UBC Theses and Dissertations

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UBC Theses and Dissertations

The differential effects of empathic reflection and the Gestalt empty-chair dialogue on depth of experiencing… Maslove, Vera Joyce 1989

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THE DIFFERENTIAL EFFECTS OF EMPATHIC REFLECTION AND THE GE5TALT EMPTY-CHAIR DIALOGUE ON DEPTH OF EXPERIENCING WHEN / USED WITH AN ISSUE OF UNFINISHED BUSINESS By VERA 30YCE MASLOVE B.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 , 1976 B . S . W . , 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 , 1978 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTERS OF ARTS i n THE FACULTY OF GRADUATE STUDIES THE DEPARTMENT OF COUNSELLING PSYCHOLOGY We a c c e p t t h i s t h e s i s as c o n f o r m i n g to the r e q u i r e d s t a n d a r d THE UNIVERSITY OF BRITISH COLUMBIA 3 u l y 1989 ( c i V e r a J o y c e M a s l o v e , 1989 In presenting this thesis in partial fulfilment of the requirements for an advanced degree at the University of British Columbia, I agree that the Library shall make it freely available for reference and study. I further agree that permission for extensive copying of this thesis for scholarly purposes may be granted by the head of my department or by his or her representatives. It is understood that copying or publication of this thesis for financial gain shall not be allowed without my written permission. Department of y The University of British Columbia Vancouver, Canada DE-6 (2/88) ABSTRACT The p u r p o s e of t h i s s t u d y was to compare the d i f -f e r e n t i a l e f f e c t s of two c o u n s e l l i n g i n t e r v e n t i o n s ( e m p a t h i c r e f l e c t i o n and the G e s t a l t e m p t y - c h a i r d i a l o g u e on c l i e n t p r o c e s s (as measured by the E x p e r i e n c i n g S c a l e ) when used w i t h a c l i e n t i s s u e of u n f i n i s h e d b u s i n e s s . The p o p u l a t i o n c o n s i s t e d of 28 s u b j e c t s drawn f r o m g r a d u a t e and u n d e r g r a d u a t e s t u d e n t s e n r o l l e d i n a c o u n s e l l i n g c o u r s e at a ma j o r u n i v e r s i t y . S u b j e c t s were randomly a s s i g n e d to the e m p a t h i c r e f l e c t i o n c o n -d i t i o n or to the G e s t a l t e m p t y - c h a i r d i a l o g u e c o n d i t i o n . The empathy s c a l e of the B a r r e t t - L e n n a r d R e l a t i o n s h i p I n v e n t o r y (RI) was admi n i s t e r e d . t o s u b j e c t s to a s s e s s t h e i r p e r c e i v e d t h e r a p i s t ' s empathy. The p r o c e s s measure the E x p e r i e n c i n g S c a l e was used to measure the i n - s e s s i o n d i f f e r e n t i a l e f f e c t s of the two c o u n s e l l i n g i n t e r v e n t i o n s The s t u d y showed t h a t the G e s t a l t e m p t y - c h a i r d i a l o g u e c o n d i t i o n p r o d u c e d s i g n i f i c a n t l y h i g h e r l e v e l s of e x p e r -i e n c i n g t h a n the e m p a t h i c r e f l e c t i o n c o n d i t i o n . The r e s u l t s s u g g e s t t h a t the G e s t a l t e m p t y - c h a i r d i a l o g u e i n the c o n t e x t of an e m p a t h i c r e f l a t i o n s h i p may make a c o n -t r i b u t i o n to the t r e a t m e n t of u n f i n i s h e d b u s i n e s s . - i i i -TABLE OF CONTENTS Ab s t r ac t i i T a b l e of C o n t e n t s i i i L i s t of T a b l e s v i CHAPTER I INTRODUCTION 1 The P r o b l e m and B a c k g r o u n d of the P r o b l e m 1 J u s t i f i c a t i o n f o r the Study 6 D e f i n i t i o n of Terms 7 U n f i n i s h e d B u s i n e s s 7 E m p a t h i c R e f l e c t i o n 8 G e s t a l t E m p t y - C h a i r D i a l o g u e 9 The E x p e r i e n c i n g S c a l e 11 H y p o t h e s e s 1 2 CHAPTER I I LITERATURE REV IEW 16 U n f i n i s h e d B u s i n e s s i n P s y c h o t h e r a p y 16 R e s e a r c h i n the Use of G e s t a l t T e c h n i q u e s i n P s y c h o t h e r a p y 25 R e s e a r c h on the G e s t a l t T r e a t m e n t A p p r o a c h w i t h t h e I s s u e of U n f i n i s h e d B u s i n e s s 29 R e s e a r c h i n the Use of E m p a t h i c R e f l e c t i o n i n P s y c h o t h e r a p y 31 - i v -TABLE OF CONTENTS - C o n t i n u e d The E x p e r i e n c i n g S c a l e and I t ' s Use i n P s y c h o t h e r a p y 36 Change P r o c e s s R e s e a r c h 45 In C o n c l u s i o n and P u r p o s e of t h i s S tudy 54 CHAPTER I I I METHODOLOGY 5 5 P a r t i c i p a n t s i n the Study 55 S u b j e c t s 55 T h e r a p i s t s 56 A d h e r e n c e R a t e r s 5 7 E x p e r i e n c i n g S c a l e R a t e r s 58 In s t r ume n t a t i o n 60 The E x p e r i e n c i n g S c a l e 60 The B a r r e t t - L e n n a r d R e l a t i o n s h i p I n v e n t o r y 61 P r o c e d u r e s 63 T r a n s c r i pt i on 64 S c o r i n g 65 D e s c r i p t i o n of T r e a t m e n t s 6 5 E m p a t h i c R e f l e c t i o n 65 G e s t a l t E m p t y - C h a i r D i a l o g u e 66 D e s i g n and A n a l y s i s 69 CHAPTER IV RESULTS 72 - V -TABLE OF CONTENTS - C o n t i n u e d R e l a t i o n s h i p I n s t r u m e n t - The B a r r e t t -L e n n a r d R e l a t i o n s h i p I n v e n t o r y 73 E x p e r i e n c i n g S c a l e I n t e r r a t e r R e l i a b i l i t y 74 C o m p a r i s o n of E x p e r i e n c i n g L e v e l s f o r the E m p a t h i c R e f l e c t i o n C o n d i t i o n and the G e s t a l t E m p t y - C h a i r D i a l o g u e C o n d i t i o n 7 4 C o m p a r i s o n of P r o p o r t i o n s L e v e l 4 and Above 75 C o m p a r i s o n of P r o p o r t i o n s L e v e l 5 and Above 80 C o m p a r i s o n of P r o p o r t i o n s L e v e l 6 and Above 81 C o m p a r i s o n of Mean E x p e r i e n c i n g L e v e l s 82 T h e r a p i s t / T r e a t m e n t C o n d i t i o n I n t e r a c t i o n E f f e c t s 83 CHAPTER V DISCUSSION 8 9 O v e r v i e w 8 9 I n t e r p r e t a t i o n of F i n d i n g s 90 L i m i t a t i o n s of the Study 94 F u t u r e R e s e a r c h 95 REFERENCES 9 7 APPENDICES 108 - v i -L I S T OF TABLES T a b l e Page I Means and S t a n d a r d D e v i a t i o n s of the B a r r e t t -L e n n a r d R e l a t i o n s h i p I n v e n t o r y - E m p a t h y D i m e n s i o n S c o r e s 7 4 II Modal E x p e r i e n c i n g L e v e l F r e q u e n c i e s Per T r e a t m e n t C o n d i t i o n 76 I I I Peak E x p e r i e n c i n g L e v e l F r e q u e n c i e s Per T r e a t m e n t C o n d i t i o n 76 IV P r o p o r t i o n of Segments w i t h E x p e r i e n c i n g L e v e l s of 4,5,& 6- Modal R a t i n g s 77 V P r o p o r t i o n of Segments w i t h E x p e r i e n c i n g L e v e l s of 4,5,& 6- Peak R a t i n g s 78 VI T r a n s f o r m e d Modal P r o p o r t i o n s f o r E x p e r i e n c i n g L e v e l k and Above 79 VII T r a n s f o r m e d Peak P r o p o r t i o n s f o r E x p e r i e n c i n g L e v e l 4 and Above 79 V I I I Me an E x p e r i e n c i n g L e v e l - Mo d a l S c o r e s 85 IX Mean E x p e r i e n c i n g L e v e l - Peak S c o r e s 86 X Means and S t a n d a r d D e v i a t i o n s of Mean E x p e r i e n c i n g L e v e l - Modal S c o r e s 87 XI Means and S t a n d a r d D e v i a t i o n s of Mean E x p e r i e n c i n g L e v e l - Peak S c o r e s 87 X I I A n a l y s i s of V a r i a n c e by Modal S c o r e s / T h e r a p i s t / T r e a t m e n t C o n d i t i o n 88 X I I I A n a l y s i s of V a r i a n c e by Peak S c o r e s / T h e r a p i s t s / T r e a t m e n t C o n d i t i o n 88 - 1 -CHAPTER I INTRODUCTION The P r o b l e m and B a c k g r o u n d of the P r o b l e m P r o c e s s r e s e a r c h i s the s t u d y of the i n t e r a c t i o n s between t h e c l i e n t and t h e r a p i s t s y s t e m s , w h i c h a t t e m p t s to i d e n t i f y the p a t t e r n s and mechanisms of change i n the i n t e r a c t i o n s of t h e s e s y s t e m s . A g o a l of p s y c h o t h e r a -p e u t i c p r o c e s s r e s e a r c h i s to e x p l o r e and u l t i m a t e l y d e t e r m i n e how p s y c h o t h e r a p y s u c c e e d s or f a i l s and to u n d e r s t a n d the e s s e n t i a l i n g r e d i e n t s of p s y c h o t h e r a p y . A m a j o r p r o b l e m i n c o n s t r u c t i n g q u a n t i t a t i v e r e s e a r c h i n p s y c h o t h e r a p y i s the t r erne n d o u s c omp l e x i t y of 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 . E v a l u a t i n g the e f f e c t i v e n e s s of any s i n g l e t h e r a p i s t , c l i e n t or s i t u a t i o n a l v a r i a b l e i s a h i g h l y complex e n d e a v o u r . R e s e a r c h e r s such as S t r u p p and B e r g i n (1969) have s u g g e s t e d t h a t the s t a n d a r d q u e s t i o n of p s y c h o t h e r a p y r e s e a r c h s h o u l d be "what s p e c i f i c t h e r a p e u t i c i n t e r v e n t i o n s p r o d u c e s p e c i f i c changes i n s p e c i f i c p a t i e n t s under s p e c i f i c c o n d i t i o n s ? " ( p . 2 0 ) . " I s o l a t i o n and m a n i p u l a t i o n of s i n g l e v a r i a b l e s i s e s s e n t i a l f o r a d v a n c i n g knowledge c o n c e r n i n g the p r o -c e s s of t h e r a p e u t i c c h ange" ( S t r u p p & B e r g i n , 1969, p . 2 5 ) . B e r g i n (1971) i n d i c a t e s t h a t the p r o g r e s s i n p s y c h o t h e r a p y r e s e a r c h t h a t has o c c u r r e d has r e s u l t e d t h r o u g h i s o l a t i n g s p e c i f i c v a r i a b l e s f r om the mu l t i t u d e of e v e n t s t h a t o c c u r i n the t h e r a p e u t i c p r a c t i c e . B e r g i n and S t r u p p - 2 -(1972) c o n c l u d e t h a t f u r t h e r s t u d y of g r o s s , c omp l e x and r e l a t i v e l y n o n - s p e c i f i c t r a d i t i o n a l p r a c t i c e o f f e r e d l i t t l e hope f o r advancement of knowledge i n the f i e l d . They s t r e s s e d t h a t g r e a t e r s p e c i f i c i t y and s i m p l i c i t y of d e s i g n were r e q u i r e d and corrment on the work of c l i e n t -c e n t e r e d r e s e a r c h e r s i n s t u d y i n g s i n g l e v a r i a b l e s l i k e empathy. They f e e l t h a t to u n d e r s t a n d the complex p r o -c e s s of p s y c h o t h e r a p y i t i s n e c e s s a r y to b r e a k i t i n t o i t ' s component p a r t s . T h i s p r o c e s s may l e a d to new methods w i t h d i f f e r e n t i a l a p p l i c a b i l i t y to s p e c i f i c symptoms. They s t a t e r e p e a t e d l y the i m p o r t a n c e of s y s t e m a t i c and i n c r e a s i n g l y r e f i n e d c o m p a r i s o n s between d i f f e r e n t t e c h n i q u e s i n s p e c i f i e d s i t u a t i o n s and the a s s e s s m e n t of d i f f e r e n t i a l e f f e c t s ( S t r u p p & B e r g i n , 1969). R e s e a r c h s h o u l d a d d r e s s w h i c h p a t i e n t c h a r a c t e r i s t i c s and p r o b l e m s a r e most amenable to w h i c h t e c h n i q u e s c o n -d u c t e d by w h i c h t y p e of t h e r a p i s t i n what t y p e of s e t t i n g . A c c o r d i n g to t h e i r p r e d i c t i o n , " . . . t h e t h e r a p y of t h e f u t u r e w i l l c o n s i s t of a s e t of s p e c i f i c t e c h n i q u e s t h a t can be d i f f e r e n t i a l l y a p p l i e d under s p e c i f i a b l e c o n d i t i o n s to s p e c i f i c p r o b l e m s , symptoms and c a s e s " ( S t r u p p & B e r g i n , 1969, p . 6 8 ) . T h i s s t u d y a t t e m p t e d to i s o l a t e and compare the d i f f e r e n t i a l e f f e c t s of two i n t e r v e n t i o n s on a s p e c i f i c c l i e n t i s s u e i n an a n a l o g u e s i t u a t i o n . The c l i e n t i s s u e - 3 -e x p l o r e d was u n f i n i s h e d b u s i n e s s , a c o n s t r u c t o r i g i n a t i n g f r o m the G e s t a l t p s y c h o t h e r a p y t r a d i t i o n . A number of a u t h o r s (Cohn, 1970; D a l d r u p , B e u t l e r , E n g l e & G r e e n b e r g , 1988; D a l d r u p , B e u t l e r & G r e e n b e r g , 1985; E n r i g h t , 1970; G r e e n b e r g & S a f r an, 1987; L a t n e r , 1973; L e v i t s k y & P e r l s , 1970; P e r l s , 1970; P e r l s , H e f f e r 1 i n e & Goodman, 1951; and P o l s t e r & P o l s t e r , 1973) have w r i t t e n on the t h e o r e t i c a l s i g n i f i c a n c e of u n f i n i s h e d b u s i n e s s as an i m p o r t a n t t h e r a p e u t i c i s s u e ; but t h e r e i s a p a u c i t y of r e s e a r c h i n v e s t i g a t i n g the s p e c i f i c i s s u e of u n f i n i s h e d b u s i n e s s and the t e c h n i q u e s w h i c h may be h e l p f u l i n a c h i e v i n g r e s o l u t i o n . T h e r e e x i s t s one outcome s t u d y c o n d u c t e d by K i n g (1988) w h i c h found t e n t a t i v e r e s u l t s s u g g e s t i n g t h a t the G e s t a l t e m p t y - c h a i r d i a l o g u e i n the c o n t e x t of an e m p a t h i c r e l a t i o n s h i p may make a c o n t r i b u t i o n to the t r e a t m e n t of the i s s u e of u n f i n i s h e d b u s i n e s s . The two c o u n s e l l i n g i n t e r v e n t i o n s compared were 1) e m p a t h i c r e f l e c t i o n and 2) the G e s t a l t e m p t y - c h a i r d i a l o g u e . R o g e r s (1957) has s u g g e s t e d t h a t the t h e r a -p e u t i c c o n d i t i o n s of a c c u r a t e empathy, warmth and genu-i n e n e s s a r e n e c e s s a r y and s u f f i c i e n t c o n d i t i o n s f o r s u c c e s s f u l t h e r a p y to o c c u r . S t r u p p (1972) s u g g e s t e d d e s i g n i n g s t u d i e s i n w h i c h R o g e r ' s t h r e e c o n d i t i o n s a r e compared w i t h t h e s e c o n d i t i o n s p l u s a t e c h n i c a l i n t e r v e n t i o n . The d i f f e r e n t i a l e f f e c t i s o l a t e d was the c l i e n t - a -p r o c e s s as m easured by the E x p e r i e n c i n g S c a i e , w h i c h has been s u g g e s t e d as r e v e a l i n g the change p r o c e s s i n t h e r a p y ( K l e i n , M a t h i e u , G e n d l i n & K i e s l e r , 1969). P s y c h o t h e r a p y p r o c e s s r e s e a r c h i s at a v e r y young s t a g e of s c i e n t i f i c e n q u i r y , w i t h l i t t l e o v e r t h i r t y y e a r s of h i s t o r y . S t i l e s (1986) s u g g e s t s t h a t an u n d e r s t a n d i n g of how p s y c h o t h e r a p y works i n the l o n g t e r m must f i r s t r e s t on an u n d e r s t a n d i n g of how each e n c o u n t e r a f f e c t s or f a i l s to a f f e c t the c l i e n t . " . . . T h e r e can be no l o n g t e r m e f f e c t s w i t h o u t s h o r t t e r m e f f e c t s , even i f the s h o r t t e r m e f f e c t s a r e c o v e r t , r e -q u i r i n g i n c u b a t i o n or c umu 1 a t i o n to s ome c r i t i c a l ma s s b e f o r e a p p e a r i n g as major l i f e c h a n g e s " ( p . 1 8 4 ) . T h i s s t u d y a t t e m p t e d to i s o l a t e and measure the i n - s e s s i o n p r o c e s s . To c o n d u c t p r o c e s s r e s e a r c h i t i s i m p o r t a n t to have i n s t r u m e n t s or p r o c e s s a n a l y s i s systems t h a t r e l i a b l y m easure d i f f e r e n t a s p e c t of 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 . The E x p e r i e n c i n g S c a l e i s "among the o l d e s t and most e s t a b l i s h e d ( m e a s u r e s ) i n the f i e l d " ( K i e s l e r , 1986, p . v i i ) . R e s e a r c h on the E x p e r i e n c i n g S c a l e s u g g e s t s t h a t the d e p t h of e x p e r i e n c i n g , a measure of the p a r t i c u l a r t y p e of c l i e n t i n v o l v e m e n t i m p o r t a n t to the e x p e r i e n t i a l l y o r i e n t e d t h e r a p i e s i s r e l a t e d to change. The p u r p o s e of t h i s s t u d y was t o e o m p a r e the e f f e c t on the d e p t h of e x p e r i e n c i n g of e m p a t h i c r e f l e c t i o n and the G e s t a l t e m p t y - c h a i r d i a l o g u e . - 5 -R e s e a r c h on change p r o c e s s e s i s needed to h e l p e x p l a i n how p s y c h o t h e r a p y p r o d u c e s change. It i s i m p o r t a n t to be a b l e to s p e c i f y and measure i m p o r t a n t i n - s e s s i o n changes t h a t r e s u l t f r o m s p e c i f i c i n t e r v e n t i o n s and the o v e r a l l i n t e r a c t i o n . T h e o r i e s of p r a c t i c e w h i c h a r e t i e d to a c t u a l p e r f o r m a n c e of t h e r a p i s t and c l i e n t need to be s p e l l e d out and t e s t e d , i n o r d e r to h e l p e x p l a i n how change a c t u a l l y o c c u r s i n s p e c i f i c t h e r a p e u t i c s i t u a t i o n s . Once we know what i n t e r v e n t i o n s were most a p p r o p r i a t e f o r w h i c h c l i e n t s t a t e s and what r e s u l t i n g c l i e n t p e r f o r m a n c e s l e d to p r o b l e m r e s o l u t i o n , we would be much c l o s e r to d e s c r i b i n g how change a c t u a l l y t a k e s p l a c e i n t h e r a p y . We would then be a b l e t o i d e n t i f y the a c t i v e i n g r e d i e n t s of change and'exp1 a i n the mechanisms t h a t l e a d t o t h i s c h a n g e . ( G r e e n b e r g & P i n s o f , 1986, p.718-719) T h i s r e s e a r c h was an a n a l o g u e s t u d y . A n a l o g u e r e s e a r c h e v a l u a t e s t r e a t m e n t under c o n d i t i o n s t h a t o n l y r e s e m b l e or a p p r o x i m a t e the c l i n i c a l s i t u a t i o n ( B e r g i n & G a r f i e l d , 1986). I t has been s u g g e s t e d ( B e r g i n , 1971; B e r g i n & S t r u p p , 1972) as a p r o m i s i n g s t r a t e g y of e n q u i r y p a r t i c u l a r l y i n the i n i t i a l s t a g e s of i s o l a t i n g r e l e v a n t t h e r a p e u t i c v a r i a b l e s . T h e s e s t u d i e s add to the under-s t a n d i n g of s p e c i f i c phenomena and i n d i c a t e d i r e c t i o n s f o r f u r t h e r i n v e s t i g a t i o n under mo re n a t u r a l i s t i c con-d i t i o n s . A n a l o g u e r e s e a r c h has as i t ' s m a j o r a d v a n t a g e , the c a p a c i t y to surmount many of the m e t h o d o l o g i c a l , p r a c t i c a l and e t h i c a l i s s u e s a s s o c i a t e d w i t h c o n d u c t i n g r e s e a r c h i n c l i n i c a l s e t t i n g s . The a b i l i t y to c o n t r o l m u l t i p l e c o n d i t i o n s of t h e e x p e r i m e n t and, c o n s e q u e n t l y - 6 -to m i n i m i z e v a r i a b i l i t y i n the d a t a , p e r m i t s a n a l o g u e r e s e a r c h to a d d r e s s q u e s t i o n s t h a t w o u l d o t h e r w i s e be d i f f i c u l t t o s t u d y . The c e n t r a l r e s e a r c h q u e s t i o n was, i s t h e r e a d i f f e r e n t i a l e f f e c t of the two c o u n s e l l i n g i n t e r v e n t i o n s ( e m p a t h i c r e f l e c t i o n and the G e s t a l t e m p t y - c h a i r d i a l o g u e ) on c l i e n t p r o c e s s (as measured by the E x p e r i e n c i n g S c a l e ) when used w i t h a c l i e n t i s s u e of u n f i n i s h e d b u s i n e s s ? It was h y p o t h e s i z e d t h a t G e s t a l t e m p t y - c h a i r d i a l o g u e w i l l p r o d u c e h i g h e r l e v e l s of e x p e r i e n c i n g than e m p a t h i c r e f l e c t i o n . J u s t i f i c a t i o n f o r the s t u d y T h e r e i s s u p p o r t i n the l i t e r a t u r e f o r the n o t i o n t h a t d e p t h of e x p e r i e n c i n g i s p o s i t i v e l y c o r r e l a t e d w i t h outcome ( K l e i n e t a l . , 1969). If an i n t e r v e n t i o n can enhance a c l i e n t ' s d e p t h of e x p e r i e n c i n g , i t may t h e r e -f o r e move a c l i e n t c l o s e r to p r o d u c t i v e p s y c h o t h e r a p y . If the h y p o t h e s i s s t a t e d e a r l i e r i n t h i s c h a p t e r i s i n d e e d s u p p o r t e d , more w e i g h t w i l l be g i v e n to the argument t h a t a l t h o u g h e m p a t h i c r e f l e c t i o n may be a n e c e s s a r y , b a s e l i n e c o n d i t i o n f o r s u c c e s s f u l c o u n s e l l i n g , a more a c t i v e t e c h -n i q u e such as the G e s t a l t e m p t y - c h a i r d i a l o g u e may h e l p move the c l i e n t more q u i c k l y toward change than w i l l the use of e m p a t h i c r e f l e c t i o n . Such a f i n d i n g w ould have i mp l i c a t i o n s f o r c o u n s e l l i n g as i t i s p r a c t i c e d i n the f i e l d t o d a y as w e l l as c o u n s e l l o r t r a i n i n g . - 7 -D e f i n i t i o n of Terms U n f i n i s h e d B u s i n e s s A c c o r d i n g to G e s t a l t t h e o r y , when p e o p l e a t t e m p t to b l o c k or a v o i d t h e i r e m o t i o n a l e x p e r i e n c e , d i f f i c u l t i e s i n l i v i n g and d y s f u n c t i o n c a n o c c u r . When t h e s e b l o c k e d e m o t i o n s and u n e x p r e s s e d f e e l i n g s a r e i n r e l a t i o n to a s i g n i f i c a n t o t h e r p e r s o n and then they i n t e r f e r e w i t h a c l i e n t ' s c u r r e n t f u n c t i o n i n g , t h i s i s c o n s i d e r e d u n f i n -i s h e d b u s i n e s s . It i s o n l y by a l l o w i n g the f u l l e x p r e s s i o n and e x p e r i e n c i n g of t h e s e i n t e r r u p t e d f e e l i n g s t h a t the c l i e n t i s r e l e a s e d to d e v e l o p a more b a l a n c e d v i e w of the s i t u a t i o n and l e t go of the a s s o c i a t e d n e g a t i v e f e e l -i n g s ( G r e e n b e r g & S a f r a n , 1987). As l o n g as the e x p r e s -s i o n of a f f e c t toward the o t h e r remains i n c o m p l e t e , the i n d i v i d u a l w i l l not be a b l e to a c h i e v e c l o s u r e of the r e l a t i o n s h i p . Four c l i e n t p e r f o r m a n c e i n d i c a t o r s have been i d e n t i f i e d ( D a l d r u p et a l . , 1988; G r e e n b e r g & M i n d e n , 1988; G r e e n b e r g & S a f r a n , 1987) w h i c h t a k e n t o g e t h e r c o n s t i t u t e a marker of u n f i n i s h e d b u s i n e s s . T h e s e components a r e : 1. The c l i e n t has a l i v e l y e x p e r i e n c e of a f e e l i n g of a n g e r , s a d n e s s , h u r t or g r i e f . 2. The e x p r e s s i o n of t h i s f e e l i n g i s r e l a t e d to a s i g n i f i c a n t o t h e r , such as a p a r e n t , s p o u s e , or l o v e r . 3. The e x p e r i e n c e and e x p r e s s i o n i s b e i n g c u r r e n t l y i n t e r r u p t e d and/or r e s t r i c t e d . - 8 -4. The e x p e r i e n c e of the f e e l i n g and i t s i n t e r -r u p t i o n i s p r o b l e m a t i c f o r the c l i e n t , as i n d i c a t e d by d i r e c t v e r b a l ackn ow 1 e d g erne n t s , i n d i r e c t v e r b a l s i g n s of the d i f f i c u l t y ( e . g . , v e r b a l s t a t e m e n t s of h o p e l e s s n e s s , c y n i c i s m , d e s p a i r ) , or n o n v e r b a l s i g n s of i n t e r r u p t e d e x p r e s s i o n ( e . g . , l i p b i t i n g , s w a l l o w i n g of t e a r s , or t i g h t e n e d jaw or f i s t . ( G r e e n b e r g & M i n d e n , 1988, p.13) E m p a t h i c R e f l e c t i o n E m p a t h i c r e f l e c t i o n i s a t h e r a p e u t i c t e c h n i q u e by means of w h i c h the t h e r a p i s t e x p r e s s e s u n d e r s t a n d i n g of what the c l i e n t i s f e e l i n g and the e x p e r i e n c e s u n d e r l y i n g t h e s e f e e l i n g s . The t h e r a p i s t , i n h i s or her own words and i n h i s or her own way, cormnunicates t h i s u n d e r s t a n d i n g to the c l i e n t . C a r k h u f f (1969) has d e s c r i b e d e m p a t h i c r e f l e c t i o n as o c c u r r i n g a t f i v e l e v e l s . L e v e l s 1 and 2 a r e c o n s i d e r e d d e t r i m e n t a l . L e v e l s 3, 4 and 5 e m p a t h i c r e f l e c t i o n s a r e c o n s i d e r e d f a c i l i t a t i v e and a r e d e s c r i b e d by C a r k h u f f (1969) as f o l l o w s : L e v e l 1 The v e r b a l and b e h a v i o r a l e x p r e s s i o n s of the h e l p e r e i t h e r do not a t t e n d to or d e t r a c t s i g n i f i c a n t l y f r o m the v e r b a l and b e h a v i o r a l e x p r e s s i o n s of the h e l p e e ( s ) i n t h a t t h e y corrmunicate s i g n i f i c a n t l y l e s s of the h e l p e e ' s f e e l i n g s and e x p e r i e n c e s than the h e l p e e has corrmun i c a t ed h i m s e l f . L e v e l 2 W h i l e the h e l p e r r e s p o n d s to the e x p r e s s e d f e e l i n g s of the h e l p e e ( s ) , he does so i n such a way t h a t he s u b t r a c t s n o t i c a b l e a f f e c t f r o m the cormnun i ca t i on s of the h e l p e e . L e v e l 3 The e x p r e s s i o n s of the h e l p e r i n r e s p o n s e to the e x p r e s s i o n s of the h e l p e e ( s ) a r e e s s e n t i a l l y i n t e r c h a n g e a b l e w i t h t h o s e of the h e l p e e i n t h a t they e x p r e s s e s s e n t i a l l y the same a f f e c t and m e a n i n g . - 9 -4 The r e s p o n s e s of the h e l p e r add n o t i c a b l y to the e x p r e s s i o n s of h e l p e e ( s ) i n such a way as to e x p r e s s f e e l i n g s a l e v e l deeper than the h e l p e e was a b l e to e x p r e s s h i m s e l f . 5 The h e l p e r ' s r e s p o n s e s add s i g n i f i c a n t l y to the f e e l i n g and meaning of the e x p r e s s i o n s of the h e l p e e ( s ) i n such a way as to a c c u r a t e l y e x p r e s s f e e l i n g l e v e l s below what the h e l p e e h i m s e l f was a b l e to e x p r e s s o r , i n the e v e n t of o n g o i n g , deep s e 1 f - e x p 1 or a t i o n on the h e l p e e ' s p a r t , to be f u l l y w i t h him i n h i s d e e p e s t moments. (p.174-175) G e s t a l t E m p t y - C h a i r D i a l o g u e The G e s t a l t e m p t y - c h a i r d i a l o g u e i s an e x p e r i e n t i a l t e c h n i q u e d e s i g n e d to work on the c l i e n t i s s u e of u n f i n -i s h e d b u s i n e s s ( D a l d r u p et a l . , 1988; G r e e n b e r g & M i n d e n , 1988; G r e e n b e r g & S a f r a n , 1987; P e r l s , 1969; T o b i n , 1975). The c l i e n t i s a s k e d to v i s u a l i z e the s i g n i f i c a n t o t h e r i n an empty c h a i r and e n c o u r a g e d to e l i c i t memories and e x p r e s s f e e l i n g s toward the s i g n i f i c a n t o t h e r . The c l i e n t i s d i r e c t e d by the t h e r a p i s t to e s t a b l i s h a sense "as i f " the s i g n i f i c a n t o t h e r was i n the c h a i r . From the b e g i n n i n g , the t h e r a p i s t makes i t c l e a r t h a t the c l i e n t i s to speak to the s i g n i f i c a n t o t h e r , not about him or h e r . The p u r p o s e of t h i s t e c h n i q u e i s to h e l p the c l i e n t e n c o u n t e r the u n f i n i s h e d b u s i n e s s t h a t has been t a r g e t e d and to m a g n i f y the e m o t i o n a l and s e n s o r y components a s s o c i a t e d w i t h the e x p e r i e n c e . Z i n k e r (1977) a p t l y d e s c r i b e s t h i s p r o c e s s : Le ve 1 Le ve 1 10 -The e x p e r i m e n t i s a c o r n e r s t o n e of e x p e r i e n t i a l l e a r n i n g . It t r a n s f o r m s t a l k i n g about i n t o d o i n g , s t a l e r e m i n i s c i n g and t h e o r i z i n g i n t o b e i n g f u l l y h e r e w i t h a l l one's i m a g i n a t i o n , e n e r g y , and e x c i t e -ment. F o r example, by a c t i n g out an o l d , u n f i n i s h e d s i t u a t i o n , the p a t i e n t i s a b l e to comprehend i t i n i t ' s r i c h e s t c o n t e x t and to c omp l e t e the e x p e r i e n c e u s i n g the r e s o u r c e s of h i s p r e s e n t wisdom and under-s t a n d i n g of l i f e . ( p . 123)_ W i t h t h i s t e c h n i q u e the c l i e n t i s r e q u e s t e d to assume bo t h p a r t s of the i n t e r p e r s o n a l c o n f l i c t . The c l i e n t w i l l move b o d i l y f r o m one c h a i r to the o t h e r a s s u m i n g each p o s i t i o n . The t h e r a p i s t d i r e c t s the c l i e n t to change c h a i r s , assume the r o l e of the o t h e r and t o r e s p o n d to s t a t e m e n t s made f r o m the p r e v i o u s c h a i r . It i s i m p o r t a n t to p o i n t out t h a t the te r m t w o - c h a i r d i a l o g u e has been used to r e f e r to the t e c h n i q u e used w i t h a c l i e n t s p l i t - "a v e r b a l p e r f o r m a n c e p a t t e r n i n w h i c h a c l i e n t r e p o r t s a d i v i s i o n of the s e l f p r o c e s s i n t o two p a r t i a l a s p e c t s of the s e l f or t e n d e n c i e s " ( G r e e n b e r g , 1979, p . 3 2 3 ) . The t e r m e m p t y - c h a i r d i a l o g u e i s used p r i m a r i l y f o r the i s s u e of u n f i n i s h e d b u s i n e s s , and i s q u a l i t a t i v e l y d i f f e r e n t f r o m t w o - c h a i r d i a l o g u e . T w o - c h a i r d i a l o g u e i n v o l v e s an a c t i v e and a l t e r n a t i n g d i a l o g u e between two p a r t s of the c l i e n t i n an i n t r a p e r s o n a 1 c o n f l i c t ( G r e e n -b e r g , 1979). A l t h o u g h the c l i e n t does engage i n d i a l o g u e f r o m the two c h a i r s i n u n f i n i s h e d b u s i n e s s work, the ma j o r i t y of the d i a l o g u e i s f r om the e x p e r i e n c i n g ( s e l f ) c h a i r of the c l i e n t r a t h e r than the c h a i r i n w h i c h the s i g n i f i c a n t o t h e r i s v i s u a l i z e d . - 1 1 The E x p e r i e n c i n g S c a l e The E x p e r i e n c i n g S c a l e was d e v e l o p e d f r o m G e n d l i n ' s e x p e r i e n t i a l and R o g e r ' s c l i e n t - c e n t e r e d t h e o r i e s to cap-t u r e the e s s e n t i a l q u a l i t y of the c l i e n t ' s i n v o l v e r n e n t i n p s y c h o t h e r a p y . The s c a l e o r i g i n a t e d f r o m a s e r i e s of t h e r a p y p r o c e s s and outcome s t u d i e s as a p r o m i s i n g measure t h a t r e l a t e d to c l i e n t outcome i n one of two ways: 1) as a q u a l i t y or b e h a v i o r t h a t i n c r e a s e d o v e r time i n s u c c e s s f u l t h e r a p y or 2) as p r e s e n t f r o m the b e g i n n i n g and c o n t i n u i n g t h r o u g h o u t s u c c e s s f u l t h e r a p y ( K l e i n et a l . , 1969) The E x p e r i e n c i n g S c a l e c o n s i s t s of one 7 p o i n t s c a l e d e s i g n e d to be a p p l i e d to t a p e r e c o r d i n g s or t r a n s c r i p t s of p s y c h o t h e r a p y ( K l e i n e t a l . , 1969). The 7 s c a l e " s t a g e s " or s t e p s d e f i n e the p r o g r e s s i o n of c l i e n t i n v o l v e -ment i n i n n e r r e f e r e n t s f r o m i m p e r s o n a l (1) or s u p e r -f i c i a l ( 2 ) , t h r o u g h e x t e r n a l i z e d or l i m i t e d r e f e r e n c e s and f e e l i n g s ( 3 ) , to d i r e c t i n n e r r e f e r e n t s ( 4 ) , to q u e s t i o n i n g an u n c l e a r i n n e r r e f e r e n t ( 5 ) , to f o c u s i n g w i t h a s t e p t o r e s o l u t i o n ( 6 ) , and f i n a l l y to the p o i n t where f o c u s i n g comes e a s i l y and p r o v i d e s the c o n n e c t i o n s f o r i n n e r d i s c o u r s e ( 7 ) . D e p t h of e x p e r i e n c i n g i s the e x t e n t to w h i c h a p e r s o n ' s b o d i l y f e l t f l o w of e x p e r i e n c i n g c o n s t i t u t e s h i s or her a w a r e n e s s , and i s e x p r e s s e d v e r b a l l y . It i s - 1 2 -an import an c o n s t r u c t f o r t h e r a p i e s i n w h i c h s e l f -a wareness and s e l f - u n d e r s t a n d i n g a r e major g o a l s . H y p o t h e s e s H^ The G e s t a l t e m p t y - c h a i r d i a l o g u e , when used w i t h an i s s u e of u n f i n i s h e d b u s i n e s s w i l l p r o d u c e s i g n i f i c a n t l y more modal r a t i n g s of 4 and above on the E x p e r i e n c i n g S c a l e , than t h a t p r o d u c e d by the use of e m p a t h i c r e f l e c t i o n . 0 1 The G e s t a l t e m p t y - c h a i r d i a l o g u e , when used w i t h an i s s u e of u n f i n i s h e d b u s i n e s s w i l l not p r o d u c e s i g n i f i -c a n t l y more modal r a t i n g s of 4 and above on the E x p e r i e n c i n g S c a l e , than t h a t p r o d u c e d by the use of e m p a t h i c r e f l e c t i o n . H 2 The G e s t a l t e m p t y - c h a i r d i a l o g u e , when used w i t h an i s s u e of u n f i n i s h e d b u s i n e s s w i l l p r o d u c e s i g n i f i c a n t l y more peak r a t i n g s of 4 and above on the E x p e r i e n c i n g S c a l e , than t h a t p r o d u c e d by the use of e m p a t h i c r e -f l e c t i o n . H Q 2 The G e s t a l t e m p t y - c h a i r d i a l o g u e , when used w i t h an i s s u e of u n f i n i s h e d b u s i n e s s w i l l not p r o d u c e s i g n i f i -c a n t l y more peak r a t i n g s of k and above on the E x p e r i e n c i n g S c a l e , t h an t h a t p r o d u c e d by the use of e m p a t h i c r e f l e c t i o n . H^ The G e s t a l t e m p t y - c h a i r d i a l o g u e , when used w i t h an - 1 3 -i s s u e of u n f i n i s h e d b u s i n e s s wi 1 i p r o d u c e a s i g n i f i -c a n t l y g r e a t e r p r o p o r t i o n of modal r a t i n g s of 5 and above on the E x p e r i e n c i n g S c a l e , than t h a t p r o -duced by the use of e m p a t h i c r e f l e c t i o n . H Q 3 The G e s t a l t e m p t y - c h a i r d i a l o g u e , when used w i t h an i s s u e of u n f i n i s h e d b u s i n e s s w i l l not p r o d u c e a s i g n i f i c a n t l y g r e a t e r p r o p o r t i o n of modal r a t i n g s of 5 and above on the E x p e r i e n c i n g S c a l e , than t h a t p r o -duced by the use of e m p a t h i c r e f l e c t i o n . The G e s t a l t e m p t y - c h a i r d i a l o g u e , when used w i t h an i s s u e of u n f i n i s h e d b u s i n e s s w i l l p r o d u c e a s i g n i f i -c a n t l y g r e a t e r p r o p o r t i o n of peak r a t i n g s of 5 and above on the E x p e r i e n c i n g S c a l e , than t h a t p r o d u c e d by the use of e m p a t h i c r e f l e c t i o n . H Q ^ The G e s t a l t e m p t y - c h a i r d i a l o g u e , when used w i t h an i s s u e of u n f i n i s h e d b u s i n e s s w i l l not p r o d u c e a s i g -n i f i c a n t l y g r e a t e r p r o p o r t i o n of peak r a t i n g s of 5 and above on the E x p e r i e n c i n g S c a l e , than t h a t p r o -duced by the use of e m p a t h i c r e f l e c t i o n . The G e s t a l t e m p t y - c h a i r d i a l o g u e , when used w i t h an i s s u e of u n f i n i s h e d b u s i n e s s w i l l p r o d u c e a s i g n i f i -c a n t l y g r e a t e r p r o p o r t i o n of modal r a t i n g s of 6 on the E x p e r i e n c i n g S c a l e , than t h a t p r o d u c e d by the use of e m p a t h i c r e f l e c t i o n . H Q ^ The G e s t a l t e m p t y - c h a i r d i a l o g u e , when used w i t h an 14 -i s s u e of u n f i n i s h e d b u s i n e s s w i l l not p r o d u c e a s i g -n i f i c a n t l y g r e a t e r p r o p o r t i o n of modal r a t i n g s of 6 on the E x p e r i e n c i n g S c a l e , than t h a t p r o d u c e d by the use of e m p a t h i c r e f l e c t i o n . Hg The G e s t a l t e m p t y - c h a i r d i a l o g u e , when used w i t h an i s s u e of u n f i n i s h e d b u s i n e s s w i l l p r o d u c e a s i g n i f i -c a n t l y g r e a t e r p r o p o r t i o n of peak r a t i n g s of 6 on the E x p e r i e n c i n g S c a l e , than t h a t p r o d u c e d by the use of e m p a t h i c r e f l e c t i o n . The G e s t a l t e m p t y - c h a i r d i a l o g u e , when used w i t h an i s s u e of u n f i n i s h e d b u s i n e s s w i l l not p r o d u c e a s i g -n i f i c a n t l y g r e a t e r p r o p o r t i o n of peak r a t i n g s of 6 on the E x p e r i e n c i n g S c a l e , than t h a t p r o d u c e d by the use of e m p a t h i c r e f l e c t i o n . H 7 The G e s t a l t e m p t y - c h a i r d i a l o g u e , when used w i t h an i s s u e of u n f i n i s h e d b u s i n e s s w i l l p r o d u c e s i g n i f i c a n t l y g r e a t e r mo d a I mean e x p e r i e n c i n g l e v e l s on t h e E x p e r -i e n c i n g S c a l e , than t h a t p r o d u c e d by the use of e m p a t h i c r e f l e c t i o n . HQJ The G e s t a l t e m p t y - c h a i r d i a l o g u e , when used w i t h an i s s u e of u n f i n i s h e d b u s i n e s s w i l l not p r o d u c e s i g -n i f i c a n t l y g r e a t e r modal mean e x p e r i e n c i n g l e v e l s on the E x p e r i e n c i n g S c a l e , t han t h a t p r o d u c e d by the use of e m p a t h i c r e f l e c t i o n . Ho The G e s t a l t e m p t y - c h a i r d i a l o g u e , when used w i t h an - 15 -i s s u e of u n f i n i s h e d b u s i n e s s w i l l p r o d u c e g r e a t e r peak mean e x p e r i e n c i n g l e v e l s on the E x p e r i e n c i n g S c a l e , than t h a t p r o d u c e d by the use of e m p a t h i c r e f l e c t i o n , ring The G e s t a l t e m p t y - c h a i r d i a l o g u e , when used w i t h an i s s u e of u n f i n i s h e d b u s i n e s s w i l l not p r o d u c e g r e a t e r peak mean e x p e r i e n c i n g l e v e l s on the E x p e r i e n c i n g S c a l e , t han t h a t p r o d u c e d by the use of e m p a t h i c r e f l e c t i o n . - 16 -CHAPTER I I LITERATURE REV IEW A r e v i e w o f t h e l i t e r a t u r e p e r t i n e n t t o t h i s s t u d y w i l l f o c u s on: 1) d i s c u s s i o n o f u n f i n i s h e d b u s i n e s s i n p s y c h o t h e r a p y 2) r e s e a r c h i n t h e use of G e s t a l t t e c h n i q u e s i n p s y c h o t h e r a p y 3) r e s e a r c h on t h e G e s t a l t t r e a t m e n t a p p r o a c h w i t h t h e i s s u e o f u n f i n i s h e d b u s i n e s s 4) r e s e a r c h i n t h e use of e m p a t h i c r e f l e c t i o n i n p s y c h o t h e r a p y 5) The E x p e r i e n c i n g S c a l e and i t ' s use i n p s y c h o -t h e r a p y 6) c h a n g e p r o c e s s r e s e a r c h U n f i n i s h e d B u s i n e s s i n P s y c h o t h e r a p y U n f i n i s h e d b u s i n e s s i s one of t h e key c o n c e p t s of G e s t a l t t h e r a p y . To f a c i l i t a t e an u n d e r s t a n d i n g of u n f i n i s h e d b u s i n e s s w i t h i n i t ' s t h e o r e t i c a l c o n t e x t , a b r i e f i n t r o d u c t i o n t o t h e G e s t a l t v i e w o f human n a t u r e w i l l be d i s c u s s e d , b e f o r e a d d r e s s i n g u n f i n i s h e d b u s i n e s s i n p s y c h o t h e r a p y . F r i t z P e r l s , t h e f o u n d e r of G e s t a l t t h e r a p y , h e l d a h o l i s t i c v i e w of man. - 17 -...Human n a t u r e i s o r g a n i z e d i n t o p a t t e r n s or w h o l e s . It i s e x p e r i e n c e d by the i n d i v i d u a l i n t h e s e t e r m s , and i t can o n l y be u n d e r s t o o d as a f u n c t i o n of the p a t t e r n s or wh o l e s of w h i c h i t i s m a d e . ( P e r l s , 1973, p.5) He saw man as a c t i v e and h a v i n g c o n t r o l over h i s own be-h a v i o r , w i t h n o t h i n g s u r p a s s i n g the s e 1 f - r e g u 1 a t i n g c a p a -b i l i t i e s of the i n d i v i d u a l . G e s t a l t t h e o r y r e g a r d s emo-t i o n as a b i o l o g i c a l l y a d a p t i v e o r i e n t a t i o n s y s t e m t h a t c o n t i n u a l l y g u i d e s a d a p t i v e a c t i o n i n man ( P e r l s , H e f f e r -l i n e and Goodman, 1951). An i n d i v i d u a l ' s a f f e c t i v e , as w e l l as s e n s o r y , c o g n i t i v e and b e h a v i o r a l systems a r e i n c o n s t a n t i n t e r a c t i o n w i t h the e n v i r o n m e n t . T h r o u g h the i n t e r a c t i o n , i n d i v i d u a l s d e v e l o p a c o n c e p t u a l v i e w or i n t e g r a t e d r e p r e s e n t a t i o n ( i e . a G e s t a l t ) of the w o r l d and t h e i r p o s i t i o n i n i t (K a p l a n ; & K a p l a n , 1 9 8 5 ) . When the boundary between s e l f and e n v i r o n m e n t i s kept perme-a b l e t o a l l o w e xchanges and f i r m enough f o r o r g a n i s m i c autonomy, c o n t a c t forms a g e s t a l t . When the boundary becomes l o s t , impermeable or u n c l e a r , t h i s r e s u l t s i n a d i s t u r b a n c e of d i s t i n c t i o n between s e l f and o t h e r , c o n t a c t and a wareness ( P e r l s , 1973; P o l s t e r & P o l s t e r , 1973). P e r l s (1969) saw p e o p l e ' s a t t e m p t s to c o n t r o l or deny t h e i r e m o t i o n s as a c a u s e of d y s f u n c t i o n , as the e x p e r -i e n c e d e m o t i o n s a r e not a l l o w e d to be e x p r e s s e d to the p o i n t of n a t u r a l c o m p l e t i o n and r e s o l u t i o n . The needs of the o r g a n i s m a r e not f u l l y s a t i s f i e d and the g e s t a l t 18 -does not c l o s e . " I t i s a b a s i c t e n d e n c y of the o r g a n i s m to c o m p l e t e any s i t u a t i o n or t r a n s a c t i o n w h i c h f o r i t i s u n f i n i s h e d " ( P e r l s et a l . , 1951, p . 5 0 ) . T h i s need may r e c e d e i n t o the b a c k g r o u n d but the g e s t a l t i s not c o m p l e t e . P e r l s et a l . (1951) have l a b e l l e d t h i s r e s i d u e of t e n s i o n u n f i n i s h e d b u s i n e s s . The G e s t a l t a p p r o a c h h o l d s t h a t e m o t i o n s a r e o f t e n b l o c k e d b e f o r e they can e n t e r awareness or go v e r y f a r i n o r g a n i z i n g a c t i o n ; and a number of mechanisms a r e i m p l i c a t e d i n w h i c h b l o c k i n g l e a d s to u n d e r l y i n g c o n f l i c t and u n f i n i s h e d b u s i n e s s . At the c o r e of b l o c k i n g i s the a v o i d a n c e of p a i n f u l f e e l i n g s and the f e a r of unwanted e m o t i o n ( G r e e n b e r g & S a f r a n , 1987). D i s o w i n g o c c u r s e i t h e r b e c a u s e e x p e r i e n c e s a r e i n t e r r u p t e d b e f o r e i n t e -g r a t i o n i s p o s s i b l e or b e c a u s e s a n c t i o n s e x i s t a g a i n s t a c c e p t i n g c e r t a i n t y p e s of e x p e r i e n c e . B e c a u s e t h e s e e x p e r i e n c e s a r e not owned, they do not s m o o t h l y f i t w i t h e i t h e r p r i o r or p r e s e n t e x p e r i e n c e s , and t h e r e -a f t e r i n t r u d e upon and d i s t o r t new e x p e r i e n c e s . U n f i n i s h e d b u s i n e s s i s the i n c o m p l e t e e x p e r i e n c e and u n c h a n e l l e d e x c i t e r n e n t and i s a c o n s e q u e n c e of b l o c k e d a w a r e n e s s . Need c y c l e s a r e not c o m p l e t e d ; t e n s i o n i s a r o u s e d but not r e d u c e d ; e x c i t e m e n t mounts but i s not d i s c h a r g e d ; and the f l o w of need i n t o b e h a v i o r i s d i s r u p t e d . ( G r e e n b e r g & S a f r a n , 1 987 , p.52) T h e r a p y must among o t h e r t h i n g s , h e l p the p e r s o n e n t e r s i t u a t i o n s i n w h i c h they p r e v i o u s l y e x p e r i e n c e d the unwanted e m o t i o n s or e x c i t e m e n t . "The awareness o f , - 19 -and the a b i l i t y t o en d u r e unwanted e m o t i o n s a r e the c o n d i t i o n s , s i n e qua non, f o r a s u c c e s s f u l c u r e " ( P e r l s , 1969, p . 1 7 9 ) . These u n f i n i s h e d s i t u a t i o n s a r e u n d e r s t o o d to p r e v e n t p e o p l e f r o m a p p r o a c h i n g s i m i l a r s i t u a t i o n s i n an open manner and t a k i n g i n new e x p e r i e n c e s f r o m them. When u n f i n i s h e d b u s i n e s s becomes p o w e r f u l enough " t h e i n d i v i d u a l i s b e s e t w i t h p r e o c c u p a t i o n , c o m p u l s i v e b e h a v i o r , w a r i n e s s , o p p r e s s i v e e n e r g y and much s e l f -d e f e a t i n g e n e r g y " ( P o l s t e r & P o l s t e r , 1973, p . 3 6 ) . The g r i e v i n g p r o c e s s i s one f o r m of i n t e r r u p t e d emo-t i o n a l e x p r e s s i o n (or u n f i n i s h e d b u s i n e s s ) t h a t i s o f t e n seen i n p s y c h o t h e r a p y but the p a r a m e t e r s of u n f i n i s h e d b u s i n e s s e x t e n d w e l l beyond t h i s e m o t i o n ( G r e e n b e r g & S a f r a n , 1987). U n f i n i s h e d b u s i n e s s can i n v o l v e f e e l i n g s of a n g e r , r e s e n t m e n t , r a g e , h a t r e d , p a i n or f e a r of abandon-ment (Cohn, 1970). D a l d r u p e t a l . (1985) c o n s i d e r u n f i n i s h e d b u s i n e s s to u s u a l l y i n v o l v e anger and h u r t . L e v i t s k y and P e r l s (1970) h o l d t h a t r e s e n t m e n t i s the most corrmon f e e l i n g i n u n f i n i s h e d b u s i n e s s . T h e s e emo t i o n a l r e a c t i o n s ma y r ema i n i n c omp l e t e t h r o u g h r a t i o n a l -i z a t i o n , i n t e l l e c t u a l i z e d j udgements, a n a l y z i n g and d e n i a l ( D a l d r u p e t a l . , 1985). Any i n c o m p l e t e g e s t a l t r e p r e s e n t s an u n f i n i s h e d s i t u a t i o n t h a t c l a m o u r s f o r a t t e n t i o n and i n t e r -f e r e s w i t h the f o r m a t i o n of any n o v e l , v i t a l G e s t a l t . I n s t e a d of growth a n d . d e v e l o p m e n t , we then f i n d s t a g n a t i o n and r e g r e s s i o n . ( P e r 1 s e t a l . , 1951, p.36) - 20 -P e r l s et a l . (1951) t a l k about a n e u r o t i c c o m p u l s i o n to b r i n g c l o s u r e to u n f i n i s h e d s i t u a t i o n s . T h i s may t a k e the f o r m of r e t u r n i n g to the o l d b u s i n e s s or i t may r e l a t e to p a r a l l e l c i r c u m s t a n c e s . O n l y by r e t u r n i n g to the u n f i n i s h e d s i t u a t i o n and e x p r e s s i n g the r e s t r i c t e d a f f e c t , can the i n d i v i d u a l be f r e e d to f u l l y d i f f e r e n t i a t e a l l the f e e l i n g s i n v o l v e d i n the o r i g i n a l s i t u a t i o n and a t t a i n c l o s u r e . Many forms of t h e r a p y i n c l u d i n g c 1 i e n t - c e n t e r e d t h e r a p i e s and e x p e r i e n t i a l t h e r a p i e s e n c o u r a g e the p r o c e s s of e x p r e s s i n g p r e v i o u s l y s u p p r e s s e d or u n e x p r e s s e d emo-t i o n s and of a c c e p t i n g the f e e l i n g s a s s o c i a t e d w i t h t h e s e e m o t i o n s . T h e r a p y i s t h e p r o c e s s of becoming aware of and i n t e g r a t i n g r e s i s t a n c e s i n o r d e r to a c c e s s the i n t e r -r u p t e d e x p e r i e n c e . D a l d r u p et a l . (1988) d e f i n e 5 s t e p s f o r w o r k i n g w i t h u n f i n i s h e d b u s i n e s s w h i c h a r e d e s i g n e d to evoke a g r a d u a l i n c r e a s e of e m o t i o n a l i n t e n s i t y , f o l -lowed by d i m i n u t i o n of a f f e c t i v e l e v e l , and f i n a l l y by r e c o n c e p t u a l i z a t i o n or r e f r am i n g of p a s t e x p e r i e n c e s . 1. F o c u s - The t h e r a p i s t w i t h the c l i e n t i d e n t i f i e s a f o c a l p o i n t f o r work. The f o c a l p o i n t i s u s u a l l y i d e n t i f i e d by a f e e l i n g or b e h a v i o r t h a t the c l i e n t de-s i r e s t o c hange. The benchmarks f o r u n f i n i s h e d b u s i n e s s a r e o b s e r v e d . 2. Corrmi t tmen t - The t h e r a p i s t g e t s a committment - 21 f r o m the c l i e n t to work on a c h o s e n f o c a l p o i n t . The t h e r a p i s t s u p p o r t s the c l i e n t to change t e n t a t i v e n e s s to d e f i n i t e n e s s by p r o v i d i n g encouragement and a s s u r a n c e . A m a j o r p r o b l e m f o r a l l forms of p s y c h o t h e r a p y i s to m o t i v a t e the c l i e n t to do what needs to be done. The c l i e n t must r e t u r n to the u n f i n i s h e d b u s i n e s s w h i c h he l e f t u n f i n i s h e d i n the p a s t b e c a u s e i t was so p a i n f u l t h a t he had to f l e e . In the p r e s e n t , i f he i s e n c o u r a g e d to go back and f i n i s h i t , i t i s s t i l l p a i n f u l ; i t r e a c t i v a t e s h i s m i s e r y and f r o m the s h o r t - r u n view, i t i s s t i l l to be a v o i d e d . 3. E x p e r i m e n t - The t h e r a p i s t a s s i s t s the c l i e n t to engage the s i g n i f i c a n t o t h e r i n a p i e c e of u n f i n i s h e d b u s i n e s s and h e i g h t e n s a f f e c t i v e and s e n s o r y e x p e r i e n c e t h r o u g h e x p e r i e n t i a l t e c h n i q u e s ( i e . emp t y - c h a i r , p h y s i c a l l y a c t i n g o u t , changes i n l a n g u a g e such as " I " s t a t e r n e n t s ) to the p o i n t of e x p r e s s i o n and r e l e a s e . 4. A s s e s s m e n t - The t h e r a p i s t a s s i s t s the c l i e n t to a s s e s s and e v a l u a t e the work done and to b e g i n the p r o c e s s of r e c o g n i z i n g p e r c e p t u a l g e s t a l t s , t h r o u g h a wareness of s e n s o r y , a f f e c t i v e and c o g n i t i v e s e n s a t i o n s . 5. Plans/Homework - The t h e r a p i s t e x p l o r e s w i t h the c l i e n t the f u t u r e p l a n s to use new a w a r e n e s s e s o b t a i n e d . D a l d r u p et a l (1988) have s u g g e s t e d a s e r i e s of phases of e x p e r i e n c e t h a t a c l i e n t may go t h r o u g h i n the - 22 -p r o c e s s of u n f i n i s h e d b u s i n e s s work. The phases c o i n -c i d e w i t h what P e r l s (1970) has c a l l e d the f i v e l a y e r s of n e u r o s i s . 1'. D i s o w n i n g - The c l i e n t may deny h i s e m o t i o n a l e x p e r i e n c e d i r e c t l y ; he may i n d i r e c t l y a t t r i b u t e t h e s e f e e l i n g s e x t e r n a l l y to a n o t h e r ; or he may o t h e r w i s e d i s -t a n c e h i m s e l f f r o m the e x p e r i e n c e and the e x p e c t e d c o n -sequence of f e e l i n g s , d e n y i n g or m i n i m i z i n g the impact t h e f e e l i ngs a r e h a v i n g on him. 2. P h o b i c R e a c t i o n - The c l i e n t b e g i n s to r e c o g -n i z e t h e a v a i l a b i l i t y and s i g n i f i c a n c e of the l e f t o v e r emo t i o n and t h e r e i s a p h o b i c r e a c t i o n to the erne r g i n g i n t e n s i t y of the e x p e r i e n c e d emo t i o n of c a t a s t r a u p h i c p r o p o r t i o n s . 3. I m p l o s i o n - The c l i e n t b e g i n s to f e e l dead or numb and has no awareness of f e e l i n g . 4. E x p l o s i o n - An o f t e n sudden s h i f t of reawakened e m o t i o n and an a c c e p t a n c e of d e n i e d and disowned e m o t i o n i s e v i d e n t . The c l i e n t b e g i n s to e x p r e s s s p o n t a n e o u s l y a l l t h o u g h t s , f e e l i n g s and s e n s a t i o n s a s s o c i a t e d w i t h the i n t e r r u p t e d e x p e r i e n c e . 5. C o m p l e t i o n - T h e r e i s a c o g n i t i v e r e p r o c e s s i n g of b o t h the t h e r a p y work and the e v o k i n g e x p e r i e n c e s . T h e r e i s an i n c r e a s e d o w n e r s h i p and r e i n t e g r a t i o n of p r e v i o u s l y d isowned f e e l i n g s t a t e s and a s i g n i f i c a n t - 23 -d i m i n u t i o n of h o s t i l e f e e l i n g s . The i m p o r t a n t change mechanism i s " t h e e x p r e s s i o n of e m o t i o n s to t h e i r n a t u r a l c o m p l e t i o n and the r e p r o c e s s i n g of the e x p e r i e n c e i n o r d e r to b r i n g about a c o g n i t i v e r e o r g a n i z a t i o n or r e e v a l u a t i o n of the e x p e r i e n c e " ( G r e e n -b e r g & S a f r a n , 1987, p . 2 2 2 ) . D e a l i n g s u c c e s s f u l l y w i t h u n f i n i s h e d b u s i n e s s r e -q u i r e s the a c t i v a t i o n of sch ema t i c memo ry of p a r t i c u l a r e p i s o d e s ( G r e e n b e r g & S a f r a n , 1987). A sch ema i s the r e p r e s e n t a t i o n of a s p e c i f i c e m o t i o n a l e x p e r i e n c e t h a t has t a k e n p l a c e i n the p a s t , as w e l l as key p e r c e p t u a l f e a t u r e s t h a t have e l i c i t e d the e m o t i o n a l r e s p o n s e s to s t i m u l i ( L e v e n t h a l & E v e r h a r t , 1979). T h i s i s f a c i l -i t a t e d and h e i g h t e n e d i n t h e r a p y by e n a c t i n g or r e l i v i n g the s i t u a t i o n as much as i t i s p o s s i b l e t h r o u g h d i a l o g u e and s e n s o r y a w a r e n e s s . E m o t i o n a l memory a p p e a r s to e s t a b l i s h s t a b l e r e p r e s e n t a t i o n s of p e o p l e , or what has been r e f e r r e d to as s t a b l e o b j e c t r e l a t i o n s ( G u n t r i p , 1969). S t a b l e o b j e c t r e l a t i o n s h i p s a r e formed f r o m an i n t e g r a t i o n of our e x p e r i e n c e of s i g n i f i c a n t o t h e r s i n our l i v e s , w h i c h i n c l u d e s a s e t of a t t i t u d e s and e m o t i o n s toward the p e r s o n . T h i s i n t e g r a t i o n c o n s t i t u t e s the o b j e c t ( p e r s o n ) as a d i s c r e t e u n i f i e d e n t i t y i n our i n n e r w o r l d . In f i n i s h i n g u n f i n i s h e d b u s i n e s s , p e o p l e o f t e n evoke a memory s t r u c t u r e of the r e l a t i o n s h i p w i t h the s i g -- 24 -n i f i c a n t o t h e r . When s c h e m a t i c r e p r e s e n t a t i o n s of the w o r l d i n c l u d e i n j u n c t i o n s a g a i n s t e n c o u n t e r i n g c e r t a i n t y p e s of e x p e r i e n c e , s e n s i t i v i t y to one's p r e s e n t i n t e r -n a l and/or e x t e r n a l e n v i r o n m e n t i s i n v a r i a b l y r e d u c e d . The way i n w h i c h e x p e r i e n c e i s d i s t o r t e d i s g o v e r n e d by the i n t e r n a l r e p r e s e n t a t i o n s or schemas t h a t implement the i n j u n c t i o n s a g a i n s t e n c o u n t e r i n g c e r t a i n k i n d s of c o g n i t i v e , s e n s o r y , or a f f e c t i v e s t i m u l i . T hese i n -t e r n a l r e p r e s e n t a t i o n s or schemas t h e n , a r e the p r i m a r y t a r g e t s of t h e r a p e u t i c change. What seems to happen i n the p r o c e s s of e v o k i n g schemas i s " t h a t by b r e a k i n g the e m o t i o n a l s t r u c t u r e i n t o components and b r i n g i n g a l l the components to a w a r e n e s s , one can p r e v e n t them f r o m a u t o -m a t i c a l l y r e i n t e g r a t i n g i n t o the same network ( G r e e n b e r g & S a f r a n , 1987, p . 2 8 1 ) . "Renewed awareness of momentary e x p e r i e n c e l e a d s not o n l y to the e x p r e s s i o n of o l d h u r t s , but a l s o t o f r e s h and s u r p r i s i n g p e r -s p e c t i v e s and enhanced p e r c e p t i o n " ( G r e e n b e r g & S a f r a n , 1987, p . 5 3 ) . The p r e s e n c e of new schema s t i m u l a t e s a new e m o t i o n and the b e g i n n i n g of r e s t r u c t u r i n g . The e x p r e s s i o n of t h e p r i m i t i v e anger a p p e a r s to evoke the good i n t e r n a l o b j e c t . T h i s g e n e r a l t y p e of phenomenon, i n w h i c h the i n t e n s e e x p r e s s i o n of one e m o t i o n seems t o evoke a p o l a r o p p o s i t e emo-t i o n ; has o f t e n been r e f e r r e d to i n the t h e r a p e u t i c l i t e r a t u r e and r e q u i r e s f u r t h e r i n v e s t i g a t i o n . ( G r e e n b e r g & S a f r a n , 1987, p.285) G r e e n b e r g and S a f r a n (1987) h y p o t h e s i z e t h a t the e x p r e s s i o n - 25 -of the r e s t r i c t e d a f f e c t to i t ' s f u i i e s t i n t e n s i t y i n the s a f e t y of the t h e r a p e u t i c s i t u a t i o n a l l o w s f o r the a d m i s s i o n of new i n f o r m a t i o n to the d y s f u n c t i o n a l schema. The c o m p l e t e p r o c e s s i n g of a s p e c i f i c e m o t i o n a l e x p e r i e n c e l e a d s to a s h i f t i n the n a t u r e of the emo t i o n a 1 e x p e r i e n c e . P e o p l e b e n e f i t by r e p r o c e s s i n g the s i t u a t i o n i n w h i c h they r e s t r i c t e d t h e i r e x p e r i e n c e , by e x p r e s s i n g t h e i r u n e x p r e s s e d f e e l i n g s , and by d i f f e r e n t i a t i n g them and s y m b o l i z i n g new m e a n i n g s . What a p p e a r s to be e s -s e n t i a l to r e s o l u t i o n i s the c l i e n t b e i n g a b l e to see the w o r l d f r o m the s i g n i f i c a n t o t h e r ' s p o i n t of v i e w and b e i n g a b l e to u n d e r s t a n d and a c c e p t t h i s v iew. The e x p r e s s i o n of i n t e n s e n e g a t i v e a f f e c t toward the r e j e c t i n g o b j e c t and s u b s e q u e n t i d e n t i f i c a t i o n w i t h the r e j e c t i n g o b j e c t p r o d u c e s u f f i c i e n t cues ••';v. to a c t i v a t e an a l t e r n a t e schema of the more com-•' p a s s i o n a t e o t h e r . T h i s s h i f t l e a d s to an emo t i o n a 1 r e s t r u c t u r i n g t h a t i s marked by f e e l i n g s of a c c e p t -ance and f.orgi v e n e s s . . . 11 i s pos i ted t h a t the a c t i v a t i o n of an a l t e r n a t e mo re p o s i t i v e i n t e r n a l o b j e c t schema and a sense of s e l f - w o r t h i s b r o u g h t about by the a r o u s a l of the n e g a t i v e a f f e c t i n -v o l v e d i n the u n f i n i s h e d e x p e r i e n c e and the c a r r y -i n g f o r w a r d to c o m p l e t i o n of t h i s p r e v i o u s l y i n t e r r u p t e d e x p r e s s i o n . ( G r e e n b e r g & S a f r a n , 1987, p.290) R e s e a r c h on the Use of G e s t a l t T e c h n i q u e s i n P s y c h o t h e r a p y The m a j o r i t y of r e s e a r c h t h a t e x i s t s on G e s t a l t t e c h n i q u e s c e n t e r s on the G e s t a l t t w o - c h a i r d i a l o g u e and on the c l i e n t s t a t e of i n t r a p s y c h i c c o n f l i c t r e f e r r e d to as a s p l i t . In G e s t a l t t w o - c h a i r d i a l o g u e , the c l i e n t - 26 -i s a s k e d to a l t e r n a t e l y assume the two s i d e s of an i n t r a -p s y c h i c c o n f l i c t . G r e e n b e r g (1979) p r e s e n t s the f o l l o w i n g f i v e p r i n c i p l e s t h a t c o n s t i t u t e the main s t r u c t u r e of the o p e r a t i o n : m a i n t e n a n c e of a c o n t a c t b oundary, r e s p o n s i b i l i t y , a t t e n d i n g , h e i g h t e n i n g , and e x p r e s s i n g . G r e e n b e r g (1979) d e f i n e s a s p l i t as h a v i n g f o u r i d e n t -i f i a b l e f e a t u r e s : i n d i c a t o r s of two p a r t s of the s e l f , a c o n t r a d i c t i o n i n d i c a t o r , and a s t r u g g l e i n d i c a t o r . In a s e r i e s of s t u d i e s , G r e e n b e r g and c o - w o r k e r s have shown t h a t the a p p l i c a t i o n of G e s t a l t t w o - c h a i r d i a l o g u e at an i n - t h e r a p y s t a t e m e n t of a s p l i t l e a d s to g r e a t e r d e p t h s of e x p e r i e n c i n g than d i d e m p a t h i c r e -f l e c t i o n . G r e e n b e r g (1975) found t h a t G e s t a l t t w o - c h a i r r o l e p l a y , when used at a s p l i t i n t h e r a p y , r e p e a t e d l y p r o d u c e d deeper l e v e l s of e x p e r i e n c i n g than d i d em-p a t h i c r e f l e c t i o n i n t h r e e s i n g l e c a s e s t u d i e s . C l a r k e (1977) and G r e e n b e r g and C l a r k e (1979) r e p o r t e d on an a n a l o g u e s t u d y of 16 s u b j e c t s i n w h i c h i t was found t h a t the G e s t a l t t w o - c h a i r d i a l o g u e r e s u l t e d i n g r e a t e r d e p t h of e x p e r i e n c i n g and a g r e a t e r change i n awareness than d i d e m p a t h i c r e f l e c t i o n at a s p l i t i n t h e r a p y . G r e e n b e r g and H i g g i n s (1980) r e p l i c a t e d t h i s s t u d y w i t h 28 s u b j e c t s i n an a n a l o g u e and fo u n d t h a t the t w o - c h a i r d i a l o g u e at a s p l i t p r o d u c e d s i g n i f i c a n t l y more d e p t h of e x p e r i e n c i n g than d i d f o c u s i n g p l u s e m p a t h i c r e f l e c t i o n . - 27 -D o m p i e r r e (1979) and G r e e n b e r g and D o m p i e r r e (1981) s t u d i e d the s p e c i f i c e f f e c t s of G e s t a l t t w o - c h a i r d i a l o g u e at a s p l i t i n c o u n s e l l i n g . They found t h a t d e p t h of e x p e r i e n c i n g and s h i f t s i n a w a r e n e s s , r e p o r t e d c o n f l i c t r e s o l u t i o n and r e p o r t e d b e h a v i o r c h a n g e s , were g r e a t e r f o l l o w i n g a G e s t a l t t w o - c h a i r d i a l o g u e than t h a t o b t a i n e d w i t h e m p a t h i c r e f l e c t i o n . G r e e n b e r g and R i c e (1981) i n an i n - d e p t h a n a l y s i s of 3 c l i e n t s , t r a i n e d t h e r a p i s t s to use a p r e - d e t e r m i ned s c h e d u l e of r e s p o n s e s to a s p l i t . The s c h e d u l e randomly a l t e r n a t e d a c c u r a t e empathy r e s p o n s e s w i t h t w o - c h a i r o p e r a t i o n s . H i g h e r e x p e r i e n c i n g and s p e c i f i c a l l y many more peak e x p e r i e n c i n g r a t i n g s of f i v e and above were found t o o c c u r a f t e r the t w o - c h a i r o p e r a t i o n s than a f t e r e m p a t h i c r e s p o n d i n g . T h e s e r e s u l t s s u g g e s t the more d i r e c t and s t r i k i n g impact of the s p e c i f i c a l l y t a r g e t e d G e s t a l t t e c h n i q u e . G r e e n b e r g (1980a) d e l i n e a t e d a v e r y c o n s i s t e n t p a t t e r n of s p l i t r e s o l u t i o n : The " s e l f " c h a i r f i r s t r e a c h e s e x p e r i e n c i n g l e v e l 4; t h e n the " o t h e r " c h a i r , a f t e r h a v i n g p r o c e e d e d at low e x p e r i e n c i n g l e v e l s , i n c r e a s e s to l e v e l k as w e l l ( m e r g e s ) ; and then b o t h c h a i r s move to s t a g e 5 and 6, whereupon the c o n f l i c t i s r e s o l v e d . G r e e n b e r g ' s (1983b) r e l a t e d r e s e a r c h demon-s t r a t e d t h a t c o n f l i c t r e s o l u t i o n p e r f o r m a n c e i n the two-c h a i r d i a l o g u e o c c u r s by a p r o c e s s of deeper e x p e r i e n c i n g - 28 -of p r e v i o u s l y r e j e c t e d a s p e c t s of the s e l f . In t h i s s t u d y G r e e n b e r g a n a l y z e d c o n f l i c t r e s o l u t i o n w i t h n o n - r e s o l u -t i o n p e r f o r m a n c e s . He d e v e l o p e d a t h r e e s t a g e s e q u e n t i a l m o d e l . G r e e n b e r g and Webster (1982) a l s o s t u d i e d c l i e n t s who e x p e r i e n c e d i n t r a p s y c h i c c o n f l i c t r e l a t e d to m aking a d e c i s i o n . In t h i s s t u d y , c l i e n t s who e x p e r i e n c e d a s o f t e n i n g of t h e i r c r i t i c showed g r e a t e r c o n f l i c t r e s o l u t i o n , l e s s d i s c o m f o r t , g r e a t e r mood change and g r e a t e r g o a l a t t a i n m e n t than d i d c l i e n t s who d i d not e x p e r i e n c e the s o f t e n i n g . C l a r k e (1981) and C l a r k e and G r e e n b e r g (1984) com-p a r e d t h e G e s t a l t t w o - c h a i r d i a l o g u e w i t h a c o g n i t i v e Prob1 em-So 1 v i n g c o u n s e l l i n g i n t e r v e n t i o n to h e l p c l i e n t s r e s o l v e an i n t r a p e r s o n a 1 c o n f l i c t r e l a t e d to a c a r e e r d e c i s i o n . F o r t y e i g h t p e o p l e were randomly a s s i g n e d t o t h r e e g r o u p s , 16 i n each of a prob1 em-so 1 v i n g g r o u p , a t w o - c h a i r group and a w a i t l i s t c o n t r o l g r o u p . T r a i n e d c o u n s e l l o r s saw c l i e n t s f o r two s e s s i o n s . S u b j e c t s were p r e and p o s t t e s t e d on m e asures of i n d e c i s i o n and s t a g e of d e c i s i o n - m a k i n g . R e s u l t s showed t h a t the a f f e c t i v e i n t e r v e n t i o n was more e f f e c t i v e than the c o g n i t i v e i n t e r -v e n t i o n or no t r e a t m e n t f o r r e d u c i n g i n d e c i s i o n . B oth c o u n s e l l i n g a p p r o a c h e s were more e f f e c t i v e than no t r e a t -ment i n f a c i l i t a t i n g movement t h r o u g h the s t a g e s of d e c i s i o n ma k i n g . R e s e a r c h t h a t does not f o c u s on the c l i e n t s t a t e of - 29 -s p l i t s i s s c a n t . B o h a r t (1977) i n an a n a l o g u e s t u d y of 80 s u b j e c t s r e p o r t e d t h a t G e s t a l t t w o - c h a i r r o l e p l a y was more e f f e c t i v e i n r e d u c i n g a n g e r , h o s t i l e a t t i t u d e s and b e h a v i o r a l a g g r e s s i o n than were i n t e l l e c t u a l a n a l y s i s or e m o t i o n a l d i s c h a r g e t e c h n i q u e s . K i p p e r and G i l a d i (1978) fo u n d t h a t the t w o - c h a i r method l e d t o an e q u i v a l e n t r e -d u c t i o n of t e s t a n x i e t y as d i d s y s t e m a t i c d e s e n s i t i z a -t i o n . S erok and Zemet (1983) d e s c r i b e an e x p e r i m e n t a l s t u d y of group t h e r a p y u s i n g G e s t a l t p r i n c i p l e s and met h o d s . R e s u l t s showed a s i g n i f i c a n t i n c r e a s e i n r e a l -i t y p e r c e p t i o n and d i f f e r e n t i a t i o n i n the G e s t a l t e x p e r -i m e n t a l g r o u p . One outcome s t u d y c o n d u c t e d by K i n g (1988) f o u n d t e n t a t i v e r e s u l t s s u g g e s t i n g t h a t the G e s t a l t e m p t y - c h a i r d i a l o g u e i n t h e c o n t e x t of an e m p a t h i c r e -l a t i o n s h i p may make a c o n t r i b u t i o n t o the t r e a t m e n t of the i s s u e of u n f i n i s h e d b u s i n e s s . B e u t l e r e t a l . (1988) at the U n i v e r s i t y of A r i z o n a r e s e a r c h i n g F o c u s e d E x p r e s s i v e P s y c h o t h e r a p y e m p l o y i n g the e m p t y - c h a i r t e c h n i q u e w i t h the c l i e n t i s s u e of u n f i n i s h e d b u s i n e s s , s p e c i f i c a l l y a n g e r ; r e p o r t s i g n i f i c a n t t r a i n i n g d i f f e r e n c e s a r e o b t a i n e d by f o l l o w i n g the manual f o r F o c u s e d E x p r e s s i v e P s y c h o t h e r a p y , a l t h o u g h some d a t a a r e s t i l l i n the p r o -c e s s of b e i n g a n a l y z e d . R e s e a r c h on the G e s t a l t T r e a t m e n t A p p r o a c h w i t h the I s s u e of U n f i n i s h e d B u s i n e s s To d a t e , one s t u d y e x i s t s on the G e s t a l t t r e a t m e n t - 30 -a p p r o a c h w i t h the i s s u e of u n f i n i s h e d b u s i n e s s . K i n g (1988) found t e n t a t i v e r e s u l t s s u g g e s t i n g t h a t the G e s t a l t e m p t y - c h a i r d i a l o g u e may make a c o n t r i b u t i o n to the t r e a t m e n t of the i s s u e of u n f i n i s h e d b u s i n e s s . In t h i s s t u d y s u b j e c t s were s o l i c i t e d f r o m s t u d e n t s e n r o l l e d i n a c o u n s e l l i n g c o u r s e at the U n i v e r s i t y of B.C. S u b j e c t s were t o l d t h a t the s t u d y was an i n v e s t -i g a t i o n of u n f i n i s h e d b u s i n e s s and the c o n s t r u c t of u n f i n i s h e d b u s i n e s s was d e s c r i b e d . A p o o l of 41 v o l u n t e e r s were randomly a s s i g n e d to e i t h e r the G e s t a l t e m p t y - c h a i r d i a l o g u e c o n d i t i o n or the e m p a t h i c r e f l e c t i o n c o n d i t i o n . The s t u d y showed t h a t the G e s t a l t emp t y - c h a i r d i a l o g u e c o n d i t i o n p r o d u c e d s i g n i f i c a n t l y mo re t o l e r a n c e to the s u b j e c t s ' f e e l i n g s towards a s i g n i f i c a n t o t h e r as measured by the A f f e c t i v e R e a c t i o n s Q u e s t i o n n a i r e on an i s s u e of u n f i n i s h e d b u s i n e s s , than t h o s e p r o d u c e d by e m p a t h i c r e f l e c t i o n . The r e s u l t s f u r t h e r s u g g e s t e d t h a t a g r e a t e r improvement i n i n i t i a l t a r g e t c o m p l a i n t as m easured by the T a r g e t C o m p l a i n t Measure was r e p o r t e d by s u b j e c t s i n the G e s t a l t emp t y - c h a i r d i a l o g u e c o n d i t i o n than was r e p o r t e d by s u b j e c t s i n the e m p a t h i c r e f l e c t i o n c o n d i t i o n . - 31 R e s e a r c h i n the Use of E m p a t h i c R e f l e c t i o n i n P s y c h o t h e r a p y R o g e r s (1957) s u g g e s t e d empathy i s one of the c o r e t h e r a p e u t i c c o n d i t i o n s b o t h n e c e s s a r y and s u f f i c i e n t t o p r o d u c e c l i e n t c hange. F o r p s y c h o t h e r a p e u t i c change to o c c u r , i t i s n e c e s s a r y t h a t the f o l l o w i n g c o n d i t i o n s e x i s t and c o n t i n u e over a p e r i o d of t i m e : 1. Two p e o p l e a r e i n p s y c h o l o g i c a l c o n t a c t . 2. The f i r s t , whom we s h a l l t e r m the c l i e n t i s i n a s t a t e of i n c o n g r u e n c e , b e i n g v u l n e r a b l e or a n x i o u s . 3. The second p e r s o n , whom we s h a l l t e r m the t h e r a p i s t ; i s c o n g r u e n t or i n t e g r a t e d i n the r e l a t i o n s h i p . 4. The t h e r a p i s t e x p e r i e n c e s u n c o n d i t i o n a l p o s i t i v e r e g a r d f o r the c l i e n t . 5. The t h e r a p i s t e x p e r i e n c e s an e m p a t h i c under-s t a n d i n g of the c l i e n t ' s i n t e r n a l frame of r e f e r e n c e and e n d e a v o u r s to cormnun i c a t e t h i s e x p e r i e n c e to the c l i e n t . 6. The corrmun i ca t i on to the c l i e n t of the t h e r a p i s t ' s e m p a t h i c u n d e r s t a n d i n g and u n c o n d i t i o n a l p o s i -t i v e r e g a r d i s to a m i n i m a l d e g r e e a c h i e v e d . ( R o g e r s , 1957, p.96) R o g e r s (.1957) d e f i n e d empathy as - " t o sense the c l i e n t ' s p r i v a t e w o r l d as i f i t were your own, but w i t h -- 32 -o u t e v e r l o s i n g t h e "as i f " q u a l i t y . . . t o s e n s e t h e c l i e n t ' s a n g e r , f e a r o r c o n f u s i o n as i f i t were y o u r own, y e t w i t h o u t y o u r own a n g e r , f e a r or c o n f u s i o n g e t t i n g bound up i n i t " ( p . 9 9 ) . A g r e a t d e a l o f r e s e a r c h on t h e r a p i s t warmth and empathy has been done t o t e s t R o g e r s ' t h e o r y of f a c i l i -t a t i v e c o n d i t i o n s . " R e s e a r c h on empathy, warmth and g e n u i n e n e s s i s among t h e l a r g e s t f o r any t o p i c o f s i m i l a r s i z e i n t h e f i e l d o f p s y c h o l o g y " ( P a t t e r s o n , 1984, p . 4 3 1 ) . R e v i e w s of empathy r e s e a r c h have been done by t h e f o l l o w i n g a u t h o r s : T r u a x and M i t c h e l l ( 1 9 7 1 ) ; B e r g i n and S u i n n ( 1 9 7 5 ) ; Gurman ( 1 9 7 7 ) ; M i t c h e l l , B o z a r t h and K r a u f t ( 1 9 7 7 ) ; O r l i n s k y and Howard ( 1 9 7 8 , 1 9 8 6 ) ; P a t t e r s o n ( 1 9 8 4 ) ; L a m b e r t , S h a p i r o and B e r g i n ( 1 9 8 6 ) . T r u a x and M i t c h e l l ( 1 9 7 1 ) f o u n d t h a t t h e r a p i s t s a n d c o u n s e l l o r s who a r e a c c u r a t e l y e m p a t h i c , n o n - p o s s e s s i v e 1 y warm i n a t t i t u d e and g e n u i n e a r e i n d e e d e f f e c t i v e . T h i s f i n d i n g h e l d f o r t h e r a p i s t s f r o m d i f f e r e n t o r i e n t a t i o n s and t r a i n i n g , d i f f e r e n t c l i e n t g r o u p s ; a c c r o s s a v a r i e t y of t h e r a p e u t i c c o n t e x t s . They c o n c l u d e d t h a t e mpathy, warmth and gen-u i n e n e s s w e r e r e l a t e d d i r e c t l y t o o u t c o m e , and t h a t t h e s e c o n d i t i o n s w e r e b o t h n e c e s s a r y and s u f f i c i e n t f o r c l i e n t c h a n g e . Gurman's ( 1 9 7 7 ) r e v i e w a l s o s u p p o r t e d t h e s e f i n d i n g s . " T h e r e e x i s t s s u b s t a n t i a l , i f not o v e r w h e l m i n g e v i d e n c e i n s u p p o r t o f t h e h y p o t h e s i z e d r e l a t i o n s h i p be-tween p a t i e n t - p e r c e i v e d t h e r a p e u t i c c o n d i t i o n s and outcome - 33 -i n i n d i v i d u a l p s y c h o t h e r a p y and c o u n s e l l i n g " (Gurman, 1977, p . 5 2 3 ) . In O r l i n s k y and Howard's r e v i e w ( 1 9 7 8 ) , a p p r o x i m a t e l y t w o - t h i r d s of 23 s t u d i e s on warmth and a s i m i l a r p e r -c e n t a g e of 35 s t u d i e s on empathy showed a s i g n i f i c a n t p o s i t i v e r e l a t i o n s h i p between e x t e r n a l l y r a t e d a s p e c t s of t h e r a p i s t i n t e r p e r s o n a l b e h a v i o r and t h e r a p e u t i c outcome. "The s t u d i e s done thus f a r s u g g e s t t h a t the p o s i t i v e q u a l i t y of the r e l a t i o n a l bond, as ex emp 1i f i e d i n the r e c i p r o c a l i n t e r p e r s o n a l r e l a t i o n s h i p b e h a v i o r s of the p a r t i c i p a n t s , i s more c l e a r l y r e l a t e d to p a t i e n t improvement than a r e any of the p a r t i c u l a r t r e a t m e n t t e c h n i q u e s used by the t h e r a p i s t s " ( O r l i n s k y & Howard, 1978, p . 2 9 6 ) . O t h e r r e s e a r c h r e v i e w s have come to e q u i v o c a l and c o n f l i c t i n g c o n c l u s i o n s r e g a r d i n g the v a r i a b l e s of empathy, warmth and g e n u i n e n e s s . M i t c h e l e t a l . (1977) s t a t e " t h e mass of d a t a n e i t h e r s u p p o r t s nor r e j e c t s the o v e r -r i d i n g i n f l u e n c e of such v a r i a b l e s as empathy, warmth and g e n u i n e n e s s i n a l l c a s e s . The r e c e n t e v i d e n c e , a l t h o u g h e q u i v o c a l , does seem to s u g g e s t t h a t empathy, warmth and g e n u i n e n e s s a r e r e l a t e d i n some way to c l i e n t change but t h a t t h e i r p o t e n c y and g e n e r i z a b i 1 i t y a r e not as g r e a t as once t h o u g h t " ( p . 4 8 3 ) . P a r l o f f , Waskow and Wo I f e (1978) i n r e s e a r c h i n g t h e r a p i s t v a r i a b l e s in;, r e l a -t i o n to p r o c e s s and outcome c o n c l u d e d t h a t " t h e u n q u a l i -f i e d c l a i m t h a t h i g h l e v e l s ( a b s o l u t e or r e l a t i v e ) of - 34 -a c c u r a t e empathy, warmth and g e n u i n e n e s s ( i n d e p e n d e n t of the s o u r c e of r a t i n g or the n a t u r e of the i n s t r u m e n t ) r e p r e s e n t the n e c e s s a r y and s u f f i c i e n t c o n d i t i o n s f o r e f f e c t i v e t h e r a p y ( i n d e p e n d e n t of the outcome measures or c o n d i t i o n s ) i s not s u p p o r t e d " ( p . 2 9 3 ) . I n c o n s i s t e n c i e s i n the r e s e a r c h l i t e r a t u r e have been e x p l a i n e d i n p a r t by a number of c o n c e p t u a l and method-o l o g i c a l p r o b l e m s w i t h the measurement of empathy f r o m an o b s e r v a t i o n a l p e r s p e c t i v e (Lambert et a l . , 1978; M i t c h e l l et a l . , 1977). A c c o r d i n g t o G l a d s t e i n ( 1 9 8 3 ) , p r o b a b l y the p r i m a r y r e a s o n f o r the c o n f u s i o n i s t h a t v a r i o u s t h e o r e t i c a l models have been used i n d e f i n i n g and me a s u r i n g emp a t h y . A l s o M i t c h e l l e t a l . (1977) fo u n d i n t h e i r r e v i e w t h a t h i g h group mean s c o r e s among t h e r a p i s t s i n many s t u d i e s b a r e l y s u r p a s s e d 2.0 on the C a r k h u f f and T r u a x S c a l e s , s u g g e s t i n g t h a t the i n c o n c l u s i v e r e s u l t s may have been due to low l e v e l s of empathy. O t h e r r e s e a r c h f i n d i n g s s u g g e s t t h a t empathy, warmth and g e n u i n e n e s s i n t e r a c t w i t h o t h e r t h e r a p i s t v a r i a b l e s such as d i r e c t i v e n e s s ( M i n t z , L u b o r s k y & A u e r b a c h , 1971) and t h a t they a r e p o s s i b l y f a c i l i t a t i v e o n l y at p a r t i c u l a r , p r e c i s e times i n t h e r a p y (Lambert et a l . , 1978; M i t c h e l l e t a l . , 1977). B e r g i n and S u i n n (1975) s u g g e s t i n t h e i r r e v i e w of the l i t e r a t u r e t h a t the c o r e c o n d i t i o n s of empathy, warmth and g e n u i n e n e s s s h o u l d not be g e n e r a l i z e d as the b a s i c s of good t h e r a p y - 35 -nor c o n s i d e r e d as n e c e s s a r y and s u f f i c i e n t c o n d i t i o n s beyond the c 1 i e n t - c e n t e r e d a p p r o a c h , as t h e s e c o n d i t i o n s p r o b a b l y do not h o l d f o r o t h e r a p p r o a c h e s . P a t t e r s o n (1984) i n a s t r o n g l y worded c r i t i c i s m of the l i t e r a t u r e w h i c h he r e v i e w e d s u g g e s t e d t h a t r e v i e w s were b i a s e d i n a number of ways. He r e a c h e d f a r d i f f e r -ent c o n c l u s i o n s ; " t h e e v i d e n c e f o r the n e c e s s i t y , i f not s u f f i c i e n c y , of the t h e r a p i s t c o n d i t i o n s of a c c u r a t e empathy, r e s p e c t , or warmth, and g e n u i n e n e s s i s i n c o n t r o -v e r t i b l e " ( p . 4 3 7 ) . The most r e c e n t r e v i e w by O r l i n s k y and Howard (1986) c o n c l u d e t h e r e i s s t r o n g s u p p o r t f o r t h e r a p i s t empathy as making an i m p o r t a n t c o n t r i b u t i o n when empathy was measured as p e r c e i v e d by the c l i e n t . Lambert e t a l . (1986) s t r e s s t h a t r e l a t i o n s h i p f a c t o r s a r e i m p o r t a n t but q u e s t i o n how t h e s e f a c t o r s r e l a t e to t h e r a p i s t t e c h n i q u e . In c o n c l u s i o n , most i f not a l l p s y c h o t h e r a p i e s and p s y c h o t h e r a p i s t s , a c knowledge the i m p o r t a n t of the r e l a t i o n s h i p between the t h e r a p i s t and the c l i e n t . P r a c t i c a l l y e v e r y t h e o r y s t a t e s t h a t empathy i s i m p o r t -ant to i n i t i a t i n g and b u i l d i n g a c o u n s e l l i n g r e l a t i o n -s h i p ( G l a d s t e i n , 1983). B a r r e t t - L e n n a r d (1962) d e v e l o p e d the B a r r e t t - L e n n a r d R e l a t i o n s h i p I n v e n t o r y ( R l ) s p e c i f i c a l t o a s s e s s R o g e r s ' c l a i m of s u f f i c i e n t and n e c e s s a r y c o n d i -t i o n s f o r c l i e n t change. He found s u p p o r t f o r the p o s i -t i o n t h a t c l i e n t ' s p e r c e p t i o n of the t h e r a p e u t i c emp a t h i c - 36 -r e s p o n s e s f a c i l i t a t e d c l i e n t change. B a r r e t t - L e n n a r d (1962) s u g g e s t e d t h a t " t h e c l i e n t ' s e x p e r i e n c e of the t h e r a p i s t ' s r e s p o n s e i s the p r i m a r y f o c u s of t h e r a p e u t i c i n f l u e n c e i n t h e i r r e l a t i o n s h i p " ( p . 2 ) . The i m p o r t a n c e of t h e r a p y o c c u r r i n g i n an a t m o sphere of a p o s i t i v e r e l a t i o n s h i p and a good w o r k i n g a l l i a n c e has been e x t e n s i v e l y docu-mented ( B a r r e t t - L e n n a r d , 1962, 1982, 1986; C a r k h u f f , 1969; G r e e n b e r g , 1981, 1982; Gurman, 1977; M i t c h e l l , B o z a r t h & K r a u f t , 1977; T r u a x & C a r k h u f f , 1967; T r u a x and Wargo, 1966; O r l i n s k y & Howard, 1978, 1986). The r e l a t i o n s h i p between empathy, warmth and g e n u i n e n e s s , and outcome i s much more complex than had been u n d e r s t o o d by the e a r l y r e s e a r c h e r s . The l i t e r a t u r e s u g g e s t t h e s e c o n d i t i o n s a r e seen l a r g e l y as n e c e s s a r y but the l i t -e r a t u r e i s e q u i v o c a l as to whether t h e s e c o n d i t i o n s a r e s u f f i c i e n t to p r o d u c e c l i e n t change. The E x p e r i e n c i n g S c a l e and I t ' s Use i n P s y c h o t h e r a p y A c c o r d i n g to R o g e r s ( 1 9 5 9 ) , the g o a l of s u c c e s s f u l t h e r a p y and o p t i m a l p e r s o n a l i t y f u n c t i o n i n g , i s f o r the p e r s o n to be open to h i s or her f e e l i n g s , f e e l i n g s t h a t may c o n s t a n t l y change as the p e r s o n i s f u l l y engaged i n the p r o c e s s of l i v i n g . T h i s p r o c e s s R o g e r s (1950) d e f i n e d as " e x p e r i e n c i n g " , the c l i e n t ' s s e n s e of e x p l o r i n g h i s or her p e r c e p t u a l f i e l d . W i t h a s s i s t a n c e of such n o t a b l e c o l l a b o r a t o r s as G e n d l i n , R o g e r s sought to i d e n t i f y the e x p e r i e n c i n g p r o c e s s , f i r s t i n f e r e n t i a l 1 y v i a c h a r a c t e r -- 37 -i s t i c s of the c l i e n t ' s v e r b a l e x p r e s s i o n such as r i c h -ness of d e t a i l , and s u b s e q u e n t l y by d e v i s i n g a s c a l e t h a t w o u l d a l l o w the c o u n s e l l o r to e s t i m a t e the l e v e l of the c l i e n t ' s i n m e d i a t e e x p e r i e n c i n g ( G e n d l i n & Z i m r i n g , 1955; G e n d l i n , 3enney & S h l e i n , 1960). From 1960 to 1969, c o n t i n u o u s e f f o r t s were made to i n s t r u -m e n t a l i z e the e x p e r i e n c i n g c o n s t r u c t ( G e n d l i n & T o m l i n s o n , 1962, 1.967; Toml i nson & H a r t , 1962; R o g e r s , 1952,, 1959b; W a l k e r , R a b l e n & R o g e r s , 1960; R o g e r s , G e n d l i n , K i e s l e r & T r u a x , 1967). T h i s work c u l m i n a t e d i n the p r e s e n t f o r m of the E x p e r i e n c i n g S c a l e ( K l e i n et a l . , 1969). The E x p e r i e n c i n g S c a l e was d e v e l o p e d to t e s t the r e l a t i o n s h i p of e x p e r i e n c i n g to 3 t h e r a p i s t c o n d i t i o n v a r i a b l e s : pos-i t i v e r e g a r d , empathy and c o n g r u e n c e as d e f i n e d by R o g e r s (1957, 1959). S t r o n g a s s o c i a t i o n s of e x p e r i e n c i n g w i t h t h e s e t h e r a p i s t v a r i a b l e s (measured f r o m the p e r s p e c t i v e of b o t h p a t i e n t s and r a t e r s ) c a r r i e d over f r o m p r e l i m -i n a r y s t u d i e s to the f i n a l a n a l y s i s of t h i s p r o j e c t ( R o g e r s et a l . , 1967 ) . E x p e r i e n c i n g i s the e x t e n t to w h i c h i n n e r r e f e r e n t s beeome the f e l t datum of a t t e n t i o n f o r the i n d i v i d u a l ; and the d e g r e e to w h i c h e f f o r t s a r e made to f o c u s on, expand and p r obe t h e s e d a t a . The E x p e r i e n c i n g S c a l e a t t e m p t s to measure t h i s p r o c e s s of f o c u s i n g inward i n o r d e r t o s o l v e p r o b l e m s , an i m p o r t a n t b e h a v i o r i n moments - 38 -of change ( G r e e n b e r g & S a f r a n , 1987). "In such moments, p e o p l e f o c u s on and f r e e l y e x p r e s s t h e i r f e e l i n g s , a t t i t u d e s and meanings r e l a t e d to b e h a v i o r and e x p e r -i e n c e s ; t h e y i n t e g r a t e the a f f e c t i v e and r a t i o n a l e com-po n e n t s of t h i s a f f e c t i v e l y - t o n e d me a n i n g c omp l e x by d i f f e r e n t i a t i n g and i n t e g r a t i n g new meanings and they use the new p e r s p e c t i v e s g a i n e d f r o m t h i s p r o c e s s to g u i d e new b e h a v i o r " ( G r e e n b e r g & S a f r a n , 1987, p.75) At the low l e v e l of e x p e r i e n c i n g , the c l i e n t p r o -v i d e s no d e s c r i p t i o n of f e e l i n g s , and d i s c o u r s e i s sup-e r f i c i a l and i m p e r s o n a l . A t the m o d e r a t e l e v e l of ex-p e r i e n c i n g , the c l i e n t d e s c r i b e s and e l a b o r a t e s h i s or her f e e l i n g s , the g r e a t e r d e p t h s of e x p e r i e n c i n g a r e a c h i e v e d when the c l i e n t e x p l o r e s h i s or her f e e l i n g s and p r o g r e s s e s to s e l f - u n d e r s t a n d i n g and p r o b l e m r e s o l u t i o n . At h i g h e r l e v e l s of the s c a l e , t h e r e i s a s y n t h e s i s of r e a d i l y a c c e s s i b l e f e e l i n g s and e x p e r i e n c e s t o r e s o l v e p e r s o n a l l y s i g n i f i c a n t i s s u e s ( K l e i n e t a l . , 1969). T h e r e a p p e a r s to be a b i d i m e n s i o n a 1 i t y i n the s c a l e , i n t h a t i t i s marked by a s h i f t i n p e r s p e c t i v e at l e v e l 4, w h i c h i s the m i d p o i n t ( K l e i n , Ma t h i eu-Cough 1 an & K i e s l e r , 1986). S t a g e s 1 to 3 d e f i n e the c l i e n t ' s p r o g r e s s i v e own-e r s h i p of a f f e c t i v e r e a c t i o n to e x t e r n a l r e f e r e n t s at S t a g e 1 to a n o t h e r ' s r e a c t i o n at S t a g e 2, and to e x t e r n a l e v e n t s at S t a g e 3. S t a g e 4 marks a s h i f t f r o m a t t e n d i n g o u t w a r d l y to f o c u s i n g i n t e r n a l l y , i n a s e l f - d e s c r i p t i v e and a s s o c i a t i v e way, on - 39 -f e e l i n g s and p e r s o n a l e x p e r i e n c e s . At S t a g e 5, the c l i e n t s t a t e s p r o b l e m s or advances p r o p o s i t i o n s about f e e l i n g s or p e r s o n a l e x p e r i e n c e s i n an ex-p l o r a t o r y , e l a b o r a t e f a s h i o n . At S t a g e 6, the c l i e n t r e s o l v e s t h o s e p r o b l e m s , v i v i d l y e x p r e s s i n g h i s or her f e e l i n g s . A t S t a g e 7, an i n t e g r a t i o n and s y n t h e s i s of new i n f o r m a t i o n t a k e s p l a c e to a f f i r m the r e s o l u t i o n , and to expand and i n t e g r a t e the newly formed p e r s p e c t i v e . ( G r e e n b e r g & S a f r a n , 1987, p.74) The e x p e r i e n c i n g c o n s t r u c t has b o t h a c o g n i t i v e and a f f e c t i v e d i m e n s i o n . A r e v i e w of r e c e n t s t u d i e s l o o k i n g at the r e l a t i o n s h i p of e x p e r i e n c i n g to o t h e r p r o c e s s v a r i a b l e s suggests t h a t the E x p e r i e n c i n g S c a l e i s more c l o s e l y r e l a t e d t o " c o n c e p t u a l l y s i m i l a r m easures of d i s c l o s u r e , p r o b l e m e x p r e s s i o n , and i n t e r n a l f o c u s than i t i s to measures of c o n c r e t e n e s s , s p e e c h f l u e n c y and a f f e c t i v e d i s t r e s s " ( K l e i n e t a l . , 1986, p . 4 3 ) . T h e s e r e s u l t s a r e not s u r p r i s i n g and a r e c o n s i s t e n t w i t h the s c a l e ' s f o c u s on the p r o g r e s s i v e o w n e r s h i p of f e e l i n g s , se 1 f - r e v e 1 a t i o n , and p r o b l e m a t i c f o c u s . The modest r e -l a t i o n s h i p s f o r a f f e c t and n e g a t i v e r e l a t i o n s h i p s f o r c o n c r e t e n e s s a r e c o n s i s t e n t w i t h the f a c t t h a t i n t e n s e a f f e c t i v e e x p r e s s i o n and s i t u a t i o n a l d e t a i l a r e a s s o c i a t e d w i t h lower s t a g e s of the s c a l e . The e a r l y d e v e l o p m e n t a l work w i t h the E x p e r i e n c i n g S c a l e p r o v i d e d c o n s i s t e n t e v i d e n c e of r e l a t i o n s h i p s be-tween e x p e r i e n c i n g l e v e l , e i t h e r a v e r a g e d over a l l of t h e r a p y or at the end of t h e r a p y , w i t h v a r i o u s me a s u r e s of p a t i e n t improvement ( K l e i n e t a l . , 1969; K i e s l e r , 1971; - 40 -K a r o n & VandenBos, 1970; R o g e r s et a l . , 1967). The most c o n s i s t e n t f i n d i n g was t h a t s u c c e s s f u l t h e r a p y c l i e n t s s t a r t e d , c o n t i n u e d and ended t h e r a p y at h i g h e r l e v e l s of e x p e r i e n c i n g than d i d l e s s s u c c e s s f u l c l i e n t s . Some of the e a r l i e r s t u d i e s showed changes i n e x p e r -i e n c i n g o v e r t i m e ; upward movement over t h e r a p y was a s s o c i a t e d w i t h s u c c e s s , and downward movement was a s s o c i a t e d w i t h f a i l u r e ( R o g e r s et a l . , 1967). T h i s e a r l y r e s e a r c h s u g g e s t e d t h a t e x p e r i e n c i n g was to some d e g r e e a measure of h e a l t h as w e l l as a measure of p r o d u c t i v e t h e r a p e u t i c i n v o l v e m e n t ( K i e s l e r e t a l . , 1965; K i e s l e r , 1971; R o g e r s et a l . , 1967). E x p e r i e n c i n g was a l s o i d e n t i f i e d t o be r e l a t e d to v e r b a l and e x p r e s s i v e c a p a c i w h i c h i n t u r n has been a s s o c i a t e d w i t h good m o t i v a t i o n and p r o g n o s i s f o r t h e r a p y ( R o g e r s et a l . , 1967). R eviews of the p r o c e s s and outcome l i t e r a t u r e un-f a i l i n g l y r e p o r t on the p r o m i s e of the e x p e r i e n c i n g measure as an i n d i c a t o r of p r o d u c t i v e t h e r a p y ( L u b o r s k y , C h a n d l e r , Cohen & B a c h r a c h , 1971; O r l i n s k y & Howard, 1978). L u b o r k s y et a l . (1971) r e p o r t e d t h a t e x p e r i e n c i n was one of the few f a c t o r s f o u n d to r e l a t e to outcome, and t h a t of a l l p r o c e s s measures i t was the most r e p e a t -e d l y s u c c e s s f u l i n p r e d i c t i n g outcome ( L u b o r k s y et a l . , 1971). O r l i n s k y and Howard (1978) i n a r e v i e w of p r o c e s s - 41 -and outcome r e s e a r c h s u p p o r t e a r l i e r r e v i e w s t h a t e x p e r -i e n c i n g seems to r e l a t e to outcome. Of the 10 s t u d i e s t h a t have f o c u s e d on e x p e r i e n c i n g l e v e l , 9 d e m o n s t r a t e d s i g n i f i c a n t p o s i t i v e c o r r e l a t i o n s w i t h good t h e r a p e u t i c outcome ( G e n d l i n , Beebe, C a s s e n s , K l e i n & O b e r l a n d e r , 1968; K i e s l e r , 1971; K i e s l e r , M a t h i e u & K l e i n , 1967; K i r t n e r , C a r t w r i g h t , R o b e r t s o n & F i s k e , 1961; S t o l e r , 1967; Van der Veen, 1967; W a l k e r , R a b l e n & R o g e r s , 1966). O n l y T o m l i n s o n (1967) f a i l e d to y i e l d a s i g n i f i c a n t a s s o c a t i o n . The r e s u l t s were somewhat l e s s d e c i s i v e w i t h r e s p e c t to i n c r e a s e of e x p e r i e n c i n g and outcome. Four s t u d i e s r e p o r t a s i g n i f i c a n t p o s i t i v e r e l a t i o n between i n c r e a s e i n e x p e r i e n c i n g and outcome ( G e n d l i n et a l . , 1968; K i e s l e r et a l . , 1967; T o m l i n s o n , 1967; T o m l i n s o n & H a r t , 1962). Two s t u d i e s found no s i g n i f i c a n t p o s i t i v e a s s o c -i a t i o n ( K i e s l e r , 1971 Van der Veen, 1967). O r l i n s k y and Howard (1978) on the b a s i s of t h e i r r e v i e w of the s t u d i e s , c o n c l u d e d t h a t " i n c 1 i e n t - c e n t e r e d t h e r a p y at l e a s t , h i g h l e v e l s of p r o c e s s f u n c t i o n i n g and e s p e c i a l l y " e x p e r i e n c i n g " i n p a t i e n t corrmun i c a t i ons a r e c o n s i s t e n t l y p r e d i c t i v e of t h e r a p e u t i c outcome" ( p . 3 0 5 ) . K i e s l e r (1973) i n a r e v i e w of the v a l i d i t y s t u d i e s found l e v e l of e x p e r i e n c i n g r e l a t e d to o u t c ome w i t h mo re s u c c e s s f u l c a s e s showing h i g h e r l e v e l s of e x p e r i e n c i n g . He a l s o f ound t h a t p a t i e n t s t e n d to show a U-shaped c u r v e of - 42 -change a c r o s s t h e r a p y s e s s i o n s , but t h a t change i n e x p e r i e n c i n g was not found to r e l a t e to outcome. Thus d e s p i t e f i n d i n g s of the e a r l y r e s e a r c h e r s , e f f o r t s t o d e t e r m i n e the c o u r s e of change i n e x p e r i e n c i n g over t h e r a p y and to l i n k e x p e r i e n c i n g change to outcome have y i e l d e d more complex and i n c o n s i s t e n t r e s u l t s . T h e r e i s s t r o n g s u p p o r t i n the l i t e r a t u r e t h a t c o n s i s t e n t l y h i g h r a t i n g s on the E x p e r i e n c i n g S c a l e a r e i n d i c a t i v e of b e h a v i o r i n t h e r a p y t h a t l e a d s to improvernent or p e r -s o n a l i t y c hange. But the e x p e r i e n c i n g l e v e l i t s e l f does not n e c e s s a r i l y change i n any c o n s i s t e n t way over t i m e . S u bsequent r e s e a r c h , e s p e c i a l l y s t u d i e s u s i n g more d e t a i l e d r a t i n g s of l o n g e r segments of t h e r a p y , s u g g e s t e d t h a t the E x p e r i e n c i n g S c a l e v a r i e s and goes t h r o u g h c y c l e s w i t h i n and a c r o s s t h e r a p y and the o c c u r r e n c e of p a r t i c u -l a r p a t t e r n s or peaks a r e r e l a t e d to s u c c e s s f u l o u t c ome ( e g . K i e s l e r , 1971; R o g e r s . e t a l . , 1967). Peak r a t h e r than me an i n d i c e s se em to be mo re p r e d i c t i v e of o u t c ome ( G r e e n b e r g & P i n s o f , 1987). In a r e v i e w of the v a l i d i t y s t u d i e s , K l e i n e t a l . (1986) f o u n d the f o l l o w i n g : As a p e r s o n a l i t y c h a r a c t e r i s t i c , E x p e r i e n c i n g has been more c l o s e l y r e l a t e d to n e u r o t i c i s m , i n t r o -s p e c t i v e n e s s , and c o g n i t i v e c omp l e x i t y than t o a f f e c t i v e d i s t r e s s . T h i s s u g g e s t s the s c a l e i s more a measure of r e f l e c t i v e or s e l f - o b s e r v a t i o n a l s t y l e t h a n e x p r e s s i v e n e s s . W h i l e e x p e r i e n c i n g may come e a s i l y to some i n d i v i d u a l , i t can a l s o be t a u g h t or e n c o u r a g e d . The more s p e c i f i c a l l y the i n t e r v e n t i o n - 43 -was .targeted at e x p e r i e n c i n g , the s t r o n g e r t h i s a s s o c i a t i o n has been. W h i l e t h e r e has been some e v i d e n c e of h i g h e r e x p e r -i e n c i n g i n r e l a t i o n to g l o b a l measures of t h e r a p i s t s k i l l and t h e r a p e u t i c c l i m a t e , i t s r e l a t i o n s h i p to t h e r a p i s t p r o c e s s v a r i a b l e s has been c o n s i d e r -a b l y s t r o n g e r and c l e a r e r i n f i n e r - g r a i n e d s e q u e n t i a l a n a l y s e s . H i g h e r l e v e l s of e x p e r i e n c i n g were found i n c o n j u n c t i o n w i t h " h e l p f u l " or d y n a m i c a l l y apt t h e r a p i s t i n t e r v e n t i o n s i n d i f f e r e n t k i n d s of i n d i v -i d u a l t h e r a p y , and w i t h an e x p l i c i t e x p e r i e n t i a l e x e r c i s e i n G e s t a l t t h e r a p y . F i n a l l y , the a s s o c i a t i o n of e x p e r i e n c i n g to t h e r a -p e u t i c outcome has been shown f o r e x p e r i e n c i n g l e v e l s at v a r i o u s p o i n t s i n t h e r a p y , most c o n s i s t e n t l y at p o i n t s a f t e r the f i r s t few s e s s i o n s . T h i s sug-g e s t s t h a t the s c a l e i s a r e f l e c t i o n of a mode of p r o d u c t i v e f u n c t i o n i n g r a t h e r than a s t a b l e p e r s o n -a l i t y t r a i t . Thus the o r i g i n a l v i e w of e x p e r i e n c i n g as a p r o c e s s v a r i a b l e s and of the s c a l e as a r e f l e c t i o n of t h i s e s s e n t i a l q u a l i t y of s e l f - i n v o l v e r n e n t and p a r t i c i p a t i o n i n the t h e r a p y p r o c e s s s t i l l h o l d s , (p.53) The E x p e r i e n c i n g S c a l e can be a p p l i e d to i n d i v i d u a l t h e r a p y as w e l l as o t h e r i n t e r a c t i o n a l f o r m a t s such as m o n o l o g u e s , s t r u c t u r e d i n t e r v i e w s , group t h e r a p y and G e s t a l t t w o - c h a i r e x e r c i s e s ; and to t h e r a p y f r o m d i f f e r -ent t h e o r e t i c a l o r i e n t a t i o n s such as dyn am i c , p s y c h o -a n a l y t i c , G e s t a l t and c o g n i t i v e . The E x p e r i e n c i n g S c a l e i s used by i n d e p e n d e n t r a t e r s who a p p l y the v a r i o u s s c a l e s t a g e judgernents to t y p e s c r i p t s or r e c o r d i n g s of p a t i e n t s p e e c h d u r i n g a c t u a l p s y c h o t h e r a p y . The s c a l e was de-s i g n e d f o r use w i t h tape r e c o r d i n g s and t r a n s c r i p t s of i n d i v i d u a l t h e r a p y s e s s i o n s , f o r u n i t s of 2 to 8 m i n u t e s i n l e n g t h . R a t e r s a r e t r a i n e d to summarize t h e i r r a t i n g s by two s c o r e s ; modal r a t i n g s and peak r a t i n g s . A modal - 44 -r a t i n g c h a r a c t e r i z e s the o v e r a i l o r a v e r a g e s c a l e l e v e l of the segment or u n i t ; t h a t i s , i t i s r e p r e s e n t a t i v e of the most g e n e r a l or f r e q u e n t l y o c c u r r i n g e x p e r i e n c i n g l e v e l i n the se gme n t . A peak r a t i n g i s g i v e n to any p o i n t where a h i g h e r l e v e l i s r e a c h e d even m o m e n t a r i l y i n the segment or u n i t ( K l e i n e t a l . , 1986) K l e i n et a l . (1986) i n r e v i e w i n g the r e s e a r c h r e p o r t c o n s i s t e n t l y h i g h r e -l i a b i l i t i e s of r a t i n g s . T welve out of 15 s t u d i e s showed r a t e r i n t e r r e 1 i a b i 1 i t y c o e f f i c i e n t s i n the 80s and 90s. G r o u p s , c o u p l e s , G e s t a l t t w o - c h a i r e x e r c i s e s and monologues have a l l been r e l i a b l y r a t e d ( K l e i n e t a l . , 1986). The E x p e r i e n c i n g S c a l e i s an i n v a l u a b l e t o o l i n p s y c h o t h e r a p e u t i c p r o c e s s r e s e a r c h i n t h a t i t i s sen-s i t i v e to changes i n c l i e n t i n v o l v erne nt even w i t h i n a s i n g l e t h e r a p y s e s s i o n , t h e r e f o r e ma k i n g i t u s e f u l f o r m i c r o s c o p i c p r o c e s s s t u d i e s , i e . to e v a l u a t e the e f f e c t -i v e n e s s of t h e r a p i s t i n t e r v e n t i o n s . "As a measure of moment by moment i n t e g r a t e d a f f e c t i v e - c o g n i t i v e change, i t can be used to me a s u r e change i n a f f e c t i v e j udg erne n t s i n s p e c i f i c t h e r a p e u t i c c o n t e x t s " ( G r e e n b e r g & S a f r a n , 1987, p . 7 6 ) . - 45 -Change P r o c e s s R e s e a r c h P s y c h o t h e r a p y p r o c e s s r e s e a r c h has y i e l d e d some i n t e r e s t i n g f i n d i n g s ( O r l i n s k y & Howard, 1978) but has not l e d to the t y p e of u n d e r s t a n d i n g and e x p l a n a t i o n s of p s y c h o t h e r a p y t h a t the f i e l d has needed ( G r e e n b e r g , 1986). P r o c e s s r e s e a r c h i s "any r e s e a r c h i n v e s t i g a t i o n t h a t , t o t a l l y or i n p a r t , c o n t a i n s as i t ' s d a t a some d i r e c t or i n d i r e c t measurement of p a t i e n t , t h e r a p i s t or d y a d i c ( p a t i e n t - t h e r a p i s t i n t e r a c t i o n ) b e h a v i o r i n the t h e r a p y i n t e r v i e w " ( K i e s l e r , 1973, p . 2 ) . H i s t o r i c a l l y t h e r e has been a s t r i c t p r o c e s s - o u t c o m e d i s t i n c t i o n i n the a r e a of r e s e a r c h t h a t has d e v e l o p e d the use of p r e and p o s t t r e a t m e n t outcome d e s i g n s w h i c h have o v e r l o o k e d the f o r m of the change between the two p o i n t s . T h i s s p u r i o u s d i n s t i n c t i o n between p r o c e s s and outcome r e -s e a r c h has h i n d e r e d the development of knowledge i n the f i e l d ( K i e s l e r , 1986). A l t h o u g h p r o c e s s f a c t o r s may have been e v e n t u a l l y r e l a t e d to outcome, t y p i c a l l y t hey have been s t u d i e d i n d e p e n d e n t l y of t r e a t m e n t e f f i c a c y ( B e r g i n & G a r f i e l d , 1986). T h i s p r o c e s s - o u t c o m e d i s -t i n c t i o n c r e a t e d a f a l s e d i c h o t o m y i n w h i c h i n - t h e r a p y improvement or change was not seen as l e g i t i m a t e . Such d e s i g n s have p r e c l u d e d an u n d e r s t a n d i n g of the p r o c e s s of change. T h e r e i s l i t t l e or no d a t a to show what e f f e c t i v e p s y c h o t h e r a p y r e a l l y i s , what the e f f e c t i v e components a r e and no d a t a - b a s e d e x p l a n a t i o n s of h ow and wh y i t wo r k s - 46 -( G r e e n b e r g , 1982). Over the l a s t decade a s h i f t has o c c u r r e d i n p r o c e s s r e s e a r c h toward e m p h a s i z i n g the s t u d y of change ( G r e e n -b e r g & P i n s o f , 1986) and t h e r e has been a c a l l f o r more r i g o r o u s and i n t e n s i v e o b s e r v a t i o n and me a s u r erne n t of s p e c i f i c t h e r a p i s t / c l i e n t o b s e r v a b l e b e h a v i o r s and i n -t e r n a l p e r c e p t i o n s and e x p e r i e n c e s , i n the c o n t e x t i n w h i c h t h e y o c c u r ( G r e e n b e r g , 1982; O r l i n s k y & Howard, 1978; Ro sen & P r o c t o r , 1981).)'. The r e l i a b l e me a s u r erne n t of i n - s e s s i o n changes ( i rrme d i a t e o u t c ome s) and p r o c e s s e s l e a d i n g t o t h e s e o b s e r v e d changes has become the f o c u s of p s y c h o t h e r a p y r e s e a r c h . W i t h the a d v e n t of a u d i o and v i d e o r e c o r d i n g s of p s y c h o t h e r a p y s e s s i o n s , came a more h o p e f u l a t t i t u d e about t r a c k i n g a c t u a l change p r o -c e s s e s . T h e s e r e c o r d e d s e s s i o n s p r o v i d e d the avenue f o r s c r u t i n y of t h e o r e t i c a l w r i t i n g s about change and g l o b a l t h e r a p i s t and p a t i e n t r e c o l l e c t i o n s about t h e r a p y . The measure of p r o c e s s has i n c r e a s i n g l y been seen as e s s e n t i a l to i d e n t i f y c r i t i c a l l i n k s between i n t e r v e n t i o n and o u t -come and to o p e r a t i o n a l i z e c o n s t r u c t s t h a t a r e p o s i t e d as i m p o r t a n t i n t h e o r y (Rosen & P r o c t o r , 1981). F o c u s i n g p r o c e s s r e s e a r c h on the p r o c e s s of change a l s o has had the f o r t u n a t e c o n s e q u e n c e of r e d u c i n g the p r o c e s s - o u t c o m e d i c h o t o m y , as change i n h e r e n t l y l i n k s p r o c e s s to some k i n d of outcome. The s t u d y of change i n t e g r a t e s the s t r e n g t h s of b o t h the p r o c e s s and outcome - 47 -r e s e a r c h t r a d i t i o n s as i t f o c u s e s the r e s e a r c h e r on b o t h the b e g i n n i n g and end p o i n t s of t r e a t m e n t (or a t r e a t m e n t e p i s o d e ) and a l s o a t t e m p t s to i d e n t i f y the p r o c e s s e s t h a t l e a d to the change between the end p o i n t s ( G r e e n b e r g & P i n s o f , 1 9 8 6 ) . "OP.his new emphasis on the d e s c r i p t i o n , e x p l a n a t i o n , and p r e d i c t i o n of change i s p r o b a b l y the most d r a m a t i c s h i f t t h a t has o c c u r r e d s i n c e the p u b l i c a -t i o n of K i e s l e r ' s (1973) book ( G r e e n b e r g & P i n s o f , 1986, p . 5 ) " . Up u n t i l the l a s t d e c a d e , c o n v e n t i o n a l d e s i g n s f o r s t u d y i n g p r o c e s s and outcome have been based on the a s s u m p t i o n t h a t outcome i s a s i m p l e s t a t i c phenomenon t h a t i s b e s t m easured i n some d e f i n t i v e sense at the end of t r e a t m e n t or at f o l l o w up. K i e s l e r (1973) and o t h e r s more r e c e n t l y ( R i c e & G r e e n b e r g , 1984) have a r g u e d f o r a r e s e a r c h p a r a d i g m t h a t views outcome as a f l u i d and c o n t i n u o u s p r o c e s s t h a t i s not d e f i n i t i v e l y b e s t m easured a t t e r m i n a t i o n or any o t h e r s i n g l e p o i n t . As the c o n v e n t i o n a l p r o c e s s - o u t c o m e d i c h o t o m y d i s -a p p e a r s , outcome can be m e a s u r e d m e a n i n g f u l l y a t many p o i n t s i n t r e a t m e n t and f o l l o w up. Outcome becomes a s e r i e s of l i t t l e o ' s . From t h i s p e r s p e c t i v e , p s y c h o t h e r a p y r e s e a r c h bee ome s the a n a l y s i s of the p r o c e s s e s t h a t o c c u r o u t s i d e of the t h e r a p y s e s s i o n s and p r o c e s s e s t h a t o c c u r w i t h i n the s e s s i o n s and the i n t e r a c t i o n s between them. ( G r e e n b e r g & P i n s o f , 1986, p.7) B e r g i n and G a r f i e l d (1986) i n t h e i r r e v i e w of r e -s e a r c h c o n c l u d e d t h a t the s t u d y of p r o c e s s and o u t c ome t o g e t h e r i s a c r i t i c a l s t e p i n g e n e r a t i n g or e v a l u a t i n g - 48 -t h e o r y about the b a s i s of p a r t i c u l a r t r e a t m e n t t e c h n i q u e s . Outcome and p r o c e s s r e s e a r c h e r s a l m o s t s i m u l t a n e o u s l y have come to the r e a l i z a t i o n of the n e c e s s i t y and v a l u e of i n t e g r a t i n g t h e i r two t r a d i t i o n s ( G r e e n b e r g & P i n s o f , 1986). Outcome r e s e a r c h e r s began to r e a l i z e t h a t to c o n s i d e r o n l y outcome w i t h o u t a l s o s p e c i f y i n g what i t was t h a t worked and how. i t worked u n d e r m i n e d the r e p l i c a b i l i t y of s c i e n t i f i c r e s e a r c h and i s u l t i m a t e l y of l i m i t e d v a l u e ( B e r g i n & Lambert, 1978; G r e e n b e r g & P i n s o f , 1986). In the s t u d y of t h e r a p e u t i c e f f e c t s , outcome r e s e a r c h e r s r e a l i z e d s p e c i f i c a t i o n and c o n t r o l of t r e a t m e n t i n t e r v e n t i o n s d e l i v e r e d were n e c e s s a r y i n o r d e r to s u p p o r t c l a i m s about what was b r i n g i n g about the change i n p s y c h o t h e r a p y . R i c e and G r e e n b e r g ( 1 9 8 4 ) , Gottman and Markham ( 1 9 7 8 ) , and K a z d i n (1986) have s t a t e d the i m p o r t a n c e t h a t t r e a t m e n t s a r e v e r i f i a b l y a d m i n i s t e r e d , i n c l u d i n g s p e c i f y i n g t h e r a p i s t b e h a v i o r s and c h e c k i n g to e n s u r e t h e y o c c u r . A f u r t h e r s h i f t to the s p e c i f i c a t i o n of in-ses.s i o n p r o c e s s d e v e l o p e d when outcome r e s e a r c h e r s began to l o o k not o n l y at the t h e r a p i s t ' s b e h a v i o r but a l s o at the p a t i e n t ' s e x p e r i e n c e of the t h e r a p y . The p o s i t i v e q u a l i t y of the t h e r a p e u t i c r e l a t i o n s h i p or bond between t h e r a p i s t and c l i e n t i s c o n s i d e r e d to be an " e x t r e m e l y i m p o r t a n t f a c t o r i n p a t i e n t outcome" ( O r l i n s k y & Howard, 1986, p . 3 5 7 ) . - 49 -T h e r a p i s t empathy when measured as p e r c e i v e d by the c l i e n t has a l s o been i d e n t i f i e d as c o n t r i b u t i n g to p o s i t i v e outcome ( O r l i n s k y & Howard, 1986; G r e e n b e r g & P i n s o f , 1986; B a r r e t t - L e n n a r d , 1962, 1982, 1986). P r o c e s s r e -s e a r c h e r s have come to the r e a l i z a t i o n t h a t i f p r o c e s s i s not r e l a t e d e v e n t u a l l y to s ome k i n d of o u t c ome then i t i s b a s i c a l l y i r r e l e v a n t so they have begun to l i n k i n - t h e r a p y v a r i a b l e s to o u t - o f - t h e r a p y v a r i a b l e s . Un-f o r t u n a t e l y , the s e a r c h f o r p r o c e s s and o u t c ome l i n k s has l e d t o some d i s t r e s s i n g f i n d i n g s . Few s t u d i e s have found any s i g n i f i c a n t r e l a t i o n s h i p between any s p e c i f i c wi t h i n - s e s s i o n p r o c e s s v a r i a b l e and any s p e c i f i c outcome v a r i a b l e (measured at t e r m i n a t i o n and f o l l o w up) w h i c h w o u l d h o l d up a c r o s s more than one s t u d y or w h i c h c o u l d be r e p l i c a t e d o u t s i d e of a p a r t i c u l a r r e s e a r c h group (Or 1 i n s k y & Howard, 1 978; P a r 1 o f f , Waskow & Wo 1 f e , 1978). M e t h o d o l o g i c a l s h o r t c o m i n g s of r e s e a r c h d e s i g n , i n s t r u -me n t a t i o n, s amp l i n g and s t a t i s t i c a l a n a l y s i s have been i d e n t i f i e d as a r e a s of c o n c e r n . G r e e n b e r g and P i n s o f (1986) a r g u e t h a t c o n v e n t i o n a l r e s e a r c h s t r a t e g i e s f o r s t u d y i n g p r o c e s s - o u t c o m e l i n k s a r e too demanding, too g r a n d i o s e i n e x p e c t a t i o n , i f not a l t o g e t h e r u n s u i t a b l e f o r the e x a m i n a t i o n of most t h e r a p e u t i c e f f e c t s ; as c o n v e n t i o n a l r e s e a r c h s t r a t e g i e s used to a c c e s s p r o c e s s -o u t c ome r e l a t i o n s h i p s u s u a l l y i n v o l v e r e l a t i n g some a s p e c t - 50 -of the i n - s e s s i o n p r o c e s s at some p o i n t i n t r e a t m e n t to the amo unt of p r e - p o s t change i n the c l i e n t as me a s u r e d at t e r m i n a t i o n or f o l l o w up. "Most p s y c h o t h e r a p e u t i c e f f e c t s t h a t w i l l be s i g n i f i c a n t at t e r m i n a t i o n a r e the r e s u l t of the c u m u l a t i v e impact of a complex of e v e n t s and f a c t o r s t h a t p l a y o u t and a c c u m u l a t e over t i m e " G r e e n -b e r g & P i n s o f , 1986, p . 7 ) . F o c u s i n g on s h o r t term, s m a l l e r p r o c e s s - o u t c o m e u n i t s f i t s the c u r r e n t d e v e l o p m e n t a l s t a g e of p s y c h o t h e r a p y r e s e a r c h f a r more than a f o c u s on l o n g - t e r m l i n k s . The l o n g t e r m f i n d i n g s may e v e n t u a l l y be f o u n d , but they w i l l have emerged out of the a c c umu l a t i o n of e v i d e n c e about s h o r t -t e r m l i n k s . In some ways, the " s m a l l e r i s b e t t e r " a p p r o a c h i m p l i c i t l y a d m i t s t h a t we have been too g r a n d i o s e i n our e x p e c t a t i o n s about p r o c e s s - o u t c o m e r e s e a r c h . However, i t must be remembered t h a t i t i s no me an a c h i e v erne n t to d emo n s t r a t e a s i g n i f i c a n t r e l a t i o n s h i p between c e r t a i n i n - t h e r a p y p r o c e s s e s and c e r t a i n p a t i e n t changes at c e r t a i n p o i n t s or d u r i n g c e r t a i n p h ases of t h e r a p y , even i f t h o s e changes do not n e c e s s a r i l y h o l d up at t e r m i n a t i o n . Such knowledge l a y s the f o u n d a t i o n f o r a s c i e n t i f i c body of knowledge about how p s y c h o t h e r a p y w o r k s . ( G r e e n b e r g & P i n s o f , 1986, p.8-9) A second c o n v e n t i o n a l d e s i g n of m e t h o d o l o g i c a l c o n c e r n f o r l i n k i n g p r o c e s s to o u t c ome has i n v o l v e d a v e r a g i n g p r o c e s s m e asures ov e r the c o u r s e of t h e r a p y and a t t e m p t i n g to r e l a t e t h e s e a v e r a g e s to outcome at t e r m i n a t i o n . S t u d i e s of p r o c e s s over time have shown t h a t h o m o g e n e i t y of p r o c e s s w i t h i n a s e s s i o n or over the e n t i r e c o u r s e of t h e r a p y i s u n s u p p o r t e d . R i c e and G r e e n b e r g ( 1 9 8 4 ) , and Gurman (1973) s u g g e s t t h a t mean me a s u r e s ma y o b s c u r e the v a r i a t i o n t h a t ma y be mo s t - 51 r e l a t e d to o u t c ome . Change p r o c e s s r e s e a r c h p l a c e s a g r e a t e r emphasis on d e s c r i p t i o n and i d e n t i f i c a t i o n of p a t t e r n s . I d e n t -i f i c a t i o n of p a t t e r n s i n c l i e n t and t h e r a p i s t i n - s e s s i o n p e r f o r m a n c e i s the key s t r a t e g y i n s t u d i e s aimed at e x p l a n a t i o n (Gottman, Markham & N o t a r i u s , 1977; G r e e n -b e r g , 1980, 1983, 1984a, 1984b; H o r o w i t z , 1970). One a p p r o a c h i s t a s k a n a l y s i s ( G r e e n b e r g , 1984b). In a t a s k a n a l y s i s of a t h e r a p e u t i c e v e n t , a h y p o t h e t i c a l i d e a l i z e d c l i e n t p e r f o r m a n c e , w h i c h r e p r e s e n t s the c l i n i c i a n ' s b e s t u n d e r s t a n d i n g of how r e s o l u t i o n t a k e s p l a c e , i s compared w i t h d e s c r i p t i o n s of a c t u a l c l i e n t r e s o l u t i o n p e r f o r m a n c e s f r o m a s e r i e s of r i g o r o u s l y o b s e r v e d s i n g l e - c a s e s t u d i e s . T h i s d i s c o v e r y o r i e n t e d p r o c e d u r e of c o m p a r i n g a c t u a l and p o s s i b l e p e r f o r m a n c e s , r e p r e s e n t s an i n t e n s i v e f o r m of i n d u c t i v e c l i n i c a l t h e o r i z i n g w h i c h r e s u l t s i n the c o n s t r u c t i o n of a model i n terms w h i c h can be t e s t e d by p r o c e s s measurement. In a t a s k a n a l y s i s of a number of c o n f l i c t r e s o l u t i o n e v e n t s u s i n g the t w o - c h a i r d i a l o g u e , G r e e n b e r g (1975, 1980a; 1983b, 1984a) found f o r each s i d e of the c o n f l i c t , a c h a r a c t e r i s t i c p a t t e r n of v o i c e q u a l i t y , d e p t h of e x p e r -i e n c i n g and p a t t e r n s of a f f i l i a t i o n a s s o c i a t e d w i t h r e s o l u -t i o n . Change p r o c e s s r e s e a r c h c a l l s f o r s t a n d a r d i z a t i o n of u n i t s of s t u d y and a s h a r e d d e s c r i p t i v e framework. " I t - 52 -i s o n l y t h r o u g h the s t u d y of what i s c o n s e n s u a l l y a g r e e d to a c t u a l l y o c c u r i n t h e r a p y t h a t we w i l l advance our u n d e r s t a n d i n g of how change t a k e s p l a c e " ( G r e e n b e r g , 1986b, p . 7 1 2 ) . D r a w i n g on the s t u d i e s of Pear.ce and C r o n e n (1980) who p r o p o s e d a h i e r a r c h i a l model of meaning f o r u n d e r s t a n d i n g corrmun i c a t i on , G r e e n b e r g ( 1986b) d e f i n e s t h r e e l e v e l s f o r a n a l y s i s i n r e s e a r c h : 1) Speech A c t - What one p e r s o n i s d o i n g to a n o t h e r by s a y i n g or d o i n g s o m e t h i n g , i e . such as a d v i s e , p r o m i s e , t h r e a t e n , e t c . F e a t u r e s of the a c t s t h a t h e l p i n u n d e r s t a n d i n g the meaning of the s p e e c h a c t such as d e p t h of e x p e r i e n c i n g ( K l e i n e t a l . , 1969) would be i n c l u d e d i n t h i s c a t e g o r y . 2) E p i s o d e - "Cormnunicative r o u t i n e s w h i c h ( t h e p a r t i c i -p a n t s ) v i e w as d i s t i n c t w h o l e s , s e p a r a t e f r o m o t h e r t y p e s of d i s c o u r s e , c h a r a c t e r i z e d by s p e c i a l r u l e s of s p e e c h and n o n - v e r b a l b e h a v i o r and o f t e n d i s t i n g u i s h e d by c l e a r l y r e c o g n i z a b l e o p e n i n g or c l o s i n g s e q u e n c e s " (Gumperz, 1972, p . 1 7 ) . 3) R e l a t i o n s h i p - T h i s l e v e l d e s c r i b e s the q u a l i t i e s t h a t p e o p l e a t t r i b u t e to the r e l a t i o n s h i p t h a t go beyond any p a r t i c u l a r c o n t e n t , a c t , or e p i s o d e . I n h e r e n t i n t h i s model i s the i m p o r t a n c e of r e c o g n i z i n g c o n t e x t to a d e q u a t e l y r e s e a r c h p r o c e s s . T h e s e l e v e l s need to be viewed i n c o n t e x t and i n r e l a t i o n s h i p to each o t h e r . T h i s a p p r o a c h would r e s u l t i n a mu 11imeasurement - 53 -r e s e a r c h des i gn. To f u r t h e r d e v e l o p a v a l i d d e s c r i p t i v e m e t h o d o l o g y f o r p s y c h o t h e r a p y , R i c e and G r e e n b e r g (1974, 1984) have s u g g e s t e d an e v e n t s - b a s e d a p p r o a c h to the s t u d y of change p r o c e s s e s . An e v e n t i s a t h e r a p e u t i c e p i s o d e c o n s i s t i n g of f o u r components: the p a t i e n t p r o b l e m m a r k e r , the t h e r a p i s t o p e r a t i o n , the c l i e n t p e r f o r m a n c e and the i nmne d i a t e i n - s e s s i o n o u t c ome. A s e r i e s of s t u d i e s c o n -d u c t e d by G r e e n b e r g and c o - w o r k e r s on the e f f e c t s of the G e s t a l t t w o - c h a i r d i a l o g u e ( G r e e n b e r g , 1979; G r e e n b e r g & C l a r k e , 1979; G r e e n b e r g & H i g g i n s , 1980; G r e e n b e r g & R i c e , 1981; G r e e n b e r g & D o m p i e r r e , 1 9 8 1 ; G r e e n b e r g & C l a r k e , 1984) and one on e f f e c t s of the emp t y - c h a i r d i a l o g u e ( K i n g , 1988) have c o n t r i b u t e d to a r e s e a r c h base of com-p r e h e n s i v e c l a s s i f i c a t i o n schernes. D i f f e r e n t i a l i n t e r -v e n t i o n s t u d i e s where the f o c u s i s on i n - t h e r a p y o u t -comes f o r p a r t i c u l a r p r o b l e m s t a t e s can p r o v i d e e v i d e n c e on what i n t e r v e n t i o n s a r e most e f f e c t i v e at p a r t i c u l a r p o i n t s i n t h e r a p y ( G r e e n b e r g , 1 9 8 6 c ) . T h i s s t u d y i s c o n g r u e n t 1 y d e s i g n e d i n r e l a t i o n to t h i s s p e c i f i c t r e n d i n change p r o c e s s r e s e a r c h . The p a r t i c u l a r o p e r a t i o n s of e m p a t h i c r e f l e c t i o n and G e s t a . l t emp t y - c h a i r d i a l o g u e have been d e f i n e d , o p e r a t i o n a l i z e d and c h e c k e d to e n s u r e t h e y o c c u r r e d i n the s t u d y . The c l i e n t p e r f o r m a n c e was measured by the E x p e r i e n c i n g S c a l e - 54 -( K l e i n e t a l . , 1969), a measure w h i c h has been r e l i a b l y r e l a t e d to outcome. The p s y c h o t h e r a p e u t i c r e l a t i o n s h i p between t h e r a p i s t and c l i e n t was measured by a f o r m of the Bar r e t t - L e n n a r d R e l a t i o n s h i p I n v e n t o r y . T h i s measure was of the c l i e n t ' s p e r c e i v e d empathy of the t h e r a p i s t . In C o n c l u s i o n and P u r p o s e of t h i s Study Much has been w r i t t e n on the t h e o r e t i c a l s i g n i f i c a n c e of U n f i n i s h e d B u s i n e s s i n p s y c h o t h e r a p y , y e t l i t t l e e x i s t s i n the a r e a of r e s e a r c h . G i v e n the p a u c i t y of r e s e a r c h i n v e s t i g a t i n g t h i s s p e c i f i c i s s u e of u n f i n i s h e d b u s i n e s s , t h i s s t u d y a t t e m p t s to a d d r e s s t h i s r e s e a r c h need. The p u r p o s e of t h i s s t u d y i s to compare the d i f f e r e n t i a l e f f e c t s of two c o u n s e l l i n g i n t e r v e n t i o n s ( e m p a t h i c r e f l e c t i o n and the G e s t a l t e m p t y - c h a i r d i a l o g u e ) on c l i e n t p r o c e s s (as measured by the E x p e r i e n c i n g S c a l e ) when used w i t h an i s s u e of u n f i n i s h e d b u s i n e s s . The E x p e r i e n c i n g S c a l e has been c h o s e n as the p r o c e s s measure as t h i s r e l i a b l e i n s t r u m e n t has been s u g g e s t e d as r e v e a l i n g the change p r o c e s s i n t h e r a p y and has been c o r r e l a t e d w i t h outcome (K1e in e t a l . , 1969). I f an i n t e r v e n t i o n can enhance a c l i e n t ' s d e p t h of e x p e r i e n c i n g , i t ma y mo ve a c l i e n t c l o s e r to p r o d u c t i v e p s y c h o t h e r a p y and may make a c o n t r i b u t i o n to the t r e a t m e n t of u n f i n i s h e d b u s i n e s s . - 55 -CHAPTER I I I METHODOLOGY The r e s e a r c h m e t h o d o l o g y used i s a c o m p a r a t i v e t r e a t m e n t s t r a t e g y i n an a n a l o g u e s t u d y . The i n d e p e n d e n t v a r i a b l e s a r e the two c o u n s e l l i n g i n t e r v e n t i o n s : 1) e m p a t h i c r e f l e c t i o n and 2) G e s t a l t e m p t y - c h a i r d i a l o g u e . The dependent measure i s the c l i e n t p r o c e s s , l e v e l of e x p e r i e n c i n g , as measured by the E x p e r i e n c i n g S c a l e ( K l e i n e t a i . , 1 969 ) . P a r t i c i p a n t s i n the Study S u b j e c t s S u b j e c t s were u n d e r g r a d u a t e and g r a d u a t e s t u d e n t s e n r o l l e d i n e i t h e r a f o u r t h y e a r u n d e r g r a d u a t e or a f i r s t y e a r g r a d u a t e c o u r s e i n c o u n s e l l i n g . S u b j e c t s were t o l d t h a t the s t u d y was an i n v e s t i g a t i o n of u n f i n i s h e d b u s i n e s s and the c o n s t r u c t of u n f i n i s h e d b u s i n e s s was d e s c r i b e d to them. They were a s k e d to t h i n k of a p e r -s o n a l l y m e a n i n g f u l i s s u e of u n f i n i s h e d b u s i n e s s to d i s c u s s i n a c o u n s e l l i n g s i t u a t i o n . The s u b j e c t s were not i n -formed on any of the v a r i a b l e s under c o n s i d e r a t i o n . A p o o l of 41 v o l u n t e e r s were s o l i c i t e d f r o m w h i c h 28 were randomly s e l e c t e d . V o l u n t e e r s were s o l i c i t e d f r o m 8 d i f -f e r e n t c l a s s e s c o n t a i n i n g between 10 and 20 s t u d e n t s e a c h . The s e l e c t e d v o l u n t e e r s were randomly a s s i g n e d to e i t h e r - 56 -the G e s t a l t e m p t y - c h a i r d i a l o g u e c o n d i t i o n or the e m p a t h i c r e f l e c t i o n c o n d i t i o n . S u b j e c t s ranged i n age f r o m 24 y e a r s to 52 y e a r s of age. S u b j e c t s i n c l u d e d 7 men and 21 women. Some of the s u b j e c t s had t a k e n o n l y one i n t r o d u c t o r y c o u r s e i n the p r o g r am and o t h e r s had c omp l e t e d 7 c o u r s e s . The r a p i s t s Seven t h e r a p i s t s were used i n t h i s s t u d y , 3 men and 4 women. A l l t h e r a p i s t s had at l e a s t 96 hou r s of t r a i n -i n g i n G e s t a l t t h e r a p y c o n s i s t i n g of 32 w e e k l y 3 hour s e s s i o n s . In a d d i t i o n a l l t h e r a p i s t s r e c e i v e d a p p r o x i m a t e l y 20 hou r s of i n t e n s i v e t r a i n i n g i n empty-c h a i r work as i t a p p l i e s to the i s s u e of u n f i n i s h e d b u s i n e s s . A l l t h e r a p i s t s had a minimum of 100 hours of i n t e r p e r s o n a l s k i l l t r a i n i n g a c c o r d i n g to the Egan model or o t h e r p e r s o n a l m o d e l . A l l t h e r a p i s t s had w o r k i n g exper i e n c e : us i n g t h e s e s k i l l s of at l e a s t two y e a r s . F i v e of the 7 t h e r a p i s t s s a i d they used more e m p a t h i c r e f l e c t i o n i n t h e i r p r a c t i c e than G e s t a l t t e c h n i q u e s , two of the 7 t h e r a p i s t s s a i d they used b o t h t e c h n i q u e s e q u a l l y i n t h e i r p r a c t i c e . E a c h t h e r a p i s t saw 4 c l i e n t s , two u s i n g e m p a t h i c r e f l e c t i o n and two u s i n g G e s t a l t e m p t y - c h a i r d i a l o g u e . T h e r a p i s t s were randomly a s s i g n e d t r e a t m e n t m o d a l i t i e s i n s u r i n g t h a t h a l f the t h e r a p i s t s used e m p a t h i c r e f l e c t i o n - 57 -w i t h t h e i r f i r s t s u b j e c t and h a l f used G e s t a l t e m p t y - c h a i r d i a l o g u e w i t h t h e i r f i r s t s u b j e c t . T h e r a p i s t s were b l i n d to the r e s e a r c h h y p o t h e s e s . A d h e r e n c e R a t e r s To e n s u r e t h a t the t h e r a p i s t s used the a s s i g n e d o p e r a t i o n s ( e m p a t h i c r e f l e c t i o n and e m p t y - c h a i r d i a l o g u e ) , two g r a d u a t e s t u d e n t s i n the M a s t e r s d e g r e e p r o g r a m a t the U n i v e r s i t y of B.C. d i d a d h e r e n c e r a t i n g of the a s s i g n e d o p e r a t i o n f o r each s e s s i o n . The r a t e r s had a minimum of 100 h o u r s of t r a i n i n g i n the Egan model and at l e a s t 100 h o u r s of t r a i n i n g i n G e s t a l t t h e r a p y i n c l u d i n g t r a i n i n g i n the G e s t a l t e m p t y - c h a i r p r o c e d u r e . The v i d e o t a p e s f r o m the e m p a t h i c r e f l e c t i o n s e s s i o n s were s u b m i t t e d to two i n d e p e n d e n t r a t e r s who r a t e d t h e r a p i s t r e s p o n s e s f r o m L e v e l 1 to L e v e l 5 on the C a r k h u f f S c a l e ( C a r k h u f f , 1969) i n w h i c h L e v e l 3 i s c o n s i d e r e d to be m i n i m a l l y f a c i 1 i t a t i v e . The r a t e r s l i s t e n e d to two 5 m i n u t e segments t a k e n at a p p r o x i m a t e l y the 15 m i n u t e mark and the 35 m i n u t e mark i n each s e s s i o n and d e t e r m i n e d whether e a c h segment was at l e a s t m i n i m a l l y f a c i l i t a t i v e on the C a r k h u f f S c a l e . None of the segments w a r r a n t e d a r a t i n g of l e s s t h a t 3.0 . T h e r e f o r e a l l s e s s i o n s were r e t a i n e d . One s u b j e c t d i d not g i v e p e r m i s s i o n to v i d e o -t a p e the s e s s i o n , so the a u d i o t a p e was used f o r r a t i n g . - 58 -V i d e o t a p e s of the G e s t a l t e m p t y - c h a i r s e s s i o n s were s u b m i t t e d to two i n d e p e n d e n t r a t e r s to e n s u r e t h a t the G e s t a l t e m p t y - c h a i r d i a l o g u e o c c u r r e d . A f i v e p o i n t s c a l e r a n g i n g f r o m "Not at a l l " , t h r o u g h "A l i t t l e " , "Somewhat" and " M o s t l y " to " A l l the t i m e " was u s e d . The r a t e r s used c l i n i c a l judgement to d e t e r m i n e where on the s c a l e the segments were p l a c e d . The r a t e r s were to d e t e r m i n e t h a t at l e a s t the m i d d l e r a t i n g of "Somewhat" o c c u r r e d . A t e n m i n u t e segment was s e l e c t e d and g i v e n a com-b i n e d r a t i n g . The r a t i n g s c a l e d e s c r i b e d above was used to d e t e r m i n e to what e x t e n t the G e s t a l t e m p t y - c h a i r d i a l o g u e o c c u r r e d . C l i n i c a l judgement was used to de-t e r m i n e t h a t the o p e r a t i o n was p e r f o r m e d a d e q u a t e l y . B o t h r a t e r s c o n f i r m e d the o c c u r r e n c e of the G e s t a l t empty-c h a i r d i a l o g u e i n a l l G e s t a l t s e s s i o n s . B o t h r a t e r s a l s o c o n f i r m e d t h a t a minimum r a t i n g of "Somewhat" o c c u r r e d i n a l l G e s t a l t s e s s i o n s . T h e r e f o r e a l l s e s s i o n s were r e t a i n e d . R a t e r s were b l i n d to the e x p e r i m e n t a l h y p o t h e s e s . E x p e r i e n c i n g S c a l e R a t e r s T r a n s c r i p t s of the s e s s i o n s were s u b m i t t e d t o two r a t e r s , g r a d u a t e s t u d e n t s i n the M a s t e r s d e g r e e p r o g r a m at the U n i v e r s i t y of B.C., f o r r a t i n g on the E x p e r i e n c i n g S c a l e . T h e s e r a t e r s were d i f f e r e n t f r o m the a d h e r e n c e r a t e r s . E ach E x p e r i e n c i n g S c a l e r a t e r i n d e p e n d e n t l y - 59 -r a t e d t w o - t h i r d s of t h e t r a n s c r i p t s , i n o r d e r t o p r o v i d e o n e - t h i r d o f t h e t a p e s f o r an i n t e r r a t e r r e l i a b i l i t y c h e c k . T r a n s c r i p t s w e re d i v i d e d i n t o two m i n u t e segments and p r e s e n t e d t o t h e r a t e r s i n a r a n d om o r d e r . S e gme n t s w e r e a s s i g n e d two s c o r e s , f r o m one t o s e v e n i n c l u s i v e , i n d i c a t i n g t h e peak and t h e m o d a l s c o r e o b t a i n e d by t h e s u b j e c t a c c o r d i n g t o t h e E x p e r i e n c i n g S c a l e . The i n t e r -r a t e r r e l i a b i l i t y f o r o n e - t h i r d o f t h e segments ( 2 0 3 ; s e g -m e n t s ) f o r modal s c o r e s was a P e a r s o n P r o d u c t Moment C o r r e l a t i o n of .74 . The i n t e r r a t e r r e l i a b i l i t y f o r one-t h i r d o f t h e se gme n t s ( 2 0 3 ) s egme n t s ) f o r peak s c o r e s was a P e a r s o n P r o d u c t Moment C o r r e l a t i o n o f .80 . D i s c r e p a n c y b e t w e e n t h e two r a t e r s on r a t i n g s o f t h e o v e r l a p p i n g one-t h i r d of t o t a l segments was s u b m i t t e d ! , t o a t h i r d r a t e r f o r t i e - b r e a k i n g and d e f i n i t i v e s c o r i n g . T h i s t h i r d r a t e r was a l s o t r a i n e d i n t h e use of t h e E x p e r i e n c i n g S c a l e . The r a t e r s r e c e i v e d a p p r o x i m a t e l y 48 h o u r s of t r a i n i n g and p r a c t i c e a c c o r d i n g t o t h e p r o c e d u r e s d e s c r i b e d i n t h e E x p e r i e n c i n g S c a l e T r a i n i n g M a n u a l ( K l e i n e t a l . , 1 9 6 9 ) . In t h e t r a i n i n g m a n u a l , e x p l i c i t p r o c e d u r e s and m a t e r i a l s f o r r a t e r t r a i n i n g a r e g i v e n , i n c l u d i n g i n t r o -d u c t i o n o f t h e c o n c e p t , d e s c r i p t i o n o f t h e s c a l e and i n s t r u c t i o n s f o r t h e r a t i n g t a s k . The f o r m a l t r a i n i n g p r o g r a m f o r r a t e r s i s d i v i d e d i n t o 8 two hour s e s s i o n s , e a c h i n v o l v i n g r a t i n g p r a c t i c e segments (10 f o r e a c h - 60 -s e s s i o n ) . P r a c t i c e r a t i n g s a r e t h e n compared w i t h c r i t e r i o n r a t i n g s and j u s t i f i c a t i o n s - e x p 1 a n a t i o n s a r e p r o v i d e d by the a u t h o r s . F i n a l a s s e s s m e n t of r a t e r r e l i a b i l i t i e s at the end of the t r a i n i n g a r e done on a b l o c k of 20 se gme n t s . In s t r umen t at i on The E x p e r i e n c i n g S c a l e The E x p e r i e n c i n g S c a l e ( K l e i n et a l . , 1969) was u sed to measure the dependent v a r i a b l e , d e p t h of e x p e r -i e n c i n g . T h i s s c a l e was d e v e l o p e d to e v a l u a t e the q u a l i t y of a p a t i e n t ' s s e l f - i n v o l v erne nt i n p s y c h o t h e r a p y , i s a seven p o i n t s c a l e w h i c h i s a p p l i e d to v e r b a l s p e e c h of the c l i e n t by i n d e p e n d e n t r a t e r s . The s c a l e i s " f r e e of d e t a i l of d i a g n o s i s , s p e c i f i c c o m p l a i n t or p r o b l e m , p e r s o n a l i t y , s t y l e , r a t e , tone of s p e e c h , s p e c i f i c a f f e c t i v e s t a t e , s p e c i f i c t o p i c or t o p i c s e q u e n c e " ( K l e i n et a l . , 1969, p . 7 ) . The c o n c e n t r a t i o n i s on f e e l i n g s and p e r s o n a l meanings as c o r e c o n t e n t . The l o w e s t l e v e l s of the s c a l e r a t e s u p e r f i c i a l c l i e n t d i s c o u r s e , the c e n -t r a l l e v e l s mark s i m p l e d e s c r i p t i o n s of f e e l i n g s whereas h i g h l e v e l s of e x p e r i e n c i n g i n d i c a t e e x p l o r a t i o n of f e e l -i n g s t h a t may l e a d to p r o b l e m s o l v i n g and s e l f - u n d e r -s t a n d i n g . Wherever an i n d i v i d u a l ' s s p e e c h can be i s o l a t e d to be r a t e d ( t a p e r e c o r d i n g s or t r a n s c r i p t s ) , the s c a l e can be a p p l i e d . - 61 R e l i a b i l i t i e s f o r p s y c h o t h e r a p y s e s s i o n d a t a a c r o s s 15 s t u d i e s range i n the .80s or .90s f o r 12 out of 15 s t u d i e s ( K i e s l e r , M a t h i e u & K l e i n , 1964). I n t e r r a t e r r e l i a b i l i t i e s o b t a i n e d i n E x p e r i e n c i n g S c a l e s t u d i e s have been g e n e r a l l y h i g h ( K i e s l e r , 1973). The s c a l e i s se n -s i t i v e to s h i f t s i n p a t i e n t i n v o l v e m e n t even w i t h i n a s i n g l e i n t e r v i e w s e s s i o n , m aking i t u s e f u l f o r m i c r o -s c o p i c p r o c e s s s t u d i e s , f o r ex ample, to e v a l u a t e the e f f e c t i v e n e s s of t h e r a p i s t i n t e r v e n t i o n s and to a s s e s s the p r o d u c t i v i t y of d i f f e r e n t * o p i c s ( K l e i n et a l . , 1969). As a measure of moment by moment i n t e g r a t e d a f f e c t i v e -c o g n i t i v e change, i t can be used to measure change i n a f f e c t i v e judgement i n s p e c i f i c t h e r a p e u t i c c o n t e x t s . B a r r e t t - L e n n a r d R e l a t i o n s h i p I n v e n t o r y (RI) The B a r r e t t - L e n n a r d R e l a t i o n s h i p I n v e n t o r y was d e s i g n e d to measure the c l i e n t ' s p e r c e p t i o n of the c o u n s e l l o r ' s warmth, c o n g r u e n c e , empathy and p o s i t i v e r e g a r d . The RI i s based on R o g e r ' s s t a t e m e n t " i t i s the q u a l i t y of the i n t e r p e r s o n a l e n c o u n t e r w i t h the c l i e n t w h i c h i s the most s i g n i f i c a n t e l ement i n d e t e r m i n i n g e f f e c t i v e n e s s " ( R o g e r s , 1971, p . 8 5 ) . R o g e r s (1957) c o n -s i d e r e d c o n s t r u c t i v e p e r s o n a l i t y change or p s y c h o t h e r a -p e u t i c change to o c c u r i f the t h e r a p i s t e x p e r i e n c e d u n c o n d i t i o n a l p o s i t i v e r e g a r d f o r the c l i e n t , the t h e r a -p i s t e x p e r i e n c e d an e m p a t h i c u n d e r s t a n d i n g of the c l i e n t ' s - 62 -i n n e r s t a t e and i f the c o r r m u n i c a t i o n to the c l i e n t of the t h e r a p i s t ' s e m p a t h i c u n d e r s t a n d i n g and u n c o n d i t i o n a l p o s i t i v e r e g a r d i s at l e a s t m i n i m a l l y a c h i e v e d . In o t h e r w o r ds, t h e c l i e n t must p e r c e i v e t h e t h e r a p i s t ' s warmth, c o n g r u e n c e , empathy and p o s i t i v e r e g a r d , f o r change i n c l i e n t b e h a v i o r to o c c u r . In t h i s s t u d y , the 16 items c o m p r i s i n g the empathy s u b s c a l e were used to measure the s u b j e c t ' s p e r c e p t i o n of the t h e r a p i s t ' s u n d e r s t a n d i n g . The items range f r o m " y e s , I s t r o n g l y f e e l t h a t i t i s t r u e " t h r o u g h f o u r i n t e r m e d i a t e s t a g e s to "no, 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 " . T h e r e i s no n e u t r a l or m i d p o i n t c a t e g o r y to e n s u r e t h a t s u b j e c t s make a s e l e c t i o n i n the " y e s " or "no" d i r e c t i o n , however t e n t a t i v e t h i s c h o i c e may be. The empathy s c a l e was a d m i n i s t e r e d a f t e r the c o m p l e t i o n of the s e s s i o n s . B a r r e t t - L e n n a r d (1962) r e p o r t e d s p l i t - h a l f r e l i a b i l i t y c o e f f i c i e n t s f o r e m p a t h i c u n d e r s t a n d i n g of .86 . Gurman (1977) c o n f i r m e d the s t a b i l i t y of t h e s e f i n d i n g s i n a r e v i e w of f o u r t e e n s t u d i e s of i n t e r n a l r e l i a b i l i t y and te n s t u d i e s of t e s t - r e t e s t r e l i a b i l i t y . He found i n t e r n a l r e l i a b i l i t i e s a c r o s s the 24 s t u d i e s f o r emp a t h y to be .84 and t e s t - r e t e s t r e l i a b i l i t i e s f o r empathy of .85 . B a r r e t t - L e n n a r d (1986) s t a t e d t h a t t h e r e was e v i d e n c e of c o n t e n t v a l i d i t y and " e x t e n s i v e and s t r o n g e v i d e n c e of ( p r e d i c t i v e ) c o n s t r u c t v a l i d a t i o n " ( p . 4 5 9 ) . - 63 -B a r r e t t - L e n n a r d (1981) th e o r i z e s t h a t t h e r e a r e t h r e e d i s t i n c t s t a g e s t h a t a r e i n v o l v e d i n the p r o c e s s of e m p a t h i c i n t e r a c t i o n : e m p a t h i c r e s o n a t i o n by the t h e r a p i s t to the e x p r e s s i o n of the c l i e n t ; the t h e r a p i s t ' s corrmun i c a t i ve e x p r e s s i o n or e x p r e s s e d empathy; and r e -c e i v e d empathy as p e r c e i v e d by the c l i e n t . B a r r e t t -L e n n a r d (1981, 1986) h o l d s t h a t the empathy s c a l e of the RI m e a sures the r e c e i v i n g p e r s o n ' s d e s c r i p t i o n of the o t h e r ' s r e s p o n s e w i t h i n the r e l a t i o n s h i p or Phase t h r e e empathy. In t h i s s t u d y the empathy s c a l e of the RI was used to a s s e s s the s u b j e c t ' s p e r c e p t i o n of r e c e i v e d emp a t h y. P r o c e d u r e s D u r i n g the s o l i c i t a t i o n of v o l u n t e e r s , p r o s p e c t i v e v o l u n t e e r s were r e q u e s t e d to t a k e p a r t i n two c o u n s e l l i n g s e s s i o n s , the s e c o n d s e s s i o n one week s u b s e q u e n t to the f i r s t . T h i s p r o c e d u r e was done as b o t h s e s s i o n s were to be p o t e n t i a l l y a n a l y s e d . T h i s p r o c e d u r e was a l s o e n l i s t e d f o r e t h i c a l r e a s o n s , so as not to have one s e s s i o n and not be aware of the impact on the s u b j e c t who m i g h t need f u r t h e r f o l l o w up or a t t e n t i o n f r o m the f i r s t c o u n s e l l i n g s e s s i o n . The s e c o n d s e s s i o n was not a n a l y s e d due to the time consuming n a t u r e of t r a n s c r i p t i o n and the p r e s s i n g need of time to c o m p l e t e the s t u d y . B e f o r e the f i r s t c o u n s e l l i n g s e s s i o n , s u b j e c t s were a s k e d to i d e n t i f y t h e i r c o r e c omp l a i n t of u n f i n i s h e d b u s i n e s s . Next the s u b j e c t s p a r t i c i p a t e d i n an i n d i v i d u a l - 64 -i n d u c t i o n s e s s i o n . They were b r i e f e d on the f o r m of t h e r a p y t h e y were to r e c e i v e and a r a t i o n a l e was p r e s e n t e d f o r i t ' s use i n the r e s o l u t i o n of u n f i n i s h e d b u s i n e s s . S i g n e d p e r m i s s i o n was o b t a i n e d f r o m each s u b j e c t to a u d i o t a p e and v i d e o t a p e the s e s s i o n s . A l l c o u n s e l l i n g s e s s i o n s were a u d i o t a p e d and v i d e o t a p e d w i t h the e x c e p -t i o n of one s u b j e c t who w i t h h e l d p e r m i s s i o n to v i d e o t a p e the s e s s i o n s . In the c a s e of t h i s s u b j e c t the a u d i o t a p e was used by the a d h e r e n c e r a t e r s to d e t e r m i n e i f the t h e r a p e u t i c i n t e r v e n t i o n had o c c u r r e d . V i d e o t a p e s and one a u d i o t a p e ( i n the a b s e n c e of a v i d e o t a p e ) were t r a n s c r i b e d and s e p a r a t e d i n t o two m i n u t e segments, w h i c h were the n p r e s e n t e d i n a random o r d e r to the E x p e r i e n c i n g S c a l e r a t e r s . The i n i t i a l c o u n s e l -l i n g s e s s i o n i s the u n i t of a n a l y s i s f o r t h i s s t u d y . T r a n s c r i pt i o n The f o l l o w i n g c l i e n t and t h e r a p i s t m a r k e r s were o b s e r v e d b e f o r e t r a n s c r i p t i o n c orrme need. In the Ge s t a 11 emp t y - c h a i r d i a l o g u e c o n d i t i o n , the t h e r a p i s t o p e r a t i o n of e v o k i n g the s e n s e d p r e s e n c e of the s i g n i f i c a n t o t h e r was i n i t i a t e d . In the e m p a t h i c r e f l e c t i o n c o n d i t i o n , t h e t h e r a p i s t o p e r a t i o n of an e m p a t h i c r e s p o n s e was i n i t i a t e d . In b o t h c o n d i t i o n s the c l i e n t marker of the c l i e n t ' s s t a t e m e n t of u n f i n i s h e d b u s i n e s s w i t h a s i g n i f i c a n t o t h e r to be the f o c u s of work, was n e c e s s a r y f o r t r a n s c r i p t i o n - 65 -to b e g i n . T r a n s c r i p t i o n ended when the u n f i n i s h e d b u s i n e s s was no l o n g e r the f o c u s of i n t e r c h a n g e i n the s e s s i o n . Scor i n g S c o r i n g o c c u r r e d i n two s t a g e s . A check w a s f i r s t made u s i n g the Empathy S c a l e of the R e l a t i o n s h i p Inven-t o r y to e n s u r e t h a t a l l c l i e n t s p e r c e i v e d t h e i r t h e r a p i s t as m i n i m a l l y e m p a t h i c . Two a d h e r e n c e r a t e r s then r a t e d i n d e p e n d e n t l y the t a p e s to e n s u r e t h a t the t h e r a p i s t s were c o r r e c t l y c o n d u c t i n g b o t h t h e r a p e u t i c o p e r a t i o n s as d e s c r i b e d above. D e s c r i p t i o n of T r e a t m e n t s E m p a t h i c R e f l e c t i o n C a r k h u f f (1969) l i s t s g u i d l i n e s f o r the f o r m u l a -t i o n of e m p a t h i c r e s p o n s e s . "The u l t i m a t e p u r p o s e of the e m p a t h i c r e s p o n s e i s to communicate to the h e l p e e a d e p t h of u n d e r s t a n d i n g of him and h i s p r e d i c a m e n t i n such a manner t h a t he can expand and c l a r i f y h i s own s e l f - u n d e r s t a n d i n g as we 11 as h i s u n d e r s t a n d i n g of o t h e r s ' ! ( C a r k h u f f , 1969, p . 2 0 2 ) . H i s s u g g e s t e d g u i d l i n e s a r e as f o l l o w s : 1. The h e l p e r w i l l f i n d t h a t he i s most e f f e c t i v e i n c o r r m u n i c a t i n g an e m p a t h i c u n d e r s t a n d i n g when he c o n c e n t r a t e s w i t h i n t e n s i t y upon the h e l p e e ' s e x p r e s s i o n s , b o t h v e r b a l and n o n v e r b a l . 2. The h e l p e r w i l l f i n d t h a t i n i t i a l l y he i s most e f f e c t i v e i n c o r r m u n i c a t i n g e m p a t h i c u n d e r s t a n d i n g when he c o n c e n t r a t e s upon r e s p o n s e s t h a t a r e i n t e r -c h a n g e a b l e w i t h t h o s e of the h e l p e e . The a b i l i t y to a c h i e v e i n t e r c h a n g e a b l e c o r m n u n i c a t i o n p r o v i d e s - 66 -an a c c u r a t e base f r o m w h i c h to f o r m u l a t e h i g h e r -l e v e l e m p a t h i c r e s p o n s e s at a l a t e r p o i n t . 3. The h e l p e r w i l l f i n d t h a t he i s most e f f e c t i v e i n corrmun i c a t i ng e m p a t h i c u n d e r s t a n d i n g when he f o r m u l a t e s h i s r e s p o n s e s i n la n g u a g e t h a t i s most a t t u n e d to the h e l p e e . 4. The h e l p e r w i l l f i n d t h a t he i s most e f f e c t i v e i n corrmun i c a t i ng e m p a t h i c u n d e r s t a n d i n g when he r e s p o n d s i n a f e e l i n g tone s i m i l a r to t h a t com-m u n i c a t e d by the h e l p e e . 5. The h e l p e r w i l l f i n d t h a t he i s most e f f e c t i v e i n corrmun i c a t i ng e m p a t h i c u n d e r s t a n d i n g when he i s most r e s p o n s i v e . The more f r e q u e n t l y the h e l p e r r e s p o n d s to the h e l p e e , the l e s s l i k e l y he i s to d e v i a t e f r o m the way the h e l p e e e x p e r i e n c e s the w o r l d or the more l i k e l y he i s to be aware t h a t he i s d e v i a t i n g s i g n i f i c a n t l y f r o m the h e l p e e ' s p h e n ome n o1o g y. 6. The h e l p e r w i l l f i n d t h a t he i s most e f f e c t i v e i n corrmun i c a t i ng e m p a t h i c u n d e r s t a n d i n g when, h a v i n g e s t a b l i s h e d an i n t e r c h a n g e a b l e base of c orrmu n i c a t i o n , he moves t e n t a t i v e l y toward e x p a n d i n g and c l a r i f y i n g the h e l p e e ' s e x p e r i e n c e s at h i g h e r l e v e l s . 7. The h e l p e r w i l l f i n d t h a t he i s most e f f e c t i v e i n corrmun i c a t . i ng e m p a t h i c u n d e r s t a n d i n g when he c o n c e n t r a t e s upon what i s not b e i n g e x p r e s s e d by the h e l p e e . The d e e p e s t l e v e l of empathy, t h e n , i n v o l v e s f i l l i n g i n what i s m i s s i n g r a t h e r than s i m p l y d e a l i n g w i t h what i s p r e s e n t . 8. The h e l p e r w i l l f i n d t h a t he i s most e f f e c t i v e i n corrmun i c a t i ng e m p a t h i c u n d e r s t a n d i n g when he employs the h e l p e e ' s b e h a v i o r as the b e s t g u i d e -l i n e to a s s e s s the e f f e c t i v e n e s s of h i s r e s p o n s e s . ( C a r k h u f f , 1969, pp.202-204) G e s t a l t E m p t y - C h a i r D i a l o g u e T h e r a p e u t i c work i n the e m p t y - c h a i r d i a l o g u e can be d i v i d e d i n t o 3 p h a s e s : a r o u s a l , e x p r e s s i o n , r e c o v e r y and c o m p l e t i o n ( G r e e n b e r g & M i n d e n , 1988; G r e e n b e r g & S a f r a n , 1987). In the a r o u s a l phase the t h e r a p i s t g u i d e s - 67 -the c l i e n t i n e v o k i n g the s i g n i f i c a n t o t h e r u s i n g s e n s o r y images. The c l i e n t i s d i r e c t e d to r e a c t to the s i g n i f i -c a n t o t h e r and to e x p r e s s to the s i g n i f i c a n t o t h e r what he or she i s e x p e r i e n c i n g . The c l i e n t i s a s k e d to speak f r o m h i s own e x p e r i e n c e s , u s i n g I, not h u r l i n g a c c u s a t i o n s . O f t e n the c l i e n t e x p r e s s e s a c o m p l a i n t . The t h e r a p i s t a t t e n d s to the c l i e n t ' s e x p r e s s i o n n o t i n g whether the c l i e n t ' s e x p r e s s i o n i s spon-t a n e o u s or d e l i b e r a t e , whether the a f f e c t b e i n g e x p r e s s e d i s p r i m a r y ( s u c h as g e n u i n e a n g e r , s a d -ness or h u r t ) or i n s t r u m e n t a l ( s u c h as r e a c t i v e a n g e r , w h i n i n g , d e f e a t or h e l p l e s s n e s s ) . U s u a l l y , the c l i e n t ' s c o m p l a i n t r e p r e s e n t s f e e l i n g s w h i c h have remained u n d i f f e r e n t i a t e d as w e l l as unex-p r e s s e d and i t i s the t h e r a p i s t ' s t a s k to h e l p the c l i e n t b o t h d i f f e r e n t i a t e and e x p r e s s t h e s e . ( G r e e n b e r g & M i n d e n , 1988, p.16) The t h e r a p i s t may ask the c l i e n t to r e p e a t or i n t e n s i f y some s p o n t a n e o u s n o n - v e r b a l e x p r e s s i o n i n o r d e r to h e i g h t e n a r o u s a l . The t h e r a p i s t a l s o d i r e c t s the c l i e n t to e n a c t the s i g n i f i c a n t o t h e r i n the empty c h a i r , and i n s t r u c t s the c l i e n t to f o c u s on and e n a c t b o t h v e r b a l l y and n o n - v e r b a l l y the f i g u r a l n e g a t i v e a s p e c t s of the s i g n i f i c a n t o t h e r . F o c u s i n g on a s p e c i f i c s i t u a t i o n may a l s o be used to i n c r e a s e a r o u s a l . The t h e r a p i s t ' s t a s k i s to a s s i s t the c l i e n t to b o t h d i f f e r -e n t i a t e and e x p r e s s the r e s t r i c t e d a f f e c t . In the e x p r e s s i o n p h a s e , the t h e r a p i s t f a c i l i t a t e s the c l i e n t ' s f u l l d i f f e r e n t i a t i o n and e x p r e s s i o n of emo -t i o n i n r e l a t i o n to the s i g n i f i c a n t o t h e r . The t h e r a p i s t d i r e c t s the c l i e n t to s h i f t f r o m p o r t r a y i n g the s i g n i f i -c a n t o t h e r i n the empty c h a i r to r e s p o n d i n g as h i m s e l f . - 68 -" I f the c l i e n t has remembered and evoked a p a s t u n f i n -i s h e d s i t u a t i o n (as i s o f t e n the c a s e i f a p a r e n t i s i n v o l v e d ) the t h e r a p i s t w i l l e n c o u r a g e the c l i e n t to r e s p o n d to the o t h e r as h i m s e l f w i t h i n t h a t s i t u a t i o n , a l l o w i n g the c l i e n t the o p p o r t u n i t y to r e e x p e r i e n c e and d i f f e r e n t i a t e the f u l l range of f e e l i n g s t h a t the c l i e n t f e l t t h e n " ( G r e e n b e r g & M i n d e n , 1988, p . 1 6 ) . R e a c t i v e - i n s t r u m e n t a 1 e m o t i o n ( s u c h as w h i n i n g , d e f e a t , or h e l p l e s s n e s s ) i s d i s c o u r a g e d and e x p r e s s i o n of p r i m a r y e m o t i o n i s e n c o u r a g e d and v a l i d a t e d by the t h e r a p i s t . B e s i d e s b r i n g i n g to the c l i e n t ' s awareness h i s p r i m a r y a d a p t i v e e m o t i o n s , the t h e r a p i s t a l s o b r i n g s to the c l i e n t ' s awareness the e x p r e s s i v e s i g n s of the a v o i d a n c e of i n t e r r u p t e d e m o t i o n a l e x p e r i e n c e and ex-p r e s s i o n . The t h e r a p i s t a s s i s t s the c l i e n t to e x p r e s s to the s i g n i f i c a n t o t h e r the u n f u l f i l l e d need and e x p e c t a t i o n i n r e g a r d s , to the s i g n i f i c a n t o t h e r . In the r e c o v e r y p h a s e , the t h e r a p i s t s u p p o r t s the c l i e n t i n l e t t i n g go of u n f u l f i l l e d e x p e c t a t i o n . T h i s o f t e n happens s p o n t a n e o u s l y as a r e s u l t of the f u l l e x p r e s s i o n of the r e s t r i c t e d a f f e c t . In t h o s e s i t u a t i o n s where the c l i e n t does not l e t go of the un-f u l f i l l e d e x p e c t a t i o n , the t h e r a p i s t a s s i s t s the c l i e n t to e v a l u a t e whether he may e v e r get h i s e x p e c t a t i o n s met and whether t h e h a n g i n g on may be s e l f - d e f e a t i n g . "The t h e r a p i s t r e c o g n i z e s t h a t f u l l e x p r e s s i o n has o c c u r r e d - 69 -when a s h i f t has o c c u r r e d f o r t h e c l i e n t , p e r h a p s a s o f t e n i n g o f f e e l i n g t o w a r d t h e o t h e r or t h e a r t i c u l a t i o n o f a r e s o l u t i o n by t h e c l i e n t n e v e r t o f o r g i v e t h e o t h e r " ( G r e e n b e r g & M i n d e n , 1988, p . 1 7 ) . The t h e r a p i s t s u p p o r t s t h e e m e r g i n g p o s i t i v e r e p r e s e n t a t i o n of t h e s i g n i f i c a n t o t h e r . F o r e x a m p l e , t h e t h e r a p i s t may d i r e c t t h e c l i e n t t o e n a c t t h e s i g n i f i c a n t o t h e r and e n c o u r a g e t h e s i g n i f i -c a n t o t h e r ' s a d m i s s i o n o f i n a d e q u a c y and r e q u e s t f o r f o r g i v e n e s s . The t h e r a p i s t w i l l a s s e s s w h e t h e r f u r t h e r e x p r e s s i o n of need and l e t t i n g go of t h e u n f u l f i l l e d e x p e c t a t i o n i s n e c e s s a r y . I f so a t e m p o r a r y goodbye t o t h e s i g n i f i c a n t o t h e r i s s u g g e s t e d and f u t u r e empty-c h a i r w ork p r e s c r i b e d . I f r e s o l u t i o n has been a s s e s s e d , a f i n a l g oodbye i s e v o k e d . The t h e r a p i s t e x p l o r e s and s u p p o r t s new m e a n i n g s and u n d e r s t a n d i n g w i t h t h e c l i e n t s u r r o u n d i n g t h e r e l a t i o n s h i p w i t h t h e s i g n i f i c a n t o t h e r . D e s i g n and A n a l y s i s In t h i s c o m p a r a t i v e t r e a t m e n t s t r a t e g y , a c o u n t e r -b a l a n c e d d e s i g n was u s e d i n w h i c h a l l t h e r a p i s t s u s e d b o t h t r e a t m e n t t e c h n i q u e s and t h e o r d e r of a d m i n i s t r a t i o n was v a r i e d so t h a t h a l f t h e t h e r a p i s t began w i t h e m p a t h i c r e f l e c t i o n and h a l f began w i t h t h e Ge s t a 1t emp t y-c h a i r d i a l o g u e . T h i s d e s i g n was u s e d t o e l i m i n a t e t h e p o t e n t i a l c o n f o u n d i n g e f f e c t s b e t ween t h e t h e r a p i s t s c h a r a c t e r i s t i c s and t r e a t m e n t d i f f e r e n c e s . - 70 -The s e s s i o n d a t a of peak ( h i g h e s t a t t a i n e d ) and modal (most o f t e n o c c u r r i n g ) r a t i n g s f o r each two m i n u t e segment was a n a l y s e d to d i s c o v e r whether t h e r e i s a s i g n i f i c a n t d i f f e r e n c e i n the c l i e n t p r o c e s s between the two t r e a t m e n t c o n d i t i o n s . The p r o p o r t i o n of peak r a t i n g s of 4 and above, 5 and above and 6 were c a l c u l a t e d f o r each t r e a t m e n t c o n d i t i o n . The p r o p o r t i o n of modal r a t i n g s of k and above, 5 and above, and 6 were c a l c u l a t e d f o r e ach t r e a t m e n t c o n d i t i o n . Mean e x p e r i e n c i n g l e v e l s f o r the s u b j e c t s i n the two c o n d i t i o n s was a l s o compared. L e v e l s 4 and above have been c h o s e n f o r s c r u t i n y as t h e r e i s o n l y at l e v e l s k and above an i n t e r n a l f o c u s and e x p l o r a t i o n of f e e l i n g s t h a t may l e a d to p r o b l e m s o l v i n g and s e 1 f - u n d e r s t a n d i n g . "The s c a l e may be v iewed as two s u b s c a l e s , the f i r s t m o v ing f r o m e x t e r n a l to i n t e r n a l r e f e r e n t s , and the second mo v i n g f r om a n inward f o c u s to a p r o c e s s of i n t e r n a l l y f o c u s e d a f f e c t i v e p r o b l e m s o l v i n g " G r e e n b e r g & S a f r a n , 1987, p . 7 5 ) . The p r o p o r t i o n of b o t h modal and peak s c o r e s r e -p r e s e n t i n g t h e p r o p o r t i o n of se gme n t s i n each i n t e r v i e w w h i c h were r a t e d 4 and above were p a s s e d t h r o u g h an a r c s i n t r a n s f o r m a t i o n i n o r d e r to make them a p p r o p r i a t e f o r t - t e s t a n a l y s e s ( K i r k , 1968). The a r c s i n p r o -p o r t i o n s of modal r a t i n g s of k and above were compared between the two t r e a t m e n t c o n d i t i o n s , and the a r c s i n p r o p o r t i o n s of peak r a t i n g s of 4 and above were compared - 71 between the two t r e a t m e n t c o n d i t i o n s . P r o p o r t i o n s of 5 and above, and 6, modal and peak r a t i n g s were a n a l y s e d a c c o r d i n g to the z - t e s t w h i c h m e asures " t h e s i g n i f i c a n c e of the d i f f e r e n c e s of two p r o p o r t i o n s " ( Z a r , 1984, p . 3 9 6 ) . Due to the f r e q u e n t l y o c c u r r i n g z e r o c o u n t s of s c o r e s 5 and above and 6 i n b o t h modal and peak r a t i n g s f o r s u b j e c t s , the d a t a was i n s u f f i c i e n t to use an a r c s i n t r a n s f o r m a t i o n and t - t e s t . Mean e x p e r i e n c i n g l e v e l s f o r each c l i e n t were c a l -c u l a t e d and the d i f f e r e n c e s i n the means f o r the two c o n d i t i o n s were a n a l y s e d by a t - t e s t . T h e r a p i s t i n t e r a c t i o n e f f e c t s by c o n d i t i o n were a l s o q u a l i t a t i v e l y a n a l y s e d . W i t h l i m i t e d e x c e p t i o n , t h e r a p i s t s o u t p e r f o r m e d t h e m s e l v e s i n the G e s t a l t e m p t y - c h a i r d i a l o g u e c o n d i t i o n i n terms of g r e a t e r p r o p o r t i o n s of L e v e l 4 and above o b s e r v e d f o r t h e i r s u b j e c t s . E x c e p t i o n was one p a i r e d a n a l y s i s f o r modal s c o r e s and two p a i r e d a n a l y s e s f o r peak s c o r e s . T h e r a p i s t i n t e r a c t i o n e f f e c t s by co n -d i t i o n were a l s o s t a t i s t i c a l l y a n a l y s e d w i t h a two way a n a l y s i s of v a r i a n c e . ( G i v e n the s m a l l sample s i z e , the i n t e r p r e t a t i o n of t h e s e s t a t i s t i c a l r e s u l t s must be made w i t h c a u t i o n . ) - 72 -CHAPTER IV RESULTS T h i s c h a p t e r p r e s e n t s the r e s u l t s of the s t a t -i s t i c a l a n a l y s e s p e r f o r m e d on the d a t a . The OS form of the B a r r e t t - L e n n a r d R e l a t i o n s h i p I n v e n t o r y ( R l ) , empathy s c a l e was a d m i n i s t e r e d to s u b j e c t s to a s s e s s whether the t r e a t m e n t c o n d i t i o n s o c c u r r e d i n the c o n t e x t of p e r c e i v e d t h e r a p i s t empathy. A t - t e s t was used to compare t h e s u b j e c t s i n the two t r e a t m e n t c o n d i t i o n s t o a s s e s s f o r d i f f e r e n c e s i n p e r c e i v e d t h e r a p i s t empathy. The d i f f e r e n t i a l e f f e c t s of the two t r e a t m e n t c o n -d i t i o n s were measured by the E x p e r i e n c i n g S c a l e . An a r c s i n t r a n s f o r m a t i o n and t - t e s t were used to a s s e s s the d i f -f e r e n t i a l l e v e l s of e x p e r i e n c i n g at L e v e l 4 and above between the two c o n d i t i o n s . Z - t e s t s were used to i s o l a t e s t a t i s t i c a l d i f f e r e n c e s i n p r o p o r t i o n s of L e v e l 5 and above, and L e v e l 6, f o r mode and peak r a t i n g s on the E x p e r i e n c i n g S c a l e , between the two t r e a t m e n t c o n d i t i o n s . C l i e n t mean e x p e r i e n c i n g l e v e l s were c a l c u l a t e d and a t - t e s t used to compare mean e x p e r i e n c i n g l e v e l s between the two t r e a t m e n t c o n d i t i o n s . A P e a r s o n P r o d u c t Moment C o r r e l a t i o n ( H o p k i n s & S t a n l e y , 1981) was used to c a l c u l a t e the i n t e r r a t e r r e l i a b i l i t y f o r the r a t e r s on the E x p e r i e n c i n g S c a l e . A two way a n a l y s i s of v a r i a n c e was done to a s s e s s - 73 -f o r p o s s i b l e t h e r a p i s t / t r e a t m e n t c o n d i t i o n i n t e r a c t i o n e f f e c t s . R e l a t i o n s h i p I n s t r ume n t B a r r e t t - L e n n a r d R e l a t i o n s h i p I n v e n t o r y ( R l ) The B a r r e t t - L e n n a r d R e l a t i o n s h i p I n v e n t o r y , empathy s c a l e , was used to measure the s u b j e c t ' s p e r c e p t i o n of t h e i r t h e r a p i s t ' s empathy. The s c o r e of 16 i s the l o w e s t a c c e p t a b l e s c o r e f o r a t h e r a p i s t to be p e r c e i v e d as m i n i m a l l y f a c i 1 i t a t i v e , out of a p o s s i b l e maximum s c o r e of 48. Four s u b j e c t s were d e l e t e d f r o m the s t u d y , two f r o m the e m p a t h i c r e f l e c t i o n c o n d i t i o n and two f r o m the G e s t a l t emp t y - c h a i r d i a l o g u e c o n d i t i o n , as th e y r a t e d t h e i r t h e r a p i s t s lower than 16 on the empathy s c a l e . T h e r e f o r e 12 s u b j e c t s i n each c o n d i t i o n have been co n -s i d e r e d to have t a k e n p a r t i n the s t u d y . The mean s c o r e of the t h e r a p i s t s r e m a i n i n g i n the s t u d y was 34.26, w i t h a s t a n d a r d d e v i a t i o n of 7.66 . To d e t e r m i n e i f t h e r e was a d i f f e r e n c e between the two t r e a t m e n t groups i n p e r c e i v e d empathy of the t h e r a p i s t , a t - t e s t was p e r f o r m e d . A t - v a l u e of 1.23 was found w h i c h i n d i c a t e d t h a t no s i g n i f i c a n t d i f f e r e n c e (p = . 2 31 ) e x i s t e d between the two t r e a t m e n t g r o u p s at the =.05 s i g n i f i c a n t l e v e l . See T a b l e 1 f o r the means and s t a n d a r d d e v i a t i o n s of the two g r o u p s . The mean f o r the G e s t a l t e m p t y - c h a i r d i a l o g u e c o n d i t i o n (32.18) was lower than t h a t - 74 -f o r the e m p a t h i c r e f l e c t i o n group ( 3 6 . 1 7 ) . TABLE 1 MEANS AND STANDARD DEVIATIONS OF BARRETT-LENNARD RELATIONSHIP INVENTORY EMPATHY DIMENSION SCORES T r e a t m e n t C o n d i t i o n Mean S t a n d a r d D e v i a t i o n G e s t a l t E m p t y - C h a i r 32.1818 7.653 D i a l o g u e E m p a t h i c R e f l e c t i o n 36.1667 7.826 Exper i e n c i n g S c a l e I n t e r r a t e r R e l i a b i l i t y As r e p o r t e d i n the m e t h o d o l o g y s e c t i o n , two r a t e r s t r a i n e d i n the use of the E x p e r i e n c i n g S c a l e i n d e p e n d e n t l y r a t e d t w o - t h i r d s of the t o t a l l e d segmented t r a n s c r i p t s . The r a t e r s o v e r l a p p e d on o n e - t h i r d of the segments (203 s e g m e n t s ) . A P e a r s o n P r o d u c t Moment C o r r e l a t i o n was c a l c u l a t e d f o r the two r a t e r s ' modal and peak r a t i n g s of the 203 segments. The i n t e r r a t e r r e l i a b i l i t y on the 203 rand om i z e d s e gme n t s wa s .74 f o r mo d a l r a t i n g s and .80 f o r peak r a t i n g s . C o m p a r i s o n of E x p e r i e n c i n g L e v e l s f o r the E m p a t h i c R e f l e c t i o n C o n d i t i o n and the G e s t a l t E m p t y - C h a i r D i a l o g u e C o n d i t i o n F r e q u e n c i e s of modal and peak s c o r e s L e v e l 4 and - 7 5 -above, L e v e l 5 and above, and L e v e l 6, f o r the two t r e a t -ment c o n d i t i o n s a r e r e p o r t e d i n T a b l e s 2 and 3 r e s p e c t i v e l y . P r o p o r t i o n s of modal and peak s c o r e s f o r L e v e l 4, L e v e l 5, L e v e l 6, and L e v e l 4 and above, a r e l i s t e d by c l i e n t f o r each t r e a t m e n t c o n d i t i o n , and a r e r e p o r t e d i n T a b l e s 4 and 5 r e s p e c t i v e l y . C o m p a r i s o n of P r o p o r t i o n s L e v e l 4 and Above To make the p r o p o r t i o n s s u i t a b l e f o r t - t e s t a n a l y s i s , the p r o p o r t i o n s of s c o r e s L e v e l 4 and above were p a s s e d t h r o u g h an a r c s i n t r a n s f o r m a t i o n . The means and s t a n d a r d d e v i a t i o n s of the t r a n s f o r m e d modal and peak p r o p o r t i o n s of s c o r e s L e v e l 4 and above per t r e a t m e n t group a r e r e -p o r t e d i n T a b l e s 6 and 7. F o r modal s c o r e s L e v e l 4 and above, the t r a n s f o r m e d mean f o r the G e s t a l t e m p t y - c h a i r d i a l o g u e c o n d i t i o n was 1 . 5 8 2 and the t r a n s f o r m e d mean f o r the e m p a t h i c r e f l e c t i o n c o n d i t i o n was . 8 6 7 . A t -v a l u e of 2 . 7 3 was found w h i c h i n d i c a t e d t h a t a s i g n i f i c a n t d i f f e r e n c e (p =.012) e x i s t e d between the two t r a n s f o r m e d means at the°c=.05 c o n f i d e n c e l e v e l . T h e r e f o r e the h y p o t h e s i s ( H ^ ) was r e t a i n e d and the n u l l h y p o t h e s i s (HQ J ) r e j e c t e d . The G e s t a l t e m p t y - c h a i r d i a l o g u e , when used w i t h an i s s u e of u n f i n i s h e d b u s i n e s s w i l l p r o d u c e s i g n i f i c a n t l y more modal r a t i n g s of 4 and above on the E x p e r i e n c i n g - 76 -TABLE 2 MODAL EXPERIENCING LEVEL FREQUENCIES PER TREATMENT CONDITION k & 5 & ABOVE ABOVE G e s t a l t E m p t y - C h a i r D i a l o g u e 158 17 2 E m p a t h i c R e f l e c t i o n 69 2 1 TABLE 3 PEAK EXPERIENCING LEVEL FREQUENCIES PER TREATMENT CONDITION 4 & 5 & ABOVE ABOVE G e s t a l t E m p t y - C h a i r D i a l o g u e 200 38 E m p a t h i c R e f l e c t i o n 101 5 - 77 -TABLE 4 PROPORTION OF SEGMENTS WITH EXPERIENCING LEVELS OF 4, 5, & 6 MODAL RATINGS EMPATHIC REFLECTION GESTALT EMPTY-CHAIR DIALOGUE EXPERIENCING LEVELS 4 5 6 4& EXPERIENCING LEVELS 4 5 6 4& CLIENT CLIENT 1 .09 .00 .00 . 09 2 . 59 .03 . 00 . 62 6 . 1 4 . 00 .00 . 1 4 5 . 57 . 1 1 . 07 . 75 24 . 22 . 00 .00 . 22 26 . 24 .00 . 00 .24 1 5 . 1 1 . 00 .00 . 1 1 8 . 37 . 00 . 00 . 37 1 6 . 38 . 00 . 00 . 38 21 . 54 . 1 9 . 00 . 73 25 .78 . 00 . 00 .78 1 1 . 23 .05 . 00 . 27 1 9 . 00 . 00 .00 . 00 7 . 33 .00 . 00 . 33 20 .08 . 00 . 00 . 08 9 . 36 . 00 . 00 . 36 1 3 .00 . 00 .00 . 00 29 . 20 .03 .00 . 23 1 8 . 04 . 00 .00 . 04 23 . 22 . 00 . 00 . 22 28 .61 . 04 . 04 . 70 3 . 78 . 1 1 . 00 . 89 22 . 1 9 . 00 . 00 . 1 9 4 . 88 . 06 . 00 . 94 1 - 78 -T A B L E 5 PROPORTION OF SEGMENTS WITH E X P E R I E N C I N G L E V E L S O F 4 , 5 , & 6 P E A K RATINGS E M P A T H I C R E F L E C T I O N G E S T A L T E M P T Y - C H A I R D I A L O G U E E X P E R I E N C I N G L E V E L S E X P E R I E N C I N G L E V E L S 4 5 6 4& 4 5 6 4& X I E N T C L I E N T 1 . 1 7 .04 . 00 . 22 2 . 72 . 0 3 . 00 . 76 6 . 29 . 00 . 00 . 29 5 .71 . 07 . 1 8 . 96 24 .41 . 00 . 0 0 . 4 1 26 . 24 . 00 . 04 .28 1 5 . 29 .00 . 00 . 29 8 . 43 . 00 . 00 . 43 1 6 .54 . 00 .08 . 62 21 . 54 . 35 .04 . 92 25 . 78 . 00 . 00 . 78 1 1 . 59 . 09 . 0 0 . 68 19 . 1 7 .00 . 00 . 1 7 7 . 33 . 00 . 00 . 33 20 . 1 3 . 00 . 00 . 1 3 9 . 50 . 00 . 0 5 . 55 1 3 . 00 . 00 . 0 0 . 00 29 . 37 . 03 . 0 7 . 47 1 8 .04 . 00 . 0 0 .04 23 . 26 . 00 . 0 9 . 35 28 . 70 .04 .04 . 78 3 .61 . 1 7 . 1 1 . 8 9 22 .31 . 00 . 0 0 .31 4 . 79 . 06 . 1 2 . 97 - 79 -TABLE 6 TRANSFORMED MODAL PROPORTIONS FOR EXPERIENCING LEVEL 4 AND ABOVE T r e a t m e n t C o n d i t i o n S t a n d a r d S t a n d a r d E r r o r Mean D e v i a t i o n of the Mean G e s t a l t E m p t y - C h a i r D i a l o g u e E m p a t h i c R e f l e c t i o n 582 867 603 675 . 1 7 . 1 9 TABLE 7 TRANSFORMED PEAK PROPORTIONS FOR EXPERIENCING LEVEL 4 AND ABOVE S t a n d a r d S t a n d a r d E r r o r T r e a t m e n t C o n d i t i o n Mean D e v i a t i o n of the Mean G e s t a l t E m p t y - C h a i r D i a l o g u e 1.906 .622 .18 E m p a t h i c R e f l e c t i o n 1.163 .654 .19 - 80 -S c a l e , than t h a t p r o d u c e d by the use of e m p a t h i c r e f l e c t i o n . F o r peak s c o r e s L e v e l 4 and above, the t r a n s f o r m e d mean f o r the G e s t a l t e m p t y - c h a i r d i a l o g u e c o n d i t i o n was 1.906 and the t r a n s f o r m e d mean f o r the e m p a t h i c r e f l e c t i o n c o n d i t i o n was 1.163. A t - v a l u e of 2.85 was found w h i c h i n d i c a t e d t h a t a s i g n i f i c a n t d i f f e r e n c e (p=.0096) e x i s t e d between the means at t h e ° c = . 0 5 c o n f i d e n c e l e v e l . T h e r e -f o r e the h y p o t h e s i s ( F ^ ) was r e t a i n e d and the n u l l h y p o t h e s i s ( H 0 2 ) r e j e c t e d . H 2 The G e s t a l t e m p t y - c h a i r d i a l o g u e , when used w i t h an i s s u e of u n f i n i s h e d b u s i n e s s w i l l p r o d u c e s i g -n i f i c a n t l y more peak r a t i n g s of 4 and above on the E x p e r i e n c i n g S c a l e , than t h a t p r o d u c e d by the use of e m p a t h i c r e f l e c t i o n . C o m p a r i s o n of P r o p o r t i o n s L e v e l 5 and Above Z - t e s t s were used to compare the p r o p o r t i o n s of modal and peak s c o r e s L e v e l 5 and above. For the modal c o m p a r i s o n , a z - s c o r e of 4.75 was found w h i c h i n d i c a t e d a s i g n i f i c a n t d i f f e r e n c e between p r o p o r t i o n s as t h i s s s c o r e s u r p a s s e d the c r i t i c a l v a l u e of 1.96 at the .05 c o n -f i d e n c e l e v e l . T h e r e f o r e the h y p o t h e s i s ( H ^ ) was r e t a i n e d and the n u l l h y p o t h e s i s (HQ^) w a s r e j e c t e d . H 3 The G e s t a l t e m p t y - c h a i r d i a l o g u e , when used w i t h an i s s u e of u n f i n i s h e d b u s i n e s s w i l l p r o d u c e a s i g -- 81 n i f i c a n t l y g r e a t e r p r o p o r t i o n of modal r a t i n g s of 5 and above on the E x p e r i e n c i n g S c a l e , than t h a t p r o d u c e d by the use of e m p a t h i c r e f l e c t i o n . F o r the peak c o m p a r i s o n , a z - s c o r e of 5.22 was fo u n d w h i c h i n d i c a t e d a s i g n i f i c a n t d i f f e r e n c e between p r o -p o r t i o n s as t h i s s c o r e s u r p a s s e d the c r i t i c a l v a l u e of 1.96 at the .05 c o n f i d e n c e l e v e l . T h e r e f o r e the hypo-t h e s i s ( H ^ ) was r e t a i n e d and the n u l l h y p o t h e s i s ( H Q ^ ) wa s r e j e c t e d . The G e s t a l t e m p t y - c h a i r d i a l o g u e , when used w i t h an i s s u e of u n f i n i s h e d b u s i n e s s w i l l p r o d u c e a s i g n i f -i c a n t l y g r e a t e r p r o p o r t i o n of peak r a t i n g s of 5 and above on the E x p e r i e n c i n g S c a l e , than t h a t p r o d u c e d by the use of e m p a t h i c r e f l e c t i o n . C o m p a r i s o n of P r o p o r t i o n s L e v e l 6 Z - t e s t s were used to compare the p r o p o r t i o n s of modal and peak s c o r e s L e v e l 6. For the modal c o m p a r i -son, a z - s c o r e of .55 was fo u n d w h i c h d i d not i n d i c a t e a s i g n i f i c a n t d i f f e r e n c e between the p o r p o r t i o n s at the .05 c o n f i d e n c e i n t e r v a l . T h e r e f o r e the h y p o t h e s i s ( H ^ ) was r e j e c t e d and the n u l l h y p o t h e s i s ( H N ^ ) r e t a i n e d . HQ^ The G e s t a l t e m p t y - c h a i r d i a l o g u e , when used w i t h an i s s u e of u n f i n i s h e d b u s i n e s s w i l l not p r o d u c e a s i g n i f i c a n t l y g r e a t e r p r o p o r t i o n of modal r a t i n g s - 82 -of 6 on t h e E x p e r i e n c i n g S c a l e , t h a n t h a t p r o d u c e d by t h e use of e m p a t h i c r e f l e c t i o n . F o r t h e peak c o m p a r i s o n , a z - s c o r e of 3.57 was f o u n d w h i c h i n d i c a t e d a s i g n i f i c a n t d i f f e r e n c e b e t ween p r o p o r t i o n s as t h i s s c o r e s u r p a s s e d t h e c r i t i c a l v a l u e of 1.96 a t t h e .05 c o n f i d e n c e i n t e r v a l . T h e r e f o r e t h e h y p o t h e s i s (Hg) was r e t a i n e d and t h e n u l l h y p o t h e s i s (Hgg) r e j e c t e d . Hg The G e s t a l t e m p t y - c h a i r d i a l o g u e , when u s e d w i t h an i s s u e of u n f i n i s h e d b u s i n e s s w i l l p r o d u c e a s i g -n i f i c a n t l y g r e a t e r p r o p o r t i o n of peak r a t i n g s of 6 on t h e E x p e r i e n c i n g S c a l e , t h a n t h a t p r o d u c e d by t h e use of emp a t h i c r e f l e c t i o n . C o m p a r i s o n of Mean E x p e r i e n c i n g L e v e l s . T a b l e s 8 and 9 show t h e mode and peak mean e x p e r -i e n c i n g l e v e l s c o r e s l i s t e d by c l i e n t . T a b l e 10 shows t h e mo d a 1 c omp a r i s o n of t h e me ans and s t a n d a r d d e v i a t i o n s f o r t h e two t r e a t m e n t c o n d i t i o n s . The mean f o r t h e G e s t a l t e m p t y - c h a i r d i a l o g u e c o n d i t i o n was 3.33 and t h e me an f o r t h e emp a t h i c r e f l e c t i o n c o n d i t i o n wa s 2.719. A t - v a l u e of 2.99 was f o u n d w h i c h i n d i c a t e d t h a t a s i g -n i f i c a n t d i f f e r e n c e (p=.007) e x i s t e d b e t ween t h e two g r o u p means a t the°C=.05 c o n f i d e n c e l e v e l . T h e r e f o r e t h e h y p o t h e s i s (H7) was r e t a i n e d and t h e n u l l h y p o t h e s i s (HQ7) was r e j e c t e d . - 83 -Yiy The G e s t a l t e m p t y - c h a i r d i a l o g u e , when used w i t h an i s s u e of u n f i n i s h e d b u s i n e s s w i l l p r o d u c e s i g -n i f i c a n t l y g r e a t e r mo d a 1 me an e x p e r i e n c i n g l e v e l s on the E x p e r i e n c i n g S c a l e , than t h a t p r o d u c e d by the use of e m p a t h i c r e f l e c t i o n . T a b l e 11 shows the peak means and s t a n d a r d dev-i a t i o n s f o r the two t r e a t m e n t c o n d i t i o n s . The mean f o r the G e s t a l t e m p t y - c h a i r d i a l o g u e c o n d i t i o n was 3.7 77 and the mean f o r the e m p a t h i c r e f l e c t i o n c o n d i t i o n was 3.17 . A t - v a l u e of 3.37 was found w h i c h i n d i c a t e d t h a t a s i g -n i f i c a n t d i f f e r e n c e (p=.0029) e x i s t e d between the two group means at theoC=.05 c o n f i d e n c e l e v e l . T h e r e f o r e the h y p o t h e s i s (Hg) was r e j e c t e d . Hg The G e s t a l t emp t y - c h a i r d i a l o g u e , when used w i t h an i s s u e of u n f i n i s h e d b u s i n e s s w i l l p r o d u c e g r e a t e r peak mean e x p e r i e n c i n g l e v e l s on the E x p e r i e n c i n g S c a l e , than t h a t p r o d u c e d by the use of emp a t h i c r e f l e c t i o n . T h e r a p i s t / T r e a t m e n t C o n d i t i o n I n t e r a c t i o n E f f e c t s A two-way a n a l y s i s of v a r i a n c e was done to t e s t f o r p o s s i b l e i n t e r a c t i o n e f f e c t s of t h e r a p i s t s and t r e a t m e n t c o n d i t i o n f o r b o t h modal and peak s c o r e s . See T a b l e 12 and 13 f o r r e s u l t s . F o r modal s c o r e s , s t a t i s t i c a l l y s i g n i f i c a n t main e f f e c t s were o b t a i n e d f o r t h e r a p i s t s (F=7.859) and t r e a t m e n t c o n d i t i o n (F=20.801) - 84 -but no s t a t i s t i c a l l y s i g n i f i c a n t i n t e r a c t i o n e f f e c t s were o b t a i n e d (F=1.985). F o r peak s c o r e s , s t a t i s t i c a l l y s i g n i f i c a n t main e f f e c t s were o b t a i n e d f o r t h e r a p i s t s (F= 11.482) and t r e a t m e n t c o n d i t i o n (F=30.413) but no s t a t i s t i c a l l y s i g n i f i c a n t i n t e r a c t i o n e f f e c t s were o b t a i n e d (F=2.624). - 85 -T A B L E 8 MEAN E X P E R I E N C I N G L E V E L MODAL SCORES E M P A T H I C R E F L E C T I O N G E S T A L T E M P T Y - C H A I R D I A L O G U E C L I E N T MEAN C L I E N T MEAN 1 6 1 3 1 5 1 6 1 8 1 9 20 22 24 25 28 2. 52 2 . 5 7 2 .0 2 . 4 3 3 . 1 9 2 . 3 3 2 . 3 5 2 . 2 5 2 . 8 5 2 .74 3 . 7 0 3 . 7 0 2 5 29 8 21 23 7 9 4 26 1 1 3 3 . 5 7 3 . 2 5 2 . 9 7 3 . 1 7 3 . 8 5 2 . 7 8 3 . 3 7 3 . 1 8 4 . 0 0 2 . 6 8 3 . 1 4 4 . 00 - 86 -TABLE 9 MEAN EXPERIENCING LEVEL PEAK SCORES EMPATHIC REFLECTION GESTALT EMPTY-CHAIR DIALOGUE CLIENT MEAN CLIENT MEAN 1 6 1 3 1 5 1 6 1 8 1 9 20 22 24 25 28 3.04 3.10 2.44 3.14 3.73 2.67 2.78 2.92 3.31 3.22 3.78 3.91 2 5 29 8 2 1 23 7 9 4 26 1 1 3 3.79 4.39 3.47 3.43 4.35 3.43 3.37 3.59 4 . 26 3 . 24 3 . 73 4.28 - 87 -TABLE 10 MEANS AND STANDARD DEVIATIONS OF MEAN EXPERIENCING LEVEL MODAL SCORES T r e a t m e n t C o n d i t i o n Mean S t a n d a r d S t a n d a r d E r r o r D e v i a t i o n of the Mean G e s t a l t E m p t y - C h a i r D i a l o g u e 3.330 .444 .13 E m p a t h i c R e f l e c t i o n 2.719 .551 .16 TABLE 11 MEANS AND STANDARD DEVIATIONS OF MEAN EXPERIENCING LEVEL PEAK SCORES T r e a t m e n t C o n d i t i o n Mean S t a n d a r d S t a n d a r d E r r o r D e v i a t i o n of t h e Mean G e s t a l t E m p t y - C h a i r D i a l o g u e 3.777 .428 .12 E m p a t h i c R e f l e c t i o n 3.17 .455 .13 - 88 -TABLE 12 ANALYSIS OF VARIANCE BY MODAL SCORES/THERAPISTS/TREATMENT CONDITION S o u r c e of V a r i a t i o n D e g r e e s of F S i g n i f i c a n c e F r e edom of F Ma i n E f f e c t s T h e r a p i s t s 5 7.859 .002 T r e a t m e n t C o n d i t i o n 1 20.801 .001 2-Way I n t e r a c t i o n s T h e r a p i s t / T r e a t m e n t C o n d i t i o n 5 1.98 5 .153 TABLE 13 ANALYSIS OF VARIANCE BY PEAK SCORES/THERAPISTS/TREATMENT CONDITION S o u r c e of V a r i a t i o n D e g r e e s of F S i g n i f i c a n c e F r e e d om of F Ma i n E f f e c t s T h e r a p i s t s 5 11.482 .000 T r e a t m e n t C o n d i t i o n 1 30.413 .000 2-Way I n t e r a c t i o n s The r ap i s t / T r e a t m e n t C o n d i t i o n 5 2 . 624 .079 - 89 -DISCUSSION Ove rv i ew R e s e a r c h e x i s t s w h i c h a t t e s t s to the f a c i l i t a t i v e e f f e c t s of the G e s t a l t t w o - c h a i r d i a l o g u e on l e v e l of e x p e r i e n c i n g i n c o m p a r i s o n w i t h e m p a t h i c r e f l e c t i o n when used w i t h i n t r a p s y c h i c c o n f l i c t ( G r e e n b e r g , 1975; C l a r k e , 1 977; D o m p i e r r e , 1979; G r e e n b e r g <5c C l a r k e , 1979; G r e e n b e r g & D o m p i e r r e , 1981; G r e e n b e r g & W e b s t e r , 1981). T h i s s t u d y i s the f i r s t t o a d d r e s s the f a c i l i t a t i v e e f f e c t s of the G e s t a l t e m p t y - c h a i r d i a l o g u e on l e v e l of e x p e r i e n c i n g i n c o m p a r i s o n w i t h e m p a t h i c r e f l e c t i o n when used w i t h the c l i e n t i s s u e of u n f i n i s h e d b u s i n e s s . T h i s s t u d y i s c o n g r u e n t i n d e s i g n w i t h a c o l l e c t i o n of r e c e n t r e s e a r c h e f f o r t s i n p u r s u i t of more r i g o r o u s o b s e r v a t i o n and measurement of s p e c i f i c t h e r a p i s t / c l i e n t b e h a v i o r s i n the c o n t e x t i n w h i c h they o c c u r . T h i s s t u d y has f o c u s e d on s p e c i f y i n g and d e s c r i b i n g the c l i e n t i s s u e , t h e r a p i s t o p e r a t i o n s and the r e l a t i o n s h i p c o n t e x t . A r e l i a b l e measure was used to measure i n - s e s s i o n c l i e n t c h ange. Such s p e c i f i c i t y c o n t r i b u t e s to a r e s e a r c h base of c omp r e h e n s i v e c l a s s i f i c a t i o n sch erne s and a 1 1 emp t s to f o s t e r r e p r o d u c a b i 1 i t y . In t h i s a n a l o g u e f o r m a t , f i n d i n g s were s u p p o r t i v e t h a t i n the c o n t e x t of a c l i e n t p e r c e i v e d e m p a t h i c r e -l a t i o n s h i p , the G e s t a l t emp t y - c h a i r d i a l o g u e l e a d s to - 90 -s i g n i f i c a n t l y h i g h e r l e v e l s of e x p e r i e n c i n g than emp a t h i c r e f l e c t i o n . T h e r e i s s u p p o r t i n the l i t e r a t u r e f o r t h e n o t i o n t h a t d e p t h of e x p e r i e n c i n g i s p o s i t i v e l y c o r r e l a t e d w i t h outcome ( K l e i n e t a l . , 1969). S i n c e f i n d i n g s s u g g e s t t h a t the G e s t a l t e m p t y - c h a i r d i a l o g u e can enhance a c l i e n t ' s d e p t h of e x p e r i e n c i n g when used w i t h an i s s u e of u n f i n i s h e d b u s i n e s s i n an a n a l o g u e s i t u a t i o n , t h i s t e c h n i q u e may move a c l i e n t c l o s e r to p r o d u c t i v e p s y c h o t h e r a p y when a d d r e s s i n g the i s s u e of u n f i n i s h e d b u s i n e s s . I n t e r p r e t a t i o n of F i n d i n g s The G e s t a l t e m p t y - c h a i r d i a l o g u e l e d to s i g n i f i -c a n t l y h i g h e r l e v e l s of e x p e r i e n c i n g at L e v e l 4 and above than d i d e m p a t h i c r e f l e c t i o n . T h i s may be e x p l a i n e d by the a c t i v e and d i r e c t i v e q u a l i t y of the G e s t a l t empty-c h a i r d i a l o g u e . L e v e l 4 on the E x p e r i e n c i n g S c a l e i s d e s c r i b e d as f o l l o w s : The c o n t e n t i s a c l e a r p r e s e n t a t i o n of the s p e a k e r ' s f e e l i n g s , g i v i n g a p e r s o n a l i n t e r n a l p e r s p e c t i v e or a c c o u n t of f e e l i n g s about the s e l f . F e e l i n g s or the e x p e r i e n c i n g of e v e n t s , r a t h e r than the e v e n t s t h e m s e l v e s , a r e the s u b j e c t of t h e d i s c o u r s e r e -q u i r i n g the s p e a k e r to a t t e m p t to h o l d on to i n n e r r e f e r e n t s . ( K l e i n e t a l . , 1969, p.4) The G e s t a l t e m p t y - c h a i r d i a l o g u e e n c o u r a g e s c l i e n t s to t a k e a p e r s o n a l f o c u s by u s i n g " I " s t a t e m e n t s , and e n c o u r a g e s c l i e n t s to e n a c t r a t h e r t han t a l k about t h e i r e m o t i o n a l memories. The G e s t a l t t e c h n i q u e i s d i r e c t i v e - 91 i n f o c u s i n g the c l i e n t back to t h e i r s u b j e c t i v e e x p e r i e n c e , i . e . " s t a y w i t h i t " , " s a y i t a g a i n " (as d i r e c t e d by t h e t h e r a p i s t ) . See A p p e n d i x I f o r an example of t h e s e t e c h n i q u e s . "Awareness of d e n i e d or d isowned e m o t i o n s can be f a c i l i t a t e d by m a g n i f y i n g c u r r e n t e m o t i o n a l s e n s o r y or c o g n i t i v e e x p e r i e n c e s " ( D a l d r u p e t a l . , 1988, p . 1 1 ) . W i t h c 1 i e n t - c e n t e r e d t h e r a p y ( e m p a t h i c r e f l e c t i o n ) , the t h e r a p i s t r e s p o n d s s u p p o r t i v e l y w i t h u n d e r s t a n d i n g a c c e p t a n c e , w h i c h i s q u a l i t a t i v e l y d i f -f e r e n t f r o m the G e s t a l t t h e r a p i s t r e s p o n s e s of q u e r y i n g c l i e n t r e s p o n s e s , p u s h i n g the c l i e n t f o r g r e a t e r e x p l o r -a t i o n and s t i m u l a t i n g a f f e c t i v e e x p e r i e n c e . It a p p e a r s t h a t w i t h u n f i n i s h e d b u s i n e s s t h e r e can be a t e n d e n c y f o r the c l i e n t to t a l k about the s i g -n i f i c a n t o t h e r and to g i v e a n a r r a t i v e of e v e n t s r a t h e r than keep an i n n e r f o c u s . W i t h the l e s s d i r e c t i v e t e c h -n i q u e of e m p a t h i c r e f l e c t i o n , i t may have been p o s s i b l e f o r c l i e n t s to remain to a l a r g e r d e g r e e more e x t e r n a l l y f o c u s e d , t h e r e f o r e e x p l a i n i n g i n p a r t the q u a l i t a t i v e d i f f e r e n c e s i n the l e v e l of e x p e r i e n c i n g f o r the two g r o u p s . Lower e x p e r i e n c i n g l e v e l s f o r the l e s s d i r e c t i v e e m p a t h i c r e f l e c t i o n c o n d i t i o n may a l s o have o c c u r r e d due to the a v o i d a n c e .component of u n f i n i s h e d b u s i n e s s of e x p e r i e n c i n g f e e l i n g s c o n c e r n i n g the s i g n i f i c a n t o t h e r . By d e f i n i t i o n u n f i n i s h e d b u s i n e s s c o n c e r n s - 92 -r e s t r i c t e d a f f e c t . W i t h the G e s t a l t e m p t y - c h a i r d i a l o g u e , the c l i e n t i s e n c o u r a g e d and d i r e c t e d to e x p r e s s d i r e c t l y the u n e x p r e s s e d e m o t i o n . W i t h e m p a t h i c r e f l e c t i o n t h e r e may have been more l a t i t u d e to t a l k about the s i g n i f i c a n t o t h e r , p o s s i b l y at a more c o g n i t i v e l e v e l and w i t h l e s s of an immediate e x p e r i e n c e . The f o l l o w i n g i s an e x c e r p t f r o m a c l i e n t i n the e m p a t h i c r e f l e c t i o n c o n d i t i o n w h i c h ma y ex emp l i f y the a v o i d a n c e c omp o n e n t . T h e r a p i s t : . . . f e e l i n g when you t h i n k about your f a t h e r and the p a s t s i t u a t i o n C l i e n t : Yeah, i t ' s l i k e I guess I'm a l i t t l e a f r a i d to go back and r e t r a c e some of t h o s e f e e l i ng s. T h e r a p i s t : I t ' s s c a r e y f o r you to want to l o o k at t h a t aga i n. C l i e n t : Yeah, I t h i n k p a r t of me i s a f r a i d of g e t t i n g s t u c k back t h e r e . . . The f o l l o w i n g i s an e x c e r p t f r o m the G e s t a l t empty-c h a i r d i a l o g u e c o n d i t i o n . C l i e n t : I t ' s v e r y s t r a n g e . I don't want to f e e l a n g r y . I t r y not to f e e l t h o s e e m o t i o n s . ( T h e r a p i s t : Y e s ) They h u r t too much. T h e r a p i s t : Y e s , I u n d e r s t a n d . They a r e v e r y p a i n -f u l . I am i n v i t i n g you h e r e to f e e l some of t h o s e b e c a u s e e v e n t u a l l y they b u i l t up such a p r e s s u r e . C l i e n t : I am a f r a i d of t h a t - a f r a i d of t h a t d e p t h of e m o t i o n , ( T h e r a p i s t : Yeah) w h i c h i s r e a l l y o b v i o u s l y f i g u r e s b e c a u s e he has d e p r i v e d me of t h a t k i n d of emo t i o n , I g u e s s . C l i e n t s r o u t i n e l y spoke of s e l f - i m p o s e d d i f f i c u l t y of e x p r e s s i n g u n f i n i s h e d b u s i n e s s such as i n the f o l l o w i n g - 93 -e x c e r p t of a G e s t a l t e m p t y - c h a i r d i a l o g u e c l i e n t . C l i e n t : I j u s t r e a l i z e d t h a t I ( p a u s e ) i f I c o u l d see her t h e r e I c o u l d n ' t say a n y t h i n g to h e r . A s i g n i f i c a n t d i f f e r e n c e between the two t r e a t m e n t c o n d i t i o n s was a l s o found f o r L e v e l s 5 and 6. L e v e l 5 has been d e f i n e d as f o l l o w s . The c o n t e n t i s a p u r p o s e f u l e l a b o r a t i o n or e x p l o r -a t i o n of the s p e a k e r ' s f e e l i n g s and e x p e r i e n c i n g . T h e r e a r e two n e c e s s a r y components: F i r s t , the s p e a k e r must pose or d e f i n e a p r o b l e m or p r o p o s i t i o n about h i m s e l f ( h e r s e l f ) i n terms of f e e l i n g s . The p r o b l e m or p r o p o s i t i o n may i n v o l v e the o r i g i n , s e q u e n c e , or i m p l i c a t i o n of f e e l i n g s or r e l a t e f e e l i n g s to o t h e r p r i v a t e p r o c e s s e s . Second, the s p e a k e r must e x p l o r e or work w i t h the p r o b l e m i n a p e r s o n a l way. ( K l e i n et a l . , 1969, p.5) L e v e l 6 i s d e f i n e d as " a s y n t h e s i s of r e a d i l y a c c e s s i b l e , newly r e c o g n i z e d or more f u l l y r e a l i z e d f e e l i n g s and e x p e r i e n c e s to p r o d u c e p e r s o n a l l y me a n i n g f u l s t r u c t u r e or to r e s o l v e i s s u e s " ( K l e i n et a l . , 1 969, p . 6 1 ) . G i v e n the g r e a t e r irrmediacy e n g e n d e r e d by the G e s t a l t e m p t y - c h a i r d i a l o g u e , i e . " I " s t a t e m e n t s , e n a c tment; t h i s a p p r o a c h may be c o n s i d e r e d more f a c i l i t a t i v e of a s y n t h e s i s of r e a d i l y a c c e s s i b l e , newly r e c o g n i z e d or more f u l l y r e a l i z e d f e e l i n g s . A c c o r d i n g to G r e e n b e r g and S a f r a n (1987) the m a g n i f i c a t i o n and i n t e n s i f i c a t i o n of c u r r e n t f e e l i n g s f a c i l i t a t e s e m o t i o n a l e x p r e s s i o n and a deeper e x p l o r a t i o n of b l o c k e d e m o t i o n s i n r e s o l v i n g u n f i n i s h e d b u s i n e s s . The e m p t y - c h a i r d i a l o g u e h e l p s the i n d i v i d u a l d i f f e r e n t i a t e f e e l i n g s w h i c h can l e a d - 94 -to new a w a r e n e s s e s . T a k i n g on the r o l e of t h e o t h e r can h e i g h t e n the e m o t i o n a l e x p e r i e n c e and l e a d to new a w a r e n e s s e s and p e r c e p t i o n s of the o t h e r . The l e v e l of e x p e r i e n c i n g a t t a i n e d and o t h e r ob-s e r v a b l e m e a sures such as a f f e c t i v e e x p r e s s i o n and comments by c l i e n t s such as the f o l l o w i n g , i n d i c a t e t h a t a l t h o u g h t h i s was an a n a l o g u e s i t u a t i o n the c o u n s e l l i n g s e s s i o n was m e a n i n g f u l to the c l i e n t . C l i e n t A: I d i d n ' t know i t would go back t h i s f a r at a l l my g o d . . . I t ' s been c e r t a i n l y s u r p r i s i n g s i n c e I d i d n ' t e x p e c t to get to t h i s p o i n t at a l l . (emp a t h i c r e f l e c t i o n . c o n d i t i o n ) C l i e n t B: I t f e e l s l i k e a g r e a t r e l i e f to be a b l e to s i t and t a l k about i t at l e a s t and uh I f e e l r e a l l y good about i t . ( e m p a t h i c r e f l e c t i o n c o n d i t i o n ) C l i e n t C: W e l l t h i s i s r e a l l y r e a l f o r me b e c a u s e we a r e g o i n g t h r o u g h t h i s s i t u a t i o n . ( G e s t a l t empty-c h a i r d i a l o g u e c o n d i t i o n ) The l a c k of s i g n i f i c a n t d i f f e r e n c e between modal s c o r e s of L e v e l 6 f o r the two c o n d i t i o n s can be ex-p l a i n e d due to t h e f l e e t i n g and t r a n s i t o r y n a t u r e of t h i s l e v e l . In a d d i t i o n , g i v e n t h i s f a c t t h a t o n l y one s e s s i o n was the u n i t of a n a l y s i s , d r a m a t i c s h i f t s c a n n o t be e x p e c t e d . L i m i t a t i o n s of the Study A l t h o u g h a n a l o g u e r e s e a r c h has the a d v a n t a g e of p r o v i d i n g o p p o r t u n i t i e s to e v a l u a t e the mechanism of change t h r o u g h c o n t r o l of m u l t i p l e c o n d i t i o n s of the - 95 -e x p e r i m e n t , and t h r o u g h m i n i m i z i n g v a r i a b i l i t y i n the d a t a , the o b v i o u s l i m i t a t i o n and c o n c e r n w i t h a n a l o g u e r e s e a r c h i s the e x t e n t to w h i c h the r e s u l t s can be gen-e r a l i z e d to the c l i n i c a l s e t t i n g . The d e g r e e to w h i c h the r e s u l t s can be g e n e r a l i z e d to a p o p u l a t i o n o u t s i d e of the p o p u l a t i o n sampled, such as p s y c h o t h e r a p y c l i e n t s i s l i m i t e d . F o r example, s u b j e c t s may d i f f e r f r o m c l i e n t s s e e k i n g c o u n s e l l i n g f o r u n f i n i s h e d b u s i n e s s p o s s i b l y i n the d e g r e e to w h i c h the u n f i n i s h e d b u s i n e s s was a c o n c e r n . As s u b j e c t s had not sought c o u n s e l l i n g f o r u n f i n i s h e d b u s i n e s s , the c o n c e r n about the u n f i n i s h e d b u s i n e s s may not have been as s e v e r e . A n o t h e r l i m i t a t i o n of the s t u d y was the low N. As w i t h a low N t h e r e i s the i n c r e a s e d r i s k of making a Type II e r r o r ( i n c o r r e c t l y c o n c l u d i n g t h a t the h y p o t h e s i s was t r u e when i t was f a l s e ) . An a d d i t i o n a l l i m i t a t i o n was the a n a l y s i s of o n l y one s e s s i o n . The a n a l y s i s of more than one s e s s i o n w o u l d have the s t u d y more g r e a t l y a p p r o x i m a t e the c l i n i c a l s e t t i n g . F u t u r e R e s e a r c h F u t u r e r e s e a r c h m i g h t i n v o l v e a l a r g e r N and p o s s i b l y the s t u d y b e i n g done i n a c l i n i c a l s e t t i n g w i t h p s y c h o -t h e r a p y c l i e n t s . F u t u r e r e s e a r c h m i g h t a l s o l o o k at the r e l a t i o n s h i p between l e v e l of e x p e r i e n c i n g and outcome m e a s u r e s . For example, i n the 1988 s t u d y - 96 -c o n d u c t e d by K i n g , r e s u l t s s u g g e s t e d t h a t the G e s t a l t e m p t y - c h a i r d i a l o g u e l e a d s to s i g n i f i c a n t l y more t o l e r -ance i n the s u b j e c t s ' f e e l i n g s toward a s i g n i f i c a n t o t h e r as measured by the A f f e c t i v e R e a c t i o n s Q u e s t i o n n a i r e ; when compared w i t h e m p a t h i c r e f l e c t i o n . R e s e a r c h i n g t h i s p o s s i b l e r e l a t i o n s h i p may l e a d to a g r e a t e r under-s t a n d i n g of the p r o c e s s of change and to e m p i r i c a l o b s e r v a t i o n w h i c h may s u p p o r t t h e o r y . - 97 -REFERENCES Bar r e t t - L e n n a r d , G.T. ( 1962). D i m e n s i o n s of t h e r a p i s t r e s p o n s e as c a u s a l f a c t o r s i n t h e r a p e u t i c c hange. P s y c h o l o g i c a l Monographs, 7 6 ( 4 3 ) , 1-36. B a r r e t t - L e n n a r d , G.T. ( 1 9 6 4 ) . The R e l a t i o n s h i p I n v e n t o r y , Form OS - 64. U n i v e r s i t y of New E n g l a n d , A u s t r a l i a . Bar r e t t - L e n n a r d , G.T. ( 1 9 8 1 ) . The empathy c y c l e : R e f i n e m e n t of a n u c l e a r c o n c e p t . J o u r n a l of C o u n s e l i n g P s y c h o l o g y , 2 8 ( 2 ) , 91-100. B a r r e t t - L e n n a r d , G.T. ( 1 9 8 6 ) . The r e l a t i o n s h i p i n v e n t o r y now: I s s u e s and a d v a n c e s i n t h e o r y , method and u s e . In L.S. G r e e n b e r g & W.M. P i n s o f ( E d s . ) . 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 : A R e s e a r c h Handbook ( p p . 4 3 9 - 4 7 6 ) . N.Y.: The G u i 1 f o r d P r e s s . B e r g i n , A.E. ( 1 9 7 1 ) . The e v a l u a t i o n of t h e r a p e u t i c outcomes. In A.E. B e r g i n & S.L. G a r f i e l d ( E d s . ) . Handbook of P s y c h o t h e r a p y and B e h a v i o r Change ( 1 s t . ed. pp.217-270). N.Y.: John W i l e y & Sons. B e r g i n , A.E., & L a mbert, M.3. ( 1 9 7 8 ) . The e v a l u a t i o n of t h e r a p e u t i c outcomes. In S.L. G a r f i e l d & A.E. B e r g i n ( E d s . ) . Handbook of P s y c h o t h e r a p y and B e h a v i o r Change: An E m p i r i c a l A n a l y s i s (2nd ed. pp. 139-189). N.Y.: 3ohn W i l e y & Sons. B e r g i n , A.E., & S u i n n , R.M. ( 1 9 7 5 ) . I n d i v i d u a l p s y c h o -t h e r a p y and b e h a v i o r c hange. In M.R. R o s e n z w e i g & L.W. P o r t e r ( E d s . ) . A n n u a l R e v i e w of P s y c h o l o g y . P a l o A l t o , C a l i f : A n n u a l R e v i e w s . B e r g i n , A.E. 6c S t r u p p , H.H. ( 1972). C h a n g i n g F r o n t i e r s i n the S c i e n c e of P s y c h o t h e r a p y . C h i c a g o : A l d i n e -At he r t on. B o h a r t , A.C. ( 1 9 7 7 ) . R o l e p l a y i n g and i n t e r p e r s o n a l c o n f l i c t r e d u c t i o n . J o u r n a l of C o u n s e l i n g P s y c h o l o g y , 2 4 ( 1 ) , 15-24. C a r k h u f f , R.R. ( 1 9 6 9 ) . H e l p i n g and Human R e l a t i o n s ( V o l . 1 ) . New Y o r k : H o l t , R i n e h a r t & W i n s t o n . C l a r k e , K.M. ( 1 9 7 7 ) . The d i f f e r e n t i a l e f f e c t s of two t r e a t m e n t s at a c o n f l i c t marker i n t h e r a p y . U n p u b l i s h e d M a s t e r s T h e s i s , 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 , V a n c o u v e r . - 98 -C l a r k e , K.M. ( 1 9 8 1 ) . The e f f e c t s of the g e s t a l t two-c h a i r e x p e r i m e n t and c o g n i t i v e prob1 em-so 1 v i n g on c a r e e r d e c i s i o n - m a k i n g . U n p u b l i s h e d D o c t o r a l D i s s e r t a t i o n , U n i v e r s i t y of C h i c a g o . C l a r k e , K.M., & G r e e n b e r g , L.S. ( i n p r e s s ) . The d i f f e r -e n t i a l e f f e c t s of the g e s t a l t t w o - c h a i r e x p e r i m e n t and c o g n i t i v e prob1 em-so 1 v i n g i n r e s o l v i n g d e c i s i o n a l c o n f l i c t . J o u r n a l of C o u n s e l i n g P s y c h o l o g y . Cohn, R.C. ( 1 9 7 0 ) . T h e r a p y i n g r o u p s : P s y c h o a n a l y t i c , e x p e r i e n t i a l and g e s t a l t . In J . Fagan & I.L. Sh e p h e r d ( E d s . ) , G e s t a l t T h e r a p y Now (pp.130-139). N.Y.: H a r p e r C o l o p h o n Books. D a l d r u p , R . J . , B e u t l e r , L . E . , & G r e e n b e r g , L.S. ( 1 9 8 5 ) . F o c u s e d e x p e r i e n t i a l p s y c h o t h e r a p y : A g e s t a l t p s y c h o t h e r a p y i n t e r v e n t i o n f o r i n d i v i d u a l s w i t h c o n s t r i c t e d a f f e c t . U n p u b l i s h e d M a n u s c r i p t . D a l d r u p , R . J . , B e u t l e r , L . E . , E n g l e , D., & G r e e n b e r g , L.S.. ( 1 9 8 8 ) . F o c u s e d E x p r e s s i v e P s y c h o t h e r a p y : F r e e i n g the O v e r c o n t r o 1 1 e d P a t i e n t . New Y o r k : The G u i l f o r d P r e s s . D o m p i e r r e , L.M. ( 1 9 7 9 ) . D i f f e r e n t i a l e f f e c t s of g e s t a l t t w o - c h a i r d i a l o g u e and e m p a t h i c r e f l e c t i o n a t a s p l i t i n t h e r a p y . U n p u b l i s h e d M a s t e r s T h e s i s , 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 , V a n c o u v e r . 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N.Y.: John W i l e y & Sons. - 106 r S t r u p p , H.H., & B e r g i n , A.E. ( 1 9 6 9 ) . Some e m p i r i c a l and c o n c e p t u a l bases f o r c o o r d i n a t e d r e s e a r c h i n p s y c h o t h e r a p y : A c r i t i c a l r e v i e w of i s s u e s , t r e n d s and e v i d e n c e . 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 i a t r y , 7 ( 2 ) , 18-90. T o b i n , S.A. ( 1 9 7 5 ) . S a y i n g goodbye. In J . S t e v e n s ( e d . ) , G e s t a l t Is ( p p . 1 1 9 - 1 3 1 ) . Moab, U t a h : R e a l P e o p l e P r e s s . T o m l i n s o n , T.M. ( 1 9 6 7 ) . The t h e r a p e u t i c p r o c e s s as r e l a t e d to outcome. In C.R. R o g e r s , E.T. G e n d l i n , D . J . K i e s l e r , & C.B. T r u a x ( E d s . ) , The T h e r a p e u t i c R e l a t i o n s h i p and I t ' s Impact: A Study of P s y c h o -t h e r a p y w i t h S c h i z o p h r e n i c s . M a d i s o n : U n i v e r s i t y of W i s c o n s i n P r e s s . T o m l i n s o n , T.M., & H a r t , J.T. ( 1 9 6 2 ) . A v a l i d a t i o n of the p r o c e s s s c a l e . J o u r n a l of C o n s u l t i n g P s y c h o l o g y , 26, 74-78. T o m l i n s o n , T.M., & S t o l e r , N. ( 1 9 6 7 ) . The r e l a t i o n s h i p between a f f e c t i v e e v a l u a t i o n and r a t i n g s of t h e r a p y p r o c e s s and o u t c ome w i t h s c h i z o p h r e n i c s . P s y c h o -t h e r a p y : T h e o r y , R e s e a r c h & P r a c t i c e , 4, 14-18. T r u a x , C.B., & C a r k h u f f , R.R. ( 1 9 6 7 ) . Toward E f f e c t i v e C o u n s e l i n g and P s y c h o t h e r a p y . C h i c a g o : A l d i n e . T r u a x , C.B., & M i t c h e l l , K.M. ( 1 9 7 1 ) . R e s e a r c h on c e r t a i n t h e r a p i s t i n t e r p e r s o n a l s k i l l s i n r e l a t i o n to p r o c e s s and outcome. In A.E. B e r g i n & S.L. G a r f i e l d ( E d s . ) . Handbook of P s y c h o t h e r a p y and B e h a v i o r Change ( 1 s t . ed. pp.299-344). N.Y.: 3ohn W i l e y & Sons. T r u a x , C.B., & Wargo, D.G. ( 1966). P s y c h o t h e r a p e u t i c e n c o u n t e r s t h a t change b e h a v i o r : F o r b e t t e r or f o r w o r s e . A m e r i c a n J o u r n a l of P s y c h o t h e r a p y , 20, 499-520) . van der Veen, F. ( 1 9 6 7 ) . B a s i c e l e m e n t s i n the p r o c e s s of p s y c h o t h e r a p y . J o u r n a l of C o n s u l t i n g P s y c h o l o g y , 31 , 295-301 . W a l k e r , A., R a b l e n , R.A., & R o g e r s , C.R. ( 1 9 6 6 ) . Development of a s c a l e to measure p r o c e s s change i n p s y c h o t h e r a p y . J o u r n a l of C l i n i c a l P s y c h o l o g y , 16, 79-85. - 107 -W e b s t e r , M.C. ( 1 9 8 1 ) . The r e s o l u t i o n of d e c i s i o n a l c o n f l i c t : R e l a t i n g p r o c e s s to outcome. U n p u b l i s h e d D o c t o r a l D i s s e r t a t i o n , U n i v e r s i t y of B r i t i s h Co 1umb i a , V a n c o u v e r . Z a r , J.H. ( 1 9 8 4 ) . B i o s t a t i s t i c a 1 A n a l y s i s . Englewood C l i f f s , N . J . : P r e n t i c e - H a 11,Inc. Z i n k e r , 3. ( 1 9 7 7 ) . C r e a t i v e P r o c e s s i n G e s t a l t T h e r a p y . New Y o r k : Brunner/Maze 1. 108 A P P E N D I X 1 SEGMENT 5-7 C . W e l l , I r e s e n t t h a t , t h a t , t h a t I was n e v e r a l l o w e d to e x p r e s s my e m o t i o n s . 1 had to k e e p t h e m i n and be h a r m o n i o u s and be g o o d , be p l e a s a n t and when 1 d i d n ' t f e e l p l e a s a n t . A n d y e t what I f e l t t h a t i t was my f a u l t and now I know t h a t i t w a s n ' t my f a u l t , t h a t maybe I had s o m e t h i n g t o do w i t h i t but i t was t h e t h r e e o f us t o g e t h e r t h a t c r e a t e d t h a t s i t u a t i o n . T . T e l l h e r a g a i n , i t was not my f a u l t . C . I t was n o t my f a u l t . T . A g a i n . C . It was n o t my f a u l t . T . Mo r e , s ome mo r e , I wa s n o t C . I was n o t t o b l a m e f o r ( T . a g a i n ) . I was n o t t o b l a m e f o r what went on when I was a t e e n a g e r ( s i g h ) I was n o t to b l a m e f o r a l l t h e u n p l e a s a n t n e s s and t h e f i g h t i n g t h a t went on a t home b e c a u s e ( p a u s e ) I was a l s o not t o b l a m e f o r t h e c o l d n e s s t h a t , t h a t I showed y o u . Y o u t h o u g h t I was a r e a l l y c o l d p e r s o n . I am n o t a c o l d p e r s o n at a l l . I c a r e so much t h a t i t i s ( c r y i n g ) T . S t a y w i t h t h i s . A g a i n . - 1 0 9 -I c a r e v e r y , v e r y m u c h . I d o n ' t t h i n k you and dad have any u n d e r s t a n d i n g a-bout how much I c a r e . T e l l h e r . I t h i n k I have v e r y , v e r y d e e p f e e l i n g s , d e e p e r t h a n any of y o u r o t h e r c h i l d r e n but I had to be c o l d t o h o i d you o f f . T e l l her what you do c a r e a b o u t . I v e r y much want t h e l o v e o f my f a t h e r . ( T . Mn,rrm) I d o n ' t want you l o v e . 1 10 APPENDIX 11 T h i s r e s e a r c h p r o p o s a l was s c r u t i n i z e d and passed by the B e h a v i o r a l S c i e n c e s S c r e e n i n g Corrmittee for R e s e a r c h and Other S t u d i e s I n v o l v i n g Human S u b j e c t s . The t h e r a p i s t s used in t h i s s tudy were e x p e r i e n c e d p r a c t i t i o n e r s and the p s y c h o t h e r a p e u t i c data g a t h e r e d in t h i s . s t u d y was done so under the s u p e r v i s i o n of a c l i n i c a l s u p e r v i s o r . Any r e p r o d u c t i o n of the t e c h n i q u e s used in t h i s study by u n t r a i n e d p e r s o n n e 1 . shou1d not be a t t e m p t e d . 

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