A Psych0therapeutic Approach with Elementary School Teachers Giuseppe Multari, D.S.P.*
ABSTRACT: The traditional "'lectures delivering" approach to classroom teachers used by mental health practitioners is investigated in the present study. An attempt is made to demonstrate the validity of preventative work in helping elementary school teachers as important agents in the promotion of more positive mental hygiene in the classroom and by adding to the lectures the variable of group therapy-"ego-sparing" techniques type. The latter approach seems to promote a teacher's own sense of security, more security in dealing the pupils, an easier acceptance of differences in others, and, finally, it tends to stimulate the development of a teacher's own ability to deal more sensibly, more conscientiously, and more realistically with daily problems.
One of the major concerns of the community mental health movement focuses on the utilization of professional and nonprofessional personnel outside of the traditional mental health fields of psychiatry, clinical psychology, and psychiatric social work in creating new, or expanding old, preventive or therapeutic mental health services. This paper is concerned with the application of this broad tenet in the public school situation through training teachers toward greater effectiveness as observers of personal problems, and as agents toward their appropriate remediation, in the classroom. The concept of the public school as an area of community mental health activity is, of course, not new. One need only mention the work and formulations of Sarason (1966) at Yale Psychoeducational Clinic and the research carried out by Cowen, Gardner, and Zax, (1967) within the framework of the public school system in Rochester, New York. The present project, much less ambitious in scope, aims to increase the effectiveness of teachers as agents of community mental health by combining the traditional didactic approach with discussion--a group psychotherapy program. The assumption underlying this undertaking was that unexpressed and unrecognized attitudes and problems of a personal, social, and professional nature would stand in the way of absorption of factual mental health information and would prevent its utilization in the classroom unless an opportunity to air and work through these opinions, feelings, and beliefs were to be provided. The mode of application of these objectives is given below. METHOD
Subjects The total g r o u p of subjects Ss consisted of 56 teachers s u b d i v i d e d into two groups: one experimental g r o u p of 28 Ss; one control g r o u p of 28 Ss. The two g r o u p s were
*Dr. Multari is presently Clinical Psychologist C.V.I. Mental Health Centre, 285 Prideaux Street, Nanaimo, B.C., Canada, and was formerly Director Instituto Medico Psico-Pedagogico Villa Brescianelli Castiglione delle Stiviere (MN) Italy. 122
Community Mental Health Journal, Vol. 11 (2), 1975
Giuseppe Multari
123
comparable in their representation of the two sexes. The 56 teachers for the present study were selected on a random basis out of a pool of 350 teachers who participated in a 1-day seminar on the "Exceptional Child," held in Newmarket, Ontario, Canada, under the auspices of the York County Mental Health Clinic and the Canadian Mental Health Association, York County Branch. The program of this seminar is reported in Figure 1.
Preliminary Observation The teachers' participation during the seminar was rather active. The type of question asked of the various speakers suggested to the author the following considerations: (a) The teachers for the sake of meeting the educational objective in the classroom often unwittingly risked creating a neurotic atmosphere in their classroom; (b) most teachers feel an intense, yet usually unmet need to understand more specifically the basic principles underlying the mental hygiene in the school; (c) the daily problems shown by the pupils in the classroom are often interpreted in a rather exaggerated fashion, and often thought to be insurmountable by the teachers.
Development of the Program These considerations provide the basis of the present work which was initiated in the following way. Letters were sent to the school inspectors and the principals informing them of the project. Several meetings were held to discuss with them the possibility of offering the teachers a series of lectures in child psychology and mental hygiene applied to the school, and eventually a psychotherapeutic program for the teachers who would wish to avail themselves of this approach.
Teaching Technique A 12-week program of lectures on child psychology was set up for teachers of the area served by the clinic. The total number of lectures was 12 for a period of 12 weeks with one 1-hour lecture per week, which made possible a daily participation of 11 teachers per lecture, except on Fridays when the participants were 12. Each lecture took 35 minutes, which allowed a 25-minute period for discussion. The content of the lectures concerned itself with three broad topics: normal behavior, pathological behavior, and appropriate ways of handling a problem child (see Figure 2). The rationale for this lecture and discussion series was that teachers are in a unique position to foster the development of a better mental health climate throughout the school, thus providing the techniques for helping the children with any behavior or personal difficulties that are not self-correcting or amenable to traditional educational techniques for handling them.
Group-Psychotherapy Technique The technique utilized during the group therapy meetings was based on the "ego-sparing" approach, as described by Szyrinski (1964). In brief, this type of group psychotherapy aims at creating a therapeutic rapport by establishing better interpersonal contact and accomplishes this end by focusing attention not on a teacher's own problem but on the psychological difficulties experienced by the children with whom the teachers are in daily contact.
FIGURE 1
Seminar on "The Exceptional Child" 9:30--Recognizing Emotional Disorders in Childhood 10:30--Movie: Child Behind the Wall 11:00--The Exceptional Child and the Average Class 2:00--The Importance of Playtherapy with Exceptional Children 2:30--Helping the Family of Exceptional Children 3:00--Movie: Angry Boy 3:30--Panel: Teaching the Exceptional Child 4:30--Conclusion
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Community Mental Health Journal
FIGURE 2
Lectures' P r o g r a m m e 1. Introduction, Definition, and Historical Background of Mental Hygiene, 2. The Psychological Defenses 3. Child Development (Basic Principles of Growth) 4. Intelligence, IQ, and IQ Testing 5. Mental Retardation 6. The Transference in Teaching 7. Emotions and Learning Retardation 8. Cultural Factors in Behavior 9. Severe Emotional Disorders in Children 10. Milder Emotional Disorders in Children 11. Acting Out as a Symptom in the Classroom 12. Organic and Hereditary Defects
(Psychiatrist) (Psychologist) (Psychologist) (Psychologist) (Social Worker) (Psychologist) (Psychologist) (Social Worker) (Psychiatrist) (Social Worker) (Social Worker) (Psychiatrist)
This type of psychotherapy consists of contact with small groups of teachers and the therapist. The topics of the discussions were not intially or primarily concerned with the teachers themselves but focused on the children with whom they were in daily contact and experiencing problems. The anticipated result of this type of approach is the strong possibility of spontaneous application of interpretation and insight, therefore of a much more positive mental hygiene within the classroom environment both for the pupils as well as for the teachers. Compatible approaches have also been used in other settings by community mental health programs with the participation of the present author (Jensen, Multari, & Boden, 1963, 1964). In keeping with the "ego-sparing" approach, the discussion topics were less client focused than are most types of conventional psychotherapy. Rather, attention was directed at problems experienced by other people, notably pupils and other teachers. It might be appropriate to describe the approach chosen as "psychotherapy in the third person" as contrasted to the typical "first-person psychotherapy."
Comparisons The present study is concerned with the effects of two interventions: didactic and group therapeutic. The didactic approach was constant for the two groups and the group therapeutic was variable between them. In this manner the exposure of both groups to the lecture series constituted the baseline for the assessment of the group therapy procedure. This technique of assessing effects is roughly akin to that of comparing several graded modes of psychotherapeutic intervention as recommended by Goldstein, Heller, and Sechrest (1966) and represents a compromise between the practical need for providing mental health orientation and the research desideration of objective appraisal of the procedures used. Experimental Measure A case history (Figure 3) prepared by the author and found acceptable by three other colleagues not connected with this study was handed to all teachers before the first lecture to be studied for 10 minutes. After this 10-minute study, the teachers were to answer a questionnaire prepared for this purpose and based on the generally accepted principles of mental hygiene (Figure 4). The teachers were asked to be as frank as possible in answering all questions. The actual instructions were as follows: In front of you there is a report of a school-age boy. Read it Carefully. When you are through, keep it right in front of you and face up. When you have been told, you will turn the other sheet, also in front of you right side up; read the instructions carefully and follow them as given. Be sure to be as frank as you can, and work as fast as possible. Please do not spend much time on any one question. One month after the lectures ended, the teachers (N = 28) forming the control group were invited back to the clinic to complete their part in this research project by answering the same
Giuseppe Multari
125
FIGURE
3 Case History
Anthony: A g e 8 years a n d 1 m o n t h . IQ, Average. A n t h o n y is a pale, a n x i o u s boy, s e c o n d of three children from an average l o w e r - m i d d l e - c l a s s home.
Behavior and School Report: He s h o w s irritating b e h a v i o r at h o m e a n d at school, p l a y i n g the fool, m a k i n g n o i s e s a n d faces; b a c k w a r d n e s s at school, s p e e c h difficulty, fear a n d t e m p e r t a n t r u m s , slow learner. He is a year older t h a n t h o s e in his class, far b e l o w average in r e a d i n g a n d arithmetic, b u t average in practical subjects. He likes to go to school; h o w e v e r , he does not w o r r y a b o u t school work, n o r does he m a k e a n y effort. He is a n x i o u s to be liked, so he g i v e s a w a y h i s c a n d i e s b u t little s u c c e s s is g a i n e d b y it. He is in conflict w i t h the teacher a n d w i t h the o t h e r children, getting into fights, u s i n g o b s c e n e l a n g u a g e , a n d h a v i n g i n t e n s e rage t a n t r u m s .
Note: S t u d y this case for 10 m i n u t e s .
FIGURE
4
Questionnaire Sex__
Age__
Number_
K n o w i n g Only the above facts, give y o u r a n s w e r to t h e following q u e s t i o n s b y circling either T (true) or F (false) or Q (doubtful). Answer Questions T F Q 1. It is e a s y to deal w i t h this b o y in the classroom T F Q 2. The child is physically sick T F Q 3. Principal s h o u l d be i n f o r m e d at once T F Q 4. Parents s h o u l d be i n f o r m e d at once 5. He s h o u l d be referred i m m e d i a t e l y to the Mental T F Q Health Clinic 6. Child acts this way, primarily, as a result of T F Q home environment 7. Child acts this way, primarily, as a result of T F Q school e n v i r o n m e n t 8. Child irritates a n d plays fool to get attention T F Q T F Q 9. He is b a c k w a r d in school b e c a u s e of h i s average IQ 10. The child feels strongly rejected T F Q 11. The child is jealous of his siblings T F Q 12. The conflict b e t w e e n child a n d teacher is d u e to: (a) The child dislikes the t e a c h e r T F Q T F Q (b) The teacher dislikes the child T F Q (c) The teacher i g n o r e s h i m (d) The teacher s h o w s o p e n l y favoritism to o t h e r children T F Q T F Q (e) N o n e of the above T F Q (f) All of the above 13. C h i l d ' s rage t a n t r u m s are d u e to feelings of T F Q i n a d e q u a c y to learn 14. Too m u c h is expected from the child T F Q
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Community Mental Health Journal
FIGURE 4 (cont'd) 15. C h i l d does not m a k e a n y effort b e c a u s e he w a n t s to: (a) P u n i s h his p a r e n t s (b) P u n i s h his teachers (c) P u n i s h h i m s e l f (d) N o n e of the above (e) All of the above
T T T T T
F F F F F
Q Q Q Q Q
q u e s t i o n n a i r e a n d in the s a m e f a s h i o n as before the lectures. The o t h e r 28 teachers, f o r m i n g the e x p e r i m e n t a l group, participated in small g r o u p s (5 a n d 6 p e r group) in the p s y c h o t h e r a p e u t i c s e s s i o n s , 12 in all, u n d e r the g u i d a n c e of the a u t h o r , (a p s y c h o l o g i s t w h o acted as d i s c u s s i o n leader). The g u i d a n c e of the t h e r a p i s t w a s n e v e r a u t h o r i t a r i a n or directive. H i s p r e s e n c e w a s i n t e n d e d to g u i d e the g r o u p into a d y n a m i c interpretation a n d the e v e n t u a l d e t e r m i n a n t s to each a n s w e r to the q u e s t i o n n a i r e . Such a m e t h o d (th~ a u t h o r believes) s h o u l d facilitate a d e e p e r p e r s o n a l i n s i g h t , t h u s l e a d i n g to greater t h e r a p e u t i c results. O n e m o n t h after the s e s s i o n s e n d e d the m e m b e r s of the e x p e r i m e n t a l g r o u p a n s w e r e d t h e s a m e q u e s t i o n n a i r e as t h e y d i d at the b e g i n n i n g of the lectures, b a s e d o n the s a m e case history.
RESULTS T h e y i e l d of t h e c o m p a r i s o n s d e s c r i b e d a b o v e is p r e s e n t e d in Table 1. It will be seen that the two groups yielded virtually identical scores before the differential exposure to the conditions of the study. The lecture material alone to w h i c h the control group was exposed p r o d u c e d an i n c r e m e n t that fell short of an acceptable or a borderline significance level. By contrast, the experience with b o t h the lecture series and p s y c h o t h e r a p y in the experimental g r o u p p r o d u c e d a small, but statistically highly significant, increase over its o w n baseline and over the performance of its c o m p a r i s o n group at the comparable point in time. These findings justified the conclusion that the translation of the academic information transmitted on the simulated real-life case s t u d y was significantly facilitated b y the experience of a limited n u m b e r of g r o u p p s y c h o t h e r a p y sessions centered on the school situation and the teacher-pupil relationship. The design of this exploratory study did not permit differentiated information to emerge concerning another p r o b l e m - - t h a t is, w h e t h e r the joint experience of the lecture series and p s y c h o t h e r a p y produced a superior effect to that of group p s y c h o t h e r a p y alone. TABLE 1 Intergroups and Pre versus Post Comparisons
of Experimental Questionnaire Scores Conditions
C o n t r o l Group
Experimental Grou~ M
Difference between groups
Before
23.77
4.9
23.64
4.8
tsO.621 (N.S.)
After
24.10
5.0
26.82
5.3
I"=2.865; P=O.OI
Differences between conditions
t - 0 . 8 6 5 (N.S.)
I~3. 296
P=O.OI
Giuseppe Multari
127
The quantitative appraisal presented so far does not exhaust all the information gathered in the study. It was the author's impression, which, admittedly, remains tentative and is subject to explicit future validation,- that the teachers of the control group differed from those of the experimental groups in three respects: exaggerated expenditure of energy in trying to solve children's problems, minimizing the extent of children's problems or denying their existence, and false dichotomizing of problematic behavior in "scholastic" and "family" varieties. Underlying these specific tendencies there was a broader trend: a tendency to overlook the influence of early childhood experiences on the behavior of children of school age in the classroom. DISCUSSION With the rather modest means at the author's disposal it was demonstrated that a dual approach combining academic and therapeutic approaches was superior to a purely didactic one in increasing teachers' psychological mindedness and sensitivity to the interpersonal and interpsychic problems likely to be encountered in a classroom. In more general terms, and following Hayes (1955) formulation, it would appear that teachers changed toward a greater ability to "accept fundamental differences in others" and a greater ability to "cope sensibly and appropriately with everyday problems." Whether a concomitant change was brought about in the third component of Hayes' concept of mental hygiene, that is, in the ability to "accept, respect, like, and forgive oneself," cannot be definitely answered in the light of the available questionnaire data. The therapist's episodic observations of the group psychotherapy process, however, would lead to the tentative conclusion that changes in the direction of a more positive selfconcept, in Rogers' (1957, 1961) sense, were indeed experienced. More practically, the results presented would appear to demonstrate that with reasonably adequate personalities, free of major clinical impairment, perceptible changes in attitude toward an appraisal of others can be brought about through a limited expenditure of professional resources and time. The question as to the actual translation of these attitudinal changes in teachers' classroom behavior and their persistence beyond the period of this study remains open. These problems can and should be investigated within the context of a more formal research undertaking and a more extensive combination of classroom behavior ratings, self-report measures, pupil perception, and interrelations among all of the above. For the time being it may be appropriate to conclude that teachers can be effectively brought to a more sensitive recognition of and appropriate reaction to human problems of school-age children. Over 200 years ago, Rousseau wrote, "Start therefore with knowing your pupils, because most likely you don't know them at all." The present report may be construed as an attempt, in a small way, to heed this admonition, so consonant with the tenets of the community mental health. CONCLUSIONS The present study is intended to investigate the results obtainable from a course of lectures in child psychology as it applies to the
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classroom situation as well as the validity of preventative w o r k in the mental health field t h r o u g h the use of p s y c h o t h e r a p y - - e g o - s p a r i n g t e c h n i q u e s t y p e - - w i t h elementary school teachers, w h o could be the most efficient agents in this type of preventative work. The lectures alone seem insufficient in this respect; at the most they seem to change the outlook but not the quality of the a p p r o a c h used b y the teachers in the classroom with their children's problems. The variable of g r o u p p s y c h o t h e r a p y a d d e d to the lectures seems to facilitate a deeper and more complete k n o w l e d g e of the child's b e h a v i o r thus p r o b a b l y facilitating some better self-knowledge and self-understanding. It stimulates and p r o m o t e s a more positive mental h y g i e n e in the classroom, a greater serenity, and easier acceptance of differences in others. It helps in d e v e l o p i n g a positive attitude and an ability to deal sensibly and conscienciously w i t h the daily problems. Finally, the results of the present investigation suggest that a similar a p p r o a c h m i g h t be especially fruitful for further research w i t h a greater n u m b e r of subjects, more h o m o g e n e o u s groups, and finer experimental tools, a n d m i g h t lead to similar results. REFERENCES Cowen, E. L., Gardner, E. A., & Zax, M. Emergent approaches to mental health problems. New York: Appleton-Century-Crofts, 1967. Goldstein, A. P., Heller, K., & Sechrest, L. B. Psychotherapy and psychology of behavior change. New York: Wiley, 1966. Hayes, R. H. A new community mental health program. Mental Hospitals, 1959, 10, 9-11. Jensen, S. E., Multari, G., Boden, F. K. A county mental health clinic. Paper presented at the Annual Meeting of the Canadian Psychiatric Association, Toronto, June 1963. Jensen, S. E., Multari, G., & Boden, F. K. Public health and preventive psychiatry. Canadian Journal of Public Health, 1964, 55, 147-150. Rogers, C. R. On becoming a person. Boston: Houghton Mifflin, 1961. Rogers, C. R. The necessary and sufficient conditions of psychotherapeutic personality changes. Journal of Consulting Psychology, 1957, 21, 95-103. Sarason, S. B. Psychology in community settings: Clinical, educational, and social aspects. New York: Wiley, 1966. Szyrynski, V. Sociatric psychotherapy in juvenile delinquency. Canadian Journal of Corrections, 1964, 6, 74-86.
ABSTRACT: The traditional "'lectures delivering" approach to classroom teachers used by mental health practitioners is investigated in the present study. An attempt is made to demonstrate the validity of preventative work in helping elementary school teachers as important agents in the promotion of more positive mental hygiene in the classroom and by adding to the lectures the variable of group therapy-"ego-sparing" techniques type. The latter approach seems to promote a teacher's own sense of security, more security in dealing the pupils, an easier acceptance of differences in others, and, finally, it tends to stimulate the development of a teacher's own ability to deal more sensibly, more conscientiously, and more realistically with daily problems.
One of the major concerns of the community mental health movement focuses on the utilization of professional and nonprofessional personnel outside of the traditional mental health fields of psychiatry, clinical psychology, and psychiatric social work in creating new, or expanding old, preventive or therapeutic mental health services. This paper is concerned with the application of this broad tenet in the public school situation through training teachers toward greater effectiveness as observers of personal problems, and as agents toward their appropriate remediation, in the classroom. The concept of the public school as an area of community mental health activity is, of course, not new. One need only mention the work and formulations of Sarason (1966) at Yale Psychoeducational Clinic and the research carried out by Cowen, Gardner, and Zax, (1967) within the framework of the public school system in Rochester, New York. The present project, much less ambitious in scope, aims to increase the effectiveness of teachers as agents of community mental health by combining the traditional didactic approach with discussion--a group psychotherapy program. The assumption underlying this undertaking was that unexpressed and unrecognized attitudes and problems of a personal, social, and professional nature would stand in the way of absorption of factual mental health information and would prevent its utilization in the classroom unless an opportunity to air and work through these opinions, feelings, and beliefs were to be provided. The mode of application of these objectives is given below. METHOD
Subjects The total g r o u p of subjects Ss consisted of 56 teachers s u b d i v i d e d into two groups: one experimental g r o u p of 28 Ss; one control g r o u p of 28 Ss. The two g r o u p s were
*Dr. Multari is presently Clinical Psychologist C.V.I. Mental Health Centre, 285 Prideaux Street, Nanaimo, B.C., Canada, and was formerly Director Instituto Medico Psico-Pedagogico Villa Brescianelli Castiglione delle Stiviere (MN) Italy. 122
Community Mental Health Journal, Vol. 11 (2), 1975
Giuseppe Multari
123
comparable in their representation of the two sexes. The 56 teachers for the present study were selected on a random basis out of a pool of 350 teachers who participated in a 1-day seminar on the "Exceptional Child," held in Newmarket, Ontario, Canada, under the auspices of the York County Mental Health Clinic and the Canadian Mental Health Association, York County Branch. The program of this seminar is reported in Figure 1.
Preliminary Observation The teachers' participation during the seminar was rather active. The type of question asked of the various speakers suggested to the author the following considerations: (a) The teachers for the sake of meeting the educational objective in the classroom often unwittingly risked creating a neurotic atmosphere in their classroom; (b) most teachers feel an intense, yet usually unmet need to understand more specifically the basic principles underlying the mental hygiene in the school; (c) the daily problems shown by the pupils in the classroom are often interpreted in a rather exaggerated fashion, and often thought to be insurmountable by the teachers.
Development of the Program These considerations provide the basis of the present work which was initiated in the following way. Letters were sent to the school inspectors and the principals informing them of the project. Several meetings were held to discuss with them the possibility of offering the teachers a series of lectures in child psychology and mental hygiene applied to the school, and eventually a psychotherapeutic program for the teachers who would wish to avail themselves of this approach.
Teaching Technique A 12-week program of lectures on child psychology was set up for teachers of the area served by the clinic. The total number of lectures was 12 for a period of 12 weeks with one 1-hour lecture per week, which made possible a daily participation of 11 teachers per lecture, except on Fridays when the participants were 12. Each lecture took 35 minutes, which allowed a 25-minute period for discussion. The content of the lectures concerned itself with three broad topics: normal behavior, pathological behavior, and appropriate ways of handling a problem child (see Figure 2). The rationale for this lecture and discussion series was that teachers are in a unique position to foster the development of a better mental health climate throughout the school, thus providing the techniques for helping the children with any behavior or personal difficulties that are not self-correcting or amenable to traditional educational techniques for handling them.
Group-Psychotherapy Technique The technique utilized during the group therapy meetings was based on the "ego-sparing" approach, as described by Szyrinski (1964). In brief, this type of group psychotherapy aims at creating a therapeutic rapport by establishing better interpersonal contact and accomplishes this end by focusing attention not on a teacher's own problem but on the psychological difficulties experienced by the children with whom the teachers are in daily contact.
FIGURE 1
Seminar on "The Exceptional Child" 9:30--Recognizing Emotional Disorders in Childhood 10:30--Movie: Child Behind the Wall 11:00--The Exceptional Child and the Average Class 2:00--The Importance of Playtherapy with Exceptional Children 2:30--Helping the Family of Exceptional Children 3:00--Movie: Angry Boy 3:30--Panel: Teaching the Exceptional Child 4:30--Conclusion
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Community Mental Health Journal
FIGURE 2
Lectures' P r o g r a m m e 1. Introduction, Definition, and Historical Background of Mental Hygiene, 2. The Psychological Defenses 3. Child Development (Basic Principles of Growth) 4. Intelligence, IQ, and IQ Testing 5. Mental Retardation 6. The Transference in Teaching 7. Emotions and Learning Retardation 8. Cultural Factors in Behavior 9. Severe Emotional Disorders in Children 10. Milder Emotional Disorders in Children 11. Acting Out as a Symptom in the Classroom 12. Organic and Hereditary Defects
(Psychiatrist) (Psychologist) (Psychologist) (Psychologist) (Social Worker) (Psychologist) (Psychologist) (Social Worker) (Psychiatrist) (Social Worker) (Social Worker) (Psychiatrist)
This type of psychotherapy consists of contact with small groups of teachers and the therapist. The topics of the discussions were not intially or primarily concerned with the teachers themselves but focused on the children with whom they were in daily contact and experiencing problems. The anticipated result of this type of approach is the strong possibility of spontaneous application of interpretation and insight, therefore of a much more positive mental hygiene within the classroom environment both for the pupils as well as for the teachers. Compatible approaches have also been used in other settings by community mental health programs with the participation of the present author (Jensen, Multari, & Boden, 1963, 1964). In keeping with the "ego-sparing" approach, the discussion topics were less client focused than are most types of conventional psychotherapy. Rather, attention was directed at problems experienced by other people, notably pupils and other teachers. It might be appropriate to describe the approach chosen as "psychotherapy in the third person" as contrasted to the typical "first-person psychotherapy."
Comparisons The present study is concerned with the effects of two interventions: didactic and group therapeutic. The didactic approach was constant for the two groups and the group therapeutic was variable between them. In this manner the exposure of both groups to the lecture series constituted the baseline for the assessment of the group therapy procedure. This technique of assessing effects is roughly akin to that of comparing several graded modes of psychotherapeutic intervention as recommended by Goldstein, Heller, and Sechrest (1966) and represents a compromise between the practical need for providing mental health orientation and the research desideration of objective appraisal of the procedures used. Experimental Measure A case history (Figure 3) prepared by the author and found acceptable by three other colleagues not connected with this study was handed to all teachers before the first lecture to be studied for 10 minutes. After this 10-minute study, the teachers were to answer a questionnaire prepared for this purpose and based on the generally accepted principles of mental hygiene (Figure 4). The teachers were asked to be as frank as possible in answering all questions. The actual instructions were as follows: In front of you there is a report of a school-age boy. Read it Carefully. When you are through, keep it right in front of you and face up. When you have been told, you will turn the other sheet, also in front of you right side up; read the instructions carefully and follow them as given. Be sure to be as frank as you can, and work as fast as possible. Please do not spend much time on any one question. One month after the lectures ended, the teachers (N = 28) forming the control group were invited back to the clinic to complete their part in this research project by answering the same
Giuseppe Multari
125
FIGURE
3 Case History
Anthony: A g e 8 years a n d 1 m o n t h . IQ, Average. A n t h o n y is a pale, a n x i o u s boy, s e c o n d of three children from an average l o w e r - m i d d l e - c l a s s home.
Behavior and School Report: He s h o w s irritating b e h a v i o r at h o m e a n d at school, p l a y i n g the fool, m a k i n g n o i s e s a n d faces; b a c k w a r d n e s s at school, s p e e c h difficulty, fear a n d t e m p e r t a n t r u m s , slow learner. He is a year older t h a n t h o s e in his class, far b e l o w average in r e a d i n g a n d arithmetic, b u t average in practical subjects. He likes to go to school; h o w e v e r , he does not w o r r y a b o u t school work, n o r does he m a k e a n y effort. He is a n x i o u s to be liked, so he g i v e s a w a y h i s c a n d i e s b u t little s u c c e s s is g a i n e d b y it. He is in conflict w i t h the teacher a n d w i t h the o t h e r children, getting into fights, u s i n g o b s c e n e l a n g u a g e , a n d h a v i n g i n t e n s e rage t a n t r u m s .
Note: S t u d y this case for 10 m i n u t e s .
FIGURE
4
Questionnaire Sex__
Age__
Number_
K n o w i n g Only the above facts, give y o u r a n s w e r to t h e following q u e s t i o n s b y circling either T (true) or F (false) or Q (doubtful). Answer Questions T F Q 1. It is e a s y to deal w i t h this b o y in the classroom T F Q 2. The child is physically sick T F Q 3. Principal s h o u l d be i n f o r m e d at once T F Q 4. Parents s h o u l d be i n f o r m e d at once 5. He s h o u l d be referred i m m e d i a t e l y to the Mental T F Q Health Clinic 6. Child acts this way, primarily, as a result of T F Q home environment 7. Child acts this way, primarily, as a result of T F Q school e n v i r o n m e n t 8. Child irritates a n d plays fool to get attention T F Q T F Q 9. He is b a c k w a r d in school b e c a u s e of h i s average IQ 10. The child feels strongly rejected T F Q 11. The child is jealous of his siblings T F Q 12. The conflict b e t w e e n child a n d teacher is d u e to: (a) The child dislikes the t e a c h e r T F Q T F Q (b) The teacher dislikes the child T F Q (c) The teacher i g n o r e s h i m (d) The teacher s h o w s o p e n l y favoritism to o t h e r children T F Q T F Q (e) N o n e of the above T F Q (f) All of the above 13. C h i l d ' s rage t a n t r u m s are d u e to feelings of T F Q i n a d e q u a c y to learn 14. Too m u c h is expected from the child T F Q
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FIGURE 4 (cont'd) 15. C h i l d does not m a k e a n y effort b e c a u s e he w a n t s to: (a) P u n i s h his p a r e n t s (b) P u n i s h his teachers (c) P u n i s h h i m s e l f (d) N o n e of the above (e) All of the above
T T T T T
F F F F F
Q Q Q Q Q
q u e s t i o n n a i r e a n d in the s a m e f a s h i o n as before the lectures. The o t h e r 28 teachers, f o r m i n g the e x p e r i m e n t a l group, participated in small g r o u p s (5 a n d 6 p e r group) in the p s y c h o t h e r a p e u t i c s e s s i o n s , 12 in all, u n d e r the g u i d a n c e of the a u t h o r , (a p s y c h o l o g i s t w h o acted as d i s c u s s i o n leader). The g u i d a n c e of the t h e r a p i s t w a s n e v e r a u t h o r i t a r i a n or directive. H i s p r e s e n c e w a s i n t e n d e d to g u i d e the g r o u p into a d y n a m i c interpretation a n d the e v e n t u a l d e t e r m i n a n t s to each a n s w e r to the q u e s t i o n n a i r e . Such a m e t h o d (th~ a u t h o r believes) s h o u l d facilitate a d e e p e r p e r s o n a l i n s i g h t , t h u s l e a d i n g to greater t h e r a p e u t i c results. O n e m o n t h after the s e s s i o n s e n d e d the m e m b e r s of the e x p e r i m e n t a l g r o u p a n s w e r e d t h e s a m e q u e s t i o n n a i r e as t h e y d i d at the b e g i n n i n g of the lectures, b a s e d o n the s a m e case history.
RESULTS T h e y i e l d of t h e c o m p a r i s o n s d e s c r i b e d a b o v e is p r e s e n t e d in Table 1. It will be seen that the two groups yielded virtually identical scores before the differential exposure to the conditions of the study. The lecture material alone to w h i c h the control group was exposed p r o d u c e d an i n c r e m e n t that fell short of an acceptable or a borderline significance level. By contrast, the experience with b o t h the lecture series and p s y c h o t h e r a p y in the experimental g r o u p p r o d u c e d a small, but statistically highly significant, increase over its o w n baseline and over the performance of its c o m p a r i s o n group at the comparable point in time. These findings justified the conclusion that the translation of the academic information transmitted on the simulated real-life case s t u d y was significantly facilitated b y the experience of a limited n u m b e r of g r o u p p s y c h o t h e r a p y sessions centered on the school situation and the teacher-pupil relationship. The design of this exploratory study did not permit differentiated information to emerge concerning another p r o b l e m - - t h a t is, w h e t h e r the joint experience of the lecture series and p s y c h o t h e r a p y produced a superior effect to that of group p s y c h o t h e r a p y alone. TABLE 1 Intergroups and Pre versus Post Comparisons
of Experimental Questionnaire Scores Conditions
C o n t r o l Group
Experimental Grou~ M
Difference between groups
Before
23.77
4.9
23.64
4.8
tsO.621 (N.S.)
After
24.10
5.0
26.82
5.3
I"=2.865; P=O.OI
Differences between conditions
t - 0 . 8 6 5 (N.S.)
I~3. 296
P=O.OI
Giuseppe Multari
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The quantitative appraisal presented so far does not exhaust all the information gathered in the study. It was the author's impression, which, admittedly, remains tentative and is subject to explicit future validation,- that the teachers of the control group differed from those of the experimental groups in three respects: exaggerated expenditure of energy in trying to solve children's problems, minimizing the extent of children's problems or denying their existence, and false dichotomizing of problematic behavior in "scholastic" and "family" varieties. Underlying these specific tendencies there was a broader trend: a tendency to overlook the influence of early childhood experiences on the behavior of children of school age in the classroom. DISCUSSION With the rather modest means at the author's disposal it was demonstrated that a dual approach combining academic and therapeutic approaches was superior to a purely didactic one in increasing teachers' psychological mindedness and sensitivity to the interpersonal and interpsychic problems likely to be encountered in a classroom. In more general terms, and following Hayes (1955) formulation, it would appear that teachers changed toward a greater ability to "accept fundamental differences in others" and a greater ability to "cope sensibly and appropriately with everyday problems." Whether a concomitant change was brought about in the third component of Hayes' concept of mental hygiene, that is, in the ability to "accept, respect, like, and forgive oneself," cannot be definitely answered in the light of the available questionnaire data. The therapist's episodic observations of the group psychotherapy process, however, would lead to the tentative conclusion that changes in the direction of a more positive selfconcept, in Rogers' (1957, 1961) sense, were indeed experienced. More practically, the results presented would appear to demonstrate that with reasonably adequate personalities, free of major clinical impairment, perceptible changes in attitude toward an appraisal of others can be brought about through a limited expenditure of professional resources and time. The question as to the actual translation of these attitudinal changes in teachers' classroom behavior and their persistence beyond the period of this study remains open. These problems can and should be investigated within the context of a more formal research undertaking and a more extensive combination of classroom behavior ratings, self-report measures, pupil perception, and interrelations among all of the above. For the time being it may be appropriate to conclude that teachers can be effectively brought to a more sensitive recognition of and appropriate reaction to human problems of school-age children. Over 200 years ago, Rousseau wrote, "Start therefore with knowing your pupils, because most likely you don't know them at all." The present report may be construed as an attempt, in a small way, to heed this admonition, so consonant with the tenets of the community mental health. CONCLUSIONS The present study is intended to investigate the results obtainable from a course of lectures in child psychology as it applies to the
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classroom situation as well as the validity of preventative w o r k in the mental health field t h r o u g h the use of p s y c h o t h e r a p y - - e g o - s p a r i n g t e c h n i q u e s t y p e - - w i t h elementary school teachers, w h o could be the most efficient agents in this type of preventative work. The lectures alone seem insufficient in this respect; at the most they seem to change the outlook but not the quality of the a p p r o a c h used b y the teachers in the classroom with their children's problems. The variable of g r o u p p s y c h o t h e r a p y a d d e d to the lectures seems to facilitate a deeper and more complete k n o w l e d g e of the child's b e h a v i o r thus p r o b a b l y facilitating some better self-knowledge and self-understanding. It stimulates and p r o m o t e s a more positive mental h y g i e n e in the classroom, a greater serenity, and easier acceptance of differences in others. It helps in d e v e l o p i n g a positive attitude and an ability to deal sensibly and conscienciously w i t h the daily problems. Finally, the results of the present investigation suggest that a similar a p p r o a c h m i g h t be especially fruitful for further research w i t h a greater n u m b e r of subjects, more h o m o g e n e o u s groups, and finer experimental tools, a n d m i g h t lead to similar results. REFERENCES Cowen, E. L., Gardner, E. A., & Zax, M. Emergent approaches to mental health problems. New York: Appleton-Century-Crofts, 1967. Goldstein, A. P., Heller, K., & Sechrest, L. B. Psychotherapy and psychology of behavior change. New York: Wiley, 1966. Hayes, R. H. A new community mental health program. Mental Hospitals, 1959, 10, 9-11. Jensen, S. E., Multari, G., Boden, F. K. A county mental health clinic. Paper presented at the Annual Meeting of the Canadian Psychiatric Association, Toronto, June 1963. Jensen, S. E., Multari, G., & Boden, F. K. Public health and preventive psychiatry. Canadian Journal of Public Health, 1964, 55, 147-150. Rogers, C. R. On becoming a person. Boston: Houghton Mifflin, 1961. Rogers, C. R. The necessary and sufficient conditions of psychotherapeutic personality changes. Journal of Consulting Psychology, 1957, 21, 95-103. Sarason, S. B. Psychology in community settings: Clinical, educational, and social aspects. New York: Wiley, 1966. Szyrynski, V. Sociatric psychotherapy in juvenile delinquency. Canadian Journal of Corrections, 1964, 6, 74-86.
