Dr John Birtchnell

Career Summary

Immediately after graduation, moved to Liverpool (House Physician in Psychiatry [observation wards], Sefton General Hospital, January-August, 1960). Moved to Walton Hospital, Liverpool. (House Surgeon in Neurosurgery, September, 1960-February, 1961; S.H.O. in Neurology, March-August, 1961; S.H.O. in Psychiatry [mostly out-patient psychotherapy], September, 1961-August, 1962).

Moved to Dumfries, Scotland (Registrar, Crichton Royal Hospital, September, 1962-November, 1964) Obtained DPM and started to collect data for MD. Moved to Aylesbury, Buckinghamshire [place of birth] (Senior Registrar, St John's Hospital, Stone, November, 1964-November, 1966) Last NHS appointment.

Completed MD study. Moved to Aberdeen to do a one-year (November, 1966-November, 1967), full-time course in psychotherapy at the Ross Clinic and the Department of Mental Health, with an honorary Senior Registrar appointment and supported by a Medical Research Council Award for Further Education in the Medical Sciences.

Stayed in Aberdeen (Mental Health Research Unit) to do the first two years (December, 1967-December, 1969) of a three-year MRC Clinical Research Fellowship, drawing upon data accumulated in the North East of Scotland Psychiatric Case Register. Made a film on the art productions of a young man with dysmorphophobia.

In 1970, moved to the MRC Clinical Research Unit in Chichester, West Sussex to complete the third year of the Fellowship. Retained in the Unit as a Scientific Officer on a three-year contract.

In 1973, awarded a permanent MRC contract and made an honorary consultant psychiatrist. Carried out a community study of 40-49 year old women, with John Kennard, another Unit member and Jackie Powell, from the Department of Sociology at Southampton University.

In 1982, on the retirement of the Unit Director, moved to the MRC Social Psychiatry Unit at the Institute of Psychiatry in London. Made an honorary Senior Lecturer at the Institute and an honorary Consultant Psychiatrist at the Maudsley Hospital. Carried out a new community study of 23-34 year old married women and their husbands in Thamesmead, South London.

In 1989, the Unit became the Social and Community Psychiatry Unit, with a new director.

From 1990 to the present developed a number of instruments for the measurement of relating and used them in research into individual psychotherapy and couple therapy. Began work on How Humans Relate.

In 1992, retired from the MRC but retained the honorary contract at the Institute of Psychiatry. How Humans Relate first published in 1993. Paperback version published in 1996. Began work on Relating in Psychotherapy in 1995. First published in 1999. Paperback version  published in 2002. Began working on The Two of Me in 2000. Published in 2003.

Dr John Birtchnell has since retired from all research interests.

Relating Theory

Relating is that which one person does to another, or to others, so it is a characteristic of an individual. Relating can apply as much to what happens in an instant as to what happens over the course of a lifetime; so offering someone a seat on a bus is as much relating as is being someone who goes through life needing to help people. A person can relate as much to internalised people and to people in the real world. Relating is so essential a part of our being that we never stop doing it, just as our hearts never stop beating.

The essentials of relating theory:

  1. Relating occurs along two intersecting axes, a horizontal one, concerning a need for involvement with others (closeness) versus a need for separation (distance), and a vertical one, concerning a need to relate from above downwards (upperness) versus a need to relate from below upwards (lowerness).
  2. Each of the four positions (closeness, distance, upperness and lowerness) carries advantages for the individual.
  3. No position is either better or worse than any other.
  4. Each position is described as a state of relatedness, which carries its own particular satisfaction.
  5. Each position is considered to constitute a relating objective, with its own specific drive.
  6. The emotions convey to us whether we are on course in attaining and maintaining the states of relatedness.
  7. Whilst we are born with innate dispositions to the four states of relatedness, we need in the course of maturation, to develop competence in attaining and maintaining each of them.
  8. A person who is competent in all states of relatedness is called versatile.
  9. Competent relating is called positive, an relating that falls short of competence is called negative. One of the objectives of psychotherapy is the elimination of negative relating.
  10. There are four intermediate states that result from a blending of a horizontal state and a vertical state. These are called upper close, lower close, upper distant and lower distant. The four pure states (which are called neutral) and the four intermediate states are organised into a theoretical structure that is called the interpersonal octagon.

Measures of relating and interrelating

The Person's Relating to Others Questionnaire (PROQ)

The PROQ (as distinct from the PROQ2) was the earliest relating measure and was described in Birtchnell, Falkowski & Steffert (1992). It was later described in Chapter 9 of both How Humans Relate (Birtchnell, 1993/6) and Relating in Psychotherapy (Birtchnell, 1999/2002). It is a 96-item, self-administered questionnaire, with twelve items contributing to each of the eight scales, which correspond to each octant of the interpersonal octagon. Of the twelve items, two refer to positive relating, and are not normally scored, and ten refer to negative relating. The positive items are included to give respondents something good to say about themselves. There are four options for each item providing a score range of 0-3. Thus for each octant scale, the score range is 0-30, and the total score, combining the scores for each scale has a maximum of 240.

 

The PROQ2

In 1995, a revised version of the PROQ was produced, called the PROQ2. Its aims were to improve the clarity and factorial structure and to reduce the correlation between scales. The wording of the response options was changed to "Nearly always true" "Quite often true" "Sometimes true" and "Rarely true." Since the introduction of the PROQ2, the original PROQ has dropped out of use. The Birtchnell, Falkowski & Steffert (1992) paper is the only one on the original PROQ; and at present, the only paper on the PROQ2 is the one by Birtchnell & Shine (2000). The 1992 paper contains the items of the PROQ. The items of the PROQ2 have not been published, but copies of the PROQ2 are available from me.

The scales of the PROQ and the PROQ2, named after the octants of the interpersonal octagon, are called upper neutral (UN), upper close (UC), neutral close (NC), lower close (LC), lower neutral (LN), lower distant (LD), neutral distant (ND) and upper distant (UD).

 

The PROQ2a and PROQ3

These two measures are attempts to produce a shortened version of the PROQ2. Both are half the length of the PROQ2, i.e. they have 48 items, six for each octant. Five of these six items are negative and one is positive. The PROQ2a is made up entirely of items from the PROQ2, whereas the PROQ3 includes some new items. The PROQ2a items comprise those with the highest loadings on the eight factors that emerged from a principal components analysis of the PROQ2 items and with the lowest commonalities. In the PROQ3, all of the UC items, and some of the LD items have been replaced. The point of this is to render the UC scale more pathological and to reduce the high correlation between the LD scale and the LN scale.

 

The Couple's Relating to Each Other Questionnaires (CREOQ)

The interrelating between two people can be measured by a set of questionnaires called the Couple's Relating to Each Other Questionnaires (CREOQ). These were first developed for the measurement of the interrelating between two people in a couple relationship. They can however be modified to measure the interrelating between any two specified people. The CREOQ is made up of a set of four questionnaires called the MS, MP, WS and WP. The MS measures how the man considers he relates to the woman, the MP measures how the man considers the woman relates to him, the WS measures how the woman considers she relates to the man and the WP measures how the woman considers the man relates to her. As with the PROQ, each of the four questionnaires has 96 items, 12 for each of the eight octants. Again, ten of these concern negative relating and two concern positive relating.

There is an optional, additional questionnaire may be used with the CREOQ called the US. It is the same for each partner. The letters US do not stand for anything; they simply mean us, as in the two of us. The US has 20 true/false items. It measures how each partner considers the two partners get on together. Each item scores zero or one. Half the items require a true response for a score and half require a false response for a score. Scores contribute to a measure of relationship difficulty; so a maximally poor relationship gets a score of 20. In an unpublished study (Birtchnell & Spicer) the mean US scores for 32 couples reporting a good relationship were 1.4 (sd 1.8) for men and 1.7 (sd 2.1) for women. The mean scores for 92 couples seeking couple therapy were 8.8 (sd 5.3) for men and 10.5 (sd 5.6) for women. The t values were 7.62 for men and 8.66 for women, both p <0.001) A sample of over 100 couples reporting a good relationship was recently collected by Gordon (unpublished).

 

The CREOQ3

On the basis of an exploratory factor analysis, a shorter version of the CREOQ, with only 48 items compared with the original 96, for each of the four scales, MS, MP, WS and WP, was created. As with the CREOQ, the items for the MS, and the WS and for the MP and the WP, are identical apart from gender words. It is made up of those items with the heaviest loadings on the extracted factors, though excludes items loaded on more than one factor. A number of new items were introduced in order to more clearly differentiate between certain neighboring scales (e.g. UN and UD). This new version is called the CREOQ3, so as to be comparable with the PROQ3 (though there never was a CREOQ2).

Questionnaire scoring.

Scoring software for PROQ2, PROQ3 and CREOQ3 can be downloaded from GitHub. To use the software first download it as a Zip file, extract the contents and then open index.html in any modern web browser. For the time being the software can also be used online here.

 

Manual scoring instructions.

 

PROQ2

Each question can contribute from zero to three points to one of the scores,

Nearly always true = 3 points
Quite often true = 2 Points
Sometimes true = 1 Point
Rarely True = 0 Points

The table below shows the eight negative and eight positive scores.
Listed next to each score are the question numbers of each question that contributes to that score, there are 10 questions that contribute to each negative score giving a total of between 0 and 30 points for each score, and 2 questions that contribute to each positive score giving a total of between 0 and 6 points each.

UN negative: 09, 19, 30, 40, 46, 49, 60, 69, 86, 91. positive: 06, 84.

UC negative: 07, 16, 28, 37, 44, 57, 70, 74, 77, 85. positive: 24, 61.

NC negative: 05, 15, 21, 29, 33, 35, 41, 48, 64, 79. positive: 17, 52.

LC negative: 02, 10, 12, 25, 34, 50, 72, 78, 80, 83. positive: 66, 95.

LN negative: 08, 20, 27, 36, 39, 51, 62, 65, 73, 82. positive: 11, 68.

LD negative: 03, 13, 18, 22, 42, 56, 71, 87, 89, 96. positive: 31, 45.

ND negative: 01, 23, 47, 53, 55, 58, 63, 75, 92, 94. positive: 38, 88.

UD negative: 14, 26, 32, 43, 54, 59, 67, 81, 90, 93. positive: 04, 76.

 


PROQ2a & PROQ3

Follow the same procedure as for PROQ2, giving eight negative scores totaling between 0 and 15 points, and eight positive scores totaling between 0 and 3 points.

UN negative: 09, 19, 27, 35, 38. positive: 05

UC negative: 17, 24, 33, 39, 42. positive: 13

NC negative: 04, 11, 18, 22, 43. positive: 30

LC negative: 06, 14, 28, 41, 44. positive: 36

LN negative: 10, 16, 23, 25, 29. positive: 37

LD negative: 02, 32, 40, 45, 48. positive: 20

ND negative: 01, 08, 12, 31, 47. positive: 46

UD negative: 07, 15, 21, 26, 34. positive: 03


CREOQ

Follow the same procedure as for PROQ2, giving for each questionnaire eight negative scores totalling between 0 and 30 points, and eight positive scores totalling between 0 and 6 points.

MS/WS

UN negative: 05, 12, 15, 40, 45, 49, 53, 56, 69, 88. positive: 35, 71.

UC negative: 04, 10, 31, 36, 42, 61, 75, 81, 89, 92. positive: 78, 84.

NC negative: 02, 28, 47, 50, 54, 64, 66, 68, 87, 96. positive: 06, 19.

LC negative: 07, 22, 32, 37, 51, 59, 72, 76, 83, 93. positive: 21, 33.

LN negative: 09, 23, 25, 29, 34, 38, 44, 46, 55, 65. positive: 60, 79.

LD negative: 01, 13, 17, 20, 39, 48, 52, 67, 74, 85. positive: 90, 94.

ND negative: 08, 11, 16, 24, 30, 43, 57, 62, 70, 73. positive: 14, 27.

UD negative: 03, 18, 26, 41, 58, 63, 77, 80, 82, 91. positive: 86, 95.


MP/WP

UN negative: 09, 19, 30, 33, 43, 52, 63, 69, 73, 77. positive: 79, 84.

UC negative: 03, 07, 14, 22, 26, 60, 80, 85, 90, 92. positive: 06, 15.

NC negative: 18, 24, 37, 47, 58, 74, 81, 88, 89, 94. positive: 10, 40.

LC negative: 11, 16, 29, 31, 44, 56, 71, 78, 83, 96. positive: 34, 75,

LN negative: 02, 36, 41, 50, 53, 59, 61, 66. 67, 95. positive: 27, 46,

LD negative: 05, 13, 17, 20, 25, 35, 39, 49, 64, 93. positive: 45, 82.

ND negative: 01, 08, 23, 32, 42, 51, 68, 76, 86, 87. positive: 55, 62.

UD negative: 04, 12, 28, 38, 48, 54, 57, 65, 72, 91. positive: 21, 70.

 

CREOQ3

MS/WS

UN negative: 5, 10, 23, 32, 37

UC negative: 1, 16, 21, 27, 41

NC negative: 8, 19, 34, 43, 46

LC negative: 3, 14, 25, 29, 31

LN negative: 7, 11, 20, 40, 44

LD negative: 2, 13, 22, 45, 47

ND negative: 4, 17, 28, 33, 38

UD negative: 15, 26, 30, 35, 39

Positive: 6, 9, 12, 18, 24, 36, 42, 48


MP/WP

UN negative: 1, 11, 19, 25, 33

UC negative: 5, 22, 27, 38, 42

NC negative: 2, 13, 32, 41, 46

LC negative: 10, 14, 21, 29, 34

LN negative: 3, 17, 20, 43, 47

LD negative: 16, 26, 31, 40, 45

ND negative: 4, 7, 23, 37, 44

UD negative: 9, 15, 28, 35, 39

Positive: 6, 8, 12, 18, 24, 30, 36, 48


US

For each even numbered question a tick in the true column scores one point For each odd numbered question a tick in the false column scores one point, giving you a total score between 0 and 20.