Journal of Consulting and Clinical Psychology 1975, Vol. 43, No. 1, 90-91
Attitude Similarity and Therapist Credibility as Predictors of Attitude Change and Improvement in Psychotherapy Larry E. Beutler Baylor College of Medicine Dale T. Johnson and Charles W. Neville, Jr. Highland Hospital Division, Duke University Medical Center David Elkins Avis M. Jobe Stephen F. Austin State University Texas Research Institute of Mental Sciences, Houston In recent years there have been many efforts to apply theories developed in the social psychology laboratory to clinical problems. It seems apparent that the ultimate value of any laboratory-derived theory must be assessed by its ability to accurately predict events in naturalistic situations. Since psychotherapy seems to parallel in many respects the process of interpersonal persuasion, it seems appropriate to determine if psychotherapy outcome can be facilitated through a manipulation of variables found to increase interpersonal influence in the laboratory. Whereas laboratory findings suggest that some initial attitude similarity between communicators is necessary in facilitating a persuader's influence, psychotherapy studies (e.g., Beutler, 1971) have demonstrated that greater attitude changes on the part of the patient are likely to occur when initial dissimilarity between patient and therapist is maximal. One concept that may clarify this discrepancy derives from the work of Aronson, Turner, and Carlsmith (1963), who demonstrated that high-credible communicators have greater influence if they are dissimilar to their audience, whereas low-credible communicators produce the opposite effect. The present study attempted to (a) assess the effects of therapist credibility and patient-therapist similarity on interpersonal persuasion and (b) to further assess the relationship between patient attitude change and psychotherapy outcome. Attitude similarity and change in the present study was measured by the Situational Appraisal Inventory, Form J (Pittel & Mendelsohn, 1969). Initial patient-therapist similarity was measured by comparing patient pretherapy Situational Appraisal Inventory responses with those of their therapist. Ninety-seven essentially randomly selected psychiatric patients and their six therapists
were divided into high-, medium-, and low-similarity groups. These groups were further divided into groups of high and low perceived therapist credibility on the basis of a semantic-differentialtype index. At the end of psychotherapy, interpersonal influence was assessed by means of a difference score comparing pretherapy and posttherapy similarity. Patient improvement was evaluated by obtaining two ratings from each patient and each therapist. A significant initial similarity effect (F (2, 97) = 12.082, p < .01) was obtained on the attitude change measure, indicating that low initial similarity produced greater therapist influence than either high or medium initial smilarity. Therapist credibility did not affect attitude change significantly. Therapists perceived as high in credibility consistently produced higher patient ratings of improvement than low-credible therapists (F (1,80) = 18.680, p < .001; F (1, 80) = 8.107, p < .01). Results using therapist global improvement ratings (F (2,80) = S.087, p < .01) indicated that as initial patient-therapist similarity becomes greater, therapists of low credibility are likely to give higher improvement ratings, whereas therapists perceived as highly credible give no indication of changing their ratings as a function of initial similarity. The results suggest that initial patient-therapist similarity is inversely related to the therapist's persuasive influence, regardless of his perceived credibility. Although these findings are contrary to those obtained in the analogue studies of Aronson et al. (1963), they are consistent with findings obtained in previous psychotherapy research (Beutler, 1971; Beutler, Jobe, & Elkins, 1974). Although attitude change itself does not relate to improvement, it is logical to assume that similarity and other variables that influence attitude change may affect credibility, and in turn may affect outcome. The present findings affirm that therapist credibility affects therapy outcome. The differen-
Requests for reprints should be sent to Larry E. Beutler, Department of Psychiatry, Baylor College of Medicine, Texas Medical Center, Houston, Texas 77025.
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BRIEF REPORTS tial effects on outcome of low- and high-credible therapists suggest that highly credible therapists do not need the reassurance of patients with similar attitudes to the extent that low-credibility therapists do. REFERENCES Aronson, E., Turner, J. A., & Carlsmith, J. M. Communicator credibility and communication discrepancy as determinants of opinion change. Journal of Abnormal Psychology, 1963, 67, 31-36, Beutler, L. E. Predicting outcomes of psychotherapy:
A comparison of predictions from two attitude theories. Journal of Consulting and Clinical Psychology, 1971, 37, 411-416. Beutler, L, E., Jobe, A. M., & Elkins, D. Outcomes in group psychotherapy: Using persuasion theory to increase treatment efficiency. Journal of Consulting and Clinical Psychology, 1974, 42, 547-553. Pittel, S. M., & Mendelsohn, G. A. Situational Appraisal Inventory: Development and validation of a measure of evaluative attitudes, Journal of Consulting and Clinical Psychology, 1969, 33, 396-405. (Received February 7, 1974)
Attitude Similarity and Therapist Credibility as Predictors of Attitude Change and Improvement in Psychotherapy Larry E. Beutler Baylor College of Medicine Dale T. Johnson and Charles W. Neville, Jr. Highland Hospital Division, Duke University Medical Center David Elkins Avis M. Jobe Stephen F. Austin State University Texas Research Institute of Mental Sciences, Houston In recent years there have been many efforts to apply theories developed in the social psychology laboratory to clinical problems. It seems apparent that the ultimate value of any laboratory-derived theory must be assessed by its ability to accurately predict events in naturalistic situations. Since psychotherapy seems to parallel in many respects the process of interpersonal persuasion, it seems appropriate to determine if psychotherapy outcome can be facilitated through a manipulation of variables found to increase interpersonal influence in the laboratory. Whereas laboratory findings suggest that some initial attitude similarity between communicators is necessary in facilitating a persuader's influence, psychotherapy studies (e.g., Beutler, 1971) have demonstrated that greater attitude changes on the part of the patient are likely to occur when initial dissimilarity between patient and therapist is maximal. One concept that may clarify this discrepancy derives from the work of Aronson, Turner, and Carlsmith (1963), who demonstrated that high-credible communicators have greater influence if they are dissimilar to their audience, whereas low-credible communicators produce the opposite effect. The present study attempted to (a) assess the effects of therapist credibility and patient-therapist similarity on interpersonal persuasion and (b) to further assess the relationship between patient attitude change and psychotherapy outcome. Attitude similarity and change in the present study was measured by the Situational Appraisal Inventory, Form J (Pittel & Mendelsohn, 1969). Initial patient-therapist similarity was measured by comparing patient pretherapy Situational Appraisal Inventory responses with those of their therapist. Ninety-seven essentially randomly selected psychiatric patients and their six therapists
were divided into high-, medium-, and low-similarity groups. These groups were further divided into groups of high and low perceived therapist credibility on the basis of a semantic-differentialtype index. At the end of psychotherapy, interpersonal influence was assessed by means of a difference score comparing pretherapy and posttherapy similarity. Patient improvement was evaluated by obtaining two ratings from each patient and each therapist. A significant initial similarity effect (F (2, 97) = 12.082, p < .01) was obtained on the attitude change measure, indicating that low initial similarity produced greater therapist influence than either high or medium initial smilarity. Therapist credibility did not affect attitude change significantly. Therapists perceived as high in credibility consistently produced higher patient ratings of improvement than low-credible therapists (F (1,80) = 18.680, p < .001; F (1, 80) = 8.107, p < .01). Results using therapist global improvement ratings (F (2,80) = S.087, p < .01) indicated that as initial patient-therapist similarity becomes greater, therapists of low credibility are likely to give higher improvement ratings, whereas therapists perceived as highly credible give no indication of changing their ratings as a function of initial similarity. The results suggest that initial patient-therapist similarity is inversely related to the therapist's persuasive influence, regardless of his perceived credibility. Although these findings are contrary to those obtained in the analogue studies of Aronson et al. (1963), they are consistent with findings obtained in previous psychotherapy research (Beutler, 1971; Beutler, Jobe, & Elkins, 1974). Although attitude change itself does not relate to improvement, it is logical to assume that similarity and other variables that influence attitude change may affect credibility, and in turn may affect outcome. The present findings affirm that therapist credibility affects therapy outcome. The differen-
Requests for reprints should be sent to Larry E. Beutler, Department of Psychiatry, Baylor College of Medicine, Texas Medical Center, Houston, Texas 77025.
90
91
BRIEF REPORTS tial effects on outcome of low- and high-credible therapists suggest that highly credible therapists do not need the reassurance of patients with similar attitudes to the extent that low-credibility therapists do. REFERENCES Aronson, E., Turner, J. A., & Carlsmith, J. M. Communicator credibility and communication discrepancy as determinants of opinion change. Journal of Abnormal Psychology, 1963, 67, 31-36, Beutler, L. E. Predicting outcomes of psychotherapy:
A comparison of predictions from two attitude theories. Journal of Consulting and Clinical Psychology, 1971, 37, 411-416. Beutler, L, E., Jobe, A. M., & Elkins, D. Outcomes in group psychotherapy: Using persuasion theory to increase treatment efficiency. Journal of Consulting and Clinical Psychology, 1974, 42, 547-553. Pittel, S. M., & Mendelsohn, G. A. Situational Appraisal Inventory: Development and validation of a measure of evaluative attitudes, Journal of Consulting and Clinical Psychology, 1969, 33, 396-405. (Received February 7, 1974)
