Self-Disclosure and Outcome in Short-Term Group Psychotherapy

Author(s): Erich Coché and Barbara Polikoff

Source: Group, Vol. 3, No. 1 (Spring 1979), pp. 35-47
Published by: Eastern Group Psychotherapy Society
Stable URL: http://www.jstor.org/stable/41717938
Accessed: 17-12-2015 13:42 UTC

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Self-Disclosure and Outcome in
Short-Term Group Psychotherapy

ErichCoché
Barbara Polikoff

Since the publication of Jourard'sbook, self-disclosurehas received a

great deal of attention as a major aspect of the therapeutic process.
Jourard (1964) emphasized the importance of a capacity for self-
disclosure in interpersonal relationships. He insisted that self-
disclosure maintainspsychological health and fosterspersonal growth.
Likewise,Allen (1973) took the position that self-disclosureis a sign of
psychological health. Other authors assert (Egan, 1970; Sinha, 1976)
that self-disclosurecan be not only an importantingredientof psycho-
therapybut also one of its goals. In psychotherapy,self-disclosurecan
furtherconsensual understandingand increase self-disclosurein other
situations(Allen, 1973). Corsini and Rosenberg (1955) and Yalom (1970)
see self-disclosure as a necessary precondition in psychotherapy
without which certain "curative factors,"especially in group psycho-
therapy,could not operate. Similarly,Culbert (1970) sees self-disclosure
as a condition that provides opportunitiesfor realitytestingin the form
of interpersonalfeedback.
Research on self-disclosure is based to a large extent on studies
using paper-and-pencil tests of self-disclosure,in which the subjects
indicate their willingnessto disclose certain factsabout themselves to
other importantpeople in theirenvironment.The prime instrumentof
this is the self-disclosurescale by Jourardand Lasakow (1958). Several
authors (Allen, 1973; Hurley & Hurley,1969; Burhenne & Mireis, 1970;
Cozby, 1973) have criticized the fact that such paper-and-pencil

Erich
Coché,PhD, isDirector ofPsychologicalServices andResearch atFriends ,
Hospital
, Pa and Clinical
Philadelphia AssistantProfessorat Hahnemann , Phil-
MedicalCollege
Ms.Polikoff
adelphia. isa research intheDepartment
assistant Services
ofPsychological
andResearch at Friends Theauthors
, Philadelphia.
Hospital wantto expresstheirgrati-
tudetoDr.R.Coleman , Dr.C. Gantman, R.Gallagher, andM. Pauerandtothenursesof
Friends
Hospital forparticipating
in theratings
, alsoto Dr.Robert Diesforhishelpful
suggestions.
Requestsforreprintsmaybe addressed toErichCochê,PhD, Departmentof
Services
Psychological andResearch , Friends
Hospital, 19124.
, Pennsylvania
Philadelphia

GROUPVolume 3,Number 1979

1,Spring 35
0362-4021
/79/1 ®1979
byHuman
300-0035$00.95 Sciences
Press

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Group

measures are used ratherthan actual behavioral measures. In fact,there

is much questioning whether the Jourard Self-Disclosure Question-
naire is validlyrelated to actual self-disclosingbehavior (Cozby, 1973).
Hurley and Hurley (1969) raised doubts about its capacity to predict
actual self-disclosure in counseling sessions. Similarly,Burhenne and
Mireis (1970) found that self-disclosurescales such as Jourard'sdid not
predict self-disclosure in self-descriptiveessays. On the other hand,
Weigel and Warnath (1973) found a significantpositive relationship
between self-reportedself-disclosureand ratingsof self-disclosurein
groups.
Another criticismhas been that much of the research on self-
disclosure is based on populations that are not representativeof typical
participantsin psychotherapy.Many of the subjects were college and
high school students who were relativelyfree frompsychopathology.
Comparativelylittleresearch is available using adults and patientswith
emotional problems. Thus, the reviewers of the self-disclosurelitera-
ture (Allen, 1973; Cozby, 1973) recommend that furtherstudies make
more use of actual behavioral measures and actual therapeutic situ-
ations.
Despite these limitationssome of the research findingson self-
disclosure appear to have a direct bearing on the conduct of group
psychotherapy. According to these, self-disclosure is a complex
functionof the subject's personalityand sex, modeling by the therapist,
and the target person. There is consensus that women are more self-
disclosingthan men (Jourard,1958; Allen, 1973).
Lombardo and Fantasia (1976) found a positive correlation
between self-disclosureand interpersonaladjustment, by which high
levels of self-disclosurewere associated with betteradjustment.Truax,
Altmann,and Wittmer(1973), however, found the opposite relation-
ship. Mayo (1968) indicated that there were studies suggesting an
association between neurotic illness and low self-disclosure but that
there were no empirical investigationsof this hypothesis.Mayo's own
study indicated that inpatient neurotics were significantlylower on
self-reported self-disclosure than normals. On the other hand,
Persons and Marks (1970) and Pedersen and Breglio (1968) found that
high levels of self-disclosure were related to a high level of
psychopathology. Allen (1973) and Cozby (1973) summarize the
research as suggesting a curvilinear relationship between self-
disclosure and adjustment; both too littleand too much self-disclosure
may be socially maladaptive. Allen reportson a number of studies sup-
porting this contention, but again many of these are based on self-
reportmeasures.

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 Erich
CochéandBarbara
Polikoff

Relating these studies to the group therapy situation, it seems

appropriate to conclude that increasing the self-disclosure of low-
disclosing subjects is likelyto contributeto theiremotional adjustment
wheras high-disclosingsubjects may need to be toned down. Allen
(1973) also suggested that an over-disclosing group member mightbe
rejected because the group may be threatened by such an inappropri-
ate level of disclosure. Likewise, Leuchtman (1969) suggests that
subjects may react negativelyto highlypersonal disclosures, particular-
ly from strangers.On the other hand, the low-disclosing subject may
feel alienated if he/she cannot respond on the same level as his/her
peers.
Even though there is some admonition by certainauthors (Yalom,
Houts, Zimerberg, & Rand, 1967; Mowrer, 1964; Jourard,1964) that
self-disclosurein group psychotherapyis desirable, there is as yet little
research to support their contention. Yalom's reasoning is that high
cohesiveness of a group and popularitywithinthat group are positive
predictorsforgood psychotherapyoutcome and that patientswho are
high disclosers in the early meetings often assume high popularityin
their groups. Furthermore,Kirschner (1976) found that highly self-
disclosing groups are more cohesive.
More direct evidence that self-disclosure relates to therapy
outcome is given by Truax and Carkhuff (1965), who found that
patients' success in group therapy correlated with their transparency
during the therapy group, and by Peres (1947), who showed that suc-
cessfullytreated patients made almost twice as many self-disclosing
statementsas did unsuccessfullytreated patients. Heckel and Salzberg
(1967), however, found that self-discloserswere less likely to attend
theirtherapies regularly.Strassberg,Roback, Anchor, and Abramowitz
(1975) found that among male chronic schizophrenics low self-
disclosers profitedmore from psychotherapythan did high disclosers.
Similarly,Lieberman, Yalom, and Miles (1973) demonstrated that the
depth of self-disclosure is not invariably linked with favorable
outcome. These authors concluded: "Self-disclosure and the expres-
sion of positive feeling led to personal gain primarilywhen accompa-
nied by cognitive insight"(p. 422).
The present studywas designed to make another contributionto
the question of whether self-disclosure in group psychotherapy
does indeed contribute to better group psychotherapy outcome.
Despite some hesitation because of the findingsby Strassberget al.
(1975), it was hypothesized that self-disclosure in a therapy group
would be positivelyrelated to therapyoutcome.

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Group

METHOD

Subjects

The subjects were 50 adult inpatients at a small, private psychiatric

hospital in Philadelphia. All subjects participated in a short-term
psychotherapygroup at some point during their usually briefhospital
stay.
The original sample consisted of 94 patients who were accepted
for short-termgroup therapy during a six-month period. Eliminated
from the study were those patients who had attended less than six
therapysessions (out of eight) and patients for whom data collection
was incomplete (due to patient transferfromone hall to another, staff
not available for ratings,and patient background informationunavail-
able or insufficient).
Subjects were classifiedas either neurotic or psychotic,according
to theirfinaldiagnosis at the time of discharge. The sample consisted of
29 neurotic patients, which included 15 males and 14 females. The
mean age of thisgroup was 36.7 (5D = 11.7). The remainderconsisted of
21 psychotic patients, which included 13 males and 8 females. The
mean age of this group was 30.5 (SD = 9.2). There were no significant
differencesin the mean ages of males and females. Between the mean
ages of neurotics and psychotics there was a differenceof about six
years,which was not significant(t = 2.006, p > .05, df =48). There were
no significantdifferencesin the proportionsof the diagnoses between
the sexes (x2= .182,p>.05, df=V.

Group Psychotherapy

Prospective group members were referredto the PsychologyDepart-

ment by their attending physiciansand evaluated by the group thera-
pists prior to the commencement of group. Appropriate patients
(n = 6-10) were selected for each two-week group, which met for 90
minutes, four times weekly. Each group was closed to membership
once it began. All groups were conducted by teams of two therapists
each. Although members of the department rotated in conducting the
groups, their styleswere quite similar.The mode of therapywas inter-
actional, with a humanistic and behavioral orientation. An extensive
descriptionof these groups can be found in Pastushak(1978).
Following each group session the therapistswrote progress notes
of 8-10 lines describingeach patient'sactivityduringthatsession.

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 CochéandBarbara
Erich Polikoff

TargetComplaints

The use of the Target-ComplaintsProcedure has been recommended

by Strupp and Bloxom (1975) for measuring change as a result of
psychotherapy.The Target-ComplaintsTechnique was developed by
Battle, Imber, Hoehn-Saric, Stone, Nash, and Frank (1966) and is
designed to measure the amount of change thatoccurs duringtherapy
relative to the specific subjective complaints that the patient presents
priorto therapy.
The adaptation of this Target-ComplaintsProcedure used in the
presentstudywas as follows:
Aftera patient was accepted for group therapy but prior to the
beginning of the group, the researcher contacted a nurse on the
patient's hall and obtained three major complaints, i.e., the problems
that the stafffeltthe patient was having the most difficultieswith.The
nurses were encouraged to referto the patient's nursingcare plan and
other written informationwhen formulatingthe three target com-
plaints for the patient. Any type of complaint that was relevant to
psychiatrictreatmentwas accepted by the researcher.
At the end of the two-week course of group therapy,the research-
er contacted the same staffmembers again and asked them to rate the
amount of change that had occurred for each of the writtentarget
complaints.The followingratingscale was used:

-3 marked deterioration
-2 moderate deterioration
-1 mild deterioration
0 no change
1 mild improvement
2 moderate improvement
3 marked improvement

For each patient, an average overall improvement score was

computed fromtheirthree targetcomplaint ratings.
At a later time, all target complaints were classified into four
categories, representing impaired functioning in four different
spheres:

1. Subjective feelingof distress;

e.g., depressed, hopeless, high anxiety,low self-esteem,night-
mares.
2. Problems in interpersonaladjustment;
e.g., isolation, withdrawal, distrust, dependent, unable to

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Group

express self, misdirected anger, lacks social skills, passive,

stuttering.
3. Other adjustmentproblems;
e.g., can't function on job, alcohol problem, poor memory,
inappropriate behaviors, cannot set goals, suicidal, drug
dependence, cannot delay gratification,indecisive.
4. Thinkingdisorder:
e.g., hallucinations,delusions, stubborn denial, loose, avoids,
or denies his problems.
Compounds: 1&3 phobias, guiltover alcoholism;
1&2 guilt over abusing children,anxiety over in-
terpersonal relationships, depression over
interpersonalloss, grief;
4&3 denies drinkingproblem, covers depression
by hypomania, denies psychiatricproblems
by somatization;
4&2 gets involved in others' problems and avoids
his own.

Self-DisclosureRatings

Afterthe other data were collected, the therapistswho had conducted

the groups were asked to evaluate the total amount of self-disclosure
that each patient in the sample had exhibited during the two-week
course of therapy.Therapistsdid thisfrommemory,withthe aid of the
group therapy notes that they had recorded for each patient immedi-
atelyfollowingeach group session.
The ratingscale that was employed is an adaptation of the Dies
Tape Ratingof self-disclosurein group interactions(Dies, 1972). (Copies
of the adaptation are available fromthe firstauthor.) Patientsreceived
self-disclosureratingsaccording to the depth of disclosure, degree of
intimacyof the material,and willingnessto take interpersonalrisks.A
higher score corresponded to greater self-disclosure. Interraterreli-
abilityfor this instrumenton ten independentlyscored cases yielded a
correlationof .866,which was significantat the .001 level.
A total of three therapistscompleted the self-disclosureratingsfor
all of the subjects in the study. About half of the cases were rated by
both therapists,who had to reach a consensus if they had disagreed.
The raterswere not aware of the targetcomplaints resultsnor the diag-
nosticcategories of the patients.

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 Erich
CochéandBarbara
Polikoff

1: Meanimprovement
TABLE andself-disclosure
ratings
Improvement
Rating Self Disclosure Rating
Group n X SD X SD
Total sample 50 1.376 .728 4.020 1.301
Males 28 1.365 .687 3.821 1.248
Females 22 1.390 .793 4.272 1.351
Neurotic 29 1.502 .748 4.413 1.376
Psychotic 21 1.203 .679 3.476 .980
fa
Neurotic
TC subjectb 30 1.633 .964 4.300 1.235
TC interp. 40 1.550 1.060 4.300 1.417
TC adjust. 16 1.312 .946 4.625 1.310
TC thinking 8 1.500 .755 5.125 1.552
Psychotic
TC subject 15 1.333 .899 3.600 1.055
TC interp. 31 1.129 .846 3.516 .926
TC adjust. 11 .818 1.078 3.363 .674
TC thinking 11 1.545 1.035 3.181 1.078
Notes:
af indicates frequency
bTC Target Complaints
subject: subjective feelings of distress
interp.: problemsin interpersonal adjustment
adjust.: other adjustmentproblems
thinking: thinkingdisorder

Data Analysis

Linear correlations were used to determine the relationship between

self-disclosureand group psychotherapyoutcome forthe total sample,
male and female patients and neurotic and psychotic patients. Cor-

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Group

relations were also obtained for improvementscores in the separate

TargetComplaint categories in relationto the amount of self-disclosure.
Scatter diagrams of these correlations were also obtained and ex-
amined forpossible curvilinearrelationships.

RESULTS

Table 1 presents the means and standard deviations for improvement

and self-disclosureratings,for the total sample and separately by sex,
diagnosis, and target complaint type. In the part of Table 1 that deals
withthe targetcomplaint types,each patientwas counted at least three
times, once for each complaint. Compound complaints were scored
twice- once each fortheircomponent parts."Frequency" thus denotes
the frequency with which each of these target complaints occurred.
The typesof targetcomplaintswere described earlier.
The differencesbetween men and women and between psychotic
and neurotic patients were examined in respect to their significance
both for the self-disclosureand the improvementratings.Neither the
means nor the variances were found to be significantly differentwith
one exception: psychotic patients were significantlylower in self-
disclosure than neurotics(t=2.666, p <.05, two-tailed,cff=48).
Table 2 gives a listingof the correlations obtained between the
self-disclosure and improvement ratings. Again, the improvement
ratingsare based on the changes a patient has shown in his/hertarget
complaints.As in Table 1, the patientswere counted at least three times
(more in cases of compound complaints). All correlations are linear
Product-MomentCorrelation coefficients.

DISCUSSION

The data demonstratethe expected positive relationshipbetween self-

disclosure and improvementforthe total sample. Patientswho disclose
more are indeed more likely to gain from their hospitalization and
group therapy experience. However, the results also indicate that
caution in postulatinga link between self-disclosureand improvement
is warranted.
Similarto the findingsof Jourard(1958) and others summarized by
Allen (1973), women were found to be more self-disclosingthan men
but the differencewas not significant.Moreover, itwas found thatmen
are more likelyto benefitfromtheirself-disclosurethan women.

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 Polikoff
CochéandBarbara
Erich

TABLE
2: Correlation withimprovement
ofself-disclosure
Males Females Total
Group n r n r n r
Total Sample 28 .353* 22 .353 50 .350**
Neurotic 15 .615** 14 .419 29 .471**
Psychotic 13 -.025 8 -.131 21 -.054
fa f f
Neurotic
b 14 .569* 16 .369 30 .442**
TC subject.
TC interp. 21 .520** 19 .376 40 .415**
TC adjust. 10 -.082 6 .288 16 .043
TC thinking 5 .298 3 -.499 8 .182
Psychotic
TC subject. 8 -.217 7 .520 15 .150
TC interp. 20 -.242 11 -.143 31 -.215
TC adjust. 7 .930** 4 -.258 11 .237
TC thinking 6 .083 5 .597 11 .081

Notes:
af indicates frequency
bTC Target Complaints-
subject: subjective feelings of distress
interp.: problemsin interpersonal adjustment
adjust. : other adjustmentproblems
thinking: thinkingdisorder
*£ < .05 one-tailed hypothesis
**£ < .01

As a group, neurotic patients were found to exhibit more self-

disclosure than psychotic patients. On the basis of this admittedly
broad diagnostic subdivision, the results of this study confirm the
assertionof Mayo (1968) and Lombardo and Fantasia (1976) that greater
self-disclosure is more likely to occur in people with lesser degrees
of pathology. Allen (1973) and Cozby (1973), in summarizing the

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Group

research, suggest that the relationship between self-disclosure and

adjustmentis curvilinear.Evidence forthiswas not found in the present
study. It is possible, though, that more discriminatingmeasures of
pathology mighthave resulted in more complex relationshipsbetween
pathology and interpersonal openness. Neurotic patients did show
improvementas a resultof their self-disclosure.Thus, for our sample,
self-disclosureappears to be both a symptomof some degree of health
and a means of achieving a healthierpersonality,as has previouslybeen
stated by Sinha (1976).
No relationship between self-disclosure and improvement was
established for psychoticpatients.As noted earlier,Culbert (1970) sees
self-disclosure as a condition that provides opportunities for reality
testing in the formof interpersonalfeedback. Strassberget al. (1975),
who found a negative relationship between self-disclosure and
improvement with schizophrenic patients, suggest that psychotic
individuals are more apt to deliver personal material in an inappro-
priate manner, thus evoking negative reactions. Strassberget al. also
remind us that psychotic individuals are limited in their ability to
integrate successfullyconstructivesocial feedback. While our results
do not support a negative relationship between self-disclosure and
therapy outcome for psychotic patients, neither do they support a
positive relationship.
A look at the correlation between improvement and self-
disclosure separately for different Target Complaint types shows
the greatest correlations among those neurotic patients whose major
problems were either subjective feelings of distress or interpersonal
adjustment difficulties.The importance of the impaired ability of
psychiatricpatients to resolve interpersonal problems (as noted by
Spivack, Piatt, & Shure, 1976) is underscored by the fact that both
neurotic and psychoticpatientshad the greatestnumber of complaints
in this area. Neurotic patients who revealed more intimate material
during the course of group therapy improved significantlyin their
abilityto deal withinterpersonalproblems. These resultsare consistent
with the findingsof Halverson and Shore (1969), who reportthat self-
disclosure is positively related to interpersonal flexibility.Lombardo
and Fantasia (1976) furthersuggest that low disclosers are more socially
anxious than others and have difficultyestablishing and maintaining
warm personal relationships.The resultsof the present study support
these findingswhere neurotic patientsare concerned.
Thus, Yalom is likelyto be rightin his assertionthat interpersonal
openness is one of the curative factorsof group psychotherapy,but
this appears to be true only as long as the patientsare not too severely

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 CochéandBarbara
Erich Polikoff

disturbed. Even among the neurotic patients, those who had some
impairmentof their realitycontact (our Target Complaint Type 4) did
not demonstrate a positive relationship between openness and
improvement.It appears thus that writersin the field of group psycho-
therapy should be more careful when advocating openness and
interpersonal risk-takingfor all patients. So far there is no evidence
showing that self-disclosurein therapy groups is promotive of health
forthe psychoticpatient.
Lieberman et al. (1973) suggest that self-disclosure alone is not
enough. Instead, they propose that the abilityto assimilate and inte-
grate feedback during a therapeutic encounter determines outcome
more than any other factor. Our results confirmthe implication that
only patientswho are able to utilize the therapeutic process in thisway
(i.e., less disturbed patients) will benefit from self-disclosure. Those
patients "whose cognitive processes are more severely impaired may
be less able to benefitfromthe introductionof intimatematerialinto
the session" (Strassberget al., 1975, p. 1259).
An alternativeexplanation of the failure of psychotic patients to
benefit from their interpersonal openness is that perhaps their self-
disclosing statementsare inappropriate in some way; theirtimingmay
be off,their depth may be differentfrom that of the group or the
topic chosen for the disclosure is markedlydifferentfromthe group's
main concerns. Such deviations in timing,depth, or topic are likelyto
cause consternation,fear,and rejection in the group, thus negatingthe
beneficial effectsof opening up. In futurestudies we intend to investi-
gate the degree to which patients'self-disclosurefitsin withthe flowof
the group process.

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