Structure, Self-Regulating Sequences, and Institutional Third Parties in Therapy: The Veterans Administration as a Model

This article examines the structural organization and sequences of interaction among therapists, institutions, and patients and their families that contribute to the problem of institutional dependence. Our contention is that when patients have become dependent on an institution for the livelihood and/or for the stability it represents, they are only one part of a systemic relationship characterized structurally by enmeshed boundaries, and sequentially by self-regulating feedback loops. We use this premise to outline the nature of the enmeshed transactions in patient-therapist, patient-institution, and therapist-institution relationships. Family interfaces with this triad are also addressed. Sequentially, we outline the interactions among patient, family, therapist, and institution that lead to hierarchical incongruities. These sequences tend to produce self-regulating feedback loops that perpetuate and maintain the structure of the system and its patterns of interaction. The final part of this article demonstrates how we strategically use a therapy team to manipulate the hierarchical incongruities and, hence, the recursive complementarity, that characterize the interactions between and among the members of this suprasystem. Besides manipulating the role of the therapist through team intervention, we also present several paradoxical and structural interventions that have been helpful when institutions have become third parties to therapy.     

AN INVESTIGATION OF THE EFFECT AND ECONOMIC UTILITY OF CORPORATE-WIDE TRAINING

This study describes a 4 year effort to investigate the effect and utility of managerial and sales/technical training. The effort relied upon quasi-experimental designs to investigate the effect of training programs, meta-analysis to summarize the effect of different types of training, and utility analysis to estimate the economic impact of training. The utilized multi-attribute utility analysis model, based on Raju, Burke, and Normand's 1990 (RBN) model, was modified and approved by the senior management of a Fortune 500 pharmaceutical company; it included a measure of criterion deficiency and corrected for differences due to alternative methods of calculating effect sizes (e.g., repeated measures ANOVA vs. ANCOVA). Results of 18 training program evaluations (range of N = 10 to 216), which were conducted in one company on the basis of supervisor, subordinate, or peer ratings, are reported. Great variation existed between the effectiveness of the programs (range of d = -.09 to 1.11), and managerial training was found to have less effect (d = .31) and utility (mean ROI = 45%) than sales/technical training (d = .64, mean ROI = 418%). In addition, the use of a 2-point performance scale in application of the RBN utility model as well as the role of management pre-approval of utility analysis are investigated.     

DO SITUATIONAL VARIABLES ACT AS SUBSTANTIVE CAUSES OF RELATIONSHIPS BETWEEN INDIVIDUAL DIFFERENCE VARIABLES? TWO LARGE-SCALE TESTS OF “COMMON CAUSE” MODELS

James, Demaree, Mulaik, and Ladd (1992) proposed that situational variables may act as substantive ("common") causes of relationships between individual difference variables as well as statistical artifacts (i.e., measurement unreliability) associated with these variables, thus invalidating assumptions of current validity generalization/meta-analysis procedures. In this investigation, we report the results of two large-scale studies designed to test hypothesized relationships derived from two "common cause" models. Study 1 examines relationships between store-level organizational climate variables and employee satisfaction and performance variables for 33,097 sales personnel in 537 retail stores. Study 2 investigates relationships between store-level situational constraints and customer service perception and shopping variables for 31,611 customers from 564 retail stores. The results of these studies did not support the proposition that situational variables act as substantive causes of correlations among the respective employee and customer variables or the variances and reliabilities of these variables. The implications of these findings for meta-analyses in applied psychology as well as the generalizability of the findings are discussed.     

An Effect Of Change In Patient Status On Marital Interaction

In the treatment of couples and families, even more so than of individuals, therapists invariably are forced to face the problem of assessment of change in the marital or family "system." The purpose of the present study was to investigate changes in marital interaction for a special population, that is, in which one member of each married pair had been, but was no longer, a hospitalized psychiatric patient. The primary question we addressed was whether changes in marital interaction could be amply detected and whether these changes could be attributed to the particular role shift that had occurred in one spouse--from "patient" to "nonpatient." Utilizing a technique called Interaction Testing, which the senior authors devised in 1960, we found that such alterations in marital interaction do indeed arise when one member of the couple moves out of a patient role and that our instrument is useful in elucidating the nature of such effects. In addition, it can be expected that a study of this kind will be of theoretical and methodological value in dealing with the general issues of problem-solving interaction in couples and families. The clinical aspect of the study may also be expected to stimulate useful thinking regarding family theapy in hospital settings, patient management, and aftercare.     

THE INTERFACE PROJECT: BEHAVIOR MODELING AS SOCIAL TECHNOLOGY IN SOUTH AFRICA1

The Inter Face Project was a pilot study to improve race relationships between supervisors and employees in South African industry. The ultimate intent of this project was to find a path for more extensive research aimed at improving inter-racial attitudes and behavior in South Africa, especially in work situations. Nevertheless, this project is only a small step in the direction of improved inter-race relationships in that country. Behavior modeling training was the vehicle for attempting to change the behaviors. Several measures were used because it was uncertain how change would be found. However, performance records were incomplete and therefore not useful. A questionnaire and expectation scale did not reveal significant change, possibly because of the small sample size and the reluctance on the part of supervisors to be candid. Structured interviews, however, indicated dramatic improvements in inter-race attitudes and observations for both supervisors and employees. Second post-test improvements (20 weeks after training) were, in fact, even greater than improvements noted at the first post-test (six weeks after training). Before and after training comments by employees and supervisors provided strong evidence of the extent of change that occurred. Several suggestions for follow-up research were outlined.