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Scandinavian Journal of
Behaviour Therapy
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http://www.tandfonline.com/loi/sbeh19

Assertive Training in Groups:

Research in Clinical Setting
a
Sheldon D. Rose
a
School of Social Work University of Wisconsin
Published online: 26 Jul 2010.

To cite this article: Sheldon D. Rose (1977) Assertive Training in Groups: Research
in Clinical Setting, Scandinavian Journal of Behaviour Therapy, 6:2, 61-86, DOI:
10.1080/16506073.1977.9626686

To link to this article: http://dx.doi.org/10.1080/16506073.1977.9626686

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 Nordisk Tidskrift f'dr Beteendeterapi, 6, 61-86, 1977
Scandinavian Journal of Behaviour Therapy, 6, 61-86,1977

Assertive Training in Groups: Research in

Clinical Setting
SHELDON D, ROSE School of Social Work
University of Wisconsin
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Under auspices of the Interpersonal Skill Training and Research

Program a series of seven research, projects have recently been
completed in which the effectiveness of assertive training in
groups with various clinical and professional populations have
been evaluated. These populations inlcuded young adults, women,
social workers and the elderly.
The programs for assertive training included a variety of pro­
cedures such as modeling, coaching, overt behaviour rehearsal,
covert rehearsal, group feedback, buddy contacts, selected
readings, homework assignments, and contingency contracts. Data
were collected on outcome by means of assertion inventories and
audiotaped role play tests, and on process by means of observa­
tion of interaction, attendance, completion rate of assignments,
and self report at the end of each meeting. Results on the role
play tests tended to support the efficacy of assertive training
for all the populations, however, strongest results were obtained
for the women and young adults and the weakest for the elderly.
Evidence also supported the use of contingency contracts as a
means of increasing the rate of assignment completion.

Social anxiety and difficulty in relating effectively to others is

a problem shared by a large part of the population. This discomfort is
often found linked with other problems such as delinquency, school and
work absenteeism, alcoholism, depression, and loneliness. In order to
Reprints can be obtained from Sheldon D Rose, School of Social Work, University of
Wisconsin, 1*25 Henry Mall, Madison, Wise 53706.

61
 facilitate social relational skills, a program has been developed which
teaches these skills directly. In this program clients are taught such
skills as standing up for one's rights, meeting people and making new
friends, conversing and interviewing, and expressing their feelings.
There is evidence that as a person learns such skills the intensity of
social anxiety is often reduced (Wolpe, 1 9 7 3 ) .
This skill training approach to treatment is called assertive or
interpersonal skill training and refers to a set of procedures by which
clients are trained in behavioral areas in which they are deficient.
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These prodedures include primarily modeling, coaching, and behaviour

rehearsal, although other procedures are often added. Not only is there
considerable anecdotal evidence for use of this approach, in recent
years many experiments have demonstrated the efficacy of various proce­
dures within this approach in modifying specific behaviours related to
social anxiety and unassertiveness. (See for example Eisler, Hersen,
and Miller, 1973; Galassi, Kostka, and Galassi, 1975; Hersen, Eisler,
Miller, Johnson, and Pinkston, 1973; Hersen, Eisler, and Miller, 197^;
MacDonald, Lindquist, Kramer, McGrath, and Rhyne, 1975; McFall and
Lillesand, 1 9 7 1 ; McFall and Marston, 1970; McFall and Twentyman, 1973.)
Although most of the above experiments were conducted with individu­
al subjects, it would seem.that social skill deficits can be most effec­
tively treated in social situations involving more than one client. The
group can serve as a protected laboratory to practice skills which must
eventually be carried out in the community. The group provides clients
with a variety of social situations and potential roles that each can
play. Moreover, in role played modeling and rehearsal the clients pro­
vide each other with an assortment of different types of roles, in the
position of leader, therapeutic partner, or consultant to one's fellow
clients. Several studies have made use of the group context for asser­
tive training experiments (Shoemaker and Paulson, 1976; Rathus, 1972;
Lomont, Gilner, Spector, and Skinner, 1969; Hedquist and Weinhold, 1970;
and Rimm, Hill, Brown, and Stuart, 197*+; Rimm, Keyson, and Hunziker,
1971) although in none of these was explicit use of the group made.
To make use of the group, the therapist must initially strive to
1
make the group attractive to its members; to create group situations

62
 requiring social competency on the part of the members; to create a va­
riety of group roles which members can play; to delegate gradually the
responsibilities of leadership; to present situations in which members
function as consultants and partners in the therapeutic endeavor; and
to control excessive group conflict.

Interpersonal Skill Training and Research Program

The Interpersonal Skill Training and Research Program was developed

to evaluate the effectiveness of such assertive training and other so­
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cial skill groups in clinical settings with various populations as well

as to provide opportunity for group leadership, observation, and gene­
ral research training. In addition to the use of assertive training
procedures, group process was to be dealt with systematically. Since
1975 there have been seven projects completed under the auspices of
Interpersonal Skill Training and Research Program in the area of asser­
tive training; all but one of these occurred in the context of small
groups.
1) evaluation of outcome data of five assertiveness training groups
with a clinical population of young adults (Rose, 1 9 7 5 ) ;
2) comparative study between assertiveness training and behavioural
discussion groups with young adults (Schinke and Rose, 1 9 7 6 ) ;
3) comparative study between assertive training groups, group desen-
sitization, discussion groups, and a test-retest control for
women (DeLange, 1 9 7 6 ) ;
h) comparative study between assertive training and discussion train­
ing with the elderly (Berger and Rose, 1 9 7 7 ) ;
5) comparative study among problem solving, discussion and assertive
training groups for the elderly (Toseland, 1 9 7 7 ) ;
6) comparative study between assertive training and discussion train­
ing for social workers; and
7) multiple-baseline study of the effects of contingency contracting
on the completion rate of behaviour assignments in six assertive
training groups (Rose, 1977b).
Three additional projects for which data are now being collected are:
8) the effects of various intervention procedures on leadership be-

63
 haviour in assertive training groups
9) comparative study between assertive training and placebo control
group for institutionalized elderly
10) social skill training in six groups of third, fourth, and fifth
grade children.
This paper will briefly report on the assertive training program used
in the completed projects, the research procedures, the research design,
and the results.
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PROJECT ONE: Assertive training for young adults

In order to discover whether assertive training in groups was appli­

cable in social treatment agencies with typical clinical populations
programs were organized in five different agencies (Rose, 1 9 7 5 ) . Each
group used a similar treatment package. Twenty-four clients in groups
ranging in size from k-8 persons met weekly from 8-10 sessions for two
hours. The members were almost equally divided among males and females,
and were from diverse socio-economic backgrounds.

Data Collection

The data collection procedures used varied somewhat from group to

group; most included a diary kept by the members, personality invento­
ries filled out before and after treatment, such as the Rathus Asser­
tiveness Schedule (Rathus, 1 9 7 3 ) , the California Personality Inventory
(Gough, 1 9 5 7 ) 5 "the Situation Reaction Inventory of Anxiousness (Endler
and Okada, 1 9 7 5 ) , and the Willoughby Personality Inventory (Wolpe, 1 9 7 3 ) ,
and audiotaped behaviour role play test which was also given prior to
and following treatment. The audiotaped behavior role play test consist­
ed of a number of social situations requiring an assertive response.
Most of these situations were obtained from the clients themselves when
they were recruited. In the testing situation each situation was read
aloud to each client who then responded as if she or he was in that si­
tuation. The responses were recorded on audiotape and later coded for
assertiveness. Of the above tests only the RAS was given in all five
groups. Ongoing data about the group process was also collected in

6k
 most groups. This included data on participation (collected by obser­
vers), satisfaction (responses from the clients on a seven point sca­
le), productivity (the percentage of behaviour assignments completed),
and attendance. Clients also kept self-report data on behaviours ac­
tually changed in the real world or stress situations successfully
dealt with.

Intervention

The major intervention procedures used in this project were model­

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ing, coaching, behaviour rehearsal, covert rehearsal, homework assign­

ments, contingency contracting, and group feedback. In most groups re­
laxation training was also used. Leaders also worked on keeping the
attraction of the group high, keeping a broad distribution of partici­
pation, and involving the members in leadership responsibilities. In
a typical meeting, members brought in diaries kept during the week.
Each would describe one social situation with which she or he was ha­
ving difficulty. The group members would ask for amplification. Sug­
gestions would be made as to how it might be done differently. Some­
one in the group would demonstrate to the given client how it might
be carried off. Following discussion of the modeling event, the given
client would rehearse the situation often with suggestions from a
coach who sat behind the client. Other members would play the role
of the significant other. The group would then discuss what the client
did well and what she or he might have done somewhat differently.
When everyone had roleplayed at least one situation, members decided
on homework assignments such as keeping a diary, practicing relaxa­
tion, trying out a rehearsed behaviour in the real world, and contacting
a "buddy" (their partner in the group). Some would attach contingen­
cies to the completion of the assignment. At the end of the meeting
clients were given relaxation practice and asked to fill in an evalua­
tion of the meeting. (These procedures are described in detail in
Rose, 1977a).

65
 Results

On the self report data, all but three persons reported change on
at least one behaviour they worked on. The average was 1.6 behaviours
changed per person. Of 2k persons completing the program, 21 showed
positive changes on the Rathus Assertiveness Schedule. On all other
instruments all but two clients showed changes in the desired direc­
tion. On the basis of those data, it was concluded that 21 persons
(86 %) successfully utilized the program. However, even though most
people showed improvement, several still showed extremely low (non-
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assertive) scores. These people were referred for additional training.

Although the results were generally positive, in the absence of a
control group, one could not reject the hypothesis that some general
effect (placebo) rather than assertive training brought about these
shifts in behaviour and test scores. Moreover, the programs though
similar varied as to length, recruitment procedures, content of pro­
gram, and a number of other relevant features. To deal with these
problems, Project Two was designed.

PROJECT TWO: Assertive training and behaviour discussion

The purpose of Project Two was to compare the effectiveness of com­

mon elements found in the clinical packages used in Project One to a
discussion group condition under standardized conditions. Subjects we­
re recruited who were similar to the clients in Project One (Sehinke
and Rose, 1 9 7 6 ) . All groups, with five to six members each, met for
six weekly two-hour sessions. Subjects were randomly assigned to four
experimental groups and three control groups, consisting of 21 and 1 5 ,
respectively. These groups were led by seven comparably trained gradua­
te students (who were somewhat more experienced than those in Project
One).
Assessment instruments included a Social Contact Monitoring Sheet,
a self-report survey of assertive behaviours, the Rathus Assertive­
ness Schedule, and the California Psychological Inventory, Class 1
Scales. All were administered at pre-treatment, six weeks later at
post-treatment, and three months later at follow-up. Audio-taped

66
 behavioural role-plays were administered at post-treatment and follow-
up, using stimulus situations gathered from the study sample at an
initial telephone contact.
The assertive training procedures were similar to the ones descri­
bed in Project One except that no relaxation training was used. In
the placebo control (behavioural discussion) groups, the same type of
situations that were rehearsed in the experimental group were dis­
cussed, members provided each other with feedback on how to do them,
but no rehearsal was permitted.
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The results of this comparative evaluation indicate that subjects

receiving the experimental package were rated as significantly
(p < 0.001) more assertive on components of the audio-taped behavioral
role-play at post-treatment and follow-up, than subjects receiving
the placebo-control condition. The three self-report instruments, the
Social Contact Monitoring Sheet, the Rathus Assertiveness Schedule,
and the California Psychological Inventory, show strong gains for sub­
jects in both conditions from pre-treatment to post-treatment and from
post-treatment to follow-up, but there are no significant differences
between the two conditions on these three measurements.
Results were interpreted as lending support to the hypothesis that
group assertiveness training is useful approach to treatment of cli­
nical population of young adults.

PROJECT THREE: Assertive training, desensitization and discussion

In the first two projects, clients of both sexes were recruited.

Many of the women recruited for assertive training groups have ex­
pressed a desire to be in an all-women's group. On the basis of this ex­
pressed client interest, DeLange (1976) designed a project for women
only to compare the effectiveness of assertive training in groups,
group desensitization, a discussion control and an assessment only
control. An additional purpose was to study the effect of the client's
general level of anxiety on the treatment method. Also, in contrast
to the first two projects, DeLange made use of semi automated treat­
ment procedures.

67
 In order to generalize to the large numbers of assertive training
groups being attended by women throughout the country, recruitment was
specifically designed to increase probability of obtaining women from
different age groups and occupations. One hundred twenty women were
recruited by advertising, posters, newspaper stories, and word of mouth.

Program and Test Development

DeLange carefully adhered to the model recommended by Goldfried and

D'Zurilla (1969) for constructing a behavior role play test and evolving
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training situations for the treatment program. Thirty women kept seven
day logs of all situations requiring an assertive response. They also
described any other similar situation which might require an assertive
response and which had previously occurred to them or others they knew.
On the basis of these data, 50 vignettes and an accompanying question­
naire were constructed and submitted to hO women who responded to each
situation in terms of its frequency of occurrence to them and. their
degree of comfortableness and satisfaction in handling the situation.
New situations were also requested. Thus a list of 8k situations were
generated, some of which were eliminated if not sufficiently relevant
or problematic. The remaining items were in turn submitted to the sub­
ject population who rated them in terms of satisfaction and comfortable­
ness with their responses, its importance for them to work on, and
whether the situation ever happened to them. On the basis of the above
criteria, items were selected which also fit into the following five
categories: stating one's needs and initiating confrontation; handling
criticism; requesting from others; interaction with authority figures;
and initiating actions.
For purposes of the group desensitization condition, test items were
placed in a hierarchy of difficulty based on the degree of discomfort
on the items.
Response alternatives were elicited by submitting the remaining 62
items to a population not in the experiment, this resulted in 1 1 to 15
responses for each situation ranging from unassertive to aggressive.
Expert judges rated the responses to the 1 1 test items on a 5 point
scale from unassertive (ineffective) to most assertive (effective) and

68
 wrote out criteria for making a judgement. On the basis of these judge­
ments a rating manual was devised.

Research Design

The 120 subjects were divided into two levels of anxiety, high and
low, on the basis of scores on a test designed to measure trait anxiety,
forming two equal groups. Each woman in these conditions was then ran­
domly assigned to one of four treatment conditions: systematic desensi­
tization, assertive training, discussion, and assessment-control. There
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were 30 women in each condition, 15 high anxiety and 15 low anxiety

women. Within each treatment condition, women were arranged into groups
of six, three high anxiety and three low anxiety, on the basis of their
schedules of available meeting times. There were five groups of six wo­
men within each treatment condition. The design was counterbalanced for
therapist; each of five highly trained female therapists was assigned
one group in each treatment condition, randomly where possible within
available time schedules. All groups were conducted simultaneously within
the same six weeks using the same assertive situations in all groups in
every treatment condition within the same week. Each person paid a $18.00
deposit (with several exceptions).
The final evaluation instruments used were the behaviour role play
test, the Assertion Inventory (Gambrill and Richey, 1 9 7 5 ) , the Rathus
Assertion Schedule (Rathus, 1 9 7 3 ) , and the State Trait Anxiety (STAl),
A-Trait (Spielberger, Gorsuch, and Lushene, 1970). All except the STAI
were administered at pre- and post-treatment. The STAI is a self-report
measure reflecting an individual's general anxiety level. The median of
the scores on the STAI-A-Trait was used as the dividing point for high
and low-anxiety subjects.
The behaviour role play test consisted of 1 1 tape recorded items. Of
these items, six were used in the training sessions, three others were
in the same categories as those used in the training sessions but of
different content (novel), and two were of different content and diffe­
rent general categories (novel-novel). This breakdown enabled testing
for generalization within categories to untreated situations and across
categories to situations in untreated categories. During the test each

69
 woman responded to each item as if she were in that situation. The re­
sponse was tape recorded. After each response, the subject stated her
anxiety level and her satisfaction with her response.

Treatment Condition

Each treatment used six situations within a specified category per

session, with the exception of the first session which contained only
three. Every group, regardless of treatment condition, worked on the
same six situations in the same week of sessions. All situations were
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presented by means of an audio-tape recorder.

After a woman volunteered or agreed to work on a situation the As­
sertive Training procedures were as follows:
Via audiotape:
1. presentation of the situation
2. coaching
The narrator discussed the situation in terms of the task to be
done and generally how to handle it
3. model one
A female voice responded to the situation
k. coaching
The narrator pointed out what the model had done and gave more
instructions
5. model two
A second female voice responded giving an alternative approach
Via therapist:
6. group discussion of the models
The emphasis was on these models only as alternatives. A woman in
the group could offer another way of approaching it and the woman
rehearsing it could incorporate these approaches or use her own
7. behavior rehearsal
The taped situation was again played and the designated S respond­
ed to it
8. self-evaluation and self-reinforcement
The subject reported her anxiety level and satisfaction verbally
and recorded them on her record card; she told the group what she

70
 liked about her response and what she would like to change. She
gave herself points on a clicker counter from one to three (l =
making a response; 2 = improvement over what you might have done
before, fairly satisfied; 3 = really feel good about response,
the way I would like to do it) also recording them on her card.
9. group feedback
Members and therapist told the client specifically what they
liked about the response and gave a suggestion for change.
10. repeat practice, steps 7~9
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1 1 . repeat practice again, if so desired (DeLange, 1976, pp. U6-kT)

Women were told that they could practice as often as they felt it nece
sary to feel comfortable about what they had performed. Therapists were
advised to give everyone an opportunity to respond and to facilitate
specific positive and negative comments from every member. The highly
audible clicker, used for giving oneself points, enabled the group mem­
bers and therapist to respond positively to the number of points a wo­
man gave to herself.
In the group desensitization condition the therapist demonstrated
relaxation, trained the group in visualization of scenes, and taught
the members how to report anxiety level. Within each session the members
were first put into a state of deep muscle relaxation; and hierarchial
items were presented (3 times each). Six scenes only were visualized
each session. After desensitization, members discussed relaxation, vis­
ualization, the arousal of tension, and any questions and comments the
group or therapist wanted to make regarding the desensitization proce­
dure a common clinical practice.
In the placebo-control (discussion) condition,women listened to the
same situations via an audio-tape. Approximately every 15 minutes a new
situation was played by the therapist. Women were instructed to think
of how they would normally respond and what feelings were elicited. The
emphasis was on understanding what one felt, why assertive behavior was
inhibited, and what had occurred in the past to cause that reaction.
Women shared the feelings aroused by the situation and related similar
past experiences. They endeavored to identify the emotions felt, to
specify what the current blocks to handling themselves in assertive sit-

71
 uations were, and to explore the reasons, past and present, that caused
their current feelings. Therapists were instructed to treat this group
as a support group. Any specific suggestions by group members as to
what to say or how to act in a situation were minimized, with the thera­
pist refocusing the discussion on feelings and causes of inhibition.
Women in the assessment control were randomly selected to wait for
the second round of groups. These women completed all pre- and post-
tests in the same week that women in the other treatment conditions did.
These women were then debriefed and given six weeks of treatment with­
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out cost. They were allowed to select the type of techniques used with
their group.
The complete findings are too detailed to be reported here. In gene­
ral the data supported the hypothesis that assertive training was the
most effective procedure. Women given Assertive Training improved their
performance on the behavior role-play test significantly more than any
other treatment condition. On the two self-report measures of assertive­
ness, although differences were less pronounced, pre- to post-treatment
scores indicated that the Assertive Training group improved the most on
both measures. A related hypothesis, that, for low-anxiety women, Asser­
tive Training would be more effective in increasing assertive responses
than any other condition, was supported. In addition, within the Asser­
tive Training treatment itself, greater generalization of treatment ef­
fects to untreated situations occurred for low-anxiety women than for
high-anxiety women. These results suggest that the level of general anx­
iety does influence the effect of assertion training; the lower the
anxiety level, the greater the amount of improvement that can be expect­
ed to generalize across situations.

PROJECT FOUR; Assertive training and discussion for elderty

In the first three projects, clients were from a broad social back­
ground, ranging in age from 16 to 56 with the median age being 30. The
question was raised whether this same or a similar program could be uti­
lized with an elderly population. In Project Four and Five the focus
was on the elderly.

72
 Project Four was concerned with the elderly in an institution (Berger
and Rose, 1977)- Of the 160 patients in the institution only 90 were
considered as neither too ill nor too disoriented to participate. Of
these 90, ^0 who agreed to participate in the study were from a wide
variety of socio-economic "backgrounds. Most of them had serious medical
problems. Of the ho, 27 were randomly assigned to either the Assertive
Training condition or one of the two control conditions. The others had
participated in the development of the role play situations.
Because of special problems of illness and irregular group attendance,
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an individualized assertiveness program was developed to be followed in

a later project by a group program. A new audio-taped role play test
was also developed.
In this project, as in the previous, the format suggested by Gold-
fried and D'Zurilla (1969) was carefully followed. First, problem situa­
tions were developed which could be used in both the training program
and in the role play test used to evaluate the program.

Program and Test Development

In order to elicit problem situations the investigator interviewed

22 patients. The experimenter asked the patient to recall recent inter­
personal situations, particularly those in which the patient felt she
or he could have responded more successfully or felt better than he
actually did. Specific descriptions were elicited by asking for each
situation: l) What led up to the situation?; 2) What was the purpose
of the interaction?; 3) What were the characteristics of the other per­
son?; k) What was the physical setting?; and 5) What was the flow of
interaction? i.e. who said what to whom?
From these interviews a set of 3^ highly specific problematic situa­
tions experienced by residents in a home for the elderly were construct­
ed. These situations involved making a reasonable request, refusing an
inappropriate request, or responding to an unfair action or statement,
and initiating and maintaining a conversation. Most of the situations
involved interactions with peers, a few involved nursing home staff and
relatives.
In order to find the most relevant situations all 3h were tape re-

73
 corded and presented to seven female and four male patients, all of
whom had participated in the initial interview, who rated the items on
perceived comfort and competence, as well as whether it was likely to
arise at all. In this way 16 items were obtained for which fewer than
half the subjects rated their response to the situation as "comfortable
and able to handle it well" and fewer than one-third rated the situa­
tion as one that "would never arise".
In order to obtain responses to these situations eight staff persons
including the nursing home supervisor and other professional and non­
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professional staff listened to a tape recording of the 16 most relevant

situations. To each situation they were asked to respond out loud as if
the patient was actually experiencing that situation. Their role plays
provided a list of eight possible responses to each of the situations.
These responses were rated by other experts from very ineffective to
very effective on a five point scale and interviewees were asked to ex­
plain what it was that made it so. These 16 items constituted the beha­
viour role play test, eight of which were employed in training. The
coding manual consisted of the items plus responses.

The Assertive Training Program

The experimenter read the situation to the patient. The experimenter

read coaching material which had been prepared from the response evalua­
tions of significant others in the program development phase. This mate­
rial explained the general nature of the situation, suggested one way
in which the patient could respond, and often indicated probable
consequences of the suggested response. As an example of the coaching
material, the experimenter played the tape recorded response of a model
to the situation. All modeling responses were recorded by an 86-year-
old female. The experimenter read additional coaching material. This
material commented on the modeled response and reviewed the previous
coaching material.
In a brief discussion the experimenter asked the patient what he or
she thought of the modeled response and if the respon'se would be effec­
tive for him or her. The patients who disagreed with the response or
felt it would not be appropriate for themselves were asked to rehearse

Ik
 for the "sake of practice". The experimenter re-read the situation which
was abbreviated to avoid unnecessary repetition.
The patient who then roleplayed a response to the situation was ver­
bally reinforced for any roleplayed response. Additional reinforcement
was provided for aspects of the response that satisfied the coaching
material. In addition, the experimenter clearly indicated to the patient
the ways in which his response did and/or did not satisfy the coaching
material.
A brief discussion focused on whether the patient understood and
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agreed with the feedback. Rehearsal and feedback continued until the
experimenter determined that the patient adequately satisfied the coach­
ing content in two rehearsals. If the patient had not met this crite­
rion within three minutes the experimenter went on to the next coaching-
modeling segment of the training sequence.
In order to facilitate learning, the training sequence was structured
in such a way that only one principle of effective behaviour was presented
at a time, in one coaching-modeling segment (steps 2 to h above). When
the patient's response to the situation evidenced learning of that seg­
ment, the experimenter proceeded to the next segment.
Patients in the control condition were told that discussing social
situations makes one better able to handle these situations. The expe­
rimenter read out loud the same situations as used in the Assertive
Training sessions, in the same order. Each situation was followed by
a 15 to 20-minute discussion which focused on similar experiences which
occurred to the patient, the patient's feelings in those situations,
and a discussion of probable causes for those feelings. Specific behaviou­
ral solutions to these situations were not presented. Another control
consisted of patients who participated only in the assessment condition.

Results and Discussion

On the behavioural role play test, patients who participated in Asser­

tive Training were significantly (p < .05) more effective than Control
patients in responding to social situations to which effective response
had been explicitly taught. Assertive Training patients retained this
learning even two months after training. The results of this study how-

75
 ever, provided only limited evidence for the efficacy of Assertive Train­
ing with, elderly patients. On the role play test it was clear that learn­
ing did not generalize to novel situations, i.e., Assertive Training
patients did not learn how to apply general rules of effective behaviour
to new situations. In addition, although these patients did increase
their effectiveness, this was not reflected in the self-report measures.
That is, Assertive Training patients were not more satisfied with their
responses and did not rate social situations as less problematic or dif­
ficult. Also, Assertive Training had no effect on the patient's perfor­
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mance in a simulated interaction with a social worker.

PROJECT FIVE:
Assertive training, diseussion and problem solving for elderly

In contrast to Project Four which did not use small groups and which
worked solely with institutionalized elderly, Toseland (1977) in Pro­
ject Five sought to work exclusively in small groups with the elderly
who still lived in the community. Moreover, he sought to compare asser­
tive training in groups with problem-solving groups as well as discus­
sion groups.

Treatment Methods

The introductions were standardized across the three group methods.

All participants received the same explanation for money payments, con­
fidentiality, and an introduction to the topic of social skills in dif­
ficult interpersonal situations. Passive, aggressive and assertive be­
haviour was differentiated. All groups, meeting for six 1 1/2
hour meetings, covered the same six topic areas: session 1 , initiating
interactions;session 2, confronting others; session 3, handling service
situations and making requests; session k, giving negative feedback;
session 5, responding to criticism and turning down requests; and ses­
sion 6, expressing opinions. There were fifteen groups, five groups in
each of three treatment methods (l) Assertive Training, (2) Problem
Solving, and (3) general discussion.
Each treatment method contained a package of treatment components.

76
 The Assertive Training condition included role playing, behaviour rehear­
sal, modeling, feedback and coaching. The Problem Solving condition in­
cluded a general orientation, defining the situation, an orientation to
problem solving (cognitive restructuring, generating alternative solu­
tion, decision making criteria and implementation discussion). The Dis­
cussion Method which is similar to traditional social group work ap­
proaches included a time limited focus, a discussion of the person-in-
situation configuration with the leader acting as the facilitator of
the group's definition and discussion of the situation. In this project
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the discussion condition served as a placebo control.

Design

Project Five used a pre-, post-, and three month follow-up assess­
ment design with two experimental conditions and a placebo control.
Fifty-three subjects above the age of 55 participated in the project.
Data was analyzed in terms of group means which provided a sample size
of fifteen. These groups were made up of three to five participants.
Each group was randomly assigned to treatments with the constraint that
once a treatment contained five groups no more groups would be assigned
to it. Subjects came from three community agencies. All subjects were
volunteers who were paid two dollars for each group session attended.
Twelve leaders including six community agency staff personnel, three
students and three older people were trained in the use of the treat­
ment methods and randomly assigned to groups. Three leaders led two
groups. All other leaders led one group.
Three assessment measures were used. A role play test of eight situa­
tions was developed by interviewing sixty older persons over a one year
period. Four of the situations were used as training situations by all
groups. Four of the situations were used as untrained generalization
situations. Two coders rated the tapes based on a coder rating manual
developed in conjunction with the role play test. The Assertion Inven­
tory (Gambrill and Richey, 1975) was used to assess change in anxiety
and response probability as a result of training. A Group Evaluation
Inventory was used to assess the subjective responses of participants
in terms of satisfaction with the group method, perceived change in

77
 social skill and number of situations in which social skills learned
in the group were used in everyday situations.

Results and Discussion

On both the trained and untrained test situations, subjects in both

the Assertive Training and Problem Solving groups were significantly
(p<.Ol) more assertive at posttest than those in the Discussion groups.
The Assertive Training method subjects were consistently more assertive
on the role play test than Problem Solving subjects but the differences
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were not significant. Though scores on the role play test continued to
increase for all three conditions from posttest to follow-up, because
scores increased more rapidly for the discussion group, differences at
follow-up were not quite significant (p<.07).
No differences were found between any of the treatment methods on
the Assertion Inventory anxiety and response probability scales. Since
there was a great deal of random variation of scores within conditions,
the Assertion Inventory may not have been appropriate for use with
older persons.
The Group Evaluation Inventory showed that participants in all group
method approaches were very satisfied with the group in which they were
participants. All participants indicated moderate increases in social
skill learned by participation in a group. There was very little differ­
ence on perceived increase in social skill between treatment methods.
In terms of the number of responses where social skills were used in
everyday situations the Assertive Training condition participants re­
ported a greater number of situations where skills were used (3.10) as
compared to the Problem Solving (1.50) or the Discussion (2.23) group
participants.
These results indicate that although no effects are noted on an as­
sertion inventory in terms of behavioural outcomes the Assertive Training
group method is slightly more effective than the Problem Solving group
method and both are more effective than the Discussion Method in in­
creasing the social skill of older adults.

78
 PROJECT SIX: Assertive training and discussion for social workers

In all the previous projects, clinical population were trained in

assertive responses. In Project Six the effectiveness of an interperso­
nal skill training program for professional social workers (Rose and
Edleson, 1977) is evaluated. In order to examine this population's
response to assertive training in groups, 62 senior and graduate social
work students were assigned to experimental and control conditions. The
assignment was not random, however, but evidence suggested that the grou"
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were equivalent on major variables. Subjects in the experimental condi­

tion were taught to deal with critical situations commonly encountered
by professional social workers in their clinical practice. As in asser­
tive training, modeling, overt and covert rehearsal, videotaped and
group feedback, coaching, buddy contacts, selected readings, behavioural
assignments, contingency contracts, and delegation of group leadership
were utilized in the training program. Experimental subjects met in
small groups of four to six members for two hour sessions each week
over a period of six weeks. In addition, data on group interaction
gathered by pairs of trained observers at each session were presented
to group members by the leader as feedback on their interaction.

Role Play Test Development

The control subjects received no training. Subjects in both condi­

tions participated in behavior role play test prior to and following
the training program for the experimental group.
In order to develop items for the test professional social workers
were asked to list as many situations with clients, peers, or supervi­
sors which required some kind of assertive response from the social
worker. These items were edited and submitted to judges who selected
the best six items in terms of relevancy to professional practice, varia­
tion, clarity of the item, and amenability to multiple responses.
At this point the test development differed from the previous pro­
jects. Rather than eliciting a single response, multiple responses from
the subject were desired. In order to obtain these responses a set of
general statements which could apply to any response to a given item

79
 were interspersed between each client response. (Similar to a procedure
developed by Galassi and Galassi, 197*0.
Prior to the training program, expert judges were used to develop
the criteria for evaluating effectiveness of most possible sets of re­
sponses. These criteria consisted of overall competency, expression of
feelings and opinions, persistence, giving and seeking clarification,
appropriate affect, latency, fluency, volume, and the timing within
which critical statements were made. Only those criteria relevant to
each specific role play situation were used in evaluating the subject's
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response. (See Rose, Caynor, and Edleson, 1 9 7 7 , for a detailed descrip­

tion of this test).

Results and Discussion

The results of the study indicated that following treatment the ex­
perimental subjects were significantly (p<.0l) more effective than the
controls in dealing with both trained and untrained items on the beha­
viour role play test.Data about interaction among members also indica­
ted that leadership could be successfully delegated to group members
with an increase in member satisfaction and group productivity.

PROJECT SEVEN: Multiple-baseline effects of contingency contracting

In contrast with the earlier projects, which studied the effective­

ness of assertive training, the purpose of Project Seven was to analyze
the effectiveness of contingency contracting with adults as a means of
increasing the percentage of behavioural assignments completed in asser­
tive training groups (Rose, 1 9 7 7 b ) . Since contingency contracting had
thus far rarely been used with adults especially in assertive training
groups, this project provided a test of its efficacy under clinical con­
ditions .

Research Design

In the fall of 1976, six assertive training groups were organized

in three different agencies: a Family Service Agency, the Department of
Adult Medicine of the Medical School, and the Interpersonal Skill Train-

80
 ing and Research Project of the School of Social Work of the University
of Wisconsin. Each of the groups consisted of 3 to 8 members and met
weekly for two hour sessions. Clients, recruited primarily by adverti­
sing in local media or through posters, were chiefly university staff
and students, and professional and business people.
In all groups and for all meetings except the last one, leaders were
instructed at the end of each session to develop specific home assign­
ments with all clients. At the beginning of the subsequent session, as­
signments were monitored by asking each member to review the assign­
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ments he or she had agreed to for the previous week and to provide evi­
dence of their completion.
In groups one and two contingency contracts were introduced at the
end of the second session; in groups three and four at the end of<the
third session; in group five at the end of the fourth session; and in
group six at the end of the fifth session. Once contingency contracts
were introduced they were maintained for the remaining sessions. In all
other respects the program followed the structure outlined in Project
Two.

Results and Discussion

Four of the six groups showed dramatic increases following the intro­
duction of contingency contracts, one group showed a slight increase,
and the remaining group showed a decrease. In the group showing a
slight increase, the baseline level was so high (93 %) that only minor
increments were possible.
This project contributed support to the hypothesis that contingency
contracting in assertive training groups is an effective way of increas­
ing and maintaining rates of assignment completion.

Conolusion

In summary, the Interpersonal Skill Training and Research Program has

provided a variety of evidence to support the contention that assertive
training in groups is an efficient and beneficial approach to the treat­
ment of clinical populations, women, young adults, and the elderly. It

81
 can also provide effective training for professional social workers in
assertiveness-related skills.
Another finding, at least with women, suggests that the level of anx­
iety plays a major role in determining the degree of generalization.
High-anxiety subjects tend to show less generalization of improvement
across situations than low-anxiety subjects.
The outcome results with the elderly, though positive, are the most
tentative; the results with women and young adults in a clinical situa­
tion appear to be the strongest. Follow-up data were obtained in three
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of the studies; again the young adult population seemed to be somewhat

more effective in maintaining changes obtained in the group than the
elderly. However, differences may be due to methodological considera­
tions. It appears that with the elderly, greater use of memory aids,
more frequent sessions, and periodic booster session may be required to
achieve the same level of change and maintenance of change that younger
populations seem to obtain.
Looking at the process findings in several projects, we find that
contingency contracts appear to be a useful addition to assertive train­
ing in groups as a means of increasing the completion rates of behaviour
assignments. It is also possible to increase participation of members
through simple reinforcement procedures and to effectively delegate
leadership activities to members of the group. It is clear that a great
deal more research in this area is needed.
Two kinds of training programs were used in this study: semi-auto­
mated and partially leader directed and structured, and completely lea­
der directed. In the latter condition the leader tried to fade his or
her activities as the group approached termination. Both conditions
tended to yield the same levels of change and the same degree of satis­
faction. Though both are highly structured experiences, these structures
is objectionable to very few persons.
In all of the projects evaluated outcome, a behaviour role play test
was developed which was uniquely tailored to the population being served,
In two projects item development adhered closely to the complex approach
suggested by Goldfried and D'Zurilla (1969). In these projects items
were developed which were used in training and others which were not.

82
 This made it possible to test the degree to which the training genera­
lized to new items and even new categories of items. This appears to
be a promising use of the role play test. In the other projects a sim­
pler procedure was used in which most of the items to be used on the
test were developed by the subjects in the study or by similar subjects
in previous studies. In all but the professional training group, a
single response was demanded to each item on the role play test. In the
latter group, multiple responses interspersed with responses from the
antagonist were used. Although somewhat less reliable than the other
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tests because of the complexity in coding, it appeared to represent

the real life situation more nearly and as such may prove to be a more
valid measure. In all cases however the role play test was a sensitive
measure regardless of how it was developed.
Except in the initial noncontrol group project and in the DeLange
(1976) project, the Rathus Assertiveness Schedule and the Gambrill-
Richey Assertion Inventory fared poorly as discriminating instruments.
Almost all conditions showed improvement on these tests, but usually only
small differences between conditions were discernable. One might
conclude that on such inventories subjects tend to show how much they
liked the training rather than how much they actually changed. Alterna­
tively, one might ascertain that any treatment focusing on assertive
behavior is sufficient to bring about self-reported change, though, only
Assertive Training group approaches are likely to bring about motoric-
verbal demonstrations of change.
Although in nearly every study some methodological limitations restric­
ted confidence in the findings,the persistence of the role-play test in
demonstrating the effectiveness of Assertiveness Training in groups in
all projects can not be dismissed lightly.
Of course, there are still many unanswered questions. To what degree
must this approach be restricted to behaviors commonly described as
assertive? What other populations might profit from this approach, e.g.,
depressives, psychotherapists, public service workers, receptionists?
How important is the group condition for maintenance of changes achiev­
ed in the group? How important is our concern for group process in
achieving individual treatment gains? What is the relationship of the

83
 role play test to results to real world "behavior? These are some of the
questions with which the Interpersonal Skill Training and Research Pro­
gram will be dealing with in the coming months and years.

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