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UBC Theses and Dissertations

A study of the working alliance in psychotherapy Adler, Jean Vera 1988

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STUDY OF THE WORKING ALLIANCE IN PSYCHOTHERAPY  by JEAN VERA ADLER B.A., M.A.,  U n i v e r s i t y Of B r i t i s h C o l u m b i a , M . B . A . , York U n i v e r s i t y , 1976 U n i v e r s i t y Of B r i t i s h C o l u m b i a ,  A THESIS SUBMITTED IN  1966 1984  PARTIAL FULFILMENT OF  THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF EDUCATION in THE FACULTY OF GRADUATE STUDIES Counselling Psychology  We a c c e p t to  this  the  thesis  required  THE UNIVERSITY  conforming  standard  OF BRITISH COLUMBIA  May  ©  as  1988  Jean Vera A d l e r ,  1988  In  presenting  degree  at  this  the  thesis in  University of  partial  fulfilment  of  of  department  this or  publication of  thesis for by  his  or  her  representatives.  C o u n s e l l i n g Psychology  May 2 6 t h , 19 8 8  for  an advanced  Library shall make  it  agree that permission for extensive  It  this thesis for financial gain shall not  The University of British Columbia 1956 Main Mall Vancouver, Canada V6T 1Y3  Date  that the  scholarly purposes may be  permission.  Department of  requirements  British Columbia, I agree  freely available for reference and study. I further copying  the  is  granted  by the  understood  that  head of copying  my or  be allowed without my written  i i  Abstract Originally  identified  by  therapeutic  or w o r k i n g  in  d e c a d e been p r o p o s e d a s t h e  the  last  account  for  alliance  Freud between  psychotherapeutic  theoretical  orientations  (1912, client  the  and t h e r a p i s t  common f a c t o r  outcome  and/or  1913),  that  regardless  techniques  has  could  of  the  employed  by  therapists. Psychotherapy 1984;  Hartley  Marziali, scales  researchers  &  Strupp,  Marmar,  for  &  the  self-report  construct. 1979)  It  that  the  combination agreement  of  the  of  sessions  statistically fifth  session Another  Questionnaire 1985)  is  after of  each  related tasks  the of  of  the  self-report (Luborsky,  was a l s o a d m i n i s t e r e d  consistently  1981,  1982) the  of  the  the  (1975,  synergistic  components—goal  first  Alliance five,  cases. to  It  the was  mutuality, and  the  outcome  the  Inventory  was  tenth,  and  the  to  be  found by t h e  outcome m e a s u r e s  measure,  the  third  Helping  session,  third  to  employed.  M c L e l l a n , Woody, O ' B r i a n , at  is  alliance  and r e s p o n s i b i l i t i e s ,  related six  various  p r o p o s e d by B o r d i n  Working  the  significantly  1976;  attachments.  44 p s y c h o t h e r a p y  on f o u r  (Horvath,  product  bonds o r  study,  developed  and have q u i t e  theory  the  relevant  personal  have  Luborsky,  d e v e l o p e d t o measure  three highly  present  administered final  alliance  1981;  & Coyne,  relationship.  Inventory  b a s e d on t h e  regarding  development In  is  Horvath,  alliance  instrument  Newsom, G a b b a r d ,  1981)  an a l l i a n c e - o u t c o m e  The W o r k i n g A l l i a n c e first  1983;  Krupnick,  measuring  demonstrated  (Allen,  Alliance  & Auerbach, as  well  as  measures  of  therapist  trustworthiness. based  on  a  empathy,  six  of  differential are  offered.  is  alliance,  was  outcome  on  Speculations concerning  the  significantly  measures employed.  patterns  of  results  and  which  clinically-derived definition  the  attractiveness,  The H e l p i n g A l l i a n c e Q u e s t i o n n a i r e ,  f o u n d t o be s t a t i s t i c a l l y all  expertness,  of  related  w i t h the  the to  two a l l i a n c e  measures  i v  Table  of  Contents  Abstract L i s t of T a b l e s Acknowledgement Chapter  ii viii x  I  INTRODUCTION  1  1 . OVERVIEW  1  2.  CURRENT PROPOSITIONS ABOUT THE WORKING ALLIANCE  4  3.  DEFINITION OF TERMS  6  4.  RESEARCH QUESTIONS  Chapter II REVIEW OF LITERATURE 1. THEORETICAL DEVELOPMENT OF THE ALLIANCE CONCEPT 1.1 P s y c h o a n a l y t i c F o r m u l a t i o n s 1.2 O t h e r C o n c e p t u a l i z a t i o n s Of The R e l a t i o n s h i p  10  11 11 11 13  2.  EMPIRICAL RESEARCH ON THE ALLIANCE 2.1 The Penn R e s e a r c h G r o u p 2.2 The V a n d e r b i l t R e s e a r c h G r o u p 2.3 The L a n g l e y P o r t e r R e s e a r c h G r o u p 2.4 The M e n n i n g e r R e s e a r c h G r o u p 2 . 5 The B r i t i s h C o l u m b i a R e s e a r c h G r o u p 2 . 6 The I n v o l v e m e n t D i m e n s i o n  17 17 21 24 25 27 30  3.  SIGNIFICANCE OF THE PRESENT STUDY  31  4.  RESEARCH HYPOTHESES  33  Chapter  III  METHODS AND PROCEDURES  37  1.  DESIGN OF THE STUDY  37  2.  POPULATION  38  3.  DATA COLLECTION AND PREPARATION  40  4.  RELATIONSHIP MEASURES 4.1 W o r k i n g A l l i a n c e I n v e n t o r y 4.2 C l i e n t I n v o l v e m e n t S c a l e 4.3 R e l a t i o n s h i p I n v e n t o r y 4 . 4 C o u n s e l o r R a t i n g Form 4.5 H e l p i n g A l l i a n c e Q u e s t i o n n a i r e OUTCOME MEASURES  42 42 45 46 47 48 49  5.  V  5.1 5.2 5.3 5.4 5.5 5.6 5.7 Chapter RESULTS 1.  T a r g e t C o m p l a i n t s Improvement Symptom C h e c k l i s t - 9 0 S e l f - E s t e e m Index I n v e n t o r y Of I n t e r p e r s o n a l P r o b l e m s Strupp Posttherapy Questionnaire Therapist Posttherapy Questionnaire T h e r a p i s t Demographic D a t a S h e e t  49 50 51 52 53 54 54  IV 56  RELATIONSHIP OF PERCEIVED ALLIANCE STRENGTH TO OUTCOME 1.1 T a r g e t C o m p l a i n t s Improvement 1.2 S e l f - E s t e e m Index 1.3 Symptom C h e c k l i s t - 9 0 1.4 I n v e n t o r y Of I n t e r p e r s o n a l P r o b l e m s 1.5 S t r u p p P o s t t h e r a p y Q u e s t i o n n a i r e 1.5.1 Satisfaction 1 . 5 . 2 Change 1.5.3 Adjustment 1.6 T h e r a p i s t P o s t t h e r a p y Q u e s t i o n n a i r e 1.6.1 Satisfaction 1.6.2 Change 1.6.3 Adjustment  58 ....58 60 60 62 63 64 64 64 65 65 65 66  2.  RELATIONSHIP OF PERCEIVED CHANGE IN OUTCOME  3.  RELATIONSHIPS OF C L I E N T - P E R C E I V E D THERAPIST EMPATHY, EXPERTNESS, ATTRACTIVENESS, AND TRUSTWORTHINESS TO OUTCOME 3.1 R e l a t i o n s h i p I n v e n t o r y 3.2 C o u n s e l o r R a t i n g Form  68 69 69  RELATIONSHIP OF C L I E N T - P E R C E I V E D ALLIANCE STRENGTH AS MEASURED WITH THE HELPING ALLIANCE QUESTIONNAIRE TO OUTCOME  69  4.  5.  ALLIANCE STRENGTH TO 66  RELATIONSHIP OF PERCEIVED CLIENT INVOLVEMENT TO OUTCOME 70  6. 7.  RELATIONSHIP OF CONGRUENCE OF C L I E N T - P E R C E I V E D AND THERAPIST-PERCEIVED ALLIANCE STRENGTH TO OUTCOME POST HOC ANALYSES 7.1 A n a l y s i s Of T h e r a p i s t E f f e c t 7.2 A n a l y s i s Of E f f e c t Of T h e o r e t i c a l O r i e n t a t i o n s Of Therapists 7.3 C o r r e l a t i o n s Of The WAI W i t h The Outcome M e a s u r e s The S e v e n O c c a s i o n s 7.4 R e l a t i o n s h i p s Between The WAI And The O t h e r R e l a t i o n s h i p Measures 7.5 I d e n t i f i c a t i o n Of R e l a t i v e S t r e n g t h s Of Outcome  73 76 76 77 At 79 81  vi  Predictor Variables 7 . 6 C o m p a r i s o n Of WAI S c o r e s Of C o m p l e t e d And Prematurely Terminated Cases Chapter V DISCUSSION  84 88  91  1.  INTERPRETATION OF FINDINGS 91 1.1 R e l a t i o n s h i p Of P e r c e i v e d A l l i a n c e S t r e n g t h To Outcome 91 1.2 R e l a t i o n s h i p Of P e r c e i v e d Change In A l l i a n c e S t r e n g t h To Outcome 93 1.3 R e l a t i o n s h i p s Of C l i e n t - p e r c e i v e d T h e r a p i s t Empathy, E x p e r t n e s s , A t t r a c t i v e n e s s , And T r u s t w o r t h i n e s s To Outcome 94 1.4 R e l a t i o n s h i p Of C l i e n t - p e r c e i v e d A l l i a n c e S t r e n g t h As M e a s u r e d W i t h The H e l p i n g A l l i a n c e Q u e s t i o n n a i r e To Outcome 96 1.5 R e l a t i o n s h i p Of P e r c e i v e d C l i e n t I n v o l v e m e n t To Outcome 105 1.6 R e l a t i o n s h i p Of C o n g r u e n c e Of C l i e n t - p e r c e i v e d And T h e r a p i s t - p e r c e i v e d A l l i a n c e S t r e n g t h To Outcome . . 1 0 6 1.7 P o s t Hoc A n a l y s e s 107 1.7.1 A n a l y s i s Of T h e r a p i s t E f f e c t 107 1 . 7 . 2 A n a l y s i s Of E f f e c t Of T h e o r e t i c a l O r i e n t a t i o n s Of Therapists 108 1 . 7 . 3 C o r r e l a t i o n s Of The WAIc W i t h The Outcome M e a s u r e s At The Seven O c c a s i o n s 109 1 . 7 . 4 R e l a t i o n s h i p s Between The WAI And The O t h e r R e l a t i o n s h i p Measures 110 1 . 7 . 5 I d e n t i f i c a t i o n Of R e l a t i v e S t r e n g t h s Of Outcome Predictor Variables 111 1 . 7 . 6 C o m p a r i s o n Of WAI S c o r e s Of C o m p l e t e d And Prematurely Terminated Cases 111  2.  LIMITATIONS OF THE STUDY  111  3.  RECOMMENDATIONS FOR FUTURE RESEARCH  115  4.  SUMMARY AND CONCLUSION  117  REFERENCES  119  APPENDIX 1 AGENCIES  LETTER OF I N I T I A L CONTACT TO SOCIAL SERVICE  APPENDIX 2 -  LETTER OF I N I T I A L CONTACT TO PRIVATE  129  PRACTITIONERS  130  APPENDIX 3 -  THERAPIST CONSENT FORM  131  APPENDIX 4 -  CLIENT CONSENT FORM  133  APPENDIX 5 -  TARGET COMPLAINTS/DEMOGRAPHIC QUESTIONNAIRE 135  APPENDIX 6 -  SYMPTOM CHECKLIST-90  136  APPENDIX 7 -  S E L F - E S T E E M INDEX  140  APPENDIX 8 -  INVENTORY OF INTERPERSONAL PROBLEMS  141  APPENDIX 9 - WORKING ALLIANCE INVENTORY  (CLIENT  APPENDIX  10 -  CLIENT INVOLVEMENT SCALE  (CLIENT  APPENDIX  11 -  WORKING ALLIANCE INVENTORY  FORM)  ...147  FORM)  152  (THERAPIST FORM) 153  APPENDIX  12 -  CLIENT INVOLVEMENT SCALE  (THERAPIST FORM)  .158  APPENDIX  13 -  RELATIONSHIP  EMPATHY SUBSCALE  .159  APPENDIX  14 -  COUNSELOR RATING FORM  161  APPENDIX  15 -  HELPING ALLIANCE QUESTIONNAIRE  164  APPENDIX  16 -  STRUPP POSTTHERAPY QUESTIONNAIRE  165  APPENDIX  17 -  TARGET COMPLAINTS IMPROVEMENT RATING FORM  APPENDIX  18 -  THERAPIST DEMOGRAPHIC DATA SHEET  169  APPENDIX  19 -  THERAPIST POSTTHERAPY QUESTIONNAIRE  170  APPENDIX 20 -  LETTER OF THANKS TO CLIENTS  173  APPENDIX 21  INSTRUMENT SCORING KEYS  174  -  APPENDIX 22 -  INVENTORY -  .168  ADDITIONAL INFORMATION COLLECTED ON THE SPQ  AND THE TPQ  176  APPENDIX 23 -  R E L I A B I L I T Y ESTIMATES OF THE INSTRUMENTS  ..179  APPENDIX 24 -  DEMOGRAPHIC ANALYSIS OF THE SAMPLE  APPENDIX 25 SESSIONS APPENDIX 26 -  ESTABLISHMENT OF THE ALLIANCE THROUGH EARLY  184  186 MAGNITUDE OF CHANGE ON THE OUTCOME MEASURES 187  vi i i  List  1.  Intercorrelation  of  the  of  WAI  Tables  S u b s c a l e s at  Session  Three 44  2.  3. 4.  Relationships Improvement  between  the  WAIc  Relationships Interpersonal  between t h e Problems  WAIc  Relationships  between  WAI  and T a r g e t  Complaints 59  the  and t h e  Inventory  of 62  and t h e  SPQ and t h e TPQ 63  5.  Relationship  of  Change  6.  Relationships Measures  7.  R e l a t i o n s h i p s between t h e Outcome M e a s u r e s  between  i n WAIc Other the  Strength  t o Outcome  ...67  P r o c e s s M e a s u r e s and Outcome 68  Client  Involvement  Scale  and 70  8.  Summary of  9.  Z - R a t i o s o f D i f f e r e n c e s between WAIc-Outcome C o r r e l a t i o n s and O t h e r R e l a t i o n s h i p M e a s u r e s - O u t c o m e Correlations  72  10.  Congruence of  73  11.  WAIc-WAIt C o n g r u e n c e a t  12.  C o r r e l a t i o n of Outcome w i t h WAIc-WAIt C o n g r u e n c e a t Seven O c c a s i o n s  13.  A n a l y s i s of Variables  14. 15. 16. 17.  Relationship-Outcome  the  WAIc  Therapist  the  71  WAIt  Seven O c c a s i o n s  Effect  74  on T h r e e M a r k e r  the 75  Outcome 77  A n a l y s i s of E f f e c t T h e r a p i s t on WAIt  of  WAIc  between  Intercorrelations  Theoretical  Orientation  of 78  C o r r e l a t i o n s of the Outcome M e a s u r e s Relationships Measures  and t h e  Correlations  at  Seven O c c a s i o n s w i t h  the 80  the  WAI  and t h e  Other  Process 82  of  the  Client-Rated  Process  Measures 84  18.  Intercorrelations  of  the  Outcome M e a s u r e s  85  ix  19.  Relative  Strengths  20.  C o m p a r i s o n of WAI Terminated Cases  of  Outcome P r e d i c t o r  S c o r e s of  Variables  C o m p l e t e d and  ....87  Prematurely 89  21.  Means and S t a n d a r d D e v i a t i o n s  22.  Reliability  23.  Categorization  of  Therapists  184  24.  Categorization  of  Clients  185  25.  Intercorrelations  26.  Magnitude Inventory  of of  E s t i m a t e s of  of  the  the  of  R e l a t i o n s h i p Measures 180  Instruments  WAIc a t  the  First  Change on Symptom C h e c k l i s t - 9 0 I n t e r p e r s o n a l Problems  182  Five  Sessions 186  and 188  X  Acknowledgement  I Robert careful I  thank  the  Tolsma, Daniel reviews also  gave me a c c e s s the  members o f  of  questionnaires Finally,  with their  I  Perlman,  and  my work and f o r  thank to  my c o m m i t t e e ,  the  their they thank  confidence  Drs.  Robert  their  Leslie Conry,  helpful  experiences  in  for  their  suggestions.  p s y c h o t h e r a p i s t s and t h e i r personal  Greenberg,  clients  therapy  who  through  completed. my f r i e n d s  i n my c a p a c i t y  and f a m i l y to  who e n c o u r a g e d me  complete  this  project.  1  I. 1.  OVERVIEW  The client  concept  of  and t h e r a p i s t  attempt  in  relevance  of  &  INTRODUCTION  the 1986;  Hartley  conditions  for  (Gelso  &  Carter,  begun  to  1981;  reveal  studies  settings  the  has  long  to  an  important  element  the  therapist's  only  1984;  examination  an  been  of  theoretical Freud,  recently  recent of  the  Suh, & Strupp,  the  findings  conducted  measurement that  (i.e.,  the  (i.e.,  the  1957;  in  of  from a natural  program.  the  relationship  client),  and  the  therapist),  (Bordin,  Rogers,  Horvath,  a sample  orientation  1975,  Strupp,  initially  r e f o c u s away from  is  regardless  inconclusive findings  begun t o  in  O'Malley, some o f  after  theory  1983;  situation  1913;  sufficient"  have  treatment  c o n d i t i o n s and p r o d u c i n g relatively  and  have  & Strupp,  recognition  the  seems t o  significance  cases  be a change a g e n t ,  the  (Greenberg  r e s e a r c h and  by d r a w i n g  intensive  explain  It  studies  and  Hartley  Psychotherapy process r e s e a r c h e r s , core  source of  nature  psychotherapy  1971;  1983).  of  to  between  promising  outcome  "necessary  p e r s o n who s e e k s c h a n g e ,  Frank,  research  study has s u b j e c t e d  one who o f f e r s  1979;  and  number  Marziali,  further  real  A  1978;  and i m p l e m e n t i n g  There between  of  to  most c u r r e n t  Strupp,  the  1976;  alliance  therapeutic  " c o r e " or  (Gomes-Schwartz,  population  &  1985).  The p r e s e n t  these  to  change as a f e r t i l e  Luborsky,  1983).  (1957)  the  or w o r k i n g  process  relationship  supplanted Rogers'  alliance  represents  psychotherapy  Pinsof,  years  a therapeutic  of  1976, 1973).  focusing there,  on have  "specific",  2  (i.e., or  technical  "generic",  empirically Luborsky,  or o r i e n t a t i o n ) ,  (i.e.,  demonstrate  Singer,  Two o t h e r  been  approaches  "general"  factors  and  begun  importance 1975;  to  Strupp & Hadley,  on  change.  namely,  Rogers  conditions  empathy,  Strong's  (1968)  extent  expert,  the  to  which  approach to  product  of  the  components o f  bonds or  to  quality  of  Gelso  client  and  an  and  to and  therapist-offered,  related  client  the  specific  1912,  therapist and  therapeutic  change  therapist  to as  general  of  the  mutuality,  track in  the  In  alliance  agreement  and  of  the  in  as  regarding  investigators  therapeutic  engagements. described  strength  the  the  related  development  measure t h e  an  particular,  three highly  prompted  have  concept  factors  to  (1985)  and  and p r o m i s i n g  i s e m e r g i n g a s an  change.  responsibilities,  Carter  necessary  incorporative  conceptualization  alliance  also  and c o n g r u e n c e .  p r o p o s e d by F r e u d i n  to  have  regard,  perceived  attachments—has  attempt the  is  alliance--goal and  the  relationship  the  s y n e r g i s t i c c o m b i n a t i o n of  the  tasks  theory  of  trustworthy.  of  1979)  some  that  1978;  outcome, Rogers'  theory,  c h a n g e were  client  alliance  theory  (1975,  personal  and  integrating  Bordin's  relevant  influence  between  overarching  client  the  Originally  alliance  have  hypothesized for  social  working  approach.  to  to  1979).  impact  therapeutic  unconditional positive  attractive,  The  begin  demonstrated  have  (Gomes-Schwartz,  explicating  relationship  empirically  sufficient  an  and t o w a r d  c o r e c o n d i t i o n s and s o c i a l i n f l u e n c e  client  the  their  & Luborsky,  client-therapist (1957)  relationship),  factors  of to and  working  3  alliance,  in p a n t h e o r e t i c a l  reasonable  or  counsellor's  in  a  the  work.  "objectively" working  participants  in  the  side  Drawing  and  emotional  Carter  creating  that  is  of  goals  probably  a  theoretical  Greenberg  (1985)  (1975,  integrate  views  world stance  that  her  him.  in psychotherapy.  constitute  tasks are bonds,  while  t a s k s might  involve  the  c o m b i n a t i o n of  of  different  a  good  have  relational  overall  similarly  alliance  the  goals,  of  of  technical tasks,  the  recognized  the  the  to  the the  strengths  of  it  helps  operations  certain  types  and that of  relationship  skills.  integrative  client  of  particular  (1985)  the  trust  relationship  elements,  an the  on  to  the  that  and b o n d s , or  Docherty  to  empathy,  enough  is  c o m p l e t i o n of  and t e c h n i c a l  alliance.  concept.  one  is  by  g o a l s and t a s k s  requiring  use o f  fed  capacity  Specific technical  viewed as  relational  and  similar the  importance  technique  correct  or  together  alliance  Moreover,  view  the  contribution  the  by c l i e n t  conceptualization  the  joined  Therapist  people.  the  that  and by agreement  tasks.  has n o t e d t h a t  1979) on  to  with  conceptualization,  fostered  attachment  and  attachments  c o u n s e l l i n g make s e n s e t o  Bordin's  both  and r e s p e c t must be met  needs t o have  therapist's  are  1979)  client's  aligns sense  suggested that  have  appropriateness  form  the  (1985)  positive  to  side  (1975,  or  and  when t h e  e a c h making h i s o r h e r  bond  genuineness,  observing  on B o r d i n ' s  alignment  emotional  as e x i s t i n g  counselling relationship  shared e n t e r p r i s e ,  Gelso  terms,  It the  that  is  the  synthesis  constitutes  and H a r t l e y potential  (1985) of  the  4  Recently, 1981;  researchers  Marmar,  Marziali,  Catherall,  1984)  potential  as  variety  settings  have  of  a  Strupp,  that  it  is  types  of  findings  of  Weiss, the  therapy.  These,  in psychotherapy  &  has  Pinsof  has  say,  wide (1986)  that  been  research  they  great  in a f a i r l y  impr&ssive it  Cohen,  Pinsof &  alliance  G r e e n b e r g and  different  Horvath,  1986;  outcome  outcome when  at  1983;  Margolis,  particularly  to  ways  &  that  predictor  and c o n t e x t s .  different  different robust  potent  has been r e l a t e d  many  Horowitz,  have d e m o n s t r a t e d  observed  alliance  2.  &  Luborsky, C r i t s - C r i s t o p h , Alexander,  1983;  in  (Hartley  the  measured  centres are  with  unusually  research.  CURRENT PROPOSITIONS ABOUT THE WORKING ALLIANCE The  Gelso  first  and  three  propositions  Carter's  (1985)  that  follow  recommendations  are  drawn  for  from  research  initiatives: 1)  Regardless  important the  that  the  treatment  al. 2)  (1983), In  to  and H o r v a t h  terms  of  Bordin's  of  therapy  proceed  general for  to  agreement  treatment  goals.  be  r e s e a r c h of  bonding aspect is  the  alliance  is  s u p p o r t e d by t h e et  of  the  tasks  counselling,  Hartley  it  is  early  if  proposition  is  relatively  successful.  This  and S t r u p p  (1983),  Luborsky  (1981). (1975,  1979)  conceptualization,  d e v e l o p s most  effectively, in  of  be e s t a b l i s h e d  alliance  early  and the  duration  the that  there  work about are  slowly, must  the  be  goals  necessary to  the  whereas, at  if  least  appropriate  attain  those  5  3)  In  importance various  line of  w i t h G r e e n s o n ' s (1967)  the  phases  working of  (1983)  (1973,  1974)  notion  that  trusting  enough  to  times,  and  to  vein,  p h a s e of  therapy,  weakened  findings  Bordin the  or  as  experience faith  (1983)  consistent allows  support  in the  therapist's  negative  repairing  actually  the  Hartley  and  with the  Langs'  client  effectiveness  in  the  In  the  alliance  becomes  to  difficult  transference.  the  the  during  during  has s u g g e s t e d t h a t  p r o c e s s of  disrupted  wanes  intervention.  a strong a l l i a n c e  d u r i n g p e r i o d s of  similar  is  their  maintain  and good m o t i v e s  waxes and  psychotherapy  Strupp  feel  view  the  alliance  conceptualization,  a  middle  when  work  of  it the  treatment. The r e m a i n i n g literature 4) Strupp  and r e v i e w s  Both (1983)  be r e l a t e d over  the  propositions  to  of  Hartley  the  are  and S t r u p p  early  o c c u r r e n c e of  sessions.  point  troughed at  in  the  the  In  looked  for  changes in c l i e n t  (which changes  for  predicted to  the  and O ' M a l l e y ,  S u h , and  outcome by t h e  outcome  in a l l i a n c e  while  change  dyads  and  Strupp  to  account  behaviour  across  early  sessions  s e s s i o n ) and r e l a t e d in  therapist  more first  less successful  therapist  third  the  Suh, O'Malley  can  strength  and S t r u p p s t u d y ,  a l l i a n c e s peaking at  participation  of  general  studies that  Hartley  therapy,  differential  patterns  the  an i n c r e a s e  corresponding point.  (1986) the  (1983)  have o b s e r v e d from t h e i r the  from  alliance:  s u c c e s s f u l dyads i n c r e a s e d t h e i r quartile  drawn  warmth  these and  exploration. 5)  B a s e d on c o n v e r g e n t  r e s e a r c h from d i f f e r e n t  orientations  6  (Rice  & Kerr,  (1986)  have  client  1986;  Sampson & W e i s s ,  suggested that  s u b d i m e n s i o n and  involvement indicators  in  involvement  indicator  therapeutic  tasks  as p a r t i c i p a t i o n ,  responsibility, experiencing exploration cognitive  and  in  therapy,  and  therapy.  qualities  including positive  others, an  therapy all  of  amazingly  one  and  which,  involved 3.  in  the  of  (1985)  a  family  evaluation  predictive that  curative  task  p r o c e s s of  such as  boldness of  of  evidence  in  assignments  in  seen  the  of  positive  relationship  of  others,  involvement  therapist,  when t a k e n t o g e t h e r record  these  general  relevance,  similarly  u n d e r s t o o d by t h e  he has o b s e r v e d ,  imply  homework  has  Appropriate  indicators  inspection of  critical  such  psychotherapy,  feeling  consistent  p s y c h o t h e r a p y and  by  perceived  therapy,  Luborsky  most  alliance.  evidenced  completion  as  the  the  by o r i e n t a t i o n - s p e c i f i c  alliance  in  is  experiential  only  of  G r e e n b e r g and P i n s o f  may be t h e  optimism,  in p s y c h o a n a l y t i c  behavioural  1986),  for  qualities  the  and have  outcomes  of  are  crucially  or  emotional  therapy.  DEFINITION OF TERMS Psychotherapy:  disorders  The  treatment  or maladjustments  involving  verbal  of  mental  by p s y c h o l o g i c a l  communication.  means,  (Webster's  especially  Dictionary,  Third  Edition) Outcome; The p e r c e p t i o n s regarding  the  relates  improvements  increase  to in  success  self-esteem,  of in  of  the  client  psychotherapy, target  complaints,  resolution  of  and  the  therapist  particularly symptom  interpersonal  as  it  reduction, problems,  7  and  client's  and t h e r a p i s t ' s  i s m e a s u r e d by T a r g e t the  Interpersonal  Questionnaire  and t h e  were  a set  arrived  at  interactions.  In  to  Bordin  specific  of  the  The  client's  a  (1979)  define  theoretical  or  the  and  of  the  therapist's  and bonds t h a t helping  components a c c o r d i n g  alliance,  technical  the  Posttherapy  purposive  following  a viable  and  on  Questionnaire.  understandings,  sequence  particular,  Strupp  Outcome gain  S e l f - E s t e e m Index,  Posttherapy  agreements,  during  residual  P r o b l e m s , and the  Therapist  Working A l l i a n c e : awareness of  assessments.  C o m p l a i n t s Improvement,  Symptom C h e c k l i s t - 9 0 ,  I n v e n t o r y of  posttherapy  r e g a r d l e s s of  approach  taken  by  the the  therapist: 1) about  The  the  g o a l s of  awareness degree the  helper  that  of  implicitly 2)  helping  process.  the  The h e l p e r  with the  or  therapy  and t h e the  tasks  process  are  reasonable  (or  way t o  the  g o a l s of  the  that  are  an  the  a of  The goals  explicitly  or  helpee.  have a s e n s e o f  and  and  aims  i s engaged.  evidence  demanded  expertise),  has  and f e e l s  and i m p l i c i t  relationship  helpee  agreement  helpee  to her/him  explicit  indirect  that  have m u t u a l l y  The  relevant  s h a r e d and a c c e p t e d by t h e  capabilities indirect  h e l p e e have a s e n s e of  h e l p i n g p r o c e s s in which h e / s h e  in  agreement) helping  the  these goals are  has some d i r e c t  established  3)  the  identification  particular  helper  and  of  each  within  relevant  mutuality  (or  of  the  them  in  their in  a  global  direct  h e l p i n g p r o c e s s upon w h i c h  or they  agreed.  The h e l p e r  and t h e  helpee  experience  a s e n s e of  a  bond  8  between  them.  partnership  Some of  are  understanding,  built  sense  therapeutic  demands on t h e  components.  These  each s u c c e s s f u l all  are  b a s e s upon w h i c h s u c h a of  mutual  orientations  the  participants  unique  alliance.  three  areas  component n e c e s s a r y f o r Therapeutic theorists  trusting,  in  and terms  demands c r e a t e  liking,  strategies of  in  order  to  a successful  e a c h of  however,  quantitative produce  helping  the  1962;  Zetzel,  1956,  these for that  level  in  alliance  relationship.  A l l i a n c e ; The term e m p l o y e d by o b j e c t  (Gitelson,  make  a unique q u a l i t y  B o r d i n has m a i n t a i n e d ,  h e l p i n g d y a d s have t o a c h i e v e a b a s i c  e a c h of  therapeutic  and c a r i n g .  Different different  the  1970)  for  the  relations alliance  concept. H e l p i n g A l l i a n c e : L u b o r s k y ' s (1976)  term f o r  the  alliance  concept. Empathy: The ability of the therapist accurately and s e n s i t i v e l y t o u n d e r s t a n d e x p e r i e n c e s and f e e l i n g s and t h e i r meaning t o the c l i e n t during the moment-tomoment encounter of p s y c h o t h e r a p y . . . . [It] means t h a t the therapist is completely at home in the universe of t h e p a t i e n t . ... I t i s a s e n s i n g of t h e client's inner world ... 'as if' it were the therapist's own ... . The a b i l i t y and s e n s i t i v i t y r e q u i r e d t o communicate t h e s e i n n e r m e a n i n g s back to the client i n a way t h a t a l l o w s t h e s e e x p e r i e n c e s t o be ' h i s ' i s t h e o t h e r m a j o r p a r t . . . . The t h e r a p i s t a t a h i g h l e v e l [ o f empathy] w i l l i n d i c a t e not o n l y a sensitive understanding of t h e a p p a r e n t f e e l i n g s but will by h i s c o m m u n i c a t i o n clarify and expand the p a t i e n t ' s a w a r e n e s s of t h e s e f e e l i n g s and e x p e r i e n c e s . (Rogers, Gendlin, Kiesler, & T r u a x , 1967, p p . 104105)  P e r c e i v e d Empathy: the  helper's  empathy.  The e x t e n t  to  which a helpee  i s aware  of  9  Expertness: knowledgeable following 1)  A counsellor person  evidence  s u c h as a d i p l o m a  or  fame,  field  if  an  expert  she/he  or  has  the  specialized training  or  knowledge  of  recognized  ability  such  physical signs associated with  as  success,  and  behavioural  knowledgeable  of  evidence  and/or  affluence);  3)  his/her  as  degree;  subjective  reputation, (e.g.,  perceived  attributes:  objective  2)  in  is  evidence  arguments  of  expertise  and c o n f i d e n c e  s u c h as  rational  in presentation  and  (Strong,  1968). Attractiveness: function  of  the  The  following  physical attractiveness  2)  warmth or  opinion  friendliness  compatabi1ity (Strong,  b o t h of  1) source  the  socially of  influence  (Strong,  deep,  welfare  (Frank,  1973).  or  A helper  (Goldstein, of  1971);  is  a  1978); and  agreeableness  Factor:  is perceived  are  sanctioned  steady,  technique  helper  (Cash & S a l t z b a c h ,  terms  following  2)  Specific  a  or  likeness  of  1968).  Trustworthiness: one or  in  of  conditions:  1)  3)  to  attractiveness  trustworthy  if  present:  role  as  1968);  and  and c o n s i s t e n t  A factor  as  a  helper  concern  or v a r i a b l e  for  that  is  or  legitimate  the  client's  specific  p r o c e d u r e and a s s o c i a t e d w i t h a s p e c i f i c  to  a  approach  psychotherapy. General  or G e n e r i c  Factor:  A factor  or  variable  that  is  10  common (eg.,  to the  all  the  different  client-therapist  WAI;  The  Inventory  acronym  (Horvath,  therapist 4.  of  (WAIt)  approaches to  psychotherapy,  relationship).  'WAI' 1981,  refers 1982)  to  in  the  both  Working client  Alliance  (WAIc)  and  forms.  RESEARCH QUESTIONS  The p r e s e n t  s t u d y was  intended  to  answer  the  following  questions: 1)  Are  client-perceived  strengths  as  positively  related  2)  strength  WAI p o s i t i v e l y 3)  by  the  Working A l l i a n c e  Is  over  the  related  first to  five  Inventory  WAIc more p o s i t i v e l y  related  empathy,  sessions  as  changes  in  measured  by  a s m e a s u r e d by  the  outcome?  client-perceived alliance  therapist  alliance  t o outcome?  A r e c l i e n t - p e r c e i v e d and t h e r a p i s t - p e r c e i v e d  alliance the  measured  and t h e r a p i s t - p e r c e i v e d  to  strength  outcome t h a n  expertness,  is  client-perceived  attractiveness,  or  trustworthiness? 4)  Is  client-perceived  alliance  Helping A l l i a n c e Questionnaire 5)  Are  involvement 6)  Is  client-perceived positively  related  c o n g r u e n c e of  m e a s u r e d by t h e  strength  positively and  related  to  the  outcome?  therapist-perceived  client  t o outcome?  client-perceived alliance  WAIc and t h e r a p i s t - p e r c e i v e d  a s m e a s u r e d by t h e  a s m e a s u r e d by  WAIt p o s i t i v e l y  related  to  strength  alliance outcome?  as  strength  11  II.  REVIEW OF LITERATURE  1.  THEORETICAL DEVELOPMENT OF THE ALLIANCE CONCEPT  1.1  Psychoanalytic The  the  Formulations  concept  of  the working  psychoanalytic literature  Freud  (1912)  alliance  a s an a s p e c t o f t h e  d i s t i n g u i s h e d two t y p e s  affectionate  and  former  into  sexual  component.  negative  a conscious  emerged  of  hostile.  friendly  initially  in  transference.  transference—positive He  component  further  d i v i d e d the  and  unconscious  an  If we 'remove' the transference by making it c o n s c i o u s , we a r e d e t a c h i n g o n l y t h e s e two components of the e m o t i o n a l a c t [ i . e . , t h e n e g a t i v e h o s t i l e and t h e u n c o n s c i o u s s e x u a l ] from t h e p e r s o n of t h e d o c t o r ; the other component, which is admissible to c o n s c i o u s n e s s and u n o b j e c t i o n a b l e , p e r s i s t s and i s t h e vehicle of s u c c e s s i n p s y c h o a n a l y s i s e x a c t l y as i t i s i n o t h e r methods o f t r e a t m e n t . (p. 105) In  fact,  Freud  a prerequisite  to  (1913)  regarded the p o s i t i v e  transference  as  treatment:  When a r e we t o b e g i n making o u r c o m m u n i c a t i o n s t o the patient? ... Not u n t i l an e f f e c t i v e t r a n s f e r e n c e h a s been e s t a b l i s h e d i n t h e p a t i e n t , a p r o p e r r a p p o r t w i t h him. It remains the f i r s t aim of the treatment to a t t a c h h i m t o i t and t o t h e p e r s o n o f t h e d o c t o r . To ensure this, nothing need be done but t o g i v e him time. I f one e x h i b i t s a serious interest in him, carefully c l e a r s away t h e r e s i s t a n c e s t h a t c r o p up a t the b e g i n n i n g and a v o i d s making c e r t a i n mistakes, he will of h i m s e l f f o r m s u c h an a t t a c h m e n t and l i n k t h e d o c t o r up w i t h one o f t h e imagos o f t h e p e o p l e by whom he was a c c u s t o m e d t o be t r e a t e d w i t h a f f e c t i o n . (pp. 139-40) Hence, largely  Freud's conceptualization that  Sterba  of a l i b i d i n a l (1934)  o f t h e bond a t  attachment  and B i b r i n g  (1937)  this  of p a t i e n t  point  was  to p h y s i c i a n .  as w e l l as Freud  himself  12  (1937)  developed  conscious  a  rational  revised  part  of  (Loewenstein,  1954))  against  unconscious.  the  the  k i n d of  capable analyst  of  Object not  neurosis, the  early  relationship analyst  (the  Successful  or,  itself  theorists  other  that  regarding  transference,  mother-child culminating  as a b a s i s f o r  analyst  the  to was  patient  and  (1956)  did  1969). Zetzel  (i.e., in  successful  functions  patient  from t h e  relationship in  a s a good o b j e c t ) ,  alliance"  the  was r e l a t e d  the  words,  beginning with  "therapeutic  which  w i t h the  treatment  analyst  in  in  autonomous ego  same p u r p o s e s ( F r i e d m a n ,  relations  instead  ego  w i t h the  sustaining,  d i s t i n g u i s h the  the  was seen as a l l y i n g  relationship  s h a r i n g the  conceptualization  the the  transference revival  therapeutic  introjection the  of  of  the  alliance.  Comparably, the analyst's empathic i m b r i c a t i o n with h i s p a t i e n t ' s emotions p r o v i d e s a s u s t a i n i n g grid of 'understanding' (or ' r e s o n a n c e ' ) which l e a d s towards co-operation and identification, to the partial relinquishment of the a n a c l i t i c a t t i t u d e , and i n t h e end to a collaboration which has [been] called 'therapeutic a l l i a n c e ' . ( G i t e l s o n , 1962, p . 199)  In traditional p s y c h o a n a l y s i s the transference is i n t e r p r e t e d , while the real object relationship is often so secure that it seldom needs explicit reinforcement. ... In most therapy, in contrast, w h i l e t r a n s f e r e n c e may be o b v i o u s t o t h e t h e r a p i s t , it is the reality of the r e l a t i o n s h i p w h i c h r e m a i n s i n the f o r e f r o n t . It i s t h e s t r e n g t h e n i n g of the real object relationship which holds the potential for considerably increasing the patient's insight. ( Z e t z e l , 1970, p . 153)  Greenson's conceptualization encompassing  (1965, of  various  the  1967;  Greenson  alliance  aspects  of  is  similarly the  &  Wexler,  broad  therapeutic  in  1969) scope,  relationship  1 3  a l o n g w i t h the process.  His  theoretical element  analysis  the  contributions the  contact  the  into  transference the  insight  its  seem t o  been t h e  client  on  of  to the  fantasy  analyst's  world  an  scrutiny  together,  in  Theorists  of  and t h e i r  of  (i.e.,  the  how t h e mutual  stand of  congruence  were for  serves to  other the  schools  real  working  (1951,  conditions  ultimately  itself  of  importance  stimulated  as  current the  key three  maintaining  situation  and  risking  developing  a  understanding  and  of  serious  c o m p a s s i o n and r e s t r a i n t ;  C o n c e p t u a l i z a t i o n s Of The  conditions),  the  between  atmosphere  1.2  oriented  treatment  He i d e n t i f i e d  humanness c o n s i s t i n g of  in  constant  Rogers  for  alliance  analytic  which  client  the  oscillate  alliance,  the  stimulus  the  neurosis);  be w o r k i n g  Other  does i n  relationship.  capacity  his  straightforwardness, the  has focus  reality  conveyed  3)  the  attainment:  patient's  regressing  work  therapeutic  to  with  2)  of  and e m p i r i c a l  in  1)  quality  1957)  when  he  empathy, core,  and  patient  and t h e  analyst  c o n c e r n w i t h the  working  enhance  it.  Relationship of  therapy  relationship  have a l s o  between  stressed  therapist  and  "contract". took  the  argued  most  that  (i.e.,  the  much r e s e a r c h w h i c h has findings  radical  the  unconditional  psychotherapeutic  inconclusive  work,  relationship-  therapist-offered  positive  regard,  and  necessary  and  sufficient  benefit.  His  ideas  have  contradictory  and  produced  (Gurman,  1977;  Lambert,  1 4  DeJulio,  &  Stein,  Parloff,  Waskow  The most conditions 1962).  & Wolfe,  promising is  the  Mitchell, 1978;  Bozarth  Watson,  instrument Relationship  conditions  that  herself/himself is  experiences  the  primary  that  locus  Krauft,  in  the  core  (Barrett-Lennard, measuring  it  is  affects  of  1977;  1984).  Inventory  assumption  was  &  d e v e l o p e d t o measure  Barrett-Lennard's  perceived  thus  1978;  what  him/her  therapeutic  client-  the  client  directly  influence  in  and the  relationship. Gurman perceptions 26 s t u d i e s  of  (1977)  compared  of  therapeutic  the  relationship outcome, but  relationship  (as  positive  supportive  impressive rated like  the  result  empathy. other  results  assessed  that  of  that  1)  of  b a s e d on  to  'fall  therapist;  a  the  off  alliance  of  in  three,  studies  however,  when t h e  empathy  was of  studies  In  the  to  outcome  RI)  and mixed,  a  observer-  Gurman n o t e d  that  conditions,  involved  present  more  subjects  study,  the  i s compared  with  strength.  therapeutic charged,  therapeutic  perception  This  for  a l s o attempted to d e f i n e  successful  the  the  (and  observer  twenty of  therapist-offered  therapies.  client-rated  an e m o t i o n a l l y  2)  importantly,  In  with  reported).  registered  and  client  predominantly  were  Equally  (1971)  between  results  client-rated  Frank features  of  relationship.  were r e p o r t e d  from non c l i e n t - c e n t e r e d relationship  therapist  findings  than  studies  tended  client,  nonspecific  engagements:  confiding  rationale  common or  relationship,  accepted  by  patient  and  15  3) p r o v i s i o n o f new i n f o r m a t i o n  by  precept,  example,  and  self-discovery;  The  4)  strengthening  5)  providing  6)  facilitation  first  of the p a t i e n t ' s  the p a t i e n t  feature,  his  encounter the  context it,  help;  of e m o t i o n a l  arousal.  the p a t i e n t - t h e r a p i s t  relationship,  condition  for  all  was seen  the  other  features.  In  by  of  w i t h s u c c e s s e x p e r i e n c e s ; and  as a n e c e s s a r y b u t n o t s u f f i c i e n t common  expectation  book,  Frank  (1973)  a s a s y s t e m whose p r o p e r t i e s characteristics  of  the  i n which the encounter  in  turn,  affects  concluded that  certain  a s p e c t s of t h e p a t i e n t - t h e r a p i s t zeal  Research  on  outcome b e i n g  related  attractive,  inconclusive. Corrigan,  Dell,  b u t a l s o by t h e develops, He  relates  to  values,  interaction confidence  not o n l y  that  in  by S t r o n g  to the c l i e n t and  trustworthy  On t h e b a s i s of t h e i r L e w i s and S c h m i d t  review  (1980)  as  influence successful  the c o u n s e l l o r as  has of  the  him/her.  (1968)  perceiving  but a l s o  affect  what has become known a s t h e s o c i a l  p r o c e s s and was o p e r a t i o n a l i z e d  only  of b o t h members.  and p a t i e n t ' s  and the p a t i e n t ' s  not  As t h e s y s t e m  the s u c c e s s of p s y c h o t h e r a p y  to  patient-therapist  protagonists,  features  c o n v e r g e n c e of t h e t h e r a p i s t ' s  therapist's  the  are determined  occurs.  a  expert,  viewed  also this  concluded  proved research,  that:  Although it is important to understand the r e l a t i v e c o n t r i b u t i o n of p e r c e i v e d c o u n s e l o r a t t r i b u t e s to the v a r i o u s s t a g e s of a c o u n s e l i n g r e l a t i o n s h i p , i t may be even more important to u n d e r s t a n d t h o s e e v e n t s and counselor a t t r i b u t e s that facilitate the transition from favourable first impressions to subsequent, p r e s u m a b l y more p r o d u c t i v e , stages of a counseling relationship. (p. 437)  16  Barak  and  LaCrosse  Form t o measure t h e trustworthiness study,  the  of  r e l a t i o n s h i p s of  terms  client-rated  1979). of  the  therapist. 1)  alliance  He  to  the  therapist  approach  was  present  expertness,  compared w i t h  offered  the  between  therapeutic and  by  Bordin  working a l l i a n c e the  More s p e c i f i c a l l y , he p o s t u l a t e d  strategies  In  and  strength.  demands and a g r e e m e n t s  unique  Rating  attractiveness,  outcome a r e  attempted to d e f i n e  demands on b o t h t h e r a p i s t  Counselor  client.  client-rated  different  different  2)  the  and t r u s t w o r t h i n e s s  A distinctly (1975,  d e v e l o p e d the  counsellor's expertness,  a s p e r c e i v e d by  attractiveness, that  (1975)  client  and  in the  that:  t e c h n i q u e s would p l a c e  different  patient; would  imply  different  goals  and  objectives; 3) of,  a  good t h e r a p e u t i c  and agreement  other  words,  therapist between the  on 1)  and 2)  these elements  needs  and  alliance between  would  resources  them r e g a r d i n g g o a l s and  client  would  r e g a r d the  his/her  goals;  and  4)  a real  relationship,  between  client  a  and t h e r a p i s t ,  w o u l d demand an a c c e p t a n c e therapist  have  to  and r e s u l t  'fit'  'bond',  and  activities  would  and  agreement  consequently as r e l e v a n t  have  involving trust,  In  client  in mutual  objectives,  therapy  and c l i e n t .  to  to  develop  a c c e p t a n c e , and  liking. The (Horvath, 1)  formulation  was u n i q u e  from  several  points  of  view  1981): Although  it  i n c o r p o r a t e d some o f  the  basic  c o n c e p t s of  17  the of  analytic  s t r e a m of  therapeutic  theoretical 2)  thought,  constructs  that  defined  theoretical  but  (i.e.,  at  the  The  definition  in  terms  of  agreement  to  independent  a  particular  of  the  discrete  that  cut across  on g o a l s and t a s k s  specified  topologies within working  that these  plus  different agreements.  alliance  therapeutic  could  be  objectives.  EMPIRICAL RESEARCH ON THE ALLIANCE The p r e v i o u s d i s c u s s i o n of  exclusively During  on c l i n i c a l  the  last  have d e v e l o p e d  the  working  alliance  o b s e r v a t i o n s and l o g i c a l  was  based  extrapolations.  decade, v a r i o u s North American r e s e a r c h groups  instruments  pursued  the  variable  and a v a r i e t y  2.1  unique  process variable  same t i m e  methods would p r o d u c e u n i q u e  2.  were  a generic  strategies,  personal bonds),  explicated  was o p e r a t i o n a l l y  orientation.  It  3)  it  to  relationships of  measure between  outcome  the the  alliance alliance  and  have  as a p r o c e s s  variables.  The Penn R e s e a r c h G r o u p The e a r l i e s t  c o l l e a g u e s at Alliance (1976)  the  Scales.  empirical  work was done by  University Based  composed a l i s t  of  of  Luborsky  P e n n s y l v a n i a on t h e  on h i s c l i n i c a l s e v e n s i g n s of  and  Penn  his  Helping  o b s e r v a t i o n s , Luborsky two  types  of  helping  relationships: Type  1:  experiencing  A  therapeutic  the  therapist  himself/herself  as the  alliance as  recipient.  based  supportive  on t h e and  patient's  helpful  with  18  Type together  2: or  A therapeutic  collaborating  impeding  the  alliance  b a s e d on a s e n s e o f  in a j o i n t  patient,  with  struggle the  against  emphasis  working what  on  is  shared  responsibility. Luborsky Bachrach,  (1976; L u b o r s k y , M i n t z ,  Todd,  observers rate late  Johnson,  the  sessions  of  improved p a t i e n t s sessions that  of  twenty minutes  the  seven  most  from a p o o l of  of  seven  relationships  in  nonimprovers  did  and 2 a l l i a n c e s on  Cohen, & O ' B r i e n ,  a  the  of  early  so.  of  73 who  the  composite of  .58  with  four  two  had  had  clinical  early and  had  and  at  none of  the  least  least He  developed  whereas  two  eight  psychotherapy.  More p r e c i s e l y ,  correlated  1980)  improvers  sessions,  Crits-Cristoph,  improved  psychoanalytically-oriented  six  gain  first  Auerbach,  25  found  helping  the  eight  o c c u r e n c e of  Type 1  outcome,  (i.e.,  residual  m e a s u r e s p r o v i d e d by p a t i e n t s  and  observers). Luborsky, (1983) those  reported in which  therapist toward  C r i t s - C r i s t o p h , Alexander,  or  that the  the  the  patient treatment,  (14  (Morgan, The  felt  helped  (i.e.,  Cohen  o b s e r v e d s i g n s were or  changed  by  o b s e r v a t i o n s about  items)  converted  and  these  into  the  progress  were  a more e f f i c i e n t  applied  Luborsky, C r i t s - C r i s t o p h , C u r t i s ,  rating  counting and  frequently  and  goals).  The s i g n s were t h e n scale  most  Margolis,  method  s i g n s method  £=.95  for  was (r=  internal  &  to  the  to  be  more  .75  .88  for  interrater  reliability  same  Solomon,  shown to  rating  reliable  (coefficient  data  1982). than  the  reliability  alpha)),  and  to  19  have a l m o s t about of  equally  significant  25% o f t h e v a r i a n c e  57  pretreatment  on  predictors,  the f i r s t  Stone,  significantly  (i.e.,  that  target  symptom f o r w h i c h t h e c l i e n t Hoehn-Saric,  were a s h i g h .  complaint,  Nash,  &  Frank,  alliance  the  development  researchers concluded that to  fifth  sessions  the  early  This  finding  scores  to the l a t e  was more e v i d e n t  increased  found  from  helping  (whose  behaviour  similarities  of  A self-report,  psychotherapy  the  rating  alliance,  present  at  the  the  third  ratings),  the  s e s s i o n s ) than  highly  patients  was  with the presence of  well  (i.e.,  as  (£=.53),  Helping A l l i a n c e  O'Brien,  early  therapist with  ten  e s p e c i a l l y age  scale  was  counselling  Questionnaire  & Auerbach,  who had r e c e i v e d  drug  for less  alliance  .55 w i t h e a r l y  as  (whose  match.  11-item Woody,  The  behaviour,  and t h e r a p i s t  the r a t i n g  (n=32),  late  from  method).  improved p a t i e n t s  correlated  activity  McLellan,  to  facilitating  patient  match and r e l i g i o u s  opiate-dependent  with  Imber,  correlated  with the r a t i n g  f o r more  moderately  ratings  facilitating  roughly p a r a l l e l s  (Battle,  helping  scores decreased).  therapist  alliance  (Luborsky,  the  (r=.57  early  to correlate  observer-rated  the s p e c i f i c  method).  was a l r e a d y  sessions  6  example,  and showed a modest d e g r e e o f c o n s i s t e n c y  improved p a t i e n t s also  it  of  For  1966)),  (r=.44  Only  correlates),  (i.e.,  came t o t r e a t m e n t  with the e a r l y  to  accounting for  personality  method and r = . 5 9 w i t h t h e c o u n t i n g s i g n s As  power,  o f v a r i o u s outcome m e a s u r e s .  examined a c h i e v e d c o r r e l a t i o n s improvement  predictive  1985)  administered supportive (n=39),  to  which male  expressive  or c o g n i t i v e -  20  behavioural  psychotherapy  after  third  the  patient  session  e x p e r i e n c e d the  Therapists Therapist  completed Facilitating  Luborsky,  1986).  outcomes.  The two  ranged from In  the  .51  The  self-report  estimate  the  and t h e  therapy  a parallel  form of  the  were  with  study, HAQ t o  four the  to which  the  (Alexander with  the  helpful.  questionnaire,  correlated  &  seven-month  results—correlations  outcome d i m e n s i o n s .  relationship  outcome  alliance  strength  i s compared w i t h t h a t  measured  effectiveness  of  by  rating  their  performance  defined  treatment.  Three determinants  to  to outcome: p e r s o n a l q u a l i t i e s ,  relate  in  was a l s o e x a m i n e d by L u b o r s k y  techniques  and h e l p i n g a l l i a n c e highly.  determinants  On  manuals p r e p a r e d  scores, the  (therapists' with  researchers  concluded that  interest  in  a helping  the  helping  of  for  therapist  last  therapists' patient  specific  the  types  three  success purity  were of  were  measure,  personal  were c r i t i c a l  of  found  technique, correlating  intercorrelations  alliance  et  against  measure  personal q u a l i t i e s  helping  the  of  with the  basis  correlated  of  given  WAIc.  (1985)  most  was  as  Behaviours Questionnaire  .72  present  degree  therapist  forms p r o d u c e d s i m i l a r  to  Therapists' al.  to  Scores  as m e a s u r e d by t h e by t h e  (n=39).  of  most  these highly  r=.74),  the  adjustment  and  to  the  formation  alliance:  ... t h e major a g e n t o f e f f e c t i v e p s y c h o t h e r a p y i s t h e p e r s o n a l i t y of the t h e r a p i s t , p a r t i c u l a r l y t h e a b i l i t y t o f o r m a warm, s u p p o r t i v e r e l a t i o n s h i p . (p. 609)  21  2 . 2 The V a n d e r b i l t  R e s e a r c h Group  The V a n d e r b i l t 1979)  Psychotherapy  investigated  therapist's good  the r e l a t i v e  technical  human  were compared w i t h  selected  for  Using  their  Scale,  She of the  was  involvement  openness,  and n e g a t i v i s m patient,  therapeutic  who  to  was  occur  relationship  not  While  seem t o g i v e  college to  any  professors form  warm,  in both  groups  Psychotherapy  Process  Patients  examined  the  considerable  evidence that  dyads.  up t o 38%  outcomes c o u l d be a c c o u n t e d f o r in the t h e r a p e u t i c index  trust  in  of  process.  a  the  active  and l a c k  interaction.  therapists  by  Patient  patient's  therapy,  in the t h e r a p e u t i c  (1979)  taking a  concluded that  were  of  Given able  therapeutic  was a c o n j u n c t i o n between advantage  therapist  e x p e r i e n c e d by t h e p a t i e n t interest.  in  to  gains.  of  and  inherent  seen by e x p e r i e n c e d  by  provocative  when t h e r e  capable  t o outcome of t h e  ability  professional  S t r u p p and H a d l e y seemed  Hadley,  r e l a t i o n s h i p s among i n d i v i d u a l  was d e s c r i b e d a s an  involved  maximize  (1978)  in treatment  participation,  &  improvement.  to contribute  patient's  hostility  seen  observer-rated Vanderbilt  the v a r i a n c e  Involvement  an  equal  in therapeutic  able  clients  relationships.  Gomes-Schwartz  differences  15  untutored  empathic  the  contributions  Sixteen  therapists  showed on a v e r a g e  (Strupp  s k i l l s and t h e q u a l i t i e s  relationship.  understanding,  Project  of  whose  a  change  a  patient  benign  human  interventions  a s e x p r e s s i o n s o f c a r i n g and  genuine  the " t e c h n i q u e s " of p r o f e s s i o n a l t h e r a p i s t s rise  to measurably  superior  treatment  were  did  effects,  22  these  skills  processes patient  appeared  inherent  was a b l e  therapist's  and  variables,  (i.e.,  to f e e l  outcomes  achieved.  than  relation  concluded  an a l l i a n c e ,  Hartley Vanderbilt applied their  it  and  increased first  the  for  Vanderbilt  formed and t h e interpersonal  involvement up  to  25%  reliable  relations,  interventions  or  role who  to  i n the of  the  severely  predictors  the  researchers  the  particular  i n the development of have  difficulty  in  relations. and  Strupp  University  (1983)  Therapeutic  c o n s t r u c t e d the Alliance Scale  to samples of the V a n d e r b i l t  their  project  observer-rated (44  i n d i c a t e d no s i g n i f i c a n t  dyads  alliance  point  later  sessions.  group,  on t h e o t h e r  and  discovered  i n the i n i t i a l  of therapy  The p a t t e r n  and t h e n of s c o r e s  h a n d , was a m i r r o r  items)  data.  s c o r e s a n d outcome g r o u p s , t h e y  successful  quartile  the  Since moderately  match p l a y a major  alliance  less  to  pretreatment  of  of  were l e s s  adequate  a n a l y s i s of v a r i a n c e  between  in  alliances  levels  s p e c i f i c a l l y for patients  interpersonal  provided the  the  assessments  accounting  therapist  patient-therapist  the  relations  basically that  both  by o b s e r v e r s .  interpersonal  healing  resonate  examined  correlates),  patients'  rated  were  natural  w i t h and  (1982)  to  relationship,  as  the  therapy.  Clinical  predicted  variance impaired  approach to  personality  in  therapeutic  comfortable  Strupp  database  relations  potentiate  i n a "good human r e l a t i o n s h i p " ,  general  Moras  to  and  Although  association compared more  that  the  former  phase, peaking at the  trailing  off  f o r the l e s s image  of  again  in  successful  that.  Their  23  alliance  scores f e l l  g r o u p and r o s e a g a i n never  achieved  group.  from t h e i r at  the  later  differences  between  more  essentially  the  initial  scale.  on  the  who  own r o l e less  therapy,  in  the  Moreover,  of  the  sessions  this  in  They  terms  of  (Suh, the  in  the  they  they  once  that  in  significantly  factors  concluded  of  their  that  those  outcomes a c c e p t e d  their  became more open and  three  Therapist  Exploration  between  Involvement  in  but  relationships  sessions  more  of  in  outcome  the  than  therapist  activity  of  over  the  absolute (£=.63  accounted in  the  for early  Warmth & F r i e n d l i n e s s and high  outcomes  an  course  s e s s i o n w i t h outcome 1986)  in  and  participation  strongly  a  found a  necessarily  & Strupp,  in T h e r a p i s t resulted  i s not  with  They  process  develops  patient  third  O'Malley,  patterns  Increases  The  substantial  therapy,  g r o u p s were  first  correlated  sessions.  prognosis  no  and S t r u p p n o t e d  and t h e y  patient,  change  participation  .46).  they  (1983) measured t h e  the  concluded that  therapy.  vs.  However,  Psychotherapy Process S c a l e .  quality  patient  other  more s u c c e s s f u l  were  and A n x i e t y  change,  i n e a c h of  antecedent  three  the  end of  better  increased association  from which they  of  w i t h the  sessions.  Vanderbilt  p a t t e r n of  peak  two  (1978),  S u h , and S t r u p p  same d a t a  revised  about  therapy.  Hartley the  equality  there  Responsibility  in bringing  anxious  the  first  equal.  went on t o a c h i e v e  O'Malley, in  phases,  L i k e Gomes-Schwartz  patients  of  g r o u p s and by t h e  p h a s e of  divergent  midpoint  s c o r e s as h i g h as t h e  In  were  the  initial  in  for  low  over  early  patients. relationship  of  change  in a l l i a n c e  strength  24  sessions 2.3  t o outcome  is further  The L a n g l e y P o r t e r Marziali,  rated  Therapeutic  affective, pilot  Marmar  and K r u p n i c k  Alliance  Institute,  most and f i v e  in brief  patients  contribution outcomes.  as  rated  at  Contribution  alliance  termed the  climate. of  the Langley  25  Porter  discriminated  a  strong  had  good  as c o n t r i b u t i n g  In a  improved  Scale  making  therapeutic  Patients  least  dynamic t h e r a p y  rated  to the  study.  d e v e l o p e d an o b s e r v e r -  S c a l e t o measure what t h e y  the 21-item P a t i e n t  markedly:  (1981)  a s p e c t s of t h e t h e r a p e u t i c  study w i t h the f i v e treated  i n the p r e s e n t  R e s e a r c h Group  attitudinal  patients  explored  positive treatment  negatively  had p o o r  outcomes. In a n o t h e r patients'  study  positive  although p a t i e n t s ' Horowitz,  Marmar,  hierarchical patient  original  Patient  significant patients'  interacted  with  agreement positive  did  cases,  predict  outcome,  (r=.34  (2<.05);  1984).  However,  revealed  that  alliance  initial  scales in a  outcome. viewpoints judge  therapist-rated  Therapeutic  in sessions  not  the  and n o n p a r t i c i p a n t and  bereavement  & Rosenbaum,  regression analysis  s y s t e m s were t e s t e d  psychotherapy  did  contributions  Weiss, DeWitt,  observer-rated  measurement  pathological  (1984) compared t h r e e  therapist  sessions.  negative  way t o p r e d i c t  Marziali  52  contributions  multiple  motivation  meaningful  patient,  of  1,  3,  between  ratings  Alliance Scale.  10,  them  contributions,  alliance-  of the  The  in brief 20.  in their  estimates  for  the  the three  dynamic  15, and  less  same  scales paralleled  on 42 p a t i e n t s 5,  on t h e  There  was  of t h e  patients'  25  negative ratings  contributions, of  therapist  The p a t i e n t  as  the  concluded  that  positive  and n e g a t i v e  contributions  s y s t e m s were t h e early  and i n s i g n i f i c a n t  best  in  predictors  first  and  each  of  third  intercorrelations  of  contributions. of  the  outcome,  three  rating  b e i n g a s s o c i a t e d as  sessions.  Hence,  the  study  P a t i e n t s ' and t h e r a p i s t s ' r a t i n g s of t h e i r own and the other's positive contributions to the therapeutic relationship are powerful p r e d i c t o r s of t h e r a p e u t i c change . . . e q u a l or better ... than the ratings p r o v i d e d by n o n p a r t i c i p a n t j u d g e s . I t may be t h a t the therapeutic participants provide the more a u t h e n t i c v e r s i o n s of the q u a l i t y of the treatment r e l a t i o n s h i p , (p. 422)  In  the  client  present  study,  and t h e r a p i s t  the  ratings  relationship of  alliance  of  congruence  strength  of  t o outcome  is  explored. Marmar,  Marziali,  observer-rated 11th,  and  results  s c a l e to  12th  2.4  with  These r e s u l t s  Weiss  (segments  (1986) of  the  treatments)  Two  therapy  patient and  were c o n f i r m e d  applied 2nd,  5th,  and s u b j e c t e d positive  working  the 8th, the  factors  capacity  in a r e p l i c a t i o n  and with  patients. The M e n n i n g e r The  1974),  identified  the  therapeutic  However,  Research Group  Menninger  (Horwitz,  for  &  12-hour  analysis.  emerged—satisfaction  32  15 c a s e s  h o u r s of  to a f a c t o r  commitment.  Horowitz  the  a  Foundation's Psychotherapy Research 20-year  longitudinal  therapeutic work,  but  design  of  alliance  often the  as the  study  a s not  only  of a  main v e h i c l e  42  Project cases,  prerequisite of  s t u d y was n a t u r a l i s t i c  change. and l o o s e  26  (Gelso & C a r t e r , taken  t o be e m p i r i c a l l y The  more  current  narrowly  Luborsky's In  also  scales  the  therapeutic Colson,  be  &  assess mediating  patient's  alliance (1984)  of the p a t i e n t ' s they  Coyne  to  work  and m o t i v e s ;  from defined  activity.  restricted  To the  in psychotherapy.  (1984)  patient  t h e outcome o f t h e r a p y ;  C o l l a b o r a t i o n was d e f i n e d a s  alliance  analogous  & Allen  collaborative  skill  the  therapist,  transference,  Gabbard,  commitment,  optimism about  to  Collaboration Scale to assess to  not  alliance.  i n terms  from  Newsom,  could  of the t h e r a p e u t i c  the  Frieswyk,  exclusively  observer-rated  therapist's  separate  it  results  alliance  with  to the p a t i e n t ' s  Allen,  four  to  separate  definition  the  Type 2 h e l p i n g  technique,  alliance  measures  behaviour  order  therapist  Kansas  (1976)  its  sound.  confine  collaborative  the  1985) a n d , h e n c e ,  then  the  d e v i s e d an  alliance  factors—trust s e n s e of  and  i n the  acceptance;  and e x p r e s s i o n o f  affect.  follows:  The i n t e n t o f t h i s s c a l e i s t o d e t e r m i n e t h e e x t e n t t o which the patient is making optimal u s e of the treatment as a r e s o u r c e f o r c o n s t r u c t i v e change. More s p e c i f i c a l l y , the s c a l e a s s e s s e s the degree to which the patient actively participates in the work, c o n c r e t e l y e v i d e n c e d i n h i s o r h e r engagement in the requisite treatment tasks, whatever they may b e . R a t e r s a r e t o a s s e s s t h e p a t i e n t ' s u s e of t h e t h e r a p y , t a k i n g i n t o a c c o u n t t h e d e g r e e t o w h i c h he o r she (a) works a c t i v e l y i n t h e s e s s i o n , (b) b r i n g s s i g n i f i c a n t i s s u e s and m a t e r i a l i n t o the treatment, (c) openly p r o v i d e s i n f o r m a t i o n and e x p r e s s e s f e e l i n g s , (d) makes good use of the t h e r a p i s t ' s treatment e f f o r t s , (e) a p p l i e s t h e work done i n t h e r a p y ( e . g . , insights and advice) to life o u t s i d e the t h e r a p y , and ( f ) adopts therapeutic functions (e.g., self-observation) to c a r r y t h e work f o r w a r d i n d e p e n d e n t l y . (p. 386)  Reliability  of  the  scales  was  demonstrated  using  the  27  Vanderbilt  project  correlated  with  data. overall  use of t h e r a p i s t ' s resistance (.87).  factors  specifically  most  were:  actively  makes good  (.92);  and i s m o t i v a t e d  (1986)  plan  single  Allen, Colson,  t o employ t h e i r  cases  track  various  designed to assess  t o change  their  the a l l i a n c e  the  experience scales  required  Coyne, Gabbard, Horwitz,  instrument  (in particular  of t h e r a p e u t i c  &  i n the i n t e n s i v e  with borderline  within-session shifts types  that  shows  between  a s s o c i a t e d with the p a t i e n t ' s  They s t r e s s e d , h o w e v e r ,  highly  for  therapy.  Frieswyk,  2.5  ratings  works  (.88);  scales  The r e s e a r c h e r s a l s o f o u n d h i g h c o r r e l a t i o n s  psychoanalytic  to  (.96);  reflects  the r e l a t i o n s h i p .  were  component  collaborative  efforts  (-.89);  three mediating of  The  study of  patients)  in the a l l i a n c e  as they  Newson  i n order relate  to  interventions.  The B r i t i s h C o l u m b i a R e s e a r c h G r o u p Horvath  client after based  (1981) e m p l o y e d t h e  and  therapist  the t h i r d on  a  session  variety  self-report  of  Posttherapy  Questionnaire  theoretical  efficiently  than  (Barak  receiving  measured Wallach,  (Barrett-Lennard, 1975).  (r=.57).  correlational  data  the  & Wogan, the  An  Strupp  Relationship  1962) o r t h e C o u n s e l o r R a t i n g  therapy overview  b a s e d on t h e r a p i s t  outcome of  based  the  report  WAI  1964) more  The T a s k s u b s c a l e was t h e most  of a l l a s p e c t s of  self-report  outcome  The  with  of  in  psychotherapy  orientations.  d i d t h e Empathy s u b s c a l e  & LaCrosse,  predictor  as  (Strupp,  Inventory  versions to predict  f o r 29 c l i e n t s  p r e d i c t e d p s y c h o t h e r a p y outcome  Inventory  Working A l l i a n c e  on  results  (a m o d i f i e d  Form  useful client of  the  version  28  of  the Strupp Posttherapy Q u e s t i o n n a i r e )  domain was a l s o t h e reported  client  most  effective  satisfaction  and  respectively).  The t h e r a p i s t ' s  however,  strongly  most  Bond component  in  predicting  adjustment  perception  correlated  client  1982).  in  were  obtained  a program i n which the g e s t a l t  quality the  variety  prognostic  indices  more h i g h l y  It  i s important  were  a  highly  gestalt  applied being  in  the  two-chair  to a s i t u a t i o n  t o note  similar,  1979) was t a k e n  30 t o  that  active  dialogue),  voice  to  in a  t h a n any o f t h e o t h e r  i n d i c a t o r s a c c o u n t i n g f o r between  outcome v a r i a n c e .  (i.e.,  (Greenberg &  The Task s u b s c a l e c o n s i s t e n t l y r e l a t e d  outcome  engaged  two-chair  a n d a measure o f c l i e n t  Koke, Greenberg, & Wagstaff,  session. of  36  a n d t h e C o u n s e l o r R a t i n g Form s c a l e s were  the second s e s s i o n  (Rice,  first  from  The T a s k s u b s c a l e , t h e Empathy s u b s c a l e o f  Inventory  completed a f t e r  changes,  therapist-reported  method was u s e d t o h e l p r e s o l v e d e c i s i o n a l c o n f l i c t  Relationship  and .32  (r=.47).  involved  Webster,  the Task  therapist-  (r=.68  of  with the  R e l a t i o n s h i p a n d outcome m e a s u r e s subjects  i n d i c a t e d that  so  i n which a d i r e c t e d  46%  of  the  a l l the s u b j e c t s therapeutic  that  task,  these  results  therapeutic  t a s k was  used. Noting  this  and  the high c o r r e l a t i o n in  their  own  concluded that  utilization  perceived  the  perceive highly  by  client  the t h e r a p i s t related  as  between  study,  Task  Horvath  relevant  empathic.  t o outcome by v i r t u e  in  of t a s k s which  were  may l e a d t h e c l i e n t  Task of i t  Empathy  a n d G r e e n b e r g (1986)  by t h e t h e r a p i s t as  and  was  possibly  to  more  b e i n g a more s p e c i f i c  29  and more  interactional  perceive  their  relevant  to  empathic  even  measure,  therapists'  indicating  if  i n - s e s s i o n s u g g e s t i o n s or  their  goals,  if  s u g g e s t i o n s or  the  that  they  may p e r c e i v e  the  requests are  clients  requests  as  therapist  as  challenging  or  confronting. Moseley 25 c l i e n t s Like  (1983)  in  brief  Horvath  employed a r e v i s e d WAI therapy  (1981),  from  Moseley  a  variety  objectives,  Task),  are  highly  alliance.  et  the  were f o u n d t o  al.,  1966)  between  and t h e  & Wogan, the  alliance Anxiety  1970)  change  or  Questionnaire;  in  be  reliably  the  suggested that  study  end of  Posttherapy  the  prediction  relationships  w i t h the  change. anxiety  with  Gorsuch,  in  therapy  complaints  (Battle (Strupp,  relationship  was  found  anxiety  & Lushene,  (Tennessee S e l f - C o n c e p t  Moseley  concluded  effect  and s e l f - c o n c e p t  used  Strupp  complaints  rather  the  in  reports  on t h e  in target  Alternatively,  these  client  termination  improvement  that  instruments  between  represented a s a t i s f a c t i o n of  the  Task s u b s c a l e  change i n s t a t e  correlation  and  of  Questionnaire  Spielberger,  s e s s i o n and a t  Questionnaire  s i m p l y have  in t a r g e t  to  (i.e.,  phases  correlated  standardized personality  third  between  activities,  and t h e  self-concept  the  orientations.  early  No s i g n i f i c a n t  1965).  on  a  in general  Inventory;  findings  might  WAI  measure and e i t h e r  Fitts, both  the  Strupp Posttherapy  1964).  (State-Trait  the  in  with  issues pertaining  and t h e r a p y  a s measured by improvement  Wallach,  at  Goal),  overlapped  Again,  particular outcome  (i.e.,  of  1982)  found a s t r o n g c o r r e l a t i o n  t h e G o a l and T a s k s u b s c a l e s s u g g e s t i n g t h a t therapy  (Horvath,  than  lack  measures  of  might  30  be  explained  actual the  as  a  changes in  lack  the  of  fit  between  treatment,  t h e s e m e a s u r e s and  or a f u n c t i o n  of  the  the  brevity  of  treatments. In  the  outcome  present  study,  the  relationship  i s e x a m i n e d e m p l o y i n g a number of  reflect  the  variety  currently  of  the  WAI  outcome m e a s u r e s  being u t i l i z e d  in  the  to that  field  of  psychotherapy r e s e a r c h . 2.6  The I n v o l v e m e n t  One of  the  Dimension  most c o n s i s t e n t  research to date  h a s been t h e  involvement  therapeutic  Schwartz,  to  1978;  have  therapist 1984;  determinants  Beutler, therapists  of  & Marmar, Dunbar,  (as  significantly  success  been  1986;  & Baer  rated  more e n g a g e m e n t ,  al.,  alliance  1984;  Luborsky,  directed  at  Gomes-  research  discovering (Allen  al.,  reported  client  1976).  various  involvement  (1980)  by  et  the  Luborsky et  working  r e l a t i o n s h i p of  of  client 1985;  the  (Allen  reported e f f o r t s  accordingly  Horowitz  significant  Greenberg & P i n s o f ,  The most r e c e n t l y groups  f i n d i n g s of  the  et  al.,  1985).  t h a t more  effective  their  supervisors)  perceived  (i.e.,  involvement),  in  their  clients. Baer, factor  Dunbar,  a n a l y s i s of  e m p l o y e d by 26 patients  in  a  & Beutler  to  rate  their  psychiatric c l i n i c .  the  extent  in  therapeutic  self-awareness,  II,  (1980) p e r f o r m e d a  a 74-item psychotherapeutic process  therapists  (i.e., the  Hamilton  to which the process  insight,  by or  patient  experience  Therapeutic  with  99  Participation,  participates  demonstrating  inventory  productively  self-disclosure,  behaviour change),  emerged a s  the  31  most s i g n i f i c a n t the the  therapists'  factor  judgments  consistency  (1978),  Baer e t  accounting for  of  of  their  al.  16.5%  outcome of  findings  of  the  treatment.  w i t h those of  variance  in  R e m a r k i n g on Gomes-Schwartz  suggested that  Psychotherapy is characterized by relatively consistent dimensions of p r o c e s s and a c t i v i t y w h i c h v a r y i n d e g r e e from t h e r a p i s t t o t h e r a p i s t . (p. 569)  U s i n g the Crago,  same  clinical  and S h a n f i e l d  (1982)  personality,  l o c u s of  therapeutic  relationship  of the  best  predictor  control,  with decreases in  Patient's  global  ratings  s o m a t i c and p a r a n o i d  dropout  was  (Derogatis,  also  found  the  to  of  Davis, patient's  quality  involvement  success,  Symptom C h e c k l i s t - 9 0  Therapy  of  overall  and t h e r a p i s t  Beutler,  influence  perception  and t h e r a p y  of  Kolb,  compared t h e  p s y c h o t h e r a p y w i t h 91 p a t i e n t s .  both p a t i e n t  the  sample,  on t h e  of  the  outcome  involvement  was  being a s s o c i a t e d with of  improvement  and  symptoms a s measured  with  Lipman, be  & Covi,  1973).  predictable  from  involvement. In client  the  present  study,  and t h e r a p i s t - r a t e d  the  relationships  involvement  of  measures to  exploratory outcome  are  examined. 3.  SIGNIFICANCE OF THE PRESENT STUDY During  the  been a c t i v e l y Columbia alliance  past  decade,  generating  Research measures  conceptualization.  the  findings  Group  field  of  alliance  and h y p o t h e s e s .  has f o c u s e d on t h e  based Horvath's  on  Bordin's  (1981)  r e s e a r c h has The  use of  British  self-report  (1975,  exploratory  s t u d y of  1979) the  32  predictive provided  capacity some  evidence  measure may be a t developed  Webster's  (1982)  Moreover,  Posttherapy  satisfaction  two  correlations  administration The  present  establish  the  study  utility  is  Luborsky's of  (1976)  some r e c e n t alliance al.,  1985) a n d t h e  subdimension  are  to  and i n d i c a t o r  to  to  all  in  more  definitively measures,  is  in  based  of  on  A number  the  & Strupp,  of the a l l i a n c e  three  therapy).  field  The s t u d y a l s o  client  with  on o n l y a s i n g l e  of the a l l i a n c e .  (Hartley  client  demonstrate  Finally,  the r e l a t i o n s h i p  of  posed:  this  and t h e r a p i s t - r a t e d  utilized.  significance  be  examine  failed  b e i n g employed  outcome  the Strupp  t r u e measure o f  d e v e l o p e d HAQ w h i c h  hypotheses regarding  strength  to  a  three  t o outcome a s  at a s i n g l e point  conceptualization  research  these  (i.e.,  of c o r r e l a t i o n  of c l i e n t  outcome m e a s u r e s c u r r e n t l y  psychotherapy  than  intended  b o t h t h e WAI a n d t h e r e c e n t l y  of  o f t h e c o n s t a n c y of  them and t h e a l l i a n c e .  o f t h e WAI, ( i . e . ,  s a m p l e s have  t h e q u e s t i o n may  measures  analyses  corroborated  the a l l i a n c e  M o s e l e y ' s attempt  their  Greenberg and  restricted  rather  personality  between  based  Hence,  rater-reported  groups.  of s a t i s f a c t i o n ,  therapy  1984)?  standardized  studies  report  the  results  has  administered  s t u d i e s have  the  related  alliance  simply  as  and  s i m p l y an a r t i f a c t  through  (Glass,  (1983)  of  Questionnaire).  the c o r r e l a t i o n  more  research  small  Horvath  measured w i t h a c l i e n t  change  other  However,  working  effective  the g e n e r a l i z a b i l i t y  studies.  Is  as  this  and M o s e l e y ' s  evidence.  limited  by  client-rated that  least  measures  this  of t h e  of  subjects  change  in  1983; Suh e t  involvement (Greenberg  as  a  & Pinsof,  33  1986) 4.  to  examination.  RESEARCH HYPOTHESES  The p r e s e n t  study  was  intended  to  test  the  following  hypotheses: Ho-1: between Alliance  There  is  no s t a t i s t i c a l l y  perceived alliance  strength  I n v e n t o r y and o u t c o m e . Ho-1 a :  relationship  There  between  is  significant  as measured by  relationship the  Working  1  no  statistically  client-perceived  alliance  significant strength  as  measured by t h e WAIc and o u t c o m e . Ho-1b: relationship  There  between  is  no  statistically  therapist-perceived  alliance  significant strength  as  measured by t h e WAIt and o u t c o m e . Ha-1:  There  relationship  is  or c o r r e l a t i o n  a statistically between  significant  perceived alliance  positive strength  and o u t c o m e . Ho-2: between five  There  i s no  perceived  sessions  statistically  change  in  significant  alliance  strength  a s measured by t h e W o r k i n g A l l i a n c e  relationship over  the  Inventory  first and  outcome. Ho-2a: relationship strength  over  There  between the  is  no  statistically  client-perceived first  five  change  significant in  alliance  s e s s i o n s a s measured by t h e  WAIc  The six instruments used to measure outcome are Target C o m p l a i n t s Improvement, r e s i d u a l g a i n on t h e Symptom C h e c k l i s t 90, the S e l f - E s t e e m Index, and t h e I n v e n t o r y of Interpersonal Problems, and the Strupp Posttherapy Questionnaire and the Therapist Posttherapy Questionnaire.  34  and o u t c o m e . Ho-2b:  There  relationship  between  strength  the  over  is  no  statistically  therapist-perceived  first  five  sessions  significant  change  in  a s measured  alliance  by  the  WAIt  and o u t c o m e . Ha-2:  There  relationship strength  between  or c o r r e l a t i o n  over  Ho-3:  the  There  the  first is  no  outcome  therapist  empathy,  to  Ho-3a:  strength of of  Relationship  difference  relationship  strength  the  trustworthiness  as  to  is  to  the  strength  relationship  of  attractiveness,  expertness,  statistically  significant  of  client-perceived  outcome and t h e  no  WAIc  therapist measured  by  alliance  relationship  Empathy  subscale  outcome. statistically  relationship  a s measured by t h e  client-perceived  alliance  difference  alliance  a s m e a s u r e d by t h e  Inventory There  between  significant  and  no  a s measured by t h e WAIc  Ho-3b:  of  the  is  c l i e n t - p e r c e i v e d empathy the  in  outcome.  There  between  positive  and o u t c o m e .  client-perceived  to  trustworthiness  difference  sessions  of  significant  p e r c e i v e d change  statistically  relationship  client-perceived  between  five  a s measured by t h e WAIc  or  is a s t a t i s t i c a l l y  to  of  significant  client-perceived  outcome and t h e  attractiveness, the  Counselor  alliance  relationship  expertness, R a t i n g Form  or to  outcome. Ha-3:  There  is a larger  statistically  significant  relationship  between  client-perceived  alliance  outcome t h a n  between  client-perceived  therapist  strength empathy,  positive and  35  atractiveness, Ho-4: between  expertness,  There  i s no  or  statistically  client-percieved  alliance  Helping A l l i a n c e Questionnaire Ha-4;  There  relationship strength  trustworthiness  significant strength  a s measured by t h e  relationship  a s measured by  the  and o u t c o m e .  is a s t a t i s t i c a l l y  or c o r r e l a t i o n  and o u t c o m e .  significant  between c l i e n t - p e r c e i v e d  positive  alliance  Helping Alliance Questionnaire  and  outcome. Ho-5; between  There  is  perceied  exploratory  client  Client  Ho-5a: relationship  There  is  as  measured  by  the  S c a l e and o u t c o m e . no  statistically  client-perceived  client  There  is  no  significant  involvement  statistically  between t h e r a p i s t - p e r c e i v e d  measured by t h e  relationship  as  C I S c and o u t c o m e .  Ho-5b:  CISt  Ha-5:  client  significant  involvement  as  and o u t c o m e .  There  relationship  significant  involvement  Involvement  between  measured by t h e  relationship  no s t a t i s t i c a l l y  is a s t a t i s t i c a l l y  or c o r r e l a t i o n  significant  between p e r c e i v e d c l i e n t  positive  involvement  and o u t c o m e . Ho-6: between  There  i s no  congruence  of  statistically  significant  client-perceived  relationship  alliance  measured by t h e WAIc and t h e r a p i s t - p e r c e i v e d  strength  alliance  as  strength  as m e a s u r e d by t h e WAIt and o u t c o m e . Ha-61 relationship  There  is a s t a t i s t i c a l l y  or c o r r e l a t i o n  significant  between c o n g r u e n c e o f  p e r c e i v e d and t h e r a p i s t - p e r c e i v e d  alliance  positive  client-  strength  and o u t c o m e .  36  The r e s u l t s interpreted significance.  of  using  the the  analyses in .05  the  present  probability  level  s t u d y have of  been  statistical  37  III. 1.  DESIGN OF THE STUDY  In has by  METHODS AND PROCEDURES  the  been  present  study,  the  examined t h r o u g h  clients  and  therapeutic alliances  self-report  therapists  engagements-  development  in  the  working  course  together.  of  them  to  therapies  were  tracked  working a l l i a n c e  m e a s u r e s were  of  first  five  the  and  assess  the  measures  sessions,  final  (which  the  session.  encompassed  therapeutic  Scale  t h e WAIt,  (Client  Form),  (Therapist  Form)).  correlated  with  subscales)  as w e l l  tenth,  All  six  18  these  variety  ratings  and f i n a l  -therapist  and  of  of  that  of  the  the  ratings  each  there  employed formed,  w h i c h were  four  Involvement  Involvement  in order  to  administered  Client  (which  was  Scale  measures  were  e n c o m p a s s e d 29 to determine  the  were:  strength  Involvement  therapy  after  44 w o r k i n g a l l i a n c e s .  variables of  were  relationship  measures  last  relationship  were  Client  to  (if  seven  the  and t h e  the  taken  subscales)  WAIc,  first  session  all,  a s w i t h one a n o t h e r  independent  Bonds,  the  outcome  and e f f e c t i v e n e s s  -client Tasks,  In  ( e n c o m p a s s i n g 12 s u b s c a l e s ) of (i.e.,  The  tenth  relationships  as r e p e a t e d m e a s u r e s ,  nature  a  from  (i.e.,  measures  actual  The e f f e c t i v e n e s s of  session,  one),  their  outcome m e a s u r e s .  Forty-four  the  alliances  q u e s t i o n n a i r e s completed  has been a s s e s s e d by r e l a t i n g  self-report  of  of  after  WAI  Composite,  e a c h of  the  first  Goals, five,  sessions. of  the  strength  of WAI  Composite, Goals,  38  Tasks, five,  Bonds, tenth,  -client  and c l i e n t  Involvement  and f i n a l  therapy  rating  therapist  (Relationship  of  after  each  of  the  first  sessions. Empathy a f t e r  the  third  session  Inventory)  -client  ratings  of  and T r u s t w o r t h i n e s s a f t e r  therapist  Expertness, Attractiveness,  the  third  session  the  helping  (Counselor  Rating  Form) -client session  rating  (Helping  of  Alliance  complaints  -residual ),  self-esteem  resolution  the  third  were:  improvements  i n symptom r e d u c t i o n  (Self-Esteem Index),  ( I n v e n t o r y of  -client  (Symptom C h e c k l i s t - 9 0  and i n t e r p e r s o n a l  Interpersonal  problem  Problems)  posttherapy assessment  -therapist 2.  gains  after  Questionnaire)  The d e p e n d e n t v a r i a b l e s -target  alliance  posttherapy assessment  POPULATION The p o p u l a t i o n  actual  psychotherapies  Victoria,  British  Counselling Centre t h r o u g h May, 1.  3.  in Toronto,  1987.  sample was drawn c o n s i s t e d o f  conducted and  in  at  Ontario  Vancouver  the  York  during  were  in therapy  for  the  University  February,  The p o p u l a t i o n was r e s t r i c t e d first  as  and  1986  follows:  time  with  the  therapists.  The c l i e n t s The  being  Columbia  The c l i e n t s  participating 2.  from w h i c h t h e  were  clients  at  were  least  18 y e a r s  old.  d i a g n o s e d a s not  p s y c h o t i c and n o t  39  suicidal  by t h e  4. than  participating  The c l i e n t s  conjoint  or  s e s s i o n s may have participating service  were e n g a g i n g i n  family  therapy.  involved their  therapists,  being p r o v i d e d to  5.  The  therapists.  clients  the  were  British  employing t h e r a p i s t s  spouses,  in  the  therapy  the  and  in the  about  and a b o u t  was  able  to  40  social  60 t h e r a p i s t s  invited,  the  the  nature  study,  in order  to  and s c o p e of  the  amount  safeguards  that  of  the  been  therapist  confidentiality  detailed  below.  the  review  time the  had  w i t h the  give  their  to  was,  the  use of  the  t e r m was a v o i d e d , t h e  terms  of  an  of  broad o u t l i n e  of  protect These  of  the  and  the  safeguards  are  being  nature  of  and  working a l l i a n c e .  the  agency  client  course, given  research  then  therapists  p r o c e d u r e s would r e q u i r e , designed  of  practice and  agencies'  r e s e a r c h , the  No i n f o r m a t i o n  exploration  major  researcher attended  and a n o n y m i t y .  hypothesized structure  the  in private  by  meetings  the  service agencies  ( A p p e n d i c e s 1 and 2)  staff  of  study.  by l e t t e r  When  therapy  view  were a p p r o a c h e d , f i r s t telephone.  rather  clients. willing  Columbia,  therapy  A l t h o u g h some of  individual  informed consent to p a r t i c i p a t e In  individual  regarding  Indeed,  the  discussed  in  the  therapeutic  relationship. As w e l l ,  c l i n i c and p r a c t i c a  students  in  the  masters  and  d o c t o r a l programs i n C o u n s e l l i n g P s y c h o l o g y at  the  British  c l i n i c and c o u r s e  Columbia  were  approached  settings.  In  T o r o n t o , masters  University  were a p p r o a c h e d i n  in  students their  their in  clinic  University  Psychology setting.  at  of  York  40  From t h e r a p i s t s researchers explained  who a g r e e d t o  requested the  their  them w i t h p a c k a g e ( s )  package  was n u m e r i c a l l y  forms)  so  that  preserving  client  were p r e p a r e d clients  data  of  could  the  anonymity.  completed  therapist  only or  to  offered  to  e a c h of  the  to c o m p l e t e ,  along  questionnaires the to  information  the  packages  with  in  these  the  client  researcher  and  not  agency.  DATA COLLECTION AND PREPARATION  Therapists instruction  s i g n e d the  sheet  Therapist  entitled  participation few  from t h e i r  cases,  gratuity  of  the  and c o m p l e t e d t h e 5),  Esteem Index Problems  (Appendix after  session  the  to Therapists 3).  They  first,  offering  to  to in  an the  requested  second,  pay t h e  or,  client  in a  $25.00.  Consenting c l i e n t s  (Appendix  clients  third  C o n s e n t Form a t t a c h e d  'Instructions  Psychotherapy Research P r o j e c t '  4)  252  was  attached  asked  them so t h a t  had p r o v i d e d would be a v a i l a b l e  a  all,  Confidentiality  their  3.  In  bore  consent  while  place  participating  package  the  be c o l l e c t e d and c o n t r o l l e d  instructions  the  (except  code  were  to  forms  them w i t h e n v e l o p e s  seal  3),  Each  they  to  (Appendix  forms and q u e s t i o n n a i r e s .  that  and  the  and  questionnaires  envelopes  consent  study,  the  and d i s t r i b u t e d .  to  the  procedure,  within  and t h e r a p i s t  by p r o v i d i n g  in  administration  c o d e d and a l l  and q u e s t i o n n a i r e s  number  written  questionnaire  provided  participate  the  Target  Client  8).  7),  C o n s e n t Form  Complaints/Demographic  Symptom C h e c k l i s t - 9 0  (Appendix  (Appendix  s i g n e d the  and t h e  (Appendix Inventory  These measures are  Questionnaire  6), of  (Appendix  the  Self-  Interpersonal  described  in  later  41  sections  of  m i n u t e s of  this  the  chapter.  clients'  and  Complaints/Demographic  24,  Table  e a c h of  the  session,  but  tenth  of  required  about  level)  the  first  session  the  after  sessions  the  marital  the  not  Target analyzed  additional  the  (In  3  the  7  session  Alliance Questionnaire  the  cases,  and  both  t h e WAI  since  the  in  a  had  and  therapist  actual  therapist  was few  first  only,  clients  therapy not  yet  w i t h the  14),  the  the  (Appendix Helping  r e s e a r c h e r met w i t h  forms c o m p l e t e d t o  10th  and  three  15).  sessions,  the  completed  the R e l a t i o n s h i p I n v e n t o r y  (Appendix  10th  to c o l l e c t  them  also  ( A p p e n d i c e s 10 and  than  C o u n s e l o r R a t i n g Form ( A p p e n d i x  therapists  They  initially  c o n s i d e r e d by t h e  rather  final  together.)  third  their  the  as  respective  2 through 6 and,  through  well  T h i s form  Scale  many of  client  questionnaires,  Before  their  complete.  sessions  session(s)  i.e.,  c o n t r a c t e d t o work After  to  11).  as  and a f t e r  completed  s e c o n d s e s s i o n were  assessment  session(s),  provide  on  sessions  was one)  Involvement  WAI.  cases,  occasionally  there  minutes  administered after  the  gender,  were  therapy  ( A p p e n d i c e s 9 and  five  to  five  (if  actually  13) ,  40  them i s c o n t a i n e d i n A p p e n d i x  and t h e r a p i s t  t h e WAI  attached  be  age,  collected  summary of  completed a s i x - i t e m C l i e n t  to  client  Questionnaire  a  both c l i e n t  versions  12)  r e q u i r e d about  24.  After after  (i.e.,  education  statistically,  battery  time.  The d e m o g r a p h i c d a t a , status,  This test  that  point  the  and  to  s e s s i o n q u e s t i o n n a i r e s and w i t h  the  42  termination cheque this  questionnaire  and a l e t t e r  time,  which  target  the  of  four  Questionnaire rated  for  Therapist  concluded,  clients  the  the  (Appendix  16).  Questionnaire  Sheet  researcher.  All  were p e r f o r m e d a t  this  4.  RELATIONSHIP MEASURES  4.1  Working A l l i a n c e  designed  9  and  to  assess  g o v e r n e d by any across  to  orientations  input  18)  5)  to  the  Target  Strupp  initial  Posttherapy  complaints  were the  and the  Therapist  field  were keyed  directly  was t h e n  data  visually  management  edited  and  by  analyses  facility.  11) the  is  a  strength  and  that  a large  were i n v o l v e d  in  1981,  self-report  and d i m e n s i o n s o f  (1975,  ensure  (Horvath,  36-item  1979).  Twelve  1982)  instrument the  alliance  items  measure  bonds. the  specific theoretical  orientations,  on  19).  from t h e  each c o m p o n e n t — g o a l s , t a s k s , order  form  T h e r a p i s t s completed  Inventory  a s c o n c e p t u a l i z e d by B o r d i n  In  from the  Inventory  Working A l l i a n c e  (Appendices  17).  computing  At  17).  target  (Appendix  subsequent  20).  a g a i n completed the  (Appendix  UBC computer and a l l  gratuity  (Appendix  (Appendix  Initial  (Appendix  Demographic Data  The  client  q u e s t i o n n a i r e s as w e l l as the  Questionnaires returned into  the  R a t i n g Form ( A p p e n d i x  improvements  Posttherapy  for  had r e c o r d e d them  Improvement  When t h e r a p y battery  thanks  c o m p l a i n t s were t r a n s f e r r e d  client  Complaints  of  p a c k a g e s as w e l l a s w i t h the  number  instrument approach  of  judging  but  therapists  would  not  would from  be  apply  different  item a p p r o p r i a t e n e s s .  43  Unlike the  most  alliance,  of  the  the WAI  other  instruments  i s b a s e d on c l i e n t  (WAIt) p e r s p e c t i v e s r a t h e r  than  third  developed to  (WAIc) and  party  measure  therapist  evaluation.  ... s u c h o b s e r v e r s , no m a t t e r how w e l l trained, can only respond to the b e h a v i o u r a l e v i d e n c e a v a i l a b l e to them. I m p o r t a n t a f f e c t i v e and c o g n i t i v e components o f the p s y c h o t h e r a p e u t i c p r o c e s s are e n t i r e l y unavailable to such r a t e r s . ( H o r v a t h & G r e e n b e r g , 1986, p . 536)  The m u l t i t r a i t - m u l t i m e t h o d was  used to  three  examine  d i m e n s i o n s of  support  being  the  convergent-discriminant  validity  for  the  Task,  and  convergent  subscale  and  of  the  composite  and c o e f f i c i e n t  alpha  of  Bond—with  validity  validity  1959)  of  the  the some  three  G o a l and Task reliabilities  respectively)  were  demonstrated: form:  Therapist  form:  The r e l i a b i l i t i e s study,  (i.e.,  WAI  following  internal  and of  the  Horvath  present  .88 .88 .85 .93  Goal Task Bond Composite  .87 .82 .68 .87  derived  study  from  the  data  of  the  c o n s i s t e n c i e s and c o e f f i c i e n t s relationship  presented  were f o u n d t o  r e s e a r c h e r s as reported The  Goal Task Bond Composite  other  s e c t i o n s are  coefficients  the  & Fiske,  discriminant  consistency  Client  the  (Campbell  WAI--Goal,  Acceptable  (internal also  the  offered  s u b s c a l e s and f o r subscales.  the  matrix  in  this  to  those  Table  reported  the  22. by  of the The  other  chapter.  study p r o v i d e d evidence which that  alpha),  measures d e s c r i b e d i n  in Appendix 23,  be s i m i l a r  present  WAI  subscales  is confirmed are  in  highly  44  interrelated. (1951)  In  alpha  the  coefficient,  s u b s c a l e s measured the for  t h e WAIt  to Horvath's Horvath subscales  v a l u e s of verified  study,  (i.e.,  23, .93  this  Table for  was  median C r o n b a c h ' s  degree .91  22).  for  to  which  t h e WAIc  These v a l u e s are  t h e WAIc  h i g h degree  by i n t e r c o r r e l a t i n g  the  the  same t h i n g ) ,  (Appendix  a l o n g with the Table  present  them.  and of  of  for  the  agreement  His  corresponding findings  .87  findings the  and  .94  similar WAIt.  among  are  the  the  presented  present  study  in  1.  Table  1 -  Intercorrelation  of t h e WAI Three  BOND;GOAL  Subscales at  BOND:TASK  GOAL:TASK  WAIc WAIc  (Horvath,  1981)  .66 .84  .76 .79  .85 .88  WAIt WAIt  (Horvath,  1981)  .80 .69  .77 .59  .91 .83  These relationship  correlation among the  coefficients  subscales.  Horvath  Session  indicate  a  strong  concluded that:  While there was evidence presented that the scales are s t r o n g l y i n t e r r e l a t e d , the p o t e n t i a l v a l u e of u t i l i z i n g t h e u n i q u e i n f o r m a t i o n that may become available t h r o u g h t h e use o f the s u b s c a l e s must w e i g h h e a v i l y i n the d e l i b e r a t i o n . The a c t u a l s t r u c t u r e of the Working A l l i a n c e between h e l p e r and h e l p e e i s an e m p i r i c a l q u e s t i o n which, at t h i s time, i s i n s e p a r a b l e from the p s y c h o m e t r i c qualities of the WAI. Much further research is c a l l e d f o r to r e s o l v e the b a s i c i s s u e s u n d e r l y i n g the p r o b l e m . (p. 117)  H y p o t h e s i z i n g on the which Horvath have  has r e f e r r e d  suggested  that  the  basic  issues  above,  underlying  Greenberg  alliance  and  the  problem  Pinsof  is a transactional  to  (1986) variable  45  that  occurs at  client  a level  variable  research  for  which  have n o t e d t h e client  and  consistent  are  level  of  further  different  section) Section  in d i f f e r e n t  present  individually  4.2  the  productive  as  5 of  Client  Horvath  been  therapeutic scale  clients  the  further  It  It  task  change,  the  unravel t y p e s of  has  relevance,  and  they  most  alliance.  the the  have  critical Therefore,  directed  at  this  development  issues  client  of  involved  involvement  in that  treatments.  subscales  recommended  have been above.  (described in  and  research  examined As w e l l ,  the  a  following  compared w i t h t h e WAI  (Ho-5,  IV).  the  success  (CISc)  instrument.  of  critical  G r e e n b e r g and P i n s o f  toward  t h e WAI  Scale  consistent  (Appendices  Involvement.  I,  r e s e a r c h be  Involvement  Involvement  regarding  of  t a s k s and  employed  Chapter  B a s e d on t h e groups  study,  measure of  has  to  abstraction  discriminating  preliminary  a  from a l l i a n c e - r e l a t e d  related  measures to  the  focus  Chapter  and i n d i c a t o r  have s u g g e s t e d t h a t  In  the  subsumes  optimism, perceived  orientation-specific  are  that  I n v o l v e m e n t would emerge a s t h e  subdimension  lower  be  finding  participation,  hypothesized that  they  should  i n S e c t i o n 2 of  responsibility  client  abstraction  w h i c h H o r v a t h has c a l l e d .  As r e p o r t e d  that  of  f i n d i n g s of  relationship  (Section  2.6  of  10  11)  was  and  of  the  client  Chapter  therapists  i n c l u d e s two  items  (CI S t )  research  involvement  II),  created  was a d m i n i s t e r e d a l o n g w i t h and  various  a  six-item  t o measure the  as  WAI an  to  Client  to  both  exploratory  tapping P a r t i c i p a t i o n  (#1  and  46  #4),  two  tapping  Collaboration 4.3  (#3  Relationship  The  13)  Empathy,  1.2  The items  in  -1,  or  -3  values  of  scores  the  employed, 1  to  and - 3  study,  to  6  reflecting  the of  on  tapping  1962)  dimensions  client's  Regard, Rogers'  items  the  was e m p l o y e d  strong agreement,  was  16  1977),  respond to  present  two  the  perspective—  and  Congruence.  (1957)  for  of  concept  therapeutic  of  change  II).  has  (Gurman,  four  conditions  Because  -2,  (1981)  based  Chapter  total.  Empathy,  and  (Barrett-Lennard,  from  Level  sufficient  of  Subjects  the  are  instrument  correlated four,  Inventory  relationship  and  #6),  Inventory  dimensions  (Section  and  #5).  Unconditionality,  necessary  (#2  was d e s i g n e d t o measure  interpersonal  These  and  Relationship  (Appendix  +1,  Responsibility  RI_  only in  the  in  each s u b s c a l e y i e l d i n g  scales the  the  most  present  tend  to  be  A response of  more p o s i t i v e  the  perceptions  +3  +3,  the  item.  for  In  Horvath  polarity,  responses with of  +2,  signifies  e m p l o y e d by  correcting  were a s s i g n e d t o  of  with the  scoring adaptation after  of  study.  strong disagreement  (i.e.,  highly  representative  RI_ by a s s i g n i n g a v a l u e  each item.  64  the  higher  therapeutic  relationship). Gurman consistency reliability coefficient retest  (1977) of  the  and for  evaluated  the  coefficient  RI_  found  and that  Empathy for  14  10 the  studies  studies mean  s u b s c a l e was  Empathy  was  .83.  of  of  the  internal  its  test-retest  internal  reliability  .84. Horvath  The  mean  (1981)  test-  reported  47  a reliability 4.4  estimate  for  Empathy s u b s c a l e of  .89.  C o u n s e l o r R a t i n g Form  The  social  which t h i s Chapter  counselling (Strong,  described  consists  of  36  items  rated  by t h e  E a c h of  the  three  d i m e n s i o n s of  attractiveness,  yielding  of  in  Section  three  opposite  meaning,  an  'X'  them. to  The c l o s e r t h e  adjective,  the  descriptor. to  the  the  12 i t e m s  more  the  The CRF i s  p o i n t s between  polarity).  The c l i e n t  mark  i s made t o  the  is  adjectives  one  of  left  and summing t h e  7  scores  of  The r a n g e of  s c o r e s on e a c h s u b s c a l e v a r i e s high  that  1 to  each s u b s c a l e  representing  the  right  with  integers  (after  of  or  identified  with these  perception  s c o r e d by a s s i g n i n g t h e  scores  (i.e.,  adjective  belonging to  84 w i t h h i g h  bipolar  i s measured by are  marks  his/her  therapist  the  therapist  Attractive-Repulsive),  indicate  therapist.  items  of 1975;  social influence,  The  (eg.,  1.2  on a s e v e n - p o i n t  and t r u s t w o r t h i n e s s ) ,  subscales.  seven spaces s e p a r a t i n g with  client  1968)  & LaCrosse,  referencing  are  12 i t e m s  spaces  was  of  that  expertness,  pairs  theory  The C o u n s e l o r R a t i n g Form (Barak  14)  qualities scale.  influence  measure r e f l e c t s  II.  Appendix  to  t h e RI  correcting  influence  for  from on  12  each  dimension. Reliability were r e p o r t e d experiment approaches.  coefficients  .75  .93  LaCrosse  (1977)  which  involved  s i m u l a t i o n of  The  method  Discriminant  Dell,  and between  of  in  to  by  reported. 1977)  of  an  reliability  validity  within  for  the  analog different  instrument counselling therapeutic  assessment  was  not  c o u n s e l l o r s (Barak &  c o u n s e l l o r s ( L a C r o s s e , 1977)  have  also  48  been 4.5  demonstrated. Helping A l l i a n c e As  reported  McLellan, 11-item their  Questionnaire  in  self-report  questionnaire  Helping A l l i a n c e Rating Type  patient's  1  items  experiencing  with h i m s e l f / h e r s e l f therapeutic  collaborating patient,  -1,  of  or  -3  the  struggle  parallels  HA  alliance  (Helping  b a s e d on t h e  as s u p p o r t i v e  and  helpful  and t h r e e HA Type 2  b a s e d on a s e n s e of w o r k i n g  strong  scores  against  what  is  items  together  impeding  or the  responsibility). o f +3,  A r e s p o n s e o f +3  disagreement  with  +2,  signifies  the  item.  after  the t o t a l  Awaiting  instrument,  reflecting  more  positive  perceptions  relationship.  the p a t i e n t s '  .72.  15) w h i c h  an  1 t o 6 were a s s i g n e d t o t h e r e s p o n s e s i n t h e p r e s e n t  with higher  patients,  Luborsky,  have d e v e l o p e d  has e i g h t  therapeutic  t o each item.  and - 3  Administered  to  (a  It  II,  r e s p o n d t o t h e HAQ by a s s i g n i n g a v a l u e  the t h e r a p e u t i c  with  Scale.  as the r e c i p i e n t )  in a joint  -2,  of  study,  Chapter  (Appendix  the t h e r a p i s t  alliance  s t r o n g agreement Values  of  w i t h t h e e m p h a s i s on s h a r e d  Subjects +1,  2.1  Woody, O ' B r i e n , and A u e r b a c h (1985)  Alliance)  (a  Section  the  third  session  s c o r e was c o r r e l a t e d  to  significantly  s e v e n - m o n t h outcomes on f o u r  the r e s u l t s  Alexander  of a " r e - p a i r i n g "  and L u b o r s k y  110 d r u g - a b u s e  (1986)  (p_<.0l)  measures at study  stated  .51  employing that  Because of its relative simplicity, if the questionnaire method is comparable to the others predictively, it would become t h e f u t u r e method o f c h o i c e i n terms of e f f i c i e n c y and economy of t i m e for m e a s u r i n g h e l p i n g a l l i a n c e phenomena. (p. 354) Nothing  further  has  been  reported  by t h e Penn g r o u p on t h i s  49  issue. 5.  OUTCOME MEASURES  S i x outcome m e a s u r e s were e m p l o y e d Three  of  Moseley  them  were  (1983)--Target  Posttherapy  verified  in  the  also  their  and  employed  the  i n psychotherapy as b r o a d l y 5.1  Target  Complaints  Improvement been  employed  Penn  (Luborsky  (1981) a n d  the  Therapist with  study.  the  Strupp  Posttherapy WAI  were  The Symptom C h e c k l i s t - 9 0 ,  Inventory  in order  by H o r v a t h  the  relationships study.  present  Improvement,  and  present  S e l f - E s t e e m Index,  employed  Complaints  Questionnaire,  Questionnaire—and  were  measures  in the  of I n t e r p e r s o n a l  t o t a p t h e domain  the  Problems  of c l i e n t  change  as p o s s i b l e .  Improvement  in target  complaints  a s an i n d i v i d u a l i z e d  ( A p p e n d i c e s 5 and 17) outcome measure  has  i n both the  e t a l . , 1983; Morgan e t a l . , 1982) a n d V a n d e r b i l t  (Gomes-Schwartz,  1978)  studies.  Mintz  d e s c r i b e d the p r i n c i p a l  advantage  of t h i s  and  Kiesler  outcome  (1982)  measure:  Since they [individualized outcome measures] are t a i l o r e d to the unique treatment situation of each patient, they are purported to be o f much g r e a t e r relevance and v a l i d i t y as outcome or program evaluation i n d e x e s , in c o n t r a s t to " a c r o s s the board" or s t a n d a r d i z e d group measures t a p p i n g d i m e n s i o n s t h a t may o r may n o t be r e l e v a n t t o a particular patient, (p. 493)  Battle improvement therapists'  et  al.  with other ratings  ineffectiveness  scale,  (1966)  compared  outcome m e a s u r e s , of  overall  and a d i s c o m f o r t  target  (i.e.,  patients'  improvement, scale),  complaints  in a  a  and social  four-month  50  psychotherapy  study.  complaints correlated Target  complaints  differentially on t h e  and  severity before  significantly  as  an  were  and a f t e r the  measure  situation  were shown t o  be . h i g h l y  present  study,  clients (Appendix  beginning  the  therapy.  At  state.  improvement  ('Worse') ratings  to  therefore,  Symptom The  Any a v e r a g e d  r e p r e s e n t e d an  i s c o m p r i s e d of dimensions:  interpersonal  interview. up  to at  therapy,  instructed  Likert  scale  three the  clients to  rate  coded  1  17).  The  improvement  score over  3.0  ('Slightly  improvement.  with primary  90  (Derogatis, items  paranoid  e m p h a s i s on v a l i d i t y  clinical  drug  trials,  sensitive  to  treatment  setting.  a wide  the  variety  s t u d y w i t h 209  nine  anxiety,  as  primary  a  criterion  Developed measure  has a l s o been shown t o  nonpharmacologic f a c t o r s  subjects,  1973;  hostility,  and p s y c h o t i c i s m .  instrument of  & Covi,  obsessive-compulsive,  depression,  ideation,  Lipman,  which r e f l e c t  somatization,  sensitivity,  anxiety,  a  Appendix  reported  Checklist-90  6)  symptom  In  Better';  Symptom C h e c k l i s t - 9 0  Appendix  phobic  Lot  were a v e r a g e d .  Better'), 5.2  on e a c h on a f i v e - p o i n t  5 ('A  when  administered  were p r e s e n t e d w i t h t h e s e c o m p l a i n t s and were their  dependent  R a n k i n g s and  evaluation  c o n c l u s i o n of  respond  improvement  identified 5)  to  global  reliable  psychiatric  c o m p l a i n t s on a q u e s t i o n n a i r e of  to  target  measures.  were l e s s  than  patients  intensive  that  seemed  manipulation,  for  an  easy  found  with these other  outcome  transference  ratings  In  researchers  to experimental  patients'  ratings,  The  Derogatis,  in  in be the  R i c k e l s and Rock  51  (1976)  compared t h e symptom d i m e n s i o n s o f t h e S C L - 9 0  scales  which  SCL-90.  very  high convergent  Internal consistency coefficients  r a n g e d from .78  reflected  to  .77 t o  .90 and t e s t - r e t e s t  item  is  rated  ranging  from  minutes  to complete.  Use  'Not at a l l '  of  this  on to  a  Mental  Health's  1975)  and i t  their  alliance  f o r the  nine  reliabilities  'Extremely'.  scales  ranged  Bachman  Outcome  research  from  O'Malley  o r judgment  Bachman and O ' M a l l e y was  the  unweighted  deviation  longitudinal  takes  20  i s in  Institute  (Waskow  of  & Parloff,  Porter  group  in  II).  to refer  of h i s / h e r  adaptation  the e i g h t - y e a r study.  Factor  reported  own  heavily in  t o "an i n d i v i d u a l ' s worth"  (p.  span  1608 young men. with the It of  analysis  selfThe  (Appendix The SEI i s  five-point  Likert  i n c r e a s e d by one s t a n d a r d Bachman  and  revealed  up t o 69% of t h e common v a r i a n c e  by c o r r e l a t i o n s  their  366).  of the Rosenberg index  was f o u n d t o be a s h i g h a s . 8 1 .  was d e m o n s t r a t e d  being  and C o o p e r s m i t h (1967)  mean of t h e 10 i t e m s  explaining  reliability  Project  (1977)  r e s p o n s e s coded 1 t o 5. over  National  2 . 3 of C h a p t e r  s t a n d a r d i z e d on a sample o f  of  distress  Index and  7)  The S C L - 9 0  by t h e L a n g l e y  (Section  the term s e l f - e s t e e m  evaluation  the  Measures  i n f l u e n c e d by R o s e n b e r g (1965) of  s c a l e of  measure a s an outcome a s s e s s m e n t d e v i c e  h a s been u t i l i z e d  5.3 S e l f - E s t e e m  factor  f o r the  five-point  a c c o r d w i t h the recommendations of  scale  validity  MMPI  .90.  Each  use  with  with other  O'Malley's  a strong and  Construct variables  first  internal validity such  as  52  negative 5.4  affective  (r=-.5l)  I n v e n t o r y Of I n t e r p e r s o n a l  Horowitz, of  states  Weckler,  Interpersonal  difficulties of  a  psychotherapy identified. of  in  (1983) d e v e l o p e d t h e I n v e n t o r y  order  to  relate  to p s y c h i a t r i c complaints.  psychiatric  clinic  from  which  behaviours  were  interviewed  100  interpersonal  aggression,  compliance,  that  interpersonal  Twenty-eight  T h e s e were f o u n d t o c o n s t i t u t e  problem  (r=.54).  Problems  and D o r e n  Problems  and h a p p i n e s s  generally  before  patients beginning  problems  five  major  concerned  independence, and s o c i a l i z i n g  were  clusters intimacy, (Horowitz,  1979). One internal  hundred  students  consistency, ( i . e . ,  a cluster  (p_<.0l)).  Q-sorted  the  correlation  Test-retest  items  between  reliability  demonstrating problems  of  .77  within  was  also  demonstrated. The  current  correspondence, form  12  version  the  A p p e n d i x 8) c o n s i s t s o f  subscales.  test-retest  of  These  are  IIP  127 i t e m s ,  listed  Hard to  be I n t i m a t e  1 1 items  -  .88  Hard to  be A s s e r t i v e  17 i t e m s  -  .82  Hard to  be I n d e p e n d e n t  9 items  -  .86  Hard to  be S o c i a b l e  1 1 items  -  .90  Hard to  feel  6 items  -  .78  Hard to  be S u p p o r t i v e  1 1 items  -  .76  Hard t o  be A g g r e s s i v e  5 items  -  .69  6 items  -  .80  Too G i v i n g  -  -  personal  118 o f  below a l o n g w i t h  reliabilities:  Self-Worth  (1986,  which their  53  Too A g g r e s s i v e  -  13  items  -  .80  Too  -  10 i t e m s  -  .85  -  10 i t e m s  -  .74  9 items  -  .77  Hypersensitive  Too E a g e r t o Too  Please  Dependent  5 . 5 Strupp Posttherapy  Questionnaire  The S t r u p p P o s t t h e r a p y Wogan,  1964)  administered experience  (Appendix  at of  the  end  measurement  in  Kirtner,  Fiske,  ratings  of  Thus,  validity  appears  Horvath to  Change  (5  (1981)  items),  and  three  level  took  and t h e  place,  analyzed data  of  is presented  s o u r c e s of  The  outcome  (Cartwright,  showed t h a t  clients'  overall  (1975)  have  success  concluded,  (3 for  11  therapy-related  Satisfaction  items). the  He  (3  items),  reported  the  instrument:  .87 .88 .77 .65  dealing  the  in Appendix  with pretherapy the  d e c i s i o n to in  the  subscales:  expertise,  statistically  clients'  with treatment.  therapists'  analyzed  estimates  items  therapist's  al.  measure  determine  investigations  Parloff  and A d j u s t m e n t  other  to  &  substantial.  Satisfaction Change Adjustment Composite Eight  with  Wallach,  retrospective  with other  Strupp et  logically  reliability  (Strupp,  and s a t i s f a c t i o n  previous  Waskow  a  treatment  1963).  t o be  is  correlation  several  identify  following  of  change c o r r e l a t e d  ratings.  items  16)  improvement  SPQ has shown p o s i t i v e  &  Questionnnaire  time  terminate  present 22.  in  therapy  the  study.  conditions, until  therapy  change  were  A summary of  the  not these  54  5.6  Therapist  The  Posttherapy  Therapist  Horvath  (1981;  Questionnaire indicator include  Appendix  based  on  a  of  Horvath  for  above  of  the  client's  He  Appendix items  that  22  the  outcome of  one the  view  The  by  Posttherapy  to provide  an outcome  rationale  to  outcome measures was therapist  tends  that  (Mintz,  inappropriate following  adapted  Strupp  variance  of  analyzed  is  to  quite  1977). item  reliability  from  the  estimates  form  (Appendix  treatment, about  degree  (2 i t e m s ) (5 i t e m s ) (3 i t e m s ) (10 items)  18),  designed  the  therapist: number  and  characterized  with t h i s  work  theoretical  orientation,  statistical  a n a l y s e s , but  in  from  the  c o m p l e t e d by t h e  therapist/counsellor, the  data  the  seven  present  study.  Sheet  was  earned,  the  statistically  Demographic D a t a  information highest  .37 .75 .81 .55  i n c l u d e s a summary of  were not  Therapist This  end  that  was  the TPQ: Satisfaction Change Adjustment Composite  5.7  order  among the  point  reported  the  judgment.  suggest  (1981) d r o p p e d  form.  in  evaluation  that  the  from  therapist's  portion  independent  Questionnaire  19)  described  b a s e d on f i n d i n g s  client  Posttherapy  a therapist's  capture  Questionnaire  to  of  gather  years  client. data  a summary  the  professional  theoretical  these  therapist  of  of  affiliation,  orientation  were not them  is  the  following  experience  W i t h the  at  as  a  w h i c h most  exception  of  employed in  the  contained  in  55  Appendix  24,  The  (i.e.,  all  the  are  of  internal  the  Chapter  those  derived  from  in  Appendix  SPQ S a t i s f a c t i o n IV),  reported  the  by o t h e r  the  data  of  the  c o n s i s t e n c i e s and c o e f f i c i e n t s  outcome m e a s u r e s d e s c r i b e d i n  presented  (i.e.,  23.  reliabilities  study, of  Table  23,  Table  the 22.  preceding W i t h one  subscale discussed  coefficients researchers  in  were f o u n d t o as r e p o r t e d  present  alpha),  of  sections exception,  Section  1.5.1  be s i m i l a r  above.  to  56  IV.  Data  were c o l l e c t e d from 44  completed well,  during  some  the  data  terminated  period  were  The 44  therapy  by  cases  cases  February,  collected  prematurely  sessions. sources  RESULTS  the  have  1986  from  12  clients been  initiated  t o May, cases  after  1987.  As  that  less  categorized  and  were  than  as  to  six  their  below:  Private Victoria  practitioners  T h e r a p i s t s employed G r e a t e r Vancouver  in Greater 22 c a s e s  by  Vancouver  social service 13 c a s e s  and  agencies  in  Masters and d o c t o r a l s t u d e n t s i n c l i n i c and p r a c t i c a s e t t i n g s i n T o r o n t o , O n t a r i o and V a n c o u v e r (including two demonstration cases c o n d u c t e d by a clinic supervisor) 9 cases 44 c a s e s In  the  therapist three,  largest  source  contributed  group,  four  cases  to  and two o t h e r s c o n t r i b u t e d  supervisor  mentioned  private  practice.  sample  of  therapist analysis  44  No c l i e n t  Hence,  cases.  effect and t h e  above  was  All  of  the  i n more t h a n  i n whole o r  in part  while  therapists  employed  received  salaries  from  their  as  agencies,  in  from a  post  in Section  one c a s e i n  the  received from  social  clinic  a c a s e from  reported  directly by  The  resulting  practitioners  compensation the  each.  statistically are  one  contributed  were r e p r e s e n t e d  dependence  therefrom  private  s a m p l e , one  contributed  35 t h e r a p i s t s  examined  was r e p r e s e n t e d  the  practitioners,  two c a s e s  also  Case  results  private  their service  and  the  his the this hoc  7.1.  sample. financial clients, agencies student  57  therapists The  were not  financially  13 c a s e s c o n t r i b u t e d  compensated.  by t h e r a p i s t s  represented  seven  specializing  i n a l c o h o l and d r u g a b u s e  church-sponsored non-profit a  setting,  summary,  is  the  private  experience several  were from an  from  agency  four  from  community-based  from a t h e r a p i s t  working  from a campus c o u n s e l l i n g  contained  were,  24,  Data  when  Such  a  in  Sheet  at  asked the  to  in  service  first  (Appendix  had  least  part 18),  eclectic  in  speculation  the  psychologists  identifed  majority  orientation  of as  humanistic  their  those,  and  23 and 24. of  and  of  five  years  on  the  they  had  other  themselves.  therapists  their  #5  that  orientation  of  However,  question  indicated  In  counsellors  orientation.  categorized  some of  clients  identify/describe  It  than seems,  in  the  sample  the  findings  orientation. is  consistent  L o p e z , C a m p b e l l , and H a m m i l l  counselling  Tables  one  a s s o c i a t e d w i t h an  they  that  between  from a h u m a n i s t i c  orientation  fact,  40.2%),  i n Appendix  of  having  in  Watkins,  sample  practice  which  therefore,  the  sample c o n s i s t e d l a r g e l y  employed t e c h n i q u e s in  of  therapist  therapists,  Demographic  that  analysis  and working  theoretical  that  two  agencies  women.  therapists  the  and one  one  in  counselling,  counselling services,  The d e m o g r a p h i c  in  agencies—five  counselling centres,  hospital  for  different  employed  with  (1986)  and  found t h a t  primary  orientation  (i.e.,  36.4%),  tended  the  surveyed  majority,  as e c l e c t i c  eclecticism. to  be  716  (i.e.,  and  c l a s s i f i e d their  humanistic-existential orientations  who  of  that  eclectic It  absorbed  seemed into  58  synthetic  eclecticism,  (i.e.,  integration  contemporary a p p r o a c h e s ) , which, practitioners  to  use  seemed a p p r o p r i a t e The c l i e n t a g e s of  techniques particular  therapies  therapeutic  least  dyads  a diversity  researchers noted, from d i f f e r e n t  of  allowed  theories  that  f e m a l e s between  the  clients.  sample c o n s i s t e d l a r g e l y  26 and 35 h a v i n g a t  The  1.  for  the  of  of  some c o l l e g e e d u c a t i o n .  were  largely  would be c h a r a c t e r i z e d a s  s a m e - g e n d e r and  the  brief.  RELATIONSHIP OF PERCEIVED ALLIANCE STRENGTH TO OUTCOME The  analyses  alliance i s the  measures.  average  employed  of  the  The s e l e c t i o n of  analysis  of  the  five  first  measure  the  third,  this  this  fourth,  measure  intercorrelations  s e s s i o n s which  in  of  subsequent  and f i f t h  is  session  supported  t h e WAI  is presented  and  scores  by  of  an  each of  in Appendix 25,  Table  25. The  results  perceived  of  alliance  the  analysis  strength  of  the  t o outcome a r e  relationship  of  p r e s e n t e d by outcome  measure. 1.1  Target  C o m p l a i n t s Improvement  Target  complaints  improvement . on  the  improvement t h r e e or  client  at  the  b e g i n n i n g of  client  at  the  end o f  improvement mean  therapy  questionnaire)  was  with  less  therapy  on e a c h c o m p l a i n t  improvement  is  4.07  defined  complaints (Appendix  (Appendix  17).  5)  =  'Somewhat  a standard d e v i a t i o n  the  average  identified  by  the  and r a t e d  by  the  C l i e n t s rated  on a f i v e - p o i n t (4  as  of  Likert  scale.  Better' .59.  The  on  their The the  findings  59  for  this  similar  outcome measure a r e results  Table  2 -  of  Moseley  presented  in Table  2 along with  (1983).  R e l a t i o n s h i p s between the WAIc C o m p l a i n t s Improvement  and  Moseley  .25 . 34** .40**  COMPOSITE  .33 **  The  relationship, relationship,  WAIc  COMPOSITE  subscales correlated  improvement  approached  statistically  outcome measure The target  1  1  2<.05  scale  as  and  well  as i t s  BOND and TASK  significantly  the  significant  WAIc  GOAL  with  target  subscale  correlation  with  also this  (p_=.06).  magnitude complaints  significance,  .33 .53** .51*  statistically  complaints  n=19)  r  GOAL TASK BOND  Significant Significant  Target  (1983;  r  * **  the  of  the  correlation  improvement  (r=-.08,  Table  did  not  between reach  the  WAIt  and  statistical  8).  M o s e l e y ' s r e s u l t s were compared w i t h t h e r e s u l t s o f t h e present study by testing the differences between the correlation c o e f f i c i e n t s ( G l a s s & H o p k i n s , 1984, pp. 307-309). The r's were transformed to Fisher Z's, the variances of the Z / s c o m p u t e d , and t h e s t a n d a r d e r r o r s of t h e d i f f e r e n c e s d e t e r m i n e d . Correlations were found not to differ statistically s i g n i f i c a n t l y between t h e two s t u d i e s .  60  1.2  Self-Esteem The  and t h e  Index  S e l f - E s t e e m Index, Inventory  w i t h outcome a r e  Interpersonal  discussed  involved pretests u s i n g the  of  in  and p o s t t e s t s .  The  u s i n g the  magnitude  examined  before  pretests  of  the  as t h e on  (i.e.,  3 6 . 0 9 and 3 9 . 3 6 w i t h s t a n d a r d  standard  error  groups S . D . computing  the  divided  the  Neither and  of  the  1.3  the  semi-partial  the  and  deviations  t-value  of  the of  4.65  (i.e.,  root  of  process  was and  S e l f - E s t e e m Index,  pretest  square  magnitude  gain  on  between  reached s t a t i s t i c a l Table  the  calculated  outcome m e a s u r e s  between  difference,  by t h e  respectively,  posttest,  6.72  and  (p_<.00l).  the  pooled  n) , was  a  5.51 The  within-  employed  in  t-value.  residual  correlation  pair  1.4  controls.  For  comparing the  a  relationships  g a i n s were  these  t-test  produced  and  Checklist-90  SPSS:X to perform  relationships  means of  1.3  Residual  change  Symptom  P r o b l e m s whose  m e a s u r e s were c o n s i d e r e d .  respectively),  as t h e  Sections  REGRESSION p r o c e d u r e o f  correlations  outcome  as w e l l  the  the  of  the  SEI  WAIt  correlation nor  and  significance,  the  magnitude  residual  (£=.18  between t h e  and  gain .17  WAIc  of  the  on t h e  SEI  respectively,  8).  Symptom The  pretest  Checklist-90  magnitude to  presented instrument  posttest  of  change on t h e  was a n a l y z e d  in Appendix  26,  Table  showed s t a t i s t i c a l l y  reductions),  in  Symptom C h e c k l i s t - 9 0  by s u b s c a l e . 26.  All  of  significant  symptoms from t h e  pretests  the  These r e s u l t s  are  s u b s c a l e s of  the  improvements, to  from  the  (i.e.,  posttests.  61  The F - v a l u e s  r a n g e d from 6.54  Analysis up t o  this  point  description the  the  SCL-90 at  in  the  only.  at  to  the  register  the  Neither  correlation reached Table  8).  on  only  magnitude  gain  between  statistical  on  to  46.87  study  of  the  for  the  this  only at  some  (2^.001).  subscale level  the  and not  was  the  scale total  would all  correlation  SCL-90  nor  t h e WAIt and r e s i d u a l significance,  purpose  be of  gain  and  expected  to  the  subscales), this  (r_=.05 and .07  point.  the  magnitude on  were  level  between  the  of  between  measure  were d i s c o n t i n u e d a t the  presented  relationships  outcome  (since c l i e n t s  subscale level  the  residual  and  meaningful  subscale level  a n a l y s e s at  and  present  measures  be  change  the  S i n c e a n a l y s e s of  relationship  considered not  of  (2^.05)  the  WAIc of  the  SCL-90  respectively,  62  1.4  I n v e n t o r y Of  Interpersonal  The m a g n i t u d e Problems  from  These r e s u l t s the  s u b s c a l e s of  the  pretests  6.39  (2^.05)  Giving'  the  to to  at  this  in  Section  the  for  **  Table  26.  interpersonal the  w i t h the  All  significant  problems  F-values  of  ranged  e x c e p t i o n of  the  from from 'Too  2=' °)« 1  at  the  subscale level  the  reason stated  for  the  3 -  IIP  are  for  the  was  discontinued  Symptom C h e c k l i s t - 9 0  .40**  Significant  relationship,  WAIc  COMPOSITE  subscales correlated g a i n on t h e  presented  in Table  R e l a t i o n s h i p s between t h e WAIc and t h e of I n t e r p e r s o n a l Problems  COMPOSITE  residual  in  (g^.OOl),  .44** .45** .23  The  was a n a l y z e d by s u b s c a l e .  (i.e.,  GOAL TASK BOND  The  Interpersonal  1.3.  The f i n d i n g s Table  of  showed s t a t i s t i c a l l y  posttests,  IIP  Inventory  i n Appendix 26,  reductions),  (F=2.86,  of  point  the  the  posttest  instrument  1148.48  subscale  to  presented  (i.e.,  Analysis  change on  pretest are  improvements,  of  Problems  2-«0  3. Inventory  1  scale  as  statistically  well  as  its  significantly  GOAL and TASK with  residual  IIP.  magnitude  of  the  correlation  g a i n on t h e  IIP  d i d not  between  reach s t a t i s t i c a l  the WAIt  and  significance  63  (r=.02, 1.5  Table  8).  Strupp Posttherapy  The f i n d i n g s to  outcome Table  is 4 -  for  Questionnaire  the  discussed  SPQ and f o r  in Section  Relationships  the  1.6  between t h e t h e TPQ  GOAL  TASK  TPQ whose  are  relationship  presented  WAI  and t h e  •  in Table SPQ and  BOND  COMPOSITE  .35**  .40**  WAIc Strupp Posttherapy  Questionnaire  Change  .35**  Therapist  .41**  Posttherapy Questionnaire  Satisfaction  .33*  .34**  .24  .32*  Change  .27*  .29*  .22  .28*  Adjustment  .13  .14  .10  .13  TPQ  .28*  .28*  .22  .28*  .06  .07  Total  WAIt Strupp Posttherapy  Questionnaire  Change Therapist  .04 Posttherapy  .12  Questionnaire  Satisfaction  .24  .33*  .22  .27*  Change  .17  .21  .08  .16  Adjustment  .22  .19  .08  .17  TPQ  .24  .28*  .15  .23  * **  Total  Significant Significant  relationship, relationship,  £<.05 £<.01  4.  64  1.5.1  Satisfaction  Since  the  reliability  of the S a t i s f a c t i o n  SPQ was f o u n d t o be e x t r e m e l y (1941) the  coefficient=.25,  WAI w i t h  it  was  finding  of a H o y t ' s  subscale  (Section  conclusion  that  low i n t h e p r e s e n t  Appendix 23, Table  regarded  as  coefficient  5.6,  Chapter  the three  s u b s c a l e of the (Hoyt's  correlation  Horvath's  of  (1981)  .37 f o r t h e TPQ S a t i s f a c t i o n  III)  items  22),  invalid.  of  study  seems that  to  corroborate  constitute  this  the  scale are  poorly constructed. 1.5.2  Change The WAIc COMPOSITE a s w e l l a s  subscales correlated (r=.40,  .35,  The  statistically  . 4 1 , and .35  magnitude  client's  items  assessment  completion  resulting  significantly  of t h e c o r r e l a t i o n  from  that  and  BOND  w i t h SPQ Change  between  significance,  rather  than  therapy,  you a r e d e a l i n g  this  s u b s c a l e was j u d g e d  t h e WAIt and SPQ (r=.07).  this  capacity her/his  subscale t o cope a t  assessment  probe  any  present  invalid  problem?).  and c o r r e l a t i o n  the  t h e t i m e of of  change  ( e g . , Item #15: How a d e q u a t e l y  with  was a l s o r e g a r d e d a s Henceforth  constitute  of h i s / h e r  feel  it  TASK,  Adjustment The t h r e e  test  GOAL,  respectively).  Change d i d n o t r e a c h s t a t i s t i c a l 1.5.3  its  do y o u  Therefore,  of t h e WAI w i t h  invalid.  i n the present  SPQ Change s u b s c a l e have been  study,  only c o r r e l a t i o n s  reported.  with the  65  1.6  Therapist The  magnitude  TPQ d i d n o t the  WAIc  full  1.6.1  of  Questionnaire  the  correlation  reach s t a t i s t i c a l COMPOSITE  correlate the  Posttherapy  significance,  as w e l l as  statistically  between  its  (£=.23).  the  However,  GOAL and TASK s u b s c a l e s d i d  significantly  s c a l e and a l s o £ = . 2 8 f o r  t h e WAIt and  w i t h the  e a c h of  the  TPQ,  (£=.28  for  two s u b s c a l e s ) .  Satisfaction  The  WAIt COMPOSITE a s w e l l a s i t s  statistically  significantly  TASK s u b s c a l e  w i t h TPQ S a t i s f a c t i o n  correlated  ( £ = . 2 7 and  .33  respectively). As w e l l , correlated =.32,  the WAIc  COMPOSITE and i t s  statistically  .33,  and  .34  significantly  respectively),  a l s o approached s t a t i s t i c a l l y  GOAL and TASK s u b s c a l e s  w i t h TPQ S a t i s f a c t i o n and t h e WAIc  significant  (r_  BOND s u b s c a l e  correlation  with  it  (£  =.24). 1.6.2  Change The m a g n i t u d e  Change d i d not The  WAIc  correlated .27,  and  of  the  reach s t a t i s t i c a l COMPOSITE a s w e l l  statistically  .29  correlation  between  significance, as  its  significantly  respectively).  t h e WAIt  and  TPQ  (£=.16).  GOAL and TASK s u b s c a l e s  w i t h TPQ  Change  (£=.28,  66  1.6.3  Adjustment Neither  the  magnitude  and TPQ A d j u s t m e n t the  2.  and  .13  the  correlation  nor t h e m a g n i t u d e  WAIc and TPQ A d j u s t m e n t  =.17  of  of  the  between  the  correlation  reached s t a t i s t i c a l  WAIt  between  significance,  (r  respectively).  RELATIONSHIP OF PERCEIVED CHANGE IN ALLIANCE STRENGTH TO  OUTCOME  Suh,  O'Malley,  therapist  and  b e h a v i o u r over  Strupp  the  the  Vanderbilt  this  change s c o r e c o r r e l a t e d  measures w h i l e  measure  being  third  Suh  et  because  based  Moreover,  three  sessions  on  they  significantly  session al.'s  involved difference  unreliable  first  examined  Psychotherapy Process S c a l e .  the  However,  (1986)  of  multiple  for  did  the  Session  1 and t h e  difference  between  thereby  d o u b l i n g the  weighting  total  difference  without  of  latter  providing  a  outcome  this  inherent  change to  in  (Stanley,  2  that  not.  between  Session  the  on  considered  estimates  difference  therapy found  deriving  compounded e r r o r point  in  with various  s c o r e s which are  the  summed  They  score i t s e l f  formula  of  change  their  1971).  Session  and  3 and  Session  difference rationale  be  1,  in  their  for  this  weighting. In first slope  the five  of  measures. the  present  study,  sessions  this  line  were  the  WAIc  fitted  COMPOSITE  to a r e g r e s s i o n l i n e  was t h e n c o r r e l a t e d w i t h t h e  Although  regression l i n e ,  an rj_ o f (i.e.,  the  .89  scores  various  was computed f o r  regression  line  the  for and  the the  outcome s l o p e of  accounted  for  67  most  of  the  variance,  and,  development  was i n d e e d f o u n d t o  correlation  between  strength  over  the  the  slope,  first  five  Session and  5 WAIc  this  measures,  of  the magnitude  was  six,  this  The c o r r e l a t i o n s 5 -  with the  change  then  computed  by  correlated  significant  correlation  to  change i n WAIc two methods a r e  Regression Line  with  strength  outcome  did  occur.  Difference  Score  .15  .33*  -.04  .12  SPQ Change  .02  .08  SEI  .09  .21 .04  evidence  in Table  Strength  IIP  p^.05  the  and o u t c o m e .  presented  .20  .05 difference,  outcome  the  be s i g n i f i c a n t  .00  TPQ * Significant  alliance  subtracting  Target Complaints Improvement  SCL-90  the  the  S e s s i o n 1 WAIc COMPOSITE s c o r e  R e l a t i o n s h i p of Change i n WAIc Outcome  Fitted  in  of  WAIc  significance.  was j u d g e d not  between  the  p a t t e r n of  s e s s i o n s ) , and none of  s c o r e was  one s t a t i s t i c a l l y  a relationship  Table  be l i n e a r ) ,  COMPOSITE f r o m the  difference  B e i n g one of  the  (i.e.,  measures reached s t a t i s t i c a l l y When a d i f f e r e n c e  therefore,  5.  to  Correlation  68  Since  the  WAIt  did  significantly  w i t h outcome  relationship  of  WAIt t o 3.  change  outcome was  not  (Ho-1,  correlate  Section  in a l l i a n c e  statistically  1),  no a n a l y s i s of  the  strength  as m e a s u r e d by  the  performed.  RELATIONSHIPS OF C L I E N T - P E R C E I V E D THERAPIST EMPATHY,  EXPERTNESS,  ATTRACTIVENESS,  The f i n d i n g s summarized Table  relevant  in Table  6 -  AND TRUSTWORTHINESS TO OUTCOME  t o Ho-3  are  presented  8 which c o n c l u d e s S e c t i o n  R e l a t i o n s h i p s between O t h e r Outcome M e a s u r e s  Complaints  6  and  5.  Process Measures  EMPATHY EXPERT ATTRACT TRUST Target  in Table  and  HA J_  HA 2  .29*  .22  .03  .01  Symptom C h e c k l i s t - 90  .16  .39**  .36**  .42**  .43**  .36**  Self-Esteem  .04  .37**  .29*  .27*  .32*  .29*  .28*  .28*  .28*  .41**  .21  .13  .09  .38**  .17  -.04  .08  .28*  .31*  Index  I n v e n t o r y of Interpersonal Strupp  .26*  -.13  -.09  Problems  Posttherapy Questionnaire  Change Therapist  .15 Posttherapy  .16  Questionnaire  Satisfaction  .16  .18  Change  .24  .29*  .14  .30*  .28*  .26*  Adjustment  .20  .28*  .16  .16  .21  .35**  TPQ  .23  .29*  .10  .20  .30*  .36**  * *  Total  Significant Significant  relationship, relationship,  g<.05 £^.01  69  3.1  Relationship  The  Inventory  Empathy  significantly  subscale  with residual  the  other  3.2  Counselor Rating  residual  =.33),  gain IIP  on the  IIP  statistically  ( £ = . 2 6 ) but  not  with  Both  SCL-90  correlated  and  on t h e  SCL-90 ( £ = . 3 9 ,  significantly  Table  8),  the  SEI  TPQ  (r  SEI  6),  the  correlated  SEI_  with (£=.37),  statistically  (£=.29).  significantly the  significantly  Table  Expertness a l s o  w i t h the  .42),  (£=.42,  statistically  Attractiveness  statistically  statistically  (£=.30).  (£=.28).  significantly  =.36  g a i n on t h e  score correlated  IIP  Expertness  and t h e  RI_ c o r r e l a t e d  Form  gain  and t h e  residual  the  outcome m e a s u r e s .  The CRF t o t a l with  of  and  Trustworthiness  with r e s i d u a l  ( £ = . 2 9 and  .27),  gain  correlated  on t h e  and t h e  IIP  SCL-90  (£  (£=.28  for  both s u b s c a l e s ) . 4.  RELATIONSHIP OF C L I E N T - P E R C E I V E D ALLIANCE STRENGTH AS  MEASURED WITH THE HELPING ALLIANCE QUESTIONNAIRE TO OUTCOME The f i n d i n g s Section  3 and a r e  relevant  t o Ho-4  summarized  were p r e s e n t e d  in Table  in Table  6  in  8 which c o n c l u d e s S e c t i o n  5. The HAQ c o r r e l a t e d of  the  from  statistically  outcome measures employed i n  .29 Type  to  significantly  the  present  with a l l  study  (£  six  ranged  .44). 1  significantly  Helping  Alliance  with a l l  of  the  also  correlated  outcome measures  (£  statistically ranged  from  70  .29  to  .43),  statistically =.36) 5.  while  Type  significantly  and t h e SEI ( r = . 2 9 )  2  with residual  Alliance gain  The  relevant  exploratory  examine  the  to Ho-5 are presented  six-item  relationship  Client  Involvement  outcome  (Section  Table  Target  Involvement  and t h e r a p i s t  forms)  (Greenberg I  and S e c t i o n  &  (r  4.1  Improvement  Symptom C h e c k l i s t - 9 0  .39**  .01  .13  .27*  .10  .39**  .12  Satisfaction Change Adjustment  .37** .29* .16  .27* .23 .25*  TPQ T o t a l  .32*  .29*  Strupp Posttherapy  Posttherapy  Significant Significant  level"  1986)  to III).  1  Questionnaire  Change Therapist  order  CISt  .21 Problems  was  Involvement  .06  Inventory of I n t e r p e r s o n a l  in  of Chapter  -.02  S e l f - E s t e e m Index  7.  Scale  "lower  Pinsof,  7 - R e l a t i o n s h i p s between t h e C l i e n t S c a l e a n d t h e Outcome M e a s u r e s  Complaints  in Table  of the h y p o t h e s i z e d  variable  2 of Chapter  Client  CISc  1  on t h e S C L - 9 0  a n d w i t h t h e TPQ ( r = . 3 6 ) .  appended t o t h e WAI ( b o t h c l i e n t  * **  correlated  RELATIONSHIP OF PERCEIVED CLIENT INVOLVEMENT TO OUTCOME  The f i n d i n g s  to  Helping  Questionnaire  r e l a t i o n s h i p , p_^.05 relationship, £^.01  The CIS s c o r e s were a v e r a g e d o v e r t h e t h i r d , s e s s i o n s a s were t h e WAI s c o r e s ( S e c t i o n 1 ) .  fourth,  and f i f t h  71  The C I S c c o r r e l a t i o n s the  WAIc,  target  it  complaints  (r=.27), of  (i.e.,  w i t h outcome were s i m i l a r  correlated  statistically  improvement  SPQ Change  (r=.39),  (r=.39),  significantly  with  (i.e., the  approached s t a t i s t i c a l l y =.23,  Table  outcome  Table  residual  the TPQ,  CI S t  stronger  g a i n on t h e  significant  IIP  Correlation  than  correlated  (r=.29)),  with  that  of t h e  statistically  while  the  correlation  with  WAIt  only  it,  (r  4).  The r e l a t i o n s h i p s six  significantly  a n d t h e TPQ ( r = . 3 2 ) ) .  t h e CI S t w i t h outcome was s l i g h t l y  WAIt w i t h o u t c o m e ,  t o t h o s e of  of the seven r e l a t i o n s h i p  measures t o the  m e a s u r e s were compared a t t h e s c a l e t o t a l  level  in  8.  Table  8 -  Summary o f R e l a t i o n s h i p - O u t c o m e  Target SCL-90 Complaints  SEI  IIP  Correlations SPQ Chanqe  TPQ  WAIc  .33**  .05  .18  .40**  .40**  .28*  CISc  .39**  .02  .21  .27*  .39**  .32*  .42**  .33**  .30*  . 1 3  .21  CRF  -.07  Empathy  .03  .16  .04  .26*  .15  .23  HAQ  .29*  .44**  .33**  .38**  .34**  .34**  .07  .17  .02  .07  .23  .06  .13  .10  .12  .29*  WAIt  -.08  cist * **  .01  Significant Significant  relationship, relationship,  The d i f f e r e n c e s and t h e o t h e r  between  relationship  £<.05 p_<.0l  t h e WAIc  correlation  measure c o r r e l a t i o n  coefficients  coefficients  were  72  tested 1.1.  using the Z t r a n s f o r m a t i o n The f i n d i n g s a r e p r e s e n t e d  procedure d e s c r i b e d in Section in Table  9.  Table 9 - Z - R a t i o s of D i f f e r e n c e s between WAIc-Outcome C o r r e l a t i o n s and O t h e r R e l a t i o n s h i p M e a s u r e s - O u t c o m e C o r r e l a t ions Target SCL-90 Complaints  SEI  IIP  SPQ Chanqe  TPQ  CISC  .31  .14  .14  .67  .05  .20  CRF  1.88*  1 .81*  .73  .52  1 .33  .34  Empathy  1 .42  .50  .65  .72  1 .62  .25  .25  1 .96**  .73  . 1 1  .32  .30  1 .84*  1 .61  .25  1 .38  .05  found t o  differ  HAQ WAIt  1 .92*  .09  .05  CISt  1 .55  .05  .23  * *  Significant Significant  The  WAIc  statistically with  relationship, relationship,  p_<.05 p_<.0l  correlations  with  significantly  .46  outcome were  from t h e CRF a n d  WAIt  correlations  outcome on two m e a s u r e s , a n d from t h e HAQ c o r r e l a t i o n  with  outcome on one m e a s u r e . In o r d e r  t o compare t h e o v e r a l l  effectiveness  and t h e HAQ, e a c h was i n c l u d e d i n a m u l t i p l e with  all  explained Hence,  of  the  six  outcome  on an o v e r a l l  relationships  with  basis,  outcome.  regression  measures.  by t h e WAIc was .31 a n d t h a t  for  of  The the  t h e two a l l i a n c e  the  WAIc  equation  variance  HAQ was  (r ) 2  .32.  measures had e q u a l  73  6.  RELATIONSHIP OF CONGRUENCE OF C L I E N T - P E R C E I V E D AND  THERAPIST-PERCEIVED ALLIANCE STRENGTH TO OUTCOME  For clients  the  p u r p o s e of  and t h e r a p i s t s  The  in Table  Table  congruence  their  between  alliances  the  two  was  defined  forms  of  the  WAI  10 -  C o n g r u e n c e of  the  WAIc and t h e  WAIt  Form BOND  COMPOSITE  GOAL  .32*  .32*  .21  .30*  TASK  .37**  . 38**  .29*  . 37**  BOND  .23  .28*  .21  .25*  COMPOSITE  .32*  .33**  .24  .32*  Form:  Significant Significant  two  significant and  TASK  squared), order  to  on b o t h t h e  subscales.  approximation  They  significantly analyses of  £<.05 p_^.0l  correlated  levels  the  (i.e.,  relationship, relationship,  forms  statistically In  are  10.  Client TASK  The  as  similarly.  GOAL Therapist  * **  study,  rating  correlations  presented  this  presented  perception  was t h e  measure t h a t  p r o d u c e a more  the  normal  not  on t h e  Mahalanobis'  low  but  statistically  COMPOSITE s c a l e and on the  did  client's  reduce  at  correlate  in  minus  Tables (Bock,  the  10  11,  p.  an 399),  perception,  w i t h outcome.  resulting  a square  and  1975,  therapist's  was c o r r e l a t e d  distribution,  consistently  BOND s u b s c a l e .  distance  skewness of  GOAL  root  distribution  In to  transformation  74  was p e r f o r m e d  on  the  confirmed  with  the  (Hollander  & Wolfe,  congruence  Kolmogorow-Smirnov  occasions.  presented Table  in Table 11  Session 1 Session 2 Session 3 Session 4 Session 5 S e s s i o n 10 Final Session  The  The  found to  decreasing  was  then  fit  test  over  the  distance  are  of  somewhat  measures  of  11.  Distance  22.00 18.67 18.21 19.12 18.13 16.56 17.05  results  goodness  increase  - WAIc-WAIt C o n g r u e n c e a t Mean  Normality  1971).  C o n g r u e n c e was i n d e e d seven  data.  of  the  Seven O c c a s i o n s  S.D. 16.76 1 7.40 1 1 .37 13.52 15.02 12.68 1 3.05  the  c o n g r u e n c e w i t h outcome a r e  analysis  of  the  presented  in Table  correlation 12.  of  75  Table  12 -  C o r r e l a t i o n o f Outcome w i t h WAIc-WAIt C o n g r u e n c e a t t h e Seven O c c a s i o n s  #2  #1 Target Complaints SCL-90  -.20 -.04  SEI IIP  Change Adjustment TPQ * **  Total Significant Significant  The  gain  .14  .23  .23  .09  .09  .08  -.03  -.04  .18  .13  .26*  .25*  .42**  -.16  .02  .06  .12  -.03  -.25*  -.25  -.10  -.08  .07  -.07  .00  .13  .06  .07  -.04  .05  correlation However, target  in  .02  -.26*  Questionnaire  .15  .18  -.10  .00  -.09  -.11  -.05  .13  .10  -.01  .01  .09  .43**  .14  .08  .07  -.03  .07  .22  . 1 1  . 1 4  .02  relationship, relationship,  correlated SEI  .20  Questionnaire  results  on the  Fina!  .16  -.38**  of  the  c o n g r u e n c e w i t h outcome were sessions  #10  .13  Posttherapy  Satisfaction  #5  -.09  1  -.28*  Therapist  Session #4  -.12  Strupp Posttherapy Change  #3  and early  congruence  p<.05 £<.01  analysis equivocal.  statistically it  of  the  Congruence  significantly  approached  c o m p l a i n t s and w i t h SPQ  negatively Change  in  gain with early  in  with  statistically  sessions with r e s i d u a l correlated  correlation  of  later  residual  significant  on t h e  SCL-90.  improvement sessions  in and  Since the congruence measure s h r i n k s a s c o n g r u e n c e i n c r e a s e s , t h e c o r r e l a t i o n s of t h i s measure w i t h outcome w o u l d be expected t o be n e g a t i v e . The s i g n s o f t h e c o r r e l a t i o n c o e f f i c i e n t s h a v e , t h e r e f o r e , been r e v e r s e d .  76  negatively  with  residual  C o n g r u e n c e was u n r e l a t e d  to  7.  POST HOC ANALYSES  7.1  A n a l y s i s Of T h e r a p i s t As  described  therapists One  each,  represented 86%  of  neither  the  or  statistical  control.  being  contributing from  four  effect  multiple  that  14  cases  cases  and  therapists  contributing  performed  to  check  for  significant  was  recognized  c o u l d show i n "check"  other  ways,  indicator.  were c h o s e n and t h e i r  the  Three  would  the  lend  other one  This  case  for  itself  each 13.  a to  cases,  30 c a s e s  each),  were  between  client of  the  effects  was u s e d a s of  it  or  therapists  dependency  in Table  30  n o r was  being the  variables"  three  (i.e.,  five  differences that  presented  sample.  two g r o u p s of  the  standard deviations  g r o u p s were compared and a r e  effect,  standard deviation "marker  the  35  each.  one c a s e ) ,  from the  chapter,  cases  only  30  Although it  sessions.  two c o n t r i b u t e d  therapist  the  groups.  later  constituted  two  comparisons of  the  in  this  cases,  contributed  simple  of  44 c a s e s t h a t  a significant  balanced  Therefore, one  beginning  contributed  therapists  systematic  (i.e.,  the  two  IIP  Effect  contributed and  on t h e  outcome on t h e T P Q .  the  contributed  therapist  cases  at  gain  the  change  the  two  77  Table  13 -  A n a l y s i s of T h e r a p i s t E f f e c t Outcome V a r i a b l e s  on T h r e e  14 c a s e s from 5 therapists S.D. Improvement on T a r g e t C o m p l a i n t s ' C h a n g e ' S u b s c a l e of SPQ Self-Esteem Index—Residual Gain  7.2  Analysis Seven  therapists  Of T h e o r e t i c a l  of  cases  i n v o l v e d as  orientation--four represented effect,  as  neither  (i.e.,  orientation,  31 o r  T-tests seven  effect of  a  the  that  significant  differences  14.  three  The r e s u l t s  nor  of  were  by  the  learning.  claimed a  these  it  to  a  revealed  and o n l y  one  systematic  or  groups,  37 h u m a n i s t i c ) , the  humanistic  statistical  two  WAI.  This  orientation  orientation, was  four  theoretical  theoretical  itself  forms of  Therapists  in  as  therapists  between  and the  and t h e r a p i s t  Table  the  would l e n d  differences  non-humanistic  WAIc.  and  orientation),  both c l i e n t  the  humanistic  significant  89% of  Of  characterized  than  analytic  .64 .72 1 .05  Orientations  t h r e e c l a i m e d an a n a l y t i c  claimed a learning balanced  were  other  30 c a s e s f r o m 30 t h e r a p i s t s S.D.  .48 .74 .89  Of E f f e c t the  Marker  control.  (i.e.,  were p e r f o r m e d No  the on  statistically  i n c o m p a r i s o n s b a s e d on  t h e WAIt c o m p a r i s o n s a r e  presented  in  78  Table  14 -  A n a l y s i s of E f f e c t of T h e o r e t i c a l T h e r a p i s t on WAIt  Humanistic Mean S,. D . GOAL TASK BOND COMPOSITE *  6 7 . 50 6 8 . 22 7 4 . 44  1 .45 , 1 .95 , 1 .95 .  64 .67 65 .06 71 .52  210. 17  6,.21  201 .25  Significant  The differed  Non-Humanistic Mean S .D.  WAIt  difference,  non-humanistic  groups.  18 .65  of  t 1 .57 . 2. . 4 5 * 2, . 1 6 * 2, . 2 4 *  p_^.05  COMPOSITE as w e l l  statistically  1 .07 6. 1 5 6 .67  Orientation  as  significantly  its  TASK and BOND s u b s c a l e s  between t h e  humanistic  and  79  7.3  C o r r e l a t i o n s Of The WAI W i t h The Outcome M e a s u r e s At  Seven  Occasions  The  WAI  was  o c c a s i o n s at  which  fluctuations  over  The  mean  instrument Appendix The d a t a through  correlated it  WAI  Table  reveal the  therapy.  that  the  in  e a c h of order  the  to  seven  examine  the  seven o c c a s i o n s at  were examined and a r e reliability  alliances  continued  which  the  presented  in  coefficients. to  strengthen  therapy. of  measures  relationships These data  at  21 a l o n g w i t h the  c o u r s e of  outcome  administered  scores  was a d m i n i s t e r e d 23,  alliances'  was  w i t h outcome a t  time.  The c o r r e l a t i o n s the  The  are  each of were  the  r e p e a t e d WAIc m e a s u r e s  examined  to  determine  w i t h outcome c h a n g e d o v e r presented  in Table  15.  the  how  with the  c o u r s e of  80  Table  15 -  C o r r e l a t i o n s of t h e WAIc a t Seven O c c a s i o n s t h e Outcome M e a s u r e s  Target Complaints  SEI  SCL-90  IIP  SPQ Change  with  TPQ  COMPOSITE Session 1 Session 2 Session 3 Session 4 Session 5 S e s s i o n 10 F i n a l Session  .19 .24 .27* .29* .40** .38* .21  -.07 .06 .12 .25* .18 .21 .17  -.02 -.05 -.10 .14 . 1 1 .09 .06  .05 .31* .28* .36** .47** .55** .30*  .30* .29* .24* .40** .46** .48** .45**  .24 .17 .25* .24 .31* .41* .26*  -.03 .21 .36** .41** .46** .65** .35**  . 1 1 . 1 1 .21 .36** .39** .25 .36**  .12 .06 .20 .32* .27* .34* .30*  .12 .34** .30* .38** .56** .54** .36**  .36** .34** .24* .41** . 47** .48** .54**  .28* .17 .25* .21 .34* .39* .27*  .06 .30* . 1 1 .21 .31* .27 .14  .35** .36** .22 .34** .40** .52** .33**  .26* .25* .22 .15 .24 .35* .14  GOAL Session 1 Session 2 Session 3 Session 4 Session 5 S e s s i o n 10 F i n a l Session  .04 .08 .16 .19 .31* .22 .09  -.20 -.09 .07 .17 .12 . 1 1 .22  -.05 -.10 -.04 .19 .16 .21 .16 TASK  Session 1 Session 2 Session 3 Session 4 Session 5 S e s s i o n 10 F i n a l Session  .24 .24 .21 .29* .44** .35* .25*  .02 .12 .07 .26* .17 .21 .27*  .03 .04 -.06 .18 .16 . 1 4 . 1 3 BOND  Session 1 Session 2 Session 3 Session 4 Session 5 S e s s i o n 10 F i n a l Session * Significant ** Significant  .25* .36** .35** .32* .36** .42* .22  .00 .15 .18 .25* .19 .23 .00  -.03 -.07 -.16 .02 .00 -.11 -.11  r e l a t i o n s h i p , p_^.05 r e l a t i o n s h i p , p_<.01  81  Although predictive 1986),  it  of  the  through  been  of  in  the  the  WAI  statistically  the  assumed  outcome by t h e  data  relationship correlated  has  c o u r s e of  third  the  that  and  both  were not negative,  In  the  but  sessions, in  & Pinsof,  indicated  that  continued  however,  t h e WAI of  to  that  to  the  was u s u a l l y  at  all  (i.e., the  session  the it  strengthen  final  not  session  as s t r o n g  gain  not  (Section  occasions  on t h e  as  SEI  statistically 1.2 and  and  1.3),  sometimes  i n c r e a s e as c o n s i s t e n t l y as d i d through  were u n s t a b l e lower  were  seven  relationships they  with residual which  fifth  t h e y d i d not  WAI-outcome  and d r o p p i n g  third  lower  particular,  fifth  7.4  SCL-90,  only  (Greenberg  sessions.  on  at  was  outcome m e a s u r e s w i t h w h i c h  outcome  of  significant  other  with  The r e l a t i o n s h i p s the  alliance  therapy.  relationship in e a r l i e r  study  significantly  The a n a l y s i s a l s o r e v e a l e d , WAI's  the  session  present to  that  in the  the  over  c o u r s e of  the  third,  third,  rising  in  the  therapy. fourth, the  and  fourth,  fifth).  R e l a t i o n s h i p s Between The WAI And The O t h e r  Relationship  Measures The  relationships  relationship p u r p o s e of  measures  of  the  included  comparison with  it  are  WAI in  with the  presented  the present  four study  in Table  16.  other for  the  82  Table  16 -  R e l a t i o n s h i p s between t h e WAI and t h e P r o c e s s Measures  GOAL Working A l l i a n c e  TASK  Inventory  C l i e n t Involvement Scale (client-rated) C l i e n t Involvement S c a l e (therapist-rated) Empathy C o u n s e l o r R a t i n g Form Expertness  BOND  (Client  Other  COMPOSITE  Form)  .70**  .73**  .81**  .81**  .38*  .33*  .38*  .40**  .68**  .69**  .57**  .69**  .37**  .39**  .27*  .36**  Attractiveness  .39**  .39**  .35**  .42**  Trustworthiness  .30*  .27*  .17  .26*  CRF T o t a l  .38**  . 39**  .29*  . 38**  HA Type 1  .60**  .62**  .40**  .58**  HA Type 2  .56**  .46**  .31*  .47**  HAQ T o t a l  .63**  .62**  .40**  .58**  Helping A l l i a n c e  Questionnaire  Working  A l l i a n c e Inventory  (Therapist  Form)  .37**  .50**  .37**  .43**  .88**  .89**  .84**  . 90**  .22  .28*  .07  .19  Expertness  .24  .28*  .13  .22  Attractiveness  .06  .06  -.03  .06  Trustworthiness  .06  .06  -.08  .03  CRF T o t a l  .13  .13  .01  C l i e n t Involvement S c a l e (client-rated) C l i e n t Involvement S c a l e (therapist-rated) Empathy C o u n s e l o r R a t i n g Form  . 1 1  83  Table  16  (Cont'd.) GOAL  Helping A l l i a n c e HA Type 1  TASK  BOND  COMPOSITE  Questionnaire .37**  .41**  .20  .34**  HA Type 2  .18  .22  .06  .16  HAQ T o t a l  . 33**  . 38**  .17  .30*  * *  Significant Significant  The WAIc the  other  relationship, relationship,  correlated  statistically  therapist-rated  In rated  Rating order  process  constructs, level.  Client  Questionnaire,  Counselor  statistically  p r o c e s s measures e m p l o y e d  correlated  Alliance  p_<.05 p_<.0l  in  significantly Involvement but  not  significantly the  with a l l of  study.  The  with the c l i e n t - r a t e d  Scales with  WAIt and  and w i t h the H e l p i n g  Empathy  or  with  the  Form. to  assess  measures they  the extent  were  tapping  were c o r r e l a t e d  These c o r r e l a t i o n s  t o which the f i v e related  or  w i t h one a n o t h e r  are presented  in Table  client-  overlapping at the s c a l e  17.  84  Table  17 -  I n t e r c o r r e l a t i o n s of t h e Measures  WAIc  Empathy  CRF  HAQ  —  Empathy  .69**  CRF  .38**  .68**  HAQ  .58**  .66**  .51**  CISC  .81**  .46**  .17  Significant  With the the  CRF,  all  significantly 7.5  Process  —  WAIC  **  Client-Rated  correlation,  e x c e p t i o n of the  —  -.47**  p_£. 01  the  relationship  relationship  measures  between  the  were  CISc  and  statistically  related.  Identification  Of R e l a t i v e  S t r e n g t h s Of Outcome  Predictor  Variables In  order  combination the  of  various  to  investigate  variables outcomes,  regression equations of  SPSStX u s i n g t h e  variables  and  the  which  were the a  most  series  of  relationship useful  six  predictor(s)  multiple  was d e v e l o p e d w i t h the  forward  outcome  measures  or of  stepwise  REGRESSION p r o c e d u r e  r e l a t i o n s h i p measures as the  six  variable  as  independent  the  dependent  variables. There of  is  multiple  outcome  the  p o s s i b i l i t y of  regression  measures,  analyses  {i.e.,  the  independent),  and,  therefore,  is  that  set  higher  than  correlated  for  the  e a c h of  are  errors  performed  analyses probability the  are of  analyses.  when a  series  with  related  not  really  a Type I Some  of  error the  85  intercorrelations Table  18  are  of  the  statistically  probabilities  set  fact,  understated.  somewhat Table  s i x outcome m e a s u r e s a s p r e s e n t e d  18 -  for  the  significant  multiple  Intercorrelations  Target IIP Complaints  and,  regression analyses are,  of  the  SCL-90  SEI  SPQ Change  .17  —  S C L -•90  .18  .42**  —  SEI  .40**  .24  .44**  SPQ Change  .51**  .38**  .23  .27*  —  TPQ  .35**  .12  .24  .31*  .29*  Significant Significant  It  relationship, relationship,  was n o t e d t h a t  since a r a t i o to derive  of  that  interpretation sample only  in as  variables For  the  was  to  study.  the  e a c h of  not  independent (Kerlinger  met  of  the  variances the  level  in  in t h i s  variable .05  or  the  were  variable &  is  unstable, desireable  Pedhazur,  present  variances  contributions  s i x dependent  of  TPQ  study.  1982),  a  Hence,  no  from t h e s e a n a l y s e s beyond  The e x p l a i n e d  relationship  probability  relationship  regression equations  was t o be a p p l i e d  indications  independent the  equation  in  £<.05 £<.01  30 c a s e s p e r  a stable  condition  these  the  Outcome M e a s u r e s  Target Complaints IIP  * *  hence,  in  of  were the  reported  independent  study. outcome v a r i a b l e s , entered  less.  m e a s u r e s were f o u n d t o  (rj_)  the  into  the  only equation  Intercorrelations  of  be h i g h a s were p r e s e n t e d  one at the in  86  Section  7.3,  among t h e  Table  independent  combining  them  predictive  did  efficacy.  The i n d e p e n d e n t  with their  in order  their  Therefore,  relationship not  seemed t h a t  variables  are  weights  enter  after  the  the  was  improve  presented  w h i c h d i d not  beta  impact.  it  significantly  The r e s u l t s  variables  were l i s t e d of  17.  in  into  overlap  such  that  upon  their  Table  19.  the  equations  entering  variables  87  Table  S t r e n g t h s of Variables  Outcome  Predictor  Target Complaints Improvement  CISc HAQ WAIc CRF Empathy  .39*'  IIP  WAIc CISC Empathy CRF HAQ  .40**  HAQ WAIc CISC Empathy CRF  .44**  HAQ CRF CISC WAIc Empathy  .33*  WAIc CISc HAQ CRF Empathy  .40**  SEI  SPQ Change  1  Relative  Outcome V a r i a b l e  SCL-90  2  19 -  Beta Weights  Predictor  R Squared . 1 5  .13 .04 -.14 -.19 . 1 6 .15 .04 -.17 -.22 .19 .31 .29 .23 -.26 1 1 .22 .07 .00 -.22 16 .20 . 1 7 -.02 -.25  Not i n e q u a t i o n The c o e f f i c i e n t s of d e t e r m i n a t i o n f o r SPQ Change and f o r the TPQ are l o w e r t h a n t h o s e r e p o r t e d i n H o r v a t h ' s (1981) s t u d y , (i.e., .20 and .29 respectively). It was speculated that the d i f f e r e n c e s might have been due t o t h e s m a l l e r n , ( i . e . , 2 9 ) , of that s t u d y w h i c h made f o r a h i g h e r c h a n c e of f T t t i n g t h e e r r o r , a n d , h e n c e , f o r d e f l a t i o n upon r e p l i c a t i o n w i t h a l a r g e r sample size.  88  Table  19  Outcome  (Cont'd.) Variable  TPQ  * **  Beta  HAQ CISc WAIt WAIc CRF Empathy Significant Significant  The HAQ and  predictor, predictor,  two the  predictors 7.6  Predictor  of  outcome t h a n  C o m p a r i s o n Of WAI  Terminated Some terminated  and  R Squared .12  .34* .19 .14 . 1 1 .06 .02 p_<.05 2^*01  client-rated WAIc),  Weights  m e a s u r e s of the  CISc  were the  S c o r e s Of  the  were  alliance,  (i.e.,  consistently  C R F , Empathy,  C o m p l e t e d And  the  better  and t h e  WAIt.  Prematurely  Cases data by  The WAIc  were c o l l e c t e d on  12 c a s e s  that  were  prematurely  and  second  clients. and t h e WAIt a f t e r  were compared and t h e  results  are  the  first  presented  in Table  20.  sessions  89  Table  20 -  C o m p a r i s o n o f WAI S c o r e s o f C o m p l e t e d and Prematurely Terminated Cases  n(c)/n(t) Mean  S . D.  Mean  1  S .D.  WAIc First  Session:  GOAL TASK BOND COMPOSITE Second  66.59 8. 71 6 6 . 1 4 8. 62 8. 34 70.25  59.00 60.80 65.20  2 3 . 67  6 6 . 19 66.53 70.81 203.53  202.98  8 .43 1 1 .25 10 .33  2 .50* 1 .67 1 .65  185.00  28 .07  2 .10*  7. 53 7 . 10 6. 97  64.67 64.44 68.78  6 .48 8 .31 8 .09  .56 .78 .78  19. 71  197.89  20 .43  .78  2  44/10  Session:  GOAL TASK BOND COMPOSITE  43/9  WAIt First  Session:  GOAL TASK BOND COMPOSITE Second GOAL TASK BOND  1  2  3  61 .49 63.49 67.91  7. 68 6. 52 7. 17  62.33 65.58 67.58  7 .04 5 .87 8 .13  .34 1 .00 .13  192.88  19. 59  195.50  19 .31  .41  7 . 43 7. 31 7. 62  62.20 62.70 70.00  1 1.08 8 .00 6 .90  .23 .75 .04  43/1 2  Session: 63.05 64.65 70.09  3  43/10  B a s e d on 44 c o m p l e t e d c a s e s and 10 p r e m a t u r e l y t e r m i n a t e d c a s e s (n(c)=number c o m p l e t e d ; n(t)=number p r e m a t u r e l y terminated). T - t e s t o f t h e d i f f e r e n c e between t h e means of t h e two g r o u p s . F - t e s t s of the d i f f e r e n c e s between the variances of the two groups revealed i n a l l b u t one c a s e no s i g n i f i c a n t d i f f e r e n c e s and, hence, the t-values were based on pooled variance estimates. A s i g n i f i c a n t d i f f e r e n c e between t h e v a r i a n c e s of t h e two g r o u p s was revealed w i t h t h i s F - t e s t a n d , h e n c e , t h e _ t - v a l u e b a s e d on s e p a r a t e v a r i a n c e e s t i m a t e s was p r e s e n t e d .  90  WAIc COMPOSITE s c o r e s a s w e l l the  first  those  s e s s i o n were  who  statistically  terminated  continued to c o m p l e t i o n . after  the  a s WAIc  their This  GOAL  scores,  significantly different  therapies difference  than  for  those  did  not  hold  s e c o n d s e s s i o n and d i d not a p p l y t o WAIt  scores.  after for who true  91  V.  DISCUSSION  1.  INTERPRETATION OF FINDINGS  1.1  R e l a t i o n s h i p Of P e r c e i v e d A l l i a n c e S t r e n g t h To Outcome  It  was  hypothesized  positively  related  perceived  alliance  alliance  to  outcome.  be  WAIc  for  client-  therapist-perceived  significantly  2)  as i t  target  complaints  with  target  had a s w e l l  The BOND s u b s c a l e c o r r e l a t e d  IIP  p e r f o r m a n c e of rather  than  clients  dimensions of did their  in  the  particularly  improvement  in  the  significantly  with  t h e GOAL and that  outcome their  SEI  of  the  3),  TASK  although t h i s subscales  instrument (i.e.,  identified  d i d not  while raise  changes to  on  the  to  the  about  1.4,  this  more  and  It  may more  technical  g o a l s and t a s k s ) ,  than  they  complaints  that  w i t h r e s i d u a l g a i n on t h e  relationship  questions  (£=.44  and d e s c r i b e d .  correlate  other  was due  BOND s u b s c a l e ( £ = . 2 3 ) .  their  alliance,  are addressed in Section relevant  Table  improvements on t h e more g l o b a l t a r g e t  The WAIc  findings  to  statistically  (£=.40,  related  had t h e m s e l v e s  the  Table  also correlated  differentiated  or  statistically  (£=.33,  with  g a i n on t h e  that  they  not  for  was  study.  residual  .45)  study.  (£=.40)  The  the  improvement  (1983)  strongly  to  but  case  strength  strength.  complaints  present  perceived alliance T h i s was t h e  strength,  The WAIc c o r r e l a t e d  Moseley  that  the  r e l a t i o n s h i p of  the  measures validity  did of  interpretation  t h e HAQ t o  so.  the of  outcome.  These  WAIc  the  SCL-90  which  findings  92  The WAIc Change  did correlate  (r=.40,  Table  4).  correlated  statistically  This  an e x p e c t e d  of  was  Horvath  (1981).  pretests  and p o s t t e s t s ,  rather  true  therapy  test  it  of  a satisfaction  TPQ ( r = . 2 8 ,  process  is  subject  outcome,  counters  the  independent assessment manner  of  alliance Section  any  predictor  the  the  to  the  than  charge  with  that  by  the  involving  that  therapeutic  it  is  change),  but  significantly  of  1984)  outcome, is  later  the  that  the  but  rather  predictor  of  measure  alliance  Further  with  client-rated  outcome  inevitably  is  an i n d e p e n d e n t  of  therapist-rated  prophecy.  an  is  not  an  in-process  confirmed  in  the  evidence that  the  outcome  is discussed  in  1.7.3.  of  the  of  measures e m p l o y e d .  of  (Table  client with  the  significant  at  4).  suggests that alliance.  the  outcome d e m o n s t r a t e d  WAIt  is  The r e l a t i v e l y  (Tables  differences  Correlation  statistically  t h e WAIt t o p r e d i c t  t h e WAIt w i t h the WAIc significant  outcome a s a s s e s s e d by the  TPQ was a l s o not  study the  predict  five  failure  present  measure  w i t h SPQ C h a n g e .  rather  (i.e.,  a self-fulfilling  composite l e v e l The  subscale  SPQ i s c o m p l e t e d  This correlation  outcome w h i c h  therapist-rated the  TASK  was c o n s i s t e n t  statistically  (Glass,  The WAIt d i d not on  4).  with  claim  of  w i t h SPQ  measure.  Table  measure  it  concluded,  The WAIc a l s o c o r r e l a t e d the  since  the  (r=.4l)  s i n c e the  is  significantly  particular,  significantly  However,  after  a  In  finding  client  not  statistically  10 and  between  the  16)  not  an  effective  weak c o r r e l a t i o n s  and t h e  correlations  in  of  statistically of  the  WAIc  93  with target with these  complaints  improvement  two outcome m e a s u r e s  instruments  are  both p u r p o r t  t o be m e a s u r e s of  suggests  that  not  the  and w i t h t h e  (Table  measuring the  meaning  and t h e  indicate  that  same c o n s t r u c t ,  the of  9)  IIP  alliance.  the  alliance  WAIt  the  two  although  they  This  disparity  construct  requires  clarification. It  may be a r g u e d t h a t  stronger  correlations  outcome w o u l d have been a c h i e v e d h a d partialed thereby  out  lifting  initially  of  the  the  ceiling  strong  five  sessions  23,  Table  to  and  7.77  11.96  fifth  out out  point  of  for  the  1.2  252 252  for  not  WAI  with  values  been  measures,  regression effect  the  s u c h a p r o c e d u r e would p r o b a b l y results  WAI  Since  of  the  s e s s i o n average  imposed by t h e  alliances.  was o n l y  21)  third  initial  of  spread over WAIc  the WAIt,  have  on the  (Appendix  i n c l u s i o n of  effected  the  study  significantly.  R e l a t i o n s h i p Of P e r c e i v e d Change In  Alliance  Strength  To  Outcome It strength related  was  hypothesized  over  the  to  Suh,  outcome. O'Malley,  that  increase  and  Therapist  to  (Table  14),  the  perceived  sessions  of  T h i s was f o u n d not &  Strupp's  in  successful  behaviours alliance  when Suh e t  al.'s  the  to  the  did  alliance  positively  case.  r e s e a r c h has s u g g e s t e d  (i.e.,  early  third  in  was  be t h e  part  outcome t h a n  in  change  therapy  (1986)  behaviours,  Exploration),  such t h e r a p i s t Although  five  in t h e r a p i s t  be more c r i t i c a l of  first  that  the  Therapist of  therapy  absolute  Warmth might level  session.  increase  in  the  p r o c e d u r e was a p p l i e d  present to  the  study data,  94  no r e l a t i o n s h i p first  five  rationale  it  increase  in a l l i a n c e  s e s s i o n s and outcome was f o u n d  for their  questionable, al.'s  between  (Section  finding  related  method o f  was i n f a c t  which c o n s i s t e d of  four  the  IV),  a statistical  t o a subgroup of  (Table  calculating  2 of Chapter  it  of t h e i r  across a t o t a l  over  5).  Since the seems  may be t h a t  Suh e t  In  addition,  16 c a s e s ,  a subgroup  who  achieved  "high  sample.  1.3 R e l a t i o n s h i p s Of C l i e n t - p e r c e i v e d T h e r a p i s t  Empathy,  Expertness,  To Outcome  It  was  empathy, less  Attractiveness,  expertness,  positively  alliance  significantly  attributable  to  s u b s c a l e of only  (£=.26,  to  Carter  the  (1985)  the  to  (Section  least  highly is  there  Table  6).  and  that  complex.  trustworthiness  were  was c l i e n t - p e r c e i v e d  correlated  the  statistically  This of  poor  1.2,  between  simple  conclusions (1986)  II). linear  Marks and T o l s m a recommended t h a t  a complex c o n s t r u c t ,  its investigation  Such an of  Gelso  with and  respect Carter  relationship,  i s probably  requires  be  c o n c e r n i n g the  Gelso  therapist-offered  relationship  may  the i n s t r u m e n t .  with the  Chapter  residual  result  of p r o c e s s - o u t c o m e s t u d i e s  i s not a  o f any m a g n i t u d e ,  outcome  RI_  and of Marks and T o l s m a  findings  concluded that  therapist  one o f t h e outcome m e a s u r e s ,  limitations  contradictory empathy  and  outcome t h a n  a t t r i b u t i o n w o u l d be c o n s i s t e n t and  client-perceived  T h i s was f o u n d t o be t h e c a s e .  with  on t h e I I P  that  attractiveness,  related  strength.  The Empathy  gain  And T r u s t w o r t h i n e s s  hypothesized  the  increase  artifact.  "low p r o g n o s i s " p a t i e n t s  o u t c o m e s " and may n o t a p p l y  strength  at  c o n d i t i o n s and best viewed as since  empathy  sophisticated  95  studies  i n which the d e t a i l s  scrutinized. subject  is discussed,  presentation),  Since  the present  cases,  such v a r i a b l e s  process are c l o s e l y  as v a r i a t i o n s  (i.e.,  affect  level  the  s t u d y drew  of e m o t i o n a l  strength  upon a  than  was  significantly  SEI  with  (r=.33),  with target  Empathy, three  of  WAIc  complaints did  real  six  (r=.30),  improvement,  correlate  statistically  outcome  Table  d i d not  SPQ C h a n g e ,  statistically  measures.  (r=.42,  but i t  to  and  It 7),  correlate the TPQ.  significantly  with the  three.  with  residual  significantly outcome  statistically Horvath's  on  (discussed  (Table  complaints  9).  significant  SEI h i g h l i g h t  correlative  the  That  complaints  SCL-90  were  on  with  the l a t t e r )  correlations  (1983)  results.  In p a r t i c u l a r , the  two  However,  not with the  of t h e CRF a n d o f t h e HAQ  with r e s i d u a l  with  these  is consistent  g a i n on t h e S C L - 9 0 a n d  t h e i n a d e q u a c y o f t h e WAIc a s a  measure.  statistically  a n d SPQ Change ( t h o u g h  correlations  1.4)  improvement  t h e WAIc would o u t p e r f o r m t h e  improvement  significantly  in Section  target  from t h o s e o f t h e WAIc  (1981) a n d M o s e l e y ' s  statistically  measures'  with  gain  different  measures  CRF on t a r g e t  the  of  p r o c e s s was f e a s i b l e .  correlating the  and t h e I I P  The C R F ' s c o r r e l a t i o n and  ratings.  population  c o r r e l a t e d w i t h r e s i d u a l g a i n on t h e S C L - 9 0  latter  in  C o u n s e l o r R a t i n g Form was more c o n s i s t e n t l y r e l a t e d  outcome  The  the  content  of empathy  broad  no s u c h s c r u t i n y o f t h e e m p a t h i c  The  the  in  p o p u l a t i o n and i n t h e p r e s e n t i n g c o n c e r n a n d t h e manner  in which i t the  F o r example,  of t h e e m p a t h i c  both of these  SCL-90  were  comprehensive relationship statistically  96  significantly 1.4  stronger  than  that  of  t h e WAIc  w i t h the  R e l a t i o n s h i p Of C l i e n t - p e r c e i v e d A l l i a n c e  SCL-90.  S t r e n g t h As  M e a s u r e d W i t h The H e l p i n g A l l i a n c e Q u e s t i o n n a i r e To Outcome  It as  was h y p o t h e s i z e d t h a t  measured  positively  with  related  the  six  study,  of  the  be a t  least  as  the  administered  this  seemed  now t h a t (that for  I  is,  In  and  H e l p i n g A l l i a n c e Type be a t t r i b u t a b l e  even  their  if  to  this  items  were d i s p a r a t e conceptions, the WAI  (1986)  feels  study  suggests that  requiring  the  in  the  with  all  11-item s c a l e  is  3 6 - i t e m WAIc and seems  to  of  client  the  (Table  (i.e.,  HAQ  that  reflect  the  was  to  the  i s an  in  she/he  but feel  on my  own  other  meeting elicited  items.  empirically-driven Alexander  HAQ was d e r i v e d turn  a positive  good b e c a u s e h e / s h e b e l i e v e s  6), I  consistently  the  than  were no l o n g e r  transcripts.  evaluate  so,  #11:  conceptually-driven.  clinical  to  and I  from t h o s e  reported  they  item,  which  is  correlated  significantly  1 subscale one  therapist  Penn H e l p i n g A l l i a n c e S c a l e t h a t Luborsky's  This  and d e a l w i t h m y s e l f  appointments).),  whereas  Luborsky  8).  the  outcome  significantly  statistically  can understand myself  that  instrument  than  of  H e l p i n g A l l i a n c e Type 2 s u b s c a l e  though not  to  treatment  responses  (Table  was  effective.  strongly, eight-item  strength  case.  predictor  statistically  outcome m e a s u r e s  The t h r e e - i t e m less  T h i s was the  be a p o w e r f u l  correlating  more e f f i c i e n t l y  alliance  Helping A l l i a n c e Questionnaire  to outcome.  The HAQ p r o v e d t o present  client-perceived  from  developed  Examination or optimism  extent  to  i s being  from of  its  factor,  which or  the  she/he  will  be  97  h e l p e d by t h e  therapist.  The i m p o r t a n c e of  attitude  was  Horowitz,  a n d W e i s s (1986)  hopeful  was  affirmed  by  the that  an i m p o r t a n t  finding the  factor  this of  patient  positive  Marmar,  feeling  client  Marziali,  helped  b e i n g t a p p e d by t h e i r  and  alliance  scale. The HAQ i t e m s may be g r o u p e d by c o n t e n t Two o f  the  11  items probe the  extent  as of  follows: client-perceived  therapeutic progress: #3-1  have o b t a i n e d some new u n d e r s t a n d i n g .  #4-1  have been f e e l i n g b e t t e r  Four  items probe the  #1-1  believe  t h a t my t h e r a p i s t  #2-1  believe  that  extent  the  recently.  of  treatment  client  optimism:  i s h e l p i n g me. i s h e l p i n g me.  #5-1 can a l r e a d y see t h a t I w i l l e v e n t u a l l y t h e p r o b l e m s I came t o t r e a t m e n t for. #11-1 f e e l now t h a t I can u n d e r s t a n d m y s e l f w i t h m y s e l f on my own ( t h a t i s , even i f t h i s and I were no longer meeting for appointments). Three  items probe the  extent  of  client  work  out  and deal therapist treatment  confidence  in  the  therapist: #6-1  feel  I  #7-1  feel  the  therapist  u n d e r s t a n d s me.  #8-1  feel  the  therapist  wants me t o a c h i e v e my g o a l s .  Two  items  collaboration  can d e p e n d upon t h e  probe  w i t h the  the  extent  therapist:  therapist.  of  client-perceived client  98  #9-1 f e e l I am w o r k i n g t o g e t h e r a joint effort.  w i t h the  #10-1 believe we have s i m i l a r of my p r o b l e m s .  i d e a s about  With the measure  of  criticized  e x c e p t i o n of client  underlying  characteristics therapeutic  utilized  attitude.  such measures of  distinguish  which they  (p.  both the  classes  therapeutic  the  WAI  concerning two-thirds  of  structure  of  conceptual difficult this  responses for  less  difficulty  responses and,  al.  (1986)  active  a  have  "failed  to  attitudes  and  collaboration  which  Bordin's  in  the  collaboration which  may  reflects impact  be  in  of  its  various  client, to  of  in  1979)  g o a l s and t a s k  therefore,  its  may r e s u l t  (1975,  from t h a t  items.  more Such  less  consistent  in  relevance.  differentiated, responses  clients  i n more v a r i a t i o n  of  theory  t h e a l l i a n c e and w h i c h f o c u s e s  intellectually-adroit  hence,  t h e HAQ i s  t h e HAQ i s d i f f e r e n t  i t e m s on c l a r i t y the  nature  having  is this  change  in  intervention.  on  The WAI demands of  as  active  It  of  based  its  et  s h o r t - t e r m and l o n g - t e r m  is  the  then,  within-process variable  c o n c e p t u a l b a s i s of which  the  contributing patient  35).  barometer  variations  This  the a l l i a n c e  patient's  r e g a r d as the a  #9 and #10, Frieswyk  and  from t h e  process"  as  of  items  therapist  to  or e r r o r  may be  make  and  in  their  correlations  with  outcome. The  WAI  t h e HAQ i t e m s .  items  probe a broader  range o f  Seven i t e m s p r o b e c l i e n t  perceived therapist  behaviours:  v a r i a b l e s t h a n do  b e h a v i o u r s and  client-  99  #2do i n  and I agree about the t h i n g s I w i l l t h e r a p y t o h e l p improve my s i t u a t i o n .  #4-What I am d o i n g i n t h e r a p y l o o k i n g a t my p r o b l e m . #5-  and I  #6-  perceives accurately  gives  understand each  #22and upon g o a l s .  I  #30therapy.  collaborate  and I  me  new  need  to  ways  of  other. what my g o a l s  are working  are.  towards m u t u a l l y  for  my  #32-We have established a good u n d e r s t a n d i n g of k i n d s o f c h a n g e s t h a t would be good f o r me.  the  One i t e m p r o b e s t h e #14-The g o a l s of  extent  these  One i t e m p r o b e s t h e  on s e t t i n g  of  client  sessions  extent  of  are  goals  agreed  motivation: important  to  client-perceived  me. therapeutic  progress: #25-As a r e s u l t of how I m i g h t be a b l e  these s e s s i o n s , to change.  One i t e m p r o b e s t h e  extent  of  I  client  am c l e a r e r  item  probes  the  extent  of  to  optimism:  #16-1 f e e l t h a t t h e t h i n g s I do i n t h e r a p y me t o a c c o m p l i s h t h e c h a n g e s t h a t I want. One  as  client  will  help  confidence in  the  therapist:  #21-1  am c o n f i d e n t  One i t e m p r o b e s t h e therapy:  in  extent  's ability  of  client  t o h e l p me.  confidence  in  the  100  #35-1 believe is correct. Three  the  way we a r e  items probe the  extent  of  working  w i t h my p r o b l e m  client  orientation  toward  collaboration: #13-1 am therapy.  clear  on  what  my r e s p o n s i b i l i t i e s a r e  #18-1 am c l e a r a s t o what these s e s s i o n s . #24-We a g r e e Seven  items  between c l i e n t #8-1  on what probe  and  important  the  strength  for of  me  to  do  me t o work the  in  on.  interpersonal  bond  therapist:  believe  #17-1  is  wants  in  likes  believe  is  me. genuinely  concerned  for  my  welfare. #19-  and I  #23-1  feel  #26-  respect each  that and I  other.  a p p r e c i a t e s me. trust  one  another.  #28-My relationship with i s very important to me. #36-1 feel c a r e s a b o u t me even when I do things t h a t h e / s h e does not a p p r o v e o f . As stated  well, items,  than c l i e n t  the (i.e.,  WAI 13 of  includes a large 36),  number of  which e l i c i t  client  negativelydoubt  optimism:  #1-1  feel  uncomfortable with  #3-1  am w o r r i e d  #7-1  f i n d what I  about  the  .  outcome of  am d o i n g i n  therapy  these  sessions.  confusing.  rather  101  #9-1 w i s h sessions.  and I  could c l a r i f y  the  #11-1 b e l i e v e the time and t o g e t h e r i s not spent e f f i c i e n t l y . #12does not understand accomplish in therapy. #15-1 f i n d what and I u n r e l a t e d t o my c o n c e r n s .  doing  is me.  #27problems  different  and are.  I  have  #33-The things make s e n s e .  This client  by  and  and  to evaluate  The d i v e r s i t y  significantly relation  of  the  the  of its  (Frieswyk variables  is  ideas  honest on  I  the  and to  the the  other  doing  result  alliance  my  which probes  it  relation  client  and  client  with renders  interventions to  on  the the the  outcome  1986). probed  though  p e r f o r m a n c e of  don't of  doubts,  subsequent  being  in  activity,  charge that  al.,  my  wrong  relationship  therapist  et  about  what  am  as the  of  distinctive,  different, to  expect  therapist  alliance  in  therapy  client  specific classes  evidenced  in  characteristics,  also vulnerable  difficult  to  therapist  therapist  developing  am t r y i n g  client-perceived  the  of  I  totally  things  measure  f e e l i n g s about  impact  the  our  spending  i s a s k i n g me t o do  know what t o  activity,  is  not  that  heterogeneous  attitudes  are  t h e f e e l i n g t h a t i f I say o r do t h e w i l l s t o p w o r k i n g w i t h me.  #31-1 am f r u s t r a t e d therapy.  #34-1 d o n ' t therapy.  I  what  #20-1 feel that h i s / h e r f e e l i n g s toward  #29-1 have things,  in  are  p u r p o s e of  its  by not  the  WAI  statistically  BOND s u b s c a l e ,  relationship variables  is  and a l s o i n  both its  102  r e l a t i o n s h i p t o outcome.  A l t h o u g h t h e WAIc  at  .58  with  17),  t h e WAIc BOND s u b s c a l e c o r r e l a t e d  less  The  BOND  less  t h e HAQ ( T a b l e  strongly  at  strongly  both  COMPOSITE  (£=.38)  and £ = . 6 9  f o r t h e WAIc COMPOSITE).  The  2)  related  than  (Table  .40  (£=.57  more  the other  3)  The c h a r g e t h a t evaluation  of  performance  (Chapter  of  self-fulfilling  I,  which  is  the  therapy  i s h e l p i n g ; t h e outcome  the  client  WAI,  t h e HAQ p r o v i d e s l i t t l e  conceptual  both of which p u r p o r t  the  that  whether  concern  6)  information  differences  strongly  subscale  proposition  seems  that  the  independently  i s , in f a c t ,  an  early  c o r r o b o r a t e d as a  t o t h e HAQ, ( i . e . ,  this  the c l i e n t  that  believes  question  has h e l p e d ) . that  would  whether  Unlike assist  with a p a r t i c u l a r  between  the the  client.  t h e HAQ and t h e WAI,  t o measure t h e a l l i a n c e ,  e x p r e s s e d by G r e e n b e r g and P i n s o f  construct validity  .33  respectively).  BOND  measures  the therapy  target  vs.  was l e s s  inevitably  i n c o n s t r u c t i n g an a l l i a n c e  These  to  2).  measure  measure  the  the  Section  subscale  were t h e WAIc and t h e  (Table  (1985)  "alliance"  clinician  questions  It  than  p r o p h e c y seems t o a p p l y  believes  related  d e v e l o p s somewhat  the a l l i a n c e  outcome  d i d t h e WAIc  f o r t h e BOND  strongly  and .38  of the a l l i a n c e  aspects  16) t h a n  respectively).  w i t h G e l s o and C a r t e r ' s  aspect  correlated  t h e WAI a n d t h e HAQ ( £ = . 4 0  6)  (Table  distinctive  bonding  was  also  Table  r e s i d u a l g a i n on t h e I I P vs.  consistent  of  subscale  and . 2 9  HAQ ( £ = . 2 3 This  and w i t h Empathy  improvement  to  subscale  w i t h t h e CRF ( £ = . 2 9 ,  BOND  complaints (Table  .40.  correlated  seem  to  (1986)  support regarding  of the v a r i o u s a l l i a n c e measures.  103  Although the o v e r a l l in  accounting  statistically than  was  for  effectiveness  outcome  significantly  the  WAIc.  to  variance  was  more s t r o n g l y  Various  c o n c e r n i n g the comparative  o f t h e HAQ and t h e equal,  related  speculations  t h e HAQ was  to the  may  weakness o f t h e WAIc  in  fact  to the S E I .  that  the  A clue  to that  significant  weakness seems t o l i e  with  respectively  f o r t h e CRF and r = . 4 4 a n d .33 r e s p e c t i v e l y  Table  8).  correlated  The  HAQ  in  assessment  between  the  the  other  significantly  expertness,  6  of  its  11  items  client's  also  in his/her  participation  .33  f o r the measures  two outcome  evaluation  of  measures the  role  as  client's  therapist  i n the p e r s o n a l  (as  relationship  them).  they  demand  pathological complaints, experience the  and  and t r u s t w o r t h i n e s s .  T h e s e two outcome m e a s u r e s a r e d i f f e r e n t that  (r=.42  with these  attractiveness,  of the t h e r a p i s t  from h e r / h i s  SEI  relationship  The CRF i s a measure of t h e  therapist's  distinct  of  statistically  measures. the  None  and  in the  statistically  significantly  HAQ,  SCL-90  offered  relationship  CRF a s w e l l a s t h e HAQ c o r r e l a t e d the  SCL-90  be  t h e S C L - 9 0 a n d , t o a l e s s e r and n o t s t a t i s t i c a l l y  extent,  WAIc  that  the c l i e n t  symptoms and s e l f - e s t e e m ) , his/her  in therapy.  relationships  Such  as  with  him/herself,  in  (i.e.,  opposed  to  her/his  others,  or  her/his  The c h a n g e s m e a s u r e d w i t h t h e S C L - 9 0 a n d  SEI seem t o be d e p e n d e n t  therapist  evaluate  from the o t h e r s  upon t h e  client's  perceiving  the  as competent. an  interpretation  p l a c e d by B u t l e r  and S t r u p p  seems c o n s i s t e n t w i t h t h e e m p h a s i s (1986)  upon  the  therapist  rather  104  than  the  therapy  as the  change  agent:  ... The purpose of psychotherapy research i s to u n d e r s t a n d how one p e r s o n (the therapist) influences or fails to influence another person (the p a t i e n t ) within a therapeutic context. Therapeutic context, in turn, can be further defined as a particular interpersonal context in which one person (the patient) seeks some benefit from another (the therapist). Implicit in these statements is the assumption that it is the therapist, not "the therapy", which i s t h e i n s t r u m e n t of t h i s b e n e f i c i a l influence. (p. 37)  A  further  performance different the  of  therefore,  the  SEI  once  fact,  third,  more c l i e n t  the  instability  fourth,  (Table  15), rise  suggests  the  in  the  the  sample  the  c o u r s e of  humanistic  therapy, her/his  therapist  being to analyze  or  the  repeated  each  of  CRF were perhaps,  this  critical  correlations and  at  their  and  correlations  fourth,  of  the  WAIc  SCL-90  and  of  the  drop  third  in  the  m e a s u r e s may be  effect. in  the  present  i n w h i c h g o a l s and t a s k s a r e  in  the  lower  23)  of  session  to  the  s e s s i o n s with the  humanistic/experiential/eclectic  outset  and  c o n s i d e r a t i o n at  of  the  differential  relates  HAQ  third  p o s s i b i l i t y that  a n d c a u s i n g an  Finally,  the  the  of  and f i f t h  (i.e.,  the  intrusive  the  the  was a d m i n i s t e r e d  whereas at  of  measures  The WAI  sessions  only  s e s s i o n WAIc, fifth),  alliance  two  received  In  the  the  five  administered  over  explanation  administrations.  first  point.  possible  but  are  not  study c o n s i s t e d  cases  explicitly  rather  c o n c e i v e of  24,  Table  articulated  identified  b e c o m i n g aware of  d o e s not  (Appendix  largely  his/her  by t h e  client  process.  her/his  r e s o l v e a p r o b l e m or a d i s o r d e r ,  function but  at  The as  instead  105  as  being  the  context  (Buber,  to of  or  been  encounter  to  negative in a  mismatch  underlying  in  humanistic  "unfolding"  or an " I - T h o u "  the  uncertain  which  included  and in  this  sample  between  p s y c h o t h e r a p y and the  are  perhaps  this  more  psychoanalytic cases.  in  relationship  GOAL and TASK s u b s c a l e s  r e s p o n s e s from c l i e n t s  sample  with  existential  receive  c a s e s or c e r t a i n  a  client's  items  likely  from c l i e n t s  oriented  the  Hence,  more  noncommittal  the  a dialogic  1970).  possibly  than  facilitate  sample  learning-  T h e r e may have the  assumptions  conceptual basis  of  WAI. All  of  therapist  the  factors  as e x p e r t ,  b i a s of  the  to  weakness  the  discussed above--the  the  repeated  sample t o w a r d  relationship  of  to  some  administration  humanistic  the  WAIc  of  the  s i g n i f i c a n c e of effect,  c a s e s — m a y have  relative  to  the  outcome m e a s u r e s i n  and  the the  contributed HAQ  in  the  its  present  study. 1.5  R e l a t i o n s h i p Of P e r c e i v e d C l i e n t It  was  involvement positively  hypothesized and  related  but  that  to  outcome.  client  that  It  To Outcome  client-perceived  therapist-perceived  client-perceived outcome,  Involvement  client  involvement  was f o u n d t o  involvement  was  be t h e  positively  therapist-perceived  client  client  case  were that  related  to  involvement  was  not. The e x p l o r a t o r y the and  present  study  Pinsof's  client  in order  (1986)  variable  Client  Involvement to  provide  suggestion that  a s s o c i a t e d w i t h the  Scale  data  was  relevant  Involvement formation  of  is the  included to the  in  Greenberg critical  alliance.  106  The CIS similarly  appended  to  the  outcome m e a s u r e s suggestion than  the  comparable underlying 1.6  WAIc  (Table  implies  WAI,  to  the  both and  fact  of  WAIt  Although the  that  predictive conceptual  the  7).  that  forms  the  in  WAI  relationship  Greenberg  CIS would c o r r e l a t e  this  six-item  capacity  w i t h the  basis merits  further  scale WAI  It  Alliance  was h y p o t h e s i z e d  alliance  strength  positively  related  Strength  that  congruence  outcome.  the  and  Pinsofs  more  strongly  demonstrated its  examination. And  To Outcome  and t h e r a p i s t - p e r c e i v e d to  to  suggests that  R e l a t i o n s h i p Of C o n g r u e n c e Of C l i e n t - p e r c e i v e d  Therapist-perceived  performed  of  client-perceived  alliance  T h i s was f o u n d  strength  not  to  was  be  the  case. No client it  r e s e a r c h has a s y e t and t h e r a p i s t  relates  O'Grady,  to  ratings  of  levels  of  Perry  therapist client  effectiveness client  in  therapists  and  that  However, (in  on t h e i r Hill,  press)  of  alliance  as  Tichenor,  client  and  the  measure  therapy,  than  at  of  Spiegel, therapist  were more c o n g r u e n t  experiencing, experiential  Helms,  found that  interventions  working  congruence  at  higher  therapeutic  lower  levels  of  experiencing.  C o n g r u e n c e of  of  perspectives  outcome.  and  been p u b l i s h e d on t h e  ratings  would c o n s t i t u t e  alliance.  outcome  significance  would of  the  of  alliance  alliance  "objective"  A significant provide  the  in  evidence  relationship  strong  by  support  of  clients the  between  for  psychotherapy  the  and  presence  congruence  hypothesized  (Bordin,  1975,  1 07  1979) . In to  the  present  be w e a k l y  on  the  but  However, respect  and t h e r a p i s t later  in  target  the  of  of  the  However,  present efficacy  and  and t h e i r  study  unrelated  outcome on t h e  to  outcome m e a s u r e s a r e c o u l d be drawn  from  found except  congruence  of  are  which  equivocal  c o n g r u e n c e of 12).  significantly  approached  negatively  later  TPQ.  with  with  gain  on  improvement  sessions  sessions.  and  C o n g r u e n c e was  These f i n d i n g s  inconsistent and, hence,  in  statistically  sessions with r e s i d u a l  in  client  Congruence  c o m p l a i n t s and w i t h SPQ Change i n e a r l y IIP  were  correlated  (Table  it  correlated  g a i n on t h e  on t h e  no  various  interpretation  them.  P o s t Hoc A n a l y s e s  1.7.1  A n a l y s i s Of T h e r a p i s t Since  multiple  the cases  systematic, group of  WAI  11).  in early  with r e s i d u a l  1.7  the  seven o c c a s i o n s at  statistically  SEI  it  10),  the  alliance  correlated on  over  the  the  forms o f  (Table  predictive  correlation  SCL-90.  e  both  (Table  results  ratings  gain  significant n  to  sessions  residual  t  the  two  significantly  i n c r e a s e somewhat  were a d m i n i s t e r e d  with  the  statistically  BOND s u b s c a l e s of  was f o u n d t o they  study,  of  effect to  the  of  some  sample  14 c a s e s c o n t r i b u t e d  outcome  by 30  variables  therapists was  s i m p l e c o m p a r i s o n s of  30 c a s e s c o n t r i b u t e d  marker  Effect  the  neither  contributed  significant  standard deviations  by f i v e  therapists  therapists (Table  having  13).  were Since  and t h e  made the  on  nor  of  the  group three  standard  108  deviations of  the  large  of  the  marker as the  two g r o u p s were n o t  variables, other),  all  (i.e.,  extremely  one b e i n g not  44 c a s e s  in  the  different  more t h a n  on any twice  sample were t r e a t e d  as as  independent. 1.7.2  A n a l y s i s Of E f f e c t  Of T h e o r e t i c a l  Orientations  Of  Therapists The  data  were  inadequate  theoretical  orientation  therapists  categorized  However, were  performed.  No  their  However,  non-humanistic  therapists  of  the  their  18),  themselves.  inconsistent  application  theoretical (#5  on  seems  likely  that  This of  two the  groups clients'  did  The  differ  non-humanistic cases.  variability  validity,  the  this  in  the  therapists,  indicated  categorized  in  humanistic  represented  a s s o c i a t e d w i t h an o r i e n t a t i o n  it  the  35  two g r o u p s .  14).  questionable  several  question  Appendix  did  the  The  on t h e  TASK  alliances.  were  Moreover,  identify/describe  Sheet,  the  a n a l y s i s was of  group.  (Table  of  humanistic.  the  perceptions  c a s e s a l s o showed g r e a t e r  and GOAL components of This  the  of  than  s c o r e s of  between  than  other  were r e v e a l e d  therapists'  alliances  a possible effect  Only four  as  t h e WAI  alliances  significantly  c a s e s had weaker  part  themselves  differences  the  statistically  four  alliance.  s i m p l e c o m p a r i s o n s of  p e r c e p t i o n s of  only  on t h e  to analyze  that other  when  Therapist  they  would  in  that  difference  the  to first Data  techniques  i n which they  presumably  theoretical  asked  Demographic  had e m p l o y e d  than  since  non-humanistic  orientation  the  however,  result  orientation. actually  had in  Hence,  reflects  a  109  therapist  effect  true effect  on t h e t h e r a p i s t - r a t e d  of t h e o r e t i c a l  alliance  rather  than  a  orientation.  1.7.3  C o r r e l a t i o n s Of The WAIc W i t h The Outcome M e a s u r e s A t The  Seven  Occasions It  to  has  fifth  been assumed t h a t  session  throughout  the  (Strupp,  C r e a s e r , a n d Howard  that  this  subject  assumption  clients  sensitivity  to  Cristoph,  Curtis,  least  at  the  25  a  and  90%  sessions)  differences  and c o n c l u d e d t h a t  with  been  the a l l i a n c e  early  widespread of  Luborsky,  ratings  their Crits-  t h i r d and  done  on  the  (which c o n s i s t e d of They  and l a t e  remains s t a b l e  91  found  session  over  the  at no  ratings course  treatment. However,  Bordin  phenomenon o c c u r s w h i c h experience. that  Heppner  (1983)  postulated  constitutes and  Heesacker  the r e l a t i o n s h i p changes over The s e v e n r e p e a t e d m e a s u r e s  reveal and  the  their  the s t a t e  completed.  between  evidence  compared t h e i r  of the treatment  had  reflected  Morgan,  Solomon (1982)  Luetgert,  empirical  defined  third  constant  one i n t h a t  therapists that  remains  Saltzman,  provided  session.  ratings  " g e l s " by t h e  then  reasonable  cues  third  which  significant  of  was  session a l l i a n c e  session  (1976)  numerous  by  and  engagement.  and 19 s u b j e c t  alliances  fifth  1980)  therapeutic  Roth,  the a l l i a n c e  a trend  when  reveal  of  a trend  of  with  each  the  (1982)  taken  of  increasing strength  a  "tear-repair"  critical  in  therapeutic  have a l s o s u g g e s t e d  the c o u r s e of  increasing strength  correlated  that  the  therapy. present  of t h e a l l i a n c e  study  (Table  21)  t h e outcome measures a l s o of c o r r e l a t i o n  through the  110  c o u r s e of outcome  therapy drops  (Table  off  15).  quite  presumably because c l i e n t  However,  this  consistently  at  and t h e r a p i s t  correlation the  have  final  with  session,  terminated  their  relationship. This Section  constitutes  1.1  that  independent  what  further is  variable  being  rather  evidence  to  that  presented  in  measured  by  the  WAIc  an  than  is  an i n - p r o c e s s a s s e s s m e n t of  outcome. 1.7.4  R e l a t i o n s h i p s Between The WAI And The O t h e r  Relationship  Measures B a s e d on t h e i r one a n o t h e r , rated  it  statistically  appears  relationship  constructs,  from T a b l e s  measures  w i t h the  of  different  r e s e a r c h groups are  the  The  HAQ, a l t h o u g h  of  .58  statistically  measures  accounted  This  is  considering that  be m e a s u r i n g t h e  the  tapping  most d i s p a r a t e  for  measures,  defining  the  small,  17 t h a t  indeed  various alliance  correlation  relationships  of  (Table  alliance  17)  significant,  34% of  same c o n s t r u c t .  the  the  the two  (i.e.,  between  with  client-  overlapping the  (1986) have q u e s t i o n n e d t h e  validity  way).  16 and  are  CRF b e i n g the  G r e e n b e r g and P i n s o f the  significant  five.  construct whether  in  the  the same  the  WAIc  and  means t h a t  one  of  variance  in  instruments  the  other.  purport  to  111  1.7.5  Identification  Of R e l a t i v e  Strengths  Of Outcome  Predictor  Variables In  the stepwise m u l t i p l e  r e g r e s s i o n a n a l y s i s performed  e a c h of t h e s i x outcome m e a s u r e s r e l a t i o n s h i p measures entered  into  level that  or  19),  less.  that  This  is  was drawn  or  the  was d e v e l o p e d a t  most o f t h e r e l a t i o n s h i p  overlapping constructs that  o n l y one o f t h e s i x  t h e HAQ, t h e WAIc,  e a c h of t h e e q u a t i o n s  probability conclusion  (either  (Table  for  consistent measures  in Section  CISc) the  with  are  .05 the  tapping  1.7.4.  1 . 7 . 6 C o m p a r i s o n Of WAI S c o r e s Of C o m p l e t e d And P r e m a t u r e l y Terminated  Cases  The terminated client  limited  process  data  therapies  revealed  a significant  ratings  of t h e a l l i a n c e  who c o n t i n u e d t o Clients of  alliance  to completion not  client  after  versus  significantly  (t=2.50  recur  ratings,  on  (p<.05),  than 20).  prematurely  difference  those  lower Table  from  the f i r s t  who s u b s e q u e n t l y d r o p p e d o u t r a t e d  their  did  completion  collected  between  s e s s i o n of  who  dropped  those out.  the Goal subdimension clients  who c o n t i n u e d  Since t h i s  difference  t h e s e c o n d s e s s i o n and i s b a s e d on o n l y  further  research  seems  necessary  before  ten any  c o n c l u s i o n s may be d r a w n . 2.  LIMITATIONS  This limitations 1) were  It  study  OF THE STUDY  has  of previous  attempted  s t u d i e s of the  i s b a s e d on more  collected  in  t o overcome some of t h e d e s i g n  almost  realistic all  the  alliance: outcome d a t a , cases  when  (i.e., therapy  data was  11 2  terminated, the  rather  than  after  case in the Horvath 2)  The  problem  outcome d a t a , therapist),  (i.e., is  and M o s e l e y introduce  third  However,  a  (1981) of  both  variety  being  sources  study as i t study,  scrutiny  of  (1983)  it  of  client  not  and  Horvath  feasible  to  p r o c e s s or outcome. used  in  psychotherapy  r e s e a r c h was e m p l o y e d , a l l of w h i c h r e f l e c t e d  some  relationship  with the a l l i a n c e  correlation  between outcome  was d e m o n s t r a t e d  as w e l l  outcome r e l a t i o n s h i p a t These  alliance-outcome of  measures  based.  That  sample  their  selection  real  session  limit  consisted  settings.  to  of t h i s  of  (Section  the  and  chapter) alliance-  1.7.3  of  this  the c l a i m that  simply a  the  demonstration  the g e n e r a l i z a b i l i t y  of the  of  volunteer  is  participants  in the course of r e a l  Some l i m i t a t i o n s  it  therapies  seem i n h e r e n t  in  this  process:  who f e l t  be w i l l i n g  measures  s t u d y beyond t h e sample upon w h i c h  1) T h e r a p i s t s who v o l u n t e e r e d subset  1.1  to counter  represents  responding to the q u e s t i o n n a i r e s in  alliance  some c r o s s -  prophecy".  factors  of t h e p r e s e n t  Moreover,  (Section  seem  relationship  findings  commonly  as a " d r o p p i n g o f f "  findings  some  measures.  the f i n a l  the " s e l f - f u l f i l l i n g However,  measures  client-rated  therapist-rated  chapter).  outcome  was  a l l i a n c e and  was i n t h e  is  of e i t h e r  as  studies.  of  self-reports  in this  In a f i e l d  party  ten s e s s i o n s ,  and M o s e l e y  confounded  inherent  studies.  an a r b i t r a r y  confident  t o have t h e i r  researchers  through  to  participate  enough o f t h e i r  clients'  therapeutic  p e r c e p t i o n s of  questionnaire  represent  them  skills  a to  revealed  r e s p o n s e s t h a t were n o t  113  seen by t h e 2) to  therapists  These t h e r a p i s t s  participate  whom t h e y  felt  working  over  at  six  least  in the  3)  s e l e c t e d the  the  that  p e r i o d of  sessions), the  to  threatening  them  examining  experience  of  for  in  example,  the  whom t h e y  be  the  whom  had t o  invited  and  study r e q u i r e d , they  (i.e.,  felt  comfortable  in  with  it  them. be  able  s o p h i s t i c a t e d enough  to  the  motivated  would  with  continue  r e s e a r c h e r s who were  sessions.  crises  to  be e d u c a t e d enough t o  responses  their  able  to p a r t i c i p a t e  i d e a of  therapy, after  would  questionnaires,  their  questionnaires  with  invitation  Appropriate c l i e n t s  find  they  time that  and  r e a d and c o m p l e t e t h e  not  clients  study with them--presumably c l i e n t s  confident  enough t o p r o f e r  to  themselves.  strangers  very  enough  personal  to  complete  C l i e n t s beginning not  have  to  therapy,  been  suitable  participants. Hence,  the  sample  t o w a r d more s u c c e s s f u l the  subpopulation  moderating  factor  relationships findings therapies clients, 4)  with as w e l l Few  terminated been  of  therapies.  reflected affecting  the  may not  i s b i a s e d by a l l  study  in  the  less  educated,  less  as w i t h t h o s e  successfully  in  may  the As  of  have been a  process-outcome well,  the  therapies,  sophisticated,  and  study and  to  motivated  crises. in  the  study  by b o t h p a r t i c i p a n t s  completed.  circumstances—geographic  of  factors  homogeneity  sample  successful  therapies  upon agreement  the  demonstrated.  to  selection  The r e l a t i v e  strength  apply  the  these  In  r e l o c a t i o n of  most  were  that  the  actually work  had  cases,  external  a participant,  financial  11 4  restrictions, end  of  therapist  university  determined  the  semester,  point  of  externally-imposed reality  of  was  being  ideal  cases  assumed  to  examined  have  of  responsibilities,  of  summer v a c a t i o n —  therapy.  may  engagements  alliance  i n which the  other  onset  termination  how t h e r a p e u t i c  that  and  terminations  r e l a t i o n s h i p between  be  reassignment to  reflect  the  end,  distort  the  they  d e v e l o p m e n t and t h e r a p e u t i c  in  this  these  accurately  study,  (i.e.,  relationship-outcome  fully  Although  change  these are  relationship  d e v e l o p e d a n d , h e n c e , t o be  not can  reliably  demonstrable). 5)  Although c l i e n t s  information  p r o v i d e d to  treated confidentially assumed  to  entirely  questionnaire upon  satisfaction  with t h e i r  their  negatively-biased  therapists  inherently  reporting  therapy, form o f 6)  eliminate to  and  therapies.  or  residual  questionnaire  when  who  consisted  identified  the  would  in  own  be  their  favourably  progress  resentments,  and  in t h e i r  lives,  responses.  report  through  It  objective  such as t h a t  either  of  is,  or  largely  of  in  unbiased being  in  must be r e d u c e d t o  the  responses to q u e s t i o n n a i r e  their  be  assurance cannot  reflect  their  written  C o n v e r s e l y and o c c a s i o n a l l y ,  a subjective experience  The sample  responses  to  with others  quantitatively-scaled  humanistic  want  upon  preliminary  inclination  i m p o s s i b l e t o be w h o l l y  particularly  therapists  their  their  may have been e x p r e s s i n g  their  in  that  and a n o n y m o u s l y , t h i s  therapists  with  fact,  them  responses u s u a l l y  their  clients  were a s s u r e d i n t h e  cases  theoretical  a n d , h e n c e , may have y i e l d e d d i f f e r e n t  items.  conducted orientation results  than  by as a  115  sample w h i c h oriented  included  learning  and  some  analytically-  alliance-outcome  correlation  cases.  7)  The  coefficients 25%  more  of  significant  found i n the  outcome  coefficients alliance  variance.  indicate  for  present  that  study account In  the  considering  theorized  the  (1979)  "small"  v a r i a n c e may be i m p o r t a n t  size in  evaluations  this  3.  context  b e i n g the  r e s e a r c h and t h e o r y  to  the  They  the  of  present  the  produced  and t h a t of  limited empirical at  such  showed  context  to  that effect  the  data,  efficacy  of  time.  RECOMMENDATIONS FOR FUTURE RESEARCH  The the  s h o u l d be s e n s i t i v e  case the  psychotherapy  relevant.  7  whether  example  by R o s e n t h a l and R u b i n p e r c e n t a g e s of  only  significance  outcome s h o u l d be r e e x a m i n e d , is  for  following  present 1)  2) HAQ:  of  its  the  the  regarding  the  failure  differential  measures Bordin's  Based in  construct  on  this  (1975,  the  bonding aspect  to  exclude b r i e f  study  from t h e  findings  of  predict  That  the  outcome:  instrument  performance  of  be d i s c o u r a g e d . the  WAI  and  c o n c e r n e x p r e s s e d by G r e e n b e r g and P i n s o f  m e a s u r e s be s u b j e c t e d t o 3)  to  WAIt a s a r e s e a r c h  B a s e d on t h e  that  follow  study:  B a s e d on  utilization  recommendations  suggest the  empirical  the  early  sample  of  1979) of  of  the  strength brief  alliance cases  must  be  the  various  (1986)  alliance  investigation. of  the  BOND s u b s c a l e  psychotherapy  proposition  therapy bond  validity  the  (Section  2,  cases:  Chapter  develops slowly  i n which the established  data  be in  the  promptly  I)  That that  modified present if  the  1 16  therapy  is  4)  to  Based  outcome up t o session  successful. on  the  the tenth  s e s s i o n by  design,  such of  the  (Frieswyk the  of  to  alliance  5)  B a s e d on t h e  the  correlated research  fact  that  et  transactional  a  al.,  in  of  of  with  the  client  (1986)  alliance  of  Client  subdimension of  have  suggested i s  variable  toward  the  different  client  Such a r e c o m m e n d a t i o n drawn of  by  Stiles,  types  of  t a s k s and is  in  the  treatment would  Involvement  discriminating  in d i f f e r e n t  research  t h e WAI s u b s c a l e s  the  predictive  be  hypothesized dimensions  measures to u n r a v e l  are  alliance  therapy.  exploratory  the  to  final  Such e x a m i n a t i o n  w i t h outcome a s d i d t h e WAI: at  in  fluctuations  orientation-specific the  off the  associated 1986).  alliance  single-case  intercorrelations  t h a t G r e e n b e r g and P i n s o f the  be  of  drop That  evaluation  may  the  directed  the  employing  events  high  as s t r o n g l y be  and  relationships the  relationship  relationship:  detailed  alliance  help to c l a r i f y  and  session  session  that  interventions  the  increasing  alliance-outcome  tracked  state  be  further  Involvement subsumed  by  development  of  issues  involved  involvement  in that  treatments.  consistent  S h a p i r o , and E l l i o t t  That  Scale  with  (1986)  the  conclusion  from t h e i r  review  process-outcome research: The a l l i a n c e c o n s t r u c t i s really only a conceptual umbrella f o r u n i t i n g a number of c l i e n t and t h e r a p i s t contributions; the exact operation of these c o n s t i t u e n t f a c t o r s r e m a i n s t o be c l a r i f i e d . Although attempting to be i n c l u s i v e , the a l l i a n c e c o n c e p t i s vulnerable to criticism also lodged against the general t h e r a p i s t f a c t o r s : I t l o c a t e s the common c o r e a t t o o h i g h a l e v e l of a b s t r a c t i o n . (p. 174)  11 7  4.  SUMMARY AND CONCLUSION In  with  the  a  present  study,  self-report  (Horvath,  1981,  bonds and t h e  of  based  the  the  measured  the Working A l l i a n c e  Inventory  on  t a s k s and g o a l s of  five,  was  a s c o n s i s t i n g of  psychotherapy.  and t h e r a p i s t s  cases.  For comparative p u r p o s e s , another  alliance  well  as  empathy,  attractiveness, the  third  The  WAI  outcome  and  as  of  trustworthiness,  the  measured  Improvement,  the  the  of  Questionnaire,  therapist  other by  five  four  correlate  six  Interpersonal  while  the  six  the  of It  the  w i t h any of and  statistically  of  of  therapy  44  measure,  the  as  expertness,  also  instruments:  Symptom C h e c k l i s t - 9 0 ,  and t h e  of  expertness,  each  administered  m e a s u r e s were c o r r e l a t e d  Therapist  six  trustworthiness  HAQ  than  correlated  Strupp  while  statistically  Posttherapy  significantly  the  empathy,  the  Complaints  Questionnaire.  correlated did  with  S e l f - E s t e e m Index,  statistically  Therapist  significantly  the  Posttherapy  instruments,  them.  Target  P r o b l e m s , the  The WAIc was f o u n d t o c o r r e l a t e with  were  instrument  session. and  Inventory  the  after  1979)  relational  This  sessions  measures  and  (1975,  final  after  tenth,  alliance  Bordin's  alliance  was a d m i n i s t e r e d t o c l i e n t s first  working  instrument,  1982),  conceptualization  the  WAIt d i d  not  attractiveness, less consistently  WAIc  with  significantly  outcome, with  all  purport  to  outcome m e a s u r e s .  was c o n c l u d e d t h a t  measure  the  alliance,  response  set,  and the WAI,  the  the  two HAQ,  instruments  that  w h i c h has a p h e n o m e n o l o g i c a l  w h i c h has a more b e h a v i o u r a l  response  118  set,  are  actually  constructs. construct  measuring  Moreover,  is  it  l o c a t e d at  exploratory  measure  was  merit  of  comparably to  further  client  therapy. rated  the  third This  significantly  session,  measure,  the  construct  is distinct  one  of  the  findings with respect  in  that the  hypothesized was  found  to  therefore,  to  regarding  a  alliance  an  revealed  relationship  only at finding  the  that to  that  the  outcome  client-  statistically  outcome m e a s u r e , measures a r e  in-process  the  c o n c l u s i o n of  correlated  alliance  from  the  present to  the  purport  alliance  argument "true"  a  An  the T P Q , tapping  evaluation  a of  outcome.  phase  r e s e a r c h program,  its  WAIc,  self-reported  same-self-reported  in  therapist-rated  the  changes  alliance  abstraction.  variable  alliance  a l o n g w i t h the  w i t h the  that  the  dropping off  suggested that  instruments  of  different  the  w i t h outcome a n d ,  strengthen  finding  alliance  As  WAI  that  involvement,  alliance  m e a s u r e s of  continued to  beyond the  a level  but  investigation.  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I n t e r n a t i o n a l J o u r n a l of P s y c h o - A n a l y s i s , 37, 369-376. Zetzel, E.R. (1970). London: Hogarth.  The c a p a c i t y  for emotional  growth.  132  THERAPIST CONSENT FORM I  hereby  psychotherapy  voluntarily  research study.  been e x p l a i n e d t o me and I complete I  have  that  have any I and I  to  The n a t u r e  participate  in  the has  of  this  research  I  will  be r e q u i r e d  understand that  to  some q u e s t i o n n a i r e s . been  questionnaires w i l l and  consent  the  informed be t r e a t e d  researchers  identifying  am aware  that  I  will  nature  am f r e e  time.  Signed  Date  the  anonymously  information  have e x p l a i n e d t h e  that  not  and  on  the  the  confidentially  know my name n o r w i l l  about of  responses  they  me. r e s e a r c h t o my  to withdraw  from t h i s  client(s)  study at  any  1 33  APPENDIX 4 -  CLIENT CONSENT FORM  INFORMATION ABOUT THE PSYCHOTHERAPY RESEARCH PROJECT This kinds or  study  of  learn  about  facilitate There  about the  enable  are  of  Your  to  your  in  questionnaires. to  Then,  your  w i t h your  (which  the  to  the  the  change,  is  being ways  interactions.  opinions,  helper.  and  feelings  Your c o o p e r a t i o n  and we would  questionnaires  research  The f i r s t  set  like  to  of  with  have  the  (if  there  some more q u e s t i o n n a i r e s  for  your  is  know who you a r e  involves  the  therapy,  filling  questionnaires be a s k e d t o first  5 minutes)  one)  (which  completely  questionnaire.  the  take about  not  are  see y o u r  You w i l l  each  your  will  of  will  end o f  Thank-you  effective  ideas,  important  researchers  after  session at  is  complete.  questionnaire sessions  that  the  d e v e l o p more e f f e c t i v e  k i n d s of  therapist/counsellor  40 m i n u t e s  solve problems,  information to  about  experience.  The  Your p a r t  tenth  know some of  responses  your  The  therapists  interactions  confidential. will  help people  many d i f f e r e n t  research project  benefit  information  change.  like  your  that  generate  themselves.  will  We would  designed to  interactions  gathered to  is  of  some  take  about  respond to your  another therapy  as w e l l a s a f t e r the  we would l i k e  cooperation.  will  five'of  and a f t e r  will  out  final  40  the  session.  you t o  take another  nor  complete  minutes).  1 34  CONSENT FORM I  hereby  psychotherapy  voluntarily  consent  research study.  been e x p l a i n e d t o me and I  to  The n a t u r e  participate  in  the has  of  this  research  I  will  be r e q u i r e d  understand that  to  c o m p l e t e some q u e s t i o n n a i r e s . I  have  questionnaires and t h e  that  be t r e a t e d  I  my  information  do not  withdrawal  of  not  that  the  would a l s o  in  and  on  the  confidentially t h e y have  any  me.  no  service  in  this  way a f f e c t I  will  i n no way a f f e c t  receive.  Signed  Date  Witness  responses  know my name nor w i l l  about  will  the  anonymously  wish to p a r t i c i p a t e  decision  availability  will  will  informed  researchers w i l l  identifying If  been  (Therapist)  study, the  receive, the  I  understand  s t a n d a r d or and  s t a n d a r d of  the  that service  my I  1 35  APPENDIX 5 -  TARGET COMPLAINTS/DEMOGRAPHIC QUESTIONNAIRE  PSYCHOTHERAPY RESEARCH QUESTIONNAIRE  #1A  The e n c l o s e d q u e s t i o n n a i r e s a r e p a r t of a r e s e a r c h p r o j e c t to study how clients feel about their therapy/counselling experiences. Please t r y t o answer a l l q u e s t i o n s a s c o m p l e t e l y and a c c u r a t e l y as you c a n . Replace the completed q u e s t i o n n a i r e s i n t h e e n v e l o p e p r o v i d e d and s e a l i t . Your c o o p e r a t i o n i n this r e s e a r c h i s v e r y much a p p r e c i a t e d . Age: Sex  (check  Marital  one):  Status:  M Single  F Married  Divorced  Widowed  E d u c a t i o n ( c h e c k h i g h e s t l e v e l and c o m p l e t e q u e s t i o n ) : E l e m e n t a r y s c h o o l ( i n d i c a t e number of y e a r s : ) H i g h s c h o o l ( i n d i c a t e number of y e a r s : ) High s c h o o l graduate C o l l e g e ( i n d i c a t e number of y e a r s : ) C o l l e g e graduate Graduate study or professional t r a i n i n g ( k i n d of d e g r e e , etc.: ) P l e a s e name t h e t h r e e p r o b l e m s o r difficulties help with in p s y c h o t h e r a p y / c o u n s e l l i n g : First  Problem:  Second P r o b l e m :  Third  Problem:  you  most  want  1 36  APPENDIX 6 ~ SYMPTOM C H E C K L I S T - 9 0 PSYCHOTHERAPY RESEARCH QUESTIONNAIRE  #2  Below is a list of p r o b l e m s and c o m p l a i n t s t h a t p e o p l e sometimes h a v e . P l e a s e r e a d e a c h one c a r e f u l l y . A f t e r you have done s o , p l e a s e circle the number to the right that best d e s c r i b e s HOW MUCH DISCOMFORT THAT PROBLEM HAS CAUSED YOU DURING THE PAST WEEK INCLUDING TODAY. Mark o n l y one numbered s p a c e f o r e a c h p r o b l e m and do not s k i p any i t e m s . Circle 0 1 2 3 4  the  appropriate  number:  - Not a t a l l - A l i t t l e bit - Moderately - Quite a b i t - Extremely  HOW MUCH WERE YOU BOTHERED BY: 1.  Headaches  2.  N e r v o u s n e s s or  3.  Unwanted leave  0 1 2 3 4 shakiness inside  thoughts,  ideas  that  3 4  won't 0 1 2 3 4  F a i n t n e s s or  5.  L o s s of  6.  Feeling c r i t i c a l  7.  9.  or  y o u r mind  4.  8.  words,  0 12  dizziness  0 12  3 4  0 12  3 4  0 12  3 4  The i d e a t h a t someone e l s e c a n c o n t r o l y o u r thoughts F e e l i n g o t h e r s a r e t o blame f o r most of y o u r  0 12  3 4  troubles  0 12  3 4  0 12  3 4  0 12  3 4  0 12  3 4  0 12  3 4  0 12  3 4  0 12  3 4  0 12  3 4  sexual  Trouble  interest of  remembering  10.  Worried  about  11.  Feeling  easily  12.  Pains  13.  Feeling afraid  14.  Feeling  15.  T h o u g h t s of  in heart  low  or p l e a s u r e  others  things.  s l o p p i n e s s or a n n o y e d or  carelessness  irritated  or c h e s t i n open s p a c e s o r  in energy  or  ending your  on the  s l o w e d down life  streets.  1 37  16.  Hearing  voices that  17.  Trembling  18.  Feeling  0 12  3 4  0 12  3 4  0 12  3 4  19.  Poor a p p e t i t e  0 12  3 4  20.  Crying e a s i l y  0 12  3 4  21.  Feeling  shy o r  0 12  3 4  22.  Feeling  of  0 12  3 4  23.  Suddenly s c a r e d for  0 12  3 4  24.  Temper  0 12  3 4  25.  Feeling afraid  0 12  3 4  26.  Blaming y o u r s e l f  0 12  3 4  27.  Pains  0 12  3 4  28.  Feeling  blocked in g e t t i n g  0 12  3 4  29.  Feeling  lonely  0 12  3 4  30.  Feeling  blue  0 12  3 4  31.  Worrying  0 12  3 4  32.  Feeling  no i n t e r e s t  0 12  3 4  33.  Feeling  fearful  0 12  3 4  34.  Your  feelings  being e a s i l y  0 12  3 4  35.  Other  people  b e i n g aware of  0 12  3 4  36.  Feeling others unsympathetic  0 12  3 4  you 0 1 2  3 4  0 12  3 4  0 12  3 4  0 12  3 4  0 12  3 4  that  most p e o p l e  37.  Feeling  being trapped  38.  Having  or  go out for  of  Heart  40.  Nausea o r  41.  Feeling  opposite  sex  caught  your  control  house a l o n e . . . .  things  back  in  do not  people  do t h i n g s  p o u n d i n g or upset  inferior  done  things  hurt your  private  u n d e r s t a n d you or  are very  unfriendly slowly  racing  stomach to  things  things  correctness 39.  hear....  be t r u s t e d  you c o u l d not  t o o much a b o u t  to  cannot  do not  no r e a s o n  that  to  lower  that  people  uneasy w i t h the  outbursts  in  other  others  to  thoughts are  or d i s l i k e insure  138  42.  S o r e n e s s of  43.  Feeling  your muscles  that  you a r e  watched  or  talked  about  Trouble  45.  Having  46.  Difficulty  47.  Feeling afraid or  asleep  t o c h e c k and d o u b l e c h e c k what you do making d e c i s i o n s to  travel  on b u s e s ,  Trouble  49.  Hot  50.  Having  getting  your  breath  or c o l d s p e l l s  ...  to a v o i d c e r t a i n  activities  things,  because they  Your mind goes b l a n k  52.  Numbness or  53.  A lump i n y o u r  54.  F e e l i n g h o p e l e s s about  55.  Trouble  56.  F e e l i n g weak i n p a r t s  57.  F e e l i n g tense  58.  Heavy  59.  T h o u g h t s of  60.  Overeating  61.  Feeling  uneasy when p e o p l e  talking  about  tingling  your  body  the  future  concentrating  or  feelings  your  body  k e y e d up  death  or  arms or  legs  dying  are  watching  63.  Having urges  to  64.  Awakening  the  that are beat, early  not  your  injure,  0 12  3 4  0 12  3 4  0 12  3 4  0 12  3 4  0 12  3 4  0 12  3 4  0 12  3 4  0 12  3 4  0 12  3 4  0 12  3 4  0 12  3 4  0 12  3 4  0 12  3 4  0 12  3 4  0 12  3 4  0 12  3 4  0 12  3 4  0 12  3 4  0 12  3 4  0 12  3 4  0 12  3 4  0 12 0 12  3 4 3 4  or  you  thoughts  in  of  in your  Having  66.  of  you  throat  62.  65.  in parts  3 4  places,  frighten  51.  0 12  subways,  trains  48.  or  falling  3 4  by  others 44.  0 12  or  own harm s o m e o n e . . .  morning  H a v i n g t o r e p e a t t h e same a c t i o n s s u c h as t o u c h i n g , c o u n t i n g , washing S l e e p t h a t i s r e s t l e s s or d i s t u r b e d  1 39  67.  Having  urges  68.  Having  i d e a s or  69.  F e e l i n g very  70.  Feeling o r at  to  break  or  beliefs  smash t h i n g s that  0 12  3 4  0 12  3 4  0 12  3 4  0 12  3 4  0 12  3 4  0 12  3 4  0 12  3 4  0 12  3 4  0 12  3 4  0 12  3 4  with p e o p l e . . . .  0 12  3 4  sit  0 12  3 4  0 12  3 4  0 12  3 4  0 12  3 4  0 12  3 4  0 12  3 4  0 12  3 4  others  do not  share  s e l f - c o n s c i o u s with others  uneasy  in crowds,  such as shopping  a movie  71.  Feeling everything  72.  S p e l l s of  73.  F e e l i n g uncomfortable  terror  i s an e f f o r t  or p a n i c about  eating  or  drinking  in public 74.  Getting  into  frequent  arguments  75. 76.  F e e l i n g n e r v o u s when you a r e O t h e r s n o t g i v i n g you p r o p e r achievements  l e f t alone c r e d i t for  77.  Feeling  lonely  78.  Feeling  so r e s t l e s s y o u c o u l d n ' t  79.  Feelings  80.  Feeling  of  even when you a r e  your  still  worthlessness  that  familiar  things  are  strange  or  unreal 81.  S h o u t i n g or  82.  Feeling afraid  83.  Feeling if  throwing  that  you l e t  you w i l l  in p u b l i c  take advantage  of  you  them  Having  thoughts  85.  The i d e a  that  for  sins  about  bother  you a l o t .  ...  F e e l i n g pushed to  87.  The i d e a  that  sex t h a t  you s h o u l d be p u n i s h e d  86.  with your  faint  people w i l l  84.  your  things  get  things  something  done...  serious  is  Never  feeling  89.  Feelings  of  90.  The i d e a  that  c l o s e to  another  person  3 4  0 12  3 4  0 1 2 3 4  guilt something  0 12  wrong  body  88.  0 1 2 3 4  i s wrong w i t h y o u r  mind.  0 12  3 4  0 12  3 4  140  APPENDIX 7 -  S E L F - E S T E E M INDEX  PSYCHOTHERAPY RESEARCH QUESTIONNAIRE #3 Please indicate how often t r u e f o r y o u by c h e c k i n g t h e 1. I plane  f e e l t h a t I am a p e r s o n of with o t h e r s .  Never 2.  I  Seldom  feel  that  I  Seldom  I  to  am a b l e  Never 4.  I  Never 5.  I  do not  Seldom  Sometimes I Never  7.  I  am a u s e f u l  I  feel  Never I  Never  that  I  feel  can't  do a n y t h i n g  do i t  Almost  Always  _  Almost  Always  _  Almost  Always  Often  _  Almost  Always  Often  _  Almost  Always  Almost  Always  myself.  all.  right.  well.  Sometimes is  people.  Always  Often  Sometimes I  Always  around.  Sometimes  t h a t my l i f e Seldom  have  Always  Almost  Often  not  Sometimes  very  useful. Often  is  equal  of.  Often  am no good a t  person to  do a j o b , Seldom  toward  an  Almost Always  Often  Sometimes  Seldom  When I  10.  I  Seldom  Never 9.  think  Almost  Often  Sometimes  Seldom  Never 8.  attitude  on  Almost  a s w e l l a s most o t h e r  Sometimes  statements  qualities.  have much t o be p r o u d  take a p o s i t i v e  least  Often  Sometimes  Seldom  Never 6.  I  at  good  Sometimes  do t h i n g s  following word:  Often  Sometimes  Seldom  feel  worth,  have a number of  Never 3.  e a c h of t h e appropriate  141  APPENDIX 8 -  INVENTORY OF INTERPERSONAL PROBLEMS  PSYCHOTHERAPY RESEARCH QUESTIONNAIRE #4 Here is a list of p r o b l e m s t h a t other people. P l e a s e read the l i s t select the number that describes has been f o r y o u . Then c i r c l e t h a t 0 = Not a t a l l 1 = A little 2 = Moderately 3 = Quite a bit 4 = Extremely P a r t I. people. It  The f o l l o w i n g a r e  t h i n g s y o u f i n d h a r d t o do w i t h  i s hard  for  1 .  trust  other  2.  say  3.  join  4,  keep t h i n g s p r i v a t e  5.  let  6,  tell  7,  introduce myself  8,  confront  9,  be a s s e r t i v e w i t h a n o t h e r  10.  make  0  2  3  4  0  2  3  4  0  2  3  4  0  2  3  4  0  2  3  4  s t o p b o t h e r i n g me  0  2  3  4  to  0  2  3  4  0  2  3  4  0  2  3  4  0  2  3  4  0  2  3  4  0  2  3  4  0  2  3  4  0  2  3  4  0  2  3  4  0  2  3  4  people other  people  on g r o u p s  other  from o t h e r  p e o p l e know what  a person to  I  want  people with problems that  come u p .  person  friends, for  another  12,  have someone d e p e n d e n t  13,  disagree with other  14,  let  15,  make a l o n g - t e r m commitment person  17,  people  new p e o p l e  1 1 , e x p r e s s my a d m i r a t i o n  16,  other  me t o :  "no" to in  people report in r e l a t i n g to b e l o w , and for each item, how d i s t r e s s i n g t h a t p r o b l e m number.  other  on me  people  p e o p l e know when I  s t i c k t o my own p o i n t of swayed by o t h e r p e o p l e be a n o t h e r  person..  p e r s o n ' s boss  am a n g r y to  view  another 0 a n d not  be  142  18.  do what a n o t h e r  19.  g e t a l o n g w i t h p e o p l e who have o v e r me  20.  p e r s o n wants me t o do  be a g g r e s s i v e t o w a r d situation  calls  other  for  0  authority 0  p e o p l e when  the  it  21.  compete a g a i n s t  22.  make r e a s o n a b l e demands of  23..  s o c i a l i z e with other  24.  g e t o u t of a r e l a t i o n s h i p t h a t I d o n ' t want t o be i n . t a k e c h a r g e of my own a f f a i r s w i t h o u t h e l p  25.  from o t h e r  other  0  people  0  other  people....  people  0  people to  show a f f e c t i o n  27.  feel  28.  get  other  29.  understand another  30.  tell  31.  believe  32.  e x p r e s s my f e e l i n g s  0 people  0  people  0  person's point  personal things I  people  around other  along with other  that  to other  am l o v a b l e to  to  other  of  view..  people other  people..  0  people 0  33.  be f i r m  34.  e x p e r i e n c e a f e e l i n g of person be c o m p e t i t i v e when t h e  when I  need t o be  0  love  for  another 0  situation  calls  for  it  0  36.  set  37.  be h o n e s t w i t h o t h e r  38.  be s u p p o r t i v e of in  0 0  directly  35.  0 0  26.  comfortable  0  limits  on o t h e r  people people  another  feel  40.  really  0  person's goals  life  39.  0  0  close  to other  c a r e about  people  other  people's problems..  0 0  1 43  41.  argue w i t h another  42.  relax  person  and e n j o y m y s e l f  other  when I  go out  43.  feel  44.  become s e x u a l l y a r o u s e d t o w a r d t h e p e r s o n r e a l l y c a r e about f e e l that I deserve another p e r s o n ' s  45.  to another  1 2  3  4  0  1 2  3  4  0  1 2  3  4  0  1 2  3  4  0  1 2  3  4  0  1 2  3  4  0  1 2  3  4  0  1 2  3  4  1 2  3  4  3  4  3  4  3  4  with  people  superior  0  person I  affection 46.  keep up my s i d e of  47.  spend time a l o n e  48.  give a g i f t  49.  have l o v i n g and a n g r y f e e l i n g s t o w a r d s t h e same p e r s o n 0 m a i n t a i n a w o r k i n g r e l a t i o n s h i p w i t h someone I don't like 0  50. 51.  set  a friendship  to another  goals for  myself  person  without  other  2  people's  advice  1 2  0  1  0  1 2  3  4  accept another  53.  feel  54.  i g n o r e c r i t i c i s m from o t h e r  0  1 2  3  4  55.  f e e l l i k e a s e p a r a t e p e r s o n when I am i n a relationship 0 a l l o w m y s e l f t o be more s u c c e s s f u l t h a n o t h e r  1 2  3  4  0  1 2  3  4  0  1 2  3  4  0  1 2  3  4  0  1 2  3  4  0  1 2  3  4  0  1 2  3  4  0 0  1 2 1 2  3 3  4 4  good a b o u t  over me..  0  52.  56.  person's authority  1  winning people  people 57.  feel  58.  let  59.  respond s e x u a l l y  60.  accept praise  61.  put  62.  give c r e d i t to another person for doing something w e l l s t a y o u t of o t h e r p e o p l e ' s b u s i n e s s  63.  or  act  myself  competent feel  i n my r o l e  angry at  as p a r e n t .  somebody I  to another  from a n o t h e r  like...  person person  somebody e l s e ' s n e e d s b e f o r e my o w n . . . .  2  1 44  64.  take  instructions  authority  from p e o p l e who have  o v e r me  65.  feel  66.  g e t o v e r t h e f e e l i n g of l o s s a f t e r a r e l a t i o n s h i p has ended a s k o t h e r p e o p l e t o get t o g e t h e r s o c i a l l y  67.  good a b o u t  another  person's happiness.  w i t h me 68.  feel  angry  at  other  people  69.  give  c o n s t r u c t i v e c r i t i c i s m to  70.  experience  71.  open up and t e l l my f e e l i n g s t o a n o t h e r person f o r g i v e another person a f t e r I've been angry a t t e n d t o my own w e l f a r e when somebody e l s e i s needy  72. 73. 74. 75. 76. 77. 78.  be a s s e r t i v e h u r t i n g the  satisfaction  without w o r r y i n g about other p e r s o n ' s f e e l i n g s  be i n v o l v e d w i t h a n o t h e r f e e l i n g trapped  person  do work f o r my own sake i n s t e a d someone e l s e ' s a p p r o v a l . . .  when I  of  II.  The  79.  I  fight  80.  I  am t o o  81.  I  feel  following with other  am w i t h  things  people  get  irritated  83.  I  am t o o e a s i l y  3  4  0  1 2  3  4  0  1  3  4  0  1 2  3  4  0  1 2  3  4  0  1 2  3  4  0  1 2  3  4  0  1 2  3  4  0  1 2  3  4  0  1 2  3  4  0  1 2  3  4  0  1 2  3  4  0  1 2  3  4  0  1 2  3  4  2  other  that  you do t o o much.  t o o much  3  4  0  1 2  3  4  0  1 2  3  4  or a n n o y e d t o o e a s i l y  0  1 2  3  4  p e r s u a d e d by o t h e r  0  1 2  3  4  to c r i t i c i s m solving  other  p e o p l e ' s problems I  1 2  1 2  responsible for  82.  4  0  sensitive  too  are  3  for  people... Part  0  2  without  be c l o s e t o somebody w i t h o u t f e e l i n g t h a t I'm b e t r a y i n g somebody e l s e be s e l f - c o n f i d e n t  1  another  person sexual  0  people..  1 45  84.  I  want p e o p l e  0  1 2  3  4  85.  I  act  0  1 2  3  4  86.  I  am t o o d e p e n d e n t  on o t h e r  0  1 2  3  4  87.  I  am t o o  to  0  1 2  3  4  88.  I  open up t o  0  1 2  3  4  89.  I  am t o o  0  1 2  3  4  90.  I  am t o o a g g r e s s i v e  0  1 2  3  4  91.  I  try  0  1  3  4  92.  I  feel  attacked  0  1 2  3  4  93.  I  feel  too  0  1 2  3  4  94.  I  c l o w n a r o u n d t o o much  0  1 2  3  4  95.  I  want t o  0  1 2  3  4  96.  I  criticize  0  1 2  3  4  97.  I  trust  0  1 2  3  4  98.  I  try  0  1 2  3  4  99.  I  avoid other  0  1 2  3  4  0  1  2  3  4  0  1  2  3  4  0  1 2  3  4  0  1 2  3  4  0  1 2  3  4  0  1 2  3  4  0  1 2  3  4  100. 101.  like  to admire  a child  put  t o o much  sensitive people  people  rejection  t o o much  independent  to please  for  other  to c o n t r o l  other  what I  too m u c h . . .  have  done  t o o much t o o much  t o o much  other  people  people....  t o o much  people  people  people  other  people  by o t h e r  be n o t i c e d  other  toward  other  guilty  I am a f f e c t e d t o o much I  me t o o much  people  t o o much  t o o much  by a n o t h e r  p e r s o n ' s moods  p e o p l e ' s needs b e f o r e  my  own t o o much 102.  I  try  to  change o t h e r  103.  I  am t o o g u l l i b l e  104.  I  am o v e r l y  105.  I  am t o o a f r a i d  106.  I  worry  am t o o  of  other  other  t o o much a b o u t  reactions  people  generous to  t o o much  people  people  other  people's  t o me suspicious  of  2  107.  I  other  people  0  1 2  3  4  108.  I am i n f l u e n c e d t o o much by a n o t h e r p e r s o n ' s t h o u g h t s and f e e l i n g s  0  1 2  3  4  1 46  109.  I  110.  I worry people  111.  I  compliment  other  t o o much a b o u t  manipulate  get  people  what I  other  t o o much  disappointing  people  t o o much  I  113.  I t e l l personal things to other people t o o much I blame m y s e l f t o o much f o r c a u s i n g other p e o p l e ' s problems  115.  I  am t o o  easily  making demands of  me  117.  I am t o o e n v i o u s and j e a l o u s of o t h e r people I keep o t h e r p e o p l e a t a d i s t a n c e t o o much  120. 121. 122. 123. 124. 125.  126.  127.  I worry t o me I let much  people  t o o much about  other  people  t o o much  my f a m i l y ' s  take advantage  too g u i l t y t o do  for  what I  even when t h e c a l l for it  I feel people  in  front  I f e e l t o o a n x i o u s when another person I am a f f e c t e d by a n o t h e r m i s e r y t o o much I want t o t o o much  get  revenge  I  1 2  3  4  0  1 2  3  4  0  1 2  3  4  0  1 2  3  4  0  1 2  3  4  0  1  3  4  0  1 2  3  4  0  1 2  3  4  0  1 2  3  4  0  1  3  4  0  1 2  3  4  0  1 2  3  4  0  1 2  3  4  0  1 2  3  4  0  1  3  4  0  1 2  3  4  0  1 2  3  4  0  1 2  3  4  2  of  2  me t o o when  I  have  I feel competitive s i t u a t i o n d o e s not embarrassed t o o much  0  reactions  I t o o e a s i l y l o s e a s e n s e of m y s e l f am a r o u n d a s t r o n g - m i n d e d p e r s o n I feel failed  4  people  I  119.  with other  by o t h e r  116.  118.  argue  easily  bothered  3  to  112.  114.  too  1 2  other  want  l o s e my temper  0  of  other  am i n v o l v e d  2  with  person's  against  people  APPENDIX 9 -  WORKING ALLIANCE  PSYCHOTHERAPY RESEARCH  INVENTORY (CLIENT FORM) QUESTIONNAIRE #11  INSTRUCTIONS  On the f o l l o w i n g pages there are sentences that d e s c r i b e some of the d i f f e r e n t ways a person might think or feel about h i s or her t h e r a p i s t ( c o u n s e l l o r ) . As you read the sentences, mentally i n s e r t the name of your therapist (counsellor) in p l a c e of in the text.  Below each  2 Rarely  1 Never  you,  If the statement c i r c l e the number  Thi s  Work f a s t ;  statement  inside,  Occasionally  there  is a  seven-point s c a l e :  5 Often  Sometimes  Very  7 A1 ways  Often  d e s c r i b e s the way you a1 ways f e e l (or t h i n k ) , c i r c l e the number ' 7 ' ; i f i t never applies ' 1 ' . Use the numbers in between to d e s c r i b e the v a r i a t i o n s between these extremes.  quest ionnai re i s CONFIDENTIAL;  your f i r s t  impressions  nei ther your t h e r a p i s t  are the  ones we would  like  nor the agency  to s e e .  ITEM.)  Thank  you f o r your  © A. 0.  Horvath,  cooperation.  1981,  1982.  will  see  to  your answers.  (PLEASE DON'T FORGET  TO RESPOND  TO EVERY  Session I  f e e l uncomfortable with 1 2 Never Rarely and I 1 Never  I  4.  am w o r r i e d 1 Never  What I am 1 Never  5.  1 Never I  8.  f i n d what 1 Never  wi sh 1 Never  5 Often  Somet imes  things I w i l l need to do in therapy 3 4 Occasionally Sometimes  about the outcome 2 Rarely  of these s e s s i o n s . 3 Occasionally  g i v e s me new ways of 3 Occasionally  understand each o t h e r . 2 3 Rarely Occasionally  perceives accurately 2 Rarely  I be 1i eve 1 Never I  agree about the 2 Rarely  doing in therapy 2 Rarely  and I 1 Never  Occasionally  what my g o a l s are. 3 Occasionally  I am doing in therapy c o n f u s i n g . 2 3 Rarely Occasionally  Often  Date:  7 A1 ways  my s i t u a t i o n . 6 Very Often  7 A1 ways  Very  Often  7 Always  5 Often  Very  Often  7 Always  Somet i mes  5 Often  Very  Often  7 A1 ways  Somet imes  5 Often  Very  Often  7 A1 ways  Somet imes  5 Often  Very  Often  7 Always  Somet i mes  5 Often  Very  Often  7 A1 ways  5 Often  Very  Often  7 Always  Somet i mes looking at my 4 Sometimes  to help improve 5 Often  Very  :  5 Often problem.  1i kes me. 2 Rarely and I c o u l d 2 Rarely  Occasionally clarify  the purpose  3 Occasionally  of our  sessions.  4 Sometimes  CO  10.  11.  I d i s a g r e e with 1 Never I believe 1 Never  12.  the  14.  15.  16.  17.  18.  I am c l e a r 1 Never The g o a l s of 1 Never I f i n d what 1 Never I f e e l that 1 Never I  believe 1 Never  I am c l e a r 1 Never  and  time 2 Rarely  does not 1 Never  13.  about what 2 Rarely  I ought to 3 Occasionally  get out  of therapy. 4 Sometimes  I are spending 3 Occasionally  together is not spent e f f i c i e n t l y . 4 5 Sometimes Often  understand what I am t r y i n g to 2 3 Rarely Occasionally  on what my r e s p o n s i b i l i t i e s are in 2 3 Rarely Occasionally  accomplish in 4 Sometimes  and I 2 Rarely the things I 2 Rarely  are doing in therapy 3 Occasionally do in therapy will 3 Occasionally  4 Sometimes is  help  Very  6 Often  7 A1 ways  Very  6 Often  7 Always  5 Often  Very Often  7 Always  5 Often  Very  Often  7 A1 ways  5 Often  Very Often  7 A1 ways  therapy.  therapy. 4 Sometimes  these s e s s i o n s are important to me. 2 3 Rarely Occasionally  5 Often  u n r e l a t e d to my 4 Sometimes  concerns. 5 Often  me to accomplish 4 Sometimes  the changes that I want. 5 6 Often Very Often  Very  6 Often  7 Always  7 A1 ways  i s genuinely concerned f o r my w e l f a r e . 2 3 4 Rarely Occasionally Sometimes  5 Often  Very  Often  7 A1 ways  wants me to do 3 Occasionally  5 Often  Very  Often  7 Always  as to what 2 Rarely  in these s e s s i o n s . 4 Sometimes  and I  19.  respect each o t h e r . 2 3 Rarely Occasionally  1 Never 20.  21.  I feel 1 Never  I am c o n f i d e n t 1 Never  22.  and I 1 Never  23.  24.  25.  i s not 2 Rarely  that  I  f e e l that 1 Never  in  's  and I 1 Never  Very  Often  7 Always  5 Often  Very  Often  7 A1 ways  5 Often  Very  Often  7 A1 ways  Somet imes  5 Often  Very Often  7 A1 ways  f o r me to work on. 3 4 Occasionally Sometimes  5 Often  Very  6 Often  A1 ways  Very  6 Often  7 Always  5 Often  Very  Often  7 A1 ways  5 Often  Very  Often  7 A1 ways  his/her feelings 4 Sometimes  4 Sometimes  a p p r e c i a t e s me. 2 3 Rarely Occasionally  I am c l e a r e r 3 Occasionally  5 Often  me.  are working towards mutually agreed upon g o a l s . 2 3 4 Rarely Occasionally Sometimes  of these s e s s i o n s , 2 Rarely  27.  toward me. 5 Often  to help 3 Occasionally  As a r e s u l t 1 Never and I  7 Always  ability  2 Rarely  what is important 2 Rarely  1 Never  Often  t o t a l l y honest about 3 Occasionally  We agree on 1 Never  2G.  Very  Somet i mes  as to  one another. 2 3 Rarely Occasionally  how I might 4 Sometimes  be a b l e to 5 Often  change.  trust  have d i f f e r e n t 2 Rarely  ideas  on what my 3 Occasionally  Somet imes problems a r e . 4 Sometimes  O  28.  My r e l a t i o n s h i p with 1 Never  29.  f e e l i n g that 2 Rarely  and I  32.  I am f r u s t r a t e d 1 Never  35.  36.  I say or  do the 3 Occasionally  4 Somet i mes  wrong t h i n g s , 4 Sometimes  by the things 2 Rarely  I am doing in 3 Occasionally  t h i n g s that 1 Never  I d o n ' t know 1 Never I believe 1 Never I  feel 1 Never  the  _ i s asking me to do d o n ' t 2 3 Rarely Occasionally what to expect 2 Rarely way we are 2 Rarely  as the r e s u l t of my 3 Occasionally  Rarely  even when I 3  4 Sometimes  stop working with me. 5 6 Often Very Often  7 A1 ways  5 Often  Very  Often  7 A1 ways  5 Often  Very  Often  7 Always  that would be 5 Often  good f o r me. 6 Very Often  7 A1 ways  make sense. 4 Sometimes  5 Often  Very  Often  7 Always  therapy. 4 Sometimes  5 Often  Very  Often  7 A1 ways  5 Often  Very  Often  7 A1 ways  do things  Occasionally  7 Always  Very  will  working with my problem i s correct. 3 4 Occasionally Sometimes  cares about me 2  Often  5 Often  therapy.  We have e s t a b l i s h e d a good understanding of the kind of changes 1 2 3 4 Never Rarely Occasionally Sometimes  33.The  34.  if  to me.  c o l l a b o r a t e on s e t t i n g goals f o r my therapy. 2 3 4 Rarely Occasionally Sometimes  1 Never 31.  important 3 Occas i ona11y  Rarely  I have the 1 Never  30.  i s very 2  that he/she does 4  Sometimes  not approve o f . 5 Often  6  Very Often  7 Always  APPENDIX 1. my  I f e e l that I am f r e e l y , openly and honestly behaviour in t h i s therapy. 1 2 3 Never I  3.  4.  Rarely  f e e l that 1 Never  I am working 1 Never I am f u l l y  with my 2 Rarely  i n v o l v e d in the Rarely  that  Never 6.  I feel  process of t h i s  I am making 2 Rarely  a  good deal of  1 Never  PLEASE  Rarely  BE SURE TO  6  about  5  Sometimes  Often  Very Often  Always  5 Often  Very  Often  7 Always  changes I need to make. 4 5 Sometimes Often  Very  Often  7 Always  Very  Often  7 A1 ways  4  Occasionally  Sometimes  of t h i s 3  Occasionally  7  therapy.  therapy  5 Often  in order 4  to help me 5  Sometimes this  therapy  Very Often  6  7 Always  Very  7 Always  work.  4  5  Occasionally  Sometimes  Often  QUESTIONNAIRE IN  make changes.  Often  3  PLACE THE COMPLETED  information  therapy.  r e s p o n s i b i l i t y f o r making 2  and o f f e r i n g  4  3  the best use  FORM)  thoughts and f e e l i n g s  success of this 4 Sometimes  t h e r a p i s t to make 3 Occasionally  2  Never I feel 1  working toward the 3 Occasionally  together  INVOLVEMENT SCALE (CLIENT  e x p r e s s i n g my  Occasionally  I am a c t i v e l y 2 Rarely  1  5.  K> - CLIENT  THE ATTACHED ENVELOPE  Often  AND SEAL THE  ENVELOPE  APPENDIX 1J. -  WORKING ALLIANCE  PSYCHOTHERAPY RESEARCH  INVENTORY (THERAPIST FORM)  QUESTIONNAIRE #11  (THERAPIST FORM)  INSTRUCTIONS  feel  On the f o l l o w i n g pages there are sentences that d e s c r i b e some of the d i f f e r e n t ways a person might t h i n k about h i s or her c l i e n t . As you read the sentences, mentally i n s e r t the name of your c l i e n t in p l a c e of in the t e x t .  Below each  1 Never  you,  2 Rarely  If the statement c i r c l e the number  inside,  3 Occasionally  there i s a  seven-point  4 Sometimes  scale:  5 Often  6 Very Often  d e s c r i b e s the way you a1 ways f e e l (or t h i n k ) , c i r c l e the number 'T; if ' 1 ' . Use the numbers in between to d e s c r i b e the v a r i a t i o n s between these  T h i s quest ionnai re  Work f a s t ;  statement  your f i r s t  is  CONFIDENTIAL; nei ther your  impressions  are the  client  ones we would  like  nor  the agency w i l l  to see.  ITEM.)  Thank  you f o r your  ® A. 0.  Horvath,  cooperation.  1981,  1984.  or  7 Always  i t never applies extremes.  to  see your answers.  (PLEASE DON'T FORGET  TO RESPOND  TO EVERY  Session 1.  I f e e l uncomfortable with 1 2 Never Rarely  2.  and I  3.  and I 1 Never  5.  and I 1 Never  6.  I feel I 1 Never  7.  9.  concerns about the 2 Rarely  have a common 2 Rarely  f i n d s what  I believe 1 Never I sense a 1 Never  4 Sometimes  taken to  5 Often  improve h i s / h e r 4  5  Occasionally  Sometimes  Often  sessions. 4 Sometimes  5 Often  outcome of these 3 Occasionally  6 Very Often  7 Always  situation.  3  both f e e l c o n f i d e n t about the u s e f u l n e s s of our 2 3 4 Rarely Occasionally Sometimes  6  •  current a c t i v i t y 5 Often  in  7  Very Often  Always  6 Very Often  7 Always  therapy. 6 Very Often  7 Always  p e r c e p t i o n of h e r / h i s 3 Occasionally  goals. 4 Sometimes  5 Often  6 Very Often  7 Always  3 Occasionally  4 Sometimes  5 Often  6 Very Often  7 Always  we are doing 2 Rarely  in therapy c o n f u s i n g . 3 4 Occasionally Sometimes  5 Often  6 Very Often  7 Always  l i k e s me. 2 Rarely  3 Occasionally  5 Often  6 Very Often  7 Always  r e a l l y understand 2 Rarely  1 Never 8.  steps to be  Rarely  I have some 1 Never  4.  3 Occasionally  2  Never  Date:  .  agree about the  1  #:  need to c l a r i f y 2 Rarely  the purpose of 3  4 Sometimes  our s e s s i o n ( s ) 4  Occasionally  for  Sometimes  . 5 Often  6 Very Often  7 Always  10.  11.  12.  13.  14.  15.  I have some 1 Never I believe 1 Never  disagreements with 2 Rarely  that  I have doubts 1 Never I am c l e a r 1 Never  the time 2 Rarely  18.  and I are spending together 3 4 Occasionally Sometimes  about what we 2 Rarely  and e x p l i c i t about 2 Rarely  sessions. 5 Often  i s not spent 5 Often  are t r y i n g to accomplish in therapy. 3 4 Occasionally Sometimes what  's  3 Occasionally  Very  7 A1 ways  efficiently. 6 Very Often  7 Always  Very  Often  7 A1 ways  therapy. 5 Often  Very  6 Often  7 Always  5 Often  Very  5 Often  r e s p o n s i b i l i t i e s are 4 Sometimes  6 Often  in  The c u r r e n t goals of these s e s s i o n s are important 1 2 3 Never Rarely Occasionally  4 Sometimes  Often  7 Always  I f i n d what 1 Never  u n r e l a t e d to h e r / h i s current concerns. 4 5 6 Sometimes Often Very Often  7 Always  and I 2 Rarely  16. I feel confident des i r e s . 1 Never 17.  about the goals of these 3 4 Occasionally Sometimes  I am genuinely 1 Never I am c l e a r 1 Never  are doing in therapy 3 Occasionally  that the things 2 Rarely concerned f o r 2 Rarely  we do in  is  for  therapy w i l l  to  help  accomplish the changes  that he/she  3 Occasionally  4 Sometimes  5 Often  Very  s welfare. 3 Occasionally  Somet imes  5 Often  6 Very Often  7 Always  5 Often  Very Often  7 Always  as to what I expect to do 2 3 Rarely Occasionally  in these s e s s i o n s . 4 Sometimes  .  Often  7 A1 ways  and I  19 .  respect each o t h e r . 2 3 Rarely Occasionally  1 Never 20.  21.  22.  23.  I f e e l that 1 Never  Very  Often  7 A1 ways  5 Often  Very  Often  7 A1 ways  I am not  in my a b i l i t y 2 Rarely  Somet i mes  5 Often  Very  Often  7 A1 ways  We are working 1 Never  towards mutually agreed upon g o a l s . 2 3 4 Rarely Occasionally Sometimes  5 Often  Very Often  7 A1 ways  5 Often  Very  Often  A1 ways  5 Often  Very  Often  7 A1 ways  I  appreciate 1  We agree on 1 Never  25.  t o t a l l y honest about my f e e l i n g s toward 2 3 4 Rarely Occasionally Sometimes  5 Often  I am c o n f i d e n t 1 Never  Never 24.  Somet imes  and I 1 Never  27.  and I 1 Never  3 Occasionally  as a p e r s o n . 2 3 Rarely Occasionally what i s important 2  for  Rarely  As a r e s u l t 1 Never  26.  to help  of these s e s s i o n s , 2 Rarely have b u i l t 2 Rarely  a  have d i f f e r e n t 2 Rarely  to  Somet i mes work on.  3  4  Occasionally  Sometimes  is c l e a r e r 3 Occasionally trust. 3 Occasionally  as to 4  how she/he might 5  be a b l e to  change. 6  Sometimes  Often  Very  Often  7 A1 ways  Somet imes  5 Often  Very  Often  7 Always  Very  Often  7 A1 ways  mutual  ideas  on what h i s / h e r 3  Occasionally  real 4  problems  Sometimes  are. 5 Often  ON  28.  Our r e l a t i o n s h i p 1 Never  29.  has some  and I 1 Never  31.  if  3  4  5  Occasionally  Sometimes  Often  she/he says or 3 Occasionally  have c o l l a b o r a t e d 2  in  does the wrong t h i n g s , I will 4 5 Sometimes Often  s e t t i n g goals f o r 3  Occasionally  these s e s s i o n s . 4  Sometimes  by what I am asking her/him to do In 2 3 4 Rarely Occasionally Sometimes  We have e s t a b l i s h e d 1  between us of  stop working with h i m / h e r . 6 7 Very Often Always  5  6  7  Often  Very Often  Always  5 Often  6 Very Often  7 Always  of changes that 5  would be good 6  for  . 7  Very Often  Always  . 5 Often  6 Very Often  7 Always  5 Often  6 Very Often  7 Always  correct. 5 Often  6 Very Often  7 Always  even when he/she does things that I do not approve o f . 2 3 4 5 Rarely Occasionally Sometimes Often  6 Very Often  7 Always  we are doing 2 Rarely  b e l i e v e s the  I respect 1 Never  the kind  in therapy don't 3 Occasionally  Sometimes make much sense to 4 Sometimes  what to expect as the r e s u l t 2 3 Rarely Occasionally  1 Never  7 Always  therapy.  4  Occasionally  6 Very Often  Often  d o e s n ' t know 1 Never  35.  a good understanding 2 3  Rarely  The t h i n g s that 1 Never  34.  36.  to  is frustrated  Never 33.  f e a r s that 2 Rarely  Rarely  1 Never 32.  important 2  Rarely  1 Never 30.  is  of  therapy. 4 Sometimes  way we are working with h e r / h i s problem i s 2 3 4 Rarely Occasionally Sometimes  ^ vj-v  APPENDIX J_2 1. his/her  CLIENT INVOLVEMENT  SCALE (THERAPIST FORM)  is f r e e l y , openly and honestly expressing h i s / h e r thoughts behaviour in t h i s therapy. 1 2 3 4  Never 2.  Rarely is a c t i v e l y  1 Never 3.  i s working  is f u l l y 1 Never  5.  i s making 1 Never  6.  seems to 1 Never  together 2 Rarely  Occasionally  the best use 2 Rarely feel  a good 2 Rarely  6 Very Often  about 7 Always  therapy. 5  Sometimes  Often  Very Often  Always  to make. 5 Often  6 Very Often  7 Always  5 Often  6 Very Often  7 Always  in order to help him/her make changes. 4 5 6 Sometimes Often Very Often  7 Always  to make changes he/she needs 3 4 Occasionally Sometimes  of t h i s therapy 3 Occasionally  Often  information  4  with me  i n v o l v e d in the process of t h i s 2 3 Rarely Occasionally  and o f f e r i n g  5  Sometimes  working toward the success of t h i s 2 3 Rarely  1 Never 4.  Occasionally  and f e e l i n g s  therapy. 4 Sometimes  deal of r e s p o n s i b i l i t y f o r making 3 4 Occasionally Sometimes  this  therapy work. 5 Often  6  6 Very Often  7  7 Always  159  APPENDIX  13 -  RELATIONSHIP INVENTORY -  EMPATHY SUBSCALE  PSYCHOTHERAPY RESEARCH QUESTIONNAIRE or  Below a r e l i s t e d a v a r i e t y of ways t h a t behave i n r e l a t i o n t o a n o t h e r p e r s o n .  #12  one p e r s o n may  feel  P l e a s e c o n s i d e r e a c h numbered s t a t e m e n t w i t h reference to your p r e s e n t r e l a t i o n s h i p w i t h your c o u n s e l l o r , m e n t a l l y adding h i s o r h e r name i n t h e s p a c e provided. For example, if the other person's name was J o h n , you would r e a d s t a t e m e n t #1, a s ' J o h n wants t o u n d e r s t a n d how I see t h i n g s . ' Mark e a c h s t a t e m e n t i n t h e answer column on the right, a c c o r d i n g t o how s t r o n g l y you f e e l t h a t i t i s t r u e , o r n o t t r u e , in this relationship. P l e a s e be s u r e t o mark e v e r y o n e . Write i n +3, +2, +1, o r -1, -2, -3, to stand for the following answers: +3: +2: +1: -1: -2: -3:  Yes, Yes, Yes, than No, I than No, I No, I  I strongly feel that it i s true. I feel it is true. I f e e l t h a t i t i s p r o b a b l y t r u e , o r more t r u e untrue. f e e l t h a t i t i s p r o b a b l y u n t r u e , o r more u n t r u e true. f e e l i t i s not t r u e . s t r o n g l y f e e l t h a t i t i s not t r u e .  1.  wants  2.  may u n d e r s t a n d my words but way I  to  u n d e r s t a n d how I  see t h i n g s  _  h e / s h e d o e s not  see  the  feel  _  3.  nearly  always  4.  looks at  knows e x a c t l y  what I  what I  do f r o m h i s / h e r  mean  _  own p o i n t  of  view 5. 6.  usually I  feel  that  what h e / s h e 7.  senses or what is  feeling  him/her  what I  am  feeling....  says u s u a l l y expresses  ' s own a t t i t u d e s say p r e v e n t  realizes  and t h i n k i n g  toward  some of  at  that  the  from u n d e r s t a n d i n g me  exactly moment...  things  I  do o r  160  8.  wants me t o  think  that  u n d e r s t a n d s me more t h a n 9.  Sometimes because  10.  just or  the  that  I_ f e e l  takes  me o r  does  _  a certain  way,  way h e / s h e f e e l s  no n o t i c e  of  _  whole of  what  some t h i n g s  I  mean....  that  I  _  appreciates exactly feel At  how t h e  things  I  experience  t o me  _  times  about  thinks  a particular  14.  that  thing  I  than  feel I  a lot  really  more  strongly  do  _  u n d e r s t a n d s me  15.  _  ' s r e s p o n s e t o me i s u s u a l l y that  I  _  think  feel  12.  16.  that's  he/she r e a l l y  u s u a l l y understands the  11.  13.  thinks  he/she l i k e s  don't  When I exactly,  really  am h u r t without  or  get upset  so f i x e d  and  automatic  through to him/her c a n r e c o g n i z e my  becoming u p s e t  too  _ feelings _  161  APPENDIX  14 -  COUNSELOR RATING FORM  PSYCHOTHERAPY RESEARCH QUESTIONNAIRE  #13  L i s t e d below a r e s e v e r a l s c a l e s w h i c h c o n t a i n word p a i r s a t either end of the s c a l e and s e v e n s p a c e s between t h e p a i r s . P l e a s e r a t e t h e c o u n s e l o r you j u s t saw on e a c h of t h e s c a l e s . If word a t  you f e e l t h a t t h e c o u n s e l o r one end of the s c a l e , p l a c e fair  :  :  :  very c l o s e l y resembles a c h e c k mark as f o l l w s :  :  :  : _X  unfair  :  :  :  unfair  the  OR fair If you d e s c r i b e s the  _X:  :  :  think that one end of the s c a l e q u i t e c l o s e l y c o u n s e l o r t h e n make y o u r c h e c k mark as f o l l o w s :  rough  : _X  :  :  :  :  :  smooth  :  ! _X  :  smooth  OR rough  :  :  If you feel that d e s c r i b e s the c o u n s e l o r , active  :  :  one end of the scale only slightly t h e n c h e c k t h e s c a l e as f o l l o w s :  :  :  s  •  *  passive  '  passive  OR active  :  :  :  If both sides of t h e s c a l e seem e q u a l l y y o u r i m p r e s s i o n of t h e c o u n s e l o r o r i f t h e s c a l e t h e n p l a c e a c h e c k mark i n t h e m i d d l e s p a c e : hard Your  :  first  PLEASE NOTE: Copyright c, be r e p r o d u c e d  :  impression  : is  X : the  : best  PLACE CHECK MARKS IN M.B. L a C r o s s e and A . without p e r m i s s i o n .  :  associated with is irrelevant, soft  answer.  THE MIDDLE OF THE SPACES Barak,  1974,  1975.  Not  to  162  agreeable  :  :  :  _  unalert  :  :  :  analytic  :  :  :  unappreciative  :  :  :  attractive  :  :  :  casual  :  :  :  cheerful  :  :  :  unclear  :  :  :  distant  :  :  :  compatible  :  :  :  unsure  :  :  :  suspicious  :  :  :  undependable  :  :  :  ;  indifferent  :  :  :  :  inexperienced  :  :  :  :  inexpert  :  :  :  :  unfriendly  :  :  :  :  honest  :  :  :  :  informed  :  :  :  :  insightful  :  :  :  :  stupid  :  :  :  :  unlikeable  :  :  :  :  logical  :  :  :  :  open  :  :  :  :  prepared  :  :  :  :  unreliable  :  :  :  :  disrespectful  :  '  disagreeable alert diffuse appreciative unattractive formal depressed clear close incompatible confident believable  _  dependable  _  enthusiastic  _  experienced expert friendly dishonest ignorant insightless intelligent likeable illogical  closed unprepared reliable respectful  163  responsible  irresponsible  :  :  :  selfless  :  :  :  sincere  :  :  i  skillful  :  :  :  sociable  :  t  •  deceitful  :  :  trustworthy  :  :  genuine  :  :  warm  :  :  selfish insincere _  unsociable _  :  :  _ v_  '  unskillful  _  straightforward untrustworthy phony cold  164  APPENDIX  15 - HELPING ALLIANCE QUESTIONNAIRE  PSYCHOTHERAPY RESEARCH QUESTIONNAIRE  #14  Below a r e l i s t e d a v a r i e t y of ways t h a t one p e r s o n may f e e l or behave i n r e l a t i o n t o a n o t h e r p e r s o n . Please consider each statement w i t h r e f e r e n c e to your p r e s e n t r e l a t i o n s h i p w i t h your therapist. Mark e a c h s t a t e m e n t a c c o r d i n g t o how s t r o n g l y y o u f e e l t h a t i t i s t r u e , o r not true, in this relationship. P l e a s e mark every one. W r i t e i n +3, +2, +1 or - 1 , - 2 , - 3 , t o s t a n d f o r t h e following answers: +3. +2. +1. -1. -2. -3.  Yes, I strongly f e e l that i t i s true Yes, I f e e l i t i s true Y e s , I f e e l t h a t i t i s p r o b a b l y t r u e , o r more t r u e t h a n untrue N o , I f e e l t h a t i t i s p r o b a b l y u n t r u e , o r more u n t r u e than true N o , I f e e l i t i s not t r u e N o , I s t r o n g l y f e e l t h a t i t i s not t r u e  1.  I  believe  that  my t h e r a p i s t  2.  I  believe  that  the  3.  I  have o b t a i n e d  4.  I  have been f e e l i n g  5.  I  can a l r e a d y  problems I  i s h e l p i n g me.  treatment  i s h e l p i n g me.  some new u n d e r s t a n d i n g . better  see t h a t  came t o  I  recently.  will  treatment  work  out  the  for.  6.  I  feel  I  7.  I  feel  the  therapist  u n d e r s t a n d s me.  8.  I  feel  the  therapist  wants me t o a c h i e v e my g o a l s .  9.  I f e e l I am w o r k i n g t o g e t h e r w i t h t h e t h e r a p i s t i n a joint effort. I b e l i e v e we have s i m i l a r i d e a s a b o u t t h e n a t u r e o f my problems.  10. 11.  c a n depend upon t h e  eventually  therapist.  I f e e l now t h a t I can u n d e r s t a n d m y s e l f and d e a l w i t h m y s e l f on my own ( t h a t i s , even i f t h i s t h e r a p i s t and I were no l o n g e r m e e t i n g f o r t r e a t m e n t appointments).  165  APPENDIX  16 -  STRUPP POSTTHERAPY QUESTIONNAIRE  PSYCHOTHERAPY RESEARCH QUESTIONNAIRE 1.  How much i n need of f e e l now? No need a t a l l S l i g h t need C o u l d use more C o n s i d e r a b l e need V e r y g r e a t need  2.  What has l e d t o t h e t e r m i n a t i o n My d e c i s i o n My t h e r a p i s t ' s d e c i s i o n M u t u a l agreement External factors  3.  How much have you b e n e f i t t e d A great deal A f a i r amount To some e x t e n t Very l i t t l e Not a t a l l  4.  E v e r y t h i n g c o n s i d e r e d , how s a t i s f i e d therapy/counselling experience? Extremely d i s s a t i s f i e d Moderately d i s s a t i s f i e d Fairly dissatsifed Fairly satisfied Moderately satisfied Highly s a t i s f i e d Extremely s a t i s f i e d  5.  Was y o u r  6.  What i m p r e s s i o n d i d you have o f h i s / h e r e x p e r i e n c e as a t h e r a p i s t / c o u n s e l l o r ? Extremely inexperienced Rather inexperienced Somewhat i n e x p e r i e n c e d F a i r l y experienced Highly experienced Exceptionally experienced  7.  A t t h e b e g i n n i n g of t h e r a p y , were g e t t i n g a l o n g ? Very well F a i r l y well N e i t h e r w e l l nor p o o r l y F a i r l y poorly Very p o o r l y Extremely poorly  therapist  further  of  the  #5  therapy/counselling  of  your  from y o u r  do you  therapy/counselling?  therapy/counselling?  are  you w i t h y o u r  same sex as you? level  Yes  No  of  how w e l l d i d y o u f e e l  you  1 66  8.  How l o n g b e f o r e e n t e r i n g p r o f e s s i o n a l help? L e s s than 1 year 1-2 y e a r s 3-4 y e a r s 5-10 y e a r s 11-15 y e a r s 16-20 y e a r s years (specify)  9.  How s e v e r e l y d i s t u r b e d d i d y o u c o n s i d e r y o u r s e l f b e g i n n i n g of your t h e r a p y / c o u n s e l l i n g ? Extremely d i s t u r b e d V e r y much d i s t u r b e d Moderately disturbed Somewhat d i s t u r b e d Very s l i g h t l y d i s t u r b e d  10.  11.  12.  13.  therapy  How much a n x i e t y d i d y o u f e e l therapy/counselling? A t r e m e n d o u s amount A great deal A f a i r amount Very l i t t l e None a t a l l  at  d i d you f e e l  the  time you  i n need of  at  the  started  How g r e a t was t h e i n t e r n a l " p r e s s u r e " t o do s o m e t h i n g a b o u t t h e s e p r o b l e m s when y o u e n t e r e d t h e r a p y / c o u n s e l l i n g ? Extremely great Very great F a i r l y great R e l a t i v e l y small Very small Extremely small How much do y o u f e e l therapy/counselling? A great deal A f a i r amount Somewhat Very l i t t l e Not a t a l l  y o u have c h a n g e d a s a r e s u l t  of  How much of t h i s change do y o u f e e l has been a p p a r e n t t o others? (a) P e o p l e c l o s e s t t o y o u ( h u s b a n d , w i f e , etc.) A great deal A f a i r amount Somewhat Very l i t t l e Not a t a l l (BT C l o s e f r i e n d s A great deal A f a i r amount Somewhat Very l i t t l e Not a t a l l (cT C o - w o r k e r s , a c q u a i n t a n c e s , e t c . A great deal A f a i r amount Somewhat Very l i t t l e Not a t a l l  167  14.  On t h e w h o l e , how w e l l do you f e e l a l o n g now? Extremely w e l l Very w e l l Fairly well N e i t h e r w e l l nor p o o r l y F a i r l y poorly Very p o o r l y Extremely poorly  15.  How a d e q u a t e l y do you f e e l you a r e d e a l i n g present problem? Very adequately F a i r l y adequately N e i t h e r a d e q u a t e l y nor i n a d e q u a t e l y Somewhat a d e q u a t e l y Very inadequately  16.  To what e x t e n t have y o u r c o m p l a i n t s t h a t b r o u g h t y o u t o t h e r a p y / c o u n s e l l i n g c h a n g e d as a r e s u l t of treatment? Completely disappeared Very g r e a t l y improved C o n s i d e r a b l y improved Somewhat i m p r o v e d Not a t a l l i m p r o v e d Got worse  17.  How soon a f t e r e n t e r i n g t h e r a p y / c o u n s e l l i n g any marked c h a n g e ? h o u r s of t h e r a p y ( a p p r o x i m a t e l y )  18.  How s t r o n g l y would you recommend t h e r a p y / c o u n s e l l i n g c l o s e f r i e n d with emotional problems? Would s t r o n g l y recommend i t Would m i l d l y recommend i t Would not recommend i t Would a d v i s e a g a i n s t it  19.  you a r e  getting  with  any  d i d you  feel  to  P l e a s e i n d i c a t e the a d e q u a c y of t h i s q u e s t i o n n a i r e i n d e s c r i b i n g your therapy e x p e r i e n c e . G i v e any a d d i t i o n a l d a t a w h i c h y o u f e e l a r e r e l e v a n t t o an u n d e r s t a n d i n g of y o u r e x p e r i e n c e .  THANK-YOU FOR YOUR PARTICIPATION  IN  THIS PROJECT  a  168  APPENDIX  17 -  TARGET COMPLAINTS IMPROVEMENT RATING FORM  PSYCHOTHERAPY RESEARCH QUESTIONNAIRE  #1B  We a r e i n t e r e s t e d i n how much the following problems or difficulties of yours have changed since the b e g i n n i n g of therapy. P l e a s e c i r c l e t h e words t h a t d e s c r i b e y o u r p o s i t i o n . A  worse... same... slightly  b e t t e r . . . somewhat  better...a  lot  better  b e t t e r . . . somewhat  better...a  lot  better  b e t t e r . . . somewhat  better...a  lot  better  B  worse... same... slightly  C  worse...same...slightly  169  APPENDIX  18 -  THERAPIST DEMOGRAPHIC DATA SHEET  THERAPIST DEMOGRAPHIC DATA SHEET  1.  Professional  affiliation:  Psychologist  S o c i a l Worker  Psychiatrist  Other  2.  Highest  specify)  completed:  B.A.  M.D.  PhD.  Ed.D.  M.Ed.  B.S.W.  Other  3.  degree  (please  Counsellor  (please  Number of  specify)  years experience  None  1 -  6-10  11-15  (check  4.  Sex  5.  Identify/describe  characterizes  If  you  categories, analytic  one):  M  as a  therapist/counsellor:  5 More  F  the  theoretical  y o u r work w i t h t h i s  had  M.S.W.  particular  to place y o u r s e l f  w h i c h would y o u c h o o s e ? learning  orientation  in  most  following  three  client:  one of (check  which  the one)  humanistic  170  APPENDIX  19 -  THERAPIST POSTTHERAPY QUESTIONNAIRE  THERAPIST POSTTHERAPY QUESTIONNAIRE 1.  How much more t h e r a p y No need a t a l l S l i g h t need C o u l d use more C o n s i d e r a b l e need V e r y g r e a t need  do you f e e l y o u r  2.  What d e t e r m i n e d t h i s c h o i c e t o now? Client's decision Therapist's decision M u t u a l agreement External factors  3.  How much h a s y o u r A great deal A f a i r amount To some e x t e n t Very l i t t l e Not a t all  4.  E v e r y t h i n g c o n s i d e r e d , how s a t i s f i e d a r e y o u w i t h t h e r e s u l t s of y o u r c l i e n t ' s p s y c h o t h e r a p y e x p e r i e n c e ? Extremely d i s s a t i s f i e d Moderately d i s s a t i s f i e d Fairly dissatsifed Fairly satisfied Moderately satisfied Highly s a t i s f i e d Extremely satisfied  5.  As a t h e r a p i s t / c o u n s e l l o r , how would you d e s c r i b e Extremely inexperienced Rather inexperienced Somewhat i n e x p e r i e n c e d F a i r l y experienced Highly experienced Exceptionally experienced  6.  At t h e b e g i n n i n g o f t h e r a p y , c l i e n t was g e t t i n g a l o n g ? Very w e l l F a i r l y well N e i t h e r w e l l nor p o o r l y F a i r l y poorly Very p o o r l y Extremely poorly  client  client  needs now?  t e r m i n a t e w i t h your  benefitted  from  how w e l l  client  therapy?  d i d you f e e l  yourself?  your  171  7.  How s e v e r e l y d i s t u r b e d was y o u r therapy? Extremely d i s t u r b e d V e r y much d i s t u r b e d Moderately disturbed Somewhat d i s t u r b e d Very s l i g h t l y d i s t u r b e d  8.  How much a n x i e t y d i d y o u r c l i e n t of t h e r a p y ? A t r e m e n d o u s amount A great deal A f a i r amount Very l i t t l e None a t a l l  9.  How much i n t e r n a l " p r e s s u r e " d i d y o u r c l i e n t e x p e r i e n c e a b o u t t h e s e p r o b l e m s when h e / s h e e n t e r e d p s y c h o t h e r a p y ? Extremely great Very great F a i r l y great R e l a t i v e l y small Very small Extremely small  10.  11.  12.  How much do y o u f e e l therapy? A great deal A f a i r amount Somewhat Very l i t t l e Not a t a l l  you c l i e n t  client  at  the  beginning  experience at  the  of  beginning  has c h a n g e d a s a r e s u l t  How much of t h i s change do y o u f e e l has been others? (a) P e o p l e c l o s e s t t o h i m / h e r ( h u s b a n d , w i f e , A great deal A f a i r amount Somewhat Not a t a l l (BT C l o s e f r i e n d s A great deal A f a i r amount Somewhat Not a t a l l (cT C o - w o r k e r s , a c q u a i n t a n c e s , e t c . A great deal A f a i r amount Somewhat Not a t a l l On t h e w h o l e , how w e l l do y o u f e e l a l o n g now? Extremely well Very w e l l Fairly well N e i t h e r w e l l nor p o o r l y F a i r l y poorly Very p o o r l y Extremely poorly  apparent  to  etc.) Very  little  Very  little  Very  little  your c l i e n t  is  of  getting  172  13.  How a d e q u a t e l y do y o u f e e l y o u r c l i e n t p r e s e n t problem? Very adequately F a i r l y adequately N e i t h e r a d e q u a t e l y nor i n a d e q u a t e l y Somewhat i n a d e q u a t e l y Very inadequately  i s d e a l i n g w i t h any  14.  To what e x t e n t has y o u r c l i e n t ' s c o m p l a i n t ( s ) t h a t brought h i m / h e r to therapy changed as a r e s u l t of t r e a t m e n t ? Completely disappeared Very g r e a t l y improved C o n s i d e r a b l y improved Somewhat i m p r o v e d Not a t a l l i m p r o v e d Got worse  or  15.  How soon a f t e r e n t e r i n g t h e r a p y d i d y o u f e e l c h a n g e s had t a k e n p l a c e i n y o u r c l i e n t ? h o u r s of t h e r a p y (approximately)  that  symptom(s)  THANK-YOU FOR YOUR PARTICIPATION IN THIS PROJECT  marked  1 73  APPENDIX 20 - LETTER OF THANKS TO CLIENTS THE UNIVERSITY OF BRITISH COLUMBIA F a c u l t y of E d u c a t i o n Department of C o u n s e l l i n g P s y c h o l o g y 5780 T o r o n t o Road Vancouver, B . C . V6T 1L2  Dear  Participant,  Thank y o u f o r h e l p i n g us w i t h the Psychotherapy Research Project by c o m p l e t i n g our q u e s t i o n n a i r e s . In a p p r e c i a t i o n o f y o u r p a r t i c i p a t i o n , we a r e e n c l o s i n g a cheque f o r $ 2 5 . 0 0 .  Sincerely, Jean A d l e r Project Coordinator  174  APPENDIX 21  Symptom  -  INSTRUMENT SCORING KEYS  Checklist-90  .1  S o m a t i z a t i o n - 1 , 4, 12, 2 7 , 40, 42, 4 8 , 4 9 , 52, 5 3 , 5 6 , 58 O b s e ^ s s i v e - C o m p u l s i v e - 3 , 9, 10, 2 8 , 3 8 , 4 5 , 46, 5 1 , 5 5 , 65 I n t e r p e r s o n a l S e n s i t i v i t y - 6 , 2 1 , 3 4 , 3 6 , 37, 4 1 , 6 1 , 6 9 , 73 D e p r e s s i o n - 5 , 14, 15, 2 0 , 2 2 , 2 6 , 2 9 , 3 0 , 31, 32, 54, 7 1 , 79 Anxiety-2, 17, 2 3 , 3 3 , 3 9 , 5 7 , 72, 7 8 , 8 0 , 86 Anger-Hostility-11, 24, 6 3 , 6 7 , 74, 81 P h o b i c A n x i e t y - 1 3 , 2 5 , 47, 5 0 , 7 0 , 7 5 , 82 P a r a n o i d I d e a t i o n - 8 , 18, 4 3 , 68, 7 6 , 83 P s y c h o t i c i s m - 7 , 16, 3 5 , 62, 7 7 , 8 4 , 8 5 , 8 7 , 8 8 , 90 A d d i t i o n a l S c a l e s - 1 9 , 44, 5 9 , 6 0 , 64, 6 6 , 89 Self-Esteem 1,2,  Index  3 , 4 , 5 , 6 , 7 , 8 , 9 ,  Inventory  of  Interpersonal  J_0  1  Problems  H a r d t o be I n t i m a t e - 1 , 11, 2 6 , 3 0 , 3 4 , 37, 3 9 , 44, 7 0 , 7 1 , 72 H a r d t o be A s s e r t i v e - 2 , 5, 6, 8, 9 , 13, 17, 22, 3 2 , 3 3 , 35, 36, 4 3 , 5 7 , 6 9 , 7 4 , 78 H a r d t o be I n d e p e n d e n t - 4 , 16, 2 5 , 4 7 , 5 1 , 54, 5 5 , 5 6 , 66 H a r d t o be S o c i a b l e - 3 , 7, 10, 2 3 , 2 7 , 2 8 , 42, 4 6 , 4 8 , 62, 67 Hard to f e e l S e l f - W o r t h - 2 1 , 3 1 , 4 5 , 5 3 , 6 0 , 76 H a r d t o be S u p p o r t i v e - 1 2 , 18, 19, 2 9 , 3 8 , 4 0 , 50, 52, 6 1 , 64, 65 Hard t o be A g g r e s s i v e - 1 4 , 2 0 , 4 1 , 5 8 , 68 Not Members o f H s u b s c a l e s - 1 5 , 2 4 , 4 9 , 5 9 , 6 3 , 7 3 , 7 5 , 77 Too G i v i n g - 8 8 , 9 7 , 101, 104, 109, 113 Too A g g r e s s i v e - 7 9 , 8 2 , 9 0 , 9 6 , 9 8 , 102, 111, 112, 115, 116, 117, 123, 127 Too H y p e r s e n s i t i v e - 8 0 , 9 2 , 9 9 , 105, 106, 107, 108, 118, 124, 125 Too E a g e r t o P l e a s e - 8 1 , 8 3 , 9 1 , 9 3 , 103, 110, 114, 120, 122, 126 Too D e p e n d e n t - 8 4 , 8 5 , 8 6 , 8 7 , 9 4 , 9 5 , 100, 119, 121 Not Member o f T s u b s c a l e s - 8 9 Working  Alliance  GOAL: 3 , 6 , TASK: 2 , 4 , BOND: J _ , 5 ,  1  Inventory  (Client  Form)  9 , U> , J_2 , 14 , 22 , 7 , 11, 13, 15, 16, 8 , 17 , 19 , 20 , 21 ,  Reverse-weighted  items  are  underlined.  25 18 23  , , ,  27 24 26  , , ,  30 , 3J. , 28 ,  32 33 29  , , ,  34 35 36  175  Working A l l i a n c e GOAL: 3 , 5 , TASK: 2 , 4 BOND: 1 , 6 , Relationship 1,  2  ,  3,  Counselor  4  9  Inventory 10 11 17  ,  8  ,  12 ,  , , ,  13 19  Inventory ,  5,  Rating  6,  7  11  HA Type 1 HA Type 2 -  1, 9,  Therapist  -  -  , , ,  , , ,  25 18 23  27 , 24 , 26 ,  30 31 28  , 32 , 33 , 29  , , ,  34 35 36  Subscale) 10,  12,  ,11 13 ,  ,  15  , J_8 , 5  ,  6 ,  ,  16  12  ,  14,  15  ,  16  20  ,  21 ,  23  ,  25  24 7  , ,  , j_9  ,  26  ,  27  ,  28  ,  29  10  ,  14  ,  17  ,  9,  Questionnaire  2, 3, 4, 10, 11  5,  6,  7,  8  Questionnaire  3 , 4 , 18 J_2 , 13a , 13b - 1 , 1 4 , 1 5  Posttherapy  Satisfaction Change Adjustment  22 16 21  Form)  Form  Strupp Posttherapy Satisfaction Change Adjustment  , , ,  , 8 , 9 ,  T r u s t w o r t h i n e s s - 12 , 33 , 34 , 35 Attractiveness - 1 , 4 36 Helping A l l i a n c e  14 15 20  , ,  (Empathy  - 2 , 3 , 8  Expertness  (Therapist  ,  13c  ,  16  ,  V4  Questionnaire  3 , 4 j_0 , H a , 1 1b - 1 , 1 2 , 1 3  ,  1 1c  , 22  ,  3_0 , ,  32  ,  176  APPENDIX 22 -  On t h e following present the  ADDITIONAL  Strupp Posttherapy questions  study.  number  INFORMATION COLLECTED ON THE SPQ AND THE TPQ  of  were  Questionnaire  not  included  The numbers r e c o r d e d f o r  in  (Appendix the  16),  a n a l y s e s of  each item response  the the are  respondents.  2. What has therapy/counselling?  .led  to  the  termination  of  your  My d e c i s i o n - 4 My t h e r a p i s t ' s d e c i s i o n - 2 M u t u a l agreement -15 External factors -23 level  6. of  What i m p r e s s i o n d i d experience?  you  have  Extremely inexperienced Rather i n e x p e r i e n c e d Somewhat i n e x p e r i e n c e d F a i r l y experienced Highly experienced Exceptionally experienced No r e s p o n s e 7. At were g e t t i n g  the b e g i n n i n g along?  of  of  8. How l o n g b e f o r e p r o f e s s i o n a l help? Less than T year 1-2 y e a r s 3-4 y e a r s 5-10 y e a r s 11-15 y e a r s 16-20 y e a r s Over 20 y e a r s  entering  [your  therapist's]  - 2 - 0 - 4 -10 -20 - 7 - 1  therapy,  Very w e l l F a i r l y well N e i t h e r w e l l nor p o o r l y F a i r l y poorly Very p o o r l y Extremely poorly  of  how w e l l d i d y o u f e e l  you  -17 -16 - 5 - 1 - 3 - 2 therapy  d i d you f e e l  in  need  -16 - 8 - 5 - 9 - 3 - 1 - 2  9. How s e v e r e l y d i s t u r b e d d i d you c o n s i d e r y o u r s e l f b e g i n n i n g of y o u r t h e r a p y / c o u n s e l l i n g ?  at  the  177  Extremely d i s t u r b e d - 4 V e r y much d i s t u r b e d -16 Moderately disturbed -12 Somewhat d i s t u r b e d - 8 Very s l i g h t l y d i s t u r b e d - 4 10. How much a n x i e t y therapy/counselling?  d i d you f e e l  A tremendous amount A great deal A f a i r amount Very l i t t l e None a t a l l  about  time you  started  -15 -15 - 9 - 5 - 0  -15 -13 -12 - 4 - 0  17. How soon after any marked change?  entering  t h e r a p y / c o u n s e l l i n g d i d you  A f t e r l e s s than 5 hours of t h e r a p y a f t e r 5-10 h o u r s of t h e r a p y A f t e r more t h a n 10 h o u r s o f t h e r a p y No r e s p o n s e On t h e the  the  11. How g r e a t was t h e i n t e r n a l " p r e s s u r e " t o do something t h e s e p r o b l e m s when y o u e n t e r e d t h e r a p y / c o u n s e l l i n g ? Extremely great Very great R e l a t i v e l y small Very small Extremely small  feel  at  Therapist  following  present  Posttherapy  q u e s t i o n s were not  -19 -16 - 6 - 3  Questionnaire i n c l u d e d in  the  (Appendix a n a l y s e s of  19), the  study.  2. What c l i e n t now?  determined  this  choice  to  terminate  with your  Client's decision - 8 Therapist's decision - 0 M u t u a l agreement -17 External factors -19 5. yourself  As ?  a  therapist/counsellor,  Extremely inexperienced Rather inexperienced Somewhat i n e x p e r i e n c e d F a i r l y experienced Highly experienced  - 1 - 0 - 5 -20 -16  how  would  you  describe  178  Exceptionally No r e s p o n s e  experienced  6. At t h e b e g i n n i n g of c l i e n t was g e t t i n g a l o n g ?  therapy,  Very w e l l F a i r l y well N e i t h e r w e l l nor p o o r l y F a i r l y poorly Very poorly Extremely poorly No r e s p o n s e of  7. How s e v e r e l y therapy?  1 1 how w e l l d i d you f e e l  8. How much anxiety b e g i n n i n g of t h e r a p y ? A tremendous amount A great deal A f a i r amount Very l i t t l e None a t a l l No r e s p o n s e  did  your  - 2 -10 - 4 -15 -10 - 2 - 1  d i s t u r b e d was y o u r c l i e n t  Extremely disturbed V e r y much d i s t u r b e d Moderately disturbed Somewhat d i s t u r b e d Very s l i g h t l y d i s t u r b e d No r e s p o n s e  about  -  at  the  beginning  - 5 - 4 -18 -11 - 5 - 1 your  client  experience  at  the  - 4 -15 -21 - 3 - 0 - 1  9. How much i n t e r n a l " p r e s s u r e " d i d y o u r c l i e n t experience t h e s e p r o b l e m s when h e / s h e e n t e r e d p s y c h o t h e r a p y ? Extremely great Very great F a i r l y great R e l a t i v e l y small Very small Extremely small No r e s p o n s e  - 6 -13 -20 - 3 - 0 - 0 - 2  15. How soon a f t e r e n t e r i n g therapy did marked c h a n g e s had t a k e n p l a c e i n y o u r c l i e n t ? A f t e r l e s s than 5 h o u r s of t h e r a p y A f t e r 5-10 h o u r s of t h e r a p y A f t e r more t h a n 10 h o u r s of t h e r a p y No r e s p o n s e  -13 -23 - 6 - 2  you  feel  that  179  APPENDIX 23 - R E L I A B I L I T Y The  computer  Research Test estimate the  package  Analysis  LERTAP  algorithm  to  items  LERTAP  Nelson,  Hoyt's  (1941)  coefficients  I n t e r n a l c o n s i s t e n c y i s an subscale  (Laboratory 1974)  Educational  was  estimate  analysis  of  internal  of  the  used  to  employed i n of  variance  consistency.  extent  to  which  a l l t a p t h e same c o n s t r u c t . can  be  used  to  calculate  coefficient  alpha,  a measure o f t o t a l  degree  which  the s u b s c a l e s of the t e s t  to  of  of each of the i n s t r u m e n t s  uses  compute  LERTAP  Package;  the r e l i a b i l i t y  study.  ESTIMATES OF THE INSTRUMENTS  test  Cronbach's  reliability,  (1951) or  the  t e n d t o measure t h e  same t h i n g .  When s u b s c a l e s measure q u i t e  distinct  constructs,  the  i s e x p e c t e d t o be l e s s  than  the r e l i a b i l i t y  suggested the  total  that  total  scale  hodgepodge  found i n each of the  this  coefficient  score r e f l e c t s  of elements  q u o t e d by N e l s o n , All  scale r e l i a b i l i t y  alpha  unrelated  subscales. i s an i n d e x  "common e l e m e n t s  Cronbach of how much  rather  e a c h s p e c i f i c t o one s u b t e s t "  1974, p .  than  a  (Cronbach,  280).  o f t h e p r o c e s s and outcome  measures  employed  s t u d y were a n a l y z e d w i t h LERTAP and t h e r e s u l t s Table  or  in  the  are presented  in  22. The  means  and  measures a r e p r e s e n t e d deviations  standard  deviations  in Table  21.  The  of  the  means  o f t h e outcome m e a s u r e s a r e p r e s e n t e d  and  1.2  of C h a p t e r  ),  i n Appendix  SPQ and T P Q ) .  IV  (target  26, T a b l e  complaints  relationship and  in Sections  improvement  26 ( S C L - 9 0 and I I P ) ,  standard 1.1  and t h e SEI  and i n T a b l e  22 (  180  Table  21  -  Means and S t a n d a r d D e v i a t i o n s Measures  #1 Working  Alliance  Goal Task Bond Composite  Working  Task Bond Composite 'lient  Inventory  Responsib'ty Collaborat' n Composite  Responsib'ty Collaborat'n Composite  (Client  12. 61 1 . 78 12. 89 1 . 69 12. 30 2. 05 3 7 . 73 5. 03  Involvement  Participat'n  Session #4  (Client 70. .43 8. ,40 71 ..05 7. .76 72. .55 6. .93 214. .02 21 ..17  #5  #10  Final  71 ,.05 7. .88 72, .02 7, .48 72, .81 7, .49 215, .88 21 ,.06  70. .63 7. .77 72, .07 7, .60 73. .07 8. .00 215. .78 21 ..21  7 2 . 65 72, .05 7. 19 7, .45 71 . 92 72, .02 7. 1 1 7, .35 7 5 . 19 73, .82 7, .55 6. 09 219. 77 217, .89 17. 96 20, .50  Form)  68 .23 7 .83 68 .95 6 .77 71 .77 7 .25 208 .95 20 .64  68. 9. 68. 8. 72. 7. 208. 24.  66 .96 19 37 8 .12 67 .00 48 77 6 .66 72 .12 31 36 5 .88 98 206 .08 31 19 .28  70 .17 7 .81 69 .57 8 .43 73 .36 6 .25 213 .10 21 .48  Form)  12.65 1 .51 12.67 1 .48 12.19 1 .93 37.51 4.51  (Therapist  1 1 37 . 1 . 81 10. 91 1 . 99 10. 88 1 . 98 33. 16 5. 35  Relationship  Form)  (Therapist  6 3 . 53 6 5 . 19 66. 91 8. 66 9.03 8. 09 6 5 . 58 67.07 6 7 . 70 7. 37 7. 63 8.20 6 7 . 91 71 . 63 70.09 7. 17 7.62 5. 85 197. 02 2 0 2 . 3 5 206. 23 21 . 29 23.44 2 0 . 35  Involvement  Participat'n  !lient  Inventory  #3  68. ,50 69. .02 10. ,62 8. .82 69. .36 70, .02 9. .86 8, .52 70. .25 70, .81 8. .34 6, .97 208. . 1 1 209, .86 26. .95 22, .47  Alliance  Goal  #2  of  1 1 .67 1 .99 1 1 .44 2.11 1 1 .40 1 .95 34.51 5.89  12. 41 1 . 58 12. 59 1 . 45 12. 1 1 1 . 60 37. 1 1 4. 35  12 .61 1 .50 1 2.86 1 .37 12 .21 1 .81 37 .67 4 .42  12. 49 1 . 91 12. 83 1 . 45 12. 05 2 . 02 3 7 . 37 5. 10  12 .69 1 .19 12 .92 1 .09 12 .35 1 .41 37 .96 3 .41  12 .21 1 .62 12 .61 1 .22 12 .09 1 .64 37 .91 4 .19  1 1 86 . 1 . 95 1 1 79 . 2. 08 1 1 57 . 1 . 64 3 5 . 21 6. 1 1  1 1.88 1 .64 1 1.36 2 .16 1 1.48 1 .83 34 .72 5 .47  1 1.88 1 .69 11 .76 2 .08 1 1.62 2. 1 1 35 .24 5 .75  Form) 1 2.09 1 1 84 . 1 .53 1 . 94 1 1.70 1 1 51 . 1 .78 1 . 83 1 1.84 1 1 58 . 1 .76 1 . 65 34. 93 35 .63 5. 1 4 4 .81  181  Table  21  (Cont'd.)  #!_ Relationship  Counselor  #1_  Inventory  #3  Session #4  (Empathy s u b s c a l e ) 75.21 9.30  R a t i n g Form  Expertness Attractiveness Trustworthiness Composite Helping Alliance HA Type  1  HA Type  1  Composite  74.91 7.32 72.91 7.27 78.05 6.32 225.86 19.57 Questionnaire 41.32 4.68 13.83 1 .96 55.15 6.18  #5  #10  Final  182  Table  22  -  Reliability  Estimates  Hoyt's Relationship Working Goal Task Bond  Working A l l i a n c e Goal Task Bond  Inventory  Inventory  ( T h e r a p i s t Form) .92 (.88 t o .95) .91 (.84 t o .93) .82 (.72 t o .88)  (Client  C l i e n t Involvement Participation Responsibility Collaboration  (Therapist  Inventory  Helping Alliance HA Type HA Type  The median measures.  Coefficient  ( C l i e n t Form) .87 (.84 t o .89) .87 (.77 t o .90) .81 (.75 t o .85)  C l i e n t Involvement Participation Responsibility Collaboration  figure  Form) .79 (.68 .72 (.51 .85 (.73 Form) .80 (.74 .88 (.83 .92 (.86  (Empathy .81  C o u n s e l o r R a t i n g Form Expertness Attractiveness Trustworthiness  1  the  Instruments  Cronbach's Alpha  Measures  Alliance  Relationship  of  .91  (.85  to  .92)  .94  (.90  to  .94)  to to to  .85) .84) .89)  .92  (.89  to  .93)  to to to  .87) .94) .98)  .96  (.92  to  .97)  subscale) N/A  .84 .80 .82  .88  Questionnaire .61  .84  71  and t h e  range  are  reported  for  the  repeated  183  Table  22  (Cont'd.) Hoyt's  Outcome Target  N/A  Complaints  Symptom C h e c k l i s t - 9 0 Somatization Obsessive-Compulsive Interpersonal Sensitivity Depression Anxiety Hostility Phobic Anxiety Paranoid Ideation P s y c h o t i c ism  ,81/.84 81/.86 ,75/.82 ,85/.86 ,77/.86 ,66/.58 ,64/.84 ,65/.82 ,75/.81  Self-Esteem  ,90/.87  Index  Strupp Posttherapy Satisfaction Change Adjustment  N/A ,94/.95  Problems .78/.83 .87/.90 .75/.75 .87/.89 .57/.48 .70/.60 .67/.74 .70/.80 .85/.83 .81/.91 .75/.86 .88/.83  Questionnaire .25 .62 .74  Therapist Posttherapy Satisfaction Change Adjustment  3  Cronbach's Alpha  Measures  Inventory of I n t e r p e r s o n a l H a r d t o be I n t i m a t e H a r d t o be A s s e r t i v e H a r d t o be I n d e p e n d e n t H a r d t o be S o c i a b l e Hard t o f e e l S e l f - W o r t h H a r d t o be S u p p o r t i v e H a r d t o be A g g r e s s i v e Too G i v i n g Too A g g r e s s i v e Too H y p e r s e n s i t i v e Too E a g e r t o P l e a s e Too Dependent  2  Coefficient  87/.87  S.D. .69 .72 .82  Questionnaire .66 .89 .85 .78 .87 .90  70  S.D. .58  77  .74  Pretest/posttest coefficients. Means a r e n o t r e p o r t e d f o r t h e SPQ a n d f o r t h e TPQ b e c a u s e t h e number of possible responses per item varied on these instruments and, hence, item s c o r e s were s t a n d a r d i z e d b e f o r e s u b s c a l e s c o r e s were c o m p u t e d .  184  APPENDIX 24  Therapists:  In  DEMOGRAPHIC ANALYSIS OF THE SAMPLE  order  to d e s c r i b e the  have been c a t e g o r i z e d  i n v a r i o u s ways  that  they  at  18).  These c a t e g o r i z a t i o n s  provided  Table Professional  23 -  the  end of  are  from t h e their  presented  Categorization  affiliation  sample,  of  the  therapists  demographic  engagements in Table  23.  Therapists 2 1 9 23  Ph.D. M.S.W. B.S.W. M.A./M.Ed. B.A.  3 5 4 17 6  E x p e r i e n c e as a t h e r a p i s t  More t h a n 15 y e a r s 11-15 y e a r s 6-10 y e a r s 1-5 y e a r s Less than 1 year  3 6 7 18 1  Theoretical orientation (with t h i s c l i e n t )  Analytic Learning Humanistic  4 3 37  Gender  Female Male  21 14  degree  completed  1  data  (Appendix  Registered Psychologists Unregistered Psychologists S o c i a l Workers Counsellors  Highest  1  -  G e l s o and C a r t e r (1985) have d e f i n e d t h e t h r e e orientations as follows: Analytic: Approaches that place a premium on making t h e u n c o n s c i o u s c o n s c i o u s and t h a t a t l e a s t use F r e u d i a n p e r s o n a l i t y t h e o r y as a b a s i c s t a r t i n g p o i n t . Learning: Approaches based on or highly compatible with principles o f c l a s s i c a l or i n s t r u m e n t a l c o n d i t i o n i n g , a n d , most recently, cognitive mediational process. H u m a n i s t i c : The p e r s p e c t i v e t h a t p a y s greatest attention to the client's (and t h e t h e r a p i s t ' s ) " h e r e - a n d - n o w " f u n c t i o n i n g , to the client's inherent trustworthiness and capacity for actualization. (pp. 196-197)  185  Clients:  The c l i e n t s  ways a s p r e s e n t e d b e g i n n i n g of  have a l s o been c a t e g o r i z e d  in Table  24  their  therapies  Table  24 -  from t h e  data  (Appendix  5).  Categorization  of  they  in  various  p r o v i d e d at  Clients  Age  18-25 y e a r s 26-35 y e a r s 36-45 y e a r s Over 45 y e a r s  11 18 9 6  Gender  Female Male  29 15  Single Married Divorced  17 1 3 14  Some h i g h s c h o o l High s c h o o l graduates Some c o l l e g e College graduates Some g r a d u a t e s t u d i e s  4 5 1 5 10 10  Marital  Status  Education  Level  Thirty-three (i.e.,  client  of  and  the  therapeutic  therapist  both  the  dyads  female  or  were  same-gender,  both m a l e ) ,  and  11  were c r o s s - g e n d e r . Although p r e c i s e number they to  of  sessions  constituting  r a n g e d from 6 t o seven  estimated  months. to  be  12.  information  was  not  each c a s e ,  it  collected  on  the  was e s t i m a t e d  that  25 s e s s i o n s and i n d u r a t i o n The a v e r a g e  number  of  from s i x  sessions  per  weeks  c a s e was  186  APPENDIX 25 -  It by  ESTABLISHMENT OF THE ALLIANCE THROUGH EARLY SESSIONS  h a s been h y p o t h e s i z e d t h a t  approximately  Greenberg, In  measures of  to  the in  test  25 -  Table  .71 .55 .61 .52  The p r e s e n t of  the  fifth  this  h y p o t h e s i s , the  25  suggested that  from S e s s i o n  established  session  (Horvath  &  first  five  repeated  alliance  session measures.  Session #3  #2  .78 .79 .73  study, the  alliance  WAIc a t  #4  .86 .80  did  data  indeed  the  First  Five  #5  .81  therefore, average  the  The  3 on.  I n t e r c o r r e l a t i o n s of t h e Sessions  #1 Session 1 Session 2 Session 3 Session 4 Session 5  to  is  WAIc were c o r r e l a t e d w i t h one a n o t h e r .  become more s t a b l e Table  third  alliance  1986).  order  presented  the  the  of  has employed a s the  third,  its  fourth,  measure and  fifth  187  APPENDIX 26 - MAGNITUDE OF CHANGE ON THE OUTCOME MEASURES  Analyses posttest  on  Interpersonal (i.e., are  of the  magnitude  of  change  Symptom C h e c k l i s t - 9 0  Problems  pretest  presented  the  were  and p o s t t e s t )  in Table  26.  performed  and as  from the  pretest  to  Inventory  of  repeated  MANOVAs u s i n g S P S S : X .  measures The  results  188  Table  26 - M a g n i t u d e o f Change on Symptom C h e c k l i s t - 9 0 a n d Inventory of I n t e r p e r s o n a l Problems N of  Items  Mean  S . D.  F  1 2  Symptom C h e c k l i s t - 9 0 Somat i z a t i o n - p r e -post  12  9.03 5.68  8. 46 6. 50  8. 3 9 * *  Obsessive-Compulsive-pre -post  10  16.92 8.66  7. 98 6. 77  45. 5 4 * * *  9  13.90 8.88  6. 95 6. 42  26. 3 6 * * *  Depress ion-pre -post  1 3 2 5 . 5 3 1 1 01 . 1 2 . 7 8 8 . 95  46. 8 7 * * *  Anxiety-pre -post  10  Interpersonal  2  3  1 3 . 5 3 7 . 30 7 . 48 8.43  19. 3 4 * * *  Hostility-pre -post  6  6.05 3.52  5. 45 4 . 29  Phobic  7  3.45 2.15  4 . 06 3 . 36  6  7.07 4.09  4 . 60 4 . 25  25. 1 3 * * *  Psychoticism-pre -post  1 0  8.75 4.56  6. 99 6 . 12  21 . 3 4 * * *  SCL-90  90  Anxiety-pre -post  Paranoid  1  S e n s i t i v i t y -- p r e -post  Ideation-pre -post  Total-pre -post  114.50 54. 26 6 4 . 8 2 5 0 . 30  20. 7 3 * * * 6. 54*  3  4. g O * * *  U n i v a r i a t e F - t e s t s are reported f o r the s u b s c a l e s . Hotellings (1951) multivariate test of s i g n i f i c a n c e i s reported f o r the scale totals. The s t a n d a r d e r r o r o f t h e p a i r difference, (i.e., the pooled within-groups S.D. divided by t h e square root o f n ) , was employed i n computing the F - v a l u e . The mean t o t a l p a t h o l o g y p r e s c o r e o f 1.27 ( S . D . = . 6 0 ) is almost identical to the p r e s c o r e of 1.25 ( S . D . = .3.9) reported by D e r o g a t i s , R i c k e l s , and Rock (1976) i n t h e i r v a l i d a t i o n s t u d y o f the S C L - 9 0 .  189  Table  26  (Cont'd.) N of  Inventory Hard  of  t o be  Hard  t o be  Hard  t o be  Interpersonal  1 1  Assertive-pre -post  17  Independent-pre -post  t o be  Hard  to f e e l t o be  Hard Too Too  t o be  1 1  Sociable-pre -post  6  Self-Worth-pre -post Supportive-pre -post  1 1  Aggressive-pre -post  5  IlP-pre -post  Significant Significant Significant  difference, difference, difference,  1 1 83 . 13. 57  16 .66 1 3.09  6. 44 5. 89  40 .98 12 .01  8. 12 8. 39  9 .80 8 .31  4. 91 3. 98  13 .34 9 .97  6. 60 6. 58  10 . 1 5 4. 15 8 .77 4. 87  3g***  15. 1 g * * * 21 . 3  ^ ***  1 1 4 8 .4 8 * * * 6. 39* 17.  74***  6. 49*  8. 84 8. 55  8. 5 7 * *  17 .56 1 4.19  8. 53 8. 94  13. 7 2 * * *  18 .16 1 5.03  8. 94 7 . 58  10. 5 0 * *  1 5.56 12 .05  6. 45 6. 52  17. 3 6 * * *  1 27 231 .51 164 .68  6 7 . 84 72. 93  10  Dependent-pre -post  Total  36 .31 30 .70  25.  14 .88 1 1.72  10  Too  8. 00 7. 18  2 . 86  Hypersensitive-pre -post Please-pre -post  15 .28 10 .61  F  4. 65 4. 75  13  to  S.D.  7 .91 6 .99  6  Aggressive-pre -post  Too E a g e r  * ** ***  9 •  Giving-pre -post  Too  Mean  Problems  Intimate-pre -post  Hard  Hard  Items  9  pj^.05 p_^.0l p_<.00l  1 7 8 .37***  

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