Reversal theory: an introduction

Reversal theory: an introduction

PTiENT EduCATiON ANd COUNSdiNCj Patient Education and Counseling 22 (1993) 63-71 Reversal theory: an introduction Kathryn D. Lafreniere Assistan...

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PTiENT EduCATiON ANd COUNSdiNCj Patient

Education

and Counseling

22 (1993) 63-71

Reversal theory: an introduction Kathryn

D. Lafreniere

Assistant Professor, Psychology Department, University of Windsor, Windsor, Ontario N9B 3P4, Canada

(Received

15 May 1992; accepted

5 July 1993)

Abstract

The theory of psychological reversals, or ‘reversal theory’, is a relatively new theory of motivation and personality that places emphasis on the inconsistency and changeability of human behaviour and experience. The present paper provides a general introduction to the theory’s principal constructs and assumptions. Specific reversal theory concepts outlined here include the notions of metamotivational modes, reversals between modes and metamotivational dominance. The nature of metamotivational reversals and factors that influence the process of reversals are also described. Psychometric and experimental research in support of the theory is reviewed. The final section offers a critical evaluation of reversal theory and discusses its relevance and applicability in the health sciences. Key words: Reversal theory; Motivation;

Personality; Inconsistency

1. Introduction The theory of psychological reversals is now fairly well established within the psychological literature. Since 1975, when the theory was first described in a paper by Smith and Apter, it has been the subject of six international conferences and five books, and well over sixty journal articles

on reversal theory have been published. The theory has attracted a number of researchers and practitioners, who operate in a wide variety of fields. Reversal theory has been examined in relation to a variety of topics, including personality [l], the psychology of humour [2,3], sexual behaviour [4], * Corresponding author. 073%3991/93/$06.00 0 1993 Elsevier Scientific SSDI 0738-3991(93)00578-V

Publishers

Ireland

religious diversity [5], sports psychology [6,7], interpersonal relationships [8,9], addictive behaviour [lO,ll] and stress [12], to name but a few. Reversal theory is concerned primarily with the experience of motivation. It can be defined as ‘a theory of the different ways in which the individual interprets various aspects of his own motivational experience, and the way in which he switches between these different types of interpretation’ [13, p. 1731. It is characterized by a theoretical approach that Apter terms ‘structural phenomenology’. The term ‘phenomenology’, as employed here, refers to the need to make extensive reference to subjective experience and meaning, rather than observable behaviour, in order to understand the nature of psychological processes Ltd. All rights reserved.

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[ 131.Reversal theory places emphasis on the interpretation of experience, its nature and quality and how this nature and quality change over time. Another of reversal theory’s roots comes from the field of cybernetics. It became apparent to Apter [14] that in examining the structure of human action, certain features of that structure could be most clearly explained in cybernetic terms. In this way the person is regarded as a highly complex ‘machine’ that is relatively autonomous and that interacts with the environment in such a way as to use it for its own purposes. At some times the machine operates according to one program, while at other times another program is operative, depending on how it seeks to use the environment. 2. The nature of psychological

reversals

Many traditional models of personality, motivation and behaviour have emphasized some notion of homeostasis or equilibrium. Homeostasis or equilibrium refers to the idea that certain variables are stable only within a specified range. Examples from physiology would include body temperature and respiration rate. In both cases the values of these physiological indices are stable within a certain range, and deviations beyond the boundaries of this range stimulate other systems to initiate physiological activity that will counteract the deviations [14]. In psychology, Hebb’s theory of optimal arousal and performance [15] has been one of the most influential uses of the concept of homeostasis. According to this theory, arousal operates along a single dimension, and individuals perform best under moderate levels of arousal, while very low or high levels of arousal are detrimental to performance [ 141. Apter [ 14,161 has identified some problems arising from this approach. First, on what basis does one decide whether the experience of anxiety should be higher or lower on the arousal dimension than that of excitement? Similarly, is boredom to be considered higher or lower, in terms of felt arousal, than relaxation? Second, the single arousal dimension conceptualized in the optimal arousal approach implies that an individual must go through one high arousal state in order to reach

another (i.e. become more anxious in order to reach a state of excitement, or vice versa) and must do the same with the low arousal pair of states 1161. As an alternative to homeostasis, reversal theory employs the cybernetic concept of b&ability. A bistable system is one in which a variable is maintained within one of two ranges of values. A simple example of a bistable system is that of a lightswitch, which is either in the ‘on’ or ‘off position. If the position of the switch is changed at all, the movement will either be sufficient to bring it to the opposite position or it will return to the original position. Here the two extreme positions of ‘on’ and ‘off are stable, and all intermediate positions are unstable [ 141. As applied to motivational variables, the concept of bistability can be used to illustrate the idea that an individual has two alternative preferred levels of arousal, rather than a single optimal level of arousal. Reversal theory is concerned with how individuals experience switches from one to the other of these bistable states. When the two preferred levels of a psychological variable are opposite to each other, then a switch from one to the other is said to constitute a reversal. Reversals between opposite states occur more or less instantaneously, according to the theory. A useful analogy is that of a figure-ground reversal in certain visual displays, like that of a Necker cube. Applying this to arousal, reversal theory asserts that there are two distinct and opposite modes, which prevail at different times. When one mode is engaged, high arousal is experienced as pleasant (‘excitement-seeking’ mode). When the other mode operates, high arousal is felt to be unpleasant (‘anxiety-avoidance’ mode) [ 161. It is this process of reversing between opposite systems or modes that is of primary concern in reversal theory. 3. Metamotivational

modes

In dealing with the experience of motivation, reversal theory is less concerned with the contents of this experience (e.g. high arousal in itself) than with the way in which the experience (in this case that of high arousal) is interpreted by the individual [ 131.Thus the bistable systems involved in inter-

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preting motivational variables are referred to as pairs of metamotivational modes (sometimes referred to as metamotivational states). They are called ‘metamotivational’ because they are not in themselves motivational states. These metamotivational modes can be thought of as opposite ‘states of mind’ that we use in interpreting our experience of variables such as arousal [ 161. Apter has identified four pairs of modes: telic-paratelic, negativistic-conformist, mastery-sympathy and autocentric-allocentric. 3.1. Telic and paratelic modes The experience of arousal is merely part of the total experience of motivation. Another important aspect of motivation involves the relationship between means and ends. Reversal theory asserts that not all behaviour is goal-oriented, and suggests that there are a pair of metamotivational modes that respond to the means-end relationship in opposite ways. In the telic mode (from the Greek telos’, meaning goal), activity is directed at achieving a certain goal. In the opposite, paratelic mode, activity is engaged in for its own sake, and when there is a goal it is simply there to provide a justification for the activity. In the goal-oriented or telic mode, if an individual finds that an activity is not successfully leading to the desired goal, he or she is likely to substitute another activity that will lead to the same goal. By contrast, in the activityoriented or paratelic mode, failure to attain a goal will result in either shifting to a new goal that also provides an excuse for the activity or dropping the idea of a goal altogether [ 11.To illustrate, consider the example of a person who decides to walk to the corner store to purchase a newspaper. If the telic mode is operative, obtaining the newspaper would probably be the goal, and walking to the store would be a means of achieving that goal. If the person discovers that the store has run out of copies of the newspaper, he or she will probably go to another store to try to buy the newspaper. By contrast, in the paratelic mode the goal of buying the newspaper might simply have served as a justification for engaging in the pleasurable activity of taking a walk. If the store did not have the newspaper, it would not matter very much, since the activity was not actually directed at that goal.

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An important feature of the telic mode is its seriousness. Here, a person’s total experience is evaluated in terms of whether it will help in reaching the goal [ 11.In addition, a goal is generally experienced in the telic mode as something that is imposed from outside the individual, and one’s actions in this mode are felt to have high significance. Conversely, the paratelic mode is characterized by playfulness, and actions in this mode are often experienced as though they are ‘encapsulated’ from the real world [14]. Thus makebelieve and play are usually experienced in the paratelic mode. Pleasure in the telic mode is derived from moving towards and attaining a goal, while paratelic pleasure comes from the immediate enjoyment of the moment. Thus the telic mode is seen to be future-oriented, while the paratelic mode involves focusing on the ‘here and now’ [ 141. In the telic mode, the person is goal-oriented and wants to believe that what he or she is doing is significant (high felt significance). Since the paratelic mode involves enjoyment of the moment, pleasure is achieved in this mode by intensifying the experience to make it even more thrilling. Felt arousal is experienced in opposite ways in the telic and paratelic modes. High arousal is pleasurable in the paratelic mode and is experienced as excitement, and low arousal is unpleasant and is usually experienced as boredom. However, high arousal is unpleasant in the telic mode and is associated with anxiety, while low arousal is pleasant and is associated with calmness and relaxation [ 11. Because the telic and paratelic metamotivational modes are opposite in the ways in which they cause one to structure and interpret motivational experience, a switch from one to the other is considered to be a reversal. Physiological differences between paratelicdominant and telic-dominant subjects (i.e. individuals who tend to be more often in one mode than the other) have been demonstrated in laboratory studies of reversal theory. In one such investigation [17], telic-dominant subjects were found to show steeper electromyographic activity gradients, higher tonic skin conductance and greater thoracic respiratory amplitudes than paratelic-dominant subjects while undergoing an identical challenging task. This suggests that there are biological differ-

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ences between telic-dominant and paratelicdominant subjects. In the same investigation, interview data provided further validity for the telic-paratelic dominance distinction. These data indicated that telic-dominant and paratelic-dominant subjects have different life-styles, which reflect the conceptual distinction between the two modes. Interview data revealed that the subjects in the two groups interpreted their experiences in different ways, both in the content and in the form of descriptions of how they spent their time. Paratelic-dominant individuals reported participation in a greater variety of activities, expressed more excitement and appeared to be more spontaneous, adaptable and less well organized than their telic-dominant counterparts. Telic-dominant subjects expressed more concern for planning their activities, and appeared to spend more time working towards longer-term goals. The descriptive style of the subjects also varied between the two groups: while telic-dominant individuals tended to give highly detailed descriptions of the events of their day in chronological order, paratelic-dominant subjects’ descriptions tended to be more impressionistic, generalized accounts, in which events were not always reported in the order in which they had occurred [17,18]. Martin et al. [ 121conducted a series of investigations that examined telic versus paratelic dominance as a stress-moderating variable. In general, they predicted that telic dominance would interact with stress-level to predict outcomes such as mood disturbance and psychophysiological activation. Specifically, they hypothesized that there would be a positive relationship between frequency and severity of stressors and mood disturbance for telicdominant individuals. For paratelic-dominant individuals they predicted a curvilinear relationship, in which mood disturbance was expected to be higher under either low or very high stress than for stress of moderate intensity. On the whole, the results of their investigations suggest that paratelic-dominant individuals ‘seem to thrive on moderate levels of stress’ [12, p. 9801. Those who are telic-dominant appear to be negatively affected by even low levels of stress, and seem to function better in the absence of stress. On

the basis of their findings the investigators suggested that telic-dominant people might perceive arousal-related situations as threats, while paratelic-dominant people are more likely to regard these situations as challenges. 3.2. Negativistic and conformist modes One important aspect of the experience of motivation concerns whether a person sees his or her actions as being in line with social pressures and demands or as being opposed to these demands to conform [ 181. These opposite ways of thinking are addressed by the negativistic or conformist metamotivational modes. In the negativistic mode the individual feels rebellious and prefers to see his or her actions as being in defiance of social conventions, rules and expectations. The opposite, conformist mode is defined simply by the absence of such negativistic feelings, where one prefers to feel that one is respecting the demands of society [14]. Using an interview procedure based on that employed by Svebak and Murgatroyd [17], McDermott investigated life-style differences between negativistic-dominant and conformistdominant subjects [19]. In general, he found that the interview results provided support for the validity of the negativist-conformist distinction. Conformist-dominant subjects’ reports reflected an awareness of obligations and responsibilities, and concern when these responsibilities were not met. For example, conformist-dominant students referred to activities such as watching educational programs on television and doing laundry as ‘a waste of time’, since these subjects felt they should have used the time more productively by studying for coming exams. By contrast, negativisticdominant subjects tended to show little or no remorse for not studying, and even seemed to be somewhat proud of their rebelliousness, as evidenced by statements such as ‘Actually, it gave me great pleasure going out [when he should have stayed at home to study]. I suppose I enjoy doing things I know I shouldn’t be, br, say I can’t afford to do something so I’ll do it’ [19, p. 3221. Apart from the content of their responses, McDermott noted that negativistic-dominant and

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conformist-dominant subjects approached the interview in different ways. While the conformistdominant subject attempts to meet the requirements of the interview situation by giving a systematic and full account of the events of the day, the negativistic respondent swears, laughs, gives only a brief general account of the day and responds in a self-mocking way. As McDermott observed, this behaviour suggests that the negativistic respondent is ‘rebelling against the tacit requirement of the interview situation to respond formally and in an acceptably serious way’ [19, p. 3181. 3.3. Mastery and sympathy modes Reversal theory postulates an additional two pairs of metamotivational modes that concern the experience of emotions that arise primarily out of transactions with other people or situations. The first of these is the mastery-sympathy pair of modes. In the mastery mode, one’s orientation to interpersonal transactions is experienced in terms of power, strength and control. Thus the individual focuses on whether he or she is weak or strong in a particular situation, or controlling or being controlled in a particular encounter [18]. By contrast, in the sympathy mode one regards interpersonal transactions as being related to caring and nurturing [20]. Here the focal issue is whether people are concerned about you or not. In the mastery mode the principal goal is to feel strong, and transactions are evaluated as they bear on these issues of strength versus weakness. The chief aim in the sympathy mode is to feel liked or sympathized with, and transactions are assessed according to the evidence they provide that others are concerned about you [18]. As with other pairs of metamotivational modes, Apter has asserted that the mastery and sympathy modes are mutually exclusive ways of interpreting experience, and that a switch from one to the other constitutes a reversal [8,18]. The sense of these modes as being ‘opposites’, however, is less apparent than is the case for the telic-paratelic and negativistic-conformist mode pairs. O’Connell and Apter proposed a variable that they termed ‘felt toughness’, which is experienced in opposite ways

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in the mastery and sympathy modes [21]. Felt toughness is thus analogous to the variable of felt arousal, which is experienced in opposite ways in the telic and paratelic modes. Felt toughness is described as a continuous variable in which ‘tender’ and ‘tough’ are the low and high end-points. In the mastery mode, high toughness is felt to be pleasant (e.g. the experience of being hardy, rugged, tenacious or selfdisciplined). Low toughness is experienced as unpleasant in the mastery mode (e.g. being soft, subservient, indulgent, over-emotional or undisciplined). In the sympathy mode, high tenderness (i.e. low toughness) is experienced positively (e.g. as sensitivity, gentleness, responsiveness or generosity). Low tenderness (high toughness) is a negative experience in the sympathy mode (e.g. the feeling of being harsh, rough, uncaring or callous). Thus the mastery and sympathy modes can be regarded as systems that are opposite in the way they operate on the felt toughness dimension [2 11. 3.4. Autocentric and allocentric modes The second ‘transactional’ metamotivational mode-pair proposed by reversal theory comprises the autocentric and allocentric modes. In the autocentric mode, pleasure and displeasure are derived from what happens to oneself rather than to someone else [8]. Conversely, in the allocentric mode one identifies with another person, object or group [20] and derives pleasure (or displeasure) from what occurs to this ‘other’. Apter and Smith note that the autocentric and allocentric modes are often experienced in combination with the mastery and sympathy modes [8]. For example, in the autocentric version of the mastery mode, pleasure might be derived from defeating an opponent in a game. In the allocentric version of the mastery mode, an adult who allows a child to win a game might view losing the game as a pleasurable experience. In the sympathy mode, being given a present would be an example of an activity likely to elicit pleasure in the autocentric mode, while donating money to charity might be a source of pleasure in the allocentric mode [8]. In a study that examined interpersonal transac-

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tions between hospice nurses and their patients, Rhys analyzed interview data in terms of combinations of the autocentric-allocentric and masterysympathy metamotivational modes [22]. She found that the nurses spent most of their time in either the autocentric mastery mode, in which their work entailed controlling patients or equipment, or the allocentric sympathy mode, in which caring for and nurturing patients were the dominant goals. The nurses’ accounts of their experiences also indicated that some of their time was spent in ways that could be explained by the other mode combinations as well. For example, nurses sometimes reported that at times they wanted to feel sympathized with and liked by the patients, and were very grateful when they did receive such positive attention. These experiences are consistent with the autocentric sympathy mode [18,22]. On the whole, the results of the interviews reported by Rhys indicate that the nursing profession sometimes requires nurses to be in the mastery mode and at other times to be in the sympathy mode in order to successfully and skillfully accomplish their duties. For example, an effective nurse must be in the mastery mode to experience the emotional detachment necessary to perform certain unpleasant tasks, such as giving injections, but must be capable of switching to the sympathy mode in order to provide comfort afterwards. In other words, a successful nurse is required to be ‘a different kind of person at different moments’ in order to deal with the complex and changing demands of his or her profession [ 18, p. 1221. 4. The reversal process Apter has described three kinds of factor that tend to facilitate metamotivational reversals [ 141. The first is that of contingent events. This category includes both environmental events and psychological events that suggest that action should or should not be taken. Thus, a nearaccident while driving an automobile will probably induce a reversal to the telic mode, if it is not already operative. Social cues like smiling and laughing may serve to bring about the paratelic mode. Frustration in achieving satisfaction in one mode may induce a switch to the other mode.

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After becoming bored with playing a game while in the paratelic mode, for example, a person may decide to work in a goal-oriented fashion on some other task. Finally, satiation can produce a metamotivational reversal. Satiation refers to an innate process that builds up over time to facilitate a reversal in the absence of any contingent factors. This independent dynamic for change is not unlike that found in the sleep-waking cycle. When a person has been asleep long enough, he or she will awaken, even if nothing has occurred in the environment to disturb the sleep. After a certain amount of time the person will go back to sleep, despite other factors. Thus reversal is conceptualized as ‘an involuntary process which occurs when the factors for change at the metamotivational level are, in combination, stronger than the combined strength of the factors which oppose them’ [l, p. 2721. Comparatively little research has been conducted on the actual process of reversal itself. One study examined reversals that took place in the laboratory, in an attempt to observe the course of reversals that occurred over a two-hour period [23]. Subjects in this investigation were observed in a situation where they could spend their time either playing video games (presumably a paratelic activity) or learning from computer statistics programs (which was felt to be a telic situation). Time spent on each type of material and switches between the two were noted. Post hoc questionnaire and interview responses revealed that most subjects did experience the two types of material in the metamotivational mode expected, and that spontaneous reversals did occur. Individuals who were high in telic dominance spent significantly more time on the statistics programs than did the paratelic-dominant subjects. While many of the reversals were reported to result from frustration with the programs being used, at least some of the reversals experienced by the subjects could not be accounted for in any way other than satiation. In these cases, subjects reported that they found themselves wanting to change ‘for no good reason’ and that the motivation to switch just seemed to happen to them. Consistent with theoretical predictions, the proportion of satiation-type reversals was found to increase as the session progress-

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ed [23]. Apter notes that the finding that satiation-induced reversals do occur is consistent with common everyday experience [18]. That is, one can find oneself in quite different frames of mind, for no apparent reason, when confronting the identical situation at different times. 5. Reversal theory and personality

Reversal theory’s approach to personality has two characteristic features. First, it focuses on the experience of the individual rather than his or her behaviour. Second, its emphasis is on inconsistency rather than consistency [14]. This emphasis on the inconsistency of behaviour is shared to a certain extent by the interactionist model of personality [24]. This perspective describes behaviour as involving a continuous interaction between individuals and the situations they encounter. Here, behaviour is seen to be inconsistent across situations and across individuals. The inconsistency postulated by reversal theory differs from the interactionist position in suggesting that an individual will often respond in different (and in fact opposite) ways even when confronted with the same conditions [14]. One way in which personality differences at the metamotivational level can be expressed is through dominance. (See the paper in this issue by Apter and Apter-Desselles on the concept of dominance.) Dominance refers to an innate bias or tendency on the part of an individual to be more often in one mode than the other. The behaviour of individuals who are highly dominant in one or another metamotivational mode is likely to give the appearance of a considerable amount of consistency over time, by virtue of the choices, preferences and tendencies that they will express. Thus a person who is highly telic-dominant might be seen to spend most of his or her time engaged in serious-minded activities that have been carefully planned ahead. A negativistic-dominant person will typically choose to behave in ways that are in opposition to social rules and expectations. Despite this seeming consistency in patterns of beperson haviour, however, the telic-dominant would at times reverse into the paratelic mode and be as fully capable of ‘enjoying the moment’ as a

person who was paratelic dominant, according to the theory [ 181. Similarly, the negativistic-dominant person would at times be observed to earnestly conform to social conventions and rules. Individual differences can also be seen in how people experience reversals from one mode to another. For example, people differ in the ease, and therefore the frequency, with which they reverse between metamotivational modes. This is referred to as lability in the theory, and is influenced by the speed with which satiation builds up. It may also be the case that individuals differ in the rate at which frustration comes about. People may also differ in the degree to which they are responsive to environmental and social cues that act as contingent factors in inducing reversals [14]. One might predict, for instance, that more sensitive or empathic individuals would probably be more readily influenced by social cues than would people who are less emotionally sensitive. Another source of personality differences involves the ways in which individuals employ different strategies to achieve satisfaction appropriate to the particular metamotivational mode in which they are operating [l]. 6. Evaluating reversal theory Reversal theory is still in its early stages, and a considerable amount of additional empirical support will be needed to establish the theory as a viable model of personality. Even at this early stage, however, reversal theory has much to offer to the continuing dialogue regarding the consistency versus inconsistency of personality. As a model of personality, reversal theory appears to come closest to the interactionist perspective: both share an emphasis on the psychological meaning of situations and behaviour, and both represent a movement away from the idea that personality is based on consistent patterns of behaviour. Reversal theory goes beyond the interactionist perspective, however, in suggesting that the same person will experience even the same situation differently at different times, depending on his or her current metamotivational mode. A unique aspect of reversal theory is that it brings together widely disparate research interests

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and theoretical considerations. Such diverse areas as Zen Buddhism, psychophysiology, sports psychology, sexual dysfunction, addictive behaviour, stress, psychopathy, creativity and humour represent only a partial list of topics that have been considered from the reversal theory perspective [18,25]. The most fully developed constructs in reversal theory are the telic and paratelic metamotivational modes, and the majority of empirical investigations have studied these modes in relation to metamotivational dominance and reversals. Negativism and conformity have also been examined in a number of reversal theory studies [ 181, while the mastery-sympathy and autocentricallocentric mode pairs have received comparatively little attention in empirical investigations. The ease of administration of self-report instruments that have been developed to assess telic dominance and negativism-conformity, as compared with the more costly and time-consuming interviews necessary to examine the mastery-sympathy and autocentric-allocentric modes and dominance, has undoubtedly been a significant factor that has contributed to this lack of balance. Until similar methodologies for the measurement of the other modes are developed, the telic-paratelic modes are certain to dominate reversal theory research, possibly to the point where the theory is overidentified with telic dominance. A concerted attempt to provide empirical data in support of the construct validity of the other mode-pairs should be undertaken by reversal theory researchers. In addition, the possibility that as yet undiscovered pairs of metamotivational modes might also operate to influence the interpretation of motivational experience should be considered. As is the case with psychological research in general, most empirical investigations of reversal theory have made use of samples of young adults, with college students being particularly overrepresented. An exception to this is a study by Boekaerts, Hendriksen and Michels [26] in which a children’s version of a measure of telic dominance was developed and validated in samples of Dutch and Belgian schoolchildren. More reversal theory research employing participants of different age groups would be advantageous. Stud-

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ies of the antecedents and developmental course of adult metamotivational dominance, for example, would be particularly informative. Reversal theory goes further than other models of personality in attempting to capture the inconsistency and complexity of human experience. The theory’s greatest contribution to the study of personality arises from this attempt to examine the experience of motivation in a complex fashion, and its phenomenological approach, which places emphasis on the individual’s subjective experience of situations and behaviour. The challenge to researchers in reversal theory is to develop new methodologies, or employ existing methods in ways that are consistent with this phenomenological approach. A number of psychophysiological investigations of reversal theory by Svebak and his colleagues have placed relatively more emphasis on the question of metamotivational mode (i.e. at a particular time in an experiment) than on metamotivational dominance, and have employed a measure of telic and paratelic states to track the course of reversals during a laboratory session [18]. Other investigators have made extensive use of interview methods to examine both metamotivational mode dominance and [ 17,19,22,27]. Using these techniques is clearly more labour-intensive and costly than simply administering a single personality inventory, but is far more likely to produce data that reflects the inconsistency and complexity of human motivation and behaviour as postulated by reversal theory. When we engage in educational activities with patients, we often assume that they are in the telic, conformist, autocentric mastery modes and that they will continue to be in these modes. Reversal theory suggests that individuals are inconsistent and that sometimes they are in modes that may not be conducive to following medical recommendations. For instance, the studies reviewed in the paper by Gerkovich, Cook, O’Connell and Potocky in this issue show that subjects are relatively more likely to relapse to smoking when they are in paratelic, negativistic or sympathy modes. Patient educators might therefore improve patients’ adherence to regimens by being aware of the metamotivational modes that are actually being experienced by their patients. In this way,

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strategies to improve compliance could be tailored to take into account the metamotivational mode of the patient.

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7. References

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Apter MJ: Reversal theory and personality: a review. J Res Pers 1984; 18: 265-288. 2 Apter MJ: Fawlty Towers: a reversal theory analysis of a popular television comedy series. J Popular Culture 1982; 16: 128-138. and the theory of 3 Apter MJ, Smith KCP: Humour psychological reversals. In: Chapman A, Foot H eds. It’s a Funny Thing, Humour. Oxford: Pergamon, 1977. 4 Apter MJ, Smith KCP: Sexual behaviour and the theory of psychological reversals. In: Cook M, Wilson G eds. Love and Attraction: an International Conference. Oxford: Pergamon, 1979. 5 Hyers C: Reversal theory as a key to understanding religious diversity. In: Apter MJ, Fontana D, Murgatroyd S eds. Reversal Theory: Applications and Developments. Cardiff University College Cardiff Press, 1985. In: 6 Kerr J: A new perspective for sports psychology. Apter MJ, Fontana D, Murgatroyd S eds. Reversal Theory: Applications and Developments. Cardiff University College Cardiff Press, 1985. 7 Kerr J: Play, sport and the paratelic state. In:)Apter MJ, Kerr JH, Cowles MP eds. Progress in Reversal Theory. Amsterdam: North-Holland, 1988. ; 8 Apter MJ, Smith KCP: Experiencing personal relationships. In: Apter MJ, Fontana D, Murgatroyd S eds. Reversal Theory: Applications and Developments. Cardiff: University College Cardiff Press, 1985%. 9 Lachenicht L: A reversal theory of social relations applied to polite language. In: Apter MJ, Fontana D, Murgatroyd S eds. Reversal Theory: Applications and Developments. Cardiff: University College Cardiff Press, 1985. IO Anderson G, Brown RIF: Some applications of reversal theory to the explanation of gambling and gambling addictions. J Gambling Behaviour 1987; 3: 179-180. 11 O’Connell KA: Reversal theory and smoking cessation. In: Apter MJ, Kerr JH, Cowles MP eds. Progress in Reversal Theory. Amsterdam: North-Holland, 1988. 12 Martin RA, Kuiper NA, Olinger LJ, Dobbin J: Is stress always bad?: telic ‘versus paratelic dominance as a stressmoderating variable. J Pers Sot Psycho1 1987; 53: 970-982.

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