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The Person's Relating to Others Questionnaire (PROQ2)
Personality and Individual Differences 36 (2004) 125–140 www.elsevier.com/locate/paid
The Person’s Relating to Others Questionnaire (PROQ2) John Birtchnella,*, Chris Evansb,c a
PO59 Institute of Psychiatry, De Crespigny Park, Denmark Hill, London SE5 8AF, UK b Rampton Hospital, Notts, UK c Tavistock & Portman NHS Trust, London, UK
Received 17 June 2002; received in revised form 12 December 2002; accepted 27 January 2003
Abstract The scales of the Person’s Relating to Others Questionnaire correspond to the octants of an octagon constructed around a horizontal, close/distant axis, a vertical, upper/lower one, and four intermediate positions. The questionnaire was administered to 276 non-patients and 432 psychotherapy patients. All scales had good internal reliabilities. There were high positive correlations between some neighbouring scales, and moderate negative correlations between some opposite ones. A principal component analysis of scores, with a four component solution, generated a lower, an upper, a close/distant and an upper close component. A PCA of items, with an eight component solution, strongly supported the close, distant, upper, lower and upper close scales. For the non-patients, women were more upper close and men were more distant. For the patients, women were additionally more close, lower close and lower distant. The patients scored higher on all but the upper close and upper distant scales. # 2003 Elsevier Ltd. All rights reserved. Keywords: Interpersonal; Relating; Patients; Non-patients; Questionnaire; Psychometrics
1. Introduction The study introduces the Person’s Relating to Others Questionnaire (PROQ2), and examines its psychometric properties. The questionnaire is based upon a theory of relating (Birtchnell, 1996); so demonstrating the adequacy of its psychometric properties will provide some confirmation of the theory. The theory has been used to understand and clarify the relating deficits of patients seeking psychotherapy, and the PROQ2 has been used to identify and quantify such deficits
* Corresponding author. Fax (specifying for the attention of John Birtchnell, PO59) +44-207-703-5796. E-mail address: [email protected] (J. Birtchnell). 0191-8869/03/$ - see front matter # 2003 Elsevier Ltd. All rights reserved. doi:10.1016/S0191-8869(03)00073-4
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(Birtchnell, 1997a, 1999). The paper aims to show that psychotherapy patients have significantly higher scores than non-patients. 1.1. The underlying theory The questionnaire is based upon a theory, first called ‘‘spatial theory’’ (Birtchnell, 1996), and later called ‘‘relating theory’’ (Birtchnell, 1999), which proposes that relating can be defined within two intersecting axes; a horizontal one, concerning seeking involvement (closeness) versus seeking separation (distance) and a vertical one, concerning relating from above downwards (upperness) versus relating from below upwards (lowerness). Closeness, distance, upperness and lowerness are considered to be advantageous states of relatedness. No state is more or less important than any other, and each is appropriate to a different kind of interpersonal situation. In their simplicity, they might be conceived of as the fundamental components of relating behaviour; consequently they are recognisable, in a simpler form, in the relating of other animals. The behaviour of humans is more flexible than that of other animals; they are born only with dispositions to relate in these ways, and, during the course of maturation, they need to become competent and confident in their ability to attain and maintain each of the four states of relatedness. It has been found useful to consider classes of relating that constitute a blending of horizontal and vertical relating. There are four such classes which are called upper close (UC), lower close (LC), upper distant (UD) and lower distant (LD). When these are inserted between the four primary classes, a theoretical structure called the interpersonal octagon is created. Each of the eight positions of the octagon has a two-word name, the first word referring to the vertical axis, and the second referring to the horizontal one. For the four primary classes the word neutral is inserted where the word for the other axis would have been. Thus, they are called neutral close (NC), neutral distant (ND), upper neutral (UN) and lower neutral (LN). The argument goes that, since the states of relatedness represent innate objectives, which are vital to survival, if people cannot attain or maintain them competently, they may endeavour to do so incompetently, and this is what leads them into interpersonal difficulties. People who lack the competence or confidence to relate in a particular way have a number of options open to them. They may avoid one state of relatedness altogether, and cling anxiously to the opposite one. They may risk attaining a particular state but live in constant dread of losing it. They may force or seduce others into adopting either the same position on the horizontal axis, or into a reciprocal position on the vertical axis. For the sake of brevity, competent and confident relating is called positive, and incompetent and unconfident relating is called negative. For each of the eight octants, the characteristics of both positive and negative relating have been extensively defined (Birtchnell, 1996), and Fig. 1 provides summary definitions of each in two separate octagons. People who relate positively in all eight ways are called versatile, and they have few interpersonal difficulties. It is considered that people who seek psychotherapy are inclined to relate negatively in one or more of the eight ways, and one of the effects of psychotherapy is the reduction in negative relating. The PROQ2 was designed as a measure of negative relating, in each of the eight octants of the octagon. Some therapists have used it as a means of identifying areas of negative relating, which may then form the foci of therapy. It can be repeated at intervals throughout the therapy and at termination, to indicate where there has been improvement (Birtchnell, 1999). Comparison of PROQ2 scores at the beginning and at the end of therapy is the subject of a separate paper (Birtchnell, 2002).
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Fig. 1. Positive (upper diagram) and negative (lower diagram) forms or relating. The pairs of initial letters are abbreviations for the full names of the octants given in the text. The diagrams first appeared in Birtchnell (1994). Copyright The Tavistock Institute, 1994. Reproduced with permission.
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1.2. Comparing the interpersonal octagon with the interpersonal circle Relating theory and the interpersonal octagon bear some similarities to a body of theory, measurement and research called ‘‘interpersonal theory’’ (Kiesler, 1996; Leary, 1957). Interpersonal theory is constructed around a theoretical structure called the interpersonal circle, which has a number of versions and which has sometimes eight and sometimes sixteen segments. Clearly there are similarities between these two models but there are also major differences (Birtchnell, 1990, 1994, 1996, 1997b; Birtchnell & Shine, 2000). In Birtchnell and Shine (2000), eight differences between the octagon and the circle were enumerated. Two are particularly relevant to the present study. They concern two qualities of the interpersonal circle which do not apply to the interpersonal octagon. These are called intensity and bipolarity. Intensity, which is related to the mathematical structure called the radex (Guttman, 1954), means that maladjustment increases with increasing distance from the centre of the circle. For the circle, normality is represented at the centre and abnormality is represented at the periphery; so, in effect, abnormality is an extreme version of normality. Bipolarity, which is related to the mathematical structure called the circumplex (Guttman, 1954), means that attributes located on one side of the circle are the bipolar opposite of those located on the opposite side, so that a high score for one attribute implies a low score for the other. The principle of the circumplex is so central to interpersonal theory that the designers of some measures have forced bipolarity by selecting items for opposite octants that literally are opposites (Wiggins, 1979; Wiggins, Trapnell, & Phillips, 1988). In relating theory, in place of the radex, there are two separate octants, one concerning positive relating and one concerning negative relating (Fig. 1). Remembering the ideal that a person should be competent (relate positively) in all eight octants, were there a measure of positive relating, a versatile person would obtain maximum points on every octant. Similarly, on a measure of negative relating (which the PROQ2 is), a person who is universally incompetent (relates negatively in all eight octants), would obtain maximum points on every octant. No psychotherapy patient has ever scored in that way, but some have come close; and it is not that unusual, and perfectly reasonable within the framework of the theory, for a patient to register high scores on two opposite octants; so octants of the octagon are not necessarily bipolar, though a degree of bipolarity is sometimes apparent. Kiesler (2000), one of the main proponents of the interpersonal circle model, complained of a lack of adequate, published, psychometric data for the PROQ2. There are some problems with the analysis of a flexibility/restriction model of competencies and problems in relating, like the relating theory and interpersonal octagon model. These are clarified in the methods below. However, Kiesler’s complaint was an important one, and the present study aims to address this concern.
2. Method 2.1. Sources of participants The non-patient sample was a sample of convenience from two sources: a psychology graduate distributed copies of the PROQ2 to his friends and 99 completed questionnaires were returned to
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him. He was not given the respondents’ ages or genders. A lecturer at a college of further education distributed copies of the PROQ2 to students in selected classes and 207 questionnaires were returned to her (from 151 women and 56 men). The ages were classified under the three headings 18–25, 26–39 and 40–55. When participants with incomplete responses were eliminated the numbers were reduced to 93 gender unknown, 133 women and 50 men, providing a total sample of 276. The psychotherapy patients were obtained from three psychotherapy department in which the PROQ2 is administered routinely before the beginning of therapy. In all three departments, ethical approval was obtained and patients were informed that they were not obliged to complete the questionnaires, but they rarely refused. At the time of the cut-off date, there were 124, 179 and 199 from the three departments, providing a total sample of 502 (357 women and 145 men). When participants with incomplete responses were eliminated the numbers were reduced to 307 women and 125 men, providing a total sample of 432. The exact ages were provided for all but three patients, two women and one man. 2.2. The measure The PROQ2 is a self-administered questionnaire which has 96 items, twelve for each octant. Two of these twelve items refer to positive relating, and are not normally scored. They are included to reduce the negative tone of the questionnaire and to increase the motivation to complete it. Their removal leaves the 10 scored items per octant which indicate negative relating. The items contributing to each octant are randomly distributed throughout the questionnaire, and the questionnaire is scored by computer. For each item, there is a choice of four responses: ‘‘Nearly always true,’’ ‘‘Quite often true,’’ ‘‘Sometimes true’’ and ‘‘Rarely true,’’ which carry a score of 3, 2, 1 and 0. Thus, the maximum score for each octant is 30, and the maximum total score is 240. The computer produces both a numerical and a graphic representation of the scores (see Birtchnell, 1996, 1997a, 1999, 2001). In the computer print-out, and in the analyses presented in this paper, octants are referred to by the initial letters of their two word name, and are presented in sequence, in a clockwise direction around the octagon, starting with UN. The reader should remember that U=upper, L=lower, C=close, D=distant and N=neutral. The PROQ2 is the second version of the measure. The original version, as used in Birtchnell, Falkowski, and Steffert (1992), was revised in the light of the statistical analysis of the first 400 questionnaires. The objectives of the revision were to improve the clarity of the items, to more clearly define the response choices, to reduce the intercorrelation between scales and so discriminate more clearly between octants, and to improve the factorial structure. In the revision process, 10 items were rephrased, 20 were replaced, 10 were transferred from one scale to another and three were both rephrased and transferred. Selecting the best wording for the items was difficult because negative relating carries pejorative overtones, and is not something to which people will readily admit. Items have to be phrased in a way that enables the respondent to consider the acknowledged behaviour acceptable. The following list includes a high loading item from each of the eight scales: UN It annoys me when people will not do what I expect of them. UC I cannot resist trying to help those in need.
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NC I tend to get so close to people I can’t bear to let go of them. LC I can never be sure that people approve of me. LN I prefer it when someone else is in control. LD When there’s an argument I tend to give in. ND I don’t like others to know too much about me. UD I tend to get back at people who offend me.
2.3. The analyses Stored item responses from the PROQ2 analysis program were compiled into a single file using a perl script and analyzed using SPSS version 8.1.1. All analyses concerned only the 80 negative items, and were restricted to respondents with complete responses on all 80 items. Throughout Section 3, the analyses for the non-patient and patient samples will be presented so as to permit comparison between the two. Confidence intervals will be presented where possible, since the analyses are exploratory and magnitudes of effect are more important than statistical significance. The following analyses were carried out: 1. Internal consistency of the scales as indexed by coefficient alpha (Cronbach, 1951) and by item-total correlations. 2. Correlation between scales. With a circular ordering of scales, as is the case with both the interpersonal circle and the interpersonal octagon, a degree of overlap (indicated by positive correlations) is inevitable, particularly between neighbouring scales. High positive correlations between more distant scales, like a misfit in the PCA as described below, would be cause for concern about the model as a model of interpersonal trait differences. 3. In order to test the theoretical basis for the scales, a principal component analysis (PCA), involving intercorrelations between all 80 items was carried out, involving varimax rotation of eight components. Fit to the scale model supports the theoretical model, though misfit does not invalidate it, given that the theoretical model is of predispositions to areas of inflexibility in a general flexible pattern of relating, rather than a bipolarity model as in the interpersonal circle. Despite this restriction, if there were no link between the allocation of the items to octants of the model and their loadings in the PCA, it would indicate that the scoring by octants was not a valid way of measuring separate dimensions of difference between people in their relating problems. 4. Gender differences in terms of mean scores. Given widespread cultural norms, it would be anticipated that the negative relating of men would be more distant and upper and that of women would be more close and lower. 5. Differences in mean scores between patients and non-patients. Since the underlying theory presupposes that negative relating is a characteristic of patients seeking psychotherapy, major differences in mean scores are to be expected. If such differences are not demonstrated the PROQ2 would be shown to have no value as a measure of problems for patients entering psychotherapy.
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3. Results 3.1. Demographics Gender was not known for 93 of the non-patients. Of those for whom it was known, there was no difference in gender balance of the two samples, women accounting for 73% of the nonpatients and 71% of the patients. (Fisher’s exact test, two-tailed P=0.70). Exact age, as noted, was not recorded for the non-patients, though it was likely that the non-patients were younger. Age was known for 499 of the patients. Age ranged from 17 to 67 with a mean of 37.4 (95% CI 36.5–38.2). The women were slightly younger, mean 36.7 (CI 35.7–37.7) compared with 39.0 (CI 37.4–40.6) for the men. Mann–Whitney test P=0.03. 3.2. Comparison of the three patient sub-samples The three centres did not differ significantly in gender balance, women accounting for 75, 72 and 68% (exact P=0.36). The ages did not differ significantly (Kruskal–Wallis P=0.65; mean ages: 37,9, 37.6 and 36.8. A MANOVA of the eight octant scores showed the effect of centre to be non-significant. 3.3. Percent returning complete questionnaires The percentage of participants who completed all 80 items of the questionnaire was 90.8 for the non-patients and 86.1 for the patients. (Fisher’s exact test, two-tailed P=0.46). Non-completion was not related to gender or age in the patients. 3.4. Internal consistency of octant scales Internal consistencies of the scale scores for the respondents with complete item data for the 80 negative items are shown in Table 1. When respondents with complete data on the scale but not all the other scales were included, all values were within 0.015 of the reported values in the table, suggesting that selective non-response did not have a major effect. All of the scales for the patients showed alpha coefficients above 0.80, as did all but three of the scales for the non-patients, the lowest alpha being 0.73 for UD. There were three corrected itemtotal correlations below 0.3 in the non-patients and one in the patients. The differences between Table 1 Internal consistency (coefficient alpha) of the octant scales for the non-patients and patients
Non-patients Non-patients CI Patients Patients CI P difference
UN
UC
NC
LC
LN
LD
ND
UD
0.75 0.71–0.80 0.80 0.77–0.83 0.038
0.85 0.82–0.87 0.86 0.84–0.88 0.243
0.82 0.79–0.85 0.83 0.80–0.85 0.426
0.85 0.82–0.87 0.82 0.79–0.84 0.037
0.84 0.81–0.86 0.83 0.81–0.86 0.439
0.84 0.81–0.87 0.86 0.84–0.88 0.140
0.79 0.75–0.82 0.84 0.81–0.86 0.010
0.73 0.68–0.78 0.81 0.78–0.83 0.001
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the samples in scale alphas were statistically significant for UN, LC, ND and UD. However, the magnitudes of the differences were not large, and the sample sizes give considerable power to detect quite small differences. In both samples, there were small gender differences, the alphas tending to be slightly higher for men. 3.5. Inter-octant correlations Table 2 shows the Spearman’s rho correlations between scale scores for the non-patients (non, upper row) and patients (pat, lower row). Because all items concern negative relating, positive correlations were to be expected, particularly between neighbouring octant scales. Correlations were particularly high between the adjacent octant scales UN and UD (0.63 non, 0.66 pat) and LN and LD (0.67 non, 0.64 pat), suggesting that these pairs of octants are not as clearly distinct as dimensions of difference between people as a nomothetic application (i.e. a fixed problem version of the octant model) would suggest. There were high correlations between all three lower octants, indicating that respondents had difficulty distinguishing between the three sub-classes of lowerness. Unexpectedly, the correlation between LC and LD (0.55 non, 0.57 pat) was higher than that between LC and LN (0.40 non, 0.39 pat), which further confirms that all three octants Table 2 Correlation matrix (Spearman’s rho) of the octant scales, moving in an anticlockwise and clockwise direction around the octagon, for the non-patients (Non) and patients (Pat) Anticlockwise Non Pat Non Pat Non Pat Non Pat Non Pat Non Pat Non Pat Non Pat
LN 0.18 0.20 LD 0.21 0.25 ND 0.15 0.24 UD 0.06 0.12 UN 0.18 0.20 UC 0.21 0.25 NC 0.15 0.24 LC 0.06 0.12
Clockwise LD 0.10 0.24 ND 0.17 0.17 UD 0.12 0.08 UN 0.22 0.06 UC 0.26 0.15 NC 0.34 0.19 LC 0.34 0.36 LN 0.26 0.32
ND 0.19 0.20 UD 0.02 0.22 UN 0.16 0.09 UC 0.14 0.15 NC 0.37 0.29 LC 0.55 0.57 LN 0.08 0.07 LD 0.33 0.48
UD 0.63 0.66 UN 0.08 0.13 UC 0.43 0.25 NC 0.44 0.28 LC 0.40 0.39 LN 0.67 0.64 LD 0.21 0.16 ND 0.13 0.08
UN
UC
NC
LC
LN
LD
ND
UD
UC 0.08 0.13 NC 0.43 0.25 LC 0.44 0.23 LN 0.40 0.39 LD 0.67 0.64 ND 0.12 0.16 UD 0.13 0.08 UN 0.63 0.66
NC 0.16 0.09 LC 0.14 0.15 LN 0.37 0.29 LD 0.55 0.57 ND 0.08 0.07 UD 0.35 0.48 UN 0.19 0.20 UC 0.02 0.22
LC 0.22 0.06 LN 0.26 0.14 LD 0.34 0.19 ND 0.34 0.36 UD 0.26 0.32 UN 0.10 0.24 UC 0.17 0.17 NC 0.12 0.02
LN 0.18 0.20 LD 0.21 0.25 ND 0.15 0.24 UD 0.06 0.12 UN 0.18 0.20 UC 0.21 0.25 NC 0.15 0.24 LC 0.06 0.12
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of lowerness do not form separate dimensions of interpersonal difference. However, fitting with the model, there were moderately high negative correlations between opposite poles, UN:LN ( 0.18 non, 0.20 pat) and NC:ND ( 0.15 non, 0.24 pat), indicating a degree of bipolarity. There was quite marked bipolarity between UD and LD ( 0.33 non, 0.48 pat) but the negative correlation with LN was nearly as large ( 0.26 non, 0.32 pat). Generally, there were similar results for non-patients and patients, though there was a higher correlation for the patients between NC and both UC (0.43 non, 0.25 pat) and LC (0.44 non, 0.28 pat). Generally too, there were similar results for men and women, though, for men, the correlation was much higher for LD:LN (0.76 men, 0.58 women) and the bipolarity between NC and ND was more marked ( 0.33 men, 0.19 women). To clarify the correlation matrix of the patients, a principal component analysis was carried out on the octant scores. A varimax rotation of a four component solution produced a strong first component comprising the three lower octants, a second component contrasting UN and UD with LD, a third bipolar component contrasting ND and NC, and a fourth component comprising UC on its own. The scale correlations and the PCA of the scale scores showed some congruence with the octagonal model, but it was by no means complete. Hence, exploration of the item data was pursued to see if the misfit could be isolated to a small number of items, or was more general. 3.6. Principal component analysis (PCA) of items An eight component principal component analysis was carried out separately on the nonpatients and patients. The Kaiser–Meyer–Olkin measure of sampling adequacy was 0.82 for the non-patients and 0.88 for the patients. A scree plot suggested rotating eight, or perhaps six, components. Loadings were censored at 0.4, except where the item had no loading above 0.4. An attenuated account of the loadings will now be given. A more detailed account, and full listings of loadings, are available from the senior author. 3.6.1. Non-patients The rotated and unrotated component parameters for the non-patients are shown in Table 3. The scree plot showed a marked fall in variance across the first eight components, with a small Table 3 Principal component analysis of items—non-patients Component 1 Rotated component parameters Eigenvalue 6.6 % of Variance 8.3 Cumulative% 8.3 Unrotated component parameters Eigenvalue 12.0 % of Variance 15.0 Cumulative% 15.0
2
3
4
5
6
7
8
5.3 6.7 15.0
4.9 6.2 21.1
4.8 6.0 27.2
4.3 5.4 32.5
4.1 5.1 37.7
4.1 5.1 42.8
2.4 3.0 45.7
7.0 8.8 23.7
6.4 8.0 31.7
3.4 4.2 35.9
2.3 2.9 38.8
2.0 2.6 41.4
1.8 2.3 43.6
1.7 2.1 45.7
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but definite elbow after the eighth, supporting this choice of number of components to rotate. The eight components account for 45.7% of the variance. Eleven of the 80 items do not load above 0.4 on any of the varimax rotated components. Only six items show complex loadings using the 0.4 criterion. The analysis shows some very clear fit for the octagonal structure and some clear discrepancies. Component 1, comprising fifteen items, including two with no loadings above 0.4, is predominantly LC. Component 2, comprising 9 items, is entirely UC. Component 3, comprising 12 items, including two which narrowly miss the 0.4 criterion, is predominantly UN. Component 4, comprising 9 items, including two with no loadings above 0.4, is predominantly LN. Component 5, comprising 9 items, including one with no loadings above 0.4, is entirely ND. Component 6, comprising 9 items, six positively loaded and three negatively loaded, has a bipolar split between upper and lower items. Component 7, comprising 10 items, two with loadings below 0.4 is predominantly NC. Component 8, comprising 7 items, two with loadings below 0.4, is predominantly UD. Thus UN, UC, NC, LN, LC and ND are strongly supported, but UD and LD are diffused among other components. 3.6.2. Patients The rotated and unrotated component parameters for the patients are shown in Table 4. Again, the scree plot showed its last elbow after eight components. Six of the 80 items do not load above 0.4 on any of the varimax rotated components. Only seven items show complex loadings using the 0.4 criterion. The eight components account for 46.5% of the variance. This analysis is less supportive of the octagonal structure. Component 1, comprising 10 items, one with a loading of 0.4, is predominantly LN. Component 2, comprising 12 items, one with no loadings above 0.4 and two with complex loadings, is a mixture of LC and LD. Component 3, comprising ten items, one with a loading below 0.4, is entirely UC. Component 4, comprising 12 items, eight positively loaded and four negatively loaded, and one loading below 0.4, is a bipolar split between UD and LD. Component 5, comprising 12 items, two with a loading below 0.4, is predominantly ND. Component 6, comprising 12 items, one of which is complex, is predominantly UN. Component 7, comprising 10 items, one with a loading below 0.4 and two complex, is predominantly NC. Component 8, comprising only two items, both complex, appears to represent a sub-category of
Table 4 Principal component analysis of items—patients Component 1 Rotated component parameters Eigenvalue 5.6 % of Variance 6.9 Cumulative% 6.9 Unrotated component parameters Eigenvalue 11.5 % of Variance 14.4 Cumulative% 14.4
2
3
4
5
6
7
8
5.3 6.6 13.6
5.1 6.4 20.0
5.1 6.4 26.4
5.0 6.2 32.6
4.7 5.9 38.5
4.6 5.7 44.2
1.9 2.3 46.5
7.6 9.5 23.9
6.4 8.0 31.9
3.9 4.9 36.7
2.5 3.1 39.9
2.2 2.8 42.7
1.6 2.0 44.6
1.6 1.9 46.5
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LC. Thus UN, UC, NC, LN and ND are strongly supported, but this time, LC and LD have merged and UD and LD have become more clearly fused into a single bipolar factor. There is much agreement between the two sets of loadings. There are correspondences between non-patient component 1 and patient component 8, non-patient component 2 and patient component 3, non-patient component 3 and patient component 6, non-patient component 4 and patient component 1, component 5 of both samples, component 7 of both samples, and nonpatient component 8 and patient component 4. 3.7. Gender differences The mean scores for the 133 women and 50 men non-patients for whom the gender is known, and the 307 women and 125 men patients, are shown in Table 5. Even allowing for the fact that the confidence intervals in the smaller, non-patient sample are much larger, the gender differences are much more marked for the patients. Common to both samples is that women score significantly higher on UC (reaching out to people in need) and men score significantly higher on Table 5 Mean octant scores for the 133 women and 50 men of the non-patient sample, for whom the gender is known, and the 307 women and 125 men of the patient sample UN
UC
NC
LC
LN
Non-patients Women 13.4 23.0 11.7 8.7 11.5 SD 5.9 5.3 6.2 6.5 6.7 Men 14.5 18.3 10.3 10.3 12.2 SD 5.2 7.0 6.4 7.6 6.0 Difference 1.1 4.7 1.4 1.6 0.8 W M 3.0–0.8 2.5–6.9 0.6–3.5 3.8–0.67 2.9–1.4 CI difference t 1.2 4.3 1.4 1.4 0.7 P 0.25 < 0.0005 0.17 0.17 0.48 d 0.2 0.81 0.22 0.23 0.11 CI d 0.52–0.13 0.47–1.1 0.10–0.55 0.56–0.09 0.43–0.22 Patients Women SD Men SD Difference W M CI difference t P d CI d
15.7 7.1 17.1 7.1 1.4 2.9–0.1
22.7 6.3 17.4 8.0 5.7 3.8–6.9
15.4 7.8 12.3 7.9 3.1 1.4–4.7
22.5 6.4 18.1 6.9 4.4 3.0–5.8
14.8 7.6 12.3 7.1 2.4 0.8–4.0
LD 8.9 6.4 9.9 6.4 1.0 3.1–1.1
ND 8.3 5.9 12.2 5.5 4.0 5.9– 2.1
1.0 4.1 0.34 < 0.0005 0.16 0.67 0.48–0.17 1.0– 0.34
17.5 7.5 12.9 8.1 4.6 3.0–6.2
15.2 7.7 18.2 6.8 2.9 4.5– 1.4
UD 10.4 5.2 10.7 5.5 0.2
Total 95.9 26.7 98.5 28.4 2.5
2.0–1.5
11.4–6.7
0.3 0.80 0.06 0.38–.27
0.6 0.58 0.09 0.04– 0.15
10.3 6.6 12.6 7.3 2.3 3.7– 0.8
134.1 26.4 120.9 27.3 13.4 7.6–18.7
1.9 6.7 3.7 6.3 3.1 5.6 3.9 3.0 4.6 0.06 < 0.0005 < 0.0005 < 0.0005 < 0.0005 < 0.0005 < 0.0005 < 0.0005 < 0.0005 0.2 0.78 0.39 0.66 0.33 0.6 0.39 0.33 0.49 0.41–0.01 0.57–1.0 0.18–0.60 0.45–0.88 0.12–0.54 0.39–0.81 0.60– .18 0.54– 0.13 0.47–0.52
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ND (preferring to keep a safe distance). For the patients, the women score significantly higher on all three close scales (generally clinging) but they also score higher on LD (backing off and avoiding confrontation). 3.8. Age correlations Correlations with age were examined only in the larger, patient sample. The correlations were small, though some were highly statistically significant. The older women had lower scores on NC (rho= 0.20, P=0.001) and the older men had higher scores on UC (rho=0.28, P=0.002). 3.9. Comparing the mean scores of the non-patients and patients The mean octant scores for the 276 non-patients and 432 patients are shown in Table 6. The range of scores, as indicated by the standard deviations, was greater for the patients. For two of the scales (UD and UC) there was no significant difference between the mean scores of the two samples. For the remaining six scales the mean score of the patients was significantly higher than that of the non-patients. The effect sizes (d) for the statistically significant differences ranged from 0.26 (UN) to 1.71 (LC). The scales showing the biggest difference were LC, LD and ND. With the exception of the LC scale, the standard deviations were higher, sometimes dramatically so, for the patients than for the non-patients, and the differences were statistically significant.
4. Discussion The PROQ2 emerges from this study with many areas in which the pattern of differences between people in their responses to the 80 items fits a model of fixed predispositions to particular areas of difficulty in interpersonal relating. There are some issues that warrant further consideration. We cannot know the response rate of either source of non-patients, or what effect this may have had upon the composition of the sample. The non-patient sample was almost certainly younger than the patient sample and the general population, but from the age-comparisons that Table 6 Mean octant scores for the 278 non-patients and 432 patients UN
UC
NC
LC
LN
LD
ND
UD
Total
Non 14.3 21.5 11.8 9.5 11.4 9.3 9.6 11.1 98.5 SD 6.0 6.1 6.7 6.8 6.5 6.4 6.1 5.4 26.9 Pat 16.1 21.2 14.5 21.2 14.1 16.2 16.1 11.0 130.3 SD 7.1 7.2 7.9 6.9 7.5 7.9 7.6 6.9 27.3 Difference N P 1.8 0.4 2.7 11.7 2.8 6.9 6.5 0.1 31.7 CI difference 0.8– 2.7 1.4– 0.6 1.6– 3.8 10.7– 12.7 1.6– 3.7 5.8– 8.0 5.5– 7.5 1.0– 0.8 27.6–35.8 t 3.6 0.8 4.9 22.2 5.0 12.7 12.6 0.3 15.2 P < 0.0005 0.45 < 0.0005 < 0.0005 < 0.0005 < 0.0005 <0.0005 0.78 < 0.0005 d 0.26 0.06 0.36 1.71 0.38 0.94 0.92 0.02 1.17 CI d 0.11– 0.42 0.21– 0.10 0.21– 0.51 1.53– 1.88 0.22– 0.53 0.78– 1.09 0.76– 1.08 0.17– 0.13 1.16–1.18
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were made within the patient sample, it seems that age, though statistically significantly related to some octant scores, has only a very small magnitude of relationship with scores, and so is unlikely to have strongly influenced the comparisons that were made. It is encouraging that the gender balance in the non-patients for whom the gender was known, and patients was comparable. In the internal consistency calculations and the inter-scale correlations, the findings for the two samples were reassuringly comparable. The internal consistency for the majority of the non-patient scales and all of the patient scales was very good. This was also so in the Birtchnell and Shine (2000) study, carried out on a different sample. This may in part be due to the fact that all items are concerned with negative relating, though Birtchnell and Shine further showed that the alpha coefficients were substantially lower in three, randomly selected sets of 10 items. The high alphas may also indicate that 10 items per scale is unnecessary, and that a shorter version of the questionnaire may be feasible. The intercorrelation between scales is an improvement on the original version of the questionnaire. Since all scales are measures of negative relating, some degree of correlations must be unavoidable, but some correlations remain unacceptably high if the octants are regarded as dimensions of difference between people (what these correlation measures address). If the octants were dimensions of difference, the highest correlations should be between the main, or primary scales (those with the word neutral in their names) and the adjoining, intermediate scales; since conceptually, the intermediate scales represent a blending of two main scales, and should therefore carry some of the characteristics of the main scales to either side of them. This was indeed the case, the highest being between upper neutral and upper distant and lower neutral and lower distant. In creating an intermediate scale, the ideal blending would involve an equal contribution from each. In these two instances, because the correlation was higher with the vertical (upper or lower) scale, the contribution from the vertical scale must have been greater than that from the horizontal (distant) one; so as things stand, the upper distant scale is too upper and not distant enough, and the lower distant scale is too lower and not distant enough. Similarly, if the octant model were a model of restricting differences between people to the octants, and particularly if it were an intensity/bipolarity model, like the interpersonal circle, there would be minimal correlations between the primary vertical constructs and the primary horizontal ones. This was found for UN and NC and LN and ND, but less so for UN and ND and LN and NC. This implies that negatively upper people are inclined also to be somewhat negatively distant and negatively lower people are inclined also to be somewhat negatively close. Whilst this may indeed be understandable, it does mean that the horizontal and vertical axes are not entirely orthogonal as dimensions of interpersonal difference. Since the theory does not require the poles of an axis to be bipolar, no major bipolarity need be expected between them. In fact, there was some, slightly more in the non-patients than in the patients. This is not entirely surprising, since people who cannot bear to let go of others (NC) would be less likely not to want others to get too close to them (ND), and those who are annoyed when others do not do what they expect of them (UN) are less likely to prefer others to be in control of them (LN). However, the fact that the negative correlations are not great indicates that people sometimes do admit to both, apparently opposite, kinds of statement, and this is certainly observable in some individual patients. People are quite capable of swinging from one extreme to another, a reality that most therapists recognise in a subgroup of the population, but not a reality that can be tapped in traditional correlation analyses of cross-sectional data.
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The evidence for and against bipolarity in the four main constructs is mixed in the (patient) PCA of octant scores; the first, strong component being made up of the three lower scales (against), the next two being one that contrasts UN and UD with LD, and one that contrasts ND with NC (for). In the PCA of items, the evidence against is stronger than the evidence for. In the non-patients, there were four distinct factors that contained 8, 9, 8 and 8 of the 10 items of the main, NC, ND, UN and LN scales, respectively. In the patients, the same four factors contained 9, 10, 9 and 9 of the ten items of the same four scales. Thus, quite unlike the interpersonal circle, the interpersonal octagon provides discrete measures of negative relating in each of the four poles of the two main axes. Of the four intermediate scales, LC emerged as the most clinically relevant. In the Birtchnell and Shine (2000) study it showed high positive correlations with all the DSM-IV personality scales. In the present study, it was the scale which differentiated most clearly between the patients (mean 21.2) and the non-patients (mean 9.5), with an effect size as high as 1.71. In the non-patient sample all 10 of its items were included within the 15 items of the PCA first component. In the patient sample it contributed 7 items to the 12 of the second component, four others coming from LD. Conceptually, it comes closest to a measure of pathological dependence, which may well typify the most common type of psychotherapy patient. In both samples, it showed high correlations (0.55 and 0.57) with the LD scale. This makes good, clinical sense, in that pathologically dependent (LC) people are inclined to avoid confrontation (LD). The UC scale is quite the reverse. In the Birtchnell and Shine (2000) study, it was the only scale with no correlation with any of the DSM-IV personality scales, and in the present study, it was the only scale with a higher mean score for the non-patients than for the patients. It emerged in the PCA of scales as a separate, fourth component, and in the PCA of items, it contributed all nine items to the second component of the non-patients, and all 10 items to the third component of the patients. Conceptually, it comes closest to a measure of compulsive caring, which is perhaps more typical of therapists than of patients. Clearly, as it stands, it is not pathological enough. It needs to come closer to qualities such as jealousy, smothering and possessiveness. One rather surprising feature of the intermediate scales, evident in both the non-patients and the patients, is a moderately high positive correlation between UC and LD (0.21 and 0.25, respectively. In terms of classical interpersonal theory, these octants, located in opposite positions on the octagon, would be expected to be bipolar opposites. It implies that those who back away from confrontation with others are drawn towards people who need their help. This is a not entirely unreasonable possibility. The close alignment of the UD and LD scales with their vertical, neutral neighbours has already been commented upon. The correlation between them was quite substantially negative ( 0.35 for non-patients and 0.48 for patients) and on the PCA of scales they formed (with UN) part of a bipolar, third component. Where the UD scale did not differentiate between nonpatients and patients, the LD scale clearly did. The bipolarity is understandable, for where UD concerns retaliating, LD concerns backing away. The issue of validity has not been addressed in this paper, though obviously, it is important. The significant, high correlations between the scale scores of the PROQ2 and the PDQ-IV (Birtchnell & Shine, 2000; Hyler, 1994) is one indication of validity, as are the significantly higher scores of patients than non-patients on six of the eight PROQ2 scales. At an anecdotal level, psychotherapists have frequently been impressed by the correspondence between their own
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clinical assessments and the PROQ2 scores. Therapists who have become well-versed in relating theory, are able, with varying degrees of success, to predict their patients’ PROQ2 scores, and this has been formalised into an on-going study. What might be the most appropriate questionnaires with which to compare the PROQ2? The one that resembles it most closely in terms of item content is the Inventory of Interpersonal Problems (IIP) of Horrowitz, Rosenberg, Baer Ureno, and Villasenov (1988). Even though its factorial structure remains uncertain (Barkham, Hardy, & Startup, 1994; Savournin, Evans, Hirst, & Watson, 1995), its proposed scales, particularly the circumplex ones (Alden, Wiggins, & Pincus, 1990), bear some resemblance to those of the PROQ2. Early comparisons with the IIP have revealed some positive correlations between scales, and this work is continuing. The PROQ2 does not show the same degree of intercorrelation between items as the IIP, a feature that results in what some have called a general complaints factor. Riding and Cartwright (1999) familiarised themselves with the characteristics of the octants and selected items from the IIP that matched up with them. They then constructed a set of eight IIP scales that corresponded with the octants and examined these in a sample of 150 psychotherapy patients. The exercise was limited by the inadequate representation of certain octants in the IIP item pool. Their finding that men had significantly higher ND scores and women had significantly higher UC scores was similar to that observed in the present non-patient sample. They also found the UD scale to be a predictor of drop-out. An interesting feature of the study is the difference in the relationship between the PROQ2 scales and gender in the non-patient and patient samples. In the non-patient sample, women had a significantly higher mean score than men on only one scale (UC), but in the patient sample, they had significantly higher mean scores on three other scales (NC, LC and LD). Does this really mean that women psychotherapy patients relate more negatively than men, or are women more prepared than men to admit to negative relating, or do men have different kinds of problem? This is an issue worthy of further examination. 4.1. Practical note A copy of the PROQ2 with a full list of items and scoring details are available from the senior author on request. It may also be downloaded from the internet (www.johnbirtchnell.co.uk).
Acknowledgements The paper is based upon presentations to the Society for Psychotherapy Research, UK Chapter, annual meeting, Ravenscar, Yorkshire, 1999, and the European/UK Chapter, joint meeting, Leiden, The Netherlands, 2001. The non-patient data were collected by Robert Gough and Kim Woodbridge. The patient data were obtained from the NHS. psychotherapy departments in Northampton (Dr. Julie Roberts and colleagues) Canterbury (Dr. Graham Rehling and colleagues) and Redhill (Dr. John Stevens and colleagues). The scoring program for the PROQ2 was written by Bill Birtchnell.
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References Alden, L. E., Wiggins, J. S., & Pincus, A. L. (1990). Construction of circumplex scales for the Inventory of Interpersonal Problems. Journal of Personality Assessment, 55, 521–536. Barkham, M., Hardy, G. E., & Startup, M. (1994). The structure, validity and clinical relevance of the Inventory of Clinical Problems. British Journal of Medical Psychology, 67, 171–185. Birtchnell, J. (1990). Interpersonal theory: criticism, modification and elaboration. Human Relations, 43, 1183–1201. Birtchnell, J. (1994). The interpersonal octagon: an alternative to the interpersonal circle. Human Relations, 47, 511– 529. Birtchnell, J. (1996). How humans relate: a new interpersonal theory. Hove, East Sussex: Psychology Press. Birtchnell, J. (1997a). Attachment in an interpersonal context. British Journal of Medical Psychology, 70, 265–279. Birtchnell, J. (1997b). Personality set within an octagonal model of relating. In R. Plutchik, & H. Conte (Eds.), Circumplex models of personality and emotions. Washington, DC: American Psychological Association. Birtchnell, J. (1999). Relating in psychotherapy: the application of a new theory. Westport, CT: Praeger. Paperback edition, Hove, East Sussex: Brunner–Routledge, 2002. Birtchnell, J. (2001). Relating therapy with individuals, couples and families. Journal of Family Therapy, 23, 63–84. Birtchnell, J. (2002). Psychotherapy and the interpersonal octagon. Psychology & psychotherapy: theoryr Research and practice, 75, 349–363. Birtchnell, J., Falkowski, J., & Steffert, B. (1992). The negative relating of depressed patients: a new approach. Journal of Affective Disorders, 24, 165–176. Birtchnell, J., & Shine, J. (2000). Personality disorders and the interpersonal octagon. British Journal of Medical Psychology, 73, 433–448. Cronbach, L. J. (1951). Coefficient alpha and the internal structure of tests. Psychometrika, 16, 297–334. Guttman, L. A. (1954). A new approach to factor analysis: the radex. In P. R. Lazarsfeld (Ed.), Mathematical thinking in the social sciences. Glencoe, IL: Free Press. Horowitz, L. M., Rosenberg, S. E., Baer, B. A., Ureno, G., & Villasenor, V. S. (1988). Inventory of Interpersonal Problems: psychometric properties and clinical applications. Journal of Consulting and Clinical Psychology, 56, 885– 892. Hyler, S. E. (1994). Personality Diagnostic Questionnaire (fourth edition (PDQ-4)). New York, NY: New York State Psychiatric Institute. Kiesler, D. J. (1996). Contemporary interpersonal theory and research: personality, psychopathology and psychotherapy. New York: Wiley. Kiesler, D. J. (2000). A ‘‘relating circumplex’’ by any other name. . .. Contemporary Psychology: APA Review of Books, 46(6), 676–679. Leary, T. (1957). Interpersonal diagnosis of personality. New York: Ronald Press. Riding, N., & Cartwright, A. (1999). Interpreting the Inventory of Interpersonal Problems: subscales based on an interpersonal theory model. British Journal of Medical Psychology, 72, 407–420. Savournin, R., Evans, C., Hirst, J. F., & Watson, J. P. (1995). The elusive factor structure of the Inventory of Interpersonal Problems. British Journal of Medical Psychology, 68, 353–369. Wiggins, J. S. (1979). A psychological taxonomy of trait descriptive terms: the interpersonal domain. Journal of Personality and Social Psychology, 37, 395–412. Wiggins, J. S., Trapnell, P., & Phillips, N. (1988). Psychometric and geometric characteristics of the Revised Interpersonal Adjective Scales (IAS-R). Multivariate Behavioral Research, 23, 517–530.
The Person’s Relating to Others Questionnaire (PROQ2) John Birtchnella,*, Chris Evansb,c a
PO59 Institute of Psychiatry, De Crespigny Park, Denmark Hill, London SE5 8AF, UK b Rampton Hospital, Notts, UK c Tavistock & Portman NHS Trust, London, UK
Received 17 June 2002; received in revised form 12 December 2002; accepted 27 January 2003
Abstract The scales of the Person’s Relating to Others Questionnaire correspond to the octants of an octagon constructed around a horizontal, close/distant axis, a vertical, upper/lower one, and four intermediate positions. The questionnaire was administered to 276 non-patients and 432 psychotherapy patients. All scales had good internal reliabilities. There were high positive correlations between some neighbouring scales, and moderate negative correlations between some opposite ones. A principal component analysis of scores, with a four component solution, generated a lower, an upper, a close/distant and an upper close component. A PCA of items, with an eight component solution, strongly supported the close, distant, upper, lower and upper close scales. For the non-patients, women were more upper close and men were more distant. For the patients, women were additionally more close, lower close and lower distant. The patients scored higher on all but the upper close and upper distant scales. # 2003 Elsevier Ltd. All rights reserved. Keywords: Interpersonal; Relating; Patients; Non-patients; Questionnaire; Psychometrics
1. Introduction The study introduces the Person’s Relating to Others Questionnaire (PROQ2), and examines its psychometric properties. The questionnaire is based upon a theory of relating (Birtchnell, 1996); so demonstrating the adequacy of its psychometric properties will provide some confirmation of the theory. The theory has been used to understand and clarify the relating deficits of patients seeking psychotherapy, and the PROQ2 has been used to identify and quantify such deficits
* Corresponding author. Fax (specifying for the attention of John Birtchnell, PO59) +44-207-703-5796. E-mail address: [email protected] (J. Birtchnell). 0191-8869/03/$ - see front matter # 2003 Elsevier Ltd. All rights reserved. doi:10.1016/S0191-8869(03)00073-4
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(Birtchnell, 1997a, 1999). The paper aims to show that psychotherapy patients have significantly higher scores than non-patients. 1.1. The underlying theory The questionnaire is based upon a theory, first called ‘‘spatial theory’’ (Birtchnell, 1996), and later called ‘‘relating theory’’ (Birtchnell, 1999), which proposes that relating can be defined within two intersecting axes; a horizontal one, concerning seeking involvement (closeness) versus seeking separation (distance) and a vertical one, concerning relating from above downwards (upperness) versus relating from below upwards (lowerness). Closeness, distance, upperness and lowerness are considered to be advantageous states of relatedness. No state is more or less important than any other, and each is appropriate to a different kind of interpersonal situation. In their simplicity, they might be conceived of as the fundamental components of relating behaviour; consequently they are recognisable, in a simpler form, in the relating of other animals. The behaviour of humans is more flexible than that of other animals; they are born only with dispositions to relate in these ways, and, during the course of maturation, they need to become competent and confident in their ability to attain and maintain each of the four states of relatedness. It has been found useful to consider classes of relating that constitute a blending of horizontal and vertical relating. There are four such classes which are called upper close (UC), lower close (LC), upper distant (UD) and lower distant (LD). When these are inserted between the four primary classes, a theoretical structure called the interpersonal octagon is created. Each of the eight positions of the octagon has a two-word name, the first word referring to the vertical axis, and the second referring to the horizontal one. For the four primary classes the word neutral is inserted where the word for the other axis would have been. Thus, they are called neutral close (NC), neutral distant (ND), upper neutral (UN) and lower neutral (LN). The argument goes that, since the states of relatedness represent innate objectives, which are vital to survival, if people cannot attain or maintain them competently, they may endeavour to do so incompetently, and this is what leads them into interpersonal difficulties. People who lack the competence or confidence to relate in a particular way have a number of options open to them. They may avoid one state of relatedness altogether, and cling anxiously to the opposite one. They may risk attaining a particular state but live in constant dread of losing it. They may force or seduce others into adopting either the same position on the horizontal axis, or into a reciprocal position on the vertical axis. For the sake of brevity, competent and confident relating is called positive, and incompetent and unconfident relating is called negative. For each of the eight octants, the characteristics of both positive and negative relating have been extensively defined (Birtchnell, 1996), and Fig. 1 provides summary definitions of each in two separate octagons. People who relate positively in all eight ways are called versatile, and they have few interpersonal difficulties. It is considered that people who seek psychotherapy are inclined to relate negatively in one or more of the eight ways, and one of the effects of psychotherapy is the reduction in negative relating. The PROQ2 was designed as a measure of negative relating, in each of the eight octants of the octagon. Some therapists have used it as a means of identifying areas of negative relating, which may then form the foci of therapy. It can be repeated at intervals throughout the therapy and at termination, to indicate where there has been improvement (Birtchnell, 1999). Comparison of PROQ2 scores at the beginning and at the end of therapy is the subject of a separate paper (Birtchnell, 2002).
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Fig. 1. Positive (upper diagram) and negative (lower diagram) forms or relating. The pairs of initial letters are abbreviations for the full names of the octants given in the text. The diagrams first appeared in Birtchnell (1994). Copyright The Tavistock Institute, 1994. Reproduced with permission.
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1.2. Comparing the interpersonal octagon with the interpersonal circle Relating theory and the interpersonal octagon bear some similarities to a body of theory, measurement and research called ‘‘interpersonal theory’’ (Kiesler, 1996; Leary, 1957). Interpersonal theory is constructed around a theoretical structure called the interpersonal circle, which has a number of versions and which has sometimes eight and sometimes sixteen segments. Clearly there are similarities between these two models but there are also major differences (Birtchnell, 1990, 1994, 1996, 1997b; Birtchnell & Shine, 2000). In Birtchnell and Shine (2000), eight differences between the octagon and the circle were enumerated. Two are particularly relevant to the present study. They concern two qualities of the interpersonal circle which do not apply to the interpersonal octagon. These are called intensity and bipolarity. Intensity, which is related to the mathematical structure called the radex (Guttman, 1954), means that maladjustment increases with increasing distance from the centre of the circle. For the circle, normality is represented at the centre and abnormality is represented at the periphery; so, in effect, abnormality is an extreme version of normality. Bipolarity, which is related to the mathematical structure called the circumplex (Guttman, 1954), means that attributes located on one side of the circle are the bipolar opposite of those located on the opposite side, so that a high score for one attribute implies a low score for the other. The principle of the circumplex is so central to interpersonal theory that the designers of some measures have forced bipolarity by selecting items for opposite octants that literally are opposites (Wiggins, 1979; Wiggins, Trapnell, & Phillips, 1988). In relating theory, in place of the radex, there are two separate octants, one concerning positive relating and one concerning negative relating (Fig. 1). Remembering the ideal that a person should be competent (relate positively) in all eight octants, were there a measure of positive relating, a versatile person would obtain maximum points on every octant. Similarly, on a measure of negative relating (which the PROQ2 is), a person who is universally incompetent (relates negatively in all eight octants), would obtain maximum points on every octant. No psychotherapy patient has ever scored in that way, but some have come close; and it is not that unusual, and perfectly reasonable within the framework of the theory, for a patient to register high scores on two opposite octants; so octants of the octagon are not necessarily bipolar, though a degree of bipolarity is sometimes apparent. Kiesler (2000), one of the main proponents of the interpersonal circle model, complained of a lack of adequate, published, psychometric data for the PROQ2. There are some problems with the analysis of a flexibility/restriction model of competencies and problems in relating, like the relating theory and interpersonal octagon model. These are clarified in the methods below. However, Kiesler’s complaint was an important one, and the present study aims to address this concern.
2. Method 2.1. Sources of participants The non-patient sample was a sample of convenience from two sources: a psychology graduate distributed copies of the PROQ2 to his friends and 99 completed questionnaires were returned to
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him. He was not given the respondents’ ages or genders. A lecturer at a college of further education distributed copies of the PROQ2 to students in selected classes and 207 questionnaires were returned to her (from 151 women and 56 men). The ages were classified under the three headings 18–25, 26–39 and 40–55. When participants with incomplete responses were eliminated the numbers were reduced to 93 gender unknown, 133 women and 50 men, providing a total sample of 276. The psychotherapy patients were obtained from three psychotherapy department in which the PROQ2 is administered routinely before the beginning of therapy. In all three departments, ethical approval was obtained and patients were informed that they were not obliged to complete the questionnaires, but they rarely refused. At the time of the cut-off date, there were 124, 179 and 199 from the three departments, providing a total sample of 502 (357 women and 145 men). When participants with incomplete responses were eliminated the numbers were reduced to 307 women and 125 men, providing a total sample of 432. The exact ages were provided for all but three patients, two women and one man. 2.2. The measure The PROQ2 is a self-administered questionnaire which has 96 items, twelve for each octant. Two of these twelve items refer to positive relating, and are not normally scored. They are included to reduce the negative tone of the questionnaire and to increase the motivation to complete it. Their removal leaves the 10 scored items per octant which indicate negative relating. The items contributing to each octant are randomly distributed throughout the questionnaire, and the questionnaire is scored by computer. For each item, there is a choice of four responses: ‘‘Nearly always true,’’ ‘‘Quite often true,’’ ‘‘Sometimes true’’ and ‘‘Rarely true,’’ which carry a score of 3, 2, 1 and 0. Thus, the maximum score for each octant is 30, and the maximum total score is 240. The computer produces both a numerical and a graphic representation of the scores (see Birtchnell, 1996, 1997a, 1999, 2001). In the computer print-out, and in the analyses presented in this paper, octants are referred to by the initial letters of their two word name, and are presented in sequence, in a clockwise direction around the octagon, starting with UN. The reader should remember that U=upper, L=lower, C=close, D=distant and N=neutral. The PROQ2 is the second version of the measure. The original version, as used in Birtchnell, Falkowski, and Steffert (1992), was revised in the light of the statistical analysis of the first 400 questionnaires. The objectives of the revision were to improve the clarity of the items, to more clearly define the response choices, to reduce the intercorrelation between scales and so discriminate more clearly between octants, and to improve the factorial structure. In the revision process, 10 items were rephrased, 20 were replaced, 10 were transferred from one scale to another and three were both rephrased and transferred. Selecting the best wording for the items was difficult because negative relating carries pejorative overtones, and is not something to which people will readily admit. Items have to be phrased in a way that enables the respondent to consider the acknowledged behaviour acceptable. The following list includes a high loading item from each of the eight scales: UN It annoys me when people will not do what I expect of them. UC I cannot resist trying to help those in need.
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NC I tend to get so close to people I can’t bear to let go of them. LC I can never be sure that people approve of me. LN I prefer it when someone else is in control. LD When there’s an argument I tend to give in. ND I don’t like others to know too much about me. UD I tend to get back at people who offend me.
2.3. The analyses Stored item responses from the PROQ2 analysis program were compiled into a single file using a perl script and analyzed using SPSS version 8.1.1. All analyses concerned only the 80 negative items, and were restricted to respondents with complete responses on all 80 items. Throughout Section 3, the analyses for the non-patient and patient samples will be presented so as to permit comparison between the two. Confidence intervals will be presented where possible, since the analyses are exploratory and magnitudes of effect are more important than statistical significance. The following analyses were carried out: 1. Internal consistency of the scales as indexed by coefficient alpha (Cronbach, 1951) and by item-total correlations. 2. Correlation between scales. With a circular ordering of scales, as is the case with both the interpersonal circle and the interpersonal octagon, a degree of overlap (indicated by positive correlations) is inevitable, particularly between neighbouring scales. High positive correlations between more distant scales, like a misfit in the PCA as described below, would be cause for concern about the model as a model of interpersonal trait differences. 3. In order to test the theoretical basis for the scales, a principal component analysis (PCA), involving intercorrelations between all 80 items was carried out, involving varimax rotation of eight components. Fit to the scale model supports the theoretical model, though misfit does not invalidate it, given that the theoretical model is of predispositions to areas of inflexibility in a general flexible pattern of relating, rather than a bipolarity model as in the interpersonal circle. Despite this restriction, if there were no link between the allocation of the items to octants of the model and their loadings in the PCA, it would indicate that the scoring by octants was not a valid way of measuring separate dimensions of difference between people in their relating problems. 4. Gender differences in terms of mean scores. Given widespread cultural norms, it would be anticipated that the negative relating of men would be more distant and upper and that of women would be more close and lower. 5. Differences in mean scores between patients and non-patients. Since the underlying theory presupposes that negative relating is a characteristic of patients seeking psychotherapy, major differences in mean scores are to be expected. If such differences are not demonstrated the PROQ2 would be shown to have no value as a measure of problems for patients entering psychotherapy.
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3. Results 3.1. Demographics Gender was not known for 93 of the non-patients. Of those for whom it was known, there was no difference in gender balance of the two samples, women accounting for 73% of the nonpatients and 71% of the patients. (Fisher’s exact test, two-tailed P=0.70). Exact age, as noted, was not recorded for the non-patients, though it was likely that the non-patients were younger. Age was known for 499 of the patients. Age ranged from 17 to 67 with a mean of 37.4 (95% CI 36.5–38.2). The women were slightly younger, mean 36.7 (CI 35.7–37.7) compared with 39.0 (CI 37.4–40.6) for the men. Mann–Whitney test P=0.03. 3.2. Comparison of the three patient sub-samples The three centres did not differ significantly in gender balance, women accounting for 75, 72 and 68% (exact P=0.36). The ages did not differ significantly (Kruskal–Wallis P=0.65; mean ages: 37,9, 37.6 and 36.8. A MANOVA of the eight octant scores showed the effect of centre to be non-significant. 3.3. Percent returning complete questionnaires The percentage of participants who completed all 80 items of the questionnaire was 90.8 for the non-patients and 86.1 for the patients. (Fisher’s exact test, two-tailed P=0.46). Non-completion was not related to gender or age in the patients. 3.4. Internal consistency of octant scales Internal consistencies of the scale scores for the respondents with complete item data for the 80 negative items are shown in Table 1. When respondents with complete data on the scale but not all the other scales were included, all values were within 0.015 of the reported values in the table, suggesting that selective non-response did not have a major effect. All of the scales for the patients showed alpha coefficients above 0.80, as did all but three of the scales for the non-patients, the lowest alpha being 0.73 for UD. There were three corrected itemtotal correlations below 0.3 in the non-patients and one in the patients. The differences between Table 1 Internal consistency (coefficient alpha) of the octant scales for the non-patients and patients
Non-patients Non-patients CI Patients Patients CI P difference
UN
UC
NC
LC
LN
LD
ND
UD
0.75 0.71–0.80 0.80 0.77–0.83 0.038
0.85 0.82–0.87 0.86 0.84–0.88 0.243
0.82 0.79–0.85 0.83 0.80–0.85 0.426
0.85 0.82–0.87 0.82 0.79–0.84 0.037
0.84 0.81–0.86 0.83 0.81–0.86 0.439
0.84 0.81–0.87 0.86 0.84–0.88 0.140
0.79 0.75–0.82 0.84 0.81–0.86 0.010
0.73 0.68–0.78 0.81 0.78–0.83 0.001
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the samples in scale alphas were statistically significant for UN, LC, ND and UD. However, the magnitudes of the differences were not large, and the sample sizes give considerable power to detect quite small differences. In both samples, there were small gender differences, the alphas tending to be slightly higher for men. 3.5. Inter-octant correlations Table 2 shows the Spearman’s rho correlations between scale scores for the non-patients (non, upper row) and patients (pat, lower row). Because all items concern negative relating, positive correlations were to be expected, particularly between neighbouring octant scales. Correlations were particularly high between the adjacent octant scales UN and UD (0.63 non, 0.66 pat) and LN and LD (0.67 non, 0.64 pat), suggesting that these pairs of octants are not as clearly distinct as dimensions of difference between people as a nomothetic application (i.e. a fixed problem version of the octant model) would suggest. There were high correlations between all three lower octants, indicating that respondents had difficulty distinguishing between the three sub-classes of lowerness. Unexpectedly, the correlation between LC and LD (0.55 non, 0.57 pat) was higher than that between LC and LN (0.40 non, 0.39 pat), which further confirms that all three octants Table 2 Correlation matrix (Spearman’s rho) of the octant scales, moving in an anticlockwise and clockwise direction around the octagon, for the non-patients (Non) and patients (Pat) Anticlockwise Non Pat Non Pat Non Pat Non Pat Non Pat Non Pat Non Pat Non Pat
LN 0.18 0.20 LD 0.21 0.25 ND 0.15 0.24 UD 0.06 0.12 UN 0.18 0.20 UC 0.21 0.25 NC 0.15 0.24 LC 0.06 0.12
Clockwise LD 0.10 0.24 ND 0.17 0.17 UD 0.12 0.08 UN 0.22 0.06 UC 0.26 0.15 NC 0.34 0.19 LC 0.34 0.36 LN 0.26 0.32
ND 0.19 0.20 UD 0.02 0.22 UN 0.16 0.09 UC 0.14 0.15 NC 0.37 0.29 LC 0.55 0.57 LN 0.08 0.07 LD 0.33 0.48
UD 0.63 0.66 UN 0.08 0.13 UC 0.43 0.25 NC 0.44 0.28 LC 0.40 0.39 LN 0.67 0.64 LD 0.21 0.16 ND 0.13 0.08
UN
UC
NC
LC
LN
LD
ND
UD
UC 0.08 0.13 NC 0.43 0.25 LC 0.44 0.23 LN 0.40 0.39 LD 0.67 0.64 ND 0.12 0.16 UD 0.13 0.08 UN 0.63 0.66
NC 0.16 0.09 LC 0.14 0.15 LN 0.37 0.29 LD 0.55 0.57 ND 0.08 0.07 UD 0.35 0.48 UN 0.19 0.20 UC 0.02 0.22
LC 0.22 0.06 LN 0.26 0.14 LD 0.34 0.19 ND 0.34 0.36 UD 0.26 0.32 UN 0.10 0.24 UC 0.17 0.17 NC 0.12 0.02
LN 0.18 0.20 LD 0.21 0.25 ND 0.15 0.24 UD 0.06 0.12 UN 0.18 0.20 UC 0.21 0.25 NC 0.15 0.24 LC 0.06 0.12
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of lowerness do not form separate dimensions of interpersonal difference. However, fitting with the model, there were moderately high negative correlations between opposite poles, UN:LN ( 0.18 non, 0.20 pat) and NC:ND ( 0.15 non, 0.24 pat), indicating a degree of bipolarity. There was quite marked bipolarity between UD and LD ( 0.33 non, 0.48 pat) but the negative correlation with LN was nearly as large ( 0.26 non, 0.32 pat). Generally, there were similar results for non-patients and patients, though there was a higher correlation for the patients between NC and both UC (0.43 non, 0.25 pat) and LC (0.44 non, 0.28 pat). Generally too, there were similar results for men and women, though, for men, the correlation was much higher for LD:LN (0.76 men, 0.58 women) and the bipolarity between NC and ND was more marked ( 0.33 men, 0.19 women). To clarify the correlation matrix of the patients, a principal component analysis was carried out on the octant scores. A varimax rotation of a four component solution produced a strong first component comprising the three lower octants, a second component contrasting UN and UD with LD, a third bipolar component contrasting ND and NC, and a fourth component comprising UC on its own. The scale correlations and the PCA of the scale scores showed some congruence with the octagonal model, but it was by no means complete. Hence, exploration of the item data was pursued to see if the misfit could be isolated to a small number of items, or was more general. 3.6. Principal component analysis (PCA) of items An eight component principal component analysis was carried out separately on the nonpatients and patients. The Kaiser–Meyer–Olkin measure of sampling adequacy was 0.82 for the non-patients and 0.88 for the patients. A scree plot suggested rotating eight, or perhaps six, components. Loadings were censored at 0.4, except where the item had no loading above 0.4. An attenuated account of the loadings will now be given. A more detailed account, and full listings of loadings, are available from the senior author. 3.6.1. Non-patients The rotated and unrotated component parameters for the non-patients are shown in Table 3. The scree plot showed a marked fall in variance across the first eight components, with a small Table 3 Principal component analysis of items—non-patients Component 1 Rotated component parameters Eigenvalue 6.6 % of Variance 8.3 Cumulative% 8.3 Unrotated component parameters Eigenvalue 12.0 % of Variance 15.0 Cumulative% 15.0
2
3
4
5
6
7
8
5.3 6.7 15.0
4.9 6.2 21.1
4.8 6.0 27.2
4.3 5.4 32.5
4.1 5.1 37.7
4.1 5.1 42.8
2.4 3.0 45.7
7.0 8.8 23.7
6.4 8.0 31.7
3.4 4.2 35.9
2.3 2.9 38.8
2.0 2.6 41.4
1.8 2.3 43.6
1.7 2.1 45.7
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but definite elbow after the eighth, supporting this choice of number of components to rotate. The eight components account for 45.7% of the variance. Eleven of the 80 items do not load above 0.4 on any of the varimax rotated components. Only six items show complex loadings using the 0.4 criterion. The analysis shows some very clear fit for the octagonal structure and some clear discrepancies. Component 1, comprising fifteen items, including two with no loadings above 0.4, is predominantly LC. Component 2, comprising 9 items, is entirely UC. Component 3, comprising 12 items, including two which narrowly miss the 0.4 criterion, is predominantly UN. Component 4, comprising 9 items, including two with no loadings above 0.4, is predominantly LN. Component 5, comprising 9 items, including one with no loadings above 0.4, is entirely ND. Component 6, comprising 9 items, six positively loaded and three negatively loaded, has a bipolar split between upper and lower items. Component 7, comprising 10 items, two with loadings below 0.4 is predominantly NC. Component 8, comprising 7 items, two with loadings below 0.4, is predominantly UD. Thus UN, UC, NC, LN, LC and ND are strongly supported, but UD and LD are diffused among other components. 3.6.2. Patients The rotated and unrotated component parameters for the patients are shown in Table 4. Again, the scree plot showed its last elbow after eight components. Six of the 80 items do not load above 0.4 on any of the varimax rotated components. Only seven items show complex loadings using the 0.4 criterion. The eight components account for 46.5% of the variance. This analysis is less supportive of the octagonal structure. Component 1, comprising 10 items, one with a loading of 0.4, is predominantly LN. Component 2, comprising 12 items, one with no loadings above 0.4 and two with complex loadings, is a mixture of LC and LD. Component 3, comprising ten items, one with a loading below 0.4, is entirely UC. Component 4, comprising 12 items, eight positively loaded and four negatively loaded, and one loading below 0.4, is a bipolar split between UD and LD. Component 5, comprising 12 items, two with a loading below 0.4, is predominantly ND. Component 6, comprising 12 items, one of which is complex, is predominantly UN. Component 7, comprising 10 items, one with a loading below 0.4 and two complex, is predominantly NC. Component 8, comprising only two items, both complex, appears to represent a sub-category of
Table 4 Principal component analysis of items—patients Component 1 Rotated component parameters Eigenvalue 5.6 % of Variance 6.9 Cumulative% 6.9 Unrotated component parameters Eigenvalue 11.5 % of Variance 14.4 Cumulative% 14.4
2
3
4
5
6
7
8
5.3 6.6 13.6
5.1 6.4 20.0
5.1 6.4 26.4
5.0 6.2 32.6
4.7 5.9 38.5
4.6 5.7 44.2
1.9 2.3 46.5
7.6 9.5 23.9
6.4 8.0 31.9
3.9 4.9 36.7
2.5 3.1 39.9
2.2 2.8 42.7
1.6 2.0 44.6
1.6 1.9 46.5
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LC. Thus UN, UC, NC, LN and ND are strongly supported, but this time, LC and LD have merged and UD and LD have become more clearly fused into a single bipolar factor. There is much agreement between the two sets of loadings. There are correspondences between non-patient component 1 and patient component 8, non-patient component 2 and patient component 3, non-patient component 3 and patient component 6, non-patient component 4 and patient component 1, component 5 of both samples, component 7 of both samples, and nonpatient component 8 and patient component 4. 3.7. Gender differences The mean scores for the 133 women and 50 men non-patients for whom the gender is known, and the 307 women and 125 men patients, are shown in Table 5. Even allowing for the fact that the confidence intervals in the smaller, non-patient sample are much larger, the gender differences are much more marked for the patients. Common to both samples is that women score significantly higher on UC (reaching out to people in need) and men score significantly higher on Table 5 Mean octant scores for the 133 women and 50 men of the non-patient sample, for whom the gender is known, and the 307 women and 125 men of the patient sample UN
UC
NC
LC
LN
Non-patients Women 13.4 23.0 11.7 8.7 11.5 SD 5.9 5.3 6.2 6.5 6.7 Men 14.5 18.3 10.3 10.3 12.2 SD 5.2 7.0 6.4 7.6 6.0 Difference 1.1 4.7 1.4 1.6 0.8 W M 3.0–0.8 2.5–6.9 0.6–3.5 3.8–0.67 2.9–1.4 CI difference t 1.2 4.3 1.4 1.4 0.7 P 0.25 < 0.0005 0.17 0.17 0.48 d 0.2 0.81 0.22 0.23 0.11 CI d 0.52–0.13 0.47–1.1 0.10–0.55 0.56–0.09 0.43–0.22 Patients Women SD Men SD Difference W M CI difference t P d CI d
15.7 7.1 17.1 7.1 1.4 2.9–0.1
22.7 6.3 17.4 8.0 5.7 3.8–6.9
15.4 7.8 12.3 7.9 3.1 1.4–4.7
22.5 6.4 18.1 6.9 4.4 3.0–5.8
14.8 7.6 12.3 7.1 2.4 0.8–4.0
LD 8.9 6.4 9.9 6.4 1.0 3.1–1.1
ND 8.3 5.9 12.2 5.5 4.0 5.9– 2.1
1.0 4.1 0.34 < 0.0005 0.16 0.67 0.48–0.17 1.0– 0.34
17.5 7.5 12.9 8.1 4.6 3.0–6.2
15.2 7.7 18.2 6.8 2.9 4.5– 1.4
UD 10.4 5.2 10.7 5.5 0.2
Total 95.9 26.7 98.5 28.4 2.5
2.0–1.5
11.4–6.7
0.3 0.80 0.06 0.38–.27
0.6 0.58 0.09 0.04– 0.15
10.3 6.6 12.6 7.3 2.3 3.7– 0.8
134.1 26.4 120.9 27.3 13.4 7.6–18.7
1.9 6.7 3.7 6.3 3.1 5.6 3.9 3.0 4.6 0.06 < 0.0005 < 0.0005 < 0.0005 < 0.0005 < 0.0005 < 0.0005 < 0.0005 < 0.0005 0.2 0.78 0.39 0.66 0.33 0.6 0.39 0.33 0.49 0.41–0.01 0.57–1.0 0.18–0.60 0.45–0.88 0.12–0.54 0.39–0.81 0.60– .18 0.54– 0.13 0.47–0.52
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ND (preferring to keep a safe distance). For the patients, the women score significantly higher on all three close scales (generally clinging) but they also score higher on LD (backing off and avoiding confrontation). 3.8. Age correlations Correlations with age were examined only in the larger, patient sample. The correlations were small, though some were highly statistically significant. The older women had lower scores on NC (rho= 0.20, P=0.001) and the older men had higher scores on UC (rho=0.28, P=0.002). 3.9. Comparing the mean scores of the non-patients and patients The mean octant scores for the 276 non-patients and 432 patients are shown in Table 6. The range of scores, as indicated by the standard deviations, was greater for the patients. For two of the scales (UD and UC) there was no significant difference between the mean scores of the two samples. For the remaining six scales the mean score of the patients was significantly higher than that of the non-patients. The effect sizes (d) for the statistically significant differences ranged from 0.26 (UN) to 1.71 (LC). The scales showing the biggest difference were LC, LD and ND. With the exception of the LC scale, the standard deviations were higher, sometimes dramatically so, for the patients than for the non-patients, and the differences were statistically significant.
4. Discussion The PROQ2 emerges from this study with many areas in which the pattern of differences between people in their responses to the 80 items fits a model of fixed predispositions to particular areas of difficulty in interpersonal relating. There are some issues that warrant further consideration. We cannot know the response rate of either source of non-patients, or what effect this may have had upon the composition of the sample. The non-patient sample was almost certainly younger than the patient sample and the general population, but from the age-comparisons that Table 6 Mean octant scores for the 278 non-patients and 432 patients UN
UC
NC
LC
LN
LD
ND
UD
Total
Non 14.3 21.5 11.8 9.5 11.4 9.3 9.6 11.1 98.5 SD 6.0 6.1 6.7 6.8 6.5 6.4 6.1 5.4 26.9 Pat 16.1 21.2 14.5 21.2 14.1 16.2 16.1 11.0 130.3 SD 7.1 7.2 7.9 6.9 7.5 7.9 7.6 6.9 27.3 Difference N P 1.8 0.4 2.7 11.7 2.8 6.9 6.5 0.1 31.7 CI difference 0.8– 2.7 1.4– 0.6 1.6– 3.8 10.7– 12.7 1.6– 3.7 5.8– 8.0 5.5– 7.5 1.0– 0.8 27.6–35.8 t 3.6 0.8 4.9 22.2 5.0 12.7 12.6 0.3 15.2 P < 0.0005 0.45 < 0.0005 < 0.0005 < 0.0005 < 0.0005 <0.0005 0.78 < 0.0005 d 0.26 0.06 0.36 1.71 0.38 0.94 0.92 0.02 1.17 CI d 0.11– 0.42 0.21– 0.10 0.21– 0.51 1.53– 1.88 0.22– 0.53 0.78– 1.09 0.76– 1.08 0.17– 0.13 1.16–1.18
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were made within the patient sample, it seems that age, though statistically significantly related to some octant scores, has only a very small magnitude of relationship with scores, and so is unlikely to have strongly influenced the comparisons that were made. It is encouraging that the gender balance in the non-patients for whom the gender was known, and patients was comparable. In the internal consistency calculations and the inter-scale correlations, the findings for the two samples were reassuringly comparable. The internal consistency for the majority of the non-patient scales and all of the patient scales was very good. This was also so in the Birtchnell and Shine (2000) study, carried out on a different sample. This may in part be due to the fact that all items are concerned with negative relating, though Birtchnell and Shine further showed that the alpha coefficients were substantially lower in three, randomly selected sets of 10 items. The high alphas may also indicate that 10 items per scale is unnecessary, and that a shorter version of the questionnaire may be feasible. The intercorrelation between scales is an improvement on the original version of the questionnaire. Since all scales are measures of negative relating, some degree of correlations must be unavoidable, but some correlations remain unacceptably high if the octants are regarded as dimensions of difference between people (what these correlation measures address). If the octants were dimensions of difference, the highest correlations should be between the main, or primary scales (those with the word neutral in their names) and the adjoining, intermediate scales; since conceptually, the intermediate scales represent a blending of two main scales, and should therefore carry some of the characteristics of the main scales to either side of them. This was indeed the case, the highest being between upper neutral and upper distant and lower neutral and lower distant. In creating an intermediate scale, the ideal blending would involve an equal contribution from each. In these two instances, because the correlation was higher with the vertical (upper or lower) scale, the contribution from the vertical scale must have been greater than that from the horizontal (distant) one; so as things stand, the upper distant scale is too upper and not distant enough, and the lower distant scale is too lower and not distant enough. Similarly, if the octant model were a model of restricting differences between people to the octants, and particularly if it were an intensity/bipolarity model, like the interpersonal circle, there would be minimal correlations between the primary vertical constructs and the primary horizontal ones. This was found for UN and NC and LN and ND, but less so for UN and ND and LN and NC. This implies that negatively upper people are inclined also to be somewhat negatively distant and negatively lower people are inclined also to be somewhat negatively close. Whilst this may indeed be understandable, it does mean that the horizontal and vertical axes are not entirely orthogonal as dimensions of interpersonal difference. Since the theory does not require the poles of an axis to be bipolar, no major bipolarity need be expected between them. In fact, there was some, slightly more in the non-patients than in the patients. This is not entirely surprising, since people who cannot bear to let go of others (NC) would be less likely not to want others to get too close to them (ND), and those who are annoyed when others do not do what they expect of them (UN) are less likely to prefer others to be in control of them (LN). However, the fact that the negative correlations are not great indicates that people sometimes do admit to both, apparently opposite, kinds of statement, and this is certainly observable in some individual patients. People are quite capable of swinging from one extreme to another, a reality that most therapists recognise in a subgroup of the population, but not a reality that can be tapped in traditional correlation analyses of cross-sectional data.
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The evidence for and against bipolarity in the four main constructs is mixed in the (patient) PCA of octant scores; the first, strong component being made up of the three lower scales (against), the next two being one that contrasts UN and UD with LD, and one that contrasts ND with NC (for). In the PCA of items, the evidence against is stronger than the evidence for. In the non-patients, there were four distinct factors that contained 8, 9, 8 and 8 of the 10 items of the main, NC, ND, UN and LN scales, respectively. In the patients, the same four factors contained 9, 10, 9 and 9 of the ten items of the same four scales. Thus, quite unlike the interpersonal circle, the interpersonal octagon provides discrete measures of negative relating in each of the four poles of the two main axes. Of the four intermediate scales, LC emerged as the most clinically relevant. In the Birtchnell and Shine (2000) study it showed high positive correlations with all the DSM-IV personality scales. In the present study, it was the scale which differentiated most clearly between the patients (mean 21.2) and the non-patients (mean 9.5), with an effect size as high as 1.71. In the non-patient sample all 10 of its items were included within the 15 items of the PCA first component. In the patient sample it contributed 7 items to the 12 of the second component, four others coming from LD. Conceptually, it comes closest to a measure of pathological dependence, which may well typify the most common type of psychotherapy patient. In both samples, it showed high correlations (0.55 and 0.57) with the LD scale. This makes good, clinical sense, in that pathologically dependent (LC) people are inclined to avoid confrontation (LD). The UC scale is quite the reverse. In the Birtchnell and Shine (2000) study, it was the only scale with no correlation with any of the DSM-IV personality scales, and in the present study, it was the only scale with a higher mean score for the non-patients than for the patients. It emerged in the PCA of scales as a separate, fourth component, and in the PCA of items, it contributed all nine items to the second component of the non-patients, and all 10 items to the third component of the patients. Conceptually, it comes closest to a measure of compulsive caring, which is perhaps more typical of therapists than of patients. Clearly, as it stands, it is not pathological enough. It needs to come closer to qualities such as jealousy, smothering and possessiveness. One rather surprising feature of the intermediate scales, evident in both the non-patients and the patients, is a moderately high positive correlation between UC and LD (0.21 and 0.25, respectively. In terms of classical interpersonal theory, these octants, located in opposite positions on the octagon, would be expected to be bipolar opposites. It implies that those who back away from confrontation with others are drawn towards people who need their help. This is a not entirely unreasonable possibility. The close alignment of the UD and LD scales with their vertical, neutral neighbours has already been commented upon. The correlation between them was quite substantially negative ( 0.35 for non-patients and 0.48 for patients) and on the PCA of scales they formed (with UN) part of a bipolar, third component. Where the UD scale did not differentiate between nonpatients and patients, the LD scale clearly did. The bipolarity is understandable, for where UD concerns retaliating, LD concerns backing away. The issue of validity has not been addressed in this paper, though obviously, it is important. The significant, high correlations between the scale scores of the PROQ2 and the PDQ-IV (Birtchnell & Shine, 2000; Hyler, 1994) is one indication of validity, as are the significantly higher scores of patients than non-patients on six of the eight PROQ2 scales. At an anecdotal level, psychotherapists have frequently been impressed by the correspondence between their own
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clinical assessments and the PROQ2 scores. Therapists who have become well-versed in relating theory, are able, with varying degrees of success, to predict their patients’ PROQ2 scores, and this has been formalised into an on-going study. What might be the most appropriate questionnaires with which to compare the PROQ2? The one that resembles it most closely in terms of item content is the Inventory of Interpersonal Problems (IIP) of Horrowitz, Rosenberg, Baer Ureno, and Villasenov (1988). Even though its factorial structure remains uncertain (Barkham, Hardy, & Startup, 1994; Savournin, Evans, Hirst, & Watson, 1995), its proposed scales, particularly the circumplex ones (Alden, Wiggins, & Pincus, 1990), bear some resemblance to those of the PROQ2. Early comparisons with the IIP have revealed some positive correlations between scales, and this work is continuing. The PROQ2 does not show the same degree of intercorrelation between items as the IIP, a feature that results in what some have called a general complaints factor. Riding and Cartwright (1999) familiarised themselves with the characteristics of the octants and selected items from the IIP that matched up with them. They then constructed a set of eight IIP scales that corresponded with the octants and examined these in a sample of 150 psychotherapy patients. The exercise was limited by the inadequate representation of certain octants in the IIP item pool. Their finding that men had significantly higher ND scores and women had significantly higher UC scores was similar to that observed in the present non-patient sample. They also found the UD scale to be a predictor of drop-out. An interesting feature of the study is the difference in the relationship between the PROQ2 scales and gender in the non-patient and patient samples. In the non-patient sample, women had a significantly higher mean score than men on only one scale (UC), but in the patient sample, they had significantly higher mean scores on three other scales (NC, LC and LD). Does this really mean that women psychotherapy patients relate more negatively than men, or are women more prepared than men to admit to negative relating, or do men have different kinds of problem? This is an issue worthy of further examination. 4.1. Practical note A copy of the PROQ2 with a full list of items and scoring details are available from the senior author on request. It may also be downloaded from the internet (www.johnbirtchnell.co.uk).
Acknowledgements The paper is based upon presentations to the Society for Psychotherapy Research, UK Chapter, annual meeting, Ravenscar, Yorkshire, 1999, and the European/UK Chapter, joint meeting, Leiden, The Netherlands, 2001. The non-patient data were collected by Robert Gough and Kim Woodbridge. The patient data were obtained from the NHS. psychotherapy departments in Northampton (Dr. Julie Roberts and colleagues) Canterbury (Dr. Graham Rehling and colleagues) and Redhill (Dr. John Stevens and colleagues). The scoring program for the PROQ2 was written by Bill Birtchnell.
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