Prophecy, Behaviour and Change

An Examination of Self-fulfilling Prophecies in Helping Relationships

Gerald G. Smale

• Publisher: Routledge
• Year: 2019
• ISBN:
  9780429640308
• Edition: 1
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

Professional helpers may harm their clients instead of helping them. This is one of the important implications – for the selection, training and practice of members of the helping professions – of the evidence reviewed in this book. Originally published in 1977, Gerald Smale argues that the expectations of the professional helper, whether social worker, doctor, psychiatrist, psychoanalyst, psychotherapist or counsellor, can act as self-fulfilling prophecies on his or her clients, for better or worse.

In order to suggest how the expectations of the helper might operate, the author examines a three-stage model of self-fulfilling prophecies. The stages are: the prophecy; behaviour based upon the prophecy; the outcome brought about by the behaviour. Extensive evidence from the fields of experimenter bias, hypnosis and placebo medicine, psychotherapy, casework and counselling research, is reviewed and related to the model, and the relationship between this analysis and labelling theory is discussed.

The book demonstrates that it is the behaviour of the worker towards the client which is of crucial importance, and proposes that the client's future and his or her personal strengths should be an important focus of the helping relationship. Finally, it outlines the dangers of negative expectations, and emphasises the ways in which expectations can be used to optimum effect.

Chapter one

Introduction

The literature of the helping professions contains more than its fair share of panaceas and schools of thought. Psychologically orientated caseworkers battle with politically minded community workers, while behaviour therapists fight it out with psychoanalysts. Radical therapists challenge them all. An outsider might conclude that there is a competition to help an acute shortage of clients.

The grand synthesis or even a categorisation of who and what is effective with whom has yet to be accomplished. There are signs that some of these differences are being bridged but much more needs to be done.

Writers do not always intend to offer their theories as panaceas. But overstressed workers pressed by answer-seeking clients seize upon the writings of innovators as solutions to problems far beyond the range offered by their instigators. Thus family therapy is put forward as a solution for what is a problem of poor housing, and re-allocation of material resources suggested to overcome those interpersonal difficulties that are suffered by both rich and poor. It is not just that assessment of need is faulty but often that training in a ‘school’ of help means that the helper has only one solution to offer.

This book does not offer a panacea nor is it an attempt to suggest how change can or should be brought about in clients or their environments. The central argument is that the expectations of the professional helping person will tend to act as a self-fulfilling prophecy and thus affect the outcome of his efforts. These expectations are but one of a series of variables which influence change and so their effect should not be exaggerated. But if the hypothesis is proved then their potential influence cannot be overlooked. The evidence presented will suggest that these expectations may be a significant factor in professional intervention being harmful as well as helpful to clients. Although it will be shown that expectations can be crucial to outcome it is not suggested that if the expectations are right everything else will follow. But the reader might conclude that if expectations are not right the client is best left alone.

The controversy over the efficacy of psychotherapy, casework and counselling has brought into the open other indications that professional helpers can be harmful as well as helpful and this subject will be fully reviewed in the course of the discussion.

The conclusions of this debate have important implications for practice. It will be argued, for instance, that pathology-focused retrospective analysis, typified by psychoanalysis, can have dangers and that there is a need to bring the future into the focus of intervention and to pay more than lip service to the strengths of clients. The need to focus on the actual behaviour of professional helpers as opposed to the present emphasis on their academic training, and intellectual interpretations of events, will also be underlined.

The need for a new theoretical framework

It would be usual to begin our discussion by defining the types of professional-helping relationships which are central to this book i.e. psychotherapy, social casework and counselling. However, instead of doing so it is proposed that we illustrate the theoretical framework within which we will work by challenging the use of these nebulous yet all-embracing concepts.

Psychotherapy, casework, counselling are terms which like ‘the ether’ have been used to cover many things and describe a large number of divergent and often apparently conflicting theories. Psychotherapy, for example, encompasses Krasner’s behaviour theory-based ‘reinforcement machine’ on the one hand (Krasner, 1962), and Rogers’ accepting, empathising, congruent persons on the other (Rogers, 1966, etc.). Casework can include a multitude of actions (and sins) from giving money to the needy to intensive, psychoanalytically orientated marital analysis.

To date these umbrella terms have inspired a growing body of research literature concerning the efficacy of treatment and the pre-requisites of success. However, we should ask; what have researchers really been studying? Often the aims of research have been to demonstrate the superiority of one school of therapy over another. But, since Eysenck’s first article (1952), which claimed that psychotherapy and counselling were no more effective than ‘spontaneous remission’, there has been a more concerted effort to show that therapy per se is helpful.

However, Eysenck’s attack, and often the defences put forward, are in essence inappropriate because psychotherapy, etc. can hardly be considered a unitary phenomenon. It has been pointed out that to ask the question ‘is psychotherapy therapeutic?’ and then go about answering the question in the traditional way, is very much like the medical profession testing the efficacy of drugs by randomly giving unknown kinds of drugs in unknown quantities to one group of patients with various complaints and no drugs to another similar group (Truax and Carkhuff, 1964).

The efficacy of treatment debate, discussed in detail later, has led to attempts to identify the important helpful factors in all forms of therapy. Let us look at some of the basic arguments which support this ‘non-school’ approach to identify so called ‘non-specific’ therapeutic factors.

It has been traditionally assumed that the type of therapy offered to a client is dependent upon the theoretical orientation of the therapist but this is now open to serious doubt. It is, indeed, somewhat ironic that this assumption concerning theoretical orientation is made when often the theories illustrate that the client’s behaviour is dependent upon more than his intellectual knowledge and not likely to be changed by rational argument.

Fiedler and Strupp indicate that experience is more relevant to the therapist’s ability to provide the ‘quality of relationship’ that was successful, than the ‘school’ he belonged to (Fiedler, 1950, 1953; Strupp, 1962). Betz found that the crucial determinants of therapeutic outcome lay in the personal qualities of the physician not his theory (Betz, 1962). Truax and Carkhuff formed similar views during their Wisconsin and Kentucky research projects. They point out that after reading the theoretical and clinical writings of a number of fairly well-known clinicians and then listening to a psychotherapy session with a live patient, they were often struck by the vast inconsistencies between the actual practice and what was preached (Truax and Carkhuff, 1964). Wrenn demonstrated this phenomenon when he asked fifty-four counsellors to write responses to standard therapy situations which were designed to maximise theoretical differences in the way they might be handled; no relationship between their actual situational responses and their professed theoretical orientation was found (Wrenn, 1960). Egan, in a recent review of the literature in this area, concludes that there is often a gap between the practitioners’ theoretical stance and practice, that practitioners with the same theoretical outlook can look quite different in practice and that helpers, who have been judged effective yet hold different theories, often look similar in practice (Egan, 1975).

The extensive research work of Truax and Carkhuff et al. clearly indicates that it is the interpersonal ‘behaviour’ of the therapist that is important. It would seem, however, that this ‘behaviour’ is not directly related to the therapists’ theoretical orientation but to other factors. Indeed, it has been indicated that non-professional helpers may be just as effective as professionals (Truax and Carkhuff, 1967; Carkhuff, 1969, 1971; Goldstein, 1973; Egan, 1975).

Truax and Mitchell sum up their conclusions as follows:

(1) the therapeutic endeavour is, on the average, quite ineffective; (2) counselling or therapy itself is a nonunitary phenomenon; (3) some counsellors and therapists are significantly helpful, while others are significantly harmful, with a resulting average helpfulness not demonstrably better than the average of non-professional help; (4) through close examination of existing theories and clinical writings, it is possible to identify therapeutic ingredients likely to lead to helpful and to harmful client outcomes, and, through research, to identify such ingredients; (5) it is possible to translate the research findings into training and practice; and (6) it is therefore possible to markedly enhance the average effectiveness of counselling and psychotherapy by increasing the number of psychonoxious or harmful practitioners (Truax and Mitchell, 1971, p. 301).

Jerome Frank, in his analysis of comparative healing methods, including psychotherapy, has also shown the value of identifying the common characteristics which bring about change. He shows how pre-scientific healing rituals and mythical remedies have certain essential similarities to modern healing techniques. Other writers have also emphasised the importance of this approach (Ehrenwald, 1966; Kiev, 1966; Calestro, 1972; Frank, 1973). It is now accepted in much of the literature that the study of these so-called non-specific factors affecting outcome of the helping process are as important as the specific issues identified by the various schools of thought (Strupp, 1970, 1973).

Core themes in helping relationships

I propose to break down the constructs psychotherapy, casework and counselling into their component variables, thus taking this non-school, non-specific approach further.

One of the common fundamental central themes which runs through psychotherapy, casework and counselling is that they are all, however defined, processes where the interaction between people is designed to effect change, primarily in the person or people whom we shall refer to as clients. Responsibility for the relationship, and the planning or designing of how ‘change’ will be achieved, is invested in the person who is officially employed as the agent of change, whom we shall refer to as the professional helper.

I am very conscious of the inadequacy of the terms used throughout this discussion. To my knowledge there are no satisfactory generic terms for either the people (i.e. social workers, psychotherapists, clinical psychologists, counsellors, experimenters, doctors, hypnotists on the one hand, and clients, patients, experimentees or subjects on the other), or the process (i.e. therapy, casework, etc.). The terms ‘helper’ and ‘helpee’ have been used in the literature but are sometimes considered unsatisfactory for their somewhat patronising implications. ‘Change agent’ is often thought to sound too mechanistic. Perhaps the reader will bear with me then, and not hold the use of any one of these terms to be specific to a particular caste of helping professional, just as therapy will be used as a shorthand for the interaction between worker and client without necessarily being related to a medical model of help.

But to return to our discussion of the fundamentals of helping relationships. Carl Rogers has defined the helping relationship as follows:

A relationship in which at least one of the parties has the intent of promoting the growth, development, maturity, improved functioning, improved coping with life of the other. The other in this sense, may be one individual or a group. To put it in another way, a helping relationship might be defined as one in which one of the participants intends that there should come about, in one or both parties, more appreciation of, more expression of, more functional use of the latent inner resources of the individual (Rogers, 1961, p. 40).

Thus our approach emphasises the factors which the participants bring to the arena where change is expected to take place. This arena might be the office of the social worker or the psychotherapist, the family interview, the group, the community worker’s neighbourhood meeting, etc., etc. However, the scope of the evidence presented here is predominantly that which is deduced from one-to-one situations. Much of what is said is generally relevant to family and group situations, indeed to any situation where a professional worker sets out to bring about change with other people through his interaction with them. Thus the analysis applies to the change process at this fundamental level, and umbrella terms such as casework, psychotherapy, counselling, etc. can be left aside.

Later in our discussion it will be seen that another central common theme of helping relationships, introduced here, is relevant. It seems that if we look at the range of work which social workers, psychotherapists, counsellors and other helpers do, we can see much of it in terms of offering, providing, or, trying to find with the client an alternative modus operandi.

These alternatives may concern relatively small aspects of the client’s life such as new accommodation, provision of physical aids, a change in one aspect of the client’s behaviour, right up to alternative life styles such as in the case of drug addicts. On another, obviously interrelated continuum the alternative may be external, i.e. change in environment, or internal, i.e. change in the way the client views the world. Different workers in different settings will offer alternatives appropriate to their particular agency. However, I suggest that a core activity of all change agents, be they doctors, social workers, teachers or friends is to offer the client some alternative to his present situation.

Variables affecting change

The next step is to identify what types of variables exist in this process of change. So far we have referred to one set of antecedent variables, i.e. those concerning the therapist, but these are only one part of this picture.

In any process of change there are antecedent variables which are a pre-requisite or cause of certain functionally related consequent variables. There may also be present ‘intervening’ variables (or catalysts) which enable the functional relationship to proceed. In terms of the helping relationship referred to above it is suggested that certain antecedent variables (the accurate empathy, genuineness and non-possessive warmth of the therapist) enable the change process to take place producing the consequent variables—‘client improvement’. As yet the details of the functional relationship between these two sets of variables is vague.

The types of variables which may be fitted into this type of model are:

(1) Antecedent variables

Therapist variables: such as personality characteristics, expectancies, attitudes, theoretical orientation, training, sex, social prestige of role, etc. (see Truax and Mitchell, 1971).

Subject variables: personality characteristics, symptomatology, length of duration of ‘problem’, expectations and attitudes, social class, etc. (see Garfield, 1971).

Interactional variables: the actual behaviour of therapist and subject in interaction, the roles adopted by both, non-verbal communication, the tone of voice used by the therapist, i.e. the therapist’s actual communication with the client and the client’s responses.

Situational variables: individual, group, family, client network involvement, etc., client pre-training for therapy, length of therapy, concurrent crisis and circumstances, etc.

(2) Intervening variables

There will be factors such as the supportiveness of the client’s network of friends and/or relatives, the social/economic resources available, etc. (where changes in these factors are not specific goals of the helping relationship).

(3) Consequent variables

This is the outcome of therapy—its effects for better or for worse. Measurement of ‘outcome’ is a major area of controversy in research into the helping process (Truax and Carkhuff, 1967; Bergin, 1971; Bergin and Strupp, 1972). We might also note that the type of alternative offered the client will be a consequent variable.

Toward an eclectic framework

The above list of variables is by no means intended to be exhaustive but merely an illustration of the type of factors involved. Our knowledge of the helping relationship is such that we can only begin to fill in this type of model of the process of change.

Because change brought about as the result of interaction between people is the central focus, this model is not restricted to research under the heading of psychotherapy, casework, etc. Thus it is proposed to inform our discussion by looking at empirical evidence from other relationships where change is the product of interaction, namely the fields of placebo medicine, experimenter bias and comparative healing. However, our purpose in looking at these areas marks a departure from the traditional focus of the literature. Placebos and experimenter bias have always been seen as ‘artifacts’ in behavioural research, as such the purpose of much of the research on them is to eradicate their effect. We are looking at their effect with the opposite aim in mind. It is hoped that we might understand the mechanisms involved and the light they throw on the interactional process so as to maximise (not minimise) their effect and thus the change brought a...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Original Title Page
• Original Copyright Page
• Dedication Page
• Table of Contents
• Preface
• 1 Introduction
• 2 The self-fulfilling prophecy
• 3 Bias, hypnosis and placebos
• 4 Prophecy in helping relationships
• 5 Behaviour and change
• 6 Client-centred therapy: an example
• 7 How to maximise the prophet’s potency
• 8 For better or for worse
• 9 Prophecy and practice
• Bibliography