A comparison of clinical manifestations of hostility with Rorschach, and MAPS test performances

Citation preview

A COMPARISON OP CLINICAL MANIFESTATIONS OP HOSTILITY WITH RORSCHACH, AND MAPS TEST PERFORMANCES

A Dissertation Presented to the Faculty of the Department of Psychology The University of Southern California

In Partial Fulfillment of the Requirements for the Degree Doctor of Philosophy

by Robert G-regory Walker June 1950

UMI Number: DP30400

All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a complete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion.

Dissertation Publishing

UMI DP30400 Published by ProQuest LLC (2014). Copyright in the Dissertation held by the Author. Microform Edition © ProQuest LLC. All rights reserved. This work is protected against unauthorized copying under Title 17, United States Code

ProQuest ProQuest LLC. 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, Ml 4 8 10 6 - 1346

Pk-

0-

Ps

;i~o

u^/^3

T h is dissertatio n, w r it t e n by

....... ROBERT.. G J R E G O R Y J V A L K E R ....... u n d e r the g u id a n c e o f h.. i.S..F a c u lt y C o m m itte e on S tudies, a n d a p p ro v e d by a l l its m em bers, has been presen ted to a n d accepted by the C o u n c i l on G ra d u a te S tu d y a n d Research, in p a r t i a l f u l ­ f il l m e n t o f re q u ire m e n ts f o r the degree o f DOCTOR

OF

P H IL O S O P H Y

ean

S

D ate.

3 3 ..

¥< Com m ittee on Studies

ACKNOWLEDGMENTS Grateful acknowledgment is made to the many people who made this study possible.

The author is indebted to

Dr. S.M. Wesley and the other members of his doctoral committee for helpful guidance and criticism.

A debt of

gratitude is acknowledged to the Veteran’s Administration for the magnificent cooperation and assistance received. A special vote of thanks is made to the psychotherapists who gave so generously of their time and efforts.

While

it is difficult to acknowledge all the people who helped, it would be impossible not to mention Dr. Ruth Tolmari, Dr. Bruno Klopfer, Dr. Mortimer Meyer, Dr. Marshall 'Wheeler and Dr. Edwin Shneidman.

Greatest gratitude is expressed

to the author’s wife, Wilma, to whom this study is dedicated, for her unstinting efforts in preparing the manuscript.

4

TABLE OF CONTENTS CHAPTER I.

PAG-E

THE PROBLEM AND DEFINITION OF TERMS USED . . The problem

1

Statement of the problem . . .........

1

Importance of the study

. ...........

1

Definition of terms used . . ............

2

Hostility

II.

.

1

...........................

2

Hostility patterns...................

Ip

Defensiveness........ . .............

Ip

O b j e c t...............................

Ip

C o n t e n t .............

5

REVIEW OF THE LITERATURE.................

6

General manifestations of hostility

6

. .

Causes of h o s t i l i t y .................

12

Manifestations of hostility in projective

III.

test m a t e r i a l .....................

lip

SOURCES OF D A T A ..........................

26

The patient population .................

26

The source of the therapy ratings

30

....

The tests administered..................

3k-

The Rorschach T e s t ...................

3&

The Make A Picture Story T e s t ........

3&

The Rosenzweig Picture-Frustration S t u d y ................. ............

39

iv CHAPTER

VAGE

The Hostility Questionnaire......... IV. PROCEDURES................................ The therapy r a t i n g s ................... Distribution of the therapy ratings

Lj_l Li-5 Ip5

. .

Treatment of the therapy ratings . . . .

Ii9

The Rorschach T e s t .....................

55

The Make A Picture StoryT e s t ...........

65

V. R E S U L T S ..................................

70

Statistical treatment ofthe data

....

71

Principal findings .....................

73

Supplementary findings..................

Qli.

VI. DISCUSSION................................

92

VII. SUMMARY AND C O N C L U S I O N S ..................

98

S u m m a r y ...............................

96

Conclusions

.

.............

100

BIBLIOGRAPHY...................................

lOlf.

APPENDIX.......................................

109

LIST OP TABLES TABLE

PAGE

I. Age and Education of the Patients........ II. III.

27

...

28

Interval Between Testing and Rating . . . .

i{-6

Diagnostic Groupings of the Patients

IV. Inter-correlations of all Parts of the Rating Scale with each other and with the Over-all R a t i n g .......................

50

•V. Coefficients of Correlation Between Humber of Rorschach Responses and Rorschach Hostility S c o r e .................................

59

VI. Correlations between Ratings of Hostile Content by the Three Rorschach Judges . . VII. VIII.

Inter-correlations among Rorschach Judges .

62 61p

Guide Sheet for Scoring Hostility In the MAPS T e s t ...........

. . .

68

IX. Correlations between Therapy and Test Ratings..................... '.........

7l|_

X. Rorschach, MAPS and Questionnaire Inter­ test Correlations ..................... XI.

76

Correlations betvfeen some Hon-weighted MAPS Scores and Certain Parts of the Therapist Rating Scale

................

80

TABLE XII.

Correlations between the PictureErustration Study and Therapists1 Ratings ...........................

XIII.

'.

Correlations between Rorschach Hostility Scores and Various Parts of the Therapy Rating Scale

XIV.

.......................

Correlations between Length of Contact in Therapy, Age, Education, Diagnosis and the Therapy and Test Ratings

........

CHAPTER I THE PROBLEM AND DEFINITION OF TERMS USED I.

THE PROBLEM

Statement of the problem.

The purpose of this study

is to determine the relationships between estimates of hostility ba.sed on certain psychological test performances and clinical judgments based on therapeutic Interviews. Importance of the study.

Some reference to hostility

and its relation to personality adjustment is made in an appreciable proportion of all psychodiagnostic reports. Similarly, the psychotherapist finds almost Invariably that his patients manifest, to a greater or lesser degree, diffi­ culty In handling their hostile feelings.

Indeed, it is

felt by many clinicians that neurotic hostility patterns play a decisive role in the emotional disturbance of most individuals who seek therapy.

Horney (23) believes that

hostile Impulses of various kinds form the main source from which neurotic anxiety springs. One of the primary functions of psychological testing Is to help the therapist gain insight into the psychodynamics of his patient*

If the psychodiagnostician is to contribute

toward a better understanding of the patient’s hostility pattern, then, it is necessary that it be shown that

2 dependable relationships exist between the patient’s performance on our tests and his behavior in the thera­ peutic situation. Interest in hostility among psychodiagnosticians and therapists is understandable in view of the fact that this concept is such an essential one in the dynamics of human behavior.

Penichel (l6) discusses in almost every

type of psychiatric maladjustment the various dynamic effects of neurotic hostility upon personality functioning. In a recent book on the development and dynamics of personality, Saul (Ij-2) writes There is no more fateful motive force in man than hostility--it is essential for his survival but it also produces neurosis, criminality, war and social unrest . . . Hostility is one of the most difficult forces in human beings to domesticate. Necessary-and useful as It is in certain circumstances, such as under primitive conditions of nature in killing for food and in selfdefense, it is one of the greatest sources of human suffering. For civilized man, neither wild bea.sts nor the forces of nature nor even the dread germs of disease are the greatest cause of suffering. It is the hostility within man himself which is directed against his own kind. (ij-2 , p. 108) A final indication of the importance of investigation in this area is the extremely limited information available from previous research. II. Hostility.

DEFINITION OF TEEMS USED This term refers to any behavior (including

affective orientation, feelings or sets) motivated by the

3 wish to attack, belittle, thwart, or destroy an object. The* particular form, whether direct or indirect, the direction, and the intensity of this behavior are not implied in the term. forms.

Inimical and malevolent feelings may take many

These feelings may be expressed directly in motor

behavior--striking, kicking at the hated object; or they may be expressed verbally, with various levels of directness-criticizing, ridiculing, causing harm to or killing an object in fantasy. The hostility may be directed towards the self, another individual, group of people, institution, or an inanimate object; and the intensity may vary from mild feelings of pique to uncontrollable rage. Although many authorities (13, 2lj_, 37) use the term "aggression" more or less interchangeably with "hostility," a distinction should be made between the two terms.

Saul (ij-2)

in a succinct statement of this differentiation points out Resentment, anger, hate, violence, cruelty and similar aggressive, destructive impulses can be subsumed under the term hostility. "Hostility" is more precise than "aggressiveness," which is ambiguous in that this also implies initiative and activity which are not necessarily "hostile." (14-2 , p. 108) _ It is not within the scope of the present Investi­ gation to explore this controversy.

Instead, Inasmuch as

the present writer is in agreement with Saul that hostility and aggression are not synonoraous, the two terms will not

k

be used interchangeably in the remainder of this report except when reference is made to the works of others where aggression is given the same meaning as hostility. Hostility Patterns.

This term refers to the

varying combinations of hostile behavior and defenses against this hostility which may be manifested by an individual.

Thus, to mention a few illustrations, there

might be direct verbal hostility of marked intensity with little guilt displayed; hostile wit, mild in intensity followed by expressions of warmth, as if to undo the hostility; barbed criticism of another with subsequent signs of anxiety, and so forth. Defenses.

This term denotes types of behavior which

are utilized by an individual to reduce or alleviate unpleasant feelings related to behavior which he considers in some way to be morally wrong or emotionally dangerous, or which threaten him with anxiety or guilt. Object. This term is used both in the sense, where itrefers to a person with whom

psychoanalytic an individual

has some emotional relationship, and in the non-analytic sense, where itmeans any concrete thing.

In

certain

instances, this term will be used generically where it will refer to both types of objects.

The meaning will be

apparent in the context in which the term is used.

5 Content.

This term refers to that which the subject

sees in the projective material as distinguished from how he sees it.

Thus, in analyzing the protocols of the Rorschach

and Make A Picture Story Test, hereinafter referred to as the MAPS Test (lp7) the present study will be concerned with the content rather than the formal aspects of the responses.

CHAPTER II REVIEW OP THE LITERATURE A review of the literature pertinent to a study of hostility would seem to fall Into three parts.

First, there

are hooks and publications which discuss hostility in terms of physical symptoms and general behavior.

Second, there

are publications concerned with hostility at a more theo­ retical level which discuss its causes, and its effects on the individual and society.

Third, there are many sources

in which as yet unvalidated test signs of hostility are reported by clinicians; and a few studies in which there has been an experimental attempt, to relate psychological test signs of hostility to some outside criteria. I.

GENERAL MANIFESTATIONS OP HOSTILITY

Behavioral studies.

A great many observational

studies of hostility have been conducted with children as subjects.

Baruch (2), basing her observation on forty-six

nursery school children engaged in doll play, found that two-thirds of the group manifested hostility in some form. Some of the individual differences she noted among children were:

the denial of any feelings of hostility, manifesta­

tions of guilt over the expression of hostility, self­ directed hostility after displaying anger, and open

7 acceptance of hostile feelings. The well-known sibling-rivalry experiments by David Levy (26,27) point to rather similar findings in respect to the hostility patterns of children.

Using a mother-baby

doll set which was capable of being taken apart by children, Levy studied certain aspects of sibling rivalry.

Some

children tended to escape from the hostility stimulating situation, others displayed their aggressions in somewhat devious ways; for example, by displacing their hostility onto other toys, attacking the mother or baby doll from a distance, etc.

In most cases, there was some form, of

restitution after the hostility was expressed.

Thus some

children would rationalize ffYou let me do it so it’s all right;” others would punish themselves in some way. In a discussion of aggressive patterns in children, Lois Murphy (35) mentions constitutional factors as one probable caiise of different aggressive patterns.

She writes

Constitutional differences are at least indirectly involved . . . four-year old boys use aggressive behavior in different situations; one is aggressive only when blocked or frustrated or interfered with; another is aggressive when he is afraid; another is aggressive as a way of enhancing his sense of bigness. (35> P- 668) Lewin (28), in a study of the effects of different social climates on hostility patterns in slightly older children, reports that hostility was thirty tim.es as frequent in an autocratic group as in a democratic group.

He mentions

8 "joking” hostility as a fairly common form employed by the children. Hostile humor has been observed much more frequently among adults, and is apparently a more socially accepted way of expressing hostility.

Sears and his co-workers (ij-6 )

had twenty-one college student volunteers remain awake twenty-four hours as a form of frustration.

He found that

hostile humor was particularly prevalent among the subjects in the experiment.

Other forms noted were sarcasm and

symbolic displacement (i.e., very hostile destructive drawings). In a comparable study by McClelland and Apicella (29), hostile behavior was elicited among a group of college students by deliberately frustrating them in a card sorting task.

Their findings tend to parallel those of the previous

Investigators; hostility was expressed both directly and Indirectly and in some cases was inhibited.

In general, the

authors report that the more the subjects were frustrated, the more overt were their hostile reactions.

An Interesting

subordinate finding was the fact that two judges independently rating the subjectsT aggressive responses agreed very closely (correlation ■ *97)• Physiological correlates.

Studies of emotion date

back to the time of Darwin (11) who recognized that very

9 different emotional states may have the same or very similar somatic accompaniments.

In 1905 he commented on the pallor

characteristically present in states of both rage and terror (11, ppt

7 k - f 77).

The research of W,B, Cannon (7), and others

who followed him, has clarified the physiological nature of rage and other

emotional states.Cannon describes

the behavioral

level in this way

rage at

Prom the physiological point of view an emotion Is a typical reaction pattern. Let us consider rage as an example. In its extreme form the signs of rage include the crouching body, the moist or frowning brow, the firm lips, the clenched or grinding teeth, the growled threats or imprecations, and the tightened fists or the seized weapon ready for attack. (7, P« 24-3) Later, in discussing physiological changes common to different emotional states, he writes So far as these two quite different emotions Qfear and rage] are concerned, present physiological evidence Indicates that differences in visceral accompaniments are not noteworthy--for example, either fear or rage stops gastric secretation. There is, indeed, obvious reason why the visceral changes in fear and rage should not be different, but rather, why they should be alike« As already pointed out, these emotions accompany organic preparations for action, and just because the conditions which evoke them are likely to result in flight or conflict (either one requiring perhaps the utmost struggle), the bodily needs in either response are precisely the same. (7, pp* 34-2-34-3 ) Wolf and Wolff (53)? on the other hand, have since reported differences in physiological reactions associated with states of fear and hostility.

Their observations were

made on a fifty-six year old man who, following an accident In childhood, had a surgically produced gastric fistula

10 which permitted a direct view 01 part of the stomach lining. The subject was observed over a long period of time and a careful record was kept of both physiological and emotional changes.

They noted that

Emotions such as fear . . . were accompanied by pallor of the gastric mucosa and by inhibition of acid secretion and contractions . . . Emotional conflict involving . . . hostility and resentment was accompanied by accelerated acid secretion, hypermotility . . . and engorgement of the gastric mucosa . . . (53? P* 173) Arnold (l) has since made an evaluation of recent research in this area and asserts that there are three different physiological states corresponding to three emotions:

"Fear, with predominately sympathetic excitation;

Anger, with strong parasympathetic excitation; and Excitement or elation, with moderate parasympathetic activity. fT These conflicting reports suggest that further investigation into physiological processes accompanying emotional states is necessary.

All three studies indicate,

however, that an emotional state such as hostility is associated with marked physiological changes. Commenting on psychological factors in organic disease, Karl Menninger points out That this conflict [repressed aggressivenes0 . . . may be expressed by increased blood pressure is almost common knowledge. Plethoric, irascible old men are constantly expected . . . by their relatives to die in an attack of rage. They themselves use this as a weapon against other people. Was it not Clarence Day’s father who used to fend off invitations by reminding his long-suffering family to "look out for my blood pressure"? (31? p. 378)

11 Saul (I|_3) made a study of essential hypertension and among his conclusions mentions chronic, unsuccessful hostile rebellion against unsatisfied passive-dependent strivings as one of the key dynamics to the understanding of this psychosomatic disorder.

He further states that in

these patients the hostility Is near to awareness but since no way is found to express It, the individual is neither weak and dependent nor aggressively hostile; he 1s blocked in both directions.

Saul discovered that if either trend was

temporarily gratified, the blood pressure was lowered markedly.

The author points out, however, that inasmuch as

these findings are based on a very small number of cases, they are only suggestive. In a statistical study of the psychosomatic component In 100 child behavior problems, Deutschberger (12) found less overt hostile aggressiveness in those individuals who manifested psychosomatic disorders.

His interpretation is

that in the psychosomatic individuals, energy which otherwise might be expended in hostile destructiveness is "anchored” or tied down In somatic complaints.^ Referring again to observations on children, Murphy (35) remarks

^ Related to this observation Is CleckleyTs (8) assertion that the anti-social, psychopathic personality tends to be strikingly free from physical illness.

12 . . . Children who have learned to deal aggressively with conflict situations by kindergarten age are less likely to be neurotic than those who do not have this opportunity. There is considerable justification for this assumption in Charlotte Bilhler’s unpublished data on English children, who, more socialized than Austrian children, show many more psychosomatic difficulties of enuresis and gastric-disturbance type than do children in the groups with more social difficulties. (35, p. 67i+) II.

CAUSES OP HOSTILITY

Writers of both the psychoanalytic school and the frustration theory take the position that the origin of aggression lies in the experience of the individual.

Stress

is laid heavily upon frustrations in psycho-sexual develop­ ment in early childhood by the analytic school.

Dollard (13)

and his colleagues, on the other hand, accept frustration in any sphere of activity as a source of aggression.

However,

they too recognize the powerful role of the family and give it a (high place in assessing the origin of aggression.

1 In 1939 under the joint authorship of John Dollard, Leonard W. Doob, Heal E. Miller, O.H. Mowrer and Robert R. Sears, the book Frustration and Aggression (13) was published. This was perhaps the first systematic attempt outside of the psychoanalytic framework to explore the causes of hostility. Simply stated, the authors argue that frustration causes aggression.

The Yale group defined frustration as ,fthat

condition which exists when a goal-response suffers inter-

13 ference," (13, p. 11).

There has been some confusion,

however, as to what actually constitutes frustration. Maslow (30) points out that frustration involves two concepts--deprivation, and threat to the personality. He illustrates this distinction by the following:

One

child, reasonably seciire of his mother’s love, is refused an ice cream cone by his mother and suffers only deprivation; another child unsure of his acceptance by the mother might look upon the thwarting of his desire for the ice cream cone as evidence of rejection. Zander (55) qualifies the term frustration by stating that there is interference only when the goal is believed, both important and attainable by the individual. Since the frustration-aggression hypothesis was advanced by Dollard and his co-workers, there has been considerable■criticism and discussion of this theory in the literature.

Sears (Ij-5) in a recent article mentioned

several non-aggressive reactions to frustration.

He sum­

marizes these non-aggressive reactions under three headings: (1) Repetition of the same behavior (for example, stereotypy in feebleminded individuals), (2) Different instrumental acts with the same goal (for example, phantasy gratification), (3) Different instrumental acts but with different goalresponse (for example, substitute responses).

Sargent (Ij.1 )

and Morian (33) among others have argued that aggression

h

is not the inevitable response to frustration as suggested by the authors of Frustration and Aggression. It should be noted* however, that as far back as 19^1 Miller (32) published this revision of the frustrationaggression hypothesis Frustration produces instigations to a number of different types of responses, one of which is an instigation to some form of aggression. (32, p. 338) In tracing the development of hostile impulses from the psychoanalytic viewpoint, Fenichel (l6) points out that the first manifestations of hostility may be seen in the infant when he refuses to swallow objects which bring pain or hinder pleasure and instead attempts to spit them out. The origin of this reaction according to Fenichel lies in . . . The fact that external objects brought about a desired state of relaxed satisfaction [introducing] the complication that objects became longed for; in the beginning, it is true, they were sought only as instru­ ments which made themselves disappear again. The longing for objects thus began as a detour on the way to the goal of being rid of objects (of stimuli). This is probably meant when it is sometimes stated that hate is older than love . . . (l6, p. 35) This emphasis upon frustration with subsequent aggression suggests that the frustration-aggression and psychoanalytic theories are in essential agreement. III.

MANIFESTATIONS OF HOSTILITY IN PROJECTIVE TEST MATERIAL.

Since the inception of the Rorschach Ink Blot Test

■v

15 in 1921, the content of a subject’s responses has formed an important part of the material upon which clinicians base their interpretations.

Interpreting the protocol of a

neurasthenic patient, Hermann Rorschach (38), the originator of the test, wrote The content . •. . reveals to some extent, the subject (jnatter of] the patient’s fantasies, to wit, . . . sado-masochistic themes (the bodies hacked off and bloody, the boy crucified) . . . 08, p. lij-6) Currently many authorities in the field of Rorschach testing (I)., 21, 3lf) continue to base their interpretative remarks regarding hostility on the content.

Schafer (1|1|_) ,

in his recent book on psychological testing, suggests that additional determinants be added to the conventional Rorschach scoring.

Included among these is “Aggression” which is added

to the conventional scoring when the “content of a response includes aggressive actions, feelings or events.” For example, responses such ast

(Ml? p. 339)

. . This Is a bird’s

head and long neck stretched out on the ground, dead as dead . . .” (i-j-lp, p. 2.92) and “Here Is a head . . . it looks very fierce.”

(,

p. 253) are scored “aggression”.

Apparently the basis for deciding wha't constitutes an aggressive response is left to clinical intuition. Rapaport (37) in his chapter on the Rorschach Test lists Aggression Responses . . . In these responses things are-- splashed77! “splattered”, “split open”, “bleeding”,

l6 "shooting", "fighting”— or other direct or implicit aggressive content is apparent • . . Integration of the aggressive idea into the response refers to a great tension of aggressions within the subject, which pro­ bably plays an important part in the dynamics of the maladjustment. Every maladjustment has its share of inability to control aggressive impulses, but these responses suggest a degree of prohibition of overt manifestation of these impulses in everyday life and their representation in phantasy life instead. (37a p. 363)

Rapaport points out, however, that . . . Such an interpretation seems justified in only . occasional cases, as there has not been a well-defined investigation into the significance of these responses . . . (37, P. 363) In 19^-9i Groodwin (20) and Prince (36) as a part of their separate researches collaborated on the problem of quantifying hostility in the Rorschach.

Out of fifty

Rorschach records they selected those responses which they judged (independently) to be of a hostile hostile responses were divided into

nature.These

three groups:

(1 )

hostile animals, (2 ) oral aggression, (3 ) hostile descriptions of human beings.

Only those responses which they both

agreed contained hostility were used in the study, hence, no reliability figure on their independent judgments is reported. As neither investigator was interested in hostility per se, but only in the differences between psychosomatic groups, no attempt was made to relate the test signs of hostility with any outside criteria. In 19l|i) Crider (10) noted that, "Much has been written

17 about anxiety patterns • . • but . . • there is a paucity of material in regard to hostility,n

(10, p. 267)

When the

present study was begun, a review of the literature revealed a notable lack of research closely relevant to this study. Subsequent to that time, however, an important investigation has been reported. Elizur (15) conducted an investigation in which Rorschach content was related to outside criteria of hostility.

The subjects were thirty student volunteers from

Columbia University, ranging in age from nineteen to fortythree.

The Rorschach was administered with instructions to

give several responses to each. card.

The records used in

the study contained between twenty and forty responses. Following any response for which an anxiety or hostility score seemed uncertain, the subject was asked to tell more about his concept.

Only the procedure and findings related

to hostility will be reported here. Three outside criteria were used, a Questionnaire, a Self Rating Sheet, and an Interview.

The Questionnaire

consisted of fifty-five statements, including five related to hostility.

The subject indicated on a scale ranging

from one to nine whether he considered the statement to be more or less true for him than for the average college person. The Self Rating Sheet consisted of eleven items,

18 three of which were related to feelings of hostility.

The

students were asked to rate on a scale from one to nine the degree of intensity and frequency with which they experienced a need to control these feelings. A forty-five minute interview was conducted during which the subject was encouraged to give information on four variables, one of which was hostility.

Independent

ratings of notes taken during the .interview were made on a nine-point scale by three judges and these ratings were combined to form an over-all rating.

The reliability of

hostility ratings was .86. The Rorschach scoring was confined entirely to content.

A capital letter (H) was used whenever hostility

was expressed openly, while a small letter was used, for responses which revealed hostility to a lesser degree.

An

H received a score of 2 and an h was counted as 1_. Responses which seemed to involve both hostility and anxiety were given the combined score ah which was counted as an h for hostility.

The final scores were ma.de up of the weighted

sum of all H fs and h fs and were referred to as Rorschach Content Test Scores (RCT).

The following in condensed form

is the system used in scoring for hostility: 1.

Emotions and Attitudes Expressed or Implied.

Responses which reveal feelings or attitudes of hatred, dislike, criticism, derogation and the like are scored H.

19. Responses which manifest such feelings smaller degree are scored h. an ugly figure, scored H.

op

Examples:

attitudes

to

a

animals fighting;

Gossiping women, scored h.

2. Symbolic Responses.

Scored h.

Examples:

the

red represents struggle, a primitive war mask. 3- Objects of Aggression.

Responses containing

objects which are usually used for aggressive purposes are scored H, those usually connected with a moderate degree of aggressiveness are scored h.

Examples:

arrow, pistol,

scored H: pliers, knife, scored h. II.

Double Connotation.

Responses that contain clear

evidence of both hostility and anxiety, such as headless person, injured bear, are scored ah. Half (or fifteen) of the records were scored independently by eight Columbia University Graduate Students and the agreement between them on hostility was very high as indicated by a correlation of .82. When the total hostility scores for thirty Rorschach records were compared to each of the three outside criteria, it was found that they correlated .

with the Questionnaire,

.60 with the Interview, both significant at the 1 per cent level of confidence; and .I4.5 with the Self Rating, significant at the 5 per cent level of confidence.

Elizur concludes

that !Tthe RCT appears to be a valid technique for the assessment of the subject’s hostility."

20 Rapaport (37) in his recent book on diagnostic testing asserts that supressed aggression may be revealed by the manner in which a subject responds to the Thematic Apperception Test (TAT). In a setting of otherwise orderly stories', sudden and not too elaborate aggressive turns which are not required by the card indicates strong supressed aggres­ sions. Examples: on card 7 QScene of medical operation], a surgeon pricks his finger and dies of blood poisoning . . . on card 12M pToung man iyinS °n a cot with an older man standing nearby as though hypnotizing him'], a man is choked to death . . . (37> p. M+5)

On the other hand, Schafer (iqip) takes cognizance of the fact that vague evasive stories to stimulus material suggestive of aggression indicates repression of hostile impulses.

In discussing a non-hostile story given by a

subject to a TAT card which frequently elicits aggressive themes, Schafer says, "The aggressive implications of the picture are avoided, implying denial of aggression . . . ” P- !95)

Another reference by Schafer is made to the aggressive quality of some of the TAT cards and the implication of non-aggressive stories or markedly qualified, aggressive themes told to these cards.

He quotes the following story:

”. . . It is a picture of two young women engaged in a bitter quarrel. The picture shows one of the young women strangling the other . . . I hope she comes to her senses in time not to harm her victim . . . (iqip, p. 130) and in his interpretation mentions that the theme of this

21 story is the popular appropriate interpretation, however, u. . . the patient . . . loses distance from her story and ends with ’I hope . . . ’ The expression of aggression is implicitly rejected. 11 (If-lp, p. 138) Some of the differences in the expression of hostility in the TAT and the clinical significance of these differences is demonstrated by the following thematic stories and interpretations from The Thematic Apperception Test by Tomkins (5>l)*

In each case, Tomkin’s interpretative remarks

follow the material given by the subject "This picture is supposed to represent a person hypnotizing another. This person is an older fellow sitting there. He is an insane person. He has great illusions about himself. He thinks he can cause the will of another to snap into his own will and make him do whatever he wants. This person has gone to sleep and pays no attention. This upsets him and he goes back to the insane asylum.u The father surrogate is still portrayed as an omni­ potent figure but he is insanely so, and the younger man refuses to comply with his wishes. There is here no overt aggression or even overt rebelliousness but a passive resistance--he has "gone to sleep and pays no attention." (5l, p. 91) "This man has just set fire to a stable full of horses, but ..he couldn’t resist the temptation to stay around and watch the agony of the animals. While he was doing this a watchman catches him and he is taken to prison." This is at once the most remotely displaced object of his aggression and the most open expression of the depth of his feeling. The conditions of this story are remote in two senses. First, aggression is expressed towards animals rather than human beings, and second, the objects of his aggression are helpless victims who are incapable of counter aggression. Under these joint conditions of remoteness he can aggress, torture, and enjoy the agony of his victims. (5l> P« 93)

^ \ i S / / /

22 Particularly pertient to the present study is an experiment by Beliak (Ip) .

He divided ten TAT cards into

two groups of five cards each:

Sets A and B.

Three subjects

were first given Set A and. four subjects were first given Set B.

After the protocols had. been obtained on the five

cards, all the subjects were severlv criticized for their poor responses.

Then all the subjects were given the remain­

ing five cards.

After each card the subjects were criticized,

and the severity of the criticism increased with each story. Beliak hypothesized that if the TAT were valid for the measurement of hostility, more hostility would be expressed in the second half of the administration.

The subjects

having been frustrated could not openly express hostility toward the experimenter as he represented an authority figure to all of them.

The protocols were rated by three

judges on the basis of the number of aggressive words in each group of five cards.

Analysis of variance was applied to

the data and the results indicated that the amount of hostility increased very significantly following frustration (P * .017).

The results of this experiment would seem to

substantiate the appropriateness of studying the personality variable of hostility on the Thematic Apperception Test. A comprehensive system for scoring variables such as hostility, anxiety, warmth, etc. ; based on the content of projective test material, has recently been developed by

23 Pine (17).

In a study comparing asthmatic children with

their non-asthmatic siblings, he reports analyzing expres­ sions of hostility in the TAT and MAPS Tests by means of this system.

He states elsewhere (18) that his method ofscoring

may be used with records of doll-play and free-association material as well as with any thematic test. Another investigation in which the TAT was used to measure various aspects of hostility is that of the pre­ viously reported study by Goodwin (2).

The method he used

was to select from the TAT protocols of fifty subjects all those stories in which the content was independently judged \

by two clinicians to be hostile.

He then grouped these

expressions of hostility into several categories: 1. Hostile acts by the hero. 2. Death wished toward others. 3. Hostile attitudes toward others. Ip. Hostile acts to the hero from others. 5. Death wishes directed toward the hero.

6. Hostile attitudes toward the hero. The proportion of agreement between the two judges was calculated for each category. for the six categories.

They ranged from .82 to .93

As with the Rorschach, however,

the data were analyzed in terms of differences between the psychosomatic groups rather than in respect to the relation­ ship between hostility expressed In the test and hostile

2k behavior of the subjects in a life situation. One of the few studies designed specifically to compare measures of hostility, derived from a projective test, with some outside criteria is that of Korner (25)* Incomplete stories, dealing with everyday experience, were administered to twenty children between the ages of four and six.

To elicit the object of the child1s hostility,

the children were asked to complete the stories In both word and play.

Each child was presented with a number of

dolls making up a replica of his family constellation.

In

addition, the children were put in a free play situation where the experimenter entered only at the child’s request and when asking three standardized questions regarding parental treatment and preference.

Ratings were made on

the basis of these data and compared with two criteria: (1 ) material gained from an interview with the child’s parents, (2 ) teachers’- ratings of the children’s hostile reactions toward adults and contemporaries.

Statistical

analysis of the results yielded no significant relation­ ships between the1two sets of data.

Korner concludes that

. . . No inference could be made regarding a child’s hostile behavior in real life on the basis of observing his play . . . In the light of the findings, as generally applicable, one cannot safely estimate from the hostility expressed in play how hostile a given child may be in real life, or for that matter, infer from his fantasies what has actually happened to him in real life. (25, p. 175)

25 Another finding was that there seemed to be no relationship between the expression of hostility in play and the childTs emotional adjustment.

Possibly these inconclusive findings

were due to some extent to inexperience on the part of the “

/

parents and teachers in rating hostility. In a study comparing the performance of 100 school teachers on the Corey Role Relationship Vector Analysis p

test

with ratings of hostility by students, Corey (9 ) found

no relationship between the tendency to give a hostile response to the test and the outside criterion. To summarize, there appears to be general 'agreement as to the various ways in which hostility is expressed in clinical behavior and widespread, but largely unsupported, assertions that hostile responses in psychological tests are related to manifestations of hostility in clinical behavior.

p

This test is similar in design to the Rosenzweig Picture-Frustration Study, but consists of completely revised cartoon backgrounds.

CHAPTER III SOURCES OP DATA The following discussion will present the sources of data, including a description of the patient population, the therapy ratings,

and the psychological test data which

furnished the material for this study. I.

THE PATIENT POPULATION

Forty subjects were used In this study.

All were

patients receiving psychotherapy in a V e t e r a n ’s Administra­ tion Hospital or Clinic.^ four females.

There were thirty-six males and

The ages ranged from twenty to fifty-four

years, with a median age, to the nearest year, two.

of thirty-

Diagnoses range from mild anxiety states to psychosis. In an attempt to collect as near a random sample of

"patients in therapy" as possible, was employed.

the following procedure

The therapists who took part in this study

were asked for a list of those patients whom'they had had in therapy for a minimum of five hours,

and who they felt

^ The institutions referred to are: The Brentwood Neuropsychiatric Hospital, Birmingham General Hospital, and the Mental Hygiene Clinic; all Ve t eran’s Administration facilities in the Los Angeles area.

2 See Tables I and II.

27

TABLE I AGE AND EDUCATION OP THE PATIENTS

Vari able

Number of* eases

Median

Range

Age

40

31.8

20-54

Educational level

40

12.S

5-17

28

TABLE II DIAGNOSTIC GROUPINGS OF THE PATIENTS

Number of cases

Di agnosis Psychoneurosis Anxiety reaction Psychosomatic disorder Character disorder Psychosis

Q 7 U 13 7 TOTAL

l+O

29 might be willing to take the tests.

A brief consultation

was held between the therapist and the investigator in which one of the patients was selected at random from the list of available patients.

In most instances this list consisted

of only two or three names since many of the therapists were psychology trainees, relatively small.

and their case load was therefore

Another limiting factor was the feeling

of a. great many therapists that psychological testing might be somewhat disruptive to the therapeutic process. The next step was to contact the patient and solicit his cooperation.

The patient was told that this was a

research investigation being conducted with people in therapy. It was made explicit that the study was concerned with group findings and it was implied that the pa ti en t’s test results would not be made available to the therapist.

This was

necessary since the majorit;/ of therapists did not want their patients raising questions in therapy about the test findings.

Although the only reward offered the subject was

a statement to the effect that he would be helping others by his cooperation,

all but one patient agreed to act as a

subject.^

In this one case the man was extremely upset at the time, but indicated that he would like to participate, and later did take the tests despite the fact that he was still suffering from considerable anxiety.

30 Originally it was expected that there would be more refusals than this since cooperation was put on a completely voluntary basis.

And yet, it was felt that using administra­

tive pressure to get the subjects to take the tests would have resulted in some situational hostility which might influence the test findings.

Possibly a certain number of

the subjects agreed to take part in the study because they felt obligated and would perhaps have felt uncomfortable refusing someone who, in a sense, represented their therapist. Consequently some of the hostility manifested in the tests may stem from this situational factor.

However,

it is

assumed that the therapist eliminated those individuals who would most likely resist the testing, hostility minimal.

thus making situational

There was no selection of cases on any

other basis. II.

THE SOURCE OF THE THERAPY RATINGS

In the Appendix will be found a copy of the rating scale used by the psychotherapists in making their clinical judgments of the p a t i e n t rs hostility.

Description of the

design of the rating scale and also of the therapists who participated in the study are Included in this section. Psychotherapists were selected to make the ratings for several reasons.

They have the opportunity to observe

a person in a permissive setting where hostility is less

31 likely to be inhibited than in everyday life.

At the same

time, as clinicians, they are experienced in detecting subtle, indirect manifestations of hostility.

Due to their

special training, psychotherapists tend to be less vulnerable in terms of their own reactions to a patientTs hostile expressions than might others.

Finally, the majority of

therapists in this study are psychologists who have had both academic and clinical experience with rating scale techniques.

The thirty-six therapists who filled out these

forms are either psychologists or psychiatrists.

Qualifi­

cation of the therapists in each of the two groups are as follows:

(1 ) Eight of the twenty-five psychologists have

Ph.D. degrees in psychology and approximately three years of clinical experience at either a university clinic or under the direction of a psychiatrist.

The remaining

psychologists are either third or fourth year psychology trainees with a minimum of eighteen months of clinical experience.

(2) Each of the eleven psychiatrists has as a

minimum completed the psychiatric residency, with the exception of two cases who are third-year residents. The ratings'of these therapists were based on experience with the patients obtained in a series of sixty minute therapeutic interviews. less than five interviews.

In no case was this series

For all patients, the total

number of therapeutic interviews ranged from five to 180

hours, with a median of 19*5 hours.

In most cases (82 per

cent), the patient was seen two or three times per week. None were seen less frequently than once per week. On an a priori basis a preliminary form of the rating scale was constructed.

This contained items covering the

various ways in which hostility may be expressed, and ways in which individuals may react to their own expressions of hostility.

These forms were submitted to four judges^- with

the request that they rate one of their patients and add any items which they felt to be necessary to give an adequate description of their patient.

In addition, they were asked

to write in other forms of expressing hostility which they might have observed in any of their patients or which they believed should be included in a scale of this type.

Prom

this pilot study, the final form of the rating scale was made up. The rating scale was designed to cover the following areas:

(1) Frequency and intensity with which hostility is

manifested by the patient, (2) The direction and objects of his hostility, (3) The stimulus for (or circumstances pre­ ceding) the expression of his hostility, (ip) Reactions to

^ The writer wishes to express his appreciation to Doctors S.M. Wesley, Maurice Rapkin, and Prank Risch and to Mr. Jam.es Conant for their many helpful suggestions as to both the content and format of the rating scale.

33 his own expressions of hostility (defenses).

A four-point

rating scale was used for most of the Items^ and the thera­ pists were instructed to rate each variable independently of the others,

That is, in rating the frequency with which a

patient expresses hostility in a specific way, the rator was to ignore the intensity, the object, etc. of these expressions. Since a rating of 1_ indicated "Rarely or never," they were omitted in tallying the score.

The remaining weights 2_, ^ and

Ig w e r e added to obtain the over-all hostility score for each section of the rating scale.

The total score was simply the

sum of the section scores considered relevant to an over-all hostility rating.

A more detailed discussion of the method

used will be found in the chapter on procedures. One word might be added concerning this instrument. It is fully realized that this rating scale is a very rough measure; that undoubtedly the different items could have been differently weighted;^ and that it is subject to all

^ The headings and weights used were Rarely, never (1_), Seldom, only occasionally (2), Rather frequently, fairly often (3.), and Very frequently, consistently (Jjj.

^ G-uilford (22) has pointed out, however, that experi­ ence with weighting items in tests of personality is rather limited and in many of these Instances the technique used, correlation of Items with the test itself as the criterion, has rested on questionable logic since we do not yet know the true dimensions of personality variables. Furthermore, Guilford calls attention to the fact that frequently there tends to be a correlation between weighted and unweighted scores sufficiently high as to make the weighting--consIdering the amount of labor Involved in deriving the weights--of doubtful value.

3k the criticisms of rating scales and their inherent diffi­ culties of equal step intervals, misconception of meanings, and the like.

Some attempt to control the last criticism was

made by the writer who made it a point to discuss the rating scale with each therapist before the ratings were made to make sure the terms were all uniformly understood.

An

additional attempt to keep this source of error minimal was the inclusion of examples for most of the items in the scale. However,

the instrument,

as constructed, was the only one

with which it was possible to obtain judgments by these rators. III.

THE TESTS ADMINISTERED

For the variable under consideration,

available

objective tests of personality did not seem suitable. Accordingly it was decided to use a number of projective techniques.

A questionnaire,

constructed for this study,

was included in the test battery in order to obtain the patient fs own rating of his hostility. in the order administered,

The complete battery.,

consisted of the Rorschach! the

MAPS Test, the Picture-Frustration Study and the aforementioned questionnaire on hostility. For the most part projective tests have been used

7

The performance proper only.

35 qualitatively in a clinical setting.

In recent years,

however, considerable literature has appeared which Indi­ cates that projective techniques may also be used statisti­ cally and experimentally.

Considerable advances have been

made, particularly In the quantification of the Rorschach (2i|_). Summarizing the advantages of projective techniqes in . clinical psychology, Bell (3) indicates the difficulties involved In their use . . . aspect of method common to projective 'techniques is that they sample individual'behavior In a structured event of sufficient brevity to be clini­ cally practicable and of sufficient stimulation to call forth a wide range of Individual responses. In Inter­ pretation of the responses, the emphasis is upon the personal element shown In the diversity of behavior. Projective techniques emphasize primarily the uniqueness of the responses--those qualities that discriminate between Individuals. Thus the best technique Is that lArhich will command the"greatest range of responses in the shortest possible time. While one goal In the inter­ pretation of these methods is to develop normative standards for the responses, the value of such norms is considered to be not so much how they group persons together by means of similarities as how they show departures from the norms, or dissimilarities. This means that the responses on a projective test are less easy to abstract quantitatively under a simple formula than are the choices recorded by personality inventories. It means, further, that the responses to projective tests are usually less easy to treat statistically than are the limited types of responses secured by the paper-andpencil personality tests, thus making measurement of the reliability and validity of the techniques a difficult but essential procedure. It does not mean, however, that quantitative methods are undesired in the interpretation of projective responses. Quite the reverse is true, even though reaching such a quantification Is frequently a complicated task . . . In many respects . . . qualita­ tive measures have been the forerunners of quantitative analyses. It Is to this point, the qualitative in projective techniques, that the strongest criticism has

been directed-{-but, that there is a qualitative element in scoring and'interpretation is not usually the result of a preference for intuitive methods but ofjthe complexity of data to be dealt with, and/hence of the difficulty in applying mathematical methods^ (3, PP. 5-6) / The Rorschach Test.

At the present time, the Rorschach

is one of the most widely used methods of evaluating persona­ lity in clinical practice.

Studies on reliability and vali­

dity of the Rorschach indicate that it is an instrument which is acceptable in experimental research.

It was

selected for use In this investigation primarily to test the hypothesis that Indications of hostility In the Rorschach Test are related to manifestations of hostility In clinical behavior.

Another reason for including the Rorschach,

however, was to explore the clinical assumption that this test Is sensitive to the f,deeper,f layers of the personality; that Is, to test the supposition that unconscious hostility Is also reflected in aggressive content. With the exception of a modified form of administra­ tion, the procedure followed was that described by Klopfer and Kelly (2i|_).

This modification In Rorschach administra­

tion along with the special method devised for scoring hostility In the Rorschach will be described in the chapter on procedures. The Make a Picture Story Test.

In the MAPS Test (Jp7)

the subject selects one or more cut-out figures from a total

of sixty-seven with which he populates background pictures, making up a separate story for each situation he creates. Any figure can be placed on any of the backgrounds without violating realistic proportions.

The types of figures

include male and female adults,

adults indeterminate as

to sex, boys and girls, minority groups, legendary and fictitious characters.

animals,

and

They are depicted in

various poses, with a variety of facial expressions. ground pictures,

8|r x 11 inches in size,

Back­

include definitely

structured pictures such as a living room scene and ambiguous pictures such as a dream cloud and a blank card. Six of the twenty-two background pictures were selected for this study.

They are:

bedroom,

and blank.

dream,

cemetary,

living room,

street,

In an effort to include

backgrounds which would be more likely to elicit hostile fantasies,

two special background pictures were added.

One

of these was the blank background administered with a limited number of figures.

These were figures

cularly appropriate to hostile themes.

judged to be parti­ For example,

the

twenty figures used in this part of the test included a man with a revolver in his hand, a man holding a knife,

etc.

a woman who appears angry,

The remaining background

consisted of the street scene with two male figures pasted on it.

One of these was a man lying on the sidewalk,

presumably injured or dead,

and the other was a man with a

belligerent expression on his face and raised fist.

These

last two backgrounds were designated Forced Situation I and Forced Situation II.® were administered.

Thus a total of eight backgrounds

They were presented to the patient in the

order given here. The positions and the figures used are represented by ovals on the figure location chart so that a permanent record of the subjects1 choices and placements is kept for each story. The story itself is recorded by the examiner as nearly verbatim as possible.

The test is similar to the. TAT, but

it provides an additional freedom to the patient in allowing him to select his own figures with which to populate his story.

9 ^Although it is possible to Investigate the formal

aspects of the test^that is, the specific ways In which the cut-out figures are manipulated by the patient,Cjh; is felt that the thematic material is its essential and main contribution^

In this study, therefore, the analysis will

be limited to differences revealed In the stories related to the various backgrounds.

® Selection of these background pictures and construc­ tion of the Forced Situation backgrounds w e r e made with the help of the author of the MAPS Test, Dr. E.S. Shneidman, to whom the writer expresses his appreciation. 9 Except In Forced Situation II.

39 Because of the special nature of the method of analysis of the MAPS Test adopted for this study,

the

description of the scoring technique is postponed to the chapter on procedures. The Rosenzweig Picture-Frustration Study.

To para­

phrase Rosenzweig's description of his test, the PictureFrustration Study represents a limited projective procedure for disclosing patterns of response to everyday stress that are of widely recognized importance in both normal and abnormal adjustment.

The material of the test is a series of

twenty-four cartoons each depicting two persons who are involved in mildly frustrating situations of common occurrence. The figure at the left of each picture is shown saying certain words which either help to describe the frustration of the other individual, ting to him.

or which are themselves actually frustra­

The person on the right is always shown with

a blank caption box above.

Facial features and other

expressions of personality are purposely omitted from all pictures.

The subject is instructed to examine the situations

one at a time and to write in the blank box the first appro­ priate reply which enters his mind.

The assumption according

to Rosenzweig is that . . . The subject unconsciously identifies himself with the frustrated individual in each pictured situation and projects his own bias in the replies he gives. To determine this bias, scores are assigned each response

ko as to the direction of aggression . . . (39> P- l66)

Under direction are included E, extrapunitiveness, I_, intrapunitiveness, and M, impunitiveness. The tests were scored according to the standards established by Rosenzweig in his revised scoring manual (39).

Three additional categories may be scored.

These

are "Types of reaction," consisting of obstacle-dominance-In which the barrier occasioning the frustration stands out in the responses: ego-defense--in which the ego of the subject predominates; and need-perslstence--in which the solution of the frustrating problem is emphasized.

Since

no provision had been made in the rating scale for obtaining the therapist's judgments of these variables, scor­ ing of the P-F was limited to the direction of aggression categories.

Rosenzweig (IpO) defines the three directions

as follows Extrapuhltive: aggression is employed overtly and directed toward the personal or Impersonal environment in the form of emphasizing the extent of the frustrating situation, blaming an outside agency for the frustration, or placing some other person under obligation to solve the problem In hand. Intropunitive: aggression Is employed overtly, but directed by the subject against himself in the form of martyrlike acceptance of the frustration as beneficial, acknowledgment of guilt or shame, or an assumption of responsibility for correcting the frustrating situation. Impunitive: aggression is evaded or avoided in any overt form, and the frustrating situation Is described as insignificant, as no one's fault, or as likely to be ameliorated by just waiting or conforming. (IpO, p. 8)

Ill

Scoring categories and their meanings will be further discussed in connection with the obtained results in this report.

The scoring standards for this test have been

established on the basis of three groups: fifty normal males,

fifty normal females,

fifty mental patients.

Rosenzweig

reports that studies of reliability by means of the testretest method are in progress; validity studies are also being conducted.

He reports a correlation of .7 I4. on ratings

of extrapunitiveness between his test and the Thematic Apperception Test; however, no data are given regarding the methodology (IpO) . The Hostility Questionnaire.

The question of how

the patient himself evaluates his hostility seemed a perti­ nent one to attempt to answer.

However,

a search through

the literature revealed no clinical instrument designed specifically to measure this a s p e c t . I t

was decided that

a questionnaire presenting certain statements about hostile feelings, phrased in the first person singular, with which the patient could check agreement or disagreement would give some estimate as to the person's own feelings of hostility (See Appendix).

Accordingly,

the eighteen

statements covering various aspects of hostility which seemed

The rating scale used by Elizur with college students was felt to be too complicated and involved a scale for use with a patient population where persons of much lower educa­ tional levels would be included.

empirically clearest and most easily understood were listed in True-False form.

Self-ratings on the frequency and

intensity of expressions of hostility were obtained by an additional set of statements with a four-point rating scale provided on which the patient could mark himself as much less, somewhat less, somewhat more, much more than average in respect to these variables* On the basis of the judgment of two clinicians, the first eighteen statements were divided into ,two groups: deviant and non-deviant, and a weight of one was assigned to each deviant response.

The self-ratings in frequency

and intensity were simply ¥/eighted from 1_ to ig. these weights was considered the patient's score.

The sum of The state­

ments making up the Questionnaire with the weights assigned to each item are shown below. For the first eighteen statements the response considered deviant is indicated by a T or F preceding the item.

Where the proportion of cases checking an item in the

deviant direction was in excess of 67 per cent or where a statement was judged to be ambiguous, no weight was assigned to the item. Omitted

1. I try to cover up my poor opinion of a person so that he won't know how I feel

Omitted

2. It is unusual for me to express strong approval or disapproval of the actions of others

k3 T 1

3- I am afraid to let myself become angry-even when it is justified--because I might hurt someone

T 1.

The thing that keeps me from showing how angry I am with a person is the fear of what he might do to get even

T 1

5* The thing I like to do when I am mad at someone is to get his goat by teasing him or poking fun at him

T 1_

6.I am worried about my feelings of anger towards people

Omitted

7* Often I find myself worrying about the welfare of some member of my family

T 1

8.When I am mad at

T 1_

9» When I get angry, I kick things, or pound the table, etc.

someone, I generally show it by arguing with him

Omitted 10. Frequently v/hen I am angry, I say nothing and donTt let people know I am mad Omitted 11. When I am cross with someone, I am apt to start reading or busying myself with some little task so as not to show I am angry T 1

12. When I get mad at someone, I may threaten to strike him

F IL

13. After I have expressed anger, I calm down and feel o.k.

Omitted lip. When I have been angry, I feel uneasy and try in some way to make up for having been angry Omitted 15* Most of the time when I am angry, it is because I have done something that makes me mad at myself Omitted l6 . I find that I am mad at other people more often than I am angry with myself Omitted 17- Instead of being angry at particular

MiIndividuals, I tend to get angry at things like the company I work for, or the government, or foreign countries, or the like Omitted 18 19

After I have been angry toward someone, 1 feel guilty about it When I become angry, I generally am:

1^ 2 3 §[ 20

only slightly irritated rather annoyed definitely angry very mad

Compared with other people, I tend to get angry:

1_ much less often 2 somewhat less often 3 somewhat more often much more often 21

As a kid, the person in my family I was the most resentful of was:

2^

22

my father brother mother sister other

The person (or type of individual) towards whom I nov/ feel the most resentment ,Is:

2^

my wife (or husband) mother employer father brother (or sister) doctors certain types of persons (e.g., Negroes, Jews, Catholics, etc.) other

11 tIf -P more than one object is checked.

CHAPTER IV PROCEDURES I«

THE THERAPY RATINGS

Pistribution of the Rating Scale.

The rating scales

were distributed to the therapists after the testing had been completed

and the therapists were asiced to complete

their rating Tfithin a week from that time.

Because of

practical considerations, it was not possible to adhere rigidly to this procedure.

As can be seen in Table III,

however, 87 per cent of all the cases were rated within two weeks of the testing date.

Only 12 per cent were rated as

late as or later than three weeks from the time of testing. The interval between testing and rating was in no case more than four weeks.

It seems reasonable to state then that the

rating of the patient’s hostility pattern was made at approxi­ mately the same time the test battery was administered. The problem of ascertaining the reliability of the ratings in a study of this type Is a difficult one.

To have

the ratings made on two different occasions raises the question of how long a period should lapse between the first and senond ra,tings.

Should thns test re-test method be used

In all cases, the writer administered the complete test battery.

lj.6

TABLE III INTERVAL BETWEEN TESTING AND RATING

Number of cases

Interval in days

Per cent

22-28

2

15-21 8-L 1-7

3

8

5.0 7 •5 20.0

27

67.5

ij-0

100.0%

TOTAL

h-7

with a sufficiently long interval between ratings to off-set the memory factor on the part of the rator, there is a possibility of actual change in the patient’s hostility pattern from the first to the second rating.

Conversely,

ratings made within a relatively short period of time would probably not be appreciably influenced by changes in the patient but might be spuriously correlated because of the memory factor.

A type of "on the spot" reliability therefore

seemed indicated.

In view of the fact that four of the

patients sampled in this study vvTere in group therapy and ratings had been made on them by both the group therapist p and the group observer-recorder, it was felt that analysis of their ratings would yield information as to the reliabi­ lity of ratings on hostility in therapy.

Although the group

therapist and observer-recorder independently rated these four patients, It is recognized that their ratings were in reality not entirely Independent of each other.

The reason

for this is that one of the functions of the observer-recorder is to discuss with the therapist the dynamics of each patient In the group, the group process, and so forth.

Hence, their

ratings would be influenced to some degree by these discus­ sions.

For this reason and because of the extremely small

sample, the method used Is felt to be only a very rough 2

The four observer-recorders are psychology trainees of second year status.

approximation of the reliability of the ratings on hostility In therapy. With these limitations in mind, a four-fold table was set up comparing the ratings made by the therapists on the four patients with the ratings made by the observer-recorder on the same four patients.

Since there were twenty-eight

items in the rating scale, a total number of observations of 112 was obtained.

Because the ratings on all items were

of limited range (I_ to kj.) it was decided that the data could best be treated in terms of a dichotomy--presenceodr absence'of "hostility.

Thus a rating of 3 or k would indicate

hostility while a rating of hostility.

1_

or 2 would indicate absence of

The phi coefficient obtained was .5k{-6* which

for an N of this size (112) yields a chi square of 33*37 (with one degree of freedom a chi square of 6.635 is consi­ dered very significant (21)), indicating that there Is a real relationship between the two sources of ratings.

It

does not, however, tell us to what extent the ratings are related.

Guilford (21) has suggested a method of estimating

Pearson r from phi (21, p. 2I4.7)* but in a personal communi­ cation has stated that this may be done only when the distri­ butions are evenly divided.

Since it happened that in the

case of these four patients the proportions of both the therapist and observer-recorder ratings were markedly skev/ed in a positive direction, a Pearson r could not be estimated

k9 from the phi coefficient. Treatment of the Therapy Ratings.

In this section

will be discussed the steps taken to derive a score from, the rating scale which could be considered representative of the therapist’s rating of the patient’s hostility. As indicated in the chapter on sources of data, an over-all rating score was obtained by summing all the weights assigned by the therapist.

Before comparing the test results

with the therapy ratings, however, an analysis was made of the interrelationships among all parts and certain sections eliminated.

3

of the rating scale,

The final score used was

called the Therapist’s Hostility Rating (THR).

The inter-

correlations of all parts with each other and with the over­ all therapy rating are presented in Table IV. Part I (the frequency with, which hostility in any form is expressed),

qualitatively considered, seems to be the

most essential part of the therapist’s ratings.

It tells us

how much hostility an individual manifests whether it be

3

Part V (Intensity) consisted of ratings as to the intensity, of overt and unconscious hostility, and the Importance of hostility as one of the patient’s problems. The latter was omitted from the Part V sub-score because almost all the therapists (92 pe^ c e n t r a t e d hostility as one of the patient’s major problems. The item on unconscious hosti­ lity was also excluded from the Part V score as it appeared to call for too great a subjective judgment. Consequently, Part V consists only of ratings of overt intensity. .

4

For the sake of brevity, Part I will hereafter be referred to simply as r,Frequencyn.

TABLE IV INTER-CORRELATIONS OF ALL PARTS OF THE RATING SCALE WITH EACH OTHER AND WITH THE OVER-ALL RATING

Vari ables correlated'"

I

II

III

IV

V

I

(Frequency with which hostility In any form is expressed)

II

(Ob ject)

.20

@

III

(Stimulus)

.05

.k l * *

IV

(Defense)

•25

.15

.30

V

(Intensity)

.30

.02

.31 .17

©

VI

(Awareness)

.00

-.09

.19 .01

.03

VII

(Over-all frequency)

.6o*'Hh30

VIII (Spontaneity) IX

(Hostility outside therapy)

OVER-ALL RATING (Total of all Parts)

.05

.02

.00

.10

.oljh'

VI

VII

VIII

IX

@ @

.02 .37”“'•35":H'-.i5

-.05 .02

.15

@

-.22 .05

@

.15-. 15 - .15

-.15-.io .15

39*t%o** .31

.17 ., 57*182

©

.02

N = I(-0 Significant Very significant vn o

direct or indirect in type.

The fact that Frequency corre­

lates highest with the over-all rating (Table IV) tends to bear this out.

Part I, therefore, was included in the

final Therapist's Hostility Rating.

It should be mentioned

here, however, that in analyzing the table of intercorrela­ tions shown in Table IV, a significant relationship

b e tw e e n

a part of the scale and the over-all rating was not considered sufficient justification for including that section in the final THE.

Indeed, the over-all score obtained by combining

indiscriminately all parts of the rating scale may well be psychologically meaningless.

Some of the more obvious

flaws in this initial attempt to get an over-all therapy score are: 1. The gross discrepencies among the number of items present In each section.

Part I, for example, contains

fourteen Items while Part VI consists of a single Item. Similarly, there are ten items in Part IV and only three items in Part III.

Thus the addition of Part VI would

have very little effect on the total score, while the inclusion of Part I would have considerable influence on the over-all rating.

And yet, this difference might not be

justified o n .qualitative grounds. 2. Part VII (the over-all frequency of the expression of hostility), as defined, simply duplicates Part I and one would expect them to be highly related.

Since Part I

52 consisted of thirteen items while Part VII, over-all frequency, was a single item, the summation of items in Part I would be expected to give a more accurate rating of frequency than the over-all frequency rating, based on the single item in Part VII.

Thus, Part VII was omitted

from the TER. 3. Some of the significant correlations shown in Table IV appear to reflect, in part at least, faulty design of the rating scale, or appear to be a function of some other irrelevant factor.

An illustration of correlation due to

the design of the scale Is the high relationship indicated In Table IV between Part II (Object) and III (Stimulus). Inspection of the items which make up these sections of the scale sug;gests that the ''correlation'1 apparently Is a function of the design of the rating scale.

That Is, a

frequency rating Is required to the statement listed below: The patient’s hostile expression Is stimulated by so many types of individuals . . . it might be called free-floating hostility. (Item I in Part III of the scale). This would seem to involve the object of hostility as well as the stimulus for hostility.

Then too, Part III is rated

on the basis of the frequency with which the stimulus for the patient’s expression of hostility is noted, thus Part III over-laps with Part I.

The significant correlation

between Part III and the over-all rating appears therefore

53 spurious to some degree.

Accordingly, Part III was not

included in the THR. Since the items used in computing the Part II score consisted of the frequency with which hostility is directed toward all objects, the significant correlation between Object (Part II) and the over-all rating is partly a function of frequency alone.

Inspection of Table IV reveals phi

coefficients of .20 and .30 between Object and the two measures of frequency (Parts I and VII).

Consequently,

Part II was not included in the THR. /

Part IV (Defenses) not only appears to be signifi­ cantly related to the over-all rating (Table IV), but also seems to be qualitatively related to the judgments of hostility.

Frequently a defense against the expression

of hostility Is in part a continuation of the expression of hostility.

For example, following an angry attack on

someone else, a patient may turn his hostility in on himself saying, tTI hate myself for saying that. ” Part IV is an extension of Part I.

In a sense,

For these reasons,

Part IV was included in the THR. Although Part V (Overt intensity) is not signifi­ cantly correlated with the over-all rating, It can be seen In Table IV that there tends to be a high relationship between It and Frequency.

Also Part V shows a strong, though

statistically not significant, relationship with the over-

5k all rating.

These correlations are understandable in view of

the.following:

first, analysis of the statements in Part I

reveals the fact that many items are phrased in such a way as to necessarily involve considerations of intensity. Some illustrations taken from the scale may make this point clear Item 2. Physical Expressions, defined as: "slamming fist on desk, kicking furniture, striking himself" . . . Item 6. Argumentation, described as: ' Intellectualized hostility or matching wits as In "You told me to talk about the past, now you say I'm resisting therapy". The. therapist wan instructed to disregard intensity when rating these various forms.

However, In the first

example, strong intensity is implied; while In the latter, only mildly intense hostility is suggested.

Thus the

rating scale, as constructed, contains Implicitly a "corre­ lation" between frequency and intensity.

Second, since more

intense expressions of hostility are more easily recognized (and less Intense, subtle hostile expressions more easily overlooked) the relationship between frequency and intensity would be partly, at least, a function of the rator's inability to detect equally well hostile manifestations of varying intensities.

Accordingly, Intensity was not taken Into

consideration in obtaining the therapy rating score. The over-all rating of hostility appears to be both quantitatively and qualitatively unrelated to parts

55 VI, VIII^ and IX of 'the Rating Scale. To summarize, ratings on Part I (Frequency) and Part IV (.Defenses) were summed and combined to obtain the Therapist’s Hostility Rating.

The resulting scores

were dichotomized at the median; those above the median were labelled nhostilen and those below, "non-hostile.TT The Rorschach Test.

It was decided at the start of

the study to limit the analysis of the Rorschach records to content alone.

One reason for this was that the analysis

of anxiety, a closely related variable, in terms of the standard scoring categories has not seemed to lead to the establishment of positive results or suggestive theory (50 ). On the other hand, as indicated in the history, the few studies of hostility using content rather than determinants, did seem to promise chance of both positive results and the formation of relevant hypotheses. q

Related to this plan was

A word should be said about the inclusion of Part VIII (Spontaneity) in the rating scale. Originally this section was added.to control for a suspected relationship between the expression of feelings in geners.1 and expressions of hostility. It was believed that the individual who tends to be uninhibited,h and therefore more likely to express hostility freely, would be rated as being more hostile than the less spontaneous person who has difficulty expressing his feelings. Thus one patient might be rated high in hostility and really be less hostile than an individual who exerts more control over the expression of his feelings. Apparently, in making their ratings of hostility the thera­ pists were not influenced by the spontaneity factor as Indicated by the very low correlation between Part I and Part Vlli (phi = .05). ^

56 the decision to employ an abbreviated Rorschach administra­ tion.

In part, this was based on Elizur’s experience.

He

writes , . . It was soon realized that the usual Inquiry made for ’’location” and /’determinants'’ contributes little, if anything at all t'o the Rorschach Content Test scores . . . (15, p. 255).

Also,, the time factor had to be considered.

Administration

of the full Rorschach Test is a rather lengthy procedure (an hour to an hour and one-half) and three other tests were to be included in the battery.

Finally, since the

performance proper part of the Rorschach is least subject to variations of administration, it seemed desirable to limit the Rorschach to the subjectTs initial responses to the test.

For these reasons then, the conventional Inquiry

and testing of the limits sections were omitted.

And yet,

it was found that some responses were ambiguous as to whether they were non-hostile.

I.n such cases, the patient

to tell more about his concept.

7/as

asked

This kind of Inquiry was

kept at a minimum, however,- being used only in suspicious or doubtful cases.

The described inquiry was not made at

the end of the performance proper.

Instead, It was conducted

after the response in question had been given.

Another

variation of the Klopfer technique was the rather directive attempt to encourage at least two responses per card.

At

the beginning the patient was told "most people see two or

57 three things in each card." response, he more,"

vt&s

When the patient gave only one

asked to "look and tell me if you see any

No further encouragement was given if he were still

unable to see additional concepts.

An accepting remark

was made and he was presented with the next card. Scoring of the Rorschach Content was based on the pooled ratings of a group of judges.

Although it would have

been possible to apply Elizur’s approach in scoring the records, it was decided to develop a different scoring system for two reasons:

(1) since the experimenter had

both administered the tests and collected the rating scales from the therapists, the possibility of contamination arose if the experimenter were to assign Elizur weights to the Rorschach responses, and (2) the writer was of the opinion that Elizur’s system of weighting hostile responses either a

±_

or a 2 tended to result in too coarse a grouping.

For

example, in the Elizur system,, the "goriest" of responses: "Fighting bears, all bloody, their heads chopped off" is given the same weight as the relatively mild "A stupid animal."

Similarly, "gossiping women" receives the same

weight as "a child with cut-off arms," yet there seems to be a striking disparity in the degree of hostility implied by each. Accordingly an attempt was made to develop a broader weighting system.

Responses which the writer felt could

be considered in any way hostile were selected from twentysix of the Rorschach records.

Included were a few responses

which were believed to be non-hostile.

Where there were

responses of virtually an identical nature, for example, "fighting bears," "two animals fighting," "dogs in a fight over something," only" one was included.

Due to the large

amount of such duplication, only fifty-five "hostile" responses were obtained from these twenty-six records. Copies of these fifty-five responses were submitted to three clinicians,^ all experts In the Rorschach technique, who were asked to rate the responses on a five-point scale. judges Independently rated each response from 0_ to jj_.

The Zero

was assigned to responses considered non-hostile, Ij. to the most hostile; and the Intervening weights 1_, 2_, 3 were used to rate responses of intermediate hostility. Although the number of responses to the Rorschach varied from ten to fifty-three, It was found that no signi­ ficant relationship existed between the number of responses 7 and the total hostility score. Consequently, the records 'were scored simply by summing the individual weights with no

The writer wishes to express his gratitude to Doctors Bruno Klopfer, Mortimer Meyer, and Marshall Wheeler for their most generous cooperation in this phase of the stud 7 In Table V productivity in the Rorschach is compared with the amount of hostility scored in the test by means of both the Pearson r and phi coefficients of correlation.

59

TABLE V COEFFICIENTS OF CORRELATION BETWEEN NUMBER OF RORSCHACH RESPONSES (R) AND RORSCHACH HOSTILITY SCORE (RHS)

Variables correlated R with RHS

Number of cases I4.O

Pearson r'M~

.02

Phi .05

Due to skewness of the distributions, r was computed directly from the raw scores rather than estimated from phi.

6o correction made for the number of responses.

The actual

snoring of the responses was handled in this way:

treating

each judge’s set of ratings separately, all those responses (from the total of fifty-five) receiving the same weight were grouped together.

The Rorschach records were then

scored writh reference to each judge’s scoring system and the weights added to get a total score.

The mean of the i

three total hostility scores was then obtained and labelled the Rorschach Hostility Score (RHS).

Although this procedure

entailed scoring each record three times, it avoided the problem of dealing with fractions, which would have been necessary had the average weight of the three judges’ ratings been used directly. As previously reported in the review of the literature, Elizur (15>) obtained a reliability coefficient of .82 using the independent scorings of eight judges.

However, the

system used was that devised by Elizur; the judges scored the records by referring to examples given by Elizur.

Since

in the present study a similar method was applied in scoring the content, there did not seem to be any need to repeat the same type of reliability study.

Instead, It was felt that

ratings made independently by a group of Rorschach experts would not only serve as a measure of reliability of scoring, but might also have valuable implications as to the validity of clinical interpretations based on Rorschach content.

In

6i other words, If the ratings by the three experts are signifIclantly related with one another and also with the ratings of hostility made by the therapists, the indications are that statements now being made about a patient’s hostility based on subjective evaluations of Rorschach content predict to some extent the patient’s behavior outside the testing situation. The correlations between judges are based on their independent ratings of the fifty-five responses selected as "hostile" responses.

The three comparisons, Judges A

with B, A, with G, and B with G are shown in Table VI.

All

D

the phi coefficients of correlation

are significant at,

or better than, the 5 per cent level of confidence, indi­ cating that the Rorschach Hostility Scores are reliable. This high degree of agreement among judges, where each made his ratings on his own clinical intuition rather than on a system set forth by one individual, suggests that hostility in the Rorschach could be rated with even higher reliability had it been possible for the three experts to discuss their differences in ratings and formulate rules for scoring. After the records were scored, the ratings based on the three different methods of scoring hostility in the

Pearson r could not be estimated from phi due to uneven proportions in both distributions.

62

'ABLE VI :n g s OP HOSTILE CONTENT BY THE THREE RORSCHAOH JUDGES

Phi

A with B

53*

.34-

6.38

.02

A wlth C

55

.lj-3

10.35

.01

B with C

53*

• k -3

9.79

Two responses were not rated by Judge B.

•

Number of responses rated

H O

Chi Square Level from of Phi S igni f i c ance

Judges compared

Rorschach were compared. The inter-correlations are shown in Table VII.

All

are related to each other at a very significant level. Two factors may account for this increased relationship between the judges1 ratings' over the correlations previously di scussed. The judges made their ratings on the first twenty-six records collected in this study.

Therefore in scoring the

fourteen protocols subsequently collected it was necessary for the investigator to make certain subjective judgments. In scoring the records by each judge’s system when a. "hostile" response was encountered which was not among those rated by the judge, it was necessary to estimate the appropriate weight from the list of fifty-five responses rated by that judge.

In making these estimates the writer

may have been influenced to some extent by knowledge of all three systems.

Thus there might be an artificial heightening

of the correlations between judges. Another factor which might account for an increase In agreement among the judges would be the cancelling effects of scoring an entire Rorschach record.

That is, differences

of one point between the judges’ systems in respect to a particular response could place the response in the hostile category for Judge X and in the non-hostile category for Judge Y.

By using the total number of hostile weights

614-

table

VII

INTER-CORRELATIONS AMONG RORSCHACH JUDGES'

Scoring systems compared

Number of cases Phi

Level of Chi Square r^“SIgnifIc ance

ko

.55

12.1

—

.01

Method A with Method C . [j.0

•95

36.1

—

.01

Method B with Method C

.6o

llp.lj- .914-

Method A wi th Method B

14-0

.01

The records were scored three times in order to compare each judgefs scoring system with that of the other two judges. Estimated when both distributions were evenly divided.

65 assigned to a record these differences would tend to cancel out.

In order to clarify this point, an extreme case is

presented: RORSCHACH RECORD #00 Number of response 1 2 3 5 o 7 8 9 10 TOTAL RHS

Weight assigned by Judge Y

Weight assigned by Judge X 4 (H) 3 (H) 1 2 2 2 3 (H) (H) 1 3 (H)

3 2 2 2 3 3 2 £ 1 2

k

2?

(H)

(H) (H) (H)

21*.

Since the ratings ranged from 1_ to ij., with weights of ^ and above called "hostile," and 2 and below "non-hostile," there is a low correlation comparing ratings item by item. In this hypothetical example, however, there is very close agreement between the over-all scores.

Inasmuch as the

*

judges’ basic ratings agreed significantly with one another, whether it was the first or second factor which contributed more to the higher correlations between systems is perhaps relatively unimportant.

Instead, it would appear

that it is the significant relationships between the judges’ independent ratings which should be emphasized. The Blake A Picture Story Test.

Introduction of two

66 special MAPS background cards, described in' the section on sources of data, required a slight change in administrative procedure.

When the patient was presented with Forced

Situation I (the blank background), the sixty-seven figures he had been using were put away and the limited set of figures was spread before him.

He was told that rrThe task

now is for you to make up a story, as you have been doing, but you must select one or more characters from this smaller group of figures.”

The last background administered was

Forced Situation II (the street scene with the two figures pasted on it).

The instructions were modified in this way:

"In this last one, the figures have alres.dy been placed on the background.

The idea here is to make up a story about

the scene you see depicted.” For scoring hostility in the MAPS Test the method used in the present study was essentially that of Fine (18). According to his system, only explicit hostility is scored. Varying weights are used.

In any story where the death of

one of the characters is mentioned a weight of 3. is assigned. Similarly, any physical hostility Is scored 2 and any verbal expression of hostility in a story is scored is scored only once for each story. this procedure was slightly modified,

IL .

^

Hostility

In the present study Weights were assigned

9 rx«, or a full description of Fine’s method see (18).

67 to each separate theme.

Thus In some stories more than

one hostility score might be given. The principal modification Introduced in this study, however, was the provision for scoring indirect manifesta­ tions of hostility (see Table VIII).

It was felt necessary

to score for covert forms of hostility since a large part of the clinician’s test Interpretations in respect to hostility are based on indirect signs of hostility.

For example, a

story in which one of the female figures in the MAPS Test is called "a slut out soliciting traden patently contains elements of a derogatory attitude toward women.

At least,

this is the type of assumption common in psychodiagnostic test interpretations.

With the inclusion of indirect forms

of hostility it was necessary to revise the weighting system. Accordingly Death was weighted Ij., Physical hostility Verbal hostility 2, and Indirect hostility 1_.

The patient’s

MAPS Hostility Score (MHS) was the sum of all weights assigned to the eight stories.

Other scoring notations were made, such

as the agent of and the object of the hostility, as outlined by Fine, but these scores were not weighted nor included in computing the MHS. To determine the reliability of this scoring method, the following procedure was employed.

Eighty of the 320

stories collected were selected by randomization and scored by E.S. Shneidman.

Shneidman, who is familiar with Pine’s

68 TABLE VIII GUIDE SHEET FOR SCORING HOSTILITY IN THE MAPS TEST

FORM Direct Verbal Physical De ath. Indirect Derogatory External!zing Hostile wit Other INSTIGATION Agent Father-figure Mo the r -fIgur e Sib11ng-fIgur e Husband Wife' Subject (self) Author!ty figure Man Woman Other Situation Unspecified Rivalry Dominance He jection Authority Dependency Other OBJECT T-Examiner Father Mother Sibling Husband

Wife, fiance, sweetheart Authority figure Self (subject) Man Woman Other DEFENSES AGAINST Special states (e.g. dre aming or drunk) Denial or ignoring Restitution or undoing Psychological distance Agent Aggressor vague, animal or mythical Aggressor not mentioned Child Object Object animal or mythical or vague object Child Other RESULTANT' Feelings Anxi e ty Guilt Warmth Depression Punishment Social (e.g. jail) Physical Other resultant

system, was instructed in the modifications described above before he made his ratings.

The writer had previously

assigned scores to these same eighty stories. data were dichotomized at the median.

Both sets of

Stories scored 2_ or

more by either scorer were termed "hostile,” those scored 1_ or less, "non-hostile.”

It was felt that phi would be

appropriate for estimating the degree of relationship between the two sets of data.

The phi coefficient of .75

(chi square = lp5.12)^ is significant far beyond the 1 per cent level of confidence indicating the MAPS Hostility Scores are reliable.

Edwards (lip) points out that Pearson r cannot be estimated from phi when r is greater than .80 (Up, p. 120). We may infer then that the obtained phi indicates a true correlation between raters in excess of .80.

CHAPTER V RESULTS It did not occm feasible to consider either the therapist’s impression or the test, indices as the criterion against which the other might be validated since neither has been sufficiently validated itself.

Rather, the question

the data should attempt to answer appeared to be:

to what

extent are test signs of hostility related to the therapist’s i impression of a patient’s hostility? The two sources of data, therapy ratings and test material, give us two dif­ ferent approaches to the individual.

To the extent that

these two sources are based on internally and externally 1 consistent factors in his behavior, they should agree. In addition, the quantitative treatment of the data should attempt to answer the question:

to what extent do the tests

used in this study measure hostility at different levels of the personality?

A third question which seemed important

to investigate was:

to what extent are such variables as

age, diagnosis, and number of therapeutic interviews related to manifestations of hostility reflected in test

^ Wheeler (52) suggests that the term "externally consistent" be used in preference to "valid" when there is no evidence that either of two variables being correlated is a "true" criterion.

71 performances and therapist ratings? I.

STATISTICAL TREATMENT OP DATA

In analyzing the obtained data in the present study, one basic statistical procedure was employed:

the phi

coefficient, with chi square derived from phi as the test of significance.^

Whether dealing with age in years,

therapists' ratings of hostility, or P-F percentages in terms of direction of hostility, the following procedure was employed:. 1. Each frequency distribution was dichotomized at the median.

Measures above the median were labelled

those below, 0 (or ,Thostils,,f "non-hos tile,n respectively). 2. In comparing any two sets of data, the number of cases falling in each category (++, 00, +0, 0+) were counted and the obtained numbers were converted to proportions of the total group (N = IpO). 3. The phi coefficient of correlation was computed from the proportions according to the formula (21, p. 2l[_6) : 0

=

* \f

pq p fq T

where,

o X

= N 0

o0hi square is related to phi by the equa.tion (21, p. 2i+.6).

72 £

= proportion of cases above medians x and y ♦

For example, In a record containing

2, 1, 2, ![- the total hostility

weight (12) ivas divided by the number of hostile responses (5) re suiting In an average intensity score of 2.ip. Unfortunately, this approach resulted In too limited a range of scores for statistical treatment.

A qualitative Inspection

of the few cases falling at the extremes revealed no consistent trend between therapy ratings of Intensity and these average Intensity scores. Table XIV presents correlations between length of contact In therapy, age, education and diagnosis with the therapy and test ratings. Age, education and diagnosis appear to be essentially unrelated to either therapy or test ratings.

An Interesting,

though not statistically significant, finding is the fairly

89

TABLE XIV CORRELATIONS BETWEEN LENGTH OF CONTACT IN THERAPY, AGE, EDUCATION, DIAGNOSIS AND THE THERAPY AND TEST RATINGS

Variables correlated"'

Phi

LENGTH OF CONTACT"'** WITH • Therapist rating .30 Rorschach .30 MAPS •k l Questionnaire .15 AGE WITH: Therapist rating Rorschach MAPS One s11onnalre

.llf.15

EDUCATION' WITH: The rapIs t rati ng Rorschach MAPS Que s11onnaire

-.22 .10

DIAGNOSIS".. WITH: .Therapist rating Rorschach MAPS Que s11onnaire ■"

.00 .12

.15

.00 .30 :io

.02 .05

Chi Square

3.6 3.6

8.8 •9

v f

■k7

-

Level of Significance

—

.01 --

.8 •9

.0 .5 1-9 •k

•9

.0

--

— — --

.15 -

— — —

.15 —_ -

— __ —

3:6

.11 .0 .1

B = 40 Estimated when both dlstrl buttons were evenly divided. Number of hours the patient had been in therapy at the time of rating. Psychiatric diagnoses were dichotomized Into’two groups:. "Major Illness" and "Minor illness".

90 high correlation between therapists' hostility ratings and diagnosis (phi = .30, significant at the 10 per cent level). This would seem to indicate that the therapist finds the more disturbed patient to be the more hostile patient. The length of time a patient was in therapy at the time of rating is the only variable to be significantly related to either the therapy or test ratings.

The signi­

ficant correlation is that between length of contact and MAPS Test.

However, it should be pointed out that correla­

tions between length of contact and both the therapists’ rating and RHS approach significance (the chi square in each case is 3.6 indicating significance at the 10 per cent level).

There appear to be several explanations for this

relationship between hostility ratings and length of contact. First is the fact that one of the purposes of therapy is to help the patient express negative feelings.

Another

factor is that in later sessions a patient, feeling more secure in the therapeutic situation, tends to find it easier to express hostile feelings.

Finally, as therapy

progresses, the therapist’s understanding of his patient increases, making it easier for him to detect evidences of hostility. No intelligence scale was administered to the patients sampled in this study, but the fairly high degree of correspondance between education and I.Q. reported by many

91 Investigators, suggests that educational level could serve as an estimate of Intellectual ability.

Paralleling the

findings of Elizur, who reports an absence of significant correlations between intelligence and hostility in the Rorschach, correlations in the present study comparing education with hostility ratings based on the Rorschach Hostility Score, MAPS, Questionnaire, and Therapy Rating Scale were found to be not significant.

Elizur does report,

however, some tendency for hostility to be negatively related to age In the college population he sampled.

The

present results indicate that, for patients in therapy, there is no relationship between age and hostility.

CHAPTER VI DISCUSSION In view of the pooitivo results obtained in comparing judgments of hostility based on .therapeutic contacts with projective test signs of hostility, the conclusion appears warranted that in respect to feelings of hostility, one of the primary emotions, the projective hypothesis is further substantiated.

Perhaps the most clinically useful result

to emerge from this study was the verification of the psychodiagnostician1s working hypothesis that hostility in the Rorschach and MAPS tests is related to hostility as revealed in clinical behavior.

The indications are that

the intuitive methods Reported by Schafer, Rapaport, et al (37, 36,

kk,

5l) in regard to the Rorschach and^those of

Tomkins, Beliak, Fine, et al (Ip, 17* 37* 51) in regard to) the TAT and/or MAPS tend to be confirmed.

Since the

projective tests proved to be useful measures of a patient’s hostility while self-ratings by the patient did not, and because of a marked tendency for the self-ratings to be negatively related to the projective tests, it appears that the projective tests tend to measure hostility of which the patient is unaware.

Elizur’s finding that patients’ self-

ratings correlated significantly with the Rorschach would, at first glance, seem to indicate that the individual is

93 aware of the hostility which he expresses when he sees in the Rorschach concepts like "dead animals, silly faces, etc."

However, it should be pointed out that Elizur used a

much more projective type of questionnaire than that used in the present study.

In describing The Self Rating Sheet,

he states The self rating sheet £items dcQ not ask directly about attitudes or feelings. Rather they inquire into the control which the subject feels he has over certain wishes, desires, and tendencies . . . The underlying rationale for such a device was that it may be far easier for an Individual to admit his inner struggle against certain temptations than to directly acknow­ ledge his weaknesses. Such an approach would presumably minimize the moral coloring of the various items. (15, p. 253) Thus, the fact that the patientTs self-ratings show a negative relationship with the Rorschach while in Elizur’s study the patient’s self-ratings were positively related to hostility in the Rorschach, apparently reflects a dif­ ference in design of the questionnaires used.

It is felt

therefore that the results of the present study are not contradictory to those of Elizur. The fact that two decidedly dissimilar stimuli, the Rorschach ink blots and the MAPS story telling materials, both proved effective in measuring hostility suggests there is a certain consistency in this aspect of an individual’s behavior.

That Is, the more hostile person will be likely

to perceive hostility in the world about him whether it be

9k in amorphous stimuli such, as ink blots of in more structured situations such as in the MAPS Test. The clinical significance of the sheer amount of hostility is, however, unclear.

According to the therapist,

the amount of hostile behavior shown by a patient in therapy tends to be related to the severity of the disorder from which he suffers.

However, since there appears to be no

relationship between diagnosis and the amount of hostility manifested by the patient in the projective tests, further study of the possible relationship between hostility and diagnosis seems indicated. Yarrow (54) recently reported an investigation into the effects of frustration on projective play.

In his

discussion, Yarrow speculates that . . . A large amount of aggression would be character­ istic of the child who has been strongly frustrated . . . On the other hand, such behavior may also be characteris­ tic of the child who is free and spontaneous in the expression of his impulses, a healthy symptom within limits. It would seem, therefore, that the amount of aggression in itself might not be so important a diagno­ stic sign as . . . qualitative aspects of the aggressive fantasies . . . (54* P* 33) In the adults sampled In the present study there does not appear to be a correspondence between expressions of hostility and general spontaneity.

It would seem., however,

that this lack of relationship stems from a different frame of reference In rating hostility and spontaneity rather than from a true lack of correspondence between these two

95. variables.

That is, the hostility ratings were based to a

large extent on indirect manifestations of hostility. Ratings of spontaneity, on the other hand, had to be based solely on overt behavior since there cannot be indirect or covert spontaneity. Although the findings indicate that there is little relationship between hostility as measured by either therapy or test ratings and such variables as age, education, and diagnosis, the length of time a patient is in therapy does appear to be a relevant factor to the amount of hostility he manifests.

In a recent article on hostility, Crider (10)

points out that in his experience the hostile individual is a much more difficult patient therapeutically than the anxious patient, commenting It’s easier for a patient to admit to anxiety and fears than hostility because most people are taught that resentment, hostility, envy or jealousy are things one shouldn’t have . . . (10, p. 271) Crider emphasizes further that the passively hostile person is a much more difficult patient to treat than one who is overtly aggressive.

Most authorities agree that the more

difficult patient must be seen over a longer period of time than the more easily treated patient.

The tendency for

length of contact to be related to test and therapy ratings of hostility In the present study, therefore, may reflect this situation, as well as the previously mentioned abreactive

96 effect of therapy and the tendency for the therapist to more adequately appraise a patient’s hostility pattern as therapy progresses. Several problems for further research in the area investigated by the present study have suggested themselves. Authorities on projective techniques frequently assert that the Rorschach gets at deeper layers of personality than do other projective techniques such as thematic tests, sentence completion tests and so forth (lj-8).

Originally,

it was believed that the present study might investigate the possibility of such differences between projective techniques by comparing the efficacy with which the Rorschach and MAPS tests measure hostility.

Since the Rorschach administration

was limited to the performance proper part of the test, however, such a comparison was not possible.

Since thera­

pists complain that Rorschach interpretations often are based on unconscious material which is too difficult to work with in any but the most intensive kind of therapy, such an investigation would be of considerable value. To further standardize content scoring of hostility, an item analysis, using a large number of cases, might be made to determine the most appropriate weights for weighting hostile responses to projective techniques.

The present

findings indicate that much work needs to be done in exploring such variables as the object and direction of hostility in

97 tests and behavior.

Because of the relatively low fre­

quencies one might expect to encounter analyzing objects of hostility in a thematic type test, a very large number of cases would be essential* The fact that the P-F did not prove to be externally consistent with the therapy judgments, raises the question as to whether this test should be used in clinical practise without revision. Some additional problems for investigation suggested by the present findings are:

(1) what differences are there

between men and women in respect to hostility? (2) over a greater age range would there be differences in hostility? The technique for scoring hostility in projective tests developed in the present investigation would seem to ha.ve unlimited possibilities for comparing the amount of hostility manifested by different groups of people.

For example, the

tests could, be used in comparing controls and experimental groups in respect to their reactions to frustrating situations; or social groups of different types could be compared.

Also,

clinical groups might be studied with respect to differences in the expression of hostility.

CHAPTER VII SUMMARY AND CONCLUSIONS T. SUMMARY It was the purpose of this investigation to determine the amount of agreement between ratings of hostility based on test performances and on therapeutic Interviews. The forty subjects consisted of neuropsychiatric patients who hs.d received a minimum of five one-hour thera­ peutic interviews.

The therapy ratings were obtained from a

scale filled out by the therapist who treated the patient. The rating scale consisted of nine parts in which the therapist rated (1) the frequency with which hostility in any form is expressed, (2) the object (or direction) of the hostility, (3) the stimulus for the hostility, (1_|_) the defense (or the patient’s reaction following his expression of hostility), (5) the intensity of the hostility, (6) the patient’s awareness of his hostility, (7) the over-all frequency with which hostility is expressed, (6) a rating of the p3.tlent’s general spontaneity, and (9 ) an estimate of the patient’s hostility outside the therapeutic situation. Quantitative weights were assigned to each of the nine parts of the rating scale and from the relevant and non-overlapping parts of the rating scale a total therapy rating for hostility

99 was obtained. The forty cases were dichotomized at the median, those above the median being considered hostile and those below, non-hostile. The test battery consisted of the performance proper part of the Rorschach Test, The Make-A-Picture-Story Test, the Rosenzweig Picture-Frustration Study, and a specially devised questionnaire for obtaining the patient’s self-rating of hostility. Fifty-five Rorschach concepts, judged to be hostile responses, were independently rated by three experts in the Rorschach technique.

Scoring of the records was based

on the pooled ratings of the three judges.

The total score

was labelled the Rorschach Hostility Score (RHS).

Again an

artificial dichotomy was employed; scores above the median were labelled hostile and those below, non-hostile.

The

Rorschach Hostility Score was compared with the ratings of hostility by the therapist by means of the phi coefficient, and the chi square test of significiance. To determine reliability, the three sets of ratings were compared with each other by means of phi coefficients. A modification of Fine’s .(18) technique for scoring hostility in thematic material was employed to obtain MAPS hostility ratings.

To determine reliability, a sample

of eighty MAPS stories was independently scored by two

100 clinical psychologists.

The extent of agreement between

the two scorers was estimated by the phi coefficient.

/ I j

Ratings of hostility by the patient himself were obtained from a questionnaire, and were correlated with ratings made by the therapist in the same manner as the preceding sets of data were compared.

Similarly, the

patients’ scores on the P-F Study were compared with the appropriate parts of the rating scale. In an effort to ascertain at what level the different tests function, each test in the battery^- was compared with the other tests.

The test of statistical significance again

was chi square derived from the phi coefficients. Finally, age, education, diagnosis and length of contact in therapy were correlated with, both the test and therapy ratings to discover whether these variables influ­ enced the hostility ratings. II. CONCLUSIONS The conclusions drawn on the basis of the foregoing procedures were as follows: 1.

Hostility ratings based on content analysis of

the Rorschach performance proper and MAPS were very signi-

^ With the exception of the P-F Study which was scored for direction of hostility only.

101

ficantly related to each other, as shown by the phi correla­ tion between these two tests of .1x7 (p. = »73)» 2. Ratings of hostility based on the Rorschach Hostility Score show a very significant relationship with ratings of hostility based on therapeutic contact as re­ flected by a phi correlation of .50 (r = .78). 3. Similarly, ratings of hostility based on MAPS content were related, at a very significant level, with therapists' ratings of hostility as indicated by a phi correlation of .[{if (r = .69). if. Patients' self-ratings of hostility (the Question­ naire) showed only a chance relationship with the therapists' ratings of hostility (r = .07). 5.

Negative relationships were found between the

patient’s self-rating of hostility (the Questionnaire) and his performance on the Rorschach and MAPS tests.

The esti­

mated Pearson correlations were -.39 an respectively. Neither of these results was significant, but suggest that the pa.tient tended to be unaware of the hostility he mani­ fested in~the projective tests. ■6. Evaluations of hostility in the Rorschach perform­ ance proper were found to be internally consistent as shown by a reliability study in which the weights assigned by three judges to fifty-five Rorschach responses were compared to those of every other judge resulting in significant phi

102

correlations of

.3 k - *

*^-3 and •ij_3•

7. Since each of the three judges had independently rated the responses on his own intuitive method and since the mean of the three ratings proved to be significantly related to the therapy ratings, the implications are that clinicians1 judgments of hostility in the Rorschach are externally consistent with hostility manifested in clinical behavior. 8. Comparisons of certain MAPS.variables:

defensive­

ness; number of hostile objects; and frequency with which hostility is directed toward the "hero” and toward sibling figures failed to show significant relationships with corresponding therapy ratings.

This negative finding was

felt to be a reflection of inadequate design in the present study for testing these hypotheses.

9 . The direction of hostility, as measured by the P-P Study, showed no significant relationship with judgments by the therapist as to direction of hostility.

The phi

correlations between extrapunitive, intropunitive and. impunitive scores and ratings were .28, -.10 and -.26, respectively. 10.

Age, education and diagnosis were not related to

either therapy or test ratings of hostility as shown by phi correlations ranging from —.lip to .30. 11..The amount of hostility a patient manifests was

103

found to be related to the length of time he is in therapy as indicated by a significant phi correlation of .1|_7 between length of contact and the MAPS Test and by phi correlations of .30 (significant at the 10 per cent level) between length of contact and both the PLorschach and therapy ratings.

B I B L I O G R A P H Y

BIBLIOGRAPHY 1. Arnold, M.B., "Physiological Differentiation of Lmotional States," Psychological Review, 5>2:35~M/ 195-5* 2. Baruch, D.W., "Aggression During Doll Play in Preschool Children," American Journal of Orthopsychiatry, ll:252-260,~T ^ I l T .

3. Bell, J.E., Projective Techniques. Green and Company, 19^63

New York:

Longmans,

533 PP*

I4.. Beliak, L. , "The Concept of Projection," Psychiatry, 7 :353-370, i9kk5. Bochner, Ruth and Halpern, Florence, The Clinical Application of the Rorschach Test. New York: Grune and Stratton, 19if/. 331 pp.

6. Brill, A.A., The Basic Writings of Sigmund Freud. New York:

Random House, Inc. , 193"8T

1001 pp.

7. Cannon, W.B., Bodily Changes in Pain, Hunger, Fear and Rage. New York: D. Appleton and Company, 1929. ipO4 pp. 8. Cleckley, H.M., The Mask of Sanity. St. Louis: C.V . Mosby C ompany3 195-1. "29 8”pp.

The

9 . Corey, D.Q., "The Relationship Between Vocal Cues and Social Hostility," (Unpublished Doctor’s Dissertation, The University of Southern California, Los Angeles, April, 1950). 10. Crider, B., "The Hostility Pattern," Journal of Clinical Psychology, 2:2o7-273, 194-6 . 11. Darwin, C., Expression of the Emotions in Man and Animals. New York: D. Appleton and Company, 189*6. 372 pp. 12. Deutschberger, P., "The Psychosomatic Component in Problem Behavior," American Journal of Orthopsychiatry, li[.:521-527, I9M 4-. 13. Dollard, J., Doob, L.W. , Miller, N.B., Mowrer, O.H., and Sears, R.R. , Friistration and Aggression. New Haven, Connecticut: Yale University Press, 1939* 209 PP*

105

ik. Edwards, A.L., Statistical Analysis. New York: Rinehard and Company, I9I4.5T

360 pp.

15 Elizur, A., "Content Analysis of the Rorschach with *

Regard to Anxiety and Hostility," Journal of Techniques, 13 • 2q7-28lt, September, 19^4-9•

Protective

16. Penichel, 0., The Psychoanalytic Theory of Neurosis. New York:

W.W. Norton and Company, Inc., 194-5* 5*89 PP*

17. Pine, R., nA Quantitative Study of Personality Factors Related to Bronchial Asthma in Children," (Unpublished Doctor’s Dissertation, The University of Southern California, Los Angeles, April, 19^-8 ) Ip13 PP*

18.

, "Manual for Scoring Scheme for Verbal Projective Techniques (TAT, MAPS, Stories, and The Like)," (Unpublished manual, The University of Southern California, Los Angeles, I9I4-8 . 12 pp.

19. Franklin, J.C., and Brozek, J., "The Rosenzweig P-F Test as a Measure of Frustration," Journal of Consulting Psychology, 13^293-301, 19^4-9* 2 0 . Goodwin, P.A., "A Comparative Study of Hostility Patterns

in Patients with Peptic Ulcer and Bronchial Asthma," (Unpublished Doctor’s Dissertation, The University of Southern California, Los Angeles, 19^ 9 )• lf?9 PP* • 2 1 . Guilford, J.P., Fundamental Statisties in Psychology and

Education. New York and London: Company, Inc., 19^4-2 . 333 PP*

McGraw-Hill Book

22 . ______, Psychometric Methods.

New York and London: McGraw-Hill Book Company, Inc., 1936. 566 PP*

23. Horney, Karen, The Neurotic Personality of Our Time. New York: W.W. Norton and Company, Inc., 1937* 299 PP* 2k -

Klopfer, B., and Kelley, D.M., The Rorschach Technique. Yonkers-on-Hudson, New York: World Book Company, 19^ 2 . i_|_36 pp.

25. Korner, Anneliese F., Some Aspects of Hos111ity in Young Children. New York: Grune and Strat ton, 19ip9• 185 pp.

26. Levy, D., "Hostility Patterns in Sibling Rivalry Experiments," American Journal of Orthopsychiatry, 6:183-257, 1 9 3 ^

io6 27. ______, "Hostility Patterns,” American Journal of Orthopsychiatry, 13: ljlj-1-ij-ol, 19*43 • 28. Lewin, K., Lipett, R., and White, R., "Patterns of Aggressive Behavior in Experimentally Created Social Climates, fT Journal of Social Psychology, 10:271-2999 1939.

29. McClelland, D., and Apicella, P.S., ”A Functional Classification•of Verbal Reactions to Experimentally Induced Failure,” Journal of Abnormal and Social Psychology, ij.O:376-390> 1955". 30. Maslow, A.H. , ’'Deprivation, Threat and Frustration,” Psychological Review, I48: 36I4-366, 19^-1* 31. Menninger, K., Man Against Himself, New York: Brace and Company, 1938. I47I PP*

Hareourt,

32. Miller, N.E. , "The Frustration-Aggression Hypothesis,” Psychological Review, lj_8:337-34-2, I9I4I • 33. Mori and, G-. , ”A Note on the Frustration-Aggression Theory of Dollard and His Associates,” Psychological Review, 56:1-8, January, 19^-9*

3I4. Mowrer, O.H., and Kluckhohn, C., "Dynamic Theory of Personality,” Hunt, J.McV., Personality and the Behavior Disorders, Volume I. New York: The Ronald Press C omp any, 19)44.. 618 pp. 35. Murphy, Lois, "Childhood Experience In Relation to Personality Development,” Hunt, J.McV., Personality and the Behavior Disorders, Volume II. New York: The Ronald Press Company, 19^4* 621 pp.

36. Prince, S.D., ”A Comparative Study of Personality Characteristics in Bronchial Asthma and Peptic Ulcer Patients: as Revealed by the Rorschach Test,” (Unpublished Doctor’s Dissertation, The University of Southern California, Los Angeles, June, I9J49). U 5 pp. 37* Rapaport, D. , Diagnostic Psj c h o 1ogical Testing. Volume III. Chicago: The Year Book'Publishers, Inc7T~~19fy-6. 5l6 pp.

38. Rorschach, H., Psychodiagnostics. 19^ 2 . 226 pp.

Bern:

Hans Huber,

107 39- Rosenzweig, S ., 1*1eming, xlditin .ii•, and C1 arksj Helen J# , "Revised Scoring Manual for the Rosenzweig PictureFrustration Study, " The Journal of Psychology, 2 l\.: 165-208, 194-7. IpO. Rosenzweig, S. , "The Picture-Association Method, and its Application in a Study of Reactions to Frustration," Journal of Personality, Volume lip, Number 1 3-23, September, T 9ij-5• Ipl. Sargent, S. , "Reaction to Frustration--A Critique and Hypothesis," Psychological Review, 55*108-lllp, March, I948. Ip2. Saul, L., Emotional Maturity. Philadelphia: Lippincott Company^ 1947 • 338 pp. 43.

J.B.

, "Hostility in Cases of Essential Hypertension," Tomkins, S.S., Contemporary Psychopathology. Cambrid.ge, Massachusetts: University Press, 19^4-3• 600 pp.

I4J4.. Schafer, R. , The Clinical Applic at ion of Psychological Tests. New York: International Universities Press, Inc., I9I4-8. 336 pp. I|_5. Sea.rs, R. , "Non-aggressive Reactions to Frustrations," Psychological Review, I 4 . 8 :3113-3Ip6 , I9I4-I. 46. Sears, R., Havland, I., and Miller, N. , "Minor Studies of Aggression," Journal of Psychology, 9*275-294, I9I4.O. Ip7. Shneidman, E.S., "Schizophrenia and the MAPS Test," Genetic Psychology, -38:145-223a 194$• ip8. ____ ___, "Some Comparisons Among the Four Pictures Test, the Thematic Apperception Test and Make A Picture Story Test," Journal of Protective Techniques, 13:150-154., 19^4-9 •

49. Stagner, R., "Studies of Aggressive Social Attitudes," Journal of Soclal Psychology, 20:109-120, I9I4J4.. 50. Stewart, Barbara Ph., "A Study of the Relationship Between Clinical Manifestations of Neurotic Anxiety and Rorschach Test Performance," (Unpublished Doctor1s Dissertation, The University of Southern California, Los Angeles, 1950). lip. pp.

108

51.

Tomkins, S.S., The Thematic Apperception Test. York: G-rune and Stratton, 19^7 •~ 297 pp.

New

52.

Wheeler, W.M., "An Analysis of Rorschach Indices of Male Homosexuality," Journal of Projective Techniques, 13:97-126, June," IQijQ. “

53. Wolf, S., and Wolff, H.G. , "Evidence on the Genesis of Peptic Ulcer in Man," Tomkins, S.S., Contemporary Psychopathology, Cambridge, Massachusetts: Harvard University Press, 19^-3* 600 pp. 5^. Yarrow, L.J., "The Effect of Antecedent Prustrati on on Projective Play," Psychological Monographs, Volume 62, Number 293, -- ------------ --55. Zander, A.P., "A Study of Experimental Frustration," Psychological Monographs, Volume 56, Number 256, 19l;i|.

A P P E N D I X

109 RORSCHACH RESPONSES AND TEE RATINGS ASSIGNED BY THE THREE JUDGES

Rating ^7 Judge A B C

Response %

Animals shot Antlers on a Geer Bat that has been layed out Plat Couple of bears fighting Blood Body that has floated to the suirface after being In the water some time Bug with horns Bullet'going through some substance Bulls charging each other Casting of an ant-hole, like you take hot lead and pour it down to get a pattern Child, its hands are cut' off Crawfish opened up with a knife Dead butterfly Dead man Decayed, diseased organs Dessicated bat, d.ead, flesh has been torn and rotted away Drunk, fell on'his back Fellows In a duel, really fighting, you can see the sabres Fellows falling on their rear ends Fire Fish, funny expression on their face as If they are mad at each other Harmful creature Headless person Head of a snapping turtle Human skull I see red (Q) My brother always risaw redff Killed animal KnIghts f helmet s Lobster c1 aw's Maggie (to card VII) (of Maggie and Jiggs comic strip) Mouse cut open Mouses dancing (to card VII)

3

3

2

0 0

3

2

3

3

2

k 1

2

3

b b 1

3 3 4 3 3

3 3 3

2

3 3

k 2 b 2 3

2 1 2 2

b 2

3

1

b 3

2 3 3 l

2 2

2

3 3

k l 0

2 2

2 2 _

3

2

0

3 3 3

0

2 2 1

_

3

2 2

1 2

2 2 1

3

1 0

3

1 1 1 1 2 2 2 2 1 2 2 1

110

H RESPOUSE S AND THE RATINGS IE JUDGES (Continued)

Response Old ladies gossiping Overly polite men People with glass slivers In their feet, blood dripping, heads severed off People with dunce caps "on Person’s lungs eaten away Pistol Policeman Punch and Judy arguing Rabbits snarling at each other Rabbit that’s been cleaned and opened up Red means a battle Silly face’ Skinned goat with head left on Stupid men Tentacles of an octopus Toads, growling at each other Tigers Torn band-aid Torn down body tissue Torn flower Wire snippers Wooden figures on a stick, you jiggle them up and down (to card III)

Rating by Judge A. B C 2 2 k-

2 3 3 3 3 3 2 o J 2 2 2 2 3 2 3 3 3 **

2

1

2

1 2

3 2

ij ._ L 1 2 3 2 2 3 2 3 2 3 2 2 3 2 2 2 2 3

0

2

Ij2 0 2 2 3 3 2 3 2 0 2 2 3 2

0 0

Ill RORSCHACH RESPONSES RECEIVING APPROXIMATELY THE SAME WEIGHT BY THE THREE JUDGES*

RESPONSES WEIGHTED Ip Bullet going through some substance Two fellows In a duel, really fighting, you can see the sabres People with gl ss slivers in their feet, blood dripping, heads severed off RESPONSES WEIGHTED 2 Animals, shot Couple of bears fighting Body that has floated to ttie surface after being in the water some time Bulls charging each other Child, its hands are cut-off Crawfish opened up with a knife •Dead man Pi stol Punch and Judy arguing The red means battle Torn flower Wire snippers Rabbits snarling at each other Toad.s growling at each other RESPONSES WEIGHTED 2 Mouse cut open Drunk who fell on his back Fellov*rs falling on their rear ends Head of a snapping turtle Killed animal Xni ght fs heIme ts 'Lobster claws -Maggie (to card VII) (of Maggie and Jiggs comic strip) Overly polite men People with dunce caps on Policeman .Rabbit that’s been cleaned and opened up Responses rated the same by all three judges, or rated the same by two judges with the third rating differing by no more than one point.

112

RORSCHACH RESPOH! THE SAMS WEIGHT BY THE THREE JUDGES (Continued)

Silly .face Stupid men Tentacles o f an octopus Tigers RESPONSES WEIGHTED 1 Bug wi th horns Mouses dancing (to card VII) Old ladles gossiping Two pigs (to card VII) RESPONSES WEIGHTED 0 Hone

113 HOSTILITY RATING SCALE TO:

Psychotherapists

FROM:

Robert G. Walker

SUBJECT:

Hostility Patterns

This rating scale is part of my doctoral dissertation investigating relationships between expressions of hostility in psychotherapy and indications of hostility on projective tests. For this study I need ratings by therapists of the ways in which hostility is manifested by their pa.tients in psychotherapy. "Hostility” is herein defined as any behavior in the psychotherapeutic situation which is motivated by the patient’s wish to attack, belittle, thwart, or destroy an object. This may take many forms: verbal criticism, ridicule, etc: injurying or killing in fantasy; actual striking (e.g., poundtable), kicking, etc. The object of the hostility is usually another individual, but it can be a group of people, an inanimate object, an institution, etc. Please rate your patient in respect only to the hostility which he actually manifests during the therapeutic sessions. This point may be clarified by an illustration. One patient might tell you that on the preceding day he had been very angry with someone; in relating this experience to you, however, he expresses no hostility (i;e., in terms of emotional response). Another patient, on the other hand, might report an incident of a similar nature, but in recounting the experience, he expresses hostility--in a sense, he re­ experiences the event. In the latter case, then, the hostility would be rated while in the former, it would not. Throughout the scale,your ratings should be based on the patient’s expressions of hostility which he has manifested over the total number of therapeutic contacts at the time of your rating. In some cases, it may be difficult to make a rating on this basis since a patient in the course of therapy may show very marked changes in the way he handles his hostility. However, it is expected that in most instances each item can be rated on the basis of all sessions. Should you for any * reason find it impossible to rate an Item, please write in a bried explanation in the space provided under "Remarks." Do not hesitate to use the extremes of the scale. Within a week from the time you rate your patient on the attached rating scale, I will administer to him a short battery of projective tests. A brief report of the test findings and, later on, a summary of the over-all results of the study will be available to you if you desire them. Your cooperation in this project is sincerely appreciated.

Patient’s name: Diagnostic impression:

Patient is in:

Individual psychotherapy______________ __ _ Group psychotherapy

___

Number of hours that the patient has been in psychotherapy with you at the time of this rating:___ Usual frequency of sessions per week: In respect to this patient, you are his: Individual therapist

___

Group therapist (or observerrecorder) Both individual and group therapist (or observerrecorder)

Date

Therapist

115 1--Rarely, never 2--Seldom, only occasionally 3--Rather frequently, fairly often Ij_--Very frequently, consistently Indicate frequency by placing the appropriate number in the _____________ space provided____ _____ _ PART I

WAYS IN WHICH THE PATIENT MANIFESTS HOSTILITY In this part of the scale, we are concerned only with the ways in which the patient shows hostility. For this section, you may disregard the intensity of his hostility, and whether it is directed towards another person or himself, etc. Use the frequency key at the top of the page.

Direct, verbal hostility (e.g., "He is a s.o.b.’", ffI hate myself.^ "This hospital is a hell of a place. 1ft, etc. ). _____ Physical expres sions Slamming fist on desk, kicking furniture; striking himself (e.g., hits head with his hand exclaiming, "Why am I so dumb. 1" ) ______ 3. Withdrawal The patient leaves the session before time is up as a gesture of hostility ____ Reversing of roles The patient tries to act the part of therapist (Let’s talk about your problems today.")

____

5- Hostile wit Includes sarcasm, "kidding," humorous innuendo, etc. ("LORD Smith," in reference to a Dr. Smith)

6. Argumentation

Intellectualized hostility; "matching wits1* (You told me to talk about my past, now you say I ’m resisting therapy.1") __

7* "Hostile affection” Exaggerated warmth thinly disguising the underlying hostility ("Oh, I ’m so fond of my little brother.") __

8. Q,uestionlng therapist

Where It seems to be primarily an expression of hostility, e.g., questions about the therapist’s training, qualifications, etc. ___

9* "External!zing" "Objective," critical discussion. I.e., excessive concern and preoccupation with the defects or limitations of a person or situation, but with no apparent awareness of the subjective anger or hostility which motivates this pseudo­ objective description.

li6 1--Rarely, never 2--Seldom, only occasionally 3--Rather frequently, fairly often l|_--Very frequently, consistently Tndicate frequency by placing the appropriate number In the ______________ spaceprovided ____ __________ PART I (Continued) 10.

Tardiness and/or mis sing app o1ntme nt s Coming late, or missing an appointment as an expression of hostility.___________________________________ ____

11.

Hon-participating activity Doodling, reading, etc. only where you feel this is primarily an expression of hostility. _____

12. Silences Only where you feel the silence is primarily an expression of hostility.___________ ____ 13. Other forms

lip. Remarks:

Please describe, giving an example.

117 Frequency Key: 1--Rarely, never 2--Seldom, only occasionally 3__Rather frequently, fairly often q.--Very frequently, consistently Indicate frequency by placing the appropriate number in the _____ _____ _____ space provided ________ . PART II

TEE DIRECTION OR OBJECT OF THE PATIENT’S HOSTILITY In this part, rate how frequently the patient directs his hostility toward the objects listed below, independently of the form or intensity of the hostility. Thus, both the patient who mildly belittles himself, and the one who Is terrifically Intrapunitive or selfpunishing are rated as expressing hostility toward the self. IJse the frequency key at the top of the page.

3* Hostility directed toward the self (”1 ’m to blame.” ''Damn me, what a jerk I ami,r "I guess It’s my fault.”, etc.) ____ ‘ Towards impersonal objects or situations ("This Is the lousiest hospital in the state.’”) _____ 3* Towards other persons

____ _

3a.Objects; specific' people or types of individuals towards whom the patient Is hostile. How frequently Is his hostility directed toward: (1) Therapist . . .

(5) S p o u s e ........ .....

(2) Mother........ .....

(6) Doctors

(3) Father........

(7) Superiors

(lj.) Sibling . . . ._____

(8) Other: _____ _

. . . ._____ . . .

if.. Where situations call for hostility, how frequently does the patient respond in an impunitive (that is, evasive) way;'..how frequently does he tend to gloss over the Inci­ dent, or say, "There’s really no reason to get angry” or "Everything will turn out all right.” ____ 3>. Remarks:

118

Frequency Keyt 1--Rarely, never 2--Seldom, only occasionally 3--Rather frequently, fairly often [j___Very frequently, consistently Indicate frequency by placing the appropriate number in the space provided _______ ____________ _ PART III

STIMULUS FOR (OR CIRCUMSTANCES PRECEDING) THE PATIENT'S EXPRESSION OF HOSTILITY

1. The patient's hostile expressions tend to be stimulated by so many types of individuals and/or situations, it might be called "free-floating hostility." ___ 2. The patient’s expressions of hostility tend to be attributable to an essentially appropriate to reality situations (e.g., during a therapy session, the patient expresses anger towards the hospital for being denied what both you and he feel was a reasonable request). ‘ _____________ ___ 3. Although his expressions of hostility are stimulated by reality situations, they tend to be inappropriate to or out of proportion to the actual situation. (e.g., the patient Is slightly Inconvenienced by a hospital rule, and reacts with violent anger). ___ Ip. Please list the specific stimuli which seem to call forth hostility in this patient (e.g., the patient's hostility seems to be aroused by attempts on the part of his mother to dominate him. Another Illustration: appears to be in reaction to men who are in positions of authority over him. ) If there Is more than one stimulus or situation, please list in approximate order of importance to the patient

5. Remarks:

119 Frequency Key: 1--Rarely, never 2--Seldom, only occasionally 3--Rather frequently, fairly often lp--Very frequently, consistently Indicate frequency by placing the appropriate number in the ___ ______ ____ _ space provided PART IV

WAYS IN WHICH THE PATIENT REACTS TO HIS OWN EXPRHS SIGNS OF HOSTILITY

1. Following a hostile attack on someone else, he tends to direct hostility towards himself. (e.g., "It’s really me who's a no good bastard.'", or "Gee.' I must be an ____ awful person for saying a thing like that.") 2. Justifies by rationalizing ("I hate that doctor-everyone knows he's the meanest doctor on the virard. ")

_______

3. Projects guilt or expresses anticipation of punishment, criticism, or rejection by the therapist ("You hate ____ me for saying that.") Ip. A.ttempts to "undo" the hostility by verbalizing opposite feelings (e.g., expresses praise or warmth toward the object towards which the hostility has been directed). ____ 5. Attempts to "undo" by simple denial ("No, I don't mean that; I'm really not angry.")

_____

6. Displaces to a "safer" object; i.e., reacts by changing the object of hostility to one which is less likely to arouse anxiety or guilt. _____ 7* Withdraws to a "supporting" object; i.e., attempts to avoid feeling anxiety or guilt by turning his attention to a different, but friendly object. _____ 8. After expressing hostility, he reacts with manifestations of anxiety, (e.g., a patient expresses anger towards a parent In therapy, and then twists hands nervously, etc. but shows none of the other reactions listed above.) 9- There is apparently relief of tension and/or no discomfort or guilt over having expressed the hostility; or satisfaction seems to follow the expression of hostility. ____ 10. Other:

120

PART V

INTENSITY OP THE PATIENT’S HOSTILITY

Place an X In the space which comes closest to describing ________ • yourpatient ___ ______________ Fere, we are interested in obtaining your estimate as to the characteristic intensity of the patient’s overt manifestations of hostility, as well as your judgment as to the Intensity of his unconscious hostility.,

0vep~k On the basis of the patient’s use of rfstrong language,” degree of motoric expression, etc. his expressions of hostility are usually: a. b. c. d.

Very Intense; he has virtually a "temper tantrum” Rather intense; he is obviously angry ______ _____ Mildly Intense; he appears rather annoyed Definitely mild; he seems only slightly irritated_______________________________________ _____ e. Remarks :____ ______________________________________ _

2* Covert Estimate from this patient’s total behavior in psychotherapy, the intensity of his unconscious feelings of hostility (as contrasted with the surface manifestations you have rated above). a. Very Intense; more intense than the usual psychotherapy patient _____ b. Moderately Intense; about the same in intensity as the average patient in psychotherapy_______________ c. Mildly Intense; less Intense than In the average psychotherapy patient d. Remarks :_____ ____ ____________ _____ _________ _______ _ 3* Importance of hostility Irrespective of intensity, how Important a problem would you say hostility Is in this patient? a.. Very important; it is the patient’s major problem b. Important; it is one of the patient’s major problems. c. Secondary; not one of his main difficulties d. Minor; the patient has relatively little difficulty handling his hostility. e. Remarks:

121

PART VI

THE PATIENT’S AWARENESS OP HIS HOSTILITY

Place an X in the space which comes closest to describing your patient . ___ _

1 . When this patient manifests hostility in any indirect way (e.g., hostile wi t, reversing of roles, questioning the therapist, etc.), he most characteristically: a. appears essentially unaware that he is expressing hostility and would probably deny It (in one way or another) If It were pointed out to him.__________ __ b. seems unaware, but is able to accept the feeling with the therapist’s help; e.g., after an inter­ pretation, a patient says, nYes, for the first time, I realize that I really hate him . 1rT_________________ c. shows a vague, general awareness that he is expressing hostility.____________________________ __ d. is obviously aware that he is expressing hostility._____________________________________________________

e. Remarks: PART VII

FREQUENCY OF THE PATIENT’S MANIFESTATIONS OF HOSTILITY IN ANY FORM

Indicate frequency by placing a check on thescale 1. On an over-all basis, hostility (in any form) is expressed by this patient:

'

L________ L__________ L________ L__________ L Never, rarely

Seldom, only occasionally

PART VIII

Moderately often

Rather freq., Very fairly often frequently, • consistently

SPONTANEITY - INHIBITION

1. Rated on an over-all basis, In terms of the expression of feelings in general (whether feelings of anxiety, warmth, hostility, guilt, etc.), this patient is:

L_______ L___________L________ L__________

Very Rather .Inhibited Inhibited

Moderately free Rather In expressing spontaneous feeling

l

Very spontaneous

122

PART IX

REPRESENTATIVENESS OP THE PATIENT’S EXPRESSIONS OP HOSTILITY IN THE THERAPEUTIC SITUATION

If in therapy your patient tells about his expressions of hostility outside the therapeutic situation, he may exaggerate or minimize the incidents, and for this reason, you have been asked to rate only hostility which he actually manifests during the therapy sessions. Probably for most patients, the way they manifest hostility in therapy is fairly representa­ tive of the way they handle their hostility outside therapy. However, in some cases, there may be interesting discrepancies between what the patient does In therapy and what he says he does outside, in life situations. In this section of the scale, then, we are interested in finding out what differences, If any, your patient shows in this respect. 1. Do you feel that the ratings you have made of this patient’s expressions of hostility within the therapeutic situation give a representative picture of his method of handling his hostility In general--!.e., Including extra-therapeutic situations? Yes _______

?

No

___

If you checked nYes,,f omit PART X below PART X

THE PATIENT’S EXPRESSIONS OF HOSTILITY OUTSIDE THERAPY

Intensity According to the patient’s reports, his expressions of hostility outside therapy are: a. b. c. d.

much more intense than In therapy_______________ somewhat more Intense than in therapy less intense than in therapy much less intense than in therapy

_____ _____ ____ _____

2. Form Are there some forms or ways of expressing hostility which the patient apparently makes use of outside therapy, according to his reports, which are not as clearly manifested during the therapy sessions? If so, please indicate what they are, using PART I, pages 3 and ip of this rating scale, as a guide.

3* Object Do you feel there are any major differences between the objects of his hostility as expressed within psycho­ therapy and the objects of his hostility outside therapy? (e.g., a patient might very frequently express hostility ■ towards himself in therapy, but according to his reports, rarely express hostility towards himself in life situa­ tions). If so, please describe the differences In the space at the top of the following page.

123 PART X (Continued)

k-*

Reaction Are there any differences in the ways in which the patient reacts to his expressions of hostility outside therapy as opposed to within the therapeutic situation? If so, indicate which reactions occur more frequently and which less frequently outside therapy in terms of those reaction patterns listed in Part IV, Page 7 o f this rating scale.

12l|_

Name___________________ ___ ____ H - R

D a t e __________

QUESTIONNAIRE

Everybody experiences, at one time or another, feelings ofhostility or anger. People differ, however, as to the intensity of their anger and the frequency with which they express such feelings. Also, individuals tend to differ as to the things that make them angry. There are of course other differences. For example, there are differences in the way in which people show their anger. In this test, you are asked to Indicate whether each state­ ment is true or false as applied to you. To show that a statement is true (or usually ’true), circle the "T"; to show that a statement is false (or usually false), ,circle the "F,!. When it is difficult to decide a particular Item, circle the one which comes closest. Plea.se respond to each Item. 1.

I try to cover up my poor opinion of a person so that he won’t know how I feel T F

2. It is unusual for me to express strong approval or disapproval of the actions of others

T F

3. I am afraid to let myself become angry--even when it is justified--because I might hurt someone

T F

ip. The thing that keeps me from showing how angry I am with a person is the fear of what he might do to get even

T F

5. The thing I like to do when I am mad at someone is to get his goat by teasing; him or poking fun at him T

F

6. I am worried about my feelings of anger towards people 7. Often I find myself worrying about the welfare of some member of my family

T F T F

8. When I am mad at someone, I generally show it by arguing with him

T F

I/hen I get angry, I kick things, or pound the table, etc. T

F

10. Frequently when I am angry, I say nothing and don’t let people know I am mad T

F

125 11. When I am cross with someone, I am apt to start reading or busying myself with some little task so as not to show I am angry

T

P

12. When I get mad at someone, I may threaten to strike him 1

P

13. After I have expressed anger, 1 calm down and feel o.k.

T

P

lip. When I have been angry, I feel uneasy and some way to make up for having been angry

T

P

15. Most of the time when I am angry, it is because I have done something that makes me mad ’at myself

T

P

16. I find that I am mad at other people more often than I am angry with myself

T

P

17. Instead of being angry at particular individuals, I tend to get angry at things like the company I work for, or the government, or foreign countries or the like

T

P

18. After I have been angry toward someone, I feel guilty about it

T P

tryin

Each of the following items has a number of choices. Check the one choice which, best describes the way you feel. a. When I become angry, I generally am: (1) only slightly irritated _____ (2) rather annoyed (3) definitely angry _____ (Ip) very mad _____ b. Compared with other people, I tend to get angry: (1) much less often _____ (2) somewhat less often ______ (3) somewhat more often ______ (Jp) much more often ___ ____ c. As a kid, the person in my family I was the most resentful of was: (1) my father ___ (2) my mother _____ (3) a brother _ (Ip) a sister (5) other: who?

126 d. The person (or type of individual) towards whom I now feel the most resentment is: (1) my wife (or husband) (3) my mother (5) employer (7) certain types of persons (e.g., Negroes, Jews, Catholics, etc.)

(2) my father (4) brother (or sister) (6) doctors (8) other: who?

S m * h e m CaHfente