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

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684 R. ROSENTHAL, P. BLANCK, AND M. VANNICELLIOPTIMISTIC.2032 /2222\ "ANXIETY /36WARMTHFigure 1. Tone of voice while talking to 98 patients (four variables) as predicted from tone of voice whiletalking about those same 98 patients (five variables). (The four criterion variables are enclosed in boxes;the five predictor variables are arrayed around the perimeter.)in talking to patients could be predicted significantlyfrom knowing how therapists talkedabout patients as measured on five predictorvariables—warmth, anxiety, dominance, optimism,and honesty. The remaining two predictorvariables of hostility and professionalcompetence in talking about patients did notcontribute significantly to the prediction ofthe four factor-based dependent variables.Figure 1 summarizes the four regressionequations graphically. The four dependentvariables are shown in boxes, and the five significantpredictors are shown on the perimeterof the diagram. This form of display of a setof multiple regression equations has the advantagethat it not only shows for each dependentvariable its successful predictors butalso shows for each predictor the various dependentvariables to which it makes a predictivecontribution.The single substantive conclusion that seemsclearest is that therapists who speak withwarmth and anxiety (interpreted in this contextas concern and caring) and not in a dominantmanner about their patients, treat theirpatients with warmth and honesty as judgedfrom their tone of voice in speaking to theirpatients.Additionally, more tentative conclusionsfrom Figure 1 are that (a) therapists speakingof patients in a dominant but optimistic mannerare more likely to talk to those patientsin a professionally competent manner; (b)honesty in talking about a patient may be associatedwith anxiety in talking to that patient;and (c) honesty after correction for any componentof warmth (see Table 2) may predictdishonesty in tone of voice while talking topatients. Honesty corrected for warmth maybe akin to brutal frankness, a kind of "honesty"that may not be of therapeutic benefit.Canonical CorrelationIn our final analysis we examined the overallrelationship between the' seven predictor variablesand the four criterion variables we hadearlier examined in a series of four multipleregression equations. The resulting canonicalcorrelation R c was .584, p = .00022, showingthat the information in the predictor set significantlypredicted the information in the criterionset. Of the four canonical correlationsthat could be computed, only the first wassignificant.Table 3 shows the loadings on the first canonicalvariate for the predictor and the criterionvariables. The pattern of loadings onthe predictor variables suggest that therapistsscoring high on this canonical variate manifesta tone of voice in talking about patients thatis cold, uncaring (unanxious), perhaps overlyprofessional, and dominating—a pattern thatappears "coldly autocratic." These coldly au-
SPEAKING TO AND ABOUT PATIENTS 685Table 3Predicting Therapists' Tone of Voice WhileTalking to 98 Patients From Therapists' Tone ofVoice While Talking About Those Same 98Patients: Canonical CorrelationPredictor variableCriterion variableVariable Loading Variable LoadingProfessionalism-Professionalism-Competence .343 Competence .392Warmth -.427 Warmth -.719Absence ofhostility .081 Anxiety -.082Anxiety -.490 Honesty -.516Dominance .490Optimism -.044Honesty -.131tocratic speakers about patients when speakingto patients are characterized as being cold,dishonest, and again, perhaps overly professionalor "coldly professional." In short, therapistswho speak of patients in a coldly autocraticway tend to speak to those patients ina coldly professional way.The canonical correlation of .584 is the correlationbetween the canonical variates not theoriginal variables considered as sets. If wewant the correlation between the two sets ofvariables, we compute an index called^redundancy (Stewart & Love, 1968; Tucker& Chase, 1980). For the present data that correlationwas .388 considering all four canonicalvariates and .284 considering only the first canonicalvariate.The magnitudes of relationship found inthe present clinical context are quite comparableto those found in other clinical contextssuch as psychotherapy outcome research(Smith & Glass, 1977; Smith, Glass, & Miller,1980) and in other areas assessing the effectsof nonverbal processes of social influence suchas the effects of interpersonal expectations(Rosenthal, 1966; Rosenthal & Jacobson,1968; Rosenthal & Rubin, 1978).ConclusionThe present study shows that therapists' toneof voice in talking about patients can be usedto make significantly accurate predictionsabout therapists' tone of voice in talking topatients. Our research shows, furthermore,that these predictions are characterized by discriminantvalidity as well as predictive validity.The predictions about therapists' tone of voiceare not only significant statistically but alsopractically meaningful in magnitude. Correlationsbased on the median simple, the medianmultiple, and the cumulative canonicalcorrelations were .24, .38, and .39, respectively.These correlations are associated with improvementsin prediction from 38% to 62%,from 31% to 69%, and from 30.5% to 69.5%,respectively (Rosenthal & Rubin, 1982). Inshort, these correlations, which are about ashigh as are usually obtained in clinical researchof this type (Cohen, 1977, page 81), might wellbe of practical utility if their magnitude holdsup on replication.We are intrigued by the possibility that suchbrief clips of content-filtered speech might beuseful not only for further research on psychotherapeuticprocess but also, in the future,for the selection and supervision of therapistsas well.ReferencesAmerican Psychiatric Association. (1980). Diagnostic andstatistical manual of mental disorders (3rd ed.). Washington,DC: Author.Blanck, P. D., & Rosenthal, R. (in press). The mediationof interpersonal expectancy effects: The counselor's toneof voice. Journal of Educational Psychology.Blanck, P. D., Rosenthal, R., & Vannicelli, M. (1983).The factor structure of the therapist's tone of voice. Unpublishedmanuscript, Harvard University, Cambridge,MA.Blanck, P. D., Rosenthal, R., Vanicelli, M., & Lee, T. D.(1983). Therapist's tone of voice as predictor of psychotherapeuticprocess: The first few seconds. Unpublishedmanuscript, Harvard University, Cambridge, MA.Caporael, L. R., Lukaszewski, M. P., & Culbertson, G.H. (1983). Secondary baby talk: Judgments by institutionalizedelderly and their caregivers. Journal of Personalityand Social Psychology, 44, 746-754.Cohen, J. (1977). Statistical power analysis for the behavioralsciences (rev. ed.). NY: Academic Press.Davitz, J. R. (1964). The communication of emotionalmeaning. NY: McGraw-Hill.DePaulo, B. M., & Rosenthal, R. (1979). Ambivalence,discrepancy, and deception in nonverbal communication.In R. Rosenthal (Ed.), Skill in nonverbal communication:Individual differences (pp. 204-248).Cambridge, MA: Oelgeschlager, Gunn & Hain.DiMatteo, M. R. (1979). Nonverbal skill and the physicianpatientrelationship. In R. Rosenthal (Ed.), Skill in nonverbalcommunication: Individual differences (pp. 104-134). Cambridge, MA: Oelgeschlager, Gunn & Hain.Duncan, S., Jr., Rice, L. N., & Butler, J. M. (1968). Therapists'paralanguage in peak and poor psychotherapyhours. Journal of Abnormal Psychology, 73, 566-570.
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Speaking to and About Patients: Predicting Therapists' Tone of Voice

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