| Description |
A number of observations and comments have been made in presenting the dta and require little repetition. The therapist sample, by the nature of the experiment was small (n=7) and behooves one to rely on statistical data to strengthen the observations made. Nevertheless, the experimental design was interesting and the author believes there is merit in repeating the experiment with modifications which will be discussed later. In summarizing, the author would like to focus on those findings which seemed most intriguing and have research potential. Using a given patient for the duration of the experiment allowed an opportunity to study seven therapists interacting with the patient and eliminate the variables introduced by using multiple patients. Furthermore, the continuously conducted experiment eliminated the uncontrolled variables such as day to day mood swings, contacts with family and friends, occurrences and events, all of which tend to alter the perception of the patient toward the interview and toward the therapist. In utilizing this particular patient, the combined skills of the seven therapists were insufficient to bring about behavioral or other changes in the patient. It would appear that time is of importance in psychotherapy and although it is possible to condense the element of time compactly, the condensation did not lead towards a summation of the amount of effort expended. The patient met the criteria that had been decided prior to the experiment but questions should be raised as to the choice made. Although desirous of help, she seemed incapable of responding to the help that was offered, and the experiment demonstrated little of what is traditionally thought of as being psychotherapy. It would be of interest to speculate on the outcome of the thirteen hour transaction had the patient been of a more curious and inquiring nature. The rank order survey may have been quite different in outcome as well as the therapists' responses to the patient and the verbal productions resulting from this interaction. An important parameter overlooked was an attitudinal study of the therapists. It may have explained the relative rank order positioning on the basis of authoritarianism (Wallach 1960), anxiety level (Luborsky 1952, Bandura 1956) or degree of therapist confidence (Frank 1958). The analysis of the transcript demonstrates that is possible to examine the data by counting words and questions, and utilizing statement categories and interaction rates. The statement categories of affective words and clarifications were too subjective and were not duplicable. Some speculation should be offered for the finding that increased numbers of questions directed towards the patient diminish the total number of questions asked by the patient during the same hour. What would have been the results of bombarding the patient with questions continuously throughout the duration of the experiment? It is possible that the patient might become overwhelmed and her defenses crumble. It is equally possible that the results would have been for the patient to "tune out" the efforts of the therapists. There is need for further verification to determine whether or not this finding is independent of the patient or if, in fact, it varies with the type of patient used as the experimental subject. The Strong Vocational Interest Data and demographic data had no significant relationship to the finding obtained, but relationships may become clearer as the therapist sample enlarged. It is doubtful that our parameters are measuring Whitehorn and Betz's findings which in themselves were note clearly defined (1954, 1960). The rank order survey would support the reports of others (Kelley 1949), Polansky 1956), Heller 1961) that a significant factor in psychotherapy is related to the patient liking the therapist and may be indirectly being appraised by the various rater groups. It should be noted that in this experiment, the patient was not studied and the reactions of the patient were overlooked as our primary interest was to control the variable of the patients. Inasmuch as professionals and non-professional rate the seven therapists similarly, professional training and experience does not become an important determinant in the rank ordering of the therapist. It may be that both groups rely on stereotypes of what "good" therapists are, and that this constitutes the major criterion by which rank ordering was performed. This stereotype may closely approximate the qualities found in charisma and has important implications in psychotherapy. The charismatic leader by virtue of his special qualities is able to command without assertion and may even disrupt the established lines of communication of social institutions and cast doubt on the legitimacy of established authority (Weber 1947). The raters may be attracted to the charismatic qualities of the therapists in formulating their stereotypes. If the rank order survey is measuring stereotypes, patients would also be influenced in a like fashion and the outcome of psychotherapy may be partially determined by the therapists' ability to conform to the expectation of the patient. The adjective check list might be a valuable aid to determining the existence of a stereotype in both professional and non-professional groups. The departure of the participant therapists' wives and the junior therapist in the rank order survey from the other rater groups requires further study to determine the nature of this difference. Intrapsychic factors have been postulated earlier but need verification. The greatest concern in initiating the experiment was the unpredictability of embarking on a study with potential hazard for the patient. Long before the conclusion of the thirteen hour experiment it became obvious that the patient was quite capable of coping with the combined therapeutic skills of the Department of Psychiatry. In fact, the participant therapists were demonstrably fatigued while the patient emerged unscathed and seemingly ready to repeat another thirteen hours. At the conclusion of the experimental period and in follow-up interviews spanning a two year interval, the patient maintained her basic character structure and her assumptive world (Frank 1961) remained unchanged. It would appear that the investigator fell victim to the belief of the omnipotent role of the therapist and overlooked the natural resiliency of the patient. If the study had been abandoned, the author might still be bound by conventionality into investigating "safe" problems and continue to live with the fantasy of his own omnipotence. |
