P~ychologicalReports, 1976, 38. 105 1-1057. @ Psychological Reports 1976

USE OF CONCRETE REINFORCEMENT T O CONTROL CONTENT OF VERBAL INITIATIONS I N GROUP THERAPY W I T H ADOLESCENTS1 STANLEY ZWEBACK3 Totuson State College Summary.-Tokens in the form of %-in. diameter metal washers were used with 8 hospitalized adolescents in group therapy to reinforce two classes of verbalization content. Class I verbalizations were statements of group members' own problems, while Class 11 verbalizations were statements which dealt with problems of fellow group members. Baseline frequencies of emission of both content classes were collected. During the first and third experimental phases Class I verbalizations were reinforced, with Class I1 verbalizations reinforced only during Phase 11. Reinforcement was administered on a variable ratio 3 (VR 3 ) schedule, so that an average of one token was received by a group member for every three emitted verbalizations subject to reinforcement during a given session. Tokens earned in therapy were used to purchase a variety of items and privileges within the basic strucrure of a token economy system. Results clearly supported the hypothesis that the content of verbalizations in group therapy could be controlled through the differential use of concrete reinforcement.

Several studies have reported the intentional and direct use of verbal-social reinforcement to establish and/or influence members' verbalizations in group therapy (Dinoff, Horner, Kurpiewski, Rickard, & Timmons, 1960a, 1960b; Fromme, Whisenant, Susky, & Tedesco, 1974; Ullmann, Krasner, & Collins, 1961; Wagner, 1966; Warner & Hansen, 1970). Only recently has experimental work appeared which reported the combined use of verbal-social and concrete reinforcement to modify behavior in group therapy (Hauserman, Zweback, & Plotkin, 1972; Tracey, Bridwell, & Wilson, 1974). Group therapists working with adolescents have consistently reported that group members, especially institutionalized patients, tend to display a general resistance toward involvement in group therapy. Behavioral manifestations of resistance most frequently cited include: a low frequency of verbalization (Godenne, 1965; Kraft, 1960, 1961; Schuhan, 1952, 1957, 1959), a specific avoidance of discussing one's own problems as well as the problems of others (Gadpaille, 1959; Godenne, 1965; MacLennan, 1967; MacLennan & Felsenfeld, 1968; T h i s paper is based on the author's doctoral dissertation submitted to the Graduate School of the University of Maryland in partial fulfillment of the requirements for the Ph.D. degree. Appreciation is expressed to Donald K. Pumroy, under whose supervision the invesrigation was conducted. Gratitude is expressed to Norma Hauserman for the valuable assistance she offered throughout the course of study. Thanks are also due to Mark L. Isaacs for his administrative support and to Alan Plotkin who served a s the therapist. 3lequests for reprints should be sent to Stanley Zweback, Department of Psychology, Towson State College, Baltimore, Maryland 21204. Assistance of the Towson State College Faculty Rescarch Committee is gratefully acknowledged.

S. ZWEBACK Schulrnan, 1959), and a tendency to band together against the therapist (Ackerman, 1955; Gadpaille, 1959; Shellow, Ward, & Rubenfeld, 1958). The purpose of the present experiment was to establish control over the frequency and specific content of hospitalized adolescents' verbalizations in group therapy, through the use of token reinforcement procedures. In essence, the rationale for the study was built on the premise that what group therapists, through consensual validation, have determined as being therapeutically relevant verbal behaviors for patients could be established, increased, and generally controlled through the use of concrete reinforcement.

METHOD Subjects and Setjing The 5 girls and 3 boys were all patients in the adolescent unit at Spring Grove State Hospital in Baltimore, Maryland. Duration of hospitalization for these patients ranged from 2 to 18 mo., with the mean period being 8 mo. Chronological age of the adolescents ranged from 15 yr., 9 mo. to 17 yr., 5 mo., with a mean age of 16 yr., 6 mo. All of the participants were verbal and had at least average intelligence as measured on either the Wechsler Intelligence Scale for Children or the Wechsler Adult Intelligence Scale. While none of the patients were considered to be organically impaired, they represented a wide range of diagnostic classifications. Alice, SA.-A 17-yr.-old girl with a reported IQ of 95, was described upon admission to the hospital as presenting a schizoid personality. She was reported to have twice attempted suicide, acknowledged experiencing visual hallucinations, and was a frequent runaway from home. An amelioration of her schizoid condition was noted during the course of a 7-mo. hospitalization period. Betty, SB.-A 17-yr.-old girl with a reported IQ of 95, was described upon admission to the hospital as displaying cyclochymic type behavior. During a 3-mo. hospitalization period some stabilization of behavior had been noted. Carol, Sc.-A 16-yr.-old girl with a reported IQ of 90, was admitted to the hospital as a consequence of an almost successful suicidal attempt. N o change in her depressed condition was noted during a 2-mo. hospitalization period. Donald, SD.-A 15-yr.-old boy with a reported I Q of 134, was described upon admission to the hospital as hostile and negativistic. The juvenile court order which resulted in his hospitalization stated that Donald was a chronic truant, guilty of assault and battery, and had several counts of auto theft lodged against him. Over the course of an 11-mo. hospitalization, his behavior was consistently described as sullen, silent, and aloof. 17-yr.-old boy with a reported IQ of 94, was described Edward, Sa.-A upon admission as actively hallucinating and in a semicatatonic state. A diminution of schizophrenic type behavior was noted during the course of his 5-mo. hospitalization.

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Fred, SF.-A 17-yr.-old boy with a reported IQ of 93, was admitted to the hospital as a consequence of his emission of bizarre psychomotor activity and markedly depressed behavior. During a 3-mo. hospitalization, movement toward a positive, reality-based orientation was observed. Grace, Sa.-A 17-yr.-old girl with a reported IQ of 90, was admitted to the hospital as a consequence of an extended history of drug abuse and promiscuous behavior. She was considered to have brought her impulsive behavior under partial control during an 11-mo. hospitalization. Helen, SH.-A 17-yr.-old girl with a reported IQ of 121, was admitted to the hospital as a consequence of a suicidal attempt. At the time of admission she threatened to kill the admitting physician as well as herself if hospitalized. During the course of a 3-mo. hospitalization an over-all reduction in depressed, hostile, and agitated behavior was observed. The study was conducted over 21 semi-weekly sessions, and each meeting was 30 min. in duration. A clinical psychologist who had extensive experience working with groups of adolescents in dynamically oriented therapy served as the therapist. Group sessions were routinely held in the adolescent unit as part of the over-all treatment program. The only criterion for group membership was that of age, with all youngsters ranging between 15 and 17 yr. During the first group meeting the experimenter and each of three data collectors were introduced to the group members by the therapist. The adolescents were told that these four individuals would be present at all future meetings. The basic data for the study were derived by recording the number of Class I and Class I1 verbal initiations emitted by the group members during therapeutic sessions. Initiations were operationally defined as the spontaneous emission of verbal behavior to a group member or to the therapist. Such initiatory acts were distinguished from verbal replies, with the latter operationally defined as the answering of direct questions. Class I statements were verbal initiations whose content focused on one's own problems. Class I1 smternents were verbal initiations whose content focused on the problems of another group member. Baseline data on the adolescents emitted frequency of Class I and Class I1 verbalizations were collected during the first four group sessions, and no tokens were administered. Interjudge agreement during baseline sessions exceeded 93%. Following the baseline sessions, the experimenter contingently presented tokens to group - members on a variable ratio 3 (VR 3 ) schedule. A token was handed to the group member on the average of once for every three verbalizations emitted by the individual which were of the class content subject to reinforcement during that session. Prior to the start of the token distribution procedures group members were told that they could earn tokens in therapy

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S. ZWEBACK

as well as through the previous means established within the adolescent units' token economy system. Additionally, group members were told that during some sessions they would receive a token after making statements concerning their own problems and during another phase of the program they would earn tokens for talking about problems of fellow group members. It was pointed out that they would not receive the reinforcing tokens for each appropriate statement but only on an occasional basis. Group members' over-all response to the possibility of earning tokens in therapy was enthusiastic. Metal washers of M-in. diameter were used as tokens. The tokens were painted red and white and had embossed on them the letters AU, which was an abbreviation for adolescent unit. After each group session was terminated these "general" tokens were exchanged for individually coded tokens. Each patient in the adolescent unit was assigned a token number and could only spend tokens which were embossed with that number. A wide variety of items and privileges could be purchased with tokens and thus tokens were highly valued. The first treatment phase provided for the token reinforcement of only Class I verbalizations. A reversal procedure was employed during Phase 11, with Class I verbalizations put on extinction and Class I1 statements made subject to token reinforcement. During Phase I11 a second reversal procedure was employed by reverting to the contingencies established in Phase I. Phase I conditions remained in effect through four sessions, r~ntilsuch time that each adolescent during the course of a single group session met the criterion of a 50% or greater increase of Class I statements over his own baseline mean number of Class I statements. The reversal condition established in Phase I1 remained in effect through five sessions, until such time that each adolescent during the course of a single group session met the criterion of a 50% or greater increase in Class I1 statements over his own baseline mean number of Class I1 statements. Phase I11 conditions were the same as those described under Phase I and this condition remained in effect for eight sessions before the 50% criterion was achieved. It should be noted that at the start of Phase 111, the effects of extinction on Class I behavior during the previous experimental phase made it necessary to use a shaping ~rocedureto re-establish Class I statements. Shaping was accomplished by the therapist's directly asking specific persons to talk about their own problems. Contingent upon the emission of Class I statements in response to the therapist's request the adolescents were token reinforced. Once Class I behavior was re-established the shaping procedure was discontinued and group members were only reinforced for the spontaneous emission of Class I statements. RESULTS Fig. I shows the mean frequencies of classes of verbalization for the group

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S. ZWEBACK TABLE 1 FREQUENCIESOF VERBALIZATIONFOR CLASSES I AND 11 DURING BASELINE AND CRITERIONSESSIONS

Subjects

Baseline I I1

I Criterion I I1

I1 Critetion I I1

111 Criterion I I1

-

.25 .25 11 1 0 8 3 0 5.60 2.50 12 3 0 5 9 0 1.00 2.75 4 0 0 5 15 3 1.25 .25 4 4 1 7 2 1 E .75 1.00 5 3 0 2 4 3 F 4.25 2.00 10 6 12 10 8 1 G .750.00 3 1 1 4 7 1 H 4.50 1.25 7 2 1 13 12 8 Note.-Mean verbalization frequencies are presented for the baseline condition, and singlesession data are given for the criterion sessions. A B C D

Class I verbalizations were placed on extinction and Class I1 verbalizations were token reinforced. The predicted criterion of a 50% or greater increase over baseline mean frequency of Class I1 verbalizations was reached by all group members during the fifth session of Phase 11. No uniform increase in the frequency of Class I verbalizations over participants' baseline rates was obtained ( see Table 1 ) .

Experimental Phase I11 The same reinforcement contingency relationship established during Phase I was re-established. Specifically, Class I verbalizations were subject to token reinforcement and Class I1 verbalizations were not token reinforced. The predicted criterion of a 50% or greater increase over baseline mean frequency of Class I verbalizations was achieved by all group members during the eighth session of Phase 111. No systematic 50% or greater increase in the frequency of Class I1 verbalizations over each participant's mean baseline rate was obtained (see Table 1) .

Drscussro~ The experimental control achieved in the group therapy was certainly predicated on the over-all viability of the adolescent unit's token economy. Within well-structured and smoothly functioning institutional economies, similar attempts to increase patients' involvement with the process of group therapy should prove feasible. A point of interest relates to the potential for involving group members in the establishment of the verbalization categories subject to token reinforcement. Group members in collaboration with the therapist could determine specific therapeutically relevant classes of verbalization which would subsequently be reinforced. Another alternative might be for the therapist separately to engage each patient in the development of individualized contingency plans.

CONTROL OF VERBAL CONTENT IN THERAPY REFERENCES ACKERMAN,N . W. Group psychotherapy with a mixed group of adolescents. International J o m a l of Group Psychorherapy, 1955, 5, 231-252. DINOFF, M., HORNER, R. F., KURPIEWSKI,B. S., RICKARD,H. C., & TIMMONS, E. 0 . Conditioning verbal behavior of a psychiatric population in a group therapy-like situation. Journal of Clinical Psychology, 1960, 16, 371-372. ( a ) DINOFP, M., HORNER, R. F., KURPIEWSKI,B. S., RICKARD,H. C., & TIMMONS, E. 0. Conditioning verbal behavior of schizophrenics in a group therapy-like situation. Journal of Clinical Psychology, 1960, 16, 367-370. ( b ) FROMME,D. K., WHISENANT,W. F., SUSKY,H. H., & TEDEXO, J. F. Group modification of affective verbalizations. Jousml of Consulting and Clinical Psychology, 1974, 42, 866-871. GADPAILLE, W. J. Observations on the sequence of resistance in groups of adolescent delinquents. International Journal of Group Psychotherapy, 1959, 9, 275-286. GODBNNE, G. D. Outpatient adolescent group therapy: use of co-theta ists, psychodrama, and parent group therapy. American Journal o f ~lychorhrafiy, 1965, 19, 40-53. HAUSERMAN,N., ZWEBACK,S., & PLOTKIN,A. Use of concrete reinforcement to facilitate verbal initiations in adolescent group therapy. Journal of Consulting and Clinical Psychology, 1972, 38, 90-96. KRAFT, I. A. The nature of sociodynamics and psychodynamics in a therapy group of adolescents. Interna.tiona1 Journal o f Group Psychotherapy, 1960, 10, 313-320. KRAFT, I. A. Some special considerations in adolescent group therapy. lnternationrrl Journal of G o u p Psychotherapy, 1961, 11, 196-203. MACLENNAN,B. W. The group as a reinforcer of reality. American Journal of Orthopsychiatry, 1967. 37. 272-273. MACLENNAN,B. W., & FELSENFBLD,N. Group counseling and psychother4y with adolescents. New York: Columbia Univer. Press, 1968. SCHULMAN,I. The dynamics of cerrain reactions of delinquenu to group psychotherapy. International Journal of Group Psychotherapy, 1952, 2, 334-343. SCHULMAN,I. Modifications in group psychotherapy with anti-social adolescents. Iwernational Journal of Group Psychotberapy, 1957, 7, 310-317. SCHULMAN, I. Transference, resistance and communication problems in adolescent psychotherapy groups. international Jownal of Group Psychotherapy, 1959, 9, 496-503. SHELLOW,H. S., WARD,J. L., & RUBBNPBLD, S. Group therapy and the institutionalized delinquent. International Journal of G o u p Psychotherapy, 1958, 8, 265-275. TRACEY, D. A,, BRIDWBLL,D. W., & WILSON, T. G. Generalization of verbal and nonverbal behavior: group therapy with chronic psychiatric patients. Jownal of Applied Behavior Analysis, 1974, 7, 391-402. ULWNN, L. P., KRASNER,L., & COLLINS,B. J. Modification of behavior through verbal conditioning: effects in group therapy. Journal of Abnormal and SocMl Psychology, 1961, 62, 128-132. WAGNER,M. Reinforcement of verbal ~roductivity in group therapy. Psychological Reporrs, 1966, 19, 1217-1218. WARNER,R. W., & HANSEN,J. C. Verbal-reinforcement and model-reinforcement group counseling with alienated students. Journal of Counseling Psychology, 1970, 17, 168-172.

Accepted March 5 , 1976.

Use of concrete reinforcement to control content of verbal initiations in group therapy with adolescents.

P~ychologicalReports, 1976, 38. 105 1-1057. @ Psychological Reports 1976 USE OF CONCRETE REINFORCEMENT T O CONTROL CONTENT OF VERBAL INITIATIONS I N...
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