Journal o f Youth and Adolescence, Vol. 19, No. 3, 1990
Perceptions and Response Styles of Referred Adolescent Girls with Family Problems Janet M. Zarb 1 Received April 25, 1989; accepted May 3, 1990
Therapists working with adolescents with family-related problems would benefit from research identifying characteristic parent and peer problem situations encountered by referred adolescents, the content o f the adolescent's perceptions o f parent and peer models, parental child-rearing styles, and typical interpersonal response styles o f the adolescents and their parents. Thirty adolescent girls with low family self-concepts were compared with matched controls on measures o f the adolescent's responses to structured interview items designed to tap the above areas. Responses were categorized by two independent judges. Results indicated that referred adolescents tended to report (1) parental evaluations categorized as promiscuous or psychologically abnormal/worthless~crueL (2) descriptions o f parents categorized as cause o f parent/adolescent conflict or psychologically abnormal (3) typical parental disciplinary styles categorized as physical punishment, or laxinconsistent~threats to harm/neglect, (4) descriptions o f best friends categorized as conduct disorders, or as having similar problems, (5) descriptions o f their own typical responses in stressful situations involving parents categorized as active or passive defiance, or passive helplessness and (6) descriptions o f their own characteristic responses in stressful situations involving female peers categorized as verbal or physicai abuse, or withdraw~internalize. Application o f findings to therapy with adolescents and families is discussed. INTRODUCTION
Theory and research in recent decades suggests an important relationship between a client's cognitions and the development, maintenance, and 1To w h o m all correspondence should be addressed at 302 Rose Park Drive, Toronto, Ontario, M 4 T 1R7, Canada. 27"/ 0047-2891/90/06004)277506.00/09 1990PlenumPublishingCorporation
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treatment of psychological disorders (Beck, 1976; Goldfried and Davidson, 1976; Kendal and Hollen, 1979; Meichenbaum, 1977). This research also suggests a need to identify the client's maladaptive response styles (Mischel, 1981). Beck (1976) has provided some evidence in support of the proposition that patterns of maladaptive cognitions are typical of different adult psychological disorders. Others have proposed models for analysis of behavioral and cognitive styles linked to traditional adult psychiatric categories (Benjamin, 1981), but there has been a paucity of comparable research focusing on characteristic cognitive and behavioral styles of adolescents with familyrelated problems. Clinical experience in treating adolescent clients with family-related problems suggests characteristic patterns of cognitions and coping responses in relation to parents and peers. Problem families have also been observed to differ from normal families with adolescent children in terms of parental models and child-rearing styles. Adolescents and parents in problem families are reported to hold "negative" views of each other, and their interactions are said to be "maladaptive." However, in order to aid therapists in identifying more specific targets for cognitive-behavioral interventions in individual and family sessions, there is a need for identification of types of parents and peers with whom adolescents with family problems interact on a day-to-day basis, typical problems encountered with significant others, typical response styles of the adolescent and the significant others in these stressful interpersonal situations, and the thematic content of the adolescent's perceptions in relation to parents and peers. Therefore, the present study is a comparison of the perceptions and response styles of a sample of adolescent girls referred for therapy for family-related problems, with those of a normal control group with no identified family problems. The two groups are compared in three areas: the adolescent's perceptions of parents and peers, the youngster's parent and peer models, and the girl's typical interaction patterns with parents and peers. The rationale for studying the adolescent's perceptions of evaluations of parents and peers has stemmed from the notion that the adolescent accepts the way parents and peers behave toward her as the norm, so that the youngster's self-concept somehow reflects the way in which she has been treated by these significant people in her life. For example, research on the effects of parental discipline suggests that the more severe the punishment, the more the child feels it is deserved (Herzberger et al., 1981). Inadequate parenting has been linked to lack of social competence in children (Herbert, 1980; Becker, 1964), so that adolescents exposed to inadequate parental models and child-rearing techniques would be expected to have greater difficulty in forming adequate interpersonal relationships with normal prosocial peers.
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METHOD Sample
Subjects were two groups of girls, aged 15-18, attending the same school in a working-class Canadian urban area. The "referred" group was comprised of 30 girls referred by school staff to the school psychologist for psychological counselling, primarily because of family problems. Family problems included parental physical abuse, alcoholism, history of incest, lax-inconsistent discipline, severe marital conflict, and parental psychopathology. One third of the referred subjects had parents who were separated or divorced (as compared to 6% of the control subjects). DMS III-R categories of abnormal adolescent behaviors characterizing referred subjects included depressive disorder, conduct disorder, oppositional defiant disorder, overanxious disorder, and avoidant disorder. A comparison group of 30 subjects, labeled the "control" group, was comprised of randomly selected students from the same school who were not referred for psychological counselling. Both groups were matched for age, and ethnic group. Approximately 25 % had Canadian-born parents, 50% were children of immigrants from southern Europe, and 25% were children of immigrants from a variety of countries including Hong Kong, China, Slavic countries, South America, and the West Indies. Instruments and Procedure
The selection of variables for this investigation was influenced by clinical work with adolescent psychotherapy clients, and by the literature suggesting that a large part of variation in individual personality characteristics is directly related to the youngster's interactions with parents and peers (Perris et al., 1986). One consistent finding has been the higher incidence of psychological problems among youngsters who do not perceive themselves as accepted and valued by parents. The present study focuses on the adolescent's perceptions of behaviors and evaluations of significant others, namely parents and peers. Research suggests that youngsters, through the process of perceiving and interpreting events, actively construct a view of their social environment, and then respond according to this construction (Herzberger et al., 1981). It has been suggested that a youngster's perception of parenting practices and home life may be more important than the actual situation, in terms of the youngster's personality development and adjustment. In addition to the items designed to elicit information about the adolescent's cognitions, other questionnaire items were designed to elicit informa-
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tion about the adolescent's behavioral interactions with parents and peers in specific types of situations, namely upsetting situations and situations involving parental disapproval. Inconsistencies in the literature on parent-child relationships has been partially attributed to attempts to make global assessments of such things as parental "warmth," and "rejection," rather than specifying variations in parent-child behavioral interactions in particular situations (Herbert, 1980). Finally, since observation data on interactions with significant others are very difficult to obtain with samples of adolescents (as opposed to samples of small children), the present study relied on the adolescent's reports of her interactions with parents and peers. All data were collected during one lengthy individual session with each subject. Data collection for all subjects was carried out by the investigator. The Instructional Objectives Exchange Self Appraisal Inventory (IOX) was completed by the subject at the beginning of the assessment session. Only the Family Self Concept subscale of this instrument was used in this study. This subscale consists of 20 items that tap self-esteem in relation to interactions with family members. Following this, the Structured Interview, shown in Table I, was administered to all subjects. In keeping with evidence that direct self-reports fare well as predictors of behavior (Mischel, 1981), the Structured Interview consists of open-ended questions designed by the investigator to collect information about themes characterizing perceived parental and peer evaluations, parental models, parental disciplinary practices, types of interactions with parents and peers perceived to be stressful by the adolescent, and typical adolescent response styles in stressful interactions with parents and peers. Coding of Responses
Lists of responses to each question were transcribed verbatim, and similar responses were grouped together by the investigator to form categories. Responses were coded using specific code guidelines, as partially illustrated in Table II. Using these categories with the accompanying examples, two independent judges, experienced in counselling adolescents and blind to the subject's category status of referred or control, were asked to assign each of the verbatim responses to the most appropriate category. Interrater agreement was 81%. Disagreement was subsequently resolved by the judges. After responses elicited by each item on the Structured Interview were categorized, the referred and comparison groups were then compared in terms of the percentage of the total number of verbatim responses falling into each of the categories. (Some subjects gave more than one response to a single
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Table I. Structured Interview Questionnaire Items 1. How would your mother [father] describe you? (Elicit descriptions of personality factors, rather than physical attributes.) 2. Describe your mother [father]. 3. Describe your two best friends. 4. How would your classmates describe you? 5. How do you typically respond in upsetting or stressful situations involving (1) your mother, (2) your father, (3) another girl? (a) Describe a recent example of an upsetting situation involving the person. (b) What was your response? (c) What was the other person's response (to your response)? (d) What was your reaction to the above consequences? Was that typical? If not, what would be your typical response? 6. If you do something your mother [father] disapproves of, what is her [his] typical response?
questionnaire item. For each item, responses from an individual subject that fit t h e s a m e c a t e g o r y w e r e g r o u p e d t o g e t h e r a n d c o u n t e d as a single o c c u r rence of that category of response. Since some subjects' multiple responses t o o n e i t e m fell i n t o m o r e t h a n o n e c a t e g o r y , it w a s d e c i d e d t o c o m p a r e t h e r e f e r r e d a n d c o n t r o l g r o u p s in t e r m s o f t h e p e r c e n t a g e o f t h e t o t a l n u m b e r o f r e s p o n s e s t h a t fell i n t o a p a r t i c u l a r c a t e g o r y r a t h e r t h a n t h e p e r c e n t a g e of subjects emitting a certain category of response. Finally, because of low frequencies, some categories with similar content were collapsed.
RESULTS
AND DISCUSSION
In comparison to controls, the referred subjects were characterized by s i g n i f i c a n t l y l o w e r f a m i l y s e l f - c o n c e p t s c o r e s ( F = 3.44; p -- .01) in r e l a t i o n Table If. Sample of Guidelines for Categorization of Adolescent's Responses to Items Promiscuous Any statement by the daughter suggesting that her parent would describe her as sexually immoral. Psychologically abnormal, worthless, or cruel Any statement suggesting that the parent would describe her as (1) psychologically abnormal (e.g., "crazy," "homosexual," etc.); (2) cruelly destructive toward parents or peers; or (3) worthless, inferior, or unworthy to be a member of the family. (Descriptions suggesting "normal" developmental teenage rebellion or oppositional behavior are not included here.) Rebellious, oppositional teenager Any statement suggesting that the parent would describe her as manifesting moderate (vs. extreme) rebelliousness, or oppositional behavior, consistent with normal adolescent developmere (e.g., "rude," "disobedient," "uncommunicative," etc.).
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to family, as measured by the Family Self Concept subscale of the IOX. This lends support to the common clinical observation of poor self-esteem among girls from the types of problem families characterizing this sample. The response categories for each dimension (corresponding to a questionnaire item) are shown in Tables III and IV. The results of chi-square analyses of independence of category are shown in the tables. Percentages in the tables refer to responses whose total may exceed the sample size, because some subjects gave more than one category of response for a single item.
Table III. Perceived Parental and Peer Evaluations, Models, and Parental Discipline Styles Percent o f times each category mentioned Referred (%)
Controls (%)
Daughter's perception of parental evaluation Promiscuous Psychologically abnormal/worthless/cruel Rebellious/oppostional teen Positive descriptors Neutral descriptors
32 50 31 21 3
10 8 17 69 21
7.58 b 22.18 c 3.03ns 27.08 c 9.71 b
Descriptions of parents Cause of parental/adolescent conflict Psychologically abnormal Other derogatory terms Positive descriptors Neutral descriptors
40 35 16 50 10
4 0 6 75 38
14.14 ~ 21.36 r 2.61ns 7.35 b 12.32 c
Parents' typical disciplinary styles Physical punishment Lax-inconsistent/threats to harm/neglect Criticize/blame/yell Problem solve/withdraw privileges (No answer for one parent)
29 38 38 4 11
4 8 25 54 9
6.14 ~ 7.66 b 1.44ns 38.48 c
Perceived peer evaluation Negative descriptors Neutral descriptors Positive descriptors
58 27 24
4 67 63
17.40 c 8.76 ~ 8.454
Descriptions of best friends Conduct disorders No friends H a s similar problems to mine Positive descriptors (Other low-frequency categories)
23 20 17 34 23
0 0 0 75 25
12.69 c 18.89 r 9.16 b 18.89"
Response categories
"p < .05.
~p < .ol. Cp < .001.
Chi-square
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T a b l e I I I presents findings with respect to p e r c e i v e d p a r e n t a n d p e e r e v a l u a t i o n , m o d e l s , a n d p a r e n t a l d i s c i p l i n a r y styles. I n t e r m s o f the d a u g h ter's p e r c e p t i o n o f p a r e n t a l e v a l u a t i o n o f her [ " H o w w o u l d y o u r m o t h e r (father) describe y o u ? " ] , the following categories o f t h e m e s o c c u r r e d signific a n t l y m o r e f r e q u e n t l y in the r e f e r r e d g r o u p : (1) p r o m i s c u o u s (e.g., "slut"), a n d (2) p s y c h o l o g i c a l l y a b n o r m a l (e.g., " m e n t a l l y sick like D a d " ) / w o r t h l e s s (e.g., " s h o u l d never h a v e been b o r n " ) / c r u e l (e.g., "cause o f M o t h e r ' s b r e a k d o w n ) . O n the o t h e r h a n d , c o n t r o l subjects t e n d e d t o r e p o r t t h a t their p a r ents w o u l d describe t h e m in n e u t r a l t e r m s (e.g., "shy") o r in positive t e r m s (e.g., "helpful"). Interestingly, the g r o u p s d i d n o t d i f f e r in the f r e q u e n c y o f descriptors falling into the category o f r e b e l l i o u s / o p p o s i t i o n a l teenager (e.g., "yell at p a r e n t s , " " s p o i l e d , " " p r o b l e m child"). W i t h respect to the subject's descriptions o f their parents ["describe y o u r m o t h e r (father)"], the r e f e r r e d subjects t e n d e d to d e s c r i b e their p a r e n t s as
Table IV. Interpersonal Response Styles in Typical Stressful Situations Percent of times each category mentioned Referred (07o)
Controls (o7o)
Stressful situations involving parents Parent's use of physical punishment Parent's swearing/abusive name calling Parent angry/critical/unfair restrictions
37 34 29
0 9 91
10.59b 4.63 a 21.06c
Typical responses to stressful interactions with parents Active or passive defiance Passive helplessness Problem solve/acknowledge misdemeanor/ defer
66 37
14 0
14.77r 10.59b 37.76r
Response categories
Chi-square
6
86
Stressful situations involving female peers Girl threatening Loss of former friend Girl angry/critical Lack interactions with girls
23 20 27 13
0 0 68 0
5.93a 4.97 a 8.87b 3.18ns
Typical responses to stressful interactions with female peers Verbal or physical abuse/threats Withdraw/internalize Talk it over/defer Lack interactions with girls Other low-frequency categories
30 27 13 13 17
0 0 59 0 32
7.98 b 6.93 b 12.08c 3.18ns
ap < .05.
~p < .ol.
~p < .o01.
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the cause of parent/adolescent conflict (e.g., "puts me down") or as psychologically abnormal, in the sense of being one of the following: mentally unstable (e.g., "suicidal"), abusive spouse (e.g., "lets my father know she hates him"), or abusive parent (e.g., "beats me"). These three subcategories of response were grouped together for purposes of the analysis because of their common theme of parent's mental instability, which has been linked in the literature to psychological and conduct disorders in children (Herbert, 1980). On the other hand, the controls used a significantly higher percentage of positive descriptors (e.g., "slow to anger") and neutral descriptors (e.g., "a worrier"), as compared to referred subjects. Finally, the two groups did not differ in their frequency of use of derogatory descriptors (nonpsychopathological) in describing their parents (e.g., "critical of everyone"). With respect to parent's typical disciplinary styles ["If you do something your mother (father) disapproves of, what is his (her) typical response?"], referred subjects reported a higher incidence of disciplinary styles falling into the category of physical punishment and a higher incidence of styles falling into the combined category of lax-inconsistent/threats to harm/neglect (the daughter). Responses in the later category have been grouped together as techniques that, apart from physical abuse, have been deemed ineffective in the literature, and linked to child and adolescent psychological disorders (Becker, 1964; Herbert, 1980). Included in the category of threats to harm/neglect were reports of parents threats to kill the daughter or to expel her permanently from the home. In contrast, control subjects reported a higher incidence of responses in the problem solve/withdraw privileges category. This is consistent with the literature linking successful fostering of internalized rule formation in children to disciplinary techniques based on threatened withdrawal of approval and love, and reasoning and explanations to back up parental decisions (Patterson, 1975; Wright, 1971). Finally, the groups did not differ in the frequency of disciplinary styles in the category of criticism/blame/yell. A comparison of referred and control subjects in terms of perceived peer evaluation ("How would your classmates describe you?"), referred subjects tended to report negative descriptors (e.g., "slut"), whereas controls tended to report neutral descriptors (e.g., "average student") or positive descriptors (e.g., "fun to be with"). In response to the item "Describe your two best friends," referred subjects had a higher incidence of three types of responses. First, they tended to describe best friends in terms of behaviors that may be categorized as conduct disorders (e.g., "drug user"). Second, friends were described in terms of having psychological problems similar to the subject's (e.g, "has mental problems like me"), or as having similar family problems (e.g., "her dad drinks too").Third, referred subjects had a higher frequency of responses indicating that they had no friends at all. In contrast, control
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subjects had a higher frequency of responses falling into the positive descriptors category (e.g., "cheerful"). Table IV presents findings comparing the two groups with respect to the adolescent's interpersonal response styles in typical stressful situations ["How do you typically respond in upsetting or stressful situations involving 1) your mother, 2) your father, 3) another girl?"]. With respect to problem situations involving parents reported by subjects, in response to an item asking them to describe a recent typical upsetting situation involving a parent, the two groups differed significantly in the frequency of responses in all three categories shown in Table IV. Approximately one third of the referred subjects gave an example of a typical upsetting situation involving a parent's use of physical punishment, whereas none of the control subjects reported physical punishment. Another third of the referred subjects gave an example in which they referred to the parent's swearing or abusive name calling (e.g., "stupid mental case"). In comparison, only 9070 of the control subjects' responses fell into this combined category. On the other hand, control subjects reported a significantly higher frequency of responses in the parent angry/critical/unfair restrictions category. The following were examples in each category: parent angry responses-"Mom complained I'm away from home too much"; parent critical responses-"Mom nagged about my weight"; unfair restrictions responses - "Dad wouldn't let me go to a party." Results suggest that normal adolescents are typically exposed to differing degrees of parental criticism, but generally, the daughter is not accused of immorality, worthlessness, or inferiority. Normal adolescents, like adolescents from disturbed families, also seem to be exposed to what appears to them to be unfair restrictions. In terms of the adolescent's typical response to stressful situations with parent, the referred subjects were more likely to react with responses categorized as active or passive defiance. This category included six sub-categories: (1) abusive name calling (e.g., "I called him a child abuser"), (2) disobey prohibitions (e.g., "I refused to be grounded"), (3) physically abusive behavior toward parent (e.g., "pushed Mom"), (4) manipulative threats (e.g., "I threatened to run away from home"), (5) self-destructive behavior (e.g., "I got stoned after Dad hit me"), and (6) prolonged silent treatment (e.g., "locked myself in my room for hours"). Referred subjects were also more likely to report responses categorized as passive helplessness (e.g., "cried all day"). In contrast, control subjects were more likely to report responses in the combined category of problem solve/acknowledge misdemeanor/defer. The two groups also differed with respect to their reports of types of typical upsetting situations with female peers, and their own typical response patterns in upsetting interactions with peers. Referred subjects were more
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likely to report situations in which female peers did something that they considered threatening (e.g., "she threatened to beat me up"). They were also more likely to report situations that involved loss of former friend (e.g., "I was afraid of losing my friend") or to report that they lack interactions with girls (e.g., "I don't spend time with other girls"). On the other hand, controis reported a significantly higher frequency of upsetting peer interactions categorized as girl angry/critical (e.g., "my friend was mad at me"). Finally, the two groups differed in terms of the girl's report of her typical responses to stressful interactions with female peers. Referred subjects tended to report typical responses categorized as verbal or physical abuse/threats, whereas none of the control subjects' responses fell within this combined category (e.g., "punched her," "told her I'd beat her up next time"). Referred subjects also tended to report responses categorized as withdraw/internalize (e.g., "said nothing but felt sick"). In contrast, control subjects were significantly more likely to report responses categorized as talk it over/defer (e.g., "I gave in and apologized"). In summary, a daughter's perception of parental evaluation is an important focus of therapy with adolescents from problem families, since there is a tendency for children in these families to believe negative evaluations are deserved, even though this may not be the case (Herzberger et al., 1981). Therefore, in order to identify maladaptive cognitions for cognitive therapy interventions, the therapist will be aided by the above findings in distinguishing between typical categories of perceived parental evaluations of normal and problem adolescents. Certain types of cognitions and behavior styles are sometimes wrongly assumed by the therapist to be abnormal. For example, when asked how their parents would describe them, the referred and control groups did not differ in the frequency of descriptors such as "yells at parents," and "spoiled child," falling into the category of rebellious/oppositional teenager. Although there is a tendency among mental health workers to associate parents' use of negative labels and harsh criticism of a teenager with disturbed families, it seems that this practice is far more frequent in normal families and less "damaging" to the youngster's self-esteem than commonly thought. It should also be noted that while these descriptors reflect negative parental evaluation, they lack the connotation of pathology or evil character, and the guilt-engendering accusatory tone of the psychologically abnormal/worthless/cruel category descriptors, which are far more damaging to adolescent self-esteem. Another unexpected finding was that the referred and control groups did not differ in the frequency of derogatory descriptions of parents, as long as these descriptors did not imply parental psychopathology. This suggests that parental psychopathology, rather than the adolescent's harsh evaluation of the parent, is the distinguishing characteristic of disturbed families.
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It may also be surprising that the groups did not differ in the frequency of the reports of paternal disciplinary styles in the combined category of criticize/blame/yell, which would be labeled by some as instances of verbal abuse. The responses in this category seemed to reflect the parent's angry verbal outburst, or the parent's attempt to shape the daughter's behavior either by criticizing her performance in various areas or by blaming her for past misdemeanors. Results suggest that these tactics are commonly resorted to in normal as well as disturbed families. In general, distinguishing between "disturbed" and "disturbing" cognitions and behavior styles of adolescents and parents is an important component of effective family therapy. In terms of parental disciplinary styles, results suggest that teenage girls from normal families are upset by parental restrictions that they consider unfair and by parental criticism. Therefore, a family therapist's expectations for achievement of parent-adolescent agreement on the fairness of important rules and regulations would seem to be unrealistic. Similarly, results suggest that all forms of parental criticism of daughters need not be discouraged by family therapists, unless these criticisms imply that the daughter is immoral or worthless. Generally, the findings lend support to a commonly held theory among therapists who work with adolescents that particular types of dysfunctional parenting styles are correlated with poor adolescent interpersonal coping skills, labeled as maladaptive adolescent behaviors in the literature. They also support the notion that adolescents from problem families are either more likely to lack friends, or are more likely to befriend peers who also have significant family problems similar to their own, or who have conduct disorders. This would suggest fewer opportunities for exposure to socially well-adjusted peer models, especially in light of the finding that these youngster's also tend to perceive themselves to be negatively evaluated by classmates, and are characterized by inadequate interpersonal coping styles in stressful peer situations. Therefore, in addition to focusing on maladaptive cognitions of problem adolescents, training of more adequate coping responses with peers, as well as parents, in keeping with the response styles found to characterize girls from normal families, would be an essential component of an effective cognitive-behavioral treatment approach. Finally, there has been a tendency in the literature to attribute differences in observed pathology between referred and normal families to global factors such as divorce. In this study, an alternative explanation of findings might be that the observed differences between the groups reflect the different incidence of parental divorce rather than the status of referred subjects per se. However, apart from the fact that the majority of subjects in both groups were from intact families, and that there was relatively little difference between groups in the incidence of divorce (33% of the referred and
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6 % of c o n t r o l families), a closer look at the q u a l i t y o f responses o f subjects f r o m split families i n b o t h groups suggests that p r e o c c u p a t i o n with p a r e n t a l divorce was n o t a m a j o r issue in that it was rarely m e n t i o n e d . O n the contrary, the findings suggest the i m p o r t a n c e o f l o o k i n g b e y o n d global factors such as divorce with adolescent clients, to a m o r e detailed analysis o f everyday interactions, a n d the beliefs, attitudes, a n d self-evaluations a c c o m p a n y ing these interactions.
REFERENCES American Psychiatric Association. (1987). Diagnostic and Statistical Manual of Mental Disorders. (3rd ed., rev.). American Psychiatric Association, Washington, DC. Becker. W. C. (1964). Consequences of different kinds of parental discipline. In Hoffman, M., and Hoffman, L. (eds.), Review of Child Development Research. Russell Sage Foundation, New York. Beck, A. (1976). Cognitive Therapy and Emotional Disorders. International UniversitiesPress, New York. Benjamin, L. A. (1981). A psychosocialcompetenceclassificationsystem. In Wine, J., and Smye, M. (eds.), Social Competence. Guilford Press, New York. Goldfried, M. R., and Davidson, G. C. (1976). Clinical Behavior Therapy. Holt, Rinehart & Winston, New York. Herbert, M. (1980). Socializationfor problem resistance. In Feldman, P., and Orford, J. (eds.), Psychological Problems, The Social Context. John Wiley & Sons, New York. Herzberger, S. D., Ports, D. A., and Dillon, M. (1981). Abusive and nonabusive parental treatment from the child's perspective. J. Counsel. Clin. PsychoL 49; p. 81-90. Instructional Objectives Exchange (IOX): Measures of Self-Concept K-12. (1972). Los Angeles Instructional Objectives Exchange. Kendall, P. C., and Hollon, S. D. (eds.), Cognitive-behavioral Interventions: Theory, Research, and Procedures. Academic Press, New York. Meichenbaum, D. (1977). Cognitive-Behavior Modification. Plenum, New York. Mischel, W. (1977). On the future of personality measurement. Am. Psychol. 32: 246-254. Mischel, W. (1981). A cognitive social learning approach to assessment. In Merluzzi, T., Glass, C., and Genest, M. (eds.), Cognitive Assessment. The Guilford Press, New York. Perris, C., Arrindell, A., Perris, H., Eisenmann, M., Van der Ende, J., and Von Knorring, L. (1986). Perceived depriving parental rearing and depression. Br. J. Psychiat. 148: 170-175.
Perceptions and Response Styles of Referred Adolescent Girls with Family Problems Janet M. Zarb 1 Received April 25, 1989; accepted May 3, 1990
Therapists working with adolescents with family-related problems would benefit from research identifying characteristic parent and peer problem situations encountered by referred adolescents, the content o f the adolescent's perceptions o f parent and peer models, parental child-rearing styles, and typical interpersonal response styles o f the adolescents and their parents. Thirty adolescent girls with low family self-concepts were compared with matched controls on measures o f the adolescent's responses to structured interview items designed to tap the above areas. Responses were categorized by two independent judges. Results indicated that referred adolescents tended to report (1) parental evaluations categorized as promiscuous or psychologically abnormal/worthless~crueL (2) descriptions o f parents categorized as cause o f parent/adolescent conflict or psychologically abnormal (3) typical parental disciplinary styles categorized as physical punishment, or laxinconsistent~threats to harm/neglect, (4) descriptions o f best friends categorized as conduct disorders, or as having similar problems, (5) descriptions o f their own typical responses in stressful situations involving parents categorized as active or passive defiance, or passive helplessness and (6) descriptions o f their own characteristic responses in stressful situations involving female peers categorized as verbal or physicai abuse, or withdraw~internalize. Application o f findings to therapy with adolescents and families is discussed. INTRODUCTION
Theory and research in recent decades suggests an important relationship between a client's cognitions and the development, maintenance, and 1To w h o m all correspondence should be addressed at 302 Rose Park Drive, Toronto, Ontario, M 4 T 1R7, Canada. 27"/ 0047-2891/90/06004)277506.00/09 1990PlenumPublishingCorporation
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treatment of psychological disorders (Beck, 1976; Goldfried and Davidson, 1976; Kendal and Hollen, 1979; Meichenbaum, 1977). This research also suggests a need to identify the client's maladaptive response styles (Mischel, 1981). Beck (1976) has provided some evidence in support of the proposition that patterns of maladaptive cognitions are typical of different adult psychological disorders. Others have proposed models for analysis of behavioral and cognitive styles linked to traditional adult psychiatric categories (Benjamin, 1981), but there has been a paucity of comparable research focusing on characteristic cognitive and behavioral styles of adolescents with familyrelated problems. Clinical experience in treating adolescent clients with family-related problems suggests characteristic patterns of cognitions and coping responses in relation to parents and peers. Problem families have also been observed to differ from normal families with adolescent children in terms of parental models and child-rearing styles. Adolescents and parents in problem families are reported to hold "negative" views of each other, and their interactions are said to be "maladaptive." However, in order to aid therapists in identifying more specific targets for cognitive-behavioral interventions in individual and family sessions, there is a need for identification of types of parents and peers with whom adolescents with family problems interact on a day-to-day basis, typical problems encountered with significant others, typical response styles of the adolescent and the significant others in these stressful interpersonal situations, and the thematic content of the adolescent's perceptions in relation to parents and peers. Therefore, the present study is a comparison of the perceptions and response styles of a sample of adolescent girls referred for therapy for family-related problems, with those of a normal control group with no identified family problems. The two groups are compared in three areas: the adolescent's perceptions of parents and peers, the youngster's parent and peer models, and the girl's typical interaction patterns with parents and peers. The rationale for studying the adolescent's perceptions of evaluations of parents and peers has stemmed from the notion that the adolescent accepts the way parents and peers behave toward her as the norm, so that the youngster's self-concept somehow reflects the way in which she has been treated by these significant people in her life. For example, research on the effects of parental discipline suggests that the more severe the punishment, the more the child feels it is deserved (Herzberger et al., 1981). Inadequate parenting has been linked to lack of social competence in children (Herbert, 1980; Becker, 1964), so that adolescents exposed to inadequate parental models and child-rearing techniques would be expected to have greater difficulty in forming adequate interpersonal relationships with normal prosocial peers.
Problem Adolescents' Perceptions and Response Styles
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METHOD Sample
Subjects were two groups of girls, aged 15-18, attending the same school in a working-class Canadian urban area. The "referred" group was comprised of 30 girls referred by school staff to the school psychologist for psychological counselling, primarily because of family problems. Family problems included parental physical abuse, alcoholism, history of incest, lax-inconsistent discipline, severe marital conflict, and parental psychopathology. One third of the referred subjects had parents who were separated or divorced (as compared to 6% of the control subjects). DMS III-R categories of abnormal adolescent behaviors characterizing referred subjects included depressive disorder, conduct disorder, oppositional defiant disorder, overanxious disorder, and avoidant disorder. A comparison group of 30 subjects, labeled the "control" group, was comprised of randomly selected students from the same school who were not referred for psychological counselling. Both groups were matched for age, and ethnic group. Approximately 25 % had Canadian-born parents, 50% were children of immigrants from southern Europe, and 25% were children of immigrants from a variety of countries including Hong Kong, China, Slavic countries, South America, and the West Indies. Instruments and Procedure
The selection of variables for this investigation was influenced by clinical work with adolescent psychotherapy clients, and by the literature suggesting that a large part of variation in individual personality characteristics is directly related to the youngster's interactions with parents and peers (Perris et al., 1986). One consistent finding has been the higher incidence of psychological problems among youngsters who do not perceive themselves as accepted and valued by parents. The present study focuses on the adolescent's perceptions of behaviors and evaluations of significant others, namely parents and peers. Research suggests that youngsters, through the process of perceiving and interpreting events, actively construct a view of their social environment, and then respond according to this construction (Herzberger et al., 1981). It has been suggested that a youngster's perception of parenting practices and home life may be more important than the actual situation, in terms of the youngster's personality development and adjustment. In addition to the items designed to elicit information about the adolescent's cognitions, other questionnaire items were designed to elicit informa-
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tion about the adolescent's behavioral interactions with parents and peers in specific types of situations, namely upsetting situations and situations involving parental disapproval. Inconsistencies in the literature on parent-child relationships has been partially attributed to attempts to make global assessments of such things as parental "warmth," and "rejection," rather than specifying variations in parent-child behavioral interactions in particular situations (Herbert, 1980). Finally, since observation data on interactions with significant others are very difficult to obtain with samples of adolescents (as opposed to samples of small children), the present study relied on the adolescent's reports of her interactions with parents and peers. All data were collected during one lengthy individual session with each subject. Data collection for all subjects was carried out by the investigator. The Instructional Objectives Exchange Self Appraisal Inventory (IOX) was completed by the subject at the beginning of the assessment session. Only the Family Self Concept subscale of this instrument was used in this study. This subscale consists of 20 items that tap self-esteem in relation to interactions with family members. Following this, the Structured Interview, shown in Table I, was administered to all subjects. In keeping with evidence that direct self-reports fare well as predictors of behavior (Mischel, 1981), the Structured Interview consists of open-ended questions designed by the investigator to collect information about themes characterizing perceived parental and peer evaluations, parental models, parental disciplinary practices, types of interactions with parents and peers perceived to be stressful by the adolescent, and typical adolescent response styles in stressful interactions with parents and peers. Coding of Responses
Lists of responses to each question were transcribed verbatim, and similar responses were grouped together by the investigator to form categories. Responses were coded using specific code guidelines, as partially illustrated in Table II. Using these categories with the accompanying examples, two independent judges, experienced in counselling adolescents and blind to the subject's category status of referred or control, were asked to assign each of the verbatim responses to the most appropriate category. Interrater agreement was 81%. Disagreement was subsequently resolved by the judges. After responses elicited by each item on the Structured Interview were categorized, the referred and comparison groups were then compared in terms of the percentage of the total number of verbatim responses falling into each of the categories. (Some subjects gave more than one response to a single
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Table I. Structured Interview Questionnaire Items 1. How would your mother [father] describe you? (Elicit descriptions of personality factors, rather than physical attributes.) 2. Describe your mother [father]. 3. Describe your two best friends. 4. How would your classmates describe you? 5. How do you typically respond in upsetting or stressful situations involving (1) your mother, (2) your father, (3) another girl? (a) Describe a recent example of an upsetting situation involving the person. (b) What was your response? (c) What was the other person's response (to your response)? (d) What was your reaction to the above consequences? Was that typical? If not, what would be your typical response? 6. If you do something your mother [father] disapproves of, what is her [his] typical response?
questionnaire item. For each item, responses from an individual subject that fit t h e s a m e c a t e g o r y w e r e g r o u p e d t o g e t h e r a n d c o u n t e d as a single o c c u r rence of that category of response. Since some subjects' multiple responses t o o n e i t e m fell i n t o m o r e t h a n o n e c a t e g o r y , it w a s d e c i d e d t o c o m p a r e t h e r e f e r r e d a n d c o n t r o l g r o u p s in t e r m s o f t h e p e r c e n t a g e o f t h e t o t a l n u m b e r o f r e s p o n s e s t h a t fell i n t o a p a r t i c u l a r c a t e g o r y r a t h e r t h a n t h e p e r c e n t a g e of subjects emitting a certain category of response. Finally, because of low frequencies, some categories with similar content were collapsed.
RESULTS
AND DISCUSSION
In comparison to controls, the referred subjects were characterized by s i g n i f i c a n t l y l o w e r f a m i l y s e l f - c o n c e p t s c o r e s ( F = 3.44; p -- .01) in r e l a t i o n Table If. Sample of Guidelines for Categorization of Adolescent's Responses to Items Promiscuous Any statement by the daughter suggesting that her parent would describe her as sexually immoral. Psychologically abnormal, worthless, or cruel Any statement suggesting that the parent would describe her as (1) psychologically abnormal (e.g., "crazy," "homosexual," etc.); (2) cruelly destructive toward parents or peers; or (3) worthless, inferior, or unworthy to be a member of the family. (Descriptions suggesting "normal" developmental teenage rebellion or oppositional behavior are not included here.) Rebellious, oppositional teenager Any statement suggesting that the parent would describe her as manifesting moderate (vs. extreme) rebelliousness, or oppositional behavior, consistent with normal adolescent developmere (e.g., "rude," "disobedient," "uncommunicative," etc.).
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to family, as measured by the Family Self Concept subscale of the IOX. This lends support to the common clinical observation of poor self-esteem among girls from the types of problem families characterizing this sample. The response categories for each dimension (corresponding to a questionnaire item) are shown in Tables III and IV. The results of chi-square analyses of independence of category are shown in the tables. Percentages in the tables refer to responses whose total may exceed the sample size, because some subjects gave more than one category of response for a single item.
Table III. Perceived Parental and Peer Evaluations, Models, and Parental Discipline Styles Percent o f times each category mentioned Referred (%)
Controls (%)
Daughter's perception of parental evaluation Promiscuous Psychologically abnormal/worthless/cruel Rebellious/oppostional teen Positive descriptors Neutral descriptors
32 50 31 21 3
10 8 17 69 21
7.58 b 22.18 c 3.03ns 27.08 c 9.71 b
Descriptions of parents Cause of parental/adolescent conflict Psychologically abnormal Other derogatory terms Positive descriptors Neutral descriptors
40 35 16 50 10
4 0 6 75 38
14.14 ~ 21.36 r 2.61ns 7.35 b 12.32 c
Parents' typical disciplinary styles Physical punishment Lax-inconsistent/threats to harm/neglect Criticize/blame/yell Problem solve/withdraw privileges (No answer for one parent)
29 38 38 4 11
4 8 25 54 9
6.14 ~ 7.66 b 1.44ns 38.48 c
Perceived peer evaluation Negative descriptors Neutral descriptors Positive descriptors
58 27 24
4 67 63
17.40 c 8.76 ~ 8.454
Descriptions of best friends Conduct disorders No friends H a s similar problems to mine Positive descriptors (Other low-frequency categories)
23 20 17 34 23
0 0 0 75 25
12.69 c 18.89 r 9.16 b 18.89"
Response categories
"p < .05.
~p < .ol. Cp < .001.
Chi-square
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T a b l e I I I presents findings with respect to p e r c e i v e d p a r e n t a n d p e e r e v a l u a t i o n , m o d e l s , a n d p a r e n t a l d i s c i p l i n a r y styles. I n t e r m s o f the d a u g h ter's p e r c e p t i o n o f p a r e n t a l e v a l u a t i o n o f her [ " H o w w o u l d y o u r m o t h e r (father) describe y o u ? " ] , the following categories o f t h e m e s o c c u r r e d signific a n t l y m o r e f r e q u e n t l y in the r e f e r r e d g r o u p : (1) p r o m i s c u o u s (e.g., "slut"), a n d (2) p s y c h o l o g i c a l l y a b n o r m a l (e.g., " m e n t a l l y sick like D a d " ) / w o r t h l e s s (e.g., " s h o u l d never h a v e been b o r n " ) / c r u e l (e.g., "cause o f M o t h e r ' s b r e a k d o w n ) . O n the o t h e r h a n d , c o n t r o l subjects t e n d e d t o r e p o r t t h a t their p a r ents w o u l d describe t h e m in n e u t r a l t e r m s (e.g., "shy") o r in positive t e r m s (e.g., "helpful"). Interestingly, the g r o u p s d i d n o t d i f f e r in the f r e q u e n c y o f descriptors falling into the category o f r e b e l l i o u s / o p p o s i t i o n a l teenager (e.g., "yell at p a r e n t s , " " s p o i l e d , " " p r o b l e m child"). W i t h respect to the subject's descriptions o f their parents ["describe y o u r m o t h e r (father)"], the r e f e r r e d subjects t e n d e d to d e s c r i b e their p a r e n t s as
Table IV. Interpersonal Response Styles in Typical Stressful Situations Percent of times each category mentioned Referred (07o)
Controls (o7o)
Stressful situations involving parents Parent's use of physical punishment Parent's swearing/abusive name calling Parent angry/critical/unfair restrictions
37 34 29
0 9 91
10.59b 4.63 a 21.06c
Typical responses to stressful interactions with parents Active or passive defiance Passive helplessness Problem solve/acknowledge misdemeanor/ defer
66 37
14 0
14.77r 10.59b 37.76r
Response categories
Chi-square
6
86
Stressful situations involving female peers Girl threatening Loss of former friend Girl angry/critical Lack interactions with girls
23 20 27 13
0 0 68 0
5.93a 4.97 a 8.87b 3.18ns
Typical responses to stressful interactions with female peers Verbal or physical abuse/threats Withdraw/internalize Talk it over/defer Lack interactions with girls Other low-frequency categories
30 27 13 13 17
0 0 59 0 32
7.98 b 6.93 b 12.08c 3.18ns
ap < .05.
~p < .ol.
~p < .o01.
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the cause of parent/adolescent conflict (e.g., "puts me down") or as psychologically abnormal, in the sense of being one of the following: mentally unstable (e.g., "suicidal"), abusive spouse (e.g., "lets my father know she hates him"), or abusive parent (e.g., "beats me"). These three subcategories of response were grouped together for purposes of the analysis because of their common theme of parent's mental instability, which has been linked in the literature to psychological and conduct disorders in children (Herbert, 1980). On the other hand, the controls used a significantly higher percentage of positive descriptors (e.g., "slow to anger") and neutral descriptors (e.g., "a worrier"), as compared to referred subjects. Finally, the two groups did not differ in their frequency of use of derogatory descriptors (nonpsychopathological) in describing their parents (e.g., "critical of everyone"). With respect to parent's typical disciplinary styles ["If you do something your mother (father) disapproves of, what is his (her) typical response?"], referred subjects reported a higher incidence of disciplinary styles falling into the category of physical punishment and a higher incidence of styles falling into the combined category of lax-inconsistent/threats to harm/neglect (the daughter). Responses in the later category have been grouped together as techniques that, apart from physical abuse, have been deemed ineffective in the literature, and linked to child and adolescent psychological disorders (Becker, 1964; Herbert, 1980). Included in the category of threats to harm/neglect were reports of parents threats to kill the daughter or to expel her permanently from the home. In contrast, control subjects reported a higher incidence of responses in the problem solve/withdraw privileges category. This is consistent with the literature linking successful fostering of internalized rule formation in children to disciplinary techniques based on threatened withdrawal of approval and love, and reasoning and explanations to back up parental decisions (Patterson, 1975; Wright, 1971). Finally, the groups did not differ in the frequency of disciplinary styles in the category of criticism/blame/yell. A comparison of referred and control subjects in terms of perceived peer evaluation ("How would your classmates describe you?"), referred subjects tended to report negative descriptors (e.g., "slut"), whereas controls tended to report neutral descriptors (e.g., "average student") or positive descriptors (e.g., "fun to be with"). In response to the item "Describe your two best friends," referred subjects had a higher incidence of three types of responses. First, they tended to describe best friends in terms of behaviors that may be categorized as conduct disorders (e.g., "drug user"). Second, friends were described in terms of having psychological problems similar to the subject's (e.g, "has mental problems like me"), or as having similar family problems (e.g., "her dad drinks too").Third, referred subjects had a higher frequency of responses indicating that they had no friends at all. In contrast, control
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subjects had a higher frequency of responses falling into the positive descriptors category (e.g., "cheerful"). Table IV presents findings comparing the two groups with respect to the adolescent's interpersonal response styles in typical stressful situations ["How do you typically respond in upsetting or stressful situations involving 1) your mother, 2) your father, 3) another girl?"]. With respect to problem situations involving parents reported by subjects, in response to an item asking them to describe a recent typical upsetting situation involving a parent, the two groups differed significantly in the frequency of responses in all three categories shown in Table IV. Approximately one third of the referred subjects gave an example of a typical upsetting situation involving a parent's use of physical punishment, whereas none of the control subjects reported physical punishment. Another third of the referred subjects gave an example in which they referred to the parent's swearing or abusive name calling (e.g., "stupid mental case"). In comparison, only 9070 of the control subjects' responses fell into this combined category. On the other hand, control subjects reported a significantly higher frequency of responses in the parent angry/critical/unfair restrictions category. The following were examples in each category: parent angry responses-"Mom complained I'm away from home too much"; parent critical responses-"Mom nagged about my weight"; unfair restrictions responses - "Dad wouldn't let me go to a party." Results suggest that normal adolescents are typically exposed to differing degrees of parental criticism, but generally, the daughter is not accused of immorality, worthlessness, or inferiority. Normal adolescents, like adolescents from disturbed families, also seem to be exposed to what appears to them to be unfair restrictions. In terms of the adolescent's typical response to stressful situations with parent, the referred subjects were more likely to react with responses categorized as active or passive defiance. This category included six sub-categories: (1) abusive name calling (e.g., "I called him a child abuser"), (2) disobey prohibitions (e.g., "I refused to be grounded"), (3) physically abusive behavior toward parent (e.g., "pushed Mom"), (4) manipulative threats (e.g., "I threatened to run away from home"), (5) self-destructive behavior (e.g., "I got stoned after Dad hit me"), and (6) prolonged silent treatment (e.g., "locked myself in my room for hours"). Referred subjects were also more likely to report responses categorized as passive helplessness (e.g., "cried all day"). In contrast, control subjects were more likely to report responses in the combined category of problem solve/acknowledge misdemeanor/defer. The two groups also differed with respect to their reports of types of typical upsetting situations with female peers, and their own typical response patterns in upsetting interactions with peers. Referred subjects were more
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likely to report situations in which female peers did something that they considered threatening (e.g., "she threatened to beat me up"). They were also more likely to report situations that involved loss of former friend (e.g., "I was afraid of losing my friend") or to report that they lack interactions with girls (e.g., "I don't spend time with other girls"). On the other hand, controis reported a significantly higher frequency of upsetting peer interactions categorized as girl angry/critical (e.g., "my friend was mad at me"). Finally, the two groups differed in terms of the girl's report of her typical responses to stressful interactions with female peers. Referred subjects tended to report typical responses categorized as verbal or physical abuse/threats, whereas none of the control subjects' responses fell within this combined category (e.g., "punched her," "told her I'd beat her up next time"). Referred subjects also tended to report responses categorized as withdraw/internalize (e.g., "said nothing but felt sick"). In contrast, control subjects were significantly more likely to report responses categorized as talk it over/defer (e.g., "I gave in and apologized"). In summary, a daughter's perception of parental evaluation is an important focus of therapy with adolescents from problem families, since there is a tendency for children in these families to believe negative evaluations are deserved, even though this may not be the case (Herzberger et al., 1981). Therefore, in order to identify maladaptive cognitions for cognitive therapy interventions, the therapist will be aided by the above findings in distinguishing between typical categories of perceived parental evaluations of normal and problem adolescents. Certain types of cognitions and behavior styles are sometimes wrongly assumed by the therapist to be abnormal. For example, when asked how their parents would describe them, the referred and control groups did not differ in the frequency of descriptors such as "yells at parents," and "spoiled child," falling into the category of rebellious/oppositional teenager. Although there is a tendency among mental health workers to associate parents' use of negative labels and harsh criticism of a teenager with disturbed families, it seems that this practice is far more frequent in normal families and less "damaging" to the youngster's self-esteem than commonly thought. It should also be noted that while these descriptors reflect negative parental evaluation, they lack the connotation of pathology or evil character, and the guilt-engendering accusatory tone of the psychologically abnormal/worthless/cruel category descriptors, which are far more damaging to adolescent self-esteem. Another unexpected finding was that the referred and control groups did not differ in the frequency of derogatory descriptions of parents, as long as these descriptors did not imply parental psychopathology. This suggests that parental psychopathology, rather than the adolescent's harsh evaluation of the parent, is the distinguishing characteristic of disturbed families.
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It may also be surprising that the groups did not differ in the frequency of the reports of paternal disciplinary styles in the combined category of criticize/blame/yell, which would be labeled by some as instances of verbal abuse. The responses in this category seemed to reflect the parent's angry verbal outburst, or the parent's attempt to shape the daughter's behavior either by criticizing her performance in various areas or by blaming her for past misdemeanors. Results suggest that these tactics are commonly resorted to in normal as well as disturbed families. In general, distinguishing between "disturbed" and "disturbing" cognitions and behavior styles of adolescents and parents is an important component of effective family therapy. In terms of parental disciplinary styles, results suggest that teenage girls from normal families are upset by parental restrictions that they consider unfair and by parental criticism. Therefore, a family therapist's expectations for achievement of parent-adolescent agreement on the fairness of important rules and regulations would seem to be unrealistic. Similarly, results suggest that all forms of parental criticism of daughters need not be discouraged by family therapists, unless these criticisms imply that the daughter is immoral or worthless. Generally, the findings lend support to a commonly held theory among therapists who work with adolescents that particular types of dysfunctional parenting styles are correlated with poor adolescent interpersonal coping skills, labeled as maladaptive adolescent behaviors in the literature. They also support the notion that adolescents from problem families are either more likely to lack friends, or are more likely to befriend peers who also have significant family problems similar to their own, or who have conduct disorders. This would suggest fewer opportunities for exposure to socially well-adjusted peer models, especially in light of the finding that these youngster's also tend to perceive themselves to be negatively evaluated by classmates, and are characterized by inadequate interpersonal coping styles in stressful peer situations. Therefore, in addition to focusing on maladaptive cognitions of problem adolescents, training of more adequate coping responses with peers, as well as parents, in keeping with the response styles found to characterize girls from normal families, would be an essential component of an effective cognitive-behavioral treatment approach. Finally, there has been a tendency in the literature to attribute differences in observed pathology between referred and normal families to global factors such as divorce. In this study, an alternative explanation of findings might be that the observed differences between the groups reflect the different incidence of parental divorce rather than the status of referred subjects per se. However, apart from the fact that the majority of subjects in both groups were from intact families, and that there was relatively little difference between groups in the incidence of divorce (33% of the referred and
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6 % of c o n t r o l families), a closer look at the q u a l i t y o f responses o f subjects f r o m split families i n b o t h groups suggests that p r e o c c u p a t i o n with p a r e n t a l divorce was n o t a m a j o r issue in that it was rarely m e n t i o n e d . O n the contrary, the findings suggest the i m p o r t a n c e o f l o o k i n g b e y o n d global factors such as divorce with adolescent clients, to a m o r e detailed analysis o f everyday interactions, a n d the beliefs, attitudes, a n d self-evaluations a c c o m p a n y ing these interactions.
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