasians and minority students. As shown in Table 7, minority students had higher Outcome scores.
Outcome Score Factorial Analysis of Variance
Source of Variation SS df MS F
Main Effects 561.95 8 70.24 4.329
Treatment 89.67 3 29.89 1.842
Grade 80.58 3 26.86 1.655
Sex 27.45 1 27.45 1.692
Race 232.16 1 232.16 14.308*
Two-way Interactions 567.82 22 25.81 1.591
Treatment Grade 122.22 9 13.58 0.837
Treatment Sex 206.99 3 69.00 4.252*
Treatment Race 39.05 3 13.02 0.802
Grade Sex 91.26 3 30.42 1.875
Grade Race 118.01 3 39.34 2.424*
Sex Race 3.39 1 3.39 0.209
Explained 1309.56 30 43.65 2.690
Residual 9037.76 557 16.23
Total 10347.32 587 17.63
*p <. 10
Outcome Score Means by Treatment
Written 154 16.88
Oral 154 16.39
Combination 163 15.90
Control 139 16.68
Outcome Score Meians by Race
Caucasian 392 15,91
Minority 207r 17.54
Ninety-two percent of the sample completed the Trust scale of the questionnaire. The highest possible Trust score was 30, and the total sample score mean was 22.2.
For this dependent variable, factorial analysis of variance revealed significant main effects for treatment (F=2.468; df=3; pA.10) and for sex QF=10.412; df=3; p<.10). There was one significant interaction, grade by sex (F=2.425; df~K3; p<.10). The Trust score factorial analysis of variance i0 presented in
Main effects of treatment were examined to locate sources of difference, using Duncan's new multiple range test; however, this procedure indicated no significant comparisons at the .10 level, due to an apparent psychometric idi osyncrasy related to the partitioning of variance in mult iple regression factorial analysis. A follow-up two-tailed t-test was performed, comnparing the highest and lowest mean. This test uncovered a significant difference favoring the control group over the written information group (t=1,645; p<.10). This result did not support the experimental prediction that information would
produce more positive counseling expectancies than the control condition, Treatment means are reported in Table 9.
Trust Score Factorial Analysis of Variance
Source of Variation SS df MS F
Main Effects 593.30 8 74.16 3.276
Treatment 167-59 3 55.86 2.468*
Grade 27.95 3 9,32 0.412
Sex 235.68 1 235.68 10.412*
Race 31.60 1 31.60 1.396
Two-way Interactions 529.62 22 24.07 1.064
Treatment Grade 173.60 9 19.29 o.852
Treatment Sex 125.14 3 41.71 1.843
Treatment Race 42.23 3 14.08 0.622
Grade Sex 164.68 3 54.89 2.425*
Grade Race 65.46 3 21.82 0.964
Sex Grade 3.57 1 3.57 0.158
Explained 1151.29 30 38.38 1.695
Residual 12652.91 559 22.64
Total 13804.20 589 23.44
Trust Score Means by Treatment
Written 158 22.45
Oral 159 21.75
Combination 161 21.73
Control 134 22.69
The significant main effect of sex was evaluated by referring to score means for males and females. As Table 10 shows, females, Trust scores were higher.
Trust Score Means by Sex
Males 279 21.30
Females 32-5 22.96
Genuine ne ss
Ninety-three percent of the sample completed the Genuineness scale oft the qu.estionnaire. The highest possible Genuineness score was 30, and the total samiple score mean was 26.1.
For this dependent variable, factorial analysis of variance indicated no significant main effects for treatment (F=
0.446; df=3; pW-10). Significant main effects were found for sex (F=21.799; df~l; paC.10) and for race (F=5.182; dfl; p<.10). There was nio significant interaction. The Genuineness score factorial analysis of variance is presented in Table 11.
The absence of significant treatment effects provided no support for the experimental prediction that information would
affect counseling expectancies. Treatment means are reported in Table 12.
The significant effects of sex and race were evaluated by referring to group means. As Table 113 shows, females and Caucasians had higher Genuineness scores.
Genuineness Score Factorial Analysis of Variance
Source of Variation SS df MS F
Main Effects 538.41 8 67.30 3.883
Treatment 23.17 3 7.72 0.446
Grade 14.64 3 4.88 0.282
Sex 377.88 1 337.88 21.799*
Race 89.82 1 89.82 5.182"
Two-way Interactions 275.93 22 12.54 0.724
Treatment Grade 137.01 9 ].5.22 0.878
Treatment Sex 12.15 3 4.05 0234
Treatment Race 2.75 3 0.92 0.053
Grade Sex 104.72 3 34.91 2.014
Grade Race 15.39 3 5.13 0.296
Sex Race 0.93 1 0.93 0.053
Explained I135.34 30 37.85 2.183
Residual 984,5.88 568 17.33
Total 10981.22 598 18,36
*p < .10
Genuineness Score Means by Treatment
Written 161 26.40
Oral 156 25,61
Combination 163 26.11
Control 140 26.05
Genuineness Score Means by Sex and Race
Male 279 24.97
Female 333 27-03
Caucasian 395 26.41
Minority 215 25.44
Ninety-three percent of the sample completed the Acceptance scale of the questionnaire. The highest possible Acceptance score was 35, and the total sample score mean was 29.0.
For this dependent variable, factorial analysis of variance revealed significant main effects for treatment (F=2.874; df=3; p< .10) and for sex (F=20.055; df=l; p <.10). There was no significant interaction. The Acceptance score factorial analysis of variance is presented in Table 14.
Plain effects of treatment were examined to determine sources of difference, using Duncan's multiple range test. As Table 15 indicates, five pairwise comparisons were significant at the .10 level, No difference appeared between the scores of the control and the oral information groups; however, the written information group scored significantly higher than each other group, while -the combination group scored significantly lower than other groups. This provides support for the experimental prediction that information would favorably influence counseling expectancies in the case of written information only.