Journal of Consulting and Clinical Psychology 1975, Vol. 43, No. 1, 22-31
Relative Effectiveness of Behavioral and Reflective Group Counseling with Parents of Mentally Retarded Children Joseph B. Tavormina University of Virginia The present study evaluated the relative effectiveness of behavioral and reflective group parent counseling. Subjects were SI mothers of mentally retarded children who were assigned to behavioral, reflective, or waiting-list control groups. Six success criteria, including direct observations, attitudinal scales, maternal reports, and frequency counts, were used to measure outcome. Results indicated that both types of counseling had a beneficial effect relative to the untreated controls but that the behavioral method resulted in a significantly greater magnitude of improvement. The consistency of these results across measures strongly suggests that the behavioral technique was the treatment of choice for counseling parents of the retarded. It provided them with an understandable, consistent, and effective way to deal with the specific problems they were facing in raising their retarded children.
Parent counseling and parent education procedures are gaining popularity as interventive and preventive mental health strategies. At present there are two basic counseling models (Tavormina, 1974): one emphasizes feelings and the other emphasizes behavior as the primary starting point. The first, reflective counseling, places a major emphasis on parental awareness, understanding, and acceptance of the child's feelings (Auerbach, 1968; Ginott, 19S7). This model uses cognitively mediate variables (feelings) as a means of affecting the child's behavior and the parent-child interaction. The second method, behavior counseling, places its emphasis on actual observable behavior and the environmental variables that maintain certain behavior patterns. This counseling procedure focuses on teaching parents how to apply the principles of learning theory to their specific child-rearing problems (Patterson, 1971). Currently, both techniques are used in a variety of settings to work with many types of behavioral problems as well as with divergent populations. Yet, little has been done to compare the relative utility and cost efficiency of both procedures. Consequently, there is a need to determine which popula-
tions and which behavioral problems can be best dealt with by each model (Hartmann, Note 1; Tavormina, 1974; Walter & Gilmore, 1973). Differences in design and measurement techniques have been barriers to comparative research on these two methods. One basic problem has been the lack of comparative measures of outcome derived from the two procedures. To eliminate this obstacle, it is feasible to combine the measures typically used by each counseling model as multiple criterion variables. A combination of parent reports, attitudinal measures, and observer variables provides a broad-based, representative comparison of effectiveness. This multimethod approach minimizes the effects of bias and distortion inherent in the use of single criterion measures (Lytton, 1971; Patterson & Reid, 1973; Tavormina, Yock, & Keller, Note 2; Tramantana, 1971). Parents of retarded children represent one population for which counseling procedures may be extremely important. Parents of these children are under a great deal of situational stress and often have difficulty with day-today child management issues (Menolascino, 1970). There have been a number of attempts to determine the worth of group counseling for these parents utilizing both reRequests for reprints should be sent to J. B. flective (Lewis, 1970; Siegel, Sheridan, & Tavormina, Department of Psychology, Gilmer Hall, University of Virginia, Charlottesville, Virginia Sheridan, 1971; Tretakoff, 1969; Wolfens22901. berger, 1967) and behavioral (Cone & Sloop, 22
COUNSELING WITH PARENTS OF MENTALLY RETARDED CHILDREN 1971; Lasser, 1970; Morrey, 1971) techniques. However, to date the efficacy of neither model has been reliably demonstrated with this population. The present study was designed to deal with these issues by comparing the differential effectiveness of behavioral and reflective group counseling in work with parents of mentally retarded children. Multiple success criteria were used to provide a broad-based measurement of outcome of counseling. It was predicted that all parents who received counseling, either behavioral or reflective, would show significant improvement across outcome indices relative to comparable untreated parents. It was predicted that counseled parents would show positive change in their attitudes; report fewer behavioral problems; increase the positive quality of the motherchild interaction; and report an improvement in the quality of family life. It was also predicted that treatment modalities would yield differential changes as a function of outcome criteria; these changes were predicted to be consistent with previous findings that behavioral counseling mainly changes frequencies of deviant behavior, whereas reflective counseling results in changes in attitudes and feelings. METHOD Subjects Subjects were those SI mothers of mentally retarded children from a larger pool of 300 who responded to a letter from two facilities for mentally retarded children in Rochester, New York. The mothers' average age was 37.4 years, and their average education was 12.8 years; their treated children averaged 6.7 years of age. Twenty-three of the mothers had previously received some form of counseling about their child. The sample's socioeconomic status ranged from lower- to uppermiddle class; only one black family participated. No reliable IQ estimates could be given for most of the children, but observation and reports of previous testing revealed that most of them were below SO. There were no significant differences between any of the treatment groups on these demographic variables.
Procedure All subjects were evaluated at the beginning of the study (Baseline 1) and were told that groups would begin 2 months later. At that time (Baseline 2), they were again evaluated on all of the measures to assess the stability of these variables
23
over time and to determine whether mothers' anticipations of being in a group would affect their scores. Following this retesting, mothers were assigned to treatment (n = 38) or control conditions (n — 13) on the basis of their choice to attend groups in February and March (treatment) or April and May (control). The treatment subjects were then further divided into four groups on the basis of which day the mother chose to attend group meetings. Two of these groups employed behavioral methods (»s = 11 and 8), and two used a reflective approach (n& = 10 and 6).1 Type of treatment administered to each group was determined on the basis of which .day each of the group leaders chose to meet with a group. Results of this assignment procedure revealed no significant differences between groups on maternal age or education, child age, or the number of mothers who had received some type of prior counseling. During February and March the treatment groups received a series of eight weekly 14-hour sessions, and the controls received no treatment. Following this period, all subjects were retested on all measures to determine posttreatment scores. After this third evaluation session, mothers in the control group were administered counseling based on a combined behavioral and reflective approach.
Treatment Reflective groups followed the organizational principles suggested by Auerbach (1968) and Ginott (19S9, 1961). At the first meeting, members were told that the sessions were an opportunity to discuss their concerns and problems with their children. The group was described as the place to work on productive ways for handling problems of raising retarded children. Each participant received a copy of Between Parent and Child (Ginott, 19S9), which she was asked to read. The group leaders focused the discussions around Ginott's major principles of reflecting feelings, setting appropriate limits, and providing appropriate alternative activities. Leaders also attempted to convey the importance of empathy, acceptance, and understanding in dealing with the children. Group discussion was used extensively to apply these principles to each mother's situation and to draw from her experience in regard to the specific problems of the other mothers in the group. Analogously, mothers in the behavioral groups were taught the principles and the application of operant techniques to their specific child-rearing problems. The programmed text Parents are Teachers: A Child Management Program (Becker, 1971) was used as a general outline. The leaders followed Becker's lesson plan on fostering group discussions about the principles outlined in the text. Primarily they focused on the use of praise, the emphasis on positive rather then aversive contingencies, and the need to specify and observe the behaviors targeted 1
One mother initially assigned to the first reflective group and two from the second such group dropped out very early in the course of the sessions. These individuals were not included in the evaluation.
24
JOSEPH B. TAVOEMINA
for change. However, the major group task was the application of these principles to each mother's specific target behaviors. Group discussion, role playing, and modeling were used to work out specific programs for each mother to use in handling targeted problems. Mothers were encouraged to try these programs in order to change the child's behavior. An important part of the group process was to provide feedback about these projects and to help each mother modify and perfect the programs she was working on.
Group Leaders Leaders were four third-year clinical psychology graduate students at the University of Rochester. All had received training in the intellectual capabilities and developmental expectancies for retarded children. Each had a minimum of 1,500 hours of supervised clinical internship experience. The two reflective leaders had previously sought learning experiences in reflective techniques from doctoral-level psychologists trained in this methodology and had run therapy groups using this method. Similarly, the two behavioral leaders had done work on behavior modification techniques as part of their graduate training and had used these procedures in clinical work. However, none of the leaders had ever worked with parents of the retarded prior to this study.
Measures To insure a broad-based evaluation, the following outcome measures were employed: 1. The Hereford Parent Attitude Survey (Hereford, 1963) measures the following areas: (a) Confidence in parental role, that is, parental feelings of adequacy or inadequacy; (b) causation of the child's behavior, that is, the extent to which the parent sees himself as a major factor in determining the child's behavior; (c) acceptance, that is, the extent to which the parent is satisfied with the child and is willing to see him as an individual; (d) mutual understanding, that is, parental perceptions about the degree of reciprocity of feelings between parent and child; and (e) mutual trust, that is, the amount of confidence that the parent feels he and the child have in each other. The sum of the scale scores yields a total attitude score. 2. The Missouri Behavior Problem Checklist (Sines, Pauker, Sines, & Owen, 1969) is a yes-no checklist containing 70 statements that have been factor analyzed into group scores of parent-reported symptoms of children. Scores are tabulated to determine a child's place on the various dimensions of the scale: Aggressiveness, Inhibition, Activity Level, Sleep Disturbance, Somatization, and Sociability. The sum of the first five scales yields a total deviancy score, with high scores indicating deviancy. The Sociability scale is scored in a positive direction. 3. Behavior observations were undertaken as the mother-child interaction was observed for 25 minutes in a playroom via a one-way mirror. Observa-
tions were divided into unstructured free play and structured command play ("Please have your child pick up the toys he/she has played with and put them away") segments. Each interaction was coded 2 into three sequential categories: (a) antecedent behavior, designated as mother/child initiated behavior. Either mother or child could give a command, attempt to affiliate, or ignore the other, (b) Response behavior indicated the mother's or child's response to the previously initiated behavior; possibilities include compliance, noncompliance, or ignoring the antecedent behavior, (c) Consequent behavior referred to the mother's or child's responseconsequence segment of the previous response. This code included positive reinforcement, defined as a response that maintained or increased the probability of recurrence of the previous behavior; punishment, defined as a response that decreased the probability of recurrence of the previous behavior; or ignoring the previous response. This coding system allowed for an analysis of the sequence of interaction patterns, defined as appropriate or inappropriate by use of the principles of learning theory. Six variables were defined, three each from free and command play. They tapped (a) total appropriate interaction, defined as a completely appropriate antecedent-response-consequence pattern during each observation unit; one of the dyad initiated, the other complied, and then the initiator consequated appropriately; (b) appropriate antecedent-response, defined as an initiation by one member of the dyad and a compliant response by the other; (c) appropriate responseconsequence, defined as an appropriate responseconsequence segment by one member of the previous response of the other. Appropriate consequences included positive reinforcement for a previous compliance and punishing or ignoring a previous noncompliance or previous ignoring. Fifteen free-play and IS command-play codes were made per observation session by two independent raters (median interrater reliability = 84%, range = 68%-98% agreement). One code sequence, from antecedent to response to consequence, was noted every 30 seconds, after which there was a IS-second break before the next sequence. If more than one sequence occurred in any 30-second block, only the first one was recorded. 4. Ratings of target behavior were obtained as follows: Mothers in each condition were asked to list the three most troublesome problems that they were having with their children; these problems later became the target behaviors on which the mothers worked in the groups. Mothers were asked to rate each behavior on two dimensions (Patterson & Reid, 1973). The first was a rating of the amount of disruption that each target behavior caused at home. A 9-point scale was provided ranging from "No disruption (1)" to "Significant disruption (9)." Similarly, mothers were asked to rate each behavior in terms of the intensity of their emotional reaction 2 A full list of codes and examples is available and will be furnished upon request.
COUNSELING WITH PARENTS OF MENTALLY RETARDED CHILDREN to it. This 9-point scale ranged from "No emotional reaction (1)" to "Considerable emotional reaction (9)." 5. Mothers were asked to record the frequency of occurrence of these target behaviors at Baseline 2 and at the posttreatment evaluations. All subjects were instructed to count the number of times each behavior occurred for a period of 1 week at each time period. The experimenter developed a specific and concrete definition of each behavior for the mother and conveyed to her the importance of accurate recording. Subsequently, records were kept of those behaviors that improved, remained the same, or got worse according to the mothers' accounts. A child was then classified as reflecting improvement if two of the three target behaviors changed in a positive direction; otherwise, the case was considered not improved. 6. Following Patterson and Reid's (1973) procedures, after the termination of the group sessions, subjects were asked a series of multiple-choice questions regarding their impressions of the worth of the group. The items included whether or not the child had improved as a result of counseling, whether or not the mother felt more positively to the child, how the family as a whole was functioning, how beneficial treatment was, whether or not it was what they expected, and whether or not it made the child happier at home. Means and standard deviations for individual ratings as well as for the total rating were computed.
RESULTS Baseline Differences All Baseline 1 measures were subjected to a one-way analysis of variance to test for differences across treatment groups prior to the study. Only the Somatization scale from the Missouri Behavior Problem Checklist revealed initial significant differences between behavioral, reflective, and control groups at this time, F (2,45) = 5.8, p < .01. Thus, it may be concluded that no systematic differences on criterion measures existed among groups at the commencement of this study. Subsequently, changes in outcome measures between Baseline 1 and Baseline 2 were evaluated by a two-way variance analysis, with treatment conditions as the between-subjects factor and testing periods as the withinsubjects factor; the unweighted-means solution was employed since cell frequencies were unequal (Winer, 1962). The results showed that mothers from all treatments reduced the number of statements checked on the Aggression scale of the Missouri Checklist,/'' (1,45) = 7.9, p < .01, but that there was no signifi-
25
cant improvement on any other measure between these two evaluation sessions. These findings indicate that there were no overall improvements between baseline periods as a result of expectancies of being in a treatment group. Furthermore, without exception, even on the Somatization and Aggression scales, t tests indicated that there were no significant differences between treatment groups at Baseline 2. Consequently, one may infer that the groups were still approximately matched at this point in time. Change in Treatment To test the hypothesis that there would be beneficial changes as a result of treatment, two-way analyses of variance with treatments as a between-subjects factor and testings as a within-subjects factor were conducted on Baseline 2 and posttreatment data. Subsequently, t tests were performed to compare differential change among treatment groups. If these analyses disclosed significantly different changes among treatment conditions, an additional analysis of variance was computed on the Baseline 2-
Relative Effectiveness of Behavioral and Reflective Group Counseling with Parents of Mentally Retarded Children Joseph B. Tavormina University of Virginia The present study evaluated the relative effectiveness of behavioral and reflective group parent counseling. Subjects were SI mothers of mentally retarded children who were assigned to behavioral, reflective, or waiting-list control groups. Six success criteria, including direct observations, attitudinal scales, maternal reports, and frequency counts, were used to measure outcome. Results indicated that both types of counseling had a beneficial effect relative to the untreated controls but that the behavioral method resulted in a significantly greater magnitude of improvement. The consistency of these results across measures strongly suggests that the behavioral technique was the treatment of choice for counseling parents of the retarded. It provided them with an understandable, consistent, and effective way to deal with the specific problems they were facing in raising their retarded children.
Parent counseling and parent education procedures are gaining popularity as interventive and preventive mental health strategies. At present there are two basic counseling models (Tavormina, 1974): one emphasizes feelings and the other emphasizes behavior as the primary starting point. The first, reflective counseling, places a major emphasis on parental awareness, understanding, and acceptance of the child's feelings (Auerbach, 1968; Ginott, 19S7). This model uses cognitively mediate variables (feelings) as a means of affecting the child's behavior and the parent-child interaction. The second method, behavior counseling, places its emphasis on actual observable behavior and the environmental variables that maintain certain behavior patterns. This counseling procedure focuses on teaching parents how to apply the principles of learning theory to their specific child-rearing problems (Patterson, 1971). Currently, both techniques are used in a variety of settings to work with many types of behavioral problems as well as with divergent populations. Yet, little has been done to compare the relative utility and cost efficiency of both procedures. Consequently, there is a need to determine which popula-
tions and which behavioral problems can be best dealt with by each model (Hartmann, Note 1; Tavormina, 1974; Walter & Gilmore, 1973). Differences in design and measurement techniques have been barriers to comparative research on these two methods. One basic problem has been the lack of comparative measures of outcome derived from the two procedures. To eliminate this obstacle, it is feasible to combine the measures typically used by each counseling model as multiple criterion variables. A combination of parent reports, attitudinal measures, and observer variables provides a broad-based, representative comparison of effectiveness. This multimethod approach minimizes the effects of bias and distortion inherent in the use of single criterion measures (Lytton, 1971; Patterson & Reid, 1973; Tavormina, Yock, & Keller, Note 2; Tramantana, 1971). Parents of retarded children represent one population for which counseling procedures may be extremely important. Parents of these children are under a great deal of situational stress and often have difficulty with day-today child management issues (Menolascino, 1970). There have been a number of attempts to determine the worth of group counseling for these parents utilizing both reRequests for reprints should be sent to J. B. flective (Lewis, 1970; Siegel, Sheridan, & Tavormina, Department of Psychology, Gilmer Hall, University of Virginia, Charlottesville, Virginia Sheridan, 1971; Tretakoff, 1969; Wolfens22901. berger, 1967) and behavioral (Cone & Sloop, 22
COUNSELING WITH PARENTS OF MENTALLY RETARDED CHILDREN 1971; Lasser, 1970; Morrey, 1971) techniques. However, to date the efficacy of neither model has been reliably demonstrated with this population. The present study was designed to deal with these issues by comparing the differential effectiveness of behavioral and reflective group counseling in work with parents of mentally retarded children. Multiple success criteria were used to provide a broad-based measurement of outcome of counseling. It was predicted that all parents who received counseling, either behavioral or reflective, would show significant improvement across outcome indices relative to comparable untreated parents. It was predicted that counseled parents would show positive change in their attitudes; report fewer behavioral problems; increase the positive quality of the motherchild interaction; and report an improvement in the quality of family life. It was also predicted that treatment modalities would yield differential changes as a function of outcome criteria; these changes were predicted to be consistent with previous findings that behavioral counseling mainly changes frequencies of deviant behavior, whereas reflective counseling results in changes in attitudes and feelings. METHOD Subjects Subjects were those SI mothers of mentally retarded children from a larger pool of 300 who responded to a letter from two facilities for mentally retarded children in Rochester, New York. The mothers' average age was 37.4 years, and their average education was 12.8 years; their treated children averaged 6.7 years of age. Twenty-three of the mothers had previously received some form of counseling about their child. The sample's socioeconomic status ranged from lower- to uppermiddle class; only one black family participated. No reliable IQ estimates could be given for most of the children, but observation and reports of previous testing revealed that most of them were below SO. There were no significant differences between any of the treatment groups on these demographic variables.
Procedure All subjects were evaluated at the beginning of the study (Baseline 1) and were told that groups would begin 2 months later. At that time (Baseline 2), they were again evaluated on all of the measures to assess the stability of these variables
23
over time and to determine whether mothers' anticipations of being in a group would affect their scores. Following this retesting, mothers were assigned to treatment (n = 38) or control conditions (n — 13) on the basis of their choice to attend groups in February and March (treatment) or April and May (control). The treatment subjects were then further divided into four groups on the basis of which day the mother chose to attend group meetings. Two of these groups employed behavioral methods (»s = 11 and 8), and two used a reflective approach (n& = 10 and 6).1 Type of treatment administered to each group was determined on the basis of which .day each of the group leaders chose to meet with a group. Results of this assignment procedure revealed no significant differences between groups on maternal age or education, child age, or the number of mothers who had received some type of prior counseling. During February and March the treatment groups received a series of eight weekly 14-hour sessions, and the controls received no treatment. Following this period, all subjects were retested on all measures to determine posttreatment scores. After this third evaluation session, mothers in the control group were administered counseling based on a combined behavioral and reflective approach.
Treatment Reflective groups followed the organizational principles suggested by Auerbach (1968) and Ginott (19S9, 1961). At the first meeting, members were told that the sessions were an opportunity to discuss their concerns and problems with their children. The group was described as the place to work on productive ways for handling problems of raising retarded children. Each participant received a copy of Between Parent and Child (Ginott, 19S9), which she was asked to read. The group leaders focused the discussions around Ginott's major principles of reflecting feelings, setting appropriate limits, and providing appropriate alternative activities. Leaders also attempted to convey the importance of empathy, acceptance, and understanding in dealing with the children. Group discussion was used extensively to apply these principles to each mother's situation and to draw from her experience in regard to the specific problems of the other mothers in the group. Analogously, mothers in the behavioral groups were taught the principles and the application of operant techniques to their specific child-rearing problems. The programmed text Parents are Teachers: A Child Management Program (Becker, 1971) was used as a general outline. The leaders followed Becker's lesson plan on fostering group discussions about the principles outlined in the text. Primarily they focused on the use of praise, the emphasis on positive rather then aversive contingencies, and the need to specify and observe the behaviors targeted 1
One mother initially assigned to the first reflective group and two from the second such group dropped out very early in the course of the sessions. These individuals were not included in the evaluation.
24
JOSEPH B. TAVOEMINA
for change. However, the major group task was the application of these principles to each mother's specific target behaviors. Group discussion, role playing, and modeling were used to work out specific programs for each mother to use in handling targeted problems. Mothers were encouraged to try these programs in order to change the child's behavior. An important part of the group process was to provide feedback about these projects and to help each mother modify and perfect the programs she was working on.
Group Leaders Leaders were four third-year clinical psychology graduate students at the University of Rochester. All had received training in the intellectual capabilities and developmental expectancies for retarded children. Each had a minimum of 1,500 hours of supervised clinical internship experience. The two reflective leaders had previously sought learning experiences in reflective techniques from doctoral-level psychologists trained in this methodology and had run therapy groups using this method. Similarly, the two behavioral leaders had done work on behavior modification techniques as part of their graduate training and had used these procedures in clinical work. However, none of the leaders had ever worked with parents of the retarded prior to this study.
Measures To insure a broad-based evaluation, the following outcome measures were employed: 1. The Hereford Parent Attitude Survey (Hereford, 1963) measures the following areas: (a) Confidence in parental role, that is, parental feelings of adequacy or inadequacy; (b) causation of the child's behavior, that is, the extent to which the parent sees himself as a major factor in determining the child's behavior; (c) acceptance, that is, the extent to which the parent is satisfied with the child and is willing to see him as an individual; (d) mutual understanding, that is, parental perceptions about the degree of reciprocity of feelings between parent and child; and (e) mutual trust, that is, the amount of confidence that the parent feels he and the child have in each other. The sum of the scale scores yields a total attitude score. 2. The Missouri Behavior Problem Checklist (Sines, Pauker, Sines, & Owen, 1969) is a yes-no checklist containing 70 statements that have been factor analyzed into group scores of parent-reported symptoms of children. Scores are tabulated to determine a child's place on the various dimensions of the scale: Aggressiveness, Inhibition, Activity Level, Sleep Disturbance, Somatization, and Sociability. The sum of the first five scales yields a total deviancy score, with high scores indicating deviancy. The Sociability scale is scored in a positive direction. 3. Behavior observations were undertaken as the mother-child interaction was observed for 25 minutes in a playroom via a one-way mirror. Observa-
tions were divided into unstructured free play and structured command play ("Please have your child pick up the toys he/she has played with and put them away") segments. Each interaction was coded 2 into three sequential categories: (a) antecedent behavior, designated as mother/child initiated behavior. Either mother or child could give a command, attempt to affiliate, or ignore the other, (b) Response behavior indicated the mother's or child's response to the previously initiated behavior; possibilities include compliance, noncompliance, or ignoring the antecedent behavior, (c) Consequent behavior referred to the mother's or child's responseconsequence segment of the previous response. This code included positive reinforcement, defined as a response that maintained or increased the probability of recurrence of the previous behavior; punishment, defined as a response that decreased the probability of recurrence of the previous behavior; or ignoring the previous response. This coding system allowed for an analysis of the sequence of interaction patterns, defined as appropriate or inappropriate by use of the principles of learning theory. Six variables were defined, three each from free and command play. They tapped (a) total appropriate interaction, defined as a completely appropriate antecedent-response-consequence pattern during each observation unit; one of the dyad initiated, the other complied, and then the initiator consequated appropriately; (b) appropriate antecedent-response, defined as an initiation by one member of the dyad and a compliant response by the other; (c) appropriate responseconsequence, defined as an appropriate responseconsequence segment by one member of the previous response of the other. Appropriate consequences included positive reinforcement for a previous compliance and punishing or ignoring a previous noncompliance or previous ignoring. Fifteen free-play and IS command-play codes were made per observation session by two independent raters (median interrater reliability = 84%, range = 68%-98% agreement). One code sequence, from antecedent to response to consequence, was noted every 30 seconds, after which there was a IS-second break before the next sequence. If more than one sequence occurred in any 30-second block, only the first one was recorded. 4. Ratings of target behavior were obtained as follows: Mothers in each condition were asked to list the three most troublesome problems that they were having with their children; these problems later became the target behaviors on which the mothers worked in the groups. Mothers were asked to rate each behavior on two dimensions (Patterson & Reid, 1973). The first was a rating of the amount of disruption that each target behavior caused at home. A 9-point scale was provided ranging from "No disruption (1)" to "Significant disruption (9)." Similarly, mothers were asked to rate each behavior in terms of the intensity of their emotional reaction 2 A full list of codes and examples is available and will be furnished upon request.
COUNSELING WITH PARENTS OF MENTALLY RETARDED CHILDREN to it. This 9-point scale ranged from "No emotional reaction (1)" to "Considerable emotional reaction (9)." 5. Mothers were asked to record the frequency of occurrence of these target behaviors at Baseline 2 and at the posttreatment evaluations. All subjects were instructed to count the number of times each behavior occurred for a period of 1 week at each time period. The experimenter developed a specific and concrete definition of each behavior for the mother and conveyed to her the importance of accurate recording. Subsequently, records were kept of those behaviors that improved, remained the same, or got worse according to the mothers' accounts. A child was then classified as reflecting improvement if two of the three target behaviors changed in a positive direction; otherwise, the case was considered not improved. 6. Following Patterson and Reid's (1973) procedures, after the termination of the group sessions, subjects were asked a series of multiple-choice questions regarding their impressions of the worth of the group. The items included whether or not the child had improved as a result of counseling, whether or not the mother felt more positively to the child, how the family as a whole was functioning, how beneficial treatment was, whether or not it was what they expected, and whether or not it made the child happier at home. Means and standard deviations for individual ratings as well as for the total rating were computed.
RESULTS Baseline Differences All Baseline 1 measures were subjected to a one-way analysis of variance to test for differences across treatment groups prior to the study. Only the Somatization scale from the Missouri Behavior Problem Checklist revealed initial significant differences between behavioral, reflective, and control groups at this time, F (2,45) = 5.8, p < .01. Thus, it may be concluded that no systematic differences on criterion measures existed among groups at the commencement of this study. Subsequently, changes in outcome measures between Baseline 1 and Baseline 2 were evaluated by a two-way variance analysis, with treatment conditions as the between-subjects factor and testing periods as the withinsubjects factor; the unweighted-means solution was employed since cell frequencies were unequal (Winer, 1962). The results showed that mothers from all treatments reduced the number of statements checked on the Aggression scale of the Missouri Checklist,/'' (1,45) = 7.9, p < .01, but that there was no signifi-
25
cant improvement on any other measure between these two evaluation sessions. These findings indicate that there were no overall improvements between baseline periods as a result of expectancies of being in a treatment group. Furthermore, without exception, even on the Somatization and Aggression scales, t tests indicated that there were no significant differences between treatment groups at Baseline 2. Consequently, one may infer that the groups were still approximately matched at this point in time. Change in Treatment To test the hypothesis that there would be beneficial changes as a result of treatment, two-way analyses of variance with treatments as a between-subjects factor and testings as a within-subjects factor were conducted on Baseline 2 and posttreatment data. Subsequently, t tests were performed to compare differential change among treatment groups. If these analyses disclosed significantly different changes among treatment conditions, an additional analysis of variance was computed on the Baseline 2-
