Speaking to and About Patients: Predicting Therapists' Tone of Voice

Judges and RatingsTwelve (6 male and 6 female) undergraduates at HarvardUniversity were each paid to rate all three tapes (beginning,middle, and ending segments) of therapists talking to patients,and another 12 undergraduates (6 male and 6 female)were each paid to rate all three tapes of therapists talkingabout patients. Judges were randomly assigned to one ofthree counterbalanced conditions representing the orderin which they would rate the three tapes (i.e., ABC, BCA,CAB). Judges were told that they would hear therapiststalking and that they would be able to understand onlythe speaker's tone of voice. Consistent with our earlierexperience with this type of study, judges were given nospecial training for their task (Rosenthal, 1982). All judgesrated all the segments (98 beginning, 98 middle, and 98ending segments) on 10 dimensions—not warm-warm,not hostile-hostile, not anxious-anxious, not dominantdominant,not empathic-empathic, not competent-competent,not optimistic-optimistic, not professionalprofessional,not honest-honest, and not liking-liking. Eachsegment was played once, and all judges were given 15sto make the 10 ratings. Each rating was made on a scalerunning from 1 (not at all warm) to 9 (very warm). Becauseratings of the beginning, middle, and ending segmentswere substantially correlated (median r ?= .49 for the shortestclips), these ratings were combined prior to subsequentanalyses (see Blanck, Rosenthal, Vannicelli, & Lee, 1983,for a detailed discussion of the various types of phase-tophaseand judge-to-judge reliabilities).Principal Components AnalysisThe mean of all judges' ratings of the tone of voice inwhich therapists spoke to and spoke about their patientswere intercorrelated separately, and a principal componentsanalysis was computed for each of these 10X10 correlationmatrices of mean judges' ratings. For the ratings of therapists'tone of voice in speaking to their patients, thisanalysis yielded four interpretable factors after varimaxrotation: (a) professional-competent (consisting of competent,optimistic, ind professional), (b) warmth (consistingof warm, not hostile, not dominant, empathic, and liking),(c) anxious, and (d) honest. Each new factor-based variablewas denned as the mean rating of the variables includedin that factor with the sign of the loading taken into account.(Because the variances of these variables were so homogeneous,standardizing was not employed prior to computingmeans of ratings.) For example, the professionalcompetentvariable was denned as the mean rating of competence,optimism, and professionalism in tone of voice.In this way, the 10 variables of tone of voice in speakingto patients were reduced to four factor-based variables forsubsequent analyses. A detailed description of the factorstructure of therapist's tone of voice in talking to patientsis described in Blanck, Rosenthal, and Vanicelli (1983).For the ratings of therapists' tone of voice in speakingabout their patients, the principal components analysisyielded seven interpretable factors after varimax rotation:(a) professional-competent (consisting of professional andcompetent, (b) warmth (consisting of warm, empathic,and liking), (c) not hostile, (d) anxious, (e) dominant, (f)optimistic, and (g) honest. Each new factor-based variablewas denned as the mean rating of the nonverbal variablesSPEAKING TO AND ABOUT PATIENTS 681included in that factor with the sign of the loading takeninto account. For example, the warmth variable was dennedas the mean rating of warmth, empathy, and liking in toneof voice. In this way, the 10 variables were reduced toseven interpretable factor-based variables for subsequentanalyses. The factor structure of the therapist's tone ofvoice in talking about patients is described in detail inBlanck, Rosenthal, and Vannicelli (1983).Reliability of Judges' RatingsThe reliability of the judges' ratings of the tone of voicevariables was computed by means of intraclass correlations(Rosenthal, 1982). The effective reliability of the mean ofthe 12 judges' ratings for the 30-s clips (three clips of 10s each) of therapists speaking to patients ranged from .22to .82, with a median r of .59. The effective reliability ofthe mean of the 12 judges' ratings for the 60-s clips (threeclips of 20-s each) of therapists speaking about patientsranged from .47 to .83, with a median r of .64.In evaluating these median reliabilities of .59 and .64,respectively, one should keep in mind that they are basedon ratings of content-filtered speech of only 30-s and 60-s duration, respectively. For our present purposes the obtainedreliabilities are more than adequate; however, hadwe increased our segment lengths to 10 min, we couldhave increased our median reliabilities to .97 and .95,respectively (Rosenthal, 1982).Results and DiscussionWe employed three types of analyses to addressthe question of whether talking aboutpatients was predictive of talking to patients:(a) simple correlations, (b) multiple regressions,and (c) canonical correlation. We describeeach analysis in turn.Simple CorrelationsFor our first analysis we correlated each ofthe 10 variables that had been rated by judgeswhile therapists talked to patients with eachof the corresponding 10 variables that had beenrated by judges while therapists talked aboutpatients. The first column of correlations ofTable 1 shows the results of this analysis. Allof the correlations were positive, most weresignificant, and half were significant at p