THE EFFECTS OF PRE-THERAPY TRAINING WITH LOWER-CLASS FAMILIES ENTERING FAMILY THERAPY: ATTENDANCE AND SHORT-TERM SUBJECTIVE OUTCOME

This study examined the effectiveness of a pre-therapy training audiotape in improving the expectations, defection and attendance rates, and short-term subjective outcome ratings of lower-class families referred for family therapy to an urban community mental health clinic. In each family the identified patient was a child or an adolescent between six and eighteen years old. The pre-therapy training audiotape was designed to improve accuracy of expectations about the family therapy process, hopefulness of expectations about improvement, attendance rates, defection rates, and subjective short-term outcome ratings after approximately six weeks. The study compared 15 experimental families who received the pre-therapy training tape, with 15 control families who received a neutral pre-therapy tape giving information about the general hospital in which the mental health clinic was housed. The tapes were delivered to, and picked up from, the families' houses prior to their initial scheduled appointments. All families participated voluntarily. Families who had previously been in family therapy at the clinic were excluded. The 30 families were assigned to the experimental and control groups alternately when possible, with the qualification that as data collection neared completion, assignment of a family to a particular group was sometimes determined by the need for equal therapist representation in the two groups, and comparable mean ages of the identified patients. The study employed a basic two-group design with six major dependent measures. The first three measures were designed to assess the effectiveness of the experimental tape in influencing expectations. These measures compared the experimental and control groups in terms of expected degree of improvement and accuracy of role expectations. The other three major dependent measures were defection, overall attendance of non-defectors, and short-term improvement assessment by adult family members. These three measures were taken, for each family, after a data-collection period based on a standard six-week time frame that varied slightly from family because of situational interferences. Analysis of the data suggested that while the pre-therapy training tape apparently improved significantly the accuracy of families' expectations about the therapy process, it failed to improve defection rates, attendance rates, or short-term subjective outcome ratings in comparison to the control tape. The pre-therapy training tape also seemingly failed to increase expectations of improvement. Additional comparisons were made between the entire subject sample and a randomly selected group of no-treatment family therapy referrals from the previous year. The treatment and no-treatment groups failed to differ significantly in overall short-term attendance or first-session attendance. The results were interpreted and discussed, with an emphasis on the possibility that an audiotaped presentation may be inappropriate for a lower-class, primarily Black population such as the one chosen for the current study. Such a population has been noted by some researchers to utilize and respond to visual and action-oriented communications more readily than to verbal-cognitive ones. Suggestions for further research included the use of whole-family pre-therapy home interviews and/or videotaped pre-therapy training presentations designed for home viewing.