The Affect Phobia
as a
Unifying Theory of Change
Across Theoretical Orientations
Leigh McCullough, Lene Berggraf, and Pål Ulvenes
Modum Bad Research Institute Norway
Modum Bad Research Institute
Vikersund, Norway
McCullough, Berggraf & Ulvenes
SEPI 2010
Traditional Freudian Conflict Model
Learned and seen as
necessary to control primitive impulses
EGO
Super EGO
SELF
Rigid
Defensive
Barrier
ID
Beastial impulses need to be controlled
Berggraf & Ulvenes
Dual-Drive McCullough,
TheorySEPI
(sex
2010 and aggression)
An Updated Version of Freud’s Conflict Model
The UNIVERSAL PRINCIPLE OF PSYCHODYNAMIC PSYCHOTHERAPY
Learned from civilization
Sometimes helpful and sometimes hurtful
DEFENSES
ANXIETY - INHIBITION
SELF
Ideally, flexible
cognitive controls
that
guide feelings
ADAPTIVE
ACTIVATING FEELINGS
Biologically endowed
feelings.Berggraf
Natural
and adaptive responses
McCullough,
& Ulvenes
That need guidance, but
SEPInot
2010restriction (Tomkins)
Dollard and Miller (1950)
Stampfl and Levis (1967)
Feather and Rhoads (1972)
( Psychodynamic Behavior Therapy)
Paul Wachtel (1977)
(Behaviorism and Psychodynamics)
All believed that
Anxiety is aroused by the experience of a
specific drive or impulse.
Desensitization by exposure & prevention of avoidance
could be applied to help the patient reduce the anxiety.
McCullough, Berggraf & Ulvenes
SEPI 2010
Dollard and Miller pointed out that
Freud had observed that
anxiety can be steadily weakened by extinction
(1924; Vol 1, pp 241, 253-254).
McCullough, Berggraf & Ulvenes
SEPI 2010
Desensitization in STDP
DEFENSES-COPING
INHIBITORY AFFECTS
Thoughts, feelings, behaviors
Anxiety, guilt, shame, pain
RESPONSE PREVENTION
SELF
ACTIVATING AFFECTS
EXPOSURE
Sadness, Anger, Closeness, Positive Self Feeling, Interest, Joy
McCullough, Berggraf & Ulvenes
SEPI 2010
Comparing Dynamic & Learning Theories
TREATMENT
MODELS
ACTIVATIONAPPROACH
COMPONENT:
approach, action,
excitation, or
mobilization.
INHIBITIONAVOIDANT
COMPONENT
avoidance,
withdrawal
Signal danger
PROTECTIVE/
MAIN TREATMENT
COPING
GOAL
COMPONENT
Balance of
Responses that cope,
Opposing
protect, hide, cover Motivational Forces
up, defend (adaptive &
maladaptive)
Psychodynamic
Theory*
Learning &
Behavioral
Theory**
Updated Id:
Superego:
Ego:
Full range of
activating affects
& drives
Normative
rules to
manage Id &
Ego conflicts
Coping Skills &
Defense
Mechanisms
Affect responses
That become
Associated with
aversive stimuli
Inhibitory
affects &
conditioned
associations
Conditioned
Avoidant or
Protective
responses
McCullough, Berggraf & Ulvenes
SEPI 2010
Resolution of
Conflict
between the three
psychic
structures
To balance
approach &
avoidance:
Desensitization
Short Term Psychodynamic Models of Psychotherapy
TREATMENT
Short Term
Dynamic
Psychotherapy
McCullough
(and IEDTA)
ACTIVATION
APPROACH
COMPONENT:
INHIBITION AVOIDANT
COMPONENT
PROTECTIVE/
COPING
COMPONENT
MAIN GOAL OF
TREATMENT
Exposure to
Activating
Affects
Regulation of
Inhibitory
Affects
Build capacity to
recognize and
alter defensive/
maladaptive
patterns
Build Affective
Capacity :
by
Desensitization
McCullough, Berggraf & Ulvenes
SEPI 2010
TO WHAT EXTENT DO THESE 3 COMPONENTS:
ACTIVATION
INHIBITION
COPING RESPONSES
OCCUR IN OTHER FORMS OF THERAPY?
McCullough, Berggraf & Ulvenes
SEPI 2010
As we present
these many forms of therapy,
We want to emphasize,
that we are NOT attempting to reduce
all forms of therapy to
three simple components.
Each therapy model has beautiful and distinct
contributions to make!
We are just identifying some common factors
that we belive contribute to change
McCullough, Berggraf & Ulvenes
SEPI 2010
Psychodynamic Models of Psychotherapy
TREATMENT
MENTALISATION
Bateman,
Fonagy
TRANSFERENCE
FOCUSED
THERAPY
Kernberg.
Clarkin
ACTIVATION
APPROACH
COMPONENT:
INHIBITION AVOIDANT
COMPONENT
PROTECTIVE/
COPING
COMPONENT
MAIN GOAL OF
TREATMENT
Understand,
Understand and
Understand modes For the Patient to
reflect upon
of responding
Understand
regulate &
patients feelings
(e.g., psychic
others
reflect upon
and modes of
equivalence)
and
anxieties leading
responding
covering healthy
to feel
to modes of
feeling
understood
responding
Unconscious
conflicted
aggressive
feelings and
unintegrated &
polarized
feelings toward
self and others
Understand
reasons
(fears &
anxieties)
preventing
affective
resolution
McCullough, Berggraf & Ulvenes
SEPI 2010
Focus
On
Defenses
E.g,
Splitting
Integrate
polarized affect
states, and split
off self/other
representations
Defenses: MBT does not use the term "defense.’
MBT helps the patient distinguish how the reflective process
underlying uncertainty can regulate affect instead of
immediately going into modes such as
‘psychic equivalence’ and "assuming"
or letting the affects "decide" what transpired in reality.
These modes, (e.g., psychic equivalence and pretend mode),
underlie concepts such as pseudomentalising,
hypermentalising and different forms of acting out.
Can these be seen as "defenses" or
maladaptive coping patterns?
McCullough, Berggraf & Ulvenes
SEPI 2010
Anxiety/ Inhibition: MBT strives to regulate anxiety;
MBT is more anxiety regulating and works to
diffuse anxiety more than STDP.
(due to the focus on Borderline patients)
(STDP also uses greater anxiety regulation with
more severely ill patients.)
McCullough, Berggraf & Ulvenes
SEPI 2010
Exposure to Activating Affects: MBT does not emphasize
specific affect states per se, and does not use exposure.
MBT focuses more on the reasoning process (the modes) behind the
affect. It works to regulate and change affects by helping the patient
gain a more nuanced perspective on how situations in close
relationships have been poorly mentalized (or reflected upon).
(We would label this process, ‘Insight’).
The MBT therapist uses open questions to pursue affects and
affective/interpersonal problems.
MBT does not label affective states for patients with BPD as they see
this as a form of "planting" an idea instead of intervening in ways to
expand the patients perspective and push the patients to reflect for
themselves.
McCullough, Berggraf & Ulvenes
SEPI 2010
An Example of a patient ’Emma’
From the book by
Fonagy, P., Gergely, G., Jurist, E. and Target, M.
Affect Regulation, Mentalization,
& Development of the Self.
Other Press, New York. 2004
Pages 395 - 397
McCullough, Berggraf & Ulvenes
SEPI 2010
The patient, Emma, has a dream (p. 395-397).
A number of horses had broken out of their stables.
They were blind and threatened to trample all over her.
The therapist replied that Emma was terrified in case her anger
might break out of the stables she created for it and make
everyone in the ‘analytic hospital’ violent and mad.
(Later) Th: ’It is so painful for you to see the manifestations of
violence that being blind was almost preferable.’
Could this be an Affect Phobia about Anger?
McCullough, Berggraf & Ulvenes
SEPI 2010
The therapist replied that
Emma was terrified (INHIBITION)
in case somehow her anger (ACTIVATION)
might break out of the
stables she created for it (COPING-DEFENSES)
and make everyone in the ‘analytic hospital’ violent and mad.
(Later) Th: ‘It is so painful (INHIBITION)
for you to see the manifestations of violence (ACTIVATION)
that being blind (COPING – DEFENSES)
was almost preferable.’
Again, could this be an Affect Phobia?
McCullough, Berggraf & Ulvenes
SEPI 2010
Psychodynamic-Relational Models of Psychotherapy
TREATMENT
INTEGRATIVE
RELATIONAL
PSYCHODYNAMICS
Paul Wachtel
ACTIVATION
APPROACH
COMPONENT:
INHIBITION AVOIDANT
COMPONENT
PROTECTIVE/
COPING
COMPONENT
MAIN GOAL OF
TREATMENT
Exposure to
experiences that
were previously
avoided & kept
out of
awareness due
to fear, guilt and
shame
Anxiety
Guilt
Shame
That
Block
experience
Vicious
Cycles
that are
Consistently
Repeated
Over the
lifetime
To resolve these
conflicts
and vicious
cycles in
relationships
McCullough, Berggraf & Ulvenes
SEPI 2010
From Wachtel, Cyclical Psychodynamics, p. 181.
The patient John was a man who had not passed his
professional licensing exam.
Wachtel used gentle confrontation to uncover John’s
Defensive, dismissive response to the exam. (COPING)
And then used systematic desensitization to
Reduce his anxiety about the exam (INHIBITION)
But Wachtel also helped John see the
dynamic underpinnings of the defenses; his
disavowed wish for status and success (ACTIVATION)
that was learned from his parents
McCullough, Berggraf & Ulvenes
SEPI 2010
Barlow’s UNIFIED TREATMENT
(Cognitive Therapy)
TREATMENT
ACTIVATION
APPROACH
COMPONENT:
UNIFIED
TREATMENT
Facilitates
Expression
of
Action
Tendencies
& related
feelings
David Barlow
INHIBITION AVOIDANT
COMPONENT
COPING/
PROTECTIVE
COMPONENT
MAIN GOAL OF
TREATMENT
Response
Identify &
Facilitate
prevention
alter
action
of emotional Maladaptive tendencies by
avoidance
Cognitive
altering
Appraisals:
cognitive
appraisals, &
prevent
avoidance
McCullough, Berggraf & Ulvenes
SEPI 2010
Cognitive Models of Psychotherapy
TREATMENT
ACTIVATION
APPROACH
COMPONENT:
INHIBITION AVOIDANT
COMPONENT
COPING/
PROTECTIVE
COMPONENT
MAIN GOAL
OF
TREATMENT
CBT
Experimental Maladaptive Maladaptive To confirm
Edna Foa
tests that
emotional
responses
the validity
David Clark, trigger the
responses
that block and utility of
Aron Beck
avoided
that prevent the testing
the more
Adrian Wells
response &
adaptive
of
constructive &
Jeffrey Young
allow for
responding discomfirmadaptive
potential
atory
response
disconfirmexperiences
atory
experiences
McCullough, Berggraf & Ulvenes
SEPI 2010
.
In Young’s Schema Focused Therapy,
Schemas are maladaptive patterns that therapists need to
‘break and change.’ (COPING COMPONENTS?)
By identifying ‘avoidant strategies’ (INHIBITION?)
Schema Therapy focuses and streamlines therapy.
Young’s goals show strong similarity to
the Affect Phobia conceptualization, and
Barlow’s Unified Treatment model;
to help patients see the ‘avoidant strategies,’
give them up, and replace them with
a more constructive schema (ACTIVATION?).
McCullough, Berggraf & Ulvenes
SEPI 2010
Young gives an example of ‘Daniel’ who has fears
of closeness to women .
The therapist encourages him to imagine asking a
woman to dance. (EXPOSURE).
His anxiety increases at the thought, (INHIBITION)
but the therapist holds him in the imagery
(EXPOSURE) until he can feel relaxed and at ease
imagining this scene. (DESENSITIZATION)
Homework assignments are given to continue the
work outside the session. (MORE EXPOSURE) (pp.137- 140).
Although Young does not use the terms
‘exposure’ and ‘desensitization,’ can you see
these mechanisms
operation?
McCullough, Berggraf &in
Ulvenes
SEPI 2010
Behavioral Models of Psychotherapy
TREATMENT
ACTIVATION
APPROACH
COMPONENT:
CONSISTENCY
THEORY
Approach
Motivation
&
Approach
Goals
Klaus Grawe
DIALECTICAL
BEHAVIOR
THERAPY
Marsha Linehan
Mindfulness
to manage
feelings.
Focus on
self care &
compassion
INHIBITION
AVOIDANT
COMPONENT
COPINGPROTECTIVE
COMPONENT
Avoidance Motivation
&
Avoidance Goals
MAIN GOAL OF
TREATMENT
Balance
approach &
avoidance
motivation,
so goals are
consistent
Building
Identifies
Identifies
and reduces maladaptive coping skills,
self control,
guilt,
responses and self worth
anxiety & and adaptive
shame
alternatives
McCullough, Berggraf & Ulvenes
SEPI 2010
Experiential Models
TREATMENT
MODEL
EmotionFocused
Therapy
Les
Greenberg
ACTIVATION
APPROACH
COMPONENT:
INHIBITION AVOIDANT
COMPONENT
Focus on Specific Affects
and their functions
Primary Adaptive &
Maladaptive Affects
(Not Activation & Inhibition
Categories)
McCullough, Berggraf & Ulvenes
SEPI 2010
MAIN GOAL
COPINGOF
PROTECTIVE
TREATMENT
COMPON’T
Instru-
Attain
mental capacity to
and
use
Strategic emotions
Affects adaptively
as
motivators
of action
Greenberg does not conceptualize Activating and
Inhibitory affects in the same way we do, but the
FUNCTIONS can be observed in his examples;
‘Primary emotions need to be accessed for their
adaptive information and capacity to organize action.
Whereas maladaptive emotions need to be
regulated and transformed. (2004, p.7);
i.e, ‘Her anger undid her fear and the therapist supported
the client’s newfound sense of power.” (Ibid, p. 14).
The labels may differ, but can you see
the similar components?
McCullough, Berggraf & Ulvenes
SEPI 2010
We have looked at these components
across therapy models.
Now we will examine some data
in support of our premises.
McCullough, Berggraf & Ulvenes
SEPI 2010
The Affective Capacity Ratio
And
Frequency of Affect
Between CT and STDP
McCullough, Berggraf & Ulvenes
SEPI 2010
Videotapes from a
Clinical Trial of Psychotherapy
• Svartberg, Stiles & Seltzer, Am.J.
Psychiatry, 2004.
• Compared STDP with CT
• Patients with Axis II Cluster C Dx
(N=50), 40 sessions, all videotaped
The videotaped sessions 6 and 36, permit
analysis
of change processes
McCullough, Berggraf & Ulvenes
SEPI 2010
METHOD: ANALYSIS OF VIDEOTAPES OF THE
SVARTBERG, ET AL., 2004, RCT , AXIS II CLUSTER C PD
STDP
SIMILAR
OUTCOMES
CT
SIMILAR
PROCESSES
Improvement in both groups
Is related to:
DESENSITIZATION OF CONFLICTED AFFECTS
McCullough, Berggraf & Ulvenes
SEPI 2010
ATOS: The Achievement of
Therapeutic Objectives Scale
(McCullough et al.)
The ATOS scale evaluates how therapy impacts a
patient during each session
Like the assessment of blood levels for the
amount of medication absorbed,
...the ATOS ratings of patient behavior shows to
what degree specific therapeutic objectives are
absorbed or achieved
McCullough, Berggraf & Ulvenes
SEPI 2010
ATOS Scale - Common Factors
Measuring theAchievement of Therapeutic Objectives across
STDP and CBT
INSIGHT
MOTIVATION
EXPOSURE TO ACTIVATING FEELING
DECREASE OF INHIBITORY FEELINGS
NEW LEARNING
CHANGE IN SENSE OF SELF &
OTHERS
McCullough, Berggraf & Ulvenes
SEPI 2010
ATOS METHODS
 Each session is divided into five
10-minute segments
 For each segment the core
affective conflict is identified
 Then the achievement of each
objective is rated 1-100
McCullough, Berggraf & Ulvenes
SEPI 2010
BRIEF EXCERPTS FROM THE ACTIVATING AFFECT SCALE
51-60 Moderate affective arousal. Moderate duration. Moderate holding
back, e.g. tearing up, moderate anger, some tenderness. Moderate relief.
41-50 Low-moderate affective arousal. Mild feeling with much holding
back shown in face, vocal tone or body, e.g. briefly tears up, raises voice a
little in anger, or says a few tender words for short duration, speaks openly.
Mild relief.
31-40 Low affective arousal. Low, quickly passing experience of feeling
shown in face, vocal tone or body; e.g. clenching fist, choking up, grimaces,
sighs, slight sadness/anger/care for self but quickly stopped. A little relief.
21-30
Slight affective arousal. Minimal or barely visible/audible signs of
feeling of short duration shown in face, vocal tone or body.
11-20
No affective arousal, BUT bland verbal report of feeling. Almost no
expression on face. Flat/dull/bland tone of voice, stiff or barely moving body.
No relief
McCullough, Berggraf & Ulvenes
SEPI 2010
BRIEF EXCERPTS FROM THE INHIBITORY AFFECT SCALE
71-80 Much inhibitory affects. Much shakiness, hesitation, sighing, guardedness or
vigilance in tone of voice or non-verbal behavior. Much tightness, tension, rigidity.
Voice tone has much hesitant, trembling, inaudible. Much uneasiness.
61-70 High moderate inhibitory affect. More than moderate shakiness, hesitation, sighing or
guardedness or vigilance. More than moderately tight, tense, rigid. Tone of voice more
than moderately hesitant, trembling, or difficult to hear. More than moderate
uneasiness.
51-60 Moderate inhibitory affects. Moderate shakiness, hesitation, sighing or guardedness or
vigilance. Moderately tight, tense, rigid. Tone of voice moderately hesitant, trembling or
moderately difficult to hear. Moderate uneasiness.
41-50 Low-moderate inhibition. Low (less than) moderate shakiness, hesitation, sighing or
guardedness or vigilance. Less than moderate tightness, tension, or rigidity. Tone of
voice less than moderately hesitant, trembling or somewhat difficult to hear. Less than
moderate uneasiness.
31-40 Low inhibition. Low degree of shakiness, hesitance, sighing, guardedness, or vigilance.
Tone of voice shows only a low level of hesitance, trembling and is fairly audible. Low
levelBerggraf
of uneasiness.
McCullough,
& Ulvenes
SEPI 2010
Frequency of Affect Focus in STDP & CBT
The Predominant Affect Focus in each 10 minute segment of a session
Svartberg, Stiles, & Seltzer, Am J. Psychiatry (2004)
Total
Frequency
Short-term
Dynamic
Psychotherapy
Cognitive
therapy
Positive feelings about Self
Closeness/Tenderness
Grief
Interest/Excitement
Sexual feelings
Joy
323
251
160
113
8
1
0
143
137
87
62
4
0
0
180
114
73
51
4
1
0
Total N
856
433
423
AFFECT
Anger/Assertion
McCullough, Berggraf & Ulvenes
SEPI 2010
THE AFFECTIVE CAPACITY RATIO
LEVEL OF ADAPTIVE AFFECT EXPRESSION
(Sorrow, anger, closeness, self compassion)
AFFECTIVE
_________________________________
=
CAPACITY
LEVEL OF INHIBITORY AFFECT
(Anxiety, guilt, shame, pain)
McCullough, Berggraf & Ulvenes
SEPI 2010
CHANGE IN AFFECT PHOBIA ABOUT ANGER
Ratio = Intensity of Anger / Intensity of Inhibition
Early in therapy
(Session 6)
Late in therapy
Session 36 (of 40)
Total
Frequency
Mean Ratio
Activation/Inhibition
126
0.60 / 1.0
94
0.96 / 1.0
220
McCullough, Berggraf & Ulvenes
SEPI 2010
CHANGE IN PHOBIA ABOUT GRIEF/SADNESS
Ratio = Intensity of Grief / Intensity of Inhibition
Early in therapy
(Session 6)
Late in therapy
Session 36 (of 40)
Total
Frequency
Mean Ratio
Activation/Inhibition
45
0.70 / 1.0
32
1.25 / 1.0
77
McCullough, Berggraf & Ulvenes SEPI 2010
There were not strong differences
between STDP and CBT
In the ratio of
ACTIVATION to INHIBITION
Early to late in treatment
McCullough, Berggraf & Ulvenes
SEPI 2010
BUT….
IS THE CHANGE IN
AFFECT RATIO
ASSOCIATED WITH
OUTCOME??
McCullough, Berggraf & Ulvenes
SEPI 2010
How Activating and Inhibitory Affects
Lead to
AFFECT EXPRESSIVE CAPACITY
In three different patient populations treatments
Pål Ulvenes
Leigh McCullough, Lene Berggraf, Tore Stiles, Martin Svartberg
Modum Bad Research Institute and
NTNU Trondheim, Norway
McCullough, Berggraf & Ulvenes
SEPI 2010
Svartberg, Stiles & Selzer, 2004
RCT with 50 Patients with Cluster C PD
Cognitive and Short-Term Dynamic Therapy
ATOS ratings
Observer Ratings
Rated sessions 6 and 36
Affective Capacity
Early and Late in Treatment
STUDY
Svartberg
RCT, 2004
N=50
RATIO EARLY
RATIO LATE
TOP 25%
.6/1
1/1
1.7/1
McCullough, Berggraf & Ulvenes
SEPI 2010
TOP 10%
1.8/1
Thornes et al, 2008 Naturalistic study
52 patients
Cognitive and Short Term Dynamic Therapy Blend
Inpatient Treatment
Frequent diagnoses: depression/ dysthymia, Cluster B and C PD
Core Conflict Ratings
Self Rapport
Session 2 and 19 used
Affective Capacity
Early and Late in Treatment.
STUDY
Thornes Nat.
Study
RATIO EARLY
RATIO LATE
TOP 25%
1/1
1.5/5
1.8/1
McCullough, Berggraf & Ulvenes
SEPI 2010
TOP 10%
2.7/1
Gude, Hoffart and Monsen 2001
45 Patients
Schema Focused Therapy
Inpatient Treatment
Social phobia
Self Rapport
First and Last Sessions used
Affect Phobia Ratio
Early and Late in Treatment.
STUDY
Gude et al.
RCT
RATIO EARLY
RATIO LATE
TOP 25%
1.1/1
2.4/1
3.7/1
McCullough, Berggraf & Ulvenes
SEPI 2010
TOP 10%
3.8/1
Affect Phobia Ratio
(level of Activation over level of Inhibition)
Early and Late in Treatment.
RATIO EARLY
RATIO LATE
TOP 25%
Svartberg
RCT, 2004
N=50
.6/1
1/1
1.7/1
1.8/1
Thornes
Naturalistic
Study, 2008
N=52?
1/1
1.5/5
1.8/1
2.7/1
Hoffart RCT,
2006
N=45
1.1/1
2.4/1
3.7/1
3.8/1
STUDY
McCullough, Berggraf & Ulvenes
SEPI 2010
TOP 10%
Hierarchical Linear Regression of
AFFECTIVE CAPACITY RATIO
AT TWO YEAR OUTCOME on SCL
Controlling for Admission level, and Alliance
Svartberg et al. 2004
Beta
R2
R2Change
SCL-90
admission
.280
.078
.78
Alliance session 4
-.437
.301
.222***
Affective Capacity
Ratio
-.259
.361
.062**
McCullough, Berggraf & Ulvenes
SEPI 2010
Hierarchical Linear Regression of
AFFECTIVE CAPACITY RATIO
AT TWO YEAR OUTCOME on IIP
Controlling for Admission level, and Alliance
Svartberg et al. 2004
R2
Beta
R2Change
IIP admission
.200
.040
.040
Alliance
-.503
-.293
.253***
Affective Capacity
Ratio
-.337
-.395
.102**
McCullough, Berggraf & Ulvenes
SEPI 2010
Hierarchical Linear Regression of
AFFECTIVE CAPACITY RATIO
AT TWO YEAR OUTCOME on MCMI
Controlling for Admission level, and Alliance
Svartberg et al. 2004
Beta
R2
R2Change
MCMI admission
.577
.333
.333***
Alliance
-.293
.417
.084**
Affective Capacity
Ratio
-.314
.506
.089***
McCullough, Berggraf & Ulvenes
SEPI 2010
Hierarchical Linear Regression of
AFFECTIVE CAPACITY RATIO
AT TWO YEAR OUTCOME on Main Problem (SR)
Controlling for Admission level, and Alliance
Thornes et al. 2008
Beta
R2
R2Change
Main Problem
at admission
.520
.270
.270**
Affective
capacity ratio
-.323
.367
.097
McCullough, Berggraf & Ulvenes
SEPI 2010
Hierarchical Linear Regression of
AFFECTIVE CAPACITY RATIO
AT TWO YEAR OUTCOME on IIP
Controlling for Admission level, and Alliance
Gude, Hoffart and Monsen, 2001
Beta
R2
R2Change
IIP at admission
.661
.438
.438***
Affective
capacity ratio
-.285
.514
.076**
Alliance
-.229
.559
.045
McCullough, Berggraf & Ulvenes
SEPI 2010
Hierarchical Linear Regression of
AFFECTIVE CAPACITY RATIO
AT TWO YEAR OUTCOME on STAY
Controlling for Admission level, and Alliance
Gude, Monsen and Hoffart, 2001
Beta
R2
R2Change
STAY at
admission
.535
.286
.286***
Affective
capacity ratio
-.507
.523
.237***
Alliance
-.063
.526
.003
McCullough, Berggraf & Ulvenes
SEPI 2010
McCullough, Berggraf & Ulvenes
SEPI 2010