A-B therapist distinction, patient diagnosis, and outcome of brief psychotherapy in a college clinic.

Abstract

Prior clinical studies have suggested that therapists' A-B status interacts with patient diagnosis in determining the outcome of psychotherapy (A > B with schizophrenics; B > A with neurotics), but this interaction hypothesis has been studied almost exclusively in laboratory analogues, not in actual clinical practice. To discern whether the hypothesis would apply to brief psychotherapy in a college clinic, the "outcomes" obtained by three A and three B therapists with their schizoid and neurotic patients (N = 57) were examined in a 2 X 2 factorial design. Analyses of variance computed for three dependent measures based on therapists' and patients' posttherapy ratings revealed considerable support for the hypothesis, primarily with respect to therapists' appraisals of their own effectiveness (interaction, p < .02). The B therapists also obtained much lower improvement and rapport ratings from schizoid than neurotic patients, whereas A therapists obtained equally satisfactory results with both. The interaction hypothesis characterized A-B performance differences better than an alternate "prognostic" hypothesis tested via the inclusion of two additional diagnostic categories (adjustment reaction, passive-aggressive personality).

A-B type and the relationship between police officers and ghetto citizens

“…As a result of the A-B scores attained by the interviewees, most of them would be considered As, using both the norms developed by Berzins (in 1972) on male students and professionals and the distributions of scores for policemen found in the current study. Although such norms are obviously not directly applicable to this study's interviewee Ss, it would still suggest a greater tendency toward A than B status in the present Ss.…”

“…** The earliest work demonstrated the increased effectiveness of A-type therapists with schizophrenic patients (Whitehorn & Betz, 1954), and of B-type therapists with neurotic patients (McNair, Callahan, & Lorr, 1962). Later analogue and therapy studies have generalized the earlier findings and suggested the relative superiority of As with schizoid and extropunitive individuals (Berzins, Ross, & Friedman, 1972;Berzins, Seidman, & Welch, 1970) and of Bs with intropunitive individuals . In studies by Carson, Harden, and Shows (1964) and Berzins, Ross, and Cohen (1970), work further removed from the original outcome studies has focused on the process involved and has demonstrated the greater effectiveness of As in eliciting personal information from distrustful subjects.…”

Clinical responses of A and B practising psychotherapists to schizoid and neurotic patient prototypes

“…Taken together, the original clinical findings of Betz (1%7) and McNair et al (1%2) gave rise to the hypothesis that therapists characterized by a disinterest in selected manual, technical, or mechanical activities (As) were more clinically successful with schizophrenic patients, and less clinically successful with neurotic patients, than were therapists who indicated an interest in these activities (Bs). Due to the shortage of clinical outcome studies with the requisite factorial design, this ' A-B interaction hypothesis ' has not been fully evaluated, (for reviews see Razin, 1971; Chartier, 1974; May, 1974; Goodwin, 1974), with some indications that such differences as exist primarily concern schizophrenic rather than neurotic patients (Berzins et al, 1972 b;Chartier, 1974). Differences in clinical style have been posited to account for the differential effectiveness of A and B therapists with schizophrenic patients.…”

“…Moreover, the impact of level of psychotherapy experience on A-B interaction phenomena has never been systematically assessed, despite a growing body of empirical evidence indicating its general importance in relation to process and outcome (e.g. Meltzoff & Kornreich, 1970; Hill, 1975) as well as scattered suggestions that it may qualify A-B phenomena (Kemp, 1%9;Berzins et al, 1971;Hill, 1975).…”

Where are the A and B therapists, 1970–1975?

“…In order to evaluate the interaction hypothesis in an actual clinical setting as opposed to an analog, laboratory situation, Berzins, Ross, and Friedman (1972) tested the hypothesis in the context of short-term therapy in a college clinic with A and B therapists working with neurotic and schizoid (substituted for schizophrenic) clients. Three factors extracted from ratings completed by clients and therapists were used to evaluate the effectiveness of the therapy: (1) therapists' appraisal of his/her own effectiveness, (2) patient improvement, and (3) patientexperienced rapport.…”