Revised Literature Review: The Role of Religious Coping and Superego Anxiety on Recovery From Substance Abuse and Depression
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The Role of Religious Coping and Superego Anxiety on Recovery
From Substance Abuse and Depression
Substance Abuse and Depression has been one of the most prevalent cases among the adolescents and the adults alike. The bulk of literature on coping has shown that individuals are not merely passive victims of their circumstances but are also active participants in their own affairs (Lazarus and Folkman, 1984; Pargament, 1997a). Moreover, coping is a process that changes with time (Lazarus and Folkman, 1984; Pargament, 1997a). Lazarus & Folkman (1984) and Marler & Thoresen (2002) suggested that in most circumstances individuals employ personal, social and situational factors in coping with stress. Pargament (1997a) and Koenig (1998) found that in stressful situations many people employ religion. They stated that for a religious person, religion contributes to both their self-definition and their coping strategies. Since some who profess spirituality (belief in God) or religiousness (the exercise of spirituality in an organized manner) do not actually practice their religion, the present study will focus on the actual use of spirituality or religion in times of stress (religious coping) rather than the mere profession of spirituality (belief in God) or religiousness (the exercise of spirituality in an organized manner). In this sense, the term “religious coping” bridges some of the implicit differences between spirituality (belief in God) and religiousness (the exercise of spirituality in an organized manner).
The adoption of religious coping depends on many factors that can be summarized into personal, social, and situational factors (Lazarus & Folkman 1984; Folkman et al. 1986; Bush et al., 1999; Pargament, 2000; Pargament, 2001; Harrison et al. 2001).
First, the adoption of religious coping depends on the extent religion is incorporated into subjects’ self-definition (Pargament, 2001). For some subjects, religion is intrinsically part of their lives, for some it is not, and for some it is a direct opposite of their belief and/or life. For some deeply religious people, religion is so ingrained in their subconscious that McIntosh (1995) speaks of religious schemas that influence how they receive and process information.
Secondly, the adoption of religious coping also depends on how a particular situation is appraised (Lazarus & Folkman, 1984; Folkman et al. 1986; Bush et al., 1999). For example, if a situation is appraised as life threatening or falling outside the realm of human control, religiously minded individuals are more likely to adopt religious coping than when the situation is judged otherwise. Even when the situation is deemed life threatening, Lazarus and Folkman (1984) warn that individuals do not automatically adopt religious coping.
Harrison et al. (2001, p. 90) tried to pinpoint situations under which religious coping is likely to be adopted. They found that religious coping is often adopted when faced with negative events or situations. In these situations, religious minded individuals use God to give meaning and purpose to negative events that happen in their lives. For example, a religiously minded individual may interpret a misfortune as an opportunity for spiritual growth (Pargament et al. 2000).
Pargament’s (2000, p. 520) study went a little further in noting that religious coping influences the appraisal of a supposedly stressful situation from harmful to benevolent, depending on whether the religious coping style adopted is either positive (empowering) or negative (demoralizing). For example, if a situation is appraised negatively as a punishment from God or a lesson from a punishing God the reaction will be different from when the situation is appraised positively as a temptation, or a test of commitment to God. However, the study did not address why a religiously minded individual will adopt for example, a negative religious coping style instead of a positive religious coping style in a particular situation. In addition, the study is unclear whether the accompanying relief from religious coping was temporary or permanent.
Religious coping and spiritual coping
Initially, there was no distinction between religion and spirituality (Pargament, 1999). Spilka and McIntosh (1996) held that the twosome were used interchangeably. Recently, the concept “religion” has attracted diverse meanings (Pargament, Balzar, Van Haitsma, & Raymark, 1995; Zinnbauer, 1997; Pargament, 1999); the literature suggests that religion is increasingly defined in organizational terms while spirituality is defined in more personal and experiential terms (Zinnbauer, 1997; Pargament, 1997; Pargament, 1999; Shahabi et al.; 2002).
Miller and Thoresen’s (2003) study stated that the multidimensionality of spirituality makes it easy for the concept to elude clear-cut definitions. They concluded it is easier to know what spirituality is not than what it is because people differ from each other when they are speaking of spirituality.
This development according to Sheldrake 1992 and Wulff 1997 has forced researchers to distinguish between spirituality (belief in God) and religion (the replication of that belief in organized way).
Spirituality has been defined in the context of a search for spiritual value (Pargament, 1999); or functional in nature as in the “search for universal truth” (Scott, 1997, p. 108), or as “a conscious or unconscious belief that relates the individual to the world and gives meaning and definition to existence” (Scott, 1997, p. 115) or as the opposite of materiality (Thoresen & Harris, 2002). In all, spirituality (belief in God) is dissociated from institution.
The new trend is attributed in part to the influx of eastern religions e.g., sects of Buddhism, which McLoughlin (1978) traced to the religious revitalization movements inherent in history. Other researchers such as Finke (1990); Finke & Stark (1986, 1992); Iannaccone (1991), Marler & Hadaway (2002) trace it to the 20th century “free market” approach to religion. This trend has thrown into question the once accepted definition of religion because of the need to incorporate different sects and practices. The situation has led to not only a more narrow definition of religion but also the delineation of the concept of spirituality in order to accommodate the different sects and practices.
The rise of secularism in the later part of the last century and the growing perception of institutional religion as a hindrance to personal religious growth and development is another reason for the development (Zinnbauer et al. 1997; Turner et al. 1995). This trend, as well as the influx of eastern religions came also the inherent feeling among researchers and the public that something is lacking in the way religion is define or understood (Pargament, 1999b).
Furthermore, Pargament (1999b) and Bibby (1987) held that the prevalent trend toward individuation and autonomy created a disdain for institution and the need to deinstitutionalize. The disdain toward institutions such as big governments and big companies was extended to religious institutions. The sociologist Roof (1993) found that baby boomers in the United States mistrust institutions of all kinds. Their tendency to pursue individualized beliefs and practice makes them more likely to commit to a spiritual quest than an institutionalized religion (Roof, 2000; Marler & Hadaway, 2002). Roof (2000) also found that spirituality was defined in personal and experiential terms, while religiousness included beliefs, practices and institution.
The findings of Roof (1993) and Bibby (1987) were replicated by Woods and Ironson (1999). In addition, Woods & Ironson (1999) found that those who reported spirituality (belief in God) were more likely to see God as more loving, nonjudgmental and forgiving, whereas those who reported religiousness (organized expression of that belief) saw God more as a judgmental creator.
This development, according to Pargament (1999, p. 5), is novel because historically, religion has not been viewed in a purely institutional sense nor was it only about God. Evidently, it is no longer surprising to hear people say “I am not a religious person, but I am spiritual” (Pargament, 1999, p. 4). The concepts “religion” and “spirituality” began to mean different thing to different people.
If the popular parlance is to say, “I am not religious, but I am spiritual,” to what extent therefore does the academic understanding of the term religious coping reflect the public notion of the term? This is necessary in order to abridge the gap between the academic construct of the terms “religion” and “spirituality” with the understanding of the concept by the participants in the study.
Marler and Hadaway’s (2002) review found that the two concepts are mutually overlapping when they took the definition of the concepts to the streets. They asked regular people what might be the definition of religion and of spirituality. An older baby boomer from New England saw spirituality as “how you look at life” and religion as “the clothing for it.” An ex-conservative Protestant now married to a Muslim in Georgia saw religiousness as “being active in the church and all that,” while being spiritual was “more of inner feelings and self.” Among many respondents, religion was “organized spirituality,” “the practice of spirituality,” or “that part of spiritual experience that is institutionalized.” Marler and Hadaway (2002, 295) concluded that for most people spirituality is about a connection between the individual and some larger power, while religion is the organized expression of that connection.
Zinnbauer et al. (1999) reviewed the literature on religion and spirituality. They concluded that the two concepts are conceptually overlapping. The same finding was also replicated by Hill et al. (2000) and Marler & Hadaway (2002). Both Zinnbauer et al. (1999) and Hill et al. (2000) warn against ignoring the reality that spirituality and religion are inherently intertwined and that those who polarize the concepts oversimplify them.
In a broad based sample, Zinnbauer et al. (1997, 562) found that ninety-three percent (93%) of the respondents consider themselves spiritual; seventy-eight percent (78%) identify themselves as religious. However, they recognized that different religious and cultural groups assign different meanings to the term religiousness and spirituality. They advocated operationalizing the definition of religiousness and spirituality in a way that reflects the variety of perspectives in the sample. They also found that seventy-four percent (74%) of their sample saw religion in the same way as spirituality and did not see the need to choose between them. Although almost every one in the study believed they were spiritual, the correlation in the participants’ definition of spirituality was essentially zero. There was even less correlation in the manner mental health professionals in the study rated themselves as spiritual or religious. The study also found that more than any group, the mental health workers rate themselves spiritual more often than religious. The study points to a potential bias in psychotherapy (Kelly, 1990; Schwen & Schau, 1990) where religious solutions may be considered maladaptive or the therapist may implicitly impose his or her spiritual or secular worldview on a religiously minded client.
Marler and Hadaway (2002) review suggested that the large discrepancy between the number of those who rated themselves spiritual rather than religious in most studies on spirituality and religion depends on how the question was framed. They stated that both Roof (1993) and 1999 Gallup poll from which many of the studies were based assumed that being religious and being spiritual were mutually exclusive and did not give the respondents the choice to be both spiritual and religious. They asserted that in the Zinnbauer et al. (1997) study in which the choice was given, seventy-four (74%) of the subjects rated themselves both spiritual and religious as opposed to nineteen percent (19%) that rated themselves spiritual or the four percent (4%) that rated themselves religious. In the Marler and Hadaway (1993) study where the same choice was available to the participants, sixty-four percent (64.2%) rated themselves both spiritual and religious as opposed to nineteen percent (18.5%) and the nine percent (8.9%) that are reportedly either spiritual or religious alone.
The present study will therefore adopt Pargament’s (1999, p. 15) broadband definition of religion which includes not just institutions but all sacredness including spirituality. Religion is defined as a “search for significance in ways related to the sacred” (Pargament, 1999, p. 11). By significance, he meant, “whatever people value in their lives – be it psychological, social, physical or spiritual; be it good or bad” (Pargament, 1999, p.11). Pargament (1999, p. 12) divided the search into “a pathway and a destination”. He posited that pathways might not necessarily lead to sacred destinations because people involve themselves in religion for many reasons that may not be spiritual. What was required of each search, according to Pargament (1999, p.12) was a sacred pathway. He likened sacred pathways with religious attendance, rituals, coping, etc. Hence, the search for the sacred qualifies as religious no matter the destination. In this vein, religion is considered a broader concept than the bad, narrow and institutionally definition that is an oversimplification of an otherwise complex construct.
Psychoanalysis and religion
Religious coping (the use of spirituality or religion to cope in times of stress) has received both positive and negative evaluation from the fathers of psychoanalysis over the course of the history of psychoanalysis.
In three papers, Freud (1907; 1928; 1939) discussed religious coping and its impact on the society. His view on the origin and use of religious coping is more negative than positive. First, Freud (1928) held that religious belief is the product of primitive man’s (sic) frustrations in confronting forces beyond his (sic) control (instinctual and external). In man’s (sic) attempt to guide against unbearable forces and the subsequent anxiety from failure to deal with these forces, he (sic) projects his wishful fantasy of an omnipotent father onto the concept of God to guide and protect him from danger (Freud, 1939). By using religion as a means of coping with feelings of helplessness, man (sic) fulfills his unconscious wish for an omnipotent father by actually living and acting as if there is an omnipotent father or God to guide and protect him (sic) in times of danger. Therefore, religious coping, according to Freud fosters regression to childhood dependency. Freud (1928) stated that the strength of man’s fantasy of an omnipotent father is contingent upon the strength of his dependency issues; the use of religious coping has provided the avenue for man’s (sic) fantasy to be sustained and maintained. With the dawn of civilization, man (sic), according to Freud, attained the age of reason; subsequently religion outlived its usefulness. Freud argues that it is incumbent that the wish for an omnipotent father is replaced because continual reliance on this fantasy fosters childhood neurosis by enabling illusory infantile wishes to be sustained and maintained. Freud (1928, p. 49) writes: “men cannot remain children for ever; they must in the end go out into hostile life. We may call this education to reality.@
In Obsessive acts and religious practices, Freud (1907) held that religious rituals are analogous to symptomatic efforts to cope with unconscious guilt from the oedipal complex. The emphasis on guilt and punishment prevalent in religious rituals, according to Freud, aim at assuaging unconscious guilt from the oedipal complex. Freud (1907) held that through religious rites and rituals, the community’s unconscious guilt as well as the efforts to assuage guilt is reinforced and maintained; community neurosis is thereby sustained and maintained. This, according to Freud, (1928) hinders ego development by consistently fostering regression and obsessional neurosis.
Freud did not advocate immediate eradication of religious coping because that would create by his admission a dangerous void. For the unsophisticated, Freud allowed religious coping as their only means of sustaining civility in the state. Freud (1928/1913) saw in psychoanalysis a vehicle through which preparation for the replacement of religion can be achieved. Despite his idea that religion helps to maintain stability in the state for the unsophisticated, he was never in doubt that societies and individuals will be better, if individuals rely on science rather than religion in dealing with their problems. If religious coping fosters childhood and societal obsessional neuroses and needs to be replaced by science, there is no gainsaying that Freud’s view of religious coping is at most not favorable.
In A Common Faith, John Dewey (1934, p. 46) distinguished between what he called religion and religious experience. Like Freud, he held that religious coping is a hindrance to man’s attainment of his potentialities. Through religious coping, man (sic) continues to sustain the idea of God’s intervention in human affairs thereby relying on some external power to fulfill his responsibilities.
Flugel (1945) held that religious coping is a defense against anxiety from noxious impulses that are difficult to confront. He stated that the concept of God or an omnipotent father is a projection of a weak ego in defense of the anxiety from having to deal with the conflict between the demands of the id (basic drives) and superego (conscience). Flugel (1945) explained it by saying that the developing ego lacked libidinal energy to confront the conflicts between the instincts and the demands of conscience. In defense, the developing ego projects a disguised superego that now appears as an outside observer, otherwise known as an omnipotent and independent person i.e. God, as a defense against the anxiety of mediating between the conflicts of the id and the superego. In this sense, religious coping provides an opportunity for man to hide from his responsibilities by relying on external factor or God instead of facing realities.
Karl Marx regarded religion as “the opium of the masses.” He advocated eradication of religious coping because of his belief that religious coping hinder the working class from seeking their due rights. For Marx, religious coping represent both an expression of symptoms as well as a resistance to real expression of symptoms. It is an unconscious effort to maintain substitutive fantasy of an omnipotent God and some reward that comes with a fulfillment of an action either here or hereafter. In religious coping, this fantasy is not only maintained but lived out in religious rites and rituals such that prayers and religious rites become magical means of realizing these fantasies (Argyle, 1959).
Unlike Freud, Jung traced religious coping to the human psyche. In Psychology and religion, Jung (1938) stated that religious coping is a psychological phenomenon that is ingrained in the collective unconscious. Like Freud, Jung held that religious coping is symptomatic of unconscious conflicts but unlike Freud, Jung believed that religious coping is also therapeutic, in the sense that through religious coping unconscious conflicts are not just played out but also sublimated. In this vein, religious coping facilitates ego development through the process of identification and misidentification.
In Psychoanalysis and religion, Fromm (1950) stated that the relationship between psychoanalysis and religion is too complex to be forced into either one or two categories.
In 1983, Bergen reviewed the literature on the relationship between religious coping and mental health. He found that the literature was inconclusive. Forty-seven percent (47%) of the studies reported positive relationship between religion and mental health, twenty-three percent (23%) reported negative correlation between religion and mental health while thirty percent (30%) reported no relationship between the two.
In another review by Gartner, Larson, and Allen (1991), the emphasis was on how mental health was defined. They found that when the definition of mental health was based on what they called Ahard variables@ or “behavioral events that can be reliably observed and measured,” a positive correlation was found between religion and mental health. However, when the emphasis was on what they called Asoft variable@ that is, “paper and pencil personality tests which attempts to measure theoretical constructs,@ religion was found to correlate negatively with mental health.
In their review of the literature eighteen years later, Harrison et al. (2001) found that religious coping is linked to a variety of psychological and health indicators. They also found a great deal of variations in the size and strength of the relationship between religious coping and mental health. The study found that religious coping was common among many groups; people were more likely to adopt religious coping when faced with hopelessness and helplessness. Religious coping was prominent in situations such as terminal illnesses (Mickley et al., 1998), bereavement (Thompson & Vardaman, 1997), depression (Bickel et al., 1998), chronic pain (Bush et al., 1999), and serious life stressors (Park, Cohen, and Herb, 1990). In all, religion was found to correlate with mental health when the emphasis is on positive religious coping (Pargament, 2001) and positive appraisal (Lazarus and Folkman, 1984).
Although there is significant empirical evidence supporting a positive correlation between religious coping and mental health, there is a dearth of literature on how religious coping may interact with substance abuse and superego anxiety in depressed substance abusers. Depressed substance abusers share a sense of helplessness and hopelessness reminiscent of those who use religious coping to deal with life threatening situations but whether this helplessness and hopelessness rises to the level experienced by bereaved or terminally ill patients is not clear.
In some studies, a negative correlation was found between religiousness and substance abuse disorders (Gartner, Larson, & Allen, 1991; Gorsuch, 1995; Kendler, Gardner, & Prescott, 1997; Miller, 1998), in the sense that substance abusers were less likely to go to church, temple or synagogue; in another study, it was found to depend on the type of substance used (Uchendu, 2002).
The relationship between substance use and depression is well documented in addiction literature. In Civilization and its discontents, Freud (1930) saw addiction as a flight from “unpleasures” by escaping to a fantasized world. Like Freud, most psychodynamic theories adopted the notion that substance abuse is a medication for underlying psychological problems. The exact nature of this underlying problem has not been resolved. It has been described as depression (Rabo, 1933), euphoria of drunkenness (Fenichel, 1945), Character problems (Wieder & Kaplan, 1969), childhood trauma (Raskin, 1970), painful affect from ego deficits (Khantzian, 1985), defect in the self (Kohut, 1977), vulnerability or deficiency in self-regulation and efforts to overcome them (Golden, 1990). In all, substance abuse is considered a mask to an underlying psychological problem. The choice of depressed substance abusers for the present study is based on the idea that substance abuse is a mask for an underlying depression. In the present study, the degree of substance abuse will be predicated on the severity of depression, while the severity of depression will be contingent on the measure of superego anxiety.
Purpose of Study
This study aims to contribute to the literature by arguing out that the various outcomes often associated with religion depend on the type of religious coping adopted – positive or negative. It hypothesizes that the negative outcome often associated with religion and mental health is based on the erroneous identification of religion with negative religious coping. The present study also hypothesizes that the adoption of negative religious coping is associated with harsh superego or strong parental disavowal.
Building on the negative correlation between church attendance and substance use (Chang et al. 2001; Koenig, 2001), and the correlation between positive religious coping and mental health, the study aims at a psychotherapy technique that incorporate positive religious coping for clients with substance abuse and depression. In addition, the study has implication for both religiously and non-religiously minded clients who may be using negative religious coping style in attempts to cope with stressful situations like substance abuse and depression. The whole idea is summarized in these hypotheses.
This paper shall test the following null hypothesis:
1. The identification of religion with negative religious coping is positively related to the negative outcome of religion and mental health such as substance abuse and depression
I. Subjects who score high in positive religious coping will also report a high length of recovery from substance abuse.
II. Subjects who score high in positive religious coping will also report a high length of recovery from depression.
III. Subjects who score high in negative religious coping will report a lower length of recovery from substance abuse.
IV. Subjects who score high in negative religious coping will also report a lower length of recovery from depression.
2. There is a significant correlation between negative religious coping, harsh superego and strong parental disavowal, and the substance abuse and depression recovery of the patient
V. Subjects who score high in superego anxiety measure will also report negative religious coping because of introjected parental disavowal or harsh superego anxiety.
VI. Subjects who score high in superego anxiety measure will also report a lower length of recovery from substance abuse.
VII. Subjects who score high in superego anxiety measure will report a lower length of recovery from depression.
VIII. Subjects who score low in superego anxiety measure will also score high in positive religious coping.
IX. Subjects who score low in superego anxiety measure will report a higher length of recovery from substance abuse.
X. Subjects who score low in superego anxiety measure will report a higher length of recovery from depression.
The general subjects of this study numbering to fifty (50) will be drawn from outpatient substance abuse treatment centers and AA groups in Nassau and Suffolk counties in Long Island as well as in Brooklyn, Bronx and Queens' boroughs of New York. A majority of the participants will be drawn from the outpatient substance abuse program in Creedmoor psychiatric center in Queens' village. Participants will be made up of depressed substance abusers. The criteria for inclusion will include:
(a) Subject must be an adult (at least 18 years of age by the time of the interview).
(b) Subjects must have at least a year history of substance abuse and depression.
(c) Subjects must have a clinical diagnosis of substance abuse and depression.
(d) Subjects with psychosis e.g. schizophrenia, are ruled out.
This is a correlational study. The measures will consist of a demographic form that will include among other things subjects’ family history, history of depression, history of substance abuse, days of abstinence, and length of recovery from substance abuse and depression. Subjects’ psychiatric history is tailored to rule out subjects that do not meet the criteria of inclusion. Three scales will be used, the Beck depression inventory (BDI-II), Pargament et al. (2000) religious coping scale (Rcope), Early memory test, and the Thematic Apperception Test (TAT).
Religious Coping Scale
Pargament et al. (2000) religious coping scale (Rcope) consists of 21 subscales of 5-items to which participants respond on a 4-point scale ranging from “O” representing “not at all” to 3, which represents “a great deal.” The scale was normed with a college and a hospital sample. Reliability estimates of the subscales were generally high (alpha = .80 or greater) with the exception of two scales none of which were adopted for the present study. The four subscales selected for the present study are not only among the most reliable but also among the most commonly used subscales. The four subscales include, seeking control through a partnership with God in problem solving (collaborative religious coping subscale - alpha = .89). Redefining stressor as benevolent and potentially beneficial (benevolent religious reappraisal subscale - alpha = .91). Dissatisfaction with God’s relationship with the individual in the stressful situation (spiritual discontent - alpha =.88), and passively waiting for God to control the situation (passive religious deferral - alpha = .83). The four subscales were selected to satisfy two positive and two negative sides of Rcope. The variations in internal consistency between positive and negative subscales were underscored by Pargament et al. (2000).
Beck Depressive Inventory II (BDI-II).
The BDI-II is a self-report analysis of occurrence and severity of depressive symptoms. BDI-II reliability studies indicate a coefficient alpha of .92 for an outpatient population. This is an improvement because BDI-I had a coefficient alpha = .86. Unlike BDI-I, BDI-II is positively correlated with the Hamilton Psychiatric Rating Scale for Depression (r.71, n = 87; Beck et al. 1996). It is also consistent with DSM-IV criteria for depression (Smith & Erford, 1998). Like most measures, it is not an actual diagnosis of depression (Sundberg, 1987) because that will require in addition, a clinical judgment. BDI-II contains 21 items on a scale of 0-3 rated according to severity. It was written at the 5th grade reading level (Conoley, 1987). Since BDI-II is a new diagnostic tool, much is not known, except that five percent of the standardization samples were minorities. It is also said to be an updated version of BDI-IA, which was found to apply across racial/cultural categories (Ames, Gatewood-Colwell, & Kaczmarek, 1989).
However, differences were found in frequency and severity in the expression of depressive symptoms between men and women in the standardization sample (Beck, Brown, & Steer, 1989).
Thematic Apperception Test (TAT):
Joseph’s (2003) superego anxiety measure will be used to score five depression and substance abuse eliciting TAT cards (1, 2, 3BM, 3GF, 13MF) to determine subjects’ level of superego anxiety. Participants will be required to make up a story with this directive: “Use the picture to make up a story as you please. Describe first, what is happening in the picture right now. Secondly, write briefly, what led to it and thirdly, what happened after it. Describe what the character(s) in the picture is (a) feeling and, (b) Thinking.”
The cards were selected because they were associated with depressive symptoms (Coche & Sillitti, 1983). In addition, Coche and Sillitti (1983) reported that the presence of depressive themes on the TAT was correlated with measures of depression on MMPI and Beck Depression Inventory, one of the scales in the study.
Picture # 1:
This is a picture of a boy sitting at a table looking at a violin placed on the table in front of him.
The picture elicits how subjects deal with impulse versus control, personal demands and external controlling agent, and general attitude toward authority (Groth-Marnat, 1999).
Picture # 2:
This is a picture of a country scene with a woman holding a book in the foreground. In the background, a man is working a field while a woman watches.
This picture elicits issues of autonomy from the family versus status quo. It also deals with how individuals cope with challenges of people living together, competition among siblings etc (Groth-Marnat, 1999).
Picture # 3:
A boy is huddled next to a couch. On the floor next to him is an ambiguous object that could be a set of keys or a revolver.
This picture centers on an individual who has been emotionally involved with another person or who is feeling guilty over some past behavior he has committed. Drug addicts often perceive the person in the picture as an addict (Groth-Marnat, 1999).
Picture # 4:
A woman is standing next to an open door with one hand grabbing the side of the door and other holding her downcast face.
This picture elicits stories on interpersonal loss and contemplated harm because of guilt over past behavior (Groth-Marnat, 1999).
Picture # 5:
A young man is standing in the foreground with his head in his arms. In the background is a half-naked woman lying in a bed.
This picture elicits stories on sexual conflicts. It also focuses on guilt induced by illicit sexual activity (Groth-Marnat, 1999).
Joseph Superego Anxiety Measure
Joseph’s (2003) superego anxiety measure was designed to measure three ways of expressing critical attitudes from narrative material. This measure consists of three subscales. The subscale I measures self-criticism. The subscale II, measures perceived criticism of others, and the subscale III measures criticism of others, condition, situation or environment.
The narratives from the early memory and TAT stories will be scored by reading and scoring each sentence for the presence or absence of subscale I, II and III. Sentences receive one score. Since it is a measure of explicitly stated attitudes, sentences are scored only when critical attitude are reflected in them. A sentence may be scored for the presence of any of the three types of criticism at the same time. Critical attitudes are not scored in sentences unless explicitly stated. With no training, Joseph’s superego anxiety scale was found to enjoy a moderate level of interrater reliability (r= .4 to .6). By the third time of scoring patient narratives, interrater reliability was found to be over .7. Three doctoral students trained in Joseph’s (2003) superego anxiety scale will rate the stories independently.
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